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Home My WebLink AboutTRAILS END BLK 1 LT 8Treils End Block I Lot 8 #015-191 -07 Municipality of Anchorage.:':" Development Services Department .~ '.~-' Building Safety Division On-Site Water and Wastewater Program. 4700 S. Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 Page www.ci.anchorage.ak.us (907)343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. .~'t.~ OIOO~7 PlDNumben Ot~,- (91-O? "'"~: ~-~- S~o/~afn WastewaterSystem: [] New [] Upgrade ~'~'" ~ yot Lon~,/~o,'n ,~tt. , /ta cJ~. 9~5't g' ABSORPTION FIELD LEGAL DESCRIPTION ~w~e ~q, Well: F:.x~$1' [] New [] Upgrade n. r,. n. F~ D - .3 0 :Z ¥ ~ q/ID/ZOo t TANK SEPARATION DISTANCES I~ septic I'-I Holding [] S.T.E,P. [] Other, ~ Septic AbsorptionLift Holding Public/Pdvat~ Tank Field Station Tank SewerLine /~'/t~'~lO/~ ~' '~4:Z/t J~' 1~'4~)0 Gal w. ti3 ~c/'~¢1 \¥/ --.I"TSTAT'O" ~'"'"~ BENCH MARK ~--a~/~ c~,o¢./7~, oFxy.~/~,, o.;f;.~/ N. ~,,.tt o£ ko~¢ ioo,o~ .~ C:."'.: Engineer's Stamp Inspectionspedormedby: Flab~ff ~ec4. ;ve, Dates: 1" q/to/o/ Developme~Se~ices D~padment Approval_ -.~"-~'~tl' PERMIT NO: SW010057 PAGE 2 OF 2 EXISTING (1983) ' PID NO: 015-191-07 ~' SOIL ABS. TRENCH , SWING TIES: ~ ! EXISTING (1971) =. TO: ~ ~ o FDN. C.O."C" 8 , S.T.C.O. "D" t1' 32' S.T.C.O. "E" t8.5' 41' t '% o ' DBLC.O."F" 22' 43' , X~__[ C.O. "G" 35.5' 43' "F'~ N~ 1500 G~ '. .E.~ SEPTIC TANK :: · ~:'~3~'~ P~N VIEW aM : - '~ '. ~ ..... .-'./~ LOT8, BLK1 ~ ~HOUSE~{ '~ ' "' ........ T '~%~ ' ~ .......... ~ , , '~ GROUND ELEV. g7.g' ~ ~~E~ 93.0' : SEPTIC T~K~ 92.7' LOT 8, BLOCK 1, T~ILS END SlD SEPTIC TANK REP~CEMENT AS-BUILT INSPECTION REPORT PROFILE VIEW ~woP~c~c~sE~c~s SC~E:AS.OTED SCALE: 1" = 5' ~4~3o ECIIOS~ D~WN BYTFM ~CI [O~GE, ~S~ ~ 16 ~RIL, 2001 MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Apr 09, 2001 Expiration Date: Apr 09, 2002 Permit Number: SW010057 Legal Description: TRAILS END BLK I LT 8 Design Engineer: 0019 Flattop Technical Services Owner Name: MA'I-r SUBITCH Owner Address: 8401 LONGHORN STREET ANCHORAGE, AK 99516-1260 Parcel ID: 015-191-07 Total Bedrooms: 4 Site Address: 008401 LONGHORN ST Lot Size: 26997 SQ. FT. Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by ceiling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: .~"'_~. '~]//,~,-,o-~_. Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P,O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage .ak.us (907) 343-7904 ON-SITE SEWEPJWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. O t ~,- - t ? / -o '7 Permit Number SWOlO0~? Day phone Property owner(s) ~,~ Mailing address (1) Mailing address (2) Legal description (Lot, Block & Sub'd.) Lo/- ~.. Legal description (Section, Township & Range) Lot Size 2.[ '/?7 AcresQ Zip Code Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Well Only Water Storage [~] Jacuzzi [~ Water Softening Unit [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: '~',.~ ~ Waiver Fees: Date of Payment: ¥/~/ Date of Payment: Receipt Number: 0~' ~, '/'~ ¥ Receipt Number: {Rev. 12./00) LOT15 I '~ ,/' LOT16, TIMBERLINE S/D (VACANT) TIMBERLINE S/D , TRACT "A" ............. EXISTING (lg83) ~', ', /~SOIL ABS. TRENCH /: I ', EXISTING (1971) AREA EXISTING DSL. C1.