Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
GOLDEN HILLS BLK 1 LT 2
Golden Hills Block 1 Lot 2 #015-122-28 Alpine Drilling & Enterprises Well Log Permit Number: #SW131001 Date of Issue: 1-14-13 Parcel Identification Number: 01512228000. Date Started: 1-14-13 Date Completed: 1-14-13 Is well located at approved permit location? x Yes ❑ No Legal Description: Golden Hills Block 1 Lot 2 Property Owner Name & Address: Douglas White & JoAnne Thomas 10075 Grover Street Anrhnrarya Alaska oo5R7 Borehole Data: Soil Type, Thickness & Water Strata Depth (ft) From To Method of Drilling x air rotary ❑ cable tool 'Casing type: steel Stick-up 0 2 Wall Thickness:.250 inches Organics and silt 2 8 Diameter: 6 inches Depth: 161 feet Silty gravel 8 38 Liner Type: _ Diameter: _ inches Depth: feet silt 38 44 _ Casing stickup above ground: 2 feet gravelly silt 44 69 Static water level (from ground level): 144 feet silt 69 75 Pumping level: 160 feet after gravelly silt 75 111 hours pumping 15 gpm Recovery Rate: 15 gpm silt 111 136 Method of Testin air li g� —1 gravelly silt 136 155 Well Intake Opening Type: water sand & gravel 155 161 x Open End ❑ Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start_ feet Stopped feet Grout Type: bentonite granules Volume: 2 bgs De the Start 0 feet Stopped ? feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? x Yes ❑ No WATER QUALITY TESTING Method of Disinfection: chlorine tablets Coliform ua9 CoV100mL Comments: Nitrates 7 oZ mg/L Arsenlc Nn ug/l. Well Driller: Alpine Drilling &Enterprises PO Box 110496 Anchorage AK 99511 Development Services Department Building Safety Division GE w�eV • On -Site Water & Wastewater Program a4PFk ' o 4700 Elmore Rood P.O. Box 196650 1 t Anchorage, AK 99507 s " e F r Mark Begich 9 Mayor www.muni.org/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW 131001 Date of Issue: 1/1412013 Parcel Identification Number: 01512228000 Legal Description Block I, Lot 2 Golden Hills Property Owner Name & Address: JoAnne Thomas/Doug White 10075 Grover St. Anchorage, AK 99516 Pump Installation Date: 1120/2013 Pump Intake Depth Below Top of Well Casing: 155 feet Pump Manufacturer's Name: Goulds Pump Model: 75807412CL Pump Size 3/4 hp Pitless Adapter Burial Depth: 11 feet Pitless Adapter Manufacturer's Name: Campbell B-10 Pitless Adapter Installer: Aarow Pump & well Service, LLC Well Disinfected Upon Completion? Q Yes ❑ No Method of Disinfection: OvrnAc t461et3, Comments: RN6- 1711 U W1411w Pump Installer Name: Aarow Pump & well Service, LLC P.O. Box 110496 Anchorage, AK 99511-0496 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Municipality of Anchorage Community Development Department Onsite Water and Wastewater Program 4700 Elmore St. • P.O. Box 198650 Anchorage, AK 99519.6850 • http:lhvww.muni.org/onaite • (907) 349-7904 Well Decommissioning Log Addren: Subdivision I, Block I Lot. —2. T R Section Lot On-site Water & Wastewetar Program cerned contractor performing the well decommissioning: Ne , 4�-i Well decommiaeloning date rc _ l. s J Me" of decommissioning: AMC 15.55.0601-1 a. ❑ b. ❑ c. 1-me ian: Use Ire apace below to provide a drawing of the properly showing the fo Its*Q items; • North arrow • Decommissioned wMl, • Olher water wells on the property, • Two separate swing lis dislances for each was shown on the drawing. Note: The swig-tie distances shag be�measured ..from agger permanent utnictures or the property eomeaa. art- / >�•�•-t_'+�' ! � c. r✓ f • Os �� UcCCr� rv. � � > �Lo� c✓c t 1 it e� i flf� GJe1! �r O1Community oavewp"nmmvriopment .%rvicmm3ukikV SafettAOn Site Water and WasiswstsrlFormsiCtierd Fortrameo Daoon misicnig fam.dao On -Site Water System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131001 Tax Code Number: 01512228000 Work Type: Well Upgrade Permit Effective Dates: January 14, 2013 to January 14, 2014 Design Engineer: Subdivision: GOLDEN HILLS Site Legal Address: GOLDEN HILLS BLK 1 LT 2 G:2539 Owner/Address: WHITE DOUGLAS S & THOMAS JOANNE M 10075 GROVER STREET ANCHORAGE AK 995077033 Site Mailing Address: 10075 GROVER ST, Anchorage This permit is for the construction of: N Disposal Field N Septic Tank N Holding Tank Lot Size in Sq Ft: 48990 Total Bedrooms: 5 N Privy Y Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: The existing well shall be decommissioned in accordance with the code. Receiv Issued MUNICIPALITY OF Community Development Department Development Services Division - On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. R51--5'2lS Property owner(s)FJOCX 111 '- l bvVl4s 12 Doc�l I Fc Day phone _ 12 ` L Mailing address tDD vVL-e'�v D 2 • 3YLeA22�� Site address _ '5a"2 -e Legal description (Sub'd., Block & Lot) G-' 0 Legal description (Township, Range & Section) Lot Size ' Sq. Ft. Number of Bedrooms , Ch f 1 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Single Family ❑ Initial (SF) L—✓J/ " Septic Tank El Upgrade Upgrade [' ADU) Holding Tank ❑ Renewal ❑ Duplex (D) FJ Privy Multiple Dwellings El❑ / (SF and/or D) Private Well Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance:— I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Permit/Rush Fees: 11200-00 Waiver Fees: Date of Payment: __I I tkll S Receipt Number: bSK;L 013s1% Permit No. _ 0415 toot Permit App_9-1-12.doc Date of Payment: Receipt Number: Waiver No. P 0 0 z zz n�, 0 0 0 a) Ncn > , 0 z (0 Ln 0 �pl U) -4 0 0 ;u :Poo Nc moo 9- ED 0 0 W < Z CA Grover Street P, U) mO C: 8 L4 (A 0;0 -V 130 M.LO,20.00S 9L'*O L > z z m 0 (n M -0-0 Z m ... m-;� iL rn .0) ",O;u cn m (4 (A ct 0 0) CD ago 0 -� fi En 10 to 0 OzD cn r— 0) 00 LI) 0 OD 0 x m 0 CA 89.2' Ln co 0 0 M" C4 L4 0 z *m"ran OD '00 c 05E O.g—ER a 0 Oc 2 se 0 93�� 9 =r §Z> � st m> rn .DMO� -SK23 XZ RD . 0 -0 •P6. 0 as :82 ADD ga) s� mm Om %0 0 - If m 3 = ^°^g m zo 00 8 Z (n C: &I m (1) zm 5A O> 2,2'— _-w > > m. 3"9 Z luQwQsD3 (;!iiin o� W m M,,90,ZO.00N F DE.; 6L ;0_1 Municipality of Anchorage Community Development Department Page I of 3 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: 05?IZ1ltZ PID Number: OtS- 127.-Z8 ❑ New ® Upgrade Name: 3 -Ay tSuTLM ABSORPTION FIELD ❑ Deep Trench ®.Shallow Trench ❑ Bed ❑ Mound Address ICO15 GRDIVU, ST, 1nCffoizA&E .AVC 9`1507 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 1"i y, ©.