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HomeMy WebLinkAboutTHE SUMMIT LT 1The Summit Lot 1 015-236-03 Not eligible for Certificate of On -Site Systems Approval because Final Inspection paperwork is needed. Municipality of Anchorage �j P.O. Ibx LN67A) • .lnchumgc, Alaska V9519 -0M• Tcicpha:c (V)7) 343-K301 • r:u ((X)7) 343-&4(X1 ; 71N1 llmgmc Slrccl • Anchomgc, A�laslu: fk),9O7 �� nv�e.rnuni.org MayorMark Teich Iluilding Safety Division 22 Jun 05 Dick Denton 11610 Hillside Drive Anchorage, AK 99516-2501 Subject: Expired On -Site Water and/or Wastewater Permit Permit Number: SW030310 Legal Description: The Summit Lot 1 Dear Mr. Denton: This letter is to inform you that your permit SW030310 expired on 13 Aug 04. Our records indicate that a house was built on this property. To date we have not received a final Inspection Report for the installation of the on-site wastewater disposal and/or the water supply system. Please be aware that you will not be able to receive a Certificate of On -Site Systems Approval at the time of any transfer of title. If you have any questions, please call this office at 343-7904. Sincerely, Kathleen Maricle Permit Clerk On -Site Water and Wastewater Program Enc: Copy of permit Community, Security, Prosperity o- Alnnieipal�of Anehorage CO. lbs 1'.X;(;50 • Anchorage, Uaska 99519 -WN) • Talchhonc (907) a3. -W l • Pas (!107) Si:i$_'(H) 4,00 6ragaw Sired •Anchorage, Alaska 905507 MIM. III Lilt .or, Mayor Mark Begich Iluildinf, Safety DlA'1510I3 July 19, 2004 Dick Denton 11610 Hillside Drive Anchorage, AIC 99516 Subject: On -Site Nater and/or Wastewater Permit. Permit Number: SW030310 Legal Description: Irhe Summit Lot"I Dear Ms. Johnson: An On -Site Nater/Wastewater Permit, number SW030310, issued by this office for a single-family system, will expire on August 13, 2004 This permit was valid for 365 calendar days. If this was a well permit and the well has been drilled, a well log must be sent to this office for documentation of the installation and to close the permit. E If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to this office for review, approval and documentation. This as -built inspection repoit must be signed by the licensed Professional Engineer who inspected the installation of the system. As -built inspection reports are required to be submitted within 30 days of the completion of the system. If no system was installed under this permit, and you are still planning to install a well or wastewater disposal system, a new permit must be obtained from this office. A new permit for a second year may be issued for a fee of $115.00 if the renewal application is received on or before the expiration date of the original permit. When applying for a new permit, the fees are: $460.00 for a wastewater permit and $175.00 for a well permit. If you have any questions, please call this office at 343-7904. Sincerely, Daniel Roth Program Manager On -Site Water and Wastewater Program Enc: Copy of permit