~O 1000 GALLON INSTALL NEW SEPTIC TANKS " ........... -~ SEPTIC TANK INSTALL FDN. C.O. LOT 7 LOT 8 ," , TRAILS LOT 9 END SlD (VACANT) ,' '-. LONGHORN STREET LOT 8, BLOCK 1, TRAILS END SlD SEPTIC TANK REPLACEMENT SITE PLAN FLATTOP TECtlNICAL SERVICES 1 INCH = 50 FEET 14530 ECIIO STREET DRAWN BY TFM ANCl IOR~OE, ALASICA 99516 APRIL, 2001 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION ,825 L Street- Anchorage, Alaska 99501 Telephone 264~720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME I~'°~E J ~ N~W MAILING ADDRESS I LEGAL DESCRIPTION LOCATION . w~,,/ lAb.orpt,o. ~,.a~, . Dwelling 2~' ~ DISTANCE TO= I ~0' PERMIT ~ ~ ~o. o, co~,..~.n,, 2 Liq. capaci~allon~ IF HOME.DE: Inside length ~ Width ~ Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer ~ -- ~ Material Liquid capacity in gallons 0 Well ~ DISTANCE TO: /~ / Foundation ~2 / Nearestlotline j7/ PERMITNO~/~ m lines ~ Length of each line Total length of lines , Trench widt~ Distance between lines~ ~ Z No. of ~ ~ ~ ' Top of tile to finish grade ~ ~ Material beneath tile Total effective absorption area Length Width Depth m PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well DISTANCE TO: Building foundation Nearest lot line ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER . P'PE UATER'ALS p yC ~ , SOl L TEST RATING 2 ~0 F~ Y~,.,~ ~',., INSTAELER / ' - REMARKS -- -~ ~ ~' I ._,, / ............. APPROVED DATE LEGAL 72-013 (Rev. 3/78) PERMIT N0. i--1Llt-J i C I.t~'~RL i T~r' I2'F DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 8-o5 "L" STREET. ANCHORAGE, AK. 99581 264-4?20 r,t~l--S I TE SE~IEF-' I_IF'~SF~'F~DE PERI'-] I T ( 82:0614 ) APPLICANT LOCATION LEGAL HILLiAM & DIANNE STEVEN ESCROWED UPGRADE 82 LAB± TRAILS END ~B. RLLRRD SRR BOX 460-R 99507 ~49-1227 LOT SIZE 999999 SQURRE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUHBER OF BEDROOMS = 5 SOIL RATING (SQ FT/BR)= 240 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEF'TH= 9. 5 LEi'4~]TH= -128 I] AR'-.-' E L [)EF'TH= 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH'OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH.IS THE MINIMUIt DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). RE _r;-!l_I I RED SEPT T I~; TRr-.IK S T ZE= 5~-:10 I]FILLI_-It'-.IS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY HELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TL-~C, (2) I ~SPEC:TI I]I~S I:I~:E F4EL~LI IRED BACKFILLING OF ANY SYSTEM HITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTHENT WILL BE SUBJECT TO PROSECUTION. itINIMUM DISTANCE BETHEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET.FOR A PRIVATE HELL OR i50 TO 200 FEET FROM A PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC HELL MINIMUM DISTANCE FROM A PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO A COMHUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'ERI'-I I T E::-:;F' I RES DECEI'-IBEF-: "~,:-1.. -1'__--~- :32-: I CERTIFY THAT %: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEHERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEbl IN ACCORDANCE 14ITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEHER SYSTEH MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 5 BEDROOMS. SIGNED: APPLICANTO/HILLIRM & DIRNNE STEVENS V4. 