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HomeMy WebLinkAboutPRATOR BLK 12A LT 2Prator Lot 2 Block 12A #017-093-10 Municipality of Anchorage • Development Services Department Building Safety Division « On -Site Water & Wastewater Program, 4700 South Bragaw St. ; « ` r P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW 30486 PID Number: 017-093-10 Name: STEPHANIE EGEN Wastewater System: 0 New ■ Upgrade Address: 6700 MARQUEZ CIRCLE a ANCHORAGE, AK • 99516 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 345-8268 4 ■ Deep Trench E) Shallow Trench C) Bed O Llound C) Other LEGAL DESCRIPTION Soll Rating: o.s Total Depth from "Inal grads: CPO/Sq. FL 10.5 MAX FL Block: Lot: Subdivision: 12A 2 PRATOR Depth to pips bottom from original grade: Gravel depth Ibmeath Dips: 6.5 (MAX) rL 4.0 FL Township: — Range: — Section: Fal added above o"ginal grads: Gravel length: SEE DWG. FL 126 (2 ® 63) rL WELL: ❑ New 13 Upgrade Gravel width: 2.5 Numbs of ones: abtonce between fines: R 2 Cbssiticotbn (Private. A.B.C): Tato/ Cased To: Total absorption orso: R Pips material: FL FL 1008 w. FL D 3034/ F-810 Driller. Date Drilled: Stack water Level: Installer, AKWWC INC. pate installed: %11/19-20/2003 R freed: Pump Set AL Cashq Nslght Above Ground: CPL, FL FL TANK SEPARATION DISTANCES aseptic 0Holding 0S.T.E.P. OOther TO Septic Absorption Lift Holding blic/Prbote Mcnufacturw: Capacity in gallons. From Tank Field Station Tank Sewer linos '{ Number of eompormsnts: Well — 1000+ — — 25'+ Material: E%�IS 11N Surface Water — 100'+ — — — LIFT STATION Lot Line — 10'+ — — — Sire N gallons: Manufacturer. — 10'+ — _ _ Pump an level at-ump oft level ot: Deter obrm at - Curtain Drain Curtain — NONE KNOWN Pump Mate i ctrkal Inspections performed by: Remarks: EXISTING SEPTIC TANK FOUND TO BE OF BENCH MARK • Lxatbn Dena Description: GOOD INTEGRITY ON 11/18/2003. BOTTOM OF SIDING NEAR DECK Assumed Elevation: 100.00 R ENGINEEirS SEA Qo 4 o� QF �. • �S�4p Dates: 1st 11/19/20034*p. Inspections performed by: AKWWC, INC. 2nd 11/19/2003 Q Q .... 3rd 11/20/2003 4th 11 /20/2003 0' y Gar ss;' X00 7953 4Q oto Development Services Department A roval s .• ` 01 Reviewed and approved by: Date: 2 -3-0 0404000 PERMIT SWONUMBER: AS—BUILT DRAWING PARCEL ID NUMBER: SW030486017-093-10 ------ -------- -----AT 8 - STI 32.24 58.77 ST2 40.90 63.36 DBL1 42.391 64.11 DBL2 43.01 1 64.21 FD 43.34 64.54 FS 53.29 48.25 C01 39.70 31.79 MT1 41.57 32.92 CO2 92.16 76.95 MT2 84.4 169.881 CO3 54.83 15.36 54.97 18.53 EC04MU 100.96 72.50 97.89 70.16 EXISTING DRAINFIELD / TO BE USED AS A INSTALLED FLOW RESERVE SITE DIVERTER / NSTALLED FLOW / SPLRTER \ n2 / c NEW DRAINFIELDS \ I/ 11 f/ I 1 DBL2 rlfl I DBL1 \ MT1I I/ A/rJ / \ C 1 CD3 \ EXISTING SEPTIC \ TANK. INTEGRITY F \ B \ VERIFIED ON / 11/16/2003 \ 4 Q IS \ I HO Sse \ \ 8 I N • � i 1 1.01 s \ \ MARQUEZ CIRCLE 12/1/2003�QF O1J DRAWN BY: p 4 ALASKA NVAT.CR & «A ' ~- BTIENVAR SGASCALE*C.J.G. Qoo-f-�00� CONSULTANTS. INC. •PHONE (007)337.6179 • FAx (9077338-32L6 ill c 40' ""' "" ' """"' "' Q 3701 E TUDOR ROAD, SUITE 101 • ANCHORAGE. AK 99507 D PREPARED FOR: PHONE NUMBER: PAGE NUMBER: Q Q STEPHANIE EGEN (907) 345-8268 2 OF 3QO •.J ff e .. s. LEGAL DESCRIPTION: PRATOR SUBDIVISION; LOT 2. BLOCK 12A 7953 4O TYPE OF WORK: �Q4c'ea,p........... ,off AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE I ' oo�a� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division _ 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 G/ —oto ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES FROM SEPTIC TANK ABSORPTION FIELD WELL Address `%// %j0 ti.1 Irl vt 0&,e /t ar'2 fe 91S-0 1 Phone(s) Permit No.No. of Bedrooms Syr—ayZo 9°0176 WELL !l6 3 /30' LOT LINE yO _ 412 s LEGAL DESCRIPTION Lot o2 BlockSubtlivisio /2i9 �T2 r FOUNDATION Z % Township, Range, Section T / IQA)W "N O — AS -BUILT DIAGRAM driveway, water bodies, (Show location of well, etc.) septic system, property lines, foundation, TANKS X SEPTIC ❑ HOLDING tot Manufacturer// Gkdt Capacity in gallons t t 3 Material Sfee� No. of Compartments Zto TYPE OF SYSTEM X TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from original grade �" FT Total depth from original grade /0 ? FT � ir r y Fill added above original grade FT Gravel depth beneath pipe 7 FT Gravel length / S3 FT Gravel width 3� FT Total absorption area � SQ FT Distance between lines FT Number of lines / Soil rating /(, SrSQ FT Pipe material 457,41 3031 CS �ltJ S Installer " 9Q -d/s7-', E4tl,i%t ooze Date Installed ?/.To Ji f WELLS Urfa/.Z.r�u PRIVATE ❑ OTHER (Identify) " e r Classification (A,B,C) ryVo- Total Depth .2®o' FT Cased to OC> FT I D y'r"d0 t B _ - $' 3 Installer( ^ _ n10 ) Su 171—u ? , d r:,//.A Date Installed: REMARKS: CU 2 e y^g .' / .,•,7 4 0-4 -� f�t GEG �'e1' (1•o�//O Scale: Inspectiongi Date: C4, Performed +e ?o 24e ic( -O by: /Z ENGINEER'S SEAL I r e r certify that this inspection was performed according to all Municipal and Slate guidelines in effect on this date: ! id Health Department Approval:Date: 72-013 (3/85) MUN1C11 -1)1 .