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HomeMy WebLinkAboutPARK PLACE LT 4Park Place Lot 4 #020-092-50 C—` MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I1 ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 2644720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE❑lp�NEW G ' Ste 2%G �p3 IOUPGRADE MAILING ADDRESS n/ Lr. A/or— E ti HTS. RC VD LEGAL DESCRIPTION Lo <j BLOCK PARK LACE c� P1V/5/o�✓ LOCATION NO. OF BEDRO MS Well Absorption area Dwelling PERMIT NO. Uy DISTANCE T0: ;:Z Manufacturer Material No. of compartments WQ ~ . N Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth 6O2 DISTANCE TO: Well Dwelling PERMIT NO. _� F Manufacturer Material Liquid capacity in gallons O DISTANCE TO: Well Foundation 1 Nearest lot0 -A PERMIT NO. w= O/ d A O 1 M Z No. of lines Length of eachf ine Total length of lines r Trench width, • �s Ines F- ?w 3r inches H Top to finish beneath tile Total of tile gradeMaterial if effective absorption area o S ir.l.es t7 Length Width Depth PERMIT NO. w ' Q F- Type of crib Crib diameter Crib depth Total effective absorption area Wd w Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS 1i c0. SOIL TEST RATING S INSTALLER SrE 5 /NG. r REMARKS oJrn 10040 s \f: I STFM 'C- is is • f Corwin w / t ou 1517, E o W� r s D frE 0 SE o. CE -523J *,. '�ttid {'t Sl • • J 1-41 O Iv PPDATE LEGAL N/I/Ub 5 I -OT* &L -K AIIA POLL acE/ 5 (72'013 (Rev. V8) MLJP4 I C I r"4NL I TY 01- Ah1CrF " '+6� AGE G. DEPARTMENT HEALTH AND ENVIRONMENTAL .10TECTION 805 L STREET, ANCHORAGE, AK 99501 264-4720 ON—E3 I 1- E= BEWE=fes PERMIT NO: .850041 l DATE ISSUED: 02/25/85 APPLICANT: ACREAGE SYSTEM INC. ADDRESS: 601 EAST NORTHERN LTS. BLVD. ANCHORAGE, AK 99503 CONTACT PHONE: 276-6550 LEGAL DESCRIP: SUBDIVISION: PARK PLACE LOT: 4 BLOCK: NA SECTION: 3 TOWNSHIP: 11N RANGE: 3W LOT SIZE: 43620 (Sb.FT. OR ACRES) MAX BEDROOMS: 4 Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I certify that: 1. I am familiar with the requirements for 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 of 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 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 BUILDIN^u CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS -GUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK, MUST BE DONE BY A LICENSED ELECTRICIAN. 5IGNEDS�n_LL, J`I DATE APPLICANT: ACREkOf SYSTEM INC. ISSUED BY ---_`Q DATE: a'c���Q� 17F2ENCH 113 =_ LQ _ I?F,:A I hE DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4.0 GRAVEL DEPTH (FT.) 8.0 0.5 3.5 TOTAL DEPTH (FT.) 12.0 4.5 7.5 GRAVEL WIDTH (FT.) 2.5 20.0 5.0 GRAVEL LENGTH (FT.) 32.0 38.0 54.0 GRAVEL VOLUME (CU.YDS..) 25.2 28.2 40.0 TANK SIZE (GALS) 1,250.0 ** 1,250.0 * 1,250.0 SOIL RATING (SQ.FT./BR) 125 125 125 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I certify that: 1. I am familiar with the requirements for 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 of 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 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 BUILDIN^u CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS -GUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK, MUST BE DONE BY A LICENSED ELECTRICIAN. 5IGNEDS�n_LL, J`I DATE APPLICANT: ACREkOf SYSTEM INC. ISSUED BY ---_`Q DATE: a'c���Q� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ACREAGE srSMS, Wa Suite 165 iZ SOILS LOG ❑ PERCOLATION TEST 601 E. Northern Ltghh Rr PERFORMED FOR: DATE PERFORMED: J IB -BS - LEGAL DESCRIPTION: S- "s/0 SLOPE SITE PLAN WAS GROUND WATER N 11 O L . ° °° ENCOUNTERED? O o• ' • P 12-00 • IF YES, AT WHAT E ° • ' DEPTH? 13 0 • o 14 ° " o 15- 16 5 ° °• . , o OF A 17 1 +� Q_.e,.•.•, 18 � � 9L r �..» ........»sem . 19 ...... a a J. Corwin W 20 �♦ o.CE,5282 (FEET) 6'0-/'J-:� 1 K✓ Net Drop .h" NNEEMM9.002 2 3- NEENEMORMN 4- 6- 6 memo 7- 78 NPAIJAME 8-- NEEMENFEENE : 9 . o U, 0 10 • WAS GROUND WATER N 11 O L . ° °° ENCOUNTERED? O o• ' • P 12-00 • IF YES, AT WHAT E ° • ' DEPTH? 13 0 • o 14 ° " o 15- 16 5 ° °• . , o OF A 17 1 +� Q_.e,.•.•, 18 � � 9L r �..» ........»sem . 19 ...... a a J. Corwin W 20 �♦ o.CE,5282 Reading Date Gross Time Net Time Depth to Water Net Drop NNEEMM9.002 NEENEMORMN memo NPAIJAME NEEMENFEENE NEEMMISMIRMN In NNIPE,NO: \rro®m ■N.■.■WNHE SKMENMENEW ow■■.R■E W IW.` --M■■.. EMENNONEEN Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN /6AND � FT PERFORMED BY: /`'l. D/1� i CERTIFIED 72-009 (6/79) DATE: \ MUNICIPALITY OF ANCHORAGE \\I DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME �IPHONE — Ll� ANEW UPGRADE MAILING A DR S S- S 50 LEGAL DESCRIPTION LOCATION NO. OF BEDR00 S. O DISTANCE TO: Well Absorption area r Dwelling - I 57W� PERMIT NO—ICI^`�S 5e EQ Wf- Manufacturer Materi NO. of co rtments Liq. cepa it m allons IF HOMEMADE: Inside length Width Liquid depth 6 Y J t72 DISTANCET0: Well Dwelling PERMIT NO. _? YQ- Manufa Ivratenal Liquid c c' IV in gallons O w= DISTANCE TO: Well s Foundation Zfo Nearest lot Itny ( /0 PERMIT NO.— j Q J w Z F-2 W No of lin Length of each li Total length of i r Trench wi *.' In Distance �t lines L.+LJ F- a Top of the to finish grader Material beneath tile J= Ir wrehes Total elfecti a apsoren area e� (Co W Length Width Depth PERMIT NO. C7 H Mw Type of crib C b tliameter Crib tl pth elective abs rption ere wWell a k—vf5TANCE TO: Buil ing foun n Nearest lot line J CI � Depth Driller Distance to lot line PERMIT NQ -7 Building founda ' n DISTANCE TO: i Seer line Septic tank w Ian Absorption area(s) OTHER PIPE MATERIALS C//�i/r1,Xnlij✓ v SOIL TEST RATING PSt ' 3 O ce A INSTA LER REMA S W PROVED ' DATE LEGAL l�..j�'/� �//� ` / wC.IC/ /2R� 72-013 (Rev. 3/78) V ' n r-, rlur-1 I V_ I F- _-41_ I T•- r -,F P-1 r4 t.. nr E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ! - G. 825 L STREET, ANCHORAGE, mm. 264-4720 L4ELL r- r4 E> CA t-4 - I TE BELIEF= F- ERt•1 I I i,A, 90 q 9 PERMIT NO. ( 790215 ) kL�loLLI SJ. APPLICANT STEVE PISA SRA BOX 475-S 49507 344 4723 'LOCATION LORP,ETTA CIRCLE LEGAL L4 PARI' PLACE S/D LOT SIZE 43620 SQUARE FEET ,TYPE OF SOIL ABSORCTION SYSTEM IS: TRENCH 'MAXIMUM NUMBER OF BEDROOMS = 4 SOIL EATING CSG! FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ' C•E == TH= 1�+ LEt�J��-f-H= r� �' GF"r=i'•.