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SAND LAKE #2 BLK 7 LT 21A
tkouc 1 "'o 1 i - 13alwiL I Municipality of Anchorage Page 1 of a DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: Sc-OgS0108 PID Number: of 113agl Name: ,Wastewater System: ❑ New Upgrade MARV G.6tit g Address: S:aL NDI<oTT 57 L1NC+Iotqq sb9SG t7 a arc. l C- ABSORPTION FIELD Phone: aye - y��3 No. of Bedrooms: 5 Z Deep Trench ❑Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: I • a GPD/S . Ft. !31 Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe a-I A % SANtIL,AIC�- #� Zl 10 Ft. % 1 Ft. Township: Range: Section: Fill added above original grade: Gravel length: Ieablr Iea2' f Qt.- .J� Ft. 'i' _I' AL- LI 5 r Ft. WELL:Ex,sr ❑ New ❑ Upgrade Gravel width: , S Number of lines: Distance between lines: ,�rs;i ��s/r u i ,ewG Ft. a 1b' Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: AS—k VA Ft. Ft. 40 71 SO. Ft. F:'s1U '-D3c>-s4 Driller: Date Drilled: Static Water Level: Installer: C'osis-r. Date installed: -7 9S Ft. 1<,A3ELL:E Yield:Pump Set at: Casing Height Above Ground: - TANK - GPM Ft. Ft. r�kISTI"& SEPARATION DISTANCES 9 Septic ❑ Holding ❑ .E. P. To Septic Absorption Lift Holding Public/Private Manufacturer: apacity in gallons: _ From Tank Field Station Tank Sewer Lines Well- 10 ( r �v t I a� t Material: Number of Compartments: Surfac IOU 4- — — — LIFT STATION Water loo+ Lot t I Size in gallons: Manufacturer: Line V, 10 Foundation s- I I ( �. _� "Pump on" level at: "Pump off' level at: water alarm at: Curtain ht C7 •E kN t.J Pump Make 8 Model Elec nspections performed by: Drain Remarks: BENCH MARK Location and Description: �P RLEAe_ aF f-)c>vsa= Assumed Elevation: jCxo.o Ft ENGINEER'S SEAL ! - 3 S ENGINK RING -la-qS .•~• InspectionsperformedlOgga Dates:lst • Eagle River, Alaska M77 2nd -7- 13-15- ; ••.• .. ��; ,,,� t0 ROBERT C. COWAN 1�r Department of Health and Human Services approval ��1,.,• cE -eaoi Reviewed and approved by: Date: "¢ '7S ``+;• .: 5��`�•� .' 'w�a•�at� 72-013 (Rev. 9/91) MOA 25 Permit No. SW950108 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 e Anchorage, Alaska 99519-6650 o Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 21A, BLOCK 7, SAND LAKE #2 PID No.: 01113249 ST1 II X99.9' GRADE 97.6' FINAL GRADE C04 . MTI/ 13 a 102.' 93.sf 011 91.4 A:NO WATER '7 9. 6 G SYST ) COMPLETELY EXISTING 5 BEDROOM DRIVE HOUSE FCO . ........ . .............. LM ISTING: 1500 GAL SEPTIC TANK LOT 20 N; MT2 I 4 h ROBERT C. COWAN CE -8801 .......... A Q �FCO- - ST1 3.2' 28' ST2 4.1 ' 39' C01 43 415 0) CO2 44' 42' CO3 45' 42' ._11--G04--5.6' 4-2-� C05 3.2' 39' C06 18' 41 I— MT1 541 42' Ci 1 MT2 17' 40' C) ....................................................... I 4 h ROBERT C. COWAN CE -8801 .......... PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE t1 DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950108 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:LEMKE RONALD W & MARY J OWNER ADDRESS:8244 ENDICOTT ST ANCHORAGE, ALASKA 99502 PARCEL ID:01113249 LEGAL DESCRIPTION: SAND LAKE #2 BLK 7 LT 21A LOT SIZE: 10157 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 6/12/95 EXPIRATION DATE: 6/12/96 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PR RECEIVED B ISSUED BY: DATE: - DATE: 12 -9s" S& lHG May 18, 1995 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTHAUTHORITY APPROVALS MUNICIPALITY UP ANCHORAGE Department o5 Health and Human Se+cv.icez P.U. Box 196650 SEWER&WATER Anchohage, AK 99519 MAIN EXTENSIONS REFERENCE: Lot 21A; Btock 7; Sand Lake Subdivision #2 SEWER&WATER Request you issue a peva t to upg1 ade the septic system serving the INSPECTION jive bedhoom house on the keJeAenced pi opmty. The septic tank was vi, uaUy vent.6ted to be o6 good tnteg)L ty on 5/13/95. ENGINEERING STUDIES ANDREPORTS A test hole was excavated and a pe,.cotati.on test pengonmed. The appnox.imate .location ob the test ho.te is .located on the attached site plan. WELLINSPECTION & FLOW TEST At the time o4 excavation no water was encountered and abteK seven-day ground water monitoring, the mowito)Li.ng tube was {round to be dry. Attached is the proposed upgrade design. we do not anticipate any SITE PLANS adverse e66ects on neighbo- i.ng pnopertl.e,6 by the i.nstattati.on ob the proposed septic system. There ate no points ob contamination within the existing weft nadi.us which can be seen on the attached site plan. ROAD DESIGN Also attached is a tetter, which has been sent to the Atasha Dept. og Env,inonmentat ConseAvati.on (AVEC) to address this upgrade's sepanati.on distance to the Ctass "C" wW .located on Lot 3. we understand you n.equ,ine congirmati.on 4tom ADEC that this upgrade is acceptable. SOILTEST Ib you aequike addition, .in4onmation, ptease contact us. PERCOLATION Since.)Lety, TEST STRUCTURAL& Rob t C. Cowan, P.E. MECHANICAL I_ INSPECTIONS RCC/ g k ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1" = 40' I SiTE FLAN 0 ti� I W m O r 10' UTILITY �w 0 > I I I AD co Z I UIo'�IImt rn �� NII a� �DmW A p ~O � in Vrp - z vo ILII Fll �X _ \ g —I < @O m� I r{ r 00 > N D � N (3i C� Z (,f) Z cli m I I I N I 0 Oz-Iw�r<' im oDW— :;Q 7ur- ® r I ti� I W m O r 10' UTILITY ESMT. `�'- 7% > D M--------- L DX Z r UIo'�IImt rn �� NII a� �DmW A p ~O � in Vrp - z vo ILII Fll �X _ \ g —I < @O m� N 4 r{ r rnr V OZ > N D � N (3i C� Z (,f) Z cli m -V m 7- ;an co zc cn Oz-Iw�r<' im oDW— :;Q 7ur- ® r Z =cnm O r p —I 70m DDW Ui Oco� cn rnp��ZDZO w ,,oW rTl N Z� co 01 Ul T Q D O m DECK D D W - 00 �m0 0 MO W D x DECK O >= =0 74 >M o= cDD OOC1 Zz O