HomeMy WebLinkAboutPENNINGTON PARK BLK 3 LT 5Pennington Park Block 3 Lot 5 #020-181-32 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program pOBox 190ssn 47ooElmore Road Anchorage, Alaska gS51Phone: V* Fax: (907) 343-7997 Permit Number: DSP211179 Work Type: SepUoTankUpgnade Tax Code Number: 82018132000 Site Legal Address: PENNiNGT2NPARK BLK 3 L 6 G:3437 Site Mailing Address: GG2OKALLANOERAVE, Anchorage Owner: HALE LAWRENCE C&JANSS Design Engineer: GARNESSENGINEERING GROUP LTD This permit is for the construction of: El Disposal Field 2Septic Tank [] Holding Tank [] Privy Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms 6/2/206/212021 22 [] Private Well [] Water Storage All construction shall beinaccordance with: 1. The attached approved design. ll al code — --5.55 and 15.65 and the State of Alaska Wastewater-nts specified in [�s urm� Regulations (1 72)'ndDhnNngWater ' Regulations (18AAC8O) 3. The wastewater code requires inspections during the installation, The engineer shall notify the Development Services Department per AMC 15.85.Provide notification bycalling (9O7)343-7SO4(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall baeither: o. Opened and Closed onthe same day, or b' Covered, sealed, and heated h)prevent freezing Special Provisions: 1. Location of surface water is to be shown on final as -built survey, submitted with record drawings. 2. End of west leg of drainfield shall be located prior to tank install to confirm 5 ft separation and to determine if field is outside the utility easement. Received By: Issued By: 3 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor On -Site SewerMell Permit Application For A Single Family Dwelling Parcel I.D. 020-181-32 Property owner(s) LAWRENCE HALE Day phone LAWRENCE HALE Mailing address 5620 KALLANDER AVENUE `ANCHORAGE, AK 99516 Site address 5620 KALLANDER AVENUE *ANCHORAGE, AK 99516 Legal description (Sub'd, Block & Lot) PENNINGTON PARK; BLOCK 3, LOT 5 Legal description (Township, Section & Range) Lot Size Sq.Ft. APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: N/A TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: 5Z 2 7 1 21 Receipt Number: 0 3 `� 3 G Permit No. 0 S PQ 11 1/ Waiver Fees: Date of Payment: Receipt Number: Waiver No. (Rev. 01/11) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211179, Rebecca Carroll, 06/02/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211179, Rebecca Carroll, 06/02/21 MUNICIPALITY OF ANCHORAGE mem- On-Site Water&Wastewater Program `, PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http:I/www.muni.org/onsite epartment 44C N_ONAGE On-Site Wastewater Disposal System Permit Permit Number: OSP171196 Effective Date: 7/24/2017 Work Type: SepticTank Upgrade Expiration Date: 7/24/2018 Tax Code Number: 02018132000 Site Legal Address: PENNINGTON PARK BLK 3 LT 5 G:3437 Site Mailing Address: 5620 KALLANDER AVE, Anchorage Owner: HALE LAWRENCE C & JANS S Lot Size in Sq Ft: 34500 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field EI Septic Tank ❑ Holding Tank El Privy ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907)343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: joer f _ Date: Issued By: CliAnZa Date: 7 Alr,_ 0 JUL 2 a 2017 1-) MUNICIPALITY OF ANCHORAG ‘ z ti Community Development Department _ Phone: 907-343-7904 Development Services % 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. 020-181-32 Property owner(s) LARRY HALE Day phone 375-2580 Mailing address 5620 KALLANDER AVENUE'ANCHORAGE,AK 99516 Site address 5620 KALLANDER AVENUE*ANCHORAGE,AK 99516 Legal description (Sub'd, Block & Lot ) PENNINGTON PARK; BLOCK 3, LOT 5 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (Nall that apply) Initial ❑ Single Family(SF) Absorption Field ❑ (w/wo ADU) Septic Tank ® Upgrade Duplex (D) ❑ Renewal ❑ Holding Tank ❑ Multiple Dwellings ❑ Privy ❑ (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. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: A15 Waiver Fees: Date of Payment: ?P /1"/' Date of Payment: Receipt Number: t3IOQR / Receipt Number: /� C l?I ! ` Permit No. VJ�r Waiver No. (Rev.01/11) ..„, t• Iluanicsi, GARNESS ENGINEERING GROUP, Ltd 9cJ—r r-c.-nom Sy—» CIVIL&ENVIRONMENTAL ENGINEERS Dealer July 14, 2017 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic Tank Replacement (2 Options) at Pennington Park; Block 3, Lot 5 To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The septic tank was installed in 1981 and is approaching the end of its useful life; therefore, the owner would like to have it upgraded. We are proposing to decommission the old septic tank per the Uniform Plumbing Code (UPC). There is minimal elevation drop between the house and drainfield (approximately four (4) inches); therefore, we have prepared two separate options for the contractor. The first option proposes to remove the "boardwalk" from the deck area to allow access for an excavator to decommission the old tank and install a new 1000 gallon septic tank. The second option proposes to install a 1250 gallon STEP tank beyond the "boardwalk" and other decking. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. in, erely J_• r- 1 . . 15.s, P.E., M.S. Pres'•e 3701 East Tudor Road,Suite 101 *Anchorage, Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246`Website: www.garnessengineering.com . . ..dilif \TANK ONLY I Y i IC u 100' WELL RADIUS 1 N ../..............."1\;c../9"-- .. .. I VPI ;G�ALE: I '-- `,- : PENNINGTON PARK; BLOCK 3, LOT 4 \ \ -:'0.1%;t0.**' \ ', •: NEW 4" PVC SE • NE D3034) r r FROM HOUSE TO T. •K SLOPED AT INSTALL NEW 1000 GALLON N / :::.::!.:.•:-':', 1/8" PER FOOT. NSU TED W111H 2" �a� SEPTIC TANK. NEW TANK SHALL •; BLUEBOARD «DE, TERED OVER 6•.( BE AT LEAST 5' FROM THE ` 1 _ SEWER LINE. l BUILDING FOUNDATION AND ANY .� DECK SUPPORT. BEDROOM----- --- \\ HOUSE \ ' PUMP EXISTING SEPTIC TAN' ��/�,- AND THEN CUT OFF TOP OF INSTALL DOTBLE ;� TANK AND FILL WITH CLEANOUTS COMPACTED PIT RUN \ -i' frIrti GRAVEL SO AS TO /RIM ACCOMMODATE ROUTING THE \ \ SEWER SERVICE UNE OVER THE TOP OF THE OLD TANK- \ 4" PVC LL BE / \ ESSENTIALLY UNEFROM FLAT.TANK INSULATETOTRENCH WITHWI4" BLUEBOARD 4' WIDE, CENTERED OVER SEWER \ ` UNE. / \ 0 EXISTING DRAINFIEL) \ "\� Jion ...---- PENNINGTON PARK; BLOCK 3, •Ici T 6 1 3C\ \ i \ \ � 1 ' / PENNINGTON PARK; BLOCK 3, LOT 9 c.---- I 100' WELL RADIUS I ..