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HomeMy WebLinkAboutMYRNA MAE LT 3AMyrna Mae Lot 3A #018-192-39 MUNICIPALITY OF ANCHORAGE DEF�TMENT OF HEALTH AND HUMAN SERFS Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES Add.ess FBOM TO SEPTIC ABSORPTION WELL lAle- �J f,! TANK FIELDIELD /%t! /%L• Phone's) ln,ma No No of EILO�pomIs '57el WELL LEGAL DESCRIPTION LOT LINE Lot block SUDWvIs.00 .3 �ia h A E FOUNDATION Township. Range. Section 7-iz,' `J _:ZZ,AS-BUILT DIAGRAM (Show location of well. septic system, property tines. loundation. 33 tluvewaywaler bodies. BIC I TANKS `> SEPTIC ❑ HOLDING w- klanulauurer Capacny.n gallons b PeZ/: 75'0 k1wehiR No of compartments TYPE OF SYSTEM 'TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Lellh to lapis WItom from Total Tiepin from Oog,ndl graue ol.grnal graao S•a FT 1A FT Fin added al oeg.nal gleoc Glavel oL•plh oenewh pipe -E�- FT (�•� FT G ©va icnga. Glavin wimp 90 FT 3 FT - Iota,ahsorptionareal I Distance oowcrn tines v /10L SO FTJ FT NumtN•r W .nes Snurating pipe male".' * •� ee4 y93 SO FT r&gA bio; Is y tom. Y mitanr• 7-1s/ Dale Installed Z WELLS ' PRIVATE ❑ OTHER (Identifvl L.asvlicdimn IA.N CI 1 old. laL•pmCased to E /rY�y FT FT inslau.-I Dale mslanea � .. REMARKS: [[14-t4 G' Scale: /JT3 /7A ii/d101_,t,V Inspections performed by A� [4 -.IJ; Sit %M/KA 10,411- JJA& T aA-6*lle - en1P L/n)P Date /o ek,JG �i[[,ayci.6as Fc'Fi a-. Aai Lfltcl y... C'r/ f /_77177--�aXt Certify that this inspection was performed according w all Municipal and State guidelines in effect an this date: Health Department Approval:. S�"r 'a' Dale. a ENGINEERS SEAL Gl n 'r•IU1\1 3: C 1 1='►aL 1: 1-V OI= saI'll C1-IL]1'.fllc:E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 020 L STREET, ANCHORAGE, Ak. 99501 264-472h Ohl—S I -TE IEE S.11=fes r'L.RP1I'T NO: 0370170 UPGRADE DOVE: ISSUED: 01/14/87 iii-'F'L.I CAI I r: ST ` -"EVA FERREL APUREWT: 2621 E 144TIl ANCHORAGE, A; 99016 P (ONI ACT PIONTI: 04t-1172 ar.q i'•ae�r ��-t�� ILBOL DESCRIP: SUBDIVISION: MYRNA MAF o LOT: BLOCK: NA SECTION: 31 TOWNSHIP: 122 RANGE: :W LIF nlZE 27125 (SU.FT. ON ACRES) I certify that: I. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. I will install the system in accordance with all MOA codes and regulations, and in compliance; with the design criteria of this permit. Z. I will adhere to all MOA and State of Alaska requirements for the set back: dista"ces from any existing well, wastewater disposal system or public ::eaw-rage system on this or any adjacent or nearby lot.. TF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA DUILDING CODES, THFEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST HE OBTAINED; (2) AS-DUILTS WILL NOV BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE. I I.F(:IFiICAL WOrik:. MUG] BE DO E BY LICENSED ELECTRICIAN. SIGNEU A!1'L1CANI: S "'JF Id� It 1_rtr.r_L I'3SULP EY no. DATE: " A AV Net Time Depth to Warr • ••... ACAAr '•.;f' E 9 / a-Iifs J• NUJ 1.7—.S ./3 Municipality of Anchorage 04* 00 ••••• •• •� *• DEPARTMENT OF HEALTH & HUMAN SERVICES / ,GIs - lits Se Arw 825 "L" Street. Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST i, •• 1�• " Y !REID, JR. 2251 PERFORMED FOR: �1r FE"4C44- DATE PERFORME4m�y-L-r//' LEGAL DESCRIPTION: 40'i3 517,6✓// %A4` Township, Range, Section: 7r��%� �7�I r ACCT IF E E T I -ro', SO ?/- 2- 3- L 1 2 = .a .. 3 �}.:...` Sp- 6,Y.Wttc7/ y�./E /So' 4- 56 5- 6-0 7- 8-0 9 10 it 12 13- 1111 14 15- 16-8 e-4 17 T1 18 19 011 IN,-/ 11l•/ "AWL WAS GROUND WATER /D. ENCOUNTERED] /V IF YES. AT WHAT DEPTH? DeP Y Water Mar b -v Oa1e Reading Dau Grow T'km Net Time Depth to Warr Not Drop e /• &41-417 / a-Iifs J• NUJ 1.7—.S ./3 Z• /ill. -/61.1- 541 w7— .67— . a .O f. ,GIs - lits Se Arw .47—•S9 oa 20 3/.if 6~ PERCOLATION RATE (m�nutes�entn) PERC HOLE DIAMETER ����'' TEST RUN BETWEEN r FT AND 8'S FT COMMENTS fOrL ?'�' IST' 2fo IrAmm cr, r T. !r Te /6 r, PERFORMED BY: AFGs 4. A111A00' 1 ��` • �i�. CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4,85) e�, Municipality of Anchorage DEPARTMENT OF HEALTH 6 HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST Ar PERFORMED FOR: 571v✓E Ft/E_.�"�" DA LEGAL DESCRIPTION: GOTS fr14 lois Township, Range, Section: DEPTH �-�± (FEET) SOIL 2-111 01- 3- L3 1. tll o pT a, t,P4-JeU-/ .SAI& - /So d 5 • s bh 7 SrtTfl s�a/b/ tZW& 8 9 10 Not Time Net Drop WAS GROUND WATER tc ENCOUNTERED? 11 (.7 3 IF YES. AT WHAT 12 DEPTH? 13 Oepth to Water Mer �,/ �R✓ Monitoring? 