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HomeMy WebLinkAboutCLEARVIEW LT 1Clearview Lot 1 #015-242-40 (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: 0 i5. 2-qZ •UQ Legal Description Property wner Name & Address: new J'If /+ 0? aY t/i � I C �lS/So Pump Installation Date: � Pump Intake Depth Below Top of Well Casing: feet Pump Manufacturer's Name: Pump Model: � �%/M I Pump Size % / hp Pitless Adapter Burial Depth: /d feet Pitles'$ Adapter Manufacturer's Name: Pitless Adapter Installer: 1A11 Disinfected Upon Completion? Yes ❑ No X. -hod of Disinfection: / f � 0 194 Comments: ANC"0RAGE VAM & Rlhi SERV. Pump Installer Name:J* 330 EAST767"AVENUE ANCHORAGE AC 99518 PNORIL 907-2430740 AVA5AXM Attention: The pump installer shall provide a pump installation log to the,DSDwithin 30 days of pump installation. Development Services Department Building Safety Division 8u On -Site Water &Wastewater Program 4700 Elmore Road P.O. Box 196650 Mark Begich Anchorage, AK 99507 Mayor www.muni.ora7onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: 0 i5. 2-qZ •UQ Legal Description Property wner Name & Address: new J'If /+ 0? aY t/i � I C �lS/So Pump Installation Date: � Pump Intake Depth Below Top of Well Casing: feet Pump Manufacturer's Name: Pump Model: � �%/M I Pump Size % / hp Pitless Adapter Burial Depth: /d feet Pitles'$ Adapter Manufacturer's Name: Pitless Adapter Installer: 1A11 Disinfected Upon Completion? Yes ❑ No X. -hod of Disinfection: / f � 0 194 Comments: ANC"0RAGE VAM & Rlhi SERV. Pump Installer Name:J* 330 EAST767"AVENUE ANCHORAGE AC 99518 PNORIL 907-2430740 AVA5AXM Attention: The pump installer shall provide a pump installation log to the,DSDwithin 30 days of pump installation. Municipality of Anchorage • Development Services Department e .,_ Building Safety Division _ On-Site Water 8 Wastewater Program, 4700 South Bragaw St.' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Paye 1 of 3 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SW040422 PID Number. 015-242-40 Nome: DALE TROMBLEY Wastewater System: ❑ New ■ Upgrade Address: 7850 ALATNA AVENUE is ANCHORAGE, AK. 99516 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 345-0723 5 O Deep Trench ■ Shollow Trench Dead O Mound O ether LEGAL DESCRIPTION s" Rete 1.2 Tctci a"'" Non''neh'a lied" 81ock: Lot: Subdivision: — 1 CLEARVIEW GPO/sa D.Pth to pipe potion. Nan, myna snedo: FL 9.0 MAX n Gww d.pth b.nroU ypr SEE DWG. rL 4.0+ rt Township: — Range: — section: — A edited a,ow "trial "ed Greva wyth: SEE DWG. n 64 (2032) rL WELL: ❑ New ❑ Upgrade Grew .:ah: 5 Nan{w of en..: aortia. banned bed: 2 15 ClopiNp.ti.r,Prlpt., Ae.C): Tool Gnaw To:10MR00T TOW ob.orption erne: rt n rr,.l.n Npi, a: `r(`, rt R 640+ sG. n D 3034/ F-810 ate' \\A- to pWd: stoop waw 1~. FL 10,aoyn aa. Mand: GEG. Ltd. 11/3-5/2004 nod: cc" N.yhl Above crowd: G� rt rL TANK SEPARATION DISTANCES ■septic 0Holding 0S.T.E.P. ODther To From Septic Tank Absorption vele Lift station Holding Tank /Pn.at. sr w Dn.s wo.Aoclww: ANCHORAGE TANK GepooiV in apron.: 0ee♦ 15001660"'"' Well too'+ 100'+ — — 25'+ STEED a p 2 Surface water 100'+ too'+ — — — LIFT STATION Lot Une 5'+ t0'+ — _ _ s" In "Maroc wo,ufectww: Foundation 5'+ m k.a a: pat a: Nqh doted warm a: Curtain DrainNONE KNOWN o.pNka knpwlipn. °'nano'° br Remarks: BENCH MARK THE OLD SEPTIC TANK WAS ABANDONED PER UPC. _ TOP OF LOWER DECK AT POST Avunwd f).wkan; 00.00 rt ENGINEER'S S F o F,� • • .•q��U v S COQ Inspections performed by: GEG, Ltd. Dates: 1st 11/3/2004 -. 2nd 11/4/2004 „•, .......... D 3rd 11/5/2005 Q Je f e A...... ss. Development Services Department ApprovalQ 00 Q°o •, C 795 �O Reviewed and approved by: Date: fQT��/ Q04 profe�Slpnic� (R«.12/07 I - �40000�� PERMIT NUMBER: AS -BUILT D RAS Z I N G PARCEL ID NUMBER: SW040422 015-242-40 I I I I I I 100' WELL RADIUS IG BED ABANDONED / 10E FOR POSSIBLE FUTURE USE. / DRAINFIELDS / \ S _ / THl1 iDBL1 A,_RETAINING WALL LLJ ry V) E3 10IIIIIIIII�: ST1 51.03 41.68 ST2 47.33 50.03 DBL1 45.92 54.03 DBL2 46.29 55.26 FS 61.44 68.86 C01 61.36 97.10 MT1 63.53 66.33 CO2 67.38 42.95 MT2 68.83 46.92 CO3 73.72 72.61 MT3 76.11 74.34 C04 81.85 54.57 C04 83.47 56.90 WELL ABANDONED BY ARROW PUMP \AND WELL SERVICE \11/15/2004 1 INACTIVE WKELL 10' UTILITY EASEMENT — _ _ _ _.