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HomeMy WebLinkAboutSAND LAKE #2 BLK 4 LT 35Sand Lake #2 Block 4 Lot 35 #011-135-18 (mev 05NZrl8) Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221116 PID Number: 011-135-18 Dwelling: H Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Upgrade Name OHARA ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 8236 SEACLIFF ST ❑ other Phone Number of Bedrooms Soil Rating depth from original grade 3 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SAND LAKE #2, BLK 4, LOT 35 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Fi, Well 100'+ 50r+ TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity GREER TANK 1000 Gal. Surface Water 100'+ Material Number of compartments Lot Line 10'+ NA PLASTIC 2 Foundation 10'+ LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer MIKE N ANDERSON, P.E. Drainfield co/MT3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 100 ft Inspection 1 6/9/22 Location and description dates:2 .a TOP OF MANHOLE 3`d 4m ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date `, i • `': _ •n iT •�� _ ............. Septic Syste� ApprovedZ9 pP Date 2 2_3 Note: this appro does not include well permit requirements. `al /,�?yL��`,,r , (mev 05NZrl8) Permit No. OSP221116 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: SAND LAKE #2, BLK 4, LOT 35 PID No.: 011-135-18 m>¥> )22\4m)Q (§{()49K §\?)(\{\ 42y%eem% akGm,e�o ®m qQo) \\ » 4 0»¥ 4 G §Q(\ ) ) 22{} m §\G] ) ®\ G / 2\d2\ 2$4\\ ¥wwwm \§{)2 orb® \ �(\ y \/\ G m/\ , §\\ \ \§k 0 4\y > \y\ ®*y m & 2 SEA CLIFF STREET ? / \ol . \ \4' & 2 SEA CLIFF STREET MUNICIPALITY OF ANCHORAGE nienr Onsite Water & Wastewater Program _off S� --PO 8ml96650---- 4700 Elmore-RoaA — — Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni,orglonsite' � Department rtmunt On -Site Wastewater Disposal System Permit Permit Number: OSP221116 Work Type: SepticTank Upgrade Tax Code Number: 01113518000 Site Legal Address: SAND LAKE #2 BLK 4 LT 35 G:2224 Site Mailing Address: 8236 SEACLIFF ST, Anchorage Owner: O'HARA MELISSA A Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: ❑ Disposal Field © Septic Tank ❑ Holding Tank ❑ Privy Effective Date: 5/25/2022 Expiration Date: 5/25/2023 Lot Size in Sq Ft: 6750 Total Bedrooms: 3 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: Locate the end of the field in order to confirm the 5' separation from the tank to the field. Place a cleanout/monitor tube at the south end of the field. Received B) Issued By: Date: S 2 2Z Date:- ZZ MUNICIPALITY OF ANCHORAGE RU5H Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 011-135-18 Property owner(s) OHARA Mailing address 8236 SEACLIFF ST, ANCH AK Site address SAME Day phone Legal description (Sub'd., Block & Lot) SAND LAKE #2 BLK 4 LT 35 Legal description (Township, Range & Section) Lot Size 6750 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank 0 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade 0.. Renewal ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) El (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. (Signature of property owner or authorized agent) Permit/Rush Fees: 7,Z S Date of Payment: (a— 20z Receipt Number: 67060q7! Permit No. 0S P2 -'Z- 1 / l 6 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc May 15, 2022 Municipalities of Anchorage On-Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: New septic tank permit Legal: SAND LAKE #2 BLK 4 LT 35 To whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. The tank will be decommissioned per the Uniform Plumbing Code (UPC). The lot has a new AWWU water service therefore no well. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221116, Deb Wockenfuss, 05/25/22 1"=50' PROPERTY LINE EXISTING HOUSE-SAND LAKE ROAD-INSTALL NEW 1,000 GALLON PLASTIC SEPTIC TANK W/ 20" RISER, DECOM. OLD TANK PER UPC, MAINTAIN 5' FROM FIELD -SEACLIFF STREET-SAND LAKE #2 BLOCK 4, LOT 34 EXISTING WELL 100' RADIUS WELL -W 82ND AVENUE- SAND LAKE #2 BLOCK 4, LOT 35 SAND LAKE #2 BLOCK 4, LOT 33 SAND LAKE #2 BLOCK 4, LOT 19 SAND LAKE #2 BLOCK 4, LOT 18 SAND LAKE #2 BLOCK 4, LOT 20 SCALE: DJRDRAWN: DATE: SAND LAKE #2, BLOCK 4, LOT 35 Anchorage, Alaska LISA O'HARA 5/6/2022 SAND LAKE #2 BLOCK 4, LOT 36 SAND LAKE #2 BLOCK 4, LOT 17 LOT SERVICED BY AWWU WATER LINE WELL WELL water provided by comm. well on lot 34 water provided by comm. well on lot 34 WELL WELL Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221116, Deb Wockenfuss, 05/25/22 5' WATER EASEMENT PFrngncn n Rnnv AFl 49 TH SHANE A. HOLT LS -6914 ' S° , °fessional �Qo THE INFORMATION HEREON 15 FOR THE USE OF LENDING INST/TUT/ONS SPEC/F/CALLY TO SHOWANY CONFLICTS BETWEEN EX/STING STRUCTURESAND PLATTED LOT LINESAND/OR EASEMENTS,AND l5 NOT TO BE USED FOR POSITION/NGADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OFRECORD, ORANY OTHER LEGAL ENTITY, OTHER THAN THOSEAPPEARING ON THE RECORD PLAT; ARE NOTSHOWN HEREON, ( UNLESS INDICATED) NOTE.' FENCELINES THAT MAYAPPEAR ON THIS DRAWINGARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR P051TIONADDITIONAL IMPROVEMENTS. ANYPAV/NG SHOWN HEREON MA YBEAPPROXIMA TEDUE TO EXCE55IVE51VOWAND/OR /CE. THIS DOCUMENT IS PREPARED FOR THE OWNER OF RECORD, • ONLY. NO OTHER USE BY OTHERS /S ALLOWED. INCLUDINGANYSURVEYDATA OR MEASUREMENTS HEREON WITHOUT WRITTEN PERMISSION. ASBUILTSURVEY ff'=20` NO CORNERS SET THIS DATE I HEREBYCERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT35, SLOCK4, SAND LAKENO 2 ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREONARE WITHIN THE PROPERTY LINESAND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED ATANCHORAGE,ALASKATHIS 9TH DAYOF JUL Y 202 15128, FB214-61 4 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 907-345-5513 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 PHONE NEW O P (— C A LI_/ T -:.7&, I-- f (��:> ❑UPGRADE MAI LING ADDRESS ) (- L-1- C" 1.4 NY, q r .s LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS 7� Well Absorption area Dwelling�7 PERMIT NO. Uy DISTANCE TO: j� `� _� 1� 7 `I �' ,L (D '63 7 F ZQ Manufacturer( _ mMaterial_ i A- _ No. of compartments N Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth { y 0 Y DISTANCE TO: Well Dwelling -PERMIT NO. Jaz 2 Z F Manufacturer Material Liquid capacity in gallons O Well �J Foundation Nearest lot line PERMIT NO. w= DISTANCE TO: C" J u. Z No. of lines Length of each line Total length of lines Trench width Distance between lines F Z w i .� �a -"'�; GJ inches Q F Top of tile to finiji grade Material beneath tile Total effective absorption area ,r-7— inches d Length Width Depth PERMIT NO. Lu (7 Q F Type of crib Crib diameter Crib depth Total effective absorption area o. a w WWell Ch Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J J W Building foundation Sewer line Septic tank Absorption areafs) DISTANCE TO: OTHER PIPE MATERIALS I , _,I _ PV �- SOI L TEST RATING INSTALLER f REMARKS — I ` )TH : p 0 Y.. o �} / L i �;``• % JUNE 25, 1971 c�,J- APPROVED DATE LEGAL - J 72-013 (Rev. 3178) ���X 9.1- X,�I Xo�r- �-- I r- r�ff ff�w9, r�`��0.3� DEPARTMENTHEALTH AND ENVIRONMENTAL �0TECTION ° 825 'L' STREET/ ANCHORAGE/ HK. 99501 ' ^ 264-4720 , ki a 0 L_ F=� " rA L's 9= F:-' F:=o F= Fm? 1 -1 1 _r PERMIT NO. ( 82-1'0324 ) ` APPLICANT DOUG GALLANT BOX 4 -LL 99509 561-1165 LOCATION LEGAL L35 B4 SAND LAKE 32 LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH NUMBER OF' BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 92 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C_mEEF�'-r"— '_=-9 I �=-R_ 0Fen/�[-=1 E -o FE F:�'-11­ 0-4 it -S. THE LEN13TH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). -1L��� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. _-- -jFWv=o < � > I F-='#= 1=� _F I RD " S_--- F:� F-c"E= ��C-A U I F-70 F-= r--" —~_ BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 350 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. �E: FRVI I _T . F�' I �E �- 1= M E? FE Pit �A � I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR Ohl -SITE SEWERS FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE RESIDENCE IS REMODELED TO INCLQ8E MORE THAN ] BEDROOMS. SIGNED:�� -_-- ... J�`� ISSUED BY ���-DHTE__��.��.!�.^.�~=]~ AND WELLS AS SET ENLARGEMENT IF THE SOILS LOG ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION s +� TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: 1>00 6AL•.L.A NT DATE PERFORMED: $l dja LEGAL DESCRIPTION: 40T 3S K 4 SAW) 6Acy-r+ 14A SEC 1Q1 TIAN) P & 0 SLOPE SITE PLAN 1 T sI L_T 2 4 b� C•w2Av.a1.L v 5-0 n Ca V/ s G 8� D 7 18 s 14 15 Ci�•AL�i 16- 49TH •+••�'r;'y .. ` 17 • ° C �. 0. 2225-E 18� 0, UNE 25 1971 •i' 19 WAS GROUND WATER S ENCOUNTERED? LtTolo 0 P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop 20 I I PERCOLATION RATE (minutes/inch) u / 1, TEST RUN BETWEEN FT AND FT COMMENTS I R V I IV E XCAV&T-m C, PERFORMED BY: • CERTIFIED BY: S DATE: 53 • . 72-008 (6/79) CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION . PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of public water system located in '- +' '� .Y u ' '� - , Alaska, submitted in accordance with 18 AAC 80.100 by `-" - have been reviewed and are approved. Q conditionally approved (see attached. conditions). P t; o � �! '• ►+�'' �` `: P<` F S I' ? UVt•+Iz =q LGG o .Y"U,CY _+ryhrC +'0 q le W z_ _- :.�� �i TITLE DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change' (contract order no. or descriptive reference) Approved by Date The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the :1 d L) D Cv9 E,-6 S /-0 r_:_ 'J T:3 i f". 9 .5 3 ? j 5, { public water system was completed on. l-ys '— --_ (date). The system is hereby granted interim approval to operate for 90 days following the cpmpletion date. B TITLE UATE As -built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate_. a TITLE a DATE Municipality of Anchorage Development Services Department Building Safety Division On -Site Water BWastewater Program `^ 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 011-135- IF, HAA# 066usl 1. GENERAL INFORMATION Expiration Date: 3 — I --I — e Complete legal description SAND LAKE SUBDMSION N2: LOT 35 BLOCK 4 Location (site address or directions) 8236 SEACUFF DRIVE ► ANCHORAGE, AK 99502 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address KRZEMINSKI, TADEUSZ & JANINA Day phone C/O AGENT Day phone LINDSEY BURNET W/COLDWELL BANKER Day phone 2525 'C' STREET • ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 265-9118 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class "Co 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 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined In the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage (les and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, 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 Lime of the fest, 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 Nucfuate 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 Wit 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 Wit it confer any legal right whatsoever. 