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Home My WebLink AboutDAV-DOR LT 3 ~ 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 PHONE ~UPGRADE MAILING ADDRESS LEGAL DESCRIPTION / NO. OF BEDROOMS I Z Manuf~turer Material No. of compartments Liq. capa~W in gallons In~ide length Width Liquid d~pth / ~ IF HOME.DE: ~O~ Well Dwelling PERMIT NO. DISTANCE TO: O Z < Manufacturer M~terial Liquid ca~clty in ~llons ~ Top of tile to finish gredo ~/ U.t,rialb,.,.thtil. 7~ inches Total Length W~dth Depth PERMIT < ~ Ty~ of crib Crib diameter Crib depth Total ef f~ti~ absorption area ~ Well Building foundation Nearest lot llne m DISTANCE TO: ~ CJass Depth Driller Distance to lot line ~ PERMIT NO. ~ Building foundation Se~r line Septic tank Absorption area(si ~ DISTANCE TO: PIPE MATERIALS OTHER ~ e. '* JUNE 25. 397[ .-~ 'PROVED DATE LEGAL {Rev, 3/78)/ PERMIT NO. PIUN I C Ir'AL I TY OF Ar-~CH_~RAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 "L'" ~TREET, ANCHORAGE, AK. 99501 2~4-472~ IqELL Rt-~D ON--5 I TE 5EI-4ER PERt~ I T APPLICANT LOCATION LEGAL DAVE HENDRICKSON 104-EVERGREEN L3 DAY-DOR SUB BX iTl4X SRRRNC LOT SIZE 40000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 5 SOIL RATING THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= :1. ¢1_'-~ LEt,IGTH= 42 GRR%.'EL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRAINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETHEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET>. THERE IS NO SET HIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETHEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET>. RE~..U I RED SEPT I ¢ TANK S I :;'E= I 500 GRLLOt-IS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY HELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE HELL HILL SERVE. Ti,IQ ( 2 ,'" I t-ISPECT I OtIS ARE REQL~ I RED BACF, FILLING OF ANY SYSTEM HITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT HILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETHEEN A HELL AND ANY ON-SITE SEHAGE DISPOSAL SYSTEM IS i00 FEET FOR R PRIVATE HELL OR 150 TO 200 FEET FROM R PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC HELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEHER LINE IS 75 FEET. HELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT HITHIN 30 DAYS OF THE HELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEHERS AND HELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I HILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEHER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS RE~D TO INCLUDE MORE THAN 5 BEDROOMS. APPLICANT DR~E HENDRICK~ON .... .... ........... MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 9950! 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERPO.~ED;O.= 'DAVI; ~E'Nb~.~e. UC~ON DATEPERFOR~ED= ~'~1'81 LEGAL DESCRIPTION: 1 4 7 14 15- 16- 17- 18- 19- :~0- coo.,,,,=t~ 'DA t/o SLOPE SITE PLAN WAS GROUND WATER ~ ENCOUNTERED? ,~L~__.~ pO E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop 2225-E JUN;' 25, 1971 PERCOLATION RATE (minutes/inch) ~ TEST RUN BETWB, EN ~ FT AND ~ FT ~ / ,ER,OR~ED~; ~ DATE: ~ =~ '~1 72-008 (6/79) ~ENi(INS WE£L DRILLING PHONE 34,~.379Z DR I LLER'S WELL L~G . TO TO TO __ TO . TO bev bor' Lot I & 3 #015-292-35 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program S ., 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH ,b, UTHOEITY .b, PPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-292-55 1. GENERAL INFORMATION Expiration Date: .,~-"- lC/. - Complete legaldescription DAV DOR SUBDIVISION; LOT 1 &: 3 Location (site address or directions) 10300 EVERGREEN STREET * ANCHORAGE~ AK Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address DAVID HENDERICKSON Day phone 440-2156 c/o LARRY SUITER w/ PRUDENTIAL VISTA Day phone LARRY SUITER w/ PRUDENTIAL VISTA Day phone 4241 "'B" STREET * ANCHORAGE, AK 99505 273-7766 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank [] Community On-site [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Cedificates of Health Authority 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 propedies 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. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation dale shown below, I verify that my investigation, based on procedures outlined in the Health Authority 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 ;'lATER &: WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineeds Printed Name JEFFREY A. GARNESS, P.E. Date ,337-6179 Engineer's Comments: In conducting this evaluation, AKWWC, Inc. 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 underthe conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wefts and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator cf 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. AKt~C, Inc. can therefore not provide any warranty or future estimate of how long the system wi//continue to meet the operational requirements of the ADEC or MOA DSD. The content cf this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor wi//it confer any legal right whatsoever, DSD SIGNATURE Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the fllowing stipulations: ,.-',~ · · 02.- Attachments: HAA Checklist Septic System Advisory Well Flow Advisory ~ : PROGRAU ..-~.~ Manitenance Agreements ~'.))~,;7'/~ ' ...... ~;~, Supplemental Engineer's Reort Other (Rev. 1~0"1) Original Certificate Date:...~ - / ~ - C'_'~ Municipality of Anchorage Development Servlces Department ' Building Safety DivisiOn O~Jlte wa~r & Wa~tewater,Program 4700:$0Ut~:l~mgaw. SL P~O: ,EI0~ 196650~AnChomge, · ' www,ci.ani=horage.ak4m (907) 343.?~04 HEAt~'tTH AUTHORITY APPROVAL CHECKLIST Nitrate: .2,46 mg./L, otherloacte~,, o T,Colonle~Ooml. Date of sample: 1/24/2003 Collected: by:., , AKWWO~.INc. e~."' CI.F~OUT iN C-ARA8£ IN OIF[ECT UNE OF SEPTIC TANK. Cleanouts(Y/N) ,, Y1E~S .... Highwater-alarm~/N),, ,,N/A , , C~ Pumper , , CHUGACH PUMPING , ..... SO~Udg:~r~'d~) 300 S~em~e, ~-.D'~P ~CH ,. Oepresslon over field ,NO , For, 5 ,bedrooms Newdepth., 0 in. AbSO~tlOn rate >= , , 750-1- g,p.d. NONE KNOWN , If yes, give date..,r, ,- , D. LIFT STATION Date installed 'Pump on" level at~ Da.~F_tum ~~ Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons, -. ~ in.~~n, High water alarm level at Meets alarm & cimuit requirements?. Septic tank/lift station on lot100'+ Absorption field on lot 100'+ Public sewer main _ N/A Sewer/septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Property line 10°+ Water service line 10'+ Curtain drain NONE KNOWN COMMENTS SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line. 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 10°+ Surface water 100°+ Wells on adjacent lots 100°+ *THERE IS A PIT WELL ON LOT. SEE An'ACHED PHOTOS. Absorption field 5'+ Surface water 100'+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and ret4ew of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Water main N/A Driveway, parking/vehicle storage 10'+ Engineer's Printed~Name Date JEFFREY A. 0ARNESS Waiver Fee $ Date of Payment Receipt Number 01/22/03 16:33 FAX 907 273 8440 PRUDENTIAL VISTA REAL ES [~002 Explanation Addenddm or Amer dment To The D sclosure Statement Use this page fo: 1) clarify repalrs, defects, or malfunctions 2) ' to explain Items in more detail 3) to make changes or to update this disclosure form AS 34.70.020 provides that if a disclosure statement or material amendment i; delivered to the Buyer after the Buyer has made a written offer, the Buyer may terminate the offer by delivering a wril :eh not/ce of termination to the Seller or the Seller's