Loading...
HomeMy WebLinkAboutSKY HARBOR ESTATES LT 2Onsite File Sky Harbor Estates Lot 2 #015-281-79 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP151377 Tax Code Number: 01528179000 Work Type: Septic Upgrade Permit Effective Dates: November 24, 2015 to November 23, 2016 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: SKY HARBOR ESTATES Site Legal Address: SKY HARBOR ESTATES LT 2 G:2735 Owner/Address: LEONARD GORDON A 11641 BARR RD ANCHORAGE AK 995162158 Site Mailing Address: 11641 BARR RD, Anchorage This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy Lot Size in Sq Ft: 19500 Total Bedrooms: 4 N Private Well N 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 (18AAC80). _ 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By By: Date: y ? �*4A Date: F ....sTi� 11�isItS �sD�x► MUNICIPALITY OF ANCHORAGE 4' ,e,., kfto.45 1 Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program AA ON-SITE SEWER/WELL PERMIT APPLIGATION "5 %rcel I.D. 015-281-79 Property owner(s) Gordon Leonard Day phone Mailing address 11641 Barr Road, Anchorage, AK 99516 Site address 11641 Barr Road Legal description (Sub'd., Block & Lot) Sky Harbor Estates, Lot 2 Legal description (Township, Range & Section) Lot Size 19,500 Sq. Ft. Number of Bedrooms -4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: - (® all that apply) _ Absorption Field Q Initial ❑ Single Family (SF) Q Septic Tank Q Upgrade Q (w/wo ADU) - Duplex (D) ❑ Holding Tank ❑ Renewal F1Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 59A t 3q/go= g104o Waiver Fees: Date of Payment: It I tG- rte Date of Payment: Receipt Number: 5(.f„ rn Receipt Number: Permit No. b5P15 lar Waiver No. Permit App_:;- : ::...:c Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Enginegr E-mail: steve0paneneak.com November 17, 2015 Subject: Sky Harbor Estates, Lot 2 Septic System Upgrade Permit Request Design Narrative This is a design narrative for a permit to install an upgrade septic system to be issued for this property. The proposed systems will serve an existing four. bedroom (4) bedroom house. Currently the lot is developed. This lot and the surrounding lots are served by private wells. The well on this lot and the surrounding wells are over 100' from the septic system. 1. Soils. One test hole was performed on this lot by PES in November of 2015, and groundwater was monitored for at least seven days. Ground water was not observed to a depth of 20.0' below the surface in the test hole monitor tube after the 7 day monitoring period. Bedrock was not encountered in the test hole. Based on the results of the percolation tests and overall soils appearance; an application rate of 1.2 gallons/day/square feet was used for a conventional wastewater system in the area of the test hole. 2. Soil Absorption System Design. a. See Sheet 1 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The existing topography generally slopes from the west to the east in the area surrounding the septic system at approximately 2%. There are no steep slopes within 50' of the proposed drain field. The proposed drain field will maintain 50' separation all steep slopes. S. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of th is or the surrounding lots. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS. USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS AND IN ACCORDANCE WITH AMC 15.65. 