�1OF AN11HORAGE Department of Health & Human Services O2� L Streetv Anchorage, Alaska 99501 343 HN- 211 aEeER in WELL PEKMIT � ��\�Lo |'ermit� �|umber: 90017� -u�-c_� �`~^'~" '`�' Date lssuefly o6/27/91) EnqinWe, Designed Uwner Name: WILLIAM to WNTHIH MARQUEl Day Phone: Owner A�dress: 711 DOUNTY UR" 345-2420 �NCHOR0�E, AK 9�51� |`arcel ld: 0i7-093-10 Lot Lega]: Rubdivision: PRATOR Lot: 2 Ulock: 12A Section: 35 Township: 12N Range: 3W Lot Size 48372 (sq,ft, or acres) Max Dedrooms: This Permit-: 4 Total Capacity: 4 SEPlIC TANP.: Minimum total septic tank capacity: 1,25O gallons. hach septic Tann must have at least 2 compartments. Depth to top of septic tank(s) < 4.0 |eeL requires insulatjon o`/er tank(s)" WELL: Log must he submitted to Municipality of Anchorage Department of Health and Human Se,vices within 30 days of well completion. INGlALi PER ENR[NEG8P ATTACHED PLANS" NOTIFY PHHS PRIOR TO EACH IN9PEC1`10N" MAINTAIN PRDPHR SETBACK DISTANCE FROM 3011 SLOPE, THiS PBk"MTT l-; [GSUED FOK THt, PLANED 4 8D14M^ SIMRiE FnMILY GWELL!Nti AND EX|'lKES ON l C[�RTIFY THAT: K I am familiar with the requirements our on-site sewers and wells as set WLh by Lhe Municipality of Anchorage (MOA) and the State of Alaska. 2" l will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permiL. 3. I will adhere to all MOA and State of Alaska requirements for the not bact distances from any existiny well, wastewater disposal system or public: sewe,age system on this or any adjacent or nearby lot, 4: I understand that this permit is valid for a maximum of 4 bedrooms. I aiso unde,s! and that the capacity of the total system is 4 hedrooms and any l tpermit.. 9igned:ATE: ~ ^� «�7> WILLIA v _~� issued By: DHTE: A ° k ALASKA 6UIROMPTAL CONROL SCRUICCS, InC. o Engmeerinq 6 Enuironmental $iudies SPECIFICATIONS FOR A TRENCH—TYPE WASTEWATER DISPOSAL SYSTEM LEGAL DESCRIPTION: LOT 2, BLOCK 12A, PRATOR SUBDIVISION 1..0 GENERAh 1.1 The Drawings, sheets 1 thru 5, shall be a part of this specification. 1.2 All materials and workmanship shall meet the requirements of the Municipality of Anchorage. Department of Health & Human Services (DHHS), the conditions of the permit, and all applicable rules and regulations currently in effect. 1.3 All elevations and depths are advisory, and are to be verified or modified in the field by the engineer or inspecting agency. 1.4 It is the responsibility of the property owner or installer to adhere to approved designs for installation, maintain the specified separation distances, and have the appropriate inspections. 1.5 It is the responsibility of the property owner or installer to report to the engineer any observed conditions which would put the system in violation of state or Municipal regulations. 1.6 If the installation is not inspected by an AECS engineer, AECS will not be responsible for the installed system. An engineer at AECS should be consulted prior to construction to determine the number of inspections that will be required and to explain what these inspections will involve. 2.0 SEPTIC TANK 2.1 If there is an existing septic tank, it may be used it if meets the capacity requirement for the residence and the approval of the MOA. 2.2 The septic tank shall be a UPC --approved two-compartment tank, constructed of 12 gauge steel with bitumastic coating and set level on undisturbed soil. If the tank is buried at a depth of 4 feet or less, it must be insulated with an overlying layer of 2 inch burial type polystyrene rigid board insulation. 2.3 The septic tank and trench shall be a minimum of `T412 N/ESti S9ftd-ri>/enU6� fTCheRAf�Ec�l-d5t41-99509-� N07) 2791553 100 feet from any private well or Body of water, 150 feet from Class "C" wells, and 200 feet from Class "A" or "B" wells, unless otherwise specified. Less than the required separation distance must have prior approval or waiver by ADCC or MOA. 2.4 The septic tank shall be a minimum of 5 feet from the house foundation, and a minimum of 5 feet from the absorption area. 2.5 Piping shall be fitted with a mechanical watertight calder coupling on the outlet and .inlet of the septic tank. Piping shall be 4 inch solid PVC ASTM D-3034 or cast iron, sloped a minimum of 1/4 inch per lineal foot. If the piping is buried at a depth of 4 feet or less, it must be insulated with an overlying layer of 2 inch burial type polystyrene rigid board insulation. 2.6 Cleanouts shall be, installed as designated and capped with air -tight rain caps (Jim Caps or equivalent), and extended a minimum of 1 foot above ground level. 2.7 If a lift station :is required it shall be a combination lift station septic tank per Anchorage Tank and welding, Inc. design. Specifications and design drawings are on file with the Municipality and the engineer. 3.0 ABSORPTION AREA 3.1 The gravel for the trench shall be 0.5 to 2.5 inch, screened rock with less than 3 percent passing the No. 200 sieve. All substitutes must have prior DHHS approval. 3.2 The bottom and sides of the excavation shall be raked with the backhoe blade to ensure that it has not been compacted during excavation. The bottom elevation shall be level. 3.3 Monitor standpipe(s) shall be placed as shown in the drawings, and shall be 4 inch rigid PVC ASTM D-3034, or cast iron. The section shown with holes may be 0.5 inch holes drilled on 6 inch centers on opposing sides of the pipe, or a regular section of perforated sewer pipe clamped to a solid section with either a no hub coupling or a solvent joint. A rubber rain cap (.Jim Cap or equivalent) shall be installed over the top of the pipe. 3.4 The distribution pipe shall be perforated 4 inch PVC with a minimum crush strength of 1500 pounds and shall meet the approval of DIMS for use as drainfield pipe. All distribution pipes shall be laid level. 3.5 Trenches may be paralleled, but must have a minimum separation distance between the trenches of 10 feet or 2 times the gravel depth (which ever is greater). 75 feet is the maximum allowed linear length of any trench. 