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HomeMy WebLinkAboutRAVEN WOODS #1 BLK 4 LT 5Raven Woods #1 Block 4 Lot 5 #015-232-28 4, Municipality of Anchorage Page I of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 51.14'80224 PID Number: o!S- 732- ZA Name: r Cq („ QtG� Wastewater System: ❑ New XU Y Pgrade Address: 6261 ABSORPTION FIELD Pho e: ((s _ 9 q c? No, of Bedrooms: �. Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: C. GPD/S.Ft. /Z•13A'r- Lot: Block: Subdivision: S Y T2AVeA.jt3oo Depth to pipe bottom from original grade: 6.6 Gravel depth beneath pipe Ft. 6.7, Ft. Township: Range: Section: Fill added abov!�original grade: Gravel length: Ft. 6 S 6 Ft. WELL: ❑ New ❑ Upgrade Gravel width: 8 Number of lines: Distance between lines: — Classification (Private, A,B,C): Total D Cased To: Ft. Total absorption area: Ft. Pipe material: FL Ft. 806 54. Ft. 'FH/0 134�3 to, Driller: Date Drilled: Static Water Level: Installer:Date in ailed: Ft. t.QJ CXP•l.�.) Yieltl: Pump Set at: Casing Height Above Ground: GPM Ft. Ft. TANK SEPARATION DISTANCES toeptic ❑Holding ❑S.T.E.P. To Septic Absorption Lift HoldingPublic/Private Manufacturer: Capacity ins gallons: From Tank Field Station Tank Sewer Lines A1C WeiY i!O /� �— Q,Z MateriaST Number of Compartments: Surfac Water /L.;o (�* — — LIFT STATION Lot�e Line Fr 6jA-- Z I r Size in gallons: Manufacturer. Foundation ` `--' "Pump on" level at: "P p at: High water alarm at: Curtain Drain -F f0o'f — PumpM odel Electrical Insocioft performed by: Remarks: I �.u3r` -rk w P, LL&ro t BENCH MARK " Location and Description: A Uen112o t Cal . TpP car CAUCA N . &-Alb on'a 2c# [2L'K.ST 2 . fF2 L�tiC2os1ldD OV E Cf2 cE �' 'Putt- A be (veg0 r Assumed Elevation: /0 0 9 "b2 ra/ Fr T cam• E yy �� * '49lh 7p f `1 Inspections performed by: S A�AAMIC&Ir3,2•B Dates: 1st 711096 2nd �!!v 14 s3 sf.aan ti Famorm �Ar 40 rt.✓At (rsl4g �'J , Department of Health and Human Services approval�Fnp�oss�oN"`� 9$-8149 Reviewed and approved by: C A4� Date: 7ZZ'Q$ 72-013 (Rev. 9/91) MOA 25 P.I.D. NO.' 015-2--2-28 ! -BUILT Cl 63.8 WASTEWATER ASS TION SYSTEM MT 65.0 LOT 5, BLOCK 4 RAVE WOOD SUBD. NOTESi 10111 91.2 1) EXIST'G TANK DORSHAPE, WAS(RVING IT WAS REPLACED WITH A NE TANK. 2) THE EXIST'G IPETHE FIELD WASCRUSHED & CRA KED, AS FULL OFLOT 4 BIOMAT, EXIST'G FIEL NDONED IN PLACE. NO WELL OR SE TIC SYSTEM 1 I WITHIN 200' OF ROPOSED EXIST'G ff SEPTIC SYSTEM. j WEL GRIZZLY AVE EXIST'C, RENCH St OTE 2 EXIST'G I 1% WELL 4 ,t ¢ NEW 12509 M SEPTIC TAN E SEE NOTE m J f I € NEW TRENCH , 65LX3'X6'EFF, CO A B 1,, r DC1 47A 17.6 i v Tl 48.8 19.9 T2 50.1 27,6 DC2 512 29.4 Cl 63.8 26.6 MT 65.0 31.5 C2 10111 91.2 NO WELL OR SEPTIC SYSTEM WITHIN 200' OF PROPOSED SEPTIC SYSTEM. ? 49R R. Pannoner O -E 8144 ••'� Ar Mr. Robert & Carol Griggs 641s 6261 Trappers Trolk ,•.•'� Anchorage, AK 99516 M (616) 938-9498 ■ I NO. SW9S 2,L3 s+s �R 9� n« } rZ 2 c o � N % Z O Q U = } wfy aW W - Q N W Lo W LdW — Q y 0C3M 3 J W Go O -d a �« 3 -,ex W Z J d J Cl W ¢3� W 44 DESIGN, PERC RATE '= 15M/I 188 SF/BR, 4 BR 752 SF REQUIRED DEEP ,TRENCH 6' EFFECTIVE 65' LONG 780 SF TOTAL PANNONE ENG. SVC P. O. BOX 142025 ANCHORAGE, ALASKA 99514 272-8218 Phone & Fax NTE, 7-15-98 AS -BUILT 1'=60' P.I.D. NO, 015-232-28 AS—BUILT DETAILS PERMIT NIL SW9P(><29 WASTEWATER ABSORPTION SYSTEM 313 LOT 5, BLOCK 4 RAVEN WOOD SUBD. 0 N O at 0, a a u C L Y d q O K L C +1 a 6 Iii v a i LJV 492 a. 0 Z El H �u� � � L/1 �JJ Y! tY LJ 3 0 z 0 co N III Mr. Robert S Carot Griggs 6261 Trappers Trait Anchorage, AK 99516 (616) 938-94913 Sam wi mN irmu93 Rhi j ¢ G ~ z d(It1/l m f ¢ inON@312 W.5 n y 3AIVA M31tl3AIQ asCi a LJ Y lOONtl3l0 zd al H•-, Ll 1naNtl= NOILVQN(mj I� I� Goal 02 W Z =oa ?