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HomeMy WebLinkAboutSEAVIEW HEIGHTS BLK 1 TR 5i ,o ��- aqk"Poo IC) Municipality of Anchorage Page of= DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 + Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: (,:;1)/ q PID Number: _01/ —M—lo Name: Wastewater System: CVNew ❑ Upgrade Address: to o 6 0 t'7 t V&40,►t� i31 ✓ � ABSORPTION FIELD Phone: No. c Bedrooms: Deep Trench CJ Shallow Trench ❑Bed ❑Mound O Other LEGAL DESCRIPTION Soil Ruling /o )-- Total Depth from original grade: CPD/S . FL Lot:_ Block: Subdivision: Depth to pipe bollonl from original grade: Gravel depth beneath pipe R b S Vii I 7" Ft a Ft. Township: Range: Section: Fill added above original grade. Gravel length: —7 5; Ft. Fl. _ WELL: L�New El Upgrade Gravel width Number of lines: Distance between lines: Ft. Ft. Classification (Private, A,B,C): Tonal Depth: Cased Too: 31 Total absorption area -7 66 Pipe material: � « 1 3 i Fl. (j Ft. SQ. Fl. © Driller: A Dale Drilled: Static Water Level: Instillc4: / �i Dale installed: I /T I to.12^ Vti Ft. t� L7—517`Z% yr'd Yieltl: Pump Set al: 1 Czsing Height Above Ground: r TANK 1157 GPM �o ONVI Ft. -3 FL SEPARATION DISTANCES septic ❑ Fielding ❑ S.T.E.P. To Septic Absorption Liu Holding Public/Private Manufacturer {�- Capacity in gallons: y ' From Tank Field Station 'I v.k Sewer Lines Well i I I Material. Number of Compartments: Surface LIFT STATION Water Lot I / v Sizr, in gallons: A -la nufacturer Line �— -- Foundation / / ,,..� .� 'Pump on' level al: "Pump oll" level at: High water alarm at: curtain Pump tdake 8 PAodnl Electrical Inspections performed by: Drain Remarks: BENCH MARK %e_ atA1 K,t ; q" Location end Description, �=loor-' Assumed Elevation: m( 04','wa 04"CC V4✓1 rt ENMNEEA S,sEALI r o � Inspections performed by: ___ Dates: 1st— Department of He Ith and u appr vat Lices ° Reviewed and approved b —WDate:�� 72.013 (Rev. 9/91) MOA 25 `1 i 25 0 25 I10 4 I 14 4 4 1 150 SECOAbARY TRENCH PRIMARY TRENCH 1 Toth �3 175 ONG FT TOTAL DEPTH 1 5 FT, OF SEWER ROCK Y) 1 2000 GAL SEPTIC TANK GREER STEEL i1 Tr 1 �- 1225 Tr 1 100.00 [j7,ENCH MARK UARAGE FLOOR OF �� 1,�►. �1 ell ° 49th �.. V........ ....................• UB I ON SPURKLAND '♦� �:�. phOFEss 0 n. 1 I 1 ITOBBEN SPURKLAND P.E. I I TRACT 5 BLOCK I SEAVIEllr HEIGHT5 I I SEPTIC STEM AS BUILT I 203 W 15TH. AVENUE DATE: FEB. 15, 1996 ANCH. AK. 99501 6008 W. DIMOND limn, N „0_70,a LEWIS IVERS SHEET: 2/3 GRID: 2323 ............: vs-•� AV C- • ' 49th ° .....: .........................:. TEN 'SPURKLAND No. CF -2225 Mira f i 140 CO L STEEL 4' Wide o REVERSE CLEANOUT 75' L ong 18' Deep 5' Sewer rock 7' Co ver O CLEAN OUT 0 FOUNDATION CL CAN OUT NO SCALE Cleanouts Monitor- 7 FL BURIAL DEPTH NO INSULATION 7' Cover q t841 84i 4- 7 INK, I EL 48.92 ELEV 79.16 71.s 71.6 8000 gal. septic tank 5 Ft or Septic Rock s Fr. NO BEDROCK NO GROUNDWATER NN SCALE SEAyicw 4r=k&,UZ TNBBEN SPURKLAND P.E. LRAL`L 5 BL17C'K 1 SEPTIC SYSTEM AS BUILT 203 W15th Ave 6008 W. DINOND BLVD, DATE. FEB. 15, 1996 Anchorage Ak 99501 o_ o, LEWIS R. IVERS SHEET: 313 GRID 8383 DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING & WATER MGMT WATER WELL RECORD LOuATION OF WELL BOROUGH _, _ 6U DIVISION � � -- - _ LOT BLOCK SECTION