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BETTY W LT 1
Onsite File Betty W Lot 1 #051-105-27 Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: 0SP201283 PID Number: 051-105-27 Dwelling: N Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Q Upgrade Name Willie Sikes ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 21714 Valley Ave ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 2 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Betty W 1 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer unknown Capacity 1000 Gal. Surface Water I I I Material Number of compartments I Lot Line I NA concrete 2 Foundation I I I I LIFT STATION Manufacturer Capacity Remarks Existing tank found to be concrete. Tank was Gal. left in place. COs & Mts installed in absorption bed Alarm location Electrical installed by Installer PIPE MATERIAL House to tank Tank to drainfield Deans Construction Drainrield CO/MT Inspector Pannone Engineering BENCH MARK (Assumed elevation) It Inspectio 1'` 11/10/20 11/16/20 Location and description 2�d 3rd 41h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: gCgs�� Date OF Co. ;. TH Steven R Pannone Septic System �-- �; . CE 8149 Approved Date � 40FESSN ��, `���'����� Note: this approval does not include well permit requirements. kRCv uOluzi 1 O) MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite Permit Number: OSP201283 Work Type: SepticTank Upgrade Tax Code Number: 05110527000 Site Legal Address: BETTY W LT 1 G:1358 Site Mailing Address: 21714 VALLEY AVE, Chugiak Owner: SIKES WILLIE L JR & Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 11cnt rS' Department 8/6/2020 8/6/2021 43774 ❑ Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: `* Locate the beginning of the beds prior to tank install to confirm that the 5' separation between the tank and fields will be met. Received By: Date 2 MUMUPAUTY OF AN,�A_OR4GE Community Development Department `t Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-105-27 Property owners) Willie Sikes Mailing address 26750 Feuding Lane Site address 21714 Valley Ave Day phone Legal description (Sub'd., Block & Lot) Betty W L1 Legal description (Township, Range & Section) Lot Size 43,774 Sq. Ft. Number of Bedrooms ;2�3_ APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (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 adcordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: -4168 7y of D Waiver Fees: Date of Payment: 30 0iJ Date of Payment: Receipt Number: n4 6c) c-, Receipt Number: Permit No. 0.5P2.0128-�, Waiver No. Permit App__- :• : .,:c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201283, Deb Wockenfuss, 08/06/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201283, Deb Wockenfuss, 08/06/20 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON—SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTAPiNCES. SSG Yom^ iz. r a � /LJ Gt }7 Address FROM TO SEPTIC ABSORPTION WELL TANK FIELD OJ G S -t /✓GliGYaSe AGt Phone(s) Permit No �1�� No. of Bedrooms WELL LEGAL DESCRIPTION LOT LINE Lot Block Subdivision e-7Y-:Ew• FOUNDATION / L/ as 71;1 Township, Range, Section -g—_ ^/ AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, / Y °` ,p S h✓ 5e e. F driveway, water bodies, etc.) TANKS _ _ _ _ X] SEPTIC Exrsr��s ❑ HOLDING e Manufacturer 1A rj Capacity in gallons / 00 6 µ pyM P Material CG No. of Compartments o"2 TYPE OF SYSTEM ❑ TRENCH [ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from original grade a FT Total depth from original grade D. S FT rOX�cr r�. , BEq J Er"t TANK s Fill added above original grade / FT Gravel depth beneath pipe ° $ FT Gravel length ed / /` FT Gravel width 6"t FT Its F Total absorption area oZag SQ FT Distance between lines /- Be c/ 6 FT I Y t Ips Number of lines a 1_;LId Soil rating 1,510 SQ FT Pipe material As t,- 3a-7 A9 Installer Date Installed GxB:F- 0&-7 WELLS 2 PRIVATEfX El (Identifv) WE Classification (A,B,C) Total Depth 1900 FT Cased to -o FT Installer Date Installed: --- D c o . REMARKS: vsfi //p kr er de r.1 .,/, Scale: ENGINEERS SEAL l,vsu /4 tri.. over Z>eof -f- InspeE4psgWj %MqAYfng Services P. 0. Rox 773994 1Ct_��)� C�' n �If's� ��} �i�C� , �� t ��' Date: Eagle River, AIC 99577 694-5195 au aaCOo�av;ac osuo°oco ac nx�,� I certify that This inspection was performed according to all 1 1c: A... Butera a` �i�6_4 Municipal and State guidelines in effect on this date: 7 Health Department Approval: -'�° Date: f�¢-F— ROt ztA: - fes. Ir-Uis (3/bb) MUNICIPALITY OF ANCHORAGE Department of Health & Human Services 825 L Street, Anchorage, Alaska 99501 343 ON - SITE SEWER & WELL PERMIT Permit Number: 5?95??- Enlargement Date Issued: 03/29/89 Engineer Designed Owner Name: H.U.D. Day Phone: Owner Address: 701 C STREET 271-0001 ANCHORAGE, AK 99513 Parcel Id: 051-105-27 Lot Legal: Subdivision: BETTY W. Lot: 1 Block: - Section: 9 Township: 15N Range: 1W Lot Size 1.25 A (sq.{t. 