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HomeMy WebLinkAboutTRAILS END BLK 1 LT 1Trails End Block 1 Lot 1 #015-191-14 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni,org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211313 Work Type: SepticTank Upgrade Tax Code Number: 01519114000 Site Legal Address: TRAILS END BLK 1 LT 1 G:2641 Site Mailing Address: 11215 TRAIL'S END RD, Anchorage Owner: MARTINEZ MARY V & EUFEMIO F Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms c ° Sc�. r Departmernt 8/3/2021 8/3/2022 27636 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ 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 (1.8AAC72) 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 B) Issued By: Date: Date:ZoL4.2 21 At V - . q OF evelopm-ent Services Department On -Site VVai:er & Wastewater Section Parcel I.D. 015-191-14 ON-SITE SEPTICM/ELL PERMIT APPLICATION Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s) MARY MARTINEZ Day phone 907-230-5870 Mailing address 11215 TRAILS END ROAD *ANCHORAGE,AK Site address 11215 TRAILS END ROAD *ANCHORAGE, AK Legal description (Sub'd., Block & Lot) TRAILS END; BLOCK 1, LOT 1 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank 0 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN Initial ❑ Upgrade Fx_1 Renewal ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) 0 (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. CS's iYteeri (Signa ure of property owner or thorized Permit/Rush Fees: 2Z5 Waiver Fees: Date of Payment: 710q17-1 Date of Payment: Receipt Number: _�6y%5-G Receipt Number: Permit No. OSAZ 1 /-7) 1:1 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 11 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211313, Rebecca Carroll, 08/03/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211313, Rebecca Carroll, 08/03/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211313, Rebecca Carroll, 08/03/21 ASpHALT f - _ ------ ----------- 1,"7 1 U ,. L/ IF �f 7e a �§ 1 m M U) f— (1J U) U) f. ui z cr0 0 7 fg� s ova a Lu LU C1 4:6 co Lai ki te; r d - Z Q Lp LL- Lu Lu ' `J Li— �� i "R PA u • PALL • A� Q E q �J - - .-..# k w a -""000/ 7 fg� s ova a Lu LU C1 4:6 co Lai ki te; r d - Z Q Lp LL- Lu Lu ' `J Li— �� i "R PA u • PALL • 7 fg� s ova a Lu LU C1 4:6 co Lai ki te; r d - Z Q Lp LL- Lu Lu ' `J Li— �� i "R G R KS Z rA t APPROVED DATE LEGAL �`— Z z sz/ ray/s C-1 o/ 5 d,, G / 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE 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 NAME WELL INSPECTION REPORT PHONE ANEW ! MAILING ADD E�.S Z� '-re) ❑UPGRADE O611LE�DESCRI�TION LOCATION C //— N0. OF BEDROOMS 2.Y DISTANCE TO: 11{. r r _ h Absorption area welling 1 PERMIT NO�/�sZ a Q Manufacturer w F -Material N < I No, of compm Liq.�yp 'n gallons Inside length I JJ LL Width IF HOMEMADE: Liquid depth (7 Z DISTANCE TO: Well Dwelling = Z Ia- Manufacturer PERMIT NO. O Material ca Liquid acit g 4 P yin allons w w L) . LL Z DISTANCE TO: No. of lines Q i FoundagfD_L Pr Nearest lot line �� PER T Q, OT d j ` Z w t- Top of file Length of each lin _(J Py f Total length of Ii esy� Trench wid h / / Distance between lines Q to finish grade / Material beneat tile �. w Length � Width O to inches Tot I effe v ee bsorptio rer 1, - Q 16- a a Type of crib Depth PE IT NO. Crib diameter Crib depth LU U) Total effective absorption area co DISTANCE TO: Well Building foundation Nearest lot line L w Class Depth Driller ancDiste to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE M TFRIGI C / II I I I G R KS Z rA t APPROVED DATE LEGAL �`— Z z sz/ ray/s C-1 o/ 5 d,, G / 72-013 (Rev. 3/78) • P1 Li to 1r r=: 1 FF-! @ _ I T' -a' ' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 L�`i-i� 1 LF� \ f f •• ! ? E._ U -D S `•6 E-' C' P-4 — IF E E:' !-•-! E F.: F:-' E F_: t -"I I T PERMIT NO. ( 820122 APPLICANT PATRICK BROD I GAN 6418 I MLATC:H , WAY 99 5 0 3 248-5057 LOCATION LONGHORNATRA I L'_ END LEGAL L1B1 TRAILS END LOT SIZE 27600 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SO FT/BR) = 150 THE REQUIRED SIZE OF THE =OIL ABSORPTION SYSTEM I S : F=" IF LEf-.l17-iIF '— := � r: 31_:l=I'%0E!_. C■EF:"IF THE LENGTH DIMENSION I S THE LENGTH ( I N FEET) OF THE TRENCH OR DRA I NF I ELD. THE DEPTH OF A TRENCH C �R PIT 15 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). rDU I r<* EC■ _•E!