agent within ~hme days after the disclosure statement or emendmen: Is delivered in person or within six days after the disclosure sta[ement or amendment is delivered by deposit in the. ms il. In compliance with AS 3~4.70.080, the Seller amends the disclosure statemenl for the real property described below:. List items changed or clarified, Use additional Addendum/Amendment I;ges, If necessary. INVe (Seller(s)) certi~ that the Information In this AddendumlAmendmen! To The .Disclosure Statement is true and correct to the best of my/our knowledge as of the date aigned. -- l/tNe (Buyer(s)) have received a copy of this Addendum/Amendment To 'i'he Disclosure Statement, Buyer: Daf e: Buyer:. Dale: Parle of., . In'Trials Date ProperS' Address Buyar'$ Irdtials Da~e 06-4229 (?~OI) REC/MLS, Inc. Forms ,Mv~s~y Group (7) 01/22/0~ 16:35 F,~[ 907 27~ ~440 PRUDE~'TIAL VISTA REAL ES ~]007 ~ $ 89'55'00" W · R ; ; R = 50 ~ ~',,'u i*. ~'cs:~ "~ i ~ t = J6.14 ~,,_~-""'*¢~u~>~"ol'r~=~', t =.21.42 · ' ~,-.__, .- .--* .-' ,._~*. .~o ~ :o 25,7~7 I I / ," : : / ~i . ~-.~ '-- ~' ' ~,,*, ,~=~ ~' .- ~.~ .... ~ ~ -. ~ I ., ~1 ,':~ . .l .~. ~ : ., ~.',~-uc~, ~ ~ . : I . -"""""~ '' ~""~"~x "~ ~ : IT IS rile RESPONSI~UTY OF THE OWNER TO DETERMINE TH~ISTENC~ OF ~E~SEMENTS. J COVENANTS, OR RESTRICTIONE WHICH DO NOY APPg4R ON TH~ RECORDED SUBDIVISION'PL4T. I UNDE~ HO CIRCUMSTANCES SHOULD 4NY.D~T~ ~REON BE USeD FOR CONSTRUCTION OR FOR ESTaBLISHInG BOUNO4RY OR FENCE LINES, 45-EC~'L T CER~Ca TE. ' I HE~ESF CERTIFY THAT I HAVE 5URVErED.THE FOLLOWING ~[SCRISED ~ROPER~Y: JND r~r ~0 C~CRO~CH~NE~ EXiSt ExCEPt ~ I~OlC4r&O. 01-28-0:~ 13:54 FROU-.CT&E ENVIRON~NTAL SRV '~'~K. ' CT&E Environmental Services Inc. 9075515301 T-533 P.02/03 F-578 CT&IE Ref.# Client l~ame Project Name/# Client Sample 1D Matrix 1030475001 AK Water & Wastcwater Consultants Inc. Day Dot 13 Drinking Water All Dates/Times are Alaska Standard Time Printed Date/Time 01/28/2003 9:52 Collected Date/Time 01/24/2003 15:35 Received Date/Time 01/24/2003 16:00 Technlca, D ir e c t o r~..~ e p.h~.~.~ Sampte Remarks: Allowlhle Prep Analysis Parameter R.,-st~lts ?QL Units Method Limits Date Date Init t'/a ~ers Depatrl:mtsnl: Nitxatc-N 2.46 0.200 mg/L EPA 300.0 (<=10) 01/25/03 JS laicz'obiolo!Iy I, aboratox'y Total Coliform 0 col/100mL SMI8 9222B 01/24/03 KAP ; D.. '] RECEIVED INSPECTION'APPOINTMENTS ITiME ~ TIME . -' TIME MUNICIPALITY OF ANCHORAGE ~lCl~U~ ~ ~O~ DEPAR~ENT OF HEALTH & ENVIRONMENTAL PROTECTION ~. O~ H~TH REQUEST FOR ~PROVAL OF INDIVIDUAL WATER AND SEW DtREC~: Co~ete ~1 ~rts on p~ 1. I~1~ ~a ~11 ~ ~ pr~. fi~ altow ten (10) ~VS for pr~ing. 1. PROPERTY ~NER PROPERTY RESIDENT Ill di~fenl from ~o~ z .... ( PHONE 3. LENDING INSTIT~ION PHONE M~LING A~O E~ % 4~ R~LT~ENT _ TYPE OF R~IDENCE ~ NUMBER OF BEDROO~ . ~ One ~ Four ~ Other ~ Two ~ Five ~ Three ~ Six '~ SINGLE FAMILY I--I MULTIPLE FAMILY WATER ~UI~LY INDIVIDUAL· COMMUNITY r-I PUBLIC UTILITY · ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that del;e, give well depth (attach log if available.) /~/~_~._~ ~ ,~DTf-e~"~ [] PUBLIC UTILITY ( ./~,~ 10 ~'-/-- O / , THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE '~ SINGLE FAMILY [--I MULTIPLE FAMILY 2. WATER SUPPLY INDIVIDUAL [] COMMUNITY [] PUBLIC UTI LITY Connection Verifiad 3. SEWAGE DISPOSAL SYSTEM I'--IINOIVIDUAL/ON -SITE [] PUBLIC UTI LITY Connection Verifiad []Septic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: NUMBER OF BEDROOMS [] ONE [] THREE ~ FIVE [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER D.ATE INSTALLED iNSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL A~SORPTION AREA 4. DISTANCES WELL TO: MATERIAL Septic/Holding Tank IAbsorption Area ISewer Line Lot OTHER Line 5. COMMENTS PNRoOVED FOR '-~ BEDROOMS, ITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE