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PROSPECT HEIGHTS #1 BLK 2 LT 25
Prospect Heights #1 Block 2 Lot 25 #015-091-20 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930177 DATE ISSUED: 6/23/93 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 6/23/94 OWNER NAME:STATE OF ALASKA OWNER ADDRESS:P.O. BOX SB DR JUNEAU AK 99811-0400 PARCEL ID:01509120 LEGAL DESCRIPTION: PROSPECT HEIGHTS #1 BLK 2 LT 25 LOT SIZE: 91040 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL.REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL . ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: PERMIT IS ISSUED LETTER FROM S&S_ RECEIVED BY: NG. ONS SPECIFIED IN 06/16/93 DATE d h' S3 ISSUED BY: }3FfiN Rmaf f DATE: �ttg trr�'� HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION June 16, 1993 cipality of Anchorage RTMENT OF HEALTH AND HUMAN SERVICES L Street orage, Alaska 99501 ROBERT SHAFER. P.E. ROGER SHAFER. P.E. CIVIL ENGINEERS (907)694-2979 FAX 694.1211 PROSPECT HEIGHTS SUBDIVISION, BLOCK 21 LOT 25 equest you issue a permit to drill a well to serve the four ENGINEERING STUDIES edroom home on the referenced property. ANDREPORTS well flow test was performed on the existing well on May 111, 1993. From this test it was concluded that the well was roducing 19.3 G.P.H., since this does not meet Municipal WELL INSPECTION equirements the owner is requesting a permit to drill a new &FLOW TEST well. The existing well will be abandoned if the new well has adequate production, otherwise the two wells may have to be SITE PLANS tied together. Attached is a site plan depicting the location of the proposed well and surrounding properties. There is no source ROAD DESIGN of contamination within 100 feet of the proposed well. If you have any questions or require additional information for your review, please contact us. SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSALSYSTEM DESIGN A. Shafer, P.E. /LSU/lsu 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER. ALASKA 99577 1" 60' WELL SITE PLAN -SCALE M N X M M r r leo 1ps MJ •y►o r� C) r STATE OF ALASKA' DfPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD LOCATION OF WELL BOROUGH - BUSOlvWON LOT BLOCK SECTION OTRS SECTION TOwNSHII RAN0E MERKIIAN ON OE Os OW LOCATION/SKETCH: WELL OWNER: �. 9y0 DEPTHS MEASURED FROM:Ocasing top Oground surface WELL DEPTH: DATE OF COMPLETION Depth of hole:_�9.� ft BOREHOLE DATA: Depth Depth of casino:1 ft �-�_ j_93 Material Type and Color From To ZIP:: DFPTI) TO STATIC WATER LEVEL: OJAIb Z ,_ /_f0 -_-'-ft below 1;0 top of casing O ground surface Date: L� METHOD OF DRILLING: sir rotary O cable tool O other USE OF WELL domestic O Irrigation '0 monitor ,i O public supply D other CASING STICK -U : _,___ft. Diam: -4-in. to it Casing type: fy_in. to j ft — WELL invAKE OPENING TYPE: O open end O scroened O perforated gopen hole Depths of openings: _ to ft SCREEN TYPE: \ Diam: — Slat/Mesh Size: Length:____ It GRAVEL PACK TY Volume used:,__ Depthto top: TYPE:_ Volume: `DCROUT Depth: from R DEVELOPMENT M HOD: _ 2199 a Duration:_ . 0 21 SeN` PUMPING LEVEL AND YIELD: 1t after _e his pumping'S gpnl Nos r peP t PUMP INTAKE DEPTH: ft Horsepower: _` WELL DISINFECTED UPON COMPLETION? 04:ES O NO CONTRACTOR /\ - A' , IMATION: REMARKS: A i g PLEASE MAIL WHITE COPY OF -LOG TO: - L?7 J .j DNR/DIVISION .W OFATER- .. Signature o urhonzed sores alive ate PO BOX 772110 . J EAGLE RIVER AK 99577-2111; .c.: - Sort By: Alaska Water A. Wastewater Consu; Bol 338 3246; Nar-22-00 '.5:00; Pape 213 i 6615211 T•744 F.A2/02 F -TCI - 13-2L-07 1/:OA FROWCTE EpIR7RIERM - CUE FWAmr msfttat SON'OY tne. fia f� - CEtat poo Cