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HomeMy WebLinkAboutSEQUOIA ESTATES BLK 2 LT 81 Municipality of Anchorage Page —1of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: PID Number: 0 (7' 1 @5 Name: Wastewater System: ❑ New 11 Upgrade Y (Si v% 'i� ROU AJ Address: pI °J�S/� ABSORPTION FIELD Phone: No. of Qedrooms: ❑ Deep Trench yShailowTrench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: GPD/Sq. Ft. Lot: Block: Subdivision: G' trepth to pipe bottom from original grade: Gravel depth beneath pipe Qj Z S ea QvC!> t IA 0.-5- Ft. O• S Ft. Township: Range: Section: Fill added above original grade: Gravel length: Z•S Ft. /So Ft. WELL: 1-1 New ❑ Upgrade Gravel width: S a Number lines : Dista/C71 een lines: Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe mater: I: W QtUArr1 &WST• Ft. Ft. ---?L SO SO. Ft. F28/0 va; q Driller: Date Drilled: Static Water Level: Installer: Date installed, -?v/ / q Ft. O W N &M— I Yield: Pump Set at: I Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES qLSeptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lin Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Ci 7t�S�r /LJ' WeIF 6 118.6 N(A AJ/ A /_25- Material: Number of Compartments: Surfac me r LIFT STATION Watere ��,� Lot 66- Df Size in gallons: Manufacturer: Line Foundation `23. M Cf "Pump on" level at: "Pum - evel at: High water alarm at: Curtain��.. wrt Pump Make & Electrical Inspections performed by: Drain BENCH MARK Remarks: 1 V©2VR 00 l(®RT,c! P_ sa7i->A0A'TrD Location and Description: T30_7rWBtLA) Noej17V kCo r, ROVAlbWA1C&4 P2oNT'7,Oknc —S -W 00aN6�%,u -r Pa csp L1c{ L5— EClj�, W= g�/.$ • Assumed Elevation: . ". °ENGINEER'S SEAL Z 2"c Q2(G,1p �1St�tgZ tc�N-PCAC O LY1 CS -1 'DQr"-OrOP � ��►, a , ` 'w k *\L ���5�PoS-�T�NIC GW �S ..�i Inspections performed by: Sc o-rr Creow t A�r��• 6 �3�/4 Dates: 1 st sr�v�N _P 2nd 2nd/r! 4 ,.e,« es..,.,,.,R:. ,....tea Steven L Panrrono op Department of Hea and Hu an a ices approvals , `cF.$,.h Reviewed and approved by: ' Date: 7 72-013 (Rev. 9/91) MOA 25 C Exist. to Re AS -BUILT WASTEWATER ABS❑RPTI❑N SYSTEM LOT 8, BLOCK 'A SEQUOIA ESTATES Lot 7 / W�S i i0f. yyC W N Q W H 1 H 0 3 Lot 2 �xx FS New 5-W1de Trench. c Q See Details Sheet 3. i SWING TIES co A B FC 5.5' 29.3 T1 20.7' 40,6 T2 28.5 43.4 DV 32.0 45.8 El 32.8 46.3 E2 40.9 43.5 E3 87.9 91.7 DC 44.0 61.0 FS 69.0 73.3 C1 333 56.1 C2 107.4 119.3 M1 108.3 120.3 C3 54.3 82.3 C4 115.4 130.5 M2 116.2 131.0 Installed Dlverte Valve i %�6 Double Clean-ou s o*`e / Existing 129 Verified In - 4 $R Nou5e a J g 36.E 18.8; 2'1. t' Exist. Weil, g Septic Tank irlty During Construction Lot 6 of Solis were at Time Exist. Well 7 4 Beoroom House Pere: Rate = 11 M/Inch Sall/Rating 150 sf/br 7516 sf required. 5z wide trench, 0.5' Effective i.0' Total Depth Reduction Factor = 1.0 Required Length = 150 LF Use 2 trenches each 75' long Area= 750 sf equly. area PANN❑NE ENG. SVC P. ❑. BOX 142025 ANCHORAGE, ALASKA 99514 272-5218 Phone L F'o.x DATEi 7-6-97 AS -BUILT =60' '; ®4 Revls4-6/ 4/97 ,.49TH .................z.....� 0\Work\849U'dw_. PREPARED FOR, ........... ......................... ® °Steven Pannone R. p 8 Gary Droubay 819 ,••\ia 6601 Gunnison Drive o °•,• •° r►® 6 Anchorage, AK 99516 .NYCE ♦ ----..• ----- _ A <907> 345-4157 g Septic Tank irlty During Construction Lot 6 of Solis were at Time Exist. Well 7 4 Beoroom House Pere: Rate = 11 M/Inch Sall/Rating 150 sf/br 7516 sf required. 5z wide trench, 0.5' Effective i.0' Total Depth Reduction Factor = 1.0 Required Length = 150 LF Use 2 trenches each 75' long Area= 750 sf equly. area PANN❑NE ENG. SVC P. ❑. BOX 142025 ANCHORAGE, ALASKA 99514 272-5218 Phone L F'o.x DATEi 7-6-97 AS -BUILT =60' AS—BUILT DETAILSl� WASTEWATER ABS❑RPTI❑N SYSTEM LOT S, BLOCK 9 SEQUOIA ESTATES 2 cu Qa�a a o 0x00 1n0N Ntl3� 00m 0 Jb 0�a.. a a 0 0 4- 0 0 00IL y e `e • O fi �e e N t Z u rl y w FL is U `~ c c L d u a6 L L� a 0 3anl ?J01INOW 3 ~ aLn_j L d � J a 6n La �h Ra )r,T e s• Z a 1J..i a og ULLJ L� 0000 1nONV313 CL N C Q E d Ql Y d m l U I +t' c S V) 00 l7 Lr5 1nONtl313 c O JWIVA ?J31M3AIa T d C f 'I'• 3 J O .. i.N x u "da 1n0NY313 z = C F m r F O L_ di' t• X34 saoc Ntl3 1nO13 xhw =:43 d do- W .N-. H 4j S' p V1 ''� Y_ •. 