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HomeMy WebLinkAboutSUN SHINE ACRES LT 4Sun Shine Acres Lot 4 #017-401-38 ,qUBMtTTAj Municipality of Anchorage OCT 1 2012 On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OS0121211 PID Number: 017-401-38 Dwelling: A Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New N Upgrade Name: PETE WOODSEN ABSORPTION FIELD ❑Deep Trench [:1 Shallow Trench ❑Bed ❑ Mound Address 8901 SPEND LOVE DR ANCHORAGE AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade FL Gravel depth beneath pipe Ft. Subdivision Block Lot Sunshine Acres 4 Fill added above original gradeGravel Ft. length FL Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 104' TANK ■ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER ' Capacity Surface Water >100' 1500 Gal. Material Number of compartments Lot Line >20' STEEL 2 NA Foundation >5' LIFT STATION Manufacturer Capacity Curtain Drain N.O. Gal. Remarks CONNECTED TOEXISTING DRAINFIELD Pump on level at Pump off level at High water alarm at in. in. in. �EPitI,rvy-,/+gtlk(.'Seit. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 ISAAC'S CONSTRUCTION Drainfield CO/MT Inspector ANSON MOXNESS BENCH MARK (Assumed elevation) 100 It Inspection ection 1r 8/23/12 Location and description 2nd 3" 4'" BOTTOM SIDING WESTERN CORNER COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Atq�� l0 w Date �E.�F ca49 i. ..GNB.....X i LAF �SPURKLAND.- / 1% 1150 +((�"F�/'ROFES10 Approve Date 3 (S— mspeaion rteparr e-ri[.eoc I I I SUNSHINE ACRES SID I I i I I Lot 4 1 £ 1 �� C N A I ABANDONED rXLSRNG SEPTIC TANK PER MOA., .. - CODE REOUIR£MENTS r I INSTALLED NEW 1500 GALLON STSWING TIESEL SEPTIC I CONNECTED TO DRAIN FIELD A 8 C 19.5 41.5 "=:� ,�,.:•, D 29.5 E 32.0 56.0 1 25 0 25 50 75 100 125 150`;' R' _ SCALE, 1' _ 50 FT _ _ _ _ _ _ _ _ :r�' SPENDLOVE DR, NOT£.. THIS 15 NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMA7E. BDUBLE CLEANOUTS lv C8WCTED TO , 1500 GALLON SEPTIC TAW r EXIST DRAINFI£LD RENCH MARK- BOTTOM SIDING ASSUMED ELEVATION 100 FEET FOUNDATION CLEANOUT SPURKLAND ENGINEER/NG Sunshine Acres Lot 4 SEPTIC SYSTEM ASBUILT 203 W 15TH: AVENUE ANCH: AK. 99501 Pete Woodsen LATE AUGUST 28, 2012 (907) 279-3916 8901 S endlove Dr., ANCHDRA6E, AK 99516 SHEET, 1/1 GRID, 3337 PERMIT # OSP 121211 PID # 017-401-38 SUNSHINEACRESL4-ASB,DVG On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP121211 Tax Code Number: 01740138000 Work Type: Septic Upgrade Permit Effective Dates: July 27, 2012 to July 27, 2013 Design Engineer: SPURKLAND ENGINEERING Subdivision: SUN SHINE ACRES Site Legal Address: SUN SHINE ACRES LT 4 G:2841 Owner/Address: WOODSON GEORGIA BURY REV TRUST WOODSON GEORGIA BURY/TRUSTEE 8901 SPENDLOVE DRIVE ANCHORAGE AK 995163359 Site Mailing Address: 8901 SPENDLOVE DR, Anchorage This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank All construction must be in accordance with: Lot Size in Sq Ft: 208130 Total Bedrooms: 4 N Privy N private Well N Water Storage 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On -Site Water & Wastewater Program Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Phone: 907-343-7904 Fax: 907-343-7997 Parcel I.D. 014-401-3$ Properlyowner(s) PETE WDcA5en Dayphone 3q5 -X335 Mailing address ftl SPENO LOVE. DR, PUMACA, AV, 995110 Site address —JAME— Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (® all that apply) Initial ❑ Absorption Field ❑ Septic Tank Upgrade Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I 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. property owner or Permit/Rush Fees: (e goo Waiver Fees: Date of Payment: 3W //.? Date of Payment: Receipt Number: e10 lqReceipt Number: Permit No. Waiver No. GABuildinglOn SiteTorms\Client FormsTermit App_010411.doc (Rev. 