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HomeMy WebLinkAboutWILD BERRY ESTATES LT 2BW 'o ildberry Estates Lot 2B #017-091-83 1 R MUNICIPALITY OF ANCHORAGE 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 E;NEW PQf�'cK S. 4ncgey ❑UPGRADE MAILING ADDRESS Si L7ow Pi4cz �{ilc/i a. •� A[al/G0. c/2J'U• LEGAL DESCRIPTION !'J`; /t/(err. l•si„�ie1 Go'l Z5 5-e 3s- rl itNfn 3w LOCATION NO. OF BEDROOMS 3 fern woad '-e {moi tc�- DISTANCE TO: Well �/ Absorption area $ `f' Dwelling PERMIT NO. v `1 � U 3 _Y i Z Manufacturer Material No. of compartments Z ti < Gr¢ e • S f -e r Lie. capacity in gallons Inside length Width Liquid depth / 0 0 J i IF HOMEMADE: DISTANCE TO: Well Dwelling PERMIT NO. Jaz gz F Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well /96 Foundation n� Nearest lot line 35 PERMIT NO. Ua S-00-76 wy ,.� J LL Z No. of Tines / Length of each line Total length of lines Trench width Distance between lines Zwre 1..0 S"O 8+ inches N>� f Top of tile to finish grade i Material beneath tile Total effective absorption area C' inches 700 0, � Length Width Depth PERMIT NO. w QF- Type of crib Crib diameter Crib depth Total effective absorption area as w N Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J w Building foundation Sewer line Septic tank Absorption areas) DISTANCE TO: OTHER 7 PIPE MATERIALS L' SOI L TEST RATI NG 125 (Pe..n" F) Z 31 CA&VAI Per/ �j cyiq[ INSTALLER Se!{ 31 REMARKS 2e.d esu• a ii�et c% ew e�K -+ /uo ne.( ,%r ,{ince �` gV F-- uG '61 %tea,-< mvPr ST '95 J elel rn 4, o d t.o.-- nF Ar 1 APPROVED DATE LEGAL 6 26 /S-5 %I/. /e:6tm� fS'/. fry' LuT Z b' �'u.3c-i/"L"Z_3 L) 72-013 (Rev. 3/78) ` ~ ^ ' P1 LJ1 lh,!! :11 C:::� 1 Vo"42; H.. 1: 0- "r � !E3 F:�: DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK99501 264-4720 c3 pi_E3 x ir EE E3 EE UJ FE F1 &: ��F� L.- L_ ��11 �,Z P-11 1: , 11 PERMIT NO: 850096 DATE ISSUED: 04/11/95 APPLICANT: PATRICK S LACKEY ADDRESS: 5819 DOW PLACF A|1[�Mg|�(0G���, AV: 99507 — ^- � CONTACT PH[}NG S61-0466 � LEGAL DESCRIP: SUBDIVISION: WILDBERRY ESTATES lCT: 29 BLOCK: NA SECTION: 35 TOWNSHIP: 12N ANOE: 31,%' / LOT SIZER 49411 (SQ.FT. []��T R ACRES) � LOT LOCATION: FERNWOOg AND PRATOR � MAX BEDROOMS: 3 � Listed below are the options available to you n 1esigning your septic. � system, Choose the option that best [its your site. DJ~ 13 Flew 1 1�!: DEPTH TO PIPE BUT TOM (FT,) 3,0 ** GRAVEL DEPTH (FT") 1"5 TOTAL DEPTH (FT.) 4"5 GRAVEL WIDTH (FT.) 5.0 GRAVEL LENGTH (FT.) 105,0 ** GRAVEL VOLUME (CU.YnS,) 38.7 TANK SIZE (GALS) 1,000.0 ** SOIL RATING (Sn.FT./RR) 225 ' ** DEPTH TO PIPE BOTTOM < 3,5 FT" REQUIRES INSULATION ** DEPTH TO PIPE BOTTOM < 4.0 FT` MAY REQUIRE A LIFT STATION ** GRAVEL LENGTH > 75 FT, REQUIRES MULTIPLE RL/NS (NOT EXCEEDING 75 FT` EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS ' � I certify that: � 1. I am familiar with the requirements for on -situ sewers and wells as sat forth by the Municipality of Anchorage (MOA) and the State of Alaskm � 2, I will install the system in accordance with all MOP codes and regulaiiono, ' and in compliance with the design criteria of this permit, � 3. I will adhere to all MOA and State of Alaska requirements For the not back � � dis`ances [rom any existing well, wastewater disposal system or public � sewerage system on this or any adjacent or nearby !at. 1. I understand that this permit