3.6 If the final grade over the trench is less than 4 feet above gravel, insulation is required, using burial type polystyrene rigid board insulation. There shall be 1 inch of insulation for every foot of soil less than the required 4 feet of cover, but there must be at least 24 inches of soil cover even though insulation is used. The solid pipe extending from the septic tank to the drainfield shall also have a minimum of 4 feet of cover or an equivalent layer of insulation to prevent freezing of the line. 3.7 Filter fabric is required. 4.0 INSPECTIONS 4.1 A minimum of two inspections are required for the installation of the trench. The first inspection will be of the open excavation to assure that the system is installed in the proper soil strata, correct depth and meet minimum specified design parameters. 4.2 The second inspection will be after placement of the gravel, monitor standpipe and distribution pipe to verify proper .installation and position prior to backfill. 4.3 The inspection of the septic tank installation can be incorporated with any one of the above listed inspections. 4.4 The lift station will require either an MOA electrical inspection or certification by a licensed electrician, depending on whether the building code applies to this part of the city. ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 JOB SHEET NO. OF CALCULATED BY � DATE F • ( 6/zt/90 CHECKED BV 12e, DATE_ pnulcl m l [ 1rc cram. m- 01471. '.. ,MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH+.& _ -:-... .:.... ENVIRONMENTAL PROTECTION 'JUR 2 61900 RCIVD pnulcl m l [ 1rc cram. m- 01471. Stiee f Z0LS a z ¢ a W Uj00 Bo 13 H H Z IG iL O O H E) La a G �� II>Qmp a H HH¢ a a H >a: 13 IL tL -iW HH -i o II a y a W I (�., z[n m h! ¢ w i i Q W H Z `(lug-i.J W IlJ � tAUH Z H a�' m -i Z En O Q nt o is c H z H Q O Z} Q iy roao � aH H Ul-W 2 IA n H �a °W N�JUYm t mcs Jo QzQJUI N z w I <ci O J W II rt C9 z W H Z H L m IL H IL O rIIi II t- y !r Z 4 to a¢t p U U ` a m ` MR �- G a 0 � m H W a o Y t U o 4 m O m W m Wa as a Hr asTo M va co �.IL. to a G G G 4 NH ¢ 1� 111Liz 0:3 ? ❑ J Ht Q W f— Cil W D ❑ 0 0 I— z H Q z W 0 J z U �I W a I H a IL G1 tiJ UJ I SOILyLOG ` 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 90501 264-4720 // SOILS LOG — PERCOLATION TEST PERFORMED FOR: rff IC (P!/If �C-.CJT I KY/ DATE PERFORMED: J"IC 22– gr? LEGAL DESCRIPTION: 1pr"10,– SLOPE SITE PLAN OL 6r, yLr%jL I 2 (a 111-_ I'1 f... ['rnJC 3 a , �tnd V4.is a'C njeee a l.`y 5 P'ir �: arc real Sanr�� 6 8 9 10 11 12 13 Date Gross 14 Depth to Pr� 6� yIf'0 Time Time Water r 16 E -2a ° — 61 — n p, p00044 4400 0YJ /6 L 18 £ �� 4 ✓wnai o°400c n0000il/� �oeo e:ERD R0D, JR. 11 n °°--2..51 o O ° c:r 19 `� �fP °O•o°G000°°°°���`/ 20- 0 3� 22- COMMENTS COMMENTS .Sa/ 40M %71 q -i�lr^f 3o°io WAS GROUND WATER , I S ENCOUNTERED? N° L O P IF YES, AT WHAT E DEPTH? E' 4,� ne L h lL Reading Date Gross Net Depth to Net Time Time Water Drop E -2a I'll — 61 — 92 el /6 '415- v5- q 2q qty ,5% gIei 20 3� 22- IU05 — sr� PERCOLATION RATE �V I�jr4minutes/inch) TEST RUN BETWEEN _ Z�''yFf�AND/—3..�FT �2 PERFORMED BY: Dw MO 'T SL/ Uo CERTIFIED BY: 72.008 (6/79) y s— �SOIL'S'IBG MUNICIPALITY OF ANCHORAGE / 0*_ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION �I TEST CATION 625 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PPE�RRCOLATION TEST G PERFORMED FOR: EhE� -- DATE PERFORMED: 3vne ZI U� »��77 I / � 2 LEGAL DESCRIPTION: 'f(� raft Bloc 42 J;* LotA& 1 2' 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 l 6 fl a COMMENTS al orI4"ic :611 r1, +r,n ifyni S;14- (IM ;1* SLOPE (IM s;tl,� ,A gravit t-ut1u� t ®nca OF �AQ mmmomme°�Li (1 ° Uf °° 49TH o°emmmi�m mom •ommeo:u .m. kl'ErW C. REID, JR. %R CE -2251 e +`` f r Ppe' . _5 in 6e WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 6`,;4A pc— kjZ 6 /Oc/p > `/r, No S L O P E Reading Date Gross Time Net Time Depth to Water Net Drop it It 11'38 2a 925 , 3-2 ,o6 it 13q tt' LIq 10 .66 83 .63 11: d t PERCOLATION RATE_�� __ •'�•_° y •(jgnuteWinch) TEST RUN BETWEENHAND'' 'fT' / l PERFORMED BY: �urc�-i MCA ffeq 02`f CERTIFIED BY: • , DATE . / •.�\fie 72-008 (6/79) , r n —3- Scale: / "r3o' �D99L 7 r4 "E I % %. GO el" { Elec7, cO' 497" ;•* r :• OY C. Kilo, J I CE -220.00 fAr •0j•° 4 •°•••° f*4P wvtl-* We!i�i SzF11< f�r�=,.r 0 / r ooa rJ'Seefi, vre� �U IV sheG1� s„Fs� / t %/r e., Y�.., Tao (efe/Je gf.ez ?ll / 12s�q°11fs�1 �s 2- I� L �reu 4 L MQ lea u e EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. we11-,de 3 7 Z s.+ ZI— "Z-l- ai, O V' 6 Alsq C- 9'll,1 F -70.it�7 PROPOSED CONSTRUCTION PLAN \ice - I hereby certify that I have surveyed the following CiY, f{ —=-described 1property: L,t 2 81c)ck 12�---1 clse. FrLcl ololka c l' " F `' on oma°•' Np H. G%ij�J:yT351�17 R� � Gam• r IN Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on prop- erty lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon: Dated at Anchorage, Alaska ih this 7 day of('144 n — 19 f ~' FRED WALATKA & ASSOCIATES Engineers and Surveyors Trrtifirh Drilling irng by DOC Co. ooa SULLIVAN WATER WELLS P.O. BOR 670272, CHUGIAK, ALASKA 99667 • TELEPHONE 606.2769 U 7 f J _/0 OWNER OF LAND _ liUl( Q Coy IRo9 � T From g_Ft. to "� Ft._A: ee&"JV S %.=15r yJ_� From C2 Ft. to -4_ -Ft.. n )i5<i3�iddr',.l From _dq__Ft. to4_Ft. / S t —1 Q DEPTH OF WELL/ l Q:� Ft. Ft. Ft. DEPT. OF HEALTH & to NVIRONMFEtNTAL PROTECTION to '.Lff. 2 5 990 to C From Ft. to Ft. -S K ri J GKt -- From t'Jl) Ft. to Ft .: vUA 664,/4 -,_From. From Ft. to Ft. vel.. / S C 3,j4?dd4_,Z__ From Ft. to�Ft._ ADDRESS 16 70 fJ ., i "= ' OC Ff `` 5/6 STATIC LEVEI. OF WATER FT. .. , Ft. Ft. to Ft. —_ to Ft. From Ft. to Ft. c=s7rYl S l.,j C l LEGAL DESCRIPTION fScC / yr j y{t.;,y� S J t),o DATE - Started Ended nn PERMIT NUMBER `"I CSU 0(0 DRAW DOWN FT, GALS. PER HR _f1Q0 KIND OF CASING 6;L rJ KIND OF FORMATION: MUNICIPALITY OF ANCHORAGE From g_Ft. to "� Ft._A: ee&"JV S %.