1111) &_Ak spuMand Engonswong Environmental Consulting and Design July 19, 2012 Municipality of Anchorage Development Services Department Building Services Division On-site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 Subject: SEPTIC TANK PERMIT APPLICATION Sunshine Acres Lot 4 Ladies and Gentlemen: We are submitting an application to upgrade the septic tank for this lot. The existing septic tank serving the above referenced property is 27 years old and the owner would like to replace it. The submittal consists of one (1) drawing showing the present improvements on the lot and the proposed improvements of the lot, of which only the septic tank is subject to this permit application. The installation of this septic tank will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses within 100 feet of the proposed septic tank location. The proposed septic tank will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or are in need of additional information please contact me at 279-3916. S' cere'U f� ars S urkland, P.E. 203 West 15`h Avenue Suite 202, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurklandEng@gci.net I I I SUNSHINE ACRES SID Lot 4 I I / \ I xT i ABANDON EXISTING SEPTIC TANK PER MOA CODE R£OULR£MENTS °'-4`•z'''''''�'•r}.. INSTALL NEW 1150 GALLON STEEL SEPTIC CONNECTED TO DRAIN FIELD �: I s z , 50 0 25 50 75 100 SCALE.- 1' = 50 FT M -- SPENDLOVE DR. NOTE. THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. 4 FEET COVER DOUBLE CL£AROUTS CIRRIECT TO EXIST BRAINFIELD 1250 GALLI7N SEPTIC TANK FOUNDATION CLEANOUT ANCH MARK SSUMED ELEVATION 100 FEET SPURKLAND ENGINEERING Sunshine Acres Lot 4 SEPTIC SYSTEM 203 V 15TH. AVENUE BATE., Ju! 19, 2012 ANCH. AK. 99501 Pete Voodsen Y (907) 279-3916 8901 Spendlove Dr., ANCHORA6E, AK 99516 SHEET, 1/1 6RID+ 3337 PERMIT # OSP 111XXXX PID 0 017-401-38 SUNSHINEACRE5L4DLDVG SPLIT almd Engomse ong Environmental Consulting and Design Single Family On-site Wastewater Disposal System Construction and Material Specifications Subject Property: Sunshine Acres Lot 4 Date: July 19, 2012 General: 1. The owner shall contract with a contractor to perform the work outlined in these specifications and plans in accordance with the attached MOA permit. There is not contractual arrangement between the contractor and the Engineer. The Engineer shall be the owner's representative and will inspect the work to document the contractors activities. Final acceptance of the contractors work rests with the owner and the MOA. 2. The scope of the work includes the installation of a new 1250 gallon septic tank. The location of the drain field is shown on the attached site plan drawings. All components of the proposed septic system must be constructed a minimum of 100 feet from any surface water or water wells in the area. A minimum of 4 feet of earthen cover is required over the septic tank. If less than 4 feet of cover is available, 2 -inch thick, 40 psi, direct bury board foam shall be installed directly over the septic tank and all installed piping. 3. Construction shall be in accordance with the approved site plan and design drawings and any special provisions noted on the Municipal well and/or septic permit. All materials, components, workmanship and construction practices shall comply with the Municipality of Anchorage's latest ordinances regarding wells and septic systems, as well as MOA, Development Services Department, On-site Water and Wastewater Program (DSD) policies. 4. The contractor is responsible for obtaining all underground utility locates, layout of the proposed system, and verifying and maintaining all required separation distances to lot lines, surface water, wells, steep slopes, etc. S. The property owner shall be responsible for final grading any depressions formed from settlement of backfill material. The property owner is also responsible for vegetation of all areas disturbed by septic system installation activities. 