Community, Security, Prosperity i MUNICIPALITY OF ANCHORAGE Development Services Department Onsite Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 Permit Number. SW030310 Legal Description;tTHE SUMMIT LT ='1' ON-SITE WATER SUPPLY PERMIT Upgrade 1,7s7U_ Date Issued: Aug 14, 2003 Expiration Date: Aug 13, 2004 Parcel ID: 015-236-03 Design Engineer: 0000 None Required Site Address: 011610 HILLSIDE DR Owner Name: DICK DENTON Lot Size: 169850 SO. FT. Owner Address: 11610 HILLSIDE DRIVE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99516-2501 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: 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 By. Issued By: Date: 8 43 Date: 8 d VON-SITE SFWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. �� Z _ `'� Permit Number SW d 303 /O Property Mailing a Mailing address (2) C Zip Code Legal description (Lot, Block & Sub'd.) e — `'v �'� �'1 14 Legal description (Section, Township & Range) Lot Size b Acres/Sq.Ft. THIS APPLICATION IS FOR: l �-�-'� Number of Bedrooms '4 Sewer Only ❑ Well Only Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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. (Signature of property owner or authorized agent) Permit Fees: Date of Payment: 15 Receipt Number: �� Z (Rev. 12/00) Fees: Date of Payment: Receipt Number: 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 C.- V www.ci.anchorage.ak.us (907)343-7904 VON-SITE SFWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. �� Z _ `'� Permit Number SW d 303 /O Property Mailing a Mailing address (2) C Zip Code Legal description (Lot, Block & Sub'd.) e — `'v �'� �'1 14 Legal description (Section, Township & Range) Lot Size b Acres/Sq.Ft. THIS APPLICATION IS FOR: l �-�-'� Number of Bedrooms '4 Sewer Only ❑ Well Only Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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. (Signature of property owner or authorized agent) Permit Fees: Date of Payment: 15 Receipt Number: �� Z (Rev. 12/00) Fees: Date of Payment: Receipt Number: e 1 x` � 2 o b tip *• :. �;':.r`^ � c .y 2 �� o •�s• wi. t�till •F" lb U 0�0 Q Iw. N Ca N ° w% ; • a 7 C O Q J O a 060 O aC O V O O ct %b, Cl 42 W O �G4N D 2U. �a ^ 1'^•••• ��� IeYINN cr w "iso vQ cN• cv U ENa� `oQ a� oc h 0 0� to � c c Wqu tz I3 O a �'� N� �� F �` p a V N0Li l •, O lV ca F ivc �4 v m o vm�Nlil N?� ec` o . lil �O o. �.r ! a to �..,, _ :;,.C,-, -P)s US I ,ON ONjjjj R.tl 1' V .,l is I t M O z a J a 0 0 CL I� .1 r 7 NN O� �N ^tap l8 -- I ,ON ONjjjj R.tl 1' V .,l is I t M O z a J a 0 0 CL I� .1 r 7 Municipality of Anchorage Page of __�L DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 O "Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: PID Number: Name: I 672ovP Wastewater System: t,;�N ww ❑Upgrade Address: 7021 b21r-TWoOE ST/L�bT ABSORPTION FIELD Phone: No.ol Bedrooms: —=/ ❑Deep Trench 0Shallow Trench XBetl ❑Mound ❑Other LEGAL DESCRIPTION Rating: Total Depth from original grade: q- rT. (M . FI. Lot / Block:�a$ubdivision: l SVr✓t IIT /h _GPD/$ Depth to pipe bottom from original grad I/ J %FI. Gravel Gravel depth beneath pipe A_ Ft. _ Township:/ Zr J Range: _ 3(.J _Z3 _ Section: Fill added above original grade- r/z Ft. Gravel length. 