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SCIMITAR #2 BLK 2 LT 26
Scimitar #2 Block 2 Lot 26 #051-132-44 ~u7.{�\ uy ou /u ff�\ L1ls��nl MUNIClPAL1TY OF ANCH�RHGL 0eparbnen� of Health & Human Servzces 8�5 L S�reet, Anchorage, Alaska 99501 343~4720 0 well we o I L0f -7 3a Z-0 7L 25 3 XCSox,(FfZ- �1.9.E (�iX3?,sol o Abaod,-" cq S1 4 1Jeeu�st-e�n \ n x 3TS` BSN Slone, Z 2 s SEWER SYSTEM LOCATION PLAN LOT BLOCK� SUBDIVISION 2 Jcii�ir SECTION/TOWNSHIP/RANGE Rte` f °GGJ[.:.. • ly .: SCALE, NOTE, • °ei < <9 / �¢,O THE ACCURACY OF LOCATION OF EXISTING F, %� „F..:' �•-] PROPERTY CORNERS, WELLS, AND SEPTIC oOC •,u •' •a a DRAWN BY SYSTEMS INDI CATED 19 NOT EXACT. • . ;q NORTH DIMENSIONS INDICATED HAVE BEEN DETERMINED BY USE OF CLOTH TAPS AND NOT BY SURVEYING TECHNIQUES. 3 PREPARED FORS �' ��t1t1�9 ErtgG�oar: sb e„4yi'Nnrt:Sa:ti9 �•4N6??.�`Y �'....: - DAT E�� �✓ C7� SHEET / 0F municipatily of Anchora9c 40OL ARTNiENl OF IlUkt-TN & HUMAN SCF 825-L" Street, Anchorage, Alaska 99507_ { SOILS LOG — PERCOLATION TE PER FORfAEO FOR: �/ LEGAL DESCRIPTION: lA/�i Y Township, Ra"n SLOPE OO L SC��✓vl� /vL/ ��..• 1 D� 2- 3- 4- 6- 6- 3 4b- 6 O 7 8 n` 9 � SITE PLAN 10 WAS GROUND WATER ENCOUNTERED? 11 G L IF YES, AT WHAT ��A]]� O DEPTH? P `_ 12 E i oe th to Wzter fitter� r 13 G M (nting7 wtt 14 is- 16- 17 - 19 5161719 20 COMMENTS L N PERCOLATION RATE — (Fninutes/inch) PERO HOLE DIAMETER TEST AF.867WEEN FTA NO _FT / PERFORMED BY: '-E ri. cep'._' �;'� �� F IFY THAT THl TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUFOELFN EFFECT THIS DATE GATE: _� U 72-008 (Rev. 41851 fj - Municipality of Anchorage f> DFPAR1 t.1ENT OF HLALTH & HUMAN SIE 625 "L" Street, Anchorage, Alaska 9950211 SOILS LOG — PERCOLATION T r' c�, PcRFoRmicD FOR: �•� Township, Range, LEGAL DESCRIPTION: --- SLOPC- OE('TR 40C 04(- X12 F- r --T 0117 1 2 :5;-1 r1e; 14'- 3 a 0 0 S 6 o� o 8 n.. 9 � s t � � srn 4 rt jnnj 3 EOR SITE PLAN WAS GROUND WATER 10 ENCOUNTERED?-- ri S o 11 L fF YES, AT WHAT DEPTH? P 12 E C Depth to Water AtterTT�t 13 6 kanitxinp? Date 14 --------- Reading Oate is- 16 - 17 51617 18 19 - COMMENTS L N Groz Net Depth to Net Time I Time I Water I Drop PERCO(AT(ON RATE _ (mintneVinchl PERC HOLE DIAMETER TEST RUN BETWE N FT NO FT PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GUI 12-008 (Rev. 4/851 i S ( IFY THAT THI TEST WAS PERFORMED IN S EFFECT THIS DATE. DATE: U IwAl X51 rj ER SYSTEM LOCATION PLAN Lor BLOCK c��f suaorn/s—wN� n, 2� 2 r SECTION/TOWNSHIP/RANGE N�tA• .. a S� e ..j SCALES /�/—�D / NOTE' THE ACCURACY OF LOCATION OF EXISTING a �✓z , p oY .����� PROPERTY CORNERS, WELLS, AND SEPTIC C) g DRAWN BY SYSTEMS INDICATED IS NOT EXACT. o ec :o o •o o r B�G DIMENSIONS INDICATED HAVE BEEN NORTH _ DETERMINED BY USE OF CLOTH TAPE AND n p ,(�^•"may— ' HOT BY SURVEYING TECHNIQUES. MINEdn i� ro o. E-5to3 °.' �: �p � 3�tt�Qw. i i. � �-£ PREPARED FORS �0• - ....• �.`_'i? Fc�. �� .y'•� i �`J�j119�,E11Q�OCC, �y DATE, SHEET / OF 3 CORWIN & ASSOCIATES, INC. 1000 E. Dimond Blvd. Suite 205 ANCHORAGE, ALASKA 99515 (907) 522.1311 FAX (907) 349.2236 JOB. SHEET NO.___ `{�^5 - OF CALCULATED BY ` "' -_ DATE CHECKED BY DATE OB-- CORWIN & ASSOCIATES, INC. SHEET NO. / _- - OF✓ _.-- 1000 E. Dimond Blvd. Suite 205z -.T -- ANCHORAGE, ALASKA 99515 cnLcuLATED ar-� ___— DnTE— (907) 522-1311 FAX (907) 349.2236 CHECKED BY _— DATE SCALE 4AN I" AXI frnim Y... 61171 in fMna. VHIINF TN I FPFF Iffi1YlSSW %� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION a8 ENVIRONMENTAL_ ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 2.64.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME _ f //' PFJONE NEW ❑ UPGRADE MAILAG ADOR ESS LEGAL DESCRIPTION �S' a �1 / -7- 1-9 r-0 LOCATION ` NO. OF BEDROOM U Well/i Absorptiol].are/ DISTANCE TO: Dwelling ( _ PERMIT N n~. Manufacturer �� / M I N6. of compartments N Liq. c act tyingallons �� IF HOMEMADE: Inside length Width Liquid depth O DISTANCE TO: ll Well Dwelling PERMIT NO. Q 2! 1 C) F Manufacturer /V Material Liquid capacity in gallons w 2 � a z Well �) (. DISTANCE TO: tV ..� No. Lines Length line Foundation �q1 i , Nearelg`1Jfpppt Iip! ✓,.� �. �"'J— Total ler4th f lines Tlencl>yv PER T t w CC—' of of each -- �`L . h _ !� (J inches --- Distance bet e.n li es Q cc F- Top of the ftnisl < lade Nf- e,?al b� gth pl�j r Total effective sorption area D L 7r L �S/C inches _ Length Width Depth _FE RMII TN0. w (7 H N a� Type of crib Crib di, ter Crib depth Total effective absorption area Building N DISTANCE TO: Well foundation Nearest lot line J Class/,� `J� Cie G Driller Distance to lot line PERMIT NO.� J / DISTANCE TO: Building foundation _ Sewer line Septic tank Absorption areas) OTHER — C PIPE MATERIALS J v SOIL TEST RATIN 0 -- — INSTALLE �//J�// G• -- v G REMARKS cin m C) A" 9 rJ 4 k ¢Y. I_'� � AP 0V �p DATE LEGAL L •,c'rnrtac,..I r,Sn� 995 )1 W G n v E L L R E C OR D Drill inr tor, an Name Matin u.on 1J r'1 x..1:1 I1y �- -' U.S.G.S. Local No. J - V v .J Drilling Permit No. LOCATION OF WELL Plea Sa complete oitner a, ib, or Ic. A.D.L. No. 1.;. Do rough .-._T Subdivision LOY Rlock Ib. Fraction section No. Township Rahe Krieg, rld l an E Il tlf - ' Ancp l�'Cd:1Jd.+s, 1._....�51...n.-.�..,____,_..� _.e _..�...._ _....e...,..e.-�_,,.. ,.. .., ...-.- .-n.,. le. Distance and Direction from Iload In torsadtioos 3,, OWNER OF WELL: Phr0 .rall.l. Myoxt3 Addrasc: Mt-�yorqo Cy�onatruc,t i,ou 13gjda_Q Riverg Alta �4. WELL DEPTH:V(completod) Surface Elevation Da [e of � Cotnp I e t 1 on S. rT❑Cable tool�.f,:. Rotary 00rlven Dug Auger IJ Jotted E]Bored❑Other: G. USE:XYaa Donesatic Opublir Supply Industry D-1Irrigation L_�RecMrge ocvm. Fclal IITest Holl 0thi: r•: 7, CASING: �El Thrcnded L. h� ldud _�_.a...,.__.,..._._..�_ ^6 In, to ft. Depth Weight 17ibs/ft. in. to ft, DePeil 0. FINISH OF 1iLLl�_.�_�s-e.,_._,_,,..��__,.._�-�,____-_,._,_,w� Type: U}11X1 110:1.0 Dlamaeor: 611 Siot/R^sh Size: _..mm_^.- ------ Length: Sot between ft. and ft. Fittings: 9. STATIC NATER LE7EI^m^, ft..,_m„__��__s_ Above [16elon land surface 'ypa of Measureatimt: 10. PUMPING LIVEL below land surface ft. of to hrb. pumping ._ g. p. rl. y� ft. of ter hrs. purip ing g, p. m. 11. WELL HEAD COMPLETION: In Approved PIt u Plticss Adapter _ Inches above grado 12, GROU111IG: M-�Wpll Grouted: L-ryoaL0 N.omm�aAeC_� Material: U Neat Cas>„nt lJ Other: 13. PUMP (If availeble)F HP �'-��-�T p���--•_ Length of Drop Plpe f[. capacity g.p. 1 Type: G Subaorslhle []Reciprocating Jat [] Other: 14. REMARK$: Production of 5 GPM Street ^Address AM Arce of Well Locatlen WELL LOG Ij" Feet Beim, e`I�F __Surf^ce Material Type _m•-� - rap Lot torr 2 2 _. 