6. Contractors installing wastewater disposal systems must be certified to do so by the MOA DSD, On-site Water Wastewater Program. Property owners installing their own systems must receive advanced approval from MOA DSD prior to system installation activities. 7. The contractor shall ensure that ALL materials being used are in compliance with the most current guidelines established by the Municipality of Anchorage. Refer to "Standards and Specifications for Component Parts and Materials Used in the Construction of On-site Wastewater Disposal Systems", Dated December 2000, as provided by MOA DSD, On-site Water and Wastewater Program. 203 West 15th Avenue Suite 202, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurldand@gci.net SPLIT o�and Engonawong Environmental Consulting and Design Septic Tank Installation: 1. A new septic tank, of the size specified in the design drawings, shall be procured from a qualified manufacture/supplier if the existing septic tank is found to be defective. Construction shall include two 4" diameter cleanouts for pumping access. 2. The burial rating of the tank shall be adequate for the actual burial depth encountered. 3. The tank shall be level and sufficiently bedded to prevent settling of shifting of the tank. 4. All standpipes on the tank shall extend a minimum of 121nches above the final grade. S. Tanks installed with less than 4 feet of cover shall be insulated. 6. The sewer service line from the house to the tank shall have a minimum slope of 2% unless prior approval is obtained from the engineer. 7. The inlet and outlet lines from the tank shall be bedded in drain rock or the soil shall be sufficiently compacted to prevent future settlement of the soil. 8. Septic tank inlets, outlets and cleanouts shall be fitted with water tight couplings. 9. A cleanout shall be installed 1 to 4 feet from the foundation. 30. Post tank cleanouts shall be installed per MOA requirements. Does not apply to pressurized lines. 11. In areas with high ground water, the septic tank shall be sufficiently anchored to resist buoyancy forces when there is not adequate soil cover to resist uplift force. The contractor shall refer to the engineer for direction regarding this matter. 12. The tank backfill shall be graded sufficiently to ensure positive drainage away from the tank. 13. All holding tank and lift stations shall have an audible and visible alarm inside the residence being served. 14. All lift stations shall be wired in compliance with all MOA guidelines and the Uniform Electrical Code. A municipal electrical permit and inspections must be obtained where required by the MOA. 15. The contractor shall verify that the septic tank/lift station is a minimum of 100 feet from any residential water well, 150' from any class 'C'well and 200 feet from any community water wells. Additional separation distances must also be maintained. 16. The contractor shall remove or abandon the existing tank in compliance with the Unform Plumbing Code. Inspections: 1. A minimum of one inspection is required by the Municipality of Anchorage. These inspections must be conducted under the supervision of a Professional Engineer licensed to practice in the State of Alaska. 2. The septic tank may be set in place, but may not be backfilled. 3. The contractor shall provide a legible copy of all field notes relating to system layout and construction to the engineer for the use in preparing the record drawings. 