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HomeMy WebLinkAboutSEQUOIA ESTATES BLK 1 LT 8ion- \sa.,(D , ALASKA CI iuInOURTAL COnTROL Seh,CeS, InC. Engineerinq & enuironmeninl SJludies April 11, 1987 tly 'Itc rOlt Municipality of Anchorage �4%Fk ),tottO Department of Health & Human services i N 825 L Street e 199 Anchorage, Alaska 99501 /� Cie/ Re: L^t 8, Block 1, Sequoia Estates �® On December 28, 1985 we applied for a health authority for the subject lot for a Mr. Herb Woller. The HAA was refused because there was no "as -built" on file for the sewer system. Our records show it was released to New World (Haddy) around August 24, 1984. Apparently he never turned in the report. He has since gone out of business and we can not find him. I doubt if we will ever know who has the originals. We have located our file copy of the as -built. Here is a recertified copy for your records. Probably this will not be the last inspection on this subdivision which has been lost. If you have any questions, please let me know. C Sincerely, rl�erzo_yC.Reid Jr., P D, PE President k 1200 UJesl 33rd Auenue. Juile 3 9 Anchorage. Alaska 99503 • (907( 561-5040 I 72-013 (Rev. 3173) MUNICIPALITY OF ANCHORAGE .' �- DEPART"—NT OF HEALTH & ENVIRONMENTAL PRC (TION VIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/013 WELL INSPECTION REPORT NAME HONE � NEW -f- /n� / Ko 6e,- y kD %IP, S G2 7 �Zfy ID UPGRADE MAILING ADDRESS D r✓c.�Z)" C nc,4c fje At�jA-03 Wn r I.Sfd ✓ A LEGAL DESCRIPTION 777 zNV-3 1'-) Q.— 7_=A LOCATION S& NO. OF BEDROOMS Vc, a DISTANCE TO: Well / / / Absorption �ea //7 / Dwelling 3 / PERMIT NOv y C Uy a Q Manufacturer Mater l� r No, of compartments H Lin. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth O y DISTANCE TO: Well Dwelling PERMIT NO. JOZ A < Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: Well '2 / Foundation / Nearest lot line/U / PERMIT ,�VO._.p�^L� Y 7i U LL Z No. of lines Lenge �f each Iin2 Total length of nes Trench Distance between linesi F, ? inches Top tile to finish Material beneath tile Total ' CP of grade / i / D effective absorp �a7a r cc inches Length Width Depth PERMIT NO. W f7 Q t- Type of crib Crib diameter Crib depth Total effective absorption area wa W to DISTANCE TO: Well Building foundation Nearest lot line J Clas Depth Driller Distance to lot line PERMIT NO. J W DISTANCE TO: Buildingfoundation Sewer line Zg Septic tank p / 13/ Absorption area(s) OTHER PIPE MATERIALSW[1 /QVC C 1 SOIL TEST RATING 12,5 >� INSTALLER NQW REMARKS r )4L cwclled D- 1-7 I K JJ // 1 v a� c! h� k d' Min-r���ru��� / 4444 ` Al Alu_� APPROVED DATE LEGAL of -V09? F'3, 13 44 / cof s e 72-013 (Rev. 3173) t IL.A NO 7[: q - q= " it"� q .:. � T v ��� If t � q� { q'.r � q �[::P F< W=11 C-3 E;:: DEPARTMEENT OF" HE-AI_TH AND ENVl:RONME:NTAL r'ROTE_L'TION 025 L :�iTRE�E T ANf::1fGIFi(•aGF= n Af; 1717501. 264-4720 " Ph.0 •-1 a T: "T" E— . E-1 IE 04 FE F;A PERMIT NO-. DATE ISSUED- APPL.If''ANT, ADDRESS-, CON"FAC T PHONE-. -. 840526 HAND WRITT[ N 06 /.'cl /84 HERBERT 0 WOLL..E IR 406 ..') WEE S W("IOD DRIVE; ANCHORO GE., AE`: 99503 562-2828 I-03'Af_ DI::SCRI! . SUEIDIVISIONa SEQUOIA ESTATES LOT: 8 BLOCK- 1. SECTION: 26 TOWNSHIP: 12N RANGE: 3W L.OT 1";1ZE- 48270 (f33G! FT. OR ACRES) I c er t i f' y that: 1. I am familiar with the recluiremeh-Us f'or on-site scaw+=yrs and wells as- g5et forth by tE1G Municipality of Anchorage (MOM and the State of Alaska. ?. I will. :.11stAll the siystem ii-) accords -.ince with all MIA codes and regulra-Lionlipp and in compliance with the design cr•it_ei-ia of this permit. _:" I wi.l.l. aci,here t.ca. al l MCIA and State of Alaska requi.rement<s, f'or, tl--ie < i:jt•. back: distances from any existing well, wastL5Vja'L.er cii�l�o=sal. system rar EaLAblif.