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HomeMy WebLinkAboutMALLORY LT 1Mallory Lot 1 #020-093-44 Municipality of Anchorage Page / of I DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ..~,/ ~/~01~1 PIe Number: Name: ~/~ ~O~ E5 ¢ ~N Q. Wastewater System: ~ew D Upgrade AdOress~/0~ ~ U4 ~ ~'~¢ ABSORPTION__ ~ FIELD No. of Bedrooms: Phone: ~--~7~ ~ ~0~ ~ Deep Trench wTrench ~Bed ~Mound ~Other LEGAL DESCRIPTION sol, Rating: ~ ~ GPU/Sq. Ft, Total Depth from Lot: Bmock: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe  I Fill added above original grade: Gravel length: Township://~ Range: ~~ Section: ~ ¢ Ft. 7~ Ft. ~w O Upg fade Gravel width: ~ Ft. Number/of lines:I I 0istance~betweealines:Ft' WELL: Classification [Private. A.B.C): Total Depth: Cased To: Total absorption area: Pipe material: ~ Date rg]ed: Static Water Level: Installer: / Driller: Date installS: Yield: Pump Set at: Casing Height Above Ground: SEPARATION DISTANCES ~tic ~ Holding ~ S.T.E.P. To Sepdc Absorption Lift Holding ~/Private Manuf8cturer: Capacity in gallons: Mater' h Number of Compartments: Surface Water ,/¢¢¢ ./¢¢s ~ ~ >/~ % LIFT STATION Line C ucta,. >.~ ' ~.o~' ~/~ ~ > er/ P u~pMake&Model I ElectHcallnspectionsperformeOby: Drain Remarks: BENOH ~ARK Location and Description: Assumed Elevation: /~o~ Ft, E~ E~ 'S SEAL Inspections performed by: Dates: ls*/,,-~,,,~ ;~~CoC.~ Department of Heal pproval ,,,~..., oD ,,. Reviewed and approved by: e: ~...~:. · 72-013 (Rev 9191} MOA 25 Mu. nicipaility of Adc'hO(age : ':" .'.i';-'.";i::;" '':::'::?~: ~. DEPARTMENT OF HEALTH ANDHUMAN sERVICES '" " ' '.'.' . ENVIRONMENTALSERV~CES DIVISION ',... ' · .P.O. Box 196650 · Anchorage, Alaska 99519-6650 -'Telephone: 84~-4744 "On-S~te W~¥~water DiS~=-, ,~xo,=,,. ~r~:~0r Well Inspe~i0~ Re PiD No.: ~,'~.. Permit NO. 5'kW' ~/O,'5'! Page 3 of -~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O, Box 196650 · Anchorage, Alaska 995~ 9-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: STATE OF ALASKA DEPARTMENT OF NATURAL DIVISION OF WATER ~QCATION OF WELL WATER WELL RECORD ~q// ~ TOWN,HIP flANOE M~JOIAN O~ EIN DE [3S E3W L OC/A,~I,ONtSKETCH: WF~I~ OWNER: ~.DEPTH$ MEASURED. FI~OM:[~¢a$ing top Fgground surface WELl. DEI~rH: DATE OP COMPLETION ;8~3~EHOLE DA?A~ Depth Dspth of caslng:...,~,,~ ft ~ / ?0 / Met~rial Type and Color From To ~~ ' ~ ~ ~ / ~ ft below op of Casing D ground ~~ METHODOFDRILLING; ~,,rrotaW ....... USE OF. WELL: ~domestic ~ irrigation ~ monitor ~ ......... , ...... ~ public supply ~ o~er ..... ~t CASING STICK~P~ ft, Diem: G In. to, WELL INTAKE OPTING TYPE~ ~ open end ~ screened [". ~0 /~ ~ pedoratod ~ open hole ....... Depths of openings'. .......... to .... ft SCREEN TYPE: Dlam: ........ in, SIo~Mesh Size: _ Le~h: ft O~VEL PACE TYPE: ................... Volume used: Depth to top: OROUT TYPE: Volume: ................. ~ep~h; from ............. ft to ..... ft ~ PUMPING LEVEL AND YIELD: ...... ~ o /~ ~ ~ ft afte~ ~ hfs pumping ~ gpm PUMP INTAKE DEPTH= ~ ft Horsepower: ..... ~ ............ ~LL DISINFECTED UPO~ COMP~ION? ~ YES '~ REMARKS: PLEASE MAIL WHITE COPY OF LOG TO: DNR/OIVISION OF WATER PO BOX 772116 EAGLE RIVER AK 99577-~116 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 May 19, 1994 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Attention: Robbie Robinson Subject: S 1/2,NW 1/4,NE 1/4,SW 1/4,S 3 ,T 12N,R3W Septic System Design Dear Robbie: I have revised the septic system design for the subject lot to include 2' of sand to raise the system the required 4' from the groundwater table. I have also decided to go with a pressure type distribution system to increase the life and effectiveness of the bed system. The bed has been redesigned for a maximum width of 15'. The laterals are now 134' in length. Water monitoring on the testholes for the proposed septic system location has been ongoing for over a year. No groundwater has been noted closer than 4' to the surface. We have seen small pools of surface water in the area during breakup. These pools percolate into the ground once the frost is gone. Low areas will be graded during construction of the Please advise if you Sincerely, Michael E. Anderson, P.E. system to prevent any pooling in the future. have further questions. S 1/2,NW1/4,NE1/4,SW 1/4,S3,T12N,R3W DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home Shallow Bed System Perc. Rate: 35 Min./Inch 1,500 Gal. S.T.E.P. System Application Rate: .3 GPD/SF 2' Clean Sand Under Pipe 4 Bdrms. X 150 GPD / .3 GPD/SF = 2,000 SF 2,000 SF / 15' Wide = 134' Long Therefore: Construct a Pressure Distribution System Utilizing 1,500 Gal. S.T.E.P. System with 3 Laterals, Each 134' in Length. Pump Type: 20 OSI 05 HHF - 5 Stage Three Laterals - 134' Long 12.1 GPM/Lateral 5 Orifices Per Lateral 26.8' Spacing Orifice Size .25" Facing Downward Lateral Diameter - 1" Manifold Diameter - 2" a NOTE: TYPICAL SHALLOW BED SYSTEM (No Scale) Remove all Peat/Organics to Underlying SM M. Provide 2" of Direct Burial Insulation Over Bed Maintain 4' Separation from Bottom of System to Groundwater. SHEET NO. OF CHECRED BY. SATE SCALE : /..4-~ .g'~.~'~no~ ~. ~.~1.. :, .j~ ....~ :. ~~o~.. :,....: 5 :. :......., ............ ....... i....~.~.S0o~r ~g~..~......~.~.Am~..~' ~ ~ j...... ~.z~' i : j' ~ : ........... : ~'"":. ~)~" &~ ~Z ~:.::.~.':.~..~;~ .~'~.~ ~.~.~... e~.t~. ~ .~. ~¢,~'~':.:~.'..~.:' ~ ~ ~ ~ i ~ i SINGLE-PHASE, 6OHZ ..L...i.. "'L'L'i}i'!"LH F ..L....LL;..Z.....b.b.~..~- -~.. -b.b 1'i2'i' 115/230 VOLT · 20 OS115 - 9 stage -..b ...~..~..;--i---...~-...~..~. '--~.~. PC#2 ,~_-.'..+......+ ....... i.-+..~ ...... ?-"+" -+'-.~-"?'i"' ...b.i...b.-~-...~-....i...i .... ..}--.~ -.*--~ ~.!.-- ...';-.l..i.. -.b-b i--.';.-.-i---b-!-.-i-....b.~.-i..+....+....,_~ ...... ?.-? ~ ~ ~ ~ i ~i ~ ~ ~ ©5/92 ~ ..4..b..:-..4.-:-.~-..~ ..~ ........... ~-:---:..-:..4...-b..-: ............... :..., ............. :---~--.,.-"?."""' "}ff"["i'":'}~20OSI05HHF-Ssi~ ::: : ~:: : ::: :: : 0.~ 5.~ lO.ffi 15.ffi 20.~ 25.~ ~.~ 35.~ ~.~ 45.