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HomeMy WebLinkAboutSTEWART BLK 1 LT 4Stewart Lot 4 Block 1 #014-162-07 O V r IV, ITRF-4 0 U U2 r4 r4 V) r 4 re La: L): a! a: r4j 'o F. $4 l Idi w U ou Imi VFX L) i U. Vi ii i e41 eq r4:: ol IT! en! (D: eq! 0! CD: (14: M 7: %0: �D: %D: ON: r�. r4! k4 E4 F E4 Eq E4 yr SFr [Fr FF FE 4 ; C> 0 00 C4 M: 'T %0 %o ow O V) MU" I C I F-�f=l L. I TY r7 F= n N Cr H 0 FZ n 13 EZ DEPARTMENT OF�HEALTH AND ENVIRONMENTAL POOTECTION 825 'L� STREET, ANCHORAGE, AK. 99L A. 264-4720 t4EL-L- PEFTM I T PERMITNO. C 810374 ) gg APPLICANT JACK COF.NELLIUS 7801 SPRUCE RD Scoyl 344-6754 LOCATION SPRUCE ST. LEGAL LT4 BLK1 STEWART SID LOT SIZE 10000 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. Wc"" "uuz nmc mmwulKtU AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F='EFSM I T EXP I FZES~ L?ECEME3ER 31. 15+L 2 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 INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. SIGNED Ff ISSUED BY V4. 0 ! t>Eiftl.�tIEK7 GF FRFs( iH F�d> E1lY]FC"lEM iL MOUG710t! �. 62S 'L' STREET. AWIODRWDE. RiC. j �Frrcl T .Na. c sl i�.f74 � L I CWFT Jf" C ERNE L L I LIS 7881 Cf mx!E Ft+ 3�I4_67rst ?t7!C+N SMICZ 57. C L74 ELICi :•TENRRT Vr> LOT S.I2E 1O00H SQC"YE FEET PHA4 DISIAHCE 6ETNEEFI A WELL AWF*N' (W -SITE S-EwFIGE Dl£F -AL 5Y54EM IS i FEET FM R PfiIYFtTE NELL M 3;A TQ 2w FEET FK''C44 fi F-M:LJC WELL DEPERNNG N THE ltif'E OF RELIC. WELL. 1IM %4 DISIAW-:E FEU4 A MIME WELL TO H PRJYRTE SEWER LINE IS 2`. FEET F?1U A U444LIN11Y SEWER LIRE IS 75 FEM IL mow_. me rjLwujpxi) AND Mr --T E£ P.E7LX;JkD IC, THE DEFFPTHEla WITHIN ZQt MF -- 'THE NELL CEM1 LF110H. I:R REQUIRT-w NTS MRY APPLY. °fECIFIMTIOtC AN['� P--MTF.LC.TjUj DIfiC4ZF415 RR£ ilLAE4.E TO INSUF.E flt"V IN5,7ALLRTIM �`l=lei I '1' E7�F I F<E� L7ECEt�t��it: 31.. 1_lG:-. ERTIFY 1HRI J AM FFd4ILIFR WITH IML FEWIFfMCNTS FOR "%'—SITE S.ENEF-. FaS> NELL_• R5 SEI :TH BY THE MMICIFS4.I1Y OF FtNCHCfS;sE. d WILL MIALL IHE SYSTEM IN F4:t CMICE WITH THE Ci0,ES• --�___-- AF'F'L / Cffd&tlll tlED ___ C_ Y4. 0 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.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 014-162.07 1. GENERAL INFORMATION Complete legal description Stewart Block 1 Lot 4 Location (site address) .7801 Spruce Drive COSA # DtAngw Expiration Date: r — -2. g - o & Current Property owner(s) John & Patricia Gorbulev Day phone Mailing address Lending agency Day phone Mailing address Real Estate Agent Neil Tysver/Next Home Realty Day phone -7Z7-'3//O Mailing Address Unless otherwise requested, COSA 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 ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding Tank ❑ Community On-site ❑ Public Sewer El The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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 Certificate of Onsite Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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 Watkins Engineering, INC. Phone (907) 349-1851 Address P.O. Box 110443 Engineer's Printed Name Cindy W. Ellis Date March 17, 2006 5. DSD SIGNATURE _>Z Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following 49LH IAy W. Ellis CE -106)7 . . Attachments: COSA Checidist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: W. Original Certificate Date: � ' � � ' 0 (r tR.AI ) Municipality of Anchorage • Development Services Department ' Building Safety Division Onsite Water 6 Wastewater Program 4700 Bragew Street P.O. Box 196650 Anchorage, AK 995198650 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal DeeMplon: Stewart Blk 1 Lot 4 Parcel ID: 014-162-07 A. WELL DATA Well type Pri It A, B, or C provide PWSID 0 _ Date completed 5/21/81 Sanitary seal (YM) Yes Total depth 102 R. Cased to 102 fl. FROM WELL LOG Date of test May 21, 1981 Static water level NA R, Well production 15 O.P.M. WATER SAMPLE RESULTS: Coliform 0 cdoniesh00mL Nitrate 0.603 mg(L Arsenic: 10_005 m9A Date of sample: 3/8/08 B. SEPTICIHOLDING TANK DATA Tank Type/Material WA Tank sae gal. Number of Compartments _ Weti Lag (YM) Yes Wires properly protected (YIN) Yes Casing height (above ground) 24 in. AT INSPECTION March 8, 2006 26 R. 5.0 g.p.m. Other bacteria 1 colonies/1 00 mL Collected by: Rocky Trainor Daft installed Cleanouts (YIN) Foundation cleanout (Y/N) _ Depression aver tank (Y" _ High water alarm (YM) Date of pumping C. ABSORPTION FIELD DATA Date installed WA Length IL Total depth R. Pumper Sol rating (g.p.dAI? or fefi)dnn) System type R. Gravel below pipe ft. Eft. absorption area _ilz Monitoring tube _ Depression aver laid Date of adequacy test Results (Pess/Feli) For _ bedrooms Fluid depth in absorption field before test in. Water added gal. New depth In. Elapsed Time: min. Final fluid depth in. Absorption rate >. 9.p.d. Any rejuvenation treatment (peat 12 mo.) (YM & type) If yes, give date D. LIFT STATION Data installed N/A Size in gallons Manhole/Access (Y/N) 'Pump on' level at _ in. 'Pump off level at _ in. High water alarm level at in. Datum Cycles tasted E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot WA Absorption geld on lot WA Public sewer main 140'+ Sewer Iseptic service One 5' Animal containment areas 144'+ Masts alarm 6 circuit requirements? On adjacent lets On adjacent lets I W+ Public sewer manhole/cleanout 144'+ Holding tank WA Manure/animal excrete storage areas 140'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation WA Property One _ Absorption geld Water main Wells on adjacent lots Water service One Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property One WA Water Service One Curtain drain F. COMMENTS: G. ENGINEER'S CERTIFICATION Building foundation Water main Surface water Wells on adjacent lob I certlly that I have determined through geld inspections and review of Municipal records that the above systema are m conformance with MOA COSA guidefinea in effect on this date. Engineer's Printed Name Cindy W. EOle COSA Fee S 130 Date of Psymem 3111r%110% Recelpt Number �Iioqi J4* (Rev. 11/65) Driveway, paridnplvehicte storage Waiver Fee S Date of Payment Receipt Number 49k C11ti�ji W Ellis h�...''CE-low .. SCS Ref.4 1061145001 Client Name Watkins Engineering Project Name/I! Water Samples Client Sample ID Stewart Blk 1 Lot 4 Itlatrts Drinking Water PWSID 0 Sample Remarks: All Dates/17mes are Alaska Standard Time Printed Datefrime 03/16/2006 8:04 Collected Datefrime 03/08/2006 9:51 Received DateMme 03/08/2006 14:22 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Rmulu PQL Units Method Cemaim,D Limits Date Date ]pp Metals by ZCP/MS Arsenic ND 5.00 ug/L EF200.8 C ("10) 03/10/06 03/13/06 TK Waters Department Nivatc-N 0.603 0.100 Microbiology Laboratory Total Coliform 1 CID. No Coli mgt, EPA 3532 B (o-10) 03/09/06 JC col/100mL SM209222B A ("I) 03/08/06 TLF N 89059r'30W 74.400 9Z13U 30 W F N 0 io' urn. 6sM!7 - — -- — 32li /8= lie /FR h r< N N /Z4 SCALE. 