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HomeMy WebLinkAboutSLEEPY ACRES LT 3Sleepy Acres
Lot 3
#017-091-80
Municipality of Anchorage Page of
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
Permit Number: .51/V920010 PID Number.
Name: y�M � ��`/
Wastewater System: ❑ New ❑ Upgrade
Address:
ABSORPTION FIELD
Phone:
N of Bedrooms.2
J
❑Deep Trench ❑Shallow Trench kV Bed ❑Mound ❑Other
�Deptl3;m
— --
---
LEGAL DESCRIPTION
--
Soil Rating: ), GPD/S Ft
Tot/al
6;nel grade
_
Lot: gg Block: % Sub/c�gvision:
3 lee / / s
Depth to pipe bottom from original grade:
�Y" JiA Ft.
Gravel depth beneath pipe
2r �� Ft.
_
Township:
Range:
Section:—
Fill added above original gr do:
'%! Gravel length: ? /)
FL
Ft.
---
WELL:❑ New ❑ Upgrade
•
Gravel width: 1�
Number of lines:
3
Distance between lines:
1
Fl
FI.
Classification (Private, A,B,C):
Total De
Cased To:
Total absorption area:
3
Pipe material: A�9�/]
ell
Ft.
Ft.
SD, Ft.
3C_`�'3
Driller: ��
Date Drilled:
Sialic Water level:
Ft.
—�
Installer � Q \1_
/ �YA,Z, �
Date installed /' /,
���'�
—
Yield: Pump Set at: Casing Height Above Ground:
—y er�PM Ft. -- Ft.
TANK
__-- --
SEPARATION DISTANCES
septic ❑Holding ❑S.T.E.P.
_
To
Septic
Absorption
LIII
Holding
ublic/Private
Manufa turer:: _._-
Capacity in gallons:
From
'rank
Field
Station
Tank
Sewer Lines
, /{%/J7a% Ile,
Well'
/
/0
)
Material:/ Number of Compartments�
Surface
Water
/Dv+
//JD 4_
-
—
LIFT STATION
Lot
Line
lb 4-
+
Size in gallons: Manufacturer:
Foundation
/
/
"Pump on" level at: T Woo "level at: High water alarm at:
Curtain,_
A
�E
7� I
_
Pump Make&M elm Electrical Inspections performed by:
Drain
-
�
Remarks:+ 4C) kytptQVI O-U/c�L (�4�rzt_�'
—�—o_---
BENCH MARK
.
Location and Description::
'72A
Assumed Elevation:
Assumed
ENGINEERS SEAL
�y1e \�`
Of• A ( 11
1�
—
v �p�E.••.....,,,gs,
%
a.r ..... ..........p
-------
' ', Dates: ''�..
Inspections performed by: 1
�� .�
�1
.... ...: .....0
t 2nd -tr�9=
��rn1� K::.:::r!:I M. Uu
y
T�/ /
�� P .• C 71
�1oy�op�fo;�7NP���-�
Department of Health and Human Services approva
Reviewed and approved by: _ �/� v - - — Date: ��� 92` _
�
O,A �w
0 013 (Rev 9/91) MOA 25
AS -BUILT SYSTEM DETAILS/SITE PLAN Permit SW970070
SLEEPY ACRES SUBDIVSION LOT 3 PID#017 091 80
23 E 140th Ave 22
EL=0.00 10' UTILITY ESMT, EL=0.00
....... _......... ........... __...... .. ........._ b....: ._..... _. .... ........... ......................
n
6 D
l SEPTIC
� 0
F
G
CO 9 1p
0
EX ST. S STEM AB DONED !. c
a
I>
A -C-17,2' COQ COEXIST STAN ANDONED
B -C=30,10' 1000 S.T.
A -D=23.20' cO C B
B -D=30,86' FCO
A -E=91.58' A APPROX. WATER LINE LOCATION
3 BD M
B -E=89.19' SFR
A -F=100.43'
B -F=97.07'
A -G=92.90'
B -G=77.11'
A-hi=101.64'
B -H=86,10'
LUT 4 L T 3 SCALE 1' = 50'
9Inn
95,31
4288,4135 a 89.190RIGINAL GRADE 89.28
'A PILITR IRRRIL VARIES
N
N 1000 GAL T
4 O1 SEPTIC 83.44 83.43
TANK 83,43 SEWER ROCK 83,42
83,45 83,43
./ �OF AT \4 91,44 81.17
......_.......L 4
91,65 —{I
WITH = I5'
*/4 TH*
...,..0 —� SCALES NTS69.69 ami
FUS
CE -711 wa PREPARED FOR1 KND ENGINEERING
w / 20441 PTARMIGAN BLVD
��/
iTOM SPENCER EAGLE RIVER, AK, 99577
pftlTS81OW00 / 7010 E. 140TH AVENUE (907)696-6111/Fax (907)696-8HI
ANCHORAGE, ALASKA 99516 DATE: 8/8/97 �RpWING 7t
SCALES AS NOTED e7o12—sl
d� c OPP
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
�sr
G
PAGE 1 OF
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW970070
DESIGN ENGINEER:KND ENGINEERING
OWNER NAME:SPENCER L THOMAS & CHRISTIE L
OWNER ADDRESS:7010 E 140TH AVE
ANCHORAGE, ALASKA 99516
PARCEL ID:01709180
LEGAL DESCRIPTION:
SLEEPY ACRES LT 3
LOT SIZE: 49043 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
�, - /S--- 9 7
00/4. <h,
DATE ISSUED: 4/24/97
EXPIRATION DATE: 4/24/98
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
THE SAND USED IN THE FILTER LAYER MUST BE] A CLEAN COARSE
SAND WITH 4% OR LESS PASSING THE #100 SIEVE AND 20 OR LESS
PASSING THE *200 SIEVE. A SIEVE ANALYSIS MUST BE PROVIDED
ON THE SAND USED OR OBTAINED FROM AN APPROVED SOURCE. /
RECEIVED BY:DATE: ��" "" �' S ^ e)'7
ISSUED BY: DATE: 4 - 9/
KN 1) ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AI< 99577-8736
(907)696-6111/PAX (907)696-8111
April 9, 1997
Municipality of Anchorage
Dept. of Health & Human Services
On -Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
Subject: Sleepy Acres Subdivision Lot 3 - Septic Upgrade Permit
Gentlemen:
Following a request from the owner, we conducted an adequacy test on the existing
septic system for the subject property. The system began backing up into the septic
tank after approximately 200 gallons of water was injected into the field. The owner
requested we proceed with the upgrade of the septic system. On March 2.2, 1997 we
dug a testhole for the proposed upgrade. The results of this test are attached. 'The lot
is served by a class "C" well previously approved by ADEC.
