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HomeMy WebLinkAboutHANSHEW HEIGHTS LT 2BHanshew Heights Lot 2B #015-051-30 .� Municipality of Anchorage •''t '` f, Development Services Department Building Safety Division • • r On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage. AK 99519.6650 Page of www.ci.anchorage.ek.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: JW 0381 PID Number: 015— 0 1-3O Name �m Wastewater System: ❑ New Upgrade Address. $o N C; ABSORPTION FIELD Phone. Number Of eedrpoms Oesp Trench O Shallow Trench p Bed ❑ Mound ❑ Other: LEGAL DESCRIPTION Sod Rating � O Total Depth from orip-nal grade P F,tq Ft Blocs Let. Subdivision: Depth to pipe bottom from original grade Gravel depth beneath PPS. Lo -r N = V'/ Et Ts Ft. Ft Township Range Section. Fill added above original grade: L T Gravel Length. ND Ft. Ft. Well ❑New C] Upgrade Gravel width' Numberoflmes. I Dntancebetweenlmes Fl. Fl Glass.ficaUon tPnvale. A. B, C) Total Depth: Lased to. Total absorption area: /� Pipe Material. ,1 PVC, Ft. FI ./ CTO Fts Se 14ke 10 D, lle- C Date Drilled: Static Water Level: installer. Date Installed: f t�`810-1, V cit V•sid Pump Set at: Casing Height Above Ground: TANK GPM FI. FL SEPARATION DISTANCES p Septic [:]Holding S.T.E.P. ❑ Other: To Septic Absorption Lift Holding Puttlic[Privat Manufacturer. capacity. From Tank Field Station Tank Sewer Line At 164 elLi % 1;-Cj0 Gal . Keil I t o 1'•4D � � � '`''/q o - Material: Number of Compartments Surface Water N N "/A- N LIFT STATION Lot Line q O 10 140 Sae-.. I ;L -Bo Gat Manufacturer. 04A.41 L 0 Foundal*n f 'Pump on' level at 'Pump orf' level at "n water warm at 121 .2 in. m T,Iz n Cuda n Drain N/C N 1b ZLQA, Pump Make a Model Electrical Inspections performed by, D 4&W Remarks BENCH MARK Location and DescnPlen: �e on.4t �-�•Ldlsll A sumed Elevation t do!!� Ft + t OF F At. %I so * !491H Inspections performed by: 1 s Dates: 1a` �// o L- I//•.wcy ♦ ..«.»«...a..... 2nd �Ol9/0 L ♦ ? ...»«.» ... Development Services Department Approval Reviewed and approved by: Date: r• t3��9F�'••,,.,,.•4-0 4W pROFE5510�i+ ,- 0 ' 3—BfDR" SEPTIC 1250 QL STV I I I SNOW o_r to I I I I E'TT 6W Roar I I I 2 FM com AMOM EW. Ther. aereC Gln I I r U I rl�r�RTr I I � I II I iI eo � T60 n- Z II 44aj sBD 21 AD �b9 OD 27 I 1 � I B c ;IID BENOl wax I I i I I I I I I I I I I I 4c aw AV 49th s ............................................ I I rom SPURKLAND p I I No. CE-2226 �•�•� I I IIolkik% ♦♦ i i I I i 40 I I I I I I I I I 25 0 I I 50 75 100 its iso I I tSCALD 1' = 50 FT. I IWrTom I 1 eat ed�a�r I � ASSV Mora". 100.00 R "'°D`" 'r"R^`""" 1 LUT ,ZB MNS'HEff HEIGHTS SEPTIC SYSTEM AS BUILT 203 W 157H. AVENUE ANCH. AK. 99501 1 JEAN CORM/£ DATE.• OCT. 22, 2001 907 279-3916 111 9300 NICKELL CIRCLE SHEET 2/3 GRID: 2437 PERMIT # SV020381 PID # 015-051-30 HHE002B2.DWG Standard Trenches 2' Wide 40' Long 9' Beep 7.0' Sewer rock 2' Cover (#mu r) NO SCALE f— Monitor Silt Barrier 915 7.0 ft of Septic Rock Effective P� rAun^ /AMAIr) NO SCALE '� 49th No. CE -2225 3 0 a z 0 a 1250 GAL STEP TANK 1250 GAL STEP TANK KNM surer W"M SIDW ASRW IUV. 100.00 fr. TOBBEN SPURKLAND P.E. LOT 2B HANSHEfl HEIGHTS SEPTIC SYSTEM AS BUILT 203 W15th Ave nglrJEAN CORA!lf DATE Anchorage Ak 99501 OCT. 22, 2002 SHEET, 313 GRID, 2437 PERM/T SWO20381 PARCEL ID # • 015-051-30 NNE00293.DWG ., 0 0 0 1250 GAL STEP TANK 1250 GAL STEP TANK KNM surer W"M SIDW ASRW IUV. 100.00 fr. TOBBEN SPURKLAND P.E. LOT 2B HANSHEfl HEIGHTS SEPTIC SYSTEM AS BUILT 203 W15th Ave nglrJEAN CORA!lf DATE Anchorage Ak 99501 OCT. 22, 2002 SHEET, 313 GRID, 2437 PERM/T SWO20381 PARCEL ID # • 015-051-30 NNE00293.DWG ., R;.=rL– btFAX 10/24/2002 8:52 pAOE 1/1 RightFAX Inspection Report Municipality of Anchorage, Building Safety Division 4700 South Bragaw IM9F3ECTIDN: VOICE 343-8300 INSPECTION: FAX (907)249-7777 INFO: 343-8211 NaritO Brick's Electric: BIII Permit 02-9099 Addreewsm 9300 NICKELL CIR Phone 440-9351 345-2923 Legal LT2B Inspection Data 10/25/2002 AM Subdilw1 ton Commmnts or Directions HANSHEW HEIGHTS Grounds and neutrals separated at panel RetroElectrical ;t, Reinspection Y CE OBS5kVED PENTIALAS EXPLAINED BELOW AT NEXT ❑ DO NOT CONCEAL UNTIL REINSPECTION COMMENTS: (for inspector use only) Sty%G % �-W4.- Inspector /jam Inspector �. • ; /� / ( Z Date:_ Snspection NONCOMP NO ❑ CORPLE-MONS ❑ WILL RE-EXAMI INSPECTION HANSHEW HEIGHTS Grounds and neutrals separated at panel RetroElectrical ;t, Reinspection Y CE OBS5kVED PENTIALAS EXPLAINED BELOW AT NEXT ❑ DO NOT CONCEAL UNTIL REINSPECTION COMMENTS: (for inspector use only) Sty%G % �-W4.