¢ z�vwi ,QF i(1 J H J R F X I Imo— ZLo I In — � z cu PANNONE ENG. SVC. P. O. BOX 142025 ANCHORAGE, ALASKA 99514 274-G308 272-8218 FAX kTQ 7-15-98 AS -BUILT ❑T TO SCALE Permit Number: SW980229 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Legal Description: RAVEN WOODS #1 BLK 4 LT 5 Design Engineer: Steven R. Pannone Owner Name: Robert & Carol Griggs Owner Address: 6261 Trappers Trail Anchorage , AK 99516-2407 Upgrade Lo ?IJ �y q 2)Q �C-" Date Issued: Jul 10, 1998 Expiration Date: Jul 10, 1999 Parcel ID: 015-232-28 Site Address: 006261 TRAPPERS TRAIL RD Lot Size: 55321 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ✓❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage Vl construction must be in accordance with: 2. The attached approved design. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska 3, Wastewater Disposal Regulations( 18AAC72 ) and Drinking Water Regulations( 18AAC80 ). The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling 4. (907) 343-4744 (24 hours). ( Not required for a Water Supply Permit only). 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: Issued By: t4/t-� C t /� Date: • (0' I8 Steven R. Pannone, P.E. P.O. Box 142025 Consulting Engineer Anchorage, Alaska, 99514 (907)272-8218 (907)272-8218 Fax July 5, 1998 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 5, Block 4 Raven Wood Subdivision, No. 1 EMERGENCY Septic Upgrade Permit Existing System Ism Failure Gentlemen: My firm was contacted to conduct a Health Authority Investigation the septic system serving this lot due for an coming sale. One hundred thirty eight gallons of water was added to the system when water was observed flowing into the tank instead of the field. Liquid levels were noted in the clean-out at the end of the field to be above the level of the invert. The existing system was is in failure. A single test hole was excavated on July 3, 1998 for a system upgrade. The soils report and a percolation test result is attached. No ground water was encountered. No bedrock was encountered in the test hole. The lot is approximately 1.5 acres in size. Lot 5 slopes to the east at a rate of approximately 1 percent. The proposed installation will be located on the eastern portion of the lot. The existing field will be left in place. A diverter valve will be installed after the tank to control the direction of the effluent flow. The existing tank will be verified for integrity, and reused if found competent and replaced if found to be leaking. Double clean -outs will be installed after the tank and diverter valve. The proposed location is greater than 100 feet away from the existing well serving this property and 25 feet from the water service lines. The surrounding wells 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. Please contact me at 272-8218 or 227-3522 if you have,any questions about the proposed installation. Sincerely, 0P Steven R- Pannone,P.E. 7k Attachments: _...,..._ Etavae R. Panne" rrEss �. !'tiY}FS.51t7� i C AW0Rx\5ax�wood.001. v,pd P.I.D. NO. iI G N i PERMIt NO. NOTESi 1) VERIFY TAN FOUND COMPITI DETERIORATED. 