4. The contractor shall coordinate all inspections with the Engineer. A minimum of 24 hours notice is required prior to the start of construction. If necessary, a preconstruction meeting will be held on-site. 203 West 15"' Avenue Suite 202, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net MUNICIPALITY OF ANCHORAGE / DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 82.5 L Street - Anchorage, Alaska 99501 Telephone 204.4720 �- ON-SITE SEWAGE DISPOSAL. SYSTEM AND/OR WELL INSPECTION REPORT ❑UPNAM� Z GRADE MAILM§pK11C -1 D QJ 04, P K- 5-l t LEGALDESCRIPTION L11AT106k3V)(JOU f� -- F^� 1��„t ,// A A ` NO. OF 6E UROOMS ✓ l.• V� t) ___ DISTANCE TO: We 11llll/Q� Absorption area --1- I 0 Dwell iin'g(-bvl .-I- PERMIT NO 5_' ®oo7 S Fes-- Q Manufacturer �LE/J N M r}al _ No. of compare nts W s Liq. capact it -61 onIF HOMEMADE: (J Insidelength Width Liquid depth ❑ t/' Z DISTANCE TO; Well Dwelling PERMIT NO.� S FManufacturer _ Material Liquid capacity in gallons ❑ Lu DISTANCE TO: WellY� I (Oo Fou dation ® � IN crest I I"ne �'L� PERMIT NP, ( I�On(•� ae LL Z Z W [C No. of lines Le gtll oq f e t line — - 'iolIeitytJ_pl lines (� j french idih 'Y [O L inches - Distance b�tw•eef mes /V / r� tt F Top of tile to finish grade ( Material beneath tile// , _ 6 Tot.'d, eff cove absorptic ^h If6 area p R� inches 5 -' Length Width Depth PER NO. w Qt- ua Type of crib Crib diameter Crib depth Total effective absorption area ru DISTANCE TO: Well Building foundation ___ Nearest lot line .Glees �� Depth1 Jr9rGA!(iwN Oril er JkJkAa1D-(O9� st nee t lot line D"Ll" l PERMIT NO. C� �jS(TD(S— CVIVc�i! U)ti) DISTANCE TO: Buildin f undation k+ I i Sewer lin ! -�-5-0 Septi c to tk ( Absorption area( OTHER PIPE MATERIALS G!1, SOI L TEST RATI NG (5`O t INSTALLER A) G Lk) 1150 Il Z f - I'ZS REMARK�s Vit) ILC.,%c� �£�Dr�V0hA — [ D s { 0 rL a [� 1.fCs u vSGav - dy% i�V s� dt5-p$a (3 iC )Af Aty APPROVED DATE LEGAL - // /'� r r� GnA, F5--0-z'-:SC: S U �1 sR`9 2� ��5 l 50kishmej AG JD --5!' 72.013 (Rev. 3178) 1 )'Z -k), ,j GO, 5 ll. ��JtWH T 11; JL 170:31R.. :1: -1 - "V" C I Vol DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 171,%H_1133.�EE E! 117 R4 En hot too imp HOC �L. ���IH-H 1 -H PERMIT NO: 950095 DATE ISSUED: 04/11/8! i APPLICANT: R & P INVESTMENTS AnnRESR: io O 9gx m9O5 ANCHORAGE, AK 99511 CONTACT PHONE: 346-2787 LEGAL DESCRIP: SUBDIVISION: SUNSHINE ACRES LOT: 4 N4 SECTION, 25 TOWNSHIP: 12N :8NGL: 7W LOT SIZE: 4"778A (SQ,FT. OR ACRES) LOT LOCATION: SPENDLDVE DRIVE MAX BEDROOMS: 4 Listed below are the options available to you in designing your septic system. Choose the option that best fits our site,. -------------------------------------`-- �Fz n Pj u H -U RAA~ T01?d2l 1: HVII DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 GRAYEL DFPTH (FT,) 8"O 3,5 TOTAL DEPTH (FT.) 12.0 7.3 GRAVEL WIDTH (FT. > 2.5 5"O GRAVL�L LENGTH (FT.) 38.O 65.0 GRAVEL VpLUME (CU.YDS.) 3O^0 402 TANK SIZE (GALE) 1,250,0 ** 1,250,0 ** SOIL RATING (SQ^FT./BR) 150 150 / ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify thaL; 1. 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� 2, T will install the system in accordance with all MOM codes and regulations, and in compliance with the design critepia of this permit. 7" I will adhere to all MOM and State of Alaska roquirements for Lhe not hack distances from any existing well, wastewator disposal system or public sewerage system on this o, any adjacent or nearby lot, 4. I understand that this permit is valid for a maximum of 4 bedrooms and any enlargement will require an additional permit, IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA 8UILDING FODES, THEN (1) AN EiECTRICAL PERMIT AND INSPECTION MUST BE OBTAINFD; (2) AS-BUILTS WILL NpT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRI�AL WORK MUST BE DONE BY A LICENSED ELECTRICIAN,: SIGNED APPLICANT: R & P INVESTMENTS ISSUED BY DATE: `_-____ /_�_�___. / ' SOILS LOG o, - MUNICIPALITY OF ANCHORAGE El PERCOLATION �� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST • el 825 L. Street, Anchorage, Alaska 99501 264-4720 �_ SOILS LOG — PERCOLATION TEST PERFORMED FOR: CA V—LES 0 A.) C-C'iU S L • DATE k)PERFORMEED: L LI .