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HomeMy WebLinkAboutSEA TURN BLK 2 LT 2I.�a a blo�2 a lill b�l 1111111111 10 illiiiilliilliillillll 0211111111 CO) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L•• Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE: SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT DISTANCES 7no'l LOVAS /1"mie "4mo l— r, an> TO SEPTIC ABSORPTION Address FROM TANK FIELD WELL 58,10 4z 4 e-11 a1,wzF- WELL O Phone(s) --- Perms No- No. of Bedrooms 7f/z 8�soo �s 41 LOT LINE 0 J 0 LEGAL DESCRIPTION Lot Block Subdivision 9 5PA - LILLI FOUNDATION Township, Range, Section ___ AS -BUILT DIAGRAM (Show location of well. septic system. property _ lines, foundation, r driveway, wafer bodies, etc.) TANKS 4,2 SEPTIC ❑ HOLDING Manulactwer T Capacity in gallons Material No. of Compartments _ _ w — TYPE OF SYSTEM 4 X80' N O i�Hwl Ecce ❑ TRENCH ❑ RED W. DRAIN ❑ OTHER Depth to pipe botlom from original grade Total depth from original grade FT FT _ , Fill added above ongmal grace Gravel depth beneath plan U Fr FT Gravel lengtl! Gravel width - -- --- — — S FT FT / f _ Total absorption area Distance belween lines 17- �5 SQ FT I Fr — — — �1, I _ Number of lines Sod rating _ f. ICiN! , Pipe material r! 275 SOFT I''VC..',. of � I to I 1 --- Installer f_(1 Date Installed V SfT1CC.'a�, yjt-'7'Ff Otil 3 LI -- — — WELLS ,. � 7 -- - PRIVATE ❑ OTHER (Identity) a.o -- — ----- — Classhcation (A.B. Total Depih Cased to Installer Date Installed. -- — -- g 18 18 Ell - - REMARKS: — f Ile /O/3// Scale: /77_ Inspections Performed _--QI-__Vl[-_(/Jq� _ 'rby. _�/. 1"1r I`.•/'1 f1 f_I PU'py�°, �y,'�{% �VCk' cy Date C !l!� "f •dol I / �`Yy�}��sba fs7 f �'f` .c� fin� °er� n — - — _ OG e, r• RPn+Ce4Y ecu Ou C5Vee yy t A U4 L C AJ a aSo �� Michael cerlily Ilial This inspeclion was performed according to all li;+>' °. 4381 L. AncicrsGn - F Municipal and Slate guidelines in effect on this d f/�e/ i�3 �'u Health De vimentA royal: �. Date. 72-013 (3/85) Key Bank of Alaska A KeyCorp Bank Mortgage Lending Division 101 West Benson Boulevard Post Office Box 100420 Anchorage, Alaska 99510-0420 (907) 562-6100 June 6, 1989 Mr. Dan Bolles Municipality of Anchorage Dept. of Health and Human Services Division of Envronmental Services 825 "L" Street, Room 502 Anchorage, Alaska 99501 Re: Lot 2, Block 2, Seaturn Subdivision, a/k/a 5840 Azalea Drive, Anchorage Dear Mr. Bolles: 50-w BANK MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION AP, 'D 1989 RECEIVED Attached is a copy of the Health Authority Approval for the above referenced property. This approval was conditional for some minor work to be completed by June 1, 1989. We are having a bit of difficulty with this one as the builder responsible for completing this work has left the state (we just confirmed). We are attempting to contact the subcontractor that was suppose to do this work and get him out to the property to finish up. In fact he has already been paid by the contractor, we also have additional escrowed funds if we have to find another sub, but feel he will end up doing the work as there is additional work which is more substantial to be done. The name of the subcontractor is Harten Construction Company. We also have a phone message into the engineer to enlist his help in getting this finished. The owners of the property are left to arrange all of the work to be done on their own and want to make sure they coordinate it in the most economical manner as to not go over the amount which has been escrowed for the whole job. They want to arrange for Harten