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HomeMy WebLinkAboutGINAMI HILLS LT 3A1Ginami Hills Lot 3A #015-461-48 Municipality of Anchorage Page % of -3— DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ��2���c�- PID Number: Name: Wastewater System: KNew ❑ Upgrade Address: ABSORPTION FIELD Z Phone: No. of Bedrooms: ❑Deep Trench f,(Shallow Trench El Bed ❑Mound El Other LEGAL DESCRIPTION Soil Rating: �+ e,4,_:5 Total Depth /moriginal gr�de: GPD/Sq. Ft. Lot: Block: / Sub ivision: �, Depth to pipe bottom from original grade: FL Gravel depth beneath pipe Ft. Township: Range: Section: Fill added above original grade: Gravel length: IZ,Ft. Ft. WELL: XNew ❑ Upgrade Gravel width: /v Number of lines: Distance between lines: Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: 2 Ft. Ft. l . SQ. Ft. Driller: ®v`r z- Date Dri led: Static Water Level: installe Date installed: Ft. Yield: Pu Set at: Casing Heightbove Ground: / TANK GPM Ft. Ft. SEPARATION DISTANCES XI Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private 111 Manufacturer: y Capacity in gallons: n From Tank Field Station Tank Sewer Lines Material: / Number of Compartments: Well Mo 2 Surface LIFT STATION Water Lot Size in gallons: Manufacturer: Line 7 "Pump on" level at: "Pump off' level at: High water alarm at: Foundation Curtain / 7 Pump Make & Model Electrical Inspections performed by: Drain 3� BENCH MARK Remarks: Location and Description: Assumed Elevation: 11A Ft ENGINEER'S SEAL / _ .. 7 > , �- T- 0��it A� -z Inspections performed by: r�� �. Dates: 1st 2nd_L�9Z ©e• . ....:. ......'.:#.s z .. - �� Charles E. Wilson, Jr. Department of Health n Se v'ces approval 4 CE 6281 Date: Reviewed and approved by: �, - f_ 72-013 (Rev. 9/91) MOA 25 IreV,. r , /tp P_NiZ /ZAOPZ- Gr N �., ' y� s'a e Permit No. -��'� -�'` Page 2 of -3 Municipality of Anchorage 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 r / Legal Description: /J7/�� �� PID No.: d y 00 `r'' COQ / �7/ir l? coe orf? v /Y V 4 A�/ X08 VV // O T> s 72-013 A (Rev. 9/91) MOA 25 f i �p ENGINEER'SSEAL 9 4 '1�b%9z'if�l - •• Charles E. Wilson, Jr. _A // •,• CE 6281 �Q0 AV , f mfessioKa\ ®�® 72-013 A (Rev. 9/91) MOA 25 Permit No. Page a of Municipality of Anchorage 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 Legal Description: PID No % v 72-013 A (Rev. 9/91) MOA 25 0 o° e o .PS (J000e� eo•oe• oso ee•��z Charles E. Wilson, Jr, �® C8 6281 e4 % 70 G"D e4 Municipality of Anchorage � a -- Department of Health and Human Services CihS Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 December 9, 1992 Charles E. Wilson, P. E. 8054 Seaview Street Anchorage, Alaska 99502 Subject: Waiver Request Waiver Request SW920036 Dear Mr. Wilson: for Lot 3A1 Ginami Hills Subdivision #WR920084, PID #015-461-48, HA920825 Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 4 feet from the property line. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, �7 </ C� Daniel N. Bolles On-site Services DNB/ljm MUNICIPALITY OF ANCHORAGE - Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR#:„pgjjr)(-)0, PID# 015-461-48 HA# �LQAMT Permit # SW920036 Date Received: December 8, 1992 Legal Description: Lot 3A1 Ginami Hills Subdivision Engineer: Charles E. Wilson, P. E. 8054 Seaview Street, Anchorage, Alaska 99502 Applicant: Charles E. Wilson Waiver Requested: Lot line Waiver - 4 feet. Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: y4s- Waiver is NOT Granted: List Conditions or Reasons for above: I rrr•w:• Rec #: 24299 Amount: $ 70.00 Date Paid: 12-8-92 CHARLES E. WILSON, P.E. 8054 Seaview Street Anchorage, Alaska 99502 243-8372 December 8, 1992 Municipality of Anchorage Department of Health & Human Services Environmental Services Division P.O. Box 196650 Anchorage, Alaska 99519-6650 RE: Permit No. SW920036 Lot 3A-1 Ginami Hills Subdivision Ladies & Gentlemen: MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION DLc 0 r 1992 An as -built survey by Lantech, Inc. revealed the location of the leachfield cleanouts on the subject property to be 4' from the northern lot line. Enclosed is a revised Inspection Report correcting the distance from the lot line to the cleanouts. Please accept this letter as a request for a variance from the 10' setback requirement of the leachfield to the lot line. The granting of the variance will not adversely impact future or existing development of adjacent parcels. Sinc rely, Charles Wilson, P.E. -7a,, crb 12_7---fz 44-zp9 Com) aep. in- 177G UJ; 9b HT1 P81 _ •. .. ,.: .. .�-/P .. •1'.1-'Q•i'..'l'iy i•.. Yw�.faiy y. .. ..�... ... ..: .'�:_..n. ..,..:r. .. .. .. , r STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD LOCATION OF WELL BOROUGH SUBDIVI¢ION LOT BLOCK SECTION OTRS SECTION TOWNSHIP RANOE MERIDIAN [IN of OS (JW LOCATION/SKETCH: WELL OWNER: J DEPTHS MEASURED FROM:Ocasing top []ground surface WELL DEPTH: J DATE OF COMPLETION Depth of hole: ft I BOREHOLE DATA: Depth Depth of casing:_ 1. it Material Type and Color From To �r �I , i ( 1 t ! J f / 6 DEPTH STATIC WATER LEVEL: ' ft below W� top of casing 13 ground surface Date: I�r' Ctr1rC.� –• �'1,r/(�( METHOD OF DRILLING: Fair rotary C_i Cable tool . .© +�t`� ' C� I I� other / l�, �� rl USE OF WELL: C(dOmestic ❑ irrigation 0 monitor jir,wi ,Y1f)(11 of .:)�i 0 public supply 0 other ��t'� �{ �f CASING STICK-UP. —L ft. Dlam:-S/-i�in. to 01 ft t t i' / Y. r ��. .;.`~•�� Casing type:in. to ft .a..„ r / WELL INTAKE OPENING TYPE: Ikbpen and 11screened perforated kopanhole Depths of openings: �I to r r ft C1 L SCREEN TYPE: Diam: in. Slot/Mesh Size: Length: ft GRAVEL PACK TYPE: Volume used: Depth to top: GROUT TYPE: Volume: Depth: from ft t0 it DEVE40PMENT METHOD: �l i Duration: PUMPING LEVEL AND YIELD: L 11-r ft after TTL hrs pumping__�_gpm PUMP INTAKE DEPTH: it Horsepower: WELL DISINFECTED UPON COMPLETION? tZYES 0 NO CONTRACTOR INFORMATION: REMARKS: /G( ff 01W fie1e Business ,Name e�. PLEASE MAIL WHITE COPY OF LOCI TO: DNR/DIVISION OF WATER Signature R Aut orizod iesp�ontaat ve Date PO BOX 772116 EAGLE RIVER AK 99577-2116 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 AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW920036 DESIGN ENGINEER:HARDING LAWSON ASSOCIATES OWNER NAME:WILSON CHARLES E JR & DEBRA L OWNER ADDRESS:8054 SEAVIEW STREET ANCHORAGE, ALASKA 99502 PARCEL ID:01546148 LEGAL DESCRIPTION: GINAMI HILLS LT 3A LOT SIZE: 99781 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 PAGE 1 OF 1 DATE ISSUED: 3/20/92 EXPIRATION DATE: 3/20/93 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: AT THE TIME OF CONSTRUCTION, ENGINEER SHALL PERFORM AN ADDITIONAL PERC. TEST IN THE GM MATERIAL AT THE APPROXIMATE DEPTHS OF 1.5 TO 5 FEET TO DETERMINE IF THE MATERIAL HAS THE SAME PERC. RATE AS THE SM MATERIAL BELOW IT. RECEIVED BY: DATE: ON-SITE SEWER/1^WELL. PERMIT APPLICATION COT 3A9 GINAMI HILLS SUBDIVISION 3/12/91 AF.E.A.....:T.nF.GRAF.N Y Cot 3A slopes from east to west ,approximately 8 percent, There are no areas of excessive slope, The area of the proposed dr'ainfield slopes approximately 3 percent from east to west. There ,yr•- no surface drainage courses within 100 feet of the proposed fie c.