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HomeMy WebLinkAboutSEQUOIA ESTATES BLK 2 LT 2equoia Estates Block 2 Lot 2 #017-152-25 J1 MUNICIPALITY OF ANCHORAGE DEF .TMENT OF HEALTH AND HUMAN SER\ -'S Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES �JM TO SEPTIC ABSORPTION WELL Address CA"�-I C FROM TANK FIELD V�� Permit No. No of Bed�roP ms WELL /J o 1- ; f",�76V Phone(s) : LOT LINE 55Z LEGAL DESCRIPTION Lot Block Z' Subdivision rr I G FOUNDATION �p ; Township, Range, Section AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, pL•tQ driveway, water bodies, etc.) TANKS R_ SEPTIC ❑ HOLDING Manulact er Capacity In gallons Material / No. of Compartments TYPE OF SYSTEM ❑ TRENCH "ED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from Total depth from original grade r I original grade Z FT C FT Fill added above original grade Gravel depth beneath pipe _ 1 FT FT _ Gravel length .3s FT Gravel width 4jFT Total absorption area q/Z, Distance between lines SO FTJ FT 2' Number of mes Soil rating Pipe material ISO SO FTPVU5T-M X0,3 q 11 o Installer Date Installed W(t I R WELLS ❑ PRIVATE ❑ OTHER (Identity) Classification (A,B,C) Total Depth Cased to FT FT � C'� �777F_ Installei Date installed: REMARKS: k Car (krid I nScal /lil�L2 co Inse: pections Perforf}'ed by: ENGINEER S SEAL `� Gt&/O liiT Ul 4-A Date: .1 3 © :Ywf,_e. Al I � cen y teal Isis i pociioo was pe�ocmetl accoctli�g to all � 1 Qsl!(10 p hJAe-y , � eQ f Municipal and State guidelines in ellecl on this date: b, i`� L' °o ^ J. Corwill °ej o. C;"-52 "c.? Health Department Approval: �� Date: � V � . 013 (3/85)' . ' � �1 L���1 ��������� ��� ��4 ��A ������� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PR0TECTI8N ` 825 L STREETANCHORAGE; AK ?950 1 264-4720 C.) ONO ��to-1 E: F�: ������'I- PERMIT NO: 860138 DATE ISSUED: 05/22/86 APPLICANT: ACREAGE SYSTEMS INC. ADDRESS: 601 E" NORTHERN LIGHTS SUITE 165 ANCHORAGE, AK 99503 CONTACT PHONE: 276-6552 LEGAL DESCRIP: SUBDIVISION: SEQUOIA EST" LOT: 2 BLOCK: 2 SECTION: 26 TOWNSHIP: 121\1 RANGE: 3W LOT SIZE: 51579 (SQ.FT. OR ACRES} MAX BEDROOMS: 4 , Listed below are the options avai1able to you in designing your septic system. Choose the option that best Ifits your site" .... ... ... ��� ���������� DEPTH TO PIPE BOTTOM (FT") 2"5 ** GRAVEL DEPTH (FT.) 0,5 TOTAL DEPTH (FT.> 3"0 GRAVEL WIDTH (FT.> 22.0 GRAVEL LENGTH F. 41.� GRAVEL VOLUME (CU,YDS ANK SIZE (GALS) 1,250.O ** � SOIL RATING (SQ.FT./BR) 150 � ** DEPTH TO PIPE BOTTOM < 3"5 FT" REQUIRES INSULATION ** DEPTH TO PIPE BOTTOM < 4"0 FT^ MAY REQUIRE A LIFT STATION ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS ... .... �..... ..... ... ... ... .... �����������������������^��� I certify that: � 1. I liar with the requirements on-site sewers and wells as set � � forth by the Municipality of Anchorage (MOA) and the State of Alaska. � 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3" I will adhere to all MOA and State o� Alaska requirements for the set back distances from any existing well, wastewater disposal system or public � sewerage system on this or any adjacent or nearby lot" 4" I understand that this permit is valid f'or, a maximum of 4 bedrooms and any enlargement