30rr X eO Ft. WELL: New ❑ Upgrade Gravel depth: Number ofdlines. Distance betwe/en lines Ft Ft. Classification (Private, A,B,C): TotalDepth: , Cased To: Total absorption area: Pipe material: PV 1- Q 1k/47 L� T,3 Ft. q.3 Ft. 9040 SQ. Ft. Driller: ALA)IJ[ �,2,ILt-;I.1(a Date 9rilled: /0 Z7 "g/ Slatic walan Level: O Ft. Installer: RAPrc:7j se _ Dale installed: /✓ 3U Yield: Z-5- Pump Sol at:Casing Height Above Ground: Z TANK GPM FI.1 Ft _SEPARATION DISTANCES Zseptic DHolding S.T.E.P. To Septic Absorption Lill Holding Publen'rivale Manufacturer./. Capacity in gallons:? From Tank Field station 'rank Sewer Lines OO y�}� L�r.lcaI /z,Q Wellf /'*9 ) // L/ "J /,4 N�A n /A Material: Et Number of Compartments , pZ Surface Water 404c- owl Co-- �STL LIFT STATION Lot Line (I • 2/D -.- N/4 l /, �V H /�/� Size in gallons: Manufacturer: Foundation I /Ll 37l �lA "Pump on" level at. "Pum ofl" level at: p la Hioh water arm at.. Curtain / �O /� / Pump Make & Model Electrical Inspections perlormed by. Drain 3r✓ IST Remarks: BENCH MARK _ _ ' W E Ll_ [-0 LY L,r iTA �/-%:� --- Location and Description: 7--- -- � 0j,::/ p Un.t fj A-�/U,.J LJ L Assumed Elevation. _ /00 �'�•EFLiQtME1F�R'S SEAL t Inspections performed by: AC,4171 Dates: 1st d 3J 2nd )l2',`; ° 6'�ic6aol 8 <M E. Andorsgn drl Department of Heal th�q�iHrrf n ; ervi approve/a,l4/QV / Reviewed and approved by: Date: 72-013 11/91) MOA 25 Permit No. _Si.J cwz5L{ Page Z —Of—,/ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • 'relephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: L07- /, SurnrAt7` 561)lJIS10J PIDNo.:-0/$23/0$_ 30, �LkAiNgG(S PJcb , r-XI$T11,16 6aov JG G�*a2 FM3RIc�-"'�a 40o°Co 99 6.'90' DR/i�1a1=1cu 120 L4 j L/ � „j) 72-013 A (2/91) MOA 25 9 j-ouNbAMDa 0o"- ASluME6 6'L - (9D, joa— Si),MT 5uw ROCKFORD CORPORATION P.O. Box 111706 SHEET NO. ANCHORAGE, ALASKA 99511 CALCULATED By DATE 1 (907) 344.4551 FAX (907) 344-2130 CHECKED BYDA SCALE -1 'W 'IV v F. An&rson Q 4381 - E ROCKFORD CORPORATION P.O. Box 111706 ANCHORAGE, ALASKA 99511 (907) 344.4551 FAX (907) 344-2130 66(2' JYr_ ' � � I TMI 71W or A e' ,is - Michael E. f M6u rsoll ld 4-31 - E '08 �T lt_�'Sgvll SHEET NO. q - OF CALCULATED BY-.� DATE 414 CHECKE1)6y-- DATE - From : RLPIHE DRILL 907 3,45 0202 LOCATION OF WELL Nov. 12. 1931 09:50 AM Pei STATE OF AS.ASKA DPPA1i ZMY.'NT OF NATURAL RESOURCES D)'✓ISION OF GF.OLOG i!;AL AND GEOMSI^.AL SURVEYS Wi %77R WEI.1. RECORD AOROUGH SUED)VISION LOT B)AC'K SECTIO14 QTRS OW)JSHI)' k):NGt; MErk DIM SUmmSt 1 0 L] N �L n 5 W 1 DIRECTIONS: —' WELL O4.R.'ER; ----Des igns In W003 WL;LL DEPTH; Depth of hole:4 ft. ---Depth of ct„:ng; Lys-.,. DATP OF COMPLETION: 10 '-27-91 _- -""�---ap N.EASURING PDINT: ®top oY caring 09rouno surface 0ot.her: BOREHOLE DATA: Depth —^�T STATIC 6ATEk LMTEL: 0 i�. .