rn -u i L=J p r � —� G �7 m ENDIC®TT ST. OM!P� OmD2 Z(JADf^ Vy Ns y'� O��ZZ OZQ LINA moo ms wx z 1 P N v --• (J� ' W �] cn �I -/)W 1--1 CJS O !1 O r ©r Frip > D 0 0 DX Z r UIo'�IImt rn �� NII a� �DmW A p m� ILII Fll �X _ o —I < @O m� N 4 r{ r rnr V OZ > N D � N (3i C� Z (,f) Z cli m -V m 7- ;an co zc cn Oz-Iw�r<' im oDW— �po � W o m_ r. Z rR o p —I 70m DDW Ui cn rnp��ZDZO w z Z� co 01 0 0 DX I O�O� Z =� O _ Z O � ay I �DmW A za �A vDi�O �Zm I Z—{ _ m Fll �X ncn-�m�Eoo� O o I C Z m (A r{ I D rnr V OZ r p Z (,f) Z cli m -V m 7- ;an co zc Oz-Iw�r<' im oDW— C Fri W o m_ r. Z rR o p —I 70m DDW Ui cn rnp��ZDZO w z Z� co 01 tmi)om'W�mZ D O W �m0 0 MO W D x >= =0 74 >M o= cDD OOC1 Zz O rn -u 2:0 OZ � 0 0 O�ODO ;:o0D—ZI —� �7 •" •• O 3 .. Z� m M4 r ton OC/1 0 e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST ` PERFORMED FOR: / V " L L"l:✓tixc DATE PEP 3- 4- 5- 611 456 �40pwnship, Range, Section: COAfUEZ Sq.(, tomjE 8 9 b 10 WAS GROUND WATER ENCOUNTERED? 11 ; e ? P 7AG6N IF YES, AT WHAT t 12 DEPTH? o c CN�Nlcat, AN�uYsrs� cS `. fl 13 1 t L{ 0 Depth to Water After D (1 C� Monftoring? P�RL�/S!S F� 14 ` I� owt AK Ifs -( 15 y _ t"!NF (AW60AR S,�tf✓+'J 17 �• nrABLE 6 eq'mw" D14, Sqg- 18 c CtzJS4,rina- cucr� iu r'- ' nw cr y Iry 74a 19 °� , �3.c� �• 20 COMMENTS SLOPE S L O P E Date: oZU SITE PLAN D A eading Date Gross Time Net Time Depth to Water Net Drop 5139 �JIC. nrABLE 6 eq'mw" D14, Sqg- 7146 KOUS AP CtzJS4,rina- cucr� iu r'- ' nw cr y Iry 74a 410 C G 1WLY,�(S k17AO PERCOLATION RATE 7 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND 3 FT PERFORMED BY:(Um (�/� S & S EN?INEERING 17034 Eegle River Rea 0. CERTIFY THAT /THIS TEST jyrAS PERFORMED IN ACCORDANCE WI ALL STATE AND MUNICIPAL ¢d6WRW*)%fif"q%"HIS DATE. DATE: nO-� 72-008 (Rev. 4/85) ro Percent Passing by Weight -• N W .P (31 0) V 00 W O O O O O O O O O O O 0 0 0 0 0 0 0 0 0 0 \ \ \ \ \ \ \ \ \ \ O m n o O 0 O 0 O O O O O O O �'. O O O O O W H W 0 oo ,,., OO 00 0% LA A W N �-. .+ O p 0 0 Cl O O O ON O 00 o m n y m A w o 00 0 0 qj N o W O O O c O o O O O O O O ts n y %O a II Co oQ a °' n 4 ~ z° HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN S&S� ,ineentng ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS Xzr zXzVk:r; : Lot 21A, Block 7, Sand Lake S/D #2 May 18, 1995 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 1. The scope of this project includes the installation of a leachfield trench to serve the existing five bedroom residence on the referenced property. The existing 1500 gallon septic tank's integrity has been verified. 2. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. IC TANK INSTALLATION: 1. A septic tank is to be constr by a certified septic tank m u cturer. struction1 shall include two 4" cle�no s or ping access. 2. The septic nk shall be sufficiently bedded to prevent tling or shifting of the tank. 3. 1 standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 21A, Block 7, Sand Lake S/D #2 May 18, 1995 4. Septic tanks installed with less than 4 ft. of r shall be insulated. 5. A foundation cleano t shall be inlled one to four feet from the building f un tion. the line between the tank and the leachfield t e s 1 be two adjacent cleanouts (unless an efflu n p m g system exists within the septic tank). These lean s shall be located on undisturbed soil not more t 10 ft. from the tank. The first cleanout, in 1' , shall be to clean toward the leachfield. The second eanout shall be to clean toward the septic tank. 6. Fi grading over the septic tank shall be such that a sitive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 21A, Block 7, Sand Lake SID #2 May 18, 1995 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIALS SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 21A, Block 7, May 18, 1995 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 21A, Block 7, Sand Lake SID #2 May 18, 1995 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER kEAW ROBERTC. COWAN, P.E. RME RIVE nrnG ROBERTA. SHAFER, P.E. May 18, 1995 CIVIL ENGINEERS (907)694-2979 FAX(907)694-1211 HEALTHAUTHORITY State of Alaska APPROVALS Department of Environmental Conservation 800 East Dimond Blvd. #3-470 Anchorage, Alaska 99515 SEWER&WATER REFERENCE: Lot 21A, Block 71 Sand Lake #2; MAIN EXTENSIONS Request your approval to upgrade the septic system serving the five bedroom residence located on the referenced property. The existing system is currently in a state of failure. This system SEWER&WATER was installed in July, 1981 for a five bedroom residence ( see INSPECTION attached inspection report). The existing system lies within a utility easement and will be abandoned such that it cannot be used in the future. ENGINEERING STUDIES The proposed upgrade is within the 150' Class C well radius AND REPORTS located on Block 3, Lot 7, Sand Lake S/D #2. However, the 150' well to septic distance has been waived down to 100' per a DEC Operations Certificate dated 11-21-83 (see attached). The WELL INSPECTION proposed upgrade will be located a distance of greater than 135' &FLOWTEST from the Class C well ( see attached design) . If you require any additional information for your review, please contact us. SITE PLANS Sincerely, ROAD DESIGN 4�� Robert C. Cowan, P.E. JPW/dhl SOIL TEST PERCOLATION _ TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSISTEM - DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION . PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of - 2 blit water system located in lIC [i_C V Ck —T Alaska, submitted in accordance with 18 AAC 80.100 by— t e C C C1% tt S f have been reviewed and are 19 approved. conditionally approved (see attached conditions). C tp.