is valid for a maximum of 3 bedrooms and any eniargement will require an additional permit, IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED, (2) AS-9UILTS. WILL NOT BE APPROVED WITHOUT Ahl EIFQTRICAL INSPECTION REPORT; AND (3) THE � ELECTRICAL WORK MU D ELECTRICIAN" � � SIGNED DATE;: ------------------------ ------------------- APPiICANT: PATRICK � LACKEY - � ISSUED BY / DATE: �// hy j l,� 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 PERFORMED FOR: Pa -i 4ay"y DATE PERFORMED: _C /'t / K–' % – LEGAL DESCRIPTION: /.t%1 –lI Z't o2'u SeG 3,� 'T/1,N A 31-J Ti+' I IC�jE T SLOPE — SITE PLAN (kEVT OL 6'1v, CC S'G\'t I I I ' I 1 I 11 I I I f I 2 3 4 5 6 7 8 9 ,.10 11 12 13 14 Date 1 ®3nIIA3 9861, v IM Depth to 15 Time Time NO110310M 1V1N3WN0211AN: 16 12 H11V3H d0 '1d30 3UaOHONV d0 )WIVdIDINM 17 18- 19- 20- I 4b 81920 t4b 2 210 WAS GROUND WATER S ENCOUNTERED? 0 L O P E IF YES, AT WHAT DEPTH? ".1.__ L,1, /) Reading Date Gross Net Depth to Net Time Time Water Drop 11, ay /n •s -o X10 113y I6 'Ya o $ 3 l a v o S-6 J6 n y Y 60 ^ 115y 1 03- ov vy S- 10 S-1 / 1wy i-1 'ou PERALATION RATE 2 1 I �' (minuteshnch"1 y 0 t TEST RUN BETWEEN 9 12- FT AND 10 FT ,k -"t /�14 .231 Modic' - n PERFORMEDBY: �Var«( min- S1-8s--o2-y CERTIFIEDBY: 1 J 72-009 (6/79) DATE:_ / I SOILS LQO- � / . MUNICIPALITY OF ANCHORAGE U� "PERCOLATION sl DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIO TEST 925 L. Street, Anchorage, Alaska 99501 264-4720 " SOILS LOG— PERCOLATION TEST) j� pp — PERFORMED FOR:�tV ' �"�] DATE PERFORMED: Z3 —SO LEGAL DESCRIPTION. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DUF"t— SLOPE SITE PLAN - gQo 4,V/.1 -S/t.i - r/6f MOIST g�ne:.wN f//NDy S/LT �SM� r Lei �r/ SILTI% GL'AVl�L. COMMENTS PERFORMED 79.-008 (6/79) WAS GROUND WATER S ENCOUNTERED? /1/0 L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop /------ _.--Z•-/5...__ Z:45 .. _PP rQ.o __ '�.-. 0 __ �a 3Z_i..._ l /l Il _.3:45_. ' �4S __3of ADD "IZO 3.-1/- —' �l PERCOLATION RATE ?� - (minutes/inch) TEST RUN BETWEEN.� FT AND 4 FT CERTIFIED DATE: - G 55996 DEC 2 8 1981 ,` F �•✓ ``^� WATER WELL RECORD MUNICIPALITY OF ANCHORAGE STATE OF ALASKA DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys APR 2505 R C E l V E D Drilling Permit No. LOCATION OF WELL (Please complete either Is, Ib or Ic. - A.D.L. No. la. Borough Lot Block Ib. I/r qt rs. Section No. TownahipN❑ Range E❑ Meridian (�$'u¢division 11 bbU`-� bq,2 �`LJ —af—of—ot— S❑ W❑ "rt 1LC5 Ic, DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: Address: Street Address and Area of Well Location AnCV, 1,�!� 95ei7 Feet Below 2. WELL LOG Surface 4. WELL DEPTH: (final) 5. DATE OF COMPLETION AMaterial Type Top Bottom 6, ❑Cable tool ©Rotary C] Driven ❑Dug ❑ Auger ❑ Jetted ❑ Bored ❑ Other: � C/ - e -a ✓ 1'_"O c /--e A 5 T.USE: E]Domestic ❑ Public Supply —] Industry ❑ Irrigation ❑ Recharge ❑ Commerical ❑ Test Well ❑ Other: 8"5 114 ry- -= r� ✓ S. CASING: ❑ Threaded Q Welded. - diem. in. to 1 (i ft. Depth Weight —lbs./ft. diam. in. to ft. Depth Stickup ft. z'/5A Z6 I 9. FINISHZIL,,LtrType: / Diameter: Slot/Mesh Size: pJ� it SLength: / Y' )�, / �• Set between�.7 �/ ft. and ft. Backfilling Gravel pack 10. STATIC WATER LEVEL ft. ❑ Above or ® Below land surface Dote - i,�ll Equipment used: ..QL O. L ` 'fin_ � JYU_ • II . PUMPING LEVEL below land surface and YIELD —ft. affer hra. Pumping g.p.m. ft. after hrs. pumping g.p.m. 12.GROUTING Well Grouted: ❑Yea fl No Material: ❑ Neat Cement ❑ Other: 13, PUMP: (If available) HP Length of Drop Pipe ft. capacity O.P.M. ❑ Subm. ❑ Jet ❑ Centrifical ❑ Other 14. REMARKS: r- 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Wafer Temperature _° ❑ F ❑ C under my jurisdiction and this report is true to the best�jof my knowledge and belief; This well drilled under Twos (n� 'JIB N0. tl�IJ1C19 _/—_KL ,', 7�P/r7YiSFS !'