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HomeMy WebLinkAboutHANSHEW HEIGHTS LT 2AHanshew Heights Lot 2A #015-051-26 ,,,dIUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION f, ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME j II < L�_�tA PHONE NEW ❑UPGRADE MAILING ADDRESS © o -T LEGAL DESCRIPTION ��8A LOCATION � NO. OF BEDROOMS 13 F�'17 Go7T Well Absorption area Dwelling PERMIT-I DISTANCE TO: LCD !- 1 OI %C Uy mQ Manufacturer / `may Material No. of compartments CA)~ Liq. capacity in gallons Inside length_ Width Liquid depth ©b 0 IF HOMEMADE: _. Well -_. Dwelling PERMIT NO__ a z DISTANCE TO: = z F Manufacturer Material Liquid capity in gallons p Well Foundation Nearest lot line -� C) PERMIT NOS/ � � -7 J = DISTANCE TO: r w U_ z No. of lines Length of y chi line Total length c)f lanes t Trench width i nches Distance be e I s F z w KF e Top of tile to finish grade , l Material beneath tile a o inches Total effective ab6'darea l9 0 Length Width Depth PERMIT NO. w 4 I- Type of crib Crib diameter Crib depth T otal ive absorption area CLs W LU Well Building foundation Nearest lot line W DISTA E TO: Class Depth Driller. Distance to lot line RMIT NO J J w Building foundation ewer line Septic tank I A sorption area(s) � ISTANCE TO: OTHER PIPE�� MATERIALS t st C �a Y L i�BYI SOIL TEST RATING Q INST LER (l Vt W©r LAS fb -X REMARKS r A RO ED DATE LEGAL / k6 � v — 72-013 (1419'v. 3/78) // ^' / ' PERMIT NO DEPHRTMENT O LTH HND ENV�RONME�TRL '/CTION 825 /L'-SuREET/ ANCHORAGE, HK. 99501 � , 264~4720 10"FiLF01-1 X'- HPPLICHNT REV. KIP HHNSEN LOCHTION SHME LEGHL L2H A�NSH�W D l �W��.k1�� TYPE OF SOIL HBSORBTION SYSTEM 5110 HBBOTT R.C. IS: TRENCH ]44-072 LOT SIZE ��000 SQUHRE FEET MHXIMUM NUMBER OF BEDROOMS RHTING (SQ FT/BR)� 250 TH�'REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS: Q W Ho" W 1-1 :1. Hot P.~THE hs M W 1-1 13 so! low V 1547 L.. HE, TIE ko" 4 - I - 1� � THE LENGTH DIMENSIQN IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE GROUND AND THE BOTTOM OF THE EXCHVHTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES THE GRHVELDEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE QUTFHLL PIPE AND THE BOTTOM OF THE EXCHVHTION (IN FEET). oil EIT fit U 11 � �TIE ��X 4:1 W 1"R P41 h< 53 1 2": ������ PERMIT HPPLICHNT HHS THE RESPONSIBlLITY TO INFORM THIS DEPHRTMENT DURING THE INSTHLLHTION INSPECTIONS OF ANY WELLS HDJHCENT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES THHT THE WELL WILL SERVE. �� ��31 -1: TOMMY BHCKFILLING OF HNY SYSTEM WITHOUT FINAL INSPECTION HND HPPROVHL BY THIS DEPARTMENT WILL BE SUBJECT T0 PROSECUTION MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWHGE DISPOSAL. SYSTEM IS 100 FEET FOR H PRIVATE WELL/ OR ,150 TO 2G0 FEET FROM H PUBLlC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL OTHER REQUIREMENTS MHY HPPLm SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE HVHILJ' 1BLE TO INSURE PROPER INSTT`11ALHTIO11. ��ko, 011 In I W ERE X I" A.: F,---" F -E.. �TIE Q FE.: P-1 F*_­.-.,'� V*.�:­i���� � I CERTIFY TWIT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON- --SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE. 2: I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES �]' I UNDERSTHND THHT THE ON~SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE �RES IDENCE IS REMODELED TO INCLUDE MORE THHN ] BEDRQOMS SIMED �. � HPPLICANT REV. KIP HHNSEN , � ^' 1 PERFORMED LEGAL DESCRIPTI 1 0 d 2 0 0 3- 4- 6 4 6 7 �-•C 10 11 12 13- 14- 15- 16- 17 31415 1617 0 18 0 19 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6.650, Anchorage, Alaska 