- EL C�EF•TH= �• THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATIONN CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH I5 THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL F'IF'E AND THE BOTTOM OF THE EXCAVATION CIN FEET). F'EC_!L1 I F --:EC• '�EF•'T I C- Trir-JK •c I 2.E= 1�cC-i r3F-tl_L_C r-4 'PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURINNG THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TLJQ C c ] I td= F `ECT I 0"HF=:E F='EQU I F=[_=C• --- ,BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS :DEPARTMENT WILL BE SUBJECT TO PRO'SEC:UTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON -_ITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL; OF! 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER PEOUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PPOPER INSTALLATION. F EI<:r1 I T CXF=' I FZE-=- =-:-1 , ::L!P a I CERTIFY THAT 1: I AM FAMILIAR. WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. '2: I WILL IN'_TALL THE SYSTEM IN ACCORDANCE WITH THE CODE_. 1: I UNDERSTAND TH T THb,ON TE SEWER, SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS P.EMOLED &UDE MORE THAN 4 BEDROOMS. SIGNED APPLICAI`W STEVE PISA v CCCsss,,, ISSUED BY--__--- ---DATE---- ,% / V3.2 r% 1 lA k-- �.Ac_ 10 ` G Ojo CJ- y3� Cf-' 6Lrtp%-- ao• P-94�2-1 e IM 13ox 1 3GO, STAIL ltouwk'. E�1CIIII®II2ACI y Ar.AsHA 99:;02 ::44-7714. SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 250 ;eet• DRILLED AT THE RATE OF $18.00 PER FOOT. PROPERTY OWNER rilt• S.teue Tt4a 349-4723 LOCATION OF WELL SITE Lt. Blk. Sub. 0eDRILLER Bye CCauo of XampaU D4ZUir4 VoAko. WELL LOG:, _ 0-----35' StV4 gtauet. 30 cCa4 bbidet and 15% 4an4 MateAia,C. 35---250' Bedtock. R 4edimenAaW tock with fd -3ute4 ptoducin.g .00ae wat" Rieo pa:w.lat a2ea4 and po-toU4 .tljpe tock 4howlaq f LiUc . good ua.tr�t pitoducii.on. -. 35---210' Glo4t4 att Se.d�j lock wZ& a mate& p-toductton %ton fi -ou4" olt"II 500 gat4 pee day.. 24 hout .time {Mame. Rbout 1/2 gP1r7. Sedimentary. -tock Jtoa 210 .to 241 feet. 241-250' good motet ptoductton .in a gAantrdat and potou4 tock. i Yield 4hour4 two �Tl% 2880 gat4 pet day. auaLtab.te. Thio me1.L 4hou.td a -Lao tnzAeaa .uL ptoduct.i.on .to a po44•ibte. 3500 94-t4 pet day.. Totak mate�t -tecoue44 4h.outd come m•Lthin. de -i4 .than 100 of 4utfaGe. 240'gat4 of match, in. ca4Znq. 3/4 Rode Sub. Pump 4h.outd Le i:4tatted 15 feet off bottom. Coot of Ve-U: $18.00 X 230 feet: 54140.00 Coot of 47et.t Seat: $21.00 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING Cry $4161.00 WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM D THANK YOU VERY MUCH. B R E CLAUS OF RAMPART RILLING WORKS DATE Ione 2=nd► 1979 SERVICE CHARGE 0 F IY,% PER MONTH WILL BE ASSESSED E ON PAST DUE ACCOUNTS. Municipality of Anchorage ••, a� Development Services Department Building Safety Division .. ... On -Site Water 8 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-092-50 HAA# V 4 0_6 so 1 1. GENERAL INFORMATION Expiration Date: 3 — 4 — 0..15� Complete legal description PARK PLACE SUBDMSION: LOT 4, Location (site address or directions) 16461 SAINT JAMES CIRCLE • ANCHORAGE, AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address HOWARD MORSE Day phone 830-6482 16461 SAINT JAMES CIRCLE 0 ANCHORAGE, AK 99516 Day phone DAR WALDEN w/REMAX PROPERTIES Day phone 276-2761 110 WEST 38' SUITE 100 + ANCHORAGE, AK. 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer 0 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the InformaUon obtained from the Municipality ofAnchorage 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 CARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 6 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 Mum 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 otherperson or party Is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE V Approved for 0 bedrooms. Disapproved. Date 337-6179 Conditional approval for bedrooms, with the tllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other By Original Certificate Date: (Rw. MCI) z Municipality of Anchorage • Development Services Department Building Safety Division OnSke Water R Wastewater Program 4700 South Bragaw St P.O. Box 198650 Anchorage, AK 99519-66W www.d.anchorage.sk.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: PARK PLACE S/D: LOT 4. Parcel ID: 020-092-50 A. WELL DATA *ASSUMED BASED ON WELL LOG Web type PWATE If A, B, or C provide PWSID# N A Well Log (YM) YES Date completed 6/22/79 Sanitary seal (YM) YES Wires properly protected (Y/N) YES Total depth 250 ft. Cased to •35 ft. Casing height (above ground) 12+ in. FROM WELL LOG Date of test 6/22/79 Static water level 100 ft. Well production 2 9 -p.m - WATER SAMPLE RESULTS: Coliform M6_ colonies/100 ml. Arsenic: N/A mgA. B. SEPTIC/HOLDING TANK DATA Tank Type/Material AT INSPECTION 11/23/2004 33 ft. 6.8 g.p.m. Nitrate jj UjmgJL. Older bacteria –jk_colonies/100 rd. Date of sample: 11 /23/04 Cogeded by: GEG. LtD. PUBLIC SEWER Tank size gal. Number of Compartments _ Foundation cleanout (YIN) _ DeDrnssie r ank (Y/N) C. ABSORPTION FIELD DATA Date Installed Pumper Soil rating (g.p.dJft'or ft%dnn)_ Length ft. Width ft. Total depth