(D p 0.45 GPD/SF yT1 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 31 Ft. Gravel depth beneath pipe Ll. 1 4Lh3 Ft. Subdivisiont1 Block Lot CrOLDEr, Ui.5 t Z p Fill added above original grade 1-)15 Ft. Gravel length{ _1S i 34 Ft. Township Range Section Gravel width -5 Ft. Beds: Number of Lines — Distance between lines — Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches 1 From Tank Field Tank Line 1170 Flz 2 10 + Ft. Well r IDb + r� IJP NIA t � 25,+ TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other £XISTfNrr 9 Manufacturer Capacity Gal. N �{ Surface Water ` (00'< 1+ h A Nrt Nq Material Number of compartments Lot Line 51+ 514 A/ A N Foundation 51� IA I0 f N A Al LIFT STATION !MIA Manufacturer Capacity Gal. Curtain Drain _50t+ NA. Remarks 11 Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank303 Y dra n k to -303`f ield Installer A+ Nome Se2VIGRp Drairdield Fg(O CO/MT F'810 Inspector [A25 BENCHMARK (Assumed elevation) ft 100 Inspection „ dates: t (a JZ 2ne GL 1 IZ Location and description p 3.e 4"' 13oiiow� STAIR. �•1PTO DEC.t` COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL ` OF Atgs t l Conditional Approval: Date ••v t�% � :, 49 00 9.... P KLAND j 11+�Fo z� o� Approved�A Date mspecuon meport i -i ¢row ISI 1 c BENCH MARK BOTTOM STAIR FROM DECK ASSUMED MA710M I D0.00 FT SPURKL4ND ENGINEERING Golden Hills SID Lt 2 Blk 1sEPTIC SYSTEM ASeUILT 203 V 15TH AVENUE 10075 Grover Street ANCH. AK. 99501 DATE June 25, 2012 1'07) P79-7914 I J¢v Butter SHEEP P/3 DRIB, P539 TpFXIfTf�C T,pFNCy O O O oc N o Existing 1250 gal -N 3 `n L a Septic tank o ti Verified to a Integrity Installed 50/50 Flow Solite q 321 q a c In50/50 Flow Spiiter a L° Shallow Trench, 5' Wide 78' Long 7' Max. Depth 4.1' Sewer rock NO SCALE C(eanouts Sil t Elev. 92' Elev. 87.8' Elev. 83.7' /�-- Cleanouts Silt Barrier Elev, 91.2' Shallow Trench: 5' Vide 34' Long 7 Max, Depth 4.3' Sewer rock 4.1 ft of Septic Rock NO SCALE TH 1,750150 Flow Spiiter L=WiEXG. Elev. 90.7' Elev. 81.0' Elev.-76.7' BOH. Elev. 74.2' 1 Elev, 86.9' ft of R Septic ock u TO DECK. ASSUMEENCH MARK OM STAIR 4.3 ELEVATION BOH, Elev. 77.3' 100 FEET. SPURKLAND ENGINEERING GOLDEN HILLS BLK 1 LOT 2 SEPTIC SYSTEM ASBUILT 203 W15th Ave DATES JUNE 25, 2012 Anchorage Ak 99501 JAY BUTLER E79-3916 !0073 aKOVER ST., ANLYA9A"W,, AK 999!6 SHEET, 9/9 GRID, 4535 PERMIT B L75P121112 PARCEL IB # 015-122-28 6afiENNILLSB1L2B3.BV6 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www. ci.anchorace. ak. u U*s*s (907) 343-7904 Soils Log - Percolation Test Performed For: JAY BUTLER Legal Description: GOLDEN HILLS BILK 1 LOT 2 11 16 17 18 19 COMMENTS PRE-SOAKED. Township, Range, Section: WAS GROUND WATER ENCOUNTERED? 5 IF YES, AT WHAT DEPTH? L Depth to Water After o P Monitoring? e Date: Reading Date Gross Time Net Time Depth to Water Net Drop - 6/20/12 12:07 PM 0 MIN 10.875" 9.75" 6/20/12 12:17 PM 10 MIN 11.1875" 1.125" 10.0625" 6/20/12 12:27 PM 10 MIN 11.0625" 1.125" 10" 6/20/12 12:37 PM 10 MIN 11.3125 1.0625" 10.375" 6/20/12 12:47 PM 10 MIN 11.25" 0.9375" 10.25" 6/20/12 12:57 PM 10 MIN 11.0" 1" 10.0" 6/20/12 1:07 PM 10 MIN 1" PERCOLATION RATE 10 (minutwAnch) PERC HOLE DIAMETER 6 TEST RUN BETWEEN 3 FT AND 4 F7 PERFORMED BY: ANSON MOXNESS I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6/25/2012 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP121112 Tax Code Number: 01512228000 Work Type: Septic Upgrade Permit Effective Dates: June 14, 2012 to June 14, 2013 Design Engineer: SPURKLAND ENGINEERING Subdivision: GOLDEN HILLS Site Legal Address: GOLDEN HILLS BLK 1 LT 2 G:2539 Owner/Address: BUTLER JAY C & NARDA L 10075 GROVER STREET ANCHORAGE AK 995070000 Site Mailing Address: 10075 GROVER ST, Anchorage Lot Size in Sq Ft: 48990 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field N Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: The entire subsurface disposal field and/or alternate is not within a 30 foot radius of a percolation test. The Engineer needs to do an additional percolation test prior to the construction of the septic field. Please submit stamped and signed results with the As -built Inspection Report. If the results require a design change, construction of the system will stop pending On -Site review and approval. AMC 15.65.060.B.3 Received Issued By: Municipality of Anchorage Development Services Division On -Site Water and Wastewater Program �e»t eparttnent **** VARIANCE/WAIVER REVIEW **** Waiver#: 0S1917-11 `10 COSA#: Permit#: OSP121112 PID#: 015-122-28 Legal Description: Golden Hills Block 1 Lot 2 Engineer: Spurkland Engineering Applicant: Jay Butler Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: 611,611-z- Approved by: (iV Name of Reviewer .............................................................. ................. Rae#: 06551GAmount: $200.00 Date Paid: 6114/12 **** VARIANCE/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0(5-122- ZS Property owner(s) JAv "LL Day phone Mailing address iw' 15 &Rct j&p_ ST r Li lac It c:t2Acs�� AK 4851 b Site address—5Amt:- Legal description (Sub'd., Block & Lot) Crc LCC—N !FILLS aK L LO -T7 Legal description (Township, Range & Section) Lot Size _L±3,0 Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (0 all that apply) Feld Initial E]Absorption Septic Tank ❑ Upgrade . Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. of property owner or Permit/Rush Fees `5')0 Date of Payment: U�,_ 5_1191 Receipt Number: Permit No. &5 h Waiver Fees: cW Date of Payment: 61✓// Z Receipt Number: D 6 555 Waiver No. S P 12-11 Lf 0 GABuilding\On Site\FormsUlent FormsTerrnit App_010411.doc (Rev. 1/11) go SPUT and EngoMeafong Environmental Consulting and Design SEPTIC SYSTEM DESIGN Golden Hills Block 1 Lot 2 Municipality of Anchorage June 5, 2012 Development Services Department On Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, Alaska 99519 Subject: Septic System Installation Permit 10075 Grover Street Ladies and Gentlemen: I am writing to request a well and septic system installation pen -nit for the above referenced property. The existing septic system is no longer functioning adequately. The proposed system will serve a 4 -bedroom single-family residence. Soil logs, design calculations, a site plan, design drawings and construction specifications are enclosed for your review. Design Cales: Groundwater observed to a depth of 13.3feet below ground surface (6/1/2012). Soil Rating. From Testhole 5/25/12 60 min/in = 0.45 gal per sq.ft/day (25 % absorption area) 16 min/in = 0.6 gal per sq.ft/day (75% absorption area) (5/26/98, on file) No. of Bedrooms 4 Required Area per Bedroom: 15010.6 =250 sq.ft. Required Area per Bedroom: 150/ 0.45=333 sq.ft. Total area required: 333 x 1 + 250 x 3 = 1083 sqft System: We are proposing leaving the tank in place, installing a diverter valve, followed by a shallow trench absorption field, 109 feet long with 4 feet of sewer rock (1090 sq. ft effective absorption area). Soils: A test hole was excavated on May 25th, 2012. See the attached soil logs. Ground water monitoring will continue through construction of the septic system. Ground water was observed at a depth of 13.3 feet, on June 1st, 2012. Ground water monitoring will continue through the construction of the system. A percolation test was not conducted between a depth of 7 feet and 16 feet, but the previous absorption fields extended to depth of 10 and 11 feet. The each functioned for approximately 15 years, indicating that the soils are not impermeable. Updated 203 West 15`h Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net SpwM and Enghmewomg Environmental Consulting and Design 90 1 ---1 ground water monitoring for the test hole excavated by Tobben Spurkland in 1998 is not available, but the water levels observed in the new test hole on June 1, 2012 indicate that ground water conditions have not change significantly over this period. High ground water was observed at 14' on 6/4/1998 and at 13.3' on 6/1/2012. These two test holes are approximately 50 feet apart. I was unable to locate any more recent test holes on any of the neighboring properties. Surface Water: There are no surface waters within one hundred feet of the proposed septic system upgrade. Topography: The ground level slopes down towards the west at approximately 5% grade. There are no slopes or ditches walls greater than 25% within 50 feet of the proposed absorption field. Waivers: We are requesting a waiver of the required separation distance between the proposed absorption field and the west property line. The property to the west is the ROW for Grover Street. No negative impacts are anticipated to either the proposed septic system absorption field or the neighboring property. Waiver request: 5 feet The exact location of the 1979 absorption field is unknown. This system has been abandoned for 14 years and is not likely to ever be used again. No negative impacts are anticipated from reducing the require separation distances. We are requesting a waiver of the required separation distance to 10 feet. The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or concerns, please contact me at 279-3916. Sincerely, LarsSpurkland, P.t.— Spur Civil Engineer 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net co 6PI -- LOT I Lar I Il I <, I I � I W o I Well I LnP - sz scvPz - iaz LOT 5 I W I 1 LOT 2 a I ® o I .SLCi✓E well_ _ — — 10' x10, £SMT f0' UMESMT well Well I I I I I I LOT 4 i t y LOT 3 N IW U IIIW `"III _ — I to Nlif J L__---_ 10'UTILESMT —��T-- —F -- -- -- I 1Y NOTE.• THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN fROM ON-SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. 50 0 50 100 150 200 250 300 SCALE. 1' = 100 FL SPURKLAND ENGINEERINGI I GOLDEN BILLS RLK 1 LUT Z I I SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE JAY BUTLERT DA TE. JUNE 1, 2012 ANCH. AK. 99501 (907) 279-3916 10075 GROVER STREET, ANCHORAGE, AK 99516 SHEET. • 1/3 GRID: 2539 PERMIT #OSP1210XXX PID # 015-122-28 GOLDENHILLSBIL2SCl00,DVG 0 Septics Area O INSTALL 4 -BEDROOM SEPTIC SYSTEM EXISTING 1250 GAL. SEPTIC TANK VERIFY TANK INTEGERITY INSTALL BULL RUN DIVERTER TRENCH LENGHT 1 X 75 FEET TRENCH LENGHT 1 X 34 FEET WIDTH 5 FEET MAXIMUM EXCAVDON DEPTH 7 FEET SEWER ROCK 4 FEET COVER 4 FEET W LOT 2 ti ra Qi IVY SWIF � O Q NOTE. SLOPES EXCEEDING WERE NOT OBSERVED WITHIN 50 FEET DOWN GRADIENT OF THE PROPOSED ABSORPTION FIELD LOCATION. Septic! Area THx 5/26/98 by Tabben Spurkland THxf Ex/sting Ground water nonlotor -12' deep and dry. NOTE. THIS 1S NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. 25 0 25 50 75 100 125 150 SCALE, 1' = 50 FT SPURKLAND ENGINEERING 203 W 15TH AVENUE ANCH. AK. 99501 10075 Grover Street Jay Butler APE BENCH MAxA ASSUMED ELEVATION 100.00 FT m SEPTIC SYSTEM DESIGN DATE. June 1, 2012 IPERMIT #SP1210XXX PID # 015-122-28 Gdh01021.DVG T OFXI�TING Ti�FNCH O O O o Existing 1250 gal L a Septic tank ZZ h ° Ver(Fy tank Integrity o Install 50150 Flow Spliter q z Install 50150 Flow Spliter Shallow Trench., 5' Wide 75' Long 7' Max. Depth 4' Sewer rock 4' Cover Sit t NV SCALE Cleanouts Si( t /� Cleanouts 4' Shallow Trench., 5' Wide 34' Long 7' Max. Depth 4' Sewer rock 4' Cover 4' Cover 4,0 Ft of Septic Rock ND SCALE 0 50150 Flow Spliter SPURKLAND 0 4.0 Ft of Septic Rock SPURKLAND ENGINEERING GOLDEN HILLS BU 1 LOT 2 SEPTIC SYSTEM SCHEMATIC 203 W15th Ave JAY BUTLER DATE: JUNE 1, 2011 A79c3916age Ak 99501 mora oeov[e Sr., AN6No�oc AK !9916 SHEET- 3eB GRIDS 2539 PERMIT I OSPI21OXX PARCEL ID j 015-122-28 GOLD£NHILLSB1L20.DWG Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.ci.anchoraae. ak.us (907) 343-7904 Soils Log - Percolation Test Performed For: J Ay PU keiz_ Date Performed: Legal Description: lYolcien "A, NK i LoA I Township, Range, Section: Depth 1- \ S'alC (V1,9 rl6ev) AL. 2_ Scali SA tO'&Y� 3-` Sad Slit ` 4- W� x ne<avzi 5-\ (fJLoSrh� SilL (IAi) 4A9D WAS GROUND WATER ENCOUNTERED? C Gross Time IF YES, AT WHAT DEPTH? �ZS 12 a Depth to Water After r 13,3 P Monitoring? 15 rr E Date: 4 /I Z 11MID PA R LA S . SPUPKLANO:sir ' till R Site Plan Reading Date Gross Time Net Time Depth to Water Net Drop 5jz512 f2!ltDpK 15 rr lid»" 15 - 12 11MID PA 3D Moo) lZilit ° y�lb`r Ii 5Ia" 5 25 12 l"ID PA '3D titin li 1511bto t12, 11 lie 5 25 ill I :'{I) iIA 30 sxi� irz n PERCOLATION RATE (p0 (minutes/inch) PERC HOLE DIAMETER (a �` TEST RUN BETWEEN %5 FT AND (o,5 FT COMMENTS RIE,J(7A6_ nn PERFORMED BY: &_" _N64i% I U ( CERTIFY THAT THIS TEST W S PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: JC 3D I Z Municipality of Anchorage Page I of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: PID PID Number. Name- Wastewater System: ❑ New Upgrade -c-�, y Address:-. I ®D ro�J'e, v ABSORPTION FIELD Phone: No. of Bedrooms: Deep Trench ❑ Shallow Trench ❑ Bed O Mound O Other LEGAL DESCRIPTION Soil Rating: 6). Total Depth from original grade GPD/sq-Ft_ IV —/—?5 Lot �J Block: �/ Subdivision 1 Depth to pipe bottom from original grade: Gravel depth beneath pipe Q. 'hr l� a — b Fl. 7 Ft. Township: Range: Section: Fill added above original grade: Gravel length: .�� 0 ` 1 FL 7:,'� • Ft. WELL: ❑ New ❑ Upgrade Gravel width:^^ A'.'