- sewerage system on this5 or any ad.jac:ent or nearby lcrt. IF A I....Ir"T STA'T'ION IS INSTALL.ED IN AN AREA COVERED BY MOA BUILDING CODE % THEN (1) AN ELECTRICAL. PERMIT AND INSPECTION MU13T BE OBTAINED; (?) -AS 4.1 IL.Ts WILL NOT BF.-" ;C. �WITHQUT AN E:I_ECTRICAL INSPECTION REPOR"r;; AND (u) THE' EC:;"rE,:f.(;AL. WORk DE DGI F BY a L.ICENEiI D Ea._L I TR:CGT.Afd„ SIGNED AI'PL I CAN11 FTERDF_RT GO WOLLER DATE; I:SSLJED BY _�_ ��- [)ATI::„ .� lea fey /6- >-0 J L� SOILS LOG - MUNICIPALITY OF ANCHORAGE / • �e`i, DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST P w i✓a� %<1 ✓nP 4 14 f, PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION:15"F I'v 0Ix L -S -1ec to f P 2 Li@wt Sana 6+�-.4j� wcLFe.- t io�a(ncl 3 4- 5 6 7 8 9- 10 11 12 13 14- 15 16 17 18 19 SLOPE r vJ P WAS GROUND WATER S ENCOUNTERED? t'I fF5 L O P E IF YES, AT WHAT DEPTH? SITE PLAN ter. z 6A Reading Date Gross Time Net Time Depth to Water Net Drop w � J J ti Fi . Te } t• le Lo>i-C1�Ci' ci'� ter. z 6A Reading Date Gross Time Net Time Depth to Water Net Drop 20 / el PERCOLATION RATE _(minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS Z/1fl S`�/� %OU/!l c% 7'i'rr 61C' �4e EXiai -Al CIC'G' �e=� "/D i c%r•�P9lrlcj i:�f('r�/iei-G?, N+, /n: n -'fa- 'Au de tv «.S %•`t:'i /(eci be eQw e i e AJC. 60611-a PERFORMED BY: Du "7 /'wo4 si h1/ l/CERTIFIED BY: DATE: 72-008 (6/79) PERFORMED FOR LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 y� SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST Ale rvto�sFS 'felly -Ii KL' Ci t Wi+ti w(kkI- 12 DATE PERFORMED: Jlmee l'3 /y tc-,/ ? /-,) /0 �-- / SLOPE SITE PLAN WAS GROUND WATER �fS L ENCOUNTERED? 0 P _ E ` IF YES, AT WHAT DEPTH? G � Reading Date Gross Time Net Time Depth to Water Net Drop F1 PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN - - FT AND -- FT COMMENTS Ikl Si 1-1 )QUILS Ye<.11<1 '+e'rr''bl[. JInr S"y-kJ iS 6j+ t V.r, sc rig - .S-�4i -k At ('ecg'se Id .--s «-e ...lint, y, eSF Ff�le PERFORMED BY: i'),?— CERTIFIED BY: V DATE: CKC�.r<��Znr 1j 6 d elbPwl�a 4) U` WAS GROUND WATER �fS L ENCOUNTERED? 0 P _ E ` IF YES, AT WHAT DEPTH? G � Reading Date Gross Time Net Time Depth to Water Net Drop F1 PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN - - FT AND -- FT COMMENTS Ikl Si 1-1 )QUILS Ye<.11<1 '+e'rr''bl[. JInr S"y-kJ iS 6j+ t V.r, sc rig - .S-�4i -k At ('ecg'se Id .--s «-e ...lint, ie- PERFORMED BY: i'),?— CERTIFIED BY: 20�i F1 PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN - - FT AND -- FT COMMENTS Ikl Si 1-1 )QUILS Ye<.11<1 '+e'rr''bl[. JInr S"y-kJ iS 6j+ t V.r, sc rig - .S-�4i -k At ('ecg'se Id .--s «-e ...lint, ie- PERFORMED BY: i'),?— CERTIFIED BY: DATE: CKC�.r<��Znr 1j 6 d elbPwl�a 72-008 (6/79) PERFORMED LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG — PERCOLATION TEST �'1 IIJI�Ci L•..i 1�Q1 �.S C�C SOILS LOG Gross Time / q p�-i� Depth to Water Net Drop J� PERCOLATION 2'yY TEST DATE PERFORMED: J,, -,e /3 / a 61- e7 /j /Or /L I SLOPE SITE PLAN v OUND WATER S JTERED? N� L O P AT WHAT E ng Date Gross Time Net Time Depth to Water Net Drop 6-I".3 2'yY PERCOLATION RATE (minutes/inch) I_ TEST RUN BETWEEN L v> FT AND 2- FT COMMENTS 5� uM ( � l %_ %J 'fo'1`'u11 y vnSu'ha 0C - nn S/ Sr=4j7 c. S•� 5" �'L_ - c PERFORMED BY:%)<' y CERTIFIED BY: "--i `'+-c— DATE:_(, �J 72-008 (6/79) l� yT,liU e �I v OUND WATER S JTERED? N� L O P AT WHAT E ng Date Gross Time Net Time Depth to Water Net Drop 6-I".3 2'yY PERCOLATION RATE (minutes/inch) I_ TEST RUN BETWEEN L v> FT AND 2- FT COMMENTS 5� uM ( � l %_ %J 'fo'1`'u11 y vnSu'ha 0C - nn S/ Sr=4j7 c. S•� 5" �'L_ - 9 PERFORMED BY:%)<' y CERTIFIED BY: "--i `'+-c— DATE:_(, 20 6 .: PERCOLATION RATE (minutes/inch) I_ TEST RUN BETWEEN L v> FT AND 2- FT COMMENTS 5� uM ( � l %_ %J 'fo'1`'u11 y vnSu'ha 0C - nn S/ Sr=4j7 c. S•� 5" �'L_ - 9 PERFORMED BY:%)<' y CERTIFIED BY: "--i `'+-c— DATE:_(, 72-008 (6/79) CH F::`11 VA 1C., VA FW" FA H"_ ­A E, DEPARTMENT L HEHLTH HND ENVIRONMENTAL ]TECTION ��� /L' ST���T/ �@������E/ HK� �9501 264-4720 HA 1_ Fil V-4 11D ��-V F_-- ��-4 E'.