'or acres) Max Bedrooms: This Permit: 1 Total Capacity: 3 SEPTIC TANK: Minimum total septic tank capacity: 1,000 gallons. Each septic tank must have at least 2 compartments. Depth to top of septic tank(s) < 4.0 feet requires insulation over tank(s). WELL: Log must be submitted to Municipality of Anchorage Department of Health and Human Services within 30 days of well completion. INSTALL PER PERMIT #880261. I CERTIFY THAT: 1. I am familiar with the requirements for on-site sewers and weIIs as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations' and in compliance with the design criteria of this permit. 3. I will adhere to all MOA 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. 4. I understand that this permit is valid for a maximum of 1 bedrooms. I also understand that the capacity of the total system is 3 bedrooms and any enlargement will require an additional permit. Signed: DATE: ---------------- (Owner) _____________ (Owner) H.U.D. Issued By: DATE: 3 -f/; 7--- - ----�------------ --------------- Municipality om Department of Health and Human Services . Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 January 9, 1989 Secretary of H.U.D. 701 C Street Box 64 Anchorage, Alaska 99513 Subject: Lot 1 Betty W Subdivision Permit #880261, P.I.D. #051-105-27 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1988. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. 81 If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the orginal as -built inspection report (three-part form) must be sent to this office for review and approval, and for documentation. When applying for a new permit, the fees are: $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. Sincerely, V'%'- / D- I� 6 Daniel J. Roth Acting Program Manager On-site Services Section DJR/ljw enc: Copy of Permit MUNICIPALITY OF ANCHORAGE Department of Health & Human Services 825 L Street, Anchorage, Alaska 99501 343 ON-SITE SEWER & WELL PERMIT Permit Number: 880261 Enlargement Date Issued: 11/30/88 Engineer Designed ` Owner Name: SECETARY OF H.U.D. Day Phones Owner 'Address: 701 'C' ST. 271-0001 ANCHORAGE, AK 99513 Parcel Id: 051-105-27 Lot Legal: Subdivision: BETTY W. Lot: 1 Blacks Section: 9 Township: 15N Range: 1W Lot Size 1.25 A (sq.ft. or acres) Max Bedrooms: This Permit: 1 Total Capacity: 3 SEPTIC TANK: Minimum total septic tank capacity: 1,000 gallons. Each septic tank must have at least 2 compartments. Depth to top of septic tank(s) < 4.0 feet requires insulation over tank(s). WELL: Log must be submitted to Municipality of Anchorage Department of Health and Human Services within 30 days of well completion. INSTALL PER ATTACHED APPROVED DESIGN. HISTORICAL DATA SHOWS GROUND WATER CAN OBTAIN A SEASONAL LEVEL OF -7.0'. NOl1FY DHHS PRIOR TO EACH INSPECTION BY THE ENGINEER. THIS PERMIT IS ISSUED FOR THE EXISTING 3 BR. RESIDENCE ONLY AND LxPlRES ON 12/31/88. A CLH[IFY THAT: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA 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. 4. I understand that this permit is valid for a maximum of 1 bedrooms. I also understand that the capacity of the total system is 3 bedrooms and any enlargement will require an additional permit. Signed: DATE: >) � (Owner) SECETARY OF H.U.D. Issued By: DATE: 11 12- 213 Date Gross Time MUNICIPALITY *AP WQF6k eG Depth to Water Net Drop 14- 14 DEPT. OF HEALTH & sIS' MUNICIPALITY OF ANCHORAGE e' vl oivr•nEi.rAL PROTECTION ® ❑ R R}COLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIO�L,,yr 1,11sT q )# 15- 51718 825 L. Street, Anchorage, Alaska 99501 _ 264-4720 SOILS LOG — PERCOLATION TESTRECE V PERFORMED FOR: ` u' 0, DATE PERFORMED: 16- LEGAL DESCRIPTION: 1-07L /J� !�J IAI 7_1..151V /P / 4,, Ste— `/ L) rA Lo 7` SLOPE SITE PLAN --- 1 ( ) 1/A LI-4y!ep 18.] 19 2 3 4 <SP � r=. -mac 54.E 4 • , ..� L Y •I. <.S�P_Sw� SG ,.�o( u.e i/5'rGc�G c� � �o Es 7' 5 ole J".i NC Sa..i r� %'r4ct SI J%c_ 6 4-i •n'i'�'� I, O r•• 7 b+ ` �= v bemire .To •.-.G 2oc,h 9 10- 11 12- 213 Date Gross Time 13- Depth to Water Net Drop 14- 14 sIS' i 'c") e Y q )# 15- 51718 16- 17- 18.] 19 do COMMENTS IS`d WAS GROUND WATER Yi. f S ENCOUNTERED? P After IF YES, AT WHAT / E 7�4y DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop sIS' PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT Eagle River Engineering Services PERFORMED BY: P. 0. Box 773294 CERTIFIED BY: DATE: Eagle River, AK 99577 694-5195 72-008 (6/79) 100 0 L. E_1 70 W H c G_i W LC: W 40 ii. ,_0 10 Eli rRA.It•a SIZE DISTRIBUTION T "',T REPORT C CC' rC-t C -t c, -i .C+'� t,'•a t_ i l a, tit tCt 't tit 200 100 10. cl 101 GRA I Fl SIZE mm CLAY 1_ 2. i LL P I IN=.5 D50 • f ' Fi f 1 , '_� 0. 4 5 4_i . h1r'►TERIHL DE-CF,IPTION a SAFIU, F'►.n�iF L''r' ►IiMAD-11y TRACE GRAIJEL Pr ?? Project: DETT'•r' W. LOT 1, SEPTIC S'•r STEi,'1 a L c,� 7:0 -.41 --in: TEST HOLE 1 D15 DI ri CIA ,_4I._i 0. 16 13 G=1. 1:3 11 G_i p 97 _ . 4 i_i:_,►_ = Hi'►=:HTC i P A - e rr.a r'' E.-: c H T ER TABLE AT GRAIN SIZE I► I STR I BUT Ii iH TEE-'rREPORT II �Ir i .� _�.r• � t•�� � , 1 IMill Ell 011111111mll 011111111 200 100 10. cl 101 GRA I Fl SIZE mm CLAY 1_ 2. i LL P I IN=.5 D50 • f ' Fi f 1 , '_� 0. 4 5 4_i . h1r'►TERIHL DE-CF,IPTION a SAFIU, F'►.n�iF L''r' ►IiMAD-11y TRACE GRAIJEL Pr ?? Project: DETT'•r' W. LOT 1, SEPTIC S'•r STEi,'1 a L c,� 7:0 -.41 --in: TEST HOLE 1 D15 DI ri CIA ,_4I._i 0. 16 13 G=1. 1:3 11 G_i p 97 _ . 4 i_i:_,►_ = Hi'►=:HTC i P A - e rr.a r'' E.