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HomeMy WebLinkAboutMITCHELL-STEPHANS LT 1Ml*tchell- tephans Lot 1 #015-051-37 Municipality of Anchorage : �• •, Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw SL P.O. Box 196650 Anchorage, AK 99519-66so Page ( of L www.ci.anchorage.ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: _5 W 0 (i o 45-0 PID Number: of 5-- DS-! -Z 9 Na": TaGcr. Wastewater System: ❑ New Upgrade A"m: Q ,/ 01430 %'P a'! L, (� , Y ABSORPTION FIELD Phone: Nunee, a Beereonc '3301) � p '� ,i/ Deep huKn O 9luraw Tre,Wt O Bae O Mound O Durr. LEGAL DESCRIPTION seeRettig 0.V T°"D`°"epn0npN1paee eiak: La: sue.rro an: l MI GPdFl Deem b pFe euaent can ongnel glade: 3.0 Fl. F,. Gra el depthDuran pM: � Ta p: Range: sateen: Fr add" sew, onVA grao•: O FI. Grant Length: � la fl. FI. Well: ❑ New ❑ Upgrade Grow wen: 2,0 NumewaYra: wrote eeteeenhnas. C"weCaeen (Pnror. A B. C): Taal Oapa: GFaC m: Ft. Taal aoeorpaon era 7S -(fl FI Pp. Met". Ft. FL Fr . I •it)31 Dnuer Doe Dare: S"uc Wale, Lars: FL V M .//' /pr f! r ryfj {i G /.IL 1 T fb�1 Dar Mw a,74o ` Purrp se,, aL Gkeer yng heVt e Wetar: TANK GPM FI. FL SEPARATION DISTANCES t:�Septic ❑Holding ❑S.T.E.P. [3 Other To From Septic Tank Absorpbon Field Lift Station Holding Tank ublkVinvate/a04a� Sewer Line /rr%rf, b /?r(7 Gr Wei /()Q , � / D p •)L r•T K ,4, S p r.� Marnal: Nunes at Corteanmenu. swfacewate, loo 1f loo'+ LIFT STATION La Lw Z 5 PTS ZD '�. e. acwrr. Gal. Faunoauon /Q'{' �r.f.. 'Nn W WZAWL Tung Or Wgn ne,w ssm M: M ti. Cwlan Drain N • T H14. t'unv �'° E(acvrai a�weaona Parhrmeo Dy. Remarks: BENCH MARK Lorauen aN Deunp .P� (14reicC_ I)C*,,. F—otif �7f j . on eva4al. FL Engineer's Stamp % 'rI / N1,�i.nf �f 'r/)) Inspections performed by: ilii easf�l Dates: 1" Ole ; 49TH :•* Development Services Department Approval / V1 MICHAEL N. ANDERSCN•; Reviewed and approved by: Date: L P av l�l�ff�' ///a�4�OG,• � ,, Permit No. SWO60250 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 1, MITCHELL- STEPHANS S/D PID No.: 015-051-37 MARK A B GRNO ELEV. PIPE ELEV. C01 14.1 30.1 100.1 95.5 CO2 7.4 31.9 99.9 95.7 TC01 7.6 31.8 100.0 TCO2 10.2 28.2 100.0 CO3 13.6 25.3 100.1 96.2 C04 13.6 25.3 100.1 96.2 C05 23.5 39.2 100.7 96.3 MT 20.8 35.1 100.7 C06 39.5 13.8 99.3 96.3 35 YN. Z C, 0/v CROSS BACK APPROX. SHOULDER OF SLOPE >25% .am or.o" um 1... I 1 1 1 \\ OLD TANK FILLED CONCRETE SLABk,.ZENCH MARK U40KA M I1I I I - �v 03 r I 1 1 ASBUILT \\ ALE: 1"=30' \ 2bU. I5 tea. J ,nrt.rrC O.H. DE( V4, A 2;ME'4' VYL 1.IL.n HOLE RADIUS IN PLACE z It 0 � col I I ZC0511 I °" I� "' 49LH -.o11° I�1 ��,: No. a n -� Municipality of Anchorage • Development Services Department / Building Safety Division ; On -Site Water and Wastewater Program ` 4700 South Bragaw St. ' • ' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: FILE Legal description: MITCHELL-STEPHANS LOT 1 The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on _ ❑ Calculation error in design. _ ❑ Additional soils information needed. _ ❑ Water monitoring results inadequate. _ ❑ Discrepancy in information submitted. _ ❑ Topographic information missing or Inadequate. ❑ Incomplete; missing ❑ Incomplete; missing ❑ Additional adequacy test Information needed. _ ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. ❑ Locations of all soils, percolation and water monitoring tests not shown. _ ❑ Proposed system too deep for soils information submitted. _ ❑ Well log required. ❑ Omission in narrative. _ ❑ Insufficient fill over tank or field._ ® Other. NEED TO DO A SITE VISIT TO CHECK FOR SLOPES DUE TO INFO RELAYED TO OUR DEPARTMENT A Name of reviewer. JOE Date: September 26, 2006 D \\ 'd SfT:- VISITLooks oo%3 ks Ta ,e I -no G%5t e u7 -SA'✓k.(Sepf 2�% CAGcd A"' q. To P,c��, Mik _ i}/�sls Sd� Sdr0 rf 40,4,4 7?kE A ccrk T �rNv Srt lease supply the necessary information and re -submit your requesr-�, O r Me vP w, LEAVE THIS FORM ATTACHED TO THE PAPERWORK MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: 10, 2006 Expiration Date: qug 10, 2007 Permit Number: SW060250 Parcel ID: 015-051-37 Legal Description: MITCHELLSTEPHANS LT 1 Design Engineer: 0088 ANDERSON CONSTRUCTION & E Site Address: 009430 BIRCH RD Owner Name: Jacob Maiouf Lot Size: 73909 SQ. FT. Owner Address: 9430 BIRCH ROAD Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE, AK 99516-6428 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be In accordance with: 2. 3. 4. The attached approved design. 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 ). The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date: Issued By:T(j✓ Date: Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program Parcel I.