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HomeMy WebLinkAboutTHE VILLAGES TIDE VIEW LT 12 / ~ Municipality of Anchorage /"'%~ ~)EPAR;MENT OF, HEALmTH & ENVIRONMENTAL PROTECTION POUCH 6-650 ANCHORAGE, ALASKA 99501 INSPECTION REPORT ON ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL ADDRESS PHONE(S) SEPTIC TANK MANUFACTURER.~z~ /00 ~ CAPACITY IN GALS. #OF COMPARTMENTS DEPTH MATERIAL P.,~--~ INSIOE DIM ENSIONi.~ LENGTH WIDTH SEEPAGE SYSTEM LOCATION PERMIT NUMBER DISTANCES SEPTIC SEEPAGE TANK SYSTEM WELL SEWER LINE CESSPOOL WELL r'l TILE 6RAINFIELD SYSTEM DIAGRAM NUMBER OF LINES LENGTH ~ACH TOTAL LENGTH / DISTANCE BETWEEN LINES ]TRENCH WIDTH DEPTHS: TILE TO GRADE FILL BELOW TILE FILL ABOVE TILE ~/~SEEPAGETRENCHOR npiT WIDTH LENGTH ~?,, ,~' ! ~! [] LOG CRIB [] RINGS- DIA. FILL MATERIAL DEPTH DEPT" /0 TOTAL EFFECTIVE ABSORPTION AREA: CLASSIFICATION INSTALLER REMARKS SQ. FT. WELL J DEPTH I PIPE MATERIAL 72.012 (9/77) I-,I LII'`I I C I PAL I "I-Y CIF Ar`ICHOF.'AGE /D DEPRRTHENT ~EBLTH Ri".,ID ENVIRONblENTaL F~TECTION , 825 ~L STREET, RNCHORRGE, BK. 9~ · 264-4?20 L/,~.t~, ~ ~:LL ~t~b O~--S · TE SE~ER PEE:I~ · T RPPLICRNT ~DWARD BRRDY / ~33~ NORTHW00D DRIVE LOCRT1 ON VIRGO R'qE LEGRL LO~ 12 THE VILLRGES~UB LOT SIZE ~50~0 SQURRE FEET TYPE OF SOIL RB$ORBTION SYSTEH IS: TRENCH HRXIHUM NUMBER OF BEDROOMS = ~ SOIL RRTING (SQ FT/BR)= 85/. THE REQUIRED SIZE OF THE SOIL 8BSORPTION SYSTEH IS: I.>EF'TH= :lEi LENGTH= 22 6RR\.'EL [:'EF'TH= 6 THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRaINFIELD. THE DEPTH OF 8 TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOH OF THE EXCRVRTION <IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE NINIHUH DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET>. I~EC4U I RED SEPT I C Ti:Ir-II(_c; I ZE= :[.£400 GFtLLOI'`IS F'RCI-(R¢-~E F'LI~I'`IT OPT I Ol'`i A PACKRGE PLANT HAY BE INSTALLED AT THE PERMITTEE~'S OPTION SUBJECT TO THE FOLLOWING CONDITIONS: 1. EITHER R CLRSS I OR II NSF RPPROVED PLBNT HaY BE INSTRLLED. 2. R CONTINUOUS MRINTENRNCE RGREEMENT IS REQUIRED. IF R MRINTENRNCE RGREEHENT IS NOT KEPT CURRENT YOU HRY BE REQUIRED TO EHLRRGE THE SOIL RBSORPTION SVSTEH RND?OR YOU HRY BE SUBJECT TO PROSECUTION. '-1-140 ( 2 ) I NSF'"ECT IONS FIRE REm~U I F-:ED , BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION AND RPPROVRL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MININUH DISTRHCE BETWEEN R WELL fiND ANY ON-SITE SEI,IaGE DISPOSAL SYSTEH IS 100 FEET FOR R PRIVRTE WELL OR 200 FEET FOE: R PUBLIC WELL. WELL LOGS BEE REQUIRED fiND MUST BE RETURNED TO THE DEPRRTHENT WITHIN ~0 DaYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MRY RPPLV. SPECIFICRTIONS RND CONSTRUCTION DIRGRRHS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. PERM I T EXP I RES bEi~---Et,IBEF-: 3:1.., -1977 I CERTIFY THRT l: I RH FRHILIRR WITH THE REQUIREHENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE HUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEH IN RCCORDRNCE WITH THE CODES. .~: I UNDERSTRND THaT THE ON-SITE SEWER SYSTEf'I HaY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REHODELED TO INCLUDE MORE THaN ~ BEDROOMS. S I GNED: ...... RPPLICRNT EDWRRD BRBDY ISSUE[) BY .............................. DaTE .......... ~ .... V3.0 T. SPURKLAND P.E. WEST 15TII. AVENUE SUITE 203 ANCHORAGE. ALASKA 99502-3904 {907) 279-3916 Fax (907)-276-6013 RESIDENTIAL WELL INSPECTION LEGAL: LOCATION: OWNER: Lot 12, The Villages Tide View 4500 Virgo Street Brock, William J TYPE OF WELL: Private, Single Family WELL LOG AVAILABLE: No INSTALLATION REQUIREMENTS MET: WAIVERS GRANTED: None Required WELL YIELD FROM WELL LOG: Gallons per Minute WELL YIELD FROM TEST: Yes 0.4 Gallons per Minute DATE OF INSPECTION: October 2, 1997 TEST PROCEDURE: Well was pumped at a constant rate while the drawdown was monitored with an acoustic probe. At the beginning of the test water level was found at 151 feet below top of casing. The well mn dry after 2 hours of pumping at a rate of 5 gallons per minute. The water level could not be monitored with the acoustic probe. A total of 400 gallons was pumped The well recovered for two hours and was pumped again. 