HomeMy WebLinkAboutSCIMITAR #1 BLK 2 LT 19f\",V, D%h.
4cfl6l —
to, ifirb Drilling log
DOC Co. dba
SULLIVAN WATER `YELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 686.2759
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION i r t t
DATE - Started Ended 11f/ € `f'
PERMIT NUMBER _-
DEPTH OF DELL
STAT ( LEVEL OF WATER I.- T-
DRAW DOWN FT. --
GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
FromFt.
,t
to -_
I t f `'
,: <; f�
From.
Ft.
to---
Ft.
From.. 4
Ft. to i
Ft. . Ll�t<'_
_r,_�<4'
From
Ft.
to--
Ft. _
From
Ft. to I
Ft. . i
From
Ft.
to
Ft.
From ! '
Ft. to
Ft. `; r , }
. Ifr ' rs:, i
From
Ft.
to—Ft.
From
Ft. to
s;
Ft.—`
From
Ft.
to--
Ft
From_. .'
Ft. to ''i
Ft.�'j
From .r_
Ft.
to_
Ft.
From
to 'I/
Ft. . it? 1 i
: -,x.,1:1
From
Ft,
_
_Ft.
to
Ft.
Fromm
Ft. to , •
Ft. .' I %. 1 / -f
"r ' - t !{:r r_,
From
Ft.
to
Ft.
From
Ft. to
Ft. f i Fit
=. si.
From
Ft.
to
Ft.
From
Ft. to
Ft ; i.
, r PO to r ', ..!,-:
From
Ft.
to
Ft.
From
Ft. to
Ft.
_ -%= ` ' t'
Froin
Ft.
to
Ft. i
From ?
Ft. to : -' I ;/
Ft
From
-Ft.
to_
Ft
'
From
Ft. toil
Ft.f '
.tr
From ----Ft.
to_IJGi►IQflALILLOF ANCHORAC
From
Ft. to "'
Ft. I
"-
From_.
Ft.
DEPT. OF HEAL FW-- —
to_—_Et VIRFWMENTAL PROTECTION
From
Ft. to
Ft.
From
Ft.
to
Ftr_,� O
�
From
Ft. to
Ft.
From
Pt.
to_
_. ,
Ft.
From
Ft. to
Ft.
From
Ft.
to-_
��
MISCL. INFORMATION
DRILLER'S NAME
Depar�:ent c< Hezlih & Huaan Services
8�b L Street, Anchora�e, A1aska 995�1 �43-47�0
�u� L��a�: Suhd/vis�o�: S�IMITAR �i i'ot: 19 81ock: 2
�ecti�n� !� T�wnship� 15!� Rangc: l�
i^,xe��/rons: �h�s Permit: 0 loial Capacity: 2
Iv;unici1ity o� �\:d�orage
�.�'� |/yuo ��rv�ces w�Li�in 3� days of wel� comp1ei�on
Uay Phonp;
�i���NL|� iiU�� UF S]!�0 OUTSlVE TH|1�V F7. FRU|ECr1�E �A���US
,|/UU �NY WAS[EWATER ()]SPOSAL SYSTEM. A CO[Y OF lHE WELL LOG ML/ST
0|�U�M�| lED /U DH|<S Wl|HI� 3� UAYS AF[ER T||E WELL COMPLETION.
October 29, 1990
ROBERTS HAFER, P.E.
ROGERSHAFER
CIVILENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS Municipatity o6 Anchonage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Stkeet
P.O. Box 196650
SEWER &WATER Anchonage, Akaska 99519-6650
MAIN EXTENSIONS
REFERENCE: Lot 19; Btock 2; Scimitar No.1
PERMIT REQUEST NARRATIVE
SEWER &WATER + pp pp ./-
INSPECTION Requut you 23eue a permit to daitt a weft on the ne4eneneed property
a,6 .6hown on .the attached site plan.
We pen6o)uned a $how -teat on the existing we2C on October 10, 1990 and
ENGINEERING STUDIES bound .the wete to produce onty 7 ga2.2ou pen hour. TheneUone, a new
AND REPORTS weft i,6 to be dnitted in .6eaneh ob an adequate quantity os water ,to
serve .t 2 bedroom home toeated on .the pnopenty.
f
Siniceret ,
WELL INSPECTION /
&FLOW TEST
BERT A. SHAFER, P. E.
SITE PLANS � _ 15 j gm
_/
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
M
Q
4-7
�7n
'6
�
vr�
41
Y
,
M
Q
4-7
�7n
C4
OO
Z
V5
<
L"A;
Q
V)
X
< <
INS
N
<
Ln:
co
zX
< 0:)
<
ay .