�.. DATE: 11/18/2004o�F t,4 b� DRAWN BY: o�� S�0 GARNESS ENGINEERING GROUP, Ltd. R.A.L. ppm O SCALE: �. �0 CONSULTANTS d GENERAL CONTRACTORS. O 3701 F. TUDOR ROAD. SUITF 101 • ANCNDRAGF. AK 00507 • P ONF (407)33)-AA4 • FAX (407)338.3746 1 - 40 • • • • • •' ....... "" PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 DALE TROMBLEY (907) 345-0723 2 OF 3 ,j Gor ess. oa��0 LEGAL DESCRIPTION: _ CLEARVIEW SUBDIVISION; LOT 1, �i/za/4�FoopO TYPE OF WORK: AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE4oQ4pOpp0O0� PERMIT SW0NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: SW040422 015-242-40 FINAL GRADE 104.02 (AVG.) TOP OF TANK AT INLET - 97.71 INVERT OF BUNG AT INLET - 97.12 LOWER TRENCH FINAL GRADE 99.31(AVG.) RELTTNE ELAVATION OF OF TEST HOLE O 83.7 n L4 NEW 1500 GALLON DEEP BURIAL SEPTIC TANK'I FINAL GRADE UPPER TRENCH OR- 98. DE GRA102.25(AVC. 98.76 O I I I I HIGHEST POINT INVERT OF PIPE 93.79 (AVG.) BOTTOM OF TRENCH 89.76 (AVG.) 10' .,r 11/18/20 .....___._....... .. _.__. ... DRAWN BY: GARNESS ENGINEERING GROUP, Ltd. R.A.L. �� CONSULTANTS& GENERAL CONTRACTORS SCALE: 3701 E TUDOR ROAD, SUITE 101 • ANCHORAGE. AK 00507 , P ONF (007)337-600 • PAX (007USPJl46 1 w C 409 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: DALE TROMBLEY (907) 345-0723 3 OF 3 LEGAL DESCRIPTION: CLEARVIEW SUBDIVISION; LOT 1, TYPE OF WORK: AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE TOP OF TANK AT OUTLET - 97.69 INVERT OF BUNG AT OUTLET - 96.90 [&all INVERT OF PIPE 96.00 (AVG.) )TTOM OF TRENCH 91.98 (AVG.) AAR1 1 n111 �U�1� & �VEII SFR.1%ICE, LLC �} Ro. eox 1.10996-- Lnr!;rra0e. AK 99511 C"icc 1')0713,16-1355 • Fax (Q971 333-FO'6 7l a:m..r: (907) 795.9077 • EaDIe River: (907) 622-9335 1 CUSTOMER JOB SITE r t I Ada..------....__.._. --- - ------ - -- I• -?!+L YOU SIGNATURE d u�•,.... A-inn:•Irr!�� •!.. C,+,'•�'�.•n..; i•.�^•� Ir''�+, n• Ihr. A!.C'/r Dn,Sfnprq v/..ry 1 TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.S% PER MONTH WILL BE CHARGED ON OVERDUB ACCOUNTS. rare• ;vrt f•gOnigntED rVA•r pF rrH SALESrEnc(Al - ;PJANTITY DESCRIPTION jji�QµUd N � 'T& GY . PRICE AMOUNT tic�rT� eG sT --e-r- hJ;ll;c -- I r%ov1 i . Jle ----- - -- --- ---- -- c^Q HOURS RATE AMOUNT TOTAL MATERIAL TOTAL LABOR i - -o.+roc0 2yj DATE COMP. TOTAL LABOR PAY THIS AMOUNT I I• -?!+L YOU SIGNATURE d u�•,.... A-inn:•Irr!�� •!.. C,+,'•�'�.•n..; i•.�^•� Ir''�+, n• Ihr. A!.C'/r Dn,Sfnprq v/..ry 1 TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.S% PER MONTH WILL BE CHARGED ON OVERDUB ACCOUNTS. 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 Initial / Upgrade Permit Number: SW040422 Legal Description: CLEARVIEW LT 1 Design Engineer: 0855 Gamess Engineering Group, LTD Owner Name: DALE TROMBLEY Owner Address: 7850 ALATNA ANCHORAGE. AK 99516-2538 Date Issued: Oct 08, 2004 Expiration Date: Oct 08, 2005 Parcel ID: 015-242-40 Site Address: 007850 ALATNA AVE Lot Size: 53709 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit Is for the construction of: ❑,/ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must 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 ( IBAAC80 ). 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: Issued By. I I /I" Date: Municipality of Anchorage Development Services Department — / Building Safety Division On -Site Water 8 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/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. C�I�"�- QgC2 -u> Permit Number Property owner(s) DALE TROMBLEY Day phone 345-0723 Mailing address (1) 7850 ALATNA AVENUE • ANCHORAGE. AK. Mailing address (2) Legal description (Lot, Block & Sub'd.) __ LOT 1: Cl ARVIEW SUBDIVISION .. - Legal description (Section, Township & Range) N/A Lot Size Acres q.Ft. Number of Bedrooms 5 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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. GARNESS ENGINEERING GROUP Ltd. Permit Fees: Date of Payment: /(kl_ Log Waiver Fees - Date of Payment: Receipt Number. Receipt Number. GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS October 1, 2004 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Proposed Septic System for Clearview Subdivision, Lot 1, To whom it may concern: The existing 5 bedroom house is served by a private well and septic system. There are three wells on the lot, two of which are inactive. The inactive well to the north is encroaching on