-- IRF.AN.1', ......4?PJ.....ADJAG N.1:....FR!rwEE.F.T.T.E The zoning in this area is R-9, allowing a minimum lot size of 2 1/2 acres. The lots immediately east, north, and west of this lot are presently undeveloped> Location of a subsurface disposal field in the proposed location would have no adverse effects upon ,adjacent parcels. MIL:r.....ANP....., a.RSO41NCK.WA.IER.................... Test Pits were excavated in the proposed dr•ainfield area in April, 1985 (Engineering Geology) and again in November, 1991. No groundwater was encounter in either excavation. ;oils logs and perc test results for the November, 1991 investigation are enclosed. Results of the 1985 investigation are on file with the Dept. of Health & Human Services, A groundwater monitoring tube was installed to depth of 18.5 feet on Nov. 16, 1991 at the same time; Test Pit #k2 was excavated in the proposed alternate dr•ai nfi el d area. No groundwater has been observed at any time in the monitoring tube. 0-. Charles E Silsoe, Jr./ 10 CE 6281 :. ' o 4 4 � I I ," 1 I - I 0. I' `\ 1 � I I � � I � I — i (fj ...tom -------------------- •11� -•4•~- 1. > —i 0 i e cra � f � 4v-5; s' /� (% > I'/Ue mss'• r y� !/ fT� i i f Luf%-71 % I f 00 p'_ '- lac, - 17 D a d if �� •may d �s p Z�" ®L e•e•e eo•ee`0" D 3/fie: 4 911 009.00 ee••e•e ••e •o•�i /J�� e es a • ese�C ®• o Charles E Wilson, Jr. CE 6281; � ®��CQf80e00e 090"0 G(� 0 40, e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST \e PERFORMED FOR: DATE PERFORM LEGAL DESCRIPTION: /Z 47- 2a (3)Iaeldie 171//.1 Az EPT 1 i 0 / 3- 4- 5 4 Cbt7s//�'��vFefjl �� .H�a: .sem 1. C�JZA1 / e.PGJ'.- $©61,!x/ s/,,���y ion;F/ 9 10 f pI l l Iq I WAS GROUND WATER ENCOUNTERED? 11 12 /-/d 7Z;' a � / 13 " 14-- 15 4- 15 16 17 18 19 IF YES, AT WHAT O DEPTH? P E DepthMontt to Water Aller , , _ A y)y Monitoring? _��— Dale: /� 20 UPERCOLATION RATE ��r (minutes/inch) PERC HOLE DIAMETER �G/ a TEST RUN BETWEEN � FT AND FT COMMENTS ��f� Y �� `y� '� 5e4 h4l ire PERFORMED BY: ` �✓!r Z14 X?�4 I ���1� GI Fi"- � CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev_ 4/85) —"ffF 20 UPERCOLATION RATE ��r (minutes/inch) PERC HOLE DIAMETER �G/ a TEST RUN BETWEEN � FT AND FT COMMENTS ��f� Y �� `y� '� 5e4 h4l ire PERFORMED BY: ` �✓!r Z14 X?�4 I ���1� GI Fi"- � CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev_ 4/85) Municipality of Anchorage DEPARTMENT OF. HEALTH4HVIVIAN SERY,ICES 825r"L" Street, Anchorage, Alaska 995Q2-065.0 SOILSiLOG — PERCOLATION TEST PERFORMED FOR:DATE P LEGAL DESCRIPTION:/ �/'U'nchin RannPSertinn� . ^� �r 1 2 3 4 5 / 6 7 8 9 10: 11 12 13 j� 14 15 16 17 18 19 20 COMyNp �1 � �� PERFORMED BY: �1(l L/ I ?/di ," � CERTIPYTHAT THIS TESL WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES W EFFECT ON THIS DATE. DATE T% 72-008 (Rev. 4/85) ENQINEGR!S SE, GY .-y ° ICS d9T�l . a I Charles E. Wilson, Jr. � ICL CE 6281 ^I ^mn lro m n.n, Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST I iYe jrNUI MC ,74�Y o ¢ f s` •77� 000 000 •0 00 0010//y/00 AP 0000. 0 I `•� Charles E. Wilson, Jr. CE 6281•, ® PERFORMED FOR:%iY' �l/�'"j"� DATE PERFORM Canna Rartinrc T/ :•' /i/ LEGAL DESCRI o4 1 2 6� 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS SLOPE WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? P E Depth to Water After Monitoring? Dale: Reading Date Gross Time Net Time l Depth to Water Net Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND =' FT PERFORMED BY; CERTIFY {;/ �� I �.rl,�sor/_ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES TELEPHONE 343-4200 ONOTICE OF VIOLATION 5631 Please take notice that the undersigned authorized representa- tive of the Director has reason to believe that on or about /G rl , 19 at or near the following: AP/P'ROXy ATE LOCATION NAME 1� c� ADDRESS: WITHIN THE MUNICIPALITY OF ANCHORAGE DID UNLAWFULLY: •Y' '� L , c2 �fl/2 �L 2 � which is a sep rate violation of 4 r Jr of the Anchorage Code of Ordinan- ces each and every day such condition exists. A COPY OF THIS NOTICE HAS BEEN SERVED UPON: NAME AT r717-15 IN THE FOLLOWING MAN ER: 4 .L/ 1. by personalservice 2. by certified ma . by posting this notice on or about the location described herein when such person cannot be found after diligent effort to .do so. If the violation or viola ti ns r ferred to herein have not been corrected by 19legal proceed- ings may be initiated as provided by law. Dated this /5__�dayof �'h 19 NAME 1 I TITLE 70-004 (Rev. 8/88) DISTRIBUTION: WHITE—Department CANARY—Violator P 551 670 603 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) N kRes1ricted les E. Wilson N mndSt 57th Place qorage, Ak 99518 U1S lr ee elivery Fee Delivery Fee Return Receipt showing to whom and Date Delivered N 00 Return Receipt showing to whom m Date, and Address of Delivery 3 TOTAL Postage and Fees I S Do I Postmark or Date t+7 E L3� AA, - ����/Lem t�5 /L� GZoif orized Signature) _. . 