[ Property 4700 Bragaw Street a P.O. Box 196650 rzr Anchorage, AK 99519-6650 11 www.muni.org/onsite A V �y (907) 343-7904 ON-SITE SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING phone Mailing address Z o S f D irmp ip 15LVp Zip Code 9,?r %S-- 00S Site address I ci 30 f3i2cl kd Zip Code Legal description (Sub'd, Block & Lot) M f T eN.Cj_c. Legal description (Township, Section & Range) Lot Size '77t 109 Sq. Ft. THIS APPLICATION IS FOR (®all that apply): Absorption Field pa e e n 't C 19 Holding Tank :. 9T• E3 Private Well El ON-SITE SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING phone Mailing address Z o S f D irmp ip 15LVp Zip Code 9,?r %S-- 00S Site address I ci 30 f3i2cl kd Zip Code Legal description (Sub'd, Block & Lot) M f T eN.Cj_c. Legal description (Township, Section & Range) Lot Size '77t 109 Sq. Ft. THIS APPLICATION IS FOR (®all that apply): Absorption Field V1 Septic Tank 19 Holding Tank El Privy E3 Private Well El Water Storage El Number of Bedrooms Z` THIS APPLICATION IS AN: Initial Upgrade Renewal in certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 460 -(- (i Waiver Fees: (7 S Date of Payment: 9 Q o 6 Date of Payment: X9/06 Receipt Number: y5 Z-�) (Rev. 11/05) Receipt Number: c/ Z Michael N. Anderson, P.E. Civil/Structural Engineering & Construction 4640 Shoshone Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 August 6, 2006 Municipalities of Anchorage Departments of health and Human Services P.O. Dox 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Mitchell-Stephans S/D Lot 1 To Whom it may concern: This is a request for a new septic permit. The test hole excavation was completed near the northwest comer of the property, the soils consisted of silty sand for the top 14 feet then brown silty gravel below from 14 feet to the bottom of the hole at 18 feet. Water was not observed after the 7 day monitoring period. The perc rate was 12 minutes per inch. A new deep trench will be utilized for the leach field with an effective depth of 6 feet. The application rate of 0.8 gallons per day per square foot has been use for the deep trench for a total length of 63 feet. The surrounding properties have existing systems or are vacant and will not be impacted by this new system. The owner has requested an upgrade to 4 bedrooms, therefore the secondary or reserve area has been shown for the possible future upgrade. The top of the slope along the west has been shown, however it is not greater than 25%. All the leach field will be more than 50 feet from this area otherwise the lot has a very gentle slope to the north' The neighboring lots will be impacted by this new construction. I If you have any question please call me at 345-3377 Since Michael N. Anderson, P.E. DESIGN CRITERIA: (THJI) 4 BDRM X 150 = 600 GPD OR SOILS = 600/0.8 = 750 GPD 0.5' 750/12 = 62.5' (1) TRENCH SM 9.0' DEEP 6.0' EFFECTIVE 2.0' WIDE 63' LONG i8.o' PROPERTY EXISTING WELL, 100' RADIUS L MOUND OVER ROCK EXISTING SLOPE o j WELL i PRIMARY S PTIC � EXISTING H uSE SECONDARY SE C `EXISTING EPTIC i TANK AND FIELD TO • i ii BE ABAND NED i o � —BARRY ROAD— S VACANT LOT s _ )t m �< i V Septic Design Prepared For ..�������,,' JACOB AND AMY 11fAL0UF (�.OI �1��♦ LOT 1, MITCIIELL—STEPIIANS SUBDIVISION Gj ,.••'' �� Anchorage, Alaska � 49TH si}11 Prepared By .... yP�.....�............ ................� MICHAEL N. ANDERSON, P.E. � ............ 4640 SIIOSIIONI DRIVE ♦°MICHAEL N.{NDERSONi i (907) 345-3377 / FAX (907) 345-1391 ��� ` No. 8469 SCALE: 1"=100' •�e� �O �jG �� AUGUST 5, 2006 ��7�9ES5�,�� Municipality of Anchorage Development Services Department Buldng Safety Division yam, onsite Water and Wastewater Program 47CO South Bragaw SL P.O. Box 1`:6650 Anchorage, AK 995196650 www cianchcrace.ak.us (907) 3417904 *;'49TH •. MICHAEL N. ANDERSON *QC i_•. CE -9469 :Zt:; Soils Log/ - Percolation Test $ Performed For. •To (1 y /t//o p ,.1 +— Dale Performed: Legal Description: Township. Range. Section: _ urq,�,e S 1 2- 5--9;-V +-4- 6_ .f. (f y 7. 1 11 `13- 14- is- 16- 18 3 - 1415 -16- 1$ 9 �°/4i� 19 YJAS GROUND YlATER ENCCUNTc-ED? A10 Gross Time Net Time Depth VYYater s IF YES. AT YIPAT DEPTH? L O Dgthlo Water After Monitoring? A10. (n" P E Date: -)4/6& Reading Date Gross Time Net Time Depth VYYater Net Drop 01'r M, 1 %'r z,s" 2.5•• 7 s,S z,S 40 -4 s'r' FEiCCL>T:CN PATE I - IrmtftV.01 FERCY.CLEDIAN:ETcR TESTF.L%,EET`NEEH Air Fi A\0_FT CO-MMENTS I PERFOR"IEDBY: �r j�Q/%I/%It PVtry� CERTIFY THAT THIS TEST Y` PERFORMED IN ACCOROA; 7CE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THS DATE. DATE: G 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE J DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW D & B GENERAL, INC. C.C. BUCK CONSTRUCTION 34.9-6965 ❑ UPGRADE MAILLFS NGADDRS10_1349, ANCHORAGE, ALASKA 99511 LEGAL DESCRIPTION LOT 19 MITCHELL-STEPHANS SUBDIVISION 1-11 S?