will require an additional permit, � IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN LC EETRICAL PERM IT AND INSPECTION Mus T BE OBTAINED; (2) AS~BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3> THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN^ SIGNED DATE: _______,._________ A �rr�zc*mi C. 19oucy o� DATE: � � ���^~� PERFORMED LEGAL DESCRIPTION: `EEPTu: P+ 1 il'I I OL 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS EN I13 C4 aRn C-0171� Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST J t 71 /u ce J. •Co;wino ••::�� , No. CE -5283 �9• - y. 1fI PRdOF S" DATE PERFORMED! r� I I r'G' Township, Range, Section: T i Z i\l SLOPE SITE PLAN I �A9 •� p`d °eo➢a abs e y��. cr , t ° J r, uce J. Corwin ii- �/. No, --5283 ��FiJ ®.!➢ ➢ \,tom r WAS GROUND WATER ENCOUNTERED? wQ�'M,'Ym' fo�r a,,- 2 Ma"1, Hato 6 VAC ea� s no lo. IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? S L 0 P E Date: ■■■■■■■"■■ ■■■■■�•RM■ 00 PHMIN■I■■ M.■■■■■■I■■MOMENEEMENEMENNUMENIMEI ■'■®M■■■'■■ ■"■EM■■■'■■ ■E■■E■■■INE '■�i�ii■i®■ PERCOLATION RATE j TEST RUN B WEEN I bkAl! f PERFORMED BY: T rah ME 1- ACCORDANCE WITH ALL STATE AND MUNICIPAL 72-008 (Rev. 4/85) (minutes/inch) PERC HOLE DIAMETER FTA D FT L�' 10L1,%\ Z rt Ll.7r�. Ir ERTIFY THAT THIS TEST WAS PERFORMED IN S IN EFF T ON THIS DATE. DATE: I (I M� �i.' { \ I I �'(r 17 e N e e i zcr�o�-Eb WSJ L- 1 \J� 9� L�c,�T'toN Hot -e f3 Lor. �Nu n y NOTE:- ^�. THE ACCURACY OF LOCATION OF EXISTING PROPERTY CORNERS, WELLS, AND SEPTIC / SYSTEMS INDICATED IS NOT EXACT. 1 DIMENSIONS INDICATED HAVE BEEN DETE MINED BY USE OF CLOTH TAPE AND NBY \ SURVEYING TECHNIQUES. Lvr SEWER SYSTEM LOCATION PLAN 0 Lot: 2 Block: Z —o 'Z j 8 associates,inc. Prepared for: ;Coa�utNeq Engrn��r• MChare9e,Rbslto S M7 :` ssBr-Brei Date: MH2CH^- r�r �fl s gr 1 '.\ do. CE -52S3 Lh p�OFESS\�•.•� De ?Yp F o5R 00 Bid \ ci RePfo^am 6 U Area d �{ZOPc2fi� �� o \ �Rd Re�arvCd bol L1rJE ��ti=� \� vr\ �. •�QIJ.�iq® Disposal Lo -r 1 Al M_ NOTE:' THE ACCURACY OF LOCATION OF EXISTING I PROPERTY CORNERS, WELLSv AND SEPTIC SYSTEMS INDICATED IS NOT EXACT. / DIMENSIONS INDICATED HAVE BEEN DETE — MINED BY USE OF CLOTH TAPE AND NVY SURVEYING TECHNIQUES. / �exisTiNV mal I��=Sn� } •, / / La -r 5 Lut 3 SEWER SYSTEM LOCATION PLAN Lot 2 4 `r 1 I y Ln 1 �Srp�[lryA Prepared for'. Da}e:. Block: 2 i--',,WATER WELL RECORD STATE OF ALASKA MUNICIPALITY OF ANCHORAGE DEPARTMENT OF NATURAL RESOURES DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Division of Geological a Geophysical Surveys ft$1 ' 1987 Drilling Permit No. LOCATION OF WELL -(Please complete either to, I o d,l_`.i' 4 I V E Q LL A.D.L. No. la.11 Borough Subdivision - Lot Block Ib. 1/4 gtrs. f;4 ange ECD Meridian _ - - —of —of_of— WIc. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS - LL: q Address: Street Address and Area of Well Location - - - - Feet Below 2. 2. WELL LOG Surface 4. WELL DEPTH: (final) /7 - j/ f t. 5. DATE OF COMPLETION Q—/Z — T— --t- - Material Type TOP Bottom (J'�— 6. C] Coble tool Rotary O Driven Dug Auger ❑ Jetted- ❑ Bored ❑ Other: T.USE:x Dome Nie Public SuPP1Y ❑industry Irrigation C3 Recharge commerical S. JZP7 ,.---. Test Well ❑ Other: - - 8. C ASING: Cj Threaded /Welded - - diam.