~ ~.ffi NET DI~~G PM SHEET NO. OF CHECKED BY. DATE SCALE S1/2,NWl/4,NE1/4,SW1/4,S3,T12N,R3W DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home Shallow Bed System Perc. Rate: 35 Min./Inch 1,250 Gal. Septic Tank Application Rate: .3 GPD/SF Min. 2' Accepting Soil 4 Bdrms. X 150 GPD / .3 GPD/SF = 2,000 SF 2,000 SF / 30' Wide = 67' Long Therefore: Construct a Shallow Bed System 67' (Length) X 30' (Wide). Distribution Piping placed immediately below Organic Layer. Maintain 4' separation from bottom of system to groundwater. - .. · NOTE: TYPICAL SHALLOW BED SYSTEM (No Scale) Remove all Peat/Organics to Underlying SM Mat~ Provide 2" of Direct Burial Insulation Over Bed Maintain 4' Separation from Bottom of System to Groundwater. PERFORMED FOR:_ LEGAL DESCRIPTION: 1 Municipality ol Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage, Alaska 99502-.0650 SOILS LOG -- PERCOLATION TEST ~'*'~b le,~ ~"' (._{.. ~"~/~'~ DATE PER~ V~IIZCO ~'u ~b I~' I ~)0 ~ Township, Range, Section: SLOPE WAS GROUND WATER ~/~.~ ENCOUNTERED? Il= YES, AT WHAT DEPTH? SITE PLAN /'Jo, 7 :GMMENT$ PERCO *T:ONRAT $? TEST RUN EETWEEN , ~" I (minule~.'inch) PERC HOLE DIAMETER I FTAND .Z ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 April 30, 1994 Municipality of Anchorage Department of Heath & Human 825 'L" Street Anchorage, AK 99502-0650 Services Subject: S 1/2,NW 1/4,NE1/4,SW 1/4,S3,T 11N,R3W Well and Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: The subject systems are designed for placement on a 5 Acre lot. This lot is characterized by high groundwater and a substantial peat deposit atop tmderlying silty sand. We have identified two areas in which the groundwater level will allow placement of a shallow bed system. This system will be placed immediately below the peat layer or two feet below the surface. The attached site plan defines the location and illustrates the terrain of the lot. If the systems are placed as designed the following statements can be made: The system, if constructed as designed, will have no adverse impact on the wells currently in use or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. .. The system, if constructed as designed, on drainage patterns in the area. S h~.Cel'ely, M;,chael E. Anderson, P.E. will h~av.e.~n.~.~a~verse impact Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~'P/~ E/..L LEGAL DESCRIPTION: DATE PERFI Town~hip, Range, Seclion: 5 6 7 8, 9 10 11 12 ]3 'i4- 15- 16- 17 18 PT/QL. 5L,3 SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? Reading Date 19 20 COMMENTS PERCOLATION RATE ~ ~'/". '~ (minuteUinchi PERC HOLE DIAMETER . ,, TEST RUN BETWEEN ,2 ~.,. FT AND ..~ FT P/z.~5o~ 'pr~o~t To T'~$'T'/~b. ;-CCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: THAT THIS TJ~ST WAS PERFORMED IN ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 August 22, 1994 Municipality of Anchorage Department of Heath & Human Services 825 %" Street Anchorage, AK 99502-0650 Attention: Subject: Robbie Robinson ~ R3W, S3, S2NW4NE4SW4 Revised Site Plan Permit No. SW940151 Dear Robbie: During the construction of the house proposed for the subject lot additional site grading and exploration was accomplished to determine a more suitable area for the new septic system. A subsurface french drain system was placed near the eastern boundary of the lot to provide protection from groundwater intrusion into the crawlspace of the house. This drain also served to dry up a major portion of the lot thus opening several new areas for septic system use. The attached site plan shows the area now proposed for the new drainfield. It also shows the location of the french drain. The drainfield area is much closer to the house