='T I r; IF 17! 1 `E= PERMIT APPLICANT HAS, THE RESPONSIBILITY TO INFORM iRM THI_ DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- T 1-1 e=r ■:_ 2 :■ 1 r-.6 Imo' E C T g A=r 1=1 F'= E P_: E G! U 1 I-: I= E -N BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTIC N AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM Is 100 FEET FOR A PRIVATE WELL OR 150 TO 2001 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC: WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SETTER LINE IS 25 FEET AND T� i A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN TO DA',•'_ OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F"r--- F: rl 1 T E := F• I I_: E _=. Ea E r=: E 6'•-y E E F;-:: =!: - .• - _=a :FE: I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. • I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. IGNED:---------------------------------------- APPLICANT PATRICK BROD I GAN ISSUED BY_4_7 - ----- �_-_DATE__ - - -- oZ Z ',r'4 0 A M r•? r_t PJ Y t+. 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WALL t::Ui•1:'Lt=1 I UN MAY 3a�;.�'t_'� c.�t_ �a ,nmc,.-• �.� M. r t r�;i L� C!�+ i. aft ?= F .r' - , NS�y ri -A i ) rn rl?'_r�� i=:c:+y'=c f),6TfN 1_.9T r )tc i=•f'�:1-•1 r '?_' E: :f=• t i=_7' C'� t�: 't•f :L=I= ; j_, •.+•_ J_ t :-u+ ;- : at•t r } _ [ Rp ! a r rI-t p`# : r+?►J ; f"7 t��) T : +3.^ t?N - _ : f`� _ .' ��i iC t� -r_}_ a.; ti. = T r ir- rt{ Ry T:t i•t1Jt4 i C i P; }t_ E r'1 .� t t.t rt t rtr1 rre-i_ f! _ r'� r r1 tN t-x.:r.a,��G;�r�t:r I•f i r,1 = • .1 r9 in- ,rN.11T�f`�_ on Is&E ;.::1Tt;KY';rr--m "my :'�>.�t!rr�= L7�..1��+.r�:r=t'Ir CT 174 ;� [ t•it i t is rr- nimi 4 ------------- - 77 .. - SOILS LOG A MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska' 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: FATRICV. 'BRODIC Q.i\l DATE PERFORMED: 3'/IS' 82 LEGAL DESCRIPTION: LoT 1. Rk I1 �fk I LS i..J� 'SID •�•OQ SO `L SLOPE SITE PLAN M 3 e�e DENSE SAcND �a 4 �.,;_ ; VGIi N hk•Nsks of .. 5- 1. a •.'a CA AVL 4r s 001, 7 � � V 9 .i . 10 ; L 11 WAS GROUND WATER c S ENCOUNTERED? i+ L O 124 0 44o P )IA aLc 13 14 xx 15 r P� .OF Al•"�s¢�t 16 *:'4 12 17 ..1:. ........., •. 18 �: J NE25,1971 . ' 0. 19. .. li ONAt E?" 20 COMMENTS 1 W-79 l PERFORMED BY: I . 72-008 (6/79) IF YES, AT WHAT E DEPTH? ©1 Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE Iso ••' V 4u V aj (minutes/inch) ES RUN BETWEEN FT AND FT�% Q CERTIFIED BY: DATE: 3-2—s- & Z • \ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME 9'f�� PHONEE. —�f% &TNEW G f 2l�yD ❑UPGRADE MAILING ADDRESS J d I I D�la�E Nzc LEGAL DESCRIPTION / /oc-L-/ LOCATION N'/ 0 .1 c li. o✓' s. `Y— l r z � lS L–�tcl NO. OF BEDRgOMS 1.�,( v Y DISTANCE TO: Well f�-f- fn. Absorption ar a o Dwe�� l' 1� PERMIT NO. �a ��Z. F- Z Ul Manufacturer Material No. of compartments Z Cn Liq. cap�cjtyyLr gallons IF HOMEMADE: Inside length Width Liquid depth JO be DISTANCE TO: Well Dwelling PERMIT NO. =Z<OZ< Manufacturer Material Liquid capacity in gallons W = DISTANCE TO: Well /�/b f h - Foundation Nearest lot li PERMIT NO. Z LL z Z No. of lines Length of each line Total length of lines Trench width Distance between lines 1- ¢ -7 7-3 Z inches _ cc F- Top of tile to finish grade Material beneath tile Total effective absorption area O 7 c7 4(_ inches ' / " - , w Length Width � Depth PERMIT NO. c7 a F wa Type of crib Crib diameter Crib depth Total effective absorption area Cn DISTANCE TO: Well Building foundation Nearest lot line .3 Class Depth Driller Distance to lot line PERMIT NO. J W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS 1-9b I + SOIL TEST RATING INSTALLFF; Y1v i/ A/ � REMARKS AIG It T'A[S / sYV Soy rT�i .• x 100 �•f-t/f /(o i ILI APPROVED DATE LEGAL r, ALASKA MUIR011 1RAL COnTROL SCRUICCS, Inc. Engineering & enuironmental Studies MUNICIPALITY OF ANCHORAGE DEPT. O' T . 