14- is - 16 41516 ZAlb 17 Til 1Z- 1111- 19- 20 2-1111920 SLOPE SITE ■■■■n//1I■_■■■ 3 Reading Date Grou Time Not Time Net Drop tc 3e Hi/1 WDeWpthto (.7 3 N PERCOLATION RATE 7 3 (mmutemmch) PERC HOLE DIAMETER TEST RUN BETWEEN / • S FT AND 7 FT _ COMMENTS LeXL'�7. 7F3/ r,/7i5 .b/L /Y7 /VJ—1,0dyY• /.v -VWIJY af6 -77-rr tr¢ i� �T✓yFoP DEslb.✓. PERFORMED BY:Gf �•/F^r/I 4 -et -44L— CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE G -L1-97 72-M (Rev. 4,86) OF A4 q°e rw Q• S o Tor S 00.09 . ....... ...... . I� � r ...... ...... .� 1 OT C. REI;• JR. SII 0 .4 ••CE-2251•••'��i I � � wcrr I b 0 •C w P h A C.ASf I`( PrEcc '� L S O 3 � W . PI OJ 1<t re .r. AJ Al 44 C%/fTi,l/A 7WA/t/J %Pi9DStIJ 7�00z Septh � 1 I I . l�/6tF1� •1 I� 7 y h.L 7*0f I� _ lo' 7 I M M 6, /YY L4 RVe. M ,Llo D7�rC acus twavrieAkl 3e�c.d, mp0AA eW zifl 'Mr IWZ*+. Som ssO °" NDA A'JPsr z?3a ./y s13 D 117AArRlre-/ems) LEGEND uJE 7,rc%a iso b0rV S E,%A'L 0 LOT CORNERS A _ 7f•2S Ln✓F7lr� orSE 9✓� FOUNDATION OF A \11) CA3, -�— DRAINAGE ARROWS /A/JTrAiC tlV05,1 ✓WVC T° Lt'7 P.�E,....... � .• .,'f 9 e'kfSTi./b Tits./[/ YlST • 00' 9T * 0000 j* NOTES, 1. SMALL It THE RESPONSIBILITY TMK sru T. SC ✓rRrfisD Of THE BUILDER OR OWNER TO VERIFY THAT .. ., �•• •• •'•'• ...... / IT BUILDING LOCATION SHOWN ORDINANCt$. MEET$ ALL SUBDIVISION COVENANTS AND ZONING • ,:ti':. ... .,... .,�.� •• /f R;d:Ew��QQF. P;tts a t. IT It THE RESPONSIBILITY O/ THE GUILDER TO VERIFY ALL ELEVATION$ WITH RESPECT To ALL UTILITIES & 0"IM 6C• •, fes% N;• J71�'S Z. THIS PLAT REPRESENTS THE PARCEL 01 PROPERTY DESCRIBED BELOW TAKEN 7 t \ 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 OloGr 1 l L • beers PHONE 34 S ti 6,61 EJ NEW f!9iUPGRADE MAILING ADDRESS A box 4a28 LEGAL DESCRIPTION M rna Mac Subd• Lot 3 LOCATION 'DL. Armcion Fr0nt4i-9e Roo.A NO. OF BEDROOMS Uy DISTANCE TO: Well Absorption area Dwelling PEHMIT NO. EQ WF Manufacturer Material No. of compartments Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth y JV2 DISTANCE TO: Well Dwelling PERMIT NO. _ FQ- Manufacturer Material Liquid capacity in gallons 0= TO: Well Foundation Nearestbf line I PER 2$0DISTANCE 9 Zmw ;:Z W No.of lines [.. Len m of eacl[� line Z V Total I ngt of lines Trench width ?—A Inches Distance between lines Q f O Top of tile to finish grade u I Material beneath the GO inches Total el�°f/w, 5,abso tion area 4 5� W U Length Width Depth PERMIT NO. Q F- W d Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. W 3:D ISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER J e 1, PIPE MATERIALS P v (- SOILTEST RATING 1 So 0,/ bacm INSTALLER co.rl� E`i cav i(►� REMARKS C�faylcSt" $}and.Q (QG wea plated. Sp s9 0 os 4-D be rotectect- -(iZm Coss w6q.6% occas:ona(l ar1� or Iwun, y h APPROVED DATE �LEGAL Z I�—Jj Z MyYFIA MQG SJ%!d U;t J 72413 (Rev. 31781 TYPE OF SOIL ADSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL P.ATIN& CSCE FTIPP)= 180 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C•EF•TH S=+ L•Et4r3-r"== S4 C-; GF:Ff% EL C- I--- F•TH--= 4 THE LENGTH DIMEN'ION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIM FEET?. THERE I5 NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE COTTON OF THE EXCAVATION CIM FEET). F Er=!!_� I F:EC• = EF•T I G TFit,IF=:: S^ I Z!E- 2 :i CA r FILLrrf-a PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- Cl C I r-4! .F E:0 -r I Y--Ir-4 HRE !':E+_�1_1 I EE C+ --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND AP'P'ROVAL BY THIS DEPARTMENT HILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC: WELL DEFENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEINER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AwRILABLE TO INSURE PROPER INSTALLATION. F'EF:T•i I T FE:.: -4 r-- I F:E:E. C•ECEY'IE:EF: = 1: j_r"+ I CERTIFY THAT 1 I AM FAMILIAR. WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. L. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODE. _. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RE'=IDENCE IS P MODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED: -- ,,% �L�L'---"`SSSS-`-'P'� -----SSSS-- APPLICANT ROBERT L. BEERS ISSUED BY --- L�rY=-_DATE_ _Z_�� V4. El I r_ I , aL i TY OF nI'A F1 F;;:,.n 3E 9p DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION �^ 825 `L' STREET, ANCHORAGE, AK. 93501 264-4720 CA64--•ITE 0=E1•JEF: F•EF�-'t•1 I T PERMIT NO. C 820092 ) APPLICANT ROBERT L. BEERS EFTA BOX 4028 145-4695 LOCATION LEGA_ L2 MYRNA I4AE SfD LOT 'SIZE 37500 SQUARE FEET TYPE OF SOIL ADSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL P.ATIN& CSCE FTIPP)= 180 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C•EF•TH S=+ L•Et4r3-r"== S4 C-; GF:Ff% EL C- I--- F•TH--= 4 THE LENGTH DIMEN'ION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIM FEET?. THERE I5 NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE COTTON OF THE EXCAVATION CIM FEET). F Er=!!