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MORRIS LT 30B
Morris Lot 30B #051-105-31 Municipality of Anchorage Development Services Department Building Safety Division - On -Site Water and Wastewater Program, 4700 South Bregaw Street P.O. Box 196650 Anchorage, AK 9951M650 Page 1 of 3 www.cl.anchorage.sk.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number SWSWO60397 PID Number. 051-105-31 Nemo Chris & Mike Boylan Wastewater System: []New ® Upgrade 27; Box 8. Chuglak. AK 9956Z ABSORPTION FIELD P Nome" r Beaoome D Deep Troxh ® Shrbr Trerrh O Bee 13 Mound D onw LEGAL DESCRIPTION $adReenp 19 TOW Depe ffain"net Wide Bkxk LalSWbviewrc 2OR Depth W pipe bonam ho"o"p./ Vada 2_11) F1 Grey depth beneath pyr 91 TQWWvp Rarpe aedwn FA added ebwe onrW grade- Gr"LWVM. Well: ❑ New ❑ Upgrade c. r rap Numb■rle»e DnWc.brWe■tbw. t (Pmre, A B. Cp I TOW Depth. Ca"d to Tool ebeorptin Masa Poo Me" E ISS' Private 650 F11 1 3024 PVC Drip' I DMe Drilled -F, SWKWMWLeM Mraken Ring Dre Yabekd. 10/27/2005 Held Pury Sr r C.wp HwVe Above GwM bC DS Lt= CPM FL FI TANK SEPARATION DISTANCES ® septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lift Holding ubuciprtvate 1Aai"ded1"ef Cepeaty From Tank Field Station Tank Sewer Line Anchors eTank 1500 Gr Wen 179.1 150.8 100+Steel N"m.r 2c��e Suface wets, 100+ 100+ LIFT STATION Lr Lir 45 12.1 See MenWapuer Gr FauWrun 30 28. 'Pump ore 1v 0 Twty M levet" Hph wr■rermr F kr H cMtan Drre 75+ 75+ Pump Make a Model Ewr" lnepeuurn pedamid by Rem■ke two Inches Rigid Insulationover field, tank and lines. BENCH MARK Larson Mad Dee"puon: Garage Slab Neumee Eleveb"k 100.0 FL Engineer's Stamp ♦OF,• Inspections performed by: PES. LLC Dates: 1"10/26/2005 ....................., 49TH 2""10/27/2005''" i Development Services apartment approval �_" YSJ✓ j -. ;teven (SN R. Ponnone. %y: Reviewed and approved b PP Y Date: 1��/�e �i� ' No. CE 8149 * ar ♦ • 1`fN • PERMIT NO:SW050397 RECORD DRAWING PJ.D.NO: 051-10531 WASTEWATER DISPOSAL SYSTEM LOT 30B MORRIS SID PORADE 5'Wx47LFx1.5ED, 4'TO ABANDON PORTION IN EASEMENT C3 N NO U � �a LL rwn ��O.. Owa LL KK g 7 2 N zz3v� QZ J W 0 M EX]sr(.fLELD - E24 IN FAILURE. �1 3 TO )3E REUSED I I I I I \ Ie t NEW ISDOd,1 2h I SETIC TANK I I \ mctt.WAT VA�Vt \ I I \ F I I LOT PONS FIELD ON �\ I I LOT 30B J NO WELLS OR SEPTICS "'.' CO.O V r v1.0 00.0 WAN 100 FEET OF PROPOSED E23 17.8 35.6 M1 28.8 63.2 EM1 15.3 34.3 C2 47.2 81.0 SAS UPGRADE E24 41.7 52.6 M2 48.6 82.2 DC1 47.5 23.3 C3 54.1 67.0 B LAIR AVE T2 56.5 34.6 C4 46.0 53.3 DC2 58.0 36.3 M4 46.8 51.5 0 DV 61.4 40.6 FS 52.7 54.5 EXIST'G 5 BR/ �(O R HOUSB E V -- -- ------8--------- 1 2°,6 EXIST'G TANK TO BE I o�TH1 ABANDONEC). M- M B 179.1 I!� 1 9 EXISTING 150.8 PRIVATE C F RE ADDITION WELL 11DC7� 6 2 6. 1.270 \ . A H-= 10.0 �1-2% Mat ....2 .FS L x 0ED.3 D 5W><55L'Fx1.0ED,3TD I I I I NO WELLS OR SEPTICS I I WA173.8N 100 FEET OF PROPOSED 8 \ I I SAS UPGRADE / II 30 i I I I I ��, 1) All work shall be performed In .�� OF1� accordance whh AMC15.65. ��P.••"•••�• �• �� 2) Materials used shall be In accordance with those specified It 3 txIn AMC15.65, Wastewater .--d+ ..# Disposal. R. PannonePREPARED FOR: S�g1 L n• •.•• ��� Chris 8. Mike Boylan P.O. Box 672458 Chuglak, AK 99567 CFESS% - .� 688-5963 3) Maintain 1(r separation to all lot lines and water fines, unless noted otherwise. 4) Lots served by private water systems. No wells within 100' of proposed system. EXISTING PRIVATE WELL PERCOLATION RATE 5 MP APP RATE 1.2 GPDSF (125 BEDROOMS:5 625 SF REQUIRED 5 -WIDE, VED, RF=0.87 2 TRENCHES 55 LF EACH MIN SIZE TANK:1500g PANNONE ENG. SVC, LLC P. O. BOX 102954 ANCHORAGE, ALASKA 99510 227-3522 P. 272-8211 Fax PLAN ffI REPLACEMENT SYSTEM m •••� • Infybtwn '�A#I see Seesee z 2 (y��x{ /y��♦ % tel'^ v e 1 I i _ t 1.s• c.w« afro... © ii) typical O Jan, Ln 303 9e3 '• I 1.0• 1• d'Om. drOin m ••' Am p -M. typed V III�p� ..••.� 1— 933 953 s' Typ. 70• Typ, S' Typ. 0' ;U -0 9-c'Om A mta w m Wn• x0• D —12 Groundwater monitored O m N o m We —8.0' on 10/15/05 9o.e D n �Aa o r rn O 935 T 0 m o n SECTION p A o U En fA a> r .