6 Flarei oclz � 5 -u0 IS ,+,ITER WELL CONTRACTOR'S-CATIFICATION: Th;s well as drilled under my jl.ir";dictinn Dad '.his report is :r,,e to the belt of my knowledge and bel [air: Ala Ilusotl D:ri�.��.z1 �C Reg�s[e raiT'Bu9irtess thaw Contract T7 cen5n mne7 -_1r +ddress: P-0. Box 5011 Eagle 7 �/7T1g�,yvero Ak. 99577 :!!Ina [e.._______— Nov- 1.111Ldu:ror zed ft ep re Form AI-IAIR Copy Dis:,ibution: WHITE - State DGGS. PINK - Drill, CANARY ruatn,enr TYPE CIF, SOIL HBSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS -- ] SOIL RRTING (SQ FT/BR)� 85 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS. ��� : �- 11, - 1 ���� �" I,�� fit 842 too K& Q R. ��v- 1-1� � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE GROyND HND THE BCI TTOM OF THE EXCHVHTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFALL PIPE HND THE BOTTOM OF THE EXCHYHTION (IN FEET). ��o_3 :1E E :t, F_- �: -if, ]:� J- Too WE v< 15; 1., _: — J_ ST imp RHO CIE fiI K. . L. TIT 141 W PERMIT HPPLICRNT HHS THE RESPONSIBILITY TO lNFORM THIS DEPHRTMENT DURING THE INSTHLLHTION INSPECTIONS OF MAY WELLS HDJHCENT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES THHT THE WELL WILL SERVE� ��l CIO <� > I 141170FO%475- X 0015: U01 Tic IH: IF JE oL BHCKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTION HND HPPROVHL BY 14IS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTHNCE BETNEEN H WELL HND MAY OH-00I1E SEWHGE DISPOSHL SYSTEM IS 108 FEET FOR H PRIYHTE WELL OR 150 TO 200 FEET FROM H PU8LI11 WELL DEPENDING UPON THE TYPE OF PU8LIC WELL MINIMUM DISTHNCE FROM H PRIVHTE WELL TO H PRIMATE SEWER LINE IS 25 FEET HND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS HRE REQUIRED HND MUST BE RETURNED TO THE DEPHRTMENT WITHIN ]0 DHYS OF THE WELL COMPLETION. OTHER REQUIPEMENTS MHY APPLY. SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS HRE HVHILHBLE TO INSURE PROPER INSTHLLRTION. To" Es: To! M 1 _T_ K No TO" .1 fE.E. AS �ITHE 10 W Twl 1129 EVE T�" �_�:: :'ll, :1_ lot Q aL I CERTIFY THHT A. I HM FHMILIFOR WITH THE REQUIREMENTS FOR LOW SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE. 2 I NILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES ]� I UNDERSTHND THHT THE OM^SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THHN ] BEDROOMS SIGNED ... ~~^_.... ..... _.... ISSUED BY. _—DHTE.... .... .... 7 ,�� SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 11 PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: DATE. PERFORMED: r-' LEGAL DESCRIPTION: R 7- 1-4 kO SLOPE SITE PLAN DEPTH (FEET) 2 0 3 4 5 6 7 6-- 9 —�o -7T 11 WAS GROUND WATER S ENCOUNTERED? 0 13 - 12 IF YES, AT WHAT DEPTH? I.; 14--7ft //l/w 4 J, 17 A. 19 - Reading Date Gross Time Net Time Depth to Water Not Drop 20 - PERCOLATION RATE —(minutes/inch) TEST RUN BETWEEN FT AND --- FT COMMENTS PERFORMED BY: S I 72-008 (6/79) CERTIFIED B DATE:,.,:_ 0 & E GEOTECHNICAL & DEVELOPMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 (� Russell Oyster '�� [S688-2280 Earl Ellis 694-2774 5C I ` I1' Soils £t Foundations Land Development SOIL LOG Performed for: Name: A,/Tel. No. Mailing Address: Xdr,: h, �3t./�, Z ScJr (J//V/t" l Legal Description: ), Qcl, /,Z i C`�����,��� �!!� 995 e I De thfeet Soil Characteristics 0 .. , 44 2 3 4 5 6 7 9 10 12 Ground Water Encountered: Yes- No ✓ e If yes, what depth° Proposed Installation: Seepage Pit -1� Drain Field, Comments: Performed by:� 7 ` C��= Date: e'_ZeQ :c/, / 9"7j Municipality of Anchorage }� Department of Health and Human Services 825 "L" Street Tom Fink, Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 January 26, 1989 Rick Button, P.E. Engineering Evaluation & Investigation Services, Inc. 200 West 34th, Box 267 Anchorage, Alaska 99503 Subject: Waiver Request for Lot 26 Block 2 Scimitar #2 S/D Waiver Request #WR890004, PID# 051-132-44 Dear Mr. Button: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 1 foot. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services DJR/ljw#7 ENGINEERING EVALUATION � A' INVESTIGATION SERVICESyN104p,F gNCHQaq�E DEPT. OF HEALTH ENVIRONMENTAL PROTECTION December 15, 1988 'AN 1989 VxECEIVED Mr. Dan Roth Municipality of Anchorage Department of Health and Human Services 925 "L" Street Anchorage, Alaska 99501 Document No: 8278BC3.001 Subject: Waiver for Required Separation Distance Scimitar #2 Subdivision, Lot 26, Blk 2 (Tulwar A/W/S) Dear Mr. Roth: This letter is written to request the Municipality of Anchorage, Health and Human Services, On—site Services Section (Municipality) to grant a waiver of the ten—foot separation distance between an absorption trench and the property line for the above referenced property. When it became apparent that the absorption trench violated the required ten—foot separation distance, EEIS Consulting Engineers contacted Diane Regouby. The purpose of the contact was to ask Ms. Regouby to sign a letter of non—objection to allow the Municipality to grant the Waiver of Separation Distance. The notarized letter of non—objection with Ms. Regouby's i,r y {,.: signature is attached along with a check for X70.00 to cover the MOA Review fee. If you have questions, or if I may be of further service, please do not hesitate to call. ichard C. Button, PIE. RCB:kkw attachments 'a, �-/'-go g&' I- 11-0 200 West 34th, Box 267 9 Anchorage, Alaska 99503 • (907) 274-7611 NON—OBJECTION TO GRANTING OF A WAIVER FOR LOT LINE SEPARATION FOR THE ABSORPTION FIELD OF Lot 26, Block 2 Scimitar Subdivision Unit 2 We the owners of Lot 27, Block 2 Scimitar Subdivision, Unit 2 DO NOT OBJECT to the granting of a waiver allowing the existing absorption trench for Lot 26, Block 2 Scimitar Subdivision to remain within the 10 foot setback as required by the Municipality of Anchorage, Department of Health and Human Services requirements. If the absorption field is upgraded or reconstructed in the future,—we request that it be placed at least 10 feet from our property line. r/ Di ne J. ouby Date_ CRIBS before me of � 1988. P Notary Public 'n and for the State of alifornia My ommissi' expires: in Vallejo, California this l day aNNE1TE VL SEAL NorARyai, CHEUNG BUC • CAUFORNIA NAPA COUNTY MY Comm`Expimt April A, 1969 \ p \ 42u \ �V'm� ZS�?ate a ��� J' \ SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 July 9, 1984 fir. Robert A. Shafer, P.E. S&S Engineering SRB 196X Eagle River, AK 99577 Dear Mr. Shafer: RILL SHEFFIELD, GOVERNOR Telephone: 19071 Address: 274-2533 Subject: Well