HomeMy WebLinkAboutTRAILS END BLK 5 LT 3Trails End Block 5 Lot 3 #015-192-28 Municipality of Anchorage Department of Health and Human Services Building Safety Division `T" On-Site Water and Wastewater Program, 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 5 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWSW03002 PID Number: 015-192-28 Name: nennos & Kristin Mellinger Wastewater System: E] New Z Upgrade Address: 11281 noggie Ave, 99516 ABSORPTION FIELD Phone: Number of Bedrooms: 0 Deep Trench 0 Shallow Trench D Bed D Mound 0 Other: LEGAL DESCRIPTION Soil Rating: 0.6 rPD/Ft' Total Depth from original grade: 4.0 FI_ Block: Lot: Subdivision: 5 3 Trails End Depth to pipe bottom from original grade: 2 FI_ Gravel depth beneath pipe: 1.5 Ft Township: Range: Section: Fill added above original grade: 2-3 Ft. Gravel Length: 33.44.20 Ft. Well: ❑New ❑Upgrade Gravel width: Number of lines: Distance between lines: 5.0 Ft. 3 10+ Ft. Classification (Private, A, B. C): Total Depth: Cased to: Total absorption area: Pipe Material: Existina Ft, Ft, 480 Ft' 3034 PVC Driller: Date Drilled: Static Water Level: Installer: Date Installed: Ft. A+ Home Svc 1/11/2003 Yield:GPMI Pump Set at: Casing Height Above Ground: TANK Ft. Ft. Ft. SEPARATION DISTANCES ED Septic El Holding El S.T.E.P. 0 Other: To Septic Absorption Lift Holding Dublic/Private Manufacturer: Capacity: From Tank Field Station Tank Sewer Line I Anch Tank 1000 G.I. Well 130 101.9 140 120 Material: Steel Number of Compartments: 2 Surface Water 100+ 100+ LIFT STATION Lot Line 19 6.6* 10 V Size 500 G.I. Manufacturer: Anch Tank/Orenco 7 16.7 18 Pump on" level at: "Pump olevel at: off' High water alarm at: Foundation in. in .1 in. 100+ 100+ 100+ Pump Make & Model Electrical Inspections performed by: Curtain Drain I MOA (See inspection report) Remarks: Request lot line waiver to 6 feet for drain field. BENCH MARK Location and Description: East Window Sill Assumed Elevation: 100.0 FL Engineer's Stamp AV *% # AW AV # Inspections performed by: Pannone Eng. SVC Dates: 1st1/11/2003 Air H .... .......... ............0 2"d01 /14/2003 0 0 0 Department of Health and Human approval .11 .......... ........................ 0 0 .. ..7 AW �'e�rvris # *#A" % �ArAV Reviewed and approved by: Date: 1122103 6♦ AV All, (Rev. 11/99) PERMIT NO, SW03002 RECORD DRAWING P.I.D. NOi 015-192-28 WASTEWATER DISPOSAL SYSTEM LOT 3, BLOCK 5 TRAILS END S/D LOT\, UNDEVELOPED-/ I I -RE-MEIVE CHAIN I._. LINK~_ G- -R-U'- --N-OzrC' SEE SHEET 4/4 FOR 8, HOUSE SWING TIE INFORMATION EXIS DRAINFKIL-D j PLN PL,& B 99, EXI T'G TH1 I-_ l i i I� III / WELL T 2-0 III DESIGN' III I P C ERC RATE= 10 MIN/ r���okk\DYAWING\3-5TRAILSEND.DWG188 SF/BR, 3 BR/ HOUSE 564 SF REQUIRED 5 -WIDE DRAiNFIELD SYS, 1.5' EFF, OF = 78 97 LFx 5', 4.0FACTOR' TOTALODEPTH 401 TOTAL EA 485 SF •`1000g 10OOg SEPTIC TANK • TH a : — 500 S,T,EP. TANK ... ..... ................ I ...... ............. ..... ... .................... PREPARED FORT PANNONE ENG. SVC, LLC gt. Steven R. Pannone: Dennis & Kristin Mettinger No. CE 8149 11281 boggle Ave P. 0. BOX 102954 I.. ... I ( ..." Anchorage, AK 99516 ANCHORAGE, ALASKA 99510 ........... 339-6249 227-3522 P, 272-8218 Fax DATES 12-8-01,2 RECORD SCALFi"=50 PERMIT NO 8W03002 C���Fl[�� Tl���UTN[� n�-�u/�� DRAWING uvu WASTEWATER DISPOSAL SYSTEM LOT 3' BLOCK 5 TRAILS END S/D C CO A B [ FC -.---29,Cr'^ 19.6 T1 35.5 16.4 T2 41.5 15.5 DC1 44.1 16.4 FS 46.0 17.2 L1 43.1 22.4 LS 41.9 248 N1 12.8 45fK— S1 95.4 50.�--- S2 96.2 48.5 S3 94.8 46.1 S4 50.1 5� 519 4� �� 31J 25.7 — ^m0.__------ NEW 1000 SEPTIC TAN 3 PID N��5�9�28 rVA NORTH TAT�� �F | '``�'` ' ' ' THIRD '^'^^� ~ | REPLACEMENT FIELD CURES @CE 3T[} M INTA� TOT DEPTH 4 \ | Ci\Work\DRAWING\3-5TRAILSEND,DWG REPARED FOR/ Dennis & Kristin NeK|nger 11281 DoQQle Ave Anchorage, AK 99516 339-6249 NEW 5009 STEP TA ~~ TO NORTH FlE fLOW SPLITTER � � - 0 N N 0 -N N --SOUTH TREN[ LF 5'x1.5 EFTV, 4\TD PANNONE ENG, SVC, LLC P. 0, BOX 102954 ANCHORAGE, ALASKA 99510 227-3522 P, 272-8218 Fax JE, 6-9-02 DESIGN PERMIT NO, SWO2 DESIGN DETAILS WASTEWATER ABSORPTION SYSTEM NOTEi LOT 3, BLOCK 5 TRAILS END S/D 1> ALLWORK WAS PERFORMED IN ACCORDANCE WITH, & ALL METERIALS SHALL CONFORM TO AMC15.65. 2) SEE GENERAL NOTES ON SHEET 1, 3) ADD A MINIMUM OF 1' OF FILL OVER ENTIRE TRENCH. ino NUT 4) INSULATE DRAINFIELD WITH 21 RIGID INSULATION. 5) B.O.T. STAND FOR BOTTOM OF TRENCH DRAINFIELD ELEVATION TABLE TRENCH NORTH I S. EAST I S.WEST I WEST INV. EL 97.4 -- 90.3 U B.O.T. EL 95.9 191.8 903 8818 1 191.9 90.3 GROUND 99.9 94.7 92.8 94.3 i� 5' 1.5' Drawing C,\Work\2-2SBV,DWG q -u c> CU LO 1 1 OD 0 0 1 D Lo I PREPARED FORT Dennis & Kristin Mellinger 11281 Doggle Ave Anchorage, AK 99516 339-6249 38m 801INE11 im NV31: im NV313 im NV313 im NV313 NDIlmnw P.I.D. NO, 015-192-28 2 ^— � @ p 0 x Ld0 x Z U, Z.t W _j -J _j bi O('7 CU www Cq- 0 W CL Pannone Eng, Svc,, LLC P. O. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218, PHONE & FAX 4TEt 12-8-02 1 OT TO SCALEI DESIGN -y r-1 Ld > U u 0 F --q 0 L a, F— .2 .9 (L U Li L -i PQ < L/ .0) Lj Li 5' 1.5' Drawing C,\Work\2-2SBV,DWG q -u c> CU LO 1 1 OD 0 0 1 D Lo I PREPARED FORT Dennis & Kristin Mellinger 11281 Doggle Ave Anchorage, AK 99516 339-6249 38m 801INE11 im NV31: im NV313 im NV313 im NV313 NDIlmnw P.I.D. NO, 015-192-28 2 ^— � @ p 0 x Ld0 x Z U, Z.t W _j -J _j bi O('7 CU www Cq- 0 W CL Pannone Eng, Svc,, LLC P. O. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218, PHONE & FAX 4TEt 12-8-02 1 OT TO SCALEI DESIGN JAhJ-16-2�t03_ 1?52f� FRQP1:A+ H13MESER1J3,rESP, IH, 07-868-6778 _ 70:2729219 P:1/1 • RightFAX 1/15/2003 5:L5 PAOE 1/1 RightFax ti IrmpectlOfl Repoft Municipality of Anchorage, Building Safiaty Division 4700 South Brapaw INSPECnON: VQ1C9 943-8300 :N5PECr10N- FAX (907)249-7777 INFO: M-8211 Plaine ED'S FI:EC MC Permit 03-7092 Address 11291 DOG01` AVE Phone 272-4591 L"al OK 5 LT 3 Irmpection Date 1/15/2003 AM subdMofon TRAILS END Comments or laimalone AM***SSMC LIFT***CALL 64 FOR SrM MEEt tnspeotkm Fined Electrical Rgitgapection N Retro Ekcirlml NO NONCOMPLIANCE OBSERVeD �] CORRECTIONS ESSENTIAL AS EXPLAINED BELOW WILL RE-EXAMINE AT NEXT 0 np NOT CONCeAL UNTIL RFINSPECTION INSPECTION COMMENTS- (19r Inspector use only) 4_,4k -e_ JAN 1k.-2003 THU 08:02Prl TD:P+ Ht -.)ME SER(,�IC:2 IhJC. rAc �: s Pannone Engineering Svc, LLC P.O. Box 102954 Consulting Engineers Anchorage, Alaska, 99510 (907)272-8218 (907)272-8218 Fax January 22, 2003 Mr. Dan Roth Municipality of Anchorage Development Services Department On -Site Water 8v Wastewater Program 4700 S. Bragaw. Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 3, Block 5 Trails End S%D Lot Line Waiver Request Dear Mr. Roth: I am writing to request a lot line waiver for the above referenced property. The new septic system is located six feet north of the south property line. We had to install the system this close to the property line due to location of the existing field on the property. There was no other location to place the field. The neighboring field is located ten feet south of this property line and is not expected to be affected by placing the new field this close to the line. The new field is still 16 feet from the neighbor's field, greater than the required ten foot minimum separation distance. Thank you for considering this waiver. If you have any questions or concerns, please contact me at 227-3522 or 272-8218. Sincerely, _.._ teven . Inone, P.E. Civil Engineer Attachments: L•\STEVE\WORD DOCUMENTS\3-5TRAILS END.002.DOC George P. IVuerch, Mayor 1/22/2003 Anchorage Steven R. Pannone, PE PO Box 102954 Anchorage, AK 99510 Subject: Waiver Request for Trails End Block 5 Lot 3 Waiver Request #V R030004 Parcel ID 4015-192-28 HAA#: HA030034 Dear Mr. Pannone: Your request for a waiver of the required 10 feet -horizontal separation from the absorption field to property line has been approved. The approved separation distance is 6.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, 5�;. / - Y� �'q Daniel J. Roth Civil Engineer On -Site Water & Wastewater Program P.O. Box 196650 + Anchorage, Alaska 99519-6650 • Telephone: (907) 343-8301 + Fat: (907) 343-8200 4700 South Bragaw Street +Anchorage, Alaska 99507 httl-)://-,«x,w.ci.�inchorage.al-,.us MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW030002 Legal Description: TRAILS END BILK 5 LT 3 Design Engineer: 0062 Pannone Engineering Services Owner Name: DENNIS & KRISTIN MELLINGER Owner Address: PO BOX 111086 ANCHORAGE, AK 99511-1086 Date Issued: Jan 03, 2003 Expiration Date: Jan 03, 2004 Parcel ID: 015-192-28 Site Address: 011281 DOGGIE AVE Lot Size: 22800 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: I✓i! Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. Private Well ❑ Water Storage 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3 The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date: W-, Issued By �,� $. ` � Dafe: t e Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci. anchorage. ak. us (907) 343-7904 ON-SITE SEWER ELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-192-28 Permit Number SW ©30002 Property 3000?— Property owner(s) Dennis & Kristin Mellinger Day phone 339-6249 Mailing address (1) 11281 Doggie Ave Mailing address (2)Anchorage, AK Zip Code 99516 Legal description (Lot, Block & Sub'd.) Lot 3, Block 5 Trails End S/D Legal description (Section, Township & Range) Lot Size 22253— 2 2, cqey) Acre j CSq. 30 M Number of Bedrooms Sewer Only El Well Only 0 Sewer and Well 1:1 Water Storage El Sewer Upgrade Z Hot Tub El Jacuzzi ❑ Swimming Pool El Water Softening Unit ❑ Therapy Pool F I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) 1 .1 CF,7'a Permit Fees- Waiver Fees: Date of Payment: Date of Payment: (ceipt Number: Receipt Number: (Rev. 12/00) ('9 R _. Pannone Engineering Services, LLC P.O. Box 102954 Consulting Engineers Anchorage, Alaska, 99510 (907) 272-8218 (907) 272-8218 Fax January 2, 2003 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 3, Block 5 Trails End S/D Septic System Replacement Permit Request Failed Septic System - PLEASE RUSH Gentlemen: My firm was contacted to a Health Authority Approval of the septic system serving this lot. The existing trench and bed were inundated with liquid when I arrived. The system is in failure Two test holes were excavated on November 