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 2 3 4 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: A,~AC C-Al;' L,~/w ~ 72-008 (6/79) '~___ S{.OPE DATE PERFORMED: SITE PLAN WAS GROUND WATER ENCOUNTERED? _ ~t~0 SL 0 P IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time ~ Water ~'T Drop PERCOLATION RATE : ''/ ' oE: ~/~' TEST RUN BETWEEN ~ Ri~T~,~'~,,, '7-." ,A~¢2 fo' CERTIFIED BY: (minutes/inch) ' FT AND ,, ~ ~"~' FT MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: C¢~r'~ ~ DATE PERFORMED: LEGAL DESCRIPTION: 2 3 4 5 6 7 9 10 11 12 13 14 15 16 17 18 19,, E ,,,,:LS,,Io~. B IK\ L~"'t- 8 COMMENTS PERFORMED BY: ~-~,OVth, C~ //'[~)C~/,cI,~) SLOPE SITE PLAN WAS GROUND WATER S ENCOUNTERED? ~O L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time(~,w ;n.~ Water Drop ~ Z~5 ~o . t O , ~ ~ ~ ,. ~-~ tO ,~ z ,o~ , 90 .OZ PERCOLATION RATE I 0 [5 (minutes/inch) TEST RUN BETWEEN 4.~ FT AND /'l~t'Z' FT ~,oo ~,,~\~,~ ~e~cc +'"~K ,~ 2. ' CERTIFIED BY~ DATE:~--~ --~ 72-008 (6/79) ALASKA t [IUIROFImI I1TAL COrlTROL $1 FJUICi $, Irlc. ~ncji~erincj 6, ~nuironm~nta[ StuCIics PERCOLATION TEST DATA SHEET CLIENT ADDRESS DATE, 'C~cc ~- l~- ZIP CODE LEGAL LOCATION 'l'"~,,J~s_ E~. S~ · TOTAL DEPTH OF HOLE Iq 'r;C ft. ZONE TESTED. ~ ft TO q ~r~ ft READING # CLOCK TIME NET TIME DEPTH TO NET DROP RATE (min/in) ,, (v,-a ~,,,4es') DATUM +a~. o q '. 5 '5 .... 1 · or) -- m I )0 ' 0 3 tO I ' O0 "' lb: o~ --. i. o ?.. .-.. ,, 2 ~o: i~ i o I-D 7. 0 3 )o: L-~ lo I-°~ 0 I FINAL PERCOLATION RATE PERFORMED BY 'q)~ec~ (min/in) ..... Gp~m,TER ANCHORAGE AREA BORO~'--'~.H HEALTH DEPARTMENT , 'N? "? ' 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ,/..~///___~/~;~,,,.~ ~ ~/~'/,//._~. MAILINGADDRESS LOCATION~~ LEGAL DESCRIPTION SEPTIC TANK: ,,~,,,~ DISTANCE FROM WELL LIQUID CAPACITY /z::~ ~::~:~:) GALLONS. MATERIAL --~-.~~/~- NUMBER OF / COMPARTMENTS LIQUID INSIDE LENGTH INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PiTS / OUTSIDE DIAMETER ~ OR WIDTH ~ ~/~ LENGTH -~-~ x. DEPTH L~' LINING MATERIAL f~'"~"~/ ~--,~;;~r/ DISTANCE FROM WELl ,,'/~ ~ ~ BUILDING FOUNDATION "~'~" NEAREST LOT LINE '-'~"'-~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) '~' '~'~--~' SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL / . FOUN~ NEAREST LOT LINE NUMBER. O~ DISTANCE BETWEEN~LINE~ ABS0~JJ~N AREA. SQ. FT. LENGTH OF DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH OF LINES TRENCH WIDTH IN. ~TIVE IN. ABOVE TILE WELL: -'~'"-~"~'~-'"~ DISTAbiC~FR OM TYPE ~,'~-~,~'~ ~ DEPTH ~ WATER -~'BUILDING FOUNDATION ~ ' SAMPLE, ~ , NEAREST NEAREST LOT LINE / SEWER LINE / SEPTIC SEEPAGE OTHER ,TANK ~ SYST~ ~ , CESSPOOL ~ , SOURCES DISTANCES: DIAGRAM OF SYSTEM APPROVED HEALTH AUTHORITY GREA, ER ANCHORAGE ArEA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALIT~ - 3~00 TUDOR ROAD POUCH 6-650 "' ANCHORAGE, ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION LOCATION O _ -~'~//"~~__4.. .ff~') INSTALLATION OF: SEPTIC TANK SEEPAGE PIT TYPE AND SIZE OF' F'ACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED DRAIN FIELD TO BE INSTALLED BY ~/~' ~- OTHER NOTE= THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION= 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT ~ O SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK ~'~ / SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK , DRAIN FIELD SEPTIC TANK, ~ // . SEEPAGE PIT . To RIVER. LAKE. STREAM. DRAIN FIELD DRAIN FIELD SEEPAGE PIT. ALSO CONSIDER AR.LA WELLS. DRAIN FIELD SEEPAGE AREA SIZE,,~,~..'