HomeMy WebLinkAboutWOODRIDGE BLK 2 LT 3Woodridge Block.2 Lot 3 #020-093-11 Mquaml I I -A111 tmuv UOIU41 i 8) Municipality of Anchorage W OCT 13 2020 On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201174 PID Number: 020-093-11 Dwelling: N Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 01 Upgrade Name Sashi Parameswaraan & Jennifer Wilson ABSORPTION FIELD ❑ Deep Trench ❑® Wide Trench El Bed E] Mound Site Address 16644 Virgo Ave ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 1.2 GPD/SF 9.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5.0 Ft.4.0 Gravel depth beneath pipe Ft Subdivision Block Lot Woodridge 2 3 Fill added above original grade 0 Ft, Gravel length 50 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines n/a Distance between lines n/a Ft. SEPARATION DISTANCES ToSeptic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 500 Ftz 1(N) 1(E) 10.0+ Ft. Well 100'+ 1001+ I 25'+ TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water 100'+ 100'+ Material Number of compartments Lot Line 5'+ 10'+ NA HDPE 2 Foundation 6' 101+ I LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer drainfield GLW Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 96.0 ft Inspection vt 7/21/20 7/21/20 Location and description 3`d 7/21/20 2nd 41" 8/13/20 SW Bottom House Trim ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional A�4kS Approval: Date 91 k r Steveii R. Panncrie Septic Syste `� 101'. c'= 814.? . Q Approved Date 3,A 22 ZOO Note: this approya _ oes not .inc lud_e_well_per_mit_re_quirements._____.__ tmuv UOIU41 i 8) z Jo z ........,,,, , 133HS AV19dZiDi IDN\i Nd�d 311S 0/-l lOZd50 - ��;'' `�'- 6418-3 �`i 'ON 1iw83d NOS�IM 2�3JINN3f �8 Nd�JdMS3Wd�Jt/d IHSdS did NM 80 L t-4'60-OZO ON6 �1 ze 10(112 (loom ,09 = ..l'. ,� s OZOZ/ti �gosOZOZ/5'/ll l n3a ab�sy�b..��..3ydy�= IOZB-��gs(L06�) a3�1 OOZ808tLX09 pd3NOHd ONIMV2i0 Ob003a 31Va SNOISIn3a ",,.,., (8804 TO) 371 OAS SN3 aNONNUd :S31DN w w O w\ �\ �L Lm0v ^ Q(nN \ \ IN, -- \ \ Op 1NDUSN3 .dnun Ol p p p — — — - � r- LJ 0 LJ I— :2E a cr) _ X U Y WaN i- \ C) - -- p Z --- 0 — LJ � O Q W d C � Ll nJ d' O N (nO ~ O ZO=O \ \ £ \ Y Z W I*Lorr- \ \ 0 \ \ \ \ \ zQ � \ -- LJ Q ri \ \ z\ \ \ I \ U UQ v \ _JQ FD >- L;_ z O J£ 0 0 W \ \ L \ L- d Li \ (� z \ Lnl �� \ \.w (jj0 \ O O p \ (Wn \ \ N z a Q M \ Q \ w \ s \ Owo0p N <F d W \ U \ \ \ N 0 NN - \.z \ \ \ fN- \ p U Of<U \ \ s 0 0000 \ / \ \ \O:2FaQ Q Z IN :2 of V) V) w ,I,1 O Y\ \ \ 6\ �\ Of / w w O w\ �\ �L Lm0v ^ Q(nN \ \ IN, -- \ \ Op 1NDUSN3 .dnun Ol p p p — — — - � r- LJ 0 LJ I— :2E a cr) _ X U Y WaN i- \ C) - -- p Z --- 0 — LJ � O Q W d C � Ll nJ d' O N (nO ~ O ZO=O OJ0< 3 O W p ,n I*Lorr- U Ln 0 :D: O m -- ''V)zz Q OQ -- LJ Q ri QO c Lu(�7af <�>-O�z 0J m`lU BIW Q W 0- _JQ FD >- L;_ z O J£ 0 0 D Z F- o_ (n Q (n Of � D <— _ U= _ (� z \ Lnl N 0 Lfl U� W 0 � r- 7 I— :2E a cr) _ - W WaN i- \ C) - -- p Z --- 0 — <CL� � O Q W d C � Ll nJ d' O N (nO ~ O ZO=O OJ0< 3 O W p ,n W U Ln 0 :D: O m -- C7 = Q (.� -- LJ Q ri QO c Lu(�7af <�>-O�z 0J m`lU BIW Q W 0- _JQ FD >- L;_ z (n 0 0 D Z F- o_ (n Q (n Of � D u-) 1- 0 0 0 1110 J Z. LL 0` N d Lfl M n � r- 7 L W J LLJ W OZ � � o nJ ~ O ZO=O OJ0< 3 ,n W Z U ,n WLLI a w v a :D: O m -- - - — -- -- Lr) ..rn. ri ri m - - LD u7 Uf 6i N Ln Lfl N n a' d - d O O p O N N M M •- N N <F d N - �- fN- Lei p U U 0 0 0 1110 J Z. LL 0` N d W � U J Q W L W J LLJ W OZ Z m nJ ~ O ZO=O OJ0< 3 O j O Lu W W Z U WLLI a w v a :D: O m NOTES: PANNONE ENG SVC LLC (C.I. 1088) REVISIONS DATE RECORD DRAWING P.O. BOX 1807 PALLIER, AK 99645 17/3/2020 PHOPIE (907) 745-8200 FAX (907) 745-8201- �P ''' '4 - g,.� .,q SCALE 4' 49 .? .... WOODRIDGE B2 L3 P.I.D. NO DRAWN ACP SASHI PARAMESWARAN & JENNIFER WILSON "'" '` 020-093-1 p Slevon — Pannona i 0P '. CE—BtA9 PERMIT N0. 16644 VIRGO AVE •.• _- OSP201174 TANK SECTION ANCHORAGE, AK SHEET 3 OF 3 i o L(LAJ N88° 30' 12"E 4.21 ►V8 I° 58'06"E 75.92 S87° 16'50"E 141.49 S83° 22'43 E 43.45 1 1 CUA VERT 1 0 1 50' CREEK MAINTENANCE `t EASEMENT t Scale 1" = 30' u> _ CHICKEN COOP ^ I 70 CIA �_ 158.7 I o \ 1 Lot 3, Block 2 h 1 0 � 1 Woodridge Subdivision Yu\ �L! 64, 656 S Ft. +/- 63.5 w LOT 3 PAVER PATIO g• 24.9-16644 Virgo Avenue .� 3 Story Wood Frame House \ BLOCK 9 }� 1 -x a s Z I , SEPTIC 12.1 102 \ V \�' ` COVER c� (y STONE WALKWAY WOOD SHED SHED 93.9 1 G EENHOUSE 67.1 = n —T15 10.J E_ lW� = W WOODEN PAVED DR I t 1 W 1 STAIRS DRI Y co rn � 1 (0 C:D I I 1 i I RETAINING WALL 30 I / 0 Y, Electric Meter Gas Meter LT, Tel. Pedestal ® Deck A LE, Elec. Pedestal�Over Head Utilities i W \ Well �,. Chain Link Fence 5, Septic • R.O. W. N89' 56'45"E 304.72 \ \ PAVED \ SHARED DRIVEWAY + LOT \ / I General Notes t -01 -At ,qs �'<< ®1SClplrner _ . _•� �� 1. This document is created for the purpose of a single property transaction 1. This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible H improvements and conditions at the time of the survey. This document does not constitute a boundary r 4 and is subject to Federal Copyright Laws. i survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the � ' ' ' ( ' ' • • • • • • • • � 2. Excepting for gross negligence, the liability for this survey shall not exceed responsibility of the Owner to determine the existence of any easements, covenants, or restriction i the cost of preparing this survey. which do no appear on the record plat. Under no circumstances should this document be used for I .. • . • . • • . • ................... �. 