99502 276-2221 SOILS LOG — PERCOLATION TEST Kip M. Hansen Lot 2A, Henshaw Subdivision Silt w/some gravel(ML)1,01 Gravelly Silt w/some sand (GM -ML) Dense, Sl. Moist Dk. Brown 6.0' Silty Sand w/some gravel (SM) Dense, S1. Moist Dk. Brown SOILS LOG itX PERCOLATION TEST ASI No. 02079 DATE PERFORMED: May 10, 1979 SLOPE SITE PLAN 2A I ElI I : Test Pit I i L b A I , L1 ® u� 10.0' o 0 WAS GROUND WATER S Sandy Silt w/ ENCOUNTERED? NO L some gravel o P (SM -ML) E IF YES, AT WHAT Dense, S1. MOiStDEPTH? na Dk. Brown 15:5: T. D. P�Ee OF , goo�R 0 'off-.$...�..•.Q,4.:.. Reading Date Gross Time I i I Depth to Water Net Drop 2:10 2:20 5/10/7 Reading Date Gross Time Net Time Depth to Water Net Drop 2:10 2:20 5/10/7 10min 0.27' 0.34' - 0.07' 2:30 2:40 20 " 30 " 0.38' 0.41' 0.04' 0.03' 2:50 3:00' 40 50 " 0.46' 0.48' 0.05' 0.02' 3:10 60 " 0.50' 0.02' 20 0m Stephen D. Shrader - W`S I®� �• No. 4148-E :�Z� 28 min/inch -2-S-6 S-6 PERCOLATION RATE (minutes/inch) Q �PROFESSI��P'®� TEST RUN BETWEEN 8 - 0 FT AND 9 • 8 FT COMMENTS PERFORMED BY: S. Shrader CERTIFIEDBY: S. Shrader DATE: 5/10/79 72-008 (7/76) 11jul L -A 0 CD Fc f, � � ( 0 , 6, 1: . Municipality of Anchorage e • '� Development Services Department =(t� Building Safety Division s On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite /=,,,LA�i y� C•'�YnJ (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-051-26 COSA# 4 sC 1 a f I cP f 1. GENERAL INFORMATION Expiration Date: - ;� 3 _ / Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address HANSHEW HEIGHTS S/D; LOT 2A 9220 NICKELL CIRCLE * ANCHORAGE AK * 99507 LANCE & VELDA MILLER Day phone 9220 NICKELL CIRCLE * ANCHORAGE, AK * 99507 Day phone JAMEY WOOD W/ PRUDENTIAL Day phone 273-7245 3801 CENTERPOINT DR, #200 * ANCHORAGE, AK * 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class A Well Community On-site ❑ Public Water System ❑ 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 Systems 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 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. 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. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date �e�lJz Engineer's Comments In conducting this evaluation, GEG, LtD. attempted to provide a thorough, 0006�Op conscientious engineering analysis of the system in accordance with ADEC and MOA �! OF �4�� DSD Guidelines & Regulations. The reported results described the performance of the �O ... S �O system under the conditions encountered at the time of the test, and separation j 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 during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test . . . . . . results do not guarantee future performance of the system, nor do they guarantee that QQ .J f y Garn ss: there are no hidden defects or encroachments. GEG, LTD. can therefore not provide Q CE o`� any warranty or future estimate of how long the system will continue to meet the �4,�'p b % 2•' o,`OG operational requirements of the ADEC or MOA DSD. The content of this report is for�44eQ fro1111fessiono\ the sole benefit of the owner listed above. Any reliance upon or use of this report by any �D�O��000 other person or party is not authorized, nor will it confer any legal right whatsoever. G5. DSD SIGNATURE �Q�7 ` " ry� Approved for 3 bedrooms. `_ ON-SITE Disapproved. =� WATER AND =v WASjEWATER Conditional approval for bedrooms, with the following stipulations..::, PROGRAMwoe ` iOA5 l�y��7JJJ))p}1t111����1 Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: a4lz3o&�� Original Certificate Date:' e (Rev. 11105) Municipality of Anchorage a„ • Development Services Department ° Building Safety Division On -Site Water & Wastewater Program p A E 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: HANSHEW HEIGHTS S/D; LOT 2A Parcel ID: 015-051-26 A. WELL DATA Well type COMMUNITY Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE If A, B, or C provide PWSID# 211643 Well Log (YIN) Sanitary seal (YIN)_ Cased to ft. FROM WELL LOG Coliform colonies/100 ml. Nitrate mg./L. enic: ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments 2 Wires properly protected (Y/N Casing height (abo round) in. AT I CTION ft. N' Collected by: Date installed 6/8/1979 Cleanouts(Y/N) Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 5/14/2012 Pumper ONE STOP SERVICES C. ABSORPTION FIELD DATA Date installed 6/8/1979 Soil rating (g.p.ddft`or � 250 Length 121 ft. Width 3 ft. System type TRENCH Gravel below pipe 4 ft. Total depth *10.5 ft. Eff. absorption area 960 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 5/9/2012 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 17 in. Water added 835 gal. New depth 24 in. Elapsed Time: 130 min. Final fluid depth 22 in. Absorption rate >= 450+ g,p.d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons Manhole/Access "Pump off' level High water alarm level Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service COMMUNITY WELL On adjacent On adjacent lots manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ PRIVATE/200'+ COMMUNITY SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *UNKNOWN Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ PRIVATE/200'+ COMMUNITY F. COMMENTS *20' TO NORTH PROPERTY LINE PER 1979 INSPECTION REPORT AND 2007 C.O.S.A. BY CINDY ELLIS, P.E.. ORIGINAL SUMP MISSING. DOUBLE CLEANOUTS AND MONITORING TUBE INSTALLED JANUARY 2007. EXACT DISTANCE TO PROPERTY LINE IS UNKNOWN. G. ENGINEER'S CERTIFICATION t 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 JEFFREY A. GARNESS Date !—S-// b / f L ` / LA COSA Fee $ Ligo, Waiver Fee $ Date of Payment J / 21t;2 Date of Payment Receipt Number Receipt Number (Rev. 11/05) ABBOTT ROAD- CL OADo v a S 89'5900" W 140.08' , 10'UTILITY EASEMENT 25' r�x�x x �- .—._s_x= -- I U $i I � I m 28.3 0 2% Z 0 o Z C5 a ; LOT 2A o 0 N m C I 6.0 tao I r 0 EXISTING -HOUSE 5 m l ® N taoB 31.5 n o w I A RE. N ? i - 20.3 u:%. wN1 N m o I Ilifff... o m m 16x I Shed PAVED: he� % DRIVE - I N .4".. WALL. N 89'59'00" E 140.08' i 25' LOT 28 'OQQaaQ ionoao— > NOTE: THIS DRAWING IS NOT TO BE MODIFIED FOR USE AS A PLOT PLAN W1THOUT THE EXPRESSED WRITTEN CONSENT OF LANTECH. OQd °o"a""" a t l By Lance Millen AS -BUILT .aaad Lot 2A, B pw sta *a (m Aro^Nt Wein "I Hanshew Heights Subdivision —x—x— a Wnmk SURVEY a♦1211RGtil 1,1. Ed H nmtdl a fitl a W the I,, m tna erepnty m aaean m tkl, tlrmbe mmtl It mUflq Hol txe Imprownew slluvtat txeam me .IMb en property IMa entl ro naeegimmta aabl .the tlmn noted - LAND & CONSTRUCTION SURVEYORS -PLANNERS -ENGINEERS E t..NSf Y mementti <p�vmurota, rseklc�tlFpltni « r'bl`imee w 440 West Benson Boulevard, Suite 200 Phone! 562-5291 toxlnm ansae tla not appear m the se t svetllNNta 4 u w, Anchor e, Alaska 99503 Fox: 581-6626 is aI �y�,i�eaa Nauta any dole n«.on ea u..a tv ee,,ameffm, v praprty IhsA a M Net—Wan pwows Alah 73-238 aril 2437 Derr. Sept 10, 2009 Broan 8Y CB 2009-L-140 kat.07LZ28 =p.=aa'7,, an.aWa ay. APH DT Municipality of Anchorage Development Services Department Building Safety Division _i On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Parcel I.D. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 015-051-26 1. GENERAL INFORMATION Complete legal description Hanshew Heights Lot 2A Location (site address) 9220 Nickell Cir., Anchorage Current Property owner(s) Bill Horstmann Mailing address Lending agency Mailing address Real Estate Agent Mailing Address COSA # 021)i712 - Expiration Date: PO Box 230171, Anchorage, AK 99523 Day phone Day phone Beth Simpson t Keller Williams Alaska Group Day phone 727-2384 101 W. Benson, Suite 500, Anchorage, AK 99503 Unless otherwise requested, COSA wN be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site ✓❑ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class B Well Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite 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 Onsite Systems 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 Onsite 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 affuced 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. 1 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 Watkins Engineering, Inc. Phone (907) 349-1851 Address P.O. Box 110443, Anchorage, AK 99511.0443 Engineer's Printed Name Cindy W. Ellis S. DSD SIGNATURE J� Approved for j bedrooms. Disapproved. Date January 19, 2007 Conditional approval for07 bedrooms, with the following stipulations: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: �rrv, ^ -/ lC� Original Certificate Date:/ 3- 07 �7= (Rw 11M) gr. Municipality of Anchorage • Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 Bragew Street P.O. am 196550 Anchorage, AK 99519.8650 www.muniorg/onsfte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Hanshew, Heights Lot 2A Parcel ID: 015.051,25 A. WELL DATA Well type B If A, B, or C provide PWSID 4 211843 Date completed A277 Sanitary Goal (YM) Yes Total depth 235 R. Cased to 235 ft. FROM WELL LOG Data of test 811511977 Stedc water level 50 ft. Web production 14 WATER SAMPLE RESULTS: Coliform NA colonies1100 mL Nitrate mg1L Web Log (YIN) Yes Wires properly protected (YIN) Yes Casing height (above ground) 18+ in. AT INSPECTION Other bacteria Arsenic: _ mgA Date of sample: _ Collected by: B. SEPTICfHOLDINO TANK DATA ft. g.p.m. colonies/100 ml- Arsenic: L Tank TypelMaterkd Steel Sepdc Tank pate installed 8/8179 Tank size 1000 gal. Number of Compartments 1 Cleanouts (Y/N) Yes Foundation cleanout (YAt Y� Depression over tank (YIN) No High water alarm (YIN) NA Date of pumping Jan. 12, 2007 Pumper Northland Pumping C. ABSORPTION FIELD DATA. Date installed 8/889 Soil rating (g.p.d.Ae or felbdrm)250 System type deep trench Length 121 R Width 3 ft. Gravel below pipe 4 ft. Total depth 17.5 fc E8. absorption area 958 ft Monitoring tube Yes Depression over field No Dated adequacy test 1/13/2007 Results (Pass/Fab) Pass For 3 bedrooms Fluid depth in absorption field before teat L --in. Water added 1442.5 gat. New depth 10 in. Elapsed Time: 10 min. Final fluid depth 0 in. Absorption rade >= 450 g.p.d. Any rejuvenation troatrnent (past 12 mo.) (YIN &type) No If yes, give date D. LIFT STATION Date installed N/A S¢e in gallons Manhole/Access(YIN) 'Pump on' level at _ in. 