Construction Company to bring their equipment and do the other dirt work etc., at the same time they do what- ever needs to be done for the final DEC approval. What we need is an extension of time to complete the post --tank clean out. Everything is being worked on at this time and we would like to have until at least July 1st for this. Eben though it is minor we are trying to take into consideration the contractor time in scheduling all the work to be done at once so as not to waste any of the funds we have escrowed on behalf of completion of the property. Involved. Innovative. Professional. Mr. Dan Bolles Municipality of Anchorage June 6, 1989 Page Two We have had to arrange for an extension of the C.O. and were granted until July 1, 1989. Can you please let us know as soon as possible if we can get an extension for the same? If you need any other documentation or information please let me know. Thank you for your assistance. Sincerely, Ianna L. Erwin Assistant Branch Manager Mortgage Lending Division encl. DLE/hs Municipality of Anchorage Department of Health and Human Services dht�5 825 "L" Street Tom Fink, Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 January 6, 1989 Mr. Michael E. Anderson, P.E. 2900 Boniface Pkwy. #425 Anchorage, AK. 99504 Subject: Lot 2 Blk.2 Seaturn Subdivision Dear Mr. Anderson, The as -built for the septic system installed on the subject lot is being returned for corrections on the following deficiencies: 1) Per AMC 15.65.060.0 install a four inch clean-out at each end of a t== =�- / r�u. y _ -"" Olel49t i V I l i t vi -n 9-t t� k�e .i n the-seGeFl a +a o., - / / /19/ Approval cannot be given until these deficiencies are corrected. Please call me if you have any questions concerning this matter. :in�cere�y, Daniel N. Bolles On -Site Services cc: Al Sundquist, P.E., Manager On-Site/Water Quality Building Safety db/42 MUNICIPALITY OF ANCHORAGE Department of Health it Human Services ` 825 L Street� Anchorage, Alaska 99501 343~4720 ON^SITE SEWER & WELL PERMIT Permit Number: 880055 Date Issued: 05/23/88 Engineer Designed P&re- eArlm: /21-311mm Owner N��e: TOM LOVAS & MARY ANDERSON Day Phone: Owner Address: P"O. 80X 220402 564'-0742 ANCHORAGE, AK 99522 Parcel Id: 017-121-30 1. I am familiar with the requirement� r on�site ri ewers and wells as set Lot Legal: SubdivisioO: SEATURN SUBDIVISION Lot: 2 Block: 2 system in accordance with all MOA codes and regulations, Section: 35N Township: 12N Range: 3W Lot Size 41,')329 Qiq"[t. or acres) eXisting well, wastewater dispos�lkl system or public sewerage sy�tem on Max Bedrooms: This Permit: 4 Total Capacity: 4 SIAV6111 ONIM/Q M20r/Z*AJ[Aj6 SEPTIC TANK: Minimum total septic tank capacity: 1,250 gallons" Each septic tank must have �.,it least 2 compartments. Depth to top of sceptic tank(s) at 4.0 4eet requires insulation over tank(s)" WELL: Log must be sub0ittcod to MUnicipality, of Anchorage Dep�rt0ert of H�a-lthi and Hu0an S(orvices within 30 days oh vieli co0pl�tion" INFORM D.H.H.S" PR%OR TO IST & 21\11) INSPECTIONS BY ENGINEERv IF AFTER OFFICE HOURG CALL 343~4681 AND LEAVE A MESSAGE CONSTRUCT PER ENGINEERS ATTACHED APPROVED DESIGN I CERTIFY THAT: 1. I am familiar with the requirement� r on�site ri ewers and wells as set [orth by the Mur,icip�.klity o[ AOchorage (I'll OA> and the of Alaska. 2, I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria o[ this permit" 3. I wi1l adhere to all MOA ;'And State of Alaska for the set back distances frum any eXisting well, wastewater dispos�lkl system or public sewerage sy�tem on this or �ny or nearby lot" 4" I understand that this permit i� valid for a max imum a 4 bedrooms. I also understand that the it'v of, the total 4 and any c_-.n1 tional permit. — SignEMI :DATE: _____-- (Owner) T & MARY AND�RSON ............ �������~.'��..... ..... ..... ..... (ENGINEER'S SEAL) e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 121 ZAI /7%/-l2 ( 00,S7`R0Cr10r0 DATE PERFORMED: LEGAL DESCRIPTION: X07 B//C 7— Township, Range, Section: S 3 � T /z n-/ jZ 12/ DEPTH �a1-•n t U 1' .j'l SLOPE SITE PLAN -EP-rE�0/1Cr/ nI lCS 2 3 4 5 6 ����/J/ a�+oEa 7 �i 1�?A vim` � s Date Gross Time MOOR Depth to Water Net Drop O 9 0 3.5" O ll 7- 10 "M Ale-, far 12 —�g y\Ie "6""G"Y,J ✓7 pS o r 5 1� 13 14 h4 chael E. Andarson 15®-0 J��o " 4381 16 U%/ROFES51�"5 33 17 1:3� 18 19 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? NO Depth to Water After Monitoring? A10 OJArL`P Date: 518&fs S L O P E -0 Date Gross Time MOOR Depth to Water Net Drop O 5 8 ffA Q 0 3.5" O IN "M 7 z 7.0 5 1� I NNE a■ 11 0 IN Ell 0■ 0 NAS Reading Date Gross Time Net Time Depth to Water Net Drop O 5 8 ffA Q v 3.5" O 7 z 7.0 5 20 cul PERCOLATION RATE J' 6' (minutes/inch) PERC HOLE DIAMETER C3 TEST RUN BETWEEN L( FT AND (�2_FT COMMENTS 02017<r102MIel 4PL=A ALL/A/COn!i/ rfZJJli, cF or/s <r7r :2 ' !j PERFORMED BY: AW04%ERTIFY THAT T IS/EST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) 1 • S 89° 46' 32" E 1322.18 En 1 260.18 22°.00- — - - 18w—� 13000 30.00 �„ - -- ---- -- — — -- — ` — — — — /I 3 Docilon line \ \ 1 ; (Easement \ O I N�20' UTILITY O I u', EASEMENT <o 3 \ ,6 1 (p w �i \ 20• UTILITY I C � 44,965 S.F o 2 ss EASEMENT I— I a) N ti 55,170 S.F h °° `� 1 i 30 1.02 AC. z 49,277S.F cryo° 1.267 AC. a °a�°'1N2Ta, ® 1.131 AC. y 20 o >9 s, BLOCK l s� > o Q `L `P TO . O MO p0 ` 5>pp ? nb ^i0 4 'o o,'/ \ \ F o ♦ 2 \ ro 0 ;3�ss �3�.sq `� 000 51� 347 S.F I O M' O >s 00 asoma 1.179 AC. ti /Z oo 3' SECTION LINE o 5 /3 9?9 ?� y20' UTILITY EASEMENT ?3S �S © \�EASEMENT I --- a j'?D al- MG A, / C Jt N I \ a s� �� \s ' 51,873 s 40,700 S.F o �Ai s��,v1,T/�� r,0o °° o' 1.191 l oc.o. ,. t I 0.934 AC. '�� -�3 aE ��I ,° °° s6 sso° top bs In r. B / °° 2r lWr /ss OO _ - °>p3e /'�=loo' /tPORogg� 3 5 �I r EASEMENT ��3' SECTIONLINE 3Op.0�4s 0O. a, 3- 42,294 S.F ry ;w 3y�sso \ 43,540 S.F 1 /Ns��[! u,/�<_ . �,'Olp l�%' 0.971 AC. v ' d9 °,1 \ 2e9 1.000 AC. = 4Co sr/A2�ow/�PAInI r -LC -(*1 e .� 64 �Z; �r .ro-rA� 5° e 9� 3 9? 1 v p,IPa o!I olo, , o r o h6�o la 2J�+ �� 15, Y5 0) I 46,287 S.FI/PA, ;r� 120"N2i24 SS 9„ � 25 F j L9 oer>r/f E 3 J -1 N wim,1 .3./ O O I I ° l0 0 20 UTILITY Nr0 / J p �; +C 39'3>,• p EASEMENT S65o 55+9"E \ TILITY ESMT g p P 0i�0o mxe Beoon I N 8 -� 7 1 0iee ( °n p j4 1 m /v°9 ay1 vPj' e'nt k��' 0 507083 S.F �� c °o l 1 t�d� ; M�i,cchar.e.l ooE.. oeeenns /unW x1Tern vr � - Dy 40,887 S.F 1. AC. �•,70.939 AC. I 20'UTILITY 0 I EASEMENT Anderson N Q s eo 4381 ° �'�`�.•�/ rn .a e ,y O 256.27 t0, 02 �SE. r onxonoaeoa F. o,� I N87052 29''wI .n 258.73 n ! p I 2d 30 > J V� p l l unurY o n, (T, I EASEMENT I N252 z?:}Fi i•7 17 a C I 6 0 D_ 9 3s ,a kOI c „ �� 54 577 o , o OID IN , 47, 775 S.F ' 49 918 S. 3�ar. of _ 1.253 I N L Id j 1.097 AC 1 0), 1.146 AC. / i N S of o i M -W DRILLING, Inc. 