3. All measurements/setbacks are to the visual/apparent building footprint. construction or for establishing a boundary or fence tine. s, Pier M. St gier 4 4. All dimensions to property lines are plus/minus 0.1 ft. �i7�c N .LS- 12 moo= 0 15 30 60 7� sj 08/26/2020 t1 F•pF, ' .. .. �Jy.Y Scale in Feet 11ttt0 %FESS ON;" LOT BLOCK 1 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 1470)Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 Permit Number: OSP201174 Work Type: Septic Upgrade Tax Code Number: 02009311000 Site Legal Address: WOODRIDGE BLK 2 LT 3 G:3337 Site Mailing Address: 18044VIRGO AVE, Anchorage Owner: PARAMESVVARANANTONIO SASH|& Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date 7/8/2020 7/8/2021 Lot Size in Sq Ft: 64856 Total Bedrooms: 4 Z Disposal Field RJ Septic Tank El Holding Tank El Privy 171 Private Well 1:1 Water Storage All construction shall beinaccordance with: 1. The attached approved design. 2. All requirements specified inAnchorage Municipal code Chapters 1555 and1SG5 and the State of Alaska Wastewater Disposal Regulations (1 8AAC72) and Drinking Water Regulations (I '3. The wastewater code requires inspections during the installation. The engineer shallnotify the Development t Services Department per AMC 15.SS.Provide notification bycalling (9O7)343 -79O4(24/'. 4. From October 15toApril 15. a subsurface soil absorption system under construction during freezing weather shall baeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated to prevent freezing ReneivedB� Date: -------Issued By: -- — Date: MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ;i ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 020-093-11 Property owner(s) Sash! Parameswaran & Jennifer Wilson Day phone Mailing address 16644 Virgo Avenue, Anchorage, AK 99516 Site address 16644 Virgo Avenue Legal description (Sub'd., Block & Lot) Woodridge, Block 2, Lot 3 Legal description (Township, Range & Section) Lot Size 64,656 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X Septic Tank FX]Upgrade Q (w/wo AD U) ❑ Holding Tank ElRenewal F] Duplex (D) Multiple Dwellings ❑ Privy ❑ I (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. ignature of property owner or authorized agent) Permit/Rush Fees: 5-q5- 6 (40(0-Z Waiver Fees: Date of Payment: �in� i���-016 Date of Payment: Receipt Number: MoPQ& Receipt Number: Permit No. 65P9c) Waiver No. Permit App__- : . L.,:c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201174, Deb Wockenfuss, 07/08/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201174, Deb Wockenfuss, 07/08/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201174, Deb Wockenfuss, 07/08/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201174, Deb Wockenfuss, 07/08/20 ✓� 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I( ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME�— — PHONEEyy•�-� 334 -S-D8'/ EJUPGRADE MAILING ADDRESS p yyo /3- /c"dt B4 -',c 5 Anctit�Qye Ak y7s- 1 LEGAL DESCRIPTION Lo•t- i'jooct 'a/ LOCATION NO. OF BEDROOMS V----- — DISTANCE TO: Well / Absorption area / Ls Dwelling ^ �� h PERMIT NO. wQManufacturer Material�e No. of compartments Liq. capacity inail �s Inside length Width Liquid depth DISTANCE TO: Well — Dwelling PERMIT NO. QZ H Manufacturer Material Liquid capacity in gallons O w= a Z Well DISTANCE TO: / ,Z,}- No. of lines Length of each line / Foundation n vi- ,n Total length f lines oS Nearest lot line �lS—U Trench widtlli*Distance PERMIT NO. •Yf between lines w Y 2 �- _!� in&44RF Top of tile to finish gryQMaterial beneath tile effective absorptionrarea 3 i.�z© 1)Length Width Depth IT NO. w w Q F Type of crib Crib diameter Crib depth Total effective absorption area w a w Well Building foundation Nearest lot line DISTANCE TO: J Class — Depth Driller Distance to lot linePERMIT NO. — J W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS G FE31U SOIL TEST RATING ��/`` `,f C'aein-r,'t) /2-5 L•Ti"e/al ac_fr«tel) INSTALLER L'en'�tacla s Sy,� Se, -I f E S'- 2 6S- �r — _ — R/E)MARKS p-,et%R0Vxdlri jr %�fniwi �uc rJ. lhrlr( r ll ljccaaJ¢ 1'u,"t r7 San/y anal ,fon"z- ,$' i l .Fe. a.ir.✓J rvrt � i7q-%�1�r+rff yj " it � � '-I-ef•f--ole. Cle ST j C'o,1 'r q n F/Zo '76 /-3 fir rnJ/p t�c•!-iUn G-/ 5 E — —� APPROVED DATE LEGAL (3' 3I 72-013 (Rev. 3/78) , X --/w DEPARTMGNT OF HEALTH AND ENVIRUNMENTAL PROTFCTION 825 L STREET, ANCHORAGE,'AK 995O1 264-4720 I F E7: WFl.r. F4! PERMIT NO: 850471 DATE ISSUED: 08/o6/85 APPLICANT: CONTRACTORS 1.3P7C SER ADDRESS: 8440 BROOKRIDGE DRIVE BOX 5 ANCHORAGEI AK 9 q504 CONTACT PHONE: 337~50B4 LEGAL DFSERSUBDIVISION: WOODRIDGE LOTBLnCK:�1 SECTION; "l." TOWNSHIp: 11N RAN[�F".-, 3W / LOT SIZE: 40174 (SQ^FT" OR ACRES> MAX BEDROOMS: 4 Listed below are Hie options available to you in designing your, septic system. Choose the option that best fits your site, V, -,g 0��� 94� DEPTH TO PIPF BOTTDM (FT,) 4"0 GRAVI-71 DEPTH- (FT") /t�0^0"5 3"5 �»/|/Y/»/l-.�� TOTAL DEPTH (FT.) 8-0 ,f / /`�-� 4"5 7"5 GRAVEL WIDTH (FT") 25 / 16"0 5^0 GRAVEL LENGTH (FT") 0` 32"0 37"0 8RAVEL VOLUME (CU.YDS.) 18.0 19^O 27"5 TANK SIZE (GALS) 1,250"0 ** i,250^0 ** 1,250"0 r, -,A SOIL RATING (8Q^FT.MIR ) 85 B5 B5 3( Y, TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certi[y that: 1" I am ami1.iar with the requirements for onsite sewers and we1ls as set [orth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codos and regulations� and in compliance with the designriteria oF this pe,III it. 3. I will adhere to all MOA and Gtate of Alaska requirements for the set back distances from any wastewater disposal system or public sewerage system on this orany adjacent or nearhy lot. .1. understand that this permit is valid for a maximum of 4 bedrooms and any enlargement will. require an additional permit, IF A LIFT �TATION IS INSTALLGD IN AN AREA COVFRED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAi P21RMI1` AND INSPECTION MUST BE OgTAINED; (2) AF.)