ft. Elf. absorption area _ ft' Monitorin{ Date of adequacy test Date installed High water alarm (Y/N) System type Gravel bel ft. Depresslon over flaid Fluid depth In absorpti�Ifdre be #0 In. Water added — gal. New depth _in. Elapsed Time: Final fluid depth _. In. Absorption rate >= g.p.d. anetio treatment (past 12 mo.) (YM 3 type) If yes, give date D. LIFT STATION Date instafied Size in gallonsmp oft" "Pump on" level at _in. "PuevaFee�n. E. SEPARATION DISTANCES High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tenkAifi station on lot N/A Absorption field on lot N/A Public sewer main 75'+ Sewer /septic service line 25'+ On adjacent lots 1001+ On adjacent lots 100'+ Public sewer manhole/deanout 100'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: PUBLIC SEWER Building foundation Property line Absorption field Water main Water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water service line F. COMMENTS G. ENGINEER'S CERTIFICATION Building foundation Water Surface Wells on adjacent lots I car* that I have determined through field inspections and review of Municipal records that the above systems ars in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Data (2-" MAA Fee E- Waiver Fee S Data of Payment ���� Date of Payment Receipt Number «61-a ,�pt1c Receipt Number IRsv. tarot) water perking/vehide storage 12- 2-04: 4:16PM: 0 ReLN 1047690001 [lent Name Garness Engineering Group, Ltd. roject NaMeM Park Place, Lot 4 Heat Sample ID Park Place, Lot 4 lams Drinking Water anple Remarks: :907 6615301 All Dates/Times are Alaska Standard Time Printed DateM= IV02/2004 14:44 Collected Date/Time 11/23/200449:30 Received Date/rime 11/23/22005j 5:30 Technical Director —,-�Steehe e 0 A- 2 rtuncter Results PQL Linin Method Allow bk Pr Container ID Limits Date Anil Date Inti . Iters Department Nitrate -N 0.100U 0.100 mg/L EPA 300.0 B (<-10) 11/24/04 XM .orobiology Laboratory Total Coliform 0 col/100ml, SM209222B A (<-1) 1123/04 DKC r J 'okP�E.�F� A.<gsOpO . . ............................. a SHANE A. HOLT.. AI • LS -6914 Ippn'o ..... o ST. JAMES CIRCLE iA.AI�t •„'Oyt MOV• '1•• i•A 19*1 iA O P9 / Hr t^' 4 O +P P•P � B' DAB [HNT. N 89 513'45 E 29.73 m O N E39 5B' 451 E 201.26 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS BPECIRGILLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND RATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURESORFENCELINES EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED RAT. ARE NOT SHOWN 16RECN NOTE ANY FENCELNES S KIM ARE LOCATED AFPROJOMAIELV AND ARE NOT TOM USED TO MWRMINE PROPERTY UNE OR UO TE STRUCTURES ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS, AS -BUILT SURVEY SCALE: T'R40' I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 4. PARK PLACE SUB. ANCHORAGE RECORDING DISTRICT. ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND THAT NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE. ALASKA THIS 16TH_ OAYOF NOVEMBER 2004_ HO.T LANDSURVEYING 954S.F0116.26 TEL 34S5513 1 I I I I I I I I I I S' x 2a ANCHOR EASBHBNT 1 I N E39 5B' 451 E 201.26 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS BPECIRGILLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND RATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURESORFENCELINES EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED RAT. ARE NOT SHOWN 16RECN NOTE ANY FENCELNES S KIM ARE LOCATED AFPROJOMAIELV AND ARE NOT TOM USED TO MWRMINE PROPERTY UNE OR UO TE STRUCTURES ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS, AS -BUILT SURVEY SCALE: T'R40' I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 4. PARK PLACE SUB. ANCHORAGE RECORDING DISTRICT. ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND THAT NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE. ALASKA THIS 16TH_ OAYOF NOVEMBER 2004_ HO.T LANDSURVEYING 954S.F0116.26 TEL 34S5513 �S Municipality of Anchorage •. Development Services Department Building Safety Division „ On -Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519.6650 - www.cl.enchorage.ek.us - (907)343.7904 CERTIFICATE OF HEALTH -AUTHORITY APPROVAL- FORA PPROVAL-FORA SINGLE FAMILY DWELLING Parcel I.D. 020-092-50 HAA# % ��✓ 1. GENERAL INFORMATION Expiration Date: O ! = O Complete legal description PARK PLACE SUBDIVISION: LOT 4, Location (site address or directions) 16461 SAINT JAMES CIRCLE • ANCHORAGE. AK • 99516 Current Property owner(s) TOM CRAFTON Day phone 561 =3701 , Mailing address 16461 SAINT JAMES CIRCLE • ANCHORAGE. AK 99516 Lending agency Day phone Mailing address . Real Estate Agent Mailing address Unless otherwise requested, NAA will behold by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Day phone TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (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 ss of the validation date shown below, I verify that my Investigation, based on procedures outlined In the Health AuthorilyApproval 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 heroin. 