and can be placed at an elevation low enough to provide gravity drainage from the septic tank. The area previously proposed for the septic system can now be used as the alternate site. Please review the new site plan and the drainfield design and size calculations. With your concurrence we intend to construct the septic system in the location shown. The as-built of the system will reflect this location. Please advise if you have any questions or comments ~:onceming the relocation of the new septic system. ~ ~/.r~ J Siscerely, ~ ,.5'/ Michael E. Anderson Attachments S 1/2,NW1/4,NE1/4,SW1/4,S3,T12N,R3W DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home Wide Trench System Pere. Rate: 2 Min./Inch 1,250 Gal. Septic Tank Application Rate: 1.2 GPD/SF 2' Drainfield Rock Reduction Factor = .7 4 Bdrms. X 150 GPD / 1.2 GPD/SF = 500 SF 501) SF / 5' Wide = 100' Long X .7 /Red. Factor = 70 LF of Trench Therefore: Construct a Wide Trench System with Two Laterals Each 35' in Length. Place 2' of Drainfield Rock Beneath the Lateral. NOTE: TYPICAL WIDE TRENCH SYSTEM (No Scale) Maintain 4~ Separation from Bottom of Groundwater. Grade Area Around Drainfield to Drain Away From Field. Municipality ot Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 4, 5 7 10- 11 1 13- 14 15 COMMENTS WAc: GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? PERCOLATION RATE TEST RUN BETWEEN DATE PEI Township. Range, Section: "/'~1~ SLOPE SITE PLAN /P / / I {minules/inchj PERC HOLE DIAMETER -- FTAND _. FT -r-EsT' / /,I 6, ' CCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATI=' ; :: -CG8 tRe~. 4/&5) / MunJcipalit), ot Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska gg502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3 4. 5 8 10 ll 12 13 14·, 15- 16- 17 DATE PERi Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Dete Growl Time //~ ~o SiTE PLAN PERCOLATION RATE '~ TEST RUN BETWEEN .. ~ (minute~'incll) PERC HOLE DIAMETER FTAND. '7 FT , C- ~-r~J ~,. [Rev. • • 4 e • c Municipality of Anchorage 0. On-Site Water and Wastewater Program t .� II (907)343-7904 Certificate of On-Site Systems Approval Parcel I.D. 020-093-44 Expiration Date: `7o -17 1. GENERAL INFORMATION Complete legal description Mallory Lot 1 Location (site address) 4671 Virgo Ave, Anchorage AK 99516 Current Property owner(s) Duane & Mary Grenny Day phone 907-250-1982 Mailing address 4671 Virgo Ave, Anchorage AK 99516 Real Estate Agent Kevin Sigafoos Day phone 907-244-3212 2. TYPE OF DWELLING: {] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual LI Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: 0'?17 COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 5 — Waiver Fee $ // Date of Payment ,bel/-/7 Date of Payment d v • - Receipt Number lipp At 011 1 77U Receipt Number 'r COSA# c`J C,fl 1251 U 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. Name of Firm Alaska Rim Engineering Phone 907-745-0222 Address 9131 E. Frontage Rd, Palmer AK 99645 Engineer's Printed Name 14/60-1,1 L'73G1 reit Date (/'/ /J \-ssk:Mil it'll OF AL. 1 •.-� 6. DSD SIGNATURE = 14TH .) /n1/7/4/ -6) ` System #1 Approved for bedrooms • B •• Mary L. Shreves System #2 Approved for bedrooms � �� • ` , Disapproved /,�,9e •• .. 9351 • .