~BVILTS WILL NOT BE: APPROVED WITHOUT AN ELECTRICAL INSPECTIUN REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED EL�CTRICIAN^ SIGNED DATE: »`-T-'`------'--------'��'---------^----- - ~^°~~---- APPLICANT: CONTRACTORS SPEC SER ISSUED DY DATE: �~~--~------------^-~-�~~-~~^~^-`�~~~ ~-�~~~r^------- u Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 " L•• Street, Anchorage, Alaska 99502-0650 SOILS LOGA — PERCOLATION TEST PERFORMED LEGAL DESCRIPTION: - Wwdv;dci.e -6 V- L -7?> DATE PERFORMED: ,r-7" U5Township, Range, Section: /tf��C�/ �j>c•'=-5 SLOPE S TE PLAN 10 - • {rr WAS GROUND WATER — V ENCOUNTERED? 140 � IF YES, AT WHAT DEPTH? 12- �'� 13 - • — Depth la Water Alter Monitoring? Date: 14- 15- 16- 17 -- 18 -- 19 - Reading 1819 20 - PERCOLATION RATE TEST RUN BETWEEN COMMENTS Reading Date Gross Net Depth to Net Time Time Water Drop G (minutes/inch) PEHCHOLE DIAMETER F1' AND FT - s rri�r/,.l2tT, r..n.. Nfi e✓ �t7! /O PERFORMED BY: _ LL'AL-;o-- I III CERTIFY THAT THIS TEST WAS PERFORMED IN r6_ ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: —3- 72-008 (Rev. 4/85) 2- 3- a 6 7 8-'110 9 A' 10 - • {rr WAS GROUND WATER — V ENCOUNTERED? 140 � IF YES, AT WHAT DEPTH? 12- �'� 13 - • — Depth la Water Alter Monitoring? Date: 14- 15- 16- 17 -- 18 -- 19 - Reading 1819 20 - PERCOLATION RATE TEST RUN BETWEEN COMMENTS Reading Date Gross Net Depth to Net Time Time Water Drop G (minutes/inch) PEHCHOLE DIAMETER F1' AND FT - s rri�r/,.l2tT, r..n.. Nfi e✓ �t7! /O PERFORMED BY: _ LL'AL-;o-- I III CERTIFY THAT THIS TEST WAS PERFORMED IN r6_ ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: —3- 72-008 (Rev. 4/85) u Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 " L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:t Ar,�Yi-�VC�Y � �7 DATE PERFORMED: l.�lA LEGAL DESCRIPTION: � A �1(-IRF7 F, G— L.5Township,RRange, Section: -T//Al R. 35k.S-1 1- J 3. 4- 6 6 �Y U r• _ JJ 8-. ENn 13- 14- 15- 16-- 17 - 18- 19- 20 3-14- 15- 16- 17- 18- 19- 20 - C u W S GROUND WAT CIv/�> 5VOUNTER ED? c; MIF YES, AT WHAT DEPTH? SLOPE SITE PLAN Depth to Water Alter Monitoring? I� s 6 t- s O 0 E Dale: Reading Date Gross Time Net Time Depth to Net Water Drop 1 ( r� PERCOLATION RATE 1172, PERC HOLE DIAMETER —(1911 TEST RUN BETWEEN =1_— FT AND _ ��''� FT COMMENTS �J �Ir YYI . PERFORMED BY:w�'lJ-7� (( ���Jjl/ I / 41t L�ERIIFY THAT THIS TEST WASPERFORMEDIN ACCORDANCE WITH ALL STATE AND MUMAL i'i�IfJ LINES IN EFFECT ON THIS DATE. DATE 1(i� +' 72-008 (Rev. 4/85) �yr 1201 RAIRORA ST. 99515 ANCHO1tA.4GEv ALASK,& 344-7714 SIX 344-7 711.4 - SIX INCH WATER WELL DRILLED------------ OUT TO THE DEPTH OF 285 DRILLED AT THE RATE OF S21"00 PER FOp'i. age p -t 280 %t. on.ty.. 338-0276 7800 DeJaA&. Te th{t, Robdn.00n 333--4793 (Wouk. o4de4ed Ini ffl"k, b1WAan'4) PROPERTY OWNER LOCATION OF WELL SITE -- -------- ,(,t. 3 Btlk 2 Gloodttdge Sub. MUNICIPALITY OFep-TtANCHORAGE BeRn.te CCcuLo o•t Rampatt bAlWng 004k.4. ENVIRONMENTAL PE p CTION DRILLER -- -- -- --- MAR 0 51986. WELL LOG: j� 0----16 f gL"e.L w.. h 15% b�/�. —` R E C E i,/ u) 16 --mV Latd n I A <:PJRQn ted_g1LCG1e L mat l . -- 42---44' Bedtock. A btok.en, .sack. XmteAtat, Sttet CAA"w4 ng &%teen .to u u4at at 44k. 44--2851.__ Bedrock. De,�hgoA 4edbwAtcca4.tjpee .tock. lio wat" etd 4haw Unttt� 16 0 3/4 9Pm tn. a c :t ton tock .Pxn 165 .to 168 �t. Bo 200 Wwduct inn. wa o up .t"i4t 4om.ewhat oveA one gP(R, good water ytetd a.t 1 1/2 VPI addLt.torwt , ,tow ./.tam, 241 to 24.9 A. Addtt,tonat one gRR pwn 276 .to 283 A. To.tat water Vte-td o• 3 1/2 U p0441,&4 4 9Pm. TW lde U ,ohowtd atao 4ArAecr4e do V.te td with aoe. Mater. "cove2y back up .to w.tthdn 45 P, 4 4u4p". One tic44e Sabneu4hte PUMA 4hou td be bt tatted 15 .to 20 A a" bottom - The QuaU b). o.- wate&t .t o at4o veto good. PuaLped cteaa. TOtat C04•t a� ))W UAq: 823.00 FWt .IGS X 280 A: $6440.00 Thank you. #kmk. 9tad to do b",IAeo4 with yoa. BeW,e Cta" COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF $6440.00 THANK YOU VERY MUCH. 13ERNIE CLAUS OF RAMPART RILLING WORKS DATE AUr ST 1.3'tl!'t.._ 1985. zk4��Q Jl-^ . W�_ SERVICE CFIARGE OF 1Yv P@fd MONTH WILL HE ASSESSED ON PAST DUCACCOUNTS. • Municipality of "c forage On -Site Water and Wastewater Program t a (907)343-7904. sA ETY' CERTIFICATE OF ON -.SITE SYSTEMS APPROVAL Parcel LD: 020 ^ 0 93 � It Expiration Date: 1. GENERAL INFORMATION Complete legal description `! Location (site address) i i� is `y ll Ilk /+/win uc ,,Current Property owner(s) t?00 ')3 1,u Day phone. 3 `15 IS -1 y Mailing address 16GYy P140 Allee . f �c�rey> cJ l�� 4451! Real Estate Agent13c �3�� T R� r`t v x Day phone 2 tK i 2; TYPE OF DWELLING: Single Family (wlwo ADO) Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4.. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Received by:: .COSA to be releasl pfeekre I? hr..,.,P or �—mcar J 1Zel�+' CAf �et&1-O 9 e s net wlr�n Cis !S rPe�C:-ic1, the engineer, unless otherwise requested by the engineer Date: COSA Fee $ Waiver'Fee $ Date of Payment 1o13113 Date of Payment Receipt Number d��`J �3Y Receipt Number COSA# C SC1315/d Waiver# TYPE OF WASTEWATER DISPOSAL: ® Individual ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ the engineer, unless otherwise requested by the engineer Date: COSA Fee $ Waiver'Fee $ Date of Payment 1o13113 Date of Payment Receipt Number d��`J �3Y Receipt Number COSA# C SC1315/d Waiver# S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l verify that my investigation, :based on procedures outlined in the. Certificate of On -Site .Systems Approval Guidelines for. this application; "shows that the onsite water supply and/or wastewater disposal system is (are) safe, functional. and adequate for thenumber of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and. from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm tr 1 u f ,n Te, n; cep f S e t c �� Phone . ? Y&-- 13 Address l N 3a • =c h� Qr n v�, n Rte, ii"c A&,-czcop / SrG Engineer's Printed Name Th ✓c� do --e F• G� Date I!& IFl-�iur(F turves. on' f le 4E OSA G DSD-S.IGNATURE System #1 Approved for'bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following gy py �' Original Certificate Date: The unidpal" ity o orago Development Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State _of Alaska. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineers work. - 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other If more than I septic system is on the lot: (1!• �} COSA Checklist #_J_of_J Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description:_ L o f3 (ycIrage S/j1 Parcel ID: 020 `U9 3 � 11 A. WELL DATA - Well type _EEL__ f If A, B, or C provide PWSID # N A. Well Log (YIN) / Date completed / F3 /45;'S` Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y__ Total depth 2B- ft . Cased to y Y ft, Casing height (above ground} FROM WELL LOG AT INSPECTION Date of test R/ 1 / 91 1-712013 Static water levelH. ,r fL lay,* S ft Well production <% g p.m 3. g.p:m. WATER SAMPLE RESULTS: Coliform <. / coloniestl00 mL 7 Nitrate G'• ! mglL Arsenic < Ok ug/l. + Date of sample: 9! 16/ Wi 3 Collected by: " F laflzip 7Ticti Si r B. SEPTICJHOLDING TANK DATA Tank Type/Material _ ,S`e e %+c 1<f-eel Date installed 912 &. Tank size 12-4-0 . gal. Number of Compartments • . Cleanouts (YIN) `r Foundation cleanout (Y/N) Y Depression over tank (Y/N) . IJ High water alarm (Y/N) IV Date of pumping. 2 7-6/.t3 Pumper /Fee►crec� �,hliR -�/aa4 pe�wr�,s,y C. AB90RPTION FIELD DATA Date installed /9/et Soil rating (g.p.d.W or fe/bdrm) I zr da DRe rSystem type - Trene b Length S 2 ft Width y ft Gravel below pipe S ft. Total depth 9 ft. Eff. absorption area t20 fe Monitoring tube Y Depression over field N Date of adequacy test 9 /17/ Zoe 3 Results (Pass/Fail) f'a4f For 'Y bedrooms Fluid depth in absorption field before test _0 in. Water added 67c, %gal. New depth 8. / in. en arc Elapsed Time: 9! �7 mina Final fluid depth 2_ in. Absorption rate >_" 6 e�-G g:p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Iii If yes, give date N �.. D. LIFT STAtION N• �• Date installed 'Pump on' level at in. Datum Size in.gallons Ma.ntiolelAocess (YIN) 'Pump off level at in. High water alarm level at in. Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tankilift station on lot f. 2 G r On adjacent lots 7 1616 1 Absorption field on lot i 20 On adjacent lots > l e�' o f Public sewer main N• A. Public sewer manhole/cleanout Sewer /septic service line Z ,r Holding tank l� • . Animal containment areas iUnne, 7 l Z -V ` Manure/aniinal excrete storage areas lklefiif, ieC SEPTIC/HOLDING TANK ON LOT TO: Building foundation 1-7 Property line SP i Absorption field Le `- -. `Water main N. /}. Water service line Zs Surface water Wells on adjacent lots '> le ` ABSORPTION FIELD ON LOT TO: Property line S Building foundation 10 ` Water main N Water Service line " Surface water •> C60' Driveway, paridng/vehide storage _ Curtain drain IL6,49 Seen Wells on adjacent lots F. COMMENTS lent /t Amlvl- w fiot 4003el 7/'C i' G. ENGINEER'S CERTIFICATION I certify that i have determined through .field inspections and . review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineers Printed Name w 4060 ee F. f_16'12'1? Date &C.16100- 2 n =Er ? a r COSA brown sheet_10-10-12.doc S:saua a� • MOORE C-3589 q_. Ve`X_")n 6171o/ Municipality of Anchorage •ea e • 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.ek.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.- O 2 a - o 9y - l l HAA #_ f><'ii D (D 2(o s Expiration Date: 7- 7- D / 1. GENERAL INFORMATION Complete legal description of 3 51oc_4 2_ LUc.odrio(yr S/ -b Location (site address or directions) Current Propertyowner(s) .Tum& t Sulgn Ct'ar►c Dayphone 3Y8-oc,>rs Mailing address I <6°/Y 1/rrgo ,��enc�, i4nctioo A4 99s/s Lending agency f -me s & Er 1`t yr Iggiz Day phone 762 - S -e 9rs Mailing address '32C.1 �: e Sf. A-� _ A k -79r07? Real Estate Agent FS go Day phone OcArer,rvni aob adxrre T/ -em 17e -'hl 2_'2-oS-7/ Mailing Address _729 F rs f" A-vQ.. i9, --"T,* Ak 295-,01 V Unless otherwise requested, NAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: -1/ 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site R Individual Holding tank ❑ Community On-site ❑ 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. 