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HomeMy WebLinkAboutFISCHER BLK 1 LT 3B5Fi h r Block Lot #015-292 -21 Municipality of AnchoraVe ° 1 -17 1 1 : I)d 04OL—L—of 3 DEPARTMENT OF HEALTH AND HUMAN § F*M i 1 : od RCVD ENVIRO" MENTAL SERVICES DIVISION P.O. Box 196650 • Anchcrage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: j lair 4 .3(y�' PID Number: Namev r>Yj M A2 Wastewater System: F' New L'upgrade Address. FS to i S R.—E ABSORPTION FIELD Phone: No of Be�nrns ,. Deep Trench ..; Shallow Trench C Bed ❑Mound C1 Other LEGAL DESCRIPTION Snil Rating /� O Total Depth from o0i1al grade: GPD/5 Ft. Lot: Block. bdlv,4n Depth to pipe bottom from original gra Gravel depth beneath pipe {{L�1� 1 F1. Ft. Township: Range section. Fill added above original grade'. Gravel length: -37 FI. ..5 Ft. WELL ❑New ❑ Upgrade Gravel width: 3 — Ll Number of lines: f Distance between lines FI. FI. Classification (Private, A.B,C)'. Total Depth: Cased To. Total absorption r a Pipe malerml: -j F, Ft. D SO Ft. p O Ll F S t Driller: Dale Drilled. Sul Water Levi Installer CAVIL: Dale installed/� – �� Ft 7 Yield: Pump Set at Casing Height Above Ground TANK GPM FI Ft SEPARATION DISTANCES epnc Holding ❑S.T.E.P. To septic Absorption Lift MeldingublicrPnvate Man faclurrer Capacity in gallopn From Tank Field Station Tent Sewer Lines \ ) NG T It` as Well It 1 ' Material: STF-tEL_ Number of Com anmenls: Surface '— LIFT STATION Water U Lot _ t size in gallons. Manufacturer: Line 15 3 Foundation : "Purnp on" levet at "Pump oil" level at. High water alarm at: Curtain ^ Pump Make A Model Electrical Inspections performed by. Drain Remarks: BENCH MARK Locahon and Description Cid f ° Elevation: D� — S--Assumed Ff ENGtNEER'S SEAL ,,,�/ Inspections performed by: S Dates: 1st 2nd " qr "--� Department of Hea h and Services approval 4� Reviewed and approved bye' Date:%__ 72-013 )Rev. 9/91) MOA 25 / Well / 96-01-17 11:04 RCVD —� — — — — — — — ♦ — — — Il — — — — — — — Well W 1 ♦ 1 I3,65 3B6 1 i B.N. OLD TANK BURRED Jp ♦ ♦ f5 RESAR x ? �xx O � LOC CRIB ••�C CF 4���1 x " LOG CRIB ♦ ^'s TOB • N S77KKLANL •' � ♦j f'•,� No, CE -2225 1 �" T • .......... :•• FESS 15 0 15 30 45 60 75 90 SCALE I' = 30' ITOBBEN SPURKLAND P.E. I I LOT 3B-5 BLOCK I FISCHER SID I I SEPTIC SYSTEM AS BUILT I 203 IN 15TH. AVENUE DATE: NOV. 16, 1995 ANCH. AK. 99501 DEBRA JO ANDERSON (."% ........ 5101 SPRUCE CREEK CIR. SHEET: 213 GRID: 2537 RUN VALVE Amoco 6 ft of SeE 96-01-17 11:04 RCVD NfY 1000 CAL SEPTIC TANK TOTAL DEPTH 10 ET £ff£CTIVf ROCK DEPTH TOTAL LENGTH EXIST, L06 CRIB LEAVE IN PLACE Cieanouts 6 -ns. IVU 3l,HLL BENCH MARK. CUNCRETE SLAB ASSUMED ELEV 100.00 IILIBBEN JYUKKLANIJ Y.L. I I LOT 3B5, LOT 1 FISCHER 91 -DI I SEPTIC SYSTEM AS BUILT I 203 wrath Ave MARK CAUDY DATE. NUV. 26, 1995 Anchorage Ak 99501 5101 SPRUCE CREEK CIR. SHEET 313 GRID 2,537 PAGE 1 OF 1 ' MUNICIPALITY OF ANCHORAGE nc7� DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 �ULSi� ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT 1-5317 PERMIT NUMBER:SW950366 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:CAUDY MARK E & OWNER ADDRESS:5101 SPRUCE CREEK CIR ANCHORAGE, ALASKA 99516 PARCEL ID:01529221 LEGAL DESCRIPTION: FISCHER BLK 1 LT 3B5 LOT SIZE: 11742 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED:10/30/95 EXPIRATION DATE:10/30/96 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 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. y]or" I =2.i01Mftato) Im:C RECEIVED B ISSUED BY: DATE: I 1/'1IQ's— DATE: /o —,?/ � T.SPURKILANDRIE. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907)279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT311-5 BLOCK 1 FISCHER MARK CAUDY No Ground Water or Impervious Layer to 16 ft. Use Standard Trench Soil Rating. < 1 min/in = 1.2gsfd from 2 to 7 feet 12 min/in. = 0.8 gsfd from 7 to 16 feet Use average of the two= 1 gal per sq.ft/day No. of Bedrooms 3 Required Area per Bedroom: 150/1 = 150 sq.ft.. Total area required: = 450 sq. ft. Testhole Total Depth 16 ft Less 6 feet 10 Use 6 feet of rock Lengthof Trench 450 / 12 = 37.5 ft SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 37.5 ft TOTAL WIDTH 2 TOTAL DEPTH 10 ROCK DEPTH 6 COVER 4 SEPTIC TANK 1000 gal. Check integrity of existing tank, replace if necessary The existing tank is less than 100 feet from the well on Lot 3136. The proposed drainfield will be less than 100 feet from this well. A waiver is required for both a new tank, if the existing tank must be replaced, and the proposed drainfield. Tank waiver to 80 feet, drainfield waiver to 90 feet. The installation of this septic system will not prevent wells from be 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. pg.I (ENGINEER'S SEAL) e Municipality of Anchorage `� DEPARTMENT OF HEALTH 8, HUMAN SERVICES • 825 "L" Street, Anchorage, Alaska 99502-0650 11 ,, , r SOILS � LOG — PERCOLATION TEST (�1e PERFORMED FOR: 1 tom` `—Uf DATE PERFORMED: LEGAL DESCRIPTION: LCIV 3 Bb BV- i Township, Range, Section: Ft &c-4 G IL SLOPE SITE PLAN 1:17H M 'r V�23U2OL N - 81VIII'll stAA,01aSL - 9 1 1SVlllll "^, o�12 -. cit P3 13 < r L 15 16 1vo-ro wt o F FkULt. ,7 s192018- 19- 20 COMMENTS IF YES, AT WHAT DEPTH? Depth to Water Aller Monitoring? _ Dale: ■■■■■■■■■■ ■■■■■■■■■■ ■■■■■■■■■■ Reading -m o Depth to Water 2 FILI F P So < i a 7 — O DIV qe 0 } 10,01 5- a7' 6 s l ;, 126 viz 7 .,. `16 81VIII'll stAA,01aSL - 9 1 1SVlllll "^, o�12 -. cit P3 13 < r L 15 16 1vo-ro wt o F FkULt. ,7 s192018- 19- 20 COMMENTS IF YES, AT WHAT DEPTH? Depth to Water Aller Monitoring? _ Dale: ■■■■■■■■■■ ■■■■■■■■■■ ■■■■■■■■■■ Reading Date Gross Net Time Time Depth to Water Net Drop FILI F P So < i a 7 — O i;7 0 } 10,01 3 a7' I '3-o7' `16 .ole 3 , _ _07 e PERCOLATION RATE (minutesiinch) PERG HOLE DIAMETER p r TEST RUN BETWEEN FT AND 2/7- FT PERFORMED BY: aEJ 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4?a5) Ft LUT 4B-2 LOT 4B-1 I I I II I I 3 34 341 I —-- o — — — —— ------ Fell — Welt — --4- ell ¢0 3B5 \ 3B6 3B7 I Well LOT 4CP "9 LOT 4C1 1384 I � III SPRUCE CREEK CIR. o I I � Well I I� C I III 3B3 i 3B2 I 3B1 -- —- —- —¢well —Wel OF t r49th.