5B-1 FOR: CHARLIE WILSON My commission expires Notary Public UNDERGROUND TELECOMM & ELECT. 8.4 EASEMENT TO BE VACATED. AERIAL EASEMENT VACATED FROM GROUND �� LEVEL TO 6' ABOVE GROUND. AERIAL EASEMENT TO REMAIN ABOVE 6' WELL ABOVE GROUND LEVEL DETAIL 'A' SCALE 1 "= 20' 1992. BENEFICIARY: I NOTARY . Subscribed an - FOR: CHARLE� My commissior ZONING=R-9 I Gjtj CI R CLE I wooDe 13 14 ��- � 1 � V N Qe i� 0 3B���� �rdrdi ��f don �3�2Q �GIYGfYq�! / �Fj� - I. 2A zs' s' 30' 30' z' 0 0 0 C (SEE DETAIL Municipality of Anchorage Department of Health and Human Services On -Site Services RE: Permit No. SW920036, Ginami Hills Subdivision, Lot 3A Ladies and Gentlemen, This letter responds to comments dated 8/05/92 by Mr. Dan Bolles of the Department of Health and Human Services concerning the inspection of the well and septic system installed on the above referenced property. Comments are addressed in the order they were presented. 1. The total absorption area was revised from 1000 sq. ft. to 1071 sq. ft. on Rev. 1 of the Inspection Report which is attached to this letter. 2. The location of the cleanouts and monitoring tubes is depicted on page 2 of the Report. 3. An elevation diagram indicating the relative elevation of the piping, gravel, tank and bottom of the test hole is provided on page 3 of the Report. 4. Swing ties to the cleanouts are provided on page 2 of the Report. 5. Final grading has been completed in the vicinity of the absorption field which will direct any surface water away from the field. 6. The curtain drain discharge point is 82' from the southwest corner of the field, but there is currently no flow discharging from the drain. 7. The footing drain from the house has been added to the site plan on page 2 of the Report. A flow rate of 1.5 GPM was recorded on 8/31/92. This flow has been diverted so that the surface flow remains at least 100' from the field. The water from the footing drain percolates into the ground prior entering Lot 3B, located immediately west of the subject property. B. The curtain drain was not disclosed prior to the permit being issued because the drain is not required. I decided to construct the drain as a conservative measure to prevent any future potential high groundwater from adversely effecting the performance of the field. 9. Permanent monitoring tubes were not installed because there was no groundwater observed during the installation of the drain. 10. A cleanout for the curtain drain exists and is located where shown on page 2 of the Report. 11. There is no impact on adjacent properties. The flow from the footing drain percolates before reaching Lot 3B. This flow saturates the near surface organic soils on the extreme west end of the subject property. This presently results in a very small seep near the discharge point of the curtain drain due to the activity of heavy equipment in this area. This seep peres again within 20' and will disappear entirely once the area is revegetated. 