2. SCOPE OF WORK: VERIFY 1250g SEPTIC TANK AND REPLACE IF NECESSARY. INSTALL SOIL ABSORPTION SYSTEM. 3. GROUNDWATER WAS NOT ENCOUNTERED TOA DEPTH OF 20 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN. APPARENT WATER TABLE 15.013SERVED IN ANY OF THE EXCAVATIONS LESS THAN 20 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. - - NOTES: PLAN - j UPGRADE SEPTIC SYSTEM Scale N0, BEDROOM: 4 (600 gpd) TANK SIZE: 1500g S.T.E.P, ..... . .. PERC RATE = 1 -5 MPI m�ror�M \ SOIL RATING: 1.2 GPD/SF \\ \ AREA ROD: 500 SF \ - SYS. TYPE: DEEP TRENCH 9.0' E.D. Steven R. —MIN LENGTH: 27.8 LF w 4 i i USE: p N � 180 30 LF X 3.0' WIDE, 9.0' E.D., 14.0' TD 1 TOTAL AREA: 540 SF VERIFY INTEGRITY OF 1250g SEPTIC TANK (E) I / IF FOUND TO BE LEAKING DECOMMISSION PER CODE i AND INSTALL 1250g SEPTIC TANK (P) INSTALL DOUBLE CLEAN OUT AND DIVERTER VALVE 3 1 WELL (E) 1 I ', SEPTIC AREA d� -L& 2 0 o I DRIVEWAY o' m W p U Scale o_ a 1,._50' ..... . .. ... .. .. P_LD. NO ............ 015-281-29 Steven R. ...... Pannone w 4 i •. CE 8149 .•�e p N � 180 TH-1 03: ,w w�W/ WELL (E) 3 DRAIN FIELD (P) +I / 3OLF x 2.5'W x 9.O'ED x 14.O'TD INSTALL MONITOR TUBE AND CLEAN OUT AT EACH END -� SEPTIC AREA TRA A A 3 - - PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 SKY HARBOR ESTATES, LOT 2 GORDON LEONARD 11641 BARR ROAD ANCHORAGE, AK 99516 OF AL,gsl i�'�,•' •�.9 �� Date 1/20/2015 Scale 1,._50' ..... . .. ... .. .. P_LD. NO ............ 015-281-29 Steven R. ...... Pannone PERMIT NO. •. CE 8149 .•�e --------- 1 OF 2 1 2 3 4 5 6 7 6 9 10 11 12 13 14 15 16 17 16 19 20 TEST HOLE 1 OR ORGANICS GW/ GRAV SW SAND BOH DATE PERFORMED: 11/03/15 SOILS LOG - PERCOLATION TEST SLOPE x TH WELL (E) 1 --WE-L� (E) WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? DRY DEPTH TO WATER AFTER MONITORING? DRY DATE: 11/16/2015 4BR HC (E) U r I� f . / TH-11\ WELL (E) SLOPE TH X READING DATE CLOCK - TIME NETTIME WATER LEVEL READING NETDROP 1 11/03/15 3:15 - 6.69 - -z 3:25 10 MIN 11.50 4.81 3 3:25 - 6.69 - 4 3:35 10 MIN 11.45 4.76 5 3:35 - 6.69 - s 3:45 1 10 MIN 1 11.46 4771 PEROLATION RATE 2.1 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 5 FT AND 6 FT COMMENTS: Test hole excavated by JR'S SEPTIC. Prec hole was presoaked. Test run for at least one hour. Last 3 readings reported. PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: ���� '\'\� Date FOR CONSTRUCTION I p>�Oj002299554 ENG 99910 '�F A`:gsl�� 1/20/2015 PHONE (907) 272-8218 FAX (907) 272-8211 %gip �y �� Scale SKY HARBOR ESTATES, LOT 2 GORDON LEONARD 11641 BARR ROAD SOILS LOG ANCHORAGE, AK 99516 * '*�/ NTS .... . . ... ..... P.I.D. NO 1-79 Steven �F2. �Ponnor�e�� CE 8149 PERMIT N0. .. ��/ OSPI51377 Sh2eOF 2 �30�tJC MUNICIPALITY OF ANCHORAGE j. 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 !77iU{M �'" // ►'""��. .'z- / (,J FiA rF�LQ A71%-'Z—�-- `i 17 hJt ❑ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION //W -r r - LOCATION NO. OF BEDROOMS Z e k' w2cm z n . 