�t G�Z►2GiU' �'Y�i'UTr� L tr-/L��' t_ z B TI LE ATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change contract order no. Approved by Date or descriptive reference) Th," .,APPI",eV ^.I T`0 IPFR.ATF" <^ct;-n rnu-t h? com.nipted hpfore any 4+/^ter is made avallWeto the public. APPROVAL TO OPERATE The construction of the water system was completed on �� Z –' � (date). The system is hereby granted interim approval to operate for 90 days following the cpmplef on date. TITLE DATE As -built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted fins/Napproval to operate. BY A TITLE DATE M.7Ciy�:P .N DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 555 CORDOVA ANCHORAGE, ALASKA 99501 June 2, 1995 Mr. Robert C. Cowan, P.E. S & S Engineering 17034 Eagle River, Suite 204 Anchorage, Alaska 99577 TONY KNOWLES, GOVERNOR (907) 269-7505 Subject: Lot 21A, Block 7, Sand Lake Subdivision #2, Separation Distance Waiver, Anchorage, Alaska, ADEC Project 9521 -WW -142-308, Review Dear Mr. Cowan: This letter is in response to your letter, received in this office on May 22, and June 1, 1995 in which request that a waiver for the horizontal separation distance between the Class C Public Water System located on Lot 2, Block 7 and the wastewater disposal system located on Lot 2.1 A, Block 7 be waived from 150 feet to 135 feet. As noted in your submittals, Mr Bruce Erickson issued a waiver from 150 feet to 100 feet on October 10, 1982 for the same two systems. I have completed my review of this office's file on the subdivision which includes all the previous waivers and the documentation, the information that you provided, and other pertinent information and have the following comments. The monitoring data from this area tends to indicate that the aquifer and source well are not being directly influenced by improperly treated wastewater from the wastewater disposal system in question, nor from the other systems that are located within the 150 foot protective radius of the existing Class C Public Water System Source Well. Thus, it appears that there is existing evidence in support of the requested waiver. Therefore, in accordance with the provisions of 18 AAC. 80.030, the following separation distance have been granted: Between the existing Class C Public Water System Source Well and Soil Absorption System, from 150 feet to approximately 135 feet. This waiver will remain valid until any part of the wastewater disposal system on Lot 21A, Block 7, Sand Lake Subdivision #2 requires upgrading or is modified. When the new system requires modification or upgrading, either the installation of additional treatment or a holding tank may be the only alternatives the Department will consider for future waivers between the Class C Public Water System Source Well on Lot 2 Block 7 and the wastewater disposal systems within its 150 foot protective radius. This approval does not imply granting of any additional authorizations, nor obligate any state, federal or local regulatory body to grant required authorizations. On November 10, 1994, State Wastewater Disposal and Drinking Water Regulations were modified to require fees for waivers or modifications to the regulations. The fee required for this project is $230. The fee invoice (invoice number 101520) is enclosed for your use. Thank you for your cooperation with this Department. Please submit a copy of your May 18, 1995 letter under your stamp as a Professional Engineer to complete the submittal. If you have any questions, please do not hesitate to contact me. Sincerely, Keven K Kleweno, P.E. District Engineer KKK/cf Enclosure: As Stated cc: Jim Cross, P.E., MOA, DHHS, On -Site Services, w/o Enc. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW n 1' M O -P— - f'T I'+� �O 3yy- zzLi i ❑ UPGRADE MAILING ADDRESS - 33? 'PE R Nc 14 o c Ay, 99; LEGAL DESCRIPTION L "' adA 13 LOLK S AN E LOCATION NO. OF BEDROOMS E>.L DISTANCE TO: Well I O t Absorption area Dwelling PERMIT NO. Uy wQ Manufacturer 2�F mat eSal't� / No. of compartments N~ Lie. capacity in gallons IF HOMEMADE: Inside le ngt Width Liquid depth ❑ y DISTANCE TO: Well Dwelling PERMIT NO. J(9Z 2 z F Manufacturer Material Liquid capacity in gallons O �= DISTANCE TO: Well - Foundatign, 0 Nearest Iotfir� PERMIT NO. LU J (/ J LL Z No. of lines / Length of eac¢¢��ine Total length of lines x/ Trench width -30 Distance between lines F. ? ¢ 7l) V inches H Top of tll; to finish g�raadd a Material beneath tile A 96 Total effective absorption area ❑ J inches r& qD Length Width Depth PERMIT NO. w a Q F• Type of crib Crib diameter Crib depth Total effective absorption area as w y DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line -PERMIT NO. J Lu 3: DISTANCE TO: Building foundation Sewer line Septic tank Absorption areas) OTHER PIPE MATERIALS CAST r PVA L. SOIL TEST RATIN PEMHI� 85 At 4,Q 1,25 INSTALLER e a I I � REMARKS + n S Lai II I I d -1 $f 74v APPROVED DATE LEGAL 7/% --� 1. o4 ^21A 731dct 7 attiA" � Irma irsev. shay z P4. 0 O d N N O F- MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION AUN 231988 ECEI VEa w w w w w w w w w w w w E F F F *4 E F F F F F F w Fr. W W W w pli w w w w w C� O O O O O O O O O O O O w w w w w w w w w w w w W p j >: : 04 U cd: r +: [fir C z A w A G7 N O F- MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION AUN 231988 ECEI VEa w w w w w w w w w w w w E F F F *4 E F F F F F F w Fr. W W W w pli w w w w w C� O O O O O O O O O O O O w w w w w w w w w w w w WK ta: %. w W a A 0 0 >: : cd: r +: co �: c: r -I i cV : o N N: P. Cd N cd F+: H U: Ui qi co i w ! 