Radius Waiver for Lot 26, Block 2., Scimitar Subdivision, Eagle River, Alaska (8521 -WA -007) rhe Department has reviewed the subject waiver request and hereby waives the horizontal separation between the private well and septic tank to 97 ft. Sincerely, l l Bruce E. Erickson Environmental Engineer BEE/msm cc: Robbie Robinson (MOA) Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FORA SINGLE FAMILY DWELLING /` C� Parcell.D. 051-132-44 COSA# V�OOq(o Expiration Date: Is ` .S — 02__ 1. GENERAL INFORMATION Complete legal description SCIMrrAR #2,O. L T 26, RI OCK 2 ... - ' . • 1 .. tal 1:0@1111 IMFUNT2,4113516i Current Property owner(s) LEONARD TROY M- Day phone 764-1137 Mailing address 19619 TI ILWAR CIRCLE CHI IGIAK AK gW567 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: _tt 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Engineer's Printed Name KENNETH M_ DIIFFf1S Date 02/29/08 Engineer's Comments: This Investigation was completed In compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes Inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a �Q�'���•1 OF a;l�1 system will function satisfactory for current or future �,•••«"gS�, occupants or can ArcTerra guarantee that no unseen ..Oj ; '••�Vr encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE l% Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory X— Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: --g Certificate Date:- _� �J 0 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description- SCIMITAR #12, LOT 2A, R1 O .K 2 Parcel ID: 051-132-44_- A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 11 /81 Sanitary seal (Y/N),Y Total depth 180 ft. Cased to 100 t. FROM WELL LOG Date of lest 11/1981 Static water level NOT SHOWN ft. Well production 5 g.p.m. WATER SAMPLE RESULTS Wires properly protected (Y/N) Y Casing height (above ground) 16 in. AT INSPECTION 10/18/2007 64 ft. 3.33 g.p.m. Coliform _9_colonies/100ml- Nitrate 7.45 mg%L Other bacteria _0 colonies/100 mL Arsenic: mg/l Date of sample: 2/19/08 Collected by: ArcTerra B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed _11 /1981 Tank size 1000 gal. Number of Compartments 2 'Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 10/17/07 Pumper J R' s C. ABSORPTION FIELD DATA Date installed 11/81 Soil rating (g.p.d./fe or ft'/bdrm)_65_ System type Deep Trench Length 22_ ft Width_Ja Gravel below pipe _¢._ft. Total depth 10.7 ft. (Measured 10/18/08) Eff. absorption area 264 flz. Monitoring tube y Depression over field N Date of adequacy test 10/18/07 Results (Pass/Fail) PASS For,_ bedrooms Fluid depth in absorption field before test D in. Water added-45fL gal. New depth bin. Elapsed Time:.Q min. Final fluid depth D in. Absorption rate >= 450+ 9.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date ----- D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) 'Pump on' level at_in. 'Pump off" level at_in. High water alarm level at n. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 97'* Absorption field on lot 97'* Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots 10 0'+ On adjacent tots 100'+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1'* Building foundation 9' (garage) Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parkinglvehicle storage 9' (garage) Curtain drain 50'+ (none known) Wells on adjacent lots 100'+ F. COMMENTS *MOA waivers issued previously. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are In conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date COSA Fee $430.00 Waiver Fee $ _ C Date of Payment =� r^ Date of Payment Receipt Number b 5504 Receipt Number. (Rev. 11/05) '��„''•, vel :i SGS Rcc# 1080653001 Client Name ArcTerra Engineering and Surveying Project Name/a Scimitar N2 D2 L26 Client Sample ID Scimitar 42 U2 L26 Matrix Drinking Rater PWSID 0 Sample Remarks: All Dates/flmn are Alaska Standard Time Printed Date/time 03/03/2008 9:24 Collected Date/Time 02/192008 11:00 Received Date/Time 02/192008 12:10 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date [nit Metals by ICP/MS Arsenic ND 5.00 u8/L EP200.8 C (<10) 0225108 0229/08 MI Waters Department Total Nitratc/Nitritc-N 7.45 0.100 Microbiology Laboratory Colony Count 0 Total Coliform 0 Fecal Coliform 0 mg/L SM204500NO3-F D (<I0) col/IOOmL SN1209222B coV100mL SM209222B col/IOOmL SM2092226 A (<200) A (<I) A (<I) 0227/08 LCP 02/19/08 SDP 02/19/08 SDP 02/19/08 SDP Municipality of Anchorage Development Services Department Building Safety Division ' ..... On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 080046 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 26 of Scimitar #2 subdivision. This inspection revealed a nitrate concentration of 7.45 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage • Development Services Department j Building Safety Division =: On -Site Water and Wastewater Program ' - • 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 0HAA #_ Expiration Date: '7 — 1. GENERAL INFORMATION Complete legal description Z Loi 7 g/ r 2 Location (site address or directions) 9 6 j 1 trt Lt j4-& rrni i s Current Property owner(s) /SCA) d- 1f r A-/2 i A1,44 ,yqupDay phone Mailing address Lending agency x-960 Day phone Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. Day phone 2. NUMBER OF BEDROOMS: 1Z 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site [L}� Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system rs(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Eagle River Engineering Services Phone 6 9 N- S 19 S 10421 VFW S Suite 201 Address Fanle River. AK99577 Engineer's Printed Name 6 uorS?v%0dCR- R. __1JooIN Date 111111e)6- S. 11rl/d5- 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for ON-SITE : WATER AND : to R :WASTEWATER , :• PROGRAM ':t CHOW •. .•.� /`�ti following stipulations: Additional Comments Note: The well for this property meets existing State and l%lunicipal Codes. There are nitrates present. It is suggested that periodic testing be performed to Insure the wells continued suitability. Current nitrate concentration is 6.96 mg/l. EPA maximum concentration is 10.0 mg/I. Afore Information on nitrates is available from the On -Site Services Program, at 343-7904. Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: o Original Certificate Date: 14 -114 -05- a ' -114-0s (Roy DIM2) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 54rAr7,4PL *Z twT 26 gLK Z , Parcellb: 051-/32-14U A. WELL DATA Well type EV%IA If A. B, or C provide PWSID # _ Well Log &N) *'It"5 Date completed 0,141 Sanitary seal ©N) _�W 5 Wires properly protected &4) YJ,5 Total depth 140 ft. Cased to JAC ft. Casing height (above ground) / 6 in. FROM WELL LOG AT INSPECTION Date of test tl ley 1 q/0 sf ; Static water level NOT R e Awmb ft. q ft. Well production 5 Q.P.M. 14 g.p.m. WATER 7colonies/1 RESULTS: Coliform00 ml. Nitrate �-,o mg.A. Other bacteria colonies/100 ml. Arsenic: mg.A. Date of sample:312y1dt Collected by: 500AJ 14 EN B. SEPTICIHOLDING TANK DATA Tank-Type/Material STLZL Date installed Il �4l Tank size 1,g& gal. Number of Compartments 7- Cleanouts &N) Y&5 Foundation cleanout&) _)Lk� Depression over tank (Y67 A%D High water alarm (Y& AVD Date of pumping �fDiS Pumper �J_ R '.5 C. ABSORPTION FIELD DATA Date installed q Soil rating (g.p.d•/ft= o ftZ/bdr - System type _TREW611 Length ZZ ft. Width U D 0/ is Gravel below pipe 6 ft. Total depth _ .2 ft. Eff. absorption area _kft2 Monitoring tube Depression over field Al Date of adequacy test !&TAs Results as Fait' PA -5.5 For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added gal. New depth in. Elapsed Time: J2.4 min. Final fluid depth 0 in. Absorption rate >= H SIO g.p.d. Any rejuvenation treatment (past 12 mo.) (Y& type) 00 If yes, give date u04 1; -. D. LIFT STATION Date installed Size in gallons "Pump on" level at —in. 00"Pump o�f Tevel at —in. Datum ,V Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/WWAatien on lot 97 I' � Absorption field on lot 417 I Public sewer main t 7 S Sewer /septic service line -} 2 S Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots ' -t ry0 On adjacent lots 1- 1&0 r r Public sewer manhole/cleanout 'I" IDD Holding tank +too SEPARATION DISTANCES FROM SEPTIC/HetMMG'TATRt ON LOT TO: Building foundation 446E Property line *I'0 J 1 Absorption field $ Water main 'tib tJ r Water service line +to ' _______� Surface water t-Itfo r Wells on adjacent lots + 100 r - in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r Property lin 40c wZ � Building foundation °) 4AIRAd Water main + /f) �900vY r. r Water Service line d /A � Surface water t Idr? Driveway. parking/vehicle storage �i GARi9 t t Curtain drain * St) r Amus KAk%,*1Wells on adjacent lots f-100 F. COMMENTS h G. NE GINE EE S I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name G t f =1t7P1 &F t Q- tJ&-;6 Date 14111,105- HAA 4LI105- HAA Fee $ J43' .UU Waiver Fee $ _ Date of Payment 1111216-5—OS Date of Payment Receipt Number iC(pQ�i3K! Receipt Number (Rev. 12/01) L rN46 JS ReO Client Name Project Namcf# Client Sample ID Matrix Sample Remarks: 4:25PMt 1051592001 Eagle River Engineering 19619 Tulwar Circle 19619 Tulwar Circle Drinking Water ;907 8016301 0 2/ 4 All Datedfimes are Alaska Standard Time PrintedDste/rlme 04/01/2005 15:40 Collected DateMme 03/24/2005 16:10 Received DateMme 03/25/2005 9:41 Technical Director Stephen C. Ede Allomble Prep Analysis Parameter Results PQL Unita Method Container ID Umits Date Date lnit Waters Department Nitrate -N 6.96 0.100 Microbiology Laboratory Total Coliform 0 mg/L EPA 300.0 B («IO) 03/25/05 CAM coVl00mL SM209222B A (<-1) 03/25/05 TLF 04/11/2005 11:02 9073449821 JRS SEPTIC PAGE 01 JRs Pumping PO Box 773415 Eagle River, AK 99577 (907)694-6454, [s5ung IMertetlen _ _J 0 Esoe River Ergkreenn0 Job Daacriprat: 10000 10421 VFW Rd Ste 201 P.O. Number: Diagram: Epi• River. AK 99577 Terms: Net 30 (907)""195 Solarep: Nkole • i / Map Boric: - ---'—�'1 Gass Sheets: Whaley Ave Cob >she lroarmrllon Chris Job Comments: 19519 Tutor Circle Chugalk AK 99567 (907) 8844195 Service Type Contractor Job Additional Location Comments' Cedar ranch wt green btm. Service Agreement Number: 015241 Order Deb: 04 -Apr -2005 Service Date: 05•Apr•2005 12:00 am Technician: Tari Job Type Re"a Map Grid: $8 tank • sludge ok. Front of tank access partially blocked by x0er, pipe pulled up from tank. Tax Percent: 0 ..— Qty Prow Each x 2 Men Tax 1 $110.00 No No Diagram: Tank sfa • i / • H DN Extension AeUMI $110.00 Gallons Planned: 10D0 0211" Actual: Pose LwVIh; Double Tank: ❑ Pump System: 9 Baffles Inlet: ❑ Saralee Outlel: ❑ NonTaxable Total Taxable Total Tax Total Grand Total EstimaledCharpee: $110.00 $0.00 $0.00 $110.00 Actual Chargee: Cualaner agnea to the tame and cOndltlons printed on ted boot. THIS IS A BINDING AGREEMENT. Signature and True of Customer Representative Date Accepted by JRs Pumping Dab Accepted For you added convenience we accept; American Express, Dice r, Visa and Mosler Card payments over the phone. After 30 Dare accmis will be tuned over to collections. $25.00 For NSF Checks Returned. / M. , \ Y ` V ro Iq 2 I w 0 •.o 0 o I �\ IS \ I� O a� ?3 �SEl.''%dN C/NE EAIEME�YT � /•t'GE.�nFfc9/Jot� .7� of RECERTIFICATION 6/25/91 io 'us.�iry EASEMENT RECERTIFICATION 9-13-90 GYEST cgs:""Pg GSRllll T-Lln rnouren e•11 -"""'-"' --' " " .^ice SEWARD & ASSOCIATES LAND SURVEYING 688-4566 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE` •a { FOLLOWING DESCRIBED PROPERTY 1"=40' � �;; �......°��^RSA Scimitar Subd.,Unit No. 2,Lot 26,111k. 2 DATES "'''' AND THAT NO ENCROACHMENTS EXIST EXCEPT AS 7-2-90 INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID EASEMENTS, COVENANTS, OR RESTRICTIONS Nork NW 1261 • w WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB-- i3 1 ,'•, LS 6913 i ANY DATA HEREON BE USED FOR CONSTRUCTION 13-18 OFFENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. DRAWN: DMS 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. If O 1 ! y V HAA #5� 1. E.GENERAL INFORMATION Complete legal description Lot 26; Block 2; Scimitar 42 Location (site address or directions) 19619 Tulw Chugiak, AIC Property owner AndX & Julie Rabung Day phone -66,9-h1 S1 Mailing address 19619 Tulwar Chugiak, AIC 99567 Lending agency Day phone Mailing address" Agent Stacie/ Jack Vdhite Real Estate — Day phone 762-5846 Address — 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 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 M21 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. S & S ENGINEERING Name of Firm+--703gEagle!IIfiverLoopatoadNa20d Phone 6�y a9- Address Eagle River, Alaska 99577 Engineer's signature ;t�WY� Date �r Al t. ih M r ROBERT C. COWAN I c'J\ CE-saoi .1�,�.�,,� 6. DHHS SIGNATURE bedrooms. ATURE Y Approved for 3 Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ,ZLZ�� C' v '1 Date % 2 CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates_ based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Beck MOA P21 Municipality of Anchorage�R Alms DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division DEC 5�4gy 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4 44 Municipality of Anchorage Dept. Health & Human Services Health Authority Approval Checklist Legal Description: LoT ;; b ISLo "K a 5 """ r'Ve 41?