the existing and proposed septic tanks, and will be abandoned during construction. The drainfiled is in the state of failure and needs to be upgraded. One test hole was excavated on the property. The drainfield will be designed around the 30 foot radius of this test hole. We excavated and confirmed the existing septic tank is of poor integrity. We are proposing that a new 1500 gallon septic tank and a dual trench type drainfield be installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. TRENCH DESIGN: a. Percolation Rate: <1 minutes/inch b. Proposed Application Rate: 1.2 gallons/day/112 c. Number of Bedrooms: 75 d. Design Flow: 750 gallons per day e. Minimum Absorption Area: 625 R2 f. Total Depth: 9 feet (max.) g. Effective Depth: 5 feet It. Width: 2.5 feet i. Minimum Length: 64 feet long total (2 @ 32 feet long each) j. Effective absorption area = 640 R2 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: gamessengincering.com 3. SURFACE WATERS: There are no surface waters within 100+ feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached topography site plan, the average topography in the area of the proposed drainfield is approximately 5-10% running east to west. In short, there are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If youave any questions, please contact us at 337-6179. Thank you for your assistance. P.E., M.S. NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, a soils log, and a 7 page construction specification letter which are all part of the design package for this septic system. 3701 E. Tudor Road, Suite 101 " Anchorage, AK 99507 Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: gamessengineering.com LOT 22; CLEARVIEW S/D 1 1 1 / LOT 23; / CLEARVIEW S/0 CIFARVIEW LOT 24; / \ 5/D LOT 1; MEAR S/D LOT 2; MEAR S/D EXISTING MC SYSTEM LOT 10; CLEARVIEW S/D n % XN —24-� \ LOT 3; 1 I / LOT 2; CLEARVIEW S/D •�RETAINC WALL \\ CLEARVIEW S/D ♦WELL TO BE ABANDONED D ING CONSTRUCTION EXISTING \ ; % S BEDROOM% 1 / HOUSE \\ EXWNG \ WELL / LOT 1; PRESCOTT S/D 1 i I I I I - --- - R A.L. GARNESS ENGINEERING GROUP, Ltd. '` Y -' CONSULTANTS& GENERAL CONTRACTORS SCALE: LS Q 3701 F TUnC 00AD. SUITF iM • ANC�.MAf F. AS 00501 • cl•0Nc (001II51-0DO • cez (00113•n.l)/.� 1 100'ii PREPARED FOR PHONE NUMBER: PACE NUMBER: $; DALE TROMBLEY 345-0723 1 OF 2 LEGAL DESCRIPTK)N: •+1+•9.' CLEARVIEW SUBDIVISION; LOT 1. V•,+ TYPE OF WORK: 1+�� SITE PLAN FOR PROPOSED SEPTIC SYSTEM UPGRADE LOT 4; CLEARNEW S/D D INSTALL \ / MI ILII r EXISTING SEPTIC SYSTEM TO BE COMPLETELY ABANDONED / W I I I TWO TRENCHES THAT ARE 9 FEET DEEP MAX. BY 2.5 FEET WIDE. BY 32 FEET LONG EACH (64 FEET LONG / TOTAL). ADD S FEET OF CLEAN WASHED SEWER DRAINROCK. i 14 „-iRETAING WALL \ �7'✓✓ I �WELL TO BE ABANDONED `• / \DURING CONSTRUCTION PROPOSED 1500 GALLON SEPTIC •: TANK \ I. f i .` NG EXISTI_ - - / /I •' ---- _ INACTNE WELL — — — — — — to' Tm:m EASEMENT — NOTE: THE CONTRACTOR SHALL HAVE ALL WELL RADII SHOWN FLAGGED BY 4 REGISTERED SURVEYOR PRIG Try /HSAIQTDI I/•TIlSAI GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS 5701 F TIAOR ROAD, SUITF 101 • ANCHO AGF. AK 00507 • P,I( (007)557-0170 • FA[ (001)318J7L6 PREPARED FOR: PHONE NUMBER: DALE TROMBLEY 345-0723 LEGAL DESCRIPTION: CLEARVIEW SUBDIVISION; LOT 1, TYPE OF WORK: DESIGN FOR PROPOSED SEPTIC SYSTEM UPGRADE 10/01/2004 0� tAWN BY: R.A.L.' 1 1" = 40' NUMBER: 2 OF 2 MKINA"m N,-3r4ess:• .._ _..--------------�-��-~'- �� � _ _ � ` _ ____ __ __. __.. _, o'�F.:•�F' •:9500 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS d GENERAL CONTRACTORS 0......... .... ..........0 ML 11100. RYD. RIIfE 101 • /�MClg0..0� N0 Po!0) • RIg4: 00I l-•179 • !u: Po! 33M • 1YlD5fiC p..�.p,rp,•w SOIL LOG — PERCOLATION TEST D LEGAL DESCRIPTION: CLEAFMEW SUBDMSION; LOT 1• 0 of a A. ess.- a PERFORMED FOR: DALE TROMBLEY DATE: 9/22/2004 Q��� —7953 \F4O DEPTH_ s 'Io(1'0100 (reef) ___= TEST HOLE 1 A���4000��00.� 1 ORGANICS 2 SOIL CLASSIFICATIONS GW ORG, . !•:. ., 3—. GP IML .•. GM CL �••`'�`GC OLSW MH / 5 �.•.` ..•.•. SP CH •�'l SM OH SP/GP •••' TH#I+ or SC 7 ••" ::g, DATE r. 6 ,. .. �• •. ••. •:••••: SITE PLAN ••� •� ;• � +f ---------------------- 1•=100• - 10 • ••• .:; :• SP 11 ••••• .. • .::• .....•. 13 14 GM/ML 15 16 17 18 19 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4.0 FT. AND 5.