The proposed upgrade system will be placed approximately 12' north of the existing
system. As indicated on the site plan there is sufficient grade to maintain a gravity
system. The 1000 gallon tank is damaged and will be replaced. Due to concerns with
ground water we are installing 4' sand layer to provide separation from the
accepting soils.
As indicated by the site plan drainage arrows, natural drainage is away from this site
and will be maintained after construction. There is no surface water within 100' of
the proposed installation. There are no known curtain drains within 50' of the
proposed installation. No wells exist within 100' of the proposed installation and
the community well is over 200' away from the proposed site. This upgrade should
have no adverse effect on development of adjacent lots.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
1_KJFTD Engineering
Kenneth M. Duffus,
P.E.
attachments: On -Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
75
a
0
Y
N
N
i
U
4
4
C5
rvl
0
WASTEWATER DISPOSAL SYSTEM/SITE PLAN
SLEEPY ACRES SUBDIVSION LOT 3
`
EL=0.00 10' WILIIY CUR.
EL -OAU
SEPTIC
SEPTIC
o;
PROPOSED NEW SYSi
M 9 i1
C 4
( E .•S ICM
IX
wa sa.
r
� APPRO
(. WATER LINE LOCATION
150'
APPROX. CLASS 'C' WELL LOCATION
LOT 4
LCT 3
LOT 2
LOT 1
comm, Ity Water
Community Water
bmmunity W
24
21
NO PRIVATE OR PUBLIC WELLS WITHIN 200' OF
PROPOSED SYSTEM EXCEPT AS NOTED,
410 N
AV OF ALS
�KENNETII!CE S /
CC 77' S 116 A;
w
t'ROFI;SSION Nti s
LL=u.Vn
LL=nau
DESIGN CRITERIA
1. 3 BEDROOMS X 150 GAL./DAY/BEDROOM = 450 GPD
2, SOILS RATING: 0.89 MIN✓INCH = APPL. RATE 0.7 GPD/SF
3. 450 GPD/0.7 GPD/SF = 643 SF
4. 643 SF /15'(W) = 42.87'(L)
5, MIN. DESIGN SIZE = BED - 43' LONG x IS' WIDE x 0.5' DEEP
6. DEPTH OF GRAVEL BELOW PIPE IS 0.5'.
7. TOTAL DEPTH OF SYSTEM IS 7,0' FROM ORIGINAL GRADE.
.ter
Nf7TES:
I. TIE INTO BED AT MIDPOINT.
2. USE 1000 GALLON SEPTIC TANK, INSULATE TANK IF <4' COVER.
3. INSULATE BED WITH 2' ED BURIAL FOAM IF <3' COVER.
4. CONTRACTOR WILL ENSURE MAXIMUM 2% SLOPE INTO SEPTIC TANK,
5. INSTALL MINIMUM OF 4' OF SAND FOR SEPARATION
6. EXIST. TANK & SYSTEM '10 BE ABANDONED IN PLACE.
7. INSTALL FABRIC OVER FIELD.
TOM SPENCER
7010 E. 140TH AVENUE
ANCHORAGE, ALASKA 99516
KND ENGINEERING
20441 PTARMIGAN BLVD
EAGLE RIVER, AK, 99577
(907)696-6111/Fax (907)696-8111
4ni9i
Municipality of Anchorage
(T DEPARTMENT OF HEALTH & HUMAN SERVICES ,® 491H ,,,,,, ,,,..
825 " L" Street, Anchorage, Alaska 99502-0650"am
ti .....
SOILS LOG — PERCOLATION TEST �,�% Kenneth M. Duf' v �1
0,-'. • CE 7116 s Vii'
PERFORMED FOR: O t� S2I")LI.sR_, DATE PERFOR
LEGAL DESCRIPTION: S L�C'-'G-1Ll.j L J Township, Range, Section:
Fr7l SLOPE SITE PLAN
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
I)e6aNl��
m� r*1Br> oWsS' koso(�.
SPISW COurS`L
_terzc .Leyho-a
lza'�n
Lao St',
YA L
rneo-o�c.
,o u
WAS GROUND WATER 1
ENCOUNTERED? NO
IF YES, AT WHAT
DEPTH? —
Depth to Water After
Monitoring? _ "I t\ Dale: 't s19i
Reading Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
I aaz
(0—
z
I
3
II
q
3
2 y If
t?
to
A
-
I
S7o
II
_NKwZ)17WrwIG14_ � "� /I II
PERCOLATION RATE "81_ (mmulevinch) PERC HOLE DIAMETER _'a
TEST RUN BETWEEN _ 11 FT AND 12- _FT
COMMENTS
I
T
PERFORMED C'B�Y��La� CER"rIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE.
72-008 (Rev. 4785)
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
--'
PHONE
NAME'"�'z
/� > t, , / -rte-
CL� Pte, U N\ R, F_ A— ., K y, t�1 T(2.iJ e I �'ir70 -J� Z U UPGRADE
MAILING ADDRESS
1315 14 OP ii AmC(J__/ [,e_ 295o'6
LEGAL DESCRIPTION
LOCATION
NO. OF BEDROOMS
Uy.
h- Z
W I
Well
DIS7 bsorpwelling
TANCE TO: I�OT �.t � ti on area Dwelling I
Manufacturer ��Material
R = S rj= L_
PERMIT NO. —--
�t,{�� //1_
No. of compartme iis
Y l
Liq. capacity in gallons Inside IEHOMEMADE: length Width
Liquid depth
❑j
DISTANCE TO: Well — Dwelling --
--
PERMIT NO.