_� I F:EC• = EF•T I G TFit,IF=:: S^ I Z!E- 2 :i CA r FILLrrf-a PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- Cl C I r-4! .F E:0 -r I Y--Ir-4 HRE !':E+_�1_1 I EE C+ --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND AP'P'ROVAL BY THIS DEPARTMENT HILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC: WELL DEFENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEINER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AwRILABLE TO INSURE PROPER INSTALLATION. F'EF:T•i I T FE:.: -4 r-- I F:E:E. C•ECEY'IE:EF: = 1: j_r"+ I CERTIFY THAT 1 I AM FAMILIAR. WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. L. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODE. _. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RE'=IDENCE IS P MODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED: -- ,,% �L�L'---"`SSSS-`-'P'� -----SSSS-- APPLICANT ROBERT L. BEERS ISSUED BY --- L�rY=-_DATE_ _Z_�� V4. El GRE' -TER ANCHORAGE AREA BOr-""OUGH - CII5Y/, Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME S/��f-t /'�E/�� MAILING ADDRESSPHONE -?VY- LOCATION-EYr LEGAL DESCRIPTION SEPTIC TANK: DISTANCE NUMBER OF FROM WELL MANUFACTURER loll MATERIAL COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH I IQUID CAPACITYGALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER ✓ OR WIDTH L2' LENGTH DEPTH 1'f!9' , Lox/. qq i x 'EL LINING MATERIAL 4SAII* CRIB SIZE: DIAMETERfs DEPTHL DISTANCE FROM: WELL��� �- i TOTAL EFFECTIVE,/ BUILDING FOUNDATION �S NEAREST LOT LINEA j.• ABSORPTION AREA (WALL AREA) f,;P SQ. FT. ADDITIONAL ABSORPTION L✓r Lc. Gv�'rQTtd O.✓ Lol � - JFl•-!ter �! /Gs•a' oN �er� �i�a WELL: TYPECONSTRUCTIONDEPTH ��� �T. DISTANCE FROM: BUILDING NEAREST/NEAREST SEPTIC i SEEPAGE / FOUNDATION LOT LINE /G �, SEWER LINE TANK d� r SYSTEM Z20 , CESSPOOL,/VZ�F , OTHER SOURCES APPROVED DISAPPROVED REMAR DISTANCES: DIAGRAM OF SYSTEM —? 79• 9jr INSTALLED BY: Ar/<ss'A.✓r p PIPE MATERIAL: t ..-, LOT SLOPE: A �; l a�� REMARKS: _�ooi /�✓/�</-"- M c I /SNNJi�LGy �O,L CLe�A.vi..6� DATE % ��y APPROVED DQE-4!//.cCr, G.A.A.B. fs+ic n i.— Bj' Form No. EQ -071 //e�'rN� 6Uw•w.sr � d .. V YtllUtl�f n Yyl 'A� GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 2743551 & t ((% PERMIT NO. CF.On/SY. �.,. SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT KEwq, -S V -00-%-r NAME OF APPLICANT �lIM� fS f/LR<A MAILING ADDRESS f��� y PHONE INSTALLATION LOCATION /7)C-r.Gr LR7LE 07-74C LEGAL DESCRIPTION 4-07- 3 eeAm /" INSTALLATION OF: SEPTIC TANK � SEEPAGE PIT DRAIN FIELD OTHER p TYPE AND SIZE OF FACILITY TO BE SERVED u12 o2 FINANCED THROUGH TO BE INSTALLED BY —x �'F LSC' �XC t'J° SOIL TEST RESULTS G'�e `� Ie NOTE, THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED �u 71 N O Tom.' =n/1 PEST L(JCC_C.. C /J-y✓Fj FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE / TYPE SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES. REQUIREMENTS FOUNDATION TO SEPTIC TANK 7 *Exls r.Ait> S -i' ClJcL� �'� DIAGRAM OF SYSTEM FOUNDATION TO SEEPAGE PIT µ DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL 1. ' SEPTIC TANK SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. / 2!% W EIL TO SEPTIC TANK �O .SEEPAGE PIT / DRAIN FIELD / Z'� \ ALSO CONSIDER AREA WELLS: WATER MAIN TO SEPTIC TANK r SEEPAGE PIT SEPTIC TANK. 7-00 SEEPAGE PIT 4 ;0 DRAIN FIELD TO RIVER. LAKE, STREAM. z00 CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. to �– • DATE APPLICANT'S SIGNATURE FORM NO. EQ -016 Performed for��r c, Legal Descrip on:� This form reports: Soi s Depth Feet 2_ 5M 5 - - 6 7_ RE 9- — GREATER ANCHORAGE AREA BOROU"� Department of Environmental Qu :ty 3330 "C" Street Anchorage, Alaska 99503 SOILS LOG - PEROLATION TEST . . -4 / 10 - 11 - PO o 12 - 13 - 14 Was ground water encountered? on S 70160 %Io If yes, at what depth? Date Performed 7/x/7'(/ Reading Date Gross Time Net Time Depth to Water Net Drop Percolation rate minute. Proposed installation: Seepage Pit Drain Field lidpth of Inlet Depth to bottom of pit or trench C01111ENTS : Perforrncd _E—__Certified EQ -040 (0/74) V1 a r.: t C: I I �"L_ 1. A • r C-1 F = r=F rA r-: F-1 C, F -."G F DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROKE.TION =25 'I-'^TREET. ANCHORAGE. AK. 995"- 264-4720 LJEL_t_ F'EF=_M I T PERMIT NO. { 790171 ? APPLICANT JAMES HELALA 2237 SPENARD ROAD 99503 274 6602 LOCATION 144 TH LEGAL L3 MYR:NA MAE LOT SIZE 30000 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPO,AL SYSTEM IS 100 FEET FOR A PRIG?ATE WELL: OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAY_ OF THE WELL. COMPLETION. OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'CF= M I T Exr=, I F= E1 C.EGEr•1C:EF: -=1s 1=+ I CERTIFY THAT 1: I AM FAMILIAR WITH THE R:EQUIR:EMENTS FOR: ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. SIGNEDA, _ , Mcev , ---------- --- APPLICANT JAMES HELALA IS_UE(a BY--&$ ----------- --------DATE_ 1/0 � 17 '•I_. 