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Home My WebLink AboutDEARMOUN VINEYARDS LT 1MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion?;;<HV No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. 018 395 05 DEARMOUN VINEYARDS 1 MOSESIAN FARMS OF ALASKA INC 13700 SPECKING ROAD ANCHORAGE, AK 99515 4119 04 19 2023 100 A.Y. MCDONALD 23075V3LB .75 14 MARTINSON PELLETS ANCHORAGE WELL & PUMP SERVICE 7640 KING STREET ANCHORAGE AK 99518 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201082 PID Number: 018-395-05 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name . Mosesian Farms of Alaska Inc. ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 3025 DeArmoun Rd. Anch., AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 907-447-8029 4 Existing GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot DeArmoun Vineyards 1 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well >100' N/A N/A N/A >25' TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity 1,250 Gal. Surface Water >1 N/A N/A N/AGreer Material Number of compartments Lot Line >5' N/A N/A N/A NA Plastic 2 Foundation >1 0' N/A N/A N/A LIFT STATION Manufacturer Capacity Gal. Remarks Tank only replaced under this permit. Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield Installer Wilco Contractors Drainfield N/A CO/MTD3034 Inspector L. Tidwell BENCH MARK (Assumed elevation) 100 ft Inspection �5t 5/6/20 Location and description dates: 2 tthh Top of Block Foundation at FCO 3rd 4 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp I'll r4r, OF- Conditional Conditional Approval: Date �'` •'��® 49th ®................ ......................... . d'•, MICHAEL E. ANDERSON �, '° No. CE-4381 ,• �® `+�''••. Septic System Approved Date 5/30/19 >°•'` r v#4OS� FES S Note: this approval does not include well permit requirements. 44t (Kev uo/uz/-I 25) O/E O/E O/E O/E 6' ARTERIAL LANDSCAPE EASEMENT FCO 100500 FEET 1"=50' 4-BDRM HOME DECOMMISSIONED EXISTING SEPTIC TANK IN PLACE PER MOA CODE CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND 2CO PERMIT # OSP201082 PID # 018-395-05 DE'ARMOUN VINEYARDS, LOT 1 A B DE'ARMOUN ROAD 5/30/20SABINE STREETG A R A G E GREEN HOUSEW/ SONO-TUBE FOUNDATIONGREEN HOUSE GREEN HOUSE 20' T&E EASEMENT 10' T&E EASEMENT10' T&E EASEMENTEXISTING WELL 1250-GAL SEPTIC TANK WITH 20" MANWAY. EXISTING ABSORPTION TRENCH EXISTING WELL A B CO1 40.47 MH1 42.4 SV1 47.36 2CO 49.16 23.76 26.28 28.5 29.92 PLAN AS-BUILT SV1 MH CO1 PROFILE AS-BUILT (NO SCALE) 91.6 86.1 91.9 97.85FCOMH1 SV1PERMIT # OSP201082 PID # 018-395-05 DE'ARMOUN VINEYARDS, LOT 1 5/28/2020 1,250 GAL SEPTIC TANK 2CO91.5CO1 10' EASEME DEARMOUN ROAD PLOT PLAN --- AS BUILT -X_ SCALE _1_--50-- GRID _ SW 2934Project No. -__20=2901A1____ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 0000OppO (907) 522-4625 Fax oQ Professional Land Surveyors kenOlangsurvey.com o !� ./ 9 lonothanOlonasurvev.com O ry I hereby certify that I hove surveyed the following described property: LOT 1, DEARMOUN VINEYARDS SUBDIVISION (PLAT No. 2016-77) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the __ _ Day of ------------- ?-91E , at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. '* 49TH A,..•.• KENNETH NG ..•.o 049Fo' �..LS-5202.