��in. t tt. Depth Weight _)/7 lbs./ft. !7 ' .. diam.-4/--in. to![, ft. -Depth Stickup it. - - 9. FINISH OF WE L: TYDa: Diameter!- R - SIot7Mes Slze: - Length: - - - Set between - 'ft. and ft. - - - Backfilling Gravel pack 10. STATIC WATER LEVELI,_ft. - - - - Date Ej Above or R Below land sur ce - -- - - - Equipment used: - - - - I I PUMPING LEVEL below land surface and YIELD - . - - ft. after —ol_hrs. pumping _.3— 9-P.M. - ` ft.. after hrs. pumping 9.P-m.. - - 12.GROUTING Wall Grouted: 11 Yes El No - _ ,1 Material: C] Neat Cement 0 Other: - c - 13. PUMP: (if available) HP Length of Drop Pipe .. ft. capacity - —9-p.m. ur r - _ - CD Subm. Jet_ 0 ee'ntrifical - 0 Other o 'C 14. REMARKS: 16. WATER WELL CONTRACTOR'S CERTIFICATION:. - - - 15. Water Temperature _—° ❑ F -. ❑ C This tell was drilla urs y Puri di t_iq a d this report is true to the est of 14 my kno ledge and belief; - Regi ered Business ame r - - Contract icense Number _ - Address; - Date: G e) Signed: �— - -. - - Authorized R presentative -. - - - Form 02-WWR (11/81) Copy Distribution: WHITE State DGGS, PINK Driller, CANARY- Customer - - - SIGNEDX/DATE ��/ _ ���.__ APPLICANT: ALPINE � ISSUED BY DATE: ��--�^ /~ /r� ~=~�-1 VL.0 ONO X C.", 1, 3.: Ol � ���� ����4: 8 W W -W 1-1 I=� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORA8E:1 264-4720 AK 99501 ][7FE 0: �JI RE: HL.^9 ..~ �l][11r ` PERMIT NO: 860347 v DATE /86 APPLICANT: ALPINE DRILLING ADDRESS: PO BOX 110496 ANCHORAGE, AK 99511 CONTACT PHONE: 345-0202 LEGAL DESCRlP: SUBDIVISION: SEQUOlA ESlATES LOT: 2 BLOCK: 2 SECTION: 26 TOWNSHIP: 1201 RANGE: 3W LOT SIZE: 51579 (SQ.FT, OR ACRES) J: certify that: 1. I am familiar with the requirements tor on-site sewers and wells as set forth by the Municipality o| Anchorage (MOA) and the State o[ Alaska" 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3" I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, disposal system or public sewerage system on this or any adjacent or nearby lot" SIGNEDX/DATE ��/ _ ���.__ APPLICANT: ALPINE � ISSUED BY DATE: ��--�^ /~ /r� ~=~�-1 Municipality of Anchorage Development Services Department • Building Safety Division I On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsfte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. M-1521- 2,5 COSA# bib 3 1. GENERAL INFORMATION Expiration Date: Complete legal description SEOUOIA EST. BLOCK 2. LOT 2 Location (site address) 6731 PRISM CIRCLE, ANCHORAGE, AK 99516 Current Property owner(s) CLYDE SNIFFEN Day phone 269-5220 Mailing address Lending agency Mailing address SAME AS ABOVE Day phone Real Estate Agent TAMI TAYLOR Day phone Mailing address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 244-3504 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 samples. (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 riles 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. Name of Finn GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. Date 19 IV 6 Engineers Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system to accordance with ADEC and MOA DSD Guidelines B Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational fife of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the