50 gallons were pumped before running dry. Another recovery of 2.5 hours produced 60 gallons. TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli and total nitrogen on October 3, 1997 E.Coli 0. Other Bacteria ND Total Nitrate-N 2.:38 rog/1. Max. allowable Total Nitrate-N 10 mg/I. 10 Colonies of Bacteria Allowed TEST RESULTS: This well meets the requirements of the Municipality of Anchorage. The water production from this well is 575 gallons per day. The Municipal requirement for well flow is 150 gallons of water per bedroom per day. This well exceeds this requirement. The assessment oflhe condition of the well applies only to the conditions as of the day tested. The flow rate may change due to subsurface conditions that may not be observed from the surface, and changes in the land use and other factors that may impact the aquifer feeding the well. MUNICIPALITY OF ANCHORAGE MEMORANDUM WATER WELL ADVISORY During a recent Health Authority Approval on-site inspection and test of tlJe potable water supply well on Lot /2 Block ~ of ~U;~6~$ ~ ~ Subdivision, the well's productivity was determined to be -4 gallons per minute. The minimum well productivity required by this Department (~-~C 15.55) for a ~ ~ bedroom residence is o~/ gallons · per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity'of the well may fluctuate. of non-critical water uses such as washing cars lawns and gardens may be required. This advisory must be attached to all copies of the Health Authority Approval. Restriction and watering subject October 7, 1977 Mr. Dan Harten Anchorage, Alaska S TAT Erg, ,."N T For services rendered in performing a soils investigation at the site of a proposed sanitary sewer system on Lot 12, The Villages, Tideview, Anchorage, Alaska ................. $65.00 Box 191, Star Route A Anchorage, Alaska 99502 (907)344-9150 Z PROPOSED LOT 12 ~"~ IOO' ~'" T.H.~I De.n Ilarten Property Lot ]2, The Villages, Tideview, ^nchorap. e, A] asks. Sketch not to scale. Diotnnces are approximate nnd have not been measur'eC by surveying methods. Property slopes moderately to the west, approximate elevation chanKo of 50'. T.H. No.1 9-25-77 ~i?'".~/~.' Sandy Sil~ wi~h som~© ~_-~Oravel, some.Organics ~:'.: -k x~_rn_u_~l mo~s~.~, ::~. XSandy S~lt, w~h some ~. ~Oravel, b~, sl "t~: u.-:~ ~o~. _ i.o, - Sandy Gravel, with GCC Cobbles, includes GCC Sand lenses 6" thick & 2' to 3' long, fn to med Sand, gray, si moist. (GW) NO WATER TABLE 15.0' Test hole log represents soils encountered on Lot 12, The Villages, Tideview, Anchorage, Alaska. Dan llarten Property Michael B. Bergmann Con~ulting Geologist Anchorage, Alaska USGS no. Oaf,.cli oo.p~,f,d 11'l~-77 Location sketch or ~emerks diam. ~',',',~ I,. Static water I,vel ~'~' It. (~. below)land surface, Finish 01 well: (open-end. screen, perforated, o~n-hole~, other) Oescrlbe intervals end size: ~ell yield tested by (pumplnG,~alr) at for hours with ft. of drawdow~ from static revel. orr o. DRILLER'S YATERiAL LOG Depth below lend surface in feet Give description of strata penetrated (size cf material, coloro hardness of drillinG, and water content) to m. to to to to to tO tO to to to to to I'4UN1CIPALITY OF DEPT. OF HEALTH & .RECEIVED to LOT ,~dRVEY CERTIFICATION I hereby ce,t,f$ that I hove ~r ye/ed the ~'operty Sho~n ~nd de~:r~ed s.~olo /,,= :..