_ Parcel I.D.:_ A. WELL DATA Well type 1° 6'`' V H Y- If A, B, or C, attach ADEC letter. ADEC water system number Log present 1Y )N) ~/ C S Date completed 1 Total depth Sanitary seal YIN) Date of test Static water level Well production Cased to ) t7 a Yep FROM WELL LOG / 5 c U b< .S g.p.m. _ Casing height (above ground) 1 �. Wires properly protected/N) Y �C 3 AT INSPECTION 11 /161 l q 7 -3, S g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate G L Other bacteria _ Date of sample: Collected by: S & 5 ENGINEERING 1I9Qn Eagft'-RtVUr LOOP oa e. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alasica 99577 Date installed 11 l Tank size oo ° Number of Compartments Cleanouts Oi )N) Y� Foundation cleanout 6)N) y S Depression (Y,(N}t N High water alarm (Y/0 N " _ Date of Pumping l'� �a1 ct 0 Pumper :r • /� C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 or ft2/b_ System type T'� �'1a Length _Width _ )-j 0 Gravel thickness below pipe _� Total depth ft S / •z Effective absorption area a 6 `� r' Monitoring Tube present &"), N) Y -S Depression over field (�)7 0 Date of adequacy test 11 / / y q 7 ResultsPas /Fail) s For. bedrooms Fluid depth in absorption field before test (in.); 0 Immediately after'V 70 gal. water added (in.): O Fluid depth 0 _ (ins) Minutes later: G Absorption rate = _ )j SS- n -� g.p.d. Peroxide treatment (past 12 months) (Y/N) N 0'\'C 1, 0 w r✓ If yes, give date _=� 72-026 (Rev. 3/96)` D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles E. SEPARATION DISTANCES "Pump on" I *Datum Size in gallons "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot el On adjacent lots _ * S/L,L AD@G APP&0 L C)/- Absorption field on lot _ `i -7 On adjacent lots rife 6P1'a0vG0 5c.L. t-li'( Public sewer main N Public sewer manhole/cleanout Sewer /septic service line �S Lift station %Q0 + IV 14 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation / O 1-- _ Property line 1 Absorption field Water main/service line o Surface water/drainage /00 '�- _ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property fflIff11ne Building foundation G /+nnc 6) Water main/service line Surface water ) 0 0 'I-" Driveway, parking/vehicle storage area Curtain drain N °N% K/V o w n/ F. ENGINEER'S CERTIFICATION lost 1) 1 C 6-,q /t ✓� G ti, Wells on adjacent lots / 0 0 4 f certify that / have determined thru field inspections and review of Municipal in conformance with 0 H��V gui dines in effect on this date. Signature f d% L% �l Z✓ Engineer's Name ��� ¢-�'i i - C. C0 W4 A/ D-,ItP la a 17 HAA Fee $ C5D ' 61 7 Date of Payment - (/ Receipt Number �,? l �2 T 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number CT&E Ref.# Client Name Project Name/N Client Sample ID Matrix Ordered By PWSID ME Environmental Services Inc. 977179001 S & S Engineering Lt 26 Bk 2 Scimitar No. 2 Lt 26 Bk 2 Scimitar No. 2 Drinking Water Parameter Results Nitrate -N 4.61 Waters Department Analyses Total Coliform 0.00 N Client POk Printed Date/Time 11/26/97 15:21 Collected Date/Time 11/19/97 16:15 Received Date/Time 11/21/97 09:30 Technical Director: Stephen C. Ede Released By A 0 a" 0^ f Allowable Prep PQL Units Method Limits Date 0.100 mg/1- EPA 300.0 10 max col/100mL SM18 92226 Analysis Date Init 11/22/97 GCP 11/21/97 TMW To , -4 07- 2 6 ez-ic Z o C/1 --vi- J ovG, M SUBJECT /7�SUJE'l�l�/�J/(./�Ll� L�ji/y� /C DATE MESSAGE �v d Fd _9% �k�T sa-/°fr/4ffTia�G% As paIA,, e-,E74-�u� 4y' ! o, SIGNED DATE IF®riM= 45 472 SEND PARTS 1 AND 3 INTACT PART 3 WILL BE RETURNED WITH REPLY, POLY PAK (50 SETS) 4P472 Inalvlaual 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 XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 421 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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm � & S ELNG;NSERING Phone 17034 £sale River Loop Road No, 204 Address Fa91eRiv„r_,--A1aska-99-_5 `i,— Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Condit;onal approval for Additional Comments Date w � y �o'va:l tom. 3itaic/.' ' �W 4 Io. 145:• n bedrooms, with the following stipulations: Date r� 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 421 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: j_2* &,-Z &-i�+ inn-�j��` Z Parcel I.D. �.�r/�1,7z'L�i A. WELL DATA Well type ?F-tveTL If A, B, or C, attach ADEC letter. ADEC water system number ' A. _ Log present &N) Date completed II- 1 - Sr Driller I'�A[anlusv l �cucc�G Total depth 1 E5C> Cased to I o o ` Casing height I Z - Sanitary seal (�?N) Date of test Static water level Well flow Pump level Wires properly protectedOYN) FROM WELL LOG II -t-81 UIL 9 -p.m. SEPARATION DISTANCES FROM WELL TO: t Septic/holding tank on lot — 9-1 Absorption field on lot Public sewer main Public sewer service line 1 V ; On adjacent lots _ LC>bt� On adjacent lots 10o + __ Public sewer manhole/cleanout Petroleum tank 25 i + WATER SAMPLE RESULTS: GPL�t Coliform Iao,,. Q. Nitrate 3. M� Other bacteria Date of sample: I I -`i I Collected by: 5 s 5 Gov inl2in1G, 13. SEPTIC/HOLDING TQ.NK DATA ff IItl till E3 Date installed 1 Tank size 1 DOfl (gm"- Compartments Cleanouts &N) Foundation cleanout O/N) High water alarm (YS) /q Alarm tested (Y/N) Date of pumping C9 -1S- °Il FOMPv-14 7_ Depression (Y& d4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s)onlot oil On adjacent lots Ibdlr Foundation To property line 1614- _Absorption field S t Water main/service line Surface water/drainage IOL?" - 4- - 14- 72-026 (Rev. 72-026(Rev. 3/91)Front MOA 21 CONTINUED ON BACK PAGE M AT INSPECTION C m r ® Fwa rr V Y, t't<1 t z ; On adjacent lots _ LC>bt� On adjacent lots 10o + __ Public sewer manhole/cleanout Petroleum tank 25 i + WATER SAMPLE RESULTS: GPL�t Coliform Iao,,. Q. Nitrate 3. M� Other bacteria Date of sample: I I -`i I Collected by: 5 s 5 Gov inl2in1G, 13. SEPTIC/HOLDING TQ.NK DATA ff IItl till E3 Date installed 1 Tank size 1 DOfl (gm"- Compartments Cleanouts &N) Foundation cleanout O/N) High water alarm (YS) /q Alarm tested (Y/N) Date of pumping C9 -1S- °Il FOMPv-14 7_ Depression (Y& d4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s)onlot oil On adjacent lots Ibdlr Foundation To property line 1614- _Absorption field S t Water main/service line Surface water/drainage IOL?" - 4- - 14- 72-026 (Rev. 72-026(Rev. 3/91)Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) Nigh water alarm level "Pump on" level at Meets MOA electrical codes (Y — Manufacturer Manhole/Access (Y/N) "P p-6ff I� at Cycles tested —_ SEPARATION_&fSTANCE FROM LIFT STATION TO: lot D. ABSORPTION FIELD DATA On adjacent lots Surface water Date installed _-�.L_�1 Soil rating PSR System type Length Z21 Width —!!I bN Gravel thickness (a _Total depth `1,!5 1 Total absorption area 2t, Cleanouts present( M) — Y Depression over field (Y& Date of adequacy test _ Results fail) _fD� for 60 bedrooms Peroxide treatment (past 12 months) (YC9 V!