C7Z
02 FQ-
Manufacturer
Material
Liquid capacity in gallons
❑
wU
--
DISTANCE TO:
Well ^I I ^'
IN
Foundation
�B -r-- '�
Nearest lot line —
.�0
PERMIT NO. —®—
g 0 //45
wa u.;2
F z w
No. of lin s
Length of Vch line
'—J �'�
Total length of lines
Trench width
ij (J inches
Distance between lines
--�—•
Q
O
—
Top of tile to finish grade n t
�_ � �`
Material beneath tile
inches
Total effective absor tion
�7 f j
h
LengtWidth
—
Depth
PERMIT NO.
w
U
Q F
a-
Type of crib
Crib diameter
Crib depth
Total effective absorption area
ui
LU
ui
DISTANCE TO:
_
Well
Building foundation
Nearest lot line
w
Class TO:
DISTANCE
Depth
Building foundation
—
Driller
Sewer line
—
Distance to lot line PERMIT NO.
Septic tank Absorption area(s)
---- -----
OTHER
PIPE MATERIALS
As7M- D -_z, L/
SOIL TEST RATING
INSTALLER
—
REMARKS
LL�`OGq{E.L�X� l•4.C- C.uO-F�VLu-z V-�.
--
(/�✓flJ ^7I�—
10
�•• ••w•• • •• •'.d
-,1_ r-
P•• i••- •••••.w6••• c•
P A
-
_
_
'0. oi, 2225-HInklir
19 10711
APPROVED DATE LEGAL
--- 'LCL y /, 0 _: E Pv Ac n e
72-013 (Rev. 3/78)
'
` H -H Kj lyl 1: K0 1: FO" ril L..`1: "1- "FA CA FF ���F 4 CA FZ Fl C_ -i EE
`
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, HK 99501
264~472(--,1
K.Di V -4~ I 'T'EE ���E!il 0:-,-! 9 - il l: -T
PERMIT NO: 840115 HAND WRITTEN
DATE ISSUED: 04/02/84
APPLICANT: BOB RUNKLE R & || CONSTRUCTION
ADDRESS: 481l BISHOP WRY
ANCHORAGE, HK 99508
CONTACT PHONE: ]]8-1674
LEGAL DESCRIP: SUBDIVISION: SLEEPY ACRES LOT: �.: BLOCK: NH
SECTION: 35 TOWNSHIP: 12N RANGE: ]W
LOT SIZE: 49043 (SQ.FT. OR ACRES.')
I CERTIFY THAT:
1. I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOH) AND THE STATE OF ALASKA.
2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOH CODES AND REGULATIONS,
AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
I I WILL ADHERE TO ALL NOR AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK
DISTANCES FROM ANY EXISTING WELL/ WASTEWATER DISPOSAL SYSTEM OR PUBLIC
SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT.
IF 8 LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOH BUILDING CODES.
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED/ (2) HS~BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT/ AND (]) THE
ELECTRICAL WORK MUST BE DONE BY H LICENSED ELECTRICIAN.
SIGNED____DATE:
APPLICANT: BOB RUNKLE R & H CONSTRUCTION
ISSUED BY
'
DHTE
Department
825
Pt 4 5'-/- o / /'r
MUNICIPALITY OF ANCHORAGE:
of Health and Environmental Drotection
Street, Anchorage, AK. )501
264-4720
" # HANDWRITTEN PERMIT
erma nWELL AND/OR ON-SITE SEWER PERMIT
Applicant: Mailing Address:
AOf3 /ic LL 1 _ -- �
Location: Phone Number: -3- f/1�7`/
Legal Description: l__oT' -3, SL_C=E-til fief: -s
Type of Soil Absorption System Is: T
Trench: Drainfield: A _ Seepage Bed:
Lot Size: `/-9 C, P31
Holding Tank:
Maximum Number of Bedrooms: 3 Soil Rating(sq.ft/br) / 6--d X1
g�90
The Required Size of the Soil Absorption System Is:
DEPTH 6 LENGTH S3� GRAVEL DEPTH WIDTHZ)C�r r74 76
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE _ �� GALLONS #
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(Z) INSPECTIONS ARE REQUIRED * # #
Backfilling of any system without final inspection 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 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement
the residence is remodeled to include more that 3 bedrooms.
Signed:.__ Issued by:
Applicant
Date: "L-1/I"y
SWP/024(1/81)
if
PERFORMED FOR
I
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 2044720
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: .> ICC 1�1 tre S
DEP COL)
(F4E 1 Pews. ana
1 I 1
2 I
3 I
I
4-
5-
6
7-
8-
9-
10,
Loi" 3
(tAL) i", <i If w) ;um< ,'.J.A [ "U'Irl
(1hL) -}PIS 5:111-
w.tl. no r. Ll;lr�
SLOPE
�+t < L1u<V S�•,� -••�cl
' ®'• \ W> C<��WAS GROUND WATER
11- ENCOUNTERED?
IF YES, AT WHAT
DEPTH? _
(I" aL, lx<' <
D v0 / c—
21'-- SOILS LOG'
�. r
PERCOLATION��,
TENT
DATE PERFORMED: •> 1 �' + !J
SITE PLAN
S
t.
0
P
4 s </,
Reading
Date
1
1
MEN
mom
Depth to
Water
M.
3,2657,(
00 r o
cl
o n
Ak IN.
• '
G9
e,o�'�9tJr
f>
• v
-,.< Wei..
rai
s
60.. i
0®
S
t.
0
P
4 s </,
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
3,2657,(
00 r o
cl
o n
Ak IN.
• '
G9
e,o�'�9tJr
f>
• v
-,.< Wei..
rai
s
60.. i
0®
c,
•Reid,
Lo y C.
tA.
1r.
;7
—
• PERCOLATI NT, ' ,roe•. �-(minutes/inch)
TEST RUN BETWEh"S_- FT AND FT
COMMENTS �Li / '/;, nl_�U�=1 /• <�i ,'(t � pP.< -A-r i" i/1eic '/,'r ar S IC..
CY<n S/I C_ f. Nr �n:.rN rFr
YY�
PERFORMED BY: Lir`"°� CERTIFIED BY: --DATE: e 07J
/3�y
72.008 (%i/79)
ALASKA RUIR01111611TAL COnTROL SRICCS, Inc.
Engincerinq G 6ironmentol Studies
PERCOLATION TEST DATA SHEET
CLIENT ,JAIL C �rrCUn S� DATE
ADDRESS
ZIP CODE
LEGAL LOCATION L
it
9
TOTAL DEPTH OF HOLE %� ft.