9, ENVIRJtU:,:r„A_ :..v,�-CTION October 19, 1982 Mr. Bob Pratt OOT 1 9 1982 Department of Health & Environmental Protection RECEIVED 825 L. Street Anchorage, Ak. 99502 Dear Bob: I spoke with both Jim Green and Phil Hubbard about the depth of the system for Patrick Brodigan, lot 1, block 1, Trails End Subdivision. Based on my discussions and review of the inspection report, the report is in error. My engineer forgot his tape on the first inspection and used Hubbard's tape. This tape was 2 feet short than indicated as it had been repaired. Therefore his total depth measurements are off by 2 feet. The depth a the north end was 8 feet and at the very other end it was 10' deep. The deep end was actually into a bank so the system is actually only 8 feet deep. In this lot there is little slope until right at the south end. 1� Now to compound the problem, the wrong depth of trench was used to calculate the area and the soils rating was misread e permit. It should be 150 sgft/bdrm. The system has 11/584Aqft if calculated as a standard trench and 952 sqft lculated per the equation in Table 3, Manual of Septic Tank Practices. .We have rewritten the inspection to show the correct depths. Sorry for the mistakes. Sincerely, 2 X 60 7� L�ti�Ty= 1/GS Leroy Reid Jr., hD, PE Presi ent 1220 West 25th Auenue 9 Anchorage, Alaska 99503 9 (907) 276-1361 GAAS-Hal GP_r_^QTER ANCHORAGE AREA BOROIV`�l _ HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM & NAME- `�' 0 /t� .moi AL/7 /4/k MAILING X G •�/ t %� ADDRESS PPHONEHONE j1 LOCATION ! 1' til 1 ,11-rtd"c('_LEGAL DESCRIPTION Lc t SEPTIC TANK: DISTANCE FROM WELL /.�� MATERIALNUMBER OF COMPARTMENTS— LIQUID MPARTMENTS LIQUID CAPACITY ZeF GALLONS. INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH /v , LENGTH, DEPTH; LINING MATERIAL �` �' DISTANCE FROM WELL /LO 7 BUILDING FOUNDATION___r_j0__e NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)yZ e-lL SO. FT. TILE DRAIN FIELD: DISTANCE FROM WELL , FOUNDATIO NUMBER OF LINES DISTANCE BETWEEN) ABSORPTION AREA LENGTH OF EACH LINE TOTAL LENGTH NEAREST LOT LINE , OF LINES TRENCH WIDTH IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE: IN. ABOVE TILE WELL:• �P ITANCE FROM / WATER TYPE DEPTH BUILDING FOUNDATION.G_SAMPLE NEAREST NEAREST ,,,�� / SEPTIC C� / SEEPAGE C -� / OTHER LOT LINE SEWER LINE, TANK ` , SYSTEM /� 7 ,. CESSPOOL , SOURCES Q DIAGRAM OF SYSTEM DATE -�� C APPROVED HEALTH AUTHORITY GAAB-HD-2 GREATEI-,,NCHORAGE AREA HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 A L `ROUGH 279-2511 Cag$ No. � SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT ztezn -'2 NAME OF APPLICANTS D k 0 __R U5k__g Iola A) MAILING ADDRESS , lno ti / PHONE NO. RESIDENCE ADDRESS .3 sQ% a)( IIo c,(:) LOCATION OF INSTALLATION_ Trat ( S 1JD x� LEGAL DESCRIPTION LUT / �'L,e APPLICATION TO INSTALL: SEPTIC TANK L -L , SEEPAGE PIT. ,DRAIN FIELD , OTHER TO SERVE THE FOLLOWING FACILITY_ 5:�- 4D -P cYraaA FINANCED THROUGH 'Sel-p TO BE INSTALLED BY ��P.✓5�1� �nryP��4 . ,� b TEST RESULTS ANTICIPATED DATE OF COMPLETION -24 BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS &1�2z_�ERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED - `- i .SEPTIC TANK SIZE 6 TYPE�f-SEEPAGE AREA t'es14_ D DIAGRAM OF SYSTEMa'�sf DISTANCES: /n"N AZZ-10 Sal -fa 17- 2-) V4; A_ I certify that I am familiar with the requirements of Greater Anc c above described system is in accordance with said code. c�L DATE .�5 APPLICANTS SIGNATUR TYPE mir/ .Soy/- T< .ge Area Borough Ordinance No. 28-6 ayd thatt e LU �.i WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological 8 Geophysical Surveys 16. WATER WELL CONTRACTOR'S CERTIFICATION: 15. Water Temperature ° ❑ F ❑ C Tl{ase d ri1Nd .0 der tgyt),y�risdlcllon and this report Is Irus to tr•e DestA�my knowdand belief; Re Iefered Buslnese11 NQslti CCCaJ%// cc/t I•ccee/nse Number r '��T "L • » f.6)'.� air�� x /.S—!% Date: ri I Il�pr ereUri'"' ',W2 06atri"iee: WNITE-Btrla5;GS, PINK -Driller, CANARY -Customer f Drilling Permit No. LOCATION OF WELL (Please complete either to, ib or Ic.) A.D.L. No. a. lBorough Subdivision Lot Block Ib. t/4gIrs. Section No. Town ship NO Range E❑ Meridian rlij % T of �n�-S-► ' r j- r 1 _ar_of_ai_ s❑ W❑ Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: A r� �'?l Address: !i-1C�/f✓�� q Street Address and Area of Well Location 2. WELL LOG Fea Sut Below 'w 4. WELL DEPTH: (final) 13 'y S. DATE OF COM LETION i — F2. M atarlal Type Top Bottom fl. I'll— ✓r•Ie % !�% i , 6. ,OCobls fool [3 Rotary E) Driven C3 Dug .i / •-+/V /.. / C) Au er Jetted Bored ❑ g ❑ ❑ C3 Other: /� rf� 7 i�.r1.