/71327 Re fared Business Name < Contract License Number 1 Address: I t)1i_'� i�c tLi Cr.y/ r Signed:_r '%nl fid d �)"G Date: C. `a" .� Authorized R presentative Form 02-WWR (11/81) Copy Distribution: WHITE-Stote DGGS, PINK -Driller, CANARY -Customer - C se r 0 z 0 • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Q lo+' dq i _S3. Certificate of On -Site Systems Approval Parcel I.D. Expiration Date: L 2- 1. GENERAL INFORMATION Complete legal description Wild Berry Estates, Lot 2B Location (site address) 14760 Prator Street Anchorage, AK 99516 Current Property owner(s) Frank and Verna Loosli Day phone 229-7804 Mailing address 14760 Prator Street Anchorage, AK 99516 Real Estate Agent 2. TYPE OF DWELLING: F Single Family (w/wo ADL) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: 76 (�_�-z.-� �= 61",._� ... Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ ` qO, �q Waiver Fee $ Date of Payment O/3n/4,,�� f,-3� Date of Payment Receipt Number CC LdDnOG Receipt Number COSA# CUC�`���iO.J 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Phone 522-7773 Date 8/29/2013 VA 49 17 60 A o. DSD SIGNATURE 0 System #1 Approved for bedrooms ®®� °°Mlctia= qEg System #2 Approved for bedrooms �p cE-438i Disapproved ®� PROFESS10P�ay �� Conditional approval for bedrooms, with the following stipulaaia��®�®� By. L° %� Original Certificate Date: - " 1 -3 The ni / alit chorage 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 bNe sheet(� S, c 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: Wild Berry Estates, Lot 2B A. WELL DATA Well type Private Date completed 4/25/85 Total depth 171 ft. Date of test Static water level Well production If A, B, or C provide PWSID # _ Sanitary seal (Y/N) Y Cased to 170 ft. FROM WELL LOG 4/25/85 WATER SAMPLE RESULTS 104 ft 4 g.p.m. 0 Parcel 1D: 017;x(91-83 Well Log (YIN) Y Wires properly protected (Y/N) Y Casing height (above ground) >12in. AT INSPECTION 8/26/13 108.4 ft 3.2 g.p.m. Coliform 0 colonies/100 mL Nitrate '85 mg/L Arsenic N/D ug/L Date of sample: 8/9/13 Collected by: Anderson Engrg. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,000 gal. Number of Compartments 2 Date installed 5/28/85 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 5/20/13 Pumper One Stop Pumping C. ABSORPTION FIELD DATA Date installed 5/28/85 Soil rating (g.p.d./ftz or ft2/bdrm) 225 sF/BDRM System type Deep Trench Length 50 ft. Width 4 ft. Gravel below pipe 7 ft. Total depth 11 ft. Eff. absorption area 700 ftZ Monitoring tube Y Depression over field N Date of adequacy test 8/26/13 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 53 in. Water added 458 gal. New depth 55 in. Elapsed Time: 1065 min. Final fluid depth 53 in. Absorption rate >= 450 g p d Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum _ Size in gallons _ in. "Pump off' level at Cycles tested - E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot _ Absorption field on lot Public sewer main N/A >25' >1 00' >100' Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots > 100' On adjacent lots >1 00' Public sewer manhole/cleanout N/A Sewer/septic service line Holding tank N/A Animal containment areas >50 Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >51 Property line >5 Water main >10' Water service line >10' Wells on adjacent lots > 100' ABSORPTION FIELD ON LOT TO: Property line >10 Building foundation >10 Water Service line >10 Surface water >100' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS Septic Tank is Nearly 30 Years Old. 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. Engineer's Printed Name Michael E. Anderson, P.E. Date 8/29/2013 COSA brown sheet -1 0- 10-1 2.doc Absorption field >5' Surface water >100' Water main N/A Driveway, parking/vehicle storage > in. 04 ®F q�gS��ya MICHAEL E. ANDERSON >' CE - 4381 \ Municipality of Anchorage • -• Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 / J www.muni.org/onsite 3 �J �� nsile !/ (907)343-793-79 04 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING C Parcel I.D. n �' COSA# Nl0 � Db 09 1. GENERAL INFORMATION Expiration Date: � —3— Complete legal description WILDBERRY ESTATES: LOT 28 Location (site address) 14760 PRATOR DRIVE • ANCHORAGE AK • 99516 t'. mmAlL. rf0A&Sd----# Current Property owner(s) FORECLOSURE Day phone Mailing address -� 3�.7 5t, �I Lending agency 1 �-!✓bT�V f � � Day phone Mailing address Real Estate Agent BETH SIMPSON W/ KELLER WILLIAMS Day phone 727-2364 Mailing address 101 W BENSON BLVD #503 • ANCHORAGE AK " 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 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 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 Finn GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUOOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date _ I C j 3c I U'?Z Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lost, and separation distances measured to readily ldentifiablo features. The operational life of all wells and septic systems dopend 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 there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benerit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ,_t/ Approved for 3 bedrooms. Disapproved. ,......... S�0 '•,Je f ene S•: QO C —7953 eL' . 3c.y.'Up^.•I�3••' 4�oa .aso Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitrate Advisory By: 61%7 (R9) \Q ••....••.,y, ON-SITE •�� WATER AND WASTEWATER : .• PROGRAM Original Certificate Date: Z— 3 — OR \ Municipality of Anchorage �� -•1 Development Services Department ' Building Safety Division On -Site Water & Wastewater Program 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: WILDBERRY ESTATES; LOT 213 Parcel ID: 017 — 0 q It' 8.3 A. WELL DATA Well type PRNATE If A, B, or C provide PWSID# N/A Date completed 4/25/1985 Sanitary seal (YIN) YES Total depth 171 ft. Cased to 170 ft. FROM WELL LOG Date of test 4/25/1985 Well Log (YIN) YES Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 10/14/2008 Static water level 104 ft, 106 ft. Well production 4+ g.p.m. 3.7 9 -P -m. WATER SAMPLE RESULTS: Coliform `Q colonies/100 ml. Nitrate0.