'p.0, Box 110378 • 10330 Old Seward Highway ' (907)349.8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner Clark Qonst-rucl;ion of Well Doiuestic Location (address of: 'Township, Range, Section, if known; or distance main road - i.gt 2 Block _k 2 Spaturn Subdivision Size of casing F" Depth of Hole ;1 QQ- II - feet Cased to 100.8 _feet z,� Static water level 37 Jt. MW , -Jt- land surface. Finish of well (check one) open end ( X ); Screen ( ) ; Perforated ( rf�t t t Describe screen or ptrforation ` ------ Well pumping test at_2-gat' 1s : �) (minute) for - 1 - hours with 100X _ft. of drawdown from static �It s Date of completion n 7 A 7 sa WELL LOG Depth in feet from ground surface Crit 1 �� ; 64brmations penetrated, size of material, color and hardness —0+SCts kup -!--To 3.5�As 8 ,TO ]Q r. efevl Y n 10 TO 42 x d ) hif 1. 47. 55 tStk,?>�gi+e1 `+Yormis�b' - TO- 55 TO 8 ' w s . 94 Gravely iiat4pan TO --�- _ q+' TO 96 sand & Gravel' --16 TO 103 sand & Craves. Water Bearing TO �7 — --TO- O TO- TO -TO- TO �Oy80HONd du , , —� Certificate No's. 814 & 973 3 - CONTRACT 3-CONTRACTOR 4 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. # O/7— /Z/- 30 HAA # �_A0qI fri �i R� 1. GENERAL INFORMATION Complete legal description e-' Z ez 564 Z-Vzx/ el&D Location (site address or directions) 5-9416 AZALEA Property owner Tm LodAs v- 1,242,y 9.0o"sa i Day phone 7�.Z-- 117yz Mailing address -- -- -- Lendingagency- - - - Day Phone Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: Ll 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site —v Holding tank -- Community on-site Public sewer -- NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72.025 (Rev. 1/91) Front MOA ®21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm A,,j 4c-fLscj F,,jL, i(ic.- 4 Phone z-76 -9110 Address n©. 90A 240773 A e ye)4A(,c , A -i- (7gs-7,y Engineer's signature X/Date �zl9lq� F .6. DHHS SIGNATURE Approved for Disapproved. 0 �6) bedrooms. Conditional approval for Additional Comments 111Th Of— �' '1� •aN•.o99 a4�23 � L i� u♦ g e fJ �Ro' • g� •Raja ; � �g•ROR e••aa •a•a•a oa•• a ••�•• '� - _. ee.• •ee e. ••• . e� {i ��� Michael E. Anderson Q Q� �'•e 4381 - E •D Z�;a �4 bedrooms, with the following stipulations: Date Z <_/Z The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev.1191) Beck MOAA21 /z/9 / Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L Z 9,? SFATU rtil _ Parcel I.D. 0/7- 1Z/ - 30 A. WELL DATA Well type %� IP-4rE If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) T Date completed 8���d8 _ Driller �¢u/ Total depth 70Iq Cased to 16018 —Casing height Z6 " Sanitary seal (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG g 37" NoT SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot — Public sewer main Public sewer service line _ Baa' Wires properly protected (Y/N) AT INSPECTION 3B" Y '"UNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION g.p.m. g.p.m. of rt QN7�n/t�� G%C 0 9 1991 On adjacent lots RECEIVED //8 ; On adjacent lots dab '-/- 1',*'114�s Public sewer manhole/cleanout _ .l9iC�--s Petroleum tank lVewe ®.v elor WATER SAMPLE RESULTS: Coliform 0 — Nitrate Other bacteria Date of sample: Collected by: W /��f u B. SEPTIC/HOLDING TANK DATA Date installed ' B Tank size 1050 Compartments z Cleanouts (Y/N) —_Z — Foundation cleanout (Y/N) — Depression (Y/N) N High water alarm (Y/N) N�9 Alarm tested (Y/N) t4!�A Date of pumping 5,/9i SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: i Well(s) on lot 60 � On adjacent lots /°O e Foundation 5 To property line -�f{� Absorption field �3 Water main/service line 3 3 Surface water/drainage NOME IN lmmEb//4Tp, AREA 72-026 (Rev. 3/91)Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed . Size in gallons Vent(Y/N) N/v High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water _ Date installed 2�8 Soil rating 275 System type 2,12-4IAJ Length /25� Width 5 7 Gravel thickness y Total depth B I Total absorption area 