2 M -W DRILLING, INC. DRILLING LOG Well Owner RoberLl s i ,7P7' -,f �P /7e 4 Use of Well 1)0111. Location (address of: Township, Range, Section, if known; or distance main roar, Lot 3 Hvrna Mae Subdivision, Anchora-e Size of casing 611 nepth of Hole 161 feet Cased to 161.1 feet Static water level t.' js)iove� '(below) land surface: Finish of well (check one) open Screen ( ); Perforated ( ). Describe screen or perforation Well pumping test of 5 gallons per (hoiic) (minute) for -1 --hours with 1007, cit• of drawdown from static level. Date of completion 5/22/79 WELL LOG Depth in feet from 11 ground surface Give details of formations penetrated, size of material, color and hardness -d TO 2 TO j 3 mn 17 17 TO v5 4� TO 75 TO --LO _1 101 TO 153 1�;3 •rn 161 .TO TO .TO Casin) s Organics Silty boulders Hard Loose gravel Grauilly hard pan : cobbly Gravelly hard ran: dans Sandy water gravel r wnvactor 3—CONTRACTOR N d ecwu� Q V �UQOMUNICIPALITYOFANCHORAGE MUNICIPALITY O' Af_GH7.AO� / / {Y'L� �\ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. G7 : ... 625 L Street - Anchorage, Alaska 99501 E� vI R01" :.'NTA' .. ION ENVIRONMENTAL ENGINEERING DIVISION li Ir;�if 1 0 ... I , Telephone 264.4720 CC I \\''[((�� REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWL 4((' ILLITIED DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PR ERTYOWNE . N _ MM17- , PHONE t-n(a 3►? MAILING ADDRESS ?21 `rt- N o G & ,! PROPERTY RESIDENT III d0ferent from above) PHONE 2. BUYER N PHONE MAILING ADDRESS �" k 1 ?3 /�illElz k r 5� �1 3. LE DING INSTITUTI N 1 PHONE MAILINGG/AD�D7RESS /yam / %�-y�/ nQ L rl I t�v%Z Zi (7hr �\ .���/nr ry/K }r /d7\ 4 -Z 4. REALTOR/A ENT �v PHONE MAILING ADDR 5 12 5. LEGAL DESCRIP ION STRJEY OC9TJ! 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS SINGLE FAMILY ❑ One M Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL' *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE" calf individual/on-site, give installation date � ( If system is over two (2) years old an adequacy test Is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. V THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ SINGLE FAMILY ❑ "'MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY PERMIT NUMBER ❑ INDIVIDUAL DEPTH OF WELL ❑ COMMUNITY DATE DRILLED ❑ PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ❑INDIVIDUAL/ON -SITE DATEINSTALLED ❑PUBLIC UTILITY Connection Verified INSTALLER 1:3 Septic Tank or ❑Holding Tank Size: I If Tank is homemade dimensions: SOILS RATING give TYPE OFTANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL ^ -' 4. DISTANCES SeptlC/Holding Tank Absorption Are'aJ_kNI Sewer Line Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS G�' !:it= Qdtrn.uu.l% f 0 ---'APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE t. (i1 LEGAL DESCRIPTION r \�/_� L 72-010 (Rev. 3/78) 1�\AR (fobbeu Spurklnnd P.E. 8155 Cranberry St. Anchorage, Alaska 99502 Phone (907) 2435302 ON SITS !Vit:.L'ATI011 Ip,- 3, b:YPti', b:A:.' SUIEZVISI011 rerfor^,ed for Dill Schreck Nova Peal Eatatc 2?c7 S!,onard road ArchoraLc, P,laska 99503 Euilding Dodrooas Pat ho Lot size Se:•er System 41st Pumrcd Eater 8vstem Date of test Result Eethode t;red- bray 12, 1979 Two story fir.inhed Four Two 2 27000 ft` Septic tati� an_' to crib, built in 1974 S^_;tic tnnlc is full of sludge and must be pumped 1'rivatc well beir.. installed, Pre:ertly water obtained from rcighbcr's well bray 119 1979 SY' Ir.l! 1'l 670 rallors of water vis introduced into the syster. Burin• a 90 minutes interval. hater levels ver^_ .o:.itorud in both tank and crib. No b-,ckup ras observed SE.OF. At �1 *:49Li► *• ,. N �2225-E j 1 NE 25, 1971 • • °nn s B!, • Municipality of Anchorage ° *,i - On-Site Water and Wastewater Program <' Vil�nil - (907) 343-7904 s. . , , Y Certificate of On-Site Systems Approval Parcel I.D. 0 1 8 - l92-3 9 Expiration Date: / 0 42 ._--S-1/ 7 1. GENERAL INFORMATION Complete legal description rna P1°f e S'kb 61k/I'5''0,11 Lit 3 1 Location (site address) 26 2 f= , II- 1 4 AVP/144e_ Anc h cr.,,1 e A g Current Property owner(s) p W ber t -T S si 1 fi mc K l i 5 P er Day phon(8°G`' 3 4S- 6 902 Mailing address 2621 E I `F }i'Ave, Ancil dr,ge MC 1 c 5/6 Real Estate Agent cake 13,o)5� Day phone(7O7) 930.,,S3 e 7 2. TYPE OF DWELLING: `® Single Family (w/wo ADU) LI Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well M Individual t1 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: �'t/►'� Date: �J to 2 2 0 1 7 COSA to be released to the eng neer.unless otherwise requested by the engineer. COSA Fee $ 7 c+ — Waiver Fee $ Date of Payment (,/2-?