� a.....' .............................' ...; TOBB SPURKLAND 9. No. CE -2225 •'��� FESS �� �•' 50 0 50 100 150 200 250 300 SCALE- 1' = 100 FT, ITOBBEN SPURKLAND P.E. I I LOT 3B-5 BLOCK 1 FISCHER SS/D I I SEPTIC SYSTEM DESIGN I 203 W 15TH. AVENUE ANCH. AK. 99501 DEBRA JO ANDERSON DATE: OCT. 15, 1995 tQn]N 77n_zoic 5101 SPRUCE CREEK CIR. SHEET: 1/3 GRID: 2537 4'• �. 17FFSS 1ON�i++ 1 15 0 15 30 SCALE 1' = 30' PROPOSED TRENCR' EXIST, LOG CRIB LEAVE IN PLACE TOBBEN SPURKLAND P.E. I LOT 3B-5 BLOCK 1 FISCHER Sj i I SEPTIC SYSTEM DESIGN I 203 W 15TH. AVENUE DATE: OCT: 15, 1995 ANCH. AK. 99501 DEBRA JO ANDERSON f.n,N „ _.a.� 51DI SPROrr rRrrK OR. SHEET: 2/3 GRID: 2537 EXIST. 1000 GAL TANK REPLACE IF REQUIRED Amoco 4 6 Ft of Septic Rock L PROPOSED TRENCH TOW DEPTH 10 FT fFFfCT1Vf ROCK DEPTH 6 FT TOTAL LENGTH 37.5 FT EXIST, L06 CRIB CAVE IN PLACE Cleanouts Topsoil �— 4' Cover NO SCALE Monitor PF 49'+ .i ......0 ......................... IBEY SPURKLAN: j No. CE -2225 • • Ph'OFESS� �J� - Exist. Ground 4' Min Cover over k Exis tmq 1000 gal. septic tank BENCH MARK, TOP OF FOUNDATION ASSUMED ELEV. 100.00 ITOBBEN SPURKLAND P.E. I I LOT 385, LOT 1 FISCHER SID I I SEPTIC SYSTEM DESIGN I 203 W15thAve Anchorageorage Ak 9MARK CAUDY DATE: OCT. 15, 1995 Anchorage5101 SPRUCE CREEK CIR. SHEET: 313 GRID: 2537 •�� .� hu*ipahty of AncArage Department of Health and Human. Services 825 "L" Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor 343-4744 October 30, 1995 Tobben Spurkland, P.E. 203 West 15th Avenue #203 Anchorage, Alaska 99501 dht'LS Subject: Waiver Request for Lot 3B5 Blcok 1 Fischer Subdivision Waiver Request #WR950058, PID #015-292-21, Sw950366 Dear Mr. Spurkland Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are a private well to the septic tank of 80 feet and a private well to a leachfield of 90 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, �%�;. 7 � Daniel J. Roth Civil Engineer On-site Services DJR/ljm S •MUNICIPALITY OF ANCHORAGE. Depar ent of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR950058 PID# 015-292-21 HA# Permit #�1Llt Date Received: October 19, 1995 Legal Description: Lot 3B5 Block 1 Fischer Subdivision Engineer: Tobben Spurkland, P.E. 203 West 15th Avenue #203, Anchorage, Alaska 99501 Applicant: Mark Caudy Waiver Requested: Private well to septic tank of 80 feet; private well to leachfield of 90 feet. Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: S&�eE A-jrAr&gCz-1 Date: By: Name of Reviewer Rec #: #01409/3677 Amount: $ 920.00 Date Paid: 10-19-95 r1 LJ • CJ AIVER REQuFST FoR L OT yeD — BLit / F15clycR SuOO. wAlVER RFOuESr N4meFe kIR73-00-i-g pfitVER Rma,%r coe PRiv, 7-E WELL ov LOT 3B6 TU ��ol�OSEn l r9r s YSrEM oti 4Or 3Bs FlfcHER Su B. 5EIPric Vgr4 - TK£ PROPasEp t.. 95rE wRTER SYsrEl" /s y DEEP rIt E.bCid /D ',0EEP W/rff 6 ' 5Fc..eR ROC/( W/(/CH ri<f BO%tO.H 3 FEer WILL 6,- (NTD ASH/HL M•arERiat rke,4r Pep?cj. ,FT /2 Ftvo THE u,-.wEP 3 FFFr I. IL.L ROSORB IwM R S1" 161w TK,47- PERCS, L ESS TKRA/ S ♦+/a,.v, rkE Sbv/mL A.vRTE2/A4 Ea TEivi2J To A PE'prrY of /G FEET AK/cN tk"L.19 5EOr/c T�44✓4, EFPLaF. r EFF/G/EwTL I' o?"IeR Y /aR Toi IQEH-Cw1v6 *A,i 10orc"7-1Ac pGrf}et 4` 1 prER, r/�E PRoPosfP w19sTELq DISPOSRL S Ys rEH IS P0-A�S40PE FRO- rFcE w f e c Qu esr/o,.. o,v * .4- � %kk5 EL -/n a A/,griv6 ry(6 PoTENrigL F0/2 CO. rAmIA,*rlot/ Bi ar9y OF GRouuO SURFACE, WELL D/}TA" TkE WELL (N 7140STIOAI /S 267 FEET PEEP. vyncER acts L 9YERS of 'SILTY 6At&V'SL qNP K14A?OPgAv ' OCCuif 0E7w£e1v THE 6ROu.VO SuRrvCE 4-49 rKE (Alkire✓! 6ffRy.& Ri�u/Fnq Ar 26.E (,NELCJ /N Tile Su gpacvfJ/avG V2 R RIi E9 1uoJGJ4rE T/dpi RLL T/dE 4 -ELLS I7R /4 +- Rae+ rL(€ SANF .94t •'irER RT ti 2 7L-� / 9NO CONFIN/,v( Ls1YERr ARE ALL T,L(E SiIME %iU?au6/rO r '%(rF I fi?c/q, rqo /4RrCEj TKF HYnR Ru L/F 6n tv1F_ l T APFRo cr.«Tfc Y 0 Oho Ca/ SiERvoT/✓E1Ya QETt-EEAv Tl,(.- LVE14 e SEWr/c 2/ 2 -of A. ,D. E. C. S. v w 6, fop- S. C. R. 0. P S • 26S ' - /o ' rerr•t a¢rnff SS x 82+ 7, v l90 /SS SOIL SORBTIoN / 1 s /21 )2.st�/��ii► + (s /3.0 = <.< yrs 1 2ss/ 2;s s `2 s/ 000 yy�� PF RM F, /9-0 ,L �r / / )1.2> t ( 2o�s/ 1\ ll` z v 2 WATER T19 64L E 6 RA0jeov T 0 • 7.8 4.6 2.7 2.0 QU / NTNG SE�ARAiiow/ �� s X=.2t2 2.2 6 RAA,D TOTAL 17.3 T.SPURKLAND P.E. 203 West 15th. Ave. ANCHORAGE, ALASKA 99501 (907)279-3916 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 L Street Anchorage, Alaska 99501 I \1`RSlyS8 October 13, 19V E C E I V E D Subject: REQUEST FOR WAIVER OF SEPARATION DISTANCES FOR PRIVATE WELL TO SEPTIC TANK PRIVATE WELL TO DRAINFIELD LOT 3135 BLOCK 1 FISCHER S/D Gentlemen; OCT 19 1995 Municipality of Anchorage Dept. Health & Human Services We are submitting a request for waivers from the separation distances stated in Title 18, Alaska Administrative Code, Chapter 80.020. The septic system serving the residence at 5101 Spruce Creek Circle has failed and must be replaced. The system was installed in 1974 and consist of a 1000 gal steel tank and a log crib. The