• RKNO INSU ATOM < m ii 4H 4 r ROD NS AATgN i M D 0od I Io ''^^ DD N Z D 3M PVC 4- Die Pb d V/ t^m V002 N=WZ p [ [ NnNi�0 zxA - t x rnNvmN)Z s,o NEW1500g 9 tv D G)mg Bel N� cn TANK Z Z 0 0 N `D r 4 D " (0 n 5 -WIDE TRENCHES 2 EA 55LF EACH, 1' ED. 3 T.D. y ..." O PROFILE • ti Y f -A r1. MUNICIPALITY OF ANCHORAGE 1 Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 �l ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 19, 2005 Expiration Date: Oct 19, 2006 Permit Number: SWO50397 Parcel ID: 051-105-31 Legal Description: MORRIS LT 30B Design Engineer: 0062 Pannone Engineering Services Site Address: 021636 BLAIR AVE Owner Name: CHRIS & MIKE BOYLAN Lot Size: 43560 SQ. FT. Owner Address: PO BOX 672458 Total Bedrooms: 5 Permit Bedrooms: 5 CHUGIAK , AK 99567 - This permit Is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The 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 ). 4. 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 Date: X70 ! ?• Issued By: I Date: Municipality of Anchorage • Development Services Department•'"" Building Safety Division On -Site Water and Wastewater Program .. 9.T 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 1 www.ci.anchorage.ak.us l► (907) 343-7904 �. ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 051.105.31 Permit Number SW Property owner(s)_Chris & Mike Boylan Day phone 688.5963 Mailing address (1) P.O. Box 672458 Mailing address (2)_Chugiak, AK Zip Code 99567 Legal description (Lot, Block & Sub'd.) Lot 30B Morris SID Legal description (Section, Township & Range) Lot Size 43560 Ac d Sq.Ft. THIS APPLICATION IS FOR: Site Adress: 21636 Blair Ave Number of Bedrooms 5 Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ED THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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) PermitFees!�Nirn.dy t oc- col Date of Payment: It"441 a=5 Receipt Number: " ICSC t� ,VQ 4�\ (Rev. 12100) Fees: Date of Payment: Receipt Number: Pannone Engin wing SwV1109, LLC PO Box 102951 Pannone Engineering Services, LLC Consulting Engineers (907) 272-8218 October 17, 2005 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 30B Morris S/D Septic System Upgrade Permit Request Ladies and Gentlemen: P.O. Box 102954 ge, Alaska, 99510 )07)272-8218 Fax I am writing to request that a permit to construct an upgraded septic system be issued for this property. The proposed systems will serve an existing five -bedroom house. The existing system is in failure. The existing 1500 -gallon septic tank will be inspected and replaced. The lot is served by a private water system. 1. Soils. See the attached soils logs. Two test holes were excavated on this lot. Please see the attached soils reports. The soils percolation rate was 5 mpi, with ground water was measured at a depth of —9 feet below ground surface. Bedrock was not encountered in the test holes. It is my opinion that the overall soils appearance of the soils, an application rate of 1.2 gallons/day/square feet should be used using standard treatment system. 2. Trench Design. a. Percolation Rate: b. Application Rate: c. Number of Bedrooms: d. Design Flow: e. Min. Absorption Area: f. Total depth: g. Effective Depth: h. Width: i. Reduction Factor: j. Minimum Length: k. Design Length: 1. Effective Absorption Area: in. Septic Tank Size: Cont'd on page 2 C:\Work\Letters\30B Morris.001.doc 5 Min Per Inch 1.2 gpdpsf 5 750 gallons per day 625 sf 4 feet 1.0 feet 5 feet 0.87 108 feet 110 feet 550 sf 1500 gallon, If required Page 2 3. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The average topography in the area of the proposed septic system is approximately two to three percent. 5. Upgrade of Existing System: portions of the existing system are located in the easement. This permit requests approval be given to abandon that portion in the easement and install a new "leg" on the eastern portion of the field. The existing field would like to be reused. I diverter valve will be installed after the new tank. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 227-3522 or 272-8218. Sincerely, 5 A teven R. Pannone, P.E. Civil Engineer Attachments: C:\WORK\LETTERS\30B MORRIS.001.DOC Steven 'R. �'cnnoi llc� CE 814.9 '•i�Ess.a_ PERMIT NO: DESIGN DRAWING P.I.D. NO: 051-105-31 WASTEWATER DISPOSAL SYSTEM LOT 30B MORRIS SID VW x 47 LF x 1.5 ED. 4' TO )ON PORTION IN EASEMENT -� 0 w O y0. 00 as LL N O Irtw O a�a co 4 K Aga cN z3(<O Z g W m 0 EXISTO_FIELD IN FAILURE. TO 13E REUSED I I t 11 I I I I \ I JEW 1500g \\ I SETIC TANK I I INSTALL BALL -TYPE THREE-WAY VALVE I I LOT r10A'S FIELD ON/ I I LOT 30B J NO WELLS OR SEPTICS W/IN 100 FEET OF PROPOSED SAS UPGRADE BLAIR AVE / r• au /p tea, Exim 5 BRA 3 O B HOUSE B 1-2% EXISTG TAN TO —BE o� TH1 ABANDONED— M - M �. —q1I 10,-\}1 M 11818 EXI PRIVATE) \ WELL 130.1 —_0_ TH2 I I I I O NO WELLS SEPTI S WIIN 100 FEET OF PROPOSED SAS UPGRADE II 30 I I I I I I I I r • F .