ZONE TESTED T _ft TO �.,� ft
f -c
I
READING #
'
CLOCK TIME
NET TIME
DEPTH TO NET DROP
DATUM
RATE (min/in)
i-1--(2-
r o
7
-
y
--- ----- - --
- -- -
I __X7.
47
FINAL PERCOLATION RATE
PERFORMED BY
J��-d�n Ca �ro2 47%8i�
J
m
lq
e .•
P : •'1. 1
ow co
min/im
�qp•p v �j °ee�'
bJ CfJ4o �*t�i>� •°o�
C. Paid, Jr.
�y
ALASKA RUIROnn MAL COnTROL SRRUICCS,
Engineering & Enuironrnenlal Sludies
PERCOLATION TEST DATA SHEET
nc.
CLIENT_JILL DATE~
ADDRESS
ZIP CODER__
LEGAL LOCATION Lpr
TOTAL DEPTH OF HOLE
ZONE TESTED -_—..--_ft TO T _ Q____, -^-_-•-ft
READING CLOCK TIME NET TIME DEPTH TO NET DROP
DATUM
1, 07
-e-
' .37- - --
-- °- --
-�7
to
TE (min/in)
FINAL PERCOLATION RATE �_ (min/in)
PERFORMED BY
01
/
149:04
`� ����" � 4° n° •ave• . A. �` �Qrl
4orcr C. Roll, .•. «�' �A
r °e Ar.. � 3 i
�
s I I
Ian
122.0 bsl 251h Auenue ° Anchorage, Alaska 99503 ° (901) 276-1361
tX SOILS LOG
MUNICIPALITY (,F ANCHORAGE
DEPARTMENT OF I4EALT14 AND ENVIRONMENTAL PROTECTION PERCOLArION
TEST J
025 L. Street, Anchorage, Alaska 09501 2644720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: j_- �f �IYI A�V� DATE PERFORMED: -7
LEGAL DESCRIPTION:J^ Ot 3 1
Date
Gross
oRGAN7c moss
Jwrk 61no1DN
F
.a�a va 3
Al
2
15
Wdtr`i
Drop
/0 n
7/30/91
1 o:ob ArA
4
s 0.. 8 )
NO+ hrOWVI'Sk_�resll
c4lej-s1*H&4)
10 {
11 \
1
2 END l"l10C�
13
Date
Gross
14
Dep dt m
.a�a va 3
Al
15
Wdtr`i
Drop
/0 n
7/30/91
1 o:ob ArA
O
121
I O
17
l 0id/
Q
-4.,01
1 CE19
6omliv
pirf
,V'Voa
e-i5
SLOPE
SITE PLAN
—_ S /
WAS GHOUND WATER A/ S
ENCOUNTERED? _L° 0 • L —�~—
O
P
IF YES, AT WHAT E
DEPEH? —_— —_
Reading
Date
Gross
Net
Dep dt m
Net
Time
Time
Wdtr`i
Drop
/0 n
7/30/91
1 o:ob ArA
O
121
I O
l 0id/
f7
//: v6A
6omliv
PERCOLATION RAT[ / � � � (mmures/inch) / � -:
:/r,
�,%/
�^ TEST RUN BETWEEN Ff AND FT
COMMENTS Spvr12 %L�11�S--Q SLl('-0..GE Lo r c�v
PERFORMED BY: �/V. A.✓� Illers CAI CERTIFIED BY: _ DATE:
72008 (6/79)
,IUNICIPALITY CIF ANCHORAGE
DEPARTMENT OF HEALTH AND L NVIRONMEN rAL I'll OTECTI ON
825 L. Streit, Anrho,.,go. Ahmka 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMEDF
LEGAL DESCRIPTION: ILO 3/GSLUI'fi S
b
F I bark ro,a,,, f"ZA-+ � p � �
1 j _
—
2
3
7 / J -
8
9
O
ly so( OG
❑ PEIICOLA T ION
TEST
DATE PERFORMED. 6
VTF ✓1 AfJ
10
Dale
Gr,,%s
Tim,!
NotDepth
'1'Nno
Wa
Ncl
Drop
16
COD 7v
16
11
/
17
WAS GROUND WA FR
S
L
ENCOUNIERED?
/
Q,®4.v�wva®
O
12
P
It YES, AT WHAT
E
DEPTH?
13
14
Dale
Gr,,%s
Tim,!
NotDepth
'1'Nno
Wa
Ncl
Drop
16
COD 7v
16
A
4`
........... // :.
17
••••.
8 V' INE C:10"q JON
CE -4488 '••,:,
Q,®4.v�wva®
10
20
PERCOLATION RATE
TEST HUN UETWFFN -- F AND
Reading
Dale
Gr,,%s
Tim,!
NotDepth
'1'Nno
Wa
Ncl
Drop
I
I
-
COMMENTS 5
nchl
©'
7
PERFORMEOSY: (•K). fj-P, ry CEPTIFIEU UY:DATE:
7 2.00 0 (6/7n) /�� -
s' 1
I�IIInInI�pNf"tlY!'Alipt`nRNN140gAa�ullllnl illr�li{I�ugrru�Ilh;�yr�gllly�N�h4tlNAl6l'JN�'�h'@�tl,%V�nnlnlnlnlllllllnnnlulllllll��u�llllinnlln
0T
{� STATE OF ALASKA t /
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
CONSTRUCTION AND OPERATION CERTIFICATE
^L for
PUBLIC WATER SYSTEMS
A. APPROVAL TO CONSTRUCT ��) U I F 4 d:)
P�lens for the construction or modification of. i:AM1'I L
:i, I, L,'..,_1I I r (. T d f:�, y- - r f7 - e_ r✓ publicwater system coated
In _ 14fo( No> t+1E_ —_ , Alaeks, submitted In accordance with 18 AAC 80.100
by Aodj �Wr_ L—_ have been reviewed and are
LV approved
Q conditionally approved (see attached condltlona).
BY TITLE DATE
If construction has not started within two years of the approval date, this certificate Is void and new pi he and
speclflostlons must be submitted for review and approval before conatructlon.