0: C7i w w w w w w w w w w w w f N i W i O i Oli Ol H co: d i Wi lzr: L i H O O O O O O O O O O O O N F E N F F E H F E F E wwwwwwwwwwww xi N 00 O: (b ; M M zr Ln r -i: r-1; Cl) N F J J J O O O O O O O O O O w w w w p0 Z WK ta: %. w W a A 0 0 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET/ ANCHORAGE.: 8K. 99501 264~4720 F=EEF-".l_-1 1 7" PERMIT NO. ( 810640 ) APPLICANT BORJE J. J8HHNSON ]]7 PEARL DRIVE 99502 344-2241 LOCATION LEGAL L 21H B 7 SHNDLHKE Sr^D #2 LOT SIZE 10125 SQU8RE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MHXIMUM NUMBER OF BEDROOMS � 5 SOIL RATIN1% FT/BR)� 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ��V-4 1-1-1 -1-L!" ;27-� 0F_�Fz:�VEEN ������R-A� � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELC\ THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN 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 (IN FEET), ���U I F__uP:EA I C� 1 =E--_7- :L�5-��� 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. -Ir 1.4 cm 0, :2 > I F"IE C_D _F I CH " _� F:l F? EE �FEE ��1 F -P! IE-- E. -H � BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H 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 15 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. �FEE �r-1 1E -f- IF' -1 F�3_0 E= _`_- �FEE �EE r-1 E-_- EEE F--" I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR 8N -SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 5 BEDROOMS. SIGNED: ____----~---~ HPPLICANT GORJE I JOHHNSON ISSUED V4.0 INICIPALITY OF ANCHORAGE Department 6.J Health and Environmental`.fotection ,1 825 L Street, Anchorage, AK. 99501 264-4720 e # # # HANDWRITTEN PERMIT # # # 40R ON-SITE SEWER PERMIT Applicant: �(�i 1 �• �d��'� ✓7�C�yJ Mailing Address: X33 7 UC�Qy- Location: Phone Number: L/ V � Legal Description: G � /t �e �� �C`� Z- Lot Size: JU 12 Type of Soil Absorption System Is: Trench: X Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) E S The Required Size of the Soil Absorption System Is: DEPTH / �2_, LENGTH oQ, % GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in 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(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ % 500 d GALLONS # # 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. # # # TWO(Z) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 $ 1 # # # I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) 2 understand that the on-site sewer system may require enlargement if the residence is remodeled to include more thatSt bedrooms. Signed .JJ Issued by: Applicant Date: SWP/024(1/81) t ' t / �; `. `v�Lt��,.`a!! ti',' . ���,•r'` t ,':?' �. 32-� „� „ STREET ANCHORAGE, ALASKA 99501 (907) 264-4 111 GEORGE Al. SULLIVAN, AAA YOR lei: NI OF 1iEALTI-I AND FJV1R0N1491-1JTllL['NOT ECT ON January 4, 1982 Borje Johnson 337 Pearl Drive Anchorage, AK 99502 Permit # 810386 Subject: Lot 21A Blk 7 Sandlake #2 A permit issued by this department for a well and/or sewer system has expired as of December 31, 1981. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, � 60 -dam Les N. Buchholz Program Manager Sewer and Water Program Enclosure: Copy of Permit L» MLML|H HND ENYIRONMENTHL PnOTECTION ~ ` ~ 825'K/STREET, HNCHORHGE/ AK 99,,. 264-4720 . L. -I EE: L_ L_ ���C_- CA P-4 I -T"* a -S.'EE 14 �-- IF? �EEr F�_* r-1 1 7' PERMIT NO. ( 810386 ) APPLICANT BORJE JOHNSON ]]7 PEARL DRIVE q4 '�|bZ~ 344-2211 LOCATION ENDIC8TT LEGAL LOT 21H BLK 7 SHNDLHKE #2 LOT SIZE 10157 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MHXIMUM NUMBER {)F BEDROOMS "z 4 SOIL RATING (SQ FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH (I! -,I FEET) OF THE TRENCH OR DRHINFIELD, THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND HND THE BOTTOM OF THE EXCAVATION (IN 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 (IN FEET). 1 rl?IEEE_1 ��rT_ I I::- ��T���� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE �____ "r 1-111-:1 <�2 > I I 97_ffr-4:_=. F=iF-E_=: ��E�C-!U I F2FEC-- BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS � DEPARTMENT WILL BE SUBJECT TO PROSECUTION. � MINIMUM DISTANCE BETWEEN H WELLAND ANY 8N -SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H 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 HND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 33:0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENT'S MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ��r--'Ir-1 1. -T' �r- l r -Z P�- �_::' ED, E: C: a"I--1 ED FE F%" ��_�L , I ED __L CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED: _-_------____~-_��-��--~~�~�~�-__�~ BORJE JOHNSON 33:7 A& PRIG -211 ot 21fl jDLjC- j a4MTLWE 02��� g��E PURE FEET OF SOIL ARS. € 'TJCg4 SYSTEM IS.: TRENCH MUM MMU, CIF KDROCV15, = 4 501L RRTING (50 FT/ P)Fr 85 Ix ?4fi ty SIDE TIFF CegL REa Cs F'Ti N ¢•�;�ikM 15; #; LENG-TH DIME S',10N IS, IM LEW,31 i <IN FF -E-0 OF IqE TRENCH Ok- DRAINFIELD. 