%% 1) All work shall be performed In accordance with AMC15.65. �4# 2) Materials used shall be In 1� accordance with those specified In AMC15.65, Wastewater ••••••'t•,t} 0 Disposal. R. Pannone PREPARED FOR: ^E 81 •� i �r�-•••.••� Chris & Mike Boylan P.O. Box 672458 "'•• •_,y, �� Chugfak, AK 99567 688.5963 UPGRADE SAS 2 EA TRENCHES 5'W x 55LF x 1.0 ED, 3'TD +s 1-2% \ 159.0 ExIST'G PRIVATE WELL 3) Maintain 10'separation to all lot lines and water lines, unless noted otherwise. 4) Lots served by private water systems. No wells within 100' of proposed system. APP RATE 1.2 GPDSF (125 BEDROOMS:5 625 SF REQUIRED 5 -WIDE, VED, RF=0.87 2 TRENCHES 55 LF EACH MIN SIZE TANK:1500g PANNONE ENG. SVC, LLC P. 0. BOX 102954 ANCHORAGE, ALASKA 99510 227-3522 P. 272-8218 Fax ATE: 10.14-05 :AI PLAN F• 1t5n• PERMIT NO: DESIGN DRAWING DETAILS P.LD.NO: 051-105.31 WASTEWATER DISPOSAL SYSTEM LOT 30B MORRIS S/D 1notmio ON3 HOV3IV 39n1 N0IINON I Vii;= d .fA�'A,�•. •µ'Y .w W LL 13 22 N Z to W � 3'o 1E.2LU LLI u_ 4 U 0 V/ i..` 0 n " E� J_ O ON3 NOV31V 0 39rU U011NOn LL 1nO-NV310 V � S 89 � N 1 E O L%/'NV310 & inO-N"13 inO NV313 O1 O N d z ln0 NV310 •.p�............. 5�... ♦�♦ Z Into • ♦♦ TM 49 °• / �.... 49 — / ln0 NY31O •••t""•/ NOUVONnO! /""s '""" "" ••• $ PREPARED FOR: PANNONE ENG. SVC, LLC / Steven R. Pannone + P. O. BOX 102954 /♦ S = Chris 8 Mike Boylan ♦ E 814 ' �+ P.O. Box 672458 ♦ 6f p(•'+ ANCHORAGE, ALASKA 99510 # ♦ '`QUA. •; f —`�, • Chuglak, AK 99567 ♦♦♦, q1••• 688.5963 227-3522 P, 272-8218 Fax ♦♦tt�,���••• DATE: 10.14-05 DETAILS _ SCALE: NTS U U SOILS LOG - PERCOLATION TEST E .................���♦ PANNONE ENGINEERING SERVICES :��p�" P.O. BOX 102954 i ' 49 2iN ANCHORAGE, AK 99510 i • ••+• � ••••..i.. ••� (907) 272-8218 ..., ...... W�........ i • Steven R. Pannone PERFORMED FOR: Chris 8 Mike Boylan DATE PERFORMED: 10/10/05 ♦♦♦♦ LEGAL DESCRIPTION: LOT 308 Morris S/D ♦'t�-)CF' TEST HOLE 1 TOPSOIL SLOPE SITE BUIRAVE I OR � 2 _ 30B GRAVEL ® r___ ,. 1 GP SAND W/6-9' Cobbles 5 I I , TMt 1 •� •� S 7 I S Z I TEST } 10 HOLE W 1, O m ; ING 12 ,a BOH 30A i WAS GROUND WATER SLOPE 11 ENCOUNTERED? Y 15 IF YES, AT WHAT TH 1 18 DEPTH? .9• 17 DEPTH TO WATER AFTER MONITORING? -9 iS DATE: 10/15/05 1s r�R�� READING DATE 20 PEROLATION RATE 5 (minAnch) PERC HOLE DIAMETER 6Inches TEST RUN BETWEEN 4 FT AND 5 FT COMMENTS: Test hole excavated by JR'S. Test Hole was presoaked before perc test PERFORMED BY: Steven R. Pannone P.E. 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. WATER TIME LLOCK NET TIME LEVEL NETDROP READING 7 10,110-05 1762 fp p x 1x:02 10 MIN 1' 7 � 1302 fr p 1 1x:ix 70 MIN 1' 7 s 1x:12 0' p S 1x:2x 10 MIN 1' 7 SOILS LOG - PERCOLATION TEST �� ",,��♦ 5 11:33 � PANNONE ENGINEERING SERVICES .'��� ...................... ♦j 5.' 2 P.O. BOX 102954 . . 49M �? i1?♦♦♦ P 2' ANCHORAGE, AK 99510 i' 'j ............. •i•••••0 12:03 (907) 272-8218 0..... ...... 1 12:13 10 MIN P 7 3 °;Steven R. Pannone ♦�♦� 12:15 PERFORMED FOR: Chris 8 Mike Boylan DATE PERFORMED: 10/10/05 • C 8149 • e 12:25 ♦�•,',,�;•_�y.•• 1' LEGAL DESCRIPTION: LOT 30B Morris S/D TEST HOLE 2 SLOPE SITE ROAN Top Sod 1 OR 7 r--- Silt' SAND a --------------------- 1 SMI GRAVEL GM 1 I I � T I I 1 WS Z n -m 9 } 10 TEST Poorly gmdeO ' I OLE W w SM SAND b Silt' 11 SAND CO CO 12 I i II BOH I 13 WAS GROUND WATER SLOPE 14 ENCOUNTERED? Y 15TH IF VES, AT WHAT 2 DEPTH? 9' 16 17 DEPTH TO WATER AFTER MONITORING? 9' t8 DATE: 10.10-05 ""rC E/c{r�/oSR�p� 1s CLOCK WATER READING DATE TIME NET TIME LEVEL NET DRq+ 20 READING 1 1010-0 PEROLATION RATE 6(minAnch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 5 FT AND 6 FT COMMENTS: Test hole excavated by JR's. Test Hole was presoaked before perc test PERFORMED BY: Steven R. Pannone P.E. 