2) INSTALL DI TWO FIELDS, A W K W a. a a! J ti Z LCT 5, BLOCK 4 RE USE IF IF FOUND VE BETWEEN THE G F ELD EXIST'G ° EXIST'G ° WELL SYSTEM ID SUBD, LCAT 4 NO WELL OR SE WITHIN 200' OF SEPTIC SYSTEM. GRIZZLY AVE EXIST'G 12508 SEPTIC TANK SEE NOTE 1 =RTER VALVE NO WELL OR SEPTIC SYSTEM WITHIN 200' OF PROPOSED SEPTIC SYSTEM, Mr, Robert & Caro[ Griggs 6261 Trappers Trutt Anchorage, AK 99516 (616) 938-9498 SYSTEM m WD �a c r Z c � N Y oZ r at Ll QW W ~ > Wa WEE N W ar V! W V1 � �FY 6 N VI O M J W A W o -a 6s 3E ae W " a. ZJf J ¢W 3ad DESIGNi PERC RATE = 15M/I 188 SF/BR, 4 BR 752 SF REQUIRED DEEP TRENCH 6' EFFECTIVE 65' LONG 780 SF TOTAL PANNONE ENG, SVC P. C. BOX 142025 ANCHORAGE, ALASKA 99514 272-8218 Phone & Fax NTE 7-4-98 RESIGN '_ DESIGN DETAILS PERMTT NO. 'PID: � WASTEWATER ABSORPTION SYSTEM LOT 5, BLOCK RAVEN -WOOD 2Bn _V / �\ .y R ƒ ) \� Z / { / _ _ ) / [ .u. W \ W 7 6 -.. Wim= _V3-10 U H3-EJ 3AIVA _m. �? ff _V \ __. __Dk . � tF� b ^ �� . (\ , zz 4= ; Z^ , — .................. PREPARED , PAmAE ENG. SVC. 9� \ R. {# + RobertCarol �� RE BOX 142025 �w _ 6261 Trappers Trail ANCHORAGE, kaA s34 __.a _s z4-g2.2295FAX me 938-9498 n e 12-28-96 DESIGN .TT SCALD Municipality of Anchorage DEPARTMENT OF HEALTH R HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 tC�� SOILSLOG— PERCOLATION TEST PERFORMED FOR: P�L7./tSaQtl'T Gn I Q1G1 5 p. DATE C.. LEGAL DESCRIPTION: LrV14 4 T.AV6NlfLCcV ownship, Range, Section: DEPTH SLOPE SITE PLAN FEET) 1 o24A.vtcs f stLTs aL Y3f2pW N N 2 I 1 1 9 3 4 rJ 5 d I ^l�bo/tL; GivAAtaO GsRrQVL'S 6StlTj Co$gt6S 7 s 9 10 11 12 13 14 15 16 17 C- SA,vU'r 51 L-rS 18 f4 L G,Rtav WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? p E id Depth to Water Atte Monitoring? Date:iLt*— Reading Date Gross Time Net Time Depth to Water Net Drop SON. 6'. c> se izYz 'P4 C> z,. 191 1 20 PERCOLATION RATE 11157— (minutes/inch) PERC HOLE DIAMETER —..� TEST RUN BETWEEN FT AND _ a FT COMMENTS 91CC{1VATE9� NahAA ZIL AAF f T 0.. Wks -'AD aso A 144ag-) PERFORMED BY: S •�1=�ANnuw �,P a_ I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE 0. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street -Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ® NEW Robert B. Griggs 344-2219 1 ❑ UPGRADE MAILING ADDRESS SRA Box 1558 N. Anchorage, Alaska LEGAL DESCRIPTION L5 B4 Raven Woods LOCATION - NO. OF BEDROOMS Trappers Trail 4 Well Absorption area Dwelling PERMIT NO. DISTANCE TO: Not installed 10' 10' - 780710 O _Y F-2Manufacturer Material No. of comps tments WF_Greer Steel 'n Liq. capacity in gallons Inside length - Width Liquid depth 1250 IF HOMEMADE: D '1 DISTANCE TO: Well Dwelling PERMIT NO. J(7Z 02 F Manufacturer - Material Liquid capacity in gallons D Well Foundation Nearest lot line PERMIT NO. m= DISTANCE TO: Not installed 30' 780710 LL Z No. of lines Length of each line Total length of lines Trench width Distance between lines Paw 36 inches N/A FTop tile to finish Material beneath tile Total of grade effective absorption area 0 4 Feet 6 Feet inches 612 Sq. Ft. Length Width Depth PERMIT NO. w Qf Type of crib Crib diameter Crib depth Total effective absorption area u6i a W Well Building foundation Nearest lot line DISTANCE TO: J Depth Driller Distance to lot line PERMIT NO. 1OBuilding F�LDISTANCETO: foundation Sewer line Septic tank Absorption areas) LOT `1 NS OTHER PIPE MATERIALS Cast iron 4" plastic perf. SOIL TEST RATING 150 INSTALLER H&M Excavating REMARKS Well to be installed on Front Lot E Line minimum of 100' from Tank at ( NK 120' from absorbtion area. l � s 0 u ' •••• •• o: • �- w I Ll.,5 T T Forsi, 3a'q ® z. No. 3365E APPROVED.. LEGAL 72-013 (Rev. 3/78) # r-1 1-1 r -.I 11--".