(e 39mg.lL, Other bacteria colonies/100 ml. m Arsenic:. t_ug./L. Date of sampie:10 14 2008 Collected by: GEG Ltd. B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 5/28/1985 Tank size 1000 gal. Number of Compartments E Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 10/13/2008 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA -BELOW EXISTING GRADE 6 SUMP/MT Date installed 5/28/1985 Soil rating (g.p.d./Wo Ibd 225 System type TRENCH Length 50 ft. Width 4+ ft. Gravel below pipe 7 ft. Total depth • 11.1 ft. Eff. absorption area 700 ft' Monitoring tube YES Depression over field NO Date of adequacy test "10/14/2008 Results (Pass/Fail) PASS For E bedrooms Fluid depth in absorption field before test 31 in. Water added 495 gal. New depth 48 in. i Elapsed Time: 120 min. Final fluid depth 44 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date **PRE—SOAKED ON 10/13/2008 w/ 1025 GALLONS. D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off" level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 51+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 100+ Water main N/A Water service line 10'+ Surface water 1009+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 1000+ F. COMMENTS G. ENGINEER'S CERTIFICATION o I certify that I have determined through held inspections and pie 49 review of Municipal records that the above systems are in 0' • • • • • ... "" """ " conformance with MOA COSA guidelines in effect on this date. 0"' " ' " G ness: Engineer's Printed Name JEFFREY A. GARNESS O4�, E-7 Date /� / COSA Fee Waiver Fee $ Date of Payment 0 �J��, b Date of Payment Receipt Number rT I &O 53 Receipt Number (Rev. 11/05) 133zi1S iJ01b'�fd �wP •t)W r°°�a 1 ,10S9l M„ 1,91.0 5 lN)N 6.) A11111 (1 f 1 I I �W .., •ter a ' c ; I ' Q: SINGLE FAMILY s IL FRAME HOUSE ° n y C N ° 1 WI °M. ° I >1 I QI ' n I N II O N m I N N ' OII w i 3 �I l� O • 1 h 1 o Zb Y P inI D W V• m m l o I m WI N I i Z LLI ... n I I N I 0 n I 1 1 I I i I y/1PC iCNLC I I 1 I ,ob-sq I 3,Sb,EODO N � I I �W ' Q: x IL a m C O MUNICIPALITY ANCHORAGE • DEPARTMENT OF HEALTH &HUMAN SERVICES Division of Environmental Services 1*0 1l On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0/7— eoOZ— R3 1. GENERAL INFORMATION Complete legal description � HAA#,�/�9'GFC' 2 -5 tV/ f; LSP h Location (site address or directions) 147 Property owner Mailing address Lending agency Mailing address Agent �� �� ° "_,,-, aA Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. 19 Zu 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 ai Address _-_� Engineer's signature . DHHS SIGNATURE _62�_ Approved for ,`_C' bedrooms. 0 Phone ('L —S� /L Date 1 217-314 4 Z Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7M25 (Rev. 1/91) Back MOA N21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 4011- 42 1 4evowl / Parcel I.D. a l7 — O y/— g 3 A. WELL DATA r7 / Well type l2 If A, B, or C, attach ADEC letter. ADEC water system number MfA Log present (Y/N) Date completed V R J S— Driller�� � Total depth I71 Casedto /70 Casing height Sanitary seal (Y/N) x Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION �" /Q yl�4 /6 S— Date of test MUNICIPALITY OF ANCHORAGE 1 G 7 «0 ENVIRONMENTAL SERVICES DIVISION Static water level Well flow 9 -P.M. Qii(Pr1. 1992 , /JJ Pump level RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I/J ; On adjacent lots Absorption field on lot l Ll ; On adjacent lots Public sewer main /!d -a Public sewer manhole/cleanout) y6"dD Sewer service line (00� Petroleum tank lei 1 Q WATER SAMPLE RESULTS: Coliform / / Nitrate N Other bacteria Date of sample: 1 y/Lb /'? 7- Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Tank S J Tank size %� D Compartments , Cleanouts (Y/N)_/Foundation cleanout (Y/N)— Depression (Y/N) High water alarm (Y/N) Nl/� Alarm tested (Y/N) r /Al fid,, �%Q ce e.'s Date of pumping 0/t -7 `3 i Pumper ^ wj K nee eiaa �x SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ( rty&,e LH 44 _ o No �iP c W a auH Well(s) on lot l D J On adjacent lots « Foundation !r Topropertyline% C. LIFT STATION Date installed Size in gallons Vent(Y/N) C-41 High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off' level at Cycles tested Surface water _ Date installed ���/fS- Soil rating a 3j System type - 4114 Length tD Width Gravel thickness / Total `de/nth lD Total absorption area 700 Cleanouts present (Y/N) Y �% Depression over field (Y/N) Date of adequacy test V zo Results (pass/fail) r for S bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot _-Je. /YO On adjacent lots > zu-e) Property line � Vi — To To building foundation 0 To existing or abandoned system on lot 4 Y WL -e On adjacent lots % 3 Cutbank tl -2... Water main/service line l Surface water Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name d �� e y Date02 s - A o� HAA Fee $ Date of Payment 12'-23'9 Receipt Number c 7.i9�.5U? 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Am%el�Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.If n\��-f%(!�1-5�� - 1. GENERAL INFORMATION Complete legal description t-0(- 2By w io( 4err:e Esled-el 2. 3. 4. Location (site address or directions), y760 Prot/or St Property owner Mailing address Day phone 2�7 '66ff Lending agency Frli- 0'2 4 SAn.k Day phone 276- 6300 Mailing address—f'-0- 3cx 1007207 R"n— CA&n yep Agent NIA. C re mance) Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: if community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 7M25(R.v. 119 1) Front MOA 021 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 Fla b% Tec/?l rcz( Phone 3 °/S-- t 33 -.5 - Address lM5-30 /-ctio Ski A,7c.h0 99Sf6— Engineer's signature I Date 3 /92 *;�•9TH ....................: d. •, THEODORE F. MOORE; t CE • 3589 n; Ar ju ,•. •: c^uAr •.......• p4c� Ar �4 Prcicsiar�`� 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: - ,01+K[ IS r l ( T14 Date 11ITIr The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(R.,-1191) Beck MOA N21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT 2s WILDBERRY FST. Parcel I.D. A. WELL DATA Well type PR I VAT-' If A, B, or C, attach ADEC letter. ADE water system number//'' Nitrate O. 36 ?Uzx Other bacteria Log present (Y/N) %/ Date completed /C �i12S/SS J Driller crRKS Dpi) i iaG Total depth 17b Cased to 170 Casing height 12 Sanitary seal (Y/N) / Wires properly protected (Y/N) y FROM WELL LOG AT INSPECTION cf/2s/8S 'f12o/92 -" t Date of test Static water level 1o,4 I lo 3.7 m. Well flow g.p.m Lr ►7 (SS Pump level C SEPARATION DISTANCES FROM WELL TO: 6 ; Septic/holding tank on lot 101' 10 c•o ; On adjacent lots - ruo' Absorption field on lot 14S ` ; On adjacent lots > f GG ' Public sewer main > /oo' Public sewer manhole/cleanout •> /00 Sewer service line /,�: 60 Petroleum tank NOKE OBSERvFA WATER SAMPLE RESULTS: Coliform O col /room 2 Nitrate O. 36 ?Uzx Other bacteria O,c�l It" IA4 Date of sample: 4 /J6Jg2 Collected