- F -W! ���0, e I I Y" N�. ( 8]171,264 ) HPPLICHNT ROUND~HOUSE BUILDINGS SRH BOX 15617 ]]45~]875 L("ICHTION LEGHL LOT 8 BLK 1 SEQUOIA ESTATES LOT SIZE 99999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MHXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 1]5 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ������ �� ������ �� �������� Cm IE:'-- � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIE!, D. THE DEPTH OF R 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 GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCHVHTION (IN FEET). ��������� ������ ���� ������ ���� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTHLL8TION INSPECTIONS OF HNY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES TF HT THE WELL WILL SERVE. 7, W ICH K- �C".7' 11 0—��� ������ �������������� __­­ BHCKFILL ING OF HNYSYSTEM WITHOUT FINHL INSPECTION AND APPROVAL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION. MIklIMUM DIsTANCE BETWEEN H kIELL �P.,ID ANY ON—SITE SEWHGE DISPOSAL IS 100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE I4EL� TO H PRIVHTE SEWER LINE IS 2t; FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED HND MUST BE RETURNED To THE DE"_'PAF;,TMENT 1,11THIN ]0 DAY'S OF THE IdELL COMPLETION. OTHER REGAUIREMEhITS MAY APPLY. SPE[IFICATION,5 HND CONSTRUCTION DIHGRHMS HRE AVAILABLE TO I@':;URE PROPER ��ST��L�TION I -V ����I R7;.aF_r.vS::-. �FE. ������ ��� P-E-a� I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS HND WELLS AS SET FORTH BY THE MUNICIPALITY OF HNCHORHGE. 2: I WILL INSTALL THE SYSTEM IN HCCORDHNCE WITH THE CODES. ]� I UND�RSTHND THAT THE ON—SITE SEWER SYSTEM MHY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED�__�_.�~�..�~___�._~�.�_—��~~�~—~�--~ HPPLICHN�� ROUND—HOUSE BUILDINGS ISSUED BY~ 'L STREET, ANCHORAOE, 6fe, ! 1i: )!' Rt;Lttw`i �#i��LttiE SUILVINGti SPR FOIN 115611 25:34-:5-1-S87-5 itL LCIT €t £.LFA: I S€QUOIR ESMIES LC+7 2•3�F etSc9S' e SQt.RRE FEET i jar Cilf Aesr-fp.r-,T IOtJ SYSTEII IS-: `kP N H INUM t:tUMBEA: OF REDF'QOM 4 SOIL FR I NG (eCt QtURED SIZJ� OF THE ef+3L SYSIEK 3R•: F! FE r-j*:3 -F f -f E FIf- LEidGTIF 3}II7€t iC+Pt Iss IHF- LEN&M UN FEV %,% OF 7HE TRENCH sem: FrRI'f NF3FLU. j;l, t, FUl -i OF €# TRENCH €+f? PI7 7-5 714F DIST IC:E UETREEN THE a'FPCE OF TF HE - FWtf?4j> FIND THE DUTTON [IF 'THE E;tRYFt'fICIN {]N FIf_T). '.#I %V. IS I•ICt SET WIDTH FOR TRENCHES, F,ti- UP.%8VEL DFF'TH ISS THE MINIMUM 13EPTFi OF rRfVEL DE714EEN THE OUTFF&L €lf'E t(f) THE BOTTOM OF 7HE F+X[-i=YRTION CIN FEET?. ZC' i' �f i `'t {ze ,`a`,•.M 4m +''�•i1 A..... �.,_ �$ _ t l- "FIPPLIC:FINT fIFi5 THE M5,PONSIPILITY TC-( INFORM Tfil!� KPAF'.TPIEw DURINci THE #F.Y-fiTICiN INSPEC-11£+NS OF !i!`Y i'ifLIS ADJACENT TO IRIS PROPERTY MID THE to,, OF RESIPENC:ES THRT TKE- 4IEU, MLL 1EIPVE. F 31:I* j t4f) C+F tit4y 5 4Ys EDI #d1 TI OLIT F J f*jf� I NS;FECT I ON BUD APF'ROVRL BY THIS flF`FE3`J #,JILL, BE SUBJECT Its F`RDFECUTIC+N. F;tM CrISTRNCIw BETWEEN R FBF€LL RM, MY M -5531E 'SEI -MM DISPOSAL S`s`'STEPI 3:5 F f T F'OR fi PRIVATC ,AEL.L Ctf 15C, TO P00 FEET #7 PMLIC WELL DEPENDING SII= "£ yF'E VF F`'LIDL I C- WELL.. f.UfM DI'STRNGE F%r+F9 A F-F,,IVFtTE MELL TO ft PRIVAIC .SEWER LINE IS ;fid FEE7 AND CC'tt`fI'It.NJTY 1pf-Wek LINE 3S T5A FEET. L#M-iSc RR€ Fx:EFRUIRED AND MUST i E RETURNED ICI IM KF='ARTKENT I•.FI3PF33-F 1O DAYS. WELL COMPLETION. F;UX1I REMENTS MAY FfF'[='LY, S,F'ECI F 3 C RT I C+NS My DJ RC -i A3 JS ARE .f FIU F- 711 INSURE PROPER I tai -5 I UFcT ION. Y-1 'Ff-1f-#7lsD;R F•�I7FI THE RE1C�i.t3k£PUIT€: FOR CIN �I i`F F•F 4FEFe� At�� �#EF 45 �S ET 9 r-.Nl TtdE MUNICIPALITY OF ANCHC+RRGE. t f# L 114S'€ALL,. T"E SYSTEF4 IN i=tCC-0Fi,ANCE WITH INE £CIDES. *F l f:" •TF�Ii THAT THE C+N--SI TE S€fFFfs SYS? EM FBF lY REMURE. ENL.FiF OEMEVI IF 7HF. '';-;14C:E IS, REMODELED TO INCLUDE MORE TFfRN RIROUND—HOUSE VLIJLDINS5� i i Y4. 