1 DEPTH OF 8 TPE H OR PIT 15 THE I:7I5•TR04111 SEINEE t std S -J- : AC -E Or 714E L �L� FVID THE BOTTCIM OF TPE EXC€ VRTION (IN FEET'). rflEfZE IS NO S -El WIDIH FOR TRENC-IES, Vfes WkTL: DEPTH I�, TI.E MltsiltsUM DEPTH OF GRRVEL BETWEEN THE CUTF RLL F'ID`E VAD THE OCfTTUq OF THE EXC'RVFITICIN (IN FEET). fF-$wI�3r> —T FIP L I C-RI1T HFi'a THE : •;PCIN I V I L I °I y 70 I W C FfPl THIS DE PRRT ME T DLIF: I NG THE jo-LAT 10N INS-PEC-13OWS. OF ANY WELLS AC,JW--EMT To THIS, PROPERTY Runt TfiE- :',!ER OF RESIDENCES. TNRT THE WELL WILL SERVE. t-4:5; r-� IF= C,: `T -1 Ct V4 = 174 fZz y Ga U 3" : E- V--6 ii3Cs F f ,,.T WITHOUT i iT F I P %L INSPECTION f�AID RPF'�:Ca�'RL `le TH I s '.RT NT WILL RE S.JJE..IECT TLS PROSECUTION. I U14 DISTSHCE BETWEEN A WELL RUD IIIA` CV-SITEMIRE 1115 -PV fiL <N` Tr -M Is .FEET FOR ff FP1VFiTE WELL OR �F3 TO -30 FEET FffLX-1 8 PUCILIC WELL PE DING �- THE TYPE OF PUBLIC: HELL. 1I1IL DISTRNGE FROM fi P IVRTE NEL_L TV R PRJYRTE SEWER LINE I� `• DEET RIS} ?; -CCJM l.R43 TY SEWER LINE IS. 75 FEET. LIDS FIFA REQUIPED €tW� l MUST BE RETURNED TO TIME DEF` RTMENT WITHIN g`0 DRY [HE HELL CCIMPL. E T I ON. LIZ REQUIREMENTS flRY RPF -LY- S -PEC -It; IC:RTION RK) CONSTRUG-TIEN DIf CCR-Rf-1 RPE ILFIRLE TO IN-SJURE PR'1lPFK- INS-TRL RTION. °:IeT I FSS` THRT I F0 F€I113L.IAR WI# l i i P.EQUIRE NTS FOR ON-SITE NCAS LS -97- WELLS S SET I;FI BY THE MUNI C:I PCSI iL I T'S' £3F F04C:HORRBE_ WILL INSIAU i I'IE S:' IS E M M 611TH THE C OLIE-5. F tUDEK54A D lHRT THE ffl-51U �ENER SYSTEM i"FA' RIY:I='LfIRE ENLAR-GE.&Ik"T IF Tw 'BENT -E IS MMODELEP TO INCLUDE KGW. TW14 4 BEDROCUIS- SHT.LOF_L LOG OF SOIL TEST DATE: - BY: $.hn1�GI�KL Sl/BD....jl�loR 2 TYPE BOR ING:,C-1-4-e1C V4 LOCATION: -S )%=l L&tLW-}Apy, H W U. J J O a SOIL DESCRIPTION a } a w U) SURFACE: ELEV. �_S¢ i. ii _Q/Zor.✓N Si[-rY �os�-� YE��✓�"oM.�-GIZi°cvL ML r 25 L fTUM �I s q iv a y L oZA-dA-C L. 6 w --203 WEST 15TH AVE.--ANCHORAG A� -Nw 46 C"-- - L .1 LJ nd cn /4<:> 5 89*55 00 E .00 b 89 �r- S 9055'00'E 135.00'r� 11 LLJ Cl) o Z ft, ell At ir- S 89*' 9 655f 1�g,,�tenfR . Dayp hone uty well y -tow,-An _x x ater s y "z Well system- prowde written confirmation from State ADEC attest- - -.- ality and status of system '- yf7 j�1 x,`, ER- DISPOSAL Municipality of Anchorage Auk Department of Health and Human Services no HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1^dr aid $LOL SAa'v AK�� a Parcel I.D. A. Well Data U1113aqq Well type _?RtVAlf If A, B, or C, attach ADEC letter. ADEC water system number f.( A Log present (Y)N) Date completed S -15 -Sl Driller Ta"Q IM5£Y �t21LL�Nb Total depth aWC Cased to ;t90 l Casing height JJ °+ Sanitary seal ON) Wires properly protected ON) Vf✓ S Date of test Static water level Well flow Pump levell FROM WELL LOG YJ uK 3,S SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I01 Absorption field on lot 1 * f AT INSPECTION 4 -(a -T> RECEIVED III' JUL i 11995 .P.M. 3.o gMunicipali,y of Anchurage y/K Dept. Health & Human Services On adjacent lots I o" 14 ; On adjacent lots + Public sewer main -75- e- Public sewer manhole/cleanout too 'f Sewer service linevs t Petroleum tank Z)G t WATER SAMPLE RESULTS: Coliform 'e" Nitrate 0. IQ ,,13 ( L Other bacteria Date of sample: 'f -1`t -9s B. SEPTIC/HOLDING TANK DATA Collected by: �-- �S E"(�INs5t21tic, M Date installed x-3-01 ' :: Tank size Soo Compartments Cleanouts MN), . yEs 'Foundation cleanout (�/ I) Yss Depression (Ya iso High water alarm (YM) Alarm tested (YA NIA Date of pumping 4-11-949-1 Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot to 1 On adjacent lots [3S" 0 Foundation To properly line 16, Absorption field Surface water/drainage -* CL«.51 C w£vL 72-026 (3=)• Front 1o0'+ wRtv,i-u v 0 ) 3 S"' 3 D5 Water main/service line 10 1 t CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FR STATION TO: On adjacent lots D. ABSORPTION FIELD DATA Manufacturer Manhole/Access (Y/N) Cycles "Pump off" Surface water Date installed _ '7- 13` 95 Soil rating (GPD/Ft2) I • System type Vsti '-CQFNC+F land, 1ea-a' ' Length ToiA�- _ i�' Width Z'S Gravel thickness (0.'7 Total depth / 3.5 Total absorption area &yy Cleanout present&) Ve-S Depression over field (Ye Nco Date of adequacy test Results (pass/fail) for Bedrooms Water level in absorption field before test After test Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I o, I On adjacent lots ) '5 - To building foundation On adjacent lots Property line lo' To existing or abandoned system on lot — 3 Cutbank 501+ Water main/service line _1 O '4 Surface water _ low Driveway, parking/vehicle storage area f33 Curtain drain ti!ouf kNOwrJ iF CL -495 C I,v4��L(_ w4fvi r) Tv Iss- E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelin Signature ^v� <�I �✓" - Engineer's Name �0el Date =__ `J HAA Fee $ Waiver Fee $ Date of Payment _ -�2���9s ^ Date of Payment Receipt Numberella� (/�Receipt Number 72.026 (3193)' Back oection. MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0 � 1 - I "');:) - L-`9 1. GENERAL INFORMATION HAA # k Q"A 21 C)'1 R I Complete legal description Lot 21A; Block 7; Sand Lake Subdivision #2 Location (site address or directions) 8244 Endicott Street, Anchorage, Alaska Property owner John and JoAnne Borden Day phone 278-2551 Mailing address 8244 Endicott Street, Anchorage, Alaska 99502248-5699 Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone Day phone 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 XXX 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. 