'Pump otr level at _ in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requiremenb9 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic taWft station on lot 225 On adjacent lots 1004 Absorption field on lot 245 On adjacent Iota 100'+ Public sewer main 109+ Public sewer menhoie/cleanout 100'+ Sewer /septic service line 200'+ Holding tank WA Animal containmentareas 100'+ Manure/animal excrete storage areas 109+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5' Property fine55_ Absorption field 22' Water main 70'+ Water service line 25+ Surface water 100'+ Wells on adjacent lots 225' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 20+ Building foundation 10+ Water main 20+ Water Service fine 20+ Surface water toe+ Day, paw siorqge 4r Curtain drain N/A Wells on adjacent kits 245 F. COMMENTS: MT and DCO Installed Jan. 2007. Ehdsting house is under constriction and not currently plumbed. "Oki house" on survey is on blocks. The storage building has a bathroom and kitchen and is tied into septic system. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspectlons and 49ib review of Municipal records that the above systems are in conformance wilh MOA COSH guidelines in effect on this date. Engineer's Printed Name Cindy W. Ellis Cin W. Ellis Date January 19, 2007 CE -tory COSA Fee $_ q� , Date of Payment 1�/ qk ,� Receipt Number qDU9,� (Rev. 1 M5) Waiver Fee $ Date of Payment Receipt Number ABBOTT ROAD s- cn to o p S 89.59'00" W 140.08' 10' UIILITY EASEMENT 440 NEST BENSON BLVD. 1 103 25' i X C) r m ' '� u CONCRCTE \� T PILES r 8.5 U) 20. . 28.3 L, ' ' 2%_ z QN O Cd qs �jW o 'w, GRAVEL O O I ..-•,..� ,J °: 7. 20.3 6.0 u.e„ 4.0 o EXISTING HOUSE V M, SCD 1 .0 u.e 31.5 N 1 LOT �OA � � - 20.3 ,t' - O u' STORAGE /' w: OIpC. in O1 �:�': ' 1.0 i �.9 ....:.:::.:::.::................::•.:•...:.'.:� ........ •PAVED' '::. �... ...... �: �= ... N '..RIVE•.':.:.:�:.�::.•,:.:..'.. + # ... ... ................. ......... ................................. .... 10.2 :'•MT. rq l':: :•.: ....•... 1.2- 5 0.6 N 89'59'00" E 140.08' i A nF I kt. LOT 2B 440 NEST BENSON BLVD. 1 103 25' i X C) r m INSPECTION APPOINTMENTS D:;_,c RECEIVED �(�� j�C TIME TIME TIME DATE DATE DATE One ❑ Four ❑ Other �� INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & -DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOrfNVIRONMENTAL P;;OTECTION 825 L Street - Anchorage, Alaska 99501 ❑ PUBLIC UTILITY ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED ECEIVE REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PHONE 1. PROPERTYOWNER / r� MAILING ADDRESS S! 3/r �M) P�C� 5/ PHONE PROPERTY RESIDENT Ilf different from above) PHONE 2. BU ER MAILING ADDRESS PHONE 3. LENDING INSTITUTION t__ 7� E { �� MAILING ADDRESS PHONE 4. REALTOR/AGENT MAILING ADDRESS/ 5. LEGAL DESCRIPTION . n STREET LOCATION �� i//�`c �/ yiFBED L, e2 a-, / 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS One ❑ Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7: WATER SUPPLY ❑ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled 5Z3 COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM // SZ INDIVIDUAL/ON-SITE** zox YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified - PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: 00 If Tank is homemade give dimensions: SOILS RATING - - TYPE OFTANK MANUFACTURER - TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS * APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE �0 6 6C, BY - DEPT. OF ENVIRONMENTAL CONSERVATION SOUTHCENTRAI REGIONAL OFFICE To Whom It May Concern: 437 E Street ❑ Second Floor Anchorage, AK 99501 P.O. Box 1207 ❑ Soldotna, Alaska 99669 (907) 262-5210 P.O. Box 1064 ❑ Wasilla, Alaska 99687 (907) 376-5038 August 26, 1981 According to records on file in this office the Hanshew Heights water system is in compliance with the State Drinking Water Regulation, Sincerely, d1A9z' � Mike Mathews Environmental Field Officer MM/mn 18-06 L H