�. Number of lines: Distance between Imes Fl. __. Ft. Classification (Private, A,B.C). Total Depth: Cased To: Total absorption area: Pipe material: FI. Ft. _ 10 6Z) SQ. Ft. 7 O :S -7 •' �Ci Driller: Date Drilled: Static Water Level: Installer: D.�'/I Dale i� galled: //12 /, ei q k- Yield: Purnp Set at Casing Height Above Ground: TANK GPM FL Ft. SEPARATION DISTANCES Kseptic CHolding ❑ST.E.P. To Septic Absorpbpn Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Feld Station Tank Sewer Lines Sew �'� � LA 11,� f Well �A® f' BOO NIA �iQ- Material: Number of Compartments: 0�' jgv�`a Surface Water N PJ 1-4 E; LIFT STATION Lot Size in gallons. Manufacturer: Line Foundation q O" "Pump on" level at. "Pump off' level at: High water alarm at. Curtain Pump Make 3 Model Electrical Inspections performed by: Drain �Z Remarks: BENCH MARK n �/l r 'ti cK v Location and F, ascription: I - cL lo �iCL �-'� 9_ :� cam, QG `�'r^r4t.C/M G�jQerVL4Le'1'l _ ---- Assumed Elevation - w �t 114.5 kD l ENGINEFi'g SEAL Inspections performed by: _ Dates: 1st_ `ye Department of Health and Human Services approval Reviewed and approved by Date: i1 ]Z-013 (Rev ^y 91. MCA :'5 O I I G I� I 1 — INSTALLED NEW DRAINFIELD SWING TIES; E/ 1 STANDARD TRENCH: AC 30.6 8C J2 1 E LENGTH 75 FT DEPTH 10 FT AD 42 1 EFFECTIVE ROCK 7 FT BD 41.5 AE 106 I COVER 3 FT BE 126—� rx AF 104 _ 1 BF 118 UG GAS AG 95 � 1 BG 86 pC3 1 B —Bf H MARK 1 1 I I•`` �I.4.. OF "'.. `tee .�� Air1� \ 00 I I 49th `.. . ........IV 0... .s��. t�tI .../ �'� TC]BEN SPURY.LFlNDAf •�♦fJ. �: No. CE -2225 I' A AV •...........•" I• 25 0 P5 50 75 100 125 150 SCALE- 1' = 50 FT, I I I BENCH MARK GARAGE SLAB ASSUMED ELEVATION 100100 FT I TOBBEN SPURKLAND P.F. 203 W 15TH. AVENUE ANCH. AK. 99501 GOICI212 I�IIIs S D LC % BlIf 10075 Grover Street I SEPTIC SYSTEM AS BUILT DATE: JUNE 23, 1998 (907) 279-3916 Art Sukowski SHEET: 2/3 GRID: 2539 PERMIT # SW980169 PID it 015-182-88 Gdh010?i.Dk1G cleon Out Double Clean Outs \\\ O �tiloniTOr � 1250 got Septic tank Clean Out Stondord Trench. O ' Wide 7.5' L ono 10' Deep T Sewer rock C' Cover 01 Foundation Clean out 4W� P� •.J.�..ISf ,. • 4ytl. ! V • i.....J.:..... .� TUBB SPURKI_AND _N � • r 040 6�,% NO. CE -2225 _� NO SCALE 0® � •. — . «vim Cleonouts - Monitor \� �� 3'-6' Cover I' Min Cover i i u u -u T i ii -ii i n-ui T n -i I -u T 1 ii i T vu 86.9 _i n -ii iHi u T r� a -u o -au 92.1 SIL T BARRIER 86.9 91.88 91.88 79.8— — 7 Ft of Septc Rock 79"8 I250 gal. septic lank NO SCALE 6 A BENCH MARrC GARAGE SLAB ASSUMED EL EV 100.00 �rOBBEN SPURKLAND P.E. GOLDEN DILLS BK I LOT 2 SEPTIC SYSTEM AS BUILT 203 wrath Ave Anchorage AI: 99501 SEPTIC SYSTEM SCHEMATIC DATE: JUNE 23, 1998 �7e-aeia 10075 GROV£R STREET SHEET: .51j GRIDS �?539 PERMIT N0.• SW980169 P.I.N. 015-122-28 GDHO 1023. DWG \ /1� MUNICIPALITY OF ANCHORAGE \I1�1 Department of Health and Human Services * On -Site Services Program (S.S825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW980169 Design Engineer: Tobben Spurkland, P.E. Owner Name: Art Bukowski Owner Address: 10075 GROVER ANCHORAGE , AK 99516-6833 Date Issued: Jun 12, 1998 Expiration Date: Jun 12, 1999 Parcel ID: 015-122-28 Legal Description: GOLDEN HILLS BLK 1 LT 2 Site Address: 010078 GROVER ST Lot Size: 48990 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: Disposal Field _,� Septic Tank Holding Tank Privy Private Well � J Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: V ,tint' a Date: G l6 71 e Issued By: r% �_ _ Date: 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 2 BLOCK 1 GOLDEN HILLS S/D ART BUKOWSKI 10075 GROVER STREET Municipality of Anchorage Department of Health and Social Services 820 I Street Anchorage, Alaska 99501 June 4, 1998 We are submitting an application for a septic system upgrade for this lot. The existing system has faild and must be replaced. This submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following : Use Standard Trench Soil Rating. From Testholes May 26, 1998 16 min/in = 0.6 gal per sq.ft/day No. of Bedrooms 4 Required Area per Bedroom: 150/0.6 = 250 sq.ft. Total area required: 4 x 250 = 1000 sqft Testhole depth 16.5 feet Ground Water at 14 ft Bottom Rock At 10 feet Top Rock At 3 feet Rock Depth 7 feet Total Trench Length 1000 / 14 = 71.5 ft. SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 75 FT TOTAL WIDTH 2 FT TOTAL DEPTH 10 FT ROCK DEPTH 7 FT COVER 3 FT SEPTIC TANK 1250 GAL The installation of this septic system will not prevent wells from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. BL aCK 3 Lar I -¢- Wel ANE 7EPJ H= �� Lar 4 1 i Ii I LaTl 1 --- I i' i' li I _ Well \ Lar 3 1 fYell T �I raj 19 I Lar 18B \ II� II O .L ,0�_- ---- -- - - s• ••i °♦ ------rTt l:l �.. Y,.••T 013 .�r . ..... .........•• . .....� ° : EN SPUR.KIAND ' d °�/�,':,• Ivlo. CE 2225 •.•U��� • 50 0 50 100 150 200 250 300 4 "' p o SCALE- 1` - 100 Fr. �At���S���i�•o TOBBEN SPURIQAND P. E. GOI d en Hills S D L t % fl1k I SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE DATE: JUNE 4, 1998 ANCH. AK. 99501 10075 Grover Street Mn7) 779-Wll1 Art Bukowski I I SHEET: 1/3 GRID: 2539 I PERhIIr # Sb19800xx PID # yy �_ Gd10i0PLDWG O I i I O , I ' INSTALL NEW ORAINFIELD % STANDARD TRENCH: LENGTH 75 FT DEPTH 10 FT EFFECTIVE ROCK 7 FT � COVER 3 FT I CAS REPLACE EXIST. 1250 GAL. TANK / —�- --, ' 4111............... i ell ♦�C OF q - Uell .............. w�' P\ . Arc�# / •ya I ' 49th d .� .,. ..................... ..................... ...� TO EN�SID KLAND ` �U, ••, f\lo. CE-2225AW 25 0 25 50 75 100 125 150 SCALE. P/ = 50 F L I I BENCH MARK ASSUMED ELEVATION I I 10000 FT TOBBEN SPURKLAND P.E. Golden Hill. W D Ll 2 Blk 203 W 15TH. AVENUE ANCH. AK. 99501 10075 Grover Street I SEPTIC SYSTEM DESIGN DATE: JUNE 4, 1998 (907) 279-3916 Art Bukowski SHEET.' 2/3 GRID: 2539 PERMIT It SW9800xx PI9 It Yy Gdh010PI.DWG eon Out Standard Trench 2' l✓ide 75' L ong 10' Deep 7' Sewer rock ' Co ver N0 SCALE SIL T BARRIEF ? rt of'ept c Rc Double Clean Outs 1250 gal Septic tank Foundation Clean out 50 FT .F 4 ..,�� / :• 49th � .. u:.....ae. ....................... /..... ....rP-13.............. TU JBFN SPURKLAND W m ♦ '•. iJo. CE -2225 tis ♦O ` •••• •n•••••••••CC�i Monitor Aeon Ovt l`JCl JI,HLC 6 tl BENCH MARK, ASSUMED LL EV. 100,00 TUBBEN SPURELANB P.E. GOLDL'N HILLS BK I LOT 203 W15th Ave SEPTIC SYSTEM DE[Ghl Anchorage Ak 99501 SEPTIC SYSTEM SCHEMATIC DA I E: JUNE 4, 1998 X79-39�� 10075 GROVER STREET SHEET: 3/3 GP[D: 253y PERMIT N0: SW980OXX P.I.N. YY GDH01023. DWG (E,NGINEEFVS SEAL) - - Municipality of Anchorage .r DEPARTMENT OF '-iEALTH & HUMAN SERVICES 825 "L" Street, Aixhorage, Alaska 99502-0650 SOILS LOC PERCOLATION TEST PERFORMED FOR: /"�r-._O�'),(.i"�'-Y2�, .DATE PERFORMED: j,j LEGAL DESCRIPTION: �.a.c�� �j}� GL, 1d-2 tq Township, Range, Section: DEPTH SLOPE SITE PLAN (FE T 1 2 3 4 �Jann c�v, � t + 5 6 7 u 8 9 10- 11 12 - 13 14 '7 15 16- Vt k� A"n_L � t n s eS S M !; r e"7 r yla9(9B" 17d I gtiiTuty A t= 1-10LE 18.