U.] I
>
CC
®
WX
V) 0
09
®
LLI
FL
LL
0
app
I-
14
C4
OO
Z
V5
<
L"A;
< <
INS
Ln:
an
zX
< u
SWIM
ay .
U.] I
>
CC
®
WX
V) 0
09
®
LLI
FL
LL
0
app
I-
14
0
C4
OO
Z
V5
L"A;
Ln:
i-lj
ay .
u
14
0
!4
0
R
0
0:
u
0:
W:
4-1
v):
4-4:
OR
�4:
U:
O p,
(0:
H:
0
L.O:l
0:
U:
u):
H:
Ni
?-4:
r2;
1:4
L)
O V
�:
U
4-):
U
�:
C4
OO
Z
V5
Ln:
u
14
0
!4
0
R
0
u
0:
W:
4-1
�4:
0:
U:
u):
H:
Ni
?-4:
r2;
?4:
�:
U
4-):
U
�:
U
�:
ro:
.P:
W.
-P:
0
0:
0
4J:
cl):
4-):
0
U:
co:
U::
i -j
(0::
U:
�i
-P;
U:
i4
M:
rd
ro:
rd
?4:
d
ro:
0:
R4:
co:
�-4:
Fil
w:
Q
0.
Z
PQ
C4
LL
Z
V)
un
W_
Ii.
U.
W..
w
Lr.
LL
M:
ol
co:
61
1—:
Cl
C4
OO
Z
V5
u
14
0
0
R
0
u
0:
�4:
H:
Ni
?-4:
r2;
?4:
�:
U
4-):
U
�:
U
�:
u
.P:
-P:
0
U:
0
4J:
0
4-):
0
U:
�
U::
i -j
(0::
U:
�i
U:
i4
M:
rd
ro:
rd
?4:
d
ro:
d
�-4:
Fil
w:
rJ4:
PQ
W_
Ii.
U.
W..
w
Lr.
LL
M:
ol
co:
61
1—:
Cl
co:
0.
0:
11.
N
1—:
co
cc):
oq
0
0
0
Ln;
Gi
M
a):
co
N
N
(q
Ln::
rico
0:
1- :
cc):
cc
;V-
00000000000
W
C4
fX
ce
w
C4
W
C&
C4
W
u
0
0
U:
M
U
(1):
x
iA:
ry,
1-I:
ro
0
C)
�:
U
�:
U
�:
s4:
0,
rd
�-i
0
-P .:
4J::
Cj
4-)�:
M
14
rd
-P�
U:
>-i
U:
N
U:
>
U)
0
Q3.
U:
-d
rom:
rd
(1):
rd
ro:o
�
f:q
w
11
�,
0).
?-I:
r,,:
cq
44
:q
rj,:
a1
w:
U.
U.
rn
L1
cc)::
r
r:
r4
CN.
0-):
0:
W.
o
1�
QQ
r-:
cy):
M.
IZT:
zl?
0:
m
CL
CL
W
C4
W
M
C4
CL
C4
CG
W
W.
LL,
W.
La.
w
L"
ww
GRE'ER �'ER ANCHORAGE AREA HO" _'UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM _
��-' rA% / C, - /a i._ (__
NAME: " MAILING ADDRESS PHONE
r/L. J: -S ��°_-d7-
LEGAL /1 L/Loeie Je_;r7
LOCATION I' DESCRIPTION /'
SEPTIC TANK:
lee_, :r 2u2
DISTANCE NUMBER OF
FROM WELL JOD MANUFACTURER fin' -tit MATERIAL 7Z t COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY 7o, z) GALLONS.
SEEPAGE PIT:
NUMBER OF PITS DIAMETER OR WIDTH / LENGTH ��DEPTH
LINING MATERIAL CRIB SIZE: DIAMETER
_DEPTH DISTANCE FROM: WELL
TOTAL EFFECTIVE
BUILDING FOUNDATION / NEAREST LOT LINE `ZP J1 ABSORPTION -AREA (WALL AREA) SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE 12�- CONSTRUCTION
BUILDING J/- NEAREST /+ NEAREST
FOUNDATION 16) LOT LINE SEWER LINE
CESSPOOL OTHER SOURCES
J
DEPTH Ouc-"'-l`r DISTANCE FROM:
SEPTIC / /- SEEPAGE
TANK �d-� SYSTEM
APPROVED DISAPPROVED REMARKS W&L4--
DISTANCES: �'y S�`� /� J DIAGRAM CIFSYSTEM"
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARKS: Ale) P/'_ L7 / t- 6/yt--A%
�O/L Yom[' 6' j JCnI Ur' C?✓�; i3
Form No. EQ -031
WT
F
! z
If
,� F �'
R r L' ,f A •' 9
DATE L /F.' - %<.1 APPROVED zx&L
G.A.A. B.