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 supplyand/or wastewater disposal system ls(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the Bme of Installation. . Name of Firm ALASKA WATER k WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD, SUITE 28 • ANCHORAGE, AK 99504 Engineers Printed Name JEFFREY A GARNESS, P.E. Data 41510 Engineers Comments: In conducting this evaluation, AMC Inc. attempted to provide a thorough, 00060p0 conscientious engineering analysis of the system in accordance with ADEC and MOA o F DSD Guidelines & 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 rea dify Iden tiflable lea tures. The operational life of all wells and Cl); septic systems depend on the local awls condition, groundwater levels that may .... L. .. ......:...! fluctuate during the year, and the water usage of the famliybeing served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory lest results do not guarantee future performance of the system, nor do they guarantee that QO Aire Gorness;' ° there are no hidden defects or encroachments. AV=, Inc, can therefore not provfdo future how long the to meet the Q 7953 e p any warranty or estimate of system wait continue C�4;f operational requirements of the ADEC or MOA DSD. The content of this report is for Pro�essio�° the sole benerit of the owner listed above. Any reliance upon or use of this report byany it legal �p ODOt�ilf/I//y other person or party is not authorized, nor will confer any right whatsoever. 5. DSD SIGNATURE \\`\4\QP:',•••.,':��y0 Approved for bedrooms. : J,� ON-SITE / • WATER AND •; Disapproved. :WASTEWATER PROGRAM Conditional approval for bedrooms, with the ttlowing stipulations: O�'•, ' 0 �,R C\ncks� ��JJIIJJ)111j1 Attachments: HAA Checklist Manitenance Agreements Septic System Advisory Supplemental Engineers Reort Well Flow Advisory Other By:— Original Certificate Date: 7— G%' 0 ta«. uvo> Municipality of Anchorage Development Services Department Budding Safety Division OnSke Water & Wastewater Program 4700 South Bragaw SL P.O. Boot 198850 Anehorage• AK 99519-156W www-clAnchorage.ak.us (907) 343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: PARK PLACE S/D: LOT 4. Parcel ID: 020-092-50 A. WELL DATA 'ASSUMED BASED ON WELL LOG Wall type SATE M A. B. or C provide PWSID# N/A Well Log (YM) YES Data completed 6/22/79 Sanitary seal (Y/N) `rES Wires property protected (YIN) YES Total depth z5o R Cased to '35 R FROM WELL LOG Date of test 6/22/79 Static water level 100 R Well production 2 9 -p.m WATER SAMPLE RESULTS: Coliform 0 cwloniea/100 ml. Nitrate 0.5 rrgJL. Casing height (above ground) 12+ in. AT INSPECTION 4/28/00 24 R 3.8 g.p.m. Other bacteria 0 colonles/100 ml. Date of sample: 7/2/2001 Collected by: AWWC. INC. B. SEPTICIHOLDING TANK DATA PUBLIC SEWER Tank Type/Material Date installed — Tank size gal. Number of Compartments "Mann ar )) Foundation cleanout (YIN) — Pumper C. ABSORPTION FIELD DATA (YIN)— High water alarm (YIN) Date installed So9 rating (g.p.dJr&r 4'/bdnn)— Length Total depth R Eft. absorption area_ ft' Date of adequacy test System type Gravel Depression over field Fluid depth in abaoryticrt field be t! in. Wafer added —gal. Now depth —in. Elapsed Time: Final Atdd depth — In. Absorption rata'= g p d. nation treatmon t (past 12 mo.) (YIN & type) 0 res• give date D. LIFT STATION Date installed Slav N gallon 'Pump on' level at _in. E. SEPARATION DISTANCES High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankfiltt station on lot N/A Absorption field on krt N/A Public sewer main 75'+ Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manholeideanout 100'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIGHOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Property An Absorption field. Water main Water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water Water service Ane Surrace Wens on adjacent lots F. COMMENTS 0. ENGINEER'S CERTIFICATION I cwMfy that I have determined through Reld 6upeclions and review of Munkipal records that the above systems ere M conRxmance with MOA HAA guldellnes b eA'ed on Mils date. Engineer's Printed Na,9 JEFFREY A. GARNESS Date 7ls/Or HAA Fee $ X00 . 00 Date of Payment 7/6/ Recelpt Number lat4 P (Wv.12MM Waiver Fee 5 Date of Payment Receipt Number water paridngNshicle storage A.')i;;; -7953 JUL-04-01 15:36 FR011-UIE ENVIROMENTAL SRV OOIS615301 CME Environmental Services Inc. Laboratory Division CT&E Ref. N: 1013916001 Client Name: AK Water & Wastewater Cons. Project Name: n/a Client Sample ID: Park Place Lot 4 Matrix: Drinking Water PWSID n1a 200 W. Potter Drive Anchorage. AK 99518 Tel: (907) 562-2343 Fax: (907) 561-5301 T-556 P.01/02 F-644 Client PON: n1a Printed Date/Time: 07/04/01 15:00 Collected DateTme: 07/02/01 10:45 Received DateMme: 07/02/01 11:25 Technical Director. Stephen Ede Rebased By: Sample Remarks: Allowable Prep Analysis Parameter Results POL Units Method Limits Date Date InN Total Coliform (MF) 0 coV100 m1 SM9222B 07/02/01 KAP Nitrate 0.6 U 0.5 mg/L EPA 300 10.0 07/02/01 SCL MON MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Mtn Division of Environmental Services _ Onsite Services Section P.O. Bax 196650 Anchorage, Alaska 99519.6650 (907) 3433744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel I.D. # 020-092-50 HAA # �lq �r�q<;� 1. GENERAL INFORMATION Complete legal description PARK or err SI IGDRISION' IDT 4 Location (site address or directions) 16461 ST JAMES CIRCI E Property owner JOHN AND RUTH Gil I ISPIF Day phone (907) 345-5646 Mailing address 16461 ST ,JAMES CIRCLE ANCHORAGE AK 94516 Lending agency Mailing address Agent Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 4 XX 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 Holding Tank Community on-site Public sewer 014 NOTE: If community wastewater system, provide written confirmation from State ADEC ing to the legality and status of system. 72-025 (Rev. 1191) Front MOA 921 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shalt be paid 5400.00 at, or prior to, closing for the engineering services provided. 