~0' ~'~/o - / 7- 77' Ref. F..B. No. LEGEND ~ = Bro$$ COl~d rno~Jment recovered PR 0 P0 5 E D LOT la D[~n Harten Property Lot 12, The Villages, Tideview, Anchora?,e, A]aska. Sketch not to scale. Distances are approximate :]nd have not been measured by surveying methods. Property slopes moderately to the west, approximate elevation chan~e of 50'. T.H. No.1 9-25-77 .~.".~.'.-;nndy S~l~ w~tn,soOm~ ' ~_-~Gravel, some Organics -k moi_sA.., ~: ~Sandy Silt, wi~some ~:. ~Gravel, b~, sl ~: ~ist. --1.O' Sandy Gravel, with ocs Cobbles, includes occ Sand lenses 6" thick & 2''to'3' long, fn to med Sand, gray, sl moist. (GW) NO WATER TABLE 15.0' Test hole log represents soils encountered on Lot 12, The Villages, Tideview, Anchorage, Alaska. Dan Harten Property Michael B. Bergmann Consulting Geologist Anchorage, Alaska 'October 7, 1977 ~r. Dan Harten Anchorage, Alaska Subject; Soils investigation The villages, for sanitary sewer syst'em; Lot 12, Tideview, Anchorage, Alaska. Dear Mr. Harten At your request, I conducted a soils investigation at the proposed location of a sanitary system on the subject lot. This investigation, which was accomplished September 25, 1977, consisted of the inspection of a test pit, that was dug by a backhoe to the depth of 15 feet. The topography of the lot is moderately sloping to the West, resulting in an approximate elevation change from the proposed house location to the test pit of 8' to ]0' The soils encountered in the test pit are graphically shown on the accompanying test hole log. These soils consist of a Sandy Silt, with some Gravel and Organics of 1 foot in thickness overlying a Sandy Gravel, with occasional Cobbles (GW). Occasional small lenses of fn to med Sand, 2' to 3' long and of a maximum t.hickness o£ 6" are also found within the Sandy Gravel. No groundwater table was encountered. An accompanying sketch shows the subject lot with the approximate location of the test pit in relation to the proposed house and the property lines. I appreciate the opportunity to be of service to you. Please contact me if you have any questions rel~arding this soils investigation. Very truly yours, Consultin_/~..Oeo~ogist Box 191, Star Route A Anchorage, Alaska 99502 (907)344-9150 Attachments: Drawing of test log with location sketch xc: Dept. of Health & Environmental Protection SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO, FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF' ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS CONFORM TO BOROUGH REGULATIONS REGARDING INBTALLATIDN. ABOVE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division j~ i~/.. 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907)i343~['q~Vi~ Health Authority Approval Checklist I,/Ik/vA-GE-; '~'IDJ=" ~,/I;:vC/parcol I.D.: 12.- If A, B, or C, attach ADEC letter. ADEC water system number Date completed Legal Description: A. WELL DATA Well type '~ Log present (Y/N) Total depth '~' Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~ 0 Data of sample: 10, B. SEPTIC/HOLDINGTANK DATA Dam installed Foundation cleanout (Y/N) Date of Pumping C. ABSORPTION FIELD DATA Date installed Length Width Effective absorption ama Date of adequacy test Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION I~1 Nitrate g.p.m. Fluid depth in absorption field before test (in.); Fluid depth (ins) Minutes later: Peroxide treatment (past 12 months) (y/N) 72-026 (Rev. Co,ected TT Tank size Depression (y/N) Pumper Soil rating (g.p.d./fF or fta/'edrm) Gravel thickness below pipe Monitc)riog Tube present (Y/N) Results (Pass/Fall) Immediately after Absorption rate = If yes, give dam Number of Compartments Cleanouts (Y/N)__ High water alarm (Y/N) System type Total depth Depression over field (Y/N) __ For gal. water added (in.): g.p.d. LIFT SI'ATIO N ~J/~.. Date insteiled Manhole/Access (Y/N) Size in gallons High water alarm level at* 'Pump on' level at* 'Pump off" level at* Cycles tested *Datum E. SEPARATION DISTANCES F. SEPARATION DISTANCES FROM WELL ON LOT TO: SepficJholding tank on lot Absorption field on lot Public sewer main ~ 1 013 Sewer/septic service line On adjacent lots On adj~nt lots Public sewer manhole/cleanout ~, / ~ u, ~,on r,/,,~. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ~"~/A-- Foundation Property line Absorption field Water main/service line .Surface water/drainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Wells on adjacent lots Water ma~n/sewice line Surface water Driveway, parking/vehicle storage area Curtain drain Wells on adjacent lots · ,~ ~ ,~', I certify that I have determined ~hru field inspections and review of Municipal rel~.that ~ s.yste'~ are in conformance wfth MOA HAA guidelines in effect on this da . ~ ' , ~ . ~; T,. ,L,' ~ .,.~ ~ . s,~.a~,re / ~.~t.,.~t~o.~ ~..: ,.~~'N ~ HAA Fee $ ~ L/T~ ' '~-'~ D,. o, 7 Receipt Number ~-~'~ (~"//q?~ ~-~s (R~, ~S)' Waiver Fee $ Date of Payment Receipt Number E PLAN S MUNICIPALITY OF ANCHORAGE Development Services Department \\ �s -_//' Phone: 907-343-7904 On-Site Water & Wastewater Section ` Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 020-091-56 Expiration Date: y__ 1 1 --/ 1. GENERAL INFORMATION Complete legal description THE VILLAGES TIDE VIEW LOT 12 Location (site address) 4500 VIRGO AVENUE,ANCHORAGE,AK 99516 Current property owner(s) EDMUND C.PRUSAK Day phone Mailing address 4500 VIRGO_AVENUE, ANCHORAGE, AK 99516 Real estate agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Private Septic Private Well ® Holding Tank ❑ Water Storage ❑ Community ❑ Community Well — Public Sewer Public Water System ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 550 Waiver Fee $ Date of Payment 4,1‘11 19 Date of Payment Receipt Number looll83o Receipt Number COSA# U 5C 1q/ala Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm ANDERSON CONSTRUCTION&ENGINEERING Phone 345-3377 Address 4640 SHOSHONI DRIVE,ANCHORAGE,AK 99516 Engineer's Printed Name MICHAEL N.ANDERSON,PE Date 06/04/2019 Comments:This investigation was completed in compliance with MOA guidelines,regulations, �� and best industry practices/methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested.The flow and absorption rates may change � OF A \ due to subsurface conditions that may not be observed from the surface,changes in land use, , local soil characteristics,groundwater levels that may fluctuate during the year,quality of rc�'. ' � ' construction(workmanship&materials),the water usage of the family being served by the �1.• system and maintenance. The operational life of all well and septic systems are subject to / * •:4 9� *�/ these various and dynamic characteristics and are outside the control of the evaluator of the A11//t %��I�U. well and septic system. Therefore,any estimate of how long a system will function satisfactory A for current or future occupants or guarantee that no unseen encroachments,deficiencies or discrepancies exist can be given by fits and Anderson Construction&Engineering. .1QCHAEL N. ANDERSON: No. CE 9489 6/4/19. ¢s'� 6. DSD SIGNATURE t\ ssio XSystem #1 Approved for 3 bedrooms ����� X. System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations* ik.ITY� F(r�i( 45 oN_S�T cyo o WATE E �' pR TeWA FR m 0 �GAAiv/ oma: -1»»))))1oi By: �—�--- � 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: THE VILLAGES TIDE VIEW LOT 12 Parcel ID: 020-091-56 If more than 1 septic system on lot: COSA Checklist#_of_ Structure served by this system A. *WELL DATA ® Well log is filed with Onsite (or attached) Water storage tank volume 700 gallons Date drilled 11/14/1977 Well disinfected for coliform test? ® Yes ❑ No Total depth 400+ ft ® Coliform bacteria is Negative Cased to 25 ft Nitrate 0.209 mg/L ❑ Nitrate less