126-0 Cleanouts present (Y/N) V Depression over field (Y/N) N Date of adequacy test ! Z 9i Results (pass/fail) /EfI55 for Peroxide treatment (past 12 months) (Y/N) >J If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: bedrooms WelI on lot as On adjacent lots X001 Property line z Z To building foundation 9 To existing or abandoned system on lot Na NE oti 7 - On On adjacent lots M6 7,- Cutbank N= or,!sPwr Water main/service line e15' Surface water d0&6 4"4 I/oo' Driveway, parking/vehicle storage area Curtain drain NOM E 114 STA LLEn E. ENGINEER'S CERTIFICATION I certify that f have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. r 00 ^ U `3 Signature CN�dI.t.Cs.vt.t-�� ` ;j o Engineer's Name Mt ey4c_-L_ A-ni Q ewsb,) ' Date a , , 70 "/ HAA Fee $ Waiver Fee: $ Date of Payment /a- 17' Date of Payment Receipt Number6��P'�� % Receipt Number 72-026 (Rev. 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 8 STREET ANCHORAGE, ALASKA 99518, TELEPHONE (907) 562.2343 FAX: (907) 561-5301 ATIALYSIS RUIA' 5' fart UNIVOICF ' TWO' MlArAab P10f. WATLIK ('MInt 'Onjopl'j TP WUA WA7'U 5615 PAFEA- - CiiEi / llv--Iq JWADJAN 'JAYtlI cl; n,: Ar,.ci dUAWC!' iollpoTxv ll1C 1 9 A 11.100 Prg. 1tp�iu : FCS Ci�lf r;'ii,'.Ple';!r iacai,arl Kc 2 91 0 09:00 hrp. i.erll raeor:v d. �lth AS UQUJ_:iM O dored 3y :WAYU11, IfCFA.U101 t.rvw1.ysi: CeFa7latcrl Def, z 91 fond I'mm:ts, taboaatni upar.N'lvox iTF01-VN C. $D8 ii :vAU11PN VAY}Ir.: FiiaPmLwj,q%rl By .- ' �y-r ,pr., ra R�.nY.'�Pu.IH��aU- 'a. [,q�Pa C, •[f.-1'n[e - 1'a,nr�y Ae ults linos lt.rllua Allowillin 11I1ill'AT .-P 119(ma) . _ 1."f/l - aA 3353.2 - 1.1i ;;;rile ROIJ 1;1r SAA"Pi,d CDI,ILCi:1tl AY: V. kl%FADDEH. 1 Jroj,, 1'iiir,:nld ;;De insciui initrucu torr hbasri 1JP.=1Jnh?fzi.1ob1.v ,_. jhl. 11,pn 1Ja`r Hr 1. req} - . p9 AmT'5'C tT: ;liirryl; - n' '�G ailnlZrtl J,7.•Lf' .IHi7, 12*Nsc s Member of the SGS Group (Societe Gen6rale de Surveillance) 7 ;;;rile ROIJ 1;1r SAA"Pi,d CDI,ILCi:1tl AY: V. kl%FADDEH. 1 Jroj,, 1'iiir,:nld ;;De insciui initrucu torr hbasri 1JP.=1Jnh?fzi.1ob1.v ,_. jhl. 11,pn 1Ja`r Hr 1. req} - . p9 AmT'5'C tT: ;liirryl; - n' '�G ailnlZrtl J,7.•Lf' .IHi7, 12*Nsc s Member of the SGS Group (Societe Gen6rale de Surveillance) MUNICIPALITY OF ANCHORAGE C*D Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 141 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # nl `l — 1 'r� \ -'�(� HAA #�`3(�' 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) G BZ S€"%TU,e,y S L)84- S 3S 7-1,Z /f/ 2 .alk/ Location (address or directions) SgF /Zq AZ 9LE,9 O.�'/vim (b) Property owner Torn loarrs�//lo�i�9noe'Pso Telephone: (home) Yi L�6 Business Mailing Address 5Rg 10 -"904LE.9 02/4'E '411 99 S/6 (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the following address: (or check here , if hold for pick up.) List contact person and day phone numbe�Aelow: 5410 E 16 2. TYPE OF RESIDENCE \ Single -Family P- Number of bedrooms 3. WATER SUPPLY Individual Well R' _ 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 P7 Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 Z 1 Z abed 8099 (ee2 A°a) eao-ac •>laoM s,aaaul6ua leuolssa;oid ag; ui suoissiwo Ao sjoaja ao; alglsuodsaa lou sl a6eaogouV;o AllledlolunW aq1 panssl sl aleol;llaao a aao;aq a;ep azAleue ao suoiloadsul;onpuoo lou op SHHO to soaAoldw3 •Sluawaalnbaa alels pue leaapa; uleliao Alsiles oliepio ui suoilnlllsul bulpual alaq; pue sawoq ;o siasegoind of Asalmoo a se siLal saop SHHa a41 •eilsBIV ;o ale;S aql ul paaalsl69a aaeui6ua leuoissa;oad luapuadopui ue Aq anoge 9 4dea6eied ul uanl6 suoileluasaidaa aql