[sJH ROAD Ilii llLltt((:i NO. OF BEDROOMS /4 Well Absorption area Dwelling PERMIT NO. Uy DISTANCE TO: 110 � 6' 12 � 810301 Q Manufacturer Material No. of compartments i wF GREER STL 2 N Liq. capacity in gallons Inside length Width Liquid depth 12 0 IF HOMEMADE: y DISTANCE TO: Well Dwelling PERMIT NO. JAZ O 2< Material Liquid 2 F Manufacturer capacity in gallons o Well Foundation Nearest lot line PERMIT NO. DISTANCE TO: 116 18' 20' 810301 L J LL z No. of lines Length of each line Total length of lines Trench width Distance between lines P z w 1 451 inches n a FTop to finish Material beneath tile Total effective absorption area of tile grade e 4 48 inches 360 Length Width Depth PERMIT NO. Lu C7 a F Type of crib Crib diameter Crib depth Total effective absorption area wa wWell to Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J J w Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS PVC SOIL TEST RATING 85 sq.ft./bdrm ti ;t��-• INSTALLER D & B GENERAL, INC. REMARKS ••..d'•`�� r'�F•;•' ufi ®7ITtt- 4 9 7L •, iY P a'• OCT. 24, 1970 .•-�1, MU ICI LIi OF AN HOR GE • \ m__UE tk 10,NAt4 -N IT. C iF ::A I k E IRO ME TAL PITO ECT ON 'E 17 APPROVED DATE LEGAL RECEIVED 72-013 (Rev. 3/78) ri D � o Z a , � ���-•a"�d z W Z > J Jy W Ix 0 13 LL CL m z Ix • ..y �, �. �D� M tfi 7 o r~ H�+ dUl— � o 1 J O N a z +I u 000 ° M t^.' CJ.a N CD Q 2 9 W g o CD w LL M _ N O � a 41 0 � m a LLI 2 %a N P9 K OQ V Q N J 0 CD 40 Fo !Q 41 N � e Ci J cr W O 1 J m H W h ¢ i a Uot to Z Q N I uJ d h ct 4:t ur p = oL Z d 1 Q W 0 S Q trl l0 10 19 SOILS LOG d MUNICIPALITY OF ANCHORAGE yf DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: (� C G U C- K &,V& .T'04)e-- zOAJ DATE PERFORMED: LEGAL DESCRIPTION: hOT I M iTC46(1- r S-ra0ifA VS susc;i ' NFI� SLOPE SITE PLAN 1 2 3 4 5 6 7 o— 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS Ci* alyT/e�r�y TOP&Ori- % PF' AT" 7 is t vj sw- 62pAr-tq s ANAs 4 6940-15- WAS 940i WAS GROUND WATER S N� ENCOUNTERED? L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN FT AND ni !._i_ ..- (mi PERFORMED BY: OPS Pa CERTIFIED BY: X39' f1 72-008 (6/79) • e `i .ee .... ..�.. ro.ie. � I- No. 2100 - E OCT. 24 197n 6D' 'd.v Well Log C . L . hL�' eC t �,''�.11C . For. .................................................................................................................. _ � 4ii a CK t.L STL -- L) LOT -- l c e Location ....... -� - Date completed..........".... �. c jj Depth of well........... t_��.............. a� Sizeof casing....................................................................................................... Distance to water............. ............... rr.'.� t,�� .. Distance to water while pumping.................... ?.:D!............................at rate of......:..............9.�........................gallons per hour. Formation I from I to y ! i - 1 i I ! I I dl41�-- /&44 J ............................. ................................ T. Driller DELTA DRILLING COPAPARAY SRA BOX 394 B ANCHORAGE. ALASKA 99507 Cl'. C%✓�zr-LiG� �Ga.- <�� 02-LC.-�cPP, A MUNICIPALITY O�—ANCHORAGE • �e MEMORANDUM 61 Date 190 To: From: oG�� �/0 0 D4cT — Dazs �" zcrl L Signed `"4 91-015 (Rev. 1/81) Il MUNICIPALITY di -A- CHORAGE • MEMORANDUM )m To: U From: Re: Date 19 Signed 91-015 (Rev. 1/7'). 0�.- `� /j1(11.b,,� U �. r `�"•�?`dfy'cl�a<. 4v-wr 5 -me Gtr -5i-bP SzAPT 15TOP Client's Name: �I�CVj Address: Tester: C Initial Reading on Meter: 614 div TIME GPM GALLONS A VOLUME BESSE, EPPS & PO`iTS rd • 5 2220 EAST 88 AVENUE ANCHORAGE r AK 99507 ° y' • •0000°00 (907) 349-6451 au i nP� o 21 WATER WELL TEST Dal R. errell a No. 2055-E � ' - •`�U Eo°9°oe - Date: U°ca � � -?>I-,7-7 (J V i .g Subdivision: MjTC4°(ct,L%7GPgAPJ5 6UGO. 14-9 Lot: Block: 4v-wr 5 -me Gtr -5i-bP SzAPT 15TOP Client's Name: �I�CVj Address: Tester: C Initial Reading on Meter: 614 div TIME GPM GALLONS A VOLUME GALLONS TOTAL VOLUME rd • 5 - O q . 0 2,ve '30 o 21 ► y7-6 ✓� . 5e5& 11S i .g 3.0 2 14-9 T1s, :,,55 �.gt 1 vv 2.00 foOt7 NOTES: Production Rate: 1,i3 GP, -1 24 -Hour Caoacity 10�O Gallons r-1 u r_j I H.:_- I �="F:p I -Ir 'r ke 13 F:- F__l r_4 �___ 9 -1 C-1 F�_" F� 1:3 EE ^ ' DEPARTMENT HEALTH AND ENVIRONMENTAL ?OTECTION 825 ' STREET/ ANCHORAGE.