by: FLATTOP -TECH, S✓CS. B. SEPTIC/HOLDING TANK DATA Date installed S/26/1?5' Tanksize 1000 GAS• Compartments 2- HON£ Cleanouts (Y/N) y Foundation cleanout (Y/N) i Depression (Y/N) obs RWD (SNow) High water alarm (Y/N) ty Alarm tested (Y/N) Date of pumping 10/f9J91 Pumper ISA/ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s)onlot— " IoS Onadjacentlots > «'0` Foundation 371 To property line ^7c) / Absorption field 3c, ` Water main/service line - bo ' Surface water/drainage 72-026 (Rev. 7191) Front - CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) 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 4" I8,;- Soil rating 231 m' BDRM System type TeENCH Length SO Width 48 Gravel thickness 7 Total depth 10 Total absorption area 700 13Cleanouts present (Y/N) Y Depression over field (Y/N) NONE ORSERV6b �NoM Date of adequacy test 4 /20/q Results (pass/fail) for Peroxide treatmentNoaE (past 72 months) (Y/N) iF+decvrt eNowN If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot No On adjacent lots 2 (oo ' Property line To building foundation 701 To existing or abandoned system on lot On adjacent lots_ > 3oCutbank_ N.A• Water main/service line /G Surface water >- /00 / Driveway, parking/vehicle storage area yo Curtain drain 9-A . E. ENGINEER'S CERTIFICATION bedrooms 1 certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. WWt.: ,,.....: ISl+ Signature !� •'.•.°% y� j�1 gTH S� I Engineer's Name % heo�(or'c�••••••••••••••••••••••: *. Date A rif 23 1992 d "" r THCOBORB F. MOORE ; d C .....89' �+ 4? A�R��ItsStoT. HAA Fee $ / 70• 6q71 Date of Payment Receipt Number 17 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number FLATTOP TECHNICAL SERVICES 14530 Echo St., Anchorage, AK 99516 Ph. (907) 345-1355 ADEQUACY TEST DATA SHEET Legal 'Description: L 2 B W Dj3CIPRY EST Street Address:_ lY760 PRA TaR Client Name: S7u!4 N W11,ToM Test Date:` L1120/17- Tested By: CN215 RECEIVED MAY ? 1992 Mun cipa Oy of Anchorage Dept. Health & Human Services Initial Conditions: H2O METER S. T, #2. 12" Plpf! w 14-7 " F6v1p 130 lost sTRE% Stop lost #1 in 14K #I #2 1 r.j. set " b.t.o. " b.t.o. 24 " pipe " pipe w„3� " w. " fluid fluid 1*-" Is$ 7z set 17 1}nZIP -TSMK lost #3 .1n S. M.T. set " b, " " 31 @wy TReNoH Float #4 in N. C.O. t. o.. Zs pipe " w. fluid 13z Water added through:_, I. set C,o. b.t.o. r.� iz pipe w, d " —v— fluid 81 b 1 . W/nER FLOM NoT TIRAW1 WAT. METre' p,,o 'FJMP ACTION TIME H2O METER NET. GAL WELL FLUID LEVEL TAKEN 5. Til k s t. 11EVr1, ---1--- _._1112_ 31 @wy c. o• o;lg y734r 121 sl p 0;23 7362 3� )z 31 b . r0'j2 4739-( 69 139 3/. o � 2 `l7 ' 1 0 ly 1 2 %2 6, PVT METER 19 ;,SL 1:2'1 S. G• ` g�c Kes ly-7 31 S I lug I•.zS �. ,..,„, 9 3.S6pn 14-9 63/y woRk�NG I:12 1',13 y 430 IOS6AL Igo 3/ S '11;sz 47 465 !Sz 9 If .3z 7 417 11:42 49 532 153 31 1!%. I1' s 2 `! 7 5 6,� 5I L 12:02. 47594 154 L 13 7/ tZnz `(74,36 .;31oi ISS 31 12•.22 47665 I s S 12'.32 47 6R8- 1 - S.TAI`401a 15 ' 12.`/2 '.0'2 4l 77/ -- L...: Iss 47 / 17%y o _ '1 /96 _ 155 ' "1 Illy 47828 Goa 155 y7 14/ O 1:32 47Q`I! Iss 47954 Iss STOP .2;14 __ 155 OPS Z;ZZ V,4 1s I2�.3013r f'VhP OVT per- r.. Measured os �qc 3,3 �e�-i-�i-e1 d a � J rN u1 gg X3,7 GPM 'Unito sorption .Capacity y. 793 GAL GA` AvIq erag 4'S �2'S .l DISE e Absorption Rate oS7 I/ FAc 78 n:, MIN Adequate for 7 Bdrms Surge Capacity . Adequate for .3 Bdrms 3; S s S 6404-(