— r U�7 LEGAL DESCRIPTION: q 5 VO -s I+ A]� � �- (S ^I (l F � .L�� I I ZN l` 3 LA S �� 171-17-1 �171 SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 o -r orzc,�/vics I-ZSA SIE 1 �ML) �' Y rsV (. f - •r �'p X4'1 2. (26)0y)y C° n- - 19 SJLTtj 5A'MI)y q (ZYAv6 L WAS GROUND WATER l o S ENCOUNTERED? N L 0 P IF YES, Al WHAT E DEPTH? 0 S PeO la LOIJC -()Q, Reading Date Gross Time Not - Time Depth„tq o- �_.IS'r tea Net Drop , s t to, d4, f, a 7 11 a rt3¢1 .. artI ?roe av 114 ee e n a an® C aaennn9t = : I -W - U99CaOP°4+0°f8 ae°°°a <a Eq s .-7732.1= Ls,�rpop:?R, 1966 .ta PERCOLATION RATE. (TEST RUN BETWEEN COMMENTS ISE Ct USIA- e-7 G�/ St'" Fr`UwI r 13 r -I I A' SlIrr4 L_ LS n [- G v C- L PERFORMED BY: Q(9 Y) _`)'Y. �hc� cISO C/ CERTIFIED 0 Z. 72-008 (6/79) (minutes/inch) FT AND -_-- FT I _I . t—. O 1' 1' � • • ll l� ! � � 11 N'�, � '1�` OO � 1' �� l� � 1201 RRl nh ST. 99515 ANv'xK0llAGrp AX.ASKA 34-4 SIX INCI4 WATER WELL DRILLED ------•---- OUT TO THE DEPTH OF 465 Amt, DRILLED AT THE RATE OF .123.00 -PER FOOT. , ChaAVe ¢on 450 A onJ+. PROPERTY OWNER Cit.Pete Woodoon 344-8957 263-9625 Vo tk cadeted 4q. C EA, a on ConatAuc,tLon (Rob 346.2787 U. i Bdk. 0 Serb- SUIt/�/LllLe Rc�ce o LOCATION OF WELL SITE__-- s_ WELL LOG: 0 --- 18° SbGty, wet ave L. 40,L cfajbZrt" Seve2aL • m&U boutde44. 18-441 R clongtomeAote. Biwkem deco amp Aed beduck. SuAf=e water oatvAated down thko gh .the co me nate Pw.teAA" -- _ 44-465' Bednack. R very hatd. 4e bnentaty. bed2ock, wVA atramat Vte td al wate t be- A,ze 300 A- Thtm aH,eao o.� gnanwtan .type naCk, 4how•ln.g .Dame water Vtetd, however, Wduetton 60 ga tom pen hauwt by 350 A. Pono(ea wa.tet bea4.4ny. a&ean Aon 331 .to 344 A. !Kone watet pnaduUW. auA o &V 415 .to 435 A. Rtoa mdndmat,watee bea44A4 W u ,t at bedrock 1(wn 446 .to 459 A. Tata t wa tet ptodac tton of 120 .to 150 gat tones pea, howl. 7ht4 wett . UuM atoo. 4nc✓te we .to 180 9PH (3 9PPI) wWL woe o. lJ" Total, wate t &cove # coam back up .to uWan 38 A a..•°'�j.6 gad ton.4 al - 9q, water An neoetve al- 423 A. (Over 650 qatAon4 o� water die neo °6 gn. 0,.OF One Honee su nneu ttx e. PUmp 4hoatd be tmtatted down to 430 .tc(,411, gtiy �o r, Totaq•t al, D4V t &Lg: 823.00 pews A X 450 A: 810, 350.00 ��� ti l, ca Ro Coat ./.an n0,&V tpA-ton. on ae.t up O. DnU.C. < COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF ^8109350.00 THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS e 10.th, 1985/ c ATE—�' —.-- "V �5i_ SERVICE CHARGEOF I%a% PER MONTH WILL. BE ASSESSED ON PAST DUEACCOUNTS. i MUNICIPALITY OF ANCHORAGE ' DIVISION OF ENVIRONMENTAL HEALTH ,:E,'PAEVMENT OF HEALTH AND ENVIRONMENTAL PROTECTION : ApkLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE i 1. General. Informatleon Application Date (a) X.egal Dc[sckil long� (include lot, block, subdivision section, township, range) Location (adrf—rens or directions) (b) Applicants isaZGCl,u "/ Cc rbc' -> c Telephone — Home Bus1.ncs m 1 Applicants At2eressr:e(cUzz� C `% (a) Applicant: qint ;cheekI one) Lending Institution M-1 ; Ot7ner/builder r --K Buyer. C m6 j Other b—:I (explain); (d) Lending Institution� iQ)�4,t:r,j el-( /VAC„L.��Telephone Address (e) Real Estate Co. & Agent A�IAvnaa _, j Telephone �.-- (f) Mail the MM to the following address: i ` 2. T e of Residence Single—Family Number of Bedrooms 3. Water Supply Multi—Family Other (describe) Individual. Well Mc Community Public Ej y Note: If community well system, must have written confirmation from the State Department: of Environmental Conservation attesting to the legality and stratus. 