1noNtl3'13 W j T o C •' �� NOIltlaNnU 0 7 L) o �..u.7 .. ................... � r • "e•.• • •° ••••••• •: m PREPARED FOR, STEVEN R. PANN❑NE, P.E. •••Steven R. Pannone: 41 Gar Droubn P. ❑, BOX 142025 No. CE 8149 Y Y ♦ ® 6601 Gunnison Drive 0, '•°f��6.••° ,.� AnchornAe. AK 99516 ANCHORAGE, "ONESLArAX9514 ®� kill,% (907) 3 5-4157 DATE 7-6-07 NOT TO SCAE—F AS—BUILT PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970135 DESIGN ENGINEER:STEVEN R. PANNONE OWNER NAME:DROUBAY GARY & GEORGETTE OWNER ADDRESS:6601 GUNNISON DR ANCHORAGE, AK. 99516 PARCEL ID:01715218 LEGAL DESCRIPTION: SEQUOIA ESTATES BLK 2 LT 8 LOT SIZE: 44916 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: n DATE ISSUED: 6/16/97 EXPIRATION DATE: 6/16/98 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1.) MAXIMUM DEPTH OF DRAIN FIELDS MUST NOT EXCEED 1.0 FT. BELOW ORIGINAL GRADE. 2.) IF EXISTING BED IS TO REMAIN FOR POSSIBLE FUTURE USE, THE ENGINEER MUST VERIFY/CERTIFY 4 FT. VERTICAL ll SEPARATION TO GROUNDWATER ( SUBMIT DATA WITH ASBUILT). C=/USuaa� 1',ST. Oi' 10 FT, To wE,$-r P910r GINL.- RECEIVED BY •> � DATE: (o� I we( ISSUED B' DATE: Steven R. Pannone, P.E. P.O. Box 142025 Consulting Engineer Anchorage, Alaska, 99514 (907)272-8218 (907)272-8218 Fax May 28, 1997 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 8, Block 2 Sequoia Estates Septic Upgrade Permit FAILED SYSTEM Gentlemen: My firm was contacted to conduct a Health Authority Investigate of the well and septic system serving this lot for a pending sale. The existing system was completely inundated with liquid. The fluid levels were at the elevation of the lateral pipe. I informed the owners that the system was in failure. The owners requested my firm investigate the possibility of installing a replacement system. A single test hole was excavated on May 21, 1997. The soils report and percolation test result is attached. Groundwater was monitored for seven days. Groundwater was encountered at eight feet (8') while excavating and monitored at a depth of eight feet (8) on May 28, 1997. The ground water appears to be coming from the failed septic system. The Drain Field had 8 inches of standing water in the monitor tube before excavating the test hole. A day later the system was dry. The owner admits that they take a Jacuzzi daily. This is the source of the large amounts of water. The system is designed based on this high ground water. No bedrock was encountered in the test hole. The lot is approximately 1.06 acres in size. Lot 8 slopes to the west at a rate of approximately 2 to 3 percent. The proposed installation will be located on the southwestern portion of the lot. The existing field will be reused. The septic tank will be verified during the installation. It will be reused if found competent, and replaced if found to be deteriorated. Double clean -outs will be installed down stream from the tank. The proposed location is greater than 100 feet away from the existing well serving this property and 25 feet from the water service lines. The surrounding wells are located greater than 100 feet from the proposed installation. The proposed installation shall not impact the future development of the surrounding or existing lots. See the attached design. If you have any questions about the proposed installation, please contact me at 272-8218 Sincerely, Steven R. Pannone, E. .� Attachments: C:IWORKAS-2SEQU.001 Steven R. Pannone 'Yn CE - 8149 /P>` '0' ret-' H 1 42 Lot ^c MT 75 LFZ1 IF (Proposed 5 -Wide Trench, See Design this Sheet._.- w� e.• •,�•yp e 49TH ................ ...... I................... .........1. ................... .... . :Steven R. Pannone/ s•s..�14149•••a Ci\Work\8-2SEU,dao- PREPARED F❑R1 Gary Droubay 6601 Gunnison Drive Anchorage, AK 99516 <907> 345-4157 011.9 ax Exist. Well AdItlonal Solis will be erifled at Time of nstructlon 7 Exist, Well 4 BerooM House Pere. Rate = 11 M/Inch Solt/Rating 150 sf/br 7% sf required, 5t41de trench, 0,5' Effective f.0' Total Depth Reduction Factor = 1.0 Required Length = 150 LF Use 2 trenches each 75' long Area= 750 sf equiv. area PANNONE ENG. SVC P. O. BOX 142025 ANCHORAGE, ALASKA 99514 272-8218 Phone & F*ax DATCi 5-29-97 DESIGN ISCALE,, DESIGN WASTEWATER ABSORPTION SYSTEM O ❑T 8, BLOCK SEQUOIA ESTATES c Lot 7 D) T S / =p err nstall Dlverter alve = -4 & Double Clean-ou s 0 W m n Existing 12 g Septic Tank N Verify Inte rity During Construction Exist, ed to Re In Lot 6 /P>` '0' ret-' H 1 42 Lot ^c MT 75 LFZ1 IF (Proposed 5 -Wide Trench, See Design this Sheet._.