/f/~ J'"'~"~J/'~"' TYPE DIAGRAM OF SYSTEM CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 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, HEALTH AUTHORITY OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-6B AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE A PPL,CANT'S SIGNATURE _ GREATER ANCHORAGE AEEA BOROUGH HEALTH DTPAF.T,'.~ENT 327 E~GL5 STREET AMCHORAC-E, ALASKA 99501 Date Performed Legal Descrip'~ion: -BlOck.__ .~.~-i-~n ~ , This Fcrm Reports a: So~s Leg .... f--".. , .:Percoia:zon Tes~ Depth Feet Location Sketch Was G~ound Water Encountered?_ ,~/~/0 ' If Yes, At What Depth Readlng Date Gross Time l,le~ Time Depth lo }t20 Net Drop ............ .._ , _~: _ ........ ! Frc~o:~ea installh'{'ion:-~eepage Pi~ L./'/ _Drain Field D~pL~h'Of I;3et~f Depth To B'~ttom"Of Pit Or Trench_ /~1 ,., co~z~s:"~ ~,;~:' 9),,. '-~'~_~:)~ ~,~z,._ ~ . (?/,,-,,~ -,~/, '/,' - ' Z* .... f/ · Test Performed By:., ~Q [) ........ ' Well Owner DRILLING LOG [.'~ b ,~ ~ '~:6'7 .... ~' '~' 'Use o~e]l Do~. I~ocation (address of: Township, Range, Section, if known; or distance main road Lot ~ Block 1 Trails End Subdivision 6" 'Depth of Hole 200 feet Cased to ~' feet (below) land surface. Finish of well (cheek one) Size of casing · Static water level 35 ft. :(aboVe), Screen ( ); Perforated ( Describe screen or perforat.ion Well pumping t..est at 2 ga~ll°ns per .~ti~ii~') of drawdoWn from static level. Date of completion $ !lg/y? ' : Depth in feet from open end ( xx (minute) for ] hours with WELL LOG :ft. ground surface Give details of formations penetrated, size of material, color and hardness 0 85 TO 85 TO 200 TO·, / TO TO TO TO TO TO TO TO TO TO TO TO Exis tinz Well Bedrock, water seaps .in sooratic fracturos NxA~,VA Certified Contractor Certificate Nos. 614 & 573 .' 2 -- STATE From : ALPINE DRILL 90? 345 ~202 Sap.!0,1992 0~:14 PM PO1 LOCATION OF WELL LOCATIONISK~Ctt: STATE OF ALASKA DEPARTMEh¥ OF NAIURAL R~$OUROE8 DIVISION OF WATER WATER WELl. RECORD -- . ~- d==~L__~J ..... P_~J .... , ; WELL O~ER: .. DEPTHS M~SURE~ F~0M:Oc~s;r,~ ,op Dground sumac* II w~L~ D,m: . _ DATE OF COMPL~ION BOREHOLE DATA: D~pth Material Type end Co:m F~om T'- ~ ~ ~ fl below ~ top Of casing O ground ~urface -~e~ :..~ .......... ~ .... ~ ~ other I~ USE OF WEtt: )~ domestic ~ irfigution ~ monitor , Depths 3f opo~lingr~: tr., ft SCREEN tryP/: ' D~m' in O~V~L PAC~ TYPE: GROUT TYP[~: D~/ELOPI,~Ei~T O~E~ HOD; : ........ Duration: ....... PUMP INTAKE DEPTH: WE[.t. DISINFECTED UPON COMPL~ION? R~A~K$: PLEASE MAiL WHIIi: COPY OF LOG TO: DNRIDIVISION OF WATER PO BOX 772116 E.