^�aCC 10-27-91 - _ _ Ma tcrtiaS-,.ype and color From To�- +F�.�t.<i1•-n ..._.. G 2 �--� OF DR I-0,ING: Uri. 7: rotary �Ci, t?]@ too) ..._. _ usF.. CF btELL: r_.Jdom^stic L_lirrigation Qmonitor 01�1)blic surply �othor: -- _ Feat Graliell�' ilt. 2 g 15 --- Laversandy silt H?0 - 15 3fl C1.SlKG: Stick-up, 2 £t. Diam: 6 in -_---__- � - - Gravelly si.1t -- 3B _.. .. — 41 .._ WLLL INTF.'r;}:: ® Qscreened n rerr.:orztr..d []open hole Water sand travel 41 43 Deptks o£ oponings: Lo rt _ - _and SCRIELN ']•Y1�F.' biarri: in Slot /Mesh Size: Len^th: £t Set lietwc:en and £t GRAVEL PACK to to GROUT TYPE:__ __%)a umo: _ -- DCIN:h: ICOtOfL LU ft DEVELOPI.LI:'t Du'e1: Or 1 hr REI•AMS:_----- !",1� fiJL'. ,, .r.2 )'LIMPING LEVET, AND YIELD: !tp ft. after 1 hrs pump).ng 25-gpm PUIQ INTAKE DLPTH: —ft HOrBepowcr: Date Pump In-,- Z, ) Ie d ---_.....� CONTRACTOR INFORMATION: — � eyes nO WATER c)4EN.IS:VIMP). RY E TAKEN. Alpine Drilli.np And EnterDtlGes :el) disia£eeted unon completion?_-ayes_n no Registered Business dame _T� ---- Signature c£ Asthorizcd R�resentative 1.0-27-91 T.'at0 PbI;ASS I ATI, P."HYM COPY OF .LOG WITHIN 45 r - 1:S Docs'' PO T C X 77 -?11v' G�� F'IVcR, AiC. 59579 AOROUGH LOT I I o KSURiNG POINT: [Mtop of. oaring ❑ground surface [Dother: ­ _ REMARKS: STAWX OV ALASKA DZPARTMENT OF NATUIMX R-9S0tMCES DIVISION OV GEOL001CAL AND GEOPHYSICAL SURVEYS WA7'1'%R WFI•l. RECORD ()TRS S I HW WELL OWNER: WrLL DEPTH; DATE OF COMPLETION Dcpth of ho le:lyft 7.0 -2�/••'�a Depth of Casing:_1.�_ft.._-- Depth STATIC WATER LEVEL: Q..._,..,.... ft. Date r 1°roto To — ~�� METHOD OP DRILLING: air rotary ©oablo tool. Qothe.r: �_ Z tL USE OF WELL: ®domestic. ©a.rrl.gation [3monitor [public supply El other: r';T. Stick-�up,.ZY.�ft. Diarn:�(, ---.in , 1120 15 i�j _ AKE: ❑x open andJ-R_.. A1 . [] perforated ❑open hole f opanings:—,_ Loft SCREEN TYPE: _ _ Diam: in Slot/Mesh Size:Length: __Pt Sat l3otwgon and ft 7 [� GRAVEL PACK TYPE;: _ ' EI V E Volume used: mTT—Depth to top: .- ..,._..APR 2 1992 _ _ GROUT TYPE:^� -_ V0]ume: Depth; from _ u.. ft to MUn1cjp,ejfjHv of Anchorage Trlieafifi Tuman Servic S DEVELOPMENT METIIOD: jjAX, � Duration: 1 hr CONTRACTOR INFORMATION: Alp.%Y)o 77rilli.nf; Anil 13ntwrV: isen Registered Business Name T— •.. _.•_ Signature of Authorized Rg esentative 10.27-91 Date PUMPING LEVEL AND YIF).D: .' q.0—ft after -1 __hra pumping_�Lr� :-gpw PUMP INTAKE DEPTH:__ —ft Honsepower:­ Date Pump Instal),ed WATER CHEMISTRY, SAMPLE TAKEN? Lj yeo UJno PLFASF MA.TL W111TF COPY OF LOG W171H.TN 95 DAYS TO: DGGS PO BOX 77-•7.116 EAGLE R.TVFR, AK. 99577 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 AND WASTEWATER DISPOSAI, SYSTEM PERMIT PERMIT NUMBER:SW910254 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:THE DENALI GROUP OWNER ADDRESS:7021 DRIFTWOOD ST. ANCHORAGE, AK. 99518-2316 PARCEL ID:0152.3108 LEGAL DESCRIPTION: T12N R3W SEC 23 NE4NE4NE4 & N2 SE4NE4SE4 LOT SIZE: 653000 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 8/27/91 EXPIRATION DATE: 8/27/92 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE: (�' z8' `(, ISSUED BY:d_-«-" 0r„t'-rte DATE: 9- .