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES N NO SOILS LOGGED BY: SUSAN OSWALT PERCOLATION TEST PERFORMED BY: ROB CAMPBELL COMMENTS: PERFORMED BY GEG• Ltd. I, JEFFREY A. GARNESS. CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 9/29/2004 DEPTH TO GROUNDWATER READING DRY 9/22/2004 DRY 9/29/2004 DATE READING CLOCK NET TIME WATER LEVEL TIME (MINUTES) READING NET DROP (INCHES) 9 23/2004 .NPN PgSO Np\ 1 iz-u i3 tnev. 3/ /8) —� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTFCTION I ENVIRONMENTAL ENGINEERING DIVISION 325 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE W ,(/ L !v f tit i✓ I r °uJ� �� �� L'j a ❑UPGRADE MAILING ADDRESS i LEGAL DESCRIPTION ivA z Y T /z iUr 3 LOCATION NO. OF BEDROOMS _ DISTANCE TO: Well fJv{ �y� Absorption area / � jnSes� Dwelling % PERMIT NO. �i j wQ Manufacturer &7 C� / r Material S�,� j No. of compartments H Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. = Z< Manufacturer Material Liquid capacity in gallons 0 = DISTANCE TO:LU Well Foundation Nearest lot line PERMIT N / J U- ? U No lines � Len h och ine -1"9 2 'Z '5. Total length of It 's Trench idth inches Distance between lines Y l'- Top of tile to finish grade Material beneath tile Total effective absorption area ® inches !S 3 Length Width Depth PERMIT NO. U, Q h °• a w Type of crib. Crib diameter Crib depth Total effective absorption area LU In DISTANCE TO: Well Building foundation Nearest lot line w Clas • Depth Driller Distance to lot line PERMIT NO. J w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER f7 v PIPE MATERIALS SOIL TEST RATING 5 INSTALLER sk. E 11 if :3 E �rL REMARKS s -7C' 1C.1 G C>� -�, /�l c, T- o 2'/ ly 12.5 �/P1S �S�I�' � �� /� X19+"�77>Yi �-f�♦<lS ,. 5 I I I e APPROVED DATE LEGAL 7L���e"-, 1 iz-u i3 tnev. 3/ /8) 4041 9 91U � •!t '.� No. 3A16-5 . fP �a .0 �.•...r' '`� r 1 hereby certify the following described property, LOT / , BLK CIE,4Rl//EW SUBO/V/S/oN Anchorage Recording Precinct, Alaska, has been surveyed by me, or at my direction, and that the Improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adja- cent thereto, that no Improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines, or other vislble easements on said property, except as Indicated hereon. It Is the responslbllity of the owner or builder, prior to construction, to verify proposed building grade relative to finished grade and utility con- nectlons and to determine the exlster.cs of any easements, covenants, or restrlctlons which do not appear on the racorde4 s ,bdivii!on plot. L - q�. SCHILLING a ASSOCIATES 7217 Arctic Blvd. Anchorage, Alaska 99502 344-9694 3-19-7 724 ate: 4_ Z -7- ca! e: -ca!e: f^' 5 c7 r{.. SCHILLING 4-/, C Z_ j/G_i4J 31.-e L. 4W 1//i V CHI LLI, r^!1V �I./'� JOB--- - AfCtIC Blvd. SHEET NO. __.___.� OF AnchIMs, Alaska 99502 kA 344-9694 349-7724 CALCULATED BY DATE �-�-- ASSOCIATES CHECKED BY DATE SCALE a MWOK1 *091 N—s 1w Gomm Mn 01471 MQNICIPAL ITY OF AN RAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 CA " - "-=; I -V a -4-,- a W a F;"e- -SL- PEPMIT NO: DATE ISSUED APPLICANT: ADDRESS: (CONTACT PHONE: ILEGAL DESCRIP (LOT SIZE: MAX BEDROOMS: 840344 05/15/84 WE:L-L- Fm-F=FRm i -r NORTHWAY HOMES 2447 LOUSSAC DR. ANCHORAGE.., AK 99503 349-2324 SUBDIVISION: CLEARVIEW SUB LOT: 1 -BLOCK: NO SECTION: 24 TOWNSHIP: 12N RANGE: 3W 53709 (SQ.FT. OR ACRES) 5 LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE. - - - - - - - - - - - - - - - - - - - - - T F:?- FE 1'4 IEF-1EB: - - - - - - - - FE C' -s - - - - - - - - - - - L4 - C., -' F=1' X DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4.0 GRAVEL DEPTH (FT.) 2.0 0.5 2. 0 TOTAL DEPTH (FT.) 6.0 4.5 6.0 GRAVEL WIDTH (FT.) 2.5 27.0 5.0 GRAVEL LENGTH (FT. 235. 0 53. 0 132. 0 GRAVEL VOLUME (CU.YDS.) 54.3 53.0 61.1 TANK SIZE (GALS) 1,500.0 1: 500.0 1,500.0 SOIL RATING (Sri. FT. e -BR) 188 188 188 II GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH> TANK MUST HAVE AT LEAST TWO COMPARTMENTS CERTIFY THAT: 1. 1 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. 1 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 MOR 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. 