=15r yJ_� From C2 Ft. to -4_ -Ft.. n )i5<i3�iddr',.l From _dq__Ft. to4_Ft. / S t —1 Q From From From Ft. Ft. Ft. DEPT. OF HEALTH & to NVIRONMFEtNTAL PROTECTION to '.Lff. 2 5 990 to C From Ft. to Ft. -S K ri J GKt -- From t'Jl) Ft. to Ft .: vUA 664,/4 -,_From. From Ft. to Ft. vel.. / S C 3,j4?dd4_,Z__ From Ft. to�Ft._ From Ft. Vit. From Ft. From Pt. to Ft to Ft to _Ft. to Ft. From_,_�'_Ft. to Ft. ._.h Q hly I " a $ / From From Ft. to Ft '.4 'i t..ut I From_ From Ll__ ' Ft. to�J`L_Ft._CI 4. d i S G ✓ �� L From From__/ ZFt. toa-4--Ft. V �"'J� From From 'Ft. toe S Ft.__I__11,rr, 11L T From__FL From 1%pz�l Ft, to -L , --"L Ft. T! , i -e f 5 i r- i )' 1 11 �✓iAv�'LFrom From Ft. t � (� 7 Ft. _r 16 dT �, /j j go fi From Ft. Ft. Ft. Ft. Ft. Ft. to Ft. _ to Ft. to Ft. to Ft. m to Ft. to Ft. to F[. -,1 From Ft. to Ft. _�)e,4 � u/_ � X) tE / From /' 11 Fron)) C t Ft. to . 0 FL _ /3 66do c-, lam/ /)�� /' Z'4rom Ft. Ft. to Ft. —_ to Ft. From Ft. to Ft. c=s7rYl S l.,j C l From Ft. to Ft MISCL. INFORMATION: c "is, ,,, 106ei" To 6 6 iD ,CS l.= P<,9c�d i010,) r J M r .� DRILLER'S NAME " January 10, 1986 TO: Permit Applicant R o. 3c1;<3650 ANCHORAGE ALASKA c,'50'1 0350 907% 264-4711 DEPARTMENT OF HEALTH & HUMAN SERVICES Subject: Permit # 850410 Lot 2 Block 12A Prator Subdivision t_s A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1985. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or onsite sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the onsite sewer system the original as -built inspection report(three part form) must be sent to this office for review and approval,and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Susan E. Oswalt Program Manager On-site Services SEO/ljw enc: Copy of Permit. owl 1.1 R%1 3: is: I I=- IN a.. 3: x "�Ie 1E) lFm ir- ii AJ CT F4 C3 FZ IN U3�� DFPARTMENTDF HEALTHAND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGEv AK 99501 264-4720 ���S3 :E '1­11.'�-F,: PERMIT NOw DATE ISSUED: APPLICANTS ADDRESS: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: MAX.DEDROOMS: 850410 07/12/85 1�3 FE L -J1 0 lAt tie tAJ FEE I� LARRY L OSBORN 12200 WAGNER STREET ANCHORAGE, AK 99516 345~4126 SUBDIVISIONS PRATOR SECTIONS 35 TOWNSHIP: 12N 48372 (SQ"FT" OR ACRES) 4 LOT: 2 RANGE: 3W , BLOCK: 12A Listed below are the options ** available to you in designing your septic system" Choose the option that best fits your site. ^�... .... .... ... ������ I F:z EE PA C�.' 0 -1 1AA I., FAT IN 1: IN H DEPTH TO PIPE BOTTOM (FT.) 4,0 4"0 GRAVEL DEPTH (FT") 4.0 3"5 TOTAL DEPTH (FT.) 8.0 7.5 GRAVEL WIDTH (FT.) 205 5.0 GRAVEL LENGTH (FT.) 94,0 81"0 ** GRAVEL VOLUME (CU"YDS") 39"2 60"0 TANK SIZE (GALS) 1,250"0 ** 1,250.0 ** SOIL RATING (SQ,FT^/RR) 188 188 GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT" EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1" I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MDA) and the State of Alaska" 2^ I will install the system in accordance with all MOA codes and regulations,, ` and in compliance with the design criteria of this permit" 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 4 bedrooms and any enlargement will require an additional permit" IF A LIFT STATION IS INSTALLED IM AN AREA COVERED BY MDA BUILDING CODES, I THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AG-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORk MUS 8E DONE BY A LICENSED ELECTRICIAN, SIGNED DATE: ^ APPLICANT: LARRY L OSBORN [SSUED BY OAT[�: ^-~-~------.-^`~--------.---~~^~~~'--- ----------- PERFORMED MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 025 L. Street, Anchorage, Alaska 99501 2844720 SOILS LOG — PERCOLATION TEST ' DATE PERFORMED:Ju. G 22 8t1 LEGAL DESCRIPTION: Pr -Iar- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 H COMM /'2 pL 6r<�aY11c So•� (yj� .�li�'i Snn<I Jr�JEi of m;,tcA.. p.t� a -c n/"c CWY ''- No. 2251-f_• so, l ?YUM /; SLOPE gSov(0 )ID SOILS 4L — , / PERCOLATION TEST SITE PLAN -CIwF 300/6 WASGROUND WATER ''tt� ENCOUNTERED? 'Q! IF YES, AT WHAT DEPTH? _ 8' d.;•. ne. k�L� Reading Date Gross Net Depth to Net Time Time Water Drop 6.1i q1 b/ -- 42r /o vs 16 q7q �• , s9 qY ZC2 3;L xz Jou - /6 •y3 r 3" Ivvs 7'N .. lvl,i A ,S0 .oy lul3 , sy 1023 /0 5 Ufi 41 PERCOLATION RATE_ n,I lminptes/inch) 9 •,. TEST RUN BETWEEN F �S:•Fi AND �'KT �. PERFORMED BY: D", OAT $q 07 CERTIFIED BV' •_• 72-008 (6/79) •.• trt�y ,r� j lnr,i- 89 70 �i • •tom Municipality of Anchorage ► / tilo � , $ On-Site Water and Wastewater Program • (907) 343-7904 A.1' T Y A O16g9 5 Certificate of On-Site Systems Approval Parcel I.D. 017-093-10 Expiration Date: ((9.-Z(-91g 1. GENERAL INFORMATION Complete legal description Prator Block 12A Lot 2 Location (site address) 6700 Marquez Cir. Current Property owner(s) Downs, Wayne Day phone Mailing address 6701 Downey Finch Dr. Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: P'\Received b . \►;_ � , A Date: 1 12-��i COSA to be released to the engineer,unless otherwise rte' ested by the engineer. COSA Fee $ 2--(P• /O Waiver Fee $ Date of Payment 7131(g Date of Payment Receipt Number 0H 00I Receipt Number COSA# 05C q13/5 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at the time of installation. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 6/29/2018 OF At. sli 6. DSD IGNATURE •••4W .9•'*f� System #1 Approved for bedrooms '••.Steven R. Pannone. �� �.