�-. -., , -, . A_ foot./ri' f_I 2 n 7Z.- 7.USE:9TDomestic ❑ Public Supply ❑ Industry I� �� 1/ /r/ ) T •+-, ll� 2, 7_�) ❑ Irrigation ❑ Recharge ❑ commerical (/o f 3 Test Well ❑ Other: r l = h,! f '//�•/ �? •' 'h f' �� t `; )a A 8. CASING: ❑ Threaded 'D Wetded 'Depth � 7 7 diam. In, to It.Weight / I / IDs. ft. t�� r l� ,� r r, / / �• ,/ 7 diam. In. to ft. Depth StickuD_�I1. 41,1,j9. FINISH OF WELL: / (' Type: — Gl�O•f+_ J � Dlameter� rr !L� ( ✓,, �a !/ S of/Meth Slse: Length: i f� f•/f, i (, / 7^ i i 1' 7 Set between ft. and ft. r '. 1.. Backfilling Gravel pack C� 10. STATIC WATER LEVEL: IPCi ft. ❑ Above or ,Q Below land surface Date Equipment esed: II . PUMPING LEVEL below/ land surface and YIELD i p l' FAG It. after ! hrs, plinq..�tc.p,m. µUNG tPT• CF r O ECT10 l ft. after Ars, pumping g.p.m. ,dolt" -1I - 12.GROUTING Well Grouted: ❑ Yes ^�uo 1 Material: ❑ Neat Cement ❑ Other: V rN 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity g.p.m. ❑ Subm, ❑ Jet ❑ Centrifical ❑ Other 14.REMARKS: 16. WATER WELL CONTRACTOR'S CERTIFICATION: 15. Water Temperature ° ❑ F ❑ C Tl{ase d ri1Nd .0 der tgyt),y�risdlcllon and this report Is Irus to tr•e DestA�my knowdand belief; Re Iefered Buslnese11 NQslti CCCaJ%// cc/t I•ccee/nse Number r '��T "L • » f.6)'.� air�� x /.S—!% Date: ri I Il�pr ereUri'"' ',W2 06atri"iee: WNITE-Btrla5;GS, PINK -Driller, CANARY -Customer f i )M -W DRILLING^`f'-�';��ir'�,�}rr ' , INC.r'_ n UAL; iii%% o pC� . DRILLING LOG ' r: Well Owner- Ton �iunter Dorn. Use of Well Location (address of: Township, Range, Section, if known; or distance main road N-', of Lot 1, 2, & 3, Blk 1 Trails End Subdivision .Size of casing 611 Depth of Hole 265 feet Cased to 83. 6 -feet Static water level 8A ft. (Irb'ove) (below) land surface. Finish of well (check one) open end ( Xx Screen (. ) ; Perforated Describe screen or perforation N/A Well pumping test at 15 gallons per (hour) (iiihi f -e) for 1 hours with 100`/, Wit. of drawdown from static ,level. J Date of completion 12/9/77 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 TO 2 Casing; stickup 2 TD 40 Siltv gravel 4.0 TO 60 Gravelly hardpan: cobbly 60 TO 62 Wet gravelly har. dean `i re' ` 62 TO 76 Gravelly hardpan 76 To 260 Bedrock, water seen', in-,12yuadie frzct„res t-?,rr�„c-hmit- TO TO TO —TO- O -TO- TO -TO- TO -TO- TO -TO- TO -TO— TO - CetnYw3 Certificate Ntis. 814 & 973 , .. 2 — STATE Municipality of Anchorage -_o On -Site Water & Wastewater Program — (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I. D. 015-191-14 Expiration Date: 3z� 1. GENERAL INFORMATION Complete legal description TRAILS END; BLOCK 1 LOT 1 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: 11215 TRAILS END DRIVE *ANCHORAGE AK WILLIAM (BILL) THEOBOLD Day phone 346-8277 11215 TRAILS END DRIVE *ANCHORAGE, AK E Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Day phone TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance Received by - ' Wil. , Date: 11-2 E COSA to be released to the engineer, unless othemise requested by the engineer. COSA Fee $ 1� q 0 Date of Payment - 1 I /2 5/ 3 Receipt Number 0-5267G COSA # 0-:3 C. 15 Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: — 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat 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 al/ 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, 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. 6. DSD SIGNATURE V' System #1 Approved for 9 bedrooms. System #2 Approved for Disapproved. Conditional approval for 0 bedrooms. bedrooms, with the following Phone 337-6179 Date _00600 4 ...... .... .....