system was in compliance at that time, but subsequently the adjacent lot, Lot 3136 was developed, and the well serving this lot was installed less than 100 feet from the existing septic tank on lot 3135. As the attached site plan shows, there is not sufficient space on any of the lots in Fischer S/D to install a replacement system when the original septic system fails. As a result waivers have been granted to enable replacement system to be installed. The potential for contamination of the wells from the septic systems are minimal or non existing. As the nine attached well logs show, the wells are generally 260 to 300 feet deep. There are several impervious layers that prevent percolation into the aquifer. Overland drainage towards the well casing is not possible due to topography and the location of the dwelling. A waiver to 80 feet for the septic tank and 90 feet to the drainfield is requested. Yours obben purkland P.E. lo- lq-�iS II Lor 4B-2 LOT 4B-1 II i i 3A1 II II I 3 3A I – –– – – – – Fell – – c – – – –– – – – – –– -well – Welt – i_ ell ¢ I I 3B5 \ 3B6 3B7 Well I LOT 4C2 9 LOT 4C1 11 3B4 — I SPRUCE CREEK C1R. Well I I I 3B3 i 3B2 I 3Bl Well _ _ Wel 1 CF GA-\ t♦1♦�� r 49th ° �0 ..... ............... .p... �.inGlLf .44 4 k r TOBBE SPURKLPN➢�,,� NO. CE -2225 r.= 1 ♦��P�is 50 0 50 100 150 200 250 300 SCALE 1' = 100 FF. TOBSEN SPURKLAND P.E.SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE LOT 3B-5 BLOCK I FISCHER SID DEBRA JO ANDERSON DATE: OCT. 15. 19 ANCH. AK. 99501 D 5101 SPRUCE CREEK C/R. _ __ SHEET: 1/3 GRID: 2537 Alto �ipality of Anehorage Department of Health and Human Services 825 U' Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor October 22, 1996 Tobben Spurkland, P.E. 203 West 15th Avenue #203 Anchorage, Alaska 99501 Subject: Waiver Request for Lot 3135 Block 1 Fischer Subdivision Waiver Request #WR960058, PID 015-292-21, HA960461 Dear Mr. Spurkland: Your request for a waiver of the required 10 foot separation between an on-site wastewater disposal system and lot line has been approved. The waived distance is the absorption trench to the southeast property line of 3.5 feet. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. If there are any further questions or concerns regarding this waiver, please call our office at 343-4744. S ncerely, James P. Williams Civil Engineer On-site Services JPWAjm:Caudy •MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR960058 PID# 015-292-21 HA# HA960461 Permit # Date Received: October 17, 1996 Legal Description: Lot 3B5 Block 1 Fischer Subdivision Engineer: Tobben Spurkland, P.E., 203 West 15th Avenue, suite 205, Anchorage, Alaska' 99501 Applicant: Mark Caudy Waiver Requested: Lot line waiver Trench to the southeast property line of 3.5 feet. Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Date: Rec #: 0239/3001 Z2"je 4 By: of Reviewer Amount: $ 115.00 Date Paid: Oct 17, 1996 cw La 46 WE SERVE I Archibald's Drilling Service 940 S. Diamond Palmer, Alaska 99645 (907) 745-2336 OWNER OF LAND ADDRESS .... :K?� WELL- SITE ............................................................................................... S Z' 9 .......... FT. TO ...../re, ......... DATE - STARTED .... au41 ...... 4.�. ......... J9-ry .......................... DATE - ENDED ....1.2p.<.1...........7:>�./ FT. ......... Z.. i .......................... KIND OF FORMATION: FROM .......Ll.......... FT. TO ...... C�jO ........ FT FROM ... djO .......... FT. TO ..... Od ....... FROM ....3.Q......... FT. TO ......... Y,:� ....... FROM ....:1.0........... FT. TO ......,5.-2...... FT. FROM ... S Z' 9 .......... FT. TO ...../re, ......... FF., FROM ... 4.�. ......... FT. TO ...... 7,c:--) ........ FT. DEPTH OF WELL ALLALASKA 5US 0 L -of 3 � J1105tj OF ANCHORAGE DEPT. OF HFAITH k STATIC LEVEL OF WATER FT .............................. Nov 11988 ............................ DRAW DOWN FT . ......................................... ffik .. N -E -D .... GALS. PER HR . ............................... ..... ........................ .............. KIND OF CASING ....... FROM .42e,'V ........ FT FROM .4.r?..0......... FT FROM .4.q.4.) ........ FT FROM.C?!.4L,5.7 ...... FT FROM .2.!6 �. ...... FT FROM-!?..? ! ......... FT FROM ...... 7. 0.......... FT. TO ...... ..... FT. -dww FROM FROM ..... 1. L/) ......... FT. TO .... /.& ........ FT. .. Y-jv�FROM /J7 FROM .... /221V ....... FT. TO ..../ ,-.AI2 ...... FT. Y'.d4&A)?-"A/FROM FROM ....1.!f d ........ FT. TO ... le4',d ........ FT20491tecr"L&&J"Ige FROM TO...A;Z6 ...... FT TO ... a? .. W ......... F�; TO z2T6 . . ...... FT.. TO.JZ240 ......... FT . ... . .. ............ TO:q2�2 ........ FT . ...... .....4"C' ....... C! -f ......... TWFZ(7.e ...... FT-tq 4e4 . / . 14 -MI, FT. TO ........................ FT FT. TO ........................ FT FT. TO ........................ FT FT. TO ........................ FT FROM ... Z . ......... FT. TO ..../.. ....... FT.FROM ....................... FT. TO ....................... FT. FROM .../.F.0........ FT. TO -a,& ........ FT. FROM ....................... FT. TO ........................ FT MISCL. INFORMATION: 12 DRILLER'S NAME .... ZL24< ......... L/, &114 ......................................... 1 M U N I C I P A L I T Y O F A N C H O R A G E Department. of Health & Human Services 825 L Street, Anchorage, Alaska 99501 043-00$0' fAVY O N - S I T E W E L L P E R 11 I 1 Permit Number: 880239 Upgrade Date Issued: 14/21/88 Own "•_,me: ROBERT W. LARROQUE Day Phone: !