-: c H T ER TABLE AT GRAIN SIZE I► I STR I BUT Ii iH TEE-'rREPORT II �Ir i .� _�.r• � t•�� � , 1 DRAIN SIZE DISTRIBUTION TES) DATA Test No.. 19 _______________________________________________________________-______-- Date: 11-10-88 Project No.: 88-033 Project: BETTY W. LOT 1, SEPTIC SYSTEM Sample Data Location of Sample: TEST HOLE 1 Sample Description: S ND, POORLY GRADED, TRACE GRAVEL USCS Class: SP Liquid limit: N/A AASHTO Class: A-3 Plasticity index: NP _______________________________________________________________________________ Notes ______________________________________________________________________________- ,Remarks: WATER TABLE AT 9' Fig. No.: 1 ------------------------------------------------------------------------------- Mechanical Analysis Data -------------------------------------------------------------------------------. Initial Dry sample and tare= 1325.80 Tare = 271.60 Dry sample weight = 1054.20 Tare for cumulative weight retained= 271.6 Sieve Cumul. Wt. Percent retained finer 0.75 inches 271.60 100.0 0.375 inches 307.50 96.6 # 4, 338.30 93.7 # 10 419.50 86.0 # 20 535.40 75.0 # 40 724.90 57.0 # 60 989.10 31.9 # 100 1190.60 12.8 # 200 1298.30 2.6 ------------------------------------------------------------------------------- Fractional Components ______-------------------------------------------------------------------------- % + 3 in. = 0.0 % GRAVEL = 6.3 ---% SAND = 91.1 % FINES = 2.6 D85= 1.82 D60= 0.452 D50= 0.359 D30= 0.2396 D15= 0.16125 D10= 0.13107 Cc = 0.9694 Cu = 3.4475 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: LOT 1, Betty W. Subdivision A. GENERAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department o Health and State Department Of Environmental Conservation require ments. 4. All soil tests are advisory to the design and are to be verified o modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified o modified in the field by the contractor to meet Municipality o Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permit or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot lin position and the location of any easements. B. BED 1. 2. 3. 4. 5. 6. 7. The bed is to follow the natural land contour to maintain unifor total depth of the bed bottom. The bottom of the bed shall be level, plus or minus 1.5". The total depth of the bed excavation is not to exceed 4' at an point. The sewer line is to be connected into the existing leach line t allow effluent overflow to the upgrade leachfield. The bed gravel is to be covered with typar fabric material. Soil or combination of soil and extruded board insulation of 4' or equivalent is to be placed over the leachfield. The area over the bed is to be finish graded to prevent surface water runoff. to a dept: ponding o 8. The septic tank and leachfield must not be closer than 100' to an, existing private well, 150' to any Class "C" well, or 200 feet to an; community well. RECOMMENDED LEACHFIELD DIMENSIONS TOTAL DEPTH I GRAVEL DEPTH = 6 BED LENGTH = 19' BED WIDTH = 12' Soil Rating = 150 Bedroom Capacity = 3 Septic Tank Size = 1000 gal existing ***NOTE: SAND FILTER NOT REQUIRED DUE TO PRESENCE OF SAND LAYERS NO CONFLICT WELLS +101 T VALLEY ROAD MUI JICIPALITY OF ANCHC DEPT. OF HEALTH & ENv""Ol"41nENTAL PRorF, WELL AND SEPTIC SITE PLAN LEGAL, LOT 1, BETTY W, SUBDIVISION OWNER,- H,U,D. CONTRACTOR., N/A EAGLE RIVER ENGINEERING SERVICES P❑ BX 773294 EAGLE RIVER, AK, 99577 694-5195 OF WAY ----- NG LEACH FIELD NtW LEACH FIELD HHiHi— CLEANOUT SCALE, V = 50' r01 Q °000 City '•9'J2 .63000 b.,n L4'V 01 °caoaoc6©o°o 0°00,0 Louis,%. Lutera to t CE -5736 'J Zr %ROFESS�� � a co N m 0 n 0 cn 5; C) -0 m m n 0 m a T -n -n -n "n -n -n O m m m m m m m m 0 0 0 0 0 0 0 cn 0 cn Ie m 11 0 ON 00 Ili N) N) 0 -n i -n -n -n -n n -n "0+ 0 0 0 0 0 0 0 0 -.1 0 G\ co NlQ m Fr --t- m 0 C, P. P w C, PP3 P3 I -j �-j -0 a.$= ri J3 1� c -F Saj a, F� �:b Q, 0) C+ 1 (D 0 0 Xj Fj �-j -1 CD P (D C/) w 0 n P3 -n (D 0 0 0 0 0 0 0 E" ZZ EZ iz > 0 z %_n vt N) (D ON -n n. -n -n n -n -n r+ r+ r+ f+ 0 0 0 0 0 0 0 0 -1-- ON -n -n -n Ti ,-* C13 r+ P P3 p H F -i F -i Fj C+ CD (D Ea C+ 0 (D co N m 0 n 0 cn 5; C) -0 m m n 0 m a cn 0 m m m z m a (D C+ Ei > 0 Om C" O O m m cn 0 cn Ie m 11 cn 0 m m m z m a (D C+ Ei 0 OD 0 x 00 zi 03 ET m > co co cn On 00 4 rn nt z > Tj 74 (X) m co -q 90 0 0 z C" O O 0 OD 0 x 00 zi 03 ET m > co co cn On 00 4 rn nt z > Tj 74 (X) m co -q 90 0 0 z V MUNICIPALITY OF ANCHORAGE } N DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 't"N �DISPOSA4 SY-ST-EMVI AND/GB:l;v' ' L -INSPECTION -REPORT= NAME PHONE Ila? A' ' -23 l s' ❑UPGRADE MAILING ADDRESS -5d.1 ;, F3 x V1;eK ds O LEGAL DESCRIPTION `jam 5 LOCATION / NO. OF BEDROOMS aI/e �41f �. c�� tc ; «J DISTANCE TO: Well / 0-51 Abso tion area Dwelling % PERMIT NO. �'��, •- 15�0 UY a Q Manufacturer Material/ 4` No. of compartments (n Liq. c pacity in gallons d � IF HOMEMADE: Inside length A� � Width `�- Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. = zz Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well / 1 Foundation 3,21 Nearest lot line / '3 PERMIT NO. w= J u -z z w No. of lines ? Length of each line•�� 0 }J Total length of lines�.1 Trench width c•� 1 Distance between lines -7 / J ia+el+es / cc Fes- Top of tile to finish grade a / 1 Material beneath tile f d 6 Total effective abs or tion are 2- 4F 0 0 ,+� inches n, LU Length idth Depth PERMIT NO. C7 Q F- ad W Type of crib Crib eter Crib depth Total effective absorption area in DISTANCE TO: II Building foundation Nearest lot line j Class S' Depth „� / Driller E0 Distance to lot linea i PERMIT NO. II `` e/ U w DISTANCE TO: Buildingfoundatio r 3 qIF Sewer line /J� / Septic tank j o�_ 5 / I Absorption area(s) I OTHER ) _ E� PIPE MATERIALS f SOI L TEST RAT] NG r 1/ INSTALLER] _. j ;h U ov J r 4 REMARKS 1 i l ,U. �} ?