+�.w111 II,, / 7r i\ �: • • y '+ GARNESS ENGINEERING GROUP Ltd ; :' •41' 1• �••. '•0 CIVIL&ENVIRONMENTAL ENGINEERS �j 1 i 3701 E.1%1) ROAD.9111E 101•ANCHORAGE MC 99507•PHONE(907)337-4179•FAX(907)3M-3246•0841E �.garn wpn�,wrr,y.oam •. • •• - • �1 • PREPARED FOR: PHONE NUMBER: PAGE NUMBER: �j •• �_ of J A. Gorn ss a LARRY HALE 375-2580 1 OF 1 • 0 t /CE— • % LEGAL DESCRIPTION: DRAWN BY: a �, • • PENNINGTON PARK; BLOCK 3, LOT 5 PNB •••��• ••••��,:�j._•�.. ,•I.**(,7• 44.111, TYPE OF WORK: DATE: 40 ESS, 44. SEPTIC TANK UPGRADE (OPTION 1) 7/14/2017 -ir ,` ice 1543Y STANK ONLY �� I �� 100' HELL RADIUS P 3 _I .../...."...."..../... ...C,9— , -. P / S ALE: \/ P. 1' = 40' `� NOTE: THE CONTRACTOR / SHALL HAVE THE WELL .':f_. / RADIUS FLAGGED BY A •.t PENNINGR PARK; BLOCK 3, LOT 4 \ REGISTERED LAND SURVEYOR ,;',•••7:-_::: PRIOR TO CONSTRUCTION. •_:1fir,./.6.4Y;. _: / \ \ \ --: •�: ` NEW 4' PVC SE 2' NE (D3034) ' FROM HOUSE TO T; -K SLOPED AT .- • *v:'.' 1/4' PER FOOT. I U TED WITH 2' P \ \ \j =, BLUEBOARD 4240E, CE TERED OVER '• ' SEWER UNE. CpG�j� \ i INSTALL NEW 1250 GALLON , HOUSE STEP TANK. TANK SHALL PUMP EXISTING SEPTIC TAN BE AT LEAST 5' FROM THE \ ' // ., AND THEN CUT OFF TOP OF BUILDING FOUNDATION AND � TANK AND FILL WITH ANY DECK SUPPORTS. COMPACTED PIT RUN \ ' �I� GRAVEL, SO A5 TO //,fm,, , 1.25' PVC ACCOMMODATE ROUTING THE \ MH SEWER SERVICE UNE OVER THE TOP OF THE OLD TANK. / \ \ CONVERT PRESSURIZED 1.25k PVC UNE . INTO 4' GRAMTY AT DRAINFIELD. \ e. ~ i EXISTING DRAINFIELD ' N \ \ i \� i F` .."---` \ t3fk � \� J PENNINGTON PARK; BLOCK 3, OTB Q \ \ \ ' PENNINGTON PARK; BLOCK 3, LOT 9 1 c...„--- r---- 6.G0.7I 1 _*AVM%lik i el._ • .•�P�..... ...� • Sri GARNESS ENGINEERING GROUP, Ltd s ! I . �� CIVIL 81 ENVIRONMENTAL ENGINEERS 3701 E.10001 ROM.9111E 101 •ANp10RACE AK 116007•M1011E(907)337-6179•FAX(907)339-3246•11091E: myvnoow wYi}ooT /„ ," ;• PREPARED FOR: PHONE NUMBER: PAGE NUMBER: y A; :•mess SI LARRY HALE 375-2580 1 OF 1 • 0 . CE-t795¢ ..... ...`� LEGAL DESCRIPTION: DRAWN BY: ..• f •4111.1 I PENNINGTON PARK; BLOCK 3, LOT 5 PNB 1t • •1 . . b ow .40 TYPE OF WORK: DATE: `,4'MPROFESS lCt\ik .' SEPTIC TANK UPGRADE (OPTION 2) 7/14/2017 Si 14.6-6C8 $+4 713.6—718.3 UNIFORM PLUMBING CODE 713.6 On every lot or premises hereafter connected 715.2 Joining methods and materials shall be as to a public sewer,all plumbing and drainage systems prescribed in this code. or parts thereof on such lot or premises shall be 715.3 Replacement of existing building sewer and connected with such public sewer. building storm sewers using trenchless methodology Exception: Single-family dwellings and build- and materials shall be installed in accordance with ings or structures accessory thereto,existing and IAPMO IS-26. connected to an approved private sewage disposal system prior to the time of connecting the premises to the public sewer shall be 716.0 Markings. permitted, when no hazard, nuisance, or insani- Pipe, brick, block, prefabricated septic tanks, prefab- tary condition is evidenced and written permis- ricated septic tank or seepage pit covers, or other sion has been obtained from the Authority parts or appurtenances incidental to the installation Having Jurisdiction, remain connected to such of building sewers or private sewage disposal properly maintained private sewage disposal systems shall conform to the approval requirements system when there is insufficient grade or fall to of Chapter 3 of this code. permit drainage to the sewer by gravity. 717.0 Size of Building Sewers. 714.0 Damage to Public Sewer or Private Sewage The minimum size of any building sewer shall be Disposal System. determined on the basis of the total number of 714.1 It shall be unlawful for any person to deposit, fixture units drained by such sewer, in accordance by any means whatsoever, into any plumbing with Table 7-8. No building sewer shall be smaller fixture, floor drain, interceptor, sump, receptor, or than the building drain. device which is connected to any drainage system, For alternate methods of sizingbuildingsewers, public sewer, private sewer, septic tank, or cesspool, any ashes; cinders; solids; rags; flammable, see Appendix L. poisonous, or explosive liquids or gases;oils; grease; and any other thing whatsoever that would or could 718.0 Grade, Support, and Protection of Building cause damage to the public sewer, private sewer, or Sewers. private sewage disposal system. 718.1 Building sewers shall be run in practical align- 714.2 No rain, surface, or subsurface water shall be ment and at a uniform slope of not less than one- connected to or discharged into any drainage fourth(1/4)of an inch per foot(20.8 mm/m)toward system, unless first approved by the Authority the point of disposal. Having Jurisdiction. Exception: When approved by the Authority 714.3 No cesspool, septic tank, seepage pit, or drain Having Jurisdiction and where it is impractical, field shall be connected to any public sewer or to any due to the depth of the street sewer or to the building sewer leading to such public sewer. structural features or to the arrangement of any 714.4 The Authority Having Jurisdiction shall review building or structure, to obtain a slope of one- before approval, the installation of a commercial fourth (1/4) of an inch per foot (20.8 mm/m), food waste grinder connecting to a private sewage any such pipe or piping four(4)inches(100 mm) disposal system. through six (6) inches (150 mm) shall be 714.5 An approved-type water-tight sewage or permitted to have a slope of not less than one- wastewater holding tank, the contents of which, due eighth (1/8)inch per foot(10.4 mm/m)and any to their character, must be periodically removed and such piping eight(8)inches (200 mm)and larger disposed of at some approved off-site location, shall shall be permitted to have a slope of not less be installed only when required by the Authority than one-sixteenth(1/16)of an inch per foot(5.2 Having Jurisdiction or the Health Officer to prevent mm/m). anticipated surface or subsurface contamination or 718.2 Building sewer piping shall be laid on a firm pollution, damage to the public sewer, or other bed throughout its entire length, and any such hazardous or nuisance conditions. piping laid in made or filled-in ground shall be laid on a bed of approved materials and shall be properly 715.0 Building Sewer Materials. supported as required by the Authority Having 715.1 The building sewer,beginning two(2)feet(610 Jurisdiction. mm) from any building or structure, shall be of such 718.3 No building sewer or other drainage piping or materials as prescribed in this code. part thereof, which is constructed of materials other 134 On -Site Water and/or Wastewater 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: OSP141383 Tax Code Number: 02018132000 Work Type: SepticTank Upgrade Permit Effective Dates: September 19, 2014 to September 19, 2015 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: PENNINGTON PARK Site Legal Address: PENNINGTON PARK BLK 3 LT 5 G:3437 Owner/Address: HALE LAWRENCE C & JANS S 5620 KALLANDER AVENUE ANCHORAGE AK 995165614 Site Mailing Address: 5620 KALLANDER AVE, Anchorage This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank Lot Size in Sq Ft: 34500 Total Bedrooms: 3 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. Received Issued % MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services 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. 