• cJOG aR NOo 4\ZOFfSSIONAL �o AECC963 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 - 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201082 Work Type: SepticTank Upgrade Tax Code Number: 01839505000 Site Legal Address: DEARMOUN VINEYARDS LT 1 G:2934 Site Mailing Address: 3021 DE ARMOUN RD, Anchorage Owner: MOSESIAN FARMS OF ALASKA INC Design Engineer: FORGE ENGINEERING This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date ent Department 4/30/2020 4/30/2021 Lot Size in Sq Ft: 60008 Total Bedrooms: 4 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: L/' Date:'v _ l 'q Z30 X020 Issued By:Date: J M AS ffy MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 018-395-05 Property owner(s) Mosesian Farms of Alaska Inc. Day phone 441-8029 Mailing address 13700 Specking Road, Anchorage, AK 99515-4119 Site address 3025 DeArmoun Rd Legal description (Sub'd., Block & Lot) DeArmoun Vineyards L1 Legal description (Township, Range & Section) Lot Size 60,008 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank INUpgrade RXDuplex (D) ❑ Holding Tank ❑ Renewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: �3U1aUaD Receipt Number: (on Permit No. 65 P 2 616 22 Waiver Fees: Date of Payment: Receipt Number: Waiver No. COVID-1 9 Permit App__- : : .. c 259'0 DISCOUNT APPLIED PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) April 30, 2020 MOA Development Services Department On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: DeArmoun Vineyards lot 1 – 3025 DeArmoun Road Septic System Design Dear On-Site Services Engineer: The septic tank serving the 4-bedroom home on the property has collapsed and must be replaced immediately to prevent damage to the property and to prevent a health hazard. We are submitting this request for an emergency tank replacement permit and an expedited review. The attached site plan identifies the location of the home and the well, septic location and proposed septic tank site. No conflicts exist between this proposed site and any other well or septic system on this lot or adjacent lots. Wells on this and adjacent lots are shown. The new tank will be a minimum of 100’ from all wells and surface water, and more than 10 feet away from any permanent foundation. The greenhouse located near the proposed site is supported every 12 feet by concrete sono-tubes, and the proposed site is more than 5’ away from any of these supports. Please refer plan sheet for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, PE 4/30/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201082, Rebecca Carroll, 04/30/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201082, Rebecca Carroll, 04/30/20 NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON~ITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDRESS LEGAL DESCRIPTION LoT Iic1¢, LO~ATION DISTANCE TO: IWell Liq. capacity in 0allons I I~O IF HOME.DE: DISTANCE TO: ~ Well ~Z O Z ~ Manufacturer --Q-- ~ Well No. of linesj Length of each line ~ ~ Top of tile to finish grade Length Width Type of crib Crib diameter Well DISTANCE TO: Class Depth DISTANCE TO: Building foundation PHONE I r"~NEW ~q~-~5~ [~UPGRADE FLA'FToP VI E~ ~,, ~-c. I Abs°rpti°n~aR Inside length Dwel ing Foundatio~=~ Depth Crib depth Building foundation Driller Sewer line Dwelling Ma~.erial_ ~'T'~-~L Width NO. OF BEDR~MS PERMIT NO. ~ ¥o9 o_~ No. of comp.~t~) Liquid depth PERMIT NO. Material Liquid capacity in gallons Nearest lot line Trench width PERMITAOq Oq Distance between lines inches Total effective absorPtion PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line Septic tank PERMIT NO. Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS .;"~; oF. ~/"~xt, ',5,;,'. APPROVED ~'u ~,~ ~ ~ DATE 72-013 (Rev. 3/78) LEGAL Fk#,,r ?