4 3Z4- 1B• - DrcK Ni l IN M 30 N 89°59/30'E -74.00 Recert. 3-20-06AZ AS -BUILT NO CORNERS SET THtSDATE I hereby certify that I have performed a Mortgagee's Inspection +� •�� 4 of the followinip described property: LoT 4r "Y COUR'i ..` E OF At. hil ��� + 5TEWAR T SUB D. 4. Fred Watothe NO. 32= f� �yfo 4•aN EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED i PLAT ARE NOT SHOWN HEREON. Flr,<r -Anchorage Recording Precinct, Alaska, "and "that"'the" Improvements situated thereon are within the property lines and do not overlap or encroach on the property tying adjacent thereto, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said -property except as Indicated hereon. Dated at Anchorage, Alaska this 3rd dayof AU"'51- PO 00 FRED WAIATKA & ASSOCIATES Be 1 (907) 248-1666 Engineers and Surveyors h r< SCALE. 4 10 WdOA Rer Wt" ° a / %t 6rY• fRAME ml _in t/SE N O •YI a O 4o4- DrcK Ni l IN M 30 N 89°59/30'E -74.00 Recert. 3-20-06AZ AS -BUILT NO CORNERS SET THtSDATE I hereby certify that I have performed a Mortgagee's Inspection +� •�� 4 of the followinip described property: LoT 4r "Y COUR'i ..` E OF At. hil ��� + 5TEWAR T SUB D. 4. Fred Watothe NO. 32= f� �yfo 4•aN EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED i PLAT ARE NOT SHOWN HEREON. Flr,<r -Anchorage Recording Precinct, Alaska, "and "that"'the" Improvements situated thereon are within the property lines and do not overlap or encroach on the property tying adjacent thereto, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said -property except as Indicated hereon. Dated at Anchorage, Alaska this 3rd dayof AU"'51- PO 00 FRED WAIATKA & ASSOCIATES Be 1 (907) 248-1666 Engineers and Surveyors Municipality of.Anchorage� Department of -Health and Human Services Division of Environmental Services v On -Site Services Section 825'L• Street 'Room 502 RO. Box 196650 Anchorage; AK 99519-6650 www.ci.anchorage.ak.us "- k: s :.. ` a. ,!:: (907) 343-4744 _: Li. -'z CERTIFICATE OF HEALTH AUTHORIT,Y.-APPROVA� •--.- :.; �•-; ,: The- _ a_FORAtSINGLE,FAMILY.DWELLING_._'. Parcel I.D.. - 0 r 5r = 16'2- - 07 - -- - - -- HAA# t'..........'Expiration Date: 1. INFORMATION ' r::GENERAL LA.Complete.Q';.: escnption L:ot y� !3/tic 4 1. SfaawCr -t Sim �'�•.,�` ,`:; . -'Location:(sifeaddressordirections) 760l S��act S�r.�t ... �...-•,- .,.. Current Propertyowner(s) Tom} t4oergJ '' '''` Dayphone•`C2?� y •a ..... Mailingaddress Ileo. e. tk.rfy+an Rif #S6/ An r;,oe 4-4�7- 99ss Lending agency �r`+A[}-vir;�/v, a Dayphone_ S62 -2-i& Mailing address x/60 t cw ?ado. Rol. 4. cA. h -1c 99s oY Real Estate Agent. Rannrelee_ L3ak, P- 1c, Realr` Da hone 2Y*/ -782& ___.. _Mailing Address Itor E 76r"�ve''.ttg' fhc4a�c+aP A 9�S/ = ' Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. --'NUMBER OF BEDROOMS:-"--'--`2"-`--------"�"" - - : 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 Pubc Sewer Municipality of Anchorage Department of Health and Human Services (DHHS) 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for,properties seryed by a private or Class C well and may be reissued with new water sample results less than 30 days old. 