uodn Aluo paseq paleoilpao Ienoaddy (liaoglny q;leaH sanssi (SHHa) saoinaaS uewnH pue glleaH;o;uaw;aedaa 96eaogouV;o tl!lediownn aq1 leas s,aaaulbu3 Nounvo leuol;!puo0 lenoaddV Ieuo!l!puo0;o swaal panoaddesla - \/ panoiddV Aq swooapaq f,J�,�'Q/Jo; panoaddV IV O lddV SHH12 '9 /— alea 7_57 -2v -.RWvG#1)Nt1 YLLM2 xclg (j d ssaappd —LS auogdalal eyv a(v Na r0 wa!d;o aweN •uolloadsul sly; ;o alep aql uo;oa;;a ui suollelnbej pue 'saoueulpio 'sapoo ale1S pue ledlolunN Ile q;lM aouelldwoo ui sl walsAs lesodslp ialeMalsem ao/pue Alddns aaleM alls-uo aql 'uolloodsul pue uo1;e61;s9nul Aw woa; pue salt; obeaogouV ;o !l!ledlolunN aq; woa; paulelgo uollewjo;ul aq; uo paseq ;eql A;!aan aaglanl l •ulaaaq pa;eolpul aan;ona;s;o adAj pue swooapaq;o aagwnu agl ao; alenbape pue leuol;oun; 'a;es s1 walsAs lesodslp aaleMalseM ao/pue Alddns aa;eM al!s-uo aq; leg! sMogs IenoaddV Al!joglnV g;leaH slq;;o u01le6lls9nu! Aw leg! A;!aan l 'Molaq uMogs alep uol;epllen aql;o se pue olaJaq pail;;e leas (w Aq pal;lliao sV NOIlVWUOdNI 4NV V1V0 `HO)AV38 311d `S1S31 `SN01103dSNl ONICHAOUd Wdld ONIll33NION3 '9 G� 011��\ jP�S�e • A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) �� Health Authority Approval (HAA) *1 1 11 CHECKLIST - FEBRUARY 1984 343-4744 h Legal Description: L Z !32 S,6A7-V)ZA✓ Well Classification P2/UA TE If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) -_ Date Completed 5 . 6 Yield �n Total Depth1016 Cased to4�Depth of Grouting X/0 4,XOurl-vG Static Water Level 3 Pump Set At LV/6;r DE'TVKM nv-d Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) On Adjoining Lots /DO /- To Nearest Edge of Absorption Field on Lot //B ; On Adjoining Lots >°O To Nearest Public Sewer Line �"//es To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot 97 Water Sample Collected by W. My FaddeY ; Date—//./Ay Water Sample Test Results 5AriSrAcTory Comments WELL is A DCcpvP, B. SEPTIC/HOLDING TANK DATA Date Installed S,13/98 Size l Z- 50 No. of Compartments 2 - Standpipes (Y/N) Y Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) Depression over Tank (Y/N) Al Date Last Pumped h/E w Co sir L)c r/oAl Pumping/Maintenance Contact on File (Y/N) HIE uJ for CaAsr"e0c-r/0r Holding Tank High -Water Alarm (Y/N) N�� Temporary Holding Tank Permit (Y/N) v,44 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well /00 To Building Foundation To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course To Disposal Field Comments 5e t� t C- -rA n K- i's A 1) 4 u,4 c_ 72-026 (Rev. 7/88) Front Page 1 of 2 G/ /Z/ C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 7 S_ Type of System Design w "� Date Installed 8�3�gB Length of Field Width of Field 5� Depth of Field Gravel Bed Thickness Square Feet of Absortion Area / Z S6 Statndpipes Present (Y/N) Depression over Field (Y/N) N Date of Last Adequacy Test y -f40 C" 5 <• Results of Last Adequacy Test 1Asse SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well Pc� To Building Foundation Lot N°'? e o n Lo /- To Water Main/Service Line z9, Z/ S_ , To Property Line Z 2 - ; On Adjoining Lots To Existing or Abandoned System on /00 To To Cutback (if present) Al" C To Stream, Pond, Lake, or Major Drainage Course N o n e- I A.- A ren. To Driveway, Parking Area, or Vehicle Storage Area q/y� Comments A 8526P,on Su_S�e4,1 is ADE9t/dTl-_ TtIF� STATION Date In\stal'IE Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) *'Check Permitted Bedroom Rating Against HAA Request" esz.,. "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.IF Signed `�"'�) � `"' qcn Oo°p r F «�j��as•° Company /�ivOc%fJCa7J �NGi7yr�liNG ��' a f.0_, / tnnv FCC�,�?ry Engineer's Seal Date 0 E� < MOA No. L. Andjr5or i• /X'` (',G/ Vin. '�::' .