B. APPROVED CHANGE ORDERS
Change (MINROI oma no. or diNII III Nf$WO$l
Approved by
Date
C. APPROVAL TO OPERATE
I
The "APPROVAL. TO OPERATE" section must be completed and aligned by the Department before on. water
Is made available to the public,
The conatructlon of the WS -i /��_S ae re Spublic
water system was completed on — )_C,i�-X (date). The system Is hereby
granted Interim approv I to operate for 00 days following the completion date,
9Y� TITLE DATE
As•bullt plans submit d during the Interim approval period, or an Inspection by the Department, has oo firmed
the system was constructed according to the approved plana, The system Is hereby granted final app vel to
o ernte.�
10-1 -� !
!/`�� DATE
8Y
j-�(prof, Tit S_LM ���-'4
fI C{ ,L 'f� r. 11 Y
�Y u Ihd k 5 7,Y �.� 1 �w i. S DIBTRIDUTION: 1. WHITE • ENOINEEn (OOMN611 eNeM
1 rte ^ 7. YELLOW - WAUR 9Y97EFILE (eempldf U n 0)
1 WWW I z,
o3. PINK • ENUINEEWMUNFe0R00011 (0011`014111Nlldn 0)
1ON0/ IRev. bIB'� M 4. UOLDENROD • MUNI.00R000H (OOMPIM 54010f, AI
I
STATE OF ALASKA
DEPARTMENT OF ENVIRONMENTAL CONSERVATION C C
CONSTRUCTION AND OPERATION CERTIFICATE
A. APPROVAL TO CONSTRUCT
for
PUBLIC WATER SYSTEMS
�4a.1 - (7A- )J-
n`SI�P�lans for the construction or modification of�c_940 rig S h I�
4� rr,?n,y� \ rr / �� / 3 jc� T1j -0-4- 2- �-3 public water system located
In k)c oQ4P_ ---,Alaska, submitted In accordance with 18 AAC 80.100
by_&r' J have been reviewed and are
L approved.
❑ conditionally approved (see attached conditions).
_ s = _Fid �� 68
By TITLE DATE -
If construction has not started within two years of the approval date, this ce)tificate Is void and now plans and
specifications must be submitted for review and approval before construction.
B. APPROVED CHANGE ORDERS
Change (contract ordor no. or deecrlpeee reference)
C. APPROVAL TO OPERATE
Approved by
Date
The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water
Is made available to the public.
The construction of the "TS ) . z ,'- 3
public
water system was completed on__L - 2=�Q -- � � l —(date). The system Is hereby
granted Interim approv I to operate for 90 days following the completion date. 4r
L
BA_ TITL DATE
As•bullt plans submllt d 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
Bery —
By TITLE DATE
Stora'Tc
(�o„e's�— � t o..—t'rT-a �p
T" S 7y'O Y- rl C t I a_' �,�' DISTRIBUTION: t WHITE - ENGINEER (CompleteY
fl
Cr 1 1 fCLLOW
%NG Y 0 aAtERS9TEMFEIGomIletLfton G)
ctlon C)
- - 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
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 017.091-80
1. GENERAL INFORMATION
Complete legal description Sleepy Acres Lot 3
HAA# hi �d �C7 Aq
Expiration Date: 9— 2 S= U l
Location (site address or directions) 7010 E. 1401^ Ave., Anchorage, AK 99516
Current Property owner(s) Bill & Patricia Bieber Day phone 345.5560
Mailing address
Lending agency
Mailing address
Real Estate Agent
Same as above
Day phone
Jerry Duhurst (ReMax) Day phone244.7237
Mailing Address 2600 Cordova St:, Anchorage.AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site"
Individual Water Storage
❑
Individual Holding tank
❑
Community Class ; Well
®
Community On-site
Public Water System -
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional
civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the
transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal
and/or water supply ;system. DSD also issues HAAs 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 sample results less than 30 days old. (Certificates may be reissued for a
period of up to one year with valid water samples.) Certificates are 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.
(00/u Baa)
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LLS66 NV Tf3 'PAIS ue Iwje;d 6t Z ssajppy
6669 969 auoyd
ul�aaul u3 aNX wa!d;o aweN
voge0elsui10 awl; ay} le }oa}}a ul suol}eln6ai pue 'saoueulpio 'sapoo ale}S pue IedlolunW algeopdde
Ile yi!nn aouelldwoo ul (aje)sl wa;s Cs lesodslp ja;enna}Senn jolpue liddns ja}eM a}ls-uo ay} `uol}oadsul
PUL uolle6l}sanul Cw wa; pue Salg a6eloyouy;o Al!ledloluniq ay; wa; paulelgo uollewjo;ul ayi uo paseq
;e o �}uan ales (d I 'ulajay paleolpul ain}onils ;o adAl pue swoapaq ;o jegwnu ay; Jo; alenbape pue
leuol;oun; 'ales (a�e)sl wa;s�Cs lesodslp Ja;ennalsenn Jo/pue llddns ia}enn a}ls-uo ayl 1e43 sMoys `uol;eolldde
slyi Jo; sau!laP!nJ lenaddy lluoy}ny y}leaH ay; ul paulgno sainpaooad uo paseq uol;e6lisanul
(w }ey; C;uan ! rnolaq uMoys alep uol}ep!len ayi ;o se pue olaaay paxWe leas Cw Aq pa' Up'Go sy
U33NIJN3 AG NOLLo3dSNl dO 1N3W31`d1S 'ti
Municipality of Anchorage .
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program •"
4700 South Bregaw St.
P.O. Box 196650 Anchorage. AK 99519.6650
www.ci.anchomge.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Descroon: sleeov acres Lot 3 Parcel ID: 017-91.80
A. WELL DATA
Well type rt-.- If A, B. or C provide PWSID # 8421-FA•273 Well Log (YIN)
Date completed _
Total depth _ft.
Date of test
Static water level
Sanitary seal (Y/N) _ Wires properly protected (Y/N)
Cased to _ft. Casing height (above ground)
FROM WELL LOG AT INSPECTION
ft.
Well production 9 -p.m
WATER SAMPLE RESULTS:
ft.
Coliform 0 colonies/100 ml. Nitrate 0 mgA. Other bacterlajL colonies/100m1
Date of sample: 0811312001 Collected by: KND Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel
Date installed 08M411997 Tank size 1000 gal. Number of Compartments 2
Cleanouts )L Foundation cleanout Y_Depression over tank (-High water alarm N6
Date of pumping 4125101 Pumper A+
C. ABSORPTION FIELD DATA
Date installed OB115M997 Soil rating (g.p.dJW or ft=/bdrrn) QZ System type jhd
Length 4_ fL Width 15 ft. Gravel below pipe 2.28 ft.