- HK� 9���1 �' ` 264-4720 ` WEER L_ n"C-u PERMIT NO. ( 810]01 ) HPPLICHNT D&B GEN. INC P. 0. BOX 10-1]49 349-6965 LOCATION BIRCH RD. LEGAL LOT 1 MITCHELL~~STEPHHWS SUB LOT SIZE 73908 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS 4 SOIL RATING (SA FT//BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ���> -IF 1-4 ­ =-:� I EE:r-4 -I- THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELC\ THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ���Z t-1 I F;: -o EE CA ����I C.:* �n r_4 Fz__. 1_=7 T F_= ;2!ffq 117--1 la F=� P L_ r_ -n r-4�� 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. 714 8::§ <:2 > 1: r-4 <-= 31 13 r -A -I=.����� ���U����E� BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL. BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 2.0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ���lr-ll-r ENEEI:�FEIrlE�EF-FR ��� �-1 I CERTIFY THAT 1: 1 HM FAMILIAR WITH THE REQUIREMENTS FOR 0N -SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE 8N -SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. � ISSUED �������� Y4L0 Municipality of Anchorage n evetopment Services Department ^ Building Safety Division Onsite Water Street P.O. 4700 BragawS P.O. Box 198850 Anchorage, AK 99519-8850 www.muni.orglonsite (907)343-7904 O i 4 - CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. cmc -or! -3?- COSA# 'l IlQFl7X Expirat2112-6 1 43 ion Date: 1. GENERAL INFORMATION Complete legal description Loi 1 M r r`r �e- S 4- r 6 rNS Location (site address) 9 `'t 5 O Give H• 9-4 . Current Property owners) � o k c—� /✓(a (v N �. Day phone 33'3 - 0-4q Mailing address Lending agency Mailing address Real Estate Agent Mailing Addre ss Unless otherwise requested, CASA wBl be held by DSD for pkkup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Day phone Day phone TYPE OF WASTEWATER DISPOSAL: ® Individual On-site [z ❑ Individual Holding Tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Munkipality 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 rpqulred for the transfer of title (except between spouses) for properties served by asingle-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of OnSHe Systema Approval are valid for 90 days from the date of Issue for properties served by a private or Gass 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. 0 • ' 0 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my Investigation, based on procedures outlined In the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on -she 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 verity that based on the Information obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on -she water supply and/or wastewater disposal system Is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of Installation. Name of Finn h Address HI. Engineer's Printed Name 5. DSD SIGNATURE Approved for —�_ bedrooms. Disapproved. W Phone 3yS,"7,2 Date t� OF q�`\t 49V- 5 • �/ P * MICHAEL N. AND[RSON : Q' / i••. CE 94 9 �v 44: !tZu r 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. Original Certificate Date: ► I is o ►n....,,As► Municipality of Anchorage r; •., • Development Services Department Building Safety Division ` Onsite 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: L v 1, c —571- L P �^ r N -i Parcel lD: A. WELL DATA Well type Pr'v-4--' If A, B. or C provide PWSID # _G Well Log (YIN) SYS Date completed7 ► z Yf Sanitary seal (Y/N) __Y__ Wires properly protected (YM) V Total depth is_ —fft. Cased to z3 _fft. Casing height (above ground) •/8 In. FROM WELL LOG Date of test ?h 21%f Static water level 7(,p ft. Well production /r Sr 9•p -m• WATER SAMPLE RESULTS: Coliformosi �colonies/100 mL Arsenic: ek9 B. SEPTIC/HOLDING TANK DATA TankType/Material l Nitrate 04 mg/L Date of sample: Tank size 17C -Q gat. Number of Compartments 7_ Foundation cleanout (YM) _Y__ Depression over tank (YM) _.L! Date of pumping 11140 Pumper AT INSPECTION iiVic G �. g.p.m. Other bacteria —9-1 colonies/100 mL Collected by. mllyx. Date installed 't ff/ft Cieanouts(Y/N) r High water alarm (YIN) C. ABSORPTION FIELD DATA Date installed 411 /4 6 Soil rating (g.p.dJfe or ftz(bdrm) o. System type D R o io a• S Length (.3 ft. Width -L' D ft. Gravel below pipe 6,0 ft. Total depth i0 ft. Eff. absorption area St ftp Monitoring tube _Y Depression over field /' _ Date of adequacy test 14"'(0 Results (Pass/Fail) For d( bedrooms Fluid depth in absorption field before test /in. Water added_G gal. New depth_.G in. Elapsed Time: Amin. Final fluid depth / in. Absorption rate >= � g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) ✓ If yes, give date l D. LIFT STATION Date Installed Size In gallons 'Pump on' level at_ In. 