020-181-32 Property owner(s) LARRY Mailing address 5620 KALLANDER AVENUE *ANCHORAGE, AK 99516 Day phone 375-2580 Site address 5620 KALLANDER AVENUE *ANCHORAGE, AK 99516 Legal description (Sub'd, Block & Lot) PENNINGTON PARK; BLOCK 3, LOT 5 Legal description (Township, Section & Range) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (Pall that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Upgrade Z (w/wo ADU) Septic Tank ®Duplex (D) E]Renewal Holding Tank ❑ ElP0rAVC2Lmoq ❑ a CCEPTEMul f2.1 �tipleDwellings (SF and/or D) ElPrivy Private Well ❑ Water Storage ❑ SEP 8 g014 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. GARNESS ENGINEERING GROUP Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: Fi 1 Date of Payment: Receipt Number: 03% 6 Receipt Number: Permit No. OlDPlt-f 13W3 Waiver No. (Rev. 01/11) •ago��°caBB September 3, 2014 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic Tank Replacement (2 Options) at Pennington Park; Block 3, Lot 5 To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The septic tank was installed in 1984 and is approaching the end of its useful life; therefore, the owner would like to have it upgraded. We are proposing to decommission the old septic tank per the Uniform Plumbing Code (UPC). There is minimal elevation drop between the house and drainfield (approximately four (4) inches); therefore, we have prepared two separate options for the contractor. The first option proposes to remove the "boardwalk" from the deck area to allow access for an excavator to decommission the old tank and install a new 1000 gallon septic tank. The second option proposes to install a 1250 gallon STEP tank beyond the "boardwalk" and other decking. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. _., M.S. 3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com T 0 / LY I/ P� 100' WELL RADIUS PENNINCy& PARK; BLOCK 3, LOT 4 \ \ ^• NEW 4" PVC SEW IdNE (D3034) \ FROM HOUSE TO K SLOPED AT 1/8" PER FOOT. SU TED WITH 2" / \ \ BLUEBOARD 4j141DE, C TERED OVER G,p¢p� EWER LINE. NG 3 BEDROdW INSTALL NEW 1000 HOUSE GALLON SEPTIC TAN PUMP EXISTING SEPTIC TAN INSTALL DOUBLE AND THEN CUT OFF TOP OF CLEANOUTS TANK AND FILL WITH COMPACTED PIT RUN GRAVEL, SO AS TO \ \ ACCOMMODATE ROUTING THE SEWER SERVICE LINE OVER THE TOP OF THE OLD TANK. \ \ 4" PVC LINE FROM TANK TO TRENCH WILL BE / ESSENTIALLY FLAT. INSULATE WITH 4" BLUEBOARD \ 4' WIDE, CENTERED OVER SEWER LINE. fO EXISTING DRAINFIELD PENNINGTON PARK; BLOCK 3, J'OT 6 \ 3\ \ > / PENNINGTON PARK; BLOCK 3, LOT 9 100' WELL RADIUS GARNESS ENGINEERING GROUP, Ltd .;°:.... ....................:: CIVIL & ENVIRONMENTAL ENGINEERS — 3701 E. MOOR R0,10, SUNS 101 • MCHORAOE, M W507 • PHONE (007) 337-6119 • FM (907) 338-3216 • KEB911E: xww.9ameeser,gineeM9.com / . . ,• ., ......... ••••• •,•„••.,..,d ff PREPARED FOR: PHONE NUMBER: PAGE NUMBER:ey LARRY HALE 375-2580 1 OF 1 �j�i° ���%• ness= CE-7953 '•. •.•'^\� LEGAL DESCRIPTION: DRAWN BY: PENNINGTON PARK; BLOCK 3, LOT 5 PNB �� O'.91�0��!t•.'�F �� ♦��ip, : 11 TYPE OF WORK: SEPTIC TANK UPGRADE OPTION 1`)'? DATE: 7/30/14 [TAC OfNLYI NOTE: THE CONTRACTOR SHALL HAVE THE WELL RADIUS FLAGGED BY A \REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. \ \ EXISPQG 3 BEDROOM INSTALL NEW 1250 HOUSE GALLON STEP TANK \ ' \ \ \ STI O \ \H 1.25" PVC 100' WELL RADIUS I PENNINGTON PARK; BLOCK 3, LOT 4 NEW 4" PVC SEWINE D3034) FROM HOUSE TO T K SLOPED AT 1/4" PER FOOT. I SU TED WITH 2" BLUEBOARD 4�DE, C TERED OVER SEWER LINE. PUMP EXISTING SEPTIC TANK AND THEN CUT OFF TOP OF TANK AND FILL WITH COMPACTED PIT RUN GRAVEL, SO AS TO ACCOMMODATE ROUTING THE SEWER SERVICE LINE OVER THE TOP OF THE OLD TANK. CONVERT PRESSURIZED 1.25" PVC LINE INTO 4" GRAVITY AT DRAINFlELD. G 2(. EXISTING DRAINFlELD \ \ �e2 PENNINGTON PARK; BLOCK 3, I,.OT 6 \ \ / PENNINGTON PARK; BLOCK 3, LOT 9 G_ARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS .3701 E UDM R , SME 1D1 • MCHOSIOE, M 99901 • NX .. (907) 337-8118 " FM (907) M8-12" • YffB98E: xrrv.9omwxn9lnawin, cwn . ......... ....... IREPARED FOR: PHONE NUMBER: PAGE NUMBER: j Cn •; f ,,• TOeSS 4 LARRY HALE 375-2580 1 OF 1 �j�i'• C —7953 ' .EGAL DESCRIPTION: DRAWN BY: ♦UT �� PENNINGTON PARK; BLOCK 3, LOT 5 PNB ��� �'S18.....YPE OF � r WORK:DATE:oar +,� UPGRADEI(OPTIOM- 21, /30/14 • . SEPTICslakes �•� I i MUNICIPALITY OF ANCHORAGE _ .n 4L 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 G �bn M � A� S�� PHONE (]NEW 3qc7 —�Q�Q �� k UPGRADE MAILING ADDRESS 1'x.0 � F3ok 1 I O I Z8 At�Jc�,v4,a i4k QgSJ) . . LEGAL DESCRIPTION t- 5- 1 y1 14 4-oi Nn. SEG /U I1 N 23� LOCATION /J 5'(020 K�IIehQc•t_ Oft= 6LAdQh,,reVj NO.OF BEDROOMS v Y Well ' t e/ Absorp�on area DISTANCE TO: / Dwell' / �• PERMIT NO.� 9 CA F-Z CL Q W Manufacturer G4o=�2_ Material ( s fee. No. of compartments Liq. capacity�gallons IF HOMEMADE: Inside length Widt h Liquid depth .� JaZ DISTANCE TO: Well Dwelling PERMIT NO. =? la Manufacturer Material Liquid capacity in gallons O w tj DISTANCE TO: Well 1 I t Foundation . Nearest lot line PEWIT NO. a 4 O y%D .wJ LL Z No. of lines Length of each line '� �Z Total length of lines Trench width Distance between lines f- Q ¢ inches 0 I.