- Inspector /jam Inspector �. • ; /� / ( Z Date:_ MUNICIPALITY OFANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW020381 Legal Description: HANSHEW HEIGHTS LT 2B Design Engineer: 0007 Tobben Spurkland, PE Owner Name: Jean Cormie Owner Address: 9300 NICKELL CIRCLE ANCHORAGE. AK 99516 - This permit is for the construction of: 7 Disposal Field Q✓ Septic Tank /° 1V- -e'ap '! 1°/_1 e Z',,7 Date Issued: Oct 02, 2002 Expiration Date: Oct 02, 2003 Parcel ID: 015-051-30 Site Address: 009300 NICKELL CIR Lot Size: 21266 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 ❑ Holding Tank [] Privy F] 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: JAZO z Date: UAL2 DEPT. OF ENVIRONMENTAL CONSERVATION DIVISION OF ENVIRONMENTAL HEALTH DRINKING WATER AND WASTEWATER PROGRAM 555 CORDOVA STREET ANCHORAGE, ALASKA 99501 January 22, 2003 Tobben Spurkland, P.E. 203 West 15`h Avenue, Suite 203 Anchorage, Alaska 99501 TONY KNOWLES, GOVERNOR Telephone: (907) 269-7519 Fax: (907) 269-7650 Re: Lot 213, Hanshew Heights, Separation Distance Waiver, Class B Public Water System, PWS1D # 211643, ADEC Project # 2623 Dear Mr. Spurkland: This is in response to the waiver request received in this office on September 23, 2002. 1 have reviewed the engineering drawings, the file records, sample records for the Class B public water system and the submittal information. Waivers Your requests for -waivers between the Class B public water system and the on -lot wastewater system are as follows: To lessen the separation distance between the Class B public water system and the deep trench .wastewater system serving a single family home to a distance of 150 feet. To lessen the separation distance between the Class B public water system and the 1,250 gallon two compartment step type septic tank serving a single family home to a distance of 113 feet as scaled. A review of the well logs, soil reports, resent water sample results, and the plan drawings has taken place. It appears the waiver requests are reasonable. Therefore, in accordance with the State Drinking Water Regulations (18 AAC 80.020), the following waivers are granted. The separation distance between the Class B public water system source well located on Lot - 213, Hanshew Heights Subdivision and the 1,250 gallon, two compartment step type wastewater septic tank serving a single family home on this same lot has been waived from 200 feet to l 13 feet. The separation distance between the Class B public water system source well located on Lot 213, Hanshew Heights Subdivision and the deep trench type soil absorption system_ serving a single family home on this same lot has been waived from 200 feet to 150 feet.. The distances noted in the waivers are from your submittal. It appears that these distances are from the nearest edge of the wastewater disposal system component to the nearest edge of the existing Class B public water system well. If any wastewater disposal system fails or contamination can be traced back to the system, the waivers will be invalid. I must strongly recommend that prior to submitting requests for construction approval or separation distance waivers, field verification to confirm existing conditions be completed. This approval does not imply the granting of additional authorizations nor obligate any state, federal or local regulatory body to grant required authorizations. tl DEPT. OF ENVIRONMENTAL CONSERVATION DIVISION OF ENVIRONMENTAL HEALTH DRINKING WATER AND WASTEWATER PROGRAM 555 CORDOVA STREET ANCHORAGE, ALASKA 99501 January 22, 2003 Tobben Spurkland, P.E. 203 West 15`h Avenue, Suite 203 Anchorage, Alaska 99501 TONY KNOWLES, GOVERNOR Telephone: (907) 269-7519 Fax: (907) 269-7650 Re: Lot 213, Hanshew Heights, Separation Distance Waiver, Class B Public Water System, PWS1D # 211643, ADEC Project # 2623 Dear Mr. Spurkland: This is in response to the waiver request received in this office on September 23, 2002. 1 have reviewed the engineering drawings, the file records, sample records for the Class B public water system and the submittal information. Waivers Your requests for -waivers between the Class B public water system and the on -lot wastewater system are as follows: To lessen the separation distance between the Class B public water system and the deep trench .wastewater system serving a single family home to a distance of 150 feet. To lessen the separation distance between the Class B public water system and the 1,250 gallon two compartment step type septic tank serving a single family home to a distance of 113 feet as scaled. A review of the well logs, soil reports, resent water sample results, and the plan drawings has taken place. It appears the waiver requests are reasonable. Therefore, in accordance with the State Drinking Water Regulations (18 AAC 80.020), the following waivers are granted. The separation distance between the Class B public water system source well located on Lot - 213, Hanshew Heights