NAT SUr Rnoty r Annyorago, AIMS0 45" 00 29tho7f,
Wil Nil? nd out to 270 On -W
DKINd at thn rUn of $0,50 Pon Wat,
f-' Clot �'-- P Tn(-�-r , -N��'jjju Hall 753-0361 T-6627 !I-Acat st, ryannio,
Tocationof -all Was It, RV<
')o
Miller; 9=10 (;longi, of -�7—?7d
poll Ts"S
0-----231 NOW! "Ath sevoQ SMI boW&or&,
23-010 -11(-J. a 10% clay WW,
`14. -'--'801 ('-,
7.�'avol- And cohl" ""T SUMO MOP horrin Vinn gpavol frnm 64 !-
It
It Shownd
aboirl
SUIT NO
a ?0 font he7q in rn, hour,
in ty, nn"I to Como
The cost
for
this
80-1641
,,, t, $19h,01 Damao!,
mill pa7
qr-YGI, tion{; into bedrock No Uson of
UK
char(,P, -'Ye Cn"? )IN
j"SUN thn customer Payton this cpsQ
vatn-'
in thF material
or to, of
bedrock,,
W -270f
B0000c4
Somo Qx=
of Won at 265 to 268 font, I fo,t of "Panulir-
rook Pvod"01% On& a W For wln"Q� Thr wql) Fbcyld impVoyn cowidgPohity vqtj)
use, YAW rOcOvell ShOUN he Whin 40 feet of smurnag uity 35M prOnendc
St" W" MOW and purfevatUr was hired to porforntn the 0-07 from Of
72 fooK
This
wi-
to slo" aTj twq -stn-
in ty, nn"I to Como
The cost
for
this
lyrfoppti-7 spr,,,
,,, t, $19h,01 Damao!,
mill pa7
for
UK
char(,P, -'Ye Cn"? )IN
j"SUN thn customer Payton this cpsQ
An Of MY 30th . 1975 M7 h,F Wen ;,old Tnu in fnij by Mr, Trn% 011
Tots] RIP! ups jhqq5pi
Think you new Mucl,
NICK Was of Rampart Nvlllinn•
GREATER ANCHORAGE AREA BOROUGH
O�
DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO
Y 4 3330 "C" STREET ANCHORAGE, ALASKA 99503
II )J�f TELEPHONE 274-4561
e'
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
NAME OF APPLICANT , 1 MAILING ADDRESS__ 9 % . (c)I PHONE
INSTALLATION LOCATION
LEGAL DESCRIPTION
INSTALLATION OF: SEPTIC TANK "� SEEPAGE PIT �P DRAIN FIELD OTHER ,
TYPE AND SIZE OF FACILITY TO BE SERVED �.�G- J7 y4.�� ��✓
FINANCED THROUGH TO BE INSTALLED BY
SOIL TEST RESULTS
COMPLETION DATE ANTICIPATED
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TESY
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE - TYPE SEEPAGE �F3EA SIZE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
%)
FOUNDATION TO SEEPAGE PIT DRAIN DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL 1`-5
SEPTIC TANK SEEPAGE PIT_, DRAIN FIELD
TO NEAREST LOT LINE. /
WELL TO SEPTIC TANK / ! // .) C) / SEEPAGE PIT
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK _. SEEPAGE PIT _
DRAIN FIELD //`
SEPTIC TANK, / 4")b/) r SEEPAGE PIT DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BUG
ORQH\ REGULATIONS REGARDING INSTALLATION.
51Z_
/ G.A.A.B.
OR
LICENSED DESIGNER
TYPE
DIAGRAM OF SYSTEM
i
I
I
I
i
�
i
I
I
I
j
I
'
i
I
1 i
--
—.-I-
j t
j I
I I
---�--
1
I i ( I
—
_
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE, �_-�-
i
DATE ���/� 7 APPLICANT'S SIGNATURE
I
I
I
j
I
'
I
--
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE, �_-�-
i
DATE ���/� 7 APPLICANT'S SIGNATURE
,i-2i4-4� a 4,1A11 -D
X - W/ N v %Kyr CJ
0 Et E GEOTECHNICAL Et DEVELOPMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
694-2774
Soils Fr Foundations
Earl Ellis
688-2280
Land Development
SOIL LOG
Performed for: Name: 44-:-'2.yic= 4 e, Tel . No.