1191) Front MOA 021 5. a STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone 7034 Eagle River Loop Road No. 204 Address Eagle River, Alaska 99577 Engineer's signature The conditions of the Health Authority Approval issued on 12/1/93 have been met. DHHS SIGNATURE �— Approved for S bedrooms. Disapproved. Conditional approval for Additional Comments Date jt 4 M'Ogp4FR F,F�FY9F.q�� I ROGER J. Si AFER bedrooms, with the following stipulations: By. Q c" k-hq _5;'�A t rt-+ Date 4 cl 3 111Th', 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 i idependent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. IAV 1�� Manch 26, 1993 ROBERT SHAFER, P ROGER SHAFER. P.E_ CIVILENGINEERS (907) 694-2979 FAX 694-1211 RECEIVED HEALTH AUTHORITY APPROVALS MUNICIPALITY OF ANCHORAGE MAR 2 6 1993 DEPARTMENT OF HEALTH AND HUMAN SERVICES Attn: John Smith Municipality of Anchorage P.O. Box 196650 Dept. Health & Human Services SEWER &WATER Anchorage., AK 99519 MAIN EXTENSIONS REFERENCE: Lot 21A; Btock 7; SAND LAKE SUBDIVISION 02 Dean Mn. Smith, SEWER & WATER INSPECTION Your o4jice .issued a conditi.ona2 Health Authon.ity Appnovat (H.A.A. ) .in November 1992. This conditionat approvat %equ.ijLed the septic system to be %eta ted and the nesutts o4 the adequacy test weAe to be submitted to you. The retest period 3pec.i.4.ied was du&i,ng .the month. o4 ENGINEERING STUDIES Manch 1993. AND REPORTS Attached ane. the Aesutt6 o4 an adequacy test which was pen4oAmed on the re.4enenced pnopeAty's system which shows that .the system i cuju%entty 4uncti.on.ing adequate4y 4on a 4.ive bedroom house. WELL INSPECTION &PLOW TEST Request you .issue a 4.inat H.A.A. 4oA this pnopeAty. 14 we may be. o4 4uAtheA se)Lv.ice, please contact us. SITE PLANS S.cnceA y f ROAD DESIGN �J s T A. SHAFER, P.E. RA k SOILTEST cc Shari Boyd/CotdweU BankeA PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 1 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 b 4. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER b WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION 6 FLOW TEST SITE PLANS �F�ZOF i� LIQuIO LE=UEL �ZIS� 3R0 O ROAD DESIGN ShviftAl s:'IITI-i e, 3- Al- 1�1?> 3 -al -t-93 SOILTEST PERCOLATOOl TEST ADEQUACY TEST FORM ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVILENGINEERS (907)694-2979 FAX 694-1211 LEGAL DESCRIPTION: I_nT A L.AJ« -l/b #a APPLICANT: SH(fRT_ [�6YD Z &>(Al�GG DATE OF TEST: 3Ia3I� 3 — 3IatiI93 NUMBER OF BEDROOMS: SEPTIC TANK SIZE: (SQp 6ii- TYPE OF ABSORPTION SYSTEM: DEEP T12r7\4tt , l 1- Is, (7EEP� yd I LLy% ci-Fxx/vE (%l') METER TIME I READING I (TOaiL,VOL• 1 S,TIQUIM �EYFLr1 T I COMMENTS e aasr a STRU .X �F�ZOF i� LIQuIO LE=UEL �ZIS� 3R0 O sA. MECHAN i1L ShviftAl s:'IITI-i e, INSPE No O° 1457^E seu°oma°°P�`�� 538 VtiTL/I"N 4 LVA lT(T�/ fl ; F?jS10��m'� TN. ANk i4imed) " — — 1RNK. PumPFA I),, A+ :05 �n� g310 + Lf" B5" + !'3' ` _ 1�E SE2rrlc�S 1560GAc. 3:55 5g'� = o �`��I k + oN�-s� x �FFjr7,ro� H OW 5� GR.InF tta'^� ARYJ 5 STo ADD/nl ft 12 A -gQme VME& Fac Lhdwrms 0c :o 5`C(-RZ TO ADD Moate �Y " 4a ` - M A�" ?;Lr� ml WD +may = JA?9 li-YA +M"'Y 9 „= S�ro , 0 e aasr a STRU .X �F�ZOF i� LIQuIO LE=UEL �ZIS� 3R0 O sA. MECHAN i1L ShviftAl s:'IITI-i e, INSPE No O° 1457^E seu°oma°°P�`�� 538 VtiTL/I"N 4 LVA lT(T�/ fl ; F?jS10��m'� TN. ONSITE �(ZUa �� LI�U�I> Lava=_. 2>�O 0;4 FALL_ Use 69-- EFF@cr/vc WASTEWATER DISPOSAL SYSTEM $I- �3' ` c23" t 23(3� - PD... DESIGN -_ 17Md FAALF RIVER I AAP Al IITC 9Dd FA (141 P Rlvro n t d 04C 00477 MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES M 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 /l HAA # Parcel I.D. # � �� �� -7T--- 1. GENERAL INFORMATION Complete legal description Lot 21A; Block 7; Sand Lake Subdivi.6ion No. 2 Location (site address or directions) 8244 Endicott Stceet Property owner Jo Ann 9 John Bodden Day phone 278-2551/248-5699 Mailing address 8244 Endicott S-tn.eet Anchorage A2a,6ka 99502 Lending agency Day phone Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water Day phone 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 XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91( Front MOA #21 61 6. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that n. investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 5 !I. S ENGINEERING Phone 17931 Eagle River Loop Road No. 204 Address Fs:.* River Alaska 99577 Engineer's signature No -[E: LEP�--t-I FlF_i-D T_Eao wITI-f uYp-i5 Vlzaziz�w bl,ox i VE Oros— s �[P-i l L AmczQLlrtcy I r EST �IZI U1ZJv^Eo Ar -b PPE_5E0 b" l DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Date �W Or h 41 11 3l U.] ♦L t :i iM.L 1.8+i� � bedrooms, with the following stipulations: Additional Comments SyST-I. 1 . f', it `j3y) Nc. TffAyq 3 411ri S ('-P_ TI I J -N `i'/d ki,cci rC;4-0 TO (iE; U: Z J!_C i_2C0 FCAL V- (L4e�t-Ii�7Y C , l— �.:'yi•> j .tit t�; rA U,-7 rr1 iL By; Date 4IITIr 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. 1191) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LA r_6 SMC #,2, b! 21A Parcel I.D.C�� �� -� W A. WELL DAT`AA Well type 7" 10PE — If A, B, or C, attach ADEC letter. ADEC water system number Log present &N) �S Date completed !�;,-1 S,f 8 ( Driller?C7yN Total depth a�� / Cased to L/n Casing height 'IL1 tri Sanitary seal SYN) Yes Wires properly protected &N) Yes FROM WELL LOG AT INSPECTION Date of test «K 11.2' Ili Static water level Well flow �,S g.p.m. g.pT. K K Z Pump level rrl N) y o SEPARATION DISTANCES FROM WELL TO: m Septic/holding tank on lot Ind `lQQ ; On adjacent lots rf z - Ido Absorption field on lot On adjacent lots Public sewer main A -%A Public sewer manhole/cleanout N/1 Sewer service line GO/ Petroleum tank / 6A3F mnwu WATER SAMPLE RESULTS: �\ Coliform 0 Nitrate � "nN — `✓E=1=CTC—D Other bacteria C> Date of sample: �' ��92Collected by:—St- S-_> SNC ia�lt�fz l t�tc B. SEPTIC/HOLDING TANK DATA Date installed—�^ Tank size �00 GfhC Compartments Cleanouts &N) (�U Foundation cleanout -Y&N) ES Depression (Y/6 No High water alarm (Y/N) NIA Alarm tested (Y ��N///A Date of pumping I P C" I Pumper. A� C7drila Segwlc�S SEPARATION DISTANCES FROM SEPTICS TANK TO: Well(s) on lot 1 ob On adjacent lots Foundation 2� Topropertyline 13' Absorptionfield 8' Water main/service line a6 fit - Surface Surface water/drainage I C)6, 4 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed N A Size in gallons Vent(Y/N) High water alarm level "Pump on" Meets MOA electrical codes (Y/N) SEPARATION DISTAN Well on lot D. ABSORPTION F''IELD DATA Manufacturer Manhole/Access (Y/N) M LIFT STATION TO: On adjacent lots /Cyy Pump off' level at Cycles tested Surface wa r,_ Date installed _. —�—� ( Soil rating (S Sr/13R System type l (Y Length .