filowing stipulations: Attachments: COSA Checklist L/ Septic System Advisory Well Flow Advisory Nitrate Advisory Z Arsenic Advisory Maintenance Agreements Supplemental Engineers Reort Other G. '••• O'er ON-SITE ••:��= WATERAND • rn- WASTEWATER PROGRAM ' Bv:_0' Original Certificate Date: 02 " Municipality of Anchorage -•1 Development Services Department ` Building Safety Division l On -Site Water 8 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 F Legal Description: SEQUOIA EST. LOT. 2 BLOCK 2. Parcel A. WELL DATA Well type PRNATE If A, B, or C provide PWSID# N/A Date completed 9/30/86 Sanitary seal (YIN) YES Total depth 250 ft. Cased to 250 ft. FROM WELL LOG Date of test 9/30/86 Static water level 201 ft• Well production 3 9.p -m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 5-76 mg./L. Well Log (YIN) Y Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 8/28/08 196 ft. 4.8 g.p.m. Other bacteria 0 colonies/100 ml. Arsenic: ND ug./L. Date of sample: 8/28/08 Collected by: GEG Ltd. B. SEPTICIHOLDING TANK DATA Tank Type/Material STEEL Date installed 6/30/86 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) Y Depression over tank (Y/N) NO High water alarm (YIN) N/A Date of pumping 8/28/08 Pumper MCDONALD PUMPING C. ABSORPTION FIELD DATA BELOW EXISTING GRAD Date installed 6/30/66 Soil rating (g.p.d./feo !bd 150 System type BED Length 38 ft. Width 24 ft.. Gravel below pipe Total depth •4.83 ft. Eff. absorption area912 ft= Monitoring tube YES Depression over field NO Date of adequacy test 8/28/08 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test DRY in. Water added 600 gala New depth DRY in. Elapsed Time: 0 min. Final fluid depth DRY in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 me.) (YIN & type) NONE KNOWN If yes, give date D. LIFT STATION Date Installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons Manhole/Access "Pump off" leve High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ 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 N/A Water service line 100+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 109+ Surface water 1009+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Welts on adjacent lots 1009+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and 49 _ review of Municipal records that the above systems are in 0"""' "' ' ' .. .. """'. conformance with MOA COSA guidelines In effect on this date. . Hess: ....:... e G Engineer's Printed Name JEFFREY A. GARNESSs7 E_7 3 Date 9119%v0 4Qn^dd/I'�I0t COSA Fee $ q 30 • v v Date of Payment 9107-g-/69 Receipt Number d aqt) (Rev. 11ros) Waiver Fee $ Date of Payment Receipt Number - 'rst tri ; 27; o 6 with n� 2T Alec. C � Lr 30�• r _ 0 St=Pt1t C{.ii•NOJrs \ s ♦OV qa \ a \ G� _So to unuL( •' • . (fib' G %s / t c 41 tet• PLOT PLAIT AS BUSZT X �• SGIZ£l 5t" GRID Z7� JOB 270'1-031 1731'Geor4e Fell Circle i Euab tlZt t h 88 �OL"JD Ancheraga, Alaska 99515��.�� Lot Zr « S� ■ra tar.aral tLo f•I3•'taq 1••cribadro P rarer: = f . . O �'.DlC1:nrR�^ Ra �•rt dlag D13viK� d1Uka, .al s�tlta �• P'•Parer haat cad 10 get to sa that tW laaPr•t'aa.aav ncnated to „ •••• im Pt•7alaaALt •a lla • ? � eat• :le • [raga art N P"t7 Iriaq ■Jj.taat tlatat• saoopa ad)ame elver•, th•t a. r y�'•• 'tt� •�••7"• t that thug we a• road'• t cl a tha tont ad •' 7F C 7H i r r vanrnai+ti•a liacz a •tltr rinita a•s•atgav r pfaaiisas aad 0...:... J `y ezapc ar tadiutad lgte•a. •a raid P'■rvtr -:ham'}-......