•. CE-8149 System #2 Approved for bedrooms V� 4s . •�A Disapproved �kk `, OFESSIONP� Conditional approval for bedrooms, with the a following stipulations: Stf t c A-61,14( �S 2Q eau's CtC �-P f�^ CJ L I S e � c cis 2© l euvl ecr TTU cLeQ ✓VSid r Ot„i_s,TE WATER AND WASTEWICrE� • PROCRPM c-• By: k Original Certificate Date: L The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisor Well Flow AdvisoryOther / /1k th LAI rV'►St'�c�tJ�/ COSA blue sheet : •- .. / If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Prator Block 12A Lot 2 Parcel ID: 017-093-10 A. WELL DATA Well type Private If A, B. or C provide PWSID# Well Log (Y/N) Y Date completed 9/1 990 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 200 ft. Cased to 200 ft. Casing height(above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 09/1990 06/21/18 Static water level 59 ft. 74'7 ft. Well production 10 g.p.m. 6.1 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 1 .98 mg/L Arsenic ND ug/L Date of sample: 06/21/1 8 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material SPETIC/STEEL* Date installed 09/19/1990 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation clea• •u /N) '-Depressiorrover t-•. N High water alarm (Y/N) N/A f-2,. --1-7IA Date of pumpingPumper •r " sf C. ABSORPTION FIELD DATA 1Date installed 1/20/2003 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 GPD/SF System type DEEP TRENCH Length 126(2@63) ft. Width 2.5 ft. Gravel below pipe 4'5 ft. Total depth 10.5 ft. Eff. absorption area 1008 ft` Monitoring tube 4 Depression over field N Date of adequacy test 06/21/2018 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 31 in. Water added 600 gal. New depth 32 in. Elapsed Time: 1440 min. Final fluid depth�_I_ Absorption rate >= 600+ g.p.d. N Any rejuvenation treatment (past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS * TANK PASS LEAKING TEST PREFORMED ON 06/27/18. ** FIELD PRESOAKED PER CODE. S1,VlV9 -on a, G. ENGINEER'S CERTIFICATION Ar., SOF 4��t ,G Cq lk� I certify that I have determined through field inspections and ,ArAt t �1 ��y�# review of Municipal records that the above systems are in 0*;49 /\ •.*,9 conformance with MOA COSA guidelines in effect on this date. •• +�� __ Engineer's Printed Name Steven Pannone r .Sleveri i2\•0aririorie: Date 06/29/2018 ��t+g�••CE-8149• .&." COSA canary sheet_2-6-15.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT I • `.f t i 907-343-7904 On-Site Water and Wastewater Section ^\ ' ` Fax: 343-7997 www.muni.org/onsite \� Septic Tank Advisory Certificate of On-Site Systems Approval # OSC181315 Subdivision: Prator Block:12A, Lot: 2 The septic tank for this property is 28 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. K C * r ' Ai 11 a f .fir Y y`Y • ,-,.- ' q .... , ..6...„. ..,$))547`47.''''- " '''::-.f•;,-,4,:- ;,„...jr,- , - -, , ,..., ..,.. ., ,,,.., . . ., t ,‘,„,,... : . „,..... s i, ..: ,..., 44,43,4, . - - -1.- , -_, ,, .,, -, ‘ „,,,,,-... :..... :., -., „... , ii,,,,,_ ._, . , ,-,-„..: „,... ..' _ ...411.,.. - :4:.....,A714-,- y, ; „. : ,,,,,,,,,.„ _ .,.. e lit I�, „‘.: ,,,, ......s,-4-,W1:14 *(.444fr .- %, ,f., 4 , • y — .c y t, Iiiii# t I', , % ( 3 Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # O 1-7 -- O 93 - 10 1. GENERAL INFORMATION HAA # 09 0000562 Complete legal description lot 2, o (o cl - I2A., PraAc r S11) Location (site address or directions) -67 0 cfe7. Crrc le Propertyowner Som NarYer Collekl Dayphone 3`7S-29zZ Mailingaddress 6700 "nfq"c_� 9nge A,— �c 99S1� Lendingagency & Day phone 563-2Yoi Mailingaddress 3i20 Denali Sty Salke6 h�Ghbrcrc,P /tic 99 �3 Agent 6onn,a rlchnor. Jack L4 ­'A4/' 6a, Dayphone S6� sso6 Address 32or c" S<�SuAe z�oy fr��tiar�� Ak 9�So3 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Y NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 7M25(Ray. 1/91) R.nt MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm F la!-l�X, Tp cAn Le a/ 1 -f, --v, eon Phone 3 °/s - ) 3 ss— Address /`16-30 f -7e o Sy. AACIIO�a-e /9-� 9 -Js /6 Engineer's signature '1��- 21� Date i`lce�tti -19 2-61c�o oeea oa oe°°•su••ye��"•e,i 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments CEJ Date 3-141-00 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-026 (Aw. 191) Beck MOA #21 I\LI.EIVED Municipality of Anchorage MAF 08 200 DEPARTMENT OF HEALTH & HUMAN SERVICESri Environmental Services Division MUNICIPALITY OP ANC '11nnNI LSERVICESDIVh' 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343444 Health Authority Approval Checklist Legal Description: Le f 2, (3 / /T 12 A. Prcr {rr S / /t Parcel I.D.: O I -7 - 093 - o A. WELL DATA Well type P L vd�— If A, B, or C, attach ADEC letter. ADEC water system number _ Log present (Y/N) Y Date completed OreJm. H /S'/9's Total depth H 2 /-/' _ Cased to /1/0' Casing height (above ground) lei, Sanitary seal (Y/N) FROM WELL LOG Original I Deereneo( Date of test 9/215'/ Static water level S 9' Well production /O 1 0.1( g.p.m. WATER SAMPLE RESULTS: Wires properly protected (Y/N) Y AT INSPECTION 9/ 2/ 98 MI Coliform Uco/ //Uamp _Nitrate 3.3Y mG /_( Other bacteria Nvne tyg, rfd( Date of sample: 3 /I / or) Collected by: 77 F'. MOO re _ B. SEPTIC/HOLDING TANK DATA Date installed 9 / PO Tank size ! Z­SUgz_4/ Number of Compartments 2 Cleanouts (Y/N)- Foundation cleanout (Y/N) Y Depression (Y/N) Al _ High water alarm (Y/N) N• A_ Date of Pumping _ 9 / 3 / 99 Pumper _A+ C. ABSORPTION FIELD DATA Date installed i 190 _ Soil rating (g.p.d./ft2 or ftz/bdrm) 1 e �5 ! System type -T-ren CA _ eo(r� Length 53 Width _ Gravel thickness below pipe / I Total depth 9'-S" 0/98) Effective absorption area 7 K 2 lay Monitoring Tube present (YM)Y Depression over field (Y/N) fv Date of adequacy test 213 / 98 Results (Pass/Fail) Parr For `) —bedrooms Fluid depth in absorption field before test (in.); 3s_S_ Immediately after22ys'gal. water added (in.): -71 _>� Fluid depth 70 � (ins) Minutes later: 73 Absorption rate = >GO6 g.p.d. Peroxide treatment (past 12 months) (Y/N) None known If yes, give date N. k trema A?r 'us/ 1l�e'9 innr �v SGuw v� ,n n✓erg 72-026 (Rev. 3/96)* h" r i D. LIFT STATION N. A: Date installed Manhole/Access (Y/N) High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot 1310, "Pump off" level at* On adjacent lots > 1 aG ' On adjacent lots l Zi' Public sewer main IV• A. Public sewer manhole/cleanout Sewer /septic service line > Z5 Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 32 Property line 70' Absorption field S ' Water main/service line > Z5 Surface water/drainage > 100 ' Wells on adjacent lots > SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 3S-, Building foundation -/-7 ' Water main/service line > 2,6— Surface .s'Surface water > 100' Driveway, parking/vehicle storage area > 3 el ' Curtain drain N o n e s e ,- Wells on adjacent lots F. ENGINEER'S CERTIFICATION l certify that i have determined thru field inspections and review of Municipal in conformance with MOA HAA guidelines in effect on this date. Signature �-)r Engineer's Name h ea,5�eo re T Trac„ Date 1 to v c(7 P . 77 22222 HAA Fee $ 3Go =- Date of Payment 3 1 g- 2S D Receipt Number&L— ` Z% _ 72-026 (Rev. 3/96)* Waiver Fee $ 139' "W A,,�� records that the°�¢g/5y„Mems are a +ter w�a°°no 3 Date of Payment Receipt Number 09 r MUNICIPALITY ANCHORAGE • �' DEPARTMENT OF HEALTH &HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # O 17 - 09 3 - to HAA# 0��1.:; 1. GENERAL INFORMATION Complete legal description /.o/ 2_ 616c k I ZA, pima fesr SID Location (site address or directions) - 6700 Property owner 71,� Co Oef- Day phone 3vs- 29Z Z Mailing address 62`00 lZar�uez Grcle A+c 4k 99sr� Lending agency Day phone Mailing address Agent �y�n re Matin erg Juck tuh,le Day phone S63 -s-TO-1 Address __3 Zar c" SF, Su,1 r ZOo '4nA0 Iri- 99So2 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well .. . _ 11 .- v Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(R6V.1/91) Front MOAA21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ? cAn ra l Sere w PhoneJs's— Address iNS3U 5CAO S/. 4,C_Aore y% A -k 9-2s-1,5- Engineer's 9Sl -Engineer's signature Date 5Z 6. DHHS SIGNATURE Approved for O !r bedrooms. Disapproved. Conditional approval for Additional Comments 0 bedrooms, with the following stipulations: Date I - / � - f 9 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. ]2-M(Rev.1911 Back MOAN21 G Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICffP 1 O X998 Environmental Services Division -Iu NICIPALTY OF A ,J' J 1URAGI'_ 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907),,343-4:744Fo ren, Health Authority Approval Checklist Legal Description: l.of? 9/k /2R, Prar/6,- S -1A Parcel I.D.: 0/7-y93 -/v A. WELL DATA Well type Pr'u &d'e _ If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Total depth y z Sanitary seal (Y/N) FROM DR 16 I Nf1l. Date of test Static water level Well production WATER SAMPLE RESULTS: DatecompletedD�/9�ee e� 4//s'/95 - Cased to LOG DGL- P X5N --D 78' Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION to " Y .p.m. R. 6 -1 g. P.M. Coliform 6 colon, &(/ l0a m .e _ Nitrate 2_ S3 P /-e Other bacteria None !fWo r f Pte( Date of sample: 9 / 2 / 96 Collected by: F/o f _Techs', cu / .Sr. ✓ B. SEPTIC/HOLDING TANK DATA Date installed 9 / 90 Tank sizez� Number of Compartments _ 2 Cleanouts (Y/N) }` Foundation cleanout (Y/N) Y _ Depression (Y/N) Al High water alarm (Y/N) Date of Pumping -//9 / 9 6 -Pumper .4 ,/. C. ABSORPTION FIELD DATA Date installed 91 I0 Soil rating (g.p.d./W or ft2/bdrm) /6_ 5' /.�31_ System type % r'e� c 5 Length S3 Width 3 ' — Gravel thickness below pipe 7 ' _ Total depth Effective absorption area -74/2 Monitoring Tube present (YM) I Depression over field (Y/N) N _ Date of adequacy test 9 /'z- / 9 $ - ml9R,"esults (Pass/Fail) Pave For y _bedrooms Fluid depth in absorption field before test (in.); 3S . S- Immediatelyafterz?ys gal. water added (in.): 7/ 1,, Fluid depth 74 1/B (ins) Minutes later: 73 Absorption rate =_> 600 e.p.d. Peroxide treatment (past 12 months) (Y/N) Alt,4e If yes, give date _ Al. A. _ 0 Wafer' Iujh 4e9,nn,.r -k slew u/r in in mer¢ ooe ho�,ton iii/ 72-026 (Rev. 3/96)'cu4-' L"' kron p,V. p o D. LIFT STATION V A. Date installed Manhole/Access(Y/N) High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 11q, Absorption field on lot 130, Public sewer main Sewer /septic_ service line "Pump off" level at* On adjacent lots > /oo On adjacent lots Public sewer manhole/cleanout N. A. Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 3 z- ' Property line 70' N, Absorption field S r Water main/service line > I�Surface water/drainage > r oo ' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line rve�' Building foundation y 7 Water main/service line > z s- ' Surface water > r o a ' Driveway, parking/vehicle storage area 7 6-0 ' Curtain drain NoAe se en Wells on adjacent lots F. ENGINEER'S CERTIFICATION certify that I have determined thru field inspections and review of Municipal records, -that the above systems are in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name %h coa/&ne F. r ro b 1Y Date Se���.. �e� 9, i99,9 r HAA Fee $ 3UU G� Date of Payment q/� Receipt Number d c/.0,5' Z l - oK>— 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number r+W�$f�ziE 1 lt�,tri`�' t r MUNICIPALITY OF ANCHORAGE DEPARTMENT 'F HEALTH`&HUMAN SERVICRS ri{'" k Division ot;Env)ronmental Services;== v„ r `!' ' On S(te P-0, Box 198650Anchorage,lpiaska`x99519 6650'r 'r r' l 1 s t,''(�, 4744Y' IM �; , CERTIFICATE`O� HEALTHtAUT1 ORITYI r.' ` ' ` ` APPROVAL FOA'A SINGLE FAM14Y 3t, ; D"W"ELLING z ; ��- - +i I.D. $1 _� !.