0 - �\ M SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 1 825 L. Street, Anchorage, Alaska 99501 284-4720 = SOILS LOG - PERCOLATION TEST PERFORMED FOR: N&J�iVCJ� [ DATE PERFORMED: 'T , .( LEGAL DESCRIPTION: �C �C')-lC1C' I J�.fif C)GGC.C{,! DEPTH SLOPE �! SITE PLAN (FEET) VI../ (')F�''`^ F-��I I 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMEN mL;tt'n$svnlc(. (L4' !Y) L) V)st A- $c: --k puirti iS 'S a) ' n" ;5;ft)4 .oqq WAS GROUND WATER n 1 S N ENCOUNTERED? ig L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop MUNICIPAL TY OF ANCHORA DEPT. ENVIRON OF HEALTH & ENTAL PROTECTI ''Jill 10 10PA PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) FT AND — FT, PERFORMED BY: �(_✓/ ✓l xa# wq—ozq CERTIFIED BY: DATE 72-008 (6/79) S I'U P.,.tf1% SM4'v- >��% /!SF /li/JT/_�•.3 % ff/_' /Y!�//�/f.� "F�/!//1/,C-� r"%tl FL'/�F�/_-' /� STFl%7 � 'r ri 1/ /I (./f % /✓/%. /6l4 /s /v i G2 JL/cl 1/4 /_=5 T,,> T —,S _ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF WEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION I c; '1 EST 82.5 L, Street, Anchorage, Alaslca 09501 264.4720 d SOILS LOG - PERCOLATION TEST PERFORMED FOR: /YEW WDiTLD LAND CO. DATE PERFORMED: LEGAL DESCRIPTION: L77T 8 3L0CK l RAII'V80W IZID,-F_ F.ST7A7-F,5 DEPTH (FEET) 2 3 4 DltGA ry 16S BltOWAI SANDY LOAM 5A SIGTY -SANDY Gf?-AVEL -- W. CLAY (�G .r! OF 4�,a ]hf,°'O9aoenoo 61 °e'e�, t. ?r 'p s ° 13 0 14 sm 0 .00 Earl R. Barnard ! ij/ J 154.E g (n •e c° c�;,!r% `7,7(•0 °ae•°°o°e°�t�\117ksGROUND WATER rOFE : 'COUNTERED? CMA VjEL W. - IF YES, AT WHAT ,SOM& CLAY DEPTH? (-c otic>Irvnt. rrr,r' i+ Ot.li: lai E of ,A4. °9a tr MH e_ 0���•a Earl R. Barnard /vrgp • r,r �� ,o°e 75 E '•e°�<C w PERCOLATION RATE �•� /�✓�/ (minutes/inch) al •ee °•°•° ,03• gA� p�orESS10�yy` TEST RUN BETWEEN 3, FT AND �' FT COMMENTS V&fi?N,47—,F 7"E57' 201 /VO/?r/V Di- PERFORMED BY: JL /tom _CERTIFIED BY: - DAT SLOPE w ° SITE PLAN MU � E 9. Reading Date Gross Time Net Time Depth to Water Net Drop it /1LJfl 3'_— I 9/Z'S/Y.: 5>,'/(, Pi -i — n 3rll 72-008 (6/79) l WELL LOG Date Drilled, 0 -' Static Water Level 1"' feet Draw Down '41, feet Tyne Material Drilled: 0 feet to ?? •r. , rl , ,<„r,.; '11"'T 7.7 [rvi to /10 'nn^r- awl G(1 fr`Q f- to 7�, R' ,c snnp1_ 75 fort. to 1/l> rPrw�l <: sn,ul 10`; to 11-`_' Wet Gallons Per Minute 1" Total Feet of Casing_ 3n 110 'F"C,i to 170 170 fent to _ ,q., ,1 .nt`. r f'Pt ._.rig 1/�i� /1-ra•,r;."' .,I F'a 7 -t,t„e )no 200 reef 10 ?11 13rot-rn snil Travel Hefty Drilling 7/,0 1'0(11- *) /, },,r,r:, r1;," S.R.A. Box 1553 H i("n fr, p;, in 77 ri (', 1 -.',fir sq/rOry Anchorage,Alaska 99507 ^`?0 eci rn 300 T;:,},1 rocicr, 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. # HAAtf h. GENERAL INFORMATION Complete legal description Lot 8; Block 1; Sequoia Estates Subdivision Location (site address or directions) 6901 Sequoia Circle, Anchorage, Alaska Property owner AIA.sKA pEamANENT-rLTND_coRpoRATTQN Day phone Mailing address P.O. Box 4-1000, Juneau, Alaska Lending agency Uay phone Mailing address Agent Pat Johnson/ALLSTAR REALTY Day phone Ar]Hrocc -1 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water 561-782 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. 1/91) Front MOA H21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Phone !)7NEE;111tf Address 17034 Eagle River Loop Rohl No. A04 tag e River, A asc99577 Engineer's signature 6. DHHS SIGNATURE Approved for AA bedrooms. Disapproved. Conditional approval for Additional Comments By: bedrooms, with the following stipulations: Date a�� h �:.vY K+ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA N21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST I15 i svrtes Legal Description: LU T 8 ELK I, St Quo( S/p Parcel I.D. A. WELL DATA Well type PkkuF_T F If A, a, or C, attach ADEC letter. ADEC water system number N A Log present O/N) — yes, Date completed E_2 -8'_t__ Driller ttEE71/- D21i..