WAS SECTION TOWNSHIP LDN RANGE ❑E MERIDIAN 5 ( El 0W `+ WELL OWNER: LOCATION/SKETCH: ttlF DEPTHS MEASURED FRO casing top ❑pro and surface WELL DEPTH: 11 COMPLETION Depth of halo:_ � ft Depth of casing / —it BOREHOLE VATA: Depth Material Type and Color From To r DEPTH TO STATIC WATER LEVEL: c f —it bolowtop of casing 0 ground surface pate: _._�0 _..1 " t METHOD OF DRILLING: fair rotary ❑ cable tool `5 ❑ other _ y .f USE E OF WFLL: Kdomestic ❑ irrigation ❑ monitor ❑ public supply ❑ other CASING STICK-UP- ft. Dian): �o in. to,5�ft sa- c! Casing type: n. to ft WELL INTAKE OPENING TYPE: � opon end O screened ❑ perforated ❑ open hole Depths of openings: t0 _ ft SCREEN TYPE: Diam; _in, Slot/Mesh Size: Length ft M GRAVEL PACK TYPE: __ Volume used: Depth to top: GROUT TYPE: Volume: 4 Depth: from: to it eft y� r DEVELOPMENT METHOD: PUMPING ,.EVEL AND YIELD: it after '- hrs pumping f,� gprn PUMP INTAKE DEPTH: it Horsepower: _ Munl :7—g— Ipa III Y Uf Anchar ___ LL DISINFECTED UPON COMPLETION7 f ] YES M NO UOPL I,101I w CONTRACTOR INFORMATION: egi orod Busine s Name Ignaturo of ALJthonzee espy rose tewe Date REMARKS; PLEASE MAIL W T COPY OF LOG TO: DNRIDIVISION OF ING & WATER MGMT PO B 107005 ANCHORA ' 99510.7005 V� 1 �� <q ;p� LOT 5 1 49 p....:......................: A � i OQ� ',Thomas H. Dreyer; � `r' VO4"� LS -7625 ""�O ofes cion Ol ��OO�oda Q� O 0;� (s % L l ` \� \ LOT 4 C) \ o \ N \ O \ O 1 \ O { \ z I \ II L \ /JO \ \P� i O \ N_ W � O O 36.1_ No — 33.0' las O O 36.6 6.' Iz.' �o. S 1 Z 1 — 0 P EXISTING ° Is. o' sB' 1` HOUSE - _ _45.3 1 ss• ao 9.1 "1221", J 13.1' 0 NOTE 1. THE PROPERTY EXTENDS TO THE SECTION LINE OR TO THE TIDELANDS ' - - WHICHEVER IS LESS. -'�` �7NSIT LNE) 204.10 COMP TO SECTION LINE OF � &4- e _ 255.13 COMP TO SECTION LINE SEE NOTE I F SECHON LINE I N 89.59'00" W 150.00' \ ORDERED BY: EXCLUSION NOTES: It is the owners' responsibility to determine LEGEND: SET FN[ PAUL MICHELSOHN on y the existence of easr,-,Ants, covenants, or restrictions 5/8"RB WICAPD 5/8" RB C with MICHELSOHN &DAUGHTER INC. d which o not she recorded subdivision plot. NOTE: ri Under no circumstances es sl•ould any data hereon be used for 3.25" AL.MON. $ MONUMENT construction or for establishing properly lines. HUB & TACK p FENCE- —X— X — ffMM_ SURVEY CERTIFICATION: LANTECH has conducted o OVERHANG - physical survey of this property as shown on this WOOD DECKS - drawing and that the improvements situated there CONCRETE- _ on are Within the property lines and no encroach- ASPHALT merits exist other than noted. SEPTIC STANDPIPES -Q LAND & CONSTRUCTION SURVEYORS -PLANNERS -ENGINEERS A S E3U I L 1_ O F : LEGAL DESCRIPTION: WATER WELL - ELEV.(NO DATUM)- 100.0 440 WEST DENSON BLVD. i{ 103 ANCHORAGE, ALASKA 99503 ALAS (907) 562-5291 LOT 5, BLOCK 1, WORK ORDER NUMBER: DATE:56 SCAtE: 95-L-373BpRAWN DEC. 27, 199 INUMBE (tax) 26 SEAVIEW HEIGHTS SUBDIVISION BY CHECKED BY KED GRIP NUMBER /PAGE p00K/PAGE: TAE MD 2323 359/35&36 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW950095 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:IVERS LEWIS R & BERNICE OWNER ADDRESS:6050 W DIMOND BLVD ANCHORAGE, ALASKA 99515 PARCEL ID:01129110 LEGAL DESCRIPTION: SEAVIEW HEIGHTS SLK 1 TR 5 LOT SIZE: 75600 (SQ. FT.) NUMBER OF BEDROOMS: 