Subdivision and the 1,250 gallon, two compartment step type wastewater septic tank serving a single family home on this same lot has been waived from 200 feet to l 13 feet. The separation distance between the Class B public water system source well located on Lot 213, Hanshew Heights Subdivision and the deep trench type soil absorption system_ serving a single family home on this same lot has been waived from 200 feet to 150 feet.. The distances noted in the waivers are from your submittal. It appears that these distances are from the nearest edge of the wastewater disposal system component to the nearest edge of the existing Class B public water system well. If any wastewater disposal system fails or contamination can be traced back to the system, the waivers will be invalid. I must strongly recommend that prior to submitting requests for construction approval or separation distance waivers, field verification to confirm existing conditions be completed. This approval does not imply the granting of additional authorizations nor obligate any state, federal or local regulatory body to grant required authorizations. Thank you for your cooperation. If you have any question please do not hesitate to contact me at 269-7519. Respectfully, William R. Rieth, P.E. Environmental Engineer WRR cc: Jamie Stazel, ADEC, DW/WW James Cross, P.E. MOA, DDS, on-site Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907)343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0i' h — O 51— 3 D Permit Number SWOZO38/ Property ownersEh,tA COl2M t 1g Day phone Mailing address (1) Q7_,o t4tCY—I. L— e1pCL Mailing address (2) Zip Code 4 (� Legal description (Lot, Block & Sub'd.) t-0 1 aT5 4At4S N I;;_7 yG u E(G ttTS Legal description (Section, Township s&Range) Lot Size ��(o(e Acre- F THIS APPLICATION IS FOR: Number of Bedrooms 3 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. VVE (Signature of property owner or authorized Permit Fees: A `7 60_9�!: Date of Payment: Receipt Number: A&&o y (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: T.SPULP IrLLA-14D5 DI'.DE. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 2B HANSHEW HEIGHTS JEAN CORMIE Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street Anchorage, Alaska 99519-6650 September 19, 2002 We are submitting an application for the upgrade of the septic system for this lot. The existing system failed an adequacy test and a replacement is required.. This submittal consists of three (3) drawings showing the present improvements on the lot, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable test holes are also enclosed. Hanshew Heights is served by a Class B water system Both the existing and the proposed system are within the present protective radius of the supply well, but out side of the radius in effect when the subdivision was developed. ADEC is in the process of granting a waiver to allow the installation of this proposed system, however, your Department has to issue the installation permit. This application is for a 3 -bedroom system as is the existing system. The design of the septic proposed system is based on the following : No Ground Water or Impervious Layer to 15 ft. Use Standard Trench with a lift station Soil Rating. From Test hole 08/27/02 7 min/in = 0.8 gal per sq-ft/day No. of Bedrooms 3 Required Area per Bedroom: 15010.8 = 187.5 sq.ft. Total area required: 187.5 x 3 = 562.5 sqft Test hole depth 15 feet Bottom Rock At 9 feet Top Rock At 2 feet Rock Depth 7 feet Minimum Trench Length 562.5 / 14 = 40 ft. SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 40 FT TOTAL NVIDTH 2 FT TOTAL DEPTH 9 FT ROCK DEPTH 7 FT COVER 2 FT INSULATE SEPTIC TANK 1250 GAL STEP The installation of this septic system'will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface /'subsurface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of suu6cq runoff will not result from this installation. 4 T.SPURKLAND P.E. 203 WEST 1STI1. AVENUE SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Kent Kle%%ano. P.E. Environmental F,ngineer State of Alaska Dept. of Environmental Conservation Anchora_e District Office 555 Cordova Street Anchorage. Alaska 99501 Subject: Separation Waiver Request Septic System to Class B Well Lot 2B Hanshcw Heights PWSID Gentlemen: September 23.2002 We are requesting a waiver from the Separation Distance required by 18 AAC 72.020 (e) between a Class B Hater well and a single family soil absorption septic system. A copy of the permit application to the Municipality is attached hereto. The septic s�slem on this lot can not be replaced without a waiver The test hole excavated in connection with the design of the proposed drain field showed that the soil conditions consisted of dense sandy silt/ silty sand to 15 feet. Bedrock or ground water were not encountered. The percolation rate was found to be 7 minutes per inch. The proposed septic system will be located down gradient of the groundwater source feeding the well. Yours T 66 Spurkland P.E. I ABBOTT ROAD T- I I III 2A I III I I I I I I _ l ® TtsTNocF I I Mr. TRENCH I I CONCRETE I I CRIB I ID O _ _ I I I ` 49thn'� 3YrN SPURKLAND No. Ce -2225 IiUr�dtN �r'UKI(ZANV r.t. I I LOT 2B HANSHEW HEIGHTS I ( SEPTIC SYSTEM DESIGN I 203 W 15TX. AVENUE JEAN CORM/E DATE: SEPT. 15, 2002 ANCH. AK. 99501 /907) 279-3916 9300 NICKELL CIRCLE SHEET.