- If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot _ `1'I On adjacent lots 100 `x Property line To building foundation To existing or abandoned system on lot On adjacent lots 2;60'r _Cutbank NIA Water main/service line_ Iv`� Surface water l d ' � Driveway, parking/vehicle storage area Curtain drain �la E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect onrthO,�,dft,DQhis inspection. Signature iNc; r s lrl M € a ;I� Ri Mfr ,c,0p .oner o. 2014 Engineer's Name fir, Alaska 99577 _ u Date _ _ .�; „ 'r• NAA I ee $ i c,Yt Waiver Fee: $ _ Date of Payment d_� Date of Payment Receipt Number _% `� Receipt Number 72-026 (Rev. 3/91) Back MOA 21 C_ - ' CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS REPORT BY SAMPLE for WORbordex# 35172 Date Report Printed: JUN 15 91 @ 12:48 Client Sample ID:L26 B2 SCIMITAR S/D 12 PWSID :UA Collected JUN 11 91 @ 13:40 hro. Received JUN 12 91 @ 14:30 hro. Preserved with :AS REQUIRED Analysis Completed :JUN 14 91 Laboratory Supervisor -STEPHEN C. EDE Released By Chemlab Ref #: 912678 Lab Smpl ID: 3 Matrix: WATER Parameter Tooted Result Units ------------------------------------------------------------------- HITRATE-N 3.2 mg/l Sample ROUTINE SAMPLE COLLECTED BY: RAY. Remarks: Client Name :3 & S ENGINEERING Client Acct :SNSENGP BPO # PO # 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 See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than rZO SGS Member of the SGS Group (Societe Gdndrale de Surveillance) MUNICIPALITY OF ANCHORAGE • t 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 Parcell.D.#- ��—��i �l'� HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) L ZLv BX2, l M I I A14 2- - Location (address or directions) (b) Property owner VA Ks � Telephone : (home)�I— Business Mailing Address ti Ea V, (c) Lending Institution Telephone N Mailing Address N (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here\ 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 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 ClawlKI F A5ozc�, Telephone /Z79— 181& Address :P C> , ' D( _73C) 3' 1 41sA b1 c 9%23 Date ,-71 Engineer's Seal 6. DHHS APPROVAL / Approved for - bedrooms b ' Date Z 1 0 Approved/DisapprovejdJ/ Conditional Terms of Conditional Approval L;. -, L . -- CAUTIONi, 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 0 MUNICIPALITY OF ANCHORAGE (MOA) , • Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 AW) 343-4744 t ti Legal Description: •- � -, Well Classification T K) VA 7n7—, 1 If A, B, C, D.E.C. Approved (Y/N) A Well Log Present (Y/N) _Date Completed C)q. _� >� Yield 4pyj_ Total Depth J) _Cased toCX_)1_Depth of Grouting Static Water Lever I Pump Set At 1A Itj _ Casing Height Above Ground 1 Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) _ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot i 9--7'., ; On Adjoining Lots j ` X)' t 7 To Nearest Edge of Absorption Field 11 on Lot �� �,`'' ; On Adjoining Lots K) � To Nearest Public Sewer Line IV To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot 1�4 !L�. Water Sample Collected by � ` Ihl2XII it AA- �[ Date Water Sample Test Results i 1 Comments 1v(� f V)f. _[ I. UIA VY D "`1 I"' I () SEPTIC/HOLDING TANK DATA Date Installed NDV, 51 Size No. of Compartments Standpipes (Y/N)—Air-tight Caps (Y/N) _Foundation Cleanout (Y/N) Depression over Tank (Y/N) k , I r Date Last Pumped /�`�`% Pumping/Maintenance Contact on File (Y/N)I I'' _ ; for i"l',. p,,* Holding Tank High -Water Alarm (Y/N)�) ') r Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well To Building Foundation i To Property Line To Disposal Field 2 ( t To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course I\� I f r � Comments t\ -V 11P Nt ) I-'' orf) t 72-026 (Rev. 7788) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata C hi E P` 1 Type of System Design Date Installed i o l 6) a`)i Length of Field Width of Field AD lmc",I-!e � Depth of Field Square Feet of Absortion Area `fGravel Bed Thickness ��'- Statndpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Tj I ��a yo Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FFIIELD: To Water -Supply Well o7/ /o» 1 To Property Line 1 To Building on Foundatil%T . I I (\ % ( To Existing or Abandoned System on Lot ! A To Water Main/Service Line �'! a To Stream, Pond, Lake, or Major Drainage Course On Adjoining LotshiT To Cutback (if present) 1� A To Driveway,, Parking Area, or Vehicle Storage Area Comments :A, IN I -0V1% 1IV I'l n►, -1 D. LIFT ATION Date Installed Size in Gallons "Pump On" Level at _ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments "Check Permitted Bedroo I certify that I / check inspection. Signed�� < Company Date MOA No. ��5 1r Dimensions Manhole/Access (Y/N) "Pump Off' Level at Vent(Y/N) I �\ Pumping Cycles during Adequacy Test. ating Against HAA Request" rified, or conformed to all MOA and HAA Receipt No. c) Date of Payment Amount: $ in effect on the date of this Receipt No. _ Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 Engineer's Seal 'CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC - TELEPHONE (907) 562.2343 5633 B Street Anchorage, Alaska 99518 •°• Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED A WATER SUPPLIER II TO 13E COMPLETED BY LABORATORY Er PUBLIC WATER WST EN LDAj ���—� iljJ , flea w ter s+►eiti t ...��ATE WATER MWqEM fldlNf�l Winne Phone No. 