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SCIMITAR #3 BLK 1 LT 3
Scimitar #3 Block 1 Lot 3 #051-132-70 MUNICIPALITY OF ANCHORAGE �.•% DEPARTMENT OF,HEALTH & ENVIRONMENTAL PROTECTION ' ENVIRONMENTAL ENGINEERING DIVISION ,t 825 L Street- Anchorage, Alaska 99501 . Telephone 264-4720 .. ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME .01JENEW ' MAILING •. ., AD SS j _ .. Z �)l 13UPGRADE y ; /mss LEGAL DESCRIPTION LOCATION / , I ll/ NO. OF BEDROOMS t U y Absorpbon area Owelhng/T / DISTANCE TO: Wel /Z . • fj PER IT , 1-Z NF1, Manufacturer �2EJC M �' PP ? No. of compart"025 .e , Liq. �pacitY iis.aallons Inside len th (/p(J (J IF HOMEMADE: 9 W�d[!L— G Liquid depth •0D2 -a-., =?F DISTANCE TO; Well • V Dwelling _ PERMITNO Manufacturer - �«.-..._.��._...e.,�,"_...--'--•.-�.. :..r...�...y.-.!. -� Material Liquid capwity in gallons D W = W O DISTANCE TO:. Well / Foundaborr> •�j . / Nearest lot linaZ PERMI O e _JLL z Z ~ F No. of lines Length offcJc nq, Total len f nes • Trench wi , . '• Ir �l}n Distance between his t V/ inches N a ¢ o r� Top of the to finish grade Maty ialrbenea tide • r� 1, Total effechw absorption area , ¢ �/� Z W Z Length ._ J inches tlth B WiDepth PERMIT NO. ; <I - Type W of crib Crib of ever Crib depth t Total ellecuw absorption area W N DISTANCE TO: Well •- Building foundation Nearest lot line >t J J Class O PN eller Distance to lo[ bee PERMIT NO. W _ DISTANCE T0; Building foundation' Sewer line Septic tank Absorption areafs) 4 OTHER 1I s• PIPE MATERIALSIt SOILTESTRATING rP,t. '. t S 1 INSTAL R , �• ,, •, i �3s CX C. REMARKS OP , ¢q AV •� I J ' bbrs A. ShoWFES !� �rlawwj0�"" LEGAL r APPROVED cs Y, 6. �•izn 11NEEFINC� DATE ���� R1VEr1 ALAS r PH. fee �-,:A -ar-22` i �4Z 4� 72-013 (Rev. 3/78) v r-1urJ I I:-- I F•I=iL I TY Cl F' f--irJCF-I 1F7:H13E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 'D"—= ITE=.EGJEF= t: WELL F El;Zhi I T PERMIT NO: DATE ISSUED APPLICANT ADDRESS: CONTACT PHONE 8400:2 03/27/84 C/O S $. S ENG'G. SRB 196X EAGLE RIVER, AK 694-2979 MYERS CON'=TRUCTION 99577 LEGAL DESCRIP: SUBDIVISION: SCIMITAR Al LOT: 3 BLOCK': 1 SECTION: 10 TOWNSHIP: 15N RANGE: III LOT SIZE: 45155 (SQ. FT. OR, ACRES) MAX BEDROOMS: 3 LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE. I CERTIFY THAT: 1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE, SEWERS AND WELLS HS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF FILASKA. 2. I IJILL INSTALL THE SYSTEM IFI ACCORDANCE WITH ALL 1•10FI CODE'S AND REGULATIONS, AND IFJ COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. 3. I HILL ADHERE TO ALL MOA AND STATS-�y�ALASKA REQUIREMENTS FOP' THE SET BACK' DISTANCES FROM ANY EXISTING WELL, IXTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR. ANY ADJACENT OF' NEARBY LOT. 4. I UNDERSTAND THAT THIS PERMIT IS VALID:FOR A MAXIMUM OF 3 BEDROOMS AND ANY ENLARGEMENT (JILL REQUIRE AN ADDITIONAL PERMIT. IF A LIFT -STATION IS INSTALLED IFJ AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS—GUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (_} THE ELECTRICAL WOF'K MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED 0 lIt DATE: / APPLICANT: C/O•S 7S ENG -6. MYERS CONSTRUCTION IS=UEC' BY ----�= �=—��^a—E�---------------- DATE:------ T FS_ E rJ C 1-I E* E C- W. CN F2 F1 I r-4 DEPTH TO PIPE BOTTOM (FT. } 4. 0 4. 0 4 0 GRAVEL DEPTH (FT.) 4. 0 0. 5 2. 5 TOTAL DEPTH (FT. ) S. 0 4. 5 7 5 GRAVEL WIDTH (FT. ) 2. 5 14. 0 5. 0 GRAVEL LENGTH (FT. ) 32. Cl 28. 0 28 0 GRAVEL VOLUME CCU. YDS. } 13. 3 14. 5 20. 7 TANK: SIZE (GALS) 1,000. 0 w* 1, 000. 0 W.»' 1, 00:3. n w»: SOIL RATING (SG. FT. /BR) -85 85 C., *W TANK MUST HAVE AT LEAST — — — — — — — — — — — — — — TI -10 COMPARTMENTS — — — — — — — — — a, — — — — — — — — — — — — — — — — — I CERTIFY THAT: 1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE, SEWERS AND WELLS HS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF FILASKA. 2. I IJILL INSTALL THE SYSTEM IFI ACCORDANCE WITH ALL 1•10FI CODE'S AND REGULATIONS, AND IFJ COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. 3. I HILL ADHERE TO ALL MOA AND STATS-�y�ALASKA REQUIREMENTS FOP' THE SET BACK' DISTANCES FROM ANY EXISTING WELL, IXTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR. ANY ADJACENT OF' NEARBY LOT. 4. I UNDERSTAND THAT THIS PERMIT IS VALID:FOR A MAXIMUM OF 3 BEDROOMS AND ANY ENLARGEMENT (JILL REQUIRE AN ADDITIONAL PERMIT. IF A LIFT -STATION IS INSTALLED IFJ AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS—GUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (_} THE ELECTRICAL WOF'K MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED 0 lIt DATE: / APPLICANT: C/O•S 7S ENG -6. MYERS CONSTRUCTION IS=UEC' BY ----�= �=—��^a—E�---------------- DATE:------ _ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division I _7A, l 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name FANWE MAE ALASKA DISTANCES Address 3 e;0 I C STREET # SO TO FROM SEPTIC TANK ABSORPTION FIELD WELL WELL 105" O 1 Phones) s� I - osis permit No. No of Nearooms 3 LOT LINE'�a ' 3 0 1 1 12- LEGAL DESCRIPTIO" Lot V1 woca ' S.bcn,.SIO0 Sc 'M I TAR .3 FOUNDATION � O' 2O 1 4zy Townslnp, Range. Section SECI O P 15 N R W PETERS CREEK AS-BUILT DIAGRAM (Show location o1 well. sept¢ system, propeny Anes. iouneanon• tlnr aywater