• 1 3 GRID: 2437 PERMIT # SW020XXX PID # 015-051-30 HHE002BLD05 3—BEDROOM SEPAL i 1 1250 CAL STEP I I STANDTRENCH ARD I I I I I PUT�ETfC11Vf (POCK I I I I I ABANDONE EXIST. TANK, CRIB, AND ADEN v V CHURCH PROPTic V RTY I I S I 4A I � I 1 I CC�RET F --- I I 1❑ I I I I I 1 Well Mo r I I I I I I I I I I OF �,• • •�y�I1 I I JA '• 49th 0....}..... •.• .................I. I 1 TO BEN SPURKLAND I �` `• I 1��,1, �.,•• No. CE -2225 �'•J = I I �'''••........ ••• '1� I I I ID � w;�p,.�� I I I I I I I 1 25 0 1 251 50 75 100 125 150 1 {SCALE, 1' = 50 FT. 1 I 1 I I I I I I TOBBEN SPURKLAND P.E. , LOT 2B HANSHEW HEIGHTS SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUEANCH. JEAN CORAM£ DATE: SEPT. 15, 2002 (907) 7 3916 I 9300 NICKELL CIRCLE' SHEET 2/3 GRID: 2137 907 279-3916 PERMIT # SV020XXX PID # 015-051-30 HHE002B2.DNG 49th .` SPURKLAND CE -2225 , SII t 6.0Ftof Effective NO SCALE 1250 GAL STEP TANK IVU J(oMLL TOBBEN SPURKLAND P.E. LOT 2B HANSHEW HEIGHTS SEPTIC SYSTEM DESIGN 203 W15th Ave Anchorage Ak 99501 JEAN COME DATEi SEPT. 23, 2002 9.W AWVU CIRCLE SHEETi 3/3 GRID, 2437 PERMIT j SW020XXX PARCEL ID # 015-051-30 HNE00293.DWG Municipality of Anchorage Development Services Department Building Safety Division � �a,.•. On -Site Water and Wastewater Program i 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www ci.anchoraae.ak.us (907)343.7904 'tENGINEER'S'S=ALA To' :,en SpurF.land tc� •;; `t1 'u •. Cf -2223 C; Vis• 14 Soils Log - Percolation Test I L �:�-%" •..•a.• �,p�OFESSI�a�:w.k.. oerfoamed Fce p'L Date Performed: 8��'j I . Leval Descript.on: _Lint ;Z I 13 �N S N �vl/ 14ic4%jownship, Range, Section: Slope Site Plan Dec:n 16 0 r "u LE 17• iG•)• c. zo-1 '.O..." r. `TS WAS GROUND WATER NI ENCOUNTERED? D Depth to Wale, s IF YES. AT WHAT DEPTH? p Depth to Water Aker Monitoring? D D E Date. _ IS 7. Reading Date Gross Time Net Time Depth to Wale, Net C•cc I t — LL p 1= G C) Aa Lf 11 IN D 7/j� I 4 tT 3 •7 %4Tt PERCOLATION RATE I_ pmnulesanchl PERC HOLE DIAMETER b,► TEST RUN BETWEEN 1% FT AND _FT =ERFC'V,!ED BY S I ! S CERTIFY THAT THIS TES = ER=CRIED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. 9 /:/U Z L , MUNICIPALITY OF ANCHORAGE \' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME L V% PHONE❑ 3 �. NEW UPGRADE MAILING ADDRESS LEGAL DESCRIPTION h 'P S LOCATION II^^11 NO. OF BEDROOMS �SV�• 1 Uy DISTANCE TO: Well Absorption area Dwelling PERMIT NO. F Z aQ W F. Manufacturer Material No. of compartments w Liq. capacity in gallonsI WOM MADE: Inside length Width Liquid depth ❑ z DISTANCE Well Dwelling PERMIT NO. O z Q S F Manuf urer Materia Liquid capacity in gallons ❑ w = DISTANCE TO: Well .�,(;� Foundation T Nearest lot line PERMIT NO. -f" L (j C) F�� ( 2— Lu w a U F Z w No._o dines Y� �� Length of ea a � Total length Ii Trench width Distance � et een lines 'nches 1 CC HTop ❑ of tile to finish grade ,� - x3C'1 Material beneath tile Total effec ve absorption area -ineFies z, w Length Width Depth PERMIT NO. C7 Q H Lu Type of cr' Crib diamete Crib depth I effective absorption area well rn DISTANCE TO: ng foundation Nearest J J Class Depth Driller Distance to lot line PERMIT NO. Lu ?: Building foundation DISTANCE TO: Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS 30 a SOIL TEST RATING IN (LL,7ER REMARKS © �( i APPROVED DATE LEGAL vs 72-013 (Kv.3/78) // DEPARTMENT [r HEALTH AND ENVIRONMENTAL F-ITECTION v 825 'STREET/ ANCHORAGE.- AK. 995-li � ^ ` 264-4720 93�-."i3 I -F FEE EE: t,J 1-= F-� U F-� f3 f;? F=f Ca E_= ���P1 I -IF PERMIT NO. ( 800512 ) APPLICANT JOHN LONDON LOCATION SAME LEGAL LOT 28 HANSHEW HEIGHTS 9300 NICKELL CIRCLE LOT SIZE 22000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 250 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELC\ THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (%N FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (%N FEET). I R -'F= G! U I F. -"EE r-11 '-=. E= F- -r I a::- 7r n N K �1 7' FE �� -1 0 0 0 �������P-.R�� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. ___ -rLquD < :2 > I I CRN:F- nF-oa ��F=QU I F,!,F=*E.