1 UNDERSTAND THAT THIS PERMIT IS VALID FOR A MAXIMUM OF 5 BEDROOMS FIND ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT. .IF A LIFT STATION IS INSTALLED IN AN AREA COVERED -BY MOA BUILDING CODES, THEN (i) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS -GUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. I SIGNED (APPLICANT I ISSUED Blr DATE: DATE: All I cli ti (N 000) LLI r -- co co CF) CD C\l CM X 0 m cr cn 0 0 :tr 24 x ci N: 41 ti c7 C.: L+.4: C C; C: Q3A 3D �bl EM E-4 E-4 E-4NCh:)9lbH �INIiYNIMJAJ EM 14 rij 'V3" Ol -Ldd t <7 0 :tr 24 x rij lt C4 E-4 E-4 E-4 E-4 Em ;34 0 12 z 0 :tr 24 x 501 LS LOG • MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: V �T / /� y'� " DATE PERFORMED: 4-1c3—&4- LEGAL '1`-1c3—&4- LEGAL DESCRIPTION: `- 07-(D -IJ DEPTH 3Z Sirocv c�vc�Z SLOPE SITE PLAN (FEET) OIZL,Arv[�5� �VFeoc^�/ 1 - 2 -. ol�5o G/vF�2ozc" 5;/7/- ML 3 v 4 0 5 S; ��y S4hdc, cJtt<rC C G fo M 6 7 8 r� 9- 10 10 11 WAS GROUND WATER ENCOUNTERED? 12 13- 19 Date 0F• At�tr'® 14 . O c� .' '• 0 ■■■■■■■■ i # '•4TH �,�*♦, 15- o7690" W**' --� 16 J�. T • •.•... • Robert D. Schiiling CE - 1411 •' ra '•. 17 �` �fLo .•' �i' ay 18- 8 EME! OMMIN 19 IF YES, AT WHAT DEPTH? MENNEN Date No ■■■■■■■■■■ Depth to Water Net Drop ■■■■■■■■ IN ■■■■■■■■N ■ ■■N.■.■.■■ ■ �„■ �■■■ ■.,ES'N ■FIBEli'IIMirMEN ■EMIME NEEMINEMMEM EME! OMMIN 7-4-0• t ¢ /t1O L O P E Reading Date Gross Time Net Time Depth to Water Net Drop 3:00/.^.m. 20 I I PERCOLATION RATE 3y/ - /.4./Z— (minutes/inch) u TEST RUN BETWEEN FT AND g FT COMMENTS G/sem /�yJ�lSi /� 5 ui� S 'eor*r/ PERFORMED BY: �2p !/ % ��? l/� �y CERTIFIED BY: ;Rv—,d DATE: 4'-/� B� 72-008 (6/79) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. OrS- ~,H3.- qo GENERAL INFORMATION Complete legal description ... C[¢.~rvi~ Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address COSA# O.~C,,}O /~'~."7 Expiration Date: ,.~ '- /~'-- / / Day phone Day phone 7_.~0-2.5(~0 Un/ess otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: _.~ 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 On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site System's .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 COSAs upon request to homeowners. Certificates of On-Site Systems 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. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION 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 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. Address '205 Engineer's Printed Name DSD SIGNATURE \/ ^pproved for Disapproved.. Conditional approval for Phone bedrooms. bedrooms, with the following stipulations: By: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other ',~/'~~~0 rig inal Cert ifi cate Da te: (Rev. 11/'05) MuniciPality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343~7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST I Parcel ID: 015- Legal Description: A. WELL DATA Well type Pr;~,¥{,' Date completed ~owv~ Sanitary seal (Y/N) ~ Total depth ~0 E. Cased to ~0 ~. FROM WELL LOG Date of test ~'~. ~ v':' ~ ~A~ ~5 S~tic water level ~ ff. ~ ~ Well pr~u~ion ~ g.p.m. ~ If A, B, or C provide PWSID # ~ WATER SAMPLE RESULTS: Coliform /~e.~, colonies/100mL Nitrate 4,23 mg/L Arsenic: /VD ug/L date of sample: SEPTIC/HOLDING TANK DATA Tank Type/Material ~¢~or~ ¢ Tank size J500 gal. Number of Compartments Depression over tank (Y/N) Pumper m~ Foundation cleanout (Y/N) ~ Date of pumping 1'/'13 1TM C. ABSORPTION' FIELD DATA /v -!'!S)O~ Soil rating (~orff2/bdrm) I ff.' Width $ ff. Date installed Length ' ~J Total depth 9 fl:. Date of adequacy test Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION Jll~/ 'l-otO 3-~ ft. ~, ,5 g.p.m. Collected by: Lt~r$ ,,/ {-t~ in. Fluid depth in absorption field before test ~ in. Water added '{'50 gal. Elapsed Time: ~t~t0 min. Final fluid depth ~ .... in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) Date installed iii3 - Il/5/lo°~J Cleanouts (Y/N) ' High water alarm (Y/N) Eft. absorption area ~ClO ~ Monitoring tube t,t\ ~/~.otO Results (Pass/Fail) System type Sl~,llo~ Gravel below pipe ~, 0 ft. Depression over field For 5 bedrooms New depth '7.. in. --~rSO g.p.d. If yes, give date Y D. LIFT STATION Date installed .../~._ ~ize in gallons ~./~'//~anh°le/Access (Y/N) "Pump on' level at /,' in. "Pump off" level at /i~-- High water alarm level a.~t..