12. A well log is attached. Please call me at 563-8102 if you have any more questions concerning the subject property. Sincerely, Charles Wilson, P.E. 8054 Seaview Street Anchorage, Alaska 99502 Cl I -U � L -U � � � � M I e§ S u T 0 3 CA t: ca rA 1 Cl 21 In C z z x m n m T ITTf T TAT III TTT TT ® SENDER: Complete items 1, 2, 3 and 4. Put your address in the "RETURN TO" spaca on the _ reverse side. Failure to do this will prevent this card from being returned to you. The return receipt feewillprovide you the name of the person delivered to and the date Of delivery. For additional fees the following services are available. Consult postmaster for fees and checF box(es) - forservice(s) requested. t. Show to whom, date and address of delivery. 2. ❑ Restricted Deliver%. DNB/LJM On-si,Pq Services.#502 3. Article Addressed to: ' ,- - .! Pe5 Charles E. Wilson 601 East 57th Place Anchorage, Alaska 99518 4. Type of Service: Article Number ❑ Registered ❑ Insured certified ❑ COD P 551 670 603 ❑ Express Mail Always obtain signature of addressea,Qr agent and DATE DELIVERED. 5. Signature — Addressee - X' 8.` Signature — Agent X 7. Date of Delivery - S. Addressee's Address (ONLY if requested and fee patdJ MUNICIPALITY OF ANCHORAGE • _ DEPARTMENT OF HEALTH & HUMAN SERVICES 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. # 4:q HAA # 0 Q0124 C 1. GENERAL INFORMATION / Complete legal description Z'd� � � fv.��' ��/ '%��3'�•? Location (site address or directions) /'/2-31'*� Z_4l arrr/ E,e 99_i� Property owner} /o�7 �'l — / Day phone Mailing address _1ZQ�lL 2i•�/���' ���/� 995/ Lending agency or s� �Y/o.- �r �. Day phone%�-4zsd Mailing address * Agent Z �'/ H -� Day phone 5� Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual well —A 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. 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 4�2-�s��L�a �T Shama �� �� Phone Address Engineer's signature Date 2 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments By: bedrooms. 1IITIC p y /��,' e of `Y • y S�,iseoose�e����__.______A •. Charles E. Wilson, Jr. . .'•, CE 6281 4' x bedrooms, with the following stipulations: Date Z L 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 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services _ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ` / 1�- Parcel I.D. �r y�l W A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) y Date completed Driller Total depth Cased to R/ Casing height Sanitary seal (Y/N) Date of test Static water level Well flow Pump level Wires properly protected (Y/N) FROM WELL LOG ' z 2 . D g.p.m. ZZe� SEPARATION DISTANCES FROM WELL TO: AT INSPECTION Septic/holding tank on lot On adjacent lots % zd� Absorption field on lot ; On adjacent lots ,> ZI�n Public sewer main �� m�/ Public sewer manhole/cleanout Sewer service line WATER SAMPLE RESULTS: Petroleum tank Coliform Nitrate "'9/f Other bacteria i!/_16 A% e_ Date of sample: i>� �� Collected by: B. SEPTIC/HOLDING TANK DATA Date installedTank size Compartments e_- Cleanouts (_-GN) ,Foundation cleanout (Y/N)Depression (Y/N) High waYer`alarm )(/NY , Alarm tested (Y/N) Date of ppmping . , Pumper SEPARATION -DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on Tot �z On adjacent lots >'e,!:� Foundation �S To property line -Absorption field le_�5 Water main/serviceline_ , Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE m oZ li-n 7 M D e,71 D rid m Q g.p.m.< r Mco - r? s. M m Z. Septic/holding tank on lot On adjacent lots % zd� Absorption field on lot ; On adjacent lots ,> ZI�n Public sewer main �� m�/ Public sewer manhole/cleanout Sewer service line WATER SAMPLE RESULTS: Petroleum tank Coliform Nitrate "'9/f Other bacteria i!