- --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY 8N -SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND T0 8 COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ���M I -IF aXV-"l F. -'E=`_=- 2:1 , ���,=* Pj I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON --SITE SEWERS HND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE 0N -SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED: ---_ ---^_~~-~----~,__- OD T JOHN LONDON � ~�~ ----- DATE --- Y4.0 ��~ � 82.5 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION April 14, 1980 John/Lucille London 9300 Nickell Circle Anchorage, Alaska 99507 Subject: Lot 2B Hanshew Heights Subdivision Approval for your individual sewer and water facilities can not be granted until the following items have been completed: (1) The septic tank pumped with a receipt submitted to this office. (2) An adequacy test be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this department for our review. If there are any further questions, please contact this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Alaska Statebank % Marylee Hillier 310 East Northern Lights Boulevard 99503 Conce Cullor or Bette Trump C21 - Heritage Homes 207 East Northern Lights Boulevard 99503 i ALASKA cnUIROnmcnTAL C011TROL RRUIUS, Inc. Engineering & 6nuironmental Studies 1•,I,:..,• MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION S E P 5 1930 RECEIVED 9"i f Op �°\U �p U v pl pp a � p V � N r e ppO •'•app�pOOppppO OOp 63 0 - 3ms oe me 3nm mm °em a N m C. Reed, Jr. No. 225T•E �. J if) 80 1220 West 25th Auenue • Anchorage, Alaska 99503 • (907) 276-1361 'l:`i:y. ri;;, iJ !. i " '•11`Y! � i.i ... ;.. _. ... i .i. _,t: _t . .A.;Y .� ! :`1.S_ . :t-_.<. Jr._.. ::, !.}. � , .5:{::. • V4. 11�. ��1 .}. �:.} {r. - .{.: .....-. :. {...i'.), .Y�.J R:,k'. .... ...1. _ t... !i.Y. y: �.. , ' •}�', J f p I It i.R .... +' "i .3 0 rl �.., i:�: �±-..... 6a 9"i f Op �°\U �p U v pl pp a � p V � N r e ppO •'•app�pOOppppO OOp 63 0 - 3ms oe me 3nm mm °em a N m C. Reed, Jr. No. 225T•E �. J if) 80 1220 West 25th Auenue • Anchorage, Alaska 99503 • (907) 276-1361 I'm X0 T DEPHRTMENP, HEALTH HND ENVIRONMENTH( '/|1:::.[|!UN EET/ HNCHORHGE, Al:'. 279 ..... ..... 511 PERMIT NO. ( 77]47 ) HPPLICHNT Cl, HBBOTT & NICKELL CIRCLE LEGHL L2B HANSHEW HGTS MINIMUM DISTHNCE BETWEEN H WELL HND 100 FEET FOR H PRIVHTE WELL OR 200 WELL LOGS FIRE REQUIRED HND MUST BE OF THE WELL COMPLETION 5110 HBBOTT ]44-9]57 LOT SIZE 55000 SQUHRE FEET T ON�SITE SEWHGE DISPOSHL SYSTEM IS FEET FOR H PUBLIC WELL RETURNED TO THE DEPHRTMENT WITHIN ]0 DHYS SPECIFIC8TIONS RND CONSTRUCTION DIHGRHMS FREHVHILHBLE TO INSURE PROPER INSTHLLHTION, ���� ����� ����� ������� I CERTIFY THHT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON�SITE SEWERS FORTH BY T E MUNICIPHLITY OF HNCHORHGE 2� I WI HCCORDHNCE WITH THE CODES ' 5IGNEDFl -64 . .... .. .... � HHD WELLS HS SET SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF — 235 - TP - 4 -DRILLED AT THE RATE OF 78.00 PER FOOT. 1, PROPERTY OWNER ljln '" ntckeL LOCATION OF WELL SITE Lt. B.Lk. sub. DRILLER Bew Le CAa" of- Paupaltt G7o&k4 WELL LOG: 0---199' D&ttted by, finchc& � �• t�ee�ened lrt� �atnpcur t �iot2 799 �e�. 199-231 ' S.i,L 4 4wW4 cAau, with 20% gltave L a n &Am anon. 231-235' Water beaainq 9wuet with, a pwducation of- 14 gPla. Giatet & cove&* to cao au Paid to A&U &V, ft. R cke-L Thank You U'eUtus !Ruch, Date: Au jmt 15th, 77 � GR[ ER ANLMUKAGt AKtA UV- UbM • � � Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME J/A1A�/VLLC_)- - MAILING ADDRESS _���C� 7tI'// Z-' �Jl !/� PHONE LOCATION NjCI l LL�j� v°Fh FIbG�7i %"CL LEGAL DESCRIPTION G_07 M7 jj /JS%j£ZlS !'f %s SEPTIC TANK: DISTANCE n ( 7-� /� _ FROM WELL `/ MANUFACTURER t��J�A6USl7 MATERIAL")C)�C'!Zt t NUMBER OF j COMPARTMENTS ! INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY / �'�' U GALLONS SEEPAGE PIT: NUMBER OF PITS DIAMETER ORWIDTH., LENGTH, DEPTH LINING MATERIAL 3� htjK60 CRIB SIZE: DI AMETER!--- DEPTH DISTANCE FROM: WELL �5 �( , TOTAL EFFECTIVE BUILDING FOUNDATIONC �, NEAREST LOT LINE—/5 ABSORPTION AREA (WALL AREA)ZV SQ. FT. ADDITIONAL ABSORPTION WELL: / TYPE l'Yl( f��,IIJIIC n CONSTRUCTION4 0401,ng) Ldtd DEPTH DISTANCE FROM: BUILDING I L NEAREST NEARESTSEPTIC N` /c, e I SEEPAGE / L25' FOUNDATION4A LOT LINE SEWER LINE TANK, SYSTEM CESSPOOL ^� OTHER SOURCES APPROVED DISAPPROVED DISTANCES: MS JIOWAJ INSTALLED BY: /)�PLI(/3Aj7- PIPE MATERIAL: Ogg ljz-ON LOT SLOPE: REMARKS: 8 ,S/dC OF Pi 7- WhS Ail rlr4l'y I/ 't1 /N 4T //JSI�. 9,bePrx r�rTNs E,V!) "'V 4T DtrrPi)1,VA8L1, ZTIAIVIJ. WQO L yvutrr P,F AtiA t,,Lir'D !N -ro VALi bH7C 711's SYST>nr Form No. EQ -031 REMA DIAGRAM OF SYSTEM S,m; 'R,bio aIV Wj%U. 2 ` DATE at _24.-6 4 APPROVED11 G.A.A.B. e 23 a � Fo � •.4 i�-G , '� i3 til/%i1 f (i �f USt@�L�r)C' /UC4 S,m; 'R,bio aIV Wj%U. 2 ` DATE at _24.