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT OF ON THE DATE OTHIS TEST. 5 11:33 � T C 2 12:03 10 MIN P 2' 7 12:03 T 0' 1 12:13 10 MIN P 7 3 12:15 e' p e 12:25 10 MIN 1' 2' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION • ENVIRONMENTAL ENGINEERING DIVISION ��1C��rZ.CZ-�• �•J 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ANEW f' 'J ,n� 4/ TS _KCL /` if ci Z1 •'�G r!t+°� ❑ UPGRADE MAI LING ADDRESS ! ;y , 590 NU T K v 6 LEGAL DESCRIPTION T 5N R1W SSCrj LOCATION NO. OF BEDROOMS NORTH GT RL A �D C� Uy DISTANCE TO: Well n/(}r •xh/ 1 j�"� Absorption ar a J 'f Dwelling i f PERMIT NO. to 20 j 6j P Z LU Manufacturer - z�'�2 Material STY: No. of compartments coLiq. cappacity in gallons 7 S Q IF HOMEMADE: Inside length Width Liquid depth Well Dwelling PERMIT NO. z DIScc�TANCE TO: on/ 1A O z 4 Manufacturer Material Liquid capacity in gallons 2 F Well Foundation i j Nearest lot line /� PERMIT NO. Lu DISTANCE TO: £i vT .div Y:[/— J tL _j No. of lines Length of pa I" e j Total lengt o finis Trench wi th Distance between i es Z F— Z inches finish Material beneath file Total effecti y� bsorpyion area Top of file to grade / t�i� � � inches �J Length Width Depth PERMIT NO. w 0 a F Type of crib Crib diameter - Crib depth Total effective absorption area wa _ Lu rn Well Building foundation Nearest lot line DISTANCE TO: J J CIoxs7r �r �`� VV L Depth Driller Distance to lot line PERMIT NO. w Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATING / v 71 �V INSTALLER REMARKS .-rIV51) L L19 i � d01 I ` r I I K.� xtY`efi A Sh r L 1\ S AP Ei0 DATEgL ALASKA { L V -Q 3 (Rev. 3/78) v DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 -OL' STREET.- ANCHORAGE, AK. 99501 264-4720 PERMIT NO. 820859 59 ) APPLIC=ANT MORRI'= BAKER SR1 BO`, 2570 C:HI_UGIA-'. 99567 688-2967 LOCATION LEGAL L30 T15N RIW SEC: 9 LOT SIZE 222222 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD i MAXIMUM NUMBER OF BEDROOMS _ 4 SOIL RATING (SQ FT: `BR) = 150 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: a4 /��$ GtlitsftC✓� -C� C:■��°-! 1-1= 3c_ 15 C_E-=I'A i -f "F "�-- f.:3F-4!_! E'L THE LENGTH DIMENSION I_: THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IE. THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). -F"F= -FF'Er-.1 :" L4 I C --_F" I _- C--Rc_-K&3 FF=#= -F_ THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE E:C:AVATION (IN FEET). F•Er lLI I 8 EC E.EF=•-' I C_- T'F=ir-JE : PERMIT APPLICANT HAS THE RESPONSIBILIT'r TO INFORM THI_ DEPARTMENT DURING THE INSTALLATION INSPEC:TIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- Twr_-� <;2> I tit - Er_ -.T I r_wr.i nfz;?-E Eo Q_e I ECe -- BA=KFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT �T TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND At'd'r ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 2001 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LIME IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPEC:IFIC:ATIONS AND CONSTRUC=TION DIAGRAMS ARE l AVAILABLE TO INSURE PROPER INSTALLATION. F'EF r■1 I T F= F=' I F:E:E; rAE=r=ErilE?EFZ° =<-J, :lL=�*B=ll I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS _-SET FORTH BY THE MUNICIPALITY � �F ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 2: I UNDERSTAND THAT THE Cstd-SITE SEWER SYSTEM MAY REQILIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. --_ fay' ------------------- APP CANT MORRIS BAKER ISSUED B4' _ -- _ _ �l-✓-_-G�ATE_� �l�- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST [] SOILS LOG PERCOLATION TEST LECA. DESCR,PT,ON: Z.~T 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18, 19- 2O 7'- SLOPE SITE PLAN COMMENTS WAS GROUND WATER ENCOUNTERED? O IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop +~ ~/~q~ ?:*~ -~." ,, PERCOLATION RATE .~/ (minutes/inch) TEST RUN BETWEEN '~' FT AND ·'~'~ FT 72-008 (6/79) PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW930340 DATE ISSUED: 9/03/93 DESIGN ENGINEER:DAVID R. DAYTON, P.E. EXPIRATION DATE: 9/03/94 OWNER NAME:BAKER MORRIS & LORETTA OWNER ADDRESS:RR2 BOX 8IR AVE FRANKSTON, TEXAS 75763 Mboo cla 104 30 PARCEL ID:05110511 LEGAL DESCRIPTION: T15N R1W SEC 9 LT 30 LOT SIZE: 108900 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: WELL WILL BE DRILLED ON NORTH 1/2 OF LOT. WELL. _ ; .�7 RECEIVED BY: ABANDON EXISTING DATE: ISSUED BY: . z (} DATE: FROM David R. Dayton P.E. 20210 Donalar St. Chugiak, Alaska 99567 DATE SUBJECT MESSAGE ra R 0cts.,,z (�1�1 1;�C1• 7 � 9 �' 7-E3'ef - ' N 0+�"•r32)!� 2S c�t;2.�z�¢�'Y-� i� i�l V t D Tt � 42c LYie�� ep �� YS - /l�Zs. ar �� •.