`,ddress: 5141 SPRUCE CRK. CIR. 346--1978 ANCHORAGE, AK 99516 Parcel l d : 015 -292 -WO 21 Lot Legal; Subdivision: FISCHER Lot: 3135 block: 1 Section: 15 Township: 12N Range: 114 Lot Size -!bn (sq.ft.. or acres) Max F: 1i ooms: This Permit: 0 total Capacity: 3 Vl ! be submitted to Municipality of Anchorage Department of Health and Human Services within 30 days of well completion. 11W-; I'L.tfMIT EXPIRES 12111188. 1 CERTIFY THAI: 1. 1 am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage WOW and the State of Alaska. 2. 1 will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. 1 will adhere to all MOA and State of Alaska requirements for the set back: dist.an,. s from any existing well., wastewater disposal system or p"h lic ', ,, !his or any adjacent or nearby lot. 4. i. understand that this permit is valid for a maximum of bortrr,ums. I „ =.,, us,derst.and that the capacity of the total system is 3 bedrooms and ," Marqement will require an additional permit. 'i 7. r.;; riF=,,1.: _ ... DATE: lO��ZI/� .. i0wi`nar) ..AI'iliOL'rl.l... Issued By; DAIE: � -------------- 58.9. 55'1e'E [5 WELL 75.� r PAu ev 1Vtu. u'tl( 93 1I iop r I 577m-7 ve.e (cn' /O "UT/L. E3MT \0= jLor �38(o self oZfi F 1N FY2o Acv -s -e - 32 I tJG �a 50Ep9 �gR'0 — c'�` O-- z\ .384 yt+ FRdw'T aF /ku5f' � E73D V D U DATE /O _�- Lot 3B5, Block Ascher Subdivision Anchorage Recording District, Alaska R =,;b, SPRUCE CREEK C/R. L OF A �. -1192 tttfff! aa' Ar it� LOT SURVEY CERTIFICATION LEGEND I Irreby witty that 1 have serveyed the property shown and described 0 Brass or Aluminum capped monument recovered hereon, and that the Improvements situated thereon are within the prop- O Iron pipe and/or rebar recovered. arty lines and do not overlap or encroach an adjacent property and that O 2 x 2 hub 6 tack recovered no Improvements on adjacent property overlap or eneraagh an the prprelsse O 5/8 x 30" rebar set this survey In question and that there are no roadways, utllity INee, or other visible easements an veld property swept as Indicated eeresn. I Scale / y13Or I Dat �O _/� _ I Prepared by: R. L. BUTTON I Repisferod Load Surveyor (907)279-6200 519 W. EiyhhSAve. Anchwardi AIMAo99501 LRef. ?f 57 I F B No a5 -/5 I Property at:Rof��t Larr-oquFl r GREOR ANCHORAGE AREA BOR#GH cfl� Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME PEOEA-* / COddT MAILING ADDRESS /J0/ E. 53'e'o PHONE 3�ld—BL3d LOCATION 5"oeu C6 (!/¢t -LB LEGAL DESCRIPTION Lor 38-C Rk / –',,{ewd, S:'/O SEPTIC TANK: DISTANCE FROM WELL 0 / MANUFACTURER ST.9L'K INSIDE LENGTH INSIDE WIDTH SEEPAGE PIT: NUMBER OF MATERIAL �(L�'iBJ-/3 COMPARTMENTS LIQUID DEPTH I IQUID CAPACITY /1-" GALLONS. NUMBER OF PITS DIAMETER —OR WIDTH 1`, LENGTH �` ' DEPTH �O / LINING MATERIAL [obl �iR"CRIB SIZE: DIAMETER—DEPTH iDISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION �NEAREST LOT LINE -3 / ABSORPTION AREA (WALL AREA) 31941 SQ. FT. ADDITIONAL ABSORPTION WELL &A W) TYPE X-.VD/d• CONSTRUCTION 6// DRi""a DEPTH BUILDING NEAREST / NEAREST SEPTIC / FOUNDATION—,LOT LINE -s SEWER LINE—,TANK CESSPOOL OTHER SOURCES APPROVED '" DISAPPROVED REMAR DISTANCES: INSTALLED BY: a'_h c /E•d EXCne ' PIPE MATERIAL: CAST TL�� LOT SLOPE: REMARKS: Form No. EQ -031 1 DIAGRAM OF SYSTEM 3 . V AM `I 3 : I—>sult DATE %- 3— 74 APPROVED 9/ I I 1 I I I I I DISTANCE FROM: SEEPAGE /f SYSTEM O'0 G.A.A.B. P4 poawo LOT A) T ,! • GREATER ANCHORAGE AREA BOROUGH ' 0 DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 "C" STREET ANCHORAGE, ALASKA 99503 3 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT IELOON) /EOER.J:!/r� /�O� �. 3/t/ -A( -id 4 NAME OF APPLICANT MAILING ADDRESS PHONE INSTALLATION LOCATION SPeu �E pp LEGAL DESCRIPTION Z-0% 3 s S' INSTALLATION OF: SEPTIC TANK SEEPAGE PIT DRAIN FIELD OTHER R TYPE AND SIZE OF FACILITY TO BE SERVED 3 omxf FINANCED THROUGH p TO BE INSTALLED BY SOIL TEST RESULTS -JEW � 7 / NOTE: THIS PERMIT IS/yNOT yVALID WITHOUT SOIL TEST �''j COMPLETION DATE ANTICIPATED ^ - 7S� - rr �A z) EK rWA G " CoYE'e TO z= - FINAL FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE —/0-" ?k- TYPE SEEPAGE AREA SIZE _- -- _ - -. TYPE MINIMUM DISTANCES. REQUIREMENT'S FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT ZD DRAIN FIELD /O/ SEPTIC TANK TO SEEPAGE PIT WALL �d SEPTIC TANK S/ SEEPAGE PIT �dRAIN FIELD TO NEAREST LOT LINE. �4// ly<LL TO SEPTIC TANK - DRAIN FIELD /4;1v / . SEEPAGE PIT WATER MAIN TO SEPTIC TANK DRAIN FIELD /a -v ,rJu ALSO CONSIDER AREA WELLS. SEEPAGE PIT SEPTIC TANK, SEEPAGE PIT /DRAIN FIELD TO RIVER. LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 3 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G-A.A-B. OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE FORM NO. EO -016 won-ttwation Srclt 1V 'r-r1G /S Xl.S r,&,, 'Ona tart it worth a thousand opinloni V8420 TUDOR ROAD. ANCHORADa. ALASKA 00007 0 T"a om{ 233-0472 ?erforned For Eldon Pedderson Date Performed 4-11-74 ;c•oal Description: Lot_.aejIock `-" Subdivision„ r This corm Reports Soils Log yes Percolation Test 4eoth Feet Overburden Soil Characteris 3 UCoarse Gravel with Cobbles,- A graded ,GW -GP '(85) 5 / R 7V g / Silt, graded ML ll1R/I . bottom of test pit _ WaS..Eround Water Encountered? No If Yes, At what Depth? L �/L� I2r�— � Reading Date Grnss Time Net Time Depth to H2O Net Drop' I I e—rco!Ltion Rate Minute Pr000sed Insta l� aeon: Seenage Pit_ yes Drain Field ueoth of Inlet Deoth To Bottom Of Pit Or Trench r.rlMVEYTS: 115 eq, ft. drainage area required per bodronm from minus 2 f,,. to minus d ft. No bedrock or water table to minus 11 ft. #est Performed By Z dti PCaTna go tom - Data Certified By:Construction Test Date: 4-11-74 Municipality of Anchorage O • Development Services Department Vit'' ,Y4�_ Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ei.