/fl ck. Si:13[g Date of Payment Receipt Number D-13)5 M Receipt Number COSA# 05c,niacoco 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. I Name of Firm G(Ary cd) lin PhonkctO7 33 & `)3 O S Address'320 Dt,(-(�Sen J)(,' ):rnc4loru)c Ale 9`1501- _ Engineer's Printed Name Gct fy .1-)11 1 Date G/27/2 0 ( 7 1=fiy,r).pari CJrmme41-S: The r ,.'r re4i fes,�I1.5• .4esc✓.h� �.�Cr+e, a•ice. ,,t- +t'le sy 5R',-, ;Art, 'r f-, S '� ung 7-t tt,te .0„12 1-1/4),..A--„, `mac,- s 'cct cf cr ft�5a Its dO rut- U .'Ai e 4'i'Q. er v+e s c�, .,I ,, { r II {II ff } � ��,����ir � � ysr �.��r YJ'. y..IcUi 'rt cke FC15 c ( Q"C°''6�ch"P4'fS Gu' Sol, 1 k' rc'c r i ti•'�`7^ �,C}� .... L�lll f '�- ; 11 y n � �.: C47 "t" E TJ. t' not /nr^JLlde CInV �;,F��.1�L~��� C�;"` �J tiJrhn �l �f hJ J jb�9 s1wo-) wt ii Ct7ni`IJ1.AC' rJ wet i o k' DSD' 42r' A-0 v4:A( iilc"P�cl a r5 f 6. DSD SIGNATURE .•• _ -J1yt" o°°acv\ System#1 Approved for bedrooms =(t-----.4-:.-_,-rIDi. �'° °°� 0 .; )EJ c CI �-7 0aoconoboa System#2 Approved for bedrooms o Y SOU FR ° Q • Disapproved `;L, C= - S'E3 °°°4-eff Conditional approval for bedrooms, with the following stipulatiorsti ' r ,. • ;.: fl: a.- ON-SITE t, ' WATER AND F" WA PROGRAM U By: "`"-- ,...4111,..40 Original Certificate Date: 7 fr."/ .. . ., �� —r 7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other C05A blue sheet j - t 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: \i (Oa 1114e S4b Lai 3 A Parcel ID:0J E4 •I 12 -3 I A. WELL DATA RR l , ^I Well type Pr' a 1 'n1 v �If A, B, or C provide PWSID# Well Log (Y/N) Date completed 51 22) 1 ci 75 Sanitary seal (Y/N)Y Wires properly protected (Y/N) f Total depth 161 ft. Cased to I (3/ ft. Casing height (above ground) 20 in. FROM WELL LOG AT INSPECTION Date of test J2 //q 75 20) 7 1 AJ`arI d k Static water level i11 q >10 ft. tilef.s.ircirtult 1 q E _ ft. Well production s g.p.m. , 3 g.p.m. WATER SAMPLE RESULTS: Coliform ^3aitvcolonies/100 mL Nitrate p. ¢�g/L ttete Arsenic �e g/L Date of sample: 20470711 Collected by: G:147 SO /I'll B. SEPTIC/HOLDING TANK DATA / c Tank Type/Material STce) S ev1 IC , G C ee( Date installed !—7 2 1 t I 7 Tank size 12 7 0 gal. Number of Compartments 2 Cleanouts (YIN) y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (Y/N) ( Date of pumping () /2c)20 7 Pumper G" tor J„i C. ABSORPTION FIELD DATA Date installed 7112'415 7 Soil rating (g.p.d./ft2 or ft2/bdrm) System type f f el c Length 1 0 ft. Width 3 ft. Gravel below pipe 6. 7,�I ft. Total depth �. . ft. Eff. absor tion area 1206Ye 5 Depressionfield No p � ft2 Monitoring tube � over Date of adequacy test Ci 4J 2Q 17 Results (Pass/Fail) Pg55 For 4- bedrooms Fluid depth in absorption field before test C in. Water added 7 3C) gal. New depth I I in. Elapsed Time: 61-11-61,:. ,mii Final fluid depth O.5 in. Absorption rate >= 7CC)0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N(i) If yes, give date D. LIFT STATION ( JC Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/liftstation on lot i 3 4' {f On adjacent lots 1 6 01 '41- Absorption field on lot 13 tr k t On adjacent lots 1001 - t Public sewer main 10 Ot Xt Public sewer manhole/cleanout - 100 t fi- t Sewer/septic service line O Ot Holding tank /00* (t Animal containment areas 10 C4 Ci Manure/animal excrete storage areas d.1Q- SEPTIC/HOLDING 1LSEPTIC/HOLDING TANK ON LOT TO: Building foundation 16 'CI Property line 1 V t �' Absorption field 2o, 3 -c-t• Water main h J g Water service line ' 2 5 �tI'Q t `E1 Surface water Wlslls pmadjacevlttilKe 15 O t Ft 1, 't: , \-t,- "��' ' ' Ja ABSORPTION FIELD ON LOT TO: Property II p y line 1 � } �t Building foundation l fi Water main t1 ) q r. Water Service line 2 S i CI- Surface water 1()0 f TT Driveway, parking/vehicle storage 1 0 ' el- ,- Curtain drain 5 L+ Wells on adjacent lots 150 t Ct F. COMMENTS Watt( SKmple re5,4It5 ,)01- ,, ,,,,tilt/ wn Toc 274 20) 7 5,,�pyc J4 i)l he (dI'tPQ a'\ I�Ar a.tt A t�ter 1,.i tier 6,1 1 wort/ his iPo 546 I1t-ed . G. ENGINEER'S CERTIFICATION ��sovd0i, / certify that / have determined through field inspections and ••••"...... ,,,4 review of Municipal records that the above systems are in 4l Ab•' •'•:l Q conformance with MOA COSA guidelines in effect on this date. t*1; 49T H. , '- *a® . ro.