�u �� `�� ;ems•-��f1e-� fl- L�EJ�, �✓s�it� .c�sieec�S GG_) t'Lk, C9 AJ `_7iL PJ..771= s.,���. /T✓UiJ'� Laf�e7 �:�✓�e d� ��'`� G91/`` i2-' 7 S931Meg ustunH V 41leGH idaa ebujoMouV 40 Ajilediownyq ®I / 1 H J I U SIGNED 1,` a— / rr as absF1NO REPLY NECESSARY 468-1 REPLY REQUESTED USE REVERSE SIDE POLY PAK (50 SETS) 4P466 carbon/effm „=50� ��- 3o S3cr_9 T�SN,_RIW 0.1 _ %�•1 HIIN y� %IIN�• �_��NI•NMI.N NIII • •�P / �► David R. Dayton piO: 2205-E ._— �► -- — — MUNICIPALITY OF ANCHORAGE (~4~ x DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99E01 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME . \ PHONE I J~NEW MAILING ADDRESS LEGAL DESCBIPTION LOCATION NO. OF BEDROOMS DISTANCE TO: J Wel' Dwelling PERMIT NO. ¢2~ ~¢~' Manufacturer ~X'~X WidthMater'i¢~r{C NO' °f c°mpartments X Liquid de.th Liq. caEacity in gallons Inside length Well Dwelling PERMIT NO. ~ ~ DISTANCE TO: O Z < Manufacturer/~ Material Liquid capacity in gallons Q Well Founder,on /~ 2 Nearest lot line ~,~ PERMIT ~.. DISTANCE TO: ~¢r %~ ; ~ I~ TOp of tile ,o finish grade '' Material beneath tile Total .(f~tive absor,~ion area Length Width Depth PERMIT NO. ~ ~ Typ~ of crib Orib diamattr Crib d~th Total ifftcfiw absorCtion area ~ W~ll 8uiidin~ foundation N*ar*s~ lot line ~ DISTANCE TO: J/v~IC?~ ~ y~ De.th Drimle, Distance ,o mo~ line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: REMARKS 13 {Rev. 3/78) PERMIT NO. ~PPLICRNT LOCATION LEGRL MUI~ 1' C 1'~ ,=t! I T'~ Ii:if ~-~l~l~H .,Rl=l~E DEPRRTMENT OF HEALTH RND EN¥IRONMENTRL PROTECTION 825 ~L~ STREET~ 8NCHORRG6 ~K~ 9~5~1 2~4-4~20 O~-~--S I TE SEWER PERM I T 820859 > MORRIS BBKER L~O T15N R1W SEC ~ BOX 25?0 CHUGIRK TYPE OF SOIL RBSORPTION SYSTEM IS: DRRINFIELD LOT SIZE 222222 SQURRE FEET MRXlMUM NUMBER OF BEDROOMS = 4 SOIL RATING T?~E REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= _?~. 5 LE~GTH= ~4 GR~=~'EL DFPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFRCE OF THE GROUND AND THE BOTTOM OF THE E~CRVATION <IN FEET>. THE TRENCH HIDTH IS 5. 000 FFET. THE GRRYEI DEPTH IS THE MINIMUM DEPTH OF GR~VEL BETWEEN THE OUTFRLL PIPE RND THE BOttOM OF THE E.~CRYATION (IN FEET>. REQUIRED SEPTIC TBNK SIZE= 1250 g~:lLI OI~S PERMIT RPPLICBNT HBS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RN¥ WELLS RDJBCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. TWO (: 2 > INSPECT 1' {:)NS PRE REQU I RED BRCKFILLING OF RN¥ SYSTEM WITHOUT FINRL INSPECTION RND APPROYRL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN A WELL RND 8N¥ ON-SITE SEWAGE DISPOSRL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO R PRIVBTE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY RPPLY. SPECIFICRTIONS AND CONSTRUCTION DIRGRBMS PRE 8VAILRBLe TO INSURE PROPER INSTRLLRTION. PERM I T E~P I RES DECEMBER ~-~ I CERTIFY THRT l: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS 8ND WELLS RS SET FORTH BY THE MUNICIPALITY Of RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN ACCORDRNCE WITH THE CODES. ~: I UNDERSTAND THBT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUD£ MORE THRN 4 BEDROOMS- SIGNED: ~~ ~- iCANT MORRIS BRKER ISSUED ¥4. 0 E] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaske 99501 264-4720 SOILS LOG- PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: ~AL DESC.,PTIO.: Z, ~,7' D,,TE FE.FOR EO: 1 2 3 4 5 6 7 8 9 10 11 12 13 14- 15 16 17 18 20- SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? Y~ ~'' SL 0 IF YES. AT WHAT 7~.' DEPTH? Gross Net Depth to Net' Reading Date Time Time Water Drop +~ f/~¢.. ?:~ -~." 3 7:~~ /~ COMME.TS /~.~7~ ' A~z,~ PERFORMED BY: PERCOLATION RATE ~ m/ {minutes/inchl TEST RUN 8E'rWEEN ~ FT AND ~ FT ~'~_~ ~ 1' ~ 3' ,s.~- I ~"~ .~.,.~ P~r_z CERTIFIED 'Y:~ OATE::~ 724)08 (6/79) MUNICIPALITY OF ANCHORAGE EPLAA19 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section--- Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051 105 31 1. GENERAL INFORMATION Complete legal description Morris Lot 30B Location (site address) 21636 Blair Current property owner(s) Boylan Mailing address Real estate agent 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Expiration Date: g _ / r '202-0 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Q Private Septic ED Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ -9930 Waiver Fee $ Date of Payment 1613 1 1 l 6) Date of Payment Receipt Number 0Mg Receipt Number COSA # (15 0 9 I5Z® 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. Name of Firm C&M ENGINEERING Phone 8545558 Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI Date 10/25/2019 Original Certificate Date: 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 COSA Checklist blue sheet OFq els i* •' TH s • 49 — •.