*+ QO -.J, ey . Gar ess: CE -79 3 Original Certificate Date: OF AND The Municipality or Anchorpfje Develop,emt 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: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory V Other (RAS nme) 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: TRAILS END; BLOCK 1, LOT 1 A. WELL DATA Well type PRIVATE Parcel I D: 015-191-14 If A, B. or C provide PWSID# N/A Well Log (Y/N) Date completed 6/11/82 Sanitary seal (Y/N) YES Total depth 134 ft. Cased to 79 ft. FROM WELL LOG Date of test 6/11/82 Static water level 89 ft. Well production 2.25 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: ND ug./L. B. SEPTIC/HOLDING TANK DATA Nitrate 2.87 mg./L. YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 8/1/12 88 ft. 0.90 g.p.m. Date of sample: 11/15/13 Collected by: GEG. Ltd. Tank Type/Material SEPTIC/STEEL Date installed 4/22/82 Tank size 1250 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 7/24/13 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA *BELOW EXISTING GRAD M ScH�-J\J T fQ p� rC2��1'Ctt Date installed 4/22/82 Soil rating (g.p.d./ft`or /bdrm 150 System type TRENCH Length 73 ft. Width Gravel below pipe 8 ft. Total depth *12.66 ft. Eff absorption area 1 168 ft2 Monitoring tube SES Depression over field NO Date of adequacy test 8/11/12 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 24 in. Water added 805 gal. New depth 76 in. Elapsed Time: 145 min. Final fluid depth 37 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date "APPEARS TO BE MT ONLY AT END OF TRENCH, NOT A SUMP. LIQUID LEVEL IN TRENCH WAS 31" ON 11/14/13. D. LIFT STATION Date installed Size in gallons Manhole/Ac cess (YIN "Pump on" level at in. "Pump ofd' level High water alarm level at in. Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankiliR station on lot 100'+ On adjacent lot: Absorption field on lot 100'+ On adjacent lots Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout Td�7L'J Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main 5'+ Wells on adjacent lots 100'+ Property line 5'+ Absorption field 5'+ Water service line 10'+ Surface water 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 **0' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *10' FROM PIPE TO FOUNDATION WALL. **DRAINFIELD INSTALLED PRIOR TO 1986, SEE 1992 HAA. G. ENGINEER'S CERTIFICATION I certify that / 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. Engineers Printed Name JEFFREY A. GARNESS Date (7,/1/12 (Rev. 11105) Municipality of Anchorage a Development Services Department Building Safety Division 6 On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci. anchorage. ak. us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) 4 OSC131618 During a recent COSA on-site inspection and test of the potable water supply well on Block 1, Lot 1 of Trails End subdivision, the well's productivity was determined to be .90 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is .42 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. rvaa-»ja E 92,27 ao THE INFOWTIOW HEREOF[ IS FCR THE USE OF LENDING INSTITUTION; SP£CEFMILY YO �4H ANY COMFLICTS SETSEEM EXISTING STIUCTUsel AND PLATTED LOT LINES 09 EASEMENTS AM IS NOT TO SE USED FOR POSITIONING ADOITIO" MUCIUREj OA Fi°NCELIMEI EASEMENTS OF RE^.J' RD, OTHER THAM TNOSE SWA ON THE RECOROEO PLAT, ARE NOT SNOW NEREOM V{ ti OF • Shots A. Ho)1 tsC?:4 IN a i0( AS -BUILT SURVEY INO C06ERS SET THIS DATE) j f hereby certify that f have Mortpapee'e fncttcn of the futimjnge � ' described property: LOT I, RLOCN T, TRAILS'ESDs j Anchorage RecordlnQ District, Afaata arca j that the faprovmnta Situated thereon are Within the property tins and do not d cveriap or encroach on the lvinn .�. pr"rtY -- —.a thmreto, gnat no i8wovawant■ an property tylnp adI.Cent thereto encroach on the premises in 4satfon ad that ttWa are n, roa,.t,aya, treneafeSfon tfrxi, or other visfbte uaments on said property except 44 Prefleatedhereony40ated at Anchorage, Atoka this of A >+! Tpy,�, fd MOLT AID ASSOCtATES,.LAND SURVEYORS y7os ��r11 LS LIS Mt, vi. 2 8 $ f;.; o ENn- ) FCJ- 1 I r--o-L i CIS, '�L3 .ti.yo (Fk, AL F0310 3. 52 e.i.3z =N89'S9 91.c 3 �✓89'J✓ S9 37 � o THE IXFOP,eI,tTION #EkEOM fa FCS THE USE OF LEUDINa IMSTITUTICld$ rpECIFHUALLY OF :E TO ANY CONFLltTS r .e...+ 2Ej AME..SNia" ^�.