bbtlres. etc) TANKS nA T " V, SEPTIC ❑ HOLDING A T " Manuracimer L)"i<yJOWN Capacity .n gallons 1000 E.1 Material STEEL Nu. of Compa tments z " • I S• TYPE OF SYSTEM • P1 ❑ TRENCH ❑ BED W. DRAIN P, OTHER "D • 0 t. t Depm to pope bunum from original grace , .54FT local Depth from onginal grace d % 1 f .1 FT Frit adore above Original grade O FT Gravel M�pth beneath pope 2'-4r' FT Grover long'" t�1� FF i�C y FT Gravel witlm S FT �. Total absorption area 3V 6 �� SO FT I Distance between lines V'N FT SE rr " .Aa Zc Number otbr"•a Sudrating SOFT prperninenal ASTM D 50-'-+ 4-" PERF PIP£ :. .. Instaeer UuKMot WN Date InflatieD UNKMOWN WELLS I PRIVATE ❑ OTHER (Identilv) B Ga>sobcelwn (A.tl.CI P RAVAT Iota. Depu. S FT Casino to ZI FT Instanc" UNKNOWN Date mstaneD. UNKNOWN REMARKS: S 1 5a W I E Scale: f�T Ins hons PeAm ec oretl by. S.i .9YQIN£ERS SEAL, �. ., M� �-a" paonn T /' r T,o ,� . -• ac ,�� 3 %j, -P«- .. t `�. .Myitis .........( •. J, Wain 1v ,� s":Y '"- •' .kf••.4 e:ku:. (/111Gyp4 1_C-ICOM' .T. Date � certify that this inspection was performed according to all Municipal and Stale guigelineS In ellen on this gater;CW Health Department Approval: a� -i—•Z Date. 79_n1111NSr Corwin & associates,inc. Consulting Engineers 1000 E. Dimond Blvd. • Suite 205 • Anchorage. Alaska 99515 • (907) 522.1311 June 7, 1989 Mr. Dan Roth Department of Health & Human Services Municipality of Anchorage 925 L Street Anchorage, Alaska 99502 SUBJECT: Lot 3 Blk 1 Scimitar Subdivision 11�5 Dear Mr. Roth: There are no records on the septic system on the above referenced project. Therefore we have excavated the system, completed an as -built, performed a soils test and a 7 -day water monitor. Copies of these are included. We also performed an adequacy test, and the system passed. We request that the soils test and as -built be approved. If you have any questions, contact us at 522-1311. Very truly yours, CORWIN & ASSOCIATES, INC. GERARD KRESS Project Manager ML"CIPALTTY OF ANCHO ACe DEPT. OF HEALTH g, ENVIRONMENTAL PROTECTION 'JU14 81989 RECEIVED r Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: F A N N I E MAE ALASKA DATE -N LEGAL DESCRIPTION:_ SGI M I TA R L 3_R / Township, Range, Section: 1 v O e 0 0 2- 3- 4- 5- ,-6 3 45O 6 C) '• a 8 00 9- 10- 11 10 11 4 12 13 14 15 OL SW SQY,dLj gravel Gr1 gravel SLOPE WAS GROUND WATER ENCOUNTERED? WO IF YES, AT WHAT N o ground DEPTH? w at er Oeoh b Wrly Alter� encounteredmoniwisty Y Cate jo Reading Date Gross Time 1TDEPTCIP OF ANCHORAGE . f HEALTH & RONMNTAL PROTECTION 181 ljg14 81969 20] RICEIVED III Net Depth to Time Water PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT Net Drop PERFORMED BY: 'it -t rX x Yf_J 3 I �r LfLF cf - L-LnL±L-10ERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: _�/F 12-008 (Rev. 4/a5) I LOCATION OF WELL (Places complete either le. Ib or Ic.) WATER WELL RECORD STATE OF ALASKA uLPARTMENT OF NATURAL RESOURES DivIslon of Geological a GeophyslGot Survey Drilling Permit No. A.D.L. No. la. Borough Anch Subdlri law citnitar3 Lot 3 Block tb. t/4 gt re. _ef—of—al_ Station NO. To.nanlf No ap AG -le L� WO Marldiaa Ice DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS Street Aeaross and Arta of Well Location 2. OWNER Of WELL Mr.Paul Myers. Address: P.O. Box 351 Chugiak; Ak. 99567 2. WELL LOG fate Bele. Ssr lace Material'Tyre Top Bottom 1. WILL DEPTH: (Ileal) A O� 495 f1. 0. DATE OF COMPLETION qA 3 — 21 , vr.; Sand and gravel 0 83 a. []Cable oeo1XX(Notary []Driven []Dug ❑Auger []dstied []gored []Other. 0! zed xcuk 7.116E)�n Domestic [] Poblle Sooply . [] Industry . [] Irrigation [] Redwood 0 Commorleal [] Test Well pother: biack rock and water Greenstone 318 370 Black rock 370 470 a, CASIt3s [] T62eded )m Welded 17 diem. in. to_ ft. Depth Weight Ica./ft. atom. u. to_ ft. Dean Stickup n: Grey roc with quartz suains, and water g. FINISH Of WEL11,: Type: Diameter. slot/Moa Slce: . Letgth: Set between n. and ft. Baafn11n0 Drevol rack 10. STATIC WATER LEVELS ft. [] Abort or [] Belo. Iona surface Date Equipment seed: g g If. PUMPING LEVE. ►els. lead surface end YIELD ft. afterMe. pumping' I.P.M. It. after he$. pumping_g.r.m. I2.GRounNG Well Grained: []Yes ❑ we Material: []Neal Cement []Other. nice ailly 01 n Service pept. Ne IS. PUMP: (it available) HP Length of Drop Pipe fl. capacity g.p.m. [] Subm. (3 def (3 Catrilldal O Other I/.REYARK.Vroduction of 2 GPM Ig. WATER WELL CONTRACTORS CERTIFICATION: IS. Water Temporal.'* -e [] I [] C This wall sae drilled under my jurisdiction and IMS rePorl Is true to the Dal of my knowledge and belief; MaFmuson Dri_T_Ting_ AA 5385 ae Istarea Buttress Name Contract License Number Address: P.. Box 770504 Eagle River, Ak. 99577 Signed: DotoMarch 24 1984 A tnerl cod Pepaenta rt ,farm OL'WWR 1111/80 COPY Distribution: WHITE -State OGG$. ►INN -Drilla. CANARY•Ceetomor C c v r 0 Municipality of Anchorage -� Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 05/' /3a - -7v HAA# f751)/LI3 Expiration Date: . 