/_16 A% e_ Date of sample: i>� �� Collected by: B. SEPTIC/HOLDING TANK DATA Date installedTank size Compartments e_- Cleanouts (_-GN) ,Foundation cleanout (Y/N)Depression (Y/N) High waYer`alarm )(/NY , Alarm tested (Y/N) Date of ppmping . , Pumper SEPARATION -DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on Tot �z On adjacent lots >'e,!:� Foundation �S To property line -Absorption field le_�5 Water main/serviceline_ , Surface water/drainage 72-026 (Rev. 7/91) 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) 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 4�Soil rating = System type 5� Z—_ee/ 4 Length /5� Width .5 Gravel thickness Z /0�9 h, Total depth S ¢v 7 / Total absorption area /Z 7/ >F Cleanouts present (Y/N) Depressioh'over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Date of adequacy test /lew S for If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots Property line /-d Ll To building foundation /Z/: To existing or abandoned system on lot On adjacent lots Cutbank yZl- y �) Water main/service line —& Surface water &-ig Driveway, parking/vehicle storage area /-35 Curtain drain 3 ;rte E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect Signature Engineer's Name Date 12 / HAA Fee $ � Uv Date of Payment / Z- ` O/ Z_� d Receipt Number Zl� ��r5 C&D 70 72-026 (Rev. 3/91) Beck MOA 21 Waiver Fee: $ Date of Payment Receipt Number date of this inspection. J-0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES MEMORANDUM DATE: 12/9/92 TO: Leslie Jordan, Building Safety, Permit Counter /J FROM: Dan Bolles, On-site Services SUBJECT: Lot 3A-1, Ginami Hills, PID #015-461-48 Please be advised the septic system and well serving the subject lot are now approved. This department no longer has any objection to the issuance of a certificate of occupancy. db/206 Lv " MUNICIPALITY OF ANCHORAGE OFFICE USE COMMUNITY PLANNING AND DEVELOPMENT P.O. Box 196650 RECD BY: Anchorage, Alaska 99519-6650 PRELIMINARY PLAT APPLICATION A. Please fill in the information requested below. Print one letter or number per block. 1. Vacation Code 2. Tax Identification No. 3. Street Address 1992 O O 4. NEW abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BILK 3 LOTS 34). 5. EXISTING abbreviated legal description (T1 2N R2W SEC 2 LOT 45 OR SHORT SUB BILK 3 LOTS 34) full legal on back page. 6. Petitioner's Name (Last - First) 7. Petitioner's Representative Address/�ZZ Address City �`ji State City ✓/i State Az Phone #�34S23SS Zip 995% Phone # Zip 995DZ S. Petition Area Acreage 9. Proposed 10. Existing 11. Grid Number 12. Zone Number Lots Number Lots 13. Fee $ 3 1-0 14. Community Council Y9i/1/ L—s>� B. I hereby certify that (I am) (I have been authorized to act for) the owner of the property described above and that I desire to subdivide it in conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. I understand that payment of the basic subdivision fee is nonrefundable and is to cover the costs associated with processing this application, that it does not assure approval of the subdivision. I also understand that additional fees may be assessed if the Municipality's costs to process this application exceed the basic fee. I further understand that assigned hearing dates are tentative and may have to be postponed by Planning Staff, Platting Board, Planning Commission, or the Assembly due to administrative reasons. Date: Signature 'Agents must provide written proof of authorization. 20-003 Front Rev. 9192)' c. urease cnecK or nu in me rouowing: 1. Comprehensive Plan — Land Use Classification _Residential Commercial Parks/Open Space Transportation Related 2. Comprehensive Plan — Land Use Intensity Special Study 3. Environmental Factors (if any): /, a. Wetland 1. Developable 2. Conservation 3. Preservation Marginal Land Commercial/Industrial Public Lands/Institutions Alpine/Slope Affected Industrial Special Study Dwelling Units per Acre 5, Zrie Alpine/Slope Affected b. Avalanche c. Floodplain d. Seismic Zone (Harding/Lawson) D. Please indicate below if any of these events have occurred in the last five years on the property. Rezoning Case Number Subdivision Case Number Conditional Use Case Number Zoning Variance Case Number Enforcement