- PERMIT NO: · DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: MUNICIpALIT~Z OF' ANC~-M'~!RAGE DEPARTMENT, u HEALTH AND ENVIRONMENTAL ..(OTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 OI~I--SITF. SEWER 840905 1~/=~/84 BROCK SHAMBERG P 0 BOX 110788 ANCHORAGE, AK 545-5855 99511 LEGAL DEScRIP: ' SUBDIVISION: FLATTOP~VIEW LOT: 11 & 12 SECTION: 28 TOWNSHIP: 12N RANGE: 5W LOT SIZE: 28000 (SQ.FT. OR.ACRES) LOT LOCATION: HOUSE IS SITUATED ON LOT LINE BETW 11/.12 MAX BEDROOMS: 5 BLOCK: 1 Listed below are the options available to you in designing your septic system. Choose the option that best fits your site.~ TRENCI-! BED W. DRA DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4.0 GRAVEL DEPTH .(FT.) 5.0 0.5 5.5 TOTAL DEPTH (FT.) 9.0 4.5 7.5 GRAVEL WIDTH (FT.) 2.5 19~0 5.0 GRAVEL LENGTH (FT.) 45.0 56.0, . 49.0 · GRAVEL VOLUME (CU.YDS.) 25.0 25.4 · 56.5 TANK SIZE (GALS) ~-~4,~-~J~ '1,000.0 ** 1~000.0.** 1,000.0 ** SOIL RATING (SQ.FT./BR) 150 150 150 · ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1. I am familiar with the requirements~ fo~ on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 5. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 5-bedrooms and any enlargement 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-BUILdS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (5) THE A LICENSED ELECTRICIAN. ELECTRICAL WORt.{ MUST BE .DONE/~Y APPL I CANT~_ROCK ~AMBERG" ISSUED BY ~ ~ DATE~ DATE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264~,720 SOILS LOG - PERCOLATION TEST SOILS LOG ~ PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: L~F1 k (:~_-r 1- 2- 3- 4- 5- 6- 7- 8- 9- SLOPE S I LT'~ ~AN b DATE PERFORMED= I~ 'Z~. ~ q SITE PLAN 10- 11- 12- 13- WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 14- 15- 17 - '"'; % i-' ...... 'J. t; .~' .';. ^ ,:.. . COMMENTS , Gross Reading Date Time I:t~ Net Depth to Net Time Water Drop PERCOLATION RATE ~ t~) (minutes/inch) TEST RUN BETWEEN 7 FT AND X ~' FT 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264~t720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: ~C)(.V Cot4AH~F---~ LEGAL DESCRIPTION: LoT Iici.q, g'LATTo'P ~/IE~ SLOPE SITE PLAN 2- HI- 3 F/Hr= 15o WAS ORO~.D.ATER ENCOUNTERED~ N 0 IF YES, AT WHAT DEPTH? 7 ! $ p _.. E 14- 15 - ,....,~-'"~7~ 18-9.~. N~2225-E ~ ~)'. JUN[ 20 - - ~' ' Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN COMMENTS PERFORMED BY: ~ ~ CERTIFIED BY: FT AND FT 72-008 16/79) Box 1369, J~TAR ROUTE ~J. A~'CHORAGE, .dkLAI~KA 99502 3,14-??14 SlX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF DRILLED AT THE RATE OF PROPERTY OWNER LOCATION OF WELL SIT~ DRILLER WELL LOG: $20.00 PER FOOT. 7',/..o Ud Bt. mm. 18--"~9' 49---70 70---74 70 7ee,t.. $1400.00 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF THANK YOU VERY MUCH. DAT~ BERNIE CLAUS OF RAMPART DRILLING WORKS SERVICE CHARGEOF I~% PER MONTH WILL B~E ASSESSED ON PAST DUE ACCOUNTS. PERMIT NO. APPL I ~ANT LOCAT I ON LEGAL DEPRRTMENT ! }HERLTH AND ENVIRONMENTAL! ,iOTECTION 825 '-L~ STREET, RNCHORRGE, AK. 9950& 264-4?20 [4ELL PEEr4 I T FLOYD BRAUN DERRMOUN RD BOX 10iS1 SO. STRTION__Ii L li i2 BK. ~ FLRT TOP VIEH LOT SIZE~ ~44-9824 40000 SQUARE FEET MINIMUM DISTANCE BETHEEN R HELL AND ANY ON-SITE SEHRGE DISPOSAL SYSTEM 100 FEET FOR A PRIVATE HELL OR 150 TO 200 FEET FROM A PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC HELL MINIMUM DISTANCE FROM R PRIVATE HELL TO R PRIVATE SEHER LINE IS 25 FEET AND TO R COMMUNITY SEHER LINE IS ?5 FEET. HELL LOGS RRE REQUIRED AND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DAYS OF THE HELL COMPLETION. OTHER REQUIREMENTS MRY RPPLY. SPECIFICATIONS AND CONSTRUCTION DIRGRRMS ARE AVAILABLE TO INSURE PROPER INSTRLLRTION. PERr~I I T E×P I I~E$ DECEr~IBER ~::1 .. I DE:El I CERTIFY THAT 1: I AM FAMILIAR HITH THE REQUIREMENTS FOR ON-SITE SEHERS AND HELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I HILL INSTALL THE SYSTE~IN ACCORDANCE HITH THE CODES. SIGNED: ' pRp . . ISSUED BY__~2 .............. DRTE_Z/~! i- 9 O V4. 