- w� e.• •,�•yp e 49TH ................ ...... I................... .........1. ................... .... . :Steven R. Pannone/ s•s..�14149•••a Ci\Work\8-2SEU,dao- PREPARED F❑R1 Gary Droubay 6601 Gunnison Drive Anchorage, AK 99516 <907> 345-4157 011.9 ax Exist. Well AdItlonal Solis will be erifled at Time of nstructlon 7 Exist, Well 4 BerooM House Pere. Rate = 11 M/Inch Solt/Rating 150 sf/br 7% sf required, 5t41de trench, 0,5' Effective f.0' Total Depth Reduction Factor = 1.0 Required Length = 150 LF Use 2 trenches each 75' long Area= 750 sf equiv. area PANNONE ENG. SVC P. O. BOX 142025 ANCHORAGE, ALASKA 99514 272-8218 Phone & F*ax DATCi 5-29-97 DESIGN ISCALE,, DESIGN DETAILS 0 WASTEWATER ABS❑RPTI❑N SYSTEM v LOT 8, BLOCK *SEQUOIA ESTATES =: ;;a C E)• L rm rT'1 So cD C b 0n � rTi 0909 fl b °044. 1nONtl3lJ S -..f O -p W .Y ° a 2.� 0909 °0°0 1 u ° W 0000 y 0.5' IL e o, s 'v 6 g a, s a, a a c w EL U m LU c d z CQ o m �_ 5�L 0 38n1 N01INOW 3j L ara d ++• L gin a ;F Z C ° o LLI b U e V_ 400 Lij 1nONUM 0,5' Cc t> ~•j Cf 3 a yw f Ln 4- o +� — J vi inONtl313 4 CU O U a) 1nONV3l3 X: O J d L W y c 1nONtl3l3 ' y y o ' r FBF 6 N C _c d inONW313 .0M. Xrd a0 '�''}+i' A OF®�®+� {`+a4 O ®®®®®� ®��\.........,. ��® .`''o,® �;o 1nONtl313i i 0) a C O O ® �� NOIltl8Nn03p 3 u R O ®'%t; 4gTM ';"off z^-aStva- ....,a:..................................h.....A V2ews o 6//04 '....... 'i RPannonee PREPARED FOR, STEVEN R. PANN❑NE, P.E. ii-%Steven It.. i �� •. No. CE 8149 ® ��� Gary Droubny P= ❑= BOX 142025 1 �,• tt?®® 6601 Gunnison Drlve ANCHORAGE, ALASKA 99514 .. ____________ Anchorage, AK 99516 Anchorage, (Jul) 345-415I 272-8218 PHONE A. FAX bm DATE 5-28-97 DESIGN ❑T l r. a Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: r kR�x �1]QOc9�W� DATE PERF LEGAL DESCRIPTION: BZ- SQ ?QucC t di Township, Range, Section: DEPTH �{'� �S—LOPE -� SITE PLAN (FEET) • I I I I I I I I I I I I I , 1 2 3 �4 Jr— 5 �Clrh-t- 3plm 6 7 8 9 S t -T-i SANb SILTY r% RAVwS 10 WAS GROUND WATER ENCOUNTERED? O [7 11 L vlev IF YES, AT WHAT � 0 DEPTH? P 12 E Depth to Water After It 13 Monitoring? 0 Date: 14 15 16 17 18 19 Reading Date Gross Time Net Time Depth to Water Net Drop 3 K Z— t{Z 2 20 I� u PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND �'`� FT COMMENTS iZ:5-rf s C(? SOAZZ 1"L1 -SPAV &16 PERFORMED BY: s �'WAN�NrS I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE DL iTMENT OF HEALTH AND HUMAN SER c.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 SEPTIC ABSORPTION Address FROM TO TANK FIELD WELL jNQAUV-V\ U6 WELL � 1_ N .i Phones)/ 6 - br SJ � Z- Permit No. 8 0 1 3 � No. of Bedrooms ❑ TRENCH 1 " ❑ W. DRAIN ❑ OTHER Depth to pipe bottom fromTotal LOT LINE aq I onginal grade %� _I! FT LEGAL DESCRIPTION Lot Block .�1 ('J =Iq I" FOUNDATION FT O/� lJ 'S Township, Range, Section -F/0 AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, dnveway. water bodies, etc.) TANKS SEPTIC ❑ HOLDING Manufacturer Capacity in gallons 1105-0 Material I r I I No. of Compartments WELLS. PRIVATE ❑ OTHER (Identity) Classification (A,B,C) Total Depth Casetl to FT FT Installei - Date Installed: REMARKS: nl? '.. , 9.,1 ., ,f L V Municipal and Stale j delines in etlect on jthis dale: t[ _ a Health Department Approval: iIY"�l-II�II%1 I Scale: N T—* Insjp�r ,ections PL�rtoed by: Date. Ilial Ili s impalian was parlarmd 2000rdiop fo 211 Date: 4-10-87 ENGINEERS SEAL TYPE OF SYSTEM a+, c ❑ TRENCH U,?(ED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom fromTotal depth from original grade onginal grade %� _I! FT +5' FT Fill added above original grade 0 Gravel depth beneath pipe 'n°e FT O/� lJ 'S FT Gravel length 11 Gravel width��}} Oa FT FT Total absorption area qC� Distance between lines to SQ FT FT Number of lines Soil rating Pipe material JC? SQ FT a��rM PVC �Q3lL/ Installer A. ,._ _ _ P .I. _ Date Installed n -1 n© i6ell WELLS. PRIVATE ❑ OTHER (Identity) Classification (A,B,C) Total Depth Casetl to FT FT Installei - Date Installed: REMARKS: nl? '.. , 9.,1 ., ,f L V Municipal and Stale j delines in etlect on jthis dale: t[ _ a Health Department Approval: iIY"�l-II�II%1 I Scale: N T—* Insjp�r ,ections PL�rtoed by: Date. Ilial Ili s impalian was parlarmd 2000rdiop fo 211 Date: 4-10-87 ENGINEERS SEAL a+, c sr = r r �°- 'n°e Dr J. Corwin _i. i o I o. CE-ii`ic3 1 T ���H.-A FR. 1-"4 CD EE ` DEPARTMENTOF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, AN[]fORAGE, AK 99501 264-4720 PERMIT NO: 860135 DATE ISSUED: 05/20/86 APPLICANT: ACREAGE SYSTEMS ADDRESS: 601 E NORTHERN LIGHTS SUITE 165 ANCHORAGE, AK 99503 CONTACT PHONE: 345�2122 LEGAL DESCRIP: SUBDIVISION: SEQUOIA ESIATES LOT: 8 BLOCK: 2 SEN TIUN: 26 TOWNSHIP: 12N RANGE.' 3W LOT SIZE: 44916 (SQ"FT^ OR ACRES) MAX BEDROQMS: 4 ' Listed below are the options available to you in designing your septi' system, Choose the ootion that best Fiis your site^ ** GRAVEL LENGTH > 75 FT, REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT" EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS ... ... .... ������������������� I certify that: 1, I am I'amiliar with the requirements f*or on~site sewers and wells as set �orth by the Municipality ofAnchorage (MOA> and the State of Alaska. it. I will install the system in accordance with all MOA codes and regulationsr 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 [rom any existing �ell, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot" 4. I understand that this permit is valid for 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 ELECTRICAL PERMIT AND INSPECTION MUST 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, DATE: APPLICANT: ACREAGE SYSTEMS ISSUED BY 4.` DATF 2_(p 4- � -V FAT EE. PA F_` F-0 E *E: E 0 VP~ U� F;T.,.r-2h I IM DEPTH TO PIPE BOTTOM (FT") 4"O 4,O 4,0 GRAVEL DEPTH (FT"> 3,O 0"5 2"0 TOTAL DEPTH (FT.) 7.0 4"5 6"0 GRAVEL WIDTH (FT.> 2"5 22,O 5.0 GRAVEL LENGTH (FT. > 100^0 ** 41^0 84,0 ** GRAVEL VOLUME (CU.YDS") 32.5 33^5 38"9 TANK SIZE (GALS) 1�250.0 ** 1,2500 ** 1,250"0 ** � SOIL RATING (SQ"FT^/BR> 150 150 150 � ** GRAVEL LENGTH > 75 FT, REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT" EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS ... ... .... ������������������� I certify that: 1, I am I'amiliar with the requirements f*or on~site sewers and wells as set �orth by the Municipality ofAnchorage (MOA> and the State of Alaska. it. I will install the system in accordance with all MOA codes and regulationsr 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 [rom any existing �ell, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot" 4. I understand that this permit is valid for 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 ELECTRICAL PERMIT AND INSPECTION MUST 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, DATE: APPLICANT: ACREAGE SYSTEMS ISSUED BY 4.` DATF 2_(p 4- � f c-;•/"(ENG1ER'SSEA_L),. =;A Municipality of Anchorage/DEPARTMENT OF HEALTH & HUMAN SERVICES Co x n825 "L" Street, Anchorage, Alaska 99502-0650�^3� SOILS LOG — PERCOLATION TEST PERFORMED FOR: �C('.�ct�IL �!/lldlVl/iS DATE PERFORMED:_ LEGAL DESCRIPTION: )w C� CC Township, Range, Section: 7 �tI a'Q Z SLOPE SITE PLAN 1M11111 ^ OL 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS La SP--bzmva„ sov\A V Slj-Odly ,r(JOW a�" l$� Sq•���b�f0om 0xM brovJn Si l�� 60 -nay Ire l 1ND WAS GROUND WATER Al r) ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Afier t ii 1401 Monitoring? 0 iDate: I� n Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT.AND FT 1 PERFORMED BY: FQr'M.Q� I 7,7 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFF 72-008 (Rev. 4/85) 7 --- CERTIFY THAT THIS TEST WAS PERFORMED IN 1/ THIS DATE. DATE: l q ' `ar6k I { L Sto NOTE: THE ACCURACI'OF LOCATION OF EXISTING I PROPERTY CORNERS, WELLS, AND SEPTIC / SYSTEMS INDICATED IS NOT EXACT. DIMENSIONS INDICATED HAVE BEEN DETER- / N I MINED BY USE OF CLOTH TAPE AND NOT BY SURVEYING TECHNIQUES. rot �/ 6r c J. Co win yr ee . Cc -5283 ' C;xls. ri 'I .SySTIE►ti z1__� \01 1= �► L_0T s \ o y Lor 7 UAIIVI Lar. 1"1 s i�or....Ilo Wo y�SEWER SYSTEM LOCATION PLAN �k, £ • a It as aha` .�`r Y' -`k Lot: Block: (i .t'�,-i'x.�'��F�� Subd: Z )�iA i y jw� Q rr'/�•y ! (i� 7 i > x ada C Pre1 I'1 �red for,. Date. A IZ 2 '�q Municipattty of Anchorage January 9, 1987 P.O.. k 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264 -4]tk K 4 7 4 4 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES Alpine Drilling PO Box 110496 Anchorage, Alaska 99511 Subject: Lot 8 Block 2 Sequoia Estates Subdivision On-site Well Permit #860348 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1986. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as -built inspection report (three part form) must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4744. Sincerely, R.W. Robinson Program Manager On-site Services RWR/ljw enc c copy o f pe rmi t ~ ��U��X W `� 0. 74 � kit 1=7 121 V%i WK s Fit was Is� DEPARTMENT UF HEALTH AND ENVIRONMENTAL PROTECTION ^ 825 L STREET, ANCHORAGE� AK 99501 2�4-4720 �/ CHNI—Ev XlFIFE Ax U Q, I._ F" (� 11H K 1-1 X~1 PERMI[ NQ: 860348 DATE ISSUED: 09/15/86 � APPLlCANT: ALPINE 0��4��� ADDRESS: PO,8OX 110496 ` ANCHORAGE� AK 99E;11 CONTACT PHONE: 345 202 LEGAL DESC8IP: SUBDIVISION: SEQUOIA ESTATES LOT: 8 BLOCK: 2 SECTION: 26 TOWNSHIP: 12N RANGE: 3W LOT SIZE: 44916 (SU,FT" OR ACRES> I ceptify that: 1, I am familiar with the requirements for on-site sewers and wells as set forthby the Municipality ol 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 of Alaska requirements fcir the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot, - SIGNED DATE: /�^ ____ ����/�_�_-_�_��_ APPLICANT: ISSUED BY DATE: '^'~tl r~---�r-~--------~----- ---' --���---��----- \ WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Permit No. O CAT!014 OP W911 (please comolete either la. Ib or Ic.) A.D.L. No. la. Borough Subdivision Loi Block Ib. 1/4 gtrs- Section No. Township N ❑ Range E [] Meridian jSeW�� t/ _of_of—of— S❑ W❑ c. DISTANCEAND DIRECTION O,M ROAD INTERSECTIONS 3. OWNER OF WELL TC -11 j�, OA) `Z' CJ "Z QVA (%U�AVf Address: Street Address and Area of Well Location 2. WELL LOG Feet Below Material Type Top Bottom 4. WELL DEPTH: (final) y :5 ft. 5. DAT OF COMPLETION 7G i J'1 CITJ 6. ❑ Cable too( Rotary ❑ Driven ❑ Dug Auger ❑ Jetted ❑ Bored E] Other: 11la 1� JQ / "y J� Js uomestic ❑ Public Supply ❑ Industry 7. USE: pr ❑ Irrigation ❑ Recharge ❑ commerical ❑ Test Well E] Other: �rJ P //4-:' G h9v 7 a 8. C�ASI�N Gy: I ❑ Threaded Welded /L,, diam.t./ O in. to ft. Depth Weight / lbs./ft. diam. in. to ft. Depth Stickup ft. 9. FINISH OF WELL: Type: Diameter: Slot sh Siza: Length: Set between ft. and ft. Backfilling Gravel pack (� r �( 10. STATIC WATER LEVEL: 1 _ft. !KZ/2 Dote ❑ Above or ❑ Below land surface Equipment used: 11 . PUMPING LEVEL below %,handsurface and YIELD ft. after XZ --ars. pumping -7 9-D•m- ft. after hrs. Dumping 9.pm- GN QP��.C( H� O M tiQ •,��5 P� 12.GROUTING Well Grouted: ❑ Yes No Material: ❑ Neat Cement ❑ Other: 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity 9 -P.M. ❑ Subm. ❑ Jet ❑ Centrifical - ❑ Other 14. REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: 15, Wafer Temperature —° ❑ F C This wet was drilled un er 1q jy sd4ctia and t i report is true to the best of my knowledge and belief; /f�r f lY�ii � �1YJp as e..�jnass ry a� Gonfroci License Number Address: :� / Signed : ` .s Date: /J 'f ✓�'� L�f Author)zetl Revresentative Form 02-WWR (11/81) Copy Distribution: WHITE -State DGGS, PINK -Driller, CANARY -Customer - NOTE: THE ACCURACY OF LOCATION OF EXISTING PROPERTY CORNERS, WELLS, AND SEPTIC / SYSTEMS INDICATED IS NOT EXACT. DIMENSIONS INDICATED HAVE BEEN DETER- / N I MINED BY USE OF CLOTH TAPE AND NOT BY / SURVEYING TECHNIQUES. If I Municipality of Anchorage `qt On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval Parcel I.D. 017-152-18 1. GENERAL INFORMATION Expiration Date: Complete legal description SEQUOIA ESTATES; BLOCK 2, LOT 8 Location (site address) 6601 GUNNISON *ANCHORAGE, AK 99516 Current Property owner(s) LINDA WALLACE Mailing address Real Estate Agent Day phone 348-0826 6601 GUNNISON *ANCHORAGE, AK 99516 KAY ENGLAND Day phone 440-9022 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class _ Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: N/A Distance: - Received b Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $FZ" Date of Payment (P r(0 115- CAP - Receipt Number b -I I - a G COSA# 655512-71 Waiver Fee $ Date of Payment Receipt Number Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, sh Ws th _t the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate fo of bedrooms and type of structure indicated herein. I further verify that based on the information ob ne he 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. Name of Firm Garness Engineering Group, Ltd. Phone (907) 337-6179 Address 3701 E. Tudor Rd., Suite 101, Anchorage AK. 99507-3246 Engineer's Printed Name Jeffrey A. Garness Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the systems. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail. The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/party who paid for this report 6. DSD SIG ATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved �,�� tOF AIV6 � .491 � OIN SITE WATER AND s o WASTEWATER oz PROGRAM Conditional approval for bedrooms, with the following stipulations: �ii�JopF�T SERv���� . 9n By: Original Certificate Date: (a IZa–l-6— Th unici /�y o nchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 94-12.doc If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: SEQUOIA ESTATES; BLOCK 2, LOT 8 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 8/15/1986 Sanitary seal (Y/N) YES Total depth 223 ft. Cased to 218 ft. FROM WELL LOG Date of test 8/15/1986 Static water level 195 ft, Well production 7.0 g,p,m, WATER SAMPLE RESULTS Parcel ID: 017-152-18 Well Log (Y/N) YES Vires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 5/27/2015 201 ft. 4.0+ g.p.m. Coliform 0 colonies/100 ml. Nitrate 4al mg./L. Collected by: GEG. Ltd. Arsenic: rl © ug./L. Date of sample: -5/2-Q/2015 B. SEPTIC/HOLDING TANK DATA 29 YEAR OLD SEPTIC TANK IS REACHING THE END OF ITS USEFUL LIFE Tank Type/Material SEPTIC/STEEL Date installed 4/28/1986 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 4/29/2015 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA *BELOW EXISTING GRAD 4/28/1986 150 Date installed 7/1/1997 Soil rating .p.d. r ft2/bdrm) 8 System type SHALLOW BED 41 22 Length 150 ft. Width 5 ft. Gravel below pipe 0.5 ft. *UNK 902 **YES Total depth *2.95 ft. Eff. absorption area 750 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 5/27/2015 Results (PasslFail) ***PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 605 gal, New depth Din. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — **IT IS UNKNOWN IF THE MONITORING TUBE'S IN THE BED ARE SET TO THE CORRECT DEPTH BECAUSE THERE ARE NO C/O'S PRESENT. ***TESTED SOUTH 1997 TRENCH ONLY. NORTH 1997 TRENCH AND BED MT'S REMAINED DRY THROUGHOUT TEST D. LIFT STATION Date installed Size in gallons Manhole/Aocess "Pump on" level at in. "Pump O level High water alar level at in. Cycles tested Meets alar $ circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot i 00'+ On adjacent lots 100'+ Absorption field on lot- 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ Public sewer manholeicleanout N/A Holding tank 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 10'+ 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 10'+ Surface water 1001+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certUy that I have detefmined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date (Rev. 1I=) I u c 3 rn 0 J uo sc'ake� / Lot 8 co ° C) t" �. { Septile r a Seat,c J eRce ° block ref. wail \\\ 1 deck nea \ A80 \ C? R=540.0 L--- __.—. &O GUNMSON DRIVE �U e w �6A � Sti°ry F�^airi �nt yob- o vAIC' Lot 6 (3) c3� \ OQ SCALE: V= 40' S83° 3Ci6 0 W 93.65 w 0 — AS -BUILT NO CORNERS SET THIS DATE OF a 49th r it" F r—d k1 ciC]t: 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. # 017- t F HAA # QS—) +,—) 1. GENERAL INFORMATION Complete legal description L. IT g, BL -mV -2 Scz Tu car A Location (site address or directions) b 6 o t ZDT21 ue;. Property owner C 6R -e Day phone bus- yf 6Y Mailing address ���I G,�/v.✓tso,.� �Je�vc %aNcl�����' /�� ���/!o Lending agency A4cQ r4 A en d No6Vo47- Day phone Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 v 3. TYPE OF WATER SUPPLY: Individual well )C 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 —X 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 S7w (Z Q'�+�d'dN�ty'.s. Phone 27Z -0'7_1g Address V' O ' Engineer's signatu /aZ0-es , A'Vrp- Ar- V0157Cc 6. DHHS SIGNATURE __L Approved for bedrooms. Disapproved. Conditional approval for Additional Comments M Date bedrooms, with the following stipulations: Date 7-zZ-97 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-M(Rev.1/91) Back MOA1121 Municipality of Anchorage JECEIVEDDEPARTMENT OF HEALTH & HUMAN SERVI Environmental Services Division JUL-14,1997 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Municipality of Anchorage Health Authority Approval Checklist Dept. Health & Human Services Legal Description: Lff i%Z S e137Jot A LS'c Parcel 1. D.: O 17- IS -2--t 16 A. WELL DATA Well type 'PRtVA-rf�-' If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed Total depth ZZ3 Cased to 2 1 Casing height (above ground) Y 36U Sanitary seal (Y/N) l Wires properly protected (Y/N) 4! FROM WELL LOG AT INSPECTION Date of test — Is - c/ -?-z` / R 7 Static water level (q 4 Well production g.p.m.-9-P.M. WATER SAMPLE RESULTS: Coliform � 0 - Nitrate 0. 6.5 Other bacteria Date of sample: -5/zQ Z qCollected by: • R• FI ca�sf�Ao�+1� B. SEPTIC/HOLDING TANK DATA Date installed K 2 8186 Tank size 1 zs'v Number of Compartments Z Cleanouts (Y/N)'_ Foundation cleanout (Y/N) \1 Depression (Y/N) At D High water alarm (Y/N) Date of Pumping s//btg­j, Pumper At C. ABSORPTION FIELD DATA p-ltlq- Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) O - S? System type W T Length /.S70 Width .19-S Gravel thickness below pipe d • S Total depth 3 `R Effective absorption area SSV Monitoring Tube present (Y/N) Y Depression over field (Y/N) Date of adequacy test N&w Xn.61rAcL Results (Pass/Fail) V ASS For Y bedrooms Fluid depth in absorption field before test (in.); Immediately after= gal. water added (in.): Fluid durtFh Sinsl Minutes later. Absorption rata = Peroxide treatment (past 12 months) (Y/N) •F— - If yes, give date 72-026 (Rev. 3/96)" D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm E. SEPARATION DISTANCES Size in A' level at* "Pump off' level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 1 36.6 On adjacent lots / 00 Absorption field on lot 1 lie -a' On adjacent lots / Oc' 4 - Public sewer main N�.� Public sewer manhole/cleanout L/ Sewer /septic service line tZ 's - Lift station / o0 lA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Z:I- I Property line & 15- field_ Water main/service line 3 D r Surface water/drainage /0y+_ Wells on adjacent lots /Oo -f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / O `—" Building foundation 33 • '� Water main/service line .Zt�t Surface water e d o Driveway, parking/vehicle storage area 410+ Curtain drain moo Wells on adjacent lots 100-(_ F. ENGINEER'S CERTIFICATION I certify that l have determined thru field inspections and review of Municipal recordsare in conformance with MOA HAA guidelines in effect on this date.�,od°°°+'. o°°°°° • 's$t Signature {ro4Gtiv 4° :iITd+[4gCtnlEpp%ycsni Engineer's Name 5''rc:N3 e.AJ d PA,UeUcWa P t3.°++.us...... •"••/rA� �a rf Steven R. Pannone 0 I Date 4 -� �4 J°�+s6 HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number J CT&E Environmental Services Inc. CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID Parameter Nitrate -N Total Coliform 972677002 Pannone Eng Srv. Outside Hose Bib L8,B2 Sequoia Drinking Water 0 Results 0.850 0 Client PO# Printed Date/Time 06/02/97 16:25 Collected Date/Time 05/29/97 13:30 Received Date/Time 05/29/97 13:30 Technical Director: Stephen C. Ede Released By Allowable Prep PQL Units Method Limits Date 0.100 mg/L SM18 4500-NO3F 10 max col/100mL SM18 92226 Analysis Date Init 05/30/97 JRJ 05/29/97 RAM MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services M}i 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. #�SZ �� HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) I o 6 ELK Z /_ 6�_' UL / /4 S / AT�_S Location (address or directions) (b) Property owner( 51 rz� _Le Sni) Telephone: (home�)I 34 S -Lk I Business Mailing Address J 5-7c) i` 4�_,4-7 E 1) d�/yG%r 9 P ?q � 22'S_2>_ (c) Lending Institution /� �%( Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check hereyl, if hold for pick up.) List contact person and day phone number below: !!�� 2. TYPE OF RESID/ENCE 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 11 Community ❑ Holding Tank ElNote, I Community well system, must have written confirmation irom the state Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM I2ROVIDING 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 " L7�1TTSrCf - Telephone Address oxx%l� u .a .• i No. 4149 - E -80FESSIO'P 6, DHHS APPROVAL Approved for —_ bedrooms by Date Approved _Disapproved Conditional Terms of Conditional Approval The Municipalityof 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 PG0 N0p;v`fdll)NICIPALITY OF ANCHORAGE (MOA) �\G�?pU� • Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: L©T�. �la� Z JPG7GLOl� CJD A. WELL DATA Well Classification ��/r ? If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Y Date Completed S �6' Yield Total DepthZZ3 Cased to=_ 1. Depth of Grouting U114PVC4 ,1 ✓ i Static Water Level ;✓ Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) 41 SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot a /�ca ; On Adjoining Lots >/00 AC; To Nearest Edge of Absorption field on Lot ;On Adjoining Lots 2"100 7ele- To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole 'yZX To Nearest Sewer Service Line on Lot >/Oc rV> Water Sample Collected bysT ; Date 1L1L ` 4 Water Sample Test Results �� e�'/'L✓ Comments B. SEPTIC/HOLDING TANK DATA Date Installed � � Size 1,9590 No. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) /l) Date Last Pumped Pumping/Maintenance Contact on File (Y/N)— ; for Holding Tank High -Water Alarm (Y/N) A�A Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well �lf�L? �, To Building Foundation A0 , To Property Line To Disposal Field To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course i A Comments —Acu_ 4 ' 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA //�� Soils Rating in Absorption Strata �,�� Type of System Design /3 Pw Date Installed ��� '� Length of Field 4_` _e_' Width of Field Z 2 �s Depth of Field 459; 4- Gravel Bed Thickness �� lef�La Square Feet of Absortion Area C��� Statndpipes Present (Y/N) Depression over Field (Y/N) %_J Date of Last Adequacy Test Results of Last Adequacy Test lb� SEPARATION DISTANCE FROM ABSORPTION FIELD 59 To Water -Supply Well ;7�©� To Property Line :0& To Building Foundation— To Existing or Abandoned System on Lot A?2A ; On Adjoining Lots tiZA %®� To Cutback present) To Water Main/Service Line (if resent To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area -:�` Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at — Tested for Meets MOA Electrical Codes Comments **Check Permit Bedroom I certify that I h 0eckec inspection. ran rin( Receipt No. Signed Compan r Date MOA No. Z-4 _ Dimensions Manhole/Access (Y/N) "Pump Off" Le ent (Y/N) Pumping Cycles during Adequacy Test. Ing Against HAA Request** ed, or conformed to all MOA and HAA guideli Receipt No. Date of Payment fry o2 O 00 Amount: $ n, on the date of this " ngineer's Seal K, aKn .. uc TJ. Cc rvin y C.E .92_83 ran rin( Receipt No. , Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order # 10966 Date Report Printed: DEC 21 BB @ 12:11 Client Sample ID:LB, B2 SEQUOIA EST. PWSID :UA Collected DEC 19 88 @ 12:00 hrs. Received DEC 19 88 @ 12:30 hrs. Preserved with :4 DEG. C Analysis Completed :DEC 20 88 Laboratory Supervisor HEN C. EDE Released By Special Instruct: Chemlab Ref #: 3757 Lab Smpl ID: 1 Parameter Tested -------------------------- NITRATE-N Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY J.R. Client Name CORWIN & ASSOC Client Acct CORWINP P.O.# NONE REC D Req # Ordered By : J. ERESS Send Reports to: 1)CORWIN & ASSOC 2) Matrix: WATER Result/Units Method ------------------------------------------------ 0.81 mg/l EPA 353.2 1 Tests Performed See Special Instructions Above UA -Unavailable -ND= None Detected See Sample Remarks Above _ Ohm m hmiyaq tilallm Than, GI=G 001 Than Allowable Limits 10