7 - 14 - 0-5-- 1. -S 1. GENERAL INFORMATION Complete legal description al 21 **7,4g 3 , LST -� RGUGrC Location (site address or directions) / °Y fl' 3a- SE6(1,4 D, -- Current Property owner(s) EKY/ F Ae 0 EGkA/c i2 Day phone Ssa- - / 0G 0 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone 6_1zrCT SttEA�eS C 8`: � Day phone .,S- 4)11 1 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Individual On-site 'Er_ ❑ Individual Holding tank •❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm E4GrL E 1,�,i l/ EAl(r ia/ A? in/(T Phone, GflrF- S/9S Address tort,. / I/Fm Al( FA(ri F se iyE X 995-77 Engineer's Printed Name /'H 2i STopH64-_- 2. d.4ODD 5. DSD SIGNATURE Approved for 3 Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory bedrooms. Date y — 0-0< bedrooms, with the following stipulations: WATER AND • gf1JIL\1!\I ll\ PROGRAM Maintenance Agreements Supplemental Engineer's Report Other By O� eof ��P Original Certificate Date: (R. 0IM2) Municipality of Anchorage •_•, Development Services Department 4:.: Building Safety Division On -Site Water & Wastewater Program ° 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SGi n11 rr �� �3 L a I Parcel Ib: C"51-112-70 A. WELL DATA Well type fialATC If A, B, or C provide PWSID # _ Well Log 62N) VE5 Date completed _3 1f Sanitary seal &'N) _ Wires properly protected N) 6 5; Total depth G ft. Cased to �2 _ft. Casing height (above ground) min. FROM WELL LOG AT INSPECTION Date of test 3/Z Ileoy 5 Static water level IAMC ft. 375 ft. Well production 2 9 P m• 1. e3 g.P.m. WATER SAMPLE RESULTS: Coliform 4-1colonies/100 ml. Nitrate _qY—mg.A. Other bacteria colonies/100 ml. Arsenic: mg.A. Date of sample: 3os Collected by: GflRl� [ �1aoi� B. SEPTIC/HOLDING TANK DATA Tank Type/Material , C', G6 -K Date installed Tank size I, 000 gala Number of Compartments 2 Cleanouts (?f) V673 Foundation cleanout &)�G s Depression over lank (Y(1)Ji 110 High water alarm (Y l�j Mc7 Date of pumping Pumper 4;4.1r7AXX DHw1PE25 C. ABSORPTION FIELD DATA Date installed Soil rating (g$44 or ft2lbdrm) _IS System type 712CA1c11 Length !44 ft.- Width S ft. Gravel below pipe � ft. Total depth G_ ft. Eff. absorption area Z&5 ft2 Monitoring tube gZp Depression over field )Q Date of adequacy test 126 o Results (Pass/Feil) P455 For � bedrooms Fluid depth in absorption field before lest Q_ in. Water added_�Dgal. New depth c') in. Elapsed Time: ,_KQmin. Final fluid depth 0 in. Absorption rate >= y!; -D g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) A)D _ If yes, give date N/A D. LIFT STATION i Date installed Size in gallons! `Pump on' level at _ in. r l levelat in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 't ft9D Absorption field on lot f too r Public sewer main fi 75 Sewer/septic service line t--.25t--.25r Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requiremenls7 On adjacent lots 1-100 On adjacent lots 4106 r Public sewer manhole/cleanout ! IoO r Holding tank 't" /vO r SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation + S r Property line f S r Absorption field t S r r Water main -t- /D r Water service line +/0 Surface water f /vd � Wells on adjacent lots i- Iwo ) SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: i r r Property line f-16 Building foundation Water main + /0 Water Service line 'r'/J r Surface water t Ivo Driveway, parking/vehicle storage T /0 Curtain drain _Dir 8nZ Weiss on adjacent lots �"/od f Ki1 wd F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name _Gtfk;.57vPMtYI- R, I.,Jvob Date `t AZO � HAA Fee $ Ll, o / -0 Date of Payment ill 21/05- Receipt Number 0001"Uya j (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number « u_;1 in. 11 G'3=•/4 $e i kit j� {eve I :HE INFCOMATION HEREON IS FOR THE USE Of LEADING INSTITUTIONS SPECIFICALLY TO SNOW ANY CONFLICTS SEriEEN EXISTING STRUCTURES AND PLATTED LOT LINES om EASEMENTS AND IS NOT TO SE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCELINES IN OF A(,Qs�\1j1 3.T 1k Shone A. Mal\ LS 691 • OJW 0 f9f0 �e'•..«...•'�tNO�'o.. PMOfESS100l-�_� EASEENTSOF WRL` OTHER THAN TV= SNOIN ON THE RECORDED PLAT. ARE NOT SHOW HEREON AYWILI W Vcl` teV l RlMa OC' Inla wn\cI 0i I hereby certify that I have perforsled a Ilortase"Is inspection of the follwirp—� described property: LOT 3, $LOCK 1, SCIMITAR SIA., UNIT NO. 3 Anchorage Recording District, Alaska and that the leproveaonts situated thereon are within the property Lin" and do not overlap or encroach on the property lying adjacent thereto, that to Iaprovealr\ts on property Lying adlatent thereto encroach on the preaisee In Question and that there are no roadways, transmission tiros, or other visible easements on said property except as Indicated her"nlLDated at Anchorage. Alaska this ?8 day of S !� 19_S FB 59-2 HOLT AND ASSOCIATES LAND SURVEYORS cavy ,S Retie 1051593001 'lent Name Eagle River Engineering ProjectName/N Scimitar Ll B3 03 Client Sample TD Scimitar Ll B3 Matrix Drinking Water Sample Remarks: Ali Dates/Times are Alaska Standard Time Printed Date/Time 0410112005 15:39 C Collected Date/Time 03/2412005 16:02 Received Datealme 03/25/2005 9:41 Technical Director Stephen C. Ede Allowable Prep Analysis Panmeter Remits PQL Units Method Container ID Limits Date Dare Coit Waters Department Nitrate -N 4.40 Microbiolotiv Laboratory 0.100 mg/L EPA 300.0 B (4 10) 0325105 CAM TotalColifovn 0 col/100ml, SM209222B A (o-1) 0325105 TLF Municipality of Anchorage ♦�Ot •6. • -- Development Services bepahtment Building Safely Division Onsite Water and Wastewater Program ` 4700 South Bragaw St. ' " ` 1 P.O. Box 196650 Anchorage, Ak 99519-6650 www.ci.anchorage.ok.Us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.051-132-70 HAA# 1jH'O �n _ p0t9_g7 Expiration bate: q — LZ -0 -2— GENERAL INFORMATION �Complete legal descriplion Lot 3; Block 1; Scimitar Location (site address.or4irections) 19932 Seika Dr. �Cun'entProperty owner(s) Sarah Mooney Subdivision //3 Dayphone 688-4240 -Mailing address." 19932 Seikn Dr_ Chnpiak AK 99567 Lending agency Mailing address Real Estate Agent Mailing Address Day phone Day phone Unless otherwise requested, HAA will be held by DSO /or pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Individual On-site El Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (NAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered In the Slate 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.) Certifid'ales are valid lot one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined In the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system Is(are) In compliance with all applicable Municipal and Stale codes, ordinances, and regulations in effect at the time of Installation. Name of Firm S & S EnRineerinR Phone 694-2979 Address17ni4 N Fnglp RiiTpr Toop EglERiNer7—AK 99577 Engineer's Printed Name Robert C_ Cnvan Dale G A/o 1 1, A,. ROBERT c. COWAN f! 5. DSD SIGNATURE 9tic CE-8801�w ✓ Approved for bedrooms. f off ��-•-"'-:����� Disapproved. Conditional approval for bedrooms, with the following stipulations: lltfrrrrrrni Additional Comments WATER AND( ....� IA t•TTlIT "AI zTC0 PROGRAM �J LTi_• ••• �G� Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: 0%s�2?L ..,/�, lil� �� Original Certificate Date: 6 - / % - O 3- 4% I i Municipality of Anchorage • Development Services Department Budding Safety Division 3 F r On -Site Water & Wastewater Program 4700 South Bregaw St. P.O. Box 196650 Anchorage, AK 99519-650 www.cl.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST //3 Legal Description: Lot 3; Bloc'.c 1; Scimitar Subdivision Parcel ID: 051-132-70 A. WELL DATA Well typeg V If A, B, or C provide PWSID # Date completed 3/21/34 Sanitary seal (Y/N) Ye s Total depth 495 R. Cased to 4n+ ft. FROM WELL LOG Date of test 3/21/84 Static water level u n k n nvn ft. Well production 2.0 g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 mi. Date of sample: 6/3/02 B. SEPTICIHOLDING TANK DATA Nitrate 3.7 mg -A. Well Log (Y/N) Y e s Wires properly protected (YIN) Yes Casing height (above ground) ig in. AT INSPECTION 6/3/02 472 ft• 0.33 g.p.m. Other bacteria O colonies/100 ml. Cabby; S & S Engineering Tank Type/Material S t i c/ s t e P 1 Date installed 5/ 1 7/ R 4 Tank size - i nnn ' gal.. Number of Compartments ) Cleanouts (Y/N) :gee Foundation cieanout (Y/N) Ye s Depression over tank (Y/N) No High water alarm (YIN) No Dateofpumping 5/17/02 Pumper .TR's sprr;c Pimping C. ABSORPTION FIELD DATA Date installed 5/12/9v,. Soil rating (g.p.d./ft2 or ft=/bdrm) _8 System type;hal low trench Length , 48 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth _A ft. Eff. absorption area a SS ft' Monitoring tube Yt i Depression over field t4O Date of adequacy test 5/30/02 Results (Pass/Fail) Pass For _3 bedrooms Fluid depth in absorption field before test n in. Water added_U10 gal. New depth 1_ in. Elapsed Time: 5 5 5 min. Final fluid depth in. Absorption rate >= 4 5 0 g,p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. UFT STATION Date Installed --NLA— A Size in gallons "Pump on" level at _ in. "Pump otr lave) at _ in. Datum Cydes tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankNift station on lot 100' + Absorption field on lot 1001+ Public sewer main N / A Sewer /septic service line 2 5 ' + Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots 1001+ — On adjacent lots 10 Q Public sewer manhole/deanout N / A Holding tank N / A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5 ' + Absorption field 51+ Water main N / A Water service line _—IDI ' + Surface water 10 f) ' + Wells on adjacent lots 1()0'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10' + Building foundation 10'+ Water main NIA Water Service line 10'+ Surface water t n n ' + Driveway, poWng/vehide storage i n f Curtain drain„ no ><roux Wells on adjacent lots 199'4, F. COMMENTS .*,-- , G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Re s fR T C • Date �O �l l/o �— HAA Fee $ 3 7 S. =° Waiver Fee $ _ Date of Payment (o 11110 2 Date of Payment Receipt Number © a 10 74. Receipt Number (Rev. 12100) ERT C. COWAN '`Q CE 01 1\y j Municipality of Anchorage +` Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Health Authority Approval # HA020247 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 1, Lot 3 of Scimitar #3 subdivision, the well's productivity was determined to be 0.33 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.3125 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. 