'fes Malling Address Ahica City State _lip Code SAMPLE DATE: = ® aZ J i Mo. Day Year SAMPLE TYPE: iiotutine V fl.arhsa Swrapie (forsouthm stmlple I witU`1ab ref. sm.. O 'TiteRled Wefer ❑ Special i wpose 0 Untreated Water SAMPLE Time Collected NO. LOCATION Collected y 2 4 i READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Anali is rihown a o e. aaiiSfaCtory Unsatisfactory © 13ample too tong intransit; sanV%WxwId not be over 30 flours old at examination to Indicate reliable results. Please send new sample via special delivery mall. Date Received -1 - ju-ga Time Received II zrcz- _ Analytifll Mlettiott Membrane Filter " No. oftoluntesJ7DO ml. Lab Ref. No. Retwlt' Analyst 90.2466 2 _ ED -- M BACTERIOLOGICAL WATER PSIS RECORD Membrane Filler. Direct Count Cotilorm/100ml Verification; LTB Final Membrane Reported By TNTC = Too Numberous To Count OB = Other Bacteria BGA Results PART ONE OF TWO REMAINDER TO FOLLOW r' Collform/100m1 lea 10 a.m. p.m. o,n£-`Infopl., 11);LF(s ;12 Lj'1 T1'ir:R MMTO :UA ('ol.l,ev'tod JIM 16 eo s !lip nt,'yod 3 U Iii S0 9 ,16:x5 )wo Pisa orved with :AS REQUIRED GAD IUlSTAUCTI011' 5"o'S Woal= I?ato PIT. II' J0 0 08:41 C,lIont Hera : CORMII R ASSOC. Client Ace£ CORFIL W P.OJ PON RECPIM Roq � Oxdoxod By : BRUCE Coft" r Chinr,ah Rok. 1 :902466 A:nly,�i„ Complotod : 'l 1 '10 Send Ropottu to: Lobor:nCoxy Sapoxviao€ :3 F.NnLSI C. EDP l.)COR4tI l & A:ISOC. Il c,l,p�aed f, j 7.) 7paCar.l l fi[i C, RlAG t : Chora.ai 0.1ont Pazamatoz aWusplx Matrix To Test 6lothod Un.ito Renu- t 1, 2:i !J, c,>>*)T'A 2 00153-NITRATE-If ..............oVPA 353.2 r /l _ N QDnWa1N & associates,inc. Consulting Engineers P.O. Box 230608 • Anchorage, Alaska 99523-0608 • (907) 279.8866 • FAX: (907) 279-2882 July 16, 1990 (Revised July 19, 1990) Mr. John Smith Municipality of Anchorage Department of Health and Human Services Onsite Services 825 L Street, 5th Floor Anchorage, Alaska 99501 SUBJECT: HEALTH AUTHORITY APPROVAL AND WAIVER REQUEST FOR SEWER AND SEPTIC DISTANCES TO WELL FOR LOT 26, BLOCK 2, SCHIMITAR #2 Dear Mr. Smith: We have completed a Health Authority Approval on the above referenced lot and find that both the water and sewer systems work appropriately, but there is a need for waivers for the following: 1. The distance from the well to the trench sewer system is 97 ft. 2. The distance from the well to the septic tank is 97 ft. 3. The distance from the sewer system to the lot line is less than 10 ft. (The distance to the standpipe closest the lot line is approximately 3 ft.) 4. The distance from the sewer system to the newly moved garage foundation will be less than 10 ft. (The distance will actually be 9 ft. to the standpipe). We hereby request approval of the full Health Authority Approval with appropriate waivers based on the following information: 1. The well is located such that drainage from the sewer system is directed away from the well and more toward the street area. 2. There is 60- ft. of gravel and rock before the static water level of this well and no way for contamination to reach the aquifer prior to obtaining treatment. The nitrate level in this well is 3.9 mg/1 and this would indicate that there is no existing problem due to the distances which have now existed for several years. Bedrock also exists from 85 to 180 ft. which further protects this well. Mr. John Smith July 16, 1990 Page Two Lot 26, Block 2, Scimitar #2 3. The soils testing we performed on this lot indicates a very nice gravel soil regime for the sewage to percolate through which would tend -to indicate a vertical rather than horizontal movement of the sewage away from the system. 4. A waiver of only 3 ft. from the 100 ft. requirement hardly causes any environmental damage. 5. As stated above, the existing system has been in operation in its present state since 1981. 6. Neighboring wells on Lots 24 and 27 indicate that the groundwater gradient slopes from Lot 27 across the cul-de-sac to Lot 24 which happens to be in a direction away from the well on Lot 26. The static water level from the well information on Lot 24 indicates a depth of 150 ft., while the depth of the static level in the well on Lot 27 is 25 ft. This computes to a slope of approximately 20% for a point total of 6.2 additional points. (Groundwater gradient away from the well or 6.2 points). Also, any flow from the sewer system would tend to flow away from the well on Lot 26 and toward the center of the cul-de-sac. We strongly urge your approval of the Health Authority with its waivers for 'this lot as we believe the evidence indicates no contamination can reach the well. Very truly ours, & 4,&SOCYATES, INC. Corwin, P. -E-. 0) / dove /,4 0 W'O I -f rn RECERTIFICATION 9-13-90 ASBUILT-NO CORNERS SET THIS DATE. I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: Scimitar Subd.,Unit No. 2,Lot 26,B1k. 2 AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. V 6 C( SEWARD & ASSOCIATES LAND SURVEYING 688• — SCALE: 1"=40' paat,n.�a F' a DATE 7-2-90OTH 2 9fC �i� GRID: NW 1261 r/` � .:�':�`� 9uartrt fRar'a �mna,*d! a 13-18 �M '' °• DRAWN' �n.aa4 +►'°•;° DMS '%i ZJ GL ® \� �vELL V Q 2/ �.� � SEAT/ON •=/NE E/JSEit�JE/YT /D AUT/L/TJ/ E'9J'E'MEif/T ASBUILT-NO CORNERS SET THIS DATE. SEWARD & AS I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE' FOLLOWING DESCRIBED PROPERTY: 1"=40' Scimitar Subd.,Unit No. 2,Lot 26,B1k. 2 DATE: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS 7-2-90 INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: EASEMENTS? COVENANTS, OR RESTRICTIONS NW 1261 WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: 13-18 ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN: ARY LINES. DMS OCIATES LAND SURVEYING 688-4566 OF At Ar * %P'q• J i hl�� • ��y e Dvons Mark Sword / LS - 6918 �a MUNIC]:LPLITY of ANCHORAGP DWT. ION Or FNWROMENMV, ilr_:At,l�i DEMULMENC OF fJ�;ALTH A.ND ENVI.RONMENTAI., PROTECTION APPT ICATIaV FOR REALT11 AUTHORITY APPROVM' CERTIFICATE 1. General Informal: i.or. Ip].icati.<in Date (a) ! gal D- s i.ptioq (include lot, i,].cc)5 , subdivision, section, ta.irship, range ) !- Location (address GL' 6iCC9C1:.7.1'ins) / (b) Applicants Nanxa'//i�� Telephorn Applicants Address (c) App-)licant is (check or.J.) Lending Institution darer/bui.ld07gF Buyer. f Other(explain) (d) Pending Insi:itution Address (e) Real Estate Co. & Arent Address Te.l.ephone 2. a' of :-esiderci� Single -Family ��� Multi--I'ainily f ' Numbcr of. Beclrccas 3. Water Supol.•; Individual. nza1J. Ccnnmani.ty Other. (cescrib- Public Te le phone --- - -- ,,\lot-: If comwni.ty Aell system, must have written contiematicr f cm the State Departner_t of Environmental Conservation attesting to the legality and status. Ts t.h-) vrc 1]. adequate fur the numter of badrecrms specified in this [Wk �/N) 4„ Sewage Dis ..5,n1 Onsite Public j j Ccmmurity r Holding Tank r � Is the wastewator disposal system adequate fcr the number, of Wdrocros (Y)/N) [Page 1 of 21 n 2-15-84 5. En i.neerin Firm Provic,.Ln< Ins ections, Tests, rata and Information I c-rtify tba effect on the S igre checked, verified, or conformed to all PCA HAA Guidelines in nspe-cti.on. Nam /(-)f Firm Tolephonf: Address �/�..