Action For Building /Land Use Permit For Army Corp of Engineers Permit E. Legal description for advertising. F. Checklist 30 Copies of Plat Reduced Copy of Plat (S 1/2 x 11) �— Certificate to Plat Aerial Photo Housing Stock Map Zoning Map J Water: Sewer: 20-003 Back (Rev. 9192)' _Private Wells Private Septic Fee Drainage Plan — Vj Topo Map 3 Copies yJ Soils Report 4 Copies v1/ Pedestrian Walkways '&/ Landscaping Requirements Community Well Community Sys. Waiver Public Utility Public Utility VACATION OF RIGHT-OF-WAY OR EASEMENT APPLICATION Municipality of Anchorage DEPARTMENT OF COMMUNITY PLANNING \ P.O. Box 6650 Anchorage, Alaska 99502-0650 A. Please fill in the information requested below. Print one letter or number per block. Do not write in the shaded blocks. 0. Case Number (IF KNOWN). 1. Vacation Code Tax I.D. Number 2. Abbreviated Description of Vacation (EAST 200 FEET SOME STREET). 3. Existing Abbreviated legal description (TI 2N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOT 34). 5. Petitioner's Representative. Address:_�B�ZC� City: yJ State: Zip Code: Phone No..,S�e Z S Address: 15 ry J City: State:leQe Zip Code: 99' ' Phone No.���%� 6. Petition Area Acreage. 7. Proposed Number Lots. 8. Existing Number Lots. 9. Written Justification. I-111TM III III . III 10. Grid Number. 11. Zone. 12. Fee $ /00 f 13. Community Council _,"� B. I hereby certify that (I am) (I have been authorized to act for) the owner of the property described above and that I desire to vacate it in conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. I understand that payment of the basic vacation fee is nonrefundable and is to coverthe costs associated with processing this application, that it does not assure approval of the vacation. I also understand that additional fees may be assessed if the Municipality's cost to process this application exceed the basic fee. I further understand that assigned hearing dates are tentative and may have to be postponed by Planning Staff, Platting Board, Planning Commission, pr the Assembly due to administrative reasons. Date: _//��� Sioi.ture 019lltev. Q2y R0n1 'Agents must p,rvide written 1-t,Oor or authorization. C. Please check or fill in the following: 1. Comprehensive Plan - Land Use Classification residential O Commercial O Parks/Open Space O Transportation Related 2. Comprehensive Plan - Land Use Intensity: PI Spepial Study 3. Environmental Factors (if any): lylel� a. Wetland i1 1. Developable 71 2. Conservation F1 3. Preservation 1 O Marginal Land O Commercial/Industrial O Public Lands/Institutions O Alpine/Slope Affected O Industrial O Special Study Dwelling Units per Acre: �`llyG�or/e I Alpine/Slope Affected b. Avalanche n c. Floodplain O d. Seismic Zone (Harding/Lawson) O D. Please indicate below if any of these events have occurred in the last three years on the property. Rezoning Case Number: O Subdivision Case Number: 7 Conditional Use Case Number: ,7 Zoning Variance Case Number: O Enforcement Action For - F1 Building/Land Use Permit For E. Legal Description for Advertising. F. Checklist 9-30 Copies of Plat Reduced Copy of Plat (8 1/2 x 11) FT -Certificate of Plat r5—Fee * Topo Map 3 Copies O Soils Report 4 Copies FrAerial Photo n Housing Stock Map O Zoning Map O Water: N Private Wells O Sewer: } Private Septic 20-0191Rev. 4/921' Back Waiver n Community Well O Public Utility O Community Systems n Public Utility F== -----ill -- — — — — —— 'ji 7 L—S 00'09'32" W 305.07'— W I D � _moo o as m u933oQax {O 5 jz-soF M „60,00.00 N o N I I _GINAMI STREE— �\ v _ sPRoao m26 2 I \ -333 I D 3n3o I I I � I S I I D e ` / i d3"s -v D N .53a g Z zo?y`A'n 4 Ip m ID n S� �omnog a - 3„ lno Fi�So« 9 n I➢ nm 5n no s In n= o rE I� z ° 7 o r y I Z o o s m� rGoGosOa Ip sms 11. 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