6— 7-02; 5:07GM; Ah,CUE Environmental Services Inc. a I I O O CT&E RefJ 1023136001 Client Name S & S Engineering Project Name/# Scimitar #3 Client Sample M Lot 3 Block 1 Matrix Drinking Water Ordered By 06/04/02 1DT PWSID 0 Sample Remarks ;907 561 5301 0 2/ 3 All DattsR7mes are Alaska Standard Time Printed DateMme 06/06/2002 14:36 Collected Datdfime 06/03/2002 12:00 Received DateMme 06/04/2002 9:40 TechokalDirect6Steph eq�`�de Released By (( /f Ls/ O! l . w Pa nmaer Raultr PQL Units Method Allowable Limits Prep Analysis Date Date Init Waters Department Nitrate -N 3.70 0.200 mg/L EPA 300.0 (<10) 06/04/02 1DT Microbiology Laboratory Total Colifenn 0 coV100mL SM189222B (<I) 06/04/02 KAP 05/17/2002 12:54 9076884241 G=3 /c K•••- a / 1 1 Dc— .e 7-«.. ssnery 0 'prm^c /Veeuee N ti 30. e C.wt.e ye k LB.e O"A 0: n/ jZ'YS .iO �E /L72/ nt SL i A'k !J r�rt F THE INFORMATION NEREON IS FON THE USE Of LENDING INSTITUTIONS SPECIf ICALLT TO SHCU ANY CONFLICTS IMEEM ENISTINd STRUCTURES AND PUTTED LOT LINER OE EASEMENTS AMD it NOT TO BE USED EOR POSITIONING ALdtIlOWAL STRUCTURES OE FENCELINES SARA MOONEY Sewer ✓CM! P(E �...A;;•QS ll 00 .10 ,� � • Sho.e A. Mah +� +fi •• li bola ,lQ��'� r ��hOr[SS�ON AL �T � EASEMENTS 0► IfE , OTHER THAN THOSE SHOWN W THE RECORDED ►IAT, AAE HOT SHOIM HEREON PAGE 02 S. til "Ilk I ,I- 1-- 1ea 30' AS -BUILT SIAVEY (NO CORNERS SET THIS DATE) ri 1 1 hereby certify that 1 haw perforewd a Horteaoee's Inspection of the foltwlnq—� 1 described property: LOT 3, BLOC! 1, SCIMITAR IRA.. 1 WIT NO.3 Anchoraos tscordlnp District. Alatka and , that the laprwew.nts situated thereon are within the property time and do not a overlap or encrooch on the property Who adjacent thereto, that m '1 lwrov~ts on property Who edlacent thereto encroach on the pr IS&& In 1 question and that there are m ro"ays, I truanission lines, or ether vi■lbte n eeee.eenta on sold property as tept as I 1 Indicated here ,,Dated at Anchoreae. I I A/uea Chia 29 by of S "e 1 t9_'r• fC Sl -Z HOLT AND ASSOCIATES LAND SIAIVETORS se Yy ...-.-M MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH b 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 Parcell.D.# _()4)\ - tan -an 1. GENERAL INFORMATION HAA# V�11�n��� Complete legal description 5,1_-z-. 11j. -r 413, [_c -f 3, 1 Location (site address or directions) 1`1932 AK_ q-tS67 0 Property owner DADE) 4-21"- Ca--�J� cDay phone V�$0`1 " Mailing address l9g3'L 5ci�A D,z,y4 Lending agency U^'-• Day phone Mailing address Agent Day phone Address _ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 1' 3. TYPE OF WATER SUPPLY: . Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. , 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site ✓ 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. 73-025(8 A/01) Fm MOA821 5. STATEMENT OF INSPECTION BY ENGINEER 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 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 tiles 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 ZGz- 31ci-7 Name of Firm AI_A t=K%1. V c,IGW*C--fLl" Phone 39 a -S 193 Gc-L� Address 3o)C 34111 SoL_7>o m/ytA , AV— G%Cfi Engineer's signature Date /Z-ZS-9£� ''� W+srEwA?¢� N-rer� n.+p Sa,�3 'T�:a�+•+•rr✓�.1 F>.hscu opt ������a�f<�! �cc.+o INLoa N4 T•.�1 6y Q�r7 E'f c osw�nl,?.E, P4 iL-il: P�E OF g,-a-c'Lq. too A--Sa'.GO ray rzzw.Yn f�L�71M4TaerJ P�2 cY •OC? 37' oT'Ii:a' 57A7G (7�rr' ••�•••''•. ADEG 94.4u✓' -.,.IS lti GJ,IiG Z4 ,•. c.� S�.A t'"LK f A95tY".&4 Ir+ st.as, ' , 49th_ _ WI?r1 "G W" AArfrl G, T o5. r'5 A4 E -K I%T•r+q �Y SYs.-� I rt s rsru. c0 ?R+ �+- -r+ 6-8 -537 • / �(,,,� !—' _L Si �. Ae TO ~ 6. DHHS SIGNATURE q1 ``F %;- I . 0' - 1H EE Approved for �— bedrooms. Disapproved. a Conditional approval for Additional Comments "PSA- oerq�ry OF bedrooms, with the following stipulations: �r1-vd2Q C ILa4aj Date 143'-99 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 purchasersof 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. nmm...wa ere MoAm Municipality of Anchorage RECEIVE D DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division DEC 28 1998 825 L Street, Room 502 • Anchorage, Alaska 99501 • (90#j)Qd ANCH0RAoe ENVIRONMENTAL SERVICES DIVISION, Health Authority Approval Checklist Legal Description: SC -1 r -t -rMt S✓3D. UN, -r'0'3, L'43, 54.4-( Parcel I A. WELL DATA Well type Pro vim- If A, B, or C, attach ADEC letter. ADEC water system number Log present (YM) Date completed 3-21-`d4 Total depth 49 S 4+. Cased to i3 2- 4{'. Casing height (above ground) > (7-" Sanitary seal (YM) Date of test Static water level Well production FROM WELL LOG 3 -v -s N{crud, cae.c( WATER SAMPLE RESULTS: Wires property protected (Y/N) _ Y AT INSPECTION 10-3-s92, 0v4-pr-ov,ae,( 1.6 9— p.m- Coliform Nitrate 1`4 D Other bacteria Date of sample: 10 -4 -qb Collected by: B. joEPTI TANK DATA ;kc Date installed QMN -o ow✓t Tank size 1000 Number of Compartments Z Cleanouts (Y/N)--Y— Foundation cleanout (Y/N) _� Depression (YM) 0 High water alarm (Y/N) - tJ /A- Date of Pumping i -I -x(13 Pumper TRS Py. in . Sr r %1<-P_ C. ABSORPTION FIELD DATA Dateinstalled UNiG v -J^ Soil rating (g.p.d.Worft=/bdnn) (20•4r"'Systemtype UrW-• Length / Width Sr Gravel thickness below pipe `}� Total depth ! r^4r� Effective absorption area Monitoring Tube presets (VM) �/ Depression over field (YM) Date of adequacy test 10-3-`L4� Results (Pass/Fail) �a55 For `iti ret bedrooms Fluid depth in absorption field before test (in.); Immedlatey aftsr' Ogal. water added (in.): 2r1 N Fluid depth I (ins) Minutes later. 