6 THIS PERMIT: 6 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 5/30/95 EXPIRATION DATE: 5/30/96 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 PROVISIONS: RECEIVED B oc"Iftilmlowly4l DATE: A,lC qJ9 DATE: 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN TRACT 4 BLOCK 1 SEAVIEW HEIGHTS S/D BOB PAULSON No Ground Water or Impervious Layer to 16 ft. Use Standard Trench Soil Rating. From test 5/2/95 < 1 min/in = See Sieve Analysis Use 1.2 gal per sq.ft/day No. of Bedrooms 6 Required Area per Bedroom: 150/ 1.2 = 750 sq.ft.. Total area required: 4 x 125 = 500 sq. ft. Finish Floor Elevation 155 Ground Elevation at Absorption Field 140 Testhole Total Depth 17 Less 7 Unsuitable 10 Rock Depth Length of Trench 750 / 10 = 75 [FT.] rLn G 7 SYSTEM CONFIGURATIO N p `z - D STANDARD TRENCH (sem < z a TOTAL LENGTH 75 FT. TOTAL WIDTH 2 FT. T TOTAL DEPTH 12 FT.< sfl D z ROCK DEPT145 FT. i� C` i COVER 7 FT. o C SEPTIC TANK 2000 GAL. En z The installation of this septic system will not prevent wells fi•om be installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. Pg- l N .986 0 50 100 150 200 250 300 1 = 100 FT. i i TRACl, 6 i 5 :. i I 1 TRA C1 S RAC T 4 i i i 0 49th •� :p• TCBEN SPURKL AND •I C✓��•., No. CE-2225•,••�C=vim F• TOBBEN SPURKLAND P. E- TRACT J BLOCK I SEAVIEIY HEIGHTS SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE DATE: MAY 1, 1995 ANCH. AK. 99501 6008 W. DIMOND f-\ ,,,, � LEWIS IVERS SHEET: 1/3 GRID: 2323 25 0 25 50 75 m0 1215 1150 SCALE 1' = 66.66 FT. � s I4 150 I Well .' .. ,p0 RIVEWAY = 110 rY 120 — SECONDARY IR \ vT0thole #3 \ \ \ \ PRIMARY TRENCH \ LF \ •,: tho 75 FL LONG \ Pyr \ • . A e 5 12 FT. TOTAL DEPTH \ OA1 //4 5 FL OF SEWER ROCK '4 \ LAS \4 \1 AO / Nell � \ \•.• 4\ �w®www��1' OOF" q�gS�O • 9th � �, �;• TOAir JBN,SPUR KL AND Ar' No. CE -2225 _ Ar �C 1 Ps �holP \ \ II I �5p • % \ \ \20170 GAL SEPTIC TANK O \ \ \ \ 6p I \ I 1 PR P. BLDG I TOBBEN SPURKLAND P.E. I I 171ACT Jc BLOCK I sJ1,A1111,3T II:ICrH%S I I SEPTIC SYSTEM DESIGN I 203 W 15TH. AVENUE DATE: MAY 1, 1995 ANCH. AK. 99501 6008 W. DIMOND —, LEWIS (VERS SHEET: 2/3 GRID: 2323 0 1 Foundation Clean out 2000 gal Septic tank Double Cled n Outs OF q 4 ............ y ., Ar 19th TDVEN SPURXLAND k, ♦✓✓T No, CE -2225 ,,••� S 4♦♦f,,��>tr[ SiSi V*W*•, Mira Fi 140 5 if, t of Septic RIS PRIMARY TRENCH 75 2' Vide 1 75' L ong ]2' Deep 10 5' Sewer rock 7' Co ver I 1 4- 0 Monitor Clean Hu Clean Out REPLACEMENT TRENCH NV SCALE 2 ri-11,,114 - 2000 gal, septic tank Ground ver ik NO SCALE TEBBEN SPURKLAND P.E. TRACT S BLLICK I CAMPBELL POINT SEPTIC SYSTEM DESIGN 203 W15th Ave 6008 W,, DIMOND BLVD. DATE: MAY 6, 1995 Anchorage Ak 99501 LEVIS R, IVERS SHEET: 313 GRID: 2323 ' f l 1 � (�NGJNEER S SEAL) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Ltl.0—� c-"l� 1� �1'_S DATE PERF0RME� 7T LEGAL DESCRIPTION: _OaV-t-u.0 Township, Range, Section: ( E 1 2 3 4 5 L v1 6 7 8- 9 - SLOPE 9 SLOPE S L O P E Dale: SITE PLAN 14 r11 Reading Date Gross Net Depth to Net Time Time Water Drop 15 r 1 C a' 16 z 0 Y � 17 18 E101� 19- 20 PERCOLATION RATE TEST RUN BETWEEN COMMENTS (minutes/inch) PERC HOLE DIAMETER FT AND -- FT PERFORMED BY: CERTIFY THAT T41S TEST WAS PER Rtv1ED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4185) WAS GROUND