Mailing Address:
Legal Description: Z07- i I , OC/<,
Depth(feet).Soil haracteristics���
0
rte,
3
4
7
8
9
10�
11
12
Ground Water Encountered: Yes No I--- _ If yes, what depth„,,,_
Proposed Installation: Seepage Pit Drain Field
Comments: /VIO ,gvA?cae� a/L (55�Aeac)IvO T;W4�,6
T:
Performed by: /'Date:.�T7�— '
MUNICIPALITY OF ANCHORAGE
• �� Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICE'S1
343-4744
CER'T'IFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # C) '�) ) - I _'_) _�'- Q_HAA #
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 19; Bock 2; Scirnitan #1
Location (address or directions)
19945 T
(b) Property ownerye)cex Aaaunamce Telephone : (home) Business
Mailing Address Box 7066, Madison, Wisconsin 53707
(c) Lending Institution
Mailing Address
Telephone
(d) Real Estate Company and Agent Pk R n au - WU,tneylone<s
Address 3333 Denafi, AnohoLaqe, Ak
Telephone
276-3333
(e) Mail the HAA to the following address: (or check here I$lO hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING
7034 Eagle River I OOP Road No. 904
Cagle River, Alaska 99977
2. TYPE OF RESIDENCE
Single -Family Number of bedrooms 2
3. WATER SUPPLY
Individual Well t< Community ❑ Public ❑
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-siteZk Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty 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 FirmTelephone
5< :I ..d R .idv
Address 1T034 Eagle River LOOP "load No, 20
age rver, ,rasa . a .-
Date 12�
engin Er s eal`
q
A'sS.
6. DHHS APPROVAL
/G
Approved for bedrooms b" "' "`""" Date
Approved - Disapproved Conditional _
Terms of Conditional Approval
CAUTIO -
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 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. 7/88) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE
• '� Department of Health & Human Services
_T DIVISION OF ENVIRONMENTAL SERVICES �}1
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel LD. If HAA
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 19, 82ock 2, Sc.imitan #1
Location (address or directions)
LJ_ Tutwan
(b) Property owner Ve).ex Ahsunamce
Mailing Address Box. 7066
(c) Lending Institution
Mailing Address
Telephone: (home) _ Business
Madison Wisconsin 53707
Telephone
(d) Real Estate Company and Agent Exbet2 Reaetona- Whitney Jones
Address 3333 Venati, Anchorage, Afz
Telephone
276-333
(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
17934 Eagle R14xr_oa(Z$II1�A
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single-Family,fi<7 Number of bedrooms 2
3. WATER SUPPLY
Individual Well 6 Community ❑ Public ❑
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 & Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty 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 170_'4 ac,iu ':'.Iver Loop toad No. 204
Date
Eagle River, Maska 99577
6. DHHS APPROVAL
Approved for
Approved
bedrooms by Date
. Disapproved ___7X Conditional
/�Te�rms of Conditional Approval
beer 4 cl
6t TMS��tey PW "rEl2e// GC7Z
�-7-e es
ry
r0wle. IOAIVI ae' i-
or7 //o�ei�c✓.C���B���Q7Q�7�
eav'!a/ �iay�
A La T le.