—� Width Gravel thickness' Total`i d/epth ��—�3 Total absorption area LLIO Sr Cleanouts present ON) E, /S Depression over field (Y/(9) NO Date of adequacy test Results (pass/fail) ?AS for S bedrooms Peroxide treatment (past 12 months)&N) T + H. S, If yes, give date � �5�% Z SEPARATION DISTANCE FROM ABSORPTION FIELD TO: 9�,2r 1-C PJ a7h� P/L Well on lot aid d On adjacent lots ��% Property line % To building foundation i S r To existing or abandoned system on lot / On adjacent lots is - _ Cutbank N A Water main/service line /o ''- I ( ( Surface water __ I `6GDriveway, parking/vehicle storage area 1 �()U Curtain drain � `)y�E, tQkk�N �AJqIU(L G�Sui� C)Iv-12-8 E. ENGINEER'S CERTIFICATION WIZ # gg_03d 1 88 -oZyp 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect orl;tlke,date of this inspection. 1 n a✓ Gh�:JC d s s i z:1, 41A S & S ENGINEERING G't.�"y 4�,, S�� Signature —I Z034 Eagle River Loop Road No 204 r,I Ea y�!+� la liver, Alaski 99577 ,, oa 2Zo };'cU eaaaie ae o Engineer's Name Date ;10(-A R A'SHAFFn z HAA Fee $ 1 r `1 Waiver Fee: $ Date of Payment { c2 Date of Payment L16 Receipt Number __Z -42L1 ��0 vJ� Receipt Number 72-026 (Rev. 3/91) Back MOA 21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES I Q CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date —�—� 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) 1 o / 2 0, /e, G,k 7 S,4/I-4 1-'-7'A2=- MG, 2, Location (address or directions) (b) Property OwnerAd,6%rJ• Jek9w5i9A,' Telephone: Home Business Mailing Address '-2 yy Cti�'; ca� �H c 4 14 (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or: Check here 'L -r' if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms s 3. WATER SUPPLY Individual Well 0 Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/861 Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ��SS� �_ OOf d—i a l Telephone 3 Address 2 2 Zo 5 /4* c A, ,,Ale. % 57S6 % Date :0(.<< C�,%/.c( .,)epi;c uv,e adequ« -lam a�LQ 1,tMe 0� a(A; S Engineer's Seal .. a ��a ;; e� J aaaat41a nui'aQ9uaaYa+e a+^,�� A - C oe ' 927 V v 6. DHHS APPROVAL_ Approved for bedrooms by 0 �Date 0 Approved Disapproved Conditional Terms of Conditional Approval CAUTION 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. Page 2 of 2 72-025 rRev 8/861 RaCk MUNICIPALITY OF ANCMI"MIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTHREALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTIOdHECKLIST - FEBRUARY 1984 264-4744 'JON 2 31988 L 2 M 8 7 Legal Description: RECEIVED S,4 A10 4Kz5- A/0, A. WELL DATA Well Classification &e)J, "''fU4 I If A, B, C, D.E.C. Approved (Y/N) N/A n,� /S /7TI Yield ®Z i'�Hr f"h,'s frsf Well Log Present (Y/N) Date Completed /�"�j 7,1Z 9,0,7 L,,,"t /OS —A/C "VL Depth 2 yU Cased to 2 W Depth of Grouting NP Static Water Level //$' Pump Set At (/V leV0,✓,t/ - Casing Height Above Ground — Electrical Wiring in Conduit (Y/N) Sanitary Seal on Casing (Y/N) — Depression Around Wellhead (Y/N) Separation Distances from Well: JO/ /��) To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot �2 ; On Adjoining Lots /00 To Nearest Public Sewer Line #4 Aa l e To Nearest Public Sewer , Cleanout/Manhole Mo, N e To Nearest Sewer Service Line on Lot s Water Sample Collected by AC/A' d ; Date 6 "13-9? Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA + ! Date Installed l.lu /v /99/ Size JS00 �`No. of Compartments Standpipes (Y/N) .x Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) N Date Last Pumped /�Z 94?7 Pumping/Maintenance Contract on File (Y/N) Al ; for 114141 Holding Tank High -Water Alarm (Y/N) ff-A• Temporary Holding Tank Permit (Y/N) Al, Separation Distances from Septic/Holding Tank: To Water -Supply Well JQ/ To Property Line To Water Main/Service Line S.0`t Course &0 At Comments Page 1 of 2 72-026 (Rev. 8/86) Front To Building Foundation 2,5 To Disposal Field — To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata i?s jd ,m Type of System Design %c" X Date Installed _— J6 /Y / 98/ Length of Field yU Width of Field 3o . k c Depth of Field fie) Gravel Bed Thickness Square Feet of Absorption Area ('4/04 Standpipes Present (Y/N) Y Depression over Field (Y/N) N Results of Last Adequacy Test 14 0 e Separation Distance from Absorption Field: To Water -Supply Well 126), To Building Foundation y S r Lot .Date of Last Ad3 Adequacy Test tL —1 / or S � droo M_r � i Ivo,' � lNG To Property Line 6 `N e�e ; On Adjoining Lots To Existing or Abandoned System on To Water Main/Service Line FO L To Cutbank (if present) /Vo,v e To Stream/Pond/Lake/or Major Drainage Course &� V •� To Driveway, Parking Area, or Vehicle Storage Area Comments I cx_ a-crmA„ DE- �A:S rNcovc�� D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I v chectv er' or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ` Q.t t:i `/A/ Date CompanMOA No. Receipt No.r Date of Payment Amount: $ _� �� U G —MUhVtcIPAL17Y OF ANCHORAGE /O' ()(-) ENVIRONMENTAL SERVICES DIVISION Page 2 of 2 t,4 S o2v Z�1{b I! I ISI 2 3 1988 72-026 (Rev 81861 Back RECEIVED Munic` pality of Ancli`xirage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 July 12, 1988 Besse Epps & Potts 2220 East 88th Avenue Anchorage, Alaska 99507 Attention: Mr. James D. Moore, P.E. Subject: Waiver Request for Lot 21A Block 7 Sand Lake S/D #2 Waiver Request #WR88-030, H88-0240 Dear Mr. Moore: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 42 feet to north line; 6 feet to west line. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Serivices DJR/ljw#7 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 'JUN 2 31988 RECEIVED June 21, 1988 Municipality of Anchorage Department of Health and Human Services Environmental Services P.O. Box 196650 Anchorage, AK 99519-6650 Re: Waiver Request, Lot 21A, Block 7, Sand Lake Subdivision No. 2 This is a request for a waiver from the lot line separation distances specified in AMC 15.65.040. This section of Anchorage Municipal Code specifies a ten foot separation between any portion of a wastewater disposal system and any property line. The separation distances found on the subject property between the leaching trench and adjacent property lines are four and one half feet to the north line and six feet to the west line. The septic system shows no evidence of alteration since it was installed and approved in 1981. This septic system is in current use and has been in operation since 1981. Granting this waiver will have no significant impact on the adjacent lots. Sincerely, 4 CameS D. Moore, P.E. jmm ENGINEERING, PLANNING, SURVEYING 2220 E. 88th Ave. /Anchorage, Alaska 995071 Telephone 907-349-64511344-1352 "Providing a quality personalized service to those building Alaska's future" 1.i ACKNOWLEDGMENT OF SEPARATION DISTANCE DEFICIENCY This is to acknowledge dk/nowledge that the septic system on Lot -ZLO Block- _ X,rVL—L a AL -e 2- _ Subdivision, a lot adjacent to mine, is less than the required ten feet from my lot line. I do not object to this configuration. OWNER Lot 23 Blockd LAC- A)OZSubdivision Date(y=2i%Xy —�-- 4y' :aOtCS D. A/Gov r Jr. r�✓; �U Fr `, Vp LOCATION: Client's Name: Address: TESTER: BE,SSE r EPPS 5 PO'iTS � 2220 EAST 88 AVENUE A4CHORAGErACK^C99507 (907) 349-6451 WATER WELL TEST Date: J;, -,,a- Subdivision:_��� Lot: ,4 Block: 7 xyi-C! %2<z> Initial Reading on Meter: i 7 s ILI ®®® GALLONSVOLUME • , ►r��rr�r� FOAMM �� psi- rplimloopm►� ""� - NOTES: Production Rate: G? -4 24 -.Hour Capacity __ Gallons 111, FIR I 06/13/88 Time Arrived: 1620 Date Sampled: 06/13/88 Time Sampled: 1520 Date Completed: 600 UNIVERSITY PLAZA WEST 2505 FAIRBANKS STREET SUITE_ A FAIRBANKS ALASKA 99709 ANCHORAGE_ ALASKA 99503 907-4793115 007277.8378 Besse, Epps, & Potts 2220 East 88th Avenue Anchorage, Alaska 99507 Attn: Andy Potts Source: L -21A, B-7, Sand Lake # 2 Sample ID#: A061388-9 ---------------------------------- ---------------------------------- Date Arrived: 06/13/88 Time Arrived: 1620 Date Sampled: 06/13/88 Time Sampled: 1520 Date Completed: 06/20/88 Parameter Unit Result ADEC MCC* Nitrate -N mg/1 C0.1 10 Reported By: �/ Date: 06/20/88 --------------------------------------------------------------------------------- ------------------------------------------------------------------------------------ Francois Rodigari, Anchorage Operations Manager * MCC = Maximum Contaminant Concentration T F 8')'1l� FAIRBANKS, ALASKA 99709 907-479-3115 600 UNIVERSITY PLAZA WEST, SUITE A 907-277 8378 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 Quality Control Report Client: Besse, Epps, & Potts ID#: A061388-9 Listed below are quality control assurance reference samples with a known concentration prior to analysis. The acceptable limits represent a 95% confidence interval established by the Environmental Protection Agency or by our laboratory through repetitive analyses of the reference sample. The reference samples indicated below were analyzed at the same time as your sample, ensuring the accuracy of your results. Sample # Parameter Unit Result Acceptable Limit EPA 378-12 Nitrate -N ------------------- mg/1 7.36 7.17 - 8.01 Reported By: Date: 06/20/88 ------------- Franco:is Rodigari, Anchorage Operation Manager ti� y.131 it FA NON�>~ X050 � z 33�� 1 d/{uit. WIp1.IRN Y TEIOM M� t1i 3v n I � NOTE v 213 1v890ss'oo"1q/ 1315, -Il T3 z6'' - ��3 r cONL. O 1� I�GAw/t. Pnd.-ti I/a— 17"y 1 1 320 �II111 2 stogy 2 y @ 26 S;NyI< �nmfiy 2S- Wlb 3oY Ci I I-. __ o I 12'%IB1 ` � I i SNF_ O � 2y8 I/ ni S110 ss'oo" vV SURVEYOR$ CERTIFICATION I HERESY CERTIFY THAT 1 HAVE SURVEYED THE PROPERTY DESCRIBED ON THIS PLA1 AND THE IMPROVEMENTS SITUATED THEREON ARE LOCATED AS SHOWN ON THIS PLAT. p DATED THIS _/ DAY OF ��"�� ,19 :2_ 0 A /ss, Y y LEGEND O LOT CORNERS F,vP FOUNDATION DRAINAGE ARROWS U,1 M s 0 0 I, O) U NOTES= I. IT $HALL BE THE RESPONSIBILITY OF THE BUILDER OR OWNER TO VERIFY THAT BUILDING LOCATION SHOWN MEETS ALL SUBDIVISION COVENANTS AND ZONING ORDINANCES. @. It IS THE RERPUNSIOILITY OF THE BUILDER TO VERIFY ALL -ELEVATIONS WITH RESPECT TO ALL UTILITIES, B DRAINAGE. 3. THIS PLAT REPRESENTS THE PARCEL OF PROPERTY DESCRIBED BELOW TAKEN FROM THE RECORDED PLAT DESCRISINO THAT PARCEL. INSTRUMENTS RECORDED PRIOR TO OR AFTER THE FILING OF THE RECORDED PLAT ARE NOT SHOWN ON THIS PLAT. 4. THE INFORMATION ON THIS PLAT 1$ FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS , THE PLAT IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCES. As-/3W2r /-07`.2/A 82OCK7 121VD LAKE SUf30/V/SIGN /V0.2 BESSE, EPPS St POTTS 2220 E. 88th. AVE. 349-6451 ANCHORAGE , ALASKA 99,507 344-1352 DRAWN SY, 9CALElQ'p C -C DWO. NO. CHK. BY DATE -��- (' FLO. BK.