WATER 10 - - -- ---------_�_— ENCOUNTERED? to (9 IF YES, AT WHAT 12 Q E DEPTH? J r Depth to Water After 13 G Monitoring? SLOPE S L O P E Dale: SITE PLAN 14 r11 Reading Date Gross Net Depth to Net Time Time Water Drop 15 r 1 C a' 16 z 0 Y � 17 18 E101� 19- 20 PERCOLATION RATE TEST RUN BETWEEN COMMENTS (minutes/inch) PERC HOLE DIAMETER FT AND -- FT PERFORMED BY: CERTIFY THAT T41S TEST WAS PER Rtv1ED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4185) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: L -e uu--U"� , ` _ V—e�} DATE PERFORMED LEGAL DESCRIPTIONT—'O�J- L� -U� V'1-[.�,1-'r- Township, Range, Section: D Erin (F EET 1 2 �� s ;1 3 t vl CL L/J� 4 L 5 6 7 8 9 10 11 -- 0 12 c7 CYkV if tcc. " 13 C, 19 � 14 15 9 16 f, C1 17 18I- 19 20 COMMENTS SLOPE WAS GROUND WATER ENCOUNTERED? `y S IF YES, AT WHAT L O DEPTH? P E Depth to Water Alter Monitoring? Date: SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT PERFORMED BY: I CERTIFY THAT TH S TEST WAS PERF RMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) (ENGINEERSSEAtjI, i Municipality of Anchorage r DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 .. •►� ��' ' SOILS LOG - PERCOLATION TEST "I e � qi- n N PERFORMED FOR: �"e-�0- -'L�•� •1. i,� DATE PERFORMED tic :f LEGAL DESCRIPTION: 0.✓\-2-tfrTownship, Range, Section: I I lE TY SL7 SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS WAS GROUND WATER ENCOUNTERED? 4V 0 S IF YES, AT WHAT L 0 DEPTH? p E Depth to Water After Monitoring? Date: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND -- FT PERFORMED BY: I GEF ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) K -r -H _ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 " L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST 71r. `-r c _� // _ PERFORMED FOR:-`C��.cJ-l% 'T• � L)—P�� DATE PERFORMED. . ., 1) LEGAL DESCRIPTION: ic� b �c-0.. VII'{_k —Township, Range, Section: ((F P T L1.�5 SLOPE SITE PLAN 11i1f "°` 3 4 5 6 19- 20 9 20 COMMENTS �1 v I?] WAS GROUND WATER ENCOUNTERED? -- S IF YES, AT WHAT L 0 DEPTH? P E Depth to Water After Monitoring? Date: 1 q Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST UN BETWEEN 1 FT AND /��/— FT � c �icaa<r LL. ex �t OJ f�rGt 4, c_ % l]�ra r t.v� c-e,J (-C'tCcv! — vwL�l7 PERFORMED BY: I CERTIFQ(THATT`THIS TEST F/ WAS PE RMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: — S), �`"'-� •"t 72-008 (Rev. 4/85) 9 � o 8 ,-�'C, Gr0.V�G�s� 9 10 �b c � � J 12 r � � 13 t7 0 v 14- 4 15 15 a� P 16 to-' 0 G'L WL t 17cO 18 ^, 19- 20 9 20 COMMENTS �1 v I?] WAS GROUND WATER ENCOUNTERED? -- S IF YES, AT WHAT L 0 DEPTH? P E Depth to Water After Monitoring? Date: 1 q Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST UN BETWEEN 1 FT AND /��/— FT � c �icaa<r LL. ex �t OJ f�rGt 4, c_ % l]�ra r t.v� c-e,J (-C'tCcv! — vwL�l7 PERFORMED BY: I CERTIFQ(THATT`THIS TEST F/ WAS PE RMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: — S), �`"'-� •"t 72-008 (Rev. 4/85) 6WG150.MS PHUKAN CONSULTING ENGINEERS & ASSOCIATES, INC. 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UNIFIED SOIL CLASS SYMBOL: SP AREA: Anch. COMMENTS: W. O. k: 9a694.10\7.�/. 