& W Total depth Cased to 100 —Casing height (�y + Sanitary seal (PN) Wires properly protected &N) ri FROM WELL LOG AT INSPECTION Date of test S --S y -9- `12 o z a � b tP� r Static water level 190 o�oZ� � .� 0 ;Z, � Well flow is g.p.m. 3t� g,p�,FA__ Pum level o�M n Pump f ria N 0 SEPARATION DISTANCES FROM WELL TO: m Septic/holding tank on lot On adjacent lots Ind ¢ Absorption field on lot /d� ; On adjacent lots /Od t Public sewer main _ /y�7�} Public sewer manhole/cleanout � /4V6 N _A1111, Sewer service line d Petroleum tank K WATER SAMPLE RESULTS: Coliform o Nitrate 0 lU m&A bacteria C7 Date of sample: -/`�-q2 Collected by: COther c J * `, l-N�INE�RInSC- B. SEPTIC/HOLDING TANK DATA Date installed g-1Ll- 89 Tank size So G,4L Compartments a Cleanouts ON) Foundation cleanout ('%N) ���S J Depression (Y/O A)O High water alarm (Y/N) pi //- -Alarm tested (Y/(O IJ/4 Date of pumping Ll- �- `I x Pumper A a- f IannF_ �eAL)(CC_S SEPARATION DISTANCES FROM SEPTIC/'a TANK TO: Well(s) on lot j j 3 On adjacent lots mo " Foundation 33, To property line 1)5 1+ Absorption field /I/fs Water main/service line 9S (* Surface water/drainage — /00 72-026 (Rev. 7191) Front CONTINUED ON BACK PAGE C. LIFTTION Date installed n Size in gallons Vent (Y/N) "Pump on High water alarm level Meets MOA electrical codes (Y/N) — Manufacturer Manhole/Access (Y/N) at "Pump off' level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Surface Date installed ��U sF/�Z O Soil rating System type Length 19 r Width �g r Gravel thickness 6 Total depth �6 r Total absorption area 6SH SE Cleanouts present ((— N) ),ts Depression over field (Y/6 Nd ✓ Date of adequacy test Results (Cass)fail) l A -SS for Peroxide treatment (past 12 months) (Y/© No If yes, give date y�9-92 f SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I m / On adjacent lots Property line To building foundation �c To existing or abandoned system on lot On adjacent lots 100 Cutbank X00 Water main/service line sU/� Surface water II X00 4 Driveway, parking/vehicle storage area Curtain drain NotUp- KMCON E. ENGINEER'S CERTIFICATION bedrooms I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & 5 ENGINErRING Y 3 ?9a' . 17034 Eagle River Loop Road No, A04 Signature . age River, Alaska _, r •, i n 9 „ q0 nr� p F1 Engineer's Name Date t' �� �Z i ;i V, ";::rl Vii. tk Lir>. fi:i�) i� 1 (• men r, A' N `Y 3 M HAA Fee $ 11 U, 00 Date of Payment �� ' �� 2 Receipt Number a3lpCUS 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING; il, ENAINEERINQ GO. 5833 l3 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 582.2343 FAX: (807) 561.6 Client Sample ID LB E1 SEQUOIA ESTATES Client NamPO! e :S & 3 ENGINEERING PWSID : UA Client Acct +SNSENGP ! his. EntReq# Received APR 9 92 41 .13:17 hre. Ordered By :R. SILIPER Preserved with , AS REQUIRED Collected •�aRwTonr f 301 ANALYSIS RESULTS for INVOICE # 52680 Charelab P,of # 92.1468 9nnple ! 1 Matxi:: WATER Analysis Comploted APR 10 92 Laboratory Supsxvreor STEPHEN C. EOE Released By : ��C Send Reports to: 1)S & S ENGINEERING 2) ,NONE RECEIVED Sample ROUTINE SAMPLE COLLECTED BY: UA. NO TAG FOR THIS SAMPLE. Remarks......n.... ...................................... ............................w............... I Testa Porfolned See Special Instructions Above UA -Unavailable ND- None Detected " See Sample Renarke Above NA- Not Analyzed LT -Lees TMn- GT -Greater Than fON aGa Member of the SGS Group (SocIMO GAndrale do Surveillance) a . . . . . . . . . ....... .........................n................n............................... Unite Method Allowable Lirsits Results Parameter -------------- ND(0.10) uq,l EPA 353.2 10 NI'TRATE-N Sample ROUTINE SAMPLE COLLECTED BY: UA. NO TAG FOR THIS SAMPLE. Remarks......n.... ...................................... ............................w............... I Testa Porfolned See Special Instructions Above UA -Unavailable ND- None Detected " See Sample Renarke Above NA- Not Analyzed LT -Lees TMn- GT -Greater Than fON aGa Member of the SGS Group (SocIMO GAndrale do Surveillance) MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services - DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 8; Mock 1; Sequoia Estates Location (address or directions) 6901 Sequoia Cin.a2e (b) Property owner pe4wa.qent Fu4d cg A, Telephone: (home) Mailing Address P.O.Box 4-1000 Juneau, Atka (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent ALL STAR REALTY ATTN • Pat John son ••• 07 EaAtd :g[t �� e• :' [< •' 1. Telephone 561- (e) Mail the HAA to the following address: (or check here =if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING ]-,-7n34-E4e River Loop Road No 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family XX 3. WATER SUPPLY Individual Well ❑ Number of bedrooms 3 Community,$, Public ❑ Business Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site INX 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. 72-025 (Rev. 7/88) Page 1 of 2 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 Telephone Address S & S ENGINEERING 17034 Eagle River Date Eagle River, Alaska 99577 z y =( Li'4`'b: q:A:i� •�-• 6. DHHS APPROVAL Approved for bedrooms by Date Approved—_4K,_ Disapproved Conditional Terms of Conditional Approval .. _ CAUTION; The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oranalyze 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. 7/88) Back Page 2 of 2 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: ISD -GKN iE> lf� L10/ Well Classification _ ;ril F/1AN 14 _ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) �l __ Date Completed 23 `" 7 — 84 Yield��'aA&— Total Depth Say Cased to AOO Depth of Grouting r,�' T �� ) Static Water Level _Z 12 E3 — Pump Set At — U I!C-- Casing Height Above Ground / �( r Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) 4 Depression Around Wellhead (Y/N) 1i SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot I 1 S _ ; On Adjoining Lots ( ()0 i To Nearest Edge of Absorption Field on Lot /.-� ; On Adjoining Lots 100 t To Nearest Public Sewer Line A To Nearest Public Sewer Cleanout/Manhole A) 11A To Nearest Sewer Service Line on Lot 5 i Water Sample Collected by Date as - 1 ' �l D Water Sample Test Results 6A 1 :a Ac.-�-OV ~-e> A G (r(a + Comments B. SEPTIC/HOLDING TANK DATA Date Installed SizeJa�Q No. of Compartments Standpipes (Y/N) ___Air -tight Caps (Y/N) Foundation Cleanout (Y/N) ._ Depression over Tank (Y/N) K1 Date Last Pumped Pumping/Maintenance Contact on File (Y/N) IAA ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Building Foundation To Water -Supply Well 11 5 To Property Line + To Water Main/Service Line / D To Disposal Field f_ q. t / To Stream, Pond, Lake or Major Drainage Course Comments--&+- 72-026 omments_- &+ 72-026 (Rev. 7/88) From Page 1 of 2 C. ABSORPTION FIELD DATA /� j Soils Rating in Absorption Strata 1 `_T 0 7/9 b j/9 JR Type of System Design r��C'+ Date Installed 9—.24 S q Length of Field 38 Width of Field Pl Depth of Field Gravel Bed Thickness 0.5 , Square Feet of Absortion Area Statndpipes Present (Y/N) (I Depression over Field (Y/N) Results of Last Adequacy Test —:�)✓_ (/-IG t SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well / Date of Last Adequacy Test To Property Line To Building Foundation To Existing or Abandoned System on Lot On Adjoining Lots /CC) f