~. mm Moo~ ala~ & imments? E. SEPA~TI~ DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: I Septic tank/lift station on lot JO0 t' Absorption field on lot [00 It Public sewer main /V/~ I Sewer/septic service line ~..5 t Animal containment areas /I,/,0, ~'SO'e') On adjacent lots t,00 On adjacent lots Public sewer manhole/cleanout /V/~, Holding tank Manure/animal excrete storageareas /V,o, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation IOl+ Property line I0~+ Absorption field Water main /I//A, Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water A/.0.(IOO'J~ ) Wells on adjacent lots Property line Water Service line [O Curtain drain AJ. 0, Water main /V'/,~ Driveway, parking/vehicle storage JO ~+ ~F, COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name COSA Fee $ Date of Payment /~./~/~:~ Receipt Number (;~)~_,~ ~' ~ (Rev. 4/10) Waiver Fee $ Date of Payment Receipt Number ............ SGS SGS ReL# 110607400 l ClientName Spurkland Engineering Printed Date/Time 11/16/2010 13:30 Project Name/# Clearview Lot I Collected Date/Time 11/08/2010 10:15 Client Sample ID Clearview Lot 1 Received Date/Time 11/08/2010 10:50 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: 300.0 - Anions - MS recovery for chloride is outside of QC criteria. Refer to LCS for accuracy requirements. The matrix spike was overrange for chloride. Allowable Prep Analysis Parameter Results LOQ Units Method Container 1D Limits Date Date Init Metals by ICP/MS Hardness as CaCO3 165 5.00 mg/L SM20 2340B C 11/10/10 11/15/10 NRB Waters Department Total Nitrate/Nitrite-N 4.23 0.100 mg/L SM20 4500NO3-F B 11/11/10 AYC Microbiology Laboratory E. Coli Negative I 100mL SM20 9223B A 11/08/10 DLC Total Coliform Negative I 100mL SM20 9223B A 11/08/10 DLC Private Individual Analysis Alkalinity 110 10.0 mg/L SM20 2320B D 1 Aluminum ND 20.0 ug/L EP200.8 C 11/10/10 1 Antimony ND 1.00 ug/L EP200.8 C (<6) 11/10/10 1 Arsenic ND 5.00 ugfL EP200.8 C (<10) 11/10/I0 1 Barium 11.3 3.00 ug/L EP200.8 C (<2000) 11/10/10 1 Cadmium ND 0.500 ug/L EP200.8 C (<5) 11/10/10 1 Calcium 50000 500 ug/L EP200.8 C 11/10/10 Chloride 35.6 0.100 mg/L EPA 300.0 D (<250) 11/11/10 Chromium ND 2.00 ug/L EP200.8 C (<100) 11/10/10 CO3 Alkalinity ND I0.0 mg/L SM20 2320B D Conductivity 383 1.00 umhos/cm SM20 2510B D Copper 879 1.00 ugFL EP200.8 C (<1300) 11/10/I 0 Fluoride ND 0.100 mg/L EPA 300.0 D ('<2) 11/11/10 HCO3 Alkalinity 110 10.0 mg/L SM20 2320B D 1/09/10 LP 1/15/10 NRB 1/15/10 NRB 1/15/10 NRB 1/15/10 NRB 1/15/10 NRB 1/15/10 NRB 1/12/10 SDP 1/15/10 NRB 1/09/10 LP 1/09/10 LP 1/15/10 NRB 1/12/10 SDP 1/09/10 LP .......... SGS SGS Ref.# 1106074001 ClientName Spurkland Engineering Printed Date/Time 11/16/2010 13:30 Project Name/// Clearview Lot 1 Collected Date/Time 11/08/2010 10:15 Client Sample ID Clearview Lot 1 Received Date/Time 11/08/2010 10:.50 Matrix Drinking Water Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Private Individual Analysis Iron ND 250 ug/L EP200.8 C (<300) 11/10/10 1 Lead 3.08 0.200 ug/L EP200.8 C (<15) 11/10/10 1 Magnesium 9700 50.0 ug/L EP200.8 C 11/10/10 1 Manganese 4.10 1.00 ug/L EP200.8 C (<50) 11/10/10 1 Nickel 2.38 2.00 ug/L EP200.8 C (<100) 11/10/10 OH Alkalinity ND 10.0 mg/L SM20 2320B D pH 7.40 0.100 pH units SM20 4500-H B D (6.5-8.5) Selenium ND 5.00 ug/L EP200.8 C (<50) 11/I0/10 Silver ND 1.00 ug/L EP200.8 C (<100) ll/10/10 Sodium 5410 500 ug/L EP200.8 C (<250000) 11/10/10 Sulfate 9.32 0.100 mg/L EPA 300.0 D (<250) 11/11/10 Thallium ND 1.00 ug/L EP200.8 C (<2) 11/10/10 Total Dissolved Solids 194 10.0 mg/L SM20 2540C D (<500) Zinc 80.1 5.00 ug/L EP200.8 C (<5000) 11/10/10 ! 1/15/10 NRB 1/15/10 NRB 1/15/10 NRB 1/15/10 NRB 1/15/10 NRB 1/09/10 LP 1/09/10 LP 1/15/10 NRB 1/15/10 NRB 1/15/10 NRB 1/12/10 SDP 1/15/10 NRB 1/11/10 JJR 1/15/10 NRB 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 I.D. # ~-~/,..C" L~'-~-.- 0~-~ HAA# .... ~-~C~L~C~'~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner ~/~' ~./ Telephone: (home) ~-/~Business Mailing Address (c) Lending Institution ~ ~ ~/~%~/~'~) Telephone Mailing Address (d) Real Estate Company and Agent Add ress Telephone (e) Mail the HAA to the fo owing address: (or check here ~31'if hold for pick up) List------contact person and day phone number below:/. /~,,f.~4_),, ~ /f .'~'~t"t'~/'~'/'~/4 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms '~ 3. WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [~' Public [] Community[] Holding Tank [] Note: If oommunity 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 Aarow Pump & Well Service LLC (907)346-9355 Inspection Report 12001 Graif Well camera was ran down to 45' and no perforations were found or leaks found. Brian Wille Aarow Pump & Well Service C) m m m .