- I FJW L_ I -r •T , Cl F' F' r-4 c r" f 1-1 Ci E ' DEPARTMENT OIWHEHLTH AND ENVIRONMENTHL'FWJTECTION 825 'L' STREET, ANCHORAGE: AR:. 99501 264-4720 L_ L_ 1=4 r-4 E> C-ir-r-`-a I -F EE 1Er":rEFP F"EF;?.'rl I Jr PERMIT NO. C 780710 AP'P'LICANT ROBERT E. GRIGG,S SRA BOX 1550N ANCH. 344 2219 LOCATION TRAPPERS TRAIL LEGAL L5 B4 RAVEN WOODS S/D LOT SIZE 54000 SQUARE FEET TYPE OF SOIL ABSORSTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SO FT/BR)= 150 THE REQUIRED SIZE OF THE :OIL ABSORPTION SYSTEM IS: L-°E=F1--F-1= :JL El L-a"QTH= !+:JL QFc n'v EL- C'F=F•-r F-1 =- rS THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS; THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE I5 NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAtiVATION (IN FEET). �E1D-lU I F=_EC• =..EF:' -r I r_ -r1=lraK !E- I Z�_E= :jL;22!ff-RD 1-aF-1L_L_RD 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. — — — -F w r-1 < : > I "_. F�E 1_� -r I ID P4 :E. "F= E FR E=1_-_ r-1 I F Z E C- -- - BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL. BY THI: DEPARTMENT WILL BE SUBJECT TCS -PROSECUTION. MINIMUM DISTANCE BETWE 100 FEET FOR A PRIMATE 150 TO 200 FEET FROM A WELL LOGS ARE REQUIRED OF THE WELL COMPLETION OTHER REQUIREMENTS MAY A'vAILABLE TO INSURE PRI "_N A WELL AND ANY ON-SITE SEWAGE DISP'OS'AL SYSTEM IS WELL; OR PUBLIC WELL DEPENDING, UPON THE TYPE OF PUBLIC WELL. FIND MAST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE ]PER INSTALLATION. F=•EF;ZM I -F E_XF= i FL.E_. C•E1_ Er-reEFR __:JL :1-!D 7 L-: I C:ER:TIF'Y 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 THE CODES. <.: I UNDERSTAND THAT THE Ord -SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE I'= R:EMO E TO INCLUDE MORE THAN 4 BEDROOMS. C SIGNED: ---- ------- --- -------------- APPLICANT ROBERT B. G IGGS ISSUED BY_ �5�--===+--......... DATE_ _ _%F�---- S' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6850, Anchorage, Alaska 9%02 2762221 SOILS LOG — PERCOLATION TEST g SOILS LOG ❑ PERCOLATION TEST PERFORMED FOR:YIff ` ,' DATE PERFORMED: `T i V LEGAL DESCRIPTION: l�1 i VN �N ILU�o0x S' DEP7H SLOPE SITE PLAN (FEET) 1 2 sAMAj VV\qA 3 a<�j D4- w 4v\ Ie^Asej� 04�e-c 5 -6 (i d N.i?N - SP 7- 8- aD ° 9- 60- SP 11 12- 13- 14- 15- 16- 17- is- 19- 20- PERFORMED 21314151617181920 PERFORMED BY: 72-008 (7/76) 15-0 WASGROUNDWATER `\Q Slr__�_ ENCOUNTERED? L; 0' E IF VES, AT WHAT ' DEPTH? _ j I 0 Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT CERTIFIED BY: 46 WATER WELL LOG FOSS DRILLING 1336 Ingra Street nnAnchorage, Alaska 99501 WELL OWNER /"in bo.v� �` i'S r1r, .G /. 4 U 46 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OF WEIR.0 3IZE OF CASZNGDEPTH OF HOLE�FT. CASED TO l I / FT. STATIC WATER LEVEL-J-V�FT. YIELD_,,g_GAL. PER. MIN. WITH ISI ,FEET OF DRAWDOWN. F -af -%7�1.iGil2fLL1:iG��%� DATE COMPLETED 9 PUMP TO BE SET AT- -L�t o=aS Q o ms / t OL27 1.2z oaau A ostaA ryks t0— _t 0— O_ __t0— O_ —to- -t 0— to_ to_ _to— to_ _t0_ —t t0- -t 0— Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650, www.ci.anchorage.ak.us (907) 343-7904 C CSt e SA EiT CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING •Parcell.D. 015-232-28 HAA k-- _D5 LID 1. GENERAL INFORMATION Expiration Date: Complete legal description Lot 5 Block 4 Raven Woods Addn. #1 Location (site address or directions) 6261 Trappers Trail Road Anchorage AK 99516 Current Property owner(s) Ronald& Rae Vanvranken Day