To Water Main/Service Line f �` To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course / OO + To Driveway, Parking Area, or Vehicle Storage Area oZ O Comments OM `� UAC_ NJ T— 5y sf--,%n psc� - Sa�a(f�c� r,rioy fio D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. '"Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA gu inspection. ;rr� Signed S P. S ENGINEERING Com an »034 Eagle River Loop Road No. 204 p y age River, Aiaska Date -2-'-2-2-' & r' u0. • Receipt No. c2 Date of Payment Amount: $ in effect on the date of this (r Receipt No. ;k;-=��,'�•' Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 /Engineer's Seal CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 \ FEDERAL TAX ID # 92.0040440 ANALYSIS REPORT BY SAI4PLE for Work Order # 19793 Date Report Printed: FEB 19 90 @ 16:05 Client Sample ID:L8, Bl SEQUOIA ESTATES PWSID :UA Collected @ hrs. Received FEB 13 90 @ 13:30 hrs. Preserved with :AS REQUIRED Analysis Completed :FEB 14 90 Laboratory Supervise STEPHEN C. EDE Released By : ,V C. ae.....,......<...........................<_...,......... ..�. Special Instruct: Client Name S & S ENGR Client Acct SNSENGP P.O.# NONE RECEIVED Req # Ordered By : R. SHAFER Send Reports to: 1)S & S ENGR 2) ............. ............... ,,............ � Chemlab Ref #: 900088 Lab Smpl ID: 1 Matrix: WATER Parameter Tested ---------------------------------- NITRATE-N Sample SAMPLE COLLECTED BY RDJ. Remarks: Result Units Method ------------------------------------------------ HD(0.10) mg/l EPA 353.2 Allowable Limits ----------------------- 10 1 Tests Performed Seo Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above IIA- Not Analyzed LT -Less Than, GT -Greater Than MUNICIPALITY OF ANCHORAGE: DIVISION OP ENVIROMENTAL HEALTH nE2ARTiiT'IT Or UEs9J, N AND ENVIRONMENTAL PROTECTION ,,- !sP1'LICA7'TON FOR tiIsAI,TH AUTHORITY k?PR.OVAL CERTIFICATE F Application Date Pi A ) j '% �, , � General �nforruatios� i (a) Legal Description (-!nelude lot., block, subdivision, secP.ion, township, range) 1 l i Location (address or. di.rectiont,) I (b) Applicants Name Arai: (a Telephone Howie Business Applicants Address (e) Applicant is (chock one) Landing In,ti.tu�fon ! � , O�ner/bullde) Buyer F of he: �exp.l.a: a), �.. f (d) Lending Institution Address (e) Read Estate Co. & Agent Address Telephone (f) Mall the HAA to the following address: 20 jy2e of Residence Siugle— amity Number of Bedrooms 3. Water Supply Indivi&mil Well t .� kiuli;i9' <zual.ly Other (describe) Communi.Cy Public: Note:: If conmunir.y wnlji systen, must have wr1tt:en cons'izmat,tor. 'rom !:hca State Department of Envis:ounwntal Couservat:ion attest ng to the l.egal.ttsy and stat:i,so 4e Sewa s DisnosaJ OnsitePubl i Commuait;. Holding Tank Note. If community e.el,l system, mList: havo sir tten cons:irmat,3on from. the Star -e -14 Department of Envfronment:<l. Conservation aCCesti.ng Co the leg llq and statvs. o/I- [Page l of 21 w i I Date ENGINEER SEAT,) b • DHEI'YApproval Approved for bedrooms By -_ 5• En ineeri.ng p_1 m P�:ovidin Inspections, Testi;, File Search,m Data and Information As certified by my seal affixed hereto and as of the validation date shoma below, i. verify that my investigation of this ffealth Authority Approval shows that the ort-gite water supply and/or wastawater disposal system is safe, functional. and adequate for the number of bedrooms and type of structure indi.catcd herein. I: further verify that, based on the information obtained from the Municipality of Anchorage files and from my ;investigation and inspection, the onmsito grater supply and/or wastewater disposal system is in compliance with all Municipal and State coder, ordinances, and regula- tions in effecton the date of this inspection. Name Of Fina (• I,fl ��l-! 1 !!-(( I 1 t` �( 1 i i �� - ���� `�i_�.