0 MUNICIPALITY OF ANCRORA~'E DIVISION OF ENVIRONM~-NTAL REALTH DEPARTMENT OF ~..a. LTR AN~ ~.NVIRON~fl~NTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE General Information Application Date (a) Legal Description (include lot, block, ,}u. bdivtsionI section, township, range.) Location (address or directions) (b) Applicants Name ~/'~-~ C~//~ Telephone - Home Applicants Address ~,~.- ///~) Business -~¥~-~'~.~, (c) Applicant is (check. one) Lending Institution ~-~\; Owner/bai-l~er ~--~; Buyer ~-~; Ocher ~-~ (explain); (d) Lending Institution ~/~ ~ ~ Address ~. (~). ~t~/~ 7~0 ~e~/~ (e) Real Es~a~e ~. & Asenc ~~ (f) Address Telephone Hail the HAA to the following address: 2. Type of Residence Single-Family..~. Number of Bedrooms 3. Water Supply Individual Well.,~. Multi-Family~--~ Ocher (describe) .CommtmiL-y~'~' PublicJ-~ Note: If community well system, must have written confirmation from the State Department of Environmental Co~servation attesting to the legality and status. Sewage Disposal Onsite ~ Public ~-~ Community ~ Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] Engineering Firm Providing Inspections, Tests, File Search, Data and Information e As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, 'b~sed 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 regula- tions in effect on the date of this inspection. Name of Firm ~, ~,u,'~[~.~' F~ Telephone ~7~-~/f= Address ~ '~ ~" / ~-~ DHEP Approval Approved for ~)u~(4z~ bedrooms Approve~' X- Disapproved Terms ~f Condi%ional Approval Cor~titional CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF flEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES ~LTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY A~N INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL EMGINEER'S WORK. (DHEP SEAL) RR4/eJ/D18 [Page 2 of 2] 7-19-84 A. hELL E~TA Be MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AU1MORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 Legal Description: ~01'11C c. Well Classification Well Log Present (Y/N) Total Dspth Cased to Static Water Level Casing Height Above Ground Electrical WirinG in Conduit (Y/N) Separation Distances f~cm Wall: To Septic/HoldinG Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line C leanout/Manhole Water Sample Collected By Water Sample Test Besults C~m~tS If A, B, cr C, D.E.C. Approved(Y/N) Date Ccmpleted Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Standpipes (Y/N) Depression over Tank (Y/N) siz~ I ~O No. of Ca~parUmnts T~D Air-tight Caps (Y/N))f Foundation Cleanout (Y/N) ~F ~ Date !~t Pumped N ~- %~/ Pumping/Maintermnce Contract on File (Y/N)~/~ ; for Holding Tank High-Water Alarm (Y/N) ~f/~ Temporary Holding Tank Permit (Y/N) Separation Distances frcm Septic/Holding Tank: To Water-Supply Well IO~::) To P~c~erty Line To Water Main/Service Line cou~ N~ Cca~nts To Building Foundation ~.S To Disposal Field I 0 TO Stream, Pond, Lake, or Major Drainage Receipt % ~0 -;~ f~ Date Paid: /o- ~- 6{ Amount: t/.