4. Sewage Disposal j' Community Holding Tank Public: I_e C 1 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 21 _-. A AMMW 5. InAineering firm Provi.diM-122kectionssT.ests,Ffil.e Search, Data and Information N As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation of this Health Authority Approval. shows that the on-si e 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 cry investigation and inspection, the ow -site water supply and/or wastewater disposal - system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firmfl f c`.�_! r - m. Telephone, / Address in2 �G erg �3 C. i Date 02 °° 0 (ENGINEER SEAT) �06° ooanan�nooy,� g0ea3e6gv �nQ L V j. 6'a DHEP A royal- Approved oyalApproved forfr._ bedrooms Approved Disapproved Conditional C. HOW, Jr. . 2831-r _ ...-H--:�'-s - Terms of Conditional Approval.._gM���u._ CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OP HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT— ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRFs-T MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORIC. (DHEP SEAL) RR4/ej/D18 [Page 2 of 7. ] 7-1984 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984' 264-4720 rvorviUVAL" OF ANCHORAGE DEPT., OF HEALTH 8. ENVIRONMENTAL PROTECTION C'i., f 101,385' RECEIVED Legal Description: _'L�— 5C44 ''e� A. WELL DATA Well Classification�S/G.'tIf A. B, C, D.E.C. Approved (Y/N) &A Well Log Present Y N) _ Date Completed —©'�;� YieldO GW/ Total De th _` Cased to — / p � Depth of Grouting v Static Water Level Pump Set At —LC6rkkO(vk r Casing Height Above Ground ____ ` Sanitary Seal on Casing) Electrical Wiring in ConduitYN) _ Depression Around Wellhead (Y/6) Separation Distances from Well: To Septic/Holding Tank on Lot A _ ; On Adjoining Lots— To � r To Nearest Edge of Absorption Field on Lot �T /�5—; On Adjoining Lots (lot, To Nearest Public Sewer Line�/0 To Nearest Public Sewer I r Cleanout/Manhole _Jq pI—To Nearest Sewer Service Line on Lot —C�• S Water Sample Collected by __�bA-e. ; Date ms's Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date InstalledC.zL �fe�L Size rr�""No. of Compartments Standpipes ON) _ — Air -tight Caps�&)N) Foundation Cleanout C?/N) Depression over Tank (Yo _ Date Last Pumped —. Pumping/Maintenance Contract on File (Y/N) ; for —Vl( Holding Tank High -Water Alarm (Y/N) _ 41A Temporary Holding Tank Permit (Y/N) 16 / Separation Distances from Septic/Holding Tank: To Water -Supply Well fO�t f ✓ �• To Building Foundation - — To Property Line �_� To Disposal Field To Water Main/Service Line _�27 To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/64) Z Y SG�tS h/HP✓�Cs" . C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata j5(] Type of System Design Date Installed Pre V Tai 8 5 Length of Field 6` Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present y(?N) Depression over Field (Yo Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 6-F - To Property Line 1215 To Building Foundation -O F To Existing or Abandoned System on Lot NA On Adjoining Lots '- 0 .F ( To Water Main/Service Line 50 To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course /,V(g A To Driveway, Parking Area, or Vehicle Storage Area r Comments D. LIFT STATION 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/ 'Pump evel at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test, Meets MOA I certify that I have ch ked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection Signed Pte^ Date Company Q� �vc MOA No. SSS Oo2{ vg®F°t�(°��®� Receipt No. ! r_r Lp ti4o M oQ �®Q Date of Payment I b &004% n°n°e® 960012° 000 Amount: $ ro grAt as° Ago" y C. 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