30, 2002 on the lot. The soils report and a percolation test result is attached. No bedrock was encountered in the test hole. Ground water was encountered while digging the test holes at a depth of 10 to 12 feet. The ground water stabilized at a depth of 8 to 9 feet after seven days of monitoring. This is consistent with ground water depths in this subdivision. Also, the ground water was monitored through an extremely wet fall. We received an unusually high amount of rainfall in October, November and early December. Freezing temperatures came late to the Anchorage hillside. Higher than normal ground water levels were monitored throughout the hillside late into December. An eight foot depth to ground water will be used for the ground water design depthbased on the historical data and extremely wet fall Anchorage experienced. Two trenches will be installed to obtain the requred length. A two foot step may need to occur between the east and west trenches to maintain the four foot separation to ground water. The Contractor is required to stake the well radiuses to ensure separation distances. The neighboring lot area developedand will not be adversely affected. The lot is approximately 22,253 square feet in size. Lot 3 slopes to the west at approximately 1 percent in the area of the test holes. The existing septic tank will be checked for leaks and reused if not leaking. The proposed installation will be located on the eastern portion of the lot. The lot is served by a private well. The proposed location is greater than 100 feet away from existing & neighboring wells and 25 feet from the water service lines. The surroundingwells are located greater than 100 feet from the proposed installation. The proposed installation will not affect the future development of the surrounding or existing lots. See the attached design. If you have any questions or concerns, please contad me at 227-3522 or 272-8218. Sincerely, Steven R. Pannone, P.E. Civil Engineer Attachments: C:\Work\Letters\3-5 Trails End.001.doc 1;V` r 11 � 1 .................. ...................�f.i :Steven R. Pnnnone. UJ'A 4✓ i fJo.CE 8Iv�,� �I �i Ar PERMIT NO: CV020 DESIGN DRAWING WASTEWATER DISPOSAL SYSTEM LOT 3' BLOCK 5 TRAILS END S/D . . oil UNDEVELOPE �\ ADDfY-IONAL SOILS ++ WILL BE \/ERTFTE LD DURING CONSTRUCTION LD CHAIN L RU^�� HOUSE EXIST'G 1000 SEP IC TA 00 0. PREPARED FOR: Dennis & Kristin MeK|nger 11281 Doggle Ave Anchorage, AK 99516 339-6249 L� P.I.D. N01 015-192-28 1) NORTH THIRD OF EPL/\CE�4ENT FIELD �� �1L��Xc�/X1 c�'���V/ 4'T� /.c� ' ~ ^'~^- '~ . VERIFY INTEGRITY OF T-ANK, 1 --INSTALL SECOND CL N -OUT ON TANK. SOUTH 2/3 OF 4 --REPLACEMENT TELD DESIGN:/ PERC RATE= 10 �lN/lNCH 188 SF/BR, 3 BR HOUSE 564 3F REQUIRED 5 -WIDE DRADNFDELD SYS, 1.5' EFF, REDUCTION FACTOR = 0.78 88 LFx 5', 4.0' TOTAL DEPTH TOTAL AREH=440 SF 10009 SEPTIC TANK PANNONE ENG, SVC, LLC P, 0. BOX 102954 ANCHORAGE, ALASKA 99510 227-3522 P, 272-8218 Fax DATE: 12-8-02 DESIGN SCALE: V=50' PERMIT NO: SW02 DESIGN DETAILS WASTEWATER ABSORPTION SYSTEM NOTE: LOT 3, BLOCK 5 TRAILS END S/D 1) ALLWORK WAS PERFORMED IN ACCORDANCE WITH, & ALL METERIALS SHALL CONFORM TO AMC15,65, 2) SEE GENERAL NOTES ON SHEET 1. 3) ADD A MINIMUM OF 1' OF FILL OVER ENTIRE TRENCH, im NV31 4) INSULATE DRAINFIELD WITH 2' RIGID INSULATION, -y U 1.5' 5' I Drawing C:\Work\2-2SEV,DWG ............ S5\u LLJ REPARED FOR: Dennis & Kristin Mellinger 11281 Doggle Ave Anchorage, AK 99516 339-6249 Sam KIM im NV37 im NV310 im NV313 inn NV310 N0liVGNnoj P.I.D. NO: 015-192-28 V) U Z Lj u- -J LJ Lo Co ID 0i Cu LL - C3 Pannone Eng. Svc, LLC P. 0, BOX 102954 ANCHORAGE, ALASKA 99510 272-8218, PHONE & FAX ATE; 12-8-02 I [IT TO SCALE 1 DESIGN W0 L'i u l! , W > L E3 .—a C Q- .4 L � (u Q) L 1.5' 5' I Drawing C:\Work\2-2SEV,DWG ............ S5\u LLJ REPARED FOR: Dennis & Kristin Mellinger 11281 Doggle Ave Anchorage, AK 99516 339-6249 Sam KIM im NV37 im NV310 im NV313 inn NV310 N0liVGNnoj P.I.D. NO: 015-192-28 V) U Z Lj u- -J LJ Lo Co ID 0i Cu LL - C3 Pannone Eng. Svc, LLC P. 0, BOX 102954 ANCHORAGE, ALASKA 99510 272-8218, PHONE & FAX ATE; 12-8-02 I [IT TO SCALE 1 DESIGN P.O. BOX 102954 ANCHORAGE, AK 99510 (907) 272-8218 PERFORMED FOR. Dmnb & Kflatin Mah4w DATE PERFORMED: 11-30-02 LEGAL DESCRLMON: - Lot 3, Block 5 Trails End SID 2 3 4 5 6 7 a 9 10 11 12 13 14 15 16. 17. is- 19- 20- [Tl� la 49TH ten R. Pannone No. CE 8149 -.-' WAS GROUND WATER ENCOUNTERED? yes IF YES, AT WfUT DEPM -12.0 DEPTH TO WATER AFTER MONITORING? -8 DATE: 12-a -► VIAZ BY- P -F. I Wzid"(*)P' READWO DATE GROSS TUM PE" ... ..... .... ..... .... .... .. ter DROP EX1,3'T'G 3 B' - 6- .. . . . ....... 