15-c DATE: 8 -may -95 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 �� 2 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0 11— aRi- 10 HAA # IAIM�-Ct 1C Z 2) 1. GENERAL INFORMATION Complete legal description TtZAGT' 51 13.1, 'Si~AV%aV.i 141ZIL-iH7 Location (site address or directions) &0 �5_ 0 'Lez D I A40NI 12 Property ownerr-1=�t 5 ►� f V bP-'Z Js Day phone Mailing address ° by ✓ D; oma+ (� Lending agency Day phone Mailing address Agent /+nen wo'r 1?" -W 'iQL2 1_>D riDVI Day phone Address _ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: b 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 I o1j6{w etavrV'Gkk- Phone VDY-3011b Address kl FX Ze s �lEngineer's signature Date 6. DHHS SIGNATURE Approved for Disapproved. s i x bedrooms. Conditional approval for Additional Comments NUTlc bedrooms, with the following stipulations: Date 2- / — q 9 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 courtesyto 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 W21 JUL 0 if. 1999 Municipality of Anchorage MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SEPTAL SERVICES DIVISIo 4 Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: 4'auv b, 13V, k�Sra✓i-uc 1% ci alae Parcel LD.:_ A. WELL DATA Well type P, — If A, B, or C, attach ADEC letter. ADEC water system number Nh�'– Log present (Y/N) Date completed 10 '/7, - Total depth 31 A, Cased to 3 /,r Casing height (above ground) Sanitary seal (Y/N) _� Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test 1 b 1 Z• ? 5 Static water level / 7 Well production` 9. P.M. . `� - g.p.m. WATER SAMPLE RESULTS: Coliform_ / Nitrate1D Other bacteria Date of sample: �o�,S l `! F% Collected by: ~d _ B. SEPTIC/HOLDING TANK DATA Date installed ! I�1 ?_ Tank size o2Ots�0 Number of Compartments PZ Cleanouts (Y/N)__�Z_ Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) r Date of Pumping Pumper Av4e 4 . Zed- Poo / C. ABSORPTION FIE/•LD DATA Date installed � o/ L `/ - _ Soil rating (g.p.d./ft2 or ftz/bdrm) 1. Z _ System type / /LtvL C -fir Length %5 Width Gravel thickness below pipe h _ Total depth /„ Z Effective absorption area /� `1 /U Monitoring Tube present (Y/N)1 — Depression over field (YM) 1'14 Date of adequacy test./�7! �1 "� Results (Pass/Fail)- P For _ b bedrooms Fluid depth in ab/sorption field before test (in.); Immediately after gal. water added (in.): Fluid depth aLra (ins) Minutes later: Absorption rate =. >' 9&0 g.p.d. Peroxide treatment (past 12 months) (YM) If yes, give date ti _ 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) _ High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES Size in gallons on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off" level at* Septic/holding tank on lot �!'0 U On adjacent lots % % U Absorption field on lot /� On adjacent lots Public sewer main 1Y/A Public sewer manhole/cleanout Sewer /septic service line 7 1Z5 Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation I b 25 Property line ht 0 Absorption field Water main/service line 1W Surface water/drainage lqilO Wells on adjacent lots o C) SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line d Building foundation lb 7 Water main/service line /6-3 Surface water N n Driveway, parking/vehicle storage area 10 Curtain drain %410 Wells on adjacent lots 7 F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in eff ct on this date. Signature f Engineer's Name I �a la e �i �p v V. 1c i u �c e'er Date &iiIa2s-/ `T9 HAA Fee $ lt�" ' Waiver Fee $ Date of Payment /� / Date of Payment Receipt Numbeie5? Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services ig 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 l.D.# _o«^ �2q!^ (`� HAA#-1�1�i1� l✓�=' l I. GENERAL INFORMATION Complete legal description k l ( S 1 1 Vi IF IR t 61t+'is Location (site address or directions) 6d tz' 7)i�wZ1 Property owner (-S, L j� 0(i; S Day phone Mailing address � V_" - fDIi-z0/'I () Lending agency Mailing address. Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. MUNICIPALITY OF ANCHURAGE 2. NUMBER OF BEDROOMS: ENVIRONMENTAL SERVICES DIVISION 3. TYPE OF WATER SUPPLY: FE r, 15 1996 Individual well Community well RECEIVED Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1191) Front MOA 921 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. Alnm� of Girm ► lA.L ,&, u c�c _?_ F_:_Phone �--_ g - M l ,f' Address g_0 / 1 t �� 71 Engineer's signature Date 6. "IHS SIGNATUR" _ Approved f Disapproved. 1� -.— hedrooms. Conditional approval for Additional Comments bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Heaan Hutnonry 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 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. 72-025 (Aev. 1/91) Back MOA #21 MUNICIPALITY OF ANCHUPAUr Municipality of Anchorage ENVIRONMENTAL SERVICES DIVISIO DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 1 -TI -3 15 1996 825"L" Street, Room 502 * Anchorage, Alaska 99501 • (907) 343-4744 D Health Authority Approval Checklist Legal Description: Parcel I.D.: A. WELL DATA Well type I `, If A, B. or C. attach ADEC letter. ADEC water system number N114 - Log lLog present (YIN) y Date completed /6 ./ Z - q J Total depth I /�—Cased to ��� I Casing height (above ground) I Sanitary seal (Y/N) �/ _ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test j 6'% 2' q s Static water level ` 7 Well production _ g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform Z� Nitrate D Other bacteria Date or sample: I 0 9 / 8 4 ra Collected by: (s a B. SEPTIC/HOLDINGTANK DATA Date installed 1#124)15- . Tank size o�00-V Number of Compartments Cleanouts (Y/N) Foundation cleanout (YIN) _ Depression (Y/N) N High water alarm (Y/N) 'IH Date of Pumping in g _�_ Pumper _% C. ABSORPTION FIELD DATA Date installed tb 9 _ Soil rating (g.p.d.V or felbdrm) /, �- _ System type _� r? Length -71) t Width Gravel thickness below pipe s Total depth 'a' Effective absorption area'7670 Monitoring Tube present(Y/N)—Y-- Depression over field (YIN) Date of adequacy test N Results (Pass/Fail) !" For 0- bedrooms Fluid depth in absorption field before test (in.); r It unediately after= gal. water added (in.): ' Fluid depth (ins.) Minutes later: Absorption rate = _ Peroxide treatment (past 12 months) (Y" If yes, give date g.p.d. D. LIFT STATION Date installed Manhole/Access (Y/N) Iq 01\1 � High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off' level al* f� Septic/holding tank on lot ,1 61).0 ; On adjacent lots �> / 0 i 6-0 r Absorption field on lot l (P 3 ; On adjacent lots 7 / Public sewer main nl t1 Public sewer manhole/cleanout No 4 r � Sewer /septic service line Lift station B o 2_ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: �I Building foundation (o -b Property line Absorption field 6 Water main/service line 16.0 Surface water/drainage 1%y vt L Wells on adjacent lots 1� Z4::00 0 / SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation qq ,, /&I Water main/service line 1� Surface water l d K Driveway, parking/vehicle storage area © I 1 / Curtain drain Wells on adjacent lots a G'O Property line _ !