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 Municipa� and State codes, ordinances, and regulations in effect �' on the date of this inspection. Name of Firm Engineer's Signature Phone __ (907) 337-6179 7 /to In conducting this evaluation, AWWC, I �Ite ted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and OA DHHS Guidelines & 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 life of alt wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water000000p0 A usage of the family being served by the system. These conditions are outside the control of o OF A`� the evaluator of the system. Satisfactory test results do not guarantee future performance 01 the system, nor do they guarantee that there are no hidden defects or encroachments. DLP. T r AWWC, Inc. can therefore not provide any warranty for future estimate of how long the p system will continue to meet the operational requirements of the ADEC or MOA DHHS. The content of this report Is for the sole benefit o1 the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, ....... • y�. ........ nor will it confer any legal right whatsoever. O� AG : e f �qy A. ess. 6. DHHS SIGNATURE JG Approved for Y= bedrooms Disapproved Conditional approval for Additional Comments bedrooms, with the following stipulations: 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 inspecticns 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. 1191) Back MOA #21 Computer Version Municipality of Anchorage RECEIVED DEPARTMENT OF HEALTH & HUMAN SERVIC�R 1 12000 Environmental Services Division 825 "L' Street, Rm 502 Anchorage. Alaska 99501 (907) 3434744 MUNICIPAIM OF AN Health Authority Approval ChecldIS 0NMXTa'SEKM'DIVISIM Legal Description: PARK PLACE SUBDIVISION: LOT 4 Parcel I.D.: 020-092-50 A. WELL DATA Well Type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A Log pent (YM) YES Date completed 6/22/79 Total depth 250' Cased to 35'• Casing height (above ground) 12'+ Sanitary seal (YM) YES Wires property p (YM) YES *ASSUMED BASED ON WELL LOG FROM WELL LOG Date of test 6/22/79 Static water level 100' Well production -2 9 -P.M. AT INSPECTION 4/28/2000 24 3.8 g.p.m. WATER SAMPLE RESULTS: ColBorm 0 Nitrate 0.5 mg/L Other bacteria 0 Date of sample: 8/31/2000 Collected by: A.W.W.C.. INC. a. SEPTICIMOLDING TANK DATA Date Installed Foundation cleanout Data of Tank stze Number of Pumper C. ABSORPTION FIELD DATA CITY SEWER High water alarm (Y/N) Date installed Soil rating (g.p.dM or 1121bdnn) System Length Width Gravel thickness below (Y/N) Effective absorption area Monitoring Tube Present oplY Depression over field (YM) Date of adequacy test Fluid depth In absorption field For Bedrooms Immediately after gal. water added (In.): Fluid depth Ins) Minutes toter. Absorption rate = pprod e treatment (peat 12 months) (YM) Byes. give date rbm Oka. =or CWPAK vWWO D. LIFT STATION Date 111 tatled Size Manhole/Access (YIN) 'p„ on• level or. High water alarm *Datum 'Pump off level ar E SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septiclholding tank on lot N/A On adjacent lots 100'+ Absorption held on lot N/A On adjacent kris 100'+ Public sewer main 100,+ Public sewer manhole/deanout 100'+ Sewer/septic service line 25'+ Lit station N/A SEPARATION DISTANCES FROM SEPTIVHOLDING TANK ON LOT TO: CRY SEWER Foundation Water Property water/drainage Wells on adjacent kits SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: CIN SEWER Property line Building foundation Surface water Curta�i Q[al F. ENGINEER'S A I certify that I a d tied Inspections and review of Mun/dpal t a systems are M conformance with MOA a on this date. Signature Engineers Nale JEFFREY A. GARNESS Date I /_7 W HAA Fee i 5-.;1( A . Date of Payment Receipt Number 72-M Rft. 3=r oon pdw VoWm Water parkbtg/vehide storage area Wells on adiacant lots Waiver Fee $ Date of Payment Receipt Number 09-06-00 09:21 FROl1-CTE ENVIRONIENTAL ALM CT8_E Environmental Services Inc. Cr&E Ref.# 1005233001 Client Name AK Water & Wastewater Consultants Inc. Project Name/# Park Place Lot 4 Client Sample ID Park Place Lot 4 Matrix Drinking Water Ordered By PWSID 0 ean�¢ ncnw�aa: 5615301 T-132 P.01/03 F-014 Client PO# Printed Date/time Collected DateMme Received Date/time Technical Director Released By/Oyu 09/05/2000 16:30 08/31/2000 10:30 09/01/2000 10:20 Stephen C. Ede Allow Parameter Results PQL Units Method Limits able Prep Analysis Date Date Init Waters Department Nitrate -N 0.500 U 0.500 mg/L EPA 300.0 10 tax 09/01/00 SCL Kicrobiclogy Laboratory Total Coliform 0 coU100mL SM189222D 09/01/00 JDT M 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 l.D.# Cno b�la--ti� HAA# VAQSM281 1. GENERAL INFORMATION Complete legal description Lot 4; Park Ptace subdivision; Location (site address or directions) 16461 St. James C.inote Property owner TK 9 Ann -Lizette Landon Mailing address San Diego, CaR,i6onn.ia 92129 Day phone • • . • - • . . .. • . .. .. _ 1 9. • • - Mailing address Agent Audaeu Mc Kenzie CENTURY 211ALLIANCE Day phone 561-0491 Address 707 East Tudors Road 0280 Anchorage, Alaska 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well Xx _ Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. ?M25 (R". 1121) Front MOA 021 IU VOW Wme (IWL Aou) wo u •Tom sloau!6ua leuo!ssa;ad ayl ui suo!ss!wo jo sjoaja jo; alq!suodsaj lou st e6ejoyouy;o llIed!ounj!zleg!oodsu! lonpuoo IOU op SHHO to saaAoldw3 •sluewaj!nbai alels pue lLjapa; u!elUao ys!les of iepio u! suo!lnlllsu! 6u!pu9l nayl pue sawoy;o sioseyand of Asal(noo a se s!y1 saop SHH(3 ay1 •eNselV;o ale)S eyj u! paUals!69J Jaau!6ua leuo!ssa;ad juapuadapu! uv Aq Gnoge S ydeAmed ul uan16 suo!leluasaidai eyj uodn Aluo paseq saleoipliaU lenaddy Al!joglnV WPM sanss! (SHHO) saowaS uewnH pus WMaH;o juawliedaO 96woyouV;o 14!led!o!unpq ayj ®' NUI111VJ Gle(3 :suo!lelnd!ls 6u!mollo; ayj yj!m 'swoojpaq .d h01SS3jpad`�rJ e4)) :AG sluawwoC) Isuo!I!ppV 10; Ienoidde Ieuolj!puoO 'panaddeslO •swoojpaq T Jo; panaddy �J 3an1VNJIS SHHO '9 �"ovLa b fiZ L GILD eunleu6!s s�(aau!6u3 11CAAe4se1V •JaATX 016ev W *ON peojl dool JaA!jl 016e3 b£OLj Ssa1PPV auoyd ^NM3NI0Ni4-TS— wJ!3;o GU1uN •uopodsut s!yj jo ejep ayj uo joalle ul suo!jeln6au pue'saoueupo 'sopoo ejuIS pue ILdlownV4 IP IMM Gomildwoo ul sl walsAs lesodslp Jejemalsem Jo/pue Alddns aajem aj!s-uo ayj 'uo!joadsui pue uo!le6!jsanu! Aw ww; pue sal!; G6eioyouV;o Aj!Ied!olunyq ayI woj; pau!Llgo uo!jewio;ui ayj uo paseq ILyj A!!JOAjeglJn; I •u!ajay pajeo!pu! einjoruls;o Gddj pue swooapaq;o.lagwnu eyj jo; ejenbape pus Ieuo!joun;'a;es s! walsAs Iesods!p jalemalsem.