Vie_ JjwaAce ,
C /4/9/,9D
CAUTIO4
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 irid ependent 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. 7/88) Back Page 2 of 2
IvVNICIPALITY OF ANCHORAGE (MOA)
• \1\5\9 Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
0F �v � Legal Description:
A. WELL DATA a /
Well Classification If A, B, C, D.E.C. Approved (Y/N)
Well Log Presentd:YYN) _ _ Date Completed L� `� Yield 61 V1 _
Total Depth�700I Cased to2l_�) Depth of Grouting
Static Water Levely al —,J Pump Set At
�I
Casing Height Above Ground i� -+ Sanitary Seal on Casing(�PN) _
Electrical Wiring in ConduitV/N) ` Depression Around Wellhead (Y&P _
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot (oma ; On Adjoining Lots (`- _
t
To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots `=U(
To Nearest Public Sewer Line P-� A, To Ngarest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot llz� `t
Water Sample Collected by/' t�v (��t_ ; Date �1� -qo
Water Sample Test Results (-� 6E.-e'
Comments'__ C%X tCsrlrJG� 1eJ�rLt� Ct�lre�t-� \, 1 ��j 8�j
���� ��B. SEPTIC/HOLDING TANK DATA
Date Installed - ti3'1'5 Size )Ic;� No. of Compartments
Standpipes/N) — _Air -tight CapsgY'N) Foundati n Cleanout(LWN)
Depression over Tank (YCp _ r Date Last Pumped
Pumping/Maintenance Contact on File (Y/N) ; for
Holding Tank High -Water Alarm (Y/N) A Temporary Holding Tank Permit (Y/N) P
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well 'Gt To Building Foundation
To Property Line ot4- To Disposal Field _ ti "�A )
To Water Main/Service Line
To Stream, Poonnd,`Lake
\or Major Drainage Course / 1 00' J -
Comments�� 'V dip, -S>` ��I r�� �i�t-1�1r
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata S %1.ylvr-
'Ipe of System DesignG"�
Date Installed f �' -1 Length of Field _ 12
Width of Field
_Z_
Depth of Field
SOB* A<,,Ljet�ravel Bed Thickness (o T: f� *r 3,5 f.ffGr�r}v's
Square Feet of Absortion Area l(,ea Statndpipes Presentq�Y?N) ^ /
Depression over Field (Y/Np ra Date of Last Adequacy Test
Results of Last Adequacy Test fa;. Ir�
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well 1 t�r� I To Property Line
To Building Foundation ZS = To Existing or Abandoned System on
Lot _ (A ; On Adjoining Lots > I
^ —
To Water Main/Service Line I � 4 -To Cutback (if present) /J
To Stream, Pond, Lake, or Major Drainage Course . )
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date tailed
Size in Gallon
"Pump On" Level at _
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
-f-
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 guidelines in effect on the date of this
inspection.
Signed_
Company
-:'-;E '°��r
AIwska99577
N
Date
/Z�5
��c
neak v
MOA No.
C I'�
Receipt No. _,-
��
Date of Payment - 5
Amount: $ / 7 (� - C� c)
Receipt No.
Waiver Fee: $
Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
4LAOORATO��..
e�.,,DFPj,p
Ht
V
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ,& A p
5633 B STREET • ANCHORAGE, ALASKA 99518 • TELEPHONE (907) 562-2343
FEDERAL TAX LD. #92-0040440
ANALYSIS REPORT BY SAMPLE fox Work Order # 30471
Date Report Printed: DEC 3 90 @ 10:33
Client Sample ID:L19 B2 SCIMITAR 41
PWSID :UA
Collected NOV 29 90 @ 15:30 hre.
Received NOV 29 90 @ 16:55 hrs.
Preserved with :AS REQUIRED
Analysis Completed :NOV 30 90
Laboratory Supervisor :STEPHEN C. EDE
Released By :—��%<-':`
.........................................................................
Special
Instruct:
Chemlab Ref #: 905035 Lab Smpl ID: 1
Parameter Tested
--------------------------------------------
NITRATE-N
Sample ROUTINE SAMPLE.
Remarks: SAMPLE COLLECTED BY RAY.
Matxix: WATER
Result Units
-----------------------------
0.49 mg/l
Client Name S & S ENGINEERING
Client Acct SNSENGP
P.O.# NONE RECEIVED
Req #
Ordered By : R. SHAFER
Send Reports to:
1)S & S ENGINEERING
2)
Allowable
Method Limits
-----------------------------
EPA 353.2 10
1
Tests Performed
Sae
.... .... .,.................
Special Instructions Above UA -Unavailable
ND-
None Detected
See
Sample Remarks Above
NA=
Not Analyzed
LT -Less
Than, GT -Greater Than
ii .__:. -'.., _ `; ,' . � — �i
i
TEI_EPHO"`-
A
O�'ronieo
�
uuso�
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER j
❑ PUBLIC WATER SYSTEM I.D.# E I
aT-PRIVATE WATER SYSTEM
Name
.-`.cue No.
90.5035 ' -
v^EEI
M —S yA
Mailing AAW
Eagle F:ivcr, rlar:ka 99577
E — —
City
Statee Zip Code
f
SAMPLE DATE:
1��17 1 '–= -
Mo.
Day Year
SAMPLE TYPE:
6–Routine
❑ Check Sample (for routine sample
with lab ref. no. ) ❑ Treated Water
❑ Special Purpose ❑ Untreated Water
SAMPLE Time Collected
NO. LOCATION Collected By
r5 t–oLV— 331
2
K
m
5
TO BE COMPLETED BY LABORATORY
An.alv-Qis shows this Water SAMPLE to be:
Satisfactory
Unsatisfactory
L Sar l_• e tc•o long in transit; sample Should
not be over 30 hours old at examination
to indicate reliable results. Please send
nev,, sample via special delivery mail.