than MRL (ND) • Sanitary seal is functioning correctly Arsenic ug/L ® Arsenic less than MRL (ND) • Wires are properly protected FWCS Casing height (above ground) 18+ in. Collected by '— & 907 Water Wells Date of flow test for COSA 6/7/2019** Static water level at beginning of test 223 ft. Date of Sample 5/23/19 & 6/3/19 Well production at time of test 1.5 gpm Comments *Per MOA record docs. **907 Water Wells performed well flow, chlorination and 2nd coli sample. Well was deepened at some point and is over 400' per 907. Also per owner, it was hydrofracked 20 years ago. B. TANK DATA - PUBLIC SEWER C. LIFT STATION Age of tank(s) years ❑ Required maintenance completed Tank type/material Age of lift station years Measured operating fluid level in septic tank Lift station material ❑ Standpipes/foundation cleanout per record drawing Comments: Date of pumping D. ABSORPTION FIELD DATA - PUBLIC SEWER Which system tested (date installed) Adequacy test date ❑ ALL standpipes present per record drawing Results ❑ Pass For bedrooms Total measured depth from grade _ft (max) Fluid depth prior to test in Measured depth to pipe invert from grade ft(min) Water added gal ❑ N/A— pressurized field New depth in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time min depth into effective ❑ Code-required soil cover over field Final fluid depth in El presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: COSA Checklist PUBLIC Sewer copy.docx 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' Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' Z Yes if No ft Neighboring Absorption Fields > 100' Animal Containment> 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Wells on Adjacent Lots: Property Line > 5' ® Yes if No ft Private Wells > :: ® Yes if No ft Absorption Field > 5' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Main > 10' ® Yes ft If septic tank is under driveway comment below Water Service Line > !' ® Yes if No ft S -. - ater> 100' ® Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field ' . ser driveway comment below Property Line > 10' ® Yes if No _ft - s on Adjacent Lots: Water Main > 10' ® Yes o ft Private Wells > 100' ® Yes if No _ft Water Service Line > ® Yes if No ft Community Wells > 200' ® Yes if No Sopfac Water> 00' Z 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. COSA Checklist PUBLIC Sewer copy.docx 6/7/19 • MUNICIPALITY OF ANCHORAGE 1' 3a H--1`- i' Wi.i•- WASTEWATER CONNECT PERMIT 97 - 8360 kolio*lif DATE OF APPLICATION 04/10/97 WATER&WASTEWATER UTILITY 3000 ARCTIC BLVD. SCHEDULED COMPLETION DATE 12/31/97 PHONE: (907) 564-2762 BLOCK/LOT/TRACT LT 12 IX I SINGLE FAMILY SUBDIVISION THE VILLAGES TIDE VIEW n MUTI-DWELLING No.APTS n COMMERCIAL TAX CODE 2009156 GRID 3336 AS-BUILT STREET ADDRESS 4500 VIRGO AVE OWNER BROCK ROBERT J & ELAINE PHONE MAIL ADDRESS ANCHORAGE,AK 99511-1661 CONTRACTOR JOHNSON EXCAVATION ASSESSMENTS 171 Main Line Extension ❑ Repair Existing Service Have Been Levied X On Property Only Il City Tap n ❑ pll n To Be Levied U O \s4./� ❑ Hydrant Only 50'or Longer k) Main Tap-To Property Line Only Comments: J Main Tap& On Property Connect Disconnect �� R&R-Main Tap Only Owner Staff s ISSUED BY CDF CONNECT SIZE 4 " INSPECTION FEE $ 104.00 PAID n CASH PERMIT FEE $ 35.00 CHECK# (g�� $ INSPECTED BY REIMBURSIBLE NUMBER DEPOSIT$ 0.00 TOTAL$ 139.00 DATE / / REMARKS PERMITEE (Please Print) x �� 1,1er, cT_ r� L PHONE > 3/7/5-^/Z,S,9. MAIL ADDRESS „ D . (P ) r 17 Q/ _ ?9 /) da SIGNATURE �A� POST I . A CONSPICUOUS PLACE AT THE JOB SITE AWWU INSPECTOR Original DATE SCHEDULED / / TIME INSPECTOR SUBDIVISION THE VILLAGES TIDE VIEW BLK/LT/TRACT LT 12 INDICATE NORTH l 4 trt u> i 2\# SIZE MAIN: TYPE MAIN: DEPT AT MAIN: AT PROP.LINE:P CONNECT LOCATION: / COMMENTS INSPECTED BY:, c. / DATE: VA( ; -. . s •/54/" .