<,�c,�q.: pROoo\- FESSI Conditional approval for bedrooms, with the following stipulatiblil:VM\ 8 c wk, (v\ :1, a 4,.o DO Ca /( r`S �Piv�P.(/' W 1�LoQ e ate cowlS i h d7 e(/' C e lam::H Jv` 'C Oil—SATE WATER AND WASTEWATER PROCRJ sr'. y: rev, 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 blue sheet : - ., If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Mallory Lot 1 Parcel ID: 020-093-44 A. WELL DATA Well type Private If A, B, or C provide PWSID# N/A Well Log (YIN) Y Date completed 8/10/94 Sanitary seal (YIN) Y Wires properly protected (YIN) Y Total depth 148 ft. Cased to 20 ft. Casing height(above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 8/10/94 5/30/17 Static water level -13 ft. -6'9 ft. Well production 4 g.p.m. 3 1 g.p.m. WATER SAMPLE RESULTS: Coliform A colonies/100 mL Nitrate 6.69 mg/L Arsenic ND ug/L Date of sample: 5/30/17 Collected by: Kaley Lyles B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel! Anchorage Tank Date installed 8/29/94 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping 5/24/2017 Pumper ISAACS PUMPING SERVICE C. ABSORPTION FIELD DATA Date installed 8/29-31/94 Soil rating (g.p.d.lft2 or ft2/bdrm) 1 •2 System type Shallow Trench Length 75.6 ft. Width 5 ft. Gravel below pipe 2 ft. Total depth 8'S 9'$ ft. Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5/30/2017 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 22 in. Water added 600.7 gal. New depth 22.5 in. Elapsed Time: 206 min. Final fluid depth 21 .5 in. Absorption rate >= 600.7 + g.p.d. N Any rejuvenation treatment (past 12 mo.)(Y/N & type) If yes, give date D. LIFT STATION Date installed N/A Size in gallons N/A Manhole/Access(Y/N) N/A "Pump on"level at N/A in. "Pump off"level at N/A in. High water alarm level at N/A in. Datum N/A Cycles tested N/A Meets alarm &circuit requirements? N/A E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 166' On adjacent lots 100' Absorption field on lot 172' On adjacent lots 100' Public sewer main >75' Public sewer manhole/cleanout >75' Sewer/septic service line >25' Holding tank >75' Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: >10'Building foundation Property line >5 Absorption field >5 Water main >10' Water service line >10' Surface water >100' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >1 Building foundation >10 Water main X10 Water Service line Surface water >100 Driveway, parking/vehicle storage >5 Curtain drain none known Wells on adjacent lots 100' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and , vAll11111 review of Municipal records that the above systems are in ��`��C.OFAt A 1i,, conformance with MOA COSA guidelines in effect on this date. �,` ;.••'�� �4 ' I� I _ Engineer's Printed Name' ` �Z'�ar y G. �7`l You° *; 9TM �\ �� Date 691'4/I !J. i-� W.:1:thrii7i..p '�Id F : Mar . Shreve• s G CE9351 j• z. i1`,`t,' `'` 11\\IDNN N%,, COSA canary sheet_2-6-15.doc G/)//// PLAT NO. 95-18 MALLORY SUBDIVISION W LOT 1 73,069.5' S 89°59'55"E 438.2B' r 0 0 Z p'' I I i 10' GAS ESMT. Ar ) ) LOT 1 SI o� WE .0." t "S / / Fl SHED 5 I I sHEo I i 0 52° 1:3 '0. \ W 111 / / lii -. .