'Pump off" lev( Datum Cycles tested _ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOTTO: Septic tanknift station on lot "01,1L Absorption field on lot _ /0 01 - Public sewer main Sewer /septic service line /W4 Animal containment areas /06 LF - High water alarm level at Meets alar ti circuit requirements? On adjacent lots /00 f -f. On adjacent lots /C v r + Public sewer manhole/cleanout Ar/A. Holding tank /,/ AL Manurelanimai excrete storage areas /yo f j SEPARATION DISTANCES FROM SEPTIC/F;l9LOWG TANK ON LOT TO: ' r � Building foundation /O f- Property line Z g; F Absorption field /O 7 Water main Water service line 5o'4- Surface water frJd r� Wells on adjacent lots t e o tf- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 2b f'E' Building foundat onZ o r.(- Water Service line S -U %4- Surfacewater 'e,0#4- Driveway. parkingfvehide storage NJ , Curtain drain if IA-, Wells on adjacent lots r00 4- F. COMMENTS G. ENGINEER'S CERTIFICATION �OF Al 14 I certify that I have determined through field Inspections and j �:' •• 9+r� review of Municipal records that the above systems are in , *: 491"h •••••: / conformance with MOA COSA guidelines in effect on this date. % • • • • • 0 Engineer's Printed Name t e r n d raJa1 / • MICRAEL'N. ANDDEMN Date COSA Fee $ s • Date of Payment I -' OI Receipt Number 075 ci �(3R (Rev. tiros) Waiver Fee $ Date of Payment Receipt Number In. Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-8850 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: t!y � ( mil �.r � c ( I — S�- t P L t r S Parcel ID: C9 t S OS / - 3 ?_ A. WELL DATA Weii type frlti �� If A, B. or C provide PWSID # Well Log (YM) Date completed 712 Y/ Sanitary seal (Y/N) _Y Wires properly protected (Y/N) y Total depth 23 —[ft. Cased to 1$ ( ft. Casing height (above ground) /rg in. FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. �. g.p.m. WATER SAMPLE RESULTS: Coliform {, � colonies/100 mL Nitrate �%� mglL Other bacteria _ colonies/100 mL Arsenic: Date of sample: iv tv �� Collected by. /''����7 1 7" B. SEPTIC/HOLDING T K DATA Tank Type/Material l Date installed t /1/4 Tank size t 7 c�-O gal. Number of Compartments 7L Cleanouts (Y/N) Foundation cieanout (Y/N) _Y_— Depression over tank (YM) High water alarm (Y/N) Date of pumping /J<—AD Pumper C. ABSORPTION FIELD DATA Date installed I/11/V16 Soil rating (g.p.dR or f?/bdrm) m. System type D vv, o �­m, 4. Length G 3 ft. Width 2 r D ft. Gravel below pipe 6,o ft. Total depo r0 ft. Eff. absorption area 7'5(o ftt Monitoring tube _Y Depression over field t _ Date of adequacy test idkO Results (Pass/Fail) For ( bedrooms Fluid depth in absorption field before test /in. Water added gal. New depth -,G in. Elapsed Time: Amin. Final fluid depth / in. Absorption rate >= --� g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) ✓ If yes, give date l D. LIFT STATION Date installed 'Pump on' level at _ in. Datum E. SEPARATION DISTANCES Size In gallons 'Pump ofr tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /00 ' f Absorption field on lot /0 0'4 - Public sewer main N'14-1 Sewer /septic service line /w 4 Animal containment areas /lid 4 - High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots /00 1 -F - On adjacent lots /0 v' + Public sewer manhole/deanout Holding tank _ t-1 l4L Manure/animal excrete storage areas /00 4 SEPARATION DISTANCES FROM SEPTIC/MBL=Va TANK ON LOT TO: Building foundation /O * f- Property line 74 14- Absorption field /O ' 1< Water main Water service line 5-0'4- Surface water !Cl a Weiss on adjacent lots I u 0 14-- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ?1b I 4- Building foundation Z O l� W � '�'141A =; _ Water Service line 'TU 14-- Surface water r e p' .1- Driveway. parking/vehicle storage "Cl '4 - Curtain drain t, �.4-. Wells on adjacent lots /00 td - F. COMMENTS G. ENGINEER'S CERTIFICATION �P�E• F ; 4 CXX qS 1 j 1 oertily that I have determined through field inspections and `''' / '•• ylr review of Municipal records that the above systems are in .0 * ' 4 9 LH - conformance d with MOA COSA guidelines in effect on this date. I •' " • • • • • / Engineer's Printed Name_ MI e fir- �%f do rtan % ?4. ; MICHAEL 'N: 'ANZEMN ; �r Date COSA Fee $ 11 • -f-1 q a &045'- Date OSDate of Payment ri IZ • Receipt Number (V5 e, 43Q (Rev. I IM) Waiver Fee $ Date of Payment Receipt Number IV SCS Reta 1066369001 Client Name Mike N. Anderson, P.E. Project NameM Lot I Mitchell-Stephcn Client Sample FD Lot 1 Michell-Stephcn Matrix Drinking Water All DatesMates are Alaska Standard Time Printed Date/Time 11/032006 11:13 Collected Date/Time 10202006 12:00 Received Date/Time 10202006 13:05 Technical Director Stephen C. Ede Sample Remarks: Allocable Prep Analysis Parameter Results PQL Units Mcttwd Container ID Limits Date Date Inil Metals by ICP/MS Arsenic Waters Department Nitrate -N Microbioloav Laboratory Total Coliform M 0.260 0 5.00 ug/L EP200.9 0.100 mg/L EPA 353.2 C (<10) 1024/06 1025/06 TK D (<10) coU100mL SM2092220 A (<I) 1020/06 XZ 10120106 DPT 5 89057100"W 280.1 51 280.1 OF A X04 C SHANE A. MOLT; i LS -691 4 ' Jf V K ID'ANCHOR ESMT.