- Top of tile to finish grade Material ben ath tile rr Total eeffectye a orption area Z inches 305 U3 Length Width Depth PERMIT NO. c7 a H uj Type of crib Crib dia to Crib depth Total effective absorption area Cn DISTANCE TO: Well Building foundation Nearest lot line J W Class Depth Driller Distance to lot line PERMIT NO. Lu DISTANCE TO: Building tion Sewer line Septic tank Absorption area (s) OTHER PIPE MATERIALS cAsT -mzoN) I PVC SOIL TEST RATING S[3 INSTALLER S� 13 enQCl.t'J COKSfMu c t' REMARKS 2 /� 7 OV D ..JAI —1VSf-4( 1.0 01/61L -rXG C,4DD3Ttor.J G C p uE'% 14041.E C-X ANs-. o tJ. -- $ K mvvt=D WIF AND G` . Rd,+Pr4 Ab Lh ru c Q-b LOA *fSTiL I�ci� GSa� �i•3 lu- 4% Z � � N kyr i �usp��p sY1 �.Go�Pcr`) N10 8�f-o�y APPROVED DATE LEGAL o?9;juNLT 5'I 13t 3, Penn-tiy�� A-m ,MUNICIPALITY OF ANCH, .i9GE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 525 L STREET., ANCHORAGE, AK 99501 Y / 264-4(20 '01 I T E E W E Fes' P' E r-1 I T' PERMIT 1•40: --DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: 540461 UPGRADE 06/1:4/84 NORMAN D HANSEN P 0 BOX 110128 ANCHORAGE, AK 99511 34'9-6611 LEGAL DESCRIP: SUBDIVISION: PENNINGTON PARE. LOT: 5 SECTION: 10 T014NSH I P : 11N RANGE::` 314 LOT SIZE: 35000 (SR.FT. OR ACRES) LOT LOCATION f' BLOCK: 3 .ALLENDAP.. OFF SOUTH GOLDLNVIE14 DR I CERTIFY THAT: 1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET` FORTH BY THE -MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. 2. I 14ILL 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 DISTANCE FROM ANY EXISTING WELL, 14ASTEI-IATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. IF A LIFT STATION I5 INSTALLED IN AN AREA COVERED BYMOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE. OBTAINED; (2) AS-BUILTS ldILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3)'THE -ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN." SIGNED - DATE: 114at., -- - J--------------- APPLICANT: NORMAN D HANSEN ISSUED BY DATE: SI-F- --------- ---------- /------ MUNICIPALITY OF ANCHORAGE DepartmentE Health and Environmenta3"0rotection • 825 Street, Anchorage, AK. �_-)501 J. 264-4720 ��'`�✓ Per`mlt # 64(,Q 1 # # # HANDWRITTEN PERMIT # # # WELL AND/OR ON-SITE SEWER PERMIT Applicant: A102.M,4_,V Mailing Address: P o fax 'F 9's Location: /CALL ayr>,¢IP o� Cao Scr�iY��hone Number: 3yt� - G i / Legal Description: L,7-.5- ,, /3k 3 Lot Size: 35, o 00 Type of Soil Absorption System Is: Trench: Drainfield: X _ Maximum Number of Bedrooms: 3 Seepage Bed: Holding Tank: Soil Rating (sq. ft/br) X51 2- 6 The Required Size of the Soil Absorption System Is: T DEPTH `/ 0 LENGTH 17--6y GRAVEL DEPTH �• WIDTH' S. 0 F�rro.n o� 77;06 Z) -O • The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = l �� GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. # # # TWO(2) INSPECTIONS ARE REQUIRED # # Backfilling of any system without final inspection.and approval by this departmei will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee for a private well or 150 to -200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply.' Specifications and construction diagrams are available to insure proper installation. # # # PERMIT EXPIRES DECEMBER 31, 1 9 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will -install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bedrooms. Signed: Applicant Issued by: Date: SWP/024 (1/81) e (J 'f MUNICIPALITY OF ANCHORAGE n j O 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 J) PHONE NEW /� /�ilrtS�/-p��' ❑UPGRADE MAILING ADDRESS V0 3 ,tri k< 7vj-o LEGAL DESCRIPTION /� ,% J_ � /J 3 Q� n i.z /�'h ?b, LOCATION C0 NO. OF BEDROOMS fele.,.. ✓t e -.-J 3 DISTANCE TO: Well Absorption area Dwelling PER 2x 3 F- Z CL Q in h Manufacturer r. c r, Material No. of compartments ! Liq. capacity in gallons dOr IF HOMEMADE: Inside length Width Liquid depth C x Z DISTANCE TO: Well Dwelling PERMIT NO. 0Z< 16 -Manufacturer Material Liquid capacity in gallons w = DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. w Z Zw ~ No. of linesI Length of each line Total length of lines Trench width Distance between lines H Top of tile to finish grade / Material beneath tile inches .�. Total effective absorption area Z inches w Length Width Depth PERMIT NO. r, Q F- CL n w Type of crib Crib diameter Crib depth Total effective absorption area y DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER N� PIPE MATERIALS C -1 P/r.r 4C SOI L TEST RATING INSTALLER ^ �/� s ✓ 7Z v� e� C_ ? 1/ .i REMARKS D d � APPROVED DATE LEGAL % ? f 72-013 (Rev_ 3/7R1 ' ~ �������i � �� �"�� ���� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ^ 825 'L' STREET, ANCHORAGE. -HK' 99501 � 264-4720 ��x x ��� ��° __' '__ ''—���x�—�»� ����� ����� PERMIT NO. ( 810946 ) -7- APPLICANT JIM.HRMSTRONG SRA BOX 3153 344-5743 LOCATION KALLHNDER AVE. LEGAL L5 B]'PENNINGTON PHRK 5/D LOT SIZE 34500 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRBINFIELD MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E>E-:F='-r"= -I- ���13-T-FA -4-!S �����FE I THE LENGTH DIMENSION I5THE LENGTH (IN FEET) OF THE TRENCH ORDRAINFIBLD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). -K--FF?_U=K~4 K4][ '-T' . .][�� ' | � ��' ������ U��B�: E��-�- THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTF �LL''PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET1 -- ' '' �E_ C-4 U I F:;�" F= 1> �a Fz* -r 1 1::-* -Fn N K :Z-: I =- E== :I- El 13 U-21 IM F=f I I_�1*-A:E: PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. ___ -rW#--1 <:2 > I ":E; F="E: 17_� -r- I C3 171 F --"E: ���U I F:;-'-, I=- C- BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN B WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL DR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY 5E14ER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F=` l= F; -:'M I -f- �X [=' I F;-:* a: =-. �a r-- a M E.' a F:;'--" =<-:1_ _- -1��� I CERTIFY THAT 1: I 8M FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS HND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS' - [^'(Se SIGNED: ----------------------- ----���--------------- r�o.4 APPLICANT JIM RRMSTRONG `�� `°`'-��^� �'-^--- ISSUED DATEZ2�4,� �__ /� I � . .::� • r•; t_t r•,r i z_ i 1i=' �=� t� r T'r' t � r=' F � i -i t= t -i � � f-': r=-� �� � `a cleFiiR np r CIF !-i j' -X_ rH r ilb r t,i'� [ s1t 1r } rt [ t�.. 1?rs r o T� .• r r parr �' S•!t =tyt._ ter- L� tit.-----�, r T '1t`i.•1 �. �. I.1 1 ?' j1`i L sjAL L5 a F'c- dAn [T array D LO1' 3 [ T'r'y r = sorL Ref-1.3R,orionTE?f t•t k [ t•7Ut! t AJt•1 R s � G►�ts:s��l�'� - ? SO IL fza r mr, 4 Sit i=rr'S'k > = s:•� '' t?c s:F r;•LE '-;OrL AgsoRprion _;' .5re! .i = v 1 •i L— t"f-! s� 'i,4-! = K.I. �_f i.� ri---. i-3'�r' � t.... 'C • �#� T? -•� --- „� C�, O [1• aiS r an is rH:E �_ s iG rN cin Feer: 1:V r Tt<� tb�N t]2 o;�•a Cr -k= r _-x_n TN s3F A Ma-- 'IH 0:z P[ r 1� Tt-t- G[ rt�vit. r- n•1 � d rim ',US<. -f , ,:t� T +aRL'1L!! 1v M -PE T'# 0,0 r rui! s3:- fw- Vis: iiva r I /aN < r N Fer. r . }' 1:,k1lVe- 1�_PTH Is TW- M rt•! It ISI DEPTH CIF GIRA gat S%7.rl•iEErf rw ou rt:nu- t3ND r. -r=- Ea r r1)N s'� Tt�; ski: H'��t t r i sJN c. [ ti t T= �t.a![� t--c;tri� ,=.fir= -•,T L t� -i moi'-tk. E-z._tI3s3 :3i=iL_!