-- .0 9° so 1 / I�! � / u' 3�9���c^ / / rn l0 0 it /0 \ q---(7% / z io \ CIN 4'' r / II 7.00. \ / b ; .o •410%% 5� c N , 87.6' WO° a 7 / N 89°58'27"E 1 a 1 c % \ ' 376.96' \ i 1 ' �—SEPTIC EASEMENT TO LOT 1 V ` / / / MALLORY SUBDIVISION el / / .- (BK 2791, PG 12) \ 140, 1 / / i 0N' / II/ \/ i0 V -. UtoA / .1' ' \ / / BUILDING DETAIL / SCALE: 1"=20' \\ f' •\ / L/ LOT 2 s /4---INGRESS AND EGRESS EASEMENT TO • / LOT 1, MALLORY SUBDIVISION -! / (BK 2791, PG 10) AS -B U I L T I HEREBY CERTIFY THAT I HAVE SURVEYED THE 1 "=50' / i PROPERTY DEPICTED ABOVE AND THAT NO GASTALDI !AND ENCROACHMENTS EXISTIXCEPT AS INDICATED. ***(,11110 4 SURVEYING, LLC IT IS THE RESPONSIBILITY OF THE OWNER TO �4,- % , .,A, �� ` 'I JEFF A. GASTALDI, R.LS. DETERMINE THE EXISTENCE OF ANY EASEMENTS, •'` : .. 1/45``S • — _-- _-- --- - 2000 E. DOWUNG RD., SUITE 8 COVENANTS OR RESTRICTIONS WHICH DO NOT • � `� 9 20.00' ANCHORAGE, ALASKA 99507 APPEAR ON THE RECORDED SUBDIVISION PLAT. 49TH �� * ; N 69°58'27"E PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA .• GRID DATE HEREON BE USED FOR CONSTRUCTION OR FOR . Jeffery A. Gastaldi :• o ! SW3336 6/13/2017 ESTABLISHING BOUNDARY OR FENCE UNES. t`�P,••���y/1t-• �-§ • F.H. JOB NO. ANCHORAGE RECORDING DISTRICT, ALASKA *b professionak V-e . NOTE: NO CORNERS SET THIS DATE fa,��1/�� 17-02 MALLORY1 · MUNICIPALITY OF ANCHORAGE .  DEPARTMENT OF HEALTH & HUMAN SERViCE~ D v s on of Environmental Services ~ · . On-S te Serv ces Section , - : ' : ~: Po Box'ID6650 Anchorage 'Alaska ~99519-6650' . : - CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # OZ. Od) 9 ~Z (o NAA# 3L~ ~bi' 1. GENERAL INFORMATION .... . Comp~et~ legal description Location [site address or directions Property owner Mailing address ~7_..IO Lending agency Mailing address Agent ' ' Address Day phone Day phone. Day phone Unless otherWise requested, HAA will be held for pickup. ....... T-~CU Cd': NUMBER OF BEDROOMS: /Z_ TYPE OF WATER SUPPLY: ' Individual well Community well Public water i' 9., · '. . .. . .%, - { ) :'-' NOTE: If Community well system, provide written confirmation from State,, ~'D,EC attest- ,. ~' . ~b/. .' ,, ' ..', lng to the legality and status of system. ' ,, ~,, ~,/~,/. · ,-, \q%v 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site ~Y' "( - - · · ':::::'-{,~ '::;>;.~";'"'~ HoIdin'~i' tank .' - - - - - ............. ~ ....................... ...... Community on-site .... ~: ' ....... " ' ' ' : ,.. ,-., ...:. ~:..... Public sewer ................... ._ . __ -. .... NOTE: :,,.:If community wastewater system, provide written conf!rmation~m,~tat~ e ADEG · - ...attestm to the legahty and status of system ...... .-. ...... ,...~- ~...:,..: ~. ....... ~..~ '~ .~.: ~ '~ :,~C... STATEMENT OF INSPECTION BY ENGINEER ' ' , , :'.: .... : · , ,*~, */*~ ;.* .. , As certified by my seal affixed hereto and as of the validation date shown below, I verity 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 verity 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 ~)~-~.gO/,.J ~-'".,J~ ~ ~/7_/~//~ Phone .,~5~- 5 Address PC). '~o~ ;7-5tO77.~ /~40OOFZ~C'/ A ~. c~? 5-ZA- Engineer's signature '.', ,~~ '~'- ~4.,~- ' Date c~/gL bedrooms. DHHS SIGNATURE (.