— I I EXISTING STRUCTURES AND PUTTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT STRICTURES OR FENCELINES, THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE I, �I WITHIN THE VISIBLE I ENTSEXISTOOPERTY HER THAN N TED. ENCROACHMENTS EXIST OTHER THAN NOTED. NOTE ANY FENCELINES SHOWN ME LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES y, OR LOCATE STRUCTURES DAY OF SEPTEMBER 2006 ANY PAYING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS. HOLT LAND SURVEYING 1130. FB 731,12512 TEL. 345 5513 � I � I I � � I I 1 1 � � I WE IL 1 1 ° 1 4 I OR o D 1 I o O O.M. DECK _ •2.e I Wy I die B S - I 1 C.A. ley B o R „ e IDI I n ° iYvvA. ' I: I^ •� I a I AS -BUILT SURVEY SCALE: l'-40' 1 HEREBY CERTIFY THAT 1 HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 1, MITCHELL • STEPHAN SUB. THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PUTTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT STRICTURES OR FENCELINES, THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE VISIBLE EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. ENTSEXISTOOPERTY HER THAN N TED. ENCROACHMENTS EXIST OTHER THAN NOTED. NOTE ANY FENCELINES SHOWN ME LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES DATED AT ANCHORAGE, ALASKA THIS _I ETH_ OR LOCATE STRUCTURES DAY OF SEPTEMBER 2006 ANY PAYING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS. HOLT LAND SURVEYING 1130. FB 731,12512 TEL. 345 5513 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application DateT0 1� S7 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) 2. (a) Legal Description (include lot, block, subdivision, section, township, range) MI TcHGL,�6i CPHA)J'5 5Jaa j LOT I Location (address or directions) 9430 i RCH RD / bXHO [ZAGtG_ AIC (b) Property Owner ENMIA Telephone: Home Mailing Address (c) Lending Institution Telephone Business Mailing Address -- (d) Real Estate Company and Agent Cock wLer (R.E10 Address Telephone SID -0000 �( (e) Mail the HAA to the following address: or: Check here if hold for pick up. List contact person and day phone n mber below. low. 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 72-026 (Rev 8/861 Front H3ea (99/9 Ada) seo-& - '11� \-j e 10 Z abed �aom s,jaau15ua leuolssaloid ayl ui suo!sslwo ao saoaaa jol alglsuodsai lou si a6eaoyouy to Ajged!olunn a41 ponssi si aleollpiao e aaolaq elep az (leue Ao suoiloadsui lonpuoo lou op SHH(] 10 saa/oldw3 sluawaalnbai alels pue lejapal uiepoo (ls!les of japao ui suo!lnl!lsui bulpual iiayl pue sawo4 to siaseyoand of Asalinoo a se slyl saop SHHQ ay1'eNse1y to 91elS ay1 u1 paialsibei aaau!6ua leuolssalo.id luopuedapui ue Aq anoge g ydea6eied ul uaA16 suoileluasaidaa a41 uodn Aluo paseq saleolllljao lenoaddy /luoylny U11eaH sanssi (SHHQ) sao!AaaS uewnH pue 41leaH to luawlaedaQ abeaoyouy to Al!ledlownW e41 NOi nvo lenoaddy leuoll!puo(] to swaal leuoll!puoo panaddes!(] panoaddy ale(] Aq swooapaq aol panoaddy J IVAOaddV SHHQ "9 o4�°',.^ ; a•ssoa o ` " Ila' w'a no - r �.• ... .... � C _ _ � ..•. u•H ea oea �� .!o J leaS s,10au!6u3 ale(] i'r7 f4�J i?l 8 2 ssaapPy auoydalal 5�od. 3 a wnd to aweN ` uoiloadsui s141 to alep a41 uo loalla w suo!leln6ei pue 'seoueulpio 'sopoo alelS pue led!olunV4 Ile yl!m aouelldwoo w s! wags (s lesodslp jaleMalsum ao/pue Alddns aelem al!s-uo a41 'uolloadsul pue u011e611sanul AW woal pue salll abejoyouy to A1!ledlo!un!Al a41 woal paulelgo uollewaolul ayl uo paseq leyl AluaA aaylinl I •ulaaay poleolpul ainlonjls to @dAl pue swooapaq to aagwnu ayl aol alenbape pue leuo!lounl'ales si walsAs lesodslp jalumalsem jo/pue Alddnsialigm al!s-uo agl1e41 snnoys lenoaddy (luoylny ylleaH s!yl to uo1le6!lsanu! Aw leyl A1!aaA I 'nno!aq unno4s alep uo!lep112A ayl to se pue olaaa4 pax!lle leas Aw Aq pa!1!laao sy NOI.LVWEIOdN1 ONV ylyO `HDHV3S 3l1j `S1S31 `SNO1103dSN1 ONialAOHd WFlI-q ONIN33NION3 'S MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCFIORAGE HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL SERVICES DIVISION CHECKLIST - FEBRUARY 1984 264-4744 MAR 31 1997 Legal Description:yYljl"(.MEu.i�r�P��,+►� �U� ° A. WELL DAT