� F. ENGINEER'S CERTIFICATION 1 certify that I have determined thru field inspections and review of Municipal records thq&th d4o e sV tuns are in conformance with kfOA HELI guidelines in ect on this date. Signature �= ' Engineer's Name o �eH �PLY�1,l�LR lt.� En 'ie r _ x „ Date �,��? i6 HAA Fee $ Date of Payt Receipt Nur Rev. 8/95 OSS: liaa.wk.doc Waiver Fee $ Date of Payment Receipt Number JUN -30-99 08:26 FROM-C`c ENVIRONMENTAL 15301 T-302 P.06/07 F -T50 CME Environmental Services Inc. Laboratory Division � �avert�s l���s�.� tat►► . �� '�•��►�'� '���•rr .rr� Drinking Water Analysis Report for Total Coliforn RiF,4,9 TNSfRT7C'TIO!VS ON aKERSE SIA46.EFORE COLLECTING v T B^ E o PIETBD BY w.�YET SV'PPI I E R ❑ PUBLIC "A—UR SYSTEM I'D. 4 PRIVATE WATER SYSTFK, l u Send RGSHI15 ❑ Send Invarce a� . '.1 nn ay.rcm '✓ua�um{u';y ti.,m - �a.m �unl7•i nmrc •,•—_-L Q is-n;t Resides -_-- Lf— u Send lnvoice l omP+l'S''�vnc SAMPLE DATE. ICS Month SAMPLE TYPE ❑ Routine o Retreat Sample (for routilte samPie with lab ref. no. _ J 0 Special Purpone SAMPLE LDC -.TION C�rnments L -] Rw Day TTaIr- o Treated Water G Untreated Water 'rime Collected Collected By FXebc t'lln� 200 W Putter Drive 1 Bacteria,,, Ancncifuge, ,4K M18.1605 lel (907) 562-2343 SAMPLE Fax 1907) 561-5301 TO BE COMPUTED SY LABOR.-%TOKt Analysis shows this 'Water SAMPLE ;o be. Satisfactory ❑ t."nsatlsfdctory ❑ Sample OVQr 30 hours old, results may be unreliable ❑ Sample too long m IransiL sample should Itat be over 48 hours old at examination to indicate reliable results Please send new sample via special delivery mail. Date Received Time Received Analysis BCgan 50 AnalytIV41 Method: 7Membmne filter \1 4mbcx-ofr-alan"- �o ml. ftesuiV Anal).,t 593014 ,...o f:1bCo IDdle� - _-- _ Tame Client notified of unsatisfactory results: Phoned Spoke with Faieit Dale'. Time, BACTF,RJ WGICAf WATF-It ANALYSIS RE( ORD iCa MGG Result: 'Dotal l oaform _ C_ E. Cah vRemprane Filter Dfrect Count � � Colonies ]n0 ml Verification: LTP 15G13 CQt1Flk1s1_�� � lN7C=r..o..:,, Fecal Coliform Confirmation— Final vtembrane Filter Ke, `ifs L' `� C / �Coliform7100 mi Reported By Date - 77 a� t Time _I — � —_, hra i76 - o m., au,;.. 'I Member of the SOS Group l5ocT616 (3en0ralr? da $urvN;llancy) _ ENVIRONMENTAL F,4CIl.ITIE5 IN ALASKA. CAI_ t, ,. #IA. FLORIDA. IELINDIS. MARYLAND. MICHIGAN. MISSGUPI. NEW JERSEY. Otlia- WEST V'RGIp JUN -30-09 08:24 FROM -CTE ENVIRONMEN, AL AIL CT&i= FEnvironmental Services Inc. VimAW"� AVJWAV P'W. .rs.�wn CT&E Ref .# Client Name Project Name/# Cliei Sample M Matrix Ordered B3 VWSIU Rumarks, Parameter 993014002 Tobben Spuskland P.C. N/A Lewis Ivers Drinking Water 15301 T-302 P.03/07 F-750 Client 110# Pre -Paid ColisJN03 Printed Vate/Tine 06/29/99 17:03 Collected Date/fine 06/'.x.5/99 08:00 Received Date/Time 06/25/99 09:20 Technical Director: Stephen C. I✓de Results PIL ALtoKdbte Prep Analysia Uni is Method xlml i5 Date Date If)it total Coliform 6 08/100 ML, NO COLI SM18 92225 Nitrate -N 0.500 u 0.500 reg/L EPA 300.0 10 max 06/25/99 06izJ/95i scl CT&E Environmental Services Inc. Laboratory Division �rws��irs®o.