Total depth 6.3.8.1 ft. Eft. absorption area 141jMonitoring tube Y Depression over field y
Date of adequacy test 04RS101 Results (Pasa/FaiQ Pass For I bedrooms
Fluid depth in absorption field before test L in. Water added JU gal. New depth IL in.
Elapsed Time: Q_ min. Final fluid depth L In. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN 3 type) no If yes, give date
00'00£$ swalss, �IaaaS/iTaN f£0
wvtl E:S0 i0/6c/ jegwnN 10909M
/UeWAed 10 8380
s eed jeAmm
1WZ1*A816
jegwnN idIODGM
lueuu(ed 10 9180
6ej VVH
'g.
NOLLVDIdLLM30 S.M33NION3 V
S1N3WWO0 A
+—UF slot lugOe(pe uo speM +, uIpiP ulaunO
+,If 9BwMs 9R4en/8uPVgd 'A9MenY0 +, velem eoeynS —+ F eu8 eoWgS jeleM
+, ulew JeleM uogepun0l BulPling gull dyedad
:01 101 NO 01314 NOI1dMOSSV WOMB 30NV1SIO NOLLVlMd3S
+,O;F Slol iueoe(ps uo slleM
+,cor ie1em soel+ns gull eolnies jolum +,Or ulew velem
+.S Pleg uopdio$W
+.J� gull AUedOJd ' uogepunol BulPling
:01 101 NO NNVI duSNIOIOH/J�LLd3SS W_OW SS330NV1SIO NOI1VWd3S
YN el BulPIOH � gull eolnies opdes/ jameS
inoueelo/elo4uew jemes Olignd ulew iemes olignd
9301 lugoe(pe UO
Rol lueOe(pe UO
YN MUD pleg uopCJOSW
----VW 101 uo Mom IAIPIum OgdeS
:Ol 101 NO ll3M WOMB S33NV1S10 NOI1VWd3S
S33NVJLSIO NOLLVHVd3S '3
6quewepnbei Ilnwp g uuele g9eyy pg3Sel SelOAO wn4e0
'ul le level uuele JeleM Offul — le IBAGI .10 dwnd, •ul — le level ,uo dwnd,
(N/A) SSODW/e104uep1 suolleB ul ezlS 6Fr Pellelsul eleO
NOLLVIS kill '0
•%'p,
�e0
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;,.
a :
Y SAI
ew8N PelulJd Sleaulllu3
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ul eve swelsAS enoge 941 /947 sprwer led un
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S1N3WWO0 A
+—UF slot lugOe(pe uo speM +, uIpiP ulaunO
+,If 9BwMs 9R4en/8uPVgd 'A9MenY0 +, velem eoeynS —+ F eu8 eoWgS jeleM
+, ulew JeleM uogepun0l BulPling gull dyedad
:01 101 NO 01314 NOI1dMOSSV WOMB 30NV1SIO NOLLVlMd3S
+,O;F Slol iueoe(ps uo slleM
+,cor ie1em soel+ns gull eolnies jolum +,Or ulew velem
+.S Pleg uopdio$W
+.J� gull AUedOJd ' uogepunol BulPling
:01 101 NO NNVI duSNIOIOH/J�LLd3SS W_OW SS330NV1SIO NOI1VWd3S
YN el BulPIOH � gull eolnies opdes/ jameS
inoueelo/elo4uew jemes Olignd ulew iemes olignd
9301 lugoe(pe UO
Rol lueOe(pe UO
YN MUD pleg uopCJOSW
----VW 101 uo Mom IAIPIum OgdeS
:Ol 101 NO ll3M WOMB S33NV1S10 NOI1VWd3S
S33NVJLSIO NOLLVHVd3S '3
6quewepnbei Ilnwp g uuele g9eyy pg3Sel SelOAO wn4e0
'ul le level uuele JeleM Offul — le IBAGI .10 dwnd, •ul — le level ,uo dwnd,
(N/A) SSODW/e104uep1 suolleB ul ezlS 6Fr Pellelsul eleO
NOLLVIS kill '0
JUN -20-01 08:27 FROtI-CT&E ENVIROMOTAL SRV
G CTBE Environmental Services Inc.
`e irrr rrrri rrrrr�
CF&E Ref.N
1013368001
Client Name
KNM Engineering
Project NawW#
Sleepy Acres, Lot 3
Client Sample ID
Sleepy Acres, Lot 3
Malls
Drinking Water
Ordered BY
PWSID
0
Sample Remarks
Penn
Resahs PQL
8075615301 T-008 P.02/03 F-853
Client PON
Printed Date/flme 06/1912001 17:38
Collected Date/rime 06/1412001 13:20
Received Date/time 06/1412001 113:40
Technics) Direc hen `i7
Released 'H
Allowable PMP Aaabllis Init
Units Method limits Date Date
Natere Department
NitmtrN
0.5000 0.500 mg/L EPA300.0 (<10) 06/14/Ul SCL
Microbiology Laboratory
p coV100rnL SM189222B (<1) 06/14/01 SKW
Total Coliform 0
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. # L7-19 / —9�5`
1. GENERAL INFORMATION
Complete legal description
ICIPA�"' OF ANCHORAGE
ENTAL SERVICES DIVISION
UG 13 1997
RECEIVED
HAA # � mac \
Location (site address or directions) '!�7
�6
Property owner
Mailing address
Lending agency
Mailing address.
Agent
Address
Day phone
/
Ili //l /�� to
//� J111 /; 11 p—//J /1 p �
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
2
i
Day phone
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site �\
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-02000 l/91) Front MOA N21
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 KNI) €ngineering Phone 41�9
Address 2044Pl
_1jrniganBlvd.