� D1,; o T) L. iF e 5ep ` JJ n� �� Qr Gibo'Il -,o k t� ld 1 C, e to S N d hV k A6, /'1 4 u 1 $.y a �f Y i i `' • s'� •� , L.. 1 �•••n••u•.• ...►•e..• .. - 10 53 Robert . ���•°s CE - 4535 4 •.• v� APPROVED i •°.,•°0,°.sem ATE LEGAL npRO•FE?S1�N.� ' s p 72-013 (Rev. 3/78) M i,1L-"_' MUNICIPALITY OF ANCHORAGE / S DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME RA ��A n'� SIJ PHONE _ �% '/� �� NEW ❑ GRADE R'k-, MAILING ADDRESS Ii :a 7 EJ J LEGA DESCRIPTION~ l LOC N NO. OF _SDR OMS .Y DISTANCE TO: Well ��q /v Absorptio a ea Dwellin PERMIT O. �7,_ I� 1 I— Z w Ia. .--e— Manufacturerteri��ll, _ No. of com artments N Liq. ca acity in gallons IF HOMEMADE: Inside length Width Liquid depth °v �z DISTANCE TO: Well Dwelling PERMIT NO. 2 z< Manufacturer Material Liquid capacity in gallons w = DISTANCE TO:!�� We n Found n r Nearest lot ine ®-- I ��`• �L . J u- z Z w No. of Ii Length( l ,}ine Total lepgth dines �O Trench widt i+ies Distance between line�j e HTop D of tile to finish rad - A Material beneath tile !( inches Total effective absorption area w 0 Length Width Depth PERMIT NO. < n~ Lu Type of crib Crib diameter Crib depth Total effective absorption area Lu DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. W Lu DISTANCE TO: Building foundation Sewer line Septic tank Absorption areas) OTHER PIPE MATERIALS e , SOI L TEST RATING INSTALLER . �J til 5' REMARKS f0 i n APP' VED N 74 K DATE LEGAL !�6 2'zg� iz-ui3 thev.3//8) ( N e r r I MUNICIPALITY OF ANCHORAGE,-- a:�U Department) Health and Environmental rotection 825 J Street, Anchorage, AK. 99501 264-4720 C� # # # HANDWRITTEN PERMIT # # P� yOkA WC -L "vr� � ON-SITE SEWER PERMIT Applicant: PA V19AID 8D,&U__QA1 -Mailing Address: Location: Phone Number.,:. Legal Description: L7- Lot Size: it /4 Type'of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: 2 Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH �� LENGTH _L) GRAVEL DEPTH�aIYA,64 R,GX•WIDTH �S The length dimension is the length(in feet) o e 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(H�Nt) TANK SIZE _ ®Gd 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(2) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection.and approval by this departmei will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fef 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 1 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 if the residence is remodeled to include more that 3 bedrooms Signed: Issued by: -/) f��izA Applicant" Date: t(j -2 i - 90 / SWP/0 2 4 (1/ 81) MusT eeE.�!®v�' �/r' /,7/ W e,poief C SystkM 14Rsr"ur,�� ,, �rci o5 Ty�o �s� ,pee. iA1/_,fAA&A_ A ahY Gilfilian Engineering &. Environmental Services Bob Gilfilian, P.E. SRA Box 6364 ® Palmer, Alaska 99645 (907) 376-3005 Q TEST HOLE LOG Project Name: Soil Absorption System for Lot 45 Sec 9,T15N,RlW,S®M. Helmut's Inco Excavating & Landscaping Project Number: 8155 Test Hole Number: 1 Date of Test Hole: 10/18/81 Test Hole Location: Approx. 12' from end of cast iron pipe from septic tank outlet. Method of Excavation: Existing trench excavated for soil absorption sys. Logged By: Bob Gilfilian, P.E. 0.0' ^-�- Organic Mat, forest litter,etc, 0.5' Silty Sand (loam) w/ some organics and roots 1.7' p v. C9 Olive brown Sandy Gravel w/ some cobbles , C) -e •J ••C)•' 4.01 4.. '. Brown Poorly Graded Sand (fine) Sandy GRAVEL 7.3'" �'a Ground Water Table, T.D. IRWGilfilian Engineering & Environmental Services !7 Bob Gilfilian, P.E. SRA Box 6364 e Palmer, Alaska 99645 (907) 376-3005 October 21, 1981 Mr. Chuck Staschel Helmut's Inc. Excavating & Landscaping SR Box 1245 Chugiak, AK 99567 RE: Lot 45 Sec 9, T15N, R1W, S.M. Lot owner- Ray Anderson Dear Mr. Staschel: This letter is to provide you with an engineering report on the subsurface soils conditions found on the above referenced lot. As per your request, I visited the subject lot on October 17 and 18, 1981, and observed a deep trench excavation. It was my under- standing the trench was excavated at an earlier date for the pur- pose of installing an on-site wastewater soil absorption system to serve a proposed two(2) bedroom dwelling. Attached for your review is a copy of _a soil log of the trench excavation. This log was made on the soil structure located at approximately 12 feet from the end of the septic tank cast iron outlet pipe. It is important to note that the soil structure and layering along the length of the trench was not consistent. This log however, is rather representative of the general soil conditions. It should also be pointed out that the ground water elevations along this trench was not