~ ~m ~m -~0 ~z T~ ~Z z'q oo Z 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 zo—// 1. GENERAL INFORMATION // S—, (a) Legal Description (include lot, block, subdivision, section, township, range) /3 /" K ' Lc f / 5e, z -q 7-1-Z N J231-� Location (address or directions) '.5-0 /{ la7 /1 u (b) ' Applicant Name �7 K %e.?, 6/c Telephone: Home Business Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone. Address / (e) Real Estate Company and Agent Address N A i Telephone (f) Mail the HAA to the following address: 110111, 2. TCngle-Family RESIDENCE S C( Multi-FamilyOther Ndrooms 3. WATER SUPPLY Individual Well I;� 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 ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) t 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DAT AND INFORMATION • As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 14 CCS Telephone Address /z CC' cti'e.,7 J � r � /�nc�c�kv, c /} � �✓ �J S� S Date IV,���F� 19 °a ®e a oe eooeese •eo0eaa�er •roeo• 000seeoweo®io• •oaf o LEROY C. RE D, JR. e � ee CE v 2251 i �;° e®e so' AV A�G�!]gv®oe®oeeeeo G06 `f fat z�J��1�S►4�®L®�� 6. DHEP APPROVAL Approved for bedrooms by ate W Approved _41)_Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE . • DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) h HEALTH AUTHORITY APPROVAL (HAA) Ut,T ZU CHECKLIST -FEBRUARY 1984 264-4720 RECEIVED Legal Description: C /«wi'ew C, t / /3/uck ..SCS, Z!4 rl'zNA 3� A. WELL DATA Well Classification f r"' 4"Ik- If A, B, C, D.E.C. Approved (Y/N) 'VA Well Log Present �/ ) Date Completed S_- Z�_ _ S_S7 Yield 5 GPM Total Depth Y-3 o_ Cased to 60 Depth of Grouting Static Water Level 38 Pump Set At Casing Height Above Ground --.I Sanitary Seal on Casing &N) Electrical Wiring in Conduit ea) Depression Around Wellhead (Y/tp Separation Distances from Well: To Septic/Holding Tank on Lot 170 �` ; On Adjoining Lots /O D ' To Nearest Edge of Absorption Field on Lot On Adjoining Lots toot To Nearest Public Sewer Line A/ A Cleanout/Manhole Al A Water Sample Collected by — To Nearest Public Sewer To Nearest Sewer Service Line on Lot 67- Z Y Date Water Sample Test Results Comments ACA-WlVelfm mecsvrn rerfi Waive— r-t.71Ld 1 v ADFC l B. SEPTIC/HOLDING TANK DATA Date Installed ,Qof /3) 8Y Size /S OO Standpipes (�I) Air -tight Caps &I) Depression over Tank (Y/I0 Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) Al I+ Separation Distances from Septic/Holding Tank: To Water -Supply Well -K 4 O To Property Line -7 Z' No. of Compartments A 0 Foundation Cleanout A) Date Last Pumped Naw ; for Ai A Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field /z-;— AI'A To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course. Comments c�a<ve gra„ J 6y Iz)F'c 'v, .. Page 1 of 2 r 72-026(11/84) zzl C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /B 6 C /6 Type of System Design PS Pc( Date Installed _ or -IL /3 /qOid l� Length of Field S Width of Field Z Depth of Field Gravel Bed Thickness G a Square Feet of Absorption Area Standpipes Present O Depression over Field (Y/� Date of Last Adequacy Test N* Results of Last Adequacy Test N# Separation Distance from Absorption Field: To Water -Supply Well '?O To Building Foundation 30 Lot N 4 To Water Main/Service Line / 0 To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on On Adjoining Lots 30 +- To Cutbank (if present) i✓ A" 00.4 - Comments . U, , 9,WW�lyd c. -I - - D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions — Manhole/A ss (Y/N) mp Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ha to hecked, yerified, or conformed to/all MOA and HAA guidelines in effect on the date of this inspection. Sign Date Company MOA No. sr e6 U L� Receipt No. QOl OQ-7� Date of Payment /D -� I��VOF•Ay4, .� Amount: $ Jr, • • _— Page 2 of 2 72-026 (11/84) 0 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE APPLICAT 1. General Information Application Date � 12-1 (a) Leeg)g1 Description (include lot, block, subdivision, section, township, range) 1� r� Y` �! 