� LIa �Q PrBg Signed by Date 6.DHEP Approval Approved for (ENGINEER SEAL) tedrooms By Approved F-'X...j Disapproved fY Conditional F--7 Terms of Conditional Approval The Municipality of: Anchorage Department of Fbalth and Envi.rorni*en'tal P-rotecti.on dc:es not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval. indicates that., as of the validation date shown above, bdsied on the data and information furnished ty an engineer registered in the State of Alaska, the water supply and wastewater disposal system. is safe and func— tional for the r:umbar of bedrecxTs and type of structure indicated. (MEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s [Page 2 of 21 0 -15-84 Murnclanl-iTv of r,Nc;lac��nc>f: DEN. Oi IiL;�Lltl L< ENvleor;N:.ivl,al. F,.o�rcnorl MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST —FEBRUARY 1984 A. WELTS Legal Description: Well Classification s/ _ If A, B. or C. D.E.C. Approved(Y/N) /f Well Log Present �N) Date Completed /,/10c.) / y' _ Xie 'd 5z '4011 Total Depth I C_ Cased to /�% C� Depth of Grouting Static Water Level Pump Set At I,( Casing Dight Above Ground _ �' ,� � Sanitary Seal on Casing fi)m Electrical Wiring in Conduit (Y A) Depression Around Wellhead ( Separation Distances from Nbll: l To Septic/ft Tank on Lot L2 On Adjoining Lots -7 To Nearest Edge of Absorption Field on Lot ; On Adjoining LotsG-' To Nearest Public Sewer. Line �'� )� _ To Nearest Public Sewer Cleanout/Manhole %1 (n To Nearest Sewer Service Line on Lot Water Sample Collected By .S > 5' ��//?�'C'i" f j Date' -- Water Sample Test Results — -- Comients [g/UC/u CCU?—/y, 8771 T csr- .1 AJ 5ia, _`/ it_jvu rej r� /i` Vii= G B. SEPTIC/HOLDING TANK DATA - �._____,-----_-_--- Date Installed /v L% el Size � � ^ No. of Compartments �� _ Standpipes) Air -tight Caps/( YN) Foundation. Cleanou�-- Depression over Tank (Y ) Date Last //Pumped Jl Pumping/Maintenanee Contract on File (Y/N)`�; for Holding Tank High -Water Alarm (Y /`) /1 Temporary Holding Tank Permit (Y T'1 ll% Separation Distances from Septic/Holding Tank: To Water -Supply Well _ �/� % r% /v -to Building Foundation_ To Property Lire_ Disposal _— To Dis sal Field _ To Water -M*_ n/Service Line ���'f To Stream, Pond, Lake, or Major Drainage Course /� % ✓} Comments -- -- — [Page 1 of 21 2-15-84 A;- M5j7 Ujo vo% t ROBERT A.SHAFER CIVIL ENGINEER 6942979 June 10, 1984 ADEQUACY TEST WATER AND SEWER INSPECTION WELL INSPECTIONS AND FLOW TEST SITE PLANS ROAD DESIGN SOILTEST ON SI rE WASTE WATER DISPOSAL SYSTEM DESIGN EXCAVATION WORK State of Alaska Department of Conservation 437 E Street Anchorage, Alaska 99501 ATTENTION: Bruce Erickson REFERENCE: Lot 26; Block 2; Scimitar In November, 19131, an on-s.ite waste water disposal system was installed on the referenced property. At the time of this installation the Municipality Inas commonly granting waivers on the installation of septic tanks at less than 100 feet however, normally, not Less than 85 feet. The septic tank installed on the referenced property was placed 97 feet from the well. �Th.is was the maximum distance that could be obtained and still allow for horizontal distance requirements between the septic tank and the drai.nfield and between the dra.infield and the property line. The well for this area is approximately 180 feet deep and is in bedrock at 85 feet. The well casing extends into the bedrock. Perforations at 65 to 67 feet. The well has been in use since 1981 and an analysis for total coliform bacteria was taken with satisfactory results on June 6, Attached is a copy of the application for a health Authority Approval. C} rt:.ifIcate which Is currently being filed. It is recommended and requested that you grant a waiver for the horizontal separation distance of 9-7 feet between the septic tank and the well. If we may be of further service, please do not hesitate to contact us. Si nAere BERT A. °:SIIrfPBR; A,S/ss' I 1984. iYl 'rime a Time . e Date . Date Date Inspector Inspector Inspector Comments Conditional Approval 3-3 Date Sewer Installed Permit No. Septic Tank Size Holding 'rank Size Soils Rating Well To Absorption Area 4� Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner e Phone w Mailing Address 40 /� Buyer 77/1 Address Lending Institution 77>7—" _. �� Phone Address Realty Co. & Agent 4s� Phone Address Legal Description -— Street Location type Residence ❑'Single Family L]Multiple Family No. of Bedrooms _ -3 _ _❑ Other Water upply Individual ATTACH WELL LOG. A well log is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log If _ ❑ Public Utility available. Sew cSDisposal Li Individual Year Individual Installed: — _ ❑ Public Utility When Connected to Public Utility: __ ❑Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFOFIF? PROCESSING CAN BE INITIATED. rrp� 3 I EXCAVATION WORK March 2, 1982 Myers Construction P.O. Box 351 Chugiak, Alaska 99567 Dear Mr, Myers, Reference: Lot 26; Block 27 Scimitar Subdivision ROBERT A. SHAFER CIVIL ENGINEER 694-2979 An on-site inspection of the well and sewage disposal system was performed by this office on February 25, 1982. The well casing was adequately sealed and the well wires had been placed in conduit. The ground around the well casing was adequately sloped in accordance with standard construction practices. The septic tank clean -outs were visible and horizontal distances from the well were in accordance with Municipal. standards. A water sample was taken and the analysis report for total coliform -bacteria provided by Chemical_ and Geological Laboratories of Alaska, Inc. provided satisfactory results. if we may be of further assistance, please do not hesitate to call. Since ely, , J/ E{FZT `A. SHAFER P. E. S/ss " /i j cc: Municipality of Anchorage Department of Health and Environmental SRB196X EAGLE RIVER, ALASKA Protection Municipality of Anchorage MEMORANDUM DATE: February 11, 1982 TO: Laura Crow FROM: Sewer. and Water Program SUBJECT: Request for Refund - Account #2460 Please make arrangements for the following refund. A private engineer did the inspections of the installation of on-site sewer rather than this office. Thank you. Account # 2460 Receipt $ 161623 Amount $60.00 Permit # 811156 Lot 26 Block 2 Scimitar Subdivision Permit It 811155 Lot 25 Block 2 Scimitar Subdivision Myers Construction Post Office Box 351 Chugiak, Alaska 99567 Laura J. Ward Senior Office Assistant Sewer and Water Program attachments 91-010 u/na