constant,i.e., the ground water tended to rise in elevation as one proceeded away from the septic tank. Specifi- cally, at 24 feet from the beginning of the trench nearest the sep- tic tank the water level was approximately 6 inches higher than that found at 12 feet from the beginning of the trench. These ob- servations indicated a spring(a groundwater recharge area) may be present on the opposite side of this lot. In any event, it appears that the watertable elevations in the vicinity of the septic tank may be sufficiently deep to permit,the installation of an on-site soil absorption system. In addition, I noted the invert on the discharge end of the 10 foot section of cast iron pipe located on the outlet end of the existing septic tank was approximately 516" above the groundwater table mea- sured 12 feet along the trench from the end of the pipe. Also, this cast iron pipe was laid at a depth of approximately 1.7' below the existing ground surface. Engineer Report Helmut's Inc. Page 2 10/21/81 In consideration of the above described site conditions, it is my recommendation the proposed soil absorption system consist of a shallow seepage bed. The effluent distribution system should con- sist of 411 diameter perforated pipe laid level with 6" of screened rock placed below the pipe and 2" of rock placed above the pipe. This distribution system should be connected to the existing cast iron pipe from the septic tank thus allowing for gravity flow. It is required that the bottom of the screened rock media be placed at a depth to provide a minimum of ¢ foot vertical separation above the above described groundwater elevation. Further, the native silty loam soils must be removed and replaced with clean sandy gra- vel backfill material placed up to the bottom of the screened rock. The size of the above soil absorption system is dependent on the quantity of the sewage flow and infiltration capacity of the sub- surface soils. Based on the visual and textural characteristics of the underlying sandy soils, a -wastewater application rate of 150_gallons er day per square foot of absorption area was derived. Allowing for a 1 .5mult�n_�ation_ ac.- _ _ sizing seepage beds the total bottom absorption rea re uir ectbedroom we ing is s fee -E.-) The recommended deminsions of the seep- age bed s ou e wide by 30' loner The layout and installation of the distribution system shou3d be made in accor ance with cc o -r n_L Lastly, a minimum of 2 inch thick rigid styrofoam insulation should be placed directly over the screened rock media and a minimum of 2 feet of earth cover should be placed over the styrofoam. The mound- ed surface over the entire seepage bed should be smooth to allow for positive drainage to prevent surface water from standing and/or ponding the mound surface. If additional information is needed on the above matters please do not hesitate to call upon me at your convenience. Sincerely, Bob Gil ian, P.E. Consulting Engineer (Anchorage Municipality Certificate ##ST81-035 ) 9 ; ROBERT E G1Ki�; ;ia a 113 °° N0. CE-.,�? eoo 10 D MUMCIPAUTY OF ANCHORAGE J`1 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-105-27 1. GENERAL INFORMATION Complete legal description Betty W L1 Location (site address) 21714 Valley Ave. Current property owner(s) Mailing address Real estate agent Willie Sikes 2. TYPE OF DWELLING: Fx-1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 2 Expiration Date: 3 - 3 — Z c4 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Q Private Septic E Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ �� �%, 50 C 6 Ut 13 Date of Payment JZ -3-2-C9 Receipt Number 02,397 6 - Waiver Fee $ Date of Payment Receipt Number COSA # 03CG 16 -r) e Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage riles 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water 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 system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE System #1 Approved for 2 bedrooms System #2 Approved for bedrooms Disapproved Date -�?o fl'7_, qF!!' � ®�?.• ► •fig H ` y� �•teven R` Feiitierie• CE 8149 F ,•ice DO, EiSIQ�`� F Conditional approval for bedrooms, with the following stipulations: �PJ,\TY okVOF�r, (if, n1T:1P 1-1 WATER AND r VVA6Tr- ^ ;_ VVATERol z P `O J./ 0 Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site 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 engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: Betty W L1 Parcel ID: 051-105-27 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA Q Well log is filed with Onsite (or attached) Date drilled 3113189 Total depth 200 ft Cased to 200 ft FW Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 25 in. Date of flow test for COSA 7/16/20 Static water level at beginning of test 27.1 ft. Comments B. TANK DATA Age of tank(s) 31 years Tank type/material concrete Measured operating fluid level in septic tank 48° FN Standpipes/foundation cleanout per record drawing Date of pumping 11/17/2020 D. ABSORPTION FIELD DATA Bed Which system tested (date installed) 3121/89 ALL standpipes present per record drawing Total measured depth from grade 2.8 ft (max) Measured depth to pipe invert from grade 