~,GLE RIV~ AK Ug577-2116 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. # '(~- ~ ~ \ -(~)'-~ 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing .address Lending agency Mailing address Day phone Day phone e Agent Address ~-~,~ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Day phone e TYPE OF WATER SUPPLY: Individual well NOTE: Community well Public water. I'f community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. . TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 Address Engineer's signature Phone DHHS SIGNATURE '~ Approved for 4 Disapproved. Conditional approval for bedrooms. Date ~'/~'2/q~' bedrooms, with the following stipulations: Additional Comments By:' 'T ~ '-.'-: The Municipali~ of Anchorage Depa~ment of Health and Human ~i~ (DHHS) i~u~ H~lth Authod~ Approval Ce~ifi~t~ bas~ only upon the repr~en~tions given in paragraph 5 above by an inde~ndent prof~ional engin~r r~iste~ in the S~te of Al~ka. The DHHS does this ~ a cou~esyto purch~m of hom~ and their lending institutions in order to ~tis~ ~in f~eml and s~te r~uimmen~. Employ~ of DHHS do not conduct inspections or anal~e data before a ce~ifi~te is i~ued. The Munici~li~ of Anchorage is not r~ponsible for e~om or omi~ions in the prof~ional engin~Fs wo~. 72-025(Rev. 1/91) Bac~ MOAit21 RECEIVED Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERV~Au Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: A. WELL DATA ~'~','~ ~'~c/ Pamel I.D.: W~II type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE RESULTS: If A, B, or C, attach ADEC letter. ADEC water system number ~ Y Date completed Cased to_ ~j_~ I FROM WELL LOG g.p.m. Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION g.p.m. Coliform ~) Date of sample: ~ B. SEPTIC/HOLDING TANK DATA Date installed ~.Tank size. Foundation cleanout (Y/N) *~/ Nitrate ~ Other bacteria I"1 I[~ Collected by: J.,. ~. I ~eo I 6~¢~ Number of Compartments I ' Cleanouts (Y/N). . Depression (Y/N) /~v/ High water alarm (Y/N) ~ Date of Pumping Y c. ^SSORP O..ELD DATA Date installed ~/~/,,,- ~/~' Length 7~ Width Effective absorption area 12.4,4:) Date of adequacy test Fluid depth in absorption field before test (in.); Ruid depth ~:~ (ins) Minutes later. Peroxide treatment (past 12 months) (Y/N) Soil rating (g.p.dJ1ff or fF/bdrm) ,,~ Gravel thicknes~ below pipe Monitoring Tube present (Y/N) ~ Depression over field (Y/N). Results (Pass/Fail) '~' For ~ O Immediately after.~,o gal. water added (in.): I C) Absorption rate = ~, ~7,~:)' g.p.d. t,~ If yes, give date. Total depth bedrooms 72-026 (Rev. 3/96)* Ee LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) 'Pump on" level at* 'Pump o~ level at* High water alarm level at* *Datum Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM.WELL ON LoT Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line z. IZO Z. .On adjacent lots On adjacent lots pUblic sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~- (~ Water main/service line ~',Z.~ ~ Property line Surface water/drainage Absorption field /~ ~ (**T) Wells on adjacent lots F. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain Building foundation ~ {1'? ~ 3 Lc). Water main/service line ~',~-.~" Driveway, parking/vehicle storage area /.. Z 5 Wells on adjacent lots ~~'/¢~D ENGINEER'S CERTIFICATION · . ~.~,~ ~.~: ..: ~.,-. I certify that I have determined thru field inspections and review of Municipal recL:r~!~.'~at.th~,., ...,. ~..