4— WellAbsorption - area Dwelling PERMIT NO. DISTANCE TO: {� Y _ -_ F z Manufacturer — Material No. of cnq partments ru - N Liq. capacity in gallons length Width Liquid depth IF HOMEMADE:Inside DISTANCE TO: Well Dwelling PERMIT NO. Sz < Manufacturer Material Liquid capacity in gallons 0 DISTANCE TO: WellFoundation 11 -7,� Nearest lot line PERMIT NO. wx J CL z No. of lines Length of each line Total length of lines Trench width Distance between lines E- z Lu ' 'a rg inches Top finish Material beneath - - ' Total I' of tile to grade f� tile effective absorpti n area p 4 -" '- inches Length Width Depth - PERMIT NO. LU f7 Q I— Type of crib Crib diameter Crib depth Total effective absorption area na LU LU Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. es. 0 w Building fm datioh Sewer line Se tic.t p k., Absorption area4s DISTANCE TO: OTHER PIPE MATERIALS , V-0 t--) Zr, C SOIL TEST RATING INS/TALLER REMARKS �,ge�4�i i`y it lapoo Qy�' a eeees• -¢� y, �V � .S� 49TH e�1f oo ee0e0ep 'yn x i". 09 fax o 0 s�`o - D'lbM on n e eeoo00 FDWAR g^ e _ (] 1 �C CE - J38 1 6 0! .��,, �CpCD DSD V(V iF. APPROVED � DATE '77711 LEGAL 72-013 (Rev. 3/78) WELL LOG Date Drilled: I1 -s;3 Static Water Level 5r) feet Draw Down I''/''' feet Tyre Material Drilled: 0 feet to 1 ') ssind 15 fne9. to 35 Grnvnl. 35 root to 90 CJ_ay, Gravel. 90 fnpt to 107 Gravel, �,�/�•�atrr t0 t0 Hefty Drilling S.R.A. Box 1553 H Anchorage,Alaska 99507 YK— H^rbnr 1':st,gtn- Gallons Per Minute 7', Total Feet ofasin� 1�7 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTIO14 JUL 9 1955 RECEIVED MUNICIPALITY OF ANCHORAGE Department a Health and Environmenta ?rotection 825 Street, Anchorage, AK. -9501 {l�/ 264-4720 130 c # # # HANDWRITTEN PERMIT Permit #STC) WELL AND/ ON-SITE SEWER PERMIT Applicant: L�(OPA - S4S,�-zMailing Address: C��17 Location: K.;�eA) S2c ? J Phone Number: Legal Description: L6I a S� 2 c�ST�>�S 'Lot Size: 2_(pnCDc ler` Type of Soil Absorption SysteA Is: Trench: ✓ Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: _/ The Required Size of DEPTH LENGTH 3_�r Soil Rating(sq.ft/br) AO's— Qr)i18_65: the Soil Absorption System Is: G' - GRAVEL DEPTH . ` WIDTH .So i� 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 is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ ( �­S^(-) GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. ' * * * TWO(2) INSPECTIONS ARE REQUIRED # Backfilling of any system without final inspection and approval by this departmen, will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee - for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) 1 underst d --that the bn-site sewer system may require enlargement if the si ence is remodeled to include more that 3 bedrooms. Lsi ence is remo Signed : Issued by: Appiicant 01 Date: zz / � SWP/024(1/81) PERFORMED F I SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SLOPEa ..�` •- 2 7. v 3 , -4 D Q �Ao 5 0 may' .p 6 f D. 0, 4L - z' a 7 I _- 8 9 -10 11 12 13 14 15 16 17 18 19 20 t r gay-} (jso WfY11-s`�� AP� °-'o •OeaO a°' � 0 rnts..nrn ?81U COMMEN PERFORMED BY: 72-000 (617 9) WAS GROUND WAl ENCOUNTERED? IF YES, AT WHAT DEPTH? DATE PERFORMED:7 /17 Af�.3 Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE _(minutes/inch) TEST RUN"q,GTVOEEN FT AND ,.--- FT CERTIFIED BY: DATE: UNMPALITY OF ANCH01RAGE Development Services Department ! Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-281-79 1. GENERAL INFORMATION Complete legal description Sky Harbor Estates L2 Expiration Date: Location (site address) 11641 Barr Road Anchorage, AK Current property owner(s) Gordon Leonard Day phone Mailing address Same Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 COVID-19 25% DISCOUNT APPLIED 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: 4 Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. oaU!r) COSA Fee $_5-5-t) 5- d (t l' i • 5-0 Waiver Fee $ Date of Payment `t L"aWwi'm Date of Payment Receipt Numbe/r� ©Jr q(le3C2 Receipt Number COSA# (o_-'� Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. Phone (907) 745-8200 Date 2pp O -Z -q OF ALgs�� 49 6. DSD SIGNATURE • • • • • • . • • • X System #1 Approved for bedrooms 'Steven R' 'anncrie'� CE 8149 .',, �f System #2 Approved for bedrooms �� SlFn . • 4 Disapproved G d Conditional approval for bedrooms, with the following stipulations: b�(Jm,4 (Le# Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet E -MAILED A1,1711, MI -04 COSA Checklist I Legal Description: Sky Harbor Estates L2 If more than 1 septic system on lot: COSA Checklist # 1 of A. WELL DATA On Well log is filed with Onsite (or attached) Date drilled 1983 Total depth 107 ft Cased to 107 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 4113/2020 Static water level at beginning of test 79.2 ft. Comments B. TANK DATA Age of tank(s) 5 years Tank type/material sep "st' Measured operating fluid level in septic tank 4 ❑ Standpipes/foundation cleanout per record drawing Date of pumping V /I71 D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 12/4/2015 ❑ ALL standpipes present per record drawing Total measured depth from grade 14 ft (max) Measured depth to pipe invert from grade 5 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 015-281-79 Structure served by this system 1 Well production at time of test 4.24 qpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes [✓ No ❑ Coliform bacteria is Negative Nitrate mg/L aNitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Pannone Engineering Services Date of Sample 4/73/2020 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 4113/2020 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 8 in Water added 697 gal New depth 21 in Elapsed time 200 min Final fluid depth 8 in Absorption rate '600 gpd Any rejuvenation treatment (past 12 months) no If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0 Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft ED Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10'✓Q Animal Containment > 50' 0 Yes if No ft M✓ Yes if No ft Yes if No ft Water Service Line > 10' 0 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' �✓ Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' Q✓ Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: ✓1 Absorption Field > 5' 0✓ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10'✓Q ft Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 2✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓1 Yes if No ft Private Wells > 100' U✓ Yes if No ft Water Service Line > 10' M Yes if No ft Community Wells > 200' Q✓ Yes if No ft Surface Water > 100' Q✓ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that l 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. at Coe? COSA Checklist yellow sheet a 3,,9 L,LO.OS 10 —CJ, io c-4 i 'IWS3 '0913 V WOOGIGI O*ZLI PDd I;DADJE) LO C14 ,OL ,0*21(P. c 0 0 c - LO) '21.9Z LO C14 ,OL -,00'00L.. M.9 L,LO.ON ni -77-77 I I — ��, — .'L9 �J „LL X JL :3ZIS 133HS U") K) 0 I'- Z C14 co m o 5- 3: 0 0 (o V) ry (0 0 C14 - tc) ry < 0 �7 i- 1q < , LL CL. 0' 0 r- Lli L.Lj ry Z < 0 0 cj: ci D_ C) z :::) ry 0 a_ LJ n 41 o a) E c a) 0 ax) > 0 -0. t -e c 6 E 0 0 0 CL IV 0 — 0 o 'o c: C 0.3: 0 04' -0 r- 4-0 0 0 4a (n C 0 C: 0 0 41 0 -4C1 > -C Q) ov) OL)- -.o,, C: 4- C -C C