5. DSD SIGNATURE L/ Approved for — _q bedrooms. Phone 337-6179 Date _(.Le f 0 .. ff .y......amess;�.. '• CE -795 �'`�< Disapproved. Conditional approval for bedrooms, with the following stipulations: :.- •�o��N�.5RAND1i T WASTE WAT - • vRf1PRAM Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: /a —' — O 5 (51-ZrIl -.0000- (Rm. 17A1) Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water 8 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: SAND LAKE SUBDIVISION #2: LOT 35, BLOCK 4, Parcel ID: 0 11 — / 3 5-- /.g A. WELL DATA COMMUNITY WATER Well type *C' If A. B, or C provide PWSID# 216875 Date completed Sanitary sea _ Total depth to ft. FROM WELL LOG Date of test Static water level ft, Well production g.p,m, WATER SAMPLE RESULTS: Coliform .� oolonies/100 mi. Nitrate �' i mgJL. Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION ft. g.p.m. Other bacteria—J46 oolonies/100 ml. Arsenic: N A mgJL. Date of sample: 9/14/2005 Collected by: GEG. Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL/SEPTIC Date Installed 7/8/1983 Tank size 1000 gal. Number of Compartments 2 Cteanouts (YIN) YES Foundation cieanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 9/14/2005 pumper DENALI SEWER AND DRAIN C. ABSORPTION FIELD DATA Date installed 7/8/1983 Soil rating (g.p.ddft=ort(� 92 System type DEEP TRENCH Length 23 ft. Width 2.5 ft. Gravel below pipe 6 ft. Total depth 11.5 ft. Eff. absorption area 276 ft' Monitoring tube YES Depression over field NO Date of adequacy test 9/13/2005 Results (Pass/Faili PASS For 3 bedrooms Fluid depth in absorption field before test DRY in. Water added 603 gal. New depth 16 in. Elapsed Time: 12 min. Final fluid depth DRY in. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) NONE KNOWN If yes, give date — D. LIFT STATION Date Installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main line COMMUNITY WATER On adjacent lots Public sewer manhole/deanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots •100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 /+ Building foundation t0'+ Water main 10'+ Water service line t0'+ Surface water 100'+ Driveway, parking/vehide storage 5'+ Curtain drain NONE KNOWN Wells on adjacent lots '100'+ F. COMMENTS *WAIVER GRANTED BY ADEC ON 9/9/1989 G. ENGINEER'S I certify that I have determined through field inspections andr'. '* review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. ........ Engineer's Printed Name JEFFREY A. GARNESS Date 0�t S�D r HAA Fee $ Date of Payment Receipt Number �y (Rev. 12'01) Waiver Fee $ Date of Payment Receipt Number ���2011 GASTALD! LAND R RVEY PHONE NO. : 9072489362 i' SAND LAKE ROAD 0 0 0- W O Oct. 04 2005 05:33HM PS Ertl D Z O rt' '2 • ., Dei . c ; S 1a •• P i n i .' a '�' e�*Awl 4 . it�iU�s 0 0 0- W O Oct. 04 2005 05:33HM PS N D Z O Cal � 4 �O 0 Z O N MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services p DIVISION OF ENVIRONMENTAL SERVICES1 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # _ L ��� ` 1f� HAA # � �� — L 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) ISGK " -1C.�t �s ��r<� G� k� ,�`C' 1�1i1 I'Z Ll t/ Location (address or directions) (b) Property.own�er. HU� Telephone: (home) Business Mailing Address (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Z *- Tj Telephone !O (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% Number of bedrooms 3. WATER SUPPLY Individual Well ❑ Community Ix 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-siteX Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the Iegailty and status. 