1 Absorption rate = 41b0 g.p.d. Peroxide treatment (past 12 months) (YM) If yes, give date 72-026 (Rev. 3/90)' D. uFT STATION /A' Date Installed Manhole/Access (Y/N) High water alarm level at' _ Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at' 'Datum "Pump off" level at' SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 71 o O/ On adjacent lots > 1 001 Absorption Held on lot > 1001 On adjacent lots 71001 Public sewer main . I / Public sewer manhola/cleanout 14 /A - Sewer /septic service line N /A- ( Litt station W /4— SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation > 10 Property line '?p Z 5 / Absorption field �:, Z 5 Water maintservice line "750' Surface water/drainage O d Wells on adjacent lots 7 I00/ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: m Property line 7 Z ' 5 Building foundation :;p1 o Water main/service line 7 501 Surface water > IV of Driveway, parking/vehicie storage area a 50 Curtain drain V F. ENGINEER'S Wells on adjacent lots :::> m o o / I cerfily that I have determined thru field inspections and review of Municipal in conformance with MOA HAA guidelines in effect on this date. Signature r --' —.,K,-- Engineer's Name ! zr4a; �KIA Date 12--29 -115 f� O HAA Fee $ OD" Waiver Fee $ Date of Payment �2 — Z O Z Date of Payment Receipt Number,) yev 3 ` /' / c��,dl \ L Receipt Number 0 CE - 8300 I it 72-026(Rev.3196)' -A WA575wATE-;L-54srt-� A.n5oasp f�r.n�r N v,uE7 S 6.4sCil o L FGcxD �N /,"LM4�••'! i;Y ✓"w�a 7 CC�w�,.l�D•E, D,-rEil 6 -d -0't. No ?-LSP•.�s�a,�7 ry �s py,. ncJ GoZ r.y oiNG-Rsi. ME Environmental Services Inc. Laboratory Division 200 W. Potter Drive Anchorage, AK 99518 Tel: (907) 562-2343 Fax: (907) 561-5301 ChemLab Ref. #: 98.7435 Client PO#: n/a Client Name: S&S Engineering Printed Date/Time: 12/31/98 17:00 Project Name: nfa Collected Datefrime: 12/29/98 15:30 Client Sample ID: L3 B1 Scimitar #3 Received Datefrime: 12/29/98 17:05 Matrix: Drinking Water Technical Director. Stephen Ede PWSID nfa Released By: Sample Remarks: Allowable Prep Analysis Parameter Results POL Units Method Limits Date Date Init Total Coliform (MF) 0 coV100 ml SM9222B 12/29/98 KAP Nitrate 0.17 0.1 mg/L EPA 300 10.0 12/29/98 SCL ARNE K. TIKKA, P.E. P.O. Box 3411 Soldotna, Alaska (907) 262-3197 November 10, 1998 David and Jill Crowley 19932 Seika Drive Chugiak, Alaska 99567 Subject: Lot 3, Block 1, Scimitar Subdivision, Unit #3 Onsite Wastewater System Adequacy Test Report Mr. and Mrs. Crowley: On October 3, 1998, at your request, we performed a septic system adequacy test and well flow test for your three bedroom residence on subject property. The adequacy test was conducted in general accordance with our standard procedures for testing on-site wastewater systems. A well flow flow test was conducted, however, we were unable to record water levels in the well since the static water level was greater than 200 feet in the well casing. The soil absorption system (SAS) performed adequately under the conditions of the test. According to record information (see attached On-site Sewage Disposal System and/or Well Inspection Report dated 6-8-89), a 1000 gallon steel septic tank and shallow trench SAS were installed on subject property. Prior to the test one inch of water was observed in the SAS standpipe. Approximately 460 gallons of water were entered into the system at a flow rate up to 4 gpm. Water was entered from a water storage tank at approximately 2 gpm while water was also being entered from the well. A liquid rise of one inch was observed in the standpipe nearest the septic tank while no liquid was observed in the second standpipe. During the time of testing, the SAS absorbed more than the minimum required for a three-bedroom residence. The well flowed at an average rate of 1.6 gpm for four hours. A water sample was collected and analyzed for nitrates and total coliform bacteria with results indicating satisfactory analyses. The well log and well flow information is attached. This report provides no guarantee regarding the actual materials of construction, sizes, configuration, or future performance of the onsite water and sewer systems. No responsibility is assumed for the accuracy of information provided by others. L3, B1, Scimitar SID 2 Alaska Consulting and Letter to Crowley Environmental Engineering November 10, 1998 Project No. 98127 Please call if you have any questions or need additional information. Sincerely, l� '5 _ Ame Tikka, P.E. L381SCkMar.lot Attachments Record Information for Existing Water/Sewer Systems dated 6/8/89 Professional Engineering Report Checklist for Existing Onsite Sewer and Water Systems As -Built Survey dated 28 July 1995 Well Log Coliform and Nitrate Analytical Results �- �E OF q�Rh Pumping Receipt r,P.r ""` ^•.'9S,� Well Flow and Adequacy Test Data f 49th �1 `% 01 1p,X ARNE TIKKA 1� �lEy`til EIp3`18 / 04/14/1999 10:24 3453287 M W DRILLING, INC PAGE 02 M -W Drilling, Inc. P.O. Sox 110378, Anchorage, Alaska Wil (807) 1154000 Fac: 3463g87 C51-1S_Z=1D April 09, 1999 Mr. b Mrs. Pat Mooney 19932 Seika Chugiak, AK 99567 RE: Lot 3, Block 1 Scimitar, #3, Chugiak, Alaska Water Well Rehabilitation, As -Built Notes 1. Well Statistics: Total Depth: 495'; Casing: 611; Static Level: 382'+/-; Original Yield: < 5 GPH 2. 