C 0 Q) E4� C (D0 L- Q)N a) -0 4- -C CL 41 to 0 CO a 0 0 *F L- -.s F,41 0 —>,-c 64 r- 0 (7) c .c 0 00N c a- 0 co a) c o 0 —0 ui D- Z- 0 L- 4) 0 c 0 0c 41 M UJ c 0 -C 0 c 0 00 Of o c a) .U) ., z E a 3 as c: 0 C -0 0 m o Cc: (n o+% (D a (D "a E E u)) a -a -C (D a)-- 0 41 -r (D 04 E o a > - E -a 0 0vL 41 0 0 D- (n 2 (n o C 0 -C 0 -a U) -i E.0 Lf 4) III �X Ar Aw E IAWW %J 4 0 C00 .0 'o #*% w 0 # (>, lw AW 0 E ,0*21(P. C0 O*Z I E c 0 0 - a- C� N 0)0) -C > CCC > 100 wa < E .2pp c 0 C) 0 ;�Zm U- 0-0 r- t C 3 U) -0 (D :3 00 c 0 U (D 0 L- 0 ,06 3: 0) C� CD > 0 <D (D C14 > cr- O c O N C-4 C) C14 ,O*Zt -,00'00L.. M.9 L,LO.ON ni -77-77 I I — ��, — .'L9 �J „LL X JL :3ZIS 133HS U") K) 0 I'- Z C14 co m o 5- 3: 0 0 (o V) ry (0 0 C14 - tc) ry < 0 �7 i- 1q < , LL CL. 0' 0 r- Lli L.Lj ry Z < 0 0 cj: ci D_ C) z :::) ry 0 a_ LJ n 41 o a) E c a) 0 ax) > 0 -0. t -e c 6 E 0 0 0 CL IV 0 — 0 o 'o c: C 0.3: 0 04' -0 r- 4-0 0 0 4a (n C 0 C: 0 0 41 0 -4C1 > -C Q) ov) OL)- -.o,, C: 4- C -C C C 0 Q) E4� C (D0 L- Q)N a) -0 4- -C CL 41 to 0 CO a 0 0 *F L- -.s F,41 0 —>,-c 64 r- 0 (7) c .c 0 00N c a- 0 co a) c o 0 —0 ui D- Z- 0 L- 4) 0 c 0 0c 41 M UJ c 0 -C 0 c 0 00 Of o c a) .U) ., z E a 3 as c: 0 C -0 0 m o Cc: (n o+% (D a (D "a E E u)) a -a -C (D a)-- 0 41 -r (D 04 E o a > - E -a 0 0vL 41 0 0 D- (n 2 (n o C 0 -C 0 -a U) -i E.0 Lf 4) III �X Ar Aw E IAWW %J 4 0 C00 .0 'o #*% w 0 # (>, lw AW 0 E E c c E -C > CCC :3 c wa < c 0 C) 0 ;�Zm -,00'00L.. M.9 L,LO.ON ni -77-77 I I — ��, — .'L9 �J „LL X JL :3ZIS 133HS U") K) 0 I'- Z C14 co m o 5- 3: 0 0 (o V) ry (0 0 C14 - tc) ry < 0 �7 i- 1q < , LL CL. 0' 0 r- Lli L.Lj ry Z < 0 0 cj: ci D_ C) z :::) ry 0 a_ LJ n 41 o a) E c a) 0 ax) > 0 -0. t -e c 6 E 0 0 0 CL IV 0 — 0 o 'o c: C 0.3: 0 04' -0 r- 4-0 0 0 4a (n C 0 C: 0 0 41 0 -4C1 > -C Q) ov) OL)- -.o,, C: 4- C -C C C 0 Q) E4� C (D0 L- Q)N a) -0 4- -C CL 41 to 0 CO a 0 0 *F L- -.s F,41 0 —>,-c 64 r- 0 (7) c .c 0 00N c a- 0 co a) c o 0 —0 ui D- Z- 0 L- 4) 0 c 0 0c 41 M UJ c 0 -C 0 c 0 00 Of o c a) .U) ., z E a 3 as c: 0 C -0 0 m o Cc: (n o+% (D a (D "a E E u)) a -a -C (D a)-- 0 41 -r (D 04 E o a > - E -a 0 0vL 41 0 0 D- (n 2 (n o C 0 -C 0 -a U) -i E.0 Lf 4) III �X Ar Aw E IAWW %J 4 0 C00 .0 'o #*% w 0 # (>, lw AW 0 E MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES ^ - Division of Environmental Services On -Site Services Section �,AA P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 NAR 19�8 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # - \ - �� HAA # �'-� �1 '�%Vi 1. GENERAL INFORMATION Complete legal description 0 2 - 2. Location (site (site address or directions) e i i^ . i ; '4 "z.iz. D Property owner C -i 0�'��" � �' 'rt"'L 0' Day phone M 'I'n address / ; `l ' : Ky �s.�ciL��crtc=, k F' i iv ai i g Lending agency ...... Mailing address-. Agent Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water Day ph ie Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site k 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) Front 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 Firm lLl tc_ I�>�_L_ Irl , A /.! ye, -/i �;'; �' Phone _z d-.5 � `3F 7� Address l °-;7_ 4�;_e- xf io� e/Jv' c cc- L} t�c�I� .ryr�r /fir,-- Engineer's signature /i�/! ✓ Date, V 9t a 6. DHHS SIGNATURE ` 4 ��(%� V Approved for bedrooms. Disapproved. Conditional approval for bedro ,,,is, with the following stipulations: Additional Comments O'Yl/1 ! CL 0�0l ? ' l Z ( By: l , Date O 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 er)gineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lenr institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct insr cions 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. 