20110 30 HOUSE 3 3/4' 20110 — — — ----------- 6 1/8' ---- 20,40 30 P 3/8' 3 3/4' 20,40 CS 'T'G T ---- WELLo 30 2 112' 3 3/4' Ui WAS GROUND WATER ENCOUNTERED? yes IF YES, AT WfUT DEPM -12.0 DEPTH TO WATER AFTER MONITORING? -8 DATE: 12-a -► VIAZ BY- P -F. I Wzid"(*)P' READWO DATE GROSS TUM M TMIE DRMOF WAUR ter DROP 11-30-02 1940 - 6- ---- 20110 30 2 1/4' 3 3/4' 20110 ---- 6 1/8' ---- 20,40 30 P 3/8' 3 3/4' 20,40 - 6 1/4' ---- 210 30 2 112' 3 3/4' PEROLATION RATE 8 (MWinch) PERC HOLE DIAM]CM 6 inches TEST RUN BEWTEEN 5 FT and 6 FT n r �'MUNICIPALITY OF ANCHORAGE 1 , DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 99501 Telephone 264-0720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NA .QtiJ 1 PHONE 3 yy_9j9j M UP RADE MAILING A QRESS ao LEGAL DESCRIPTION Z-13 G r �✓ LOCATION NO. OF BEDROOMS U DISTANCE TO: Well Absorption area � ' Dwelling O , PERMIT N. ^ Q/,-3`, sC7 Ei W� Manufacturer} Materia No. of comp rtmants w Liq. cap cjty'n gallons v LIF OMEMADE: Inside length Width Liquid depth d Y J02 DISTANCE TO: Well Dwelling PERMIT NO. SZ H Manufacturer Material Liquid capacity in gallons DISTANCE T0: Well n Foundation Nearest lot line l D PERMIT NO, n 6 F = W No. of lines ^ Le th of li Total length of line Trench width 9-4 3L . inches Distance betwe has H Top of the to finish grade it } Material beneath tile 6 inches i ebforp Total effecttion area / (- W Length Width Depth PERMIT NO. Q 1- W L Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J Clas3 _, Depth Driller Distance to lot line PERMIT NO. 17q Q 3/_ICJ _/ W DISTANCE TO: Building foundation Sewer line Septic tank Absorption steals) OTHER 141 f PIPE MATERIALS Ci ft ts` SOI L TEST RATI G Illo �t3:4 T1`' — — INSTALLE � ..r� W v �� REMARK�S,^, X.hX ./L'YV �lil PPR VED DLEGAL L1 GuWX7 L4� 9 . nn l C,t Z 15 72-013 (Rev. 3178) MUNICIPALITY ^ DEPT. C� 4%' & r \l WATER WELL �STr�ION • FOSS DRILLING SEP - 719%9 1336 Ingra Stree Anchorage, Alaska 94K E I V E D WELL OWNER l v USE OF WELL 1^YI EJ LOCATION SIZE OF CASING,LLDEPTH OF HOLE,&10 FT. CASED TO 8 .V FT. STATIC WATER LEVEL -4 .10 FT. YIEID_ Jk_GAL.PER.MIN. WITH t FEET OF DRAWDOWN. REMARKS DATE COMPLETED ! �y Q PUMP TO BE SET AT ,Lt o's' k_tol-v L.'/-toca-/ C�Lt oo c cat o -Z ILD —t o— to_ _t 0- -t 0— to— to— to_ _to_ to_ _t 0- -t 01— to_ to_ MUt.F 10 I F��_ I TY OF= FiNCH( ;FiGE ;an • % _ DEPARTMENT OF nEALTH AND ENVIRONMENTAL PRviECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 ---�- WELL ntJ1> ON-SITE SEWEFZ PEFZM I T� 11 , 1J PERMIT NO. ( 790369 ) ` 16utt5 g -a _' APPLICANT CARL E. LUCHSINGER BOX 2094 SRA 344-7995 3L) LOCATION ' LEGAL L385 TRAILS END S/D LOT SIZE 22800 SQUARE FEE7 TYPE OF SOIL ABSORBTION SYSTEM IS: DRRINFIELD MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 190 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: F?EF3TH= 7 LENGTH= 1S7 GFZnVEL E>EPTH= 3: THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THE TFZEtJCH W I 0TH I S S. 0(30 FEET THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). FRaQU I F2EF> SEP T I iC -rnNK SIZE= 1000 C3nt__ _ONS 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> I NSF}ECT I ONS AFZE FZ[M0U I FZEL7 BACY.FILLING OF ANY SYSTEM WITHOUT FI14AL INSPECTION AND APPROVAL BY THIS .DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL; OR 150 TO 200 FEET FROM A PUBLIC (JELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. ,OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEFZM I T EXP I FZES OECEMF:EFZ 31.E 1 8_=;l79 I CERTIFY THAT 1: I AM FAMILI R ITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THII IPALITY OF ANCHORAGE. 2: I WILL I L HE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDER_ T T THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE I- LED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED:----- - ----------------------------- APPLICANT CARL E. LUCHSINGER ISSUED Lr � ---- DATE__!�L1LJ.7------ V3. 2 l 1 �� ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE • \( DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST OLATION Pouch 6650, Anchorage, Alaska 99602 2762221 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Cit r / c L'(•� 4"' S�'�S `e DATE PERFORMED: `� V /Y s'��i G �9 7• LEGAL DESCRIPTION: 43 6 S ��` • IJ cn S. V' SLOPE SITE PLAN DEPTH (FEET) 1 5 �y "�.g vc UU 2 I-2 s E 3 7 S & 4 -)-Lv)se- $ 1 f4/ cxY,r�V� 5 J 6 ------ 8- 9- 10- 11. ----- 6- 9- 10-11. 12- 13- 14 - 2.13•14• '15• 16 17- 18 19 20 7 -0 -hs I (��. 9 v-%.v0- wt" ,wt" k 5C4K 1.0, Z. Q WASGROUNDWATER 1 S ENCOUNTERED? Q-5 LO P IF YES, AT WHAT c/ E DEPTH? II 2', d P i+ LJ e le - PERFORMED PERFORMED BY: 72008 (7/76) r, Lit, 14s ME NUMENN ON N1 sc Reading Date Gross Time Net Time Depth to Water Net Drop -7-5 D O 7-6 Z4 %i OHn O 7-(, 2461 /S., /5'tr1 PERCOLATION RATE I (minutes/inch) TEST RUN BETWEEN Z� FT AND 3 `y FT f'o s,f , / 3.2• {-. 154 Frf oh wLi+ avnsvt-f LWe, JLji -f-a C� ' JZL-_CERTIFIED BY: r %1-J DATE: t7 7 7/ s I 0 0 0 .1 w 0 M m m CD z �1 NORTH 120.00' 5' utility I Easements Lot 3, Block 5, Trails End Subdivision, i a Anchorage, Alaska C rn .e— 60'-1y TH#1 L TI I c L s0' 2 30' NORTH 120.00' Doggie Avenue NOT TO SCALE 30' Distances are approximate and have not been measured by surveying methods as to test hole location. Michael B. Bergmann Consulting Geologist Box 191, Star Route A, Anchorage, Alaska 99502 (907)344-9150 T.H. No. 1 5-23-79 0.0' Peat and Organics, sl moist, x - loose, dk brn. 1.5' — 7.0'AB Gravelly Silt: w/some sand to Silt: w/some Sand, trc Gravel, occ cobble, ned dense, sl moist to vy wet, grybrn. Water table mea at 7.0'AB 17.5'TD ' Test Hole Boring Log represents soils encountered on Lot 3, Block 5, Trails End Subdivision, Anchorage, Alaska 0')TT 0 VJ IT't cy') cy') I,— I -- C) O O rn rn W C cL ♦n o LL V a_ Q 0 i V Z a UL 1 . 