* DSD SIGNATURE 011System #1 Approved for t)bedrooms CHARLES G BALZARINI System #2 Approved for bedrooms �+��F-6, % CE -13854 • �% I Am Disapproved . • Aw �lliFOpROFE000�� Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: 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 COSA Checklist blue sheet COSA Checklist Legal Description: morris lot 30B Parcel ID: 051-105-31 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 10/93 Total depth 60 ft Cased to 60 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) +18 in. Date of flow test for COSA 10121!19 Static water level at beginning of test 14 ft. Comments B. TANK DATA Age of tank(s) 14 years Tank type/material STEEL ❑ Standpipes/foundation cleanout per record drawing Date of pumping 9/10/19 D. ABSORPTION FIELD DATA Shallow Trench Which system tested (date installed) 2005 ❑ ALL standpipes present per record drawing Total measured depth from grade 5.7 ft (max) Measured depth to pipe invert from grade 3.5 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of drainfield. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced na gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 5.33 gpm Water storage tank volume - gallons Well disinfected for coliform test? ❑ Yes Al Nc ❑ Coliform bacteria is Negative Nitrate 1.15 mg/L ❑ Nitrate less than MRL (ND) Arsenic 8.63 ug/L ❑ Arsenic less than MRL (ND) Collected by C&M ENGINEERING Date of Sample 8120119 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: tank level normal, 50" Adequacy test date 10'2119 Results ❑✓ Pass For 5 bedrooms Fluid depth prior to test 0 in Water added 750 gal New depth 0 in Elapsed time 1440 min Final fluid depth 0 , in Absorption rate 750 gpd Any rejuvenation treatment (past 12 months) NO If yes, enter date N/A E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes if No Community Sewer Manhole/Cleanout > 100' 0 Yes if No ft FV� Yes if No ft Neighboring Tank > 100' QYes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' Q Y e s if No ft Holding Tank > 100' DYes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Q✓ Yes if No ft 0 Yes if No ft ft Community Wells > 200' F,-/] Yes if No ft Yes if No Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' QYes if No ft QYes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water > 100' F,/� Yes if No ft Property Line > 5' Yes if No ft Driveway/Parking > 0' FZ Yes if No, comment Absorption Field > 5' Q✓ Yes if No ft Wells on Adjacent Lots: if No Water Main > 10' ✓Q Yes if No ft Private Wells > 100' F,71 Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' F,-/] Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft Driveway/Parking > 0' ✓Q Yes if No, comment Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100'✓Q Yes if No ft Water Service Line > 10' FV� Yes if No ft Community Wells > 200' FV� Yes if No ft Surface Water > 100' 0✓ Yes if No ft F. ENGINEER'S 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. 10/25/19 COSA Checklist yellow sheet �� ®a®®� �� of ALgsO�a �� 11-1.. t.HARLES G BALZARIRI 4 CE -13854 .•�c`�� 1®ooa�� Lot 30B Morris Subdivision 43,560 Sq. Ft. 21636 Blair Avenue 2 Story Wood Frame House With Attached 2 Car Garage S S SS S SSS SSS SS S S S SS SS SS S W N89° 59' 54"W 279.93L=3 1.43R=2 0.01 N00° 01' 00"W 125.50 N89° 59' 54"W 299.95S00° 01' 11"E 145.51 38.2 25.812.0 24.624.3 24.16.2 2.2 7.6 2.2 12.226.316.210.2 7.614.1 19.024.211.9 20.122.5 14.0 7.8 8.3PAVED DRIVEWAY12' ELECTRIC & TELE. EASEMENT100' WELL R A D I U S BLAIR AVENUEBOWERY LANE CHICKEN COOPS SHED TENT SHED OHPOHPOHPOHPOHPOHP OHPOHPOHPOHPOHPOHPOHPOHPOHPOHP LOT 30A2ND STORY DECK 5.2 33.7 145.4143.320' PATENT RESERVE R.O.W.109.362.941.5 137.438.0 15.2 15.9 16.216.741.870.430.0 R.O.W. Frederic W. Wagner NO. L.S.-9946 PROFESSIONAL SEAL Date:Frontier Surveys, LLC Project No: 650 W. 58th Ave. Suite E Anchorage, Alaska 99518 As-Built Survey of: www.frontiersurveys.com Frontier Surveys, LLC I, Frederic Wagner, hereby certify that this Mortgage Inspection Survey was performed by me, or under my direct supervision on Plat:Grid:Ordered By: 907.460.1686 - info@frontiersurveys.com This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances should this document be used for construction or for establishing a boundary or fence line. October 22nd, 2019. Legend: Scale 1" = 40'STA T E O F ALA S K A49 TH ROYEVRUSDNALLANOISSEFORP DERE T S IGER 10/23/2019 Lot 30B, Morris Subdivision General Notes: 1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws. 2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. 