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. 72.025 (Rev. 01/00)• 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined In the Health Authority Approval Guidelines for the Health Authority Approval application show that the on-site water supply and t - . /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 applicable Municipal and State codes, ordinances, -and regulations in effect at the time of installation. NameofFirm FluFfoj� •T�cloi�.�o/ ISt;.:,1�=f7 ' Ptione '•=3yS-�3SY Address I'YS 30 OCA. '-Sf i `•'i4nc4o.a �:¢�r '99s� Engineer's Printed Name TAcdoloit �Y Date Auywi 7 2boo . der or 111L 6.-DHHS SIGNATURE--____.- '` '�7}R000RE K AiOORE = A v vF •.� CE -3589 ,� p Approved for _� bedrooms. i _,-¢' •,..s �4W Disapproved. ��'> .�+ -!•'i-c C_� i .,.. cn q♦ ,rvt, lct <. Yt :'^ Sl r.�l,.^ t ^', t '�.: :' 1: �A..�'.79da'.... - Conditional approval for- ­ .-- bedrooms, with the'following stipulations. 1 r'1 Additional Comments 1;' , 1 Attachments: - HAA Checklist Maintenance Agreements Septic System Advisory. Supplemental Engineer's Report Well Flow Advisory Other By: .—Original Certificate Date: S -1 L/ - O o Expiration Date: 00 Reissue Date: 72-025 (Rev. 01/00)' - Municipality of Anchorage ' Department of Health and Human Services R E C E I V E Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 198650 Anchorage, AK 99519-6650 AUG 09 Y�Q www.ci.anchorage.ak.us AUTY OF E (907)343-4744 ""OMMM SERVICES tMrlSlt` HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: _ Lam Sip Parcel I.D.: ory -r6Z -07 A. WELL DATA Well type ivy t If A, B, or. C provide PWSID # Date completed SZ 2UZ&t Sanitary seal _r Total depth t o t It Cased to to 2 ft FROM WELL LOG Date of test Static water level S/ 2t /&9/ ft Well production Is 9 -p.m WATER SAMPLE RESULTS: Well Log Y. -I Wires properly protected _ r Casing height (above ground) 2, in. AT INSPECTION T8 It '/.96'+ 9 -p.m Coliform • O colonies/100 mi Nitrate t. 0 3 mg/l Other bacteria G oolonies/100 ml Date of sample: 8 / 3 / 2 aOc-, Collected by: T. r. hc,a t F(a/76.p 7«/A r� c S. SEPTIC/HOLDING TANK DATA N. A. ( Aww&-c Tank Type/Material Date installed Tank size Cleanouts Foundation cleanout Date of pumping C. ABSORPTION FIELD DATA gal Number of Compartments Depression over tank High water alarm Pumper N.� C Awuiu Setvtr1 Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) System type Length h Width It Gravel below pipe ft Total depth ft Effective absorption area h2 Monitoring tube Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in Water added gal. New depth in. Elapsed Time: min Final fluid depth in Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date 72-026 (Rev. 01/00)' D. LIFT STATION N• A. Date installed Size in gallons Manhole/Acoess "Pump on" level at in "Pump off" level at in High water alarm level at in Datum Cycles tested Meets alarm & circuit requirements E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N. A. On adjacent lots N• A. Absorption field on lot N. A. On adjacent lots /y. d. Public sewer main tva' Public sewer manhole/cleanout 7 tcr,+' Sewer /septic service line > es" Holding tank N. A. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: N. A, Building foundation Property line Absorption field Water main Water service line Surface water Drainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: N. A•, Property line Building foundation Water main Water Service line Surface water Driveway, parking/vee44*Q ?gees Curtain drain Wells on adjacent lots r`s'. �:•:�� s F. COMMENTS - OTH af, •T•. ,• �� 1if G. ENGINEER'S CERTIFICATION T tEOUO.E F. A 008E F� • CE -3539 I certify that I have determined through field inspections and review of Municipal records that the above systems are in ' k'a�� conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name -r-h sotp&o a F. 4*o' e Date A•Kr •sr,, 7 2 a ao HAA Fee $ 3 d©= Date of Payment Receipt Number d( 575 72-026 (Rev. 01/00)' Waiver Fee $ Date of Payment Receipt Number 08 -OT -00 15:13 FR011-M EN4IROMENTAL $615301 7-354 P.OV03 F-121 AL-CUE Environowntal Services Inc. erirr�rii�r�rr�rrrr� CUERds 1004310W1 ClkotPOP Pr"PaidColis/NO3 Mar Name n3ttop Teduical Sty. Priatcd DuNrimt 08/07/2000 13:50 Project Naawo LOT 4. Black 1 Stewart SID CaOaTtd Dattrrimt 08/03/2000 14.00 Client SOmpk W Lot 4. Block 1 Stewart S/D Poccivtd Datemaw 08/03/2000 14 00 Mama Drmkmg Watt TOcMaical Dimto S ea C. E'Ede�%f+'��G OrJcrcd 8y Rd.aveQ 8 7 tWSID 0 Samplc Rernuua Alla.Ak PrOD Amalym Pa emcw Rtwlo PQL [lute MC" Lama thm Data lair [Patera Departaanc Narue-N 103 OSW nWL EPA3000 30ttax 0"3= SCL lticrobioloyy Laboratory Toml Co4tonn 0 coU100ml. SM I8 92228 0803/00 KAP _ MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services low On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF -HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING nq Parcel I.D.12Z—CJ� HAA# _LI�Jl 1. GENERAL INFORMATION Complete legal description Lar q $t. u_ �," S-ewA1Lr 5 1301 Jisioq Location (site address or directions) 78ol Sp2ULC S{ Property owner 114R.ot.4 DI Uc.m 4d Day phone 1145"4 Mailing address 7601 :5f&'C.0 AV" S� Lending agency Day phone Mailing address Agent Day phone r Address Unless otherwise requested, NAA will be held for pickup. 2. NUMBER OF BEDROOMS: 7NlLCG- 3. TYPE OF WATER SUPPLY: Individual well�i 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 .r 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. -?2-=(Rw.1t91) Fran MOA121 .. 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 forthe number of bedrooms and type of structure indicated herein. I furtherveritythat 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 compliake with ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm AnlOc7LSf)nl L'fVG�nlLS"E72/nIG Phone 5�3-7/5S Address PQ 130A L 77 oQh6r 1L qq Engineer's signature t Date q 7 6. DHHS SIGNATURE _-_L Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments — Bjr, // \�•IIOYs�0lslipn�Y��. Pp... %:91 W -Sad E /+.