- 19- 20-- COMMENTS 81920COMMENTS WAS GROUND WATER ENCOUNTERED? Dl S IF YES, AT WHAT L O DEPTH? p e E Depth to Water Aller / F Monitoring? _4 Dale: Reading Date Gross Time Net Time Depth to Water Net Drop zo 9S -? A1_ UIV - _ 9/ 10 .3 D u PERCOLATION RATE _ (minutestinch))PERC HOLE DIAMETER TEST RUN BETWEEN '--D _ FT AND j r 7—_ FT No c tclle otse) PERFORMED BY: _._�_• _ I CERTIFY THAT"" /TPIIS/TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: tel` 72-008 (Rev. 4/85) — MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL- PROTECTION ENVIRONMENTAL_ ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL. INSPECTION REPORT NAME `"---�-------�--�'- NEW �L��C�/ _ �Jy ❑UPGRADE MAILING ADDRESS` LEGAL DESCRIPTION LOCATION r NO. OF BEDROOMS W I _ Absorption arga Dwelling � DISTANCE TO: # � -yt- / /� l --- Uy _ PEEt IT N —�� / � 2 Z4 Manufacturer ^ Materi, _ No. of compartments Liq.latcit in gallons IF HOMEMADE: Inside length Width Liquid depth O Y 02z DISTANCE TO: Well 1 welling __�__-�� PERMIT NO. 02 H Manufacturer S _ Material Liquid capacity in gallons OJ LU DISTANCE TO: Well T �• _ Foundation f hR-. Nearest In in . l PERM . % N' U- z I- Z cc NO. of lines Length f eaV line � — Total lengtl of lint's Trench, tidth u-)�j� inches Distance etw en lines HTop O of tile to finish yrade �^ Material beneath the x . inches Total effec� absorption area 70 0 tL Length Width Depth - y PERMIT NO.� i� 41- a- Type of crib Crib diameter Crib depth Total effective absorption area in DISTANCE TO: Well Building foundation Nearest lot line LULU Class DISTANCE T0: Depth Building foundation Driller Sewer line Distance to lot line - PERMIT N0. Septic tank Absorption area(s) OTHER V PIPE MAT RIALS SOIL TEST RATING INSTALLER�1 AL3 REMARKS To TA kik f I VEDf� DATE LAPP ^� ryLEGAL r+ ii4--- , ;������������� ���� �����`P P% 0EPRRTMENT OF |EHiTH HND ENVTRUNMENTHL P/ |ECTION � 825 'L' STREE[/ HNCHORRGE/ HK. 99501 264~4728 ' I A v m 1 .1, ul hN 52, HIT ��SO : 1: -1 T� A Win H KK N U21HPORVP 0� � PERMIT NO. ( ) c HFl` LICHNT HRT RUK0WSKI SRH 8OX ]6~C 749-1740 LUCHTION GROVER ST TYPE OF SUIL HBS0RBTION SYSTEM TRENCH H! i: NUM8ER OF BEDROOMS = 4 SoL 1&1 1411 (SQ FT/BR)= 223 THE REQUIRED SIZE OF THE SOlL HBSORPTlON SYSTEM IS� ������ �� 0. 1-��103��� G& 75 1 0 Q� IVY W K P. . ������ 4 11 THE LENGTH DIMENSION IS THE LENGTH (IN FEAT) OF TH[ TRENCH OR {)RHlpow IELD. THE DEPTH OF H TRENCH OR PIT IS THE DIS?HNCE BETWEEN THE SUkF!WE OF THE GRUUND HND THE BOTTOM OF THE EXCRVHTIOFA ({N FEET) THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE £XCHVRTI0N (IN FEET). TAWYAR-A IF TANUA71 5AP71110 V 1: Q - w- 1 �j 141 K A � 1 12 vy� -- A � & TS GO: CAPYK.K CoSPIA; PERMIT RPFl. ICRNT HHS THE RESPONSTBILITY TO INFORM THIS WPARTMENT DURING lHE INSTHLLHTION INSPECTIONS OF HNY NELLS HDJHCENT TO THlS PROPERTY HND THE NUM8ER OF RESIDEFACES THH[ THE WELL WILL SERYE. ~^-� �F!I_,, 11 ]f �'ll c:: A X A: KAW5 no 140 K W 0 17 w A A - A 1 9 Q E Z 0 > ~___ ,~- 8HCKFILLING OF 8NY SYSTEM WITHOUT FINHL INSPECTION 8ND HPPROVOL BY THIS DEPHRTMENT WlLL 8E SU8JECT TO PROSECUTION. TV � V "Y PIE 1 - 11- 17 X W IF 100 Q Si UT KR: w V Ep� 1-114, K fk� 1 71 A./ :1,"A T" W ISSUED B .DRTE__1511719 Yl2 L3 -'SOILS LOG -� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION J PERCOLATION � TEST \ Pouch 6650, Anchorage, Alaska 99502 276-2221 \-� SOILS LOG - PERCOLATION TEST PERFORMED FOR: /"l Y f I����� � ��t'� , � � DATE PERFORMED: I'rr 1 ci LEGAL DESCRIPTION: L 2_ I> ) C1 0 (— D L /J )-i I L L 5 DEPTH (FEET) 0- ( �Y-��`h 1 L 1� I -Z. hr✓SI li 2 3 5 6 7 8 9 10 �_ 11 12 13 14 15 16 17 18- 19 Z-4 I- I h 5 C" d Q_ Vl S C_ J� W S U Ww ChIes WAS GROUND WATER 1J O ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop -Z� O 2 141 rr C 20 PERCOLATION RATE 4�'-bY' Z � (minutes/inch) TEST RUN BETWEEN� - FT AND FT COMMENTS I c k 2" _ Z Z S S �, / PERFORMED BY: O IJS I . �= N ���ZS / T IU C CERTIFIED BY: r 'l l 'WG�a'�, DATE: 4 __ 72-006 (7/76) i \ I /z'Trl 14 OA )I ) / d c z " C. , ry t4y 'A' 4 )I ;j Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Parcell.D. www.mum.org/onsite (907) 343-7904 j S CERTIFICATE OF ON-SITE SYSTEMS APPROVAL 4 015-122-28 FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description GOLDEN HILLS BLOCK 1 LOT 2 COSA# a SC t;t6a4( Expiration Date: 6 —a 7- ! Location (site address) 10075 GROVER ST., ANCHORAGE, AK 99507 Current Property owner(s) JAY BUTLER Mailing address SAME Lending agency Mailing address Real Estate Agent Mailing Address MICHELLE NELSON Unless otherwise requested, COSA will be held by DSD for pickup. �llgi�dl�:Z�7y 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone Day phone 240-0570 TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑Q Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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. Name of Spurkland Enginneering Address 203 W. 15th Ave., Ste 202, Anchorage, AK 99501 Phone 279-3916 Engineer's Printed Name Lars Spurkland Date JUNE 25, 2012 5. DSD SIGNATURE Approved for Disapproved. bedrooms. TH d SPURKL .Mn. 0 FE` Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineers Report X Other By: -2 Original Certificate Date: (Rev.I V05) Municipality of Anchorage • ''° Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OFON-SITESYSTEMS APPROVAL CHECKLIST Legal Description: "en RJ15 Pock 1 UZ Parcel ID: 015- I ZZ -Z8 A. WELL DATA Well type PRy j. If A. B, or C provide PWSID # = Well Log (Y/N) Date completed in, Sanitary seal (YIN) Y Wires properly protected (Y/N) y Total depth 1t95 ft. Cased to I(s5 ft. Casing height (above ground) i IZ in. FROM WELL LOG AT INSPECTION Date of test Aird 1176 5 5 /2. Static water level 135 ft. )YJ ft. Well production + g.p.m. 1%+ 2 9— p.m-WATER SAMPLE RESULTS: t 1 I Coliform NEG, colonies/100 mL Nitrate b,$l mg/L Collected by: LABS Sou2Ytlw,A Arsenic: NO ug/L date of sample:5 55 r2 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Awace IgXkI%ei Date installed (01gq Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Date of pumping 1J 1 Pumper A4 nonle Serdi en C. ABSORPTION FIELD DATA Date installed G iz Soil rating (.p.d./ orfe/bdrm) 0110 0,45 System type S%a(1ow T��N Length '78 $3y ft. Width 5 