(o/pue Alddns aajem ops-uo eyj jeyj smogs uo!leo!ldde IenolddV AjpoyjnV U1leaH s!yj;o uo!je61js9nu! Aw jeyj A;uan I 'molaq umoys ejep uollepllen ayj;o se pue olalay pax!;;e Inas Aw Rq pa!;!liao sV H33NION3 A9 NO11O3dSNl dO 1N3W31V1S 'S Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �-t- ;-PA1C PlAr c-_ Parcel I.D. A. WELL DATA Well type�;nlqle�AN41�lf A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed - Z Z - `( Driller. Total depth— Cased to 26- z 5 O Casing height / Z Sanitary seal (Y/N) 4 Wires prpperly protected (Y/N) * per ped-cot,Id AA 5,- Zqt -bS J Date of test Static water level Well flow Pump level FROM WELL LOG G - 2Z-:7 :2 9.p -m. uK SEPARATION DISTANCES FROM WELL TO: AT INSPECTION �9 t �K Septic/tfoidmg n tank on lot / 0 1f" ; On adjacent lots (00 i4- Absorption field on lot (00 � ( ; On adjacent lots (00,4 - Public ,'- Public sewer main — Public sewer manhole/cleanout )JA Public sewer service lineQI1 Petroleum tank n1oA� k'N°w/J WATER SAMPLE RESULTS: Coliform Nitrate Nitrate _e)AI'SfACt(f4�l Other bacteria ZCiPo Date of sample: - f - rl Collected by: B. SEPTIC/HOLDING TANK DATA Date Installed R -,q - I Tank size 1 2 SO Compartments Z Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) IJ High water alarm (Y/N) t1A Alarm tested (Y/N)' Date of pumping l( 11 A t H0~t sc R K SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well on lot ( co' y- On adjacent lots ( OD t Foundation Topropertyline 1 0 4 Absorptionfield 5, Water main/service line / O 4 Surtacewater/drainage l ODr4 n-020 (Rw. W) Fwt MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size In gallons Vent(Y/N) on" level at - Manufacturer — Manhole/Access (Y/N) High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATIO TO: Well on lot On adjacent 1 "Pump off" level at Cycles tested Surface water _ D. ABSORPTION FIELD DATA \ Date installed - 3 - Soil rating System type!nJ��^. ( 1 Length Width' 2-+ &- Gravel thickness - Total depth (2 _ Total absorption area 5 Cleanouts present (Y/N) —u `Depression over field (Y/N) f1% Date of adequacy test Results (pass/fail) 1 for bedrooms Peroxide treatment (past 12 months) (Y/N) rJ JA If yes, give date to/ ►�) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot-- (n0 f On adjacent lots /00 t Propertyline- /O f To building foundation 1 0 ,4 To existing or abandoned system on lot 2! S � On adjacent lots 30 f r 1 Cutbank%Watermain/service tine / O f Surface water - U1 Driveway, parking/vehicle storage area -- (two rf Curtain drain N �A E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in S 8 S ENGINEERING 17034 Eagle River Loop Road No. 204 Signature—Eejle.Rtaske 99577 Engineer's Name Date this Inspection. HAA Fee $ o Waiver Fee: $ Date of Payment Date of Payment Receipt Number _Z_ 2& � y�� Receipt Number 72-M(Ray. 391)B.ck MOA 21 r L L CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING It ENGINEERING CO. 5833 8 STREET ANCHORAGE, ALASKA 99818 TELEPHONE (907) 882.2345 FA%: (907) 681-5301 lrlLT3I3 Rtpolt 92 SIMPLE for 10SRordatt 36065 cat* Repott 9tlntad: in 12 91 1 16:36 Client Saapl• ID:N 9111 !LICE 1113I0 :Ol Collected JOL 9 91 1 1S:IS bte. Received JUL 10 914 16:50 bts. 9teuatved vitb :11 III)MUD Client lar :3 a 3 INCIRIIIINC Client lett :SNSINCP 110 t 10 t NONE RICUTt0 leq t Ordered It :l. 3W11 lnalri4 Completed :JDL 12 91 Send Repotts to: Labotatoq Suprs�ttyr�oot :S'It989N C. 10t 1)3 ti 3 IICINIt1Ir0 Raleaead IT + C ui( 2) .................................................................................................................................... Choulab Ref 9: 913303 Lab Sapl ID: 1 Mattis: WEI Ista"tet Tested Iseult Unite Method ................................................................................... NITUTI-r 1010.10) sgtl Ili 353.2 seepIs ROOT111 S11(Pu COLUCTID III RDJ. Raaarl4: lllovable Limits 10 .............................................................................................................. 1 Taste htferrd . See Spafal Inattuctioee Wes 01.Ooav411able ID- None Detected .. 344 Sale Iertlu ►bora rl• rat 101ITae6 124444 9ban, CT -Creator Tban 1808GS Momtar of the SOS Group (Soctdt6 Gonerate Oe Survellanco) n MUNICIPALITY OF ANCHORAGE !A " DEPARTMENT OF HEALTH AND ENVIRONMENTAL PhJTECTION 00 "/ SO DIVISION OF ENVIRONMENTAL HEALTH o Z CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL k1�_]�• OF ON-SITE SEWER AND WATER FACILITY 2644720 Application Date d�1L�&4.0 He? 1.= GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Rn,,-V_f�ape 41LLLfd Location (address or directions) Ir_4 f I A4 �-iienaQS PILO 0 4. SEWAGE DISPOSAL Onsite GK 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(11,84) Page 1 of 2 5. ENGINEERING FIRM PROVID^ INSPECTIONS, TESTS, FILE SEARCH, I''A AND INFORMATION A. 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. l 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 ofthis in ection. Name of Firm l Off.); n 6Se;0;J% Telephone SAO / —615,t Address 4?90 $a4itPs 5 &.1-t hkd. E-/ Lek At ct lgo l Date cpto Jl aI �Q8% OF C 110 ..4 :�.MMi.•..