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 01 S- 111) -31 HAA# ,-'IA' L Expiration Date: ]1--7-01 1. GENERAL INFORMATION Complete legal description LL 3B5 Fischer S/ D Location (site address or directions) 5101 Spruce Cr Cir,Anchorage, AK 99516 Current Propertyowner(s) Hatt Friese Dayphone 346-3050/344-3020 Mailing address Lending agency Mailing address Real Estate Agent 5101 Spruce Creek Circle Anchorage, AK 99516 Day phone Day phone Mailing Address �7 Unless otherwise requested, HAA will be held by DSD for pickup. _ y 7/ o 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well EN Individual On-site C Individual Water Storaae ❑ Individual Holdino tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 5 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 uocn 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 we!I and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are vaiid 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 S & S Engineering _ Phone 694-2979 Address 17034 N Eagle RiyPr inns finite 204 E.R.99577 Engineer's Printed Name Robert C. Cowan P.E. Date 11113:3.1 2001 so BOBERT C. COWAN i ti 5. DSD SIGNATURE 1 CE -8801 _Jef� Approved for 3 bedrooms. NZipP • _w -„_:',-` ti ��•qo,e y4 Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments aK()t,nrivi -• Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By, Original Certificate Dater - 7- D / (Rev. 12;00) Municipality of Anchorage • 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 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo T 3 3 S Q i or rc 1 F ( S C H t 2 S 43 Parcel A. WELL DATA Well type PR . v A r E Date completed Total depth :) 7 Date of test If A, B, or C provide PWSID # = Well Log 6)N) Sanitary seal &N) YE Cased to H04 ft. FROM WELL LOG 10 131/ T W Static water level U IK ft. Well production g.p.m• WATER SAMPLE RESULTS: 0/,r -al)-11 Yf') Wires properly protected 61N) Y E —' Casing height (above ground) d `1 t in. AT INSPECTION -7 / 30 0 t AS7 ft g.p.m. jF Li n. T t .J 4Y PUMA & 1' VV -401w (_ Coliform D colonies/100 ml. Nitrate %' • 3). mg./I. Other bacteria O colonies/100 ml. Date of sample: 30 / 0 r Collected by: S d S ENGINEERING 17034 Eagle River Loop Road No, 204 B. SEPTIC/HOLDING TANK DATA Eagle Rlrer, Alaska 99577 Tank Type/Material J4 PT" / S7 E'E L Date installed 1) 1 4 / 9 f Tank size ) 000 gal. Number of Compartments Z Foundation cleanout(Y)N) _*5Depression over tank (Y6 _t_f) Date of pumping 7 1/ t / 0 1 Pumper AN cdoAA (ft C. ABSORPTION FIELD DATA Cleanouts ON) Yt* J High water alarm (Y/k) N U C,&Afi°taC 00k)'"^N(- Dateinstalled 11�g�er Soil rating g..d./ft2orft2/bdrm)System type TRE,vcN Length 3-7.S— ft. Width 3 rt Y ft. Gravel below pipe 6 ft. Total depth / 0 ft. Eff. absorption area 4,S-0 ft2 Monitoring tube YtJ Depression over field N 0 Date of adequacy test 7/ 30 / 0 1 ResultsPas Fail) PR f J For 3 bedrooms / ' ., -- I Fluid depth in absorption field before test I �L in. Water added d5 gal. New depthP win. Elapsed Time: GV min. Final fluid depth) I�� in. Absorption rate >= ys_ J g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) A/0`6 K ,`I0 w t. If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallons Mannole/r+ccess _ "Pump off" level at i igh water alarm level at Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /00 r On adjacent lots Absorption field on lot / 0 J t On adjacent lots in. Public sewer main N /fi Public sewer manhole/cleanout - S r'r" H Id' tk N 7JJA Sewer /septic service line o ing an SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: i r Building foundation s f Property line — Absorption field S Water main N 1.4 Water service line / O + Surface water o f Wells on adjacent lots So } SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: P rt lin 3 r Building foundation f 0 Water main *J 44 rope y e Water Service line /0 t Surface water /00 � Driveway, parking/vehicle storage / Curtain drain Wells on adjacent lots q F. COMMENTS -*- W R 9 Soong G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA nguidelines in effect on this date. /� Engineer's Printed Name 0J36A' C Cow,4,� Date 7130 lO l HAA Fee $ Date of Payment Receipt Number (Rev. 12/00) 7 31//01 pt,7el17 Waiver Fee $ Date of Payment Receipt Number U `I JlF ' " •. `CN` MUNICIPALITY ANCHORAGE M • '� DEPARTMENT OF HEALTH &HUMAN SERVICES Division of Environmental Services On -Site Services Section JUN 09 1999 P.O. Box 196650 Anchorage, Alaska 99519-6650 MUNICIPALITY OF ANCHURAGE 343-4744-NVIRONMENTAL SERVICES DIVISIOI`, CERTIFICATE OF HEALTH AUTHORITY ` APPROVAL FOR A SINGLE FAMILY DWELLING �� Parcel I.D. # D 15 — HAA # �J 1W��� a in 1. GENERAL INFORMATION Complete legal description EiS(-HEQ Y3 taw C K t 1-0 Location (site address or directions) 3 10 t 5 P ;!-U C E C )2, LE ~tom 11C,A%-"� i Property owner tae rc L Lis +nS k Day phone }(, - io 1y Mailing address ICI S��ULE C2ELic q»Iry Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: I 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. 72-025IRav 1/91) Front MOA021 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 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. b/ Name of Firm l �'b6L� S11Ja i V. t Phone 0/ 1 ✓ '-'` %c Address Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. By: REE bedrooms. Conditional approval for Additional Comments 3 Date { r bedrooms, with the following stipulations: Date 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. 