1/91) Back MOA 921 SEkvi,_r Municipality of Anchorage ,11"ONMENTA[ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MAIC 199S � 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907),4 3-4 .44 �iV�= Health Authority Approval Checklist Legal Description: Z'y'T Z Sic/ �fiF2���2- � Parcel I.D.: yam'_ � ? A. WELL DATA Well type -1�✓Z 1 / If A, B, or C, attach ADEC letter. ADEC water system number Y Log present (Y/N) Date completed Total depth %' Cased to / �' Casing height (above ground) Sanitary seal (Y/N) Date of test Static water level Well production Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION S -P " , 9/ WATER SAMPLE RESULTS: Coliform Nitrate D Other bacteria Date of sample: 8 Collected by: eGl •�V�G g.p.m. B. SEPTIC/HOLDING TANK DATA Date installed Tank size 1-k;5_0 Number of Compartments Cleanouts (Y/N)� Foundation cleanout (Y/N) Y Depression (Y/N) A/ High water alarm (Y/N) Date of Pumping �' '��98 Pumper Alo7W!- I- b C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ftz or ftz/bdrm) V,!5 �� } System type Length �y Width � Gravel thickness below pipe Total depth Effective absorption area 46-41 Monitoring Tube present (Y/N). Depression over field /(Y/lN) Date of adequacy test 3'7", y�' Results(Pass/Fail) � -s For ��� l''/,L bedrooms Fluid depth in absorption field before test (in.); 6- /( Immediately afte&voal. water added (in.): '1 // Fluid depth 2.5 (ins) Minutes later: AV Ayv"'z-`Absorption rate = � 0-0 g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)" D. LIFT STATION Date installed Manhole/Access (Y High Ovate arm level at* _ les tested E. SEPARATION DISTANCES "Pump on" SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / 7-C^ Absorption field on lot Public sewer main /7 -0/ -Jr - Sewer /septic service line 2 � i �t Size in On adjacent lots On adjacent lots "Pump off" level / a -z, Ft / P --t / '¢ Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 0c Property line a) Absorption field 1411 Water main/service line Surface water/drainage / aE' Wells on adjacent lots O"O SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Arl Building foundation 5Y)/ -J Water main/service line Surface water / 4V 14 �Driveway, parking/v6 iev 1—i cle sto>� area I/ Curtain drain N�A/C Cai&WA) Wells on adjacent lots /b -p 7� F. ENGINEER'S CERTIFICATION 2.5 0 l certify that 1 have determined thru field inspections and review of Municipal recon `i 1/16*40, tgms are in conformance with MOA HAA g idelines in effect on this date. �,� •'' e e Signature +i�{1 6,tlWT.?.TO.A Engineer'sName /�i��hfA i AAWzb /Z <, A ✓f�y�A Tom• MICHAEL N. ANDERSON Date -3111 c a69fb "• LP HAA Fee $ 3 © 0. © 0 Date of Payment 3 /t 2_ /c} S/ Receipt Number '7676 (03, 2 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 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 — 43 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name _.fit-tda __3 —LWC Telephone: Home Business Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder,, Buyer ❑ ; Other ❑ (explain); — —_—_ (d) Lending Institution -- Address (e) Real Estate Company and Agent Address__ ---- Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Familkp Multi -Family EJ Other Number of Bedrooms 3, WATER SUPPLY Telephone Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite' Public ❑ 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) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As Certified by my seal affixed hereto and as of the validation date shown below, 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 J�aa:l '"TL�9=. - � Z (Lk_ -L `1 Telephone ` 7 `' Q ', _ Addre Date 44 •0 AL Q@ p f� Engineer's Seal .•. THOM A. rlMili 4 !1 CF - 0793 2q 41 p � �rolessiona��,� 6. DHEP APPROVAL Approved for T- 7- - bedrooms Date�� Approved � Disapproved Conditiona -- Terms of Conditional Approval eo 'rte• rp' i, 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 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: A. WELL DATA Well Classification If A, B, C, .E.C. Approved (Y/N) Well Log Present (Y/N) ��� Date Completed � 13 lv-,- S Yield �7 (TP,, Total Depth � a] r Cased to (� ( Depth of Grouting N 16 Static Water Level t �p r Pump Set At r-re??4;;�Y c, Casing Height Above Ground S© Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) t� Depression Around Wellhead (Y/N) �++� Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots N To Nearest Edge of Absorption Field on Lot A73) 1 ; On Adjoining Lots To Nearest Public Sewer Line Vh To Nearest Public Sewer Cleanout/Manhole 14 To Nearest Sewer Service Line on Lot _ S© .4— Water Sample Collected by y ►-1��� �SL-i-t��--; Date —Q. _� 1_ Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed v Size f ��` No. of Compartments Standpipes (Y/N)Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) Niz�- / Date Last Pumped Pumping/Maintenance Contract on File (Y/N) N/ fA _ ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N)_�— Separation Distances from Septic/Holding Tank: f � To Water -Supply Well To Building Foundation? To Property Line Q To Disposal Field 4 To Water Main/Service Line ' To Stream, Pond, Lake, or Major Drainage Course N /A - Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption trata�� Type of System Design Date Installed Length of Field �tc) r Width of Field Depth of Field Io' Gravel Bed Thickness .7Z Square Feet of Absorption Area 4:5�C _ Standpipes Present (Y/N) c�s Depression over Field (Y/N) N qz; Date of Last Adequacy Test V\1 /JQ - t"scr,-, Results of Last Adequacy Test Separation Distance from Absorption Field: r To Water -Supply Well 1 � 3 To Property Line To Building Foundation 78 To Existing or Abandoned System on Lot VZ a ; On Adjoining Lots N r To Water Main/Service Line �" O "41 To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course A7 To Driveway, Parking Area, or Vehicle Storage Area 8� f "t Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at — High Water Alarm Level Tested for Electrical Code Y/N) Dimensions Manhole ccess (Y/N) _ 'Pump ff" Level at _ ent (Y/N) — Pum ng Cycles Test. Meets MOA ** CAeck Permiite edr Against HAA Request ** I certify that I h eck , verified, o onformed to all M A and H guidelines in effect on the date of this inspection. Signed Date S Company H17-Z'L.,A'1'M lc� MOA No. Receipt No. 4 OF A4 ""i G @J Date of Payment � �� •.•• "•.• •••� '� gyp, Engineer's Seal Amount: $ r peseo49'Ll s` 'a ......... ...... .... .. 1 ® s. Page 2 Of 2 : TH • A. FISCHER Li Pa g CE - 6793 . ' ¢,Q4 eOsre2;'••.......•• �-. 72-026 (11/84)