+,= bedrooms, with the following stipulations: Date ' ¢ II- 97 The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent rotess., engineer registered in the state ofAlaska.TheDHHSdoesthisasacourtesytopurchasers ofhomes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct Inspections or analyze data before a certificate is Issued. The Municipality of Anchorage is not responsible for errors or omissions. in the professional engineer'swork. rxos lam'• 1Nt) Owk MOA m I I - j Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: Ler- +, QG-Cbrr-1 � SrEWA/LT" Parcel I.D.: A. WELL DATA Well type PIZ I VATC If A, B, or C, attach ADEC letter. ADEC water system number Log present (YM) Y Date completed 6-/21 Is 1 Total depth /D Lf cased to . i µdr Casing height (above ground) Z i , Sanitary seal (Y/N) Y Wires properly protected (YM) Nr FROM WELL LOG Date of test Static water level Well production g.p.m. WATER SAMPLE RESULTS: AT INSPECTION 197 37' 4.7 Coliform 10 Nitrate • 35 m3 IL Other bacteria D Date of sample: y1�19 7 Collected by: M ci B. SEPTIC HOLDING TANK DATA - PUBLIC, 5&UJ d - O W `NI O) Date installed Foundation deanout(Y/N) Date of Pumping Tank size Number of Compartments Cleanouts (Y/N) Depression (YM) High water alarm (YIN) C. ABSORPTION FIELD DATA - Date Installed Length Width Effective absorption area Date of adequacy test Pumper �P113 LW, SEW cR Ll) Soil rating (g.p.d./f? or tt'/bdrm) Gravel thickness below pipe System type Total depth Monitoring Tube present (Y/N)_ Depression over field (YM) Results (Pass/Fall) For bedrooms Fluid depth in absorption field before test (in.); immediately atter_ gal. water added (in.): _ Fluid depth (ins) Minutes later: Absorption rate = a.p.d. Peroadde treatment (past 12 months) (YM) If yes, give date 72-026 (Rev. 9/98)' IFT STATION Date installed Manhole/Access (YM) High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES *Datum Size in gallons "Pump off" level at' SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot N On adjacent lots AJ 14 Absorption field on lot PJ/A On adjacent lots 14.1/7 r I Public sewer main >59 Public sewer manhole/cleanout i X00 Sewer/septic service line %/0 r Litt station /JO�lE Ori LVr SEPARATION DISTANCES FROM SEPTIC/HOLDINGTANK ON LOTTO: t,tG SEa,.ierl- (ALJW U) Foundation Property line Absorption field Water main/service line Surface water/drainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: IUB LIC-, S CW ER- CAW k%(J Property line Surface water Curtain drain F. ENGINEER'S CERTIFICATION Building foundation Water main/servics line Driveway, parking/vehicle storage area Wells on adjacent lots I certlty that I have determined f ru, Held inspecdons and review, of Municipal in conformance with /MOA HAA guidelines in effect on this date. Signature ti�v1 Engineer's Name M icwAct C Aw0Eusori i Data 1119197 Date of Payment Receipt Number 72-0213 (Rev. 3/98)" Waiver Fee $ Date of Payment Receipt Number EryFfievs tams are wrd.,ar f_ a. erxa �a WELL FLOW 'I L-' S I DATE LOCATION: �1 1 INSPECTOR 1 Eta PROJECT WELL DEPTH: " LZ — FT. CASTING ABOVE GROUND: ►� Iz FT. STATIC WATER LEVEL: 3-I - FT. (MEASURED FRCrl TOP Cr- CASTRtG) TIME tJATERE VOLUME CUM.VOL. ALG FLOW EIN LEVEL(ftT (gal) (gel) READING DI (m) COMMENTS o ----- q! S406 Jl'.zo .f�l'� � -•. 5340 •-�-g-- • _ _ 54 ]-- - - _ -- _-_ RECOVERY COMMENTS _ AVERAGE FLOW RATE: (9pm) REVIEWED BY: Under9rcund concllucns are eub ect to than g_ over Ups course ��r tluir- NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS. ALASKA 99701 (907) 456.3116 • FAX 456-3125 8005 SCHOON STREET ANCHORAGE. ALASKA 99518 (907) 349. 