€ I//�c
f Date 11L-'JV0d i
.I liilc i -'%c ,, r
Analytical P',ethod: Membrane Filter
* No. of colonies/100 ml.
Lab Ref. No.
Result* Annaallyyst,
90.5035 ' -
v^EEI
M —S yA
—_
L J
E — —
A.D.f=_:
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS Membrane Filter: Direct Count CD
BEFORE Verification: LTB
Ilform1100 ml
COLLECTING SAMPLE Final Membrane Filter Results --Coliform/100 ml
—e' . �}— _ Date o
Reported BY ;... _ � �—� I I � Time: _ �' _ a.m.
p.m.
TNTC = Too Numberous To Count
0B = Other Bacteria PART ONE GF TI -10
iy)LI-VONDER 10 FOLLO'ti.
MUNICIPALITY OF ANCHORAGE Domuils,
Department of Health & Human ServicesDIVISION 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)
Location (address or directions)
(b) Property owner `-4Qice' /c/IA� 4 Telephone: (home) _ Business
Mailing Address Z01 �' Ti" _ ci ',TG hCiS Y1 � h' r� ✓, �icJSG
(c) Lending Institution N,04 Telephone
Mailing Address _N/rI
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single -Family Number of bedrooms
3. WATER SUPPLY
Individual Well N' Community ❑ Public ❑
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 -situ] Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7188) 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 regul ioj} s,_in., effect on the date of this inspection.
Name of Firm ��n� ' Telephone `
Address
Date
7, l Cf&
ngineer's Seal
6. DHHS APPROVAL
Approved for 2 bedrooms by{� Date 3
Approved _Disapproved Conditional
Terms of Conditional Approval
1 _CAU.TId( ;
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 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. 7/88) Back Page 2 of 2
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
''• ; Hea"h Authority Approval (HAA)
INvir, r5r.(;vicFs�il LIST-FE_BRUARY1984
343-4744
VC�
Legal Description:._%_7- c' _
1447 r l� CI'm,
Well Classification PCuA-4- If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N)_Date Completed/ ` 8' _ Yield '�
Total Depth- 040' Cased to 3' Depth of Grouting Al 1A
Static Water Level
Casing Height Above Ground_
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot ;-/00
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N) u
On Adjoining Lots �/CZ r
To Nearest Edge of Absorption Field on Lot - �� ; On Adjoining Lots %r�J
To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole_
- To Nearest Sewer Service Line on Lot r
Water Sample Collected by JE42 ' �,/c'.L S� ;Date
Water Sample Test Results
Comments
c
SSGC t,
B. SEPTIC/HOLDI`NG/.TANK DA'rA 1
Date Installed /Size %U_ �V / No. of Compartments r
Standpipes (Y/N)/_- l IAir-tight Caps (Y/N)-Foundation Cleanout (Y/ ) 1'
Depression over Tank (Y/N) Date Last Pumped —t"``1 _ir.s.
Pumping/Maintenance Contact on File (Y/N) - _ ; for
Holding Tank High -Water Alarm (Y/N) -Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well -w/ To Building Foundation r
To Property Line>�� r To Disposal Field y t' .f�'e�zlr�✓z t cJ�t �/_
To Water Main/Service Line ' /0
To Stream, Pond, Lake or Major Drainage Course
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. A13SORPTION FIELD DATA
Soils Rating in Absorption Strata ZZ�� Type of System Design��;e
_ L�6�-� h � ,
Date Installed �5/%S of Field j hi (/5«�le lKTa.-(� /Z Gt1eRr
Width of Field EFY) of Field��`�
Gravel Bed Thickness
Square Feet of Absortion Area Statndpipes Present (Y/N)
Depression over Field (Y/N) Date of Last Adequacy Test
Results of Last Adequacy -rest)/s��ffc %��.e'_
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well ���� To Property Line«
To Building Foundation ��� To Existing or Abandoned System on
Lot 1q ; On Adjoining Lots
i
To Water Main/Service Line ��� To Cutback (if present) LlAM
To Stream, Pond, Lake, or Major Drainage Course _Q
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Insta d
Size in Gallon
"Pump On" Leve t _
High Water Alarm Le
Tested for
Meets MOA Electrical
Comments
at
/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N) _
Pumping Cycles during Adequacy Test.
"`Check Permit d Bedroom ating Against HAA Request"
i
I certify that Vh checke , verif" d, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection. /
Signed
Company
F Engineer's Seal
Date
MOA No.
%,
Receipt No.Receipt No.
Date of Payment 3` �� `�� Waiver Fee: $ —
Amount: $ Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
vo
CHEMIM & GEOLOGICAL LABORATORIES OFALASKA, INC.