-6 4 APPROVED11 G.A.A.B. 1 MP GREATER ANCHORAGE AREA BOROUGH 4pE kvit ,J PERMIT NO. ee` � � DEPARTMENT OF ENVIRONMENTAL QUALITY �//�//��""�� 3330"C"STREET ANCHORAGE, ALASKA 99503 Seep 51 TELEPHONE 274-4561 \\�\\VVeIIII�rz[`Y�`0SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT Lc / -Z MAILING ADDRESS ' INSTALLATION LOCATU LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SEEPAGE PIT - h , DRAIN FIELD OTHER TO BE INSTALLED BY SOIL TEST RESULTS NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST r COMPLETION DATE ANTICIPATED 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. /�/ /� il7-G G1G..� TYPE ��1"�1�%/c� ' l X c'/�/:i::J��i�J✓ �-C.�4 l .�. �/� (G�. SEPTIC TANK SIZE d SEEPAGE AREA SIZE TYPE v MINIMUM DISTANCES, REQUIREMENTS r FOUNDATION TO SEPTIC TANK > FOUNDATION TO SEEPAGE PIT `-� / DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL /'� / 1 SEPTIC TANK -! , SEEPAGE PIT p. sDRAIN FIELD TO NEAREST LOT LINE. �/JY+�"^��.�sl.�-1 �f (�✓r-'(�A- WELL TO SEPTIC TANK SEEPAGE PIT -- ALSO CONSIDER AREA WELLS. —. SEEPAGE PIT % l , DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD ie SEPTIC TANK, /�--% SEEPAGE PIT /�� DRAIN FIELD TO RIVER, LAKE, STREAM.• CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER DIAGRAM OF SYSTEM I I � i — _ ------------ .---- - I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. s i DATE APPLICANT'S SIGNATURE Ira C�.Onsi'Luatlon gest 1'aG j "One test is worth a thousand opinions" ` 6829 TUDOR ROA , ANCHORAGE. LA9KA 98807 9 TILEPHONL 333.8472 / Performed For �G � Date Performed t9 /0 Legal Descrintion: Lot Block Subdivision t? This Form Renorts Soils Loq Percolation Test_ nenth Feet Soil Characteristics p — d l7 fa..ti6� (0/'19 vtiC W ��M /$ O _ 3 4 — / C� v e- 5 5 — 14 7— of// CAti;r,/ ,C,M - a s-0 In — le Was Ground Water Encountered? Alu If Yes, At what Depth? Mt•WA Percolation Rate Minute Prnrosed Installation: Seenaae Pity1eS Drain Field _ Deoth of Inlet Depth�o Bottom OfPi Or Trench rnmMENTS : 5 0 Sa / �0row+ Test Performed By T1s- V1/114G% Data Certified By: i A -A AAA2- AI A%P J% Date: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. DIS DSS/- X30 COSA# 680-11 Expiration Date: %—! to - O! 1. GENERAL INFORMATION Complete legal description Tian&") Ne;jA s Location (site address) 9300 TYPE OF WASTEWATER DISPOSAL: Individual Well Current Property owner(s) i' ;cc 44 K-44 Al e Day phone -jjo -55 y p, Mailing address 9300 A/i lizgll 1 AncKorale . AK g954(o Lending agency Community On-site ❑ Day phone Mailipg address Public Sewer ❑ Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site ED Individual Water Storage ❑ Individual Holding Tank ❑ Community Class _ 5 _Well Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 FirmS�-i03 W2,'Le, nEb21 N(r Address 2. is" Ave- Z03i An—hm-�,,gk 77361 Engineer's Printed Name _t! APs Save fci A^ A 5. DSD SIGNATURE �� Approved for _ 3 bedrooms. Disapproved. Phone M_37/41 3`1/41 Date -7 — A-/_0 5 _z SOFAZ telk :49TH00 5 r, i 9.LARS E. SPURK.AM) jr / Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: Original Certificate Date: 7–/0-0,9 (R*v. I V05) Municipality of Anchorage .•..•�, �. Development Services Department Building Safety Division ` ��-- On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Ntnskv./ 116105 Lol( IS ParcelID: pts os -r-30 A. WELL DATA Well type 13 If A, B, or C provide PWSID #211(°43 Well Log (YIN) Date completed _ Sanitary seal (YIN) _ Wires properly protected (YIN) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Other bacteria colonies/100 mL Arsenic: _ ug/L date of sample: _ Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Se ..,. /.lieu Date installed Ig8L02 Tank size 1150 gal. , Number of Compartments 2 Cleanouts (YIN) y Foundation cleanout (YIN) _y : Depression over tank (YIN) /V High water alarm (YIN) y Date of pumping 'lo o q _ Pumper TSsacs Porn 0;,1 -SPryI c g_ J C. ABSORPTION FIELD DATA Date installed t 6 oZ -Soil rating (g.p.d./ft2 oc(tibdrm) O, B System type 06eo Trr^ck Length 4D ft. Width 2 ft. Gravel below pipe _� ft. Total depthI ft. Eff. absorption area 5(90ft2 Monitoring tube i Depression over field /V Date of adequacy test 412(.105 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test V95 in. Water added690 gal. New depth GS in. Elapsed Time:(blmin. Final fluid depth 51_ in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) /lone k&7wn If yes, give date D. LIFT STATION Date installed to oz 'Pump on' level at4(�% in. Datum t-W,m 7snk E. SEPARATION DISTANCES Size in gallons (250 'Pump off" level at tri in. Cycles tested (o SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 110 r + Absorption field on lot 1401 -/- Public sewer main A/�A Sewer /septic service line 25 r Animal containment areas SD'+ Manhole/Access (Y/N) Y High water alarm level at y7' in. Meets alar & circuit requirements? %s On adjacent lots > 200 On adjacent lots i zoo Public sewer manhole/cleanout 4A Holding tank 4A Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 21 Property line 10 Absorption field �O Water main NIA Water service line (O Surface water N, O Wells on adjacent lots >Z001 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line for Building foundation �S , Water main N�A r Water Service line 130 Surface water A],0• Driveway, parking/vehicle storage GO Curtain drain N,Wells on adjacent lots %ZOOr F. COMMENTS G. ENGINEER'S CERTIFICATION P.CE.