Engineer's signature
6. DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
Additional Comments
M-
_ Date
o�o��e`01
(E OF A4 ®1
:�P .•••......,••9S, Y�
p'
•... t. x
J.S
r , Kenne;n M. ���
n4` '90.;
•SSIaNP�
bedrooms. ,e%�,..�®�
4UTIC
bedrooms, with the following stipulations:
Date / Z / 92
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.1AJ1) Back MOAN21
ORA
Municipality of Anchorage MUNICIPALIT YOF NCE$ DIV E
C*D'
N
DEPARTMENT" OF HEALTH & HUMAN.06�k
Environmental Services Division 11997
825 L Street, Room 502 • Anchorage, Alaska 99501 • (&LW 34.3-`4,7144
Health Authority Approval Checklist R E C E I v I"
Legal Description: LoT , .5 /['Pj9.e.z__ Parcel I.D.: JYC�
A. WELL DATA /
Well type _ �� If A, B, or C, attach ADEC letter. ADEC water system number.
Lo
g resent Y/N p ( ) _—A/ ---Date completed_
Total depth Cased to _-_ Casing height (above ground)
Sanitary seal (Y/N) Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well production g.p.m. �g.p.m.
WATER SAMPLE RESULTS:
Coliform —�Z—— Nitrate _ ® - Z I -j Other bacteria
Date of sample:Collected by:�/��
B. SEPTIC/HOLDING TANK DATA
Date installed 6' -1V' -1Z Tank size _Z92ML Number oAf/Compartments --,?� Cleanouts,(/Y,//N)�
Foundation cleanout (Y/N) _� Depression (Y/N) �_ High water alarm (Y/N) /yA
Date of Pumping NA —Pumper
C. ABSORPTION FIELD DATA
Date installed/5�/ % Soil rating (g.p.d./ft2 or ftz/bdrm) :ASystem typec�C�
Length 'Widthf/ Gravel thickness below pipe 12"-26 _Total depth
Effective absorption area _ Monitoring Tube present (Y/N)_ Depression over field (Y/N)
Date of adequacy test_
Fluid depth in
Fluid depth
Peroxide tri
72-026 (Rev. 3/96)*
/Results
field before test (in.);
(ins) Minutes later:__
(past 12 months) (Y/N)
For
l imediately after gal water ad�c�d (in.):
r
_ Absorption rate =
_ If yes, give date Z
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at*
*Datum
"Pump off" level at*
SEPARATION DISTANCES FROM WELL ON LOT TO: / Z
Septic/holding tank on lot��r l On adjacent lots
Absorption field on lot %V1 On adjacent lots /y
Public sewer main 4114 Public sewer manhole/cleanout
!
Sewer /septic service line �� "� Lift station //
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation Property line Absorption field /D
Water main/service line ✓�Q ''f Surface water/drainage //J Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
! / I
Property line Building foundation Water main/service line
Surface water M i4 Driveway, parking/vehicle storage area r U[J f'
jjll � !
Curtain drain �/f Wells on adjacent lots �.17f
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal records
in conformance with MOA HAA guidelines in effect on this date.
Signature M
Engineer's Name c? /S,
Date
HAA Fee $ vV
Date of Payment O /�
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
area
�\ MUNICIPALITY OF ANCHORAGE �}fi
\\\("`\!\\�^,,,///��) Department of Health &Human Services
DIVISION OF ENVIRONMENTAL SERVICES
&logy 343-4744 ZINTS
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # c') 1 —h - t� X 8 0 HAA # t '02'_\ L:L,(
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
7060 E: I Vo /,A
(b) Property owner D14. ��laL ___ Telephone: (home).3 Business
Mailing Address %010 E 1 140i-1
w
(c) Lending Institution �u4 LA� L.,&, o,-tk Telephone
Mailing Address K -'—
(d) Real Estate Company and Agent
Address
Telephone — nCo� -
S
(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
3. WATER SUPPLY
Individual Well Community Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site Public ❑ Community CI Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/8B) Page 1 of 2
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N0lIVWH0dNI ONY V1V4 'HOHV3S 31Id 'S1S31'SN0II03dSNl ONIOIAOFid Wdld JNId33NION3 '9
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
MUNI*,
F ANCHOR/QQ HECKLIST - FEBRUARY 1984 t
ENVIRONMENTAL SERVICES DIVISION 343-4744
a i 1989 Legal Description: Lo- 3 -R1"p/ Ac 12ES
MARSRC_ 35Q I, —6LVJ
A. WELL DATA RIS C L- I V S D
Well Classification C 0-_21-,<✓&-�7 3 _ If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Date Completed
Electrical Wiring in Conduit (Y/N)
Depth of Grouting
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Yield
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot
Water Sample Collected by Date r�
Water Sample Test Results — E' tel__ NP Mn.l7 � /Y03
Comments
B. SEPTIC/F69MO Pa TANK DATA
Date Installed 1.11$'1 _Size __LCrt�No. of Compartments 'ty'/0
Standpipes (Y/N) TIAL O Air -tight Caps (Y/N) _ Foundation Cleanout (Y/N)
Depression over Tank (Y/N) rsi Date Last Pumped - HA' C,l& I181 IActmerS
Pumping/Maintenance Contact on File (Y/N) NlAr ; for --N-14
Holding Tank High -Water Alarm (Y/N) — NIA Temporary Holding Tank Permit (Y/N) N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well 130 -F To Building Foundation
To Property Line
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments
To Disposal Field — 1 y (
72-626 (Rev. 7188) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 10o Type of System Design lt110L i2srtL14
Date Installed NZBy Length of Field 53
Width of Field �' Depth of Field 10-/2 '
Gravel Bed Thickness
I/
Square Feet of Absortion Area 376 Statndpipes Present (Y/N)
Depression over Field (Y/N) r( Date of Last Adequacy Test S 113 q
Results of Last Adequacy Test -P0.ss F., 1 In r -,e- .D�cY rom w-9
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well
To Building Foundation
Lot N/�
To Water Main/Service Line 50 +
To Property Line 3 0 F
To Existing or Abandoned System on
On Adjoining Lots 1 &.0 +
To Stream, Pond, Lake, or Major Drainage Course -
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFTSTATION /yONe
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
To Cutback (if present)
N/a
Dimensions
Manhole/Access (Y/N)
"Check Permitted Bedroom Rating Against HAA Request"
"Pump Off" Level at
Vent(Y/N)
Pumping Cycles during Adequacy Test.
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection
Signed
Company lobiotN �aurltlaK� ��
Date �'{� l3, l 4 Engineer's Seal
MOA No.
Receipt No. 03
Date of Payment
Amount:$ /70-6D
Receipt No.
Waiver Fee: $ —
Date of Payment
72-026 (Rev. 7/66) Back Page 2 of 2
' i I STEVE COWPER, GOVERNOR
DEPT. OF ENVIRONMENTAL. CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 322.
ANCHORAGE, AK 99503
FOR: TOLBERT STRICKLAND
DATE: March 20, 1989
PWSID: "Class C"
To Whom It May Concern:
According to the records on file in this office, the
Sleepy Acres SID Water. System is in compliance with
the State of Alaska Drinking Water Regulations.
Sincerely,
21A1, Q-, /, C. -L.
Vera E. Craig
Environmental Field Officer
VEC:kk
MUNICIPALITY (V ANCHORAGE
DIVISION OF rtWTRO'4XEUAL, HEALTH
ULPAR'SNENIT OF llEjJ.J:H AND I NVIROtt.91_f11AL PROTECTION
APPLICATION F'OR UAL:tH AUEHORITY APPROVAL CERTIFICATE
rsnarai Information Applicatlon Date
(a) Legal Descripti.on,(includo lot, block, oubdivision, section, township, range)
i
Location (addzes or directions) `
(b) Applicants Name./..f5Tel.ephono Home � Business
i
�
Applicants Address�f /�� 'u;� it%�, j�...,�l�'`4�:a.��•�.' f: �� rl '...��..;f<'-:
(c) Applicant is (check one) Lending Institution Owner/builder `F ;
Buyer ; Other. [:�� (explain);
i
(d) Lending Institution Telephone
Address
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. jUe of Residence
Single --Family IIJ
Multi -Family F__1 Other (describe)����
Number of Bedrooms '3
3. Water SHU-L-7-
Individual Well M Community M:1 Public E-1
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
Onsite 7-1 Public
Community E.4 Holding .lank E:.
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 21
5. Eneering Firm Providing Inspections, TestsbFile 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 shown 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 regula-
tions in effect on the date of this inspection.
Name of
Date
(ENGIINEER SEAL)a�
F99 on oewA 9�Q7
0Q®°acoq<'
6. DHEP Approval
I roy c. acid, Jr.
2251—
Approved
Approved for ff•eG bedrooms By1 eo g"
Approved �- Disapprovecl� Condi,tionai.
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS 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 REQUIRE-
MENTS. 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.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2] 7-19-84
MUNIMPALITY OF ANCHORAGE
- OrPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA) APE' 1986
CHECKLIST — FEBRUARY 1984 R E C E.1
V p
A. WELL. DATA Description: ��(J 2; c�_S_c 3=5'_
Well Classification �ornmc If A, B, cc D.E.C.
Approve Y ) ��
Well Log Present_o�--^_ Date Completed _�11245J�, !T Yield L5*/,2__
Total Depth Z�' _ Cased to„� p f__ Depth of GrcutingA2VcG 1a.Q l
Static Water Level �60 Pump Set A3,Ao lel _
Casing Height Above Ground c w c 2P �/az�¢�_ sanitary Seal on Casing OL/N)_
Electrical Wiring in Conduit (Y/N) C� _ Depression Around S"kl.lhead (YM)(
Separation Distances from Well:
To Septic/Holding Tank on Lot (1?0 X/ ”
/" _—_; On Adjoining Lots_>/,S•o 11
To Nearest Edge of Absorption Field on Lo P) Vit__ ; On Adjoining Lots >16u
'.Po Nearest Public Sewer Line +yj�t' To Nearest Public Sewer
Cleanout/Manhole_--To Nearest Sewer Service Line on Lot AJI
Water Sample Collected By (tom'4ct2ne4 _ Date
Water, Sample •'Test Results'_� "s 2 ^�
B. SEPTIC/HOLDING TANK DATA
Date Installed �i�/S�8'l Size lonr), J� No. of CaTartments
Standpipes ) Air -tight Caps) —_ Foundation Cleanout dY/N)
Depression over Tank (Y�I —_ Date Last Pumped _�%_ ("< a
Pumping/Maintenance Contract on File (YM) Wtk ; for T
Holding Tank High -Water Alarm (YM) A) A- Temporary Holding Tank Permit (Y V/) �L_
Separation Distances from Septic/Holding Tank:
To Water -Supply Wall 2L?o,' To Building Foundation.���� _
To Property Lire _—_ ��To Disposal Field A)ol. s lu g
T8�`.�iylac
To Water Main/Service Line _!j Stream, Pond, Lake, cc Major Drainage
Course
} z� ��k3aa1cJ2
(Page 1 of ?.j
Receipt # < `�
Date Paid:
—
Amount: L� _
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata /ppt.. Type of System Design
Date Installed ��/S �f,"F' Length of Field 151.3
Width of Field S _ Depth of Field /�?i40
Gravel Bed Thickness c? "' (() _
Square Feet of Absorption Area 2,7,6 StandYpipes Present )
Depression over Field (Y/,LQ,) Date of Last Adequacy Test
Results of Last Adequacy Test N�+4
Separation Distance from Absorption Field:
i
To Water -Supply Wall (;?,o g/ / h To Property Line 30
To Building Foundation 3-�16/0 To Existing or Abandoned System on
Lot 0/14 ; On Adjoining Lots &0 t®
To Water Main/Service Line ol7 To Cutbank(if resent) YUI, -
To Stream/Pond/Lake/or Major Drainage Course /00 F
To Driveway, Parking Area, or Vehicle Storage Area /D tU e
Comments Cipey o�,rz�t �.a.�n rse%ldu�ci -lw�,K az�(21n4-f "8-
am
8-
QM eG dun ct� �1 e)x �S�w dG�?ad la/ii/8 "f
D. LIFT STATION DD
Date Installed N (A- Dimensions rV(%
Size in Gallons A)/A- Manhole/Access (YM) ��4
"Pump On" Level at "J(q- "Pump Off" Level at 'VIA v�
High Water Alarm Level at A)(A Vent (YM) Wl,F
Tested for n')0p- Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes(YM) 0(.A -
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on the date of this inspection. „ OF
Signed✓✓11 si�Q���.......;i
Company 1-/r�g MOA No. S'S =02 /1 '�' e. -V C--'
MOW..._
KB1/d5/s
(Page 2 of 21
I C. Reid, J, a
0.2251•E •`a
F>14IIi1