• l Engineers Seal 0FFSry CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending Institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025111/8.) MUNICIPALITY OF ANCHORAGE (111110. ) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description:�� A. WELL DATA Well Classification ?r Iya_` If A. B. C, D.E.C. Approved (Y/N) I- Well Log Present (Y/N) (dam Date Completed JyZ Yield J. Total Depth �50 r //Cased to Z Sir Depth of Grouting LM kAXWh Static Water Level 107' Pump Set At 9,35, Casing Height Above Ground ar Sanitary Seal on Casing (Y/N) —c�4? S Electrical Wiring in Conduit (Y/N) ba:$ Depression Around Wellhead (Y/N) ILA Separation Distances from Well: / 0 0 (v' To Septic/Holding Tank on Lot 1 S0I ; On Adjoining Lots I To Nearest Edge of Absorption Field on Lot : On Adjoining Lots To Nearest Public Sewer Line ALL To Nearest Public Sewer ALA, To Nearest Sewer Service Line on Lot iOOf + Cleanout/Manhole_ Water Sample Collected by Water Sample Test Results Comments *- r -f6 B. SEPTIC/HOLDING TANK DATA Date Q a -) c+�I lq8,7 _ (� ��'� a Date Installed 9-4 -*7 9 -Size-1,250W No. of Compartments Air -tight Caps Y/N) If Foundation Cleanout (Y/N) p Standpipes (Y/N) .9t P Depression over Tank (Y/N) ,V .r Date Last Pumped h -z Pumping/Maintenance Contract on File (Y/N) ry 1Q- ; for Holding Tank High -Water Alarm (Y/N) At Temporary Holding Tank Permit (Y/N) N A - Separation Distances from Septic/Holding Tank: :51To Water -Supply Well 16'() I To Building Foundation To Property Line to r f- - To Disposal Field 30/ — r To Water Main/Service Line LO _ To Stream, Pond, Lake, or Major Drainage Course /Xf 1` Comments MO 0"* D 0 9S Page 1 of 2 72-026(11,84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata as Type of System Design Ir. er) Date Installed 3 -to —8 5;: Length of Field 3-7) Width of Field 3611 Depth of Field _- /0 Gravel Bed Thickness 7' Square Feet of Absorption Area 518 Standpipes Present (Y/N) Depression over Field (Y/N) 40 Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 15() To Property Line /07.f. To Building Foundation — 3% 1 To Existing or Abandoned System on 1 Lot �$ ; On Adjoining Lots 50/ -t- To To Water Main/Service Line I To Cutbank (if present) IVA To Stream/Pond/Lake/or Major Drainage Course 1 oof f To Driveway, Parking Area, or Vehicle Storage Area 70 Comments * F(brn 1)NH5.1,;L , D. LIFT STATION Date Installed _ Size in Gallon "Pump On" Lev at _ High Water Alarm Lev Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) — "Pump Off' jAwral •' Check Permitted Bedroom Rating Against HAA Request 0' Pumping Cycles during Adequacy Test. Meets MOA I certify tha/tt��,I have checked, verified, or conformed to all MOA and HAA guideli nes in effect on the date of this inspection. Signed _3�CnlA ti (Oir-u1gqi) .// Date a& �(,A" Company (A((Jir1 1�5506d41 MOA No. Receipt No. eo /� l —0020 Date of Payment 0-24v Amount: $ r 00 Page 2 of 2 72-026 (1 1,84) OAHAN LBsi 9 Z Nflf NOISIAla S30IAa3S 1V1N3MONIAN3 90YM: ONV 40 A111Vd131NnW ......'• •- •?.� ; Engineer's Seal i 4 •.^� `?' • 1. •'1 6 a !. Corwin a y rmN, n, HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907)562-2343 FEOERAL TAX ID 092-0040440 Dtlrlf l 6L Jrl.r LL .rl: tU° -CtlnL tYc L: �U BUSiIr'��PE BL'+U jrHG D S5E I 'nG3.AL. ", V'3 F.uuii iE SA':PLE CUL'-Ei':ED 5; LAUP; CGnP 0-22-87 v i;oe7.110Pet4:6656 Lab S-nllb: I matrix: Water �i!c-:3,ie Para-eter Testee Pesult/Units !etnoc ------------------------------------ -------------------------------------------------- 1. TE 1; ND(C.I)mgi1 PGUTINE SA!'PLE L 9 SJr'E 7ISJ�: SE: H. C. iJE --------------------------------------------------------------- 1 Tests f'er:CG:eC See SveClil Instruct icns.i=ve ii;= IM'e Deteaec o• See S:rnle Per.arksr.Cove = Gr. ;nai•,":eo LT=LessTnan. C 4reaterTna" I^ n MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) LnT CLOCK Al/A _APK /�L�iG� St�/3D• Location (address or directions) (b) Applicant Name J1112159 KOTA Telephone: Home Business Applicant Address lla4C-/ ST 16MP C- 'CCE' 17 Ct 15 1G (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder IM; Buyer ❑ ;Other ❑ (explain); (d) Lending Institution ALASKA PhiCItIL UP"r, Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAQ to the following address: 2. TYPE OF RESIDENCE Single -Family VZ Multi -Family❑ Other Number of Bedrooms 4 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 the legality and status. 4. SEWAGE DISPOSAL Onsite 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 (11,64) Page 1 of 2 r� 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION R1 As certified by my seal affixed hereto and as of the validation date shown below. I verity 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. l 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 CORGtJ/hl RSSoG. /y4C Telephone Address Date DHEP APPROVAL Approved for R(l e_ b._-drooms by >� Approved— Disapproved Conditi nal _ Terms of Conditional Approval CAUTION Engineer's Seal Date The Muncipality of Anchorar;�e Department of Health and Environmental Protection (OHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the Stare of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy .ertain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a cerWicatte is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Pan. 9 of 9 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 N3:1D]17V1 2644720 2 11-111y?H a0 '1110 Legal Description: i.oT 4' nvaox x / 1� � ,i l PAMPK Pr_AGF_ :508C>ly/5/oN A. WELL DATA Well Classification P21vr7TE If A, B. CApproved (Y/N) '!