phone 868-1018 Mailing address 6261 Trappers Trail Road Anchorage AK 99516 Lending agency Day phone Mailing address Real Estate Agent _ Christine Anderson/Dynamic Prop Day phone 529-1852 Mailing Address 3111 C Street Ste 100 Anchorage AK 99503 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD 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) 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 Health Authority Approval Guidelines for 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Eng. Svc. Phone 272-8218 Address P.O. Box 102954, Anch, AK 99510 / Engineer's Printed Name Steven R. Pannone, P.E. Date Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious .��.' OF q� engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The C� reported results describe the performance of the system under the conditions encountered at the time of ���P;.••'•""���""•oq the test, and separation distances measured to readily identifiable features. The operational life of all i GJ;•' 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 i TH .....•.....: ••••••�' outside the control of the evaluator of this system. All systems eventually fail and satisfactory test a .......... results do not guarantee future performance of the system, nor do they guarantee that there are no hidd A\ • .... .......... defects or encroachments. PES can therefore not provide any warranty for future performance not give ' Steven R. Pannone any estimate of how long the system will continue to meet the operational requirements of the ADEC or 1� 0 N o. C E 8149 - ••` MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon •......... •• 1 or use of this report by any other person or party is not authorized nor will it confer any legal right �� ice• whatsoever. 1.."r . •• ,rt P �� 6. DSD SIGNATURE Approved for --4—bedrooms. bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory ExpirationDate: (Rev. 11199) X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: c?/ll 1'2�=� Reissue 0 Municipality of Anchorage Development Services Department SPG Building Safety Division On -Site Water and Wastewater Program s'a Ear. 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: Lot 5 Block 4 Raven Woods Addn #1 Parcel I.D.: 015-232-28 A. WELL DATA Well type P Date completed 9/20/19 Total depth 285 ft If A, B, or C provide PWSID # Sanitary seal Y Cased to 177 ft FROM WELL LOG Date of test 9/20/1978 Static water level 149 ft Well production 2 g P m WATER SAMPLE RESULTS: Coliform =_colonies/100 ml Nitrate 0,_[_ mg/I Well Log Y Wires properly protected Y Casing height (above ground) 12 in. AT INSPECTION 1 /28/2005 ft 9 -p.m Other bacteria_G'—colonies/100 ml Date of sample:/28/2005 Collected by: Laura Pannone ,grsent–� B. SEPTIC/HOLDING TANK DATA Tank Type/Material Anchorage Tank Steel Date installed 7114/199 Tank size 1250 gal Number of Compartments 2 Cleanouts Y Foundation cleanout Y Depression over tank N High water alarm N/A Date of pumping 1/28/2005 Pumper. A+ Home Services C. ABSORPTION FIELD DATA Date installed 7114/1998 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 System type Deep Trench Length 65 ft Width 3 ft Gravel below pipe 6.2 ft Total depth 13_75 ft Effective absorption area 606 ft' Monitoring tube Y Depression over field N Date of adequacy test 1 8 2005 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 44 in Water added603 gal. New depth56 in. Elapsed Time: 1440 min Final fluid depth 44 in Absorption rate >= 600+ P —g•p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date (Rev. 11/99) D. LIFT STATION Date installed "Pump on" level at in"Pui Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 110 On adjacent lots Absorption field on lot 128 Public sewer main N/A Sewer /septic service line 50+ Manhole/Access High water alarm level at in Meets alarm & circuit requirements? On adjacent lots 100+ Public sewer manhole/cleanout NIA Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 18 Property line 85 Absorption field 10 Water main 100+ Water service line 50 Surface water Drainage Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 21 Building foundation 25 Water main 100+ Water Service line 50 Surface water 100+ Driveway, parking/vehicle storage 50+ Curtain drain None Observed Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION �.�PC�,:''•••.�q'�# I certify that 1 have determined through field inspections and review of Municipal records that the above systems 0,,, ;,,,, ,,,, ,,,,,,,h,„ are in conformance with MOA HAA guidelines in effect on • this date. 0 ........................ ............. Steven R. Pannanei No. CE 8149 Engineer's Printed Name/ Steven R. Pannone, P.E. •�q�o2�•°1 Date Z l©f ��V���D�ss;�••. HAA Fee Date of Payment �/ i i C Receipt Number 3 (Rev. 11/99) Waiver Fee $ Date of Payment Receipt Number L = So. 10 TRAPPERS TRAIL ROAD S O°O O'O O"E 1 77.74' r IN ➢ 9ME By IOiNG tl e x x X 1N3W35tl3 A1111111 iOl N O°00'00"E 257.15' x!m M z N ZE m y II Municipality of Anchorage Development Services Department Building Safety Division On -Site Water &'Wastewater Program s 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-232-28 - HAA#__,4/jD6C0/�r(7 1. GENERAL INFORMATION Expiration Date: Complete legal description RAVEN WOODS SUBDIVISION #1; LOT 5, BLOCK 4 Location (site address or directions) 6261 TRAPPERS TRAIL ROAD * ANCHORAGE, AK 99516 Current Property owner(s) GEORGIA HALVATGIS Day phone 522-8808 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 6261 TRAPPERS TRAIL ROAD * ANCHORAGE AK 99516 Day phone MARY TUTTEROW w/ DYNAMIC Day phone 261-7682 3111 °C° STREET * ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site in Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc shall be paid $ at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. - Date Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported resultsdescribedthe 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 soils condition, groundwater levels that may. fluctuate duringthe year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor dothey guarantee that there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of thisreportis for the sole benefit of the ownerlisted above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for attt4U(((((((fjr YOB eo V. bedrooms, with the fllowing . i?ations:DN-SI T E a fir= B; WATER AND WASTFWATFR _ eRnnQANA -- Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other By; Original Certificate Date: (Rev.I.. Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: RAVEN WOODS S/D #1; LOT 5, BLOCK 4 Parcel ID: 015-232-28 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 9/20/1978 Sanitary seal (YIN) YES Total depth 285 ft. Cased to 177 ft, FROM WELL LOG Date of test 9/20/1978 Static water level 149 ft. Well production 2 — 9 -p.m - WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate Q-6 mg./L. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 11/11/2002 Other bacteria 0 colonies/100 ml. Arsenic: N A mg./L. Date of sample: 11/11/200 Collected by: AKWWC, INC. B. SEPTICIHOLDING TANK DATA Tank Type/Material STEEL Date installed 7/14/1998 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (jN)YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping �i02 Pumper ISAACS PUMPING C. ABSORPTION FIELD BELOW EXISTING GRAD Date installed 7/14/1998 Soil rating OE>ft2/bdrm) 0_8 System type DEEP TRENCH Length 65 ft. Width 3 ft. Gravel below pipe 6.2 ft. Total depth *13.7 ft. Eff. absorption area 800+ W Monitoring tube YES Depression over field NO Date of adequacy test 11/11/2002 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 32 in. Water added 627 gal. New depth 32 in. Elapsed Time: E min. Final fluid depth 32 in. Absorption rate >= 600+ g.p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons Cycles tested SEPARATION DISTANCES FROM WELL ON LOTTO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date t -t 1(!3104- HAA Fee $ M5- — Waiver Fee $ Date of Payment 1'13-03 Receipt Number 3D�3G�;�✓C (Rev, 12101) Date of Payment Receipt Number �Y' ..... °4 �. ... ... .......... a... p'•J fr y ne s, 9� E 7953 €G 4 _ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services `a'',4=' On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# c�c'S- Z3Z=Z`8 1. GENERAL INFORMATION HAA # �\ t Complete legal description I! QAu ca�ec�'� Location (site address or directions)_6_26c'—Z� ( Property owner —5a 2: r �, 20 C,2 CGs Day phone <<> ' e� ? Mailing address Lending agency Mailing add Day phone Agent P'tS, L L,_T) Dayphone Address es '._;.oto, Lf,; 'm A vnN ,AIC pj-� Unless otherwise requested, HAA will be held for pickup. G 2. ?3L'MEER OF BEDROOMS: n. - YPH OF )NATER SUPPL": 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. -. PE OF 1NASTC1NATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1:91) From MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER_ As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Fi rm��S`A 4,_1 v 4, S \ L Phone 272--g 21 Address 2P,CD. '%-.K lrt2crz� dly c(� oJe�/u ��25 Engineer's signature / / Date ��` � i" 4 6 CE -8149 6. DHHS SIGNATURE '� PPOr ES SVO�'� Approved for -- bedrooms. - Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: -w __ Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. LHt) Back MOA 6'21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES R ECE f V F Environmental Services Division q4 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343W 141 6 1998 Municipality of , ;,,e Health Authority Approval Checklist Dept. Health & Humdn Serv;ces Legal Description: Z4 7-4Vp..j-,Lx vii ( Parcel I.D.: C5 IS- 232- '2-8 A. WELL DATA Well type'_PeiyA-ru%- If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) I Date completed 7-20-;�,e Total depth Cased to Casing height (above ground) /2 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION Date of test 4%Zol�6 ��3�Y8 e Static water level Well production 2 g.p.m. Z ® g.p.m. WATER SAMPLE RESULTS: Coliform —0"- Nitrate > 0-t co L Other bacteria CC Date of sample: 78 Collected by: -,PF B. SEPTIC/HOLDING TANK DATA Date installed 7/19 i 4 g Tank size 12-e-0 Number of Compartments Z Cleanouts (Y/N) Y' Foundation cleanout (Y/N) Depression (Y/N) A-/ High water alarm (Y/N) Date of Pumping. n>BW Pumper 3M11 ?'6 C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ftz or ft2/bdrm) C> • 8 System type -D. T. Length 6 S Width 39 Gravel thickness below pipe • 2 Total depth / 2 - $ Effective absorption area 80 6 Monitoring Tube present (YIN) Y Depression over field (Y/N) Date of adequacy test -71r4I4 i3 Results (Pass/Fail).'