~ ~_~ [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date IP-~talled Illl~~ Width of Field ~'! Square Feet of Absorption A~ea Depression over Field (Y/N) ~%~O Results of Last ~quacy ~st Separation Distance frcm Absorption Field: Type of System Desi~gn Length of Field ~ Depth of Field /~ Gravel Bed Thickness q I Standpipes Present (Y/N) Date of Last Adequacy Test I,t7 ; On Adjoining Lots NO}q~' NoNI=:- To Cutbank(if p~esent) To ~ater-Supply W~ll To Building Foundation Lot ~O To Water Main/Service Line To St~eam/Pond/Lake/or Major Drainage Course To Driveway, Pa~king A=ea, or Vehicle Storage A=ea C~m~nts To Property Line /O To Existing or Abandoned System cn De s , TZON oN Date Installed Siz~ in Gallcns "P~,%) On" Level at High ~ater Alarm Level at Tested for Electrical Codes(Y/N) Cc~m~nts . .Manhole/A~ess (Y/N) · "Pump Off" Level at Vent (Y/N) Pumping Cycles ~,-ing Adequacy Test. Iqee ts MOA ** ** Check Permitted Bedroom Rating AGainst HAA Request I certify that I have ~hecked, verified, or confc~msd to all MOA HAA Guidelines in effect on t~e date of this inspection. sig d Ccmpany MOA No. KB1/d5/s [Page 2 of 2] 2-15-84 MUNICIPALITY OF ~2~CHORAGE DIVISION OF ENVIRON}rENTAL HEALTH DEPARTMENT OF N~ALTH AND Eh'VIROM~fENTAL PROTECTION APPLICATION FOR ~LTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ~0.~.~ (a) Legal Descr. iption (include lot, block, suSdivision, section, township, range) LesT' Il I t/ (b) Location (address or directions) Applicants Name ~&~-N ~f~ Applicants ~dress ~0. //0 7~ (c) Appliqant is (check one) Lending Institution Buyer~-~; Other~(explain); (e) Real Estate Co. & Agent ~0~ Telephone - Home Business Telephone ~. ~ ~ - ~ ~'f~ Address Telephone (f) f~il the HAA to the following address: 2. Type of Residence Single-Family,~ Number of Bedrooms 3. Wate~ Supply' Individual Well~-~ Hulti-Family~--~ Other (describe) Community ~-~ Public['--'-[ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Sewage Disposal Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] -. Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the fhnicipality of Anchorage files and from my investigation and inspection, the on-site %rater supply and/or %rastewater'disposal system is in compliance with all Municipal and State codes, ordinances, and regula- ttons in effect on the date of this inspection. DHEP Approval A~J~tY~ for-/~-~7{~/ bedrooms Telephone ".?' (~NC~ S~) ;/..~.Z.; .......... '~. ? . i.', ,~. .' ...~ Approved Disapproved -- Con~ttto'n~ ~' CAIrr I01I THE MUNICIPALITY OF ANCHORAGE DEPARTMEMT OF ~ALTH AND ENVIRONmeNTAL PROTECTION (DHEP) ISSUES h-FALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE P~PRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIO~kL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES ~ND T}~IR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL ~ND STATE REQULRE- MENTS. EMPLOYEES OF DHEP DO NOT CO}~UCT INSPECTIONS OR ~NALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHOP~GE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS. IN THE PROFESSIONAL ENGI}~ER'S WORK. RR4/eJ/D18 [Page 2 of 2] (DHEP SEAL) 7-19-84 A. ~ELL ~%TA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: Well Classification ~ .~. If A, B, Cr C, D.E.C. Approved(Y/N) ~//% ~ S~tic ~te~ ~1 ~,~ ~ ~t At Casing ~ight ~ Gr~nd ~ o '~ Sanit~y ~al ~ ~si~ (Y~) ~ Elec~i~l ~ri~ in ~it (Y~) ~ ~essi~ ~nd ~l~ad (Y~) ~ ~p~ation Dista~s ~ ~11: To ~ptic~oldi~ Ta~ ~ ~t To ~a~st ~ of ~ption Field ~ ~t To ~st ~blic ~r Li~ ~ 0 ~ C~an~t~le ~b ~ ~ ~est ~r ~=vi~ Li~ ~ ~t Wate~ S~le ~lle~d ~ ~ A ~; ~te ~O. 2.