�F ....go It .. �J 1 certify that I have determined through held inspections and review of Municipal records that the above systems are in 49,— TH�✓`/,Q conformance with MOA COSA guidelines in effect on this date. / U a+">✓ JRKL4;D: Engineer's Printed NameLAzs t 00purL 4r Date COSA Fee $ `7" U Date of Payment zyO Receipt Number 4 E� 6Li'3 (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number ... . O k'7' CD V 4 � c 3y �............ _.. i .. _... ... �IknJ O u °I u rs :ASPirAt r..: . to i . .a 4f.6:::: I NB9°57' Jo•�6 /40.08 >- ; nl i .. .. .. Book No. dOA ..PW No. - 40 . . 58 t// •• N0 COi2SSET. I hereby C;Vl cher I have surveyed the following dewibed property, LotlLBloek �;' ..� e NA NSNFW NEIL HiS'SGCBD. Anchorpe tecording'Preeinct,IAneka,'end that I i p111�� OF At. gS1i the ImPtouch an ntsthe situated ltvnon ere ant thereto, . the property lines and do not ovary v, i � I encro.ch on the property Iyirq iadpant tMnto, tMt no ImproveminN on lying adjacent thereto encroach pn the premiw In question and that there we no roadways,'' transmission Imes or other visible easements on $aid/° �'•°'••"' 'j° property fYeept N kWipted hereon. . �IM••'•'M`N•..NM.NNrN'.' sA IJe. uas•��' AnchorWs. nww _ 12 JAN• l98/ RECeR-7'/F/£D Z6;J41t/Z 200,3t1i,`o!lttigt0 '° Municipality of Anchora ;c C;o Development Services Department *.* ` Building Safety Division =i On -Site Water and Wastewater Program s «t " 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ek.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D._Dl5-0151-;y HAA I,_ d2-� Expiration Date.- _ 7-7- D 1. GENERAL INFORMATION Complete legal description Loi eLptj' 1.1AMS14 I._ w tk tz 1414T-5 Location (site address or directions) 4 3" N ICV E Lt, C-I.I->tLLz Current Property owner(s) 3 .0-0-h Cp,-"4 e_ Day phone qb - 165$ Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Q3do NiL1�aGt° C; r', Day phone 7-n..4r IIt scl. U_c LAekr 4?.y! Dayphone 5& 2-6gbS Unless otherwise requested, HAA will be held by ASD for pickup. 2. NUMBER OF BEDROOMS: . .3- 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class _j Well Public Water System ❑ TYPE OF WASTEWATER DISPDSAL: Individual On-site 9 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 Health Authority 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 o6Leh ��ur1%la►�G�-�. Address . 0'x-03 Uri f Lf7 Za 3 Engineer's Printed Name i C> bloc H Sv rV,I M K cf 5. DSD SIGNATURE ✓ Approved for 3 bedrooms. Disapproved. Phone A79 -'bpi t to ft - Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 7-7-o3 (Rev. 01102) Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT am1<1 CLna c.y� ��c.:T11�s Parcel ID: Oi 5- DAA- 30 A. WELL DATA Well type %,B Date completed Total depth ft. Date of test Static water level Well production If A, B, or C provide PWSID # &4 0 Well Log (Y/N) Sanitary seal (Y/N)— Cased YM)_Cased to ft FROM WELL LOG ft 9— p.m- WATER SAMPLE RESULTS: Coliform colonies/100 mi. Arsenic: mg./1. Nitrate mg.A. Wires properly protected (YM) Casing height (above ground) in. AT INSPECTION ft. n Other bacteria colonies/100 ml. Date of sample: Collected by: B. SEPTICIHOLDING TANK DATA TankType!Materials c� S14 -CA Tank size ago gal Number of Compartments Foundation cleanout (Y/N) _ Depression over tank (YM) N ty/ W-10, Date Installed Cleanouts (Y/N) y High water alarm (Y/N) Date of pumping A Pumper C. ABSORPTION FIELDL DATA Date installed +a n s Solt rating (g.p.d.W QPf A dssr+) System type I.t ewn.r, Length _ ft. Width ft. Gravel below pipe Z ft. r Total depth �, ft. Eff. absorption area ,&-,ft' Monitoring tube _.Y._ Depression over field t-1 Date of adequacy test K%! Results (Pass/Fail) ✓ For ✓ bedrooms Fluid depth in absorption field before test in. Water added ✓gal. New depth_V in. Elapsed Time: ! min. Final fluid depth ✓ in. Absorption rate >= &/ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) l/ If yes, give date ✓ W D. LIFT STATION N IY Date installed tILI o v i. Size in gallons ) 7D Manhole/Access(YIN) "Pump on" level at _- in. "Pump otr level at _A-_ in. Datum V' Cycles tested E. SEPARATION DISTANCES * 0 N c SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Ito Absorption field on lot 14 0 Public sewer main "A Sewer /septic service line High water alarm level at A in. Meets alarm & circuit requirements? TAA s e -- On adjacent lots )! 