5633 8 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343
FEDERAL TAX ID p 92.0040440
ANALYSIS REPORT By SAMPLE for Work Order 4 16943
Date Report Printed: SEP 26 89 f 16:01
Client Sample ID:L19, B2 SCIMITAR Client Name CORWIJI f, ASSOC
PWSID :UA Client Acct CORWINP
Collected SEP 22 89 0 09:45 hrs. P,0. NONE RECEIVED
Received SEP 22 89 f 15:00 hre. Req >k
Preserved with :AS REQUIRED Ordered By J. RRESS
Analysis Completed :SEP 25 89 Send Reports to:
Laboratory Sup��ex//v so :STEPHEN C. EDE I)CORWIN & ASSOC
Released By : y1,' (/- 2)
..............................................................................................
Special
Instruct:
Chomlab Ref is 7684
Lab Smpl 1D: 1
Allowable
Re? ult/Jn1ts dlethod Limits
----------------------------------------------------------------------
ND(0.10) mg/1 EPA 353.2 10
Parameter Tested
---------------------------------
NITRATE-N
Matrix: WATER
Sample ROUTINE SAMPLE
Remarks: SAMPLE COLLECTED BT J.R.
......................................................................................................
1 Tests Performed See Special Instructions Above UA -Unavailable
ND. None Detected Soo Sample Remarks Above
NA• Not Analyzed LT -Less Than, GT -Greater. Than
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
R TELEPHONE (907) 562.2343 5633 B Street
Anchorage, Alaska 99516
r'
v
^^�^°• Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
7 PUBLIC WATER SYSTEM I.D.#
X PRIVATE WATER SYSTEM
f d Rwt,j AMD A13DG1Q fS .S�ZL / 7//
Name Phone No.
Aw 15,
Mailing Address
&C4.
City State Zip Code
SAMPLE DATE: 97J Z o M
Mo. Day Year
SAMPLE TYPE:
Routine
❑ Check Sample (for routine sample
with lab ref. no. ) ❑ Treated Water
❑ Special Purpose ❑ Untreated Water
SAMPLE
NO. LOCATION
2
41
4
5 1
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Fs
sis shows this Water SAMPLE to be:
atisfactory
nsatisfactory
❑ Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery delliivveeryGmail.
Date Received /d G
Time Received
Analytical Method: Membrane Filter
' No. of colonies/100 ml.
Lah Raf FJ— Result" Analyst
7778.3
EB
'L_�JIf1jIJ
U CE
I I CD
I --J m
BACTERIOLOGICAL WATER ANALYSIS RECORD 07�CG
9/a9l�j
READ INSTRUCTIONS Membrane Filter. Direct Count Collform/100ml
BEFORE Verification: LTB BGB
COLLECTING SAMPLE Final Membrane Filter Results _ ` Coliform/100ml
Reported By S�-r � 1�,r� --gin-.e
Time: a.m.
p.m.
TNTC = Too Numberous To Count
OB = Other Bacteria
MUNICIPALITY OF ANCHORAGE
DEPARTMEP )F HEALTH AND ENVIRONMENT PROTECTION
/// 825 L Street, AnchoracQ, Alaska 99501
\.
264•-4720
Date Received: October 7, 1977
#1: Time 10_30 a.m.` II2: Time Iia: Time
Date 10-12-77 Tuesday Date Date a —`--
Ins r � Pratt _�---
I n s p ------ ---- Ins p
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILI'T'IES
1. Lending Institution Request:
Mailing Address:,•
2. Property Owner: Ernest Hall
Mailing Address: Post Office Box A-6 99567
]?hone:
Phone: 688-9179
3. Legal Description: Lot 19 Block -.2 Scimitar Subdivision
4: Single Family Residence: (xj Number of Bedrooms: Two
Multiple Family Residence: ( ) Number of Bedrooms:
`i. Well System: individual Well (�q Community/Public System ( )
Permit Ik _ —_— Depth of Well 270 _ Well Log on File ( )
Construction —� — Bacterial Analysis
6.
Sewage Disposal System: On --site System) Public Utility ( )
Permit If Installed 1975 Installer _-- --
Septic Tank Size Manufactures:
Absorption Area Soils Rate Material
7. Distances: Well to Sept=ic Tank _— _ to Absorption Area
to Sewer Line , _ Nearest Lot line __ Absorption Area
to Nearest Lot Line
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 19 Block 2 Scimitar Subdivision
Comments:
Affadavit Attached: ( ) Letter Attached: ( )
Approved:
< Date : /�o
Disapprove Date:
Department Worksheet
W
---� MUNICIPALITY OF ANCHORAGE
� 9\\ Department of Health and Environme'nt4 p
rp
�ectiorj
825 L Street, Anchorage, Alaska 99501
264-4720
�_- --.