• Doul flit ria ZLM 1+• e! �.vtn r It it thef r-"- S 9 • ai Aacir■!a, Alaska asp•atib{li •( cba • arIDiag tla azinasu K u; tatamaa A•1•T •.. K r•tWttLas 'lied!• a•t a 'nv a. Jat q '•. • � PPa•r oa els nnrlal mhti•lriro pkt. vt e•.tamv, "b � • � n • O N r• r�if•IY La •s+tT 0 i ti O t • tw O e " •3 N •tt• b.o •' • . (fib' G %s / t c 41 tet• PLOT PLAIT AS BUSZT X �• SGIZ£l 5t" GRID Z7� JOB 270'1-031 1731'Geor4e Fell Circle i Euab tlZt t h 88 �OL"JD Ancheraga, Alaska 99515��.�� Lot Zr « S� ■ra tar.aral tLo f•I3•'taq 1••cribadro P rarer: = f . . O �'.DlC1:nrR�^ Ra �•rt dlag D13viK� d1Uka, .al s�tlta �• P'•Parer haat cad 10 get to sa that tW laaPr•t'aa.aav ncnated to „ •••• im Pt•7alaaALt •a lla • ? � eat• :le • [raga art N P"t7 Iriaq ■Jj.taat tlatat• saoopa ad)ame elver•, th•t a. r y�'•• 'tt� •�••7"• t that thug we a• road'• t cl a tha tont ad •' 7F C 7H i r r vanrnai+ti•a liacz a •tltr rinita a•s•atgav r pfaaiisas aad 0...:... J `y ezapc ar tadiutad lgte•a. •a raid P'■rvtr -:ham'}-......• Doul flit ria ZLM 1+• e! �.vtn r It it thef r-"- S 9 • ai Aacir■!a, Alaska asp•atib{li •( cba • arIDiag tla azinasu K u; tatamaa A•1•T •.. K r•tWttLas 'lied!• a•t a 'nv a. Jat q '•. • � PPa•r oa els nnrlal mhti•lriro pkt. vt e•.tamv, "b � • � SCS RCEN 1083601001 Client Name Garness Engineering Group, Ltd. Project Name/# Sequoia ESL 132,1-2 Client Sample ID Sequoia ESL B2,L2 Matrix Drinking Water PW'SID 0 Printed Date/l ime 09/152008 8:37 Collected Date/Time 08282008 12:35 ReceivedDatellime 08292008 10:05 Technical Director Stephen C. Ede Sample Rcmarks: Allowable Prep Analysis Parameter Results PQL Units Medved Container ID Limits Date Date but Metals by ICP/MS Total NitmtJNitritc-N 5.76 0.100 Arsenic NRB ND 5.00 Waters Department EP200.8 Total NitmtJNitritc-N 5.76 0.100 Microbiology Laboratory NRB Colony Count 0 Total Coliform 0 Fecal Coliform 0 ug/L EP200.8 C (<10) 09/02/08 09/05/08 NRB mg/L S%120 4500NO3-F B (<10) 09/11/08 1DZ col/100mL SM20 92228 A (<200) col/100mL SN1209222B A (<I) col/100mL SM20922211 A (<I) 0829/08 KAR 0829/09 KAR 0829/08 KAR Parcel I.D. # 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 0/7 -IS. 2— zt§` N HAA# \AQcllcCJ1ACIa 1. GENERAL INFORMATION Complete legal description Lot 2; Block 2. Sequoia Estates _ Location (site address or directions) 6731 P, .ism C.i.nc°e Anchon.age AK Property owner Cax2 9 Kanen Ihwin Day phone 345-1868 Mailing address 6731 PiLism Anchoaage, AK 99516 Lending agency Day phone Mailing address Agent Btian Bnodekick/ Vista React Estate Day phone 273-7261 .Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 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 #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 S& S ENGINEERING Phone ply —;k_9 7q 17034 Eagle River Loup Ituad No. 204 Address Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE Approved forbedrooms. Disapproved: 10 Conditional approval for Additional, Comments Date 9 � � 3 A// � _ eceOF AA`,'`ti.. bedrooms, with the following stipulations: 4LJTlr 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 ana tneir lending institutions in order to satisfy ce%n federal and state requirements. EmployM 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 engineers work. 72-025 (Rev. 1/91) Back MOA #21 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage SEP 13 1996 DEPARTMENT OF HEALTH & HUMAN SERVICE E C E I V E D Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: 1-07'0 oc ez-<-avaax;f Parcel I.D.: 01-7 —IS -2 f ,�t9Gp xs�o.✓ A. WELL DATA Well type/ � If A, B, or C, attach ADECVletter. ADEC water system number Log presenter) Yes Date completed 5V'30 —4f 6 Total depth 2--!;�O Cased to ��� / Casing height (above ground) �f Sanitary sealfN) %eS Wires properly protected ON) FROM WELL LOG AT INSPECTION / Date of test 3© �& / "/ o " 9 b i Static water level 0% 9 9 Well production '3 g.p.m. S-0 g•p•m• WATER SAMPLE RESULTS: Coliform 0 Nitrate 0.1 Other bacteria O Date of sample: ct /I. r/ 9 6 Collectedby: B. pT1 HOLDING TANK DATA C. Date installed X30 46 Tank size /Z006,,PY- Number of Compartments -2 CleanoutsdPN)Y,S Foundation cleanout(ON) 4� Depression (Y&V Nd' Date of Purimping R /, Pumper ABSORPTION FIELD DATA High water alarm (Y/W1 " Date installed 6-.30 46 , x Soil rating (g.p.d./ft2 o /bdr ) OS"0 System type ���✓ Length Widtici� Gravel thickness below pipe 6 Total depth Effective, absorption area Monitoring Tube presentA)YgFs Depression over field (Y/V-�O Date of adequacy test 9—A9 Result _Pas ail) �S For bedrooms Fluid depth in absorption field before test (in.); SImmediately after602 gal. water added (in.): Fluid d.Pth -7?`ins Minutes later: �.�O'f�l Absorption rata = 700 9.p.d. Peroxide treatment (past 12 months) (Y6? /y0^vj5 If yes, give date Z, It 1_ �✓S v,4 Ai-T�0A-J p v�-'Q �F4t S o� 0e��'ovV FrEGO. 72-026 (Rev. 3/96)" 'Al. /t/1 A D. LIFT STATION Date installed Manhole/Access (Y/N)-__ -- High water alarm level E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in level at` OF "_19 tank on lot /(JO (� On adjacent lots Absorption field on lot /QCT f" Public sewer main .1/V' A Sewer /septic service line A4 A- _/ zs'rf' On adjacent lots "Pump off" level at` /D© ' f- le5'O 't - Public sewer manhole/cleanout "It/. '14. Lift station /Cq0 / "t— SEPARATION DISTANCES FROM 6�E0LHOLDING TANK ON LOT TO: Foundation Property line Absorption field J Water main/service line la I Surface water/drainage /OO "s- Wells on adjacent lots /4C2 '/- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line A,2 e � i Building foundation /0 /_ Water main/service line /0 1i' Surface water AO451 /'f" Driveway, parking/vehicle storage area Curtain drain A -,V 0 f-' 4/ Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that / have determined thru field inspections and review of Municipal in conformance with MOA HAA in a ct on this date. SignatureT'!✓'�-- Engineer's Name I` d�/� �T/ C ec)a1�f�� Date HAA Fee $ <10D E LSD Date of Payment Receipt Numbero'Z v22C;ZX2 72-026 (Rev, 3/96)' Waiver Fee $ 'qty records 060FO res ems are . • , 1� Date of Payment Receipt Number ROBERT Cc - 8-ga I 09/12/96 12:34 ME ESI ANCHORAGE - 9076941211 NO.122 903 all CT&.E Ref.