~ ~ ~ On Adjoining Lots ~0~4~-- I OO + ; On Adjoining Lots To Nearest Public Sewer Be Date Installed Size No. of Compartments Standpipes (Y/N) Air-tight Caps (Y/N) Foundation Cleancut (Y/N) Dap=ession over Tank (Y/N) Date Last Pumped Pumping/Mainter~nce Contract on File (Y/N) ; fo= Holding Tank High-Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances f~cm Septic/Holding Tank: To Water-Supply W~ll To Building Foundation To Property Lins To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, cr Major Drainage Course Receipt # Date Paid: Amount: q ~.OC} [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD E~TA Soils Rating in Absorpticn Strata Date Installed Width of Field Square Feet of Absorption A~ea Depression over Field (Y/N) Results' of Lest Adequacy Test Type cf System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes P~esent (Y/N) Date of Lest Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To P~cperty Line To Existirg or Abandoned System = On Adjoining Lots To Cutbark(if p~esent) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking A~ea, or Vehicle Storage A~ea Cc~ments D. LIFT STATION · Date Installed Size in Gallons "P~-,~ On" Level at High Water Alarm I~vel at Tested for Electrical Codes(Y/N) Din~nsions , . Manhole/Access (Y/N). "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy ~cts MDA ** Check Permitted Bedrocm Rating AGainst HAA Request I certify t~lat I have checked, ~rified, or oonfor~d to all MOA HAA Guidelines in effect on the date of this inspection. MOA No. eq&F-O'~ ENGINEERS SEAL KB1/d5/s [Page 2 of 2] 2-15-84 CONSULTING ENGINEER ~ ;, c~ ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 BROCK SHUMBER P.O.BOX 11078 ANCHORAGE, ALASKA 99511 OCTOBER 6,1984 LEGAL Lot 11 & 12, Block 1, Flattop View. LOCATION O~NER Brock 6humberg, Glenn Shier TYPE OF WELL WEL~ hO~ avalXable ~0 XNSTALLATXON P~OUX~_._~ENTS HET Yea WE~ Y~D ~OH~ELL L~ DnT~ OF TEST October 3, 1984 TEST PROCEDURE On October 3 the veil vas pumped at a rate of 6.5 ~pm. £or a total time of 105 minutes. & total of 605 gallons was pumped. TEST FOR COLXPOmtS The we11 water was tested for Colifo_r~__ on October 3, 1984. Teat was negative. TEST RESULT .,~. ,.~ ..' . ~ -..~_ ~j?g-.. .. t~.~. ~,,,. ~ The Nunicipal requirement for welXflow ia 150 gal. per bedroom per day. This · he aIlelsment O[ the condition of this ~11 applies onl~ to the conditions as of this ~ateo The flo~ rate of the veil may cha~ge due to subsurface conditions that may not be observed from the sur- face,, c_~__~_nges in land uae and other fecto~ that may 4~.act the conditions of tho aquifer feeding the ~ell. CONSULTING ENGINEER 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 BROCK SHUMBERG P.O,BOX 110788 ANCHORAGE, ALASKA 99511 OCTOBER 8, 1984 LEGAL LOCATION OWNER RESIDENCE WATER SYSTEM SEPTXC SYSTEM DATE OF TEST TEST PROCEDURE LOT 11 7 12, BLOCK 1, FLATTOP VIEW ON DEARMOUN BROCK SHU~BERG, GLENN SHIER SINGLE FAHILY, THREE BEDROOMS ON SITE WELL FROM HUNXCIPAL RECORDSs TANKs 1250 gal. Unknown material, ABSORPTION SYSTEH: Deep trench, 55 feet long, reck depth unknown. ABSORPTION A~s Unknown.. SOIL RATINGs Unknown XNSTALLATXON DATEr Unknown 10/3/84 Drainfield was charged with water at a steady rate of 6,5 gpm. At the beginning of the test a water depth of 58 Inches was measured the attn.,After adding 30 gallons the depth was 69 inches and water could be heard flowing into the tank. The t~nk was pumped on October.3, 1984. This system does not meet the requLrements'of the MunicipaLity of Anchorage as of the 'day the system was tested. The trench is obviousX~ fuXX and can not ~ccept any fXow of waste without causing wastewater to back up into the tank. It was also noted that the tank is 90 feet distant from the well. The required distance is 100 feet. The absorption trench must be replaced.. In .order to obtain a Hunicipal Pe~,~tt a testhole to detez~n_.