4. STATEMENT OF INSPECTION SY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of installation. Name of Firm (aft Ti,4,7 ca/ Phone 3ys- 13S:5— Address 3S:5Address I •/s 3U E�4o Sf c%+v�c.4P k±T 99s1 Engineer's Printed Name �1Floc�o�c f /loo -e �DQte2 Kee Zoof Qr ., .. �' r QTttr�.Z •� NEER'S s+ ......................: .FSSAMP rr q� .THEXC,+F F. goORE CZ -3u? 5. DSD SIGNATURE - ti'•Vq , •• f Approved for bedrooms. `t e; rr„ .:t r=� �,. T Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: %— o JRv. rzco) Municipality of Anchorage •�, • Development Services Department Building Safety Division a ° •, on -Me Water 3 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ciAnchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1,0t,3- i3lor-kZ k/000t ridge S//) Parcel ID: 020-092 -,It A. WELL DATA Welitype r r Date completed 8/11/6, - Total depth 2 Cl ft. Date of test Static water level Well production If A, B, or C provide PWSID # _ San" seal (YIN) Y Cased tD _j -Y- 5. FROM WELL LOG 8/ta/e< '/s- ft. 3.S - Y g.p.m. WATER SAMPLE RESULTS: Coliform O coloniesH00 ml. Nitrate 4-9 mg -A. Well Log (Y/N) Y Wires properly protected (YM) Y Casing height (above ground) IS_ in. AT INSPECTION 6,1 it/Zcscl 37 ft. G• GS t g.p.m. Other bacteria C! colonies/100 mi. Datsofsample: S/2,r/20W Collected by: FI«f,b,. Tec4n.'ce/ S�'Z B. SEPTICIHOLDING TANK DATA Tank Type/Material S L - l-:. / S/Y e / Date installed 8 / 9 / 0 is - Tank size 12 rV gal. Number of Compartments --Z Cleanouts (YIN) Y Foundation cieanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) M A Date of pumping .7 //- / v r Pumper Nor 1A /4 n ai Acr.+af C. ABSORPTION FIELD DATA Date Installed 8/9/6X- Soo rating (g.p.d.nF or ft°/bdrm) /ZS' f=1 System type Tre-c4 Length SZ ft. Width y ft. Gravel below pipe S•o ft. Total depth ivr ft. Effabsorption area Shu ft:2 Monitoring tube Y Depression over field N A"W ® M. r, Date of adequacy test Sl r Results (Pass/Fail) Pas 1 For I_ bedrooms Fluid depth in absorption field before test 10 in. s1"O$pe Elapsed Time: 11 j min. Final fluid depth $?X in Water added_CVgal. New depth - in. Absorption rate >= SOO g.p.d. Any rejuvenation treatment (past V mo.) (Y/N 8 type) Non[ l,cn o "A^ If yes, give date N• A. F,nrI 208.go/ #&a ac4/i a is xyarfrw% cQwect F/",o/ /r.../.:.. AY,T. �v rrr� en y r/y " D. LIFT STATION N. A Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallons `Pump oft level at _ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanklllft station on lot 12 0 ' Absorption field on lot 12.0' Manhole/Access (YIN) High water alarm level at Meets alarm & circuh requirements? On adjacent lots �> r 0 0 ' On adjacent lots Public sewer main A/ A Public sewer manhole/deanout Af. A. Sewer /septic service line Holding tank ", A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation ^ f Property line 5W Absorption field 140 ' Water main :-;t 2 s' Water service line 7 2S' Surface water = r / Wells on adjacent lots '> 100 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: M, Property line S Building foundation ^ 10' Water main 7 zc' Water Service line ? 24-' Surface water -> 1 21" Driveway, parkingivehide storage x S" /✓owe s•e.. Wells on adjacent lots 0 Curtain drain = 1 1S F. COMMENTS I.of Irnz wai✓er /L�9H.vk� a►� [1F di'ER « ..... G. ENGINEER'S CERTIFICATION •••• 49TH 1 certily that 1 have determined through field inspections and ....................... A review of Municipal records that the above systems are In conformance with MOA HAA guidelines in effect on this date. " C`F. NOCREJF410CE-E35C9- h. Engineer's Printed Name eopo i'2 F. /•rab.p r `- <' Date Tr cn0 Y2Uej r e 4oP rine HAA Fee $ 3 OO ';`% Waiver Fee ; g 11S ?t Date of Payment 6'1q1 © / Receipt Number C-2 79 (Rev. 12/00) Date of Payment 6 l y /O / Receipt Number S-2 7,q , F,LAT�'OP�TEGHNICAL SER�ICES'_:. CIVIL & ENVIRONMENTAL ENGLNEERLNG • ENERGY CONSERVATa)N & ANALYSIS THEODORE F. MOORE, P.E. PH: (907) 345-1355 June 4, 2001 MOA, DSD On -Site Water and Wastewater Section P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: 14530 ECHO ST. ANCHORAGE, ALASKA 99516 By means of this letter we are requesting issuance of a lot line waiver allowing the existing soil absorption trench serving the 4 -bedroom residence on Lot 3, Block 2, Woodridge S/D to be as close as 5 feet from the south property line common with Lot 2. Copies of the wastewater disposal system inspection report and an as -built survey of the subject lot are enclosed. At the time of installation in 1985 the inspecting engineer reported that the system was 11 feet from the property line, however the distance from the monitor tube to the lot line on the as -built survey scales to approximately 7 feet. My own field measurements also indicate the distance to be approximately 7 feet. This lot line waiver request is for 5 feet to allow for possible small errors in measurement and/or underground projection of the soil absorption trench a little closer to the lot line. Granting the requested waiver will have negligible impact on the ability to construct replacement soil absorption systems on Lot 2 because the lot is large and the present system is approximately 100 feet from the area in question. Also, since only one end of the trench encroaches on the normally required 10 -foot setback, the affected area on Lot 2 is very small. Please feel free to give me a call if you have any questions on this submittal. Sincerely, Ted Moore, P.E. Municipality of Anchorage George P. 117uereh, Mayor Department Or Public Works Building Safcty Division 1,0. Box 196650 a 4700 S. Bragaw Street Anchornge, Alaska 00519.6C>50 a (907) 343.5301 � tt p://tt'�t•tt'.Cl.nnl'I wri};c.nk.us Flattop Technical Services ATTN: Theodore E. Moore, PE 14530 Echo Street Anchorage, AK 99516 - June 07, 2001 Subject: Waiver Request forWOODRIDGE BLK 2 LT 3 Waiver # WRO10033 Lot Line Request for Parcel ID 020-093-11 Dear Engineer: Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater disposal system to the lot line has been approved. The approved separation distance is 5 feet. This waiver approval applies to the current on-site wastewater disposal system and lot line separation only. Any future upgrade to the on-site wastewater disposal system and lot line will require all separation distances to be met or another waiver approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, p l` Jeff Poet Engineering Technician III On -Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On.Stte Services Waiver Review Worksheet WR#: 010033 PID#: 02009311 HAM 010265 Permit#: _ Date Received: -01 Legal Description: Woodridge BLK 2 LT 3 Engineer. Flattop T 14530 Echo Street Applicant: James & Susan Clark .......... Waiver Requested: Absorotion Field to Lot Line of 5 feet. Criteria: 1. Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: 2. Special Conditions: 3. Other. .......... Waiver is Granted: List Conditions or Reasons for above: Waiver is not Granted: Date: By: t3ig.......... rp Revie er Rec#: 6.4-01 Amount: 115.00 Date Paid: 6441 Kok; TAIJ tucf 71� ptlni y ftp A. A. /f_I N o•t+O�w /97.SU 1 � hJ: �. fl �'Y....w� p �t win•/ �dx/ � n' sem• Iy I1 1 JA M 0 •f' 1 Y✓e Lt.rG.c Los h/ow+C �y 4>v,.4 L'o•ve.�LlE r •� '. amu Forwvcwsra•v ts w �� 1 t o 0 JCA g I t " t 1 �Forinl/ ?/S ie•�.ry n 1y�ietw/ �? 4 3v. 1�s� vc.v�E. �• .�•Cer7fl�r,.� f �e+.-e+y l; /?9Z, -7-A .7Zo9, A,;�- 9%07 ... wlll�1 "wM. W"NM Ln, -,j, GIcoC.r 2 wn�o.e/oc>,� Juco. F_ lQ mmo4o' 1, no, M Irw..kk k IV Ikw" IM 31t1S �.• All ,.... k k. �wrk. M k•+Ik I w k rw.s:- 4, NIM Irk k M.r •rY wk./• - .._ _.• .oi rr Yk/M w>t1 M M.MkM � A8 -BUILT d•if 711rao MUNICIPALITY OF ANCHORAGE *Dj- DEPARTMENI' OF HEAL'rH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUfHOMT( APPROVAL FORA SINGLE FAMILY DWELLING^ Parcel I.D. # oco eq U_1�2-1 HAA # )-�QW2A 1. GENERAL, INFORMATION Complete, legal description _ kv �r ✓ __�__�_ v�� ��/l. tLt 9 e Location (site address or directions) 633- 4763 Property ovinerIZ.oh;_uII Day phone 3 4 S- r�i Mailing address --7t, v i _ ��r) P1 u °l `1 Gam/ Lending agency Mailing Address Day phone 'le __ Day phone_ 76,2- t,gz6 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF NEt)63OOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1/91) From 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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address 1 Phone g7 g -39/b Engineer's signature �T __ Date 6. DHHS SIGNATURE Approved for 4 bedrooms. Disapproved. Conditional approval for Additional Comments 0 bedrooms, with the following stipulations: Date / _ 7-/ The Munlcipality 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 921 MUNICIPALITY OF ANCHORAGE: ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage FEB 1v 1907 � DEPARTMENT- OF HEALTH & HUMAN SERVICES .Environmental Services Division' ("'I V E 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 34, -4 Health Authority Approval Checklist 40-(b, Legal Description:_(3)!�r bt/uecii�a a ParceLLD.:_- QA -(993 - Il A. WELL DATA Well type i�- _ If A, B, or C, attach ADEC letter. ADEC water system number — N/A Log present (Y/N) _�/ Date completed Ai 8-r�'. r� c,�` Total depth 9 _ 3 _ Cased to _ Casing height (above ground) 8 Sanitary seal (Y/N) FROM WELL LOG Date of test (5113 -le 5 _ Static water level Well production g:p.m. WATER SAMPLE RESULTS: Wires properly protected (Y/N) AT INSPECTION g .7-- 1 -67 g.p.m. Coliform _ I _ Nitrate _ �i L Other bacteria _ �— Date of sample: °2 /Z/ [ Collected by: B. SEPTIC/HOLDING TANK DATA Date installed jg�5-� Tank sire ra50 Number of Compartments mac__ Cleanouts (Y/N)--X— Foundation cleanout (Y/N) _ ` Depression (Y/N) �� _ High water alarm (Y/N) Date of Pumping 5e ,& Pumper A a eti e,r5 C. ABSORPTION FIELD DATA Date installed f$ q J _ Soil rating (g.p.d./ft2 or ft2/bdrm) J_a!5- System type ,Gw[r' _ Length ._Width _ �✓ r Gravel thickness below pipei&;0 it Total depth _firF M Effective absorption area —5AV _ Monitoring Tube present (Y/N)---Y_ Depression over field (Y/N) NI Date of adequacy test _ /7l Results (Pass/Fail) _ For Y --bedrooms Fluid depth in absorption field before test (in.); r Immediately atter b�0 gal. water added (in.): _ 62 Fluid depth _ `oq n (ins) Minutes later: ) ✓5 Absorption rate = /k&o g.p.d. Peroxide treatment (past 12 months) (Y/N) _r) eif yes, give date 72.026 (Rev. 3/96)* D. LIFT STATION hV4 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: Septic/holding tank on lot IPO / On adjacent lots Absorption field on lot j 1 c° j On adjacent lots /6U Public sewer main Public sewer manhole/cleanout Ir -t/ Sewer /septic service line 1 Lift station A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: r f Foundation ) Property line i /b, Absorption field rJ r Water main/service line Surface water/drainage td Wells on adjacent lots > /5 n 1 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Building foundation I D Water main/service line Surface water �j'D Driveway, parking/vehicle storage area Curtain drain N 60 Wells on adjacent lots F. ENGINEER'S CERTIFICATION 1 certify that I have determined thru field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name T�bh2 H �nu r �a woQ Date 0—/l y 1g'% HAA Fee $� Waiver Fee $ Date of Payment n Date of Payment Receipt Number �� Z� J 3 it 1 Receipt Number 72.026 (Rev. 3/96)* MUNICIPALNCHORAGE • '-' DEPARTMENT OF HEALTH &HUMAN SERVICES 4—ADivision of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CE19TIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION Complete legal description ^-I'&_ 3 a Location (site address or directions) 1 6 io Tq V i r"9 0 • Property owner 1 e rr J �a� i H soNl Day phone Mailing address t66o Lending agency s�'-��{a*`�+� Day phone Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: % 3. TYPE OF WATER SUPPLY: Individual well Y Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rov. 1/91) Front MOA 421 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 l o ( lo -e L -1f9 t Sv e k 6 - Phone X7q " 3 —_ Address o20 3 LV� L J' i_ - Engineer's signature Date 6. DHHS SIGNATURE _ Approved for Disapproved. By: Z&, 4 bedrooms. Conditional approval for Additional Comments CAUTIC bedrooms, with the following stipulations: Date�� The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. IM25 (Ray. 1/91) Back MOA N21 �~ $211"4 J101<11_0711V!13 F:?~ K° 200UEST15VU.AYVIUE9111TE206 ANCH0XAG[.AiASKAYY5V2-JY04 (907) 279-3916 1EPTICSYSTEM 4DEDUACY TEST LEGAL: Lot 3, Block 2 Woodridge LOCATION: 16644 Virgo OWNER: Tammy & Terry Robinson RESIDENCE: Single Family, 3 Bedrooms WELL: Private, On Site SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: 4 Bedroom System TANK: Greer Steel 1250 Gal. Two Comparts. ABSORPTION SYSTEM: Trench ABSORPTION AREA: 520 3q. FL. SOIL RATING: 125 INSTALLATION DATE: 8-9-85 DATE OF LAST PUMPING: Isaacs 9-21-91 DATE OF TEST: March 12, 1992 TEST PROCEDURE: System was inspected and measured. Tank was found with 5 feet of cover and with a liquid level of 52 inches. Trench clean out was 6 feet deep and dry. Trench monitor tubc was 11 feet deep and dry. 100 gallons of clean water was added to the foundation clean out. This caused a 1 inch rise in the tank water level. 500 gallons were then added to the trench clean out. No water was observed at the trench sump, while the level in the tank dropped 1 inch. TEST RESULT: This system memts the code requirements of the Health and Social Services Department of the Municipality of Anchorage. NOTE The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long this system will function satisfactory for current or future occupants. / 2K3HEST \5}8.AVENUE SUDE2U6 ANCHORAGE, ALASKA Y9502 -3Y04 (707) 279-3916 RESIDENTIAL. WELL INSPECTION LEGAL: Lot 3 Block 2 Wnodridge / LOCATION: 16644 Virgn OWNER: Tammy & Terry Robinson TYPE OF WELL: Private, Single Family WELL LOG AVAILABLE- Yes i INSTALLATION REQUIREMENTS MET:Yes 'Ye` WEL| YIELD FROM WELL LOG: PUMP YIELD FROM TEST: DATE OF INSPECTION: Galloos per Minute 6 Gallons per Minute March 12, 1992 TEST PROCEDURE: Well was pumped at a constant rate while the drawdown was monitored with an acoustic probe. At the beginning of the test water level was found at 28 feet below top of casing. At a pumping rate of 6 gallons per minute the water level dropped to 113 feet after 100 minutes of pumI otal of 600 gallons were pumped The well recovered to 66 feet within 15 minutes. '� _�»// TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli and total nitrogen on March 22, 1992 EColi 0. Total Nitrogen ND (None Detecte(J}. Max^ allowable Total Nitrogen 10 mg/l TEST RESULTS: This well meets the requirements of the Municipality of Anchorage. THISWELL WILL PRODUCE MORE THAN �3GAL=0VSPER MINUTE FOD MORE THAN FOUR H]L0lE� The Municipal requirement for well flow is 15O gallnns of water per bedroom per day. This well exceed this requirement. The assessment of the condition of the well applies only to the conditions as of the day tested. The flow rate may change due to subsurface conditions that may not be observed from the surface, and changes in the land use and other factors that may impact the aquifer feedin th Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 3/2 L /Oont r'ydAQ__ Parcel I.D. O 2 ° — 093 — I I A. WELL DATA Well type --KIf A, B, or C, attach ADEC letter. ADEC water system number N�A II _ Log present (Y/N) / Date completed '6 3 8 Driller— lzc 1..1_pa<- _ Total depth— a835 _Casedto Sanitary seal (Y/N) Date of test Static water level Well flow Pump level i FROM WELL. LOG i3 1 3 1 lg ti S�. I>— - Y SEPARATION DISTANCES FROM WELL TO: Casing height_ IS ± __ Wires properly protected (Y/N) AT INSPECTION 3.//2-/9 Z MUNICIPALITY OF ANCHORAGE Oy;NNtRENTAL SERVICES DIVISION .2� -r1, % U 1992 g.p.m. g.pm > Iry REUIUED Septic/holding tank on lot I'Lo ; On adjacent lots —>1 5 P Absorption field on lot I Imo_ ; On adjacent lots /6 b Public sewer main N/A _ Public sewer manhole/cleanout ! Sewer service line rlr.E Petroleum tank N�O WATER SAMPLE RESULTS: Coliform_ Nitrate �1 _ Other bacteria Date of sample: L99 z_ Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 8A/a35 —Tank size I Compartments 2 Cleanouts (Y/N) -2 _ Foundation cleanout (Y/N) i _� _ Depressior�ny(Y/N) t� High water alarm (Y/N) N� Alarm tested (Y/N) I Date of pumping q'.2 ( 11 _ __ Pumper .Aac,ae'S SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot l20 ` On adjacent lots ? / J b To property line >10 -Absorption / field Surface water/drainage — fb Foundation Water main/service line > 95 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed - Size in gallons Vent(Y/N) NVA High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water _ Date installed a -4 — B5 Soil rating M5 System type t «c Length ✓�� Width 3 Total absorption area 51� Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Gravel thickness r\( Cleanouts present(Y/N) Total depth Date of adequacy test S//Z./,?z .2-0cl r5; for bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 118 f On adjacent lots i /,S 50 ) Property line To building foundation t D To existing or abandoned system on lot H/12L On adjacent lots i5a Cutbank N/.4 Water main/service line Surface water Z Curtain drain E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature 6 Engineer's Name �eQAr- Date o,� d� HAA Fee $ Waiver Fee: $ Date of Payment 3 J " Date of Payment Receipt Number 5 S oZ ' y3 Receipt Number 72-026 tRev. 3/91)Back MOA 21 I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH - CERTIFICATE OF: INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 3 - 4 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) vm&0 ;5G (b) Applicant Name_reel6 10-MIA41L'^l Telephone: Home 33.3 - M3 Business yl Applicant Address :7601 • �Ar' & /E Al ��� Jjz• gi500 - 1, (c) Applicant is (check onp): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); — (d) Lending Institution (e) Address Real Estate Company and Agent Address _ Telephone (i) 1 . .. .. ..... .... ..1. .. - - -- Telephone 2. TYPE OF RESIDENCE Single -Family'% Multi -Family ❑ Other Number of Bedrooms 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 the legality and status. 4. SEWAGE DISPOSAL Onsilex Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72 025 01,oa) 63 3z- iJaoD%UDGcf 5. ENGINEERING FIRM PROVIDINv INSPECTIONS, TESTS, FILE SEARCH, DA I A 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�CS Telephone Sia l SG7_ Address — __ an e')33 � ��>i� Weil. Ae� ,VSal _ Date : � ip CrAlb)' OWI/ C i T / lzz We-55s�9isA/ WYWd A/A- � �P�Fo OF v. exrL'i1D St:f%lC %7%7J�' :•.:+af`..e.t%(•••. . .� eefs�9JnrTs ANA e1B Jelf7T PlAr /f 6. DHEP APPROVAL CO3vi> / roa,vo*t.. Approved for 74",n-` bedrooms by 'Q' �"`�y Date ��a Seca Approved Disapproved —Conditional Terms of Conditional Approval co gr*�Wo eg./ -OVC, ... OW41, twr�vey. 4 �rs /Qi9 . lip -f vl ct?i�/Drcg�r•rm ;a.-ou.�Q L +e t! J" l -=f (G 1, ,•.,-,_<,_.;<-- CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (1 1184) ALASKA ENVIRONMENTAL SHEET HD/ By-- __ A7-- OF CONTROL SERVICES, INC. 4, Abe DATE 1200 West 33rd Averuwe, e B ANCHORAGE, ALWA 99003 CHEO)CED BY ---- DATE. --- (907) 561-50401."40 SCALE ---------- a f TJ 9 ALASKA ENVIRONp'QN'fAL CONTROL SERVIC , INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561.5040 SHEET NO.—._____ _.— t CALCULATED BY CHECKED SCALE OF _— DATE— DATE _ /n: o/V r redox,xm,-'�v,,,0:,',. i SHEET NO.—._____ _.— t CALCULATED BY CHECKED SCALE OF _— DATE— DATE _ /n: o/V r redox,xm,-'�v,,,0:,',. MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AI TgMjAPPROVAL (HAA) MUNICIPALI]}YY�yQF N DEPT.'Or'Y'�EAr,kJ§T - FEBRUARY 1984 ENVIRONMENTAL PROT6 *M- 20 MAR O 5 1W6gal Description: !�%�3�LaC� l�dO�Jf�i�fjG A. WELL DATA RECEIVED / Well Classification�iT/'�.— If A, E3, C, D.E.C. Approved (Y/N) — N Well Log Present Y)N) _ _ Date Completed _ 13 -�S Yield N / I` `i Total Depth Cased to _— _ Depth of Grouting i Static Water Level Pump Set At — i✓ i Casing Height Above Ground — Electrical Wiring in Condui(Y ) Separation Distances from Well: — Sanitary Seal on Casin (Y N) _ Depression Around Wellhea & ) --G— To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot 7 ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole _ — To Nearest Sewer Service Line on Lot A/ Water Sample Collected by _ �/'AECS edit Date —.3-3-y Water Sample Test Results _s�5l5q—e �7 Comments i�rle4r�:! %c-, I�/GG hA&&35/aA1 /,Jyw'-'de7. B. SEPTIC/HOLDING TANK DATA Date Installed 9-7 -Size 1446 6^ No. of Compartments _— g_' Standpipes (Y©_ — Air -tight Caps (Y NQ—_-- Foundation Cleanout ay) Depression over Tank (Y N) Date Last Pumped e �+ Pumping/Maintenance Contract on File (Y/N) for Holding Tank High -Water Alarm (Y/N) _ LJ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: i To Water -Supply Well —/1-7 To Property Line /0 -'0- To f To Water Main/Service Line Course To Building Foundation e To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments J)Afa A617- L eo,-5-,_6441ToAlW io zoc.4-rte lk/h Ekrc,✓D %r[ .rP�/✓b. Page 1 of 2 72-026(11/84) L3 Bz- pmav�'C44E C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed gr`"9`' Width of Field Square Feet of Absorption Area Depression over Field (Y& — Results of Last Adequacy Test i �Z9 %3d eJJ Type of System Design Length of Field Depth of Field's Gravel Bed Thickness — Standpipes Presen&N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well )7-7, To Property Line To Building Foundation HAIXA1041 To Existing or Abandoned System on Lot 4114 ; On Adjoining Lots zo f i To Water Main/Service Line 1-14A To Cut ank (if present) To Stream/Pond/Lake/or Major Drainage Course �� To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installe N/fi Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at nt (Y/N) Tested for Pumping Cyc ring Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request *' I certify that I ha a d,veified,orconformed toall MOA and HAA guidelines ineffect on the date ofthis inspection. Signed G-� Date Company �7vCf MOA No. OF 4! p y p Q Receipt No. Date of Payment 3 d "' X10 Amount: $ S *�U yti : 1r`' roy, C. Reid, Jr. No. 2251-6 Page 2 of 2 72-026 (1 Ve4)