2.3 ft (min) ❑ N/A — pressurized field 0 Monitor tubes go to bottom of effective. If not, state depth into effective 0 Code -required soil cover over field ® System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 1200 gallons Comments/Deficiencies: 2" of rigid insulation over Beds COSA Checklist yellow sheet Well production at time of test 4.13 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes F No © Coliform bacteria is Negative Nitrate 2.26 mg/L ❑ Nitrate less than MRL (ND) Arsenic 1.769 ug/L ❑ Arsenic less than MRL (ND) Collected by PES Date of Sample T11112020 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 711612020 Results ❑✓ Pass For 2 bedrooms Fluid depth prior to test 0 in Water added 300 gal New depth 4 in Elapsed time 200 min Final fluid depth 0 in Absorption rate >300 gpd Any rejuvenation treatment (past 12 months) If yes, enter date N/A 0 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft 7 Yes if No Neighboring Tank > 100' [Z] Yes if No ft Private Sewer/Septic Line > 25'[]✓ Yes if No Absorption Field on Lot > 100' P/l Yes if No ft Holding Tank > 100' Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' ED Yes if No M Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft ✓� Yes if No ft ft ft ft ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' E✓ Yes if No ft Surface Water > 100' Q✓ Yes if No ft Property Line > 5'Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' F Yes if No ft Private Wells > 100' 0✓ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' [❑✓ Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓Q Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No Surface Water > 100'✓0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION OF ALxl certify that i have determined through field inspections and review���9��� of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. -- Ste�nn R. Pannone y �^�• CE 8149 t COSA Checklist yellow sheet HIL ft Iico 0 Lry I G8.66Z M..OS.00 a00N a m N O a H M %A U ti 0'D£ N c a`i > E 2 E I O n `rti V� t� >>��•��/ �" J \ N p U- c O a1 �I' ay I O! u=i QI it N `n a! u p -j LU \ 4 _0 LL Er O 3 �@012 rn /u 2 P= 6 oa (8 ro v /lt/M� iaa � — �. o c m a 3 e -i 00 =-- W N -a a Y O > co i �.. ..J <c _ _ = Ire L m m O � ao `° v L-jjlVi// -- Z a a C �- O .- uj 3 'a O �. O c O - a � c O 120.4 J ovQ L vry � Ln N 0 0 N % � \ i a Z M> O N a) Z U 0 U _ 0 J C E U a O c 2 v ro Yn E UL ° �E �.N O a wo an v c E _ro O `Z 0 'O C O r '.O V) 0 U O cu +'' w £8 662 .Ole .00 oOOS { LLQ :Ew m w 0 m > ui cj I"0 � "- o u� a�'oaci" O O _ ¢ O c OU -O U O U t1J O wc ( Q aj � N c0 n d O N = v E> N_ m .O- "' O E v - J > .al U � Q l0 i \ } o Ea)m>> ons 00 V N d - >' (O O � L O a 1 co�+ i I a, -a Olm r s c Mn z c � (D � = N >- � E Ti Ln 4 > � I I 0 CD r-- CL t �. P— — LL.( I a� a 2 Z a c m@ N o o x L m O = Ln 3 IL co m 3 8 —_ -- I > m m c� aCLo >cp F w W i D N� C i Q. �.., `m.ro •. Q,l ..i I,-�? R i c/7 �, �NNQ- �z� � w 2 2 a) r cu (D vii N ° E a U vi w, r. T i /,^qq aci FL- w Q Q I I ray L� ll!, /� i7 N MUNICIPALITY OF ANCHORAGE pJ Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES —i 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 0-67— I0"5 ---Z7 HAA# "%0d D,121 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Loa 1; Betty W. Subdiv.i4ion; Sec. 9, T15N, R1W, S.M. Location (address or directions) NNN VaUeu Road, Chuaiak. Ata6ka (b) Property owner N.U.D. Telephone: (home) Business 271-2799 Mailing Address 605 West 4th Avenue, Suite 108 Anchokage, Ata6ka 99501 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent ASSOCIATFD mougg ATTN• Sawdy Address 640 West 36th Avenue Suite 01, Anchorage, Ak.. 99503 Telephone 563-3333 (e) Mail the HAA to the following address: (or check here, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle River Loop Road No 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family Cfx Number of bedrooms 3 3. WATER SUPPLY Individual Well XX Community ❑ Public ❑ -Note: If communitywell.system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site 9X Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION C 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 Address Date 5 S F-NG114EF-RING 1704 Eagle Kver Eagle River, Alaska 99577 TelephoneOGL__Z z z� � 27 a r.:�p.a�f. o • o . • +o syr n.-. abart A. Ss'iwI r , o + No. 1457.2 DHHS APPROVAL r /I j Approved for �_ bedrooms by - Date � > > �-.� Approved _ Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) • ` Health Authority Approval (HAA) T CHECKLIST - FEBRUARY 1984 M}� '= 343-4744 Legal Description: i A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present I) T Date Completed «� �� Yield Total Depth'0-6L;� Cased to ��� Depth of Grouting Static Water Level M L-4 Pump Set At Casing Height Above Ground Sanitary Seal on Casing �N) Electrical Wiring in ConduitQ?