~ne the type of soils on the lot must be dug. The Municipality .)may also rec/uL,'e that the septic tank,be moved .X0 feet to obtain the required distance to the well. I; / . ~J,/~-' ,~TE RECEIVED INSPECTION AP~INTMENT~ TIME ~ ~ TIME DATE N ~ ~ DATE MUNICIPALITY OF ANCHORAGE ~UNICIPALI~ OF AN~O~GE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPt. OF HEALTH & 825 L Str~ - A~horam, Alike REQUEST FOR APPROVAL OF INDIVIDUAL WATE~ AN~ SEW I TIME DATE INSPECTOR DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be proeesa~d. Please allow ten (10) days for processing. 1. PROPERTY OWNER MAILING ADDR'ESS PROPERTY RESIDENT III different from above) P. .t4 n~ >7,,t · 2. BUYE/~ 3. LENDING INSTITUTION . MAILING ADDRESS 4. REALTOR/AGENT MAILING ADDRESS PHONE PHONE PHONE PHONE PHONE 5. LEGAL DESCRIPTION L,'. /6/~, ~1 ! STREET LOCATION 6. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER S~I~PLY [~' INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY 8. SEWAGE DISPOSAL SYSTEM [~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY NUMBER OF~BEDROOMS [--] One [] Four [] Other [] Two E] Five ~ Three [] Six ' * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) c~/~X ~/~2~'/ YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010 (Rev. 6/79) [ 'I;.................~ ~ ..... ~~4/,b.,.~/~-. ~/~/ ~'; r.~. (,~_. 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY THIS SIDE FOR OFFICIAL USE ONLY ~ NUMBER OF BEDROOMS [] ONE [] THREE 1--1 FIVE [] TWO [] FOUR t-'l SiX [] OTHER 2. WATER SUPPLY [] INDIVIDUAL · [] COMMUNITY [] PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DR! LLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified I--ISeptic Tank or [] Holding Tank Size: give dimensions: TYPE OF TANK PERMIT NUMBER DATE INSTALLED INSTALLER If Tank is homemade SOILS RATING MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: Absorption Area to nearest Lot Line Septic/Holding Tank IAbsorption Area ISewer Line INearest Lot Line 5. COMMENTS J-~PPROVED FOR 3 BEDROOM~) [~CONDITIONAL APPROVAL (letter must ~Cc~/npany certificate) [] DISAPPROVED 72-010 (Rev. 6/79) CI¥1L - ~iTRUCTURAL ~/~.E CTR I ~A L M E C HA N I L/"'~ LAND BURVEYINra DATE TECTONICS INCORPORATED ENGINEERS & SURVEYORS SEPTIC SYSTEM ADEQUACY TEST October 31, 1980 S- 106 BOX CLIENT: Name Floyd Braun Address Box lO181 South Station Anchorage, AK 99511 LEGAL DESCRIPTION: SEPTIC TANK: Material Type Unknown Size 1250 gallons Number Bedrooms Surcharge Test ~00 Rate of percolation' Lots ll & 12, Block l, Flat Top View Subdivision LEACH PIT: Telephone 344-9824 3,000 DRAIN FIELD: 55'+ between inspection pipes Required Tank Size 1250 gal. gal. water; 0.80 (150 x No. bedrooms) min. gal./day 4-2265 ANCHORAGE, System functional and adequate. ALASKA cut just east of leach field. Sludge condition, in tank: None (pumped 10/23/80, tank volume recorded) Remarks: 400-ga). surcharge dissipated completely within 2 hours, 25 minutes. Excellent sandy gravelly soil exposed in road ANCHORAGE CESSPOOL PUMPING Star Route A. Box ]44 ANCHORAGE. ALASKA 99502 Phone 344-2632 or 344-2453