2,01V On adjacent lots �> Z oea Public sewer manholelcleanout tq!A Holding tank N/Ag SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ( Property line 4 D Absorption field /920 Water main NSA Water service line —100— Surfacewater W10 Wells on adjacent lots > Z 9-0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 Building foundation 7i_ Water main Nl^ Water Service line 6-0 Surface water 14110 Driveway, parking/vehicle storage 40 Curtain drain H D Wells on adjacent lots > Z v-0 F. COMMENTS G. ENGINEER'S CERTIFICATION 194r- - A_"1177+ib. I certify that I have determined through rreld inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name a 12 e H s a u e k (a K Data HAA Fee $ 37S -e' Waiver Fee $ _ Date of Payment 04 J/"Y Date of Payment Receipt Number rN2 I Al Receipt Number (Rev. 12/01) i 1 hereby cartify that I haw surveyed the following described property, Lot -LB -Stook r+n Ns H rs 5l�BA. Anchorage recording Precinct, Alaska, and that the Improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvemants on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on aid property except as indicated hereon. Anchorage, Alaska /2 J4 N• I P81 KEC,rR.7-1F/£D Z6;,J41NI� .2003 Lu • • ' r I r .. • • • I I .. ..1..}. jf � r ; r jj ♦III .� 1. i.. ♦...., i 1 ..t •..• .. r t • j .. . Book No: BOA tip No. 40 NO CnjL'S !jFr_ 1 hereby cartify that I haw surveyed the following described property, Lot -LB -Stook r+n Ns H rs 5l�BA. Anchorage recording Precinct, Alaska, and that the Improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvemants on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on aid property except as indicated hereon. Anchorage, Alaska /2 J4 N• I P81 KEC,rR.7-1F/£D Z6;,J41NI� .2003 5. LEGAL DESCRIPTION- 46-1-213 DATE RECEIVED, INSPECTION APPOINTMENTS Y ME TIME TIME ❑ Two ❑ Five -� � `L � � /�4.5✓ f ❑ MULTIPLE FAMILY � � ❑ Three ❑ Six C�f✓/J/ "c/a{ DATE DATE DATE since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY tt )`-'- L1- INSPECTOR INSPECTOR INSPECTO I MUNICIPALIR MUNICIPALITY OF ANCHORAGE DEPT. OF I ",LT I C< L_..'iECTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEcFNMQNiNElxII- . 825 L Street - Anchorage, Alaska 99501 APR 8 igao ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten 110) days for processing. 1. PROPERTYOWNER PHONE 1! <3yH'-c'c'e' 7)t. (,C � ort > v MAILING ADDRESS 0_ j C) C3 j/) / C, le Pi l' �,��� PROPERTY RESIDENT (If different from above) PHONE SC( 11c rx— PHONE 2. BUYER MAILING ADDRESSf�/ 3. LENDING INSTITUTION y,`)fy./ �,�,� PHONE I MAILING ADDRESS PHONE 4. REALTOR/AGENT J / ✓ 2 � �C--` `,�l)-%2� G�7 Cz% C -L l G✓ C1Y _e. ' �d ss � , � .�.1' .3 / - � e' ;' MAILING ADDRESS `- ti"t-r4y 4zL Z-/ 5. LEGAL DESCRIPTION- 46-1-213 41 z� ' —s S,7i STREET LOCATION f�'J 9jej 6J / l /Cffe 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS EDOne IF(Four`;.i� ❑ Other ( SINGLE FAMILY yam. ❑ Two ❑ Five -� � `L � � /�4.5✓ f ❑ MULTIPLE FAMILY � � ❑ Three ❑ Six C�f✓/J/ "c/a{ 7. WATER SUPPLY ❑ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled �, COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM //,YEAR ON-SITE SYSTEM WAS INSTALLED. � INDIVIDUAL/ON-SITE** -�4167 ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ��,. It 'e rte• � � �� 72-010 (Rev. 6/79) qh/�,, Dom- f 1E-)! >m.j THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY^ Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septiic Tank or ❑ Holding Tank Size:— 11�0 _ If Tank is homemade give dimensions: SOILS RATI NG n TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 9' 4. DISTANCES WELL TO: Septic/Holding Tank Absorption 4rea Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS Q c f'APPROVED FOR BEDROOMS i❑ CONDITIONAL APPROVAL (letter m st accompany certificate) I� DISAPPROVED DATE BY 9—c 72-010 72-010 (Rev. 6/79) I hereby certify that I haw surveyed the following described property, Lot 2B Bloch 1,4 NS N E VJ ilE lG H T S SC/BD. Anchorage recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on oropertY lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Anchorage, Alaska /0 -J'4M. I%8l ,eEC,r,Q_T-/Fie,r) 26.J41.vi5 2003 ' oo . V C MTI.. SG�4,LE 9.3 Z FRAME j q Nouse O � �- 25;0 ° N69 5� 30"1 E p / 4Q. QGi } . 7777 � � W _ � � •. l �. Book No, 'VOA Pop No. 48 aScxilii T" NG L C,125 ,.5 E1, I hereby certify that I haw surveyed the following described property, Lot 2B Bloch 1,4 NS N E VJ ilE lG H T S SC/BD. Anchorage recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on oropertY lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Anchorage, Alaska /0 -J'4M. I%8l ,eEC,r,Q_T-/Fie,r) 26.J41.vi5 2003