~ ~--. "Approved for / Disapproved, Conditional approval for bedrooms, with the following stipulations: Date The Municipality of Anchorage Department of Health and Human Services. (DHHS) Issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements, Employees of DHHS do not c0dduct inspections'or analyze data before a certificate is issued. The Municipal ty of Anchorage is not ~r :i : : responsible for errors Or omissions in the professional engineer's Work,',, ~i ~,¥',"~ : ': . .:! ' :':.i i : 72.{)25(Rev. 1/91) Back MOA¢21 i. _ ; : , i . ,, ;i ~::, .:. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ra$ v.J A. Well Data Well type ~/Z~q~-~F~' Log present (Y/N) Total depth Sanitary seal (Y/N) Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date oomp,eted Dr,,,er /SL~:>/ Cased to ~ 4~c~)/7--00¢ Casing height Y wires properly protected (Y/N) Y' Date of test Static water level Well flow Pump level1 FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /~, / Absorption field on lot /-~ 'Z- ~ Public sewer main Sewer service line ~' /'~'0 AT INSPECTION ~_~ ~,.j~/- g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ! >/oo WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) Y High water alarm (Y/N) Date of pumping .,~ Tank size /i Z.%0 ~-~-L,. Compartments Foundation cleanout (Y/N) '~ Depression (Y/N) ,/~ /~ Alarm tested (Y/N) /'"J/A ~ ~ ~-~'R..~ Q.I"-" I0~ Pumper ~/~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ! Well(s) on lot / ~ ~ / On adjacent lots TO property line /~'~ Surface water/drainage 79-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~:c~/Z,'] - Length '7 '~, ~ ~ Width ~ / Total absorption area ~¢ ~ Z~ Cleanout present (Y/N) Date of adequacy test /k~ ~"'~J ~ ~J ~.-r: Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) /' Gravel thickness Y System type ~HA Z / Total depth ~--~ Depression over field (Y/N) '-~ ~'~ for ~O ~ Bedrooms After test Q If yes, give date ~ /A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /TZ. To building foundation '/~ 5'0 / On adjacent lots Surface water Curtain drain On adjacent lots '> /OO Property line To existing or abandoned system on lot Cutbank /'~ O,'J ~-- Water main/service line Driveway, parking/vehicle storage area '>' ~OD / E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines ~n effect~r/~e~,at~ ~f.thl~nspect¢on. Signature ~"~ ~-d~ ~- ~'~ Engineer's Name Date HA,& Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW910045 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:YARMAC LTD. OWNER ADDRESS:840 K STREET ANCHORAGE, AK 99501 DATE ISSUED: 4/04/91 EXPIRATION DATE: 4/04/92 PARCEL ID:02009326 LEGAL DESCRIPTION: S2NW4NE4SW4 SEC.3 TllN R3W LOT SIZE: 217800 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: I. 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: WELL IS TO BE DRILLED AS PER ATTACHED SITE PLAN. WELL IS ISSUED BY: DATE: WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of GeoIogicD! El GeoDnysicol Surveys ~ of-- o~of ~ s~ w~ Feet Below 4. ~ELL DEPTH: { final) 5. DATE OF CO~PLETIO~ ~ ~ ~ Auger ~ ~elle~ ~ Bored ~ Other: 8. CASING: ~ Threaded ~Wetded ~Above or ~Below land surface Equipment use~ ~r-- MAY 2 5 19 1 , Length of Drop Pipe ~ft. capac[ly g.p.m. Mu,.c~p~t~y oi Ancno age ~¢J~'-- , ~ ~' -~ .... ~ ..... Contract Li~nse Number 7 /! O/ \ ,~;5' 1.99 ,00'i~2 !. 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