4/05-08/99: Hydrofracked well with packer settings as below: be; no. Set Depth Max Pressure Gallons Pumped 1 108' 600 2000 2 213' 600 1000 3 318' 800-1600 1000 4 423' 900 2000 If any questions remain in this regard, Please contact our office. eWayne-E. estbe , President 'i on our burinerrl ADEQUACY TEST WORK SHEET roject#/Name: 1 I s._•,.,.-,4,rt L..f3 ngineer. Tv--- Date: heck: Date: - ;TIME � METER,TOTAL READING` (GALLONS) FLOW RATE (GPM) ' FLUIdMEASUREMENT COMMENTS ST .,SAS 3V 'SAS 92 IINPVT OCCUPIED: % N SAS TYPE: T T ,4;, r. -0- 1 4i COMMENTS: I ! acis' 1, a lo v yr I•• r., p A e. o d r 1920 170 7-1 q.7 9.0 41 o root r :_.1 u L!l tisL d...,-• Ida /lF�S r )7 40 g/o 1.Y v /TO aa./•c yG0cA./ 4.4. i II Ib11s' 1. 13z -:I 1 1 1.4 1 y'o I /" I o 1 II '�. BEDPOOMS: DIST. TO WELL: Irf DATE INSTALLED: SURFACE WATER: INSTALLED BY: t•C S T SI_E: Y- GALLONS: SCUMiSLUDGE: IINPVT OCCUPIED: % N SAS TYPE: T T ,4;, r. -0- 1 4i COMMENTS: I ! l I a I I• I j � •� : r I I � � I I STEEP SLCPES: 'a FLUID LEVELS: STAND PIPES CAPPED: �' N J— APPARENT GALLONCID ABSORBED: J " j SYSTEM MEETS DAILY p a yy - Q Q� ASSOPPTION PEOUIREMENT: © N I F. 1VVKOUADElFCRM SIADECUACY W DEOTEST.SHT S dC FEALTHAUTHORITY APPROVALS SEWERAWATER MNNEXTENSIONS SEWER& WATER INSPECTION ENG INEERING STLOES ANDREPORTS WELLNSPECTION &FLOW TEST SITE PLANS ROADDESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER OTSPOSALSYSTEM DESIGN V� s' ROBERT C. COWAN. P.E. ROBERTA. SHAFER, P.E. CML ENGINEERS (907)694-2979 WELL FLOW TEST DATA FAX(907)694-1211 CLIENT: I)d J#- c: R o W L- IE' y DATE: I I t: q LEGAL DESCRIPTION: L -o— 3 a -o c K / I c, m i)'.I X $A 3 WELL DEPTH: &f q / CASING DEPTH: Sx DATE DRILLING COMPLETED: 3/dl/4y DRILLER: A.,,4c.t-Wl0,w` 1 i MISC. DATA: CASING HEIGHT: I > 4 SANITARY SEAL: Y ! f WIRES IN CONDUIT: y4 S GRADING O.K.: Y¢ BACTERIA AND NITRATE SAMPLES COLLECTED (date): 7a" x /- / -) 9 TCQT PYATA- CLOCK TIME METER READING (GAL) PUMPING RATE (GPM) DEPTH TO WATER (FT) REMARKS '3 I t oo r 1 50 _ 3 Wt Swl 3';y ocrzctio Y.7 311 b r3 0DS- z 173 a Z o c.rl o 1 y 3 'Ef r'O w4 r4/L. off y, 13'h 4: al 0;;r30 /l. Ua i Y � 1 •'•ti � fffo�.. CE -8801 RESULTS: WELL CURRENTLY PRODUCES I- GPM WITH A /o a / DRAWDOWN TESTED BY: Goa C. FLOW RATE NOT GUARANTEED—SUBSEQUENT VARIATIONS CAN OCCUR. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 'O' .0. F or ern est Lab Analytical, Environmental, Geotechnical, Cpnstruction Materials Testing PLEASE READ INSTRUCTIONS ON BACK 35186 Spur Highway Soldotna, Alaska 19071 262a624 2fi257771fax1 DRINKING WATER ANALYSIS FOR TOTAL COLIFORM BACTERIA Name b,y,�t e- -1, II !'..n`.Ic n Lab Number g P /SS Address 133!.7 S r t LG be, Phone G T$• o v r V C.Awd -c_lL A fc 94 SAMPLE INFORMATION a Private Water System ❑ Public Water System ID No. Legal Description: L 3 11 / 5 e,,� , +ems/ 5 7D IA� ,ti 3 Sample Location: le.M .m, Ita.M., eta n, j s • ! r ..r 4 Date Sampled: 1o14A, Time: /v 3o By: 9s! . V Sample Type: [r] Routine [ ] Treated [ I Special Purpose [ I Untreated [ I Check Sample (For previous unsatisfactory sample with lab reference No. nf4 reo.rt ie for the ekCNNye uae of the party tO whom it 4 addre"ed. Northern Tett U. acce0b M ms"neib14ty Or liabdiw etCaot for the due performance Of analysis COMO(ent w•I. me level Of .ere SM .krll O'n."nN .../deed Oy mem.eq Of the OrOlagn NrrowN Or.cncjm in rM I.Eaf era. UM., LmAar Cnn.inOM ol,umstaMef end Ilmit.h..s ...To be filled out by.La6 MICROBIOLOGY LABORATORY RECORD COLIFORM ANALYSIS Received/Date: JolvA72 Time: /" 0 By: 441— Paid: Date Test Started:/eA-Ai Time Test Started: 09 Ir Analyst: as COLILERT TEST RESULTS ISM 9223B) Date Time Analyst Color: [3 Clear p Yellow ❑ Yellow w/ Fluorescence /a16 A jV 710 st. f! I Negative -Satisfactory [ I Positive - Unsatisfactory [ I Confirmed Fecal Date Analysis Completed: /6A /7S- Comments: [ ] Resample Required [ I Repeat Samples Required [ I Questionable -Recommend Resample Reported By: I =:`.wP501JADE.FORMT,LA9ITESnNMCOLIFORM.MAS Rlw$,d..IWV 1998 N7ori est Lab CLIENT: SAMPLE MARKED: SAMPLE POINT: SAMPLE DATE/TIME: SAMPLED BY: SAMPLE RECEIVED: SAMPLE ANALYZED: SAMPLE NUMBER: Crowley, David and Jill Scimitar L3, B 1 Outside Faucet 10/4/98 14:30 PC 10/5/98 10/16/98 981957-01 PARAMETER METHOD RESULT UNIT ANALYST Nitrogen: Nitrate ND - Non Detect Limit= 10 Mg/L Reviewed/Released By: ATI Method 601 ND (1.0) mg/L P Crowley 35186 SPUR llWY SOLDOTNA. AIC 99669 (907) 2624624 Fax (907) 262-5777 Analytical. Environmental. Geotechnical. Construction Materials Testing 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. # C6-(' I 32 ' .76 HAA# 1. GENERAL INFORMATION Complete legal description Lot 3; Btock 1; Sc<mi.tat Subdivi6ion 03 3 3. 4. Location'(site.address or directions) 19932 Se.iha D)t i.ve Chuoiah. AK 995 Property owner R.icha)td Kkau6 Day phone 688-5886 Mailing address P.O. Box 672282 Chuq.iah, AK 99567 Lending agency Day phone Mailing address Agent • Don McKenzie Rea.0 E6.tate Day phone 694-9035 Address 13135 Otd Gtenn Hwy. Suite 100 Eante R'von AK ggS77 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water 3 N NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72_=jRM.1N1) FN MOAY21 S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l 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 forthe number of bedrooms and type of structure indicated herein. I further verity that based on the information obtained from the Municipality of Anchorage files and from my invest!qation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S A S ENGINEERING Phone f' a c y - D Address 20t - Eagle River, Alask! "T Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. I Disapproved. Conditional approval for M Additional Comments Date ?