72425 (Rft INi) Beck MOA #21 e Municipality of Anchorage JUN p 9 1999 DEPARTMENT OF HEALTH & HUMAN SERVICES � Environmental Services Division aurOUVALIIY OF ANChU_NVIRONMENTAL SERVICES D 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: ( t 38-5 , B ( Parcel I.D.: U+. 29L A. WELL DATA FISLNH� S/I> Well type Z If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) y Date completed d/;/ /'S'� NIA rl Total depth A7L% Cased to ,q Casing height (above ground) 1-11 Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: M AT INSPECTION H� Coliform Nitrate L57 nA 9 l Other bacteria Date of sample: G/�9 9 Collected by: :. J B. SEPTIC/HOLDING TANK DATA Date installed t rN� — Tank size 190V Number of Compartments o Cleanouts (Y/N)Y Foundation cleanout (Y/N) :� Depression (Y/N) N High water alar (YM) tj Date of Pumping 1011,'0Y Pumper Pe n a C. S e C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.dM or kAdwiry-- �• U System type f Xl-i" c [r 7 r i ' Length 7/7 Width 7 � `� Gravel thidmess below pipe b Total depth 9 H M t K/ Effective absorption area //.!;'0 Monitoring Tube present (Y/N)__'4_ Depression over field (YM) h) Date of adequacy test taz-4 1 Results (Pass/Fail) F For "_3 bedrooms Fluid depth in absorption field before test (in.);_ Immediately after�7J gal. water added (n.): 3 f i Fluid depth 7,94- (ins) Minutes later. ? U Absorption rate = ' _E� Jr0 g�a.p. Peroxide treatment (past 12 months) (YM) If yes, give date 72-026 (Rev. 3196)' D. LIFT STATION Date installed Manhole/Access (Y/N) Size in gallons on" 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 Absorption field on lot Public sewer main Sewer /septic service line f/ 7 "Pump off" level at* On adjacent lots i % / On adjacent lots i i i D Public sewer manhole/cleanout h/A ti U Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 1-7 Property line t'> Absorption W Water main/service line >,2.5- Surface water/drainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line �? ; Building foundation NI Water main/service line % ;2 - Surface water u Driveway, parking/vehicle storage area Curtain drain J�G Wells on adjacent lots F. ENGINEER'S CERTIFICATION I 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 l o b b? Sp a r Date 6,/m 11 el HAA Fee Date of Payment Receipt Number 72-026 (Rev. 3/96)' 0 Zi • 10YD tlRznlS���J Waiver Fee $ Date of Payment Receipt Number . MUNICIPALITY OF ANCHORAGE MSA/Gpq�'T O DEPARTMENT OF HEALTH & HUMAN SERVICES F yr rQt Division of Environmental Services�SFgy bhp On- te Services on P.O. Box 1966505iAnchorage, Alaska 99519-6650 Q 0j)-1 T 1iOFso/ SOH 343-4744 llk 96 CERTIFICATE OF HEALTH AUTHORITY l��gI/ APPROVAL FOR A SINGLE FAMILY DWELLING o Parcel I.D. # D 16- 2Y oz — A HAA # 2Nqinf _`>-kir 1. GENERAL INFORMATION Complete legal description Location (site address or directions) 'r51 D 1 ST Q t i Lla C (i2 Property owner F1 642 / CAQ ID Y Day phone Mailing address Lending agency Day phone Mailing address I 1 / JJ Agent s1/ ; o t _0_"iM.c. r Uj; w1 Day phone 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 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 (Rer. 1/91) Front MOA 621 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 —_I_& )o�r�l �b •) r, V-) a� F Phone a7y Address 9 t.� 1, # o2lo 3 „c Engineer's signature � �+ -- A&v\ Date "11714k 6. DHHS SIGNATURE Approved for+��bedrooms. M Disapproved. Conditional approval for Additional Comments .4LL,C�Gt'uG� ' bedrooms, with the following stipulations: auric 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 (Fe 1A1) Back MOA n1 cN MUI ICIP /y Municipality of Anchorage FNr� EkA DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 0Cr ] 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 34��4�4^c / 7gy% Health Authority Approval Checklist `` 11/,CD Legal Description: -o 33'7 13 K \ %15LH t=-11 Parcel I D.: �%(� — qZ — kl MIN 4Ka1Z1r1 7 Well type � Ii A, 8, or C, attach ADEC letter. ADEC water system number N /)l- Log present (Y/N) V Date completed 10 I31 I gs Total depth 9--7L4 t Cased to va7'7 r Casing height (above ground) �f5 Sanitary seal (Y/N) `/ _ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test t ok I (S,, 7 G l i& l 9b NaStatic water level od��I A(y. U Well production J g.p.m. , J q P Wl 9.p -m. WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria,' Date of sample: / (o Collected by: B. SEPTIC/HOLDtNO-TANK DATA f/ q Tank size Cleanouts Y/N Date installed j� L� Number of Compartments ( ) Foundation cleanout (Y/N) �-Depression (Y/N) �High water alarm (Y/N) Date of Pumping iligL Pumper I rJ Q It C C. ABSORPTION FIELD DATA Date installed 11 Soil rating (g.p.d./ft2 or ft2/bdrm) 7• y System type ! R)9/YC Y Length Width Gravel thickness below pipe _ _ Total depth 10 Effective absorption area 56) Monitoring Tube present (Y/N)4-- Depression over field (Y/N) ry Date of adequacy test N/A- Results (Pass/Fail) For — ' bedrooms Fluid depth in absorption field before test (in.); r� Immediately aftergal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = L� g.p.d Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at' Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* 'Datum SEPARATION DISTANCES FROM WELL ON LOT TO "Pump off" level at* I> /&% Septic/holding tank on lot I i ® On adjacent lots ' > 162-0 Absorption field on lot 19_(91 On adjacent lots Public sewer main N/fit Public sewer manhole/cleanout Sewer /septic service line XU Lift station N Ztv SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line i 5 Absorption field r Water main/service line Surface water/drainage N10 Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: I I Property line ?J. �� Building foundation oa / Water main/service line rJ I Surface water � I � Driveway, parking/vehicle storage area[�1 Curtain drain Irl 1 (� Wells on adjacent lots l: G ' F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal nkords that the above systems are in conformance with MOA HAA guidelines in effect on this date. f ri Signature44 r ~ 0 Engineer's Name b v r k lut�r✓ Date HAA Fee $ '960. Date of Payment Receipt Number 72-026 (Rev. 3/96)' Waiver Fee $ Date of Payment ReceiptNumber��/ OMUNICIPALITY OF ANCHORAGE • Department of Health &Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING /1 Parcel I.D. #0 b- 2 7 2 2 / HAA # k 8g — 03 / LIA 8 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) L of 359, Wyc (rt rLSC,yee- S/D Location (address or directions) Sdiuce Creek O rc fe (b) Property owner flO4Cr f Ao_rros�ue Telephone: (home) 3y6- r976 Business Mailing Address S-10/ S.eruce C/YeGr Crrc'/ (c) Lending Institution Co✓Arr/arJul0x!/i �ryc Telephone 278 SZ Z% Mailing Address 3333 41� 99SO3 (d) Real Estate Company and Agent 3e M0.n f24 cr Ai eS — Pefi e 4:6 y Address 2GoO <orofa.cr 5)4.. 47CAOn?4 A/r 99503 Telephone - 276/ (e) Mail the HAA to the following address: (or check here 12, if hold for pick up.) List contact person and day phone number below: f-tvore 2. TYPE OF RESIDENCE Single -Family 9 Number of bedrooms 3 3. WATER SUPPLY Individual Well ® Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ® Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7iee) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Fla f{v,e Tec A l tr ck / SeO-v"rb Telephone 3 YS� X35 s� Address !'f530 =r -Aa SX, Ancy;¢6c 99Sl6� Date e�99� A4 ��� Or : ,♦ max• �trstz'� •.s' dao/.•!;G;" Engineer's Seal Je :•i4FCDC •"c F•MOORE AV CE - 3569 ' t 0 c--; ti �°; �PrO(ession3� V+� �*6aa+s B. DHHS APPROVAL Approved for bedrooms by Cl�zt y ^ Date Approved_ Disapproved Conditional Terms of Conditional Approval CAUTION 1 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 22-025 (Rev. ]/88) Back Page 2 of 2 MUNICIPALITY Y RgcN'r1U Health Authority OF ANCHORAGE (MOA) DEPT. O Health Authority Approval (HAA) ENvIRoNMEN ION CHECKLIST - FEBRUARY 1984 343-4744 ,t IJo�l Lees al D ri f onLof 3BS B�aC/C 1 RECEIVED A. WELL DATA g c pi. , Fla cAer SID Well Classification Prf✓octe_ If A, B, C, D.E.C. Approved (Y/N) N Well Log Present (Y/N) T Date Completed 10131146 Yield 8 ;ef" .'er /C,; Total Depth2� Cased to 27 Y Depth of Grouting N.d. Static Water Level Pump Set At Casing Height Above Ground 2 2 Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot 10'i.S' fo C.a, ; On Adjoining Lots > (001 To Nearest Edge of Absorption Field on Lot 131• S Ar Co. —;On Adjoining Lots > 4`00' To Nearest Public Sewer Line NSA• To Nearest Public Sewer Cleanout/Manhole N.'4. To Nearest Sewer Service Line on Lot > es ' Water Sample Collected by T F /-foorB ; Date 1t*/ 2/8f Water Sample Test Results _'iX7t.s 7UC IOrY - e--7CQNr;" Iloo ro t Comments Thit f/ well nWlezcafAi? weft remr'%cr( on /he 9115-/Bg cyec k/4 f , wl,;C'A 1.traed okf 7r6 6e 0.7' ^r ae toe [o' u/,1 �c� ewewAe"11 SEPTIC/HOLDING TANK DATA C C4vdry e` o&la .4vA, Date Installed 71317% Size1U� No. of Compartments Standpipes (Y/N) Y Air -tight Caps (Y/N) Y 9//S/88 CAeCkl1 f, 2 Foundation Cleanout (Y/N) Al Depression over Tank (Y/N) N Date Last Pumped 8—tern" " Ruohri Pumping/Maintenance Contact on File (Y/N) IV, A. ; for N 9. Holding Tank High -Water Alarm (Y/N) N A. Temporary Holding Tank Permit (Y/N) N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well 101,S' %A' C•O. To Building Foundation To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments To Disposal Field 72-026 (Ra.. nee) Front Page 1 of 2 I /N I C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata BS 0' 43r�rm Type of System Design Set,&7e P%' Date Installed 7/3/7y Length of Field .ter Width of Field Depth of Field Gravel Bed Thickness (O � 6' Square Feet of Absortion Area 3,9 y Statndpipes Present (Y/N) Y Depression over Field (Y/N) N Date of Last Adequacy Test 9/6/86 Results of Last Adequacy Test Ae;teo&ecde 6 eo(•o0-+1 SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well � 1305 f"M Co To Property Line 10' frv'^ c-0 To Building Foundation 36' �Fr'O7' C.O. To Existing or Abandoned System on Lot N,4. ; On Adjoining Lots > 16 To Water Main/Service Line > 25' To Cutback (if present) N, 4. To Stream, Pond, Lake, or Major Drainage Course > too To Driveway, Parking Area, or Vehicle Storage AreaPTS (ty �cnc(c/ oG Cwo�, Comments D. LIFT STATION N,R• Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA gui4L@(iswq effect on the date of this inspection. m e� r � !ice( Ap / yk�p Signed CompanyFlaLvs %Ciniccal Sevvcc er Date f! / 3 /B8 j Engineer's Seal MOA No..a:,:,::_ ... e ; r„1_ t r✓ Receipt No. Receipt No. Date of Payment Amount: $ Waiver Fee: $ Date of Payment 72-026 (Rev. 7/881 Back Page 2 of 2 ®MUNICIPALITY OF ANCHORAGE • Department of Health &Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 MUNICIPALITY OF ANCHO?AG ENVIRONMENTAL SERVICES DIVIS SEP 1 5 1988 CETIFICATE OF INSPECTION APPROVAL OF ON-SITE SEWER AND WATER FACILITY T FOR SINGLE FHEALTHIAMILY DWELLING RECEIVED Parcel I.D.