ft. Gravel below pipe V.I 4, ft. Total depth ft. Eff. absorption area 1120 ft' Monitoring tube Y Depression over field Al Date of adequacy test Alev Results (Pass/fail) — For — bedrooms Fluid depth in absorption field before test — in. Water added=gal. New depth =in. Elapsed Time: — min. Final fluid depth — in. Absorption rate >= — g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) — If yes, give date D. LIFT STATION /VA Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off' level at — in. Cycles tested — SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot I oo't Absorption field on lot 100, t Public sewer main /VA Sewer /septic service line ZS I t Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots t ooI On adjacent lots 100't Public sewer manhole/cleanout Holding tank N Animal containment areas 50`t Manure/animal excrete storage areas tootf SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ID It Property line 5 1+ Absorption field S1+ Water main /VA Water service line to', Surface water joo't Wells on adjacent lots I1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 6 * Building foundation 10 Water main A/A Water Service line t0 t+ Surface water too r+ Driveway, parking/vehicle storage 5 Curtain drain So't Wells on adjacent lots loo'+ F. COMMENTS WAtv0Z on M1. G. ENGINEER'S CERTIFICATION OF �lq �1, i,.........5 I i certify that t have determined through field inspections and review of Municipal records that the above systems are in 49T conformance with MOA COSA guidelines in effect on this date. 4 Engineer's Printed Name j_A2S ,SMrhlc a SPURKV+ND: �j�• 15 Date 6125112 ii `�; .f� z.• �0 � 1, F�Pidn� ci(1NP� COSA Fee $ qr-)d Date of Payment 1-1VIQ Receipt Number 111d — (Rev. 4110) Waiver Fee $ Date of Payment Receipt Number in. I 30' 30' S4 49TH -71 yl Janice M. Zilko o LS -8629 y °� o Os O W ISPIit Rail O J Fence LAND & CONSTRUCTION SURVEYORS—PLANE 440 West Benson Boulevard, Suite 200 Anchorage, Alaska 99503 Date: June 25, 2012 lDrown By. PL Work Order: 2012—L-113 iChecked By. JMZ O� Os Os Os �X I I LxJ 3 Septic Cleanouts PVC Pipe Perk Test s0 - X10' Utility '/I Easement Lot 1 N89°56'40"W # 300.80' S89°56'40"E Ordered By. Michelle Nelson/ReMax Propertie Legal Description: 2 ^ ^_BU I I T JERS—ENGINEERS Lot 2, Block 1, Phone: 562-5291 Fax: 561-6626 Golden Hills Subdivision Plat: 76-306 Grid: 2539 Ref: 2012—L-73 Scale: 1"=30' Fb/Pg: 78116-17, 25 k Well CoShed M 281.29' Wellt Lot 3 N NOTE: N THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT Is PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LANTECH. SURVEY CERTIFICATION: LANTECH has conducted a physical survey of the property as shown on this drawing and certifies that the improvements Legend: situated thereon are within the properly lines and no encroachments exist Asphalt other than noted. Septic Standpipe QSEXCLUSIONARY NOTE: It is the owners' responsibility to determine the �;'Concrete:-.,;.'.*.'Concrete:-.,;.'.*' existence of any easements, covenants, restrictions or right–of–way Water Well ® takings which do not appear on the recorded subdivision plat. Under Overhang Fence—X—%— no circumstances should any data hereon be used for construction, iWood Deck for establishing property lines, or for plot–plan purposes. N au Z 0 0 Shed 0 Lot 2 0 C 4 Septic r Cleanouts Shed = 0 0 '\ o 0 342 3 J^� rV Existing41 0 rn House ry J ,v V S89°56'40"E Ordered By. Michelle Nelson/ReMax Propertie Legal Description: 2 ^ ^_BU I I T JERS—ENGINEERS Lot 2, Block 1, Phone: 562-5291 Fax: 561-6626 Golden Hills Subdivision Plat: 76-306 Grid: 2539 Ref: 2012—L-73 Scale: 1"=30' Fb/Pg: 78116-17, 25 k Well CoShed M 281.29' Wellt Lot 3 N NOTE: N THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT Is PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LANTECH. SURVEY CERTIFICATION: LANTECH has conducted a physical survey of the property as shown on this drawing and certifies that the improvements Legend: situated thereon are within the properly lines and no encroachments exist Asphalt other than noted. Septic Standpipe QSEXCLUSIONARY NOTE: It is the owners' responsibility to determine the �;'Concrete:-.,;.'.*.'Concrete:-.,;.'.*' existence of any easements, covenants, restrictions or right–of–way Water Well ® takings which do not appear on the recorded subdivision plat. Under Overhang Fence—X—%— no circumstances should any data hereon be used for construction, iWood Deck for establishing property lines, or for plot–plan purposes. Municipality of Anchorage s , Op {'j Community Development Department =' Development Services Division s E. On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval 4 121241 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 2 of Golden Hills subdivision. This inspection revealed a nitrate concentration of 6.81 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services it 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 NG Parcel I.D. # (7 >� Z n HAA # _LLQ! 7 9 d 1. GENERAL INFORMATION Complete legal description �_0 U C-7 C, Location (site address or directions)QL 1 5 (�� ro ye r S re e_� Property owner A � Day phone 3'16 a� C Mailing address 100, S- —IVe S 4 - Lending agency Day phone Mailing address Agent rr ti y n tic Day phone Address 0_0 aco v ;1 Unless otherwise requested, HAA will be held for pickup 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: / Individual well t/ 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(Rev.1/91) Front 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 Phone Address Engineer's signature 6. DHHS SIGNATURE _Z Approved for Fo v R bedrooms. Disapproved. Conditional approval for Additional Comments 0 UITIC 's d bedrooms, with the following stipulations: Date () -Z / - 9 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 engineer's work. 72-025 (Rev. 1/91) Back MOA #21 MUNICIPALITY OF ANCHORAGE �r DEPARTMENT OF HEALTH & HUMAN SERVICES �^ "'; Division of Environmental Services On -Site Services Section P.Q. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Q �� Parcel I.D. # 015 - 1 2� -� HAA # t � 1�n t 2)O 1. GENERAL INFORMATION Complete legal description I...D i T3 V 1 o l c1 -t v1 Location (site address or directions) I 0-0 -TS- C=?, Dov< -r s�rt_c=f- _ Property owner _Lr-� 1 .�4�ow �4 Day phone `I - _,!5a Mailing address 10 07 Y -U' Ve-LV S4- Lending agency Day phone Mailing address Agent7—T I 5 ams �2 'tel Day phone2--7,6 -0-7(o Address 4 0-0 C o rZo (inti Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well 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 (Rev. 1/91) Front MOA N21 t. 