77, Q^ 0 1..� U m a) V L L a] Z o� M 5 L a) C,6 U) L c 0- 0 O > (/) (1) C M w N 12 O O O N ti 1 00 N I LO CD0 a) U tB d co x A E O A d' N 0 N LO ti N D a) m U a) U (0 C 0) u 0 0 a^� 0 Q. a� a a 3 c s N �] E ~ ,� ~ ca O O p O C O .a L) 0 O N 0 O N o C +�+ CL V ^ to r— Q > -0 Q 0 U) -> cn .> '2 Cf)+' 3 ° Q a) cn � O 3 goo �, Q .N z Q > i Q. m O ° m a) C L O Q Q CL Q -0 O N O III EV V a) X X N N O L cn a) N C �' in N E 'a O Q 1 O _ Q„Q ° > ° N m a) O '> O> d +' O Q m _ p N O C C O a) U_ N O w Q Q Q N E = U Q O (� O N O Q = H E-- N Q L Q Q ToT rn V/ ♦'J `'J 00 rnrn r- 0 O A. - m m .Q Q Q (6 O CL 0- U) 0) 4- A N co O ^O W m a.> O c4 Q 04 O� LL Z O J Q Z 20 W d. LO v' 1 cu L Q i Q K-} 0 (D LL m co 9 C (1) >+ co 0- 0 a) 0 a� co 0 •FCO W 0 Q m O m >. N U G. O 0 L El (6 V O �. a) Q U Q V U U) ❑ Q OO ~ N o O aEcm cn E V a) � O ❑ Q. voi m a U u co ❑ ❑ 0 a) LL um M (D ❑ G cna' U) m m m O❑ C � (DO -o � � Q U)a� o ❑ c c� > W 0 0 D ElU m d a °°, � ❑° F a -9.1 M > �/� 0 o U)•�L cn N ^ O U� W ❑L ❑ a n `o � LL ElO � c Cl J Q ❑ W Elm d t r N = Q a�oi > `� cn cn cn ° m d ;, W ❑� w F- (n (n �� V/ LL 'LO' c L y L U) N V i Z _ Q O o 4- w U ) W LL O LL O H d � N M d c t �.. U N w � U) a a O � W m > ( m O H I}— U) Q a ami cu a > N M wi 6 3� W m 0 K-} 0 (D LL m co 9 C (1) >+ co 0- 0 a) 0 a� co N/A N/A N/A (907) 522-7773 Benjamin Schiller, P.E. MUNICIPALITY OF ANCHORAGE h, o nP3-790.4 1. e: -J,41 De,.eeloprrient Senlices Departmet-A 07-341,,51-7997 Ori-Sjtr�3 Watel, Wa.stevrvatler Sec -tion 7��Mfj k1l) //,w,- Owner - P"( Street Address 11,291 /1). 1 sZr Septic Tank: -Sludge level l inches -Pumping: required yes �o -Pumping completed M-0 Lift staVion: -Pump basket cleaned yes -Control floats cleaned ?no r -Operation satisfactory Les .0 -Effluent filter cleaned yeg§s6no) -Ground water intrusion at riser to tank connection jesfq) A es no .) -Ground water inM-Weep hole functional es no trusion around pipe penetrations -& -Manhole lid: Functional 6no Insulated & no Properly Secured(gve no Other -All manufacturer required inspections and maintenance completed d -Les no - 2111111 - Company /`;`f' /710 -P"-C ->C'-P1 C-1 9= Date Qualified Maintenance Provider. Technician JC Date of maintenance Company /`;`f' /710 -P"-C ->C'-P1 C-1 9= Date We, James and Ruth Willard, the owners of 11281 Doggie Ave, Anchorage AK 99507. Have not had any freeze ups or weather related issues with our septic system. James Willard Ruth Willard 11281 Doggie Ave Anchorage AK, 99507 DocuSign Envelope ID: 54A99433-D3BE-477B-A79F-992E1428B639 +J co �LLI V a) +' -� li N O Q co E L- C O V ro O •v Z 4- O }' U LLQ aJ r Ln vii O U a) a) u N N N > O Q ro JO O >' N TO au ca Q cu U >� E QJ LL Q L O to +, �O Ln a1 OU — — cu J L ; --le o W cn (Ij( Q o a 4- L O a uj ai u �vf - O V C a) � z � a L +: N u Ln m W 3 W U M 41 O LL, ull 'a c U L f -f9 c o tido u Z L L ++ q cW C @ � � a 0 E w � 3 o o 3 +J co I a) +' -� O N Q co E L- C O ro O •v O O O 4- O }' U O t aJ r Ln vii O U a) a) i U U OJ -0 Ln N N N > O Q ro JO O >' N TO au ca Q cu U >� E QJ LL Q L O to +, �O Ln a1 OU — — cu Q N E Nm O L ; --le o W cn (Ij( Q o a 4- L O �, o • coo a -J U ; L N tin aJ a1 ai u �vf O O CL aJ C E O aj i O •u 6 16 4�+ U CL N aJ N u Ln m C _0 ++ O Ln f0 N O � U cn f— u I— Municipality of Anchorage to evel6o ent Services Department X�x Building Safety Division = On -Site Water and Wastewater Program \_J F C T Y 4700 South Bragaw Street f IL 1i P.O. Box 196650 Anchorage, AK 99519-6650 . Y www.ci.anchorage.ak.us (907) 343-7904 x CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-192-28f ..;......NAA# '��f��)�a_ �1 Expiration Date: 00 i. GENERAL INFORMATION Complete legal description Log 3 Block 5 Trails Enol SID Location (site address or directions) 11281 Doggie Ave Current Property owner(s) Dennis & Kristin Melligger Day phone 339-6249 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 11281 Dc�ca�ie Ave, 99516 Day phone Kathrine Donohue Day phone 273-7716 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER 3.' BEDROOMS: .. D• O. Individual Well Individual Water Storage [� Community Class — Well El Public Water System R TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site [� Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DFIHS also issues HAAs upon request to home owners. 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 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. (Rev. 11/99) 4.* STATEMENT OF INSPECTION BY -ENGIN -E -ER As certified by my seat 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 Health Authority Approval application shows that the On-site water supply arid/or wastewater disposal system is safe, Functional and adequate for the numberof 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Enal Svc Phone 272-8218 P.O. 9ox, 102954, Arich, AK -99510 Engineer's Printed Name Steven R. Pannone, P.E.,- Date 111181200 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DHFIS Guidelines & Regulations. The -cL - time of r�mo.ctcd results describe the performance of the system under the conditions encountci I at the the test, and separation distances measured to readily identifiable feitures. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the vear, and the water usage of the family being served by the system. These conditions are =-t•••••••••• • outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results that there are no hidden defects do not guarantee future performance of the system, nor do they guarantee ti A_�, % stc- r, or encroachments. PES can therefore not provide ill%, warranty for future performance nor give ',111Y estimate of Low long the sN,stem will continue to meet the operational requirements of the ADEC or 0 MOA DI -IHS. The content of this 3, report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not -authorized nor will it confer any le -al richt whatsoever. 5. DHHS SIGNATURE Approved for bedrooms Disapproved. Conditional approval for bedrooms, with the following stipulations: 16 - Additional Comments A G "r­� V Attachments: HAA Checklist X Septic System Advisory Maintenance Agreements Supplemental Engineer's Report Well Flow Advisory Other C1 t By: Original Certificate Date, ".) Expiration Date: 4-A /0Reissue Date: (Rsv. 11,199) Municipality of Anchorage • Development Services Department r `° Building Safety Division On -Site Water and Wastewater Program s 4700 South Bragaw Street P.O, Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L3 B5 TRAILS ENDParcel I.D.: 015-192-28 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # Well Log YES Date completed 8/21/1979 Sanitary seal YES Wires properly protected YES Total depth 120 ft Cased to 83 ft Casing height (above ground) 30 in. FROM WELL LOG AT INSPECTION Date of test 8121/1979 1111/2003 Static water'level 25 ft 30 ft Well production 4 g.p.m 1.1 g.p.m WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml Nitrate 2.08 mg/I Other bacteria 2 colonies/100 ml Date of sample: 1/14/2003 Collected by: LRP Arsenic N/A mg/I B SEPTICIHOLDING TANK DATA Tank Type/Material STEEL Date installed 1/11/2003 Tank size 1000 gal Number of Compartments 2' Cleanouts YES Foundation cleanout YES Depression over tank NO High water alarm NO Date of pumping Pumper NEW C. ABSORPTION FIELD DATA Date installed 1/11/2003 Soil rating '(g.p.d./ft2 or ft2/bdrm) 006 System type 5 -WIDE Length 97 ft Width 5 ft Gravel below pipe 1.5 ft Total depth 4 ft Effective absorption area 480 f:2 Monitoring tube YES Depression over field NO Date of adequacy test Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test NEW in Water added gal. ' New depth in. Elapsed Time: min Final fluid depth in Absorption rate >= g.p.d, Any rejuvenation treatment (past 12 mo) (Y/N & type) If yes, give date (Rev. 11/99) D. LIFT STATION Date installed 1/11/2003 Size in gallons 500 Manhole/Access YES "Pump on" level at 40 in"Pump off' level at 24 in High water alarm level at 48 in Datum BOTTOM Cycles tested Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 120/130 On adjacent lots 100+ Absorption field on lot 101.9 On adjacent lots 100+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 120 Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 7/18 Property line 19/10 Absorption field 13 Water main N/A Water service line 30 Surface water 100+ Drainage 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 6.6* Building foundation 18 Water main NIA Water Service line 25 Surface water 100+ Driveway, parking/vehicle storage 25 Curtain drain 100+ Wells on adjacent lots 100+ F. COMMENTS *-Lot Line Waiver Applied For G. ENGINEER'S CERTIFICATION �.'����.`�� f '• ## `, I certify that / have determined through field inspections and review of Municipal records that the above systems are in ., l #� . conformance with MOA HAA guidelines in effect on this date. .. ................. r v Engineer's Printed Name Steven R. Pannone, P.E. 0 .. ... � .iPVC t on e s V �i Date 1-18-03 ;?>'.. .� HAA Fee $iSCg # ev Waiver Fee $ �_ Date of Payment Z 1 Date of Payment s Receipt Number fi Receipt Number `/' (Rev. 11/99) mow ulv%cr «xow KmAcx WC..wo KIKUX Km SUL04 >r?W= 30' O 0 O G-2 /VS9- S9' 30••E 5' 4n-'-. .f s --'t Gk'AUE� 49/P/I4r �j 0 /9Q. G3d' •t: 26s �S Cog L-$ k: cal ,� a /x/ 89 " 39' 30 Ile /,9,0.: 40 ' L-4 SURVEY CERTIFICATION +�-xvIfi AZT111ss Prepared by PLOT PLAN Robert E. & Assoc. ,,►•-tE,.........., �Jahns, Jr. �'Sl':•••" °'••.., �j Professional Land Surveyors MW *Wd Or 40NAMW d d 00 1A GOWN' ,• •. ! 042 E. 12 AVE . !;17801 . I� ANCHORA; ALASKA we m r i�r�.r h�w�ri« """M «e,wt t Soala Rio. Lot S.F. Roo. Plot Fpr No. FOUWCATICN AS -BUILT �e••J' .... y •.. • ,Z••,•• f it t IlMrt c 1oW x. h+^�Y r�IA a.c, •••r•Dab yw* Drown by. Choakod by. Mw ►� M A►•iWt d Yr ••••,w, ••as nn,. ••� n•,•� kmidlw « iw i1! M Ali rM am mm OW ft Grid: W10. O' 4121—S ,.�•'� 2641 2301 FINAL STRUCTURE A.S-11.1 �♦It •.. •' !