ECLIVED Well Classification ${74VAT6 If A, B, C, D.E.C. Approved (Y/N) ���-7W U. s : 5 ` elvj Well Log Present (Y/N) —i=ce Date Completed h' Yield t 40 V150A" - Total Depth Z�� Cased to Vt? ►FI3 ►eO Depth of Grouting Static Water Level 52 Pump Set At UtJkNOWN Casing Height Above Ground "� (�I� Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well To Septic/Holding Tank on Lot +(Q ; On Adjoining Lots +(O() r r To Nearest Edge of Absorption Field on Lot +(00 ; On Adjoining Lots 4 -WD To Nearest Public Sewer Line '-(-751 To Nearest Public Sewer Cleanout/Manhole f j� r To Nearest Sewer Service Line on Lot (251 Water Sample Collected by Date r-�%' Water Sample Test Results C ITO� Comments Seo F4TTA-Mu-p uJai x Wel(- iwo I,tlk( 1FW ge!s-M;T5. B. SEPTIC/HOLDING TANK DATA Date Installed ��� Size t z No. of Compartments Z Standpipes (Y/N) yC�a Air -tight Caps (Y/N) E.5 Foundation Cleanout (Y/N) Depression over Tank (Y/N) NO Date Last Pumped�°_I% Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) for Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: t To Water -Supply Well °�1UiDTo Building Foundation To Property Line +(0 To Disposal Field To Water Main/Service Line .+ CourseYi7 Page 1 of 2 72-026 (Rev 8.'86) Frani `0t To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 65 !F/15DRm Type of System Design TfZC� Date Installed � r i Length of Field i V �t � i• Width of Field Depth of Field 4 Gravel Bed Thickness Square Feet of Absorption Area 0 5F &'— Standpipes Present (Y/N) YC (cza1�) Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test --3A-n SrAUQRq r -M -3iW iZ00iY) Separation Distance from Absorption Field: To Water -Supply Well 'a"(©0 To Property Line + i® To Building Foundation 4-V To Existing or Abandoned System on Lot wome - feA2Xv-ref On Adjoining Lots '4"'�0 i I To Water Main/Service Line Z� To Cutbank (if present) 4-50 To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area +101 1Q Comments �� AMWAM to -W- meom - D. LIFT STATION N/A 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 *e Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I ave checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date 0/97 Company MOA No. .®e OFt� �j pp —7 Receipt No.Yo?—O UI— O o1 % Date of Payment 3 — J/ / J — o bi Amount: $ T6 d O`�a Page 2 of 2 72-026 (Rev. 8/86) Back a oa a oeooa4�R•Pe coat°°d9���ee eo oo•ea eke V li e Dale R. Merrell e" i No. 2055-E e �� J AROFFSSte`,A�� .dam FN UNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH -D ENT OF HEALTH AND ENVIRONMENTAL PROTECTION ?PLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1, General Information Application Date (a) Legal scx1ption,.(inc u 1 t, block, subdivision, section, township, range) Location (address or .directions) (b) Applicants Name /c, �/� . i iYt � 11C• sc- _.�A Telephone Applicants Address (c) Applicant is (check one) Lending Institution ; Owrer/bu r_ Buyer ; Other [:::3 (explain); (d) Lending Institution _ Telephone Address (e) Real Estate Co. & Agent Address Telephone 2. Tempe of Pasidenoe Single -Family I XJ Multi -Family Number of Bedrooms 3. Water Su I Other (describe) Individual Wall 0 Community � Public Note: If cc maanity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Is the well adequate for the number of bedrooms specified in this HAA((Y, 4, Sewage Disposal Onsite Public C.,oYrwnity Holding Tank Is the wastewater disposal system adequate for the number of bedrooms Y ) [Page 1 of 21 2-15-84 5. Engineering Firm ProvidirgInspections, fists, Data and Information I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed Nave ofne Address Signed by Date /a"/ Ary (ENGINEER SEAL) 6. DEIEP Approval Approved for bedrooms Approved Disapproved Terme of Conditional Approval Date r. Lery C. Reid, Jr. iR u v. 2251-1 .J °.. BY a �S �� t rz, l t- Date �' .:s` b'y Conditional The Municipality of Anchorage Department of Health and Environmental Protection does not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bedrooms and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s [Page 2 of 21 2-15-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) v86b t 11(1(' CHECKLIST - FEBRUARY 1984 N011oaload 18 H1lV3Hd d0O '1dd30g(3 a ' 3°Jtl2i0liJNVVI OAlll INnvy / Legal Description: Well Classification If A, B, or C. D.E.C. Approved(YM) Well Log Present (Y N) Date Completed Yieldd,eiS Total Depth:/ Cased to z2-3/ Depth of Groutinggv�/"'�' Static Water Level 761 Pump Set At cvx�nocJn Casing Height Above Ground /'67/ Sanitary Seal on Casing Y N ) Electrical Wiring in Conduit 0) Depression Around Welllzead (Y q-2— Separation