•.t.. ; itw, ti Engineer's Printed Name qr 56 11/ Q Date -- 1 vle 27, 201 O ,t• SOUN . .q • 1 CE -f585 kkPfigessicatt v;* �titi,.�+e` . COSA yellow sheet 2-6-15.doc Municipality of Anchorage Development Services Department Building Safety Division y' On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 I J , Anchorage, AK 99519-6650 R� n • ww907) 3 3-79 nsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 018-192-39 COSA N Qg 1 R9 Expiration Date: 7-/0 " Q R 1. GENERAL INFORMATION Complete legal description Mvma Mae SID Lot 3A Location (site address) 2621 E. 144TH Ave Anchorage Alaska Current Property owner(s) Steven Fenil Day phone (5201-221-0360 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 1601 N Champagne Trail Saint David AZ 85630 Day phone Sue Bumstin Day phone 830-8387 101 W Renson BLVD Anchorage, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well El Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site El 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 sample results. (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 edrooms and type of structure Indicated herein.,( further verify that based on the information obtained �pttit�a, vlunicipality of Anchorage files and from my inVe ti atigr�and inspection, the on-site water su� $ stewater disposal system is(are) in compliance wRtf a I app. cAbla.Municipal and State codes, or es, and regulations in effect at the time of installation. ' Name of Firm Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box 102954, Anchorage, AK 99510 Engineer's Printed Name _Steven R. Pannone. P.E. Date 0411812008 Engineers Comments: In conducting an adequacy. test, l attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water `t.•�� aaa4 levels that may fluctuate during the year, and the water usage of the family being served by the system. .•�p��'""^ aa� These conditions are outside the control of the evaluator of this system. All systems eventually fail and 4'L satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PPS can therefore not provide any warranty for future V performance nor give any estimate of how long the system will continue to meet the operational d•„ - requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed kSteven R. onnone above. Any reliance upon or use of this report by any other person or party is not authorized nor will it 0�0;�+ti No. CE 8140 confer any legal right whatsoever. ,,,/// • 5. DSD SIGNATURE �Oa, to•`• Approved for + bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: >e.=:/ Original Certificate Date: �7 ' 1 D ' Og ({iN. 11pS 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 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Myrna Mae SID lot 3A Parcel ID: 018.19239 A. WELL DATA Well type EtkgLe If A, B, or C provide PWSID p _ Date completed dl414869.51/z2*Sanitarysea[ (Y/N)Y', Total depth ,161 ft. '7q Cased to 161 ft. FROM WELL LOG Date of test 512 211 9 7 9 Static water level ft. Well production 5 g.p.m. WATER SAMPLE RESULTS: Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 22 in. AT INSPECTION 4!2!2008 97 ft. 4.2 g.p.m. Coliform C"colonies/100 mL Nitrate 0.1157mg/L Other bacteria moo'— colonies/100 mL Arsenic: Wl1 , ugfl Date of sample: 412/2008 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel septic Date installed 712811987 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) X No 6 - Date of pumping 41812008 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date Installed 712811987 Soil rating (g.p.dJf? or 0bdrm) 2$3 System type trench Length 90 ft. Width 3 ft. Gravel below pipe 6.7 ft. Total depth 12 ft. Eff. absorption area 120§_fe Monitoring tube 2 Depression over field No Date of adequacy test 41212008 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added600 gal. New depth-$ in. Elapsed Time: 1440 min. Final fluid depth 2 in. Absorption rate >= 6D0+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum Size In gallons "Pump off"level at_ in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/tift station on lot 134 Absorption field on lot 136 Public sewer main 100+ Sewer /septic service line 100+ Animal containment areas 100+ Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas None SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 16 Property line 10+ Absorption field 20.3 Water main nla Water service line 25+ Surface water _100+ Wells on adjacent lots 150+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 Building foundation 16 Water main nla Water Service line 25+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 150+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I 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 Steven R. Pannone, P.E. Date 411812008 COSA Fee $ t Waiver Fee $ Date of Payment 4 0 log Date of Payment Receipt Number INA&F Receipt Number (Rev. 11105) No. CE 8149 WN E in. LOT 48 I I a326G N89.52'BPE 125.04 25 — — — — m U61ly er4 w.r.a esm"" ------------------�— — . I I 1 I LOT 2 I I i I I I- I LOT SA I I I 1 LOT 1 w 1 JAYNIe PLACE BUBD. 0 1� I Ib I OMtlb 1 I 1 LOT 1 I 1 ell ? I�% 1 :% 4% %4% . NBB'5898'W 124.89 R R E. 144th Arene — — Aawv Ho coRRCRS BlT rNewrz '86ALE;MfA61 50 SGALZ' W 0' 0.EC00.9.OTrt0.T1MR Tgsz 5 ON n¢ RECORDED FD 06•1, PQ 70 PLAT AREE MDWT BNOMI IEREOII BE I SCS ReEN 1081316001 Client Name Pannonc Eng. Srv. Project Nsme/N 2621 E 144th Client Sample ID 2621 E 144th Matrix Drinking Water PN'SID 0 Sample Remarks: Parameter Results PQI. C (<10) Metals by ICP/MS NRB Arsenic ND 5.00 Waters Department (<10) Total Nitratc/Nivitc-N 0.457 0.100 Microbiology Laboratory Colony Count 0 Total Coliform 0 Fecal Coliform 0 All Dates/Times are Alaska Standard Time Printed Date/Fime 04,1092008 10:42 Collected Date/Time 04,1022008 10:50 Received Date/Time 04,'022008 11:38 Technical Director Stephen C. Ede Allossablc Prep Analysis Units Method Container ID Limits Date Date Mit ug/L F.P200.8 C (<10) 04/03/08 04/07/08 NRB mg/L SX120450ONO3-F B' (<10) 04/02/08 LCP col/IOOmL S%1209222B cot/IOOmL 5\120 9222B col/IOOmL S\72092228 04/02/08 ULC 04/02/08 DLC 04/02/08 DLC n r^ MUNICIPALITY OF ANCHORAGE D 13 DEPARTMENT OF HEALTH E HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264.4744 Application Date 7,,30-97 T GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) .Lo7-3 Accex A14 HYX161,4 h112' .,) 40 sEL 33 Location (address.or directions) ZL L/ E." //(v tk (b) Property Owder-2-147re rc Mailing Address (c) Lending Institution Mailing Address (d) Real Estate Company and Agent T.1.nhnn. Telephone: Home 3 S//72- Business Telephone (e) Mail the HAA to the following address: or: Check here ❑, if hold for pick up. List contact person anq day phone %jmber below,. 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. 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 77-0751RPv 8'861 From �3 HYZC44 h.tr 5. 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, l 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 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 1162!5 - Telephone SG-SoYG Address /Z"D IJ 33 _rtel nr Q gAW /97! %9Sej Date 7 -A0 -e7 e,-A/h/Ta/ih- III e,1ii r,, j; r ve. .sslrn_ / uo6, A. 7-ZSW. o �� �F• a�:��s!a /,JS�c�T� Bs� /¢CCS . i C/�: • qIlk�a A {F OY C. RE10. Sul� ` CE -2251 C�A 1 %0\\�+�.w4 DHHS APPROVAL Approved for j bedrooms by Approved � i�in Conditional _ Terms of Conditional Approval CAUTION 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 theirlending 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. Page 2 of 2 . 72-025 IR" 8'861 Back t�, 1186 - /381_ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH d HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date �Z-Z� gel - 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner (c) (d) (e) Business ¢ Mailing Address'` Lending Institution —Telephone SGZ- Z/JI/ Mailing *Address Real Estate Company and Agerit Address 2000 '!oi ,sn Telephone k Mail the HAA to the foltdwi o�address: or. Check here 13, if hold for pick up. List contact person and.da� phone number below. - Z7G / 2. TYPE OF RESIDENCE Si gle-Family) Number of pedrooms 3. WATER SUPPLY. Individual Welunity ❑ Public ❑ Note: If cdfnmunity welt'system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality'and status. 4. SEWAGE DISPOSAL Onsite t2f Public ❑ Community ❑ Holding Tank ❑ Note: 11 community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 iaw 8 eel r.oni 5. ENGINEERING FIRM PROVIDIN%a 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 Municipality of Anchorage tiles 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 Telephone Address =;;'�X /iZ 6s !/�?lflvia��+ eye yyfj/ Date Zz— dr 6. DHHS APPROVAL Approved for bedrooms Approved i....... e/ 1,0,: HUGHR.BEVAN f •• CE 7225 nnDate Conditional S.