3. All measurements/setbacks are to the visual/apparent building footprint. 4. All dimensions to property lines are plus/minus 0.1ft. Charles Balzarini 19-423 10/22/2019 94-29 N/A Gas Meter Electric Meter/Outside Power Deck Sewer C/O Water Valve Telephone Pole Fence Mailbox Overhead Utility Light Pole S G E Tel. Ped.MBT E Elec. Ped. W Water Well Concrete .r MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# yd S-3/ HAA# VA21glir�i�ln 1. GENERAL INFORMATION Complete legal description 1—e)t 3 o 2 /,12y Sir Location (site address or directions) � / 6 3 6 /Y%i � 4v, Property owner �� 4 �d �G^ `� !s'r�wY Day phone Mailing address Lending agency ^ lA Day phone Mailing address Agent ��yi� �.�iE/r — f t1..�,,�s -,"�</ �rtDay phone Address �'d✓� ��:��� /moi a ��;Y. /�,y 991, Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: y v 3. TYPE OF WATER SUPPLY: Individual well k Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site k Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 421 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm _ Eagle River Engineering Services Phone1- P.O. Box 773294, Eagie River, AK 995773294 Address Engineer's signatures�'f Date 6. DHHS SIGNATURE Approved for — 1 Disapproved. Conditional approval for Additional Comments 25 bedrooms. NUTlr bedrooms, with the following stipulations: 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 their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVIC (VISION Municipality of Anchorage AUG 12 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ®®17 r — 825 L Street, Room 502 Anchorage, Alaska 99501 • (907) 343-47" C E Health Authority Approval Checklist Legal Description: .41-o f 3e? 1-f /���-/i� %6�d. Parcel I.D.: 6,5-1- lUS- A. WELL DATA Well type Fe If A, B, or C, attach ADEC letter. ADEC water system number "'/A j�j-,,/cr Log present (Y/N) Date completed /0% ? Total depth 60 ' Cased to Sanitary seal (Y/N) Date of test Static water level Well production FROM WELL LOG /d1 -?3 WATER SAMPLE RESULTS: 601 7/ 5 — g -p.m - Casing height (above ground) • / Wires properly protected (Y/N)_ AT INSPECTION 719 y, o- r mid., Coliform 0 Nitrate ?6 0�5/4' Other bacteria Date of sample: 7 - .?v - Collected by: Z:-AlnE.l B. SEPTIC/HOLDING TANK DATA 6 - s- g.p.m. Date installed Tank size / 64 °?' Number of Compartments Cleanouts (Y/N)� Foundation cleanout (Y/N)� % Depression (Y/N) /V High water alarm (Y/N) n 14 Date of Pumping .6� 12.9 Pumper +%W AA J C. ABSORPTION FIELD DATA Date installed / '?d- a Soil rating (g p dcffF-or ft2/bdrm) /S`v System type Length yam' Width Gravel thickness below pipe Total depth 3 Effective absorption area d -2e 06 Monitoring Tube present (Y/N)Depression over field (Y/N) Date of adequacy test 7- 2-1-72 Results (Pass/Fail) psr r For 414 bedrooms Z� Fluid depth in absorption field before test (in.); %S Immediately after s`13 -'gal. water added (in.): 16,s-' Fluid depth 13 " (ins) Minutes later: / 4/o Absorption rate = t Gov Peroxide treatment (past 12 months) (Y/N) H'/W If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION N/A Date installed ` Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot t /UD '� Absorption field on lot t !oa / Public sewer main i✓/ Sewer /septic service line _t a S' I On adjacent lots "Pump off" level at* r/vo On adjacent lots t /o,> Public sewer manhole/cleanout Lift station /'/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation z Property line 1- /0 / Absorption field 7 /6no«C� Water main/service line 4-/o —"Surface water/drainage -roe / Wells on adjacent lots -a"loo SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 2l / _ Building foundation /S - Surface water 1- /,o 1)' Curtain drain Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots •tevv" /-in 11 I io / F. ENGINEER'S CERTIFICATION": +' 1 certify that 1 have determined thru field inspections and review of Municipal reStlaf•tflfb0, ems are P -K° in conformance with MOA HAA guidelines in effect on this date. � � ��_e/C__, - 77�'s.Y": y�y�•..�rr�a►w•..+i n,r4 Signature f�= F--`—,^„�.-.� —_�.• z / ./� nn ` .+w •air Y.•H1�.*1 b.�$.i a� ' LC/c'!