�. 6 O.,' t:/�� (t i �5�47Sfii 4Pz ,semf�{'�i l; GENERAL INFORMATION t complete legal descri tion,' ' l ' � p �-dT. 2 r � A 1. �3LdCl v W. Lo Locyatjlori Oite address or directions1 R 11 Ys1r �`Y•,"5.1,'�J Y�%>n / A owner FI ?Mailing address,' beY, Phone 3 y b 6 S 6 t /ZC4.a r,cN 5i Lehding agency 4`_.� ,� bay phone Mailing address is r spy If Agent "/`/yi' a ' _ ' ! �'' i i, '9a a q t )y 3 I DaY phone Address 6 LS C3 I(i k� ' 2 I ITeK'{'',£ Unless otherwise requested, HAA will " `' t'f"`'` t`" "' " "; beheld for)dkg �'' ' `r''' �' 2."" � NUM_ � � ,'� • ,: ', � tl I r, p � 1� s� ,�FsE ER'OF BEDROOMS. `df `4 't"; r r fl orb 3. TYPE OF WATE R SUPPLY: ° r ` ' 'I U t �t Individual well Coh►munIty Well 2j'n IR a= 1731E f (tr )IC t , u 1 r t, sti, 1 pU blic Water k , I , TIT - r, NOTE If community well system, �i ";; ,s a ; '(f « k..=^l` YfIyYJ I. provide Writteh=confirmation from StateACi�Cattesty) ing to the legality and status t I of system,' ijr }ft , ,. �• , , 4. TYPE OF WASTEWATER DISPOSAL Individual on s)te ; Holding tank », > °J it r; a •", COM t�AM1y Y, >�i`Ia.� ommun)ty on s)te Vin: F R , _. 1 ' .:,. ! & 7 e � �' V�) i��lx 7 ,., Publlc se i ' ,Q7 a i Ne ta, ,,e Y+a• �6 a �pF t }, �H,�.�3 's z) NOTE• if community wastAwateP a°stem { �9t t t , i r �, � *,a , fN #,,, _ {I. Y ; provideWitfenconfirrriahon from State ADEC attesting to`tlie 160a Ani '" $°' r ', 9 ,. 11 nd status o� system,;t�>,r I rr. jt, }ri{'A iET3 t r,, 1&z �� ,, tt} 72-025 (Rev. 1/91) front MOA X21 s 1 3,r r /7 n' i lt,, .'� s C ti{t�t 4s(= 1r4� r 1 .J T Conditional'approval for Additional Commei sY:r Y ✓tel „ � :, 4IR, „ The Municipal] Approval Cart[ professional en andtheirlendi conduct inspe responsible for 72-025 (Rev. 1/81( Back th,a validation date shown below, I verify that my application showsthat the on-site water supply gonial and adequatIa for the number of bedrooms jerlfythit based on the information obtained from ny Investigation and Inspection, the on-site water i coltil mpliance with all Municipal and State codes, tei ofahis"Inspection `' !Phone 333 -68th/ Date // too 1 a AW 1 j drooms( with, the, following stipulations: I1 W i; Date' S ty'of Anchorage Department' of Health and Human Seivices'(DHHS) Issues Health Authority fica1.tes based only: upon the representations'given.in paragraph 5 above by an independent ginear registered In the State of Alaska.:Tha DHHS does this as a coco urtesy to purchasers of homes ng Institutions in grderto satisfy'certaln federal anc( state requirements, Employees of DHHS do not ctions'or a1.nalyzt.e data hefor0ja�gertificate I�SISs ��I1 The Municipality 1.of Anchorage is not errors or omissions In the profession I engineer's work, unn "I i is ' I1 W i; Date' S ty'of Anchorage Department' of Health and Human Seivices'(DHHS) Issues Health Authority fica1.tes based only: upon the representations'given.in paragraph 5 above by an independent ginear registered In the State of Alaska.:Tha DHHS does this as a coco urtesy to purchasers of homes ng Institutions in grderto satisfy'certaln federal anc( state requirements, Employees of DHHS do not ctions'or a1.nalyzt.e data hefor0ja�gertificate I�SISs ��I1 The Municipality 1.of Anchorage is not errors or omissions In the profession I engineer's work, unn "I i Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: .L )- B ) � f1 PR A l ol2 W6 D_ Parcel I.D. d > 7- () '�) 3 - / A. Well Data Well type;�R/ VA -Z --If A, B, or C, attach ADEC letter. A/DEC water system number Log present (Y/N) F S Date completed `�/ 0 Driller S iA t, )-I � A /1 INA R wGc�s Total depth 0 0 Cased to a�y Casing height Sanitary seal (Y/N) S Wires properly protected (Y/N) Lj L < -• FROM WELL LOG AT INSPECTION Date of test 0)0 Static water level Well flow J O g.p.m. g•p•m• Pump levell All l SEPARATION DISTANCES FROM WELL TO Septic/holding tank on lot 11/ 6 3 / ; On adjacent lots 7 -op Absorption field on lot > 3 D ' ; On adjacent lots .1-6o Public sewer main N,ZA Public sewer manhole/cleanout N4 Sewer service line _ 44 Petroleum tank AIZA WATER SAMPLE RESULTS: n l Coliform Id Nitrate 0-,/3 Other bacteria �OY4 Date of sample: �/ I Collected by: B. SEPTIC/HOLDING TANK DATA Date installedb Tank size / 2 50 CA L. Compartments Cleanouts (Y/N) ,2 FS Foundation cleanout (Y/N) TS Depression (Y/N) High water alarm (Y/N) Alarm tested (Y/N) VA Date of pumping 2 - �=� - "� Pumper .L6 & L-) J,3Nt:) 2;n SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot J l 6 . 3 On adjacent lots 5 aO`l Foundation ,3 )- i To property line b/'°) 0/ Absorption field Water main/service line Surface water/drainage 11A 72-026(3/83)'Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes SEPARATION DISTAN I Well on lot D. ABSORPTION FIELD DATA "Pump on" level LIFT STATION TO: On adjacent lots Manufacturer (Y/N) "Pump off" Level at tested Surface water Date installed c' / 0) O Soil rating (GPD/Ft2) /6 5 System type i d IJV C /a Length 5 3 Width 3 / Gravel thickness % Total depth / 6 / Total absorption area -)- r Cleanout present (Y/N) F_ t Depression over field (Y/N) _1) 6 Date of adequacy test 6 z -3 y Results (pass/fail) for Bedrooms Water level in absorption field before test $ n (Ro sr\ Su 2 n cf -) 3 3 ° After test i.11)L5)6, 1[/i {}J T To 0, B jrOtk) Peroxide treatment (past 12 months) (Y/N) N 6 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 2 3 6 On adjacent lots < 20 D � ` Property line 2),) - To building foundation / 7 To existing or abandoned system on lot M� On adjacent lots Cutbank A/ 1A Water main/service line Surface water k% Driveway, parking/vehicle storage areanP)4- 70 Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect Signature Engineer's Name,A 7z'VA /Y Date %/a �Ib7 HAA Fee $ -� 3t��.