�NDi71bt/-jXC cVJ Terms of Conditional Approval va0VIele-20— Pv�lYf e; s! fG C� �,4Z1Wde�i7 C.cC.VCV qty Il 77y� D�B� �61� y%v0 JM.✓J s%li�i �itYr•!+r i.l4h" a 14 7`.4 00 iwlw � A/ a�..c/ �.fi v ,A- exa,17 k Ze /,04 01 �6y &/Is/BT . CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph S 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. Page 2 of 2 72-025 A. a M1 6"k n MUNICIPALITY OF ANCHORACMUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST -FEBRUARY 1984 n C r 2 /1 M= 264-4744 _ Legal Description: �o5 xl RECEIVED e��_ "-voe A. WELL DATA Well Classification /v�� If A, B. C, D.E.C. Approved (Y/N) ~� Well Log Present (Y/N) Date Completed s z-» Yield `r'.S:o,,�e- "I 110L, �wn Total Depth Cased to Depth of Grouting Static Water Level /off / �i/vw v ;9• Pump Set AtyiJi'�+�wq Casing Height Above Ground Z2 �- Sanitary Seal on Casing (Y/N% y Electrical Wiring in Conduit (Y/N) % Depression Around Wellhead (Y/N) Separation Distances from Well: Al To Septic/Holding Tank on Lot ,,o o ; On Adjoining Lots I-110 7� To Nearest Edge of Absorption Field on Lot 141" ; On Adjoining Lots P 7� To Nearest Public Sewer Line N� To Nearest Public Sewer CleanouVManhole To Nearest Sewer Service Line on Lot // Water Sample Collected by ,�`/'�?^� ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Fy o.,ro0 Date Installed ��� SizeNo. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) OOV Date Last Pumped it -of- iE6 Pumping/Maintenance Contract on File (Y/N) ,,�ez� ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: / To Water -Supply Well �o To Building Foundation To Property Line To Disposal Field To Water Main/Service Line Courge.: Commenis. +. ... 1 P6ge'1 of ? 72-029 IRw'9'PFt From '•. •"r, f1 •"/J�rir<1 �IP VA F I' C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 1/X01 Type of System Design��� Date Installed9 Z Length of Field Width of Field Depth o1 Field vw 0.4. Gravel Bed Thickness Square Feet of Absorption Area Svc, Standpipes Present (Y/N) y Depression over Field (Y/N) . Date of Last Adequacy Test Results of Last Adequacy Test. / 72 -OM 01" &W Hxw Separation Distance from Absorption Field: To Water -Supply Well l o To Property Line '• To Building Foundation % To Existing or Abandoned System on Lot On Adjoining Lots o To Water Main/Service Line To Cutbank (if present) N� To Stream/Pond/Lake/or Major Drainage Course N� To Driveway, Parking Area, or Vehicle Storage Area /o Comments D. LIFT STATION IV11,;1 Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments Dimensions Manhole/Access (Y/N) _ "Pump Off" Level at •• Check Permitted Bedroom Rating Against HAA Request •• Vent (Y/N) . Pumping Cycles during Adequacy Test. Meets MOA Icertifythatlha echecked,verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed -e-� Date Company MOA No. -Sf �L-oo 6 Receipt No. 40 0 UUU Date of Payment QZ52 / .-,�� OF At h // Amount:$ -(�f• Ld f �!`Q;••�Engi••erS6� �� h ' •9 1 r so �* Page 2 of 2 /•F HUG R.5EVAN 72 -OM 01" &W Hxw CE 1E25 b`t� r r"11 .-. 12 BEVAN ENGINEERING Anchorage. AK199511 Approved Well & Septic Engineers (907) 522.1383 (907) 258 0584 December 22, 1986 Municipality of Anchorage Department of Health & Environmental Protection 825 "L" Street Anchorage, Alaska 99501 Fe : Robert L. Beers, Health Authority Approval (HAA) Application Lot 3 Myrna Mae Subdivision Gentlemen During the period from November 24 to December 03, 1986 we performed research, site investigations, well flow testing and absorption field testing pursuant to Health Authority Approval on the above referenced lot. We performed a well flow test and found the well production to be 2.5 + gallons per minute (gpm). This exceeds the required 0.4167 gpm for a 4 bedroom home. We tool: a water sample for Coliform analysis and the results were negative. We -'performed an adequacy test on the septic system and determined that"it , absorbed at a rate of 440 gallons,per day '(gpd):'This absorption rate does not meet.the 600 gpd-required-for a 4 bedroom-home.;The septic tank: was pumped and the volume verified to be 1000 gallons. The volume of record for the tank is 1250 gallons. To our knowledge all of the information requested on the HAA Checklist and Application has been assembled. We are submitting this data to you for your review. Please contact us if we can provide any additional information. Sincerely, H�fyh F. IIevan F.E. Attachments : HAA Application HAA Checklist Sewer As -built Original Soils Investigation Well Log Total Coliform Analysis Septic Tank Pumping receipt cc Robert Beers a :.k .......... � = HuoH P.99VAN ?!t� , 0