/N) SEPARATION DISTANCES FROM WELL: Depression Around Wellhead (YAq Iff To Septic/Holding Septic/HoldingTank on Lot On Adjoining Lots l `- i To Nearest Edge of Absorption Fieldo Lot �� k- ; On Adjoining Lots To Nearest Public Sewer Line A To Nearest Public Sewer Cleanout/Manhole N To Nearest Sewer Service Line on Lot 2S' Water Sample Collected by S S �� ; Date Water Sample Test Results X15 Comments B. SEPTIC/HOLDING TANK DATA Date Installed t Size No. of Compartments Z StandpipescIRN) Air -tight CapsVN) y Foundation Cleanout<YLN) _ Depression over Tank (YJtq f-� ate Last Pumped Pumping/Maintenance Contact on File (Y/N)� ; for r-- Holding Tank High -Water Alarm (Y/N) �7A Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water- Su.pply-Well �Jt + To Building Foundation t To Property Line To Disposal Field To Water Main/Service Line �• �" ' f To Stream, Pond, Lake or Major Drainage Course 1 5-c;, Comments 72-026 (Rev. 7/88) Front Page 1 of 2 f - C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 1 Type of System Design %ty`l , Date Installed IP( �' I Length of Field 2-y Width of Field t l 2 r Depth of Field Z. S Gravel Bed Thickness 61 Square Feet of Absortion Area :5 % Statndpipes Present< AWN) Depression over Field (Y&) /`1 Date of Last Adequacy Test Results of Last Adequacy Test 3J2aj2_ (6�1L, e.S SEPARATION DISTANCE FROM ABSORPTION FIELD: 1� To Water -Supply Well `� � To Property Line �d To Building Foundation To Existing or Abandoned System on Lot4 2 ; On Adjoining Lots �� ('� ( To Water Main/Service Line To Cutback (if present) t To Stream, Pond, Lake, or Major Drainage Course A. • �" To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) **Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect inspection. mc.M Signed • S & S ENGINEERING.�?7 ,�e n•Oe CompanyRiver Loop Road No. 204 Date E.,Ie Winer, Alaska 995�A e'V2; MOA No 0Receipt No. ` Date of Payment 6 QG Amount: $ Z -� Receipt No. _ Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 the date of -.this Poo 7""" w"—wa oa•"or s+ *oo� Na td _fi MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel 1. D. # C`'� \ - \ C-) _4:�-"a-1 HAA # �,A 1 92 C-) \, \ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1 Betty W Sub T15N, R1W, Sec.9 Location (address or directions) N.H.N. Valley Road Chugiak Ak (b) Property owner H.Q.Q. Telephone : (home) Business 271-2792 Mailing Address 605 W 4th Ave Suite 081 Anchorage, AK 99501 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent The Realty Store Address 8040 QjDal Circle Anchorage, AK 99502 Telephone 279-1895 (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 a 3. WATER SUPPLY Number of bedrooms -1 Individual Well R 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 R Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, l 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 Eagle River Engineering Sery Telephone 694-5195 Address P-O.B. 773294 Eagle River, AK 99577 Date =Th ,�L'- (ny 6. DHHS APPROVAL Z,�ezl Approved for ,/,� bedrooms by Date Approved _L�— Disapproved Conditional Terms of Conditional Approval P", , . CAIITIQN�` The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HORAGE Health Authority Approval (HAA) MUNICIPAL► ES DIVISIOt�HECKLIST - FEBRUARY 1984 � 1 ENVIRONMENT 343-4744 MAR 3 1 j�$g Legal Description: TSN ?/�✓ Se. 9 A. WELL DATA RECEIVED Well Classification If A, B, C, D.E.C. Approved (Y/N) IYA Well Log Present (Y/N)—Date Completed 3/"3/85 Yield �• s G�'"' ��-rte^ ��, Total Depth Zoo , Cased to S0 Depth of Grouting `2�-4 Static Water Level 6' Pump Set At /9d' Casing Height Above Ground /8 " Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot !ov' To Nearest Edge of Absorption Field on Lot tiav ' To Nearest Public Sewer Line /Y/d Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots too ; On Adjoining Lots �lov To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot 't-)47' Water Sample Collected by Ego 4e- 5tis ; Date 3,4sZe9 Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size /ovy o5r, No. of Compartments Standpipes (Y/N) Y Air -tight Caps (Y/N) Depression over Tank (Y/N) w F2 W oma: Foundation Cleanout (Y/N) Y Date Last Pumped 3/.P5 .T/"c Pumping/Maintenance Contact on File (Y/N) A;% ; for ^J%a Holding Tank High -Water Alarm (Y/N) '"1/-4 Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well _ /°o � To Buildin Foundation / v' To Property Line ao To Water Main/Service Line t/o ' g To Disposal Field To Stream, Pond, Lake or Major Drainage Course A% Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 16;-0 4611S2 Type of System Design Date Installed Length of Field Width of Field 4r ���2-' Depth of Field 3 Gravel Bed Thickness 6 Square Feet of Absortion Area 6 7s, fid! Depression over Field (Y/N) /,✓ Statndpipes Present (Y/N) Date of Last Adequacy Test 5Ifof� Results of Last Adequacy Test S,-t%s7ce.,:-ek-. ei, X T- e4.re- SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well /GD To Property Line To Building Foundation To Existing or Abandoned System on Lot /-)- / ; On Adjoining Lots __ f30 To Water Main/Service Line t/° To Cutback (if present) ?!/� To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments /SS-/ h r-s� 1 —2 4.7,04 Sy.rA--. yips 7f6 3 -, i s.Rs. D. LIFT STATION Nly Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments 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 guid.eIin-ds; iri.eJfect on the date of this inspection.