£^.'O, 6e"#E. aT + e ET'WE-e tl EXiSrIm C1 WENEYTS AN PLATTED LOT LINES Ti WI THOSE :"M ON THE It tl01 TO a£ USED Fq P05I7ICWdwG Ec=m PLAT, A.." HOT AOOIT;LtiAL aTa g;SEN ai FUCELIMS S SHMM #EEEOY IN a 601 AS•90)1.7 WAVEY CNO CORNERS MY THIS GATE) I !hereby nrtfty that I have I mart0ageere ir- FQr.or+xd a described.4P`etf"1 of the iatiming { prc^ar rtyt LOT 1 r a10CS i, StAHISEa��'— i Archarage eecordlrV aletrlct I that the ta?rav�ants sitttr+Athareme� are within the prgerty tiros and a rat I overlap or oraroach an th C lying Rdr. property ..t ....roto, the at rA ixPravae"', an property tying disco.,. therato ""a an the proolsaa In "clan and that there are rw r� ye transafaafar ares, or other ViSIbta eaeer,mta on sold property except as indicated hereon. Dated at ArocharaS e Aleata this /7""� day of AP>%y ' t ice'. F6Yy i7 _ HOLT AND ASSOCIATES -,LAA SMVEYOeS S'70S- sye a N N OF 11 Gj . rr Iaf LGV 031, �aea.e w�..i/j77�eaLej�e nae... _ ...e*' Snena A. !io(i �; �r�CfsSjlOMRr-L'�. � �✓89'J✓ S9 37 � o THE IXFOP,eI,tTION #EkEOM fa FCS THE USE OF LEUDINa IMSTITUTICld$ rpECIFHUALLY OF :E TO ANY CONFLltTS r .e...+ 2Ej AME..SNia" ^�.£^.'O, 6e"#E. aT + e ET'WE-e tl EXiSrIm C1 WENEYTS AN PLATTED LOT LINES Ti WI THOSE :"M ON THE It tl01 TO a£ USED Fq P05I7ICWdwG Ec=m PLAT, A.." HOT AOOIT;LtiAL aTa g;SEN ai FUCELIMS S SHMM #EEEOY IN a 601 AS•90)1.7 WAVEY CNO CORNERS MY THIS GATE) I !hereby nrtfty that I have I mart0ageere ir- FQr.or+xd a described.4P`etf"1 of the iatiming { prc^ar rtyt LOT 1 r a10CS i, StAHISEa��'— i Archarage eecordlrV aletrlct I that the ta?rav�ants sitttr+Athareme� are within the prgerty tiros and a rat I overlap or oraroach an th C lying Rdr. property ..t ....roto, the at rA ixPravae"', an property tying disco.,. therato ""a an the proolsaa In "clan and that there are rw r� ye transafaafar ares, or other ViSIbta eaeer,mta on sold property except as indicated hereon. Dated at ArocharaS e Aleata this /7""� day of AP>%y ' t ice'. F6Yy i7 _ HOLT AND ASSOCIATES -,LAA SMVEYOeS S'70S- MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 . CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 015— I q I— 1 1. GENERAL INFORMATION Complete legal description VQG Cir 3.4_� HAA # �AQq Qnq'A-1 j5 Location (site address or directions) C 1 QU 5 Property owner ��M ►d )fiPa. Day phone Mailing address 1( Lending agency ir'ow�N �4 e ��� Day phone Mailing address �� 13o b 3 Yne.� Agent ]bio 5 y -&e_ . � I V1 LAN Day phone Z6,1! Address S t7 l I.L�i nldr-w4o_ ,. 1-1-1 Lrl�-s a'�Q R(oit7 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 021 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.., Name of Firm 0 �-�� �Ay--f— Phone Address Engineer' 6. DHHS SIGNATURE Approved for bedrooms. By: Date 29 Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments • The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev.1/91) Beck MOA #21 I 10, 0 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: I I yM-4-Ig Z -4 -,to Parcel I.D. DIE— t41- 14 A. WELL DATA Well type '1;�- If A, B, or C, attach ADEC letter. ADEC water system number - N/A Log present (Y/N) Date completed 6 -'1— R2- Driller De -Ac►- Total depth ti 3 Cased to -71 Casing height Sanitary seal (Y/N) y Wires properly protected (Y/N) y FROM WELL LOG AT INSPECTION � _ Date of test • I/• Z. f I. 3u • q i • /`d p Z i1 Static water level &q 85 rn (71 `'' �Y t rn 00 Well flow � j. :, ' 9 -P.M. g.p.m. Pump level SEPARATION DISTANCES FROM WELL TO: Z Septic/holding tank on lot 1157 ; On adjacent lots Absorption field on lot I ; On adjacent lots Public sewer main t4 1A Public sewer manhole/cleanout VIA Sewer service line I D Petroleum tank 141 0 WATER SAMPLE RESULTS: Coliform Nitrate �- 73 Other bacteria Date of sample: NOV 3n 1149 Z . - Collected by: _ S4 4 - B. SEPTIC/HOLDING TANK DATA Date installed 4 .,z2 - 8z_ Tank size 2.151D Compartments Cleanouts (Y/N) 1 `/ Foundation cleanout (Y/N) � Depression (Y/N) 2. High water alarm (Y/N) N�� Alarm tested (Y/N) Date of pumping__ Z I t� q •t-- A Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot iz=9- 1;5:Z On adjacent lots I L9 -"O Foundation I S To property line % Z -D Absorption field Q Water main/service line > I C) Surface water/drainage 3o - d N O �,V"aJ�6�vo �O $ •Q r �/ 72-026 (Rev. 7191) Front CONTINUED ON BACK PAGE C. LIFT STATION NIA Date installed Size in gallons Vent (Y/N) High water alarm level — "Pump on" level at Meets MOA•electrical codes (Y/N) — Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM -LIFT STATION TO: Well on lot -D. ABSORPTION FIELD DATA On adjacent lots "Pump off" l6el at Cycles tested Surface water Date installed q. Z Soil rating I � `� System type Length �3 Width Gravel thickness I Total depth Z Total absorption area Cleanouts present (Y/N) 'Depression over field (Y/N) N Date of adequacy test�- Results (pass/fail) for bedrooms Peroxide treatment (Past 12 months) (Y/N) + y If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: _ X1,2,1 Well on lot (d On adjacent lots 7 �t7 Property line To building foundation To existing or abandoned system on lot On adjacent lots 3D Cutbank �l v N L Water main/service line 7 yD fi L.1 ticc�� Surface water 30 �c rc°�e�� �U� Driveway, parking/vehicle storage area Curtain drain' t 5 r �"'� K z 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. Signature r� ��'` ;Y Engineer's Name fi • ; , ^ n. fAi' L.