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 further verifythat 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 S.nv)rl/Jck[A � ice. 1- Phone _,,,,91L Address .z, l'�/ Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. bedrooms. — Date 61A.S 196 f.a cc.. ... � "/p ec n: �ca?„a au sroas.,oacoaocenit +r'/ c �;i St [-*� Conditional approval for F -0Y bedrooms, with the following stipulations: This approval is subject to monitor tube readings between the 10th and 20th of October 1998 to verify 4 foot separation between trenc bottom and water table. Additional Comments Wile, Date 6'-2 S' 13 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-M (Rev. 1/91) Back MOA 021 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICRE C E I V E D Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (9071I 0324iA9 8 Municipality of Anchorage Health Authority Approval Checkligbpt. Health & Human Services Legal Description: 1--cA 2, V1 G o .w, , _ Parcel I.D.: 0 1 L'� -- 12-7— --- 2 6 A. WELL DATA Well type P� _ If A, B, or C, attach ADEC letter. ADEC water system number M Log present (Y/N) Date completed A p r- i Total depth 1192 P Cased to 1 (9 e) Casing height (aboveground) "1. Ll // Sanitary seal (Y/N) FROM WELL LOG Date of test A p r; L 079 -- Static water level 1 �3w Well production _ WATER SAMPLE RESULTS: Coliform Wires properly protected (Y/N) AT INSPECTION V L—a o- t [q -1 b g.p:m. I.3 *k 9— p.m- Nitrate /7-�Lg M� L- Other bacteria Date of sample: "/�-4 / q k� Collected by: �. fN ..J�) B. SEPTIC/HOLDING TANK DATA Date installed 10!" S' Tank size /6'2,5-0 Number of Compartments oz.=_ Cleanouts (Y/N) _ Foundation cleanout (Y/N) _� Depression (Y/N) High water alarm (Y/N) l`1 Date of Pumping N/A ! Pumper f� C. ABSORPTION FIELD DATA O Date installed '' /A:3 /V- _ Soil rating (g.p.d,/ft2 or ft2/bdrm) �o (�_ System type. �t-r vt C1 Length 75- Width _ 2- Gravel thickness below pipe _Z_ Total depth %O --/-15 Effective absorption area d 50 Monitoring Tube present (Y/N) Depression over field (Y/N) N Date of adequacy test _ r�✓ih_ Results (Pass/Fail) '� For _ bedrooms Fluid depth in absorption field before test (in.); _ Immediately after=`gal. water added (in.):_ Fluid depth (ins) Minutes later: Absorption rate = _g.p.d. Peroxide treatment (past 12 months) (Y/N) ` If yes, give date 72-026 (Rev. 3/96)* RECEIVE JUN 24 1998 D. LIFT STATION �1A MUNICIPALITY OF ANCHORAGE Date installed Size in gallons FNVIP.ONMENTALSERVICES DIVISION Manhole/Access (Y/N) "Pump on" level at* "Pump off' level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot i Ao-itq On adjacent lots 10� Absorption field on lot ; On adjacent lots Public sewer main N ZAP Public sewer manhole/cleanout Sewer /septic service line > l uo Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING-TANK ON LOTTO: Foune: 'on Property line 4C) Absorption field `; `—:> Water main/service line >50 Surface water/drainage N I C.) Wells on adjacent lots > 10-0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 3D Building foundation 9 � Water main/service line > X0`0 Surface water r'1 /, Driveway, parking/vehicle storage area r2 h Curtain drain L Wells on adjacent lots [rte F. ENGINEER'S CERTIFICATION 1 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 Date HAA Fee $ Waiver Fee $ % Date of Payment C� / `2 /�� / `� Date of Payment Receipt Number Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE " DEPARTMENT OF HEALTH & HUMAN SERVICES p R 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 1. D. # G1_L -J a ,-A - a� 1. GENERAL INFORMATION HAA If k�P'�lQ'I.L^,`'1 Complete legal description L 2 BC / /-"//LL.S Location (site address or directions) Property owner A 127 Ej U 1<n w —1KJ Day phone - M/� Mailing address /0075 G.R DVE2 � C Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone 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 (Rev. 1/91) F,on( MOA n21 5. 9 By: 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 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 14N bL"1_S'0,,j L� (,,N c --t" irjG Phone Address c/o 173 4-ylr,4401L., Ly- ML yqh z`�l Engineer's signature �� G��°�� C� L l wnt> —� Date /o Z- DHHS SIGNATURE `/'� Approved for _� bedrooms. Disapproved. Conditional approval for Additional Comments ii 1,7 y F°G J Vii? '^'f`tC.tui,ova�oo �1//./py{J'ypi FL� .'1 �' •D opy pp0 9 e� Anderson ; 4C81 bedrooms, with the following stipulations: Date / / /2� /% Z v 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. 72-025 (Re, 1/91) Back MOA 021 Municipality of Anchorage Department of Health & Human Services M}i� HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L Z -13L 1 (�Ol Qp�Ll tl r 113 Parcel I.D. A. WELL DATA Well type PP -1 VA T -E - If A, B, or C, attach ADEC letter. ADEC water system number,/ NZA Log present (Y/N),T Datecompleted 421elL /979 Driller1i�CT/G > 1,20 129ILCInrCy 0210 Total depth Cased to1L8 Casing height 3 Public sewer main — zw/z "�5 Public sewer manhole/cleanout in/LES _ Public sewer service line _� Sanitary seal (Y/N) _� Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION o n Date of test y��8 9",6 92 Static water level Well flow 7g.p.m. -2" % Pump level �n SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 1�10 _ ; On adjacent lots > 1,20 Absorption field on lot 0210 --;On adjacent lots -- > Z�00 Public sewer main — zw/z "�5 Public sewer manhole/cleanout in/LES _ Public sewer service line /V2/C IF S — Petroleum tank — > /,no " WATER SAMPLE RESULTS: Coliform Nitrate 3. cf M Lrl �- Other bacteria O Date of sample: J / Z 3L L° Collected by: (,AJ OAC. FA4 U *J _ B. SEPTIC/HOLDING TANK DATA Date installed Tank size __LZ_2 O Compartments 2 r Cleanouts (Y/N) Foundation cleanout (Y/N) �Le_ Depression (Y/N) High water alarm (Y/N) NIIA —Alarm tested (Y/N) Date of pumping — 2l11 i`�7� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot '200, On adjacent lots— > —Foundation 2 5 To property line > L2field 5 Water main/service line Surface water/drainage > ADO 72-026 (Rev. 3/91)Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA "Pump off" level at Cycles tested Surface water Date installed 520z1-79 Soil rating 225 System type T/?x�/yc N Length X26 Width -3/ Gravel thickness 7 Total depth Total absorption area 9 Z `/ Cleanouts present (Y/N) Depression over field (Y/N) h1 Date of adequacy test Results (pass/fail) PA SS for `f bedrooms Peroxide treatment (past 12 months) (Y/N) N If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 2 /0 On adjacent lots > /D0 Property line > Z o / To building foundation 35 To existing or abandoned system on lot LOME oN Lor On adjacent lots >Z001 Cutbank > /oo Water main/service line Surface water > Driveway, parking/vehicle storage area •�� � Curtain drain NONE /ni Act® E. ENGINEER'S CERTIFICATION / certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection HAA Fee $ / 7O < J2 Date of Payment l D `-7 Receipt Number I 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number �.