72-025 (Rev. 7/88) 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 G 5 • Telephone 7U �) Address Na Lt% Alc Date /-/j 6. DHHS APPROVAL Approved for by Approved Disapproved Conditional Terms of Conditional Approval CAUTION 0 A4,1 4 l •e•• ••g g e OY C. REID, I • if • D �' er�SFSE�51 : • ���'.� ayef.��P�-A,w.. Date ✓ 4� e 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. 72-025 (Rev. 7/88) Back Page 2 of 2 NICIPALITY OF ANCHORAGE (MOA) Zr `' Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: 1-6( r- 1 a dC P L s26 segCUK i U) 4U/ Sec. tv A. WELL DATA Well Classification If A, B,(Q) D.E.C. Approved Q N) II LogPresent (Y/N) Total th Cased to Static Water el Casing Height Above round Electrical Wiring in Conduit Date Completed Depth of Grouting SEPARATION DISTANCES FROM VVE, L To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest P is Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed Size 1000 QdtG No. of Compartments Standpipes &N) - - Air -tight Caps (DN) Foundation Cleanout (9N) Depression over Tank (Y/ JDate Last Pumped /_?_" lf�� Pumping/Maintenance Contact on File (Y/N) AM ; for N10 Holding Tank High -Water Alarm (Y/N)_ Temporary Holding Tank Permit (Y/N) ryf SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: I1 To Water -Supply Well I 16 To Building Foundation f(] To Property Line 1/9 r'– To Disposal Field — To Water Main/Service Line w �4--. To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 r C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata —Type of System Design I reyy_,� 7 Date Installed `) -e4�-!8-3 Length of Field 13 Width of Field o `l Square Feet of Absortion Area a I7 Depression over Field (Y/0 Results of Last Adequacy Test Depth of Field Gravel Bed Thickness /11 _ Statndpipes Present(Y N) Date of Last Adequacy Test 1"6 SEPARATION DISTANCEFROMABSORPTION FIELD: To Water -Supply Well IiS i* To Property Line ( To Building Foundation i% + To Existing or Abandoned System on Lot 0 ; On Adjoining Lots 10 '4 - To Water Main/Service Line %S~ To Cutback (if present) 1) To Stream, Pond, Lake, or Major Drainage Course 100 f To Driveway, Parking Area, or Vehicle Storage Area iii �- Comments FT STATION Date tailed Dimensions Size in Gallo Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments '"Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ; = �,�'rc1:It,ca�j Signed," `3 �` i �C'�'L � v®on0000c°°0c`t�& E7} j Company AV�'`�a �rgineer's Seal Date - I-13°'�f9 ® •off °°o ., MOA No. Receipt No. oaf 2 �Z (G)7.f" / Date of Payment 6� Amount: $ �1 � Receipt No. _ Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 19 I 71- oROY C. CF -2251 w 4 9��L� A pPafessia�tia� �-r4;� Time APPLIi 'NT FILLS OUT UPPER FIA►' ONLY Time Property Ownc Date Date Phone Mailing`Address ;i>:" -y=� �,! a✓1 %i Zip Code /,- Buyer Inspector Inspector Field Notes: (3) APPROVED BEDROOMS ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE /U — �` 9- 3 C.. BY: br LZ 'Qz" �S _ `CONDITIONS OF APPROVAL Soils Rating Address ; Zip Code Septic Tank Size Lending Institution �� ` J%�(1/J% '1. r1 Phone Address ;-���� ;Jr.`i�) f� _ 7�/, Zip Code Realty Co. & Agent Phone Address Zip Code Legal Description Street Location >/ Type of Residence ❑ Single Family Q Multiple Family No. of Bedrooms �❑ Other Water Supply - ❑ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ] Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal - .- 7 Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank - NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE`PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: (3) APPROVED BEDROOMS ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE /U — �` 9- 3 C.. BY: br LZ 'Qz" �S _ `CONDITIONS OF APPROVAL Soils Rating Date Sewer Installed Well To Absorption Area Well to Tank Well Log Received Septic Tank Size 72023 (3182(