€t Client Name Project Name/# Client Sample ID Matrix Ordered By PW811) CT&E Environmental Services Inc. Laboratory Division iryiyy+s',tl�yiy��y�r'�►����y�"t►�tiyiiii 964495001 5 & S Engineering L2 B2 Sequoia BStates SO 1,2 B2 Sequoia Estates S/D Drinking Water 0 200 W. Potter Drive Anchorage. AK 89518-1605 Tel: (907)662-2343 Fax: (907) 561-5301 Client P01i Printed Date/Time 09112/9611:07 Collected Date/Time 09/10/96 12:15 Received Date/Time 09/10/96 13:30 Technical Director: Stephen C. Fde Released By Samplc Remarks: Allowable Prop Analysis Results PQL units Method Limits^ Date Dates_ Init Parameter Nitrate -N 0.1000 o.100 mg/L EPA 353.2 09/10/96 EMB Total Coliform 0 0 coll100mL SM18 9222D 09/10/96 TAV w `08138 �-- Member of the $GS Group (Soci9t9 GAn9rale de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA. FLORIDA, ILLINOIS, MARYtANp, MICHIGAN. MISSOURI, NEW JERSEY. 01110. WEST VIRGINIA MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH a 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: # 01'7-15Z,- ZS-- 000 HAA # 1A dol Q3L�t�. 1. GENERAL INFORMATION C Sl ie`le 'al description -(0 Location (site address or directions) Property owner �q',.." a 5 Day phone 3 Mailinggadress*' Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: +�l Individual well 1 eS -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 es Holding tank Community on-site Public sewer NOTE: If community wastewater systerh, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOA#21 lza vow AOBe MA nee) szo-ZL -�jom s, eauibua lsuoissepid agl ui suoissiwo jo saoaaa ao; opsuodsai IOU si a6eaogouy ;o /lllediolunN agl 'panssi si alsoi;p90 s aao;aq elep azAleue ao suolloedsul lonpuoo IOU op SHHd to saaAoldw3 •sluawaalnbaa alels pus lsaapa; ulelaao l4slles oljapao ui suollnlllsui bulpual.iiagl pue sawog;o siesegoand of Asalanoo a se slgl saop SHHQ agl Te sexy;o alelS agl u paa91sl69a J99ul5us leuolssa;o.id luapuadepui ue Aq anoge g gdwbeaed ul u9ni6 suoilelueseidaa agl uodn Aluo paseq seleol; peo lenoaddy Aliaoglny glleaH senssi (SHH(3) saoiAieS uewnH pue W1139H;o luewueda4 96eaogouy;o A4!lediolunW agl :suollElndils buimollo; agl gIIM 'swooapaq � p\S53�Obd �Q OW 01 'ON r� . )a}aiuyyryry 3 aaeq°a •• _M tt % .30 �L /20*3010 alfa m sluawwo0 leuoljlPPV ao; lenoidde leuolllpuo0 'panoaddesi® 'swooapaq ao; panoaddy 3F nIVNJIS SHHa °9 ainleu6ls s�99ul6u3 2.1 I I I 14, L Q ssejPPV i v 1 1 — , . V. . , auogd (A I'kaa � 1A'q 1 a wtl� wa!3;o awEN •uoiloadsui slgl;o alep agl uo loa}}a ui suolleln6ei puu 'saoueuipao 'sapoo alelS pue ledimunW 1pe glint aouEildwoo ui si waleAs lesodslp jejumelspm ao/pue Alddns aalenn alis-uo agl 'uoiloedsul pus U01JE611SOAUI !w woe; pue sail; a6Eaogouy;o AllledlolunW agl woe; paulelgo uollEwao;ul agl uo paseq legl f41aanaagpn; I 'uiejeq paleolpui einlonals;o ad�4 pue swooapaq;o aagwnu agl ao; alenbape pue leuopun; 'a;Es si walsAs lesodsip aalemelsem ao/pue Alddns jejuni ells-uo agl legl smogs uolleoildde lenoiddy Aliaoglny glleaH sigl;o uollvbllsanui AW legl A;uan I 'molaq uMogs alep uollEPIIEn agl;o SE PUS olaaag pail;;E leas Aw Aq peiplaao sy EMNIJN3 A9 N01103dSNl :10 LN3W31t/1S .5 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST 44 Legal Description: 4 �� I ���� �� Parcel I.D. o/7 /52 z o0o A. WELL DATA Well type r�� l `« 1_e If A, B, or C, attach ADEC letter. ADEC water system number II^ IV A Log present (Y/N) ��'� Date completed 9 �`� ^ `� Driller /' l4/ t,. Total depth 05-0 Cased to Casing height Sanitary seal (Y/N) I Wires properly protected (Y/N) Ve S FROM WELL LOG AT INSPECTIOAINICIPALITY OF ANCHORAGE Date Of test l� - % � ? 2.0-EN'091iONMENTAL SERVICES DIVISION Static water level X09 ='NQ -i 1951 Well flow g•p•m E I V D i; Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main /1,14- Public 1,4 Public sewer service line r ` WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA On adjacent lots ,Z �".2.1 On adjacent lots 1 Public sewer manhole/cleanout %✓,j�l Petroleum tank Nitrate 1 /n' /4 Other ba/Acteri�a] N0� Collected by: _9,' Y / V' a nyo Date installed Tank size i7 Compartments Cleanouts (Y/N) � Foundation cleanout (Y/N)Dgpressio High water alarm (Y/N) /' / Alarm testeci`'(•Y/f!�� �7'`� / _ Date of pumpi`r)g (/ "ONA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On,ddjacent lots �,,j ( Foundation I f < r7 %i AM To property line Absorption field --� - Water main/service line ✓ � Surface water/drainage 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Manufacturer Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codecs (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed Soil rating "Pump off" level at Cycles tested Surface water _ System type ` Length Width ' Gravel thickness— Total hickness Total absorption area Cleanouts present (Y/N) . Depression over field (Y/N) 0 Date of adequacy test Results (pass/fail) <, 5 for Peroxide treatment (Past 12 months) (Y/N) 000 -c - Total depth YC c, If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ���� On adjacent lots / (D Property line To building foundation { To existing or abandoned system on lot N r�11 On adjacent lots Y Cutbank Water main/service line Surface water Lif Driveway, parking/vehicle storage area n Curtain drain E. ENGINEER'S CERTIFICATION bedrooms I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name GY94CY .l1 Ry• Y�•'+ yiDate +nsno�°•goYo+ob ueo• nl%° Robert E. Kniefol J •o• No. 4149-F. 1 HAA Fee $�. Date of Payment 7-7/ Receipt Number o22 / S K— -77(,1, 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 • FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8376 ^ FAX 274-9645 Kniefel Engineering 8441 Miles Court Anchorage AK 99504 Attn: Robert Kniefel Our Lab #: A112392 Location/Project: - Your Sample ID: 6731 Prism Sample Matrix: Water Comments: Method Parameter SM 418 C Nitrate -N Report Date: 07/29/91 Date Arrived: 07/24/91 Date Sampled: 07/24/91 Time Sampled: 1600 Collected By: FS MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION UG - 7 1991 RECEIVED Reported By: William E. Buchan Anchorage Operations Manager Flag Definitions U = Below Detection Limit DL Stated in Result B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Date Units Result Flag Analyzed ---------------------------------------------------- mg/l 1.0 07/26/91 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION UG - 7 1991 RECEIVED Reported By: William E. Buchan Anchorage Operations Manager