�srsssier.��®.�e'.�a�.r�®:��®•��.,�a.�a��®������.at�� CT&E Ref.# 96.0112-1 Laboratory Analysis Report Matrix WATER Client Sample ID SEAVIEW TRACT 5 Client Name TOBBEN SPURKLAND, P.E. WORK Order 20593 Allowable Ordered By Printed Date 01/12/96 Q 16:16 hrs. Project Name Collected Date 01/09/96 Q 14:30 hrs. Project# Received Date 01/09/96 C 16:00 hrs. PWSID UA 10 01/11/96 MCE Technical Director STEPHEN C. EDE Released By�.<---�__�"�-� Sample Remarks: SAMPLE COLLECTED BY: T.S. QC Allowable Ext. Anal Parameter Results Qual ------------------------------------------------------------------------------------------------------------------- Units Method Limits Date Date Init Nitrate-N 0.10 U mg/L EPA 300.0 ION 10 01/11/96 MCE See Special Instructions Above UA = Unavailable •� See Sample Remarks Above _ NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than 200 W. Potter Drive, Anchorage, AK 99518.1605 — Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS. MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA CT&E Environmental Services Inc. 4AL Laboratory Division Drinking Water Analysis Report for Total Coliform Bacteria 200 W. Potter Drive Anchorage, AK 99518-1605 READ INSTRUCTIONS ON REVERSESIDE BEFORE COLLECTING SAtbIPLE Tel (907) 562-2343 Fax: (907) 561-5301 MUST BE CON[PLETED BY NATER SUPPLIER TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTENI I.D. 9 Analysis shows this Water SANIPLE to be: l PRIVATE WATER SYSTEM Z' Satisfactory /// "` ❑ U t; f ctory ❑ Send Results ❑ Send Invoice 0. aver sys'em Name Company Name C oNact more Number um er � a\ � wn er �lahny Address Time: Cny Sime zip Code nsa Is a ❑ Sample over 30 hours old, results may be unreliable ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable resu Is. Please send new sample via specia de every mail. Date Received 0/0 Time Received �-Jr O ❑ Send Results ❑ Sendlnvoiee Analysis Began / / �J m 0- Compy .\]me Comae name %Wmg Address jl]l CiR i Lip Code SAMPLE DATE: m ® E 2 Month Day Year SAMPLE TYPE: ❑ Routine ❑ Treated Water Repeat Sample (for routine sample Untreated Water \%ith lab ref. no. ) ❑ Special Purpose SAMPLE LOCATION CSL � .S�a✓,� �i�c')lc�- Comments: Time Collected Q-� Collected I3y Please Print Analytical Method: Membrane Filter ❑ NEMO-MUG * Number of colonies/[ 00 ml. Lab Ref. No. Result* Analyst Lr 0 °V Sent to A.D.E.C. Ynclr Fbks Jun ❑ Faxed Date: aa_ Time: Client notified of unsatisfactory results: ❑ ❑ Phoned Spoke with Faxed Date: Time. BACTERIOLOGICAL WATER ANALYSIS RECORD -NINIO-MUG Result: Total Coliform Membrane Filter: Direct Count Verification: LTB BGB Fecal Coliform Confirmation Final Membrane FilteresoI s e Reported By Date 2 E. Coli Colonies/100 ml CO L I F I RM T.VTC = Tun ,\5rmerous Tn Count -Coliform/100 ml Time y hrs Oil = Other /Jucreriu ' SGS Member of the SGS Group (Soci6t6 Gdndrale de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA FLORIDA, ILLINOIS, MARYLAND, MICHIGAN. MISSOURI NEW JERSEY, OHIO, WEST VIRGINIA