--i.54.52' ' . Ems/ ,06°014 43, 500 S.F. ::zoT /3 0 cOo - -- - ZOT // o ' • o ; III ep\L• • •of y ,, "1 c-.' 6 • .ELL '1 ` 6`0 \\ V/ADOC, .- Cji . 5,, / , 4� 5/.E 4jIGE s-c -P1 ' \4` • Qo ).74,' • Ao Disuji. \ 9? . . �6r �,P- iDATE - S 31 �� �����; -� l—E oF AL-,0 - Lot /2 8Iock - sQ.t,' ••.......... ...1-.S 7t V%/des Tie V/eN LS1fz�! (77-205)- . ; �J .i psi ..-� ':,: .*.d to irr0r i Anchorage Recording Precinct, Alaska /,.•.., LOT SURVEY CERTIFICATION LEGEND 4.S.,.._: R.L.Button J� e LS-1192 Q I hereby certify that I have surveyed the property shown and described e .Brass capped monument recovered ao lr�••., yJ i her d that he erty�lines nand do dotnotlo overlap orents encroahon adjacent property and ed thereon are within the that no O :2x2pipe and/or rebor hub S tack recovered vexed d;pRpFEssloNh��Pe_ imprcremerts on adjacent property overlap or encroach on the premises • :5/8"x 30°rebar set tnis survey O��'►-�'�°��� in question and that there are no roadways,utility lines or other visible --X. FENCE LINE(APPROX. LOCAT/OW) easements ori.said property except as indicated hereon. seal Scale /ii_ ^• Date Prepared by: R.L. BUTTON _JLJ �O -• 7-77 Registered Land Surveyor (907)279-6200 5/9 W- E/grth Ave. Anchorage,.0/osko 9950/ Ref. 3336 F B. No./C25::)t) -45 Property of: -,q�� [_J /, Qroc servA 37018 �C� /� . ~ 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address. Lending agency Mailing address Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 4. TYPE OFWASTEWATER DISPOSAL: NOTE: Day phone Day phone If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. Individual on-site ;- -- Holding tank Community on-site ' Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system· 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 re~..~ations in effect on the date of this inspection. Phone NameofFirm /,PJ-*~-'~'/ ~u,-~'-.~-~-~(~' ~.~' Address ~q-~.~ I.~ Engineer's signature "'~-;~'"- / DHHS SIGNATURE /~' Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date //-/,.~ "~7"7 'The Muhicipality of An~'horage 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 thei.r 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. TIME DATE I~PE~FOR DIRECTIONS: ~ THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME DATE DATE I NSPE CTOR INSPECTOR 1. TYPE OF RESIDENCE NUMBER OF BEDROOM~ I'-1 SINGLE FAMILY [] ONE [] THREE I-'1 FIVE [] MULTIPLE FAMILY [] TWO [] FOUR [] SiX · 2. WATER SUPPLY PERMIT NUMBER TYPE OF TANK [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Col~le~tion Verif'ied LOG RECEIVED ~. SEWAGE,,OISPOSAL SYSTEM PERMIT NUMSER I-'IINDIVI~-~AL/oN -SITE DATE INSTALLED ~i'PUBLIC UTILITY ~/~ ,-, ~ "~ : Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: f~,~& If Tank is homemecle $OILS RATING TOTAL AS~ORPTION AREA DISTANCES WELLTO: AJ~oeptJon Area to nearest Lot Line MATERIAL S~otic/Holding Tank IAbsorpt;on Area I~ev~r Line S. COMMENTS [] OTHER lNearest Lot Line DATE [] APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) ~'"~DtSAPPROV F~ LEGAL OESCRIP'FION 72-O10 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Andtofage, AlaMca ~g501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES LENDING INSTITUTION MAILfNG ADDRESS PHONE 4, REALTOR/A~NT .-%rD PHONE STREET L O~iA,.TJ, O N . 1-'1 One [] Four [] Other SINGLE FAMILY [::] Five [] MULTIPLE FAMILY 7. WATE~,.UPPLY INDIVIDUAL* [] COMMUNITY I-'1 PUELIC UTI LITY 8. SEWAGE DISFOSAL SYSTEM ~g~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY  Two Throe r-1 Six · ATTACH WELL LOG. A well Io~ is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) *°If individual/on-site, give imt~]letion date ~"-"?' "~ 7 If system is over ~w~ (2) yeers old an adequacy tes~ is required by this Del:~r~ment. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 724)10(3178)