� �� wM 4« A►ii�iuerR, MM yy � ♦t log,•'•••s•.u.1.r••✓'••• y w� 'how w ''�ofiiflonai �`�•� LOT 3, BLOCK 5, TRAILS END SUBD. *00 0 LOT sjwmy SURVEY TYPE D FOUNQA" AS -"T SET REBAR �SYM�B' �OLS, ..ASPHALT0 FmL xnwcTtC A3 -&&T DRAINAGE D PLOT PLAN ... AS-eW T LIT svY. Tae00ArNY O PCJt REBAR CONCRETE FENCE 13 6s- NO calm" IV w&0=710mDO ASSUMED M. 7FX N METAL FENCE n2p DECK PLOT PLANS k LOT SURVEYS• IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILl- Be CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS, SEPTIC CL.SANOUTS, SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY, SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FRO►; BEING SEEN AND LOCATED, WHICH 00 NOT APPEAR ON THE RECORD DIVISt T I UNDER NO CIRCLWSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTMUSNWC BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UABIUTY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCAUNG. REPRODUCTION MAY CAUSE ERRORS CIV VALE. 01 MUNICIPALITY ANCHORAGE DEPARTMENT OF HEALTH 8 HUMAN SERVICES Division of Environmental Services low On -Site Services Section EXTa P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.A (N6 -101n -QS 1. GENERAL INFORMATION J-24< Complete legal description Lo7-3 A&r-.t- !�; "rox'y" F�/a Location (site address or directions)✓�� Dc���ic A✓E Vii, _.A Property owner 4A✓W Day phone 3'516"37-89 Mailing address Lending agency L1""' m°`� �SHnu ;� Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 �" 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 410,000 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-M(R".1/91) Fw-1 MOA921 S. 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 f4 0 CnS0.J F.j G i,j SLI u t. Phone Address )m Aox zY077-7 flnl(Nrvtntcr .9/1- q 7�/ Engineer's signature C'o etr. Date 9J► VAr 14 4381•E 6. DHHS SIGNATURE -� _-3 bedroomsApproved for . Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By. J o I+r1 nn rT) ;Date I0/zOE� auric 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. n OZ (w.. uv1) e.a, uw m - U Sc% �� 'PA14 Municipality of Anchorage s Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L3�nt�: T/oli1L5 4587 60050 Parcel I.D. A. Well Data Well type tY!�✓Alez If A, B, or C, attach ADEC letter. ADEC water system number Log present (YM) Y '• J Date completed 9/7� Driller S OIerWAC-f— Total depth 12O1 Cased to 83 Casing height Z.5' Sanitary seal (YM) Y Wires property protected (YM) Y FROM WELL LOG Date of test P JU 179 Static water level M; Well flow 4- g•p•m• Pump Ieveil G IIV SEPARATION DISTANCES FROM WELL TO: AT INSPECTION 9�4. �93 cn rn rn 4;o Ar tom g.p.m. ^" =110r - C m w Septic4mAdWg tank on lot , / ; On adjacent lots > I I0 Absorption field on lot !O/ r ; On adjacent lots -` Public sewer main ��it� Public sewer manhole/cleanout Sewer service line > //O Petroleum tank No WATER SAMPLE RESULTS: Coliform Nitrate Z�/— Other bacteria 0 Date of sample::* 7�?-0 93 Collected by: A4vV6-' �ee' B. SEPTIC/HOED" TANK DATA Date Installed 7/71 Tank size /00e> ala/s. Compartments Z Cleanouts (YM) % Foundation cleanout (Y/N) y Depression (YIN) /✓ High water alarm (YM) /✓�il- Alarm tested (YM) Date of pumping ��4 f�i3 Pumper SEPARATION DISTANCES FROM SEPTICAMBCd#OG TANK TO: Well(s) on lot '/Zn' On adjacent lots > Foundation > /o' To property line - ZO' Absorption field /D� WaterawWservice line Surface water/drainage > /S� />130, 72026M3).FMM CONTINUED ON BACK PAGE C.11STSTAXIAN IvIlf- Date Inq1gled Manufacturer Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTACOM i D. ABSORPTION FIELD DATA (Y/N) at LIFT STATION TO: at On adjacent lots ' Surface water Date installed Z&2 Soil rating W0/716 190 �� System type /rz- �k Length 77.1 Width f&' Gravel thickne ss Z� Total depth SCSI Total absorption area Cleanout present (Y/N) % Depression over field (Y/N) A/ Date of adequacy test B�2S�yS� 3 Results (passtfail) bxs for -3 Bedrooms Water level in absorption field before test J /• S • After test / C_ Peroxide treatment (past 12 months) (Y/N) _ ^/ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /O/ On adjacent lots � /00 Property line To building foundation To existing or abandoned system on lot N�f' On adjacent lots So Cutbank _AJIA- Water4noWservice line Surface water > /Op Driveway, parking/vehicle storage area Curtain drain N14 E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelin Signature Engineer's Name Arive7yed Date vn& HAA Fee $. 3M6 'dC� Date of Payment 9—///x`73 Receipt Number 72-026 (397)• Back Waiver Fee $ Date of Payment Receipt Number Y a - r�4UNICIPALITY OF ANCHORAGE n i DIVISION OF ENVIROMXNTAL HEALTH DEPARTMENT OF HEALTH AND Eh'VIROMMNTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 7-12 - R•S (a) Legal, (include lot, block, subdivision, section, township, range) Location (address or directions) .. (b) Applicants Name It, N A r- t, OAVI&Telephone - Home944-2qSIBusiness Applicants Address I12$I 0ar-r_iE Sr- LjrenvaAi,r QQS1� (c) Applicant is (check one) Lending Institution ; Ower/builder; Buyer Q ; Other Q (explain); 1�1KKK"KK (d) Lending Institution _t'iIZST L)TrfLSTATr-- Telephone Aden (e) Real Estate Co. b Agent N n M F_ Address Telephone (f) Mail the HAA to the following address: n., , MMc nlvIc a iU1,.0U.C'1 2. Type of Residence Single -Family Multi -Family Number of Bedrooms 3 3. Water Supply Other (describe) 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 Onsite Public Q 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 21 n 5. Engineering Firm Providing Inspections, Testa File Search Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein.. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is In compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm_AOt^T(t I—_N r yt4r ym - 1(.1 f_. Telephone�6(-rz Address I <-(),< L). � 6 Q,ic F_ 0. At Mace f- t -L- a��a=�;.�_-_r, f,.r i 0, d'�•• C 68 6. DEEP Approval t,BF�pRO • SS A� lApproved for -e, bedrooms By V. Date Approved t,/Disapprove ndiional Tarms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 21 7-19-84 T^ � , MUNICIPALITY OF ANCHORAGE _ DEPT. OF HEALTH 8 1AUMCffAUT( OF APF_'HO ENVIRONMENTAL PROTECTION DEPT. OF HEFT EC.TION 'E,VIO�NTAL MUNICIPALITY OF ANCHDRAGE (MOA) JUL 151QP ;UL 15 HEALTH AU'MRITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 1. c Ey Fd D JtEULL rATA T¢i.IL-S C- No &/0 SIX L4.1 Raw, T 12N Well Classification INOIVIOJAI If A, B, or C, D.E.C. Approved(Y/N) N/A Well Lcq Present (Y/N) Y Date Completed Strx IQ -7Q Yield,,, Total Depth 1,16' Cased to A 3 , Depth of Grouting_b�,m4 Static Water Level A S " Punp Set At ..• 116' Casing Height Above Ground 3 2 Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) N Separation Distances from Well: To Septic/Holding Tank on Lot I �'+ `� ; Ori Adjoining Lots it To Nearest Edge of Absorption Field on Lot l O �� -,; On Adjoining Lots I Cir] :I. To Nearest Public Sewer To Nearest Public Sewer Cleancut/Manhole Water Sample Water Sauple To Nearest Sewer Service Line on Lot I O + Date 6.2 -2-8!!K t' • •-:�13��eR7><•i�x��a[w•aS•1!�ul'Y�laEfiL�� WOW Date Installed Size No. of Compartments 2 Standpipes (Y/N) Y Air -tight Caps (Y/N) `( Foundation Cleanout WN) Depression over Tank (Y/N) N Date Last Pumped 7- I I- 8S Pumping/Maintenance Contract or: File (Y ) ; for Holding Tank High -Water Alarm (Y ) Temmmporary Holding Tank Permit (Y )RVA Separation Distances from Septic/Holdirg Tank: To Water -Supply well 1 0'-4- cam' To Building Foundation I p' To Property Lire X10 • To Disposal Field _ _ 1,2 ' To Water Main/S9 ce Line Q ' To Stream, Poral, Lake, or Major Drainage Carie N Comments (Page 1 of 21 2-15-84 :.. •4. . 4 ]I . . Soils Rating in Absorption Strata L q D ' Type of system Design Date Installed Tc)k_,! A i 9 Length of Field 77 " Width of Field y 2 " Depth of Field 2.0 wk 1.., Gravel Bed Thickness 4 a& r� Square Feet of Absorption Area b l [ T Standpipes Present (YIN) Y Depression over Field (YIN) Date of Last Adequacy Test Results of Last Adequacy Test Aoe-&JA,c Cat _l 1r-MOfVA^s✓ Separation Distance from Absorption Field: To Water -Supply Wall l O �� To Property Line l D To Building Foundation N 2 S To Existing or Abandoned System on Lot A)A ; On Adjoining Lots 14 0 + To Water Main/Service Line 6 0 + To Oatbank(if present) To Stream/Pond/Lake/or Major Drainage Course N /A To Driveway, Parking Area, cc Vehicle Storage Area Comments Angay r -m- T_l_ST 7-1 l - ZS D. LIFT STATION Date Installed Dimensions Manhole/Access (YM) "Pump Off" Level at Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(YM) Comments Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MDA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MDA HAA on the date of this inspecti Signe Casa MDA No. ST S_G-OD I KB1/d5/s�� (Page 2 of 21 effect 2-15-84 - DATE RECEIVED ` INSPECTION APPOINTMENTS 7 &U STREET LOCATION t 'J&,r) TIME TIME TIME DATE DATE DATE INSPECT INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & -\ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECIMRONMENTAL PROTECTION 1 825 L Street • Anchorage, Alaska 98501 • since June 1975. For wells drilled prior to that date, give well ENVIRONMENTAL SANITATION DIVISION NOV 2 1 1979 Telephone 2644720 B. SEWAGE DISPOSAL SYSTEM R F c I v n REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWERFA�ILIT�S DIRECTIONS: Complete all pans on page 1. Incomplete requests will not be processed. Please allow ten 110) days for processing. 1. PROPERTY �'^ DaVLS PHONE AGI 31141- 7?1 3 MAILING ADDRESS S g> 130x o5/i d- 9So PROPERTY RESIDENT (If different from above) PHONE 2. BUYER /� // PHONE .SCkAle as 15bov� MAILING ADDRESS 3. LENDING INSTITUTION n Co a PHONE -q7 I,v�/ ., ! "Z 0 7< 1, t l -1-e— (0 5� S MAILING ADDRESS r ^ n Sf l— 0. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION 3 _ / �/oC-� S p Clf� Cl _5 � „sal STREET LOCATION S. TYPE OFF RES ENCE NUMBER OF,BEDROOMS Q' SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SU LY , INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM - INDIVIDUAL/ON-SITE" /f7`7 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ SINGLE FAMILY ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY PERMITNUMBER ❑ INDIVIDUAL DEPTH OF WELL ❑ COMMUNITY DATE DRILLED ❑ PUBLIC UTILITY Connection Verified LOG RECEIVED Q,,,e4- 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ❑INDIVIDUAL/ON -SITE DATE INSTALLED ❑PUBLIC UTILITY Connection Verified INSTALLER ❑Septic Tank or EDHolding Tank Size: -1 J2 t�an= if Tank is homemade SOILS RATING give dimensions: J TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line WELL T0: Absorption Area to nearest Lot Line - 5. COMMENTS 1 V ` 0 �d t✓ ` • La -APPROVED FOR _ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY / 1 3 " V 72010 (Rev. 6/79)