# L(1�)-a9d-la1 HAA# V ---\ 'RS -C,3C1CIK 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Descriptign (i clude lot, block, subdivision, section, township, range) Location (address or directions) 5101 S02emc / Cree k Crc /P_ (b) Property owner Roy ert Aa 5r a Telephone: (home) 3v6- 076 Business 3 6332 Mailing Address S70/ S.Prs-ce Geek Cie /e h� /4h 9fsi6 (c) Lending Institution �hov Mmoeallh Ko -%Mf Telephone 2 7& - S229 Mailing Address 3333 Denali y Anci+or�e� /}k 99S0.3 (d) Real Estate Company and Agent Re Pfcvx Prolver /nar - POA ,e Sera Z Address 2 600 rorGb✓sc SfAch�ar Ah' 99503 Telephone - 2763 (e) Mail the HAA to the following address: (or check here ®, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family X 3. WATER SUPPLY Teot rYoore 3yS'' 13SS Number of bedrooms 3 Inc dual Well ® Community ❑ Public ❑ Note. if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site'% Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 71-025 (Rer. 7;W Page 1 c` " 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Fla itchnrcaI Servccc Telephone 3Yj--r3S'S Address / Y S 30 Ectio SSA /`1^ o " 94T ye Date Seri IS'. /988 i *G):-__4 9 T H.a v ....................... 0 THE DORE F. E AF :.•oCE - 3589 oR •'^ Engineer's Seal m ai aPro 6. DHHS APPROVAL Approved for 5 bedrooms by �'" ^�Date Approved — _>� Disapproved Conditional Terms of Conditional Approval CAUTION 9-29-89 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in 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 or omissions in the professional engineer's work. 72425 (RM. 7/88) Beck Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNIClpAUTy OF R4ffi~T - FEBRUARY 1984 DEPT. OF HEALTH b 264-4744 ENVIRONMENTAL PROTECTION Legal Description: Lot 361S_ 3/ock- A SEP 151988 Fix cA rs/s o A. WELL DATA RECEIVED Well Classification Prr�oJLe If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) N Date Completed /Y7)f Yield > row mewu MdAsi9 Total Depth 279' Cased to 277' Depth of Grouting A. h. Static Water Level 262' Pump Set At =1 263' Casing Height Above Ground — Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Y Sanitary Seal on Casing (Y/N) Y Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot if -7, is C' e ; On Adjoining Lots 100' ip Co. on tart VC2 To Nearest Edge of Absorption Field on Lot IVY' 116 60v ; On Adjoining Lots > too' To Nearest Public Sewer Line n.A. To Nearest Public Sewer Cleanout/Manhole N./i, To Nearest Sewer Service Line on Lot /'4A• Water Sample Collected by PfaMy Tech Servrew• Date 8 /3//bi8 Water Sample Test Results Scrfu :l;cc lfege - O rotrAno lecv w4 o - ds- LinE /•e fy hvk -/V Comments Ws(/ dwj`4 PJ*'- rvot t- rOhr/r�atTbn. D.er�n i�111 peld fecf t/rrdy 62' % 263', but Re B. SEPTIC/HOLDING TANK DATA Date Installed 7/3/7y Sizef0� No. of Compartments 2 Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) _ly Depression over Tank (Y/N) N Date Last Pumped 8/23/88 %r Abb-Roarte"- Pumping/Maintenance Contract on File (Y/N) ;for Holding Tank High -Water Alarm (Y/N) "A Temporary Holding Tank Permit (Y/N) IV. Separation Distances from Septic/Holding Tank: To Water -Supply Well Iye To Property Line To Water Main/Service Line To Building Foundation 8' To Disposal Field /1f' To Stream, Pond, Lake, or Major Drainage Course 7 foo Comments SW Ac foA 1. e. a. V $ 7� ,Ry^ ru ee// on tort Ma wmrr er rltecAe ar AV4 0AA. RSr~.i.b:Irhy Sic j:.tfs o• owner o -A /,ot 366 Srece trutf Wei/ wart elrv/tert tw6Se91.ent Jo rnf/a//=/M" aF .5VAe fenfr an Lof 385. Page 1 of 2 72-026 (Rev 6186, Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 89' W/ veer* Type of System Design 5tGf!;e t ^t Date Installed 7/31 71Y Length of Field !6 Width of Field i6, Depth of Field Gravel Bed Thickness if Square Feet of Absorption Area 3611 Standpipes Present (Y/N) Depression over Field (Y/N) M Date of Last Adequacy Test 9/6/BE Results of Last Adequacy Test or 3 J twerta0mv Separation Distance from Absorption Field: To Water -Supply Well !MS To Prope Line To Building Foundation so SwF c,., Lot N.A. On Adjoining Lots To Existing or Abandoned Sy on S !O r To Water Main/Service Line N.A. To Cutbank (if present) — 1� To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Stora rea 41-f`W11 uaOfer rr✓ewer Comments P f"NdLf JrAntc sew < 104 IF Seeole Al /YPair of &/ owner• su 9/9/Bd D. LIFT STATION N.A. 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 S Date Company F2'/dfTsui Y&4f MOA No. 2 Receipt No. (7. � � + ♦ OF fi Date of Payment 7 / 6Ar �.�� • •' • C'Qs'� Amount: $ 06'� j (�j� ' �� Engineer's Seal TH�• '•9 Page 2 of 2 72-0261Rev 81661 Pick * 49— * 0 r.e�.:-...............r...:...0 J:i:..`7s..; ... THEODORE F. MOORE • CE -3589 Ar 0 0 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: toed -mon, e.©a�r . Mailing Address: box /7/d K 3P -,q -9ysZ)7 Phone: 3v sr- yc 3,P 2. Property Owner: 1,cLm, Phone: Mailing Address: 3. Legal Description: I 4. Location: 5. Type of facility to be inspected No. of bedrooms 3 i 6. Well Data: A. Type Uj ,,&c_ B. c Depth % / C. Construction >-on K cl D. Bacterial Analysis,�—S�lr 7. Sewage Disposal System: A. Installed 'I ; -7 B. Installer lj6e C. Septic Tank: 1. Size (-C,c,2. Manufacturer D. Seepage Pit: 1. Absorption Area .3�4 U 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank AW //4 , Absorption area / Sewer Lines /7 Y, Nearest lot line %t Other contamination — B. Foundation to septic tank /I- i , Absorption area 3& C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages Pagewo pages - R * t for Approval of Individual a & Water Legalfescription Comments Approved ,iCp..,crz C'I�?^�c7<,� Disapproved Date Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date