~ ,,.ab°keJsy~ms~ .. ~, are in conformance with MOA HAA guidelines in effect on this date. ' '~ ;~ ~ ' Signature ~ Engineer'~~lame ~ Date of Paymen, /--,,' '/~.,~"--,/ '~' 'bO'~ / ! - Receipt Number ~ ,~ $/-,) f / ~'~ ~) 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number ~0N'~2~-1998 1E~: 24 CT&E ES ! ZtK CT&E Environmental Services Inc. ANCHORAGE 907~6!~01 P.04/04 CT&E ReL# Client Name Proj ecl Name/// Client Sample MatrL~ Ordered By PWSID 982385003 Tobben Spurldand P.E. I.m B r~B: I Trails End Dr.;nkbg Water Client PO# Printed Date/Time 06!02198 08:27 Collected Date/Time 05!26198 14:00 Received Date/Time 05/26/98 16:50 Technical Director: Stephen C. Erie Rcicased B} ~ Totot Coif form N~trate-N 0 0.100 Parcel I.D. # 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 1, GENERAL INFORMATION Complete legal description Lot 81 Block Ii Trails End Subdivision Location (site address or directions) Property owner . $,¢~e of A~bzska Day phone Mailing address PUBLIC EMPLOYEES RETIREMENT SYSTEM Lending agency Mailing address Day phone Agent K~th Nading/SENECA, INC. Address 34I Wc~t Tudor'~ Anchoraqe, Ala~h~. 99503 Unless otherwise requested, HAA will be held for pickup· NUMBER OF BEDROOMS: 4 \ . TYPE OF WATER SUPPLY: NOTE: Day phone 561-1022 Individual well xxx Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 Address Engineer's signature .'¢,HGINEERING River Loop Road No. 204 ,~!=__-~=_ 99577 DHHS SIGNATURE ~-. Approved for 'Z~' Disapproved. Conditional approval for Phone Date '::~-'7-'"Z-"~ ~t~- bedrooms. bedrooms, with the following stipulations: By: 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) Back MOA #21 ~ Municipality of Anchorage Department of Health ~& Human serVices. . HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-OT~! ~ I,, T~'L"~-I(.& ~x~O 5/1') Parcel I.D. A. WELL DATA · '. Well type ~tu_R-'~ If A, B, or C, attach ADEC letter.· ADEc water system hflmber Log Present ~_~) Total depth ~0~ ~ / --' Cased to, , . ~ ~ Casing height _ Sanitary seal ~N) Date of test Static water level FROM WELL LOG Well flow Pump level' SEPARATION DISTANCES FROM WELL TO.' Septic/holding tank on lot Absorption field on lot Public sewei' main. Sewer service line Nitrate Wires properly protected t~)'N) - g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout, ' ' Petroleum tank '~0~ [~TECT~ ~ ' ' Other bacteria WATER SAMPLE RESULTS: Coliform - *, (~ Date of sample: B. SEPTIC/HOLDING TANK//DATA / /2- Date installed ~,-'~"~1 / ~-3,7,-t~ Tank size [~ 0~'~- ~Oo~c Compa~ments. I Cleanouts ~N) ~Foundation cleanout (Y/~ ~ ' Depression (Y/~ ~0 High water alarm (Y~ ~/~ Alarm tested (Y/N). ~/~ Date of pump?!g ,, ~-'~-~ ~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Foundation· Wate~"mair{/s'e r~ice 'line'.. On adjacent lots /(~ ~- Absorption field, ~.~ ~ · ,, I(Y3 ~'.~-4~.~ ~"~ "~[~l~! ~:~'i.2.~'~: .'coNTiNuED ON BACK PAGE Surface water/drainage 72-026 (Rev. W91) Front. '~:::~. High water alarm level ~~ycles tested ABSORPTION FIELD DATA Date inStal'led ~_(~.--/3!! -~--.l ;.*~,-' :~ " ' ~ . t Length :'~. c/'i Width ,'~' Total absorption area, .: ...... ,;(/~ Depression over.field Y Results (pass/f,a. il)...."- Perbxide treatm~'r~t (past 12 months) (Y/~ Total depth Soil rating 12.c~sF/',~ "~System type Gravel thickness~, Cleanouts present ~N) Date __°f adequacy test for :: :::.: · .