� V!' iJ Date t`, T, t 4,'p G �; 1 - �:V ��O S°Or.e*°ems°° Esse~: HAA Fee $ Z ZZ? Waiver Fee: $ Date of Payment Z — Z Date of Payment Receipt Number 2 7 Receipt Number 72-026 (Rev. 3191) Back MOA 21 'tI 0 I v., r-• y89'SyyO~f 91.x3 0 O C �l lG a • THE INFORMATION HEREON I= FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO S#QY ANY CONFLICTS EASEMENTS OF RECORD, OTHER RETUEEN EXISTING STRUCTURES AND PLATTED LOT LINES THAN THOSE SM WN ON THE OR EASEMENTS AND ii NOT TO Ri USED FOR POSITIONING RECORDED PLAT, ARE NOT ADOITIONAL STRUCTURES OR FENCELINIS SHOWN HEREON OF�1� o ~P••...•.. 09 eq:'160 Shone A. Naln :• `%• 0. 1S 4914 +, 0rfSS1001-���►' IM ■ 401 AS -BUILT SURVEY (NO CORNERS SET THIS DATE) I I hereby certify that I hays perforsied a I Mortgagee's inap`ctton of the following I described Property.- LOT roperty:LOT I, $LOCK 1, TRAILS EMD SUS. 1 I I Anchorage Recording District, Alaska and that the iRQrovemsnts situated thereon are within the property lines and do not overlap or encroach on the property I lying adjacent the------------ reto, that no I Isprovensnts on property lying adjacent I thereto encroach on the prewises in I question and that there are no roadways, I trsnwisaion lines, or other visible I essee»nts On sold property except as j indicated hereon. Dated at Anchorage, I Alaska this /7 ;oA day of djp 1922. '-� s'Y-.7 I HOLT AND ASSOCIATES LAND SURVEYORS y7os- CHEMICAL & GEOLOGICAL LABORATORY /A0+q\1P\n' A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. \ 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 61153 Chemlab Ref.# 92.6565 Sample # 1 Matrix: WATER Client Sample ID 1/1 TRAILS END Client Name :TOBBEN SPURRLAND, P.E. PWSID IIA Client Acct :TOBBENS Collected 11/30/92 ! 12:00 hrs. BPO# PO# :NONE RECEIVED Received 11/30/92 ! 14:00 hrs. Req# Preserved with Ordered By Analysis Completed : 12/02/92 Send Reports to: Laboratory Supery ozSTEPHEN C. EDE1)TOBBEN SPUR%LAND, P.E. Released By G 2) -----------------------------------------------------------------------------------------------------------------------------------. Parameter Results Units Method Allowable Limits ---------------------------------------------------------,----------------------------------------------------------------- NITRATE -N 2.73 Mg/1 EPA 353.2/300.0 10 Sample ROUTINE SAMPLE COLLECTED BY: STUART. Remarks: ----------------------------------------------------------------------------------------------------------- ....---... 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than rv4%SSS Member of the SGS Group (Soci6t6 Gdndrale de Surveillance) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 1184_ /37G4 DIVISION OF ENVIRONMENTAL HEALTH /T CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 1. GENERAL INFORMATION 2. Application Date December ember 1 , 1986 (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1; Block 1; Trails End Location (address or directions) 11212 Trails End Road (b) Applicant Name Pat Brodigan Telephone: Home Business 276-6408 Applicant Address 11215 Trails End Road, Anchorage, Alaska (c) Applicant is (check one): Lending Institution D ; Owner/builder 0 ; Buyer O ; Other D (explain);. (d) Lending Institution Alaska Continental Bank Telephone Address 2213 East Tudor, Anchorage, Alaska 99507/ATTENTION• Ca ey (e) Real Estate Company'and Agent Address Telephone (f) the HAA to the following address: S & S ENGINEERING SRB 196X Eagle River Road EagleRiver, A1��99577 TYPE OF RESIDENCE Single -Family kk Multi -Family D Other Number of Bedrooms �nfR Eft ,gOser„� �l6tb DA TA 3. WATER SUPPLY Individual Well L) Community D Public D Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsitet Public[3 CommunityEl Holding Tank D Note: If community well system, must have written confirmation from the State.Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 0 084) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA1A 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 Telephone 2 9 Address ce a 7A/y Y.\ V— I Date EAGI it n1lnV Vj% 1Z�� 6 �k Sell ie a • �..• .� ......r,.. • Ilrb�11 A. Sh•e,s� 's No. 114474 vv•� R�•••w•••••�' ekt.' FESS% 6. DHEP APPROVAL Approved for /� ',bedrooms by 11f -Date Z _2 " Rig Approved Disapproved Conditional Terms of Conditional Approval 1 / � r r \ CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) n � MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 1 Legal Description: A. WELL DATA Well Classification �• If A, B, C, D.E.C. Approved (Y/N) _ tyA Well Log Present( ) Date Completed tp - /U -AZ- Yield 1.7 (1Pt`1 -y - Total Depth 134 r Cased to / 3Y Depth of Grouting �— Static Water Level S A 1 1/ 8, Pump Set At Casing Height Above Ground 26 It Sanitary Seal on Casing O'N) Electrical Wiring in Conduit &N) Separation Distances from Well: Depression Around Wellhead (Y/&j To Septic/Holding Tank on Lot %00/_ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot 100 /'f ; On Adjoining Lots /o 3 /-f To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole CC - To Nearest Sewer Service Line on Lot Water Sample Collected by Date Water Sample Test Results f� ' Comments �f \.JI , r n w (c`- 5i B. SEPTIC/HOLDING TANK DATA Date Installed 10 -15 -BL Size IzS�- D No. of Compartments Z Standpipes ON) Air -tight Caps PN) Foundation Cleanout O/N) Depression over Tank (YI Date Last Pumped / Z - Pumping/Maintenance Contract on File (Y/N) 1-1 14 • for Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: Temporary Holding Tank Permit (Y/N) To Water -Supply Well /ov/f To Building Foundation To Property Line To Disposal Field S To Water Main/Service Line /V To Stream, Pond, Lake, or Major Drainage Course 11/1 Comments MUNICIPALITY OF ANCHORAGE nEPT OF HEALTH & y ENVIRONMENTAL PROTECTION Page 1 of 2 pEc 2 206 RECEIVED 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed / o •r S - °JZ Length of Field Width of Field �Depth of Field 1 z� 1108 D Gravel Bed Thickness Square Feet of Absorption Area �& !;--� Standpipes Present 19/N) Depression over Field (Y& Date of Last Adequacy Test /7 -/7--go Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well f art r"a To Property Line IC5 r To Building Foundation / Z To Existing or Abandoned System on Lots= ; On Adjoining Lots 3 J� To Water Main/Service Line 16 �� To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course tilA To Driveway, Parking Area, or Vehicle Storage Area 9 -AIJ ovt� Comments :' LnoAc- A -J— 1? -JS 1*11��7141p io —15-RZ PcR- D. LIFT STATION Date Installed Dimensions Size in Gallons V Manhole/Access (Y/N) "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments "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 & 5 ENGINEERING Date /Z ' Z� �' 6 SR B 196X CompanyMOA No. Fs1�-- C" EAGLE RIVER,, AI99577 „�•.�"�`~��ti Receipt No. 2an/ 60, �� O� �L,�l.�� b�6 Date of Payment 12-1Z�"/�� v fig• • y i"� � Amount: $ �-S tl • eal bb Page 2 of 2 72-029 (11194) soyse • f �pMr1 A.SU&44c 43 4�••;. t ��F y �> , �;'`�fiROPE5s1c''c . APPLIC^IT FILLS OUT UPPER HAL��NLY Property Owntl ` %— 7��«` ' Phone Mailing Address S 5q r7 � Zlp Code — Buyer y Address Zip Code Lending Institution Phone Address T Ct p L Zip Code c Realty Co. & Agent Phone 1�' - Date Address Zip Code Date Legal Description LCi Street Location 1(�L l N\ Type of Residence ID-Ifingle Family ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply Inspector individual ❑ Community ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. ❑ Public Utility For wells drilled prior to that date, give well depth (attach log If available). Sewer Sewer sposal Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: .� ,D ' !1 cr.—'{p �j Q� tLc �Y�-'MUNICIPALITY OF ANCHORAGE DEPT. C° ff-T�_ ENVIRONmENiA' F,O;ECTION 1982 w RECEIVED ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPRO DATE �� BY. —P Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received 72-02] 1110 Well to Tank Septic Tank Size 1 ��