Distances from Well: To Septic/Holding Tank on Lot /0D ; On Adjoining Lots +-/00 ' A - To Nearest Edge of Absorption Field on Lot L/Do' X ; On Adjoining Lots /y4' � To Nearest Public Sewer Line N ,A To Nearest Public Sewer Cleanout/Manhole_ ,/��} To Nearest Sewer Service Line on Lot iv Water Sample Collected By /C Date Water Sample Test Results Comments © G�UZ� B. SEPTIC/HOLDING TANK DATA l� Date Installed Size No. of Compartments 2, Standpipes a) Air -tight Caps _ Foundation Cleanoutdv�) Depression over Tank (Y Date Last Pumped S `ZZ< Pumping/Maintenance Contract on File (Y .) fJ for Holding Tank High -Water Alarm (Y )/1/ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Nbll /Bp To Building Foundation 10 To Property Line �� To Disposal Field To Water Main/Service Line ti /„ To Stream, Pond, Lake, or Major Drainage � �(i�. �wr v�Lt n • e� �' . rrz z1^0kaA- . [Page 1 of 21 1-15-84 P C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata O'S ` Type of System Design %ham .ClCtf Date Installed q A / D Length of Field `1/w�'' Width of Field �' k Depth of Field Gravel Fled Thickness Square Feet of Absorption Area Standpipes Present (OM) Depression over Field (-YAn Date -of Last Adequacy Test � 8` Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Wb11 h/DD To Property Line ,20 � A To Building Foundation a lg To Existing or Abandoned System cn Lot At /A- ; On Adjoining Lots 30 ` To Water Main/Service Lined To Cutbank(ifpresent) d y To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, cr Vehicle Storage Area 5/D Convents D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at Dimensions Manhole/Access (YM) "Pump Off" Level at High Water Alarm Level at Vent (YM) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(YM) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or eonforned to all MOA HAA Guidelines in effect on the date of this inspection. _ -: '®F AL ®%1�� Signed rtAVm Imqw Date =y,s� Company C MOA No. dot 01 , 'r,Q-T r = EERY B9b®8£340 ej� "••bf KBl/d5/s es w �4 Ler y C. R' id, Jr., Ja® o. 2251-E `DC7 m (Page 2 of 21 2-15-84 ALASKA RUIROWnTAL COnTROL SCHICCS, Inc. engineerinq & 6nuironmental Studies MAY 22 1984 BUCK CONSTRUCTION 411 E 36TH ANCHORAGE AK 99503 SELLER — BUCK CONSTRUCTION BUYER — DEWALD SUBDIVISION — MITCHELL STEPHANS BLOCK — LOT — 1 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 360 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 800 GALLONS. B P-0 —TH ,,TEST DATA THE SYSTEM IS ACCEPTABLE FOR A ,4BEDROOM HOM . TANK WAS PLMPED ON5/22/84 FLOW TEST ON WELL — THE WELL FLOW RATE 4S .9 GPM FOR 4 HOURS,' SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 THIS 4 BEDROOM HOUSE. o p �Ca✓ Gp) U � � "� ��)A e auea sreaco. !�G_c ., toy C. Re{{{id, Jr � 4 2251.E IS ADEQUATE FOR 1200 West 33rd Auenue. Suite B • Anchoraqe. Alaska 99503 • (907) 561-5040 - APPOINTMENTS DA E RECEIVED INSPECTION �j i 0 TIME TIME / TIME pp NUMBER OF,BEDROOMS � _Ac4- AJ 7 DATE DATE DATE Three ❑ Six 7. WATER SUPPLY INSPECTOR INSPECTOR INSPECTO �_,C4'� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROThJ40PALITY OF ANCHORAGE 625 L Street - Anchorage, Alaska 99501 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 OCT 13 1981 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SPrRAfVf S DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER � , /' 1"•YM/��. � 6 MAI LINGADDRESS /5 77 � 5� !/J � � / PROPERTY RESIDENT (If different from above) PHONE 2. BUYER �ny PHONE � MAILINGADDRES �/,�t�` 4 e- A 3. LENDING INSTITUTION PHONE MAILING ADDRESS e ea- P 4 r 1,4AAI ,CGS , 4. REALTOR/AGENT PHONE Vo//Al /9'S IIL-� MAI LING ADDRESS - /r77 C7 i'3 -Al 5. LEGAL DESCRIPTION �/1 ` Iw / �j i 0 STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS EJ One E] Four ED Other SINGLE FAMILY ❑ 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.) B. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** cep / 4 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev 6/79) ' I THIS SIDE FOR OFFICIAL USE ONLY 9. TYPE OF RESIDENCE O''SINGLE FAMILY El MULTIPLE FAMILY NUMBER OF BEDROOMS ^' ❑ ONE �❑�THREE EJ FIVE El OTHER ❑ TWO EP- FOUR ❑ SIX 2. WATER SUPPLY INDIVIDUAL E< INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified _ PERMIT NUMBER - DEPTH OF WELL DATE DRILLED - LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM fI L'NDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER E:4 p is Tank or ❑ Holding Tank Size: /Z 51d If Tank is homemade give dimensions:f SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS C --E APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATES ra 72-010 (Rev. 6/79)