/ J /'S�-, 7�-r L �^ Louis A. But+ara WJ Engineer s Name �y,*y cyJ� Date /vv'�-e f//Jy1i s%6o' ut 17.e- HAA 7.eHAA Fee $ d7� Waiver Fee $ Date of Paymentr� n �— Date of Payment Receipt Number d `S , ``�� �� Receipt Number 72-026 (Rev. 3/96)* �.c Y`ii�+ .CIJ �,itiCef m t zc iK a rt n R AS -BUILT. I hereby certify that I have surveyed the following described property: LoT 3c';1$ y` Anchorage Recording Precinct,;Alaska, acid that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lytm�g ady' went thereto, that r . a -; ` YY i no improvements on property lyurg adJJscent thereto encroach on.the premises in question and that d are•no ioadways, �. `F ys• :' .j transmiision lines or outer vW3k easements on said property except as indicated hereon. Dated at Eagle Rivers Alaska . th tf - day of ° t^n✓ �o ,r ' ' ' Zg F7 ^ ROBERT C. jOHNSOId - SCALE: ReVatered Land Surveyor No_ LS BOX 77-0456.:$agk River, Alaska 99577 Ph" (9M 6SI-2541 i MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING AA# H Parcel l.D.# f%�\ \nL'-�\ - 1. GENERAL INFORMATION i Complete legal description ! / V IC .> > Z. r �i.�h' . AlOf YiS t ' n d�S" � - Location (site address or, directions) Property owner Day phone e7( Mailing address rang �/2/3�v�rSTelJ S 0 3 Lending agency Day phone Mailing address Agent �Z�i�itnl Day phorne Address Unless otherwise requested, HAA will be held for pickup. ;! 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well x Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev -1/91) Front MOA #21 5. T_ STATEMENT OF INSi-iXTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm David R. Dayton P.E. Phone 576 ! yL/ 2LPA 10 ona ar St. chuaiak. Alaska 995A 94111*14&714�1 Engineer's signature 6. DHHS. SIGNATURE _ Approved for bedrooms. t Disapproved. Conditional approval for Date G 9 .°ti's 0 A o . 5. ao..+• IJavid R. Do on .' No 2r)05.E bedrooms, with the following stipulations: Additional Comments AU, PA9.212i co(.Ica2NL2D 8145 9T)V(5e-V 11+ar T(+a✓ oN-srr& WF SiCsIU �- S rST�tit� 56kuimt, tz-i -tO A 15 Coc�L� ON Lo -r 30B By: 0k� S-OArrl.-t- _ Date 2,1 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M (Rev.1/91) Rack MOA #21 Municipality of Anchorage ® Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ,c111L �Or3u 7 -IJ --AJ /,?/ &J Legal Description: Ger 50 6 Parcel I.D. A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) y Date completed &)/711`13 Driller 0)A -Tc -72 /(J<r.&S Total depth Cased to 0 C) Casing height Sanitary seal (Y/N) y Wires properly protected (Y/N) FROM WELL LOG i6/7Z>3 sw53�3y�o Date of test Static water level Well flow Pump levell SEPARATION DISTANCES FROM WELL TO: g. p. m. Y AT INSPECTION 3AAFq/ MUNICIPALITY OF ANCHOKA(3h ENVIRONMENTAL SERVICES DIVISION' ^,Fi 0 i 1994 g.p.m. 17 RECEIVED Septic/holding tank on lot )4"o ; On adjacent lots Absorption field on lot 17 a ; On adjacent lots PE Public sewer main Public sewer manhole/cleanout Sewer service line Z s f Petroleum tank WATER SAMPLE SAMPLE RESULTS: Coliform J Nitrate © Pio Other bacteria o Date of sample: r /43/43 Collected by: paw T t11O2� 2 � yr S ii% %4564 -!�`c B. SEPTIC/HOLDING TANK DATA X3-9-10 Date installed Tank size Z w Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) /�� Depression (Y/N) 14.1 High water alarm (Y/N) j ✓�i� Alarm tested (Y/N) ^!/�t� Date of pumping Pumper Pumper 6%IifY/ `��'L'z'' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot J G o On adjacent lots 0-�-- Foundation I ?_ To property line 120 Absorption field % Water main/service line Z_L) ;0,— Surface water/drainage io- 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed � Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Manhole/Access (Y/N) "Pump off" Level at Cycles tested Surface water Date installed _ %�XZ Soil rating (GPD/Ft2) /S9 __System type 72i�u�� Length !j,S" Width Gravel thickness /.5 11Total depth Total absorption area Cleanout present (Y/N) Y Depression over field (Y/N) ',) Date of adequacy test 3 /ox Results (pass/fail) __for Bedrooms Water level in absorption field before test rz'r After test Peroxide treatment (past 12 months) (Y/N) A,,)o If yes, give; date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 17J On adjacent lots To building foundation i 00 - Property line z� To existing or abandoned system on lot On adjacent lots.. /as' Cutbank A/Ii3- Water main/service line 2 J7/__ Surface water 106-y-- Driveway, parking/vehicle storage area Curtain drain it/0ns E. ENGINEER'S CERTIFICATION l certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. David R. Dayton P.E. a Signature 20210 Donalar St. ' Chugiak, Alaska567Engineer's Name; Date " � u HAA Fee $ _3 n Waiver Fee $ _ Date of Payment '-L --.,9Z Date of Payment Receipt Number •S'J/ f Receipt Number. 72-026 (3/93)` Back