�? y._ -I i August 12, 1991 Municipality of Anchorage DHHS 825 L Street Anchorage, Alaska 99501 Impact Statement For On-site Design Lot 1 Summit Subd. Soils Investigations Excavations were performed on this lot over the last 3 years as part of a large parcel to determine the best location for septic systems. Soils on this lot were found to contain gravels underlain by silts. Some groundwater appears to travel at the bottom of the gravel layer. Wells: A well installed on this lot should have no effect on neighboring wells since the lot is so large. Wastewater Systems_ The construction of a wastewater system on this lot should have no effect of wastewater systems on adjacent lots due to the distances to neighboring systems. There is a small stream to the west of the lot and an area at the north east corner which has standing surface water which travels to the north into the adjacent Cromwell Subdivision. Reserve Space: Due to the size of the lot, soils and distances to neighboring systems the reserve space should remain intact. .....m.'V�F m.. Drains e: Most of the drainage in the area is picked up by the small stream along the property line to the west. Drainage runs from east to west. Hopefully this meets the requirements to provide information for development of this lot. If you have any questions please contact me at 344-4551. - Yours Truly, Michael E. Anderson, P.E. OF Al, 711 GNU °auv e¢ a ooec ¢"ano �Q �om�nncs^e•••om^.a on^oea+o L ' FMichael E. Andorson •+;�.i� 1 '• 1 1 1�• '1 '. l �� •I 1 Mr 1 � w I KEITH 1 I 5 �CIR VACANT LOT I VACANT LOT .� {,. 1 , I I _ _ _ — E — — a. _.Ll— —URFCE WATER - I I 'a EASEMENT — 28' — — — — S 9O OO' E 860 — — e — I _ 247 ' 4 !• 9J�_ --I 35' 35',Pc�E.cvE Bio I \� L T U E FOLLO eT 3 c.as I �s? THREAD 6STRE PR 42'35" TM j RD 1TORONG SES'- 3o'X3o' CiEo I FR k1ER TES, I � _ \ WATER .SURF' ,eO6 S b1 1' E S 625' wE"1 I ' Vi NOTE: THERE ARE NO SYSTEMS'WITHIN'200 FEET: OF THE PROPOSED AND RESERVE SYSTEMS. I I I 23 � f 50' 24 (n m SCALE: 1°=100 FEET n tY��" Dona ¢ ••n J�f,�� i+ ;lr;:`cLco1 E Andorson^ ` i:';j :.. BY DATE CLIENT CHKO. BY DESCRIPTION .......... SHEET —_---_ OF ----. XG NO. _ 1 ' f EN I y Iry {Bi P, — ——J {—� 17. . — I i j� ;.��-.-� I -- ci�.� I II —I I I W N T. — f ATN .mfr_ L, — -- - a en I I .0 f @7 o9 n usso /jaacaeo 4381 E -®ice-- ® to OFESS .�— oa ea a �_ _ -°-!- � __71�_.(ea Y r I PARA _ i EN 1S 110/781 BY DATE: CLIENT CHKO. BY DESCRIPTION i SHEET _------ of: JOB NO. PCA�i - TA 1-i K OF 7-0 Oar o E� VIP sizes Tr/��et au, i/ 7-0 TD/r v� EN 1S 110/781 BY ______ _ _ __ DATE ______ _ CLIENT 1pCHKD. BY ____ DESCRIPTION___--,-_ SHEET OF .---- JDY NO. EN IS 1701751 0 Municipality of Anchorage DEPARTMENT OF HEALTH S HUMAN SERVICES 825 -1-" Street. Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST ®I' Al ��11p8 Oaa.eooe ooaa_ as PERFORMED FOR:_—_e----- _ DATE PERF�bFAI17 EF7��eJ _— LEGAL DESCRIPTION: LQL-L—'fs/j22,m ,7 -? �8p. Township. Range. Section: SLOPE SITE PLAN DEPTH T (FEET) J 1 2- 3 - -3• 4 5 6 7 8 9 10 11 - 17. - 13- 14- 15 16 17 18 19 20 COMMENTS SM SILT\j SAmD W/Rocs -SOA WAS GROUND WATER ENCOUNTERED? —0 _ S IF YES. AT WHAT D DEPTH? - P E 040 a War Aau 104"mm? 9G 11ie �-/5 9 PERCOLATION RATE L' Immutanncnl PEAC HOLE DIAMETER �! r�r TEST RUN BETWEEN FT AND FT PERFORMED BY: � N� %yjCFj9 �� 1 JP I�.t.6LA'l.Xi G-iJG1Rt SER `57Y THAT THISf�'fEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE OATS -�- 72-OGS IS". N851 0 Municipality of Anchorage DEPARTMENT OF HEALTH A HUMAN SERVICES 825'L' Street. Anchorage. Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR:. sz %' r - —DATE PERFORMeG42.,wW- -tee LEGAL DESCRIPTION: L suM m 1 7— Township. flange. SCCGOn: '1}SLOPE SITE PLAN F I.T1 71r/ 7 I� 1 2 3 4 s 6 7 8 9 10 11 12- 13- 14- is- is. 2- 13- 14- 14•18 17 16 19 20 COMMENTS �P Poo12L1J GIUDE:D WAS GROUND WATER ENCOUNTERED? _ QoH 7 -ER IF YES. ATWHAT I DEPTH? �L U0 tr war Aar mmim p? _-. Out PERCOLATION RATE — Z (mmuto mwl PERC HOLE DIAMETER --LL TESTRUNeETWEEN -'s FTAND5• FT PERFORMED Br. -�LLLL —L=� I�D�c�I--- I — — t& ( 1 , "�a�OEATIFY THAT THISnTEST WAS PERFORMED It' ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 72400 IRH. Wes) MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES sk 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 I.D. # L\ '� - :a ?� \ - Ins— __ - - HAA # h\ V)9 PK'1, \ \ _ 1. GENERAL INFOR ATION 1 �^ Z_ 07- �+ �U/V)10I-r 5-urib IJts/oJ Complete legal Ascription CiI nOA-2c.. Location (site address or directions) Property owner Day phone Mailing address _ 7o / 7i2%GruJ7� a�j S �,Lc){. 941.8 Lending agency —_ Day phone Mailing address— Agent ddress Agent — ---- Day phone Address Unless otherwise requested, HAA willbe held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well 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 MOA0121 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 furtherverify 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 An b ctsorJ OfJ 6'TJ CL -2 ItJ b Phone 3citi- q6g/ Address PO. gox OppAU�7E `73 /4N cjAA6C A�- Engineer's signature _P"t -� d4'A Date `11Z1cf j., 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments o Ji xco a.. acvue i o k� •oo o.o�'r 6� 4 ic o+ciaooea Micha-el EARJerwn°°°`�9 4381•E . e�g$��„� WFESS\��� bedrooms, with the following stipulations: By: Date // fn — 9 .)- i"Tlr 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 M21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Zo-r /1 5UMIv1IT' 5U6 _ Parcel I.D. A. WELL DATA Well type _R.IVA7—C Log present(Y/N) Total depth If A, B, or C, attach ADEC letter. ADEC water system number `_31 \r Sanitary seal (Y/N) . _ Date completed /012719/ Driller—A-LP/"/C %21t_( tnl(, Cased to_ 41Casing height ?_ Wires properly protected (Y/N) FROM WELL LOG l /0�7 q f Date of test Static waterleve l 0 Well flow b"o Z g.p.m. Pump level SEPARATION DISTANCES FROM WELL TO: / AT INSPECTION /1I L: tn✓ Ll�n1 STd.Ufa'/fl �-) m oz— ' n — g.p.m. c l ITI y r rr II r -y -- sem' O N r111 .