-PA SS For q bedrooms Fluid depth in absorption field before test (in.); N5L Immediately after= gal. water added (in.): -- Fluid depth (ins) Minutes later: —Absorption rate = Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level a * _ Cycles -ed E. SEPARATION DISTANCES *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot //O Size in at* On adjacent lots "Pump off" level at* Absorption field on lot /'Z8 r On adjacent lots / vow Public sewer main A -fa Public sewer manhole/cleanouty�Ba Sewer /septic service line r fi `T2 Lift station /Cc7 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: � � r Foundation /g Property line Absorption field /O Water main/service line SO Surface water/drainage /oofi Wells on adjacent lots / oo ¢ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: r r � Property line 21 Building foundation -215 Water main/service line S -a Surface water / C0+ Driveway, parking/vehicle storage area .504 - Curtain drain /c7Ov Wells on adjacent lots /ooIt- F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal X in conformance with MOA HAA guidelines in effect on this date. Signature ti Engineer's Name �2�c''NAni�z�Ndm•!3 Date f rS�4¢S HAA Fee $ _"�, CX-) . (-'\i 1 Waiver Fee $ Date of Payment 1- it `til Receipt Number u Yuna ��� O 3 72-026 (Rev. 3/96)* Date of Payment Receipt Number are -t P 5. LEGAL DESCRIPTION MUNICIPALITY OF ANCH z, s MUNICIPALITY OF ANCHORAGE EPT 0, :'< DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE�NT : -TION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS 825 L Street - Anchorage, Alaska 99501 r� • ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six DIVISION FEB 2 Zl--'INDI VI DUAL* ENVIRONMENTAL ENGINEERING ❑ COMMUNITY Telephone 264-4720 FSI V E D�� ❑ PUBLIC UTILITY REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE A ILITIES _ r- /T 7 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed.. Phiosb altow-ten (10) d&v%f9r proeegeh% " **If individual/on-site, give installation date �"�`'S� PROPERTY OWNER _ 1. d Q. ��Z' If system is over two (2) years old an adequacy test is required PHONE MAILING ADDRESS NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. PROPERTY RESIDENT (If different from above) PHONE -7,5--— d�G� 2� Ov�-)S 2. BUYER / PHONE MAILING ADDRESS 5-- ? 3. LENDING INSTITUTION / �S T/i.I l'� I�C/oP�'t-�"S' �G%/�/✓ PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION z, s STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS 9�-'81NGLEFAM ILY ❑ One 93 -'Four ❑ Other - ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY Zl--'INDI VI DUAL* * 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.) df/ `-OE� 8. SEWAGE DISPOSAL SYSTEM _ r- /T 7 �NDI VI DUAL/ON-SITE" **If individual/on-site, give installation date �"�`'S� If system is over two (2) years old an adequacy test is required El PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY ` INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DR I LLED LOG RECEIVED z 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED S—? INSTALLER -p �l 4 �P n l ❑Septic Tank or 1:1 Holding Tank Size: a 5'T� If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank - Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS QJ- APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE LEGAL DESCRIPTION 72-010 (Rev. 3/78)