- -�-�4� 1 elephone.'( / Address 10 ��LtiORGO rn�4t,�;n (1 U9� � �✓ f)a 'FF` t tr'fOy 4'. i �� '• •.i �i�. •p � F1� tl�)tt ��. a '-VIP-, Approved Di,approvcd �° Conditional. e¢ .�.� o£ Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF Ji V -LTH AND ENVIRONMENTAL (DHLP) ISSUES UE"TH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPFNDENi•.t PROFP8STON!1L ENGINET0 IN THE STATE OF ALASKA., TILE DHEP DOES THIS AS A COURTFSY TO PURCHASERS OF THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CFRJATN VEDEVAL AND STATE MEN` -S. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA CERTIFICATE!, IS ISSU''D. THE MUNICIPALITY OF ANCHORAGE IS NOT R13SPONSSBLE OR OMISSIONS IN THE PROFESSIONAL ENGINEER13 WORK (DHEP SEAL) RR4/ej/DI8 PROTECTION REPRESENT - REGISTERED HOMES AND REQUIRE - BEFORE A FOR ERRORS [Page 2 of 21 7-7.9-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 iviUNICIP,A iTY OF 1 r,ICrIOF� DIG -28 '084 P F c Well Classification Lr C e_ If A, B, or C, D.E.C. Approved(Y/N) N/A Well Log Present ) Date Completed �� 7-e c( Yield c2 GPS Total Depth '30((Cased to ;;CIO r Depth of Grouting Static Water Level /qU Pump Set At G«tCGi ��a-1 Casing Height Above Ground fi�.5� Sanitary Seal on Casing )_ Electrical Wiring in Conduit N) Depression Around Wellhead {Y )2— Separation Distances from Wbll: To Septic/Holding Tank on Lot On Adjoining Lots ICO _-_- To Nearest Edge of Absorption Field on Lot On Adjoining Lots To Nearest Public Sewer Line t1A To Nearest Public Sewer Cleanout/Manhole %4 To Nearest Sewer Service Line on Lot Water Sample Collected By aal(Ars _ ��� ; Date /1? -,1_)C_- P Water Sa Conine nts B. SEPTIC/HOLDING TANK DATA Date Installed-,��{-�'�/ Size /a6(9 ��No. of Compartments Standpipes ) Air -tight Caps Foundation Cleanout Depression over Tank {x Date Last Pumped Tit _ Pumping/Maintenance Contract on File (Y/N) -. ; for _ ''(W f/� Holding Tank High -Water Alarm (YIN) N Temporary Holding Tank Permit (Y/N)/v�%� Separation Distances from Septic/Holding Tank: i To Water -Supply well %( r Cl) To Building Foundation -3 5 LIP To Property Line L`/ To Disposal Field -_ 14: 5 To Water Main/Service Line A)A To Stream, Pond, Lake, or Major Drainage Course Comment Receipt #�� Date Paid: 174 [Page Amount: / � [Page 1 of 21 2-15-84 C ABSORPTION FIELD DATA I Soils Rating in Absorption Strata ) <+(� Type of System Design— Date Installed Length of Field Width of Field /�g Depth of Field f6 Gravel Bed Thickness Square Feet of Absorption Area ���� zJ / Standpipes Present a/,A1N))/ Depression over Field ( /N) Date of Last Adequacy Test /V Results of Last Adequacy lbst L Separation Distance from Absorption Field: To Water -Supply Well 1(2 6) To Property Line To Building Foundation '�j�` C To Existing or'Abandored System cn Lot AJA On Adjoining Lots /("c 7/ -- To Water Main/Service Line �)A To Cutbank(if present) To Stream/Pond/Lake/cr Major Drainage Course To Drivray, Parking />nrea,�or Vehicle S%tcrage Area /0 f COI[¢llents O / f(r��xct l L a� G /r 02 co rrer I per ivt��/�e'� D. LIFT STATION Date Installed k1A Dir ensions Size in Gallons LA Manhole/Access (YM) 4) "Pump On" Level at AM ---- "Pump Off" Level at PA --- High -High Water Alarm Level at �,%�� Vent (Y/N) Tested for �1,'4 gqPumping Cycles during Adequacy 'ibst. Meets MDA Electrical Codes(Y/N) Counts t* Check Permitted Bedroom Rating Against HAA Request ** i certify that I have checked, verified, or, conformed to all MOA HAA Guidelines in effect on the date of this inspection. OF SignedLPA � � Date �� c2�-9V �"{{�.�. :•.� 8 Company Nag �v viUoti C•ti �I �niv�� S�jo. MOA No. 8`( �% t�;• 2 CfF6'3 �BxC'.lJc.•l.Ov�� ' 1 /� C�A-LCL fJ�'-•'••�"`•�-" T"c�cx i/-i%'e � as a B>co fit) KB1 /d5/s {Ze �L (a vp �~- d '• C..eidz JP. P z4 ar 2251• Qe �F °•° . on ,�� [Page 2 of 21 2-15-84