~/~' [~ If yes, give date ~' T,~ -' ..... SEPARATION DISTANCE FROM ABSORPTION FIELD TO: ~ Wel~n iot .[~..~c+ - '! .... ' ........ ~,c On adjacent lots t/0° Prope~y line T0 buildi~g foundation (O "/-' To existing or abandoned .system on lot On adjacent lots ~ ~ ~ ~' Cutbank h / J/']' Water main/service line bedrooms Surface water lO0 ~' Driveway, parking/vehicle storage area Curtain drain ~o~:.~o~~ ~.' '~'..:'~' I~;~.' !~::=~_..~-'l"l~/~.,~"f~ ~-.'r,~J~-~~.,. ' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effec_t on the date of this inspection.., Engineer's Name- . ' ' . '~' ~5~'~'~~' HAA Fee $ ~ Waiver Fee: $' Date of Payment 5'~' ~ T Date of Payment ~e;e~ ~um~e~ "~ do ~ ~:° 4:} . ' ~e~e~i..~e~. :' "- "'" 72-026 (Rev. 3/91) Back MOA 21 CItEMICAL & GEOLOGICAL LABORATORY ~ DWISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 P. STRE~I' ANCHORAGE. ALASKA 9951E~ I'EL. EPttOI'~E (907) 582-2343 FAX: (907) 561.5301 ~FA[T313 ,~$~[,I'5 fo~ I~¥OIC! ! 5854e Colle~tet : $[~ I? ~2 ~ 13:45 lat. ~OI ~ 00000000000000000000 00000000000C, 00000000 gOcl glO ~l :~T T ~--c~--'~ T Time - ~-, ' Time Date' Date Date Inspector Inspector Inspector Comments ' ~'_~-~: l~O~l~ ~') L.L~. ~._m~.S C~P~ '~/ ~,ditlon,l Approval I/ v ~ ~ ~cI~ ~ . / MUNIClPALI~ OF ANC~RAGE . . ~ ( --~ D?T. ,~D~ ~ ~ ~/~ ENVIR,~;g,',~,,/A.~,.O';~CTION Date .... er ,nstal,~ Permit .o..~ ~~ ~ptlc Tank Slz,~' ' ' ' ~11~ Rating~ q ~ U , ~ Holdin Tank SIz Well To ~sorptio~ Area ~ Well L~ Rece~ . ~ ~ Well to Tank /'- .APPLICANT FILLS OUT LOWER HALF ONLY[ Prope~y ~ner ~S~ ~[~ ~ ~ ~ Phone Uamng Aaaress ~ ~t~ ~~ 344-~88~ Buyer b'l%~ ~1~ ~ D~ Address 4708 ~] ~ Lending Institution ~ ~[ Phone Address ~ ~ ~ ~ 274--2551 Realty ~. & Agent ~[ ~[ Phone Address ~ 21~~ ~ ~ ~~ 263--2404 207 ~. ~ %t%~ ~1~. . L~al Description ~ 8~ ~1~ ~ ~ ~ Street Location ~ ~~ Typ~ Residence ~ingle Family ~ ~~ ~~ ~ Multiple Family No. of Bedrooms D ~her Wat~upply ~ndtvidual A~ACH WELL LOG. A well log Is r~ulr~ for all wells drlll~ Since June ~ Community 1975. For wells drilled prior to that date. give well depth (~t~ach log if ~ Public Utllit~ avallable.) Sew~ Dis~sal .. ~ndividual . Year Individual InstallS: .. ~ ....-'"" ' ~ Public Utility '" ': .... .' : 'When ~nn~t~ to ~blic Utility: ~ .... ' ~ Holding Tank .. ~'~ NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ALASKA 'b iUIROFImgI TAL COFITROL $ l tllC $, Inc. ~n(jin¢¢rinq $ ~nuironmenlal $ludies 11/27/82 -CENTURY-21 HERITAGE HOMES 207 E. NORTHERN LIGHTS ANCHORAGE AK 99503 SELLER - BILL REAVES BUYER-STEVENS SUBDIVISION-TRAILS END SUBDIVISION BLOCK-1 LOT-8 ADEQUACY TEST FOR'SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN AREA OF 372 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 66 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 1000 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS NOT ACCEPTABLE FOR A HOME OF 5 BEDROOMS. THE SEPTIC TANK WAS PUMPED ON 11/27/82 . SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLU~ OF 1000 GALLONS IS INADEQUATE BY 500 GALLONS FOR THIS HOUSE OF 5 BEDROOMS. 1200 LUcsl 33roi Auenue. Suite B · Ancl~oracje,/~loska 99503 · (907) 276-1361