-/ a' 9 / q S— bedrooms, with the following stipulations: - Date � 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. n.M M.A vn Swk MOA n1 Municipality of Anchorage e DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"V Street, Room 502 a Anchorage, Alaska 995010 (907) 343-4744 Health Authority Approval Checklist Legal Description: L-0 -r 3 S Pi- I Su r , ", d'9 Parcel I.D.: QS'/ - / 3 2 - 7D A. WELL DATA Well type -] dprrf_ If A, B, or C. attach ADEC letter. ADEC water system number 'd" Log present J Date completed 3 -2-1 -S4 Total depth LV1 S Cased to 02-0 Casing height (above ground) 17 - Sanitary scat &4) Wires properly protected On o FROM WELL LOG AT INSPECTION _, Date of test 3'2l - 8 0 - I � -Cl S c N nrn Static water level Well production Z.o g.p.m. 1 ,1 rTa p.m�, � rt WATER SAMPLE RESULTS: Z Coliform 0 Nitrate 0,/O Other bacteria O Datc of sample: 5-2-T-95- Collected by: S 3 S ENGINEERING 1 17034 Eagle River Loop Road No. 204 B. SEPTIC/HALDR46TANK DATA Se -t-- b,SPEC-. JLF-foJ-rEagle River, Alaska99577 Date installed Tank size I o0o Numbcr of Compartments 2. Cleanouts (�L Foundation'e7canout mNj Depression (Y® t High water alarm (Ylp Date of Pumping t? -9S Pumper -Tib 8041,6,J4 C. ABSORPTION FIELD DATA S fL H- SSP F=c _ 26iP a 61-r Date installed 8 y 1 `Soil rating (g.p.d./ft= or ft=/bdrm) BS� System type Length - Ye t Width Gravel thickness below pipe `i Total depth 7, S� Effective absorption area" ?5S4(11 Monitoring Tube presentL3O__y Depression over field (Yo J Date of adequacy test 9 -J1/ -9S- Results as Fail) IPA -<j For -7 bedrooms Fluid depth in absorption field before test (in.); O Immediately after379 gal. water added (in.): 1�i Fluid depth //o Minutes later: O a• (in.) Absorption rate - L✓foo., t .p.d. Peroxide treatment (past 12 months) (Yo 4A.44- P4Ja t,Wyes, give date 44 D. LIFT STATION Date installed Manholc/Acccss (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons -Pump on" level at" SEPARATION DISTANCES FROM WELL ON LOT TO: at' Septic/Itolding Link on lot /oo t ; On adjacent lots /6o tL- Absorption field on lot /oo f k ; On adjacent lots /Do l.L Public sewer main J14 Public sewer manhole/cicanout -'j 14 Saver /septic service line 2-S-14- Litt station " I/, SEPARATION DISTANCES FROM SEPTIC/HAb011hi6 TANK ON LOTTO: Foundation S t f Property line /6 / l Absorption field !r Water main/scrvicc line—/ a / t Surface water/drainage oo ty Wells on adjacent lots loo t t SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation /o / Water main/scrvicc line lot Surface hater /o0 t f Driveway, parking/vchicic storage area �e t Curtain drain A,�JE Wells on adjacent lots lot) t F. ENGINEER'S CERTIFICATION I certify that / have determined thru field inspections and review ofAfunicipal int tlw'QFe�Jt stems are in conformance with A/O 1 ILIA guidelines in ect on this date. h / Signature R/f( Engineer's Name oa¢•�7- C . C0 ti.4^1 11WERT C. COWAN Date Yl a� % �s— '� ee -eaol �� 1 av HAA Fee Date of Payment 711,7 `7 Receipt Number -25-6 Rev. 8/95 OSS: haa.vt�.doe / 5r Waiver Fee S Date of Payment Receipt Number AALCT&E Environmental Services Inc. Laboratory Division CTLE Rel.# 95.3272-1 Laboratory Analysis Report Matrix MATER Client Sample ID L3 BLK1 SCIMITAR #3 S/D Client Name S L S ENGINEERING WORK Order 16666 Ordered By R. COWAN Printed Date 08/07/9S • 16:26 hrs. Project Name Collected Date 06/02/95 • hrs. Project# Received Date 06/03/95 • 10:30 hrs. PWSID UA Technical Director STEPHEN C. EDE Released By3-��� Sample Remarks: SAMPLE COLLECTED BY: JOHN FRANKLIN. .................................................................................................................... • See Special Instructions Above UA . Unavailable •• See Sample Remarks Above NA . Not Analyzed [T . Undetected, Reported value is the practical quantification limit. IT . Less Than D.'. Secondary dilution. GT . Greater Than 0 200 W. Potter Drive, Anchorage, AK 99519.1605 — Tel: (907) 562.2343 Fax: (907) 561.5301 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA. ILLINOIS. MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO. WEST VIRGINIA QC Allowable Ext. Anal Parameter Results Qual Unita Method Limits Date Date Init -------------------------------------------------------------------------------------------------------------------- Nitrate-N 0.10 U mg/L EPA 353,2 10. 08/06/95 CMR .................................................................................................................... • See Special Instructions Above UA . Unavailable •• See Sample Remarks Above NA . Not Analyzed [T . Undetected, Reported value is the practical quantification limit. IT . Less Than D.'. Secondary dilution. GT . Greater Than 0 200 W. Potter Drive, Anchorage, AK 99519.1605 — Tel: (907) 562.2343 Fax: (907) 561.5301 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA. ILLINOIS. MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO. WEST VIRGINIA