�_//q Well Log Present (Y/N) -Es Date Completed 2Z 117 � Yield G P� Total Depth 2 Std Casrd to 250 Depth of Grouting UN K14OW "i Static Water Level 24 Pump Set At Casing Height Above Ground 2 Sanitary Seat on Casing (Y/N) YES Electrical Wiring in Conduit (Y/N) YE�� Depression Around Wellhead (Y/N) Separation Distances from Well: f To Septic/Holding Tank on Lot SO : On Adjoining Lots 1004 � d � To Nearest Edge of Absorption Field on Lot 50 ; On Adjoining Lots l G To Nearest Public Sewer Line �4A To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by TOP Date __�IZ -71 AS O Water Sample Test Results ��T'S�ACTOfLy Comments o /7 4 8 D9 = O 1 CSB GPM /Zrc 4 'h /dJECL ZEST y©CDED 'Z, C (rPY I For 2 Nf'S mrcE7-,,jJ /PNEP lZEQ LLtfFdJr5 B. SEPTIC/HOLDING TANK DATA Date Installed 94 �=��g Size J 2-50 No. of Compartments z Standpipes (Y/N) YE5 Air -tight Caps (Y/N) YES Foundation Cleanout (Y/N) SEs Depression over Tank (Y/N) n Date Last Pumped SIFE ATTACHED /N Vm/oE Pumping/Maintenance Contract on File (Y/N) /Ud : for Holding Tank High -Water Alarm (Y/N) (� Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: f To Water -Supply Well / To Building Foundation � To Property Line .40 f To Disposal Field To Water Main/Service Line N1t To Stream. Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026111:841 C. ABSORPTION FIELD DATA l Soils Rating in Absorption Strata 125- l7 6i7/tM Type of System Design i/ZErtCN Date Installed 3 — a-8 S Length of Field 3 7 1 Width of Field 3a f7 Depth of Field � Gravel Bed Thickness 7 ! Square Feet of Absorption Area l8 A5 Standpipes Present (Y/N) YES Depression over Field (Y/N) N O Date of Last Adequacy Test _Ly� Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 1,25-O ! To Property Line To Building Foundation 3 7 To E,tis Nwger Abandoned System on Lot 2 S,11 ; On Adjoining Lots 3C3 To Water Main/Service Line I !O T To Cutbank (if present) W/4 To Stream/Pond/Lake/or Major Drainage Course ^6m/ , To Driveway, Parking Area, or Vehicle Storage Area foo Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments •• Check P/ itted Bedr m Rating Against HAA Request •• Icertifytha( echeck , rified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date J _,:�e74S Company <i^CC// FOC MOA No. Receipt No. Date of Payment 3 c�ob�5 + OF„4��qS, Amount: $ L I Engineer's Seal Page 2 of 2 72-026111,841 'J. Corwin i CE -5283 r: i FIELD PUMPING TEST (1 DATA SHEET 13 i PROJECT: KU'rf� DATE OF TEST: 6-27-05 LOCATIV OF HELD (Legal Description): LOT 4 r4a� PytLE 5v6D, WELL DEPTH: 7- 6b FT. CASING: 250 FT SCREEN: UIUKI1i vjto DATE 04ILLIIIQ COMPLETED: JU015-7Z-- lg79 DRILLER: F,4NPA(ZT' PIZIU-100 1 STAT(C WATER LEVEL (Top of Casing): Z4 FT tlapsen lime bince Clock Pumping "Started / Depth to Drawidown/ Punping Remarks - Time Stopped, liin. Water, ft. I Recovery I Rate, GPt4 10 RECOVERY 0 0 A 0 1 Start October 15.,_1979__ ,{ .'.;Ui:! .,.L;T \'C':.:'J 'r• 1'I •ICI DEPT. OF H LTH & j • c :at!'::70F i'ib!".'cY:�•C •.•1.7 ° Q i,,,,,,-WlkDNWNTAL PROTECTION IfM-p fi i. 'NI. y _ ... 'S L ,-.-rre: • Ar•rbn•-gr, i+:'..%:5`::•01 q p : OCT 1 61979 toy t'�;- .L,,, CNYII!41;5?:.'•)L�Lf.`J�:'•`:F:1:!�\!�DIV(i:J"J p �/ RECEIVED II REQUIEM i=OR A?PN ./tI CF 1ii1J!V!DU.1t.4:!.ATr_f3 k^10 SE`:'.1'.7 FAC(L!TILS VIR9CTICNS: Co•r•n'N.'• r11 i,+ar rn pcyo 1. In;mmpletc rrouc ax r.:!1 no: hr F:P:r:ad, Fir ase ;,i6.v: tv. I1!', WVi lo. p•rre:vn7. 11. P:501:'ICTYO'.l^•:;;_.-__.__.—_-----__-----_—_—_._...___—._-_.-._--...._F. P:;Gia -^ �- ----PISA, Terris and Steve Steve @ game 349-4723 Terri* @ tvo-k 272-0571 _ ---- .�.---------'---------- -'- -'---- ------------ ----- ----- _c/o Totem -.� None given Property_ location is MHN Loretta Circle_ Anchorage, AK 99507-___ ' �'�G'1 H : / ri �iDLK":' Uf '.'�r�cti t u^., rncw•1 — f! !ill !. No one at present - - — - ---_� -, - David and Laurel Jeanne-Kuta- - - --- ---•---- News Pouch 6161, Anchorage, AK 99501 Alaska mutual Savings Beak ATTN: Debbie Johnson P. O. Box 1120 Anchorage, Alaska 99510 Terris Pisa Totem Realty 7521 Old Seward Highway, Suite C, Anchorage AK 99502 274-2361 274-3561 ext. 7:cto:Jn51 W ,(O Lot 4, Park Place Subd. INN Loretta Circle, Anchorage, Alaska 99507 -{ 0 On_ C:✓ Four CJ - :F-] SINGLE FAMILY [2 Two [=1 Fivc [_] MiJLTIPLF FAf.111LY [ Thrae (-) Cix --••.—_. 7. WATUR SUMP ---- - x3xIi:DiVi'vii-.: ATI ACH VA.LL"'_0G. ? Wei! 1,1 is r:ryjin:d for all e:••!Is d:J!cd 0 COMMUNITY sinca June M9 . Fo` %veils c"TL. ' Pror to 01+1 Calc, circ %veil CJ PUuL IC UTILITY drt tL• (attach ;n; r.. eLr%•ace Cls: esr L::vsTent ` o •'If d.e-Ig�..L..—• J= INDR`DU LION-S!TL'� indh•id:;.il!on-sial, givr' imtatl.iaon If sY:+cn: ii o•Jrr hvo 12) Y='ars r,tn an yri�r,::de; :rst is icJui. �'� 0 PU L1C UTILITY NOTE: THE INSPECTION FEE Ml)GT ACCOMPANY EACH fiECU[S?' f>EFO:,E CAN C$ 1NMATEC. 7:cto:Jn51 W ,(O THIS SIDE FOR UFfIC1A! u�r n ! v -y4------� ^. 6. COtnPdENTS ['r1 "r'. RCVEU t -0R L'ED11.0WIS O COMUITIO!JAI. AVPROV�• L (!carr mc,t acco'npxny r,,: Giica!eJ i_, D1sn.rPl:oVro :PLCT. F! r , I^JtiPF.:10i, - Ii1SP _—TO'�- —•_ —� 1. TYPE O.r. REMU. P:CE NU',:F.EH fiEDROOS.S _� .�O: — _ _— -- -- — —� ED SINGLErA4'ILY 'p ONE p THREE � ❑ FIVE ❑ OTHER i I_? MULTIPLS FAMILY p TWO p FOUR EJ SIX 2. IYATLI! SUPPLY FLRs117 NJ'nbcli ❑ INDIVIDUAL DEPTH OF;t LL•. ❑ CC•MMUNIIY p PUBLIC UTILITY DATE DRILLED Cannection Vcrifird _I LOG RECEIVED s. SMAGE DISPOSAL SYSTEIN PERLIIT NUAISLF7 1. If: 0IVi0UAL/ON S:TE uL #14 OPULLICUTILIT`( DATE INSTALLED —�---� /` e) — -- ''— Connection Vcl ificd -- 1 — IBJ>IALLtf;— [=1Sep;'iclTank of ❑llold:"9 lank Tank Si": �'_'0 i f Tank i; Lnmem]dc —`- __• SOILS RATING girrdcnen..fo:u: MANUFACTUREF3 TYPc CP TANK TOTAL AUSORFTIC`1 AREA MATERIAL 4. DISTANCES IS,.,,ne; -:LL Hoh!,up lank 1,<orplurn rea ew.n L:rn• N.eare.t Lc, Linv 1:., TO: 1 ----_ — �'•. ..� :,ria :O "C^: D:: LPI ,� '-- _ 6. COtnPdENTS ['r1 "r'. RCVEU t -0R L'ED11.0WIS O COMUITIO!JAI. AVPROV�• L (!carr mc,t acco'npxny r,,: Giica!eJ i_, D1sn.rPl:oVro