1000 • FAX 339-1016 Premier Mortgage 3000 A Street, Suite 102 Anchorage, AK 99503 Attn: Jodie H. Clarke, CML Our Lab 0: Location/Project: Your Sample ID: Sample Matrix: Comments: A149201 Harold Dickman 7801 Spruce Street Water Report Date: 03/18/97 Date Arrived: 03/14/97 Date Sampled: 03/13/97 Time Sampled: 1630 Collected By: •• Definitions •• B Present in Blank H Above Regulatory Max E Estimated Value H Matrix Interference D Lost to Dilution MDL Method Detection Limit Lab Date Date Number Method Parameter Units Result • MDL Prepared Analyze ----------------------------------------------------------------------------------------------- A149201 SH 4500E Nitrate -N mg/L 0.35 0.10 03/17/9 Reported By: Anthony J. Lange Chemiatry Supervisor LkTLt) %L4- NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS. ALASKA 99701 (907)456-3116 - FAX 456-3125 8005 SCHOON STREET ANCHORAGE. ALASKA 99518 (907) 349.1000 - FAx 349.1016 DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA Premier Mortoaae Public Nater Svstem I.D.# Attn: Harold Dickman 3000 A Street Suite 102 Date Received: 03/14/97 Time Received: 13:00 Anchorage, AK 99503 Date Analyzed: 03/14/97 Time Analvzed: 15:00 Date Reported: 03/17/97 Time Reported: 12:03 Next Sample Due: Phone No. Purchase Order No. Collected by: HSD Sample Type: Routine Method of Analysis: Membrane Filtration Comments: Comments: S - Satisfactory U - Unsatisfactory POS - Positive Test Result ND - None Detected TNTC - Too Numerous To Count (>200 Colonies) CG - Confluent Growth HSM - Heavy Sediment Masking, Results May Not Be Reliable SA - Sample Age >30 Hours But <48 Hours, Results May Not Be Reliable Old - Sample Age >48 Hours, Too Old For Analysis R - Resample Required NT - No Test * # Colonies/100 ml ** # Colonies/ml Sample Sample Total* Fecal* Other* HPC** Date Time Coliform Coliform Bacteria Result Lab# Location Comments 1 03/13/97 16:30 0 ND 14 NT AC4294 7801 Spruce St. Satisfactory Qs Jul Schaefer 1011" ronmental Analys Time APPLIC' NT FILLS OUT UPPER HA17,ONLY Property Owner ^� Q C [� p / N �" / �/ 5 Phone .. MaIG�; Address d c P Code Buyer Address / h C1 h C �/ ✓! ZIP Code Lending Institution p �_ / Y 5`f" /Y� / 4 j-,— Sp -rl F' A^ C] / / Phone Address ZIP Code Dare Realty Co. 6 Agent Date Phone Address ZIP Code Inspector11 Legal Description *t L L- O 7— y D C X r J Street Location ((�� ,, t/Yn id . Type of Residence ,, Y VA O Single Family Multiple Family No. of Bedrooms__ Other Water Supply O Individual Q �^- h ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. If Community <Public V ( L2 Ib Q U nij S For wells trilled prior to that date, give well depth (attach log available). Utility - Sewer Disposal - O Individual Year Individual Installed: Public utilitya Com)ilyd�ed to Public Utility: V[-(.tl Holding Tank - Septic Tank Size NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROC SSING CAN BE INITIATED. Time Time Time Time 1 Date Date Dare Date Inspector Inspector Inspector11 Inspecto ((�� ,, t/Yn id . ,, Y VA Field Notes: �! VCdJ Gu1,Q.0 y� MUNICIPALITY OF ANCHORAGE DEPT. Cr Im.r,Trl R ENVIR::Wa ---t :.-A- I.,U._CTION I: OV 19 1982 RECEIVED ( ��) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPRt�gOVAL' DATE ' BY: �J — Solea Ratlnp Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank r:un iron