` Signed Eagle Rivcr Engineer,nr Company Eagle River, AK995" ' Engineer's Seal Date 3 si/ls 9#9195 MOA No. }c13 Receipt No. Receipt No. Date of Payment � —�3/— Y/ Amount: $ C / Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 M 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 %- GENERAL INFORMATION I (a) Legal Description (include lot, block, subdivision, section, t wnship, range) 404 45--1 Location (address or directions) z. TYPE OF RESIDENCE Single -Family R111uI`:-FarniIy 0 Other Number of Bedrooms. -_21- 3. WATER SUPPLY Individual Well e'Cornmuniy 11 Publ:c El Note: if community vee llsystenn, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public 13 Community El 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 (11184) lLa 13ox 16 93 CA ttq',?R, (b) —A Applicant Name Ray A h J e I- so P, — Telephone: Home 2-'315' Business Applicant Address (c) Applicant is (check one): Lending Institution El ; Owner/builder 15'Buyer 0 Other El (explain); (d) Lending Institution 14, 1 '-31u7m's*� F�4-:'ZTelephone Address T, (e) Real Estate Company and Agent Address Telephone Mail the HAA to the following address: z. TYPE OF RESIDENCE Single -Family R111uI`:-FarniIy 0 Other Number of Bedrooms. -_21- 3. WATER SUPPLY Individual Well e'Cornmuniy 11 Publ:c El Note: if community vee llsystenn, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public 13 Community El 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 (11184) ' �i EN[JNEER|M[3 FlRV0 PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND f0FQRR8AO[>N ' As certified by myseal affixed hereto and as of thevalidation date shown below, I verifythat 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 infornnalion Obtained from the Municipality ofAnchorage files and from my investigation and inspection, the on-site water supp|yamd/or - wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in eflect on the date of this i e o1i Name of Firm 0 y -At 5' T" 7F. Telephone Date ti APPROVAL Approved for Approved u;sappr Terms of Conditional Approval rg Enginaer*s8ea[ Qj CE 45 ` \ ^ ' ^ *m~ ,Date The Muncipa|ityofAnchorage Department of Health and Environmental Protection (DHEP) issues Healffi Avt3hoftj Appnova|oertifica1esbaaodsm!e|yupontherepnaoen1skionugiven|npurmgrsph5abovebyenindepmndongpnofea�oma` � engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their fenduig � 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 inthe�.�k` professional engineer's work. Page 2od2 MUNICIPALITY OF ANCHORAGE �^ DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) ` CHECKLIST - FEBRUARY 1984 AUG of) 95 264-4720 RECEIVED C E I\� E® Legal Description: L o� `rs�� Sat 9 -r lRj I W G V S, ay ANd ekson A. WELL DATA Well Classification Si I7 Olt t-Q}„1If A, B, C, D.E.C. Approved (Y/N) /M �S Well Log Present (Y/N) — Date Completed Judi ?-� 1977 Yield I- # - Total Depth I e Cased to $1 Depth of Grouting Static Water Level w $ti��'dct Pump Set At s Casing Height Above Ground a td Sanitary Seal on Casing (Y/N)'e S Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) X'ES Wr'lf # f4nX inSid4 Kr• Separation Distances from Well: p f -A.-em. i To Septic/Holding Tank on Lot ; On Adjoining Lots'! To Nearest Edge of Absorption Field on -Lot 1 d e ; On Adjoining Lots t To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot dobe Water Sample Collected by 4' Q U: if"k ffngj-, 34010405 ; Date )*Jv 30.14d'y Water Sample Test Results L -e A1+4,11ke d 1 Comments tt Na Rn,km Stutn, 5y4e..5 w4k, , JOde ut E�rtsh'"!7 W -e11 B. SEPTIGMTANK DATA Date Install 0 +81 1000 6414sis ed, Size No. of Compartments Standpipes (Y/IG Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank E` ,' Date Last Pumped +�5 Pumping/Maintenance Contract on File (Y/N) ��` ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank.- To ank:To Water -Supply Well To Building Foundation To Property Line t To Disposal Field To Water Main/Service Line i To Stream, Pond, Lake, or Major Drainage Course f% / / Comments f Pid ,:' el - S Ls i f 1` r- y !'< 11�e�c A S .•V eoe e ' Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata SO T of System Design Date Installed 0 C 4. Length of Field 30 Width of Field 5 Depth of Field W) Gravel Bed Thickness 12 �i Square Feet of Absorption Area Standpipes. Present (Y/N) Depression over Field (Y/N) /V Date of Last Adequacy Test /VON4 Results of Last Adequacy Test 5,e e- Go P" Separation Distance from Absorption Field: i To Water -Supply Well i �'� To Property Line i To Building Foundation// To Existing or Abandoned System on Lot A'JA ; On Adjoining Lots To Water Main/Service Line N�13 To Cutbank (if present) -PIA To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ly t h� ec•4 ° Comments 54,Pkn hQs keeh ;n uSt le5ss Aaft +wo Ye4rS _A"CL as- t"114 5' jd-eke- avalla6r,,c-r. AM aiffail ey .vended. D. LIFT STATION Date Installed JV oN e- Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Lev at High Water Alarm Level at ent (Y/N) Tested for Pumping Cycles during Adequacy Test:.Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that avechecked, verified, conformed to all MOA and HAA guidelines in effect on the date of this inspection. Sign— ed��`i1 )' "'^'�" Date � , 2 %GIS'_ Company MOA No. IV Receipt No. a� Date of Payment Amount: $ 3q�3��5 o O _6_ D5 Page 2 of 2 AS-p'D 72-026 (11/84) Engineer's Seal