> 0 L I a N X Septic/holding tank on lot On adjacent lots— 7,00 y Z7 G) / 1 rn Absorption field on lot /73 ; On adjacent lots 2nd Public sewer main Public sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate Public sewer manhole/cleanout /t4, t cs Petroleum tank Alo"C Other bacteria Collected by: _ rd `r&,b b) 0 Date installedin Y0 9/ Tank size IZEF`U eaA1L _Compartments Cleanouts (Y/N) --\L-- Foundation cleanout (Y/N) 1 Depression (Yt�/N) _ N High water alarm (Y/N) � _ Alarm tested (Y/N) M/`A Date of pumping ljew CNf S•rAA.JC '/0J SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: I Well(s)onlot- /q2 —On adjacent lots ?'pp) -P--Foundation- To property line_ 0 AbsorptionAield) �/'/I Water main/service line A/ ttcS Surface water/drainage-- 72-026 (Rev. 3/91)Front MOA 21 CONTINUED ON BACK PAGE STATION — Date installed._ Size in gallons Vent (Y/N) "Pump High water alarm level Meets MOA electrical codes (Y,�N)- Manufacturer Manhole/Access (Y/N) „Pump off, Cycles tested SEPARATION_QJI8TAANCE FROM LIFT STATION TO: On adjacent lots D. ABSORPTION FIELD DATA Date installed /D/.3A/b/ Soi Length 3 0 Width SOI Surface water I rating • O 6 F T '�'- System type BG -b ,) r Gravel thickness %emsi S Total depth � /? Total absorption area 1-'7" Cfeanouts present (Y/N) Depression over field (Y/N) AJ Date of adequacy test nlcw [orJs-nw ci/ort Results (pass/fail) /V CW W Q Sm' for L4 bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: r 1 Well on lot X73 On adjacent lots 'LOO Propertyline_ r To building foundation To existing or abandoned system on lot LN / /\1D rJ c i � 1 On adjacent lots 000 -f_ Cutbank NnrJl Water main/service line Mlucs Surface water A]oti1C Driveway, parking/vehicle storage area 7S Curtain drain �,4()t�)Lr, E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. aw_l � Signature C � o Engineer's Name MIC44A<- AN Date n 't +A , Michael E. Anrlrtsona $ ct %3 � A[a HAA Fee $ /701 /17� Date of Payment � - Z_ C Z Receipt Number 3 S 2V:: OV -3 5 7-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 A@AhY873 RESUl,[:S foz T6'VOUF, d ciwml.ah Ref.= 92.1!.97 4euple 1 i-htz7.x: Wld IiG 1::G.anIl Sdnrpl.o ID � 7i`LL Wh'T,ER h1 SUDI�'i� Cli.yn6 t1a�ro :SCCAUDF:If, WAYtIr, °47ISIU _ 1114 Mi.ent Acvu :11U WU 41incteii 7AR 24 :2 0 15:00 hoc. BPO : l'OWlil'. tVU(V)b Recal%,Gd MAR ).4 92 E 7.5:46 hsa. '1We ived with AS R7.QUIRM" Oxdeeo(I By :HAYM. ITBDU,li )AIa"min c01n0,1.m'O", IIA"' 25 92 Sonil $-�porcs te: Labor c1.- �+lz 1 0 .� f>'L}111EP f,. �Df UtvCf'AUD&N, t7AYf;F, j. Pnx'a19eL0I tesrr7.ta (11]11-o 11001Od Alloaai)lo i,1iiLC& IlI:PRAT}; ;I 1.4 mil/7, RPA 7511.2 1.0 Sewp7.n 110DTINC SAtdPG6 COLhCC'IFD PAY: MCk'hpD1;11. F,cir��ka: ,. S'eete 'roe; mimed Soo Spnel. r: i, ipstnzcrClane Aheve 11A�Unavail.ehl,> tID;, )lone Ilnter;grl 1ec 5awpl.c ltenrar:k-. 0uve 11A•- Not Aur..lwd Than, CT4ier;1-er: T.hc;n 111139N ! 3(35 Member of the SGS Group (Socl6t4 G6n6rale de Surveillance)