_t-:r•-4 . -PF:T1 [ r sAPPL E CaN r } Fr:; rR7- tt:^•-3PUJts [ N v- i rY rg Er•IFs__V" TH I Cn p iTimet! r Of.tR i t tv I .{ rtr= MLLN r i ON t rr=LcT i oris !•:� r at+Jitt r TO TII t 1 Pnt.6P2ri'y,' NTs(J. T'r)E 1 111Jr1 1:sF >t •=. t car 3 rHa r M: •rs.-�C.-I < VE: Z i•��• ��-T ac i�ir•.t :� := lr - s-�: s3�.a i tr1�Q . tIF MY SYSTel 141 rH':ku r F [ MHL ri SPECT I ON n?.ID tir^PF11N11_ SY .TN i`3 L _f� tR rt Int l r ld ILL ERE ';U9JC-icer TO PRI:t•E, U r I OM t4[tJ[t•RJ14 OL•�Ti3tH:� TkiL`tl H 1.1='t.+_ Nip 114Y 13Tt-S[rE :;s_`t•ly+ ni' Gt7`�1�t_ :''�f�?# I ".� s•s:J . F� r Fs7ir fi FR'I'�ri TF !•}LZt_ 1a;2 i5t+ TG 20eFEET Ff1r3; 9 R P1_G_ 1 �: !•3�'t_t_ U�_,i•�7-t0 L C•Ju 101311 Z'1� TYPE c 13'F r"U I C 1•i'cZt_ tfiNrrn,�Tf 0V5TAW:P- t=RON A PRrYAPE I -RILL TO 13 PRrVrIT�E _, 1.1CY LIM=- [s :rs FIEEr AND TO fl s_.O.111i111J1.1Er4' Ur -PE 11 •'S FEET. t Mt_ t I-t13S ARE rc'cL1�.i l fi n tgt•!D Mi3's r e!e Piz- rupto c) To 7%- t .qR TI•}.q#•i r W I T" r tt ?O •- s;�= � }•1>±Lt_ G`.s31•t,^L� r' igti Or1#EI✓. �:=skU[ ti11;tiTS TIRV , ^SLY. n1.10 C.ou-;n.ucrwa Dmimv-r-; tifs t�b'A i L1�OL:_ TQ [ ii'iJrxE P '*rjP-zR i ►-•3 rN1_t.A r i a; - s=' r !- C�p C t::: f= r -j E* �.• ^.t:=: 3_ [ c�ru�'tr, THar is [ till FMI[1_[AR MUM Tt* i:03UIR<,-7-- TS r►aA 4N-'= ETF _. .X:P•} A 1) 3 F=f: •SE.r }'02 rH .?Y T1 �=- td1J?4i O [ Pt"j_ [ Ty 1:lF Ni H3Hus<t=tt;. 2: 1 MILL [tom rt=11;t_ TW- • et5 Tr i [N FXy. ORDANI:I� M r rH THE t_x De;. [ lar tO�..F"s Tt�,'•)o ft-iAr Tt� 13tt _ ; I Te •=•> :S•>: t' 'S'r"; ral I-IRY h� ,31J [ F• ��' � R�; ?t r [i= ri-#. IS RajuryeUED TO MORE T'H"IN 3 G*�ORXIt• :i. nP I s�a'�t�i r ,r l tf t'1szr�t•� rf14t•Jr - - - - - - - - - -- -- - - � i �-. r��.Q c� 7-�2��- .: L"r' L4A&�Iao---------PN ?! ��� =�?1 �''/� 171[. y f �1 SOILS LOG MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION 825 L. Street, Anchorage, Alaska 99501 264.4720 TEST SOILS LOG - PERCOLATION TEST PERFORMED FOR: iM AIRMSTRONEa DATE PERFORMED:_ 9.1 q �Q LEGAL DESCRIPTION:_ I D 1 S 79L.00A4 3 TEN N 1 NATON 7AVtk do C SLOPE SITE PLAN 1 .. LvA M 2 Mej; V. M4 d -em se 3 • M n • w-t(.Q --c(fACQ rct %1 •til 4: . v 9 S - 6 41 V 7 .• ,.. 8 o • � • � saKdy s.•G1t s;�� . 9- 10- 11 10 11 12 13 14 �' O F t:� ani 15 10 :4 0 :* 16 . ..... . .... 17- 2225-E 'r+- 1 E 25. 1971 a 18- , ONIAL 19 20 -L COMMENTS WAS GROUND WATER S+ S ENCOUNTERED? L Depth to Water O P IF YES, AT WHAT b I E DEPTH? (� QalU© Reading Date Gross Time Net Time Depth to Water Net Drop JPERCOLATION RATE ale•�� l TEST RUN BETWEENFT D '4'n'r t b a PERFORMED BY: 72.008 (6/79) CERTIFIED BY: (minutes/inch) — FT DATE: & , ! q `a WeiI Log For .....�'.. G �l 1J��� 1 i ? I)4- Location.. �..?.....:. ..FSl. V..e- --- ........................................................ l''�� Datecompleted.........0.........►....................................................................................... Depthof well......1�0.................................................................................. Sizeof casing ......... .................................................. ............ :................................. Distance to water........ �. �:. .�......51t` G....�- ...: =.--......................................... Distance to water whileum in ...at rate of.....................s 0 .................. gallons per hour. Formation I from ( to r7' I I I I I I i 1 I I I I I I - I I I I ...........................................joy �......... ................. Driller DELTA DRILLING COMPANY SRA BOX 394 B ANCHORAGE. ALASKA 99507 From ALPINE DRILL 907 345 0202 M 3 i- . 14. 1992 02: 20 Pil POl STATF. OF AYrASM DEPAIZ'14MUT OF NATQRAI, RESOURCE: DIVISIO14 OF GEOLOMCAL At;D GrOPHYSICAL SUM t1MER WK1,I. BOROUGH SUBDIVISION LOT BLOCK SECTION OTRS �!omgs}1Ir' RANGE MERIDIAN Park 5 3 D N E Penin ton �[� s w DIRECTIONS: --- WELL OWITER: F,sllander r ASURxNG POINT: ITE:LL DZPTH : ORTE Of' COMPLETYC top of. casing Depth of ho).e: _?.4$ £t ©ground surface other:_ — ❑ — -^- Depth of caSjr1V:_Z() `ft. �2 • _�_-92 � BOREHOL14 DATA: M&t6r-i01LyP0 and Color Bedrock,_ _ani cavi content. Bedrock Dept- - 1i 52ATIC WATER I VFL; y ?i ft ro:n To I I----- • - _well_.�_.._1 0 _1 142 highly fractured 14.2 .1E) Very hihsilt 130 2� 8 After grilling to a daPth-of 240' it appeared that the area frorr, 140' to 150' began to produce approxiamately METHOD OF DRILLING- ®R air rotary [cable t..) E3otrier: USE OF' WUL; ©c10fue-Sti c [3 S rrictat:cn ❑monitc ❑rublic snpply ❑ other:.. CASING: Sticl:-.:£_2 £t. biarn: 6 WFL!, It.°TA};r': ❑ cpt•h uric} Dscreened [j pt?rforkLed Elopen hole DOPthr. of r..1,F•riin'ts.--� to ...._...ft SCREEN TYPE:.. —_._._.._ ----.— Dim:— i Slot SOL l:estwe<eh GRAVEL PACK Voluno ustc::_—__-_-+--1)eI'�: h to top: - GROUT TYPE•'`------ —Vo l,urne Depth: front rt LU ft DEVELOPMENT METHC)F: ; air hrs htEri.p,Fl}cso - - ----- RECEIVED nUWING LEVEL AND YIELD: ft. after hrs pamring qpm . MAR 2 31992 -- PUMP INTAKE MM: ft Horsepower: Municipality of Anchorage DacO Pump Ynstalled CONTRACTOR INF'OMATION : Dept. Health & Human Servlc e-1 WA'T'ER CRE 141STRY SAM?IX 'TAKEN? ❑ yea ED= Alpine Prilling & Ent. WelI di sir,fected upon comolation? yQs M ac Registered >3usiness Name PLEASE' MAIL W11ITE COPY OF LOG WITHM DAYS 7'O: Signature �of.AkutLtjorized R rase UUve - DGGS 2-15-92 PO BOX 77-P116 nate -_ EAGLF. A.TVEIt, Ah. 99577 �.., - :moi_ i ' j PROCESSING CAN BE INITIAT ( cz t2Aat.L dz:x�2 [ v C 0 /,Df - Time APPLI:INT FILLS OUT UPPER HA�- .ONLY 351 Property`bwneri Time Phone /l tMailing Address sK/ j° D Zip'Code �9 v71 31;,&- Buyer Address 42 'J -)J —5 Zip Code Lending Institution 17� �%�,� Phone// Address f CP /�.