� �'✓,.[a Receipt No. �Q Receipt Date of Payment / o Waiver Fee: $ Amount: $ � Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 .--, C LAB INSTRUCTIONS for Work Order # 17973 S -6/—S 9 CQclj Date Report Printed: NOV 2 89 @ 15:42 // Client Sample ID:L2, B2 - SEATURN (WELL WATER @ SINK). Client Name MCFADDEN, WAYNE PWSID :UA Client Acct MCFAWC Collected NOV 1 89 @ 15:15 hrs. P.O.# NONE RECEIVED Received NOV 1 89 @ 15:00 hrs-. Req # Preserved with :AS REQUIRED Ordered By : WAYNE MCFADDEN ChemLab Ref. # :8348 Analysis Completed : //- 3 - � % Send Reports to: Laboratory Supervisor :STEPHEN C. EDE 1)MCFADDEN, WAYNE Released By 2) Special HOLD FOR PIC& UP AND PAYMENT. instruct: Chemlab Client Parameter Sample # Sample Description Matrix To Test i L2, B2 - SEATURN (WELL WATER @ 1 2.0153 -NITRATE -N Method Units Result EPA =353=?'ng%-='='__ ANDER S 0 N ENGINEERING P. 0. Boa 240773 Anchorage Alaska 99524 907 337-8367 11/13/89 Municipality of Anchorage 825 L St. Anchorage, Ak. Attn: Susan Oswalt Re: L2B2 Seaturn HAA Dear Ms. Oswalt, This letter is to infor-m4 ou--t occurred -on February 1,\198 installed in 198$-- \� You�;ruly, L. Wayne McFadden occupancy on the subject parcel actually ien though the on site systems were MUNICIPALITY OF ANCHORAGE Department of Health & Human Services L*f1a, DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 017-121-30 HAA # HA890023 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2 Block 2 Seaturn Subdivision (T12N R3W Section 35) Location (address or directions) 5840 Azalea Drive (b) Propertyowner Tom Lovas/Mary AndersorTelephone: (home)345-5116 Business 564-0742 Mailing Address PO Box 220402 Anchorage, Alaska 99522 (c) Lending Institution Key Bank Telephone 564-0218 % Sue Schlect Mailing Address 101 West Benson, 2nd Floor, Anchorage, Alaska 99503 (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; -Mx Number of bedrooms four ( 4 ) 3. WATER SUPPLY Individual Well EV- 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. 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 Address Date Anderson Engienering Telephone 337-8367 PO Box 240773, Anchorage, Alaska 99524 6. DHHS APPROVAL ,\)*:P%�ik[U,f K x x x x x x m e�&NMNK t$y ,&p:pmQx XXXXXxxx Disapproved XXXXX Conditional Terms of Conditional Approval Engineer's Seal Date June 5, 1989 Placed on Conditional Approval on January 26, 1989 to be completed by June 1, 1989. This Conditional has not been met and this property is now Disapproved. =•.. - CAUTION: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections 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 0*w- 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. # i1; \ - I �1 . - '�� L HAA # V4 cs(--) 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) LCT Z t3GdCe Z- 5EATUZAJ SUBOWIs/oN c 35 7— -/? 93(Al Location (address or directions) SBP 14z1446F4 (b) Property owner roil 4.v��n°a.t1 Telephone: (home) 3556 5-Z e— Business � 4 -d-� Mailing Address -�99X 22O VO 99s2z $GNLkF;f-!` ,B,9iy�< Telephone Flay-Ozl Z' - (c) Lending Institution _.��� P Mailing Address /01W SEAISbLf (Znd F::-(oOR)A/��No(��tC,14R' 1`?Sy3 (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: N 2. TYPE OF RESIDENCE Single -Family( Number of bedrooms 3. WATER SUPPLY Individual Well Community ❑ Public ❑ e� Zva p)e �� '. 2 P161 S u !