� Signature 1d/✓Vt�---�., e '�..�il9 ' Engineer's Name ` /)• l���E-f/i� - AN, Dob l�%'�l �`°� ., 6 Date / o ,7Z, /o/ 4T 9 � 3 G HAA Fee $ / 7O < J2 Date of Payment l D `-7 Receipt Number I 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL- OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date — > -30 / e6- 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L.af ?. 13(c,( h 1. 6olde+) / /U S'I:D Location (address or directions) rUo7� rrv�,G,� sf (b) Applicant Name Telephone: Home 3 yG - Business -7,96 1 71tly Applicant Address 100'7,; 6Zr-civ er' Sh �}+,Gl,c+ ci. IHIC 995-/6� (c) Applicant is (check one): Lending Institution 0 ; Owner/builder ® ;Buyer 17 ;Other El (explain); � (d) Lending Institution 7caf - �(uFc/ l3 unrr "�� +IC11 Telephone ��6- G3�'o Address _ Ol L1/. �61Y' / /1-ncJ1v(-v'qe 1441: g95a3 (e) Real Estate Company and Agent nto+r e- C Address Telephone (f) Mail the HAA to the following address: (hor 91cPr 2. TYPE OF RESIDENCCam�iIYEOI Single -Family IN MuOtherNumber of Bedrooms 3. WATER SUPPLY Individual Well ® Community El Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite © Public 0 Community 0 Holding Tank f!) Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 1 72-025 (11/84) 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 FirmServccC— Telephone — YS- 13SS Address clwr4]�y /fl-C— Date Sep .3 G 0 6. DHEP APPROVAL C /� Approved for %fes bedrooms by/ - Approved ------!= _ Disapproved Terms of Conditional Approval ° ° Tl A f THEODORE F. MOORE; [3 Engineer's Seal CC - 3589 .°; Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph a above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: l -O_ 2, 13 (0c -6o t den hh!ls S/.o A. WELL DATA Well Classification 1')vcc Fe If A, 13, C, D.E.C. Approved (Y/N) N, A. ' H„j r/l„� /'1i letSf44pe _ Well Log Present (Y/N) Y Date Completed ftp r' 1 1976 Yield -7 9^ % (o Total Depth t 69' Cased to 1 Depth of Grouting /1 Static Water Level t `t' -7' Pump Set At Casing Height Above Ground 36'11 Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) + Depression Around Wellhead (Y/N) fY Separation Distances from Well To Septic/Holding Tank on Lot 2 G o ; On Adjoining Lots > (c,0 To Nearest Edge of Absorption Field on Lot 10 1 ; On Adjoining Lots _ «'G To Nearest Public Sewer Line N, A To Nearest Public Sewer Cleanout/Manhole _ �I. H To Nearest Sewer Service Line on Lot Iv, A, Water Sample Collected by ; Date — ` / 2 J 106' Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed ;_/ 02 / 79- Size !! 2 V No. of Compartments _ Standpipes (Y/N) i Air -tight Caps (Y/N) )` Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) _ N Date Last Pumped �_)/t-0 / 96 Pumping/Maintenance Contract on File (Y/N) ;for Holding Tank High -Water Alarm (Y/N) fel,A Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well Zoo ` To Building Foundation To Property Line _ > 30 , To Disposal Field .>-' To Water Main/Service Line Course —__2 10L Comments Page 1 of 2 72-026(11/84) To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 2 26- 171 /3cotrm Type of System Design T-rt,1cb Date Installed S/ Z Z / '7 9 Length of Field 66 Width of Field 36' Depth of Field Gravel Bed Thickness Square Feet of Absorption Area 92 y Standpipes Present (Y/N) Depression over Field (Y/N) N Date of Last Adequacy Test Results of Last Adequacy Test /irRec�ccc<� 'F `1 0 er�(ro0`"l Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation Lot (01 3,S To Property Line i �2G To Existing or Abandoned System on ; On Adjoining Lots =' 3 O To Water Main/Service Line N, A. To Cutbank (if present) N A. To Stream/Pond/Lake/or Major Drainage Course a fool To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION K1,)0. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Z"161(_ 'rf. %?- ,< t Date %/ Company l (« Q Tec1i 5��1" / MOA No. Receipt No. -3 C7 O / cc cp Date of Payment /0 Z/ 1-96 Amount: $ �� 00 Page 2 of 2 72-026 (11/84) .- CSS- c OF A4 ��Q°,•• •.,ate®® Engineer's Seal 0 Co 10 �•a/.aae... a•eaaaa as aaa aa•.a� dea aaaa��-ar •a ��.aii'..a...•��'� T : THEODORE' F. Mo RE ; AY �� N ••a•, GE - 3589,`" /7 MI 00tJ(Yeb / c?-Aq 79 5. LEGAL DES,RIPTI 1QN�v V LLFFLLJJ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH &-ENVIRONMENTAL PROTECTION i' _-',-i;'tf.--C)ION 825 L Street - Anchorage, Alaska 99501 O CP ENVIRONMENTAL ENGINEERING DIVISION' Telephone 264.4720. R E C E I REQUESTFOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITI DIRECTIONS: Complete all parts on page 1. Incomplete requests will notbeprocessed. Please allow ten (10) days for processing. - 1. PR PERTY. W� &)V'0WS ' P� NE C MAI LING ADD ESS PROPERTY�,pJRESIDENT (If different from above) - - - - - - - PHONE -- - - - jX 2. BUYER - - - -- - - - - P ONE - — ,(7 —� COMMUNITY MAI LINU'A�LSS 3. LENDING INSTITUTION - ri IZS`- Ord OO AC- SIC PHONE & MFlILIN ADD ESS Gam, 5e �&Y-g 4. REALTOR/AGENT - - PHONE - MAI LING ADDRESS 5. LEGAL DES,RIPTI 1QN�v V LLFFLLJJ Crow STREET LOCATION pp 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS_ 1K SINGLE FAMILY E--] One j Four ❑ Other _ E Two ❑ Five E] MULTIPLE FAMILY ❑ Three CI Six 7, WATER SUPPLY V1yf INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled COMMUNITY since June 1975, For wells drilled prior to that date, give well E PUBLIC UTILITY depth (attach log if available.( - 8. SEWAGE DISPOSAL SYSTEM �j **If 3pue 1 INDIVIDUAL/ON-SITE** individual/on-site, give installation date 0 If system is over two (2) years old an adequacy test is required PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MIDST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1 INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED - 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified' PERMIT NUMBER — DATE INSTALLED INSTALLER Tank or ❑ Holding Tankt9� ❑Sept'(!D-3L-5 Size: 2 If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank - Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS IPS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78)