�� D Zip Code Date n -3 Realty Co. & Agent :�j2 Phone Address•d % (/ /G��(�c �/ Zip Code Legal Description�� (� C�✓ Jai Street Location�A • X��f.r� Type of�R �tderfe 9"91ngle Family ❑Multiple Family No. of Bedrooms ❑ Other ' WaterSu y ndividual MUNICIPALITY OF ANCHORAGE ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community DEPT. OF HEALTH & For wells drilled prior to that date, give well depth (attach log If available). ❑ Public Utility }, `_--- Sewerosal Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIAT ( cz t2Aat.L dz:x�2 [ v C 0 /,Df - Time Time Time Time Date Date Date n -3 s Date 4 - IL Inspector Inspector Inspector 1 Inspector VJi'QvJ. p a Field Notes: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & <l3� ENVIRONMENTAL PROTECTION `_--- MAK 3 11203 RECEIVED ( 3) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL - DAT —s BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Sized -� Well to Tank ,z-uzi (JI&O Time Time ne T Date Date Date ClLc.l�ciL. a� Inspector i Inspector Inspector Comments Conditional Approval i I Date Sewer Installed p Permit No. Septic Tank Size lava Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS.OUT LOWER HALF.,ONLY Property Owner Phone Mailing Address Buyer Address Lending Institution -t r Phone Address Realty Co. &Agent Phone r %vim oS� Address Legal Description L r ,5 civ N I Street Location Type ofdence LT—SE]'n'g1l Family 3 ❑ Multiple Family No. of Bedrooms ❑ Other Wate�,yp ply [Individual I ATTACH WELL LOG. A well log Is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to ;that date, give well depth (attach log if ❑ Public Utility available.) I: ; Sew at /'50-individual5-7 Year Individual Installed: ❑ Public Utility When Connected to Public Uti ity: ❑ Holding Tank '- NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. '6'r Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I D. 020-181-32 1. GENERAL INFORMATION Complete legal description PEN Location (site address) Current Property owner(s) Mailing address Real Estate Agent Expiration Date: %k V i6 5620 KALLANDER .B�, ANCHORAGE, AK, 99516 MELODY GROVER Day phone 5620 KALLANDER DRIVE, ANCHORAGE, AK, 99516 LISA HERRINGTON W/ HERRINGTON & CO. Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 522-0331 229-6822 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Date of Payment .Jg. o jly Individual On-site Receipt Number 066 `�C�-E'�) _ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for n/❑ Distance:= Received by: ✓�� Date: ^T' COSA to be released to the engineer, unless otherwise requested by the engineer. CD COSA Fee $ 567ip' Waiver Fee $ _ Date of Payment .Jg. o jly Date of Payment Receipt Number 066 `�C�-E'�) _ Receipt Number. COSA# O150C/1l73 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. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, US. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines S Regulations. The reported results described 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 sails condition, groundwater 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that them are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person orparty is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for 3 System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms. Phone 337-6179 Date 9/1-A � OF bedrooms, with the following stipulations: 'CE 79 3 Y Professioo°< OF tAIV6�(4ir, J2 ON-SITE WATER AND WASTEWATER By. (il/ . �d� Original Certificate Date: Theunici lity orA orage Develop, emit Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: l COSA Checklist a Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other m,v r1mai 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: PENNINGTON PARK S/D; BLOCK 3, LOT 5 Parcel ID: 020-181-32 A. WELL DATA *WELL DEEPENED. **CASED TO BEDROCK. Well type PRIVATE If A, B, or C provide PWSID# N/A 10/15/1981 Date completed *2/15/1992 Sanitary seal (Y/N) YES Total depth 248 ft. Cased to 19 ft. FROM WELL LOG Date of test 2/15/1992 Static water level 8 ft. Well production 30 —9-P M. WATER SAMPLE RESULTS Coliform 0 colonies/100 ml. Arsenic: ND ug./L. Nitrate ND mg./L. Date of sample: 4/28/14 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 2/10/2014 4.18+ g.p.m. Collected by: GEG, Ltd. B. SEPTIC/HOLDING TANK DATA *TANK MOVED ON 6/29/1984 Tank Type/Material SEPTIC/STEEL Date installed 11/12/81 & *6/29/84 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 5/14/2013 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed _6/29/1984 Soil rating (g.p.d./ft'or /bdrm 85 Length 54 ft. Width 5 ft. System type 5 WIDE TRENCH Gravel below pipe 1 ft. Total depth *4.3 ft. Eff. absorption area 305 ft' Monitoring tube YES Depression over field NO Date of adequacy test 2/10/2014 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test**DRYin. Water added 620 gal. New deptA*DRY in Elapsed Time: = min. Final fluid depth**DRYin. Absorption rate >= 450+ g_p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — **MT ONLY EXTENDS 10" INTO 12" EFFECTIVE DEPTH. D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump off level at wa r alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankniR station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank Animal containment areas 50'+ Manurelanimal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water **100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *10' Building foundation 10'+ Water main N/A Water service line 10'+ Surface water ** 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *PER SURVEY. CO APPEARS TO BE ON EASEMENT LINE. C/O IS NOT PRESENT AT THIS TIME. OK PER JEFF POET ON 2/12/14. G. ENGINEER'S CERTIFICATION certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date (Rev. 11105) Municipality of Anchorage 4m, Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING T! Parcel I.D. 020-181-32 HAA#y ` 1. GENERAL INFORMATION Expiration Date: '- — 0 Complete legal description PENNINGTON PARK SUBDIVISION; LOT 5, BLOCK 3 Location (site address or directions) . 5620 KALLANDER AVENUE * ANCHORAGE, AK * 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MERLE HILL Day phone 345-7517 5620 KALLANDER AVENUE * ANCHORAGE, AK * 99516 Day phone TAMMY GILLS W/ PRUDENTIAL JACK WHITE Day phone 563-5500 Community Class Well ❑ 3201 C STREET, SUITE 200 * ANCHORAGE, AK * 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well N Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site N Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval. (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 samples. (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 Health Authority 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 Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE L� Approved for :3 bedrooms. Disapproved. Phone 337-6179 Date 3 0 r• e A. Gar ess.� —7953 'or • *P** ' (O��Prof esslo��' Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory ON-SITE •: o WATERANU • EWATER PROGIUN 1 Manitenance Agreements JJJ�i� ••'' • •'•+ ��`�� Supplemental Engineer's Reort JJfJ��J11�5��►i>>����` Other By: 000'Original Certificate Date: o 0 4 (Rev. 12/01) Municipality of Anchorage ........ i; Development Services Department T.1-= Building Safety Division 5 , , X T: j On-Site Water & Wastewater Program "4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 . jwww.ci.anchorage.ak.us (907) 343-7904 ' r II HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: PENNINGTON PARKSUBDIVISION; LOT 5, BLOCK 3 Parcel ID: 020-181-32 ' A.. WELL DATA *WELL: DEEPENED. I ype ' MATE If A, B; or C provide PWSID# N A Well Log (Y/N) " YES Well t *2/15/1992 & Date'completed 10/15/1981 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES _Total depth 248 ft. Cased to 19 ft. Casing height (above ground) 24+ in. FROM WELL LOG AT INSPECTION Date of test 2/15/19921 4/20/2004 Static Water level 80 ft.. 13 ! f ' Well production 30 g.p.m 7.5+ g.p.m. f WATER SAMPLE RESULTS: ' Coliform ! ! 0 colonies/100 mL Nitrate. 0.1 mg./L. Other bacteria 0 colonies/100 ml. Arsenic:' (hN A mg./L. Date of sample: 4/21/2004 Collected by: GEG, Ltd. B. SEPTIC/HOLDING TANK DATA '**TANK MOVED 4'W & " 6'S **6/29/1984 & Tank Type /Material STEEL/SEPTIC Date installed 11/12/1981 Tarik siz 11000 gal. Number of Compartments 2 Cleanouts� (Y/N) YES Foundation cleanout (Y/N) pression over i YES De tank (Y/N) NO High water alarm (YIN) N/A 4/20/04 Pumper McDONALDS Date of pumping p C. ABSORPTION FIELD DATA **BELow ExisnNG GRADE Date installed 6/29/84 Soil rating (g.p.d./ft26r/bdrm 85 System type 5—WIDE TRENCH f Length w _ 54 ft. Width 5 ft. Grav el below pipe 1 ft. Total depth ***3.9 ft' Eff. absorption area 305 ft2 Monitoring tube YES :Depression over field NO Date of adequacy test 4/20/2004 Results (Pass/Fail) PASS For 3 bedrooms ` Fluid depth in absorption field before test 5 in. Water added 493 gal. New depth 7 in. EI I sed Time: 988 min. Final fluid depth 5 in. ; ,Absorption rate >= 450+ g.p.d. NONE KNOWN If es, give date Any rejuvenation treatment (past 12 mo.) (YIN & type) Y 6 � r L D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons Ma High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM 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 N/A Public sewer manhole/cleanout N/A Sewer /septic service line -+ Holding tank _ N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: _ .. . Property line 10'+ Building foundation 10'+ Water main_ N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain . NONE KNOWN Wells on adjacent lots 100'+ F. -COMMENTS G. ENGINEERS CERTIFICATION a o 1 certify that I have determined through field inspections and q�I review of Municipal records that the above systems are in """"" """ """"' conformance with MOA HAA guidelines in effect on this date. .. eff y Gar ss•.... Engineer's Printed a e JEFFREY A. GARNESS Da49�s C 3 ce tn�do Date 4u4O�taiPro fag HAA Fee $ - a) Waiver Fee $' Date of Payment 3 V Date of Payment Receipt Number os-aoL o 'r Receipt Number (Rev. 12/01) ■m Apr 29 04 05:05p Tammy Gills ■0 Har 2G 04 07:06p Tammy Gills ■ ■ 345-2411 p•1 X45-eti� r•1 �j poo \ •V -k o' Lam- „ •C+� .i �' VgZKJ G hoF 41_ ' S BU I OF 4L �:• It is, the responsibility of the cwncr to- etcm1ne ,( J the existence of any eacementi. COVenatitS.•dr re- ti• `stri cti ens; vrht ch do .not appear on the recgrded sub- - , r. divis'ion plat., Under no ei,Tcunstances should any OTE \��,��.�+ date -hereon be used for construction or for estab- or REt_DAD,omeCfe ntAN'R•t= i 19shir:gf6ounder�! or fence lines. The surveyor takes S11AWY GrrTNEnsCooat_O of�+r. ,.ar NOY ►• "` ti initis ansaction cnl SHOWN RIMIEom. cbi bili ty for the 1 tr Y• . ,•BLVCR 1 b.AO rM" A nw-CAly o 1R(m rit r Sr icaT Iq-��Z� ' t[�ur �so� coA.�O AIVICHICYRAGG R ECO RD ING , DISTRICT rr ate. A TASK , rwrca far. DOWUNU & ASSYJClATES 142G HYDC.R SXRCCT ANCHORAGE ALASKA 99501 , w aarE3-Y '�C-' sutfr��� woWcor.��: recdmore: �RfD 1,� 3 RaceIv.d 02-11-200A 10:27am ;roe -907 EN 2922 To-ATGA TITLE DEPT. Pad. 002 MUNICIPALITY. OF ANCHORAGE. -;;.-7=-----7-z- 0 77 DEPARTMENT OF HEALTH;&'HUMAN'SERVICES-:,:--:-- Division:of Environmental Services, 'S -Anchorage, teServices Section -77 '47% - 7 1' 7- P.O.Box 196650 -Anchora e*XI'a's*k'a 99519-6650 77= ..,7,.CERTIFICATE OF HEALTHAUTHORITY APPROVAL FOR A -SINGLE FAMILY -DWELLING 777' Parcel-I.D.- HAA i GENERAL INFORMATION AAA&- 0 J. -Complete legal descriptio'n4S B 6, -v . .... ... A ArR ay phone`7 P rojo ehy. oW ne . al ng address, 14 Lending agency' , Day, phone 2— :* T2Mallin§-addresSZ; nAnt- ��y- Phone 4 --;Unless!otherwise-re7dested.HAA Will bc7 !2A;"INUMBER .OF_BEDROOMS Jr, f -_7 3. TYPE OF WATER SUPPLY: m o-'= _� Cn Individual well 7 r rrl ........ -Community well G: Public water."- F -NOTE: —it communitywell system,-provic e written confirmation from State ADEC attest E., -;7-mt,- ung o the nd status of systern.--- t 06-dalitya I.V AN .�4� ;TYPE OF WASTEWATER DISPOSAL: _7 at: M�i Z1,7=', . LtF U bilasewe ......... \ZEC NOTE :;�;16community wastewateron rma on. m t A attesting to the legality and status of system. :;- 72-=(Rev.1/91) Front MOA 021 5. STATEMENT�._QE INSPECTION BY ENGINEER ,, :77 - As certified by my affixed hereto as of the validat add i6n date shown Delow, I verify that my itewAt6r supply'.".. app- shows the investijatidriBf this Hdc�lth-AUtti6-n*ty'App—F6ia-l'-" lidatioh s .&H. s and/or wastewater disposal system' is safe, functional land adequate for,the number of bedrooms and type of structure er rify that based on the information obtained from re indicated herein., I fu:fth' v6i the Municipali�yofAnchora e.files and from my investigation and inspection, the on-site water 9 supply and/orWastewater-disposal system is.in compliance with all.Municipal and State codes, ordinances, and regulations in effect on the date of this inspection... 0 -Phone iJ A -1-i 6 F— q Ll ,*Name of Firm U4. -..": -Address .orm�k-�',po-l-���l*, Engineer`s signature Date f _: % r-, L %J'M see& 0 06i4aso WJ 7-7 7g:7 -0 1DHH5 SIGNATURE t _t pp�o yqp 6�����edrooms'---4= m -,W �77 7n 7 -.Additional Comments _R X, _47 F 7 1 -A. reipoKsili(6 for errors lbromissions in the professional engineer's work. 72-02$ (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lors 's l�CGL 3 Parcel I.D. -PxLg, A. Well Data Well type ?)ZI /ATC' If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) T Date completed IDM I..' � q&* Driller AL�ioi,%ia Total depth. Z S Cased to J �%� Casing height Z • Sanitary seal (Y/N) Y Wires properly protected (Y/N) y LJ CLA_ ���� FROM WELL LOG AT INSPECTION Date of test � Static water levelrn Well flow UN tki nJ g.p.m. 0 'g•prn4n o Pump levels UJ lwow- ry 1 Un1ILO Oicl,J cn rn ° .. co <_ z n n SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot NO ; On adjacent lots �/� � R t Absorption field on lot /�o i f ; On adjacent