1 1� Sa�6 !3/oc k - -- L vf 7-1 l -J Se C. 2 Y Location (address or directions) ( b) Applicants Name Da/&_ Tram �/e Y Telephone - Home Business 7S7 Applicants Address 7 ,? SC (c) Applicant is (check one) Lending Institution ; Owner/builder l Buyer E::l ; Other E—� (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. ape of Residence Single -Family Multi -Family Number of Bedrooms �9_ 3. Water Supply - Individual Well � Community Other (describe) 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 Community Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] Engineering Firm Providing Inspections, Tests, File Search, Data and Information ,w 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 Tp 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 onsite 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 lAy, E. C_ S Telephone I6 IS -D L/ Address / �2 0 (0 LJ r . . -ftN-1 � Q, S Date LL ,/ I? (ENGINEER SEAL) 6. DEEP Approval Approved for Liz bedrooms By Z, oe Al eta.. q C2 e a V' ®QC'o00 osa io ova o6 ' A $9 , le y C. Reid, j No. 2251-E ; Ja Approved V_ Disapproved Conditional SMSCeLA �_'� J Terms of Conditional Approval \k -'at d\ WPb6ft_L- 5/13 )T5' 11791 �5 W • THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT— ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE— MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 • MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 'JUN 2 "' 1QR; 264-4720 A. WELL DATA Well Classification P,� 1c If A, Bim, C, D.E.C. Approved (9/N) Well Log Present�l) Date Completed ,.� - cM— 8�_ Yield —57 Total Depth o' eCased to Depth of Grouting NA NUT DN - Static Water Level Pump Set At OnT n&�yj"t, Casing Height Above Ground yS2L Sanitary Seal on Casing &) Electrical Wiring in Conduit &N) Depression Around Wellhead (Y&)) Separation, Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots To Nearest Edge of Absorption Field on Lot 9010 ; On Adjoining Lots N t To Nearest Public Sewer Line t�ky To Nearest Public Sewer Cleanout/Manhole NR To Nearest Sewer Service Line on �Lot Water Sample Collected by (r�� ; Date Water Sample Test Results A _�S�`�S't�lleod2-� d Comments ®1•i &tl-'� a10_. 4_eZ B. SEPTIC/HOLDING TANK DATA Date Installed 0 120 Size No. of Compartments Standpipes &) Air -tight Caps &N) Depression over Tank (Y& Foundation Cleanout &/ J) Date Last Pumped _. AJ A -<f L[h Pumping/Maintenance Contract on File (Y/N) N ; for Holding Tank High -Water Alarm (yo J� R Temporary Holding Tank Permit (Y�N Ain Separation Distances from Septic/Holding Tank: r To Water -Supply Well a C), © To Building Foundation 2.5� To Property Line 7a To Disposal Field To Water Main/Service Line rV To Stream, Pond, Lake, or Major Drainage Course N A Comments (Dc-00_44_,th- &AALe� `/ Page 7 of 2 I� �. 72-026(11/84) C�_e C . I C C4ct_&_vt C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 1 E E u (/ m Type of System Design Date Installed ,�' ��� Length of Field -IAMMLYI i Width of Field I -a 4 6?7 Depth of Field r Gravel Bed Thickness I S,� a Square Feet of Absorption Area � Standpipes Present6N) Depression over Field (Y& Results of Last Adequacy Test W N Separation Distance from Absorpti� Field � U To Water -Supply Well b To Property Line Io To Building Foundation'. To Existing or Abandoned System on ,+V � 41-�rY Lot � 1k ; On Adjoining Lots 3® t a6ew` To Water Main/Service Line To Cutbank (if present) NA *.Lo+ To Stream/Pond/Lake/or Major Drainage Course �lFaC� To Driveway, Parking Area, or Vehicle Storage Area yi,� / Comments (D wCic- Cti ' // Date of Last Adequacy Test �J k < Z� D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed �NLQ��-� — Date Company ALC=s MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) u wm 20, IM AbIft "Mmotaf I smfv�9.-.• IZO Vest, 3rd A"=Ws Suitt B Alli@ wap.6 Alaska 99503 gra iktWer FfWzental Separatia: betmm Well and Septic Tames Let It Marview Subdivisi2ps Vie, Alaska 274-2S33 Dtar Sir: .-IftlWrtment has rev i urod the snNett we iV er regm t mW hereby ns ives l *42.ental separation be the Well Wad septic, tank to 90 feet r AwA :subject property far a 5 bedriko single fmi y residence only. Sincerely,. District Engimv `llL //-/ Z S Q rp 4(,j , ;IGY�{- a. v,.' Ae_ �_Q' CIr- /'S ---kd 4.0 7; a ALASKA ENVIRONMENTAL CONTROL SERVIC INC. 1200 West 33rd Avenu uite B ANCHORAGE, ALASKA 99503 (907) 561.5040 *MEET NO. f OF CALCULATED BY �� DATE CHECKED By DATE