Request for Approval of Individual Sewer and,W4ter Facilities
I r
1
Property Owner: �'�/+/��f % /44ze.
a, �� it �1 �/i(e�es� s Phone
Mailing Address: p
IJ"�-a
2. Name of Buyer:
49 000-9®7�p
Mailing Address: Phone:
3. Lending Institution:
Mailing Address: Phone:
4 . Realtor/Agent : A494,; ole Ae _Ace �� ��� 4e�D4woov)
Mailing Address: Phone:
5. Legal Description: , 9r X�'°%9IiTi9R J;d.
Street Location:
6. Single Family Residence: Number of Bedrooms: Ci
Multiple Family Residence: ( ) Number of Bedrooms:
7. Water Supply: *Individual Well (/ Public/Community System ( )
If Individual Well, well depth �°
If Community System, name of system
8. Sewage Disposal System: On-site System (A Public System ( )
If On-site System, date of installation: Glnr 77
*NOTE
3/77
A well log is required on ALL wells drilled since 6/75.
�'4,A }Ot AOiACL Lp°A 1 o
G
i
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
14 ID 3330 °C" Street, Anchorage, Alaska 99503 274-4561
e�
e 10
Date Received April 26, 1976
Time of Inspection
10:15 a.m.
Date of Inspection 4—A9.-76 Thurs.
q� �Z REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Conv.
1. Approval requested by: First National Bank of ANchorage
Mailing Address: Post Office Box 4-2090
Fred
Phone: 279--4481
2. Property Owner: Ernest Hall Phone: 688-9179
Mailing Address: Post Office Box A-6, Chugiak 99567
3. Legal Description: Lot 19 Block 2 Scimitar Subdivision
4. Location: Peter's Creek
5. Type of facility to be inspected single Family No. of bedrooms 2
6. Well Data: :Individual
A. Type B. Depth
C. Construction D. Bacterial Analysis7/fL/`�.`/('%
7. Sewage Disposal System: on—site system
A. Installed _August, 1975 B. Installer D2.dam 3tC.,t1Z:) ?C�'
C. Septic Tank: 1. Size /.Q O d 2. Manufacturer -Z 6 0-6 s-9
D. Seepage Pit: 1. Absorption Area _ 2. Materials
E. Disposal Field: Total length of lines Z�7`/
8. Distances:
A. Well to: Septic tank 68 Absorption area d O Sewer Lines
Nearest lot line �/ Other contamination _eItll
B. Foundation to septic tank , Absorption area -Z4),
_
C. Absorption area to nearest lot line w
EQ -034 (1/74) Page 1 of two pages
Page 2 of two pages Ret st for Approval of Individual : :r & Water Facilities
Legal Description Lot 19 Block 2 Scimitar Subdivision
Comments
Approved
Disapproved
Date ��C�
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily. /
SIGNED
EQ -034 (1/74)
Date 6 22 - -7
141JI!ICiPALIIY i%F , �ON.AOC
I>i i'I. OF H2i..1'
M, l.PdRALITY OF ANCHORAGE
1 Df_PARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2N? ) ,a�t: Tt�m Road, Anchorage, Alaska 99504 276.2221
ff9UEST FOR APPROVAL OF
f °I`Nl ly PIPA SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA_ FHACONV _
2. Property Owner: /X� 6-
671/a 6'l "'j 'j --
Mailing Address: Z0, 4 4 /1 K - 99.5"6 7 Day Phone: l' ('J' 91 77
3. Name of Buyer: _Salm
Mailing Add
Day Phone:._ �-
4. Name of Lending Institution: /sr /�✓������� /��;•�`�=
�5ocirI/ ('e- eo /i.�r+r✓c�+
Mailing Address: 36" '/ C� /)/v C// Phone:
5. Name of Realtor or Agent: /V e) N <E --
Mailing Address:
Phone:
6. Legal Description: % 0 / i Q/,, �-- /C '.2- t s '� j « 6,
7
L-1
N
Location: V e s 0, e e ie -
Type of Facility to be Inspected:
Water Supply
Type of Supply: We,l (
Rooms
No. Bdrms.
Public Utility_ Individual
If Individual, number of dwellings presently served
If Individual, depth of well 70
Sewage Disposal System
X_
Type of System: Public Utility_ Individual (on-site) x
If Individual, date of installation_ (,l u!;i r
72-003(3/76) '..1