lots >10 0 _ z Public sewer main Al L4 Public sewer manhole/cleanout - `X14 Sewer service line >/00 r Petroleum tank A10 J'J 6 WATER SAMPLE -RESULTS: Coliform Nitrate • 1 l7 "^�f Other bacteria Date of sample:sf / 19 S Collected by: A • 1/4" LA B. SEPTIC/HOLDING TANK DATA Date installed 196 Tank size /OC> 6A -L. Compartments Tuw O Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) N)) Alarm tested (Y/N) NIA Date of pumping �lS 11 S Pumper 90HE SE!?yrCe5 �. , SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot NO On adjacent lots Foundation To property line i/D Absorption field 15 Water main/service line Surface water/drainage O At 72-026 (3193)' Front /gl CONTINUED ON BACK PAGE C. LIFT STATION t Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) High water alarm level "Pump on" level at "Pump off" Level at Cycles tested Meets MOA electrical codes (YM) . r . _ SEPARATION DISTANCE FROM LIFT.STATION;TO: Well on lot" On adjacent lofs Surface water D. ABSORPTION FIELD DATA Date installed'IgfSI l�1fi`F U 64#0 Soilrating(GPD/Ft2) $Sr%Z (3DRfv1 Systemtype WroG I A.10JC*4 Length S�- Width S Gravel thickness Total depth rp ) p (Y/N Depression over field (YM) Total absorption area 3os �r-.z-- Cleanout resent Date of adequacy test3 a� Results (pas ) Y t - s/fail _ -- �A-SS • - - for �H� Bedrooms Water level in absorption field before test 3 /Z - After test Peroxide treatment (past 12 months) (Y/N) �'`1 If yes,, give date �A ' SEPARATION DISTANCE FROM ABSORPTION FIELD TO: - - Well on lot r %t'o 1 On adjacent lots ?/00 Property line To building foundation To existing or abandoned system on lot 40, 445 r On adjacent lots ?/0 0 Cutbank A10 rJ C- Water main/service line T SO Surface water i Onf C Driveway, parking/vehicle storage area . • •. , is , . Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines irteffecf ort The -date of this inspection. Y- �'G o ---,.:_ .__ �'G ,`r 1 ,"�„ •; . p c c R re oca .-��cn,o o eo a (� Signature'n�£,..... ,, A .. _`.&;o:.�,'X'•-moi, `. Kr, Engineers Name !vf lc�t-I QrJ 6 e12SQ . /dichael ..• C� •.� A351 E n,•V Date X - HAA Fee $ " Date of Payment Receipt Number 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number u ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES w} 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. # (__)-QC) — tS1 - 3Q HAA # 0,0 t 9�12ZP 1. GENERAL INFORMATION Complete legal description Lot 5; B.Lock 3; Pennington Pa&k Subdivizion; Location (site address or directions) 5620 KaP.eanden Property owner Norman (Dean) 9 ChenyZ Hansen Day phone 261-9247 Mailing address 5620 Ka tanden Anchorage, A.easka Lending agency Day phone Mailing address Agent Dave WiAth RE/MAX PROPERTIES Day phone 257-0108 on ova StAeet Address Suite 0 100 Anchorage, A.easka 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing_ ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX 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 M21 5. STATEMENT OF INSPECTION BY ENGINEER ::,; ;,- ;! • , As certified by'my seal affixed hereto and as of the�validation 8ate'shovn' 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 ystem is in compliancevv ith all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. ';, Name of Firm' S & S EN ►WEER ri Phone 17034 Eagle River Loop Road No. 204 Address 9. e Engineer's'signature Date'Z- 6. DHHS SIGNATURE-- -. Approved for (• bedrooms Conditional approval for '' '' '' bedrooms, with the following stipulations: Additional Comments BY Date 0 11717 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 orderto 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 oromissions in the professional engineer's work. 72-025 (Rev.1/91) Back MAIM i /010 Municipality of Anchorage 0 Department of.He6lth,&"H'uman Services. ui* HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LT R LK_ Parcel LD. A. WELL DATA Well type �R�IUNTE If A, 13, or C, attach ADEC letter.. ADECwater umber Log present (SYN) YES, Date com —,:Driller ?Jeted____. -)4tp/,rvF- .1?/z,uv& Total depth ay R Cased to X)�a 9'F_DN3cjr_l q Casing height Sanitary seal 9N) yE5 Wires properly protected 61N) FROM WELL LOG AT INSPECTION Date of test 11-9 2 Z Static water level -n7D Z 'M ri I Well flow g.p.m. A— 9prrr— M 0.. Pump level U Y, M > Z r%D1 CAM 2 SEPARATION DISTANCES FROM WELL TO:.. •_/Lio' Septic/holding tank on lot On adjacent lots Absorption field on lot I SO '+ J On adjacent lots /66 Public sewer main IA- Public sewer manhole/cleanout -Sewer service line Petroleum tank /V E_ klbIAJ" WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: �-DQ-9A Collected by: SEPTIC/HGLMG TANK DATA Date installed L4 Tank size Compartments Cleanouts YES '2- -Foundation cleanout (fir N) yEg Depressiorf (Y/O High water. alarm (Y/O NA Alarm tested (Y/10 Date of pumping. i Pumper A� Awp- Ekfiblcex SEPARATION DISTANCES FROM SEPTIC/HK TO: Well(s) on lot On adjacent lots Foundation— To property line 10 .4- ' Absorptionfield 15 Wa_term'a'Wserv1c'e line (16'4- Surface water/drainage 100 '4- 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE IFT STATION Date ins +� .;'` ! • 'Manufacturer= Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump "level at `' ' "Pump off" level at High water alarm level Cycles tested Meets MOA electrical codes .(Y/N) { SEPARATION DISTANCE FROM LIFT STATION TO: -Well on lot - -:,On adjacent lots' D. ABSORPTION FIELD DATA 1 - - -Surface wat Date installed G-`��-g`"(' Soil rating S /80 - System type �REt�Gt� Length 5y Width 60 Gravel thickness is Total depth y Total absorption area ?>05 S t= Cleanouts present (DN) Depression over field (Y/6)Ny Date of adequacy test Results (pass/fail) �f}S S for bedrooms Peroxide treatment (past 12 months) (Y, J� ► ` OT Afyes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ''ISO - On adjacent lots loo i4- Property line /O r'/ SEE INtP. REPOR-7 To building foundation (� + To existing or abandoned system on lot ASA On adjacent lots too , Cutbank I UO '-t- Water main/service line 50 J_ Surface water (/�� 1 �- Driveway, parking/vehicle storage area _Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date'of this inspection. . S &'S ENGINEERING .-Q°•°_°Mwee''•�e�e��'_ Signature 17034 Eagle River Loop Road No. 204 Eag!e River, Alaska 99577 Engineer's,Name. Date � r Cis O ;• 1tiU. 04 147 �C�Fa ••••erne°go* AV too �`V ... - ( HAA Fee $ � `� •! :iI ♦ '•. 41X4 4,iy ! Wai:;:ver Fee: $ ,.. .- .: • .., .. �3 —� Z" Date of Payment y Date of Payment ! �-4 S Receipt Number . Receipt Number 72-026 (Rev. 3/91) Back MOA 21