` Sc. t4 L 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 legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm / J V O G-72 SO "J C 61PJ 4-M7b,%J L Telephone -?37]- 836 7 Address EOJ- ��f0 7&A�lC4l02.AGt' /t4 g9S7Zyy Date 111V I B 6 {� 0 �a. ° nn Engineer's Seal Michael E. Andornon A381 - E le Ste+ 4,0'. 0.0600,0 6. DHHS APPROVAL ' Approved for bedrooms by Date G -Appgwed• Disappfeved Conditional Terms of Conditional Approval /CslA-yaU �`��tL/��T/ /lGk)e—,Y� — Ze of a A�ve,6 41,114 2 -DGC i hU l!l Tls- T G7it62 �/GLL�t !` ! <O L • �`fT �hi /f GUi l( CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPAI<ITY OF ANCHORAGE (MOA) CA, <' "lth ,!�grlty Approval (HAA)t"CHECKLIST- FEBRUARY 1984 343-4744 ) ,r A. WELL DATA Legal Description: �'_- 4 P Z %EA7_1, %e / - Well Classification Pk'7V/�rz If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) --)L--_ Date Completed 916;&L? _ Yield � hip: Total Depth/08 Cased to _L00,8' Depth of Grouting 7V0 6&Qyri.vG Static Water Level _ 371 _ Pump Set At -BLOT D7_/AI"r_p Casing Height Above Ground Z6 Sanitary Seal on Casing (Y/N) y Electrical Wiring in Conduit (Y/N) y Depression Around Wellhead (Y/N) N SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot /00 ; On Adjoining Lots /O017' To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots /Do'f To Nearest Public Sewer Line /7//CeS To Nearest Public Sewer Cleanout/Manhole /n« c -_S To Nearest Sewer Service Line on Lot 617 Water Sample Collected by W ; Date / /A-.9! Water Sample Test Results SAT15 (-A c 7 K> Ou Comments 19 E_ r Ar ` /lit c�uA rF - Nr ut C_r»iSrRu crt�r l B. SEPTIC/HOLDING TANK DATA Date Installed 9,48 Size /Z �50 No. of Compartments Z Standpipes (Y/N) — _—Air -tight Caps (Y/N) I- Foundation Cleanout (Y/N) _ Depression over Tank (Y/N) N Date Last Pumped AIStl) ('Qrr57100el 7OAJ Pumping/Maintenance Contact on File (Y/N) 66ErW for Holding Tank High -Water Alarm (Y/N) /V /0, Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well /00 To Building Foundation To Property Line -3�7 'T'o Disposal Field %zt To Water Main/Service Line 3 3 To Stream, Pond, Lake or Major Drainage Course ti1o,UC 19 4elf!j Comments !SEjE?T-tC_ TA N (G 15, A 0E4)U ,4T -E 72-026 (Rev. 7788) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 275 Type of System Design Date Installed 61418F Length of Field /,? Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absortion Area 10 5o Statndpipes Present (Y/N) Y Depression over Field (Y/N) /J Date of Last Adequacy Test Me:ild COn5reucyotl Results of Last Adequacy Test Al1=tL) con sr9QcT/o„1 - FA -556b SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well To Property Line To Building Foundation To Existing or Abandoned System on Lot 1i/49,f/F 011 6'07- ; On Adjoining Lots /On" To Water Main/Service Line To Cutback (if present) Ii/OI-([E �1zE FuT To Stream, Pond, Lake, or Major Drainage Course &6&. IN 12E g To Driveway, Parking Area, or Vehicle Storage Area Comments is 5r1?//.4,-10.1 U° P7 A -DD (T 10AI 1 L C t e JQ-✓r o v T. T STATION Date Ins d Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA gi r inspection.�F' Signed.fa (, Company 14"067UUtJ46I)Q67MjP1G 4 5 Date >N a sc c a (9. F •cv2ba oegnen s MOA No. Receipt No. d 5 2 co IM Date of Payment delines in effect on the date of this 6,, 4& D� F\ o0 �IQ Engineer's Seal rn °, Michaol f:.Anelersan e' �u� 4381 - fp Receipt N0 . ta> Waiver Fee: $ Amount: $ 1-7 Z) Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 LAHQRATDRIES CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID N 92-0040440 AIUM!JI') PFDf M "Y WIFIll',Sr: Wok (O-dirlt I", 11.34 lbie R'pjrL pril'tod! I'M; 20 99 i'l 11,J)0 i 1;10Y tto, y vi�'.ow ;:AM IV,111 1", �"Ui 1pw� o: 11 Abu in