�u> Waiver Fee $ Date of Payment -) -�� c15 Receipt Number nL 72-026 (3/93)' Back Date of Payment Receipt Number s e%is inspection. ° ro P*•e„ e oi� PUTNhM C[ # 7892 *MUNICIPALITY OF ANCHORAGEDepartment of Health & Human Services glG- DIVISION OF ENVIRONMENTAL SERVICES V } 343-4744 N`�v"M�NtP qq E R ICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF C GCS OtJa6SE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I."( C)\1 - CN) tom) - uc) HAA It 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) ('O F) Location (address or directions) j '_N,f3 5, T CIZ � � IL IZ.,; A) (b) Property owner I LI��� "'^ > Telephone: (home) 3 ��-f�`�.tusiness Mailing Address(�' 7�' I Z r� > `�\ I' vJ&-e (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the following address: (or check here k9 if hold for pick up.) List contact person and day phone number below: I I i K, c r �-c� "3 D 7- I t 2 TYPE OF RESIDENCE Single -Family Number of bedrooms ~ 3. WATER SUPPLY Individual Well C.�, Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site l� Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 7M25 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm �,y t�� )r -t �2"J5" Telephone Address H� 4 V I ( k, � C' c Date (2. — < <— L o 6. DHHS APPROVAL Approved for G bedrooms by —)f-fN SKtT4 Datey2—.1181&6 Approved. Disapproved Conditional Terms of Conditional Approval CAUTION The Municipal ityofAnchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) A Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: o r Z %biz4To4 S'C4E 15L D c=iC i zA Well Classification AL iy 4-]F If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Yel Date Completed ?Z ry _ Yield % 0 Zo f, /J 1A Total Depth Cased to Depth of Grouting Static Water Level ._% ; Pump Set At Casing Height Above Ground � f� Sanitary Seal on Casing (Y/N) &S Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) ti O SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot On Adjoining Lots 7 2-0c) To Nearest Edge of Absorption Field on/ Lot 0 ' ; On Adjoining Lots 7 2 o To Nearest Public Sewer Line d (A To Nearest Public Sewer Cleanout/Manhole / To Nearest Sewer Service Line on Lot A) ( A Water Sample Collected by 131,- W I r-Li46��S°' Date Water Sample Test Results 5�� 75 t.AC_ Lb 2v Comments /,�A-moi e-',;)&//,�(i2nA U Ga t-0 cS B. SEPTIC/HOLDING TANK DATA /3 X6/1 Date Installed yb Size 2-S-0 No. of Compartments Standpipes (Y/N) —7 Air -tight Caps (Y/N) yG_� Foundation Cleanout (Y/N) Depression over Tank (Y/N) %U G> Date Last Pumped /J (-ctJ Pumping/Maintenance Contact on File (Y/N) N/ ; for &ZA n Holding Tank High -Water Alarm (Y/N) Ay A Temporary Holding Tank Permit (Y/N) /J A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well 1/6 To Building Foundation To Property Line N 70 / To Disposal Field To Water Main/Service Line N /,4 To Stream, Pond, Lake or Major Drainage Course /Ly/4 Comments n-026(Rev.7188)Front Page 1 of 2 3 .L C. ABSORPTION FIELD DATA _ Soils Rating in Absorption/� Strata /G� Type of System Design Date Installed �/ `��' Length of Field S3 Width of Field J Depth of Field Square Feet of Absortion Area Depression over Field (Y/N) Gravel Bed Thickness 7�e-Z Statndpipes Present (Y/N) Date of Last Adequacy Test n 0 Results of Last Adequacy Test — - 5.+r! SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 13U To Property Line ' i To Building Foundation � 7 To Existing or Abandoned System on Lot N/A ; On Adjoining Lots /U 1,4 JJ To Water Main/Service Line /Ul-q To Cutback (if present) /j/A To Stream, Pond, Lake, or Major Drainage Course . To Driveway, Parking Area, or Vehicle Storage Area 'y Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y Comments Dimensions Manhole/Access(Y/N) "Pump Off" Level-ec "Check Permitted Bedroom Rating Against HAA Request`* Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or onformed to all MOA and HAA guidelines in etfect.on the date of this inspection. Signed Company /4N(Tti2 Date Z —1a — r o � E R's Seal MOA No. 00 )so Receipt No. P2 3 O \ r�`� 7/ Receipt No. Date of Payment Waiver Fee: $ b Amount: $ / 70 Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 KEKNIEFEL ENGINEERING 8441 Miles Ct., Anchorage AK. 99504 (907) 337-1121 • Fax (907) 338-1874 HEALTH .......AUTHOR .I.TY... RE. 5U.4.T.S.......A.N.D......A.N.ALYS,15 Date of Testing: December 11, 1990 Legal Description: Lot 2, Block 12A, Prator Subdivision Street Address: None available Number of Bedrooms: 4 ----------------------------------------------------------------- Well Flow Test: Depth of Well: 200' Static Water Level 57' Average Flow Rate: > 6 gpm ----------------------------------------------------------------- Results of Water Quality Analysis: Total Coliform -- 0 colonies Nitrate -N -- 1.3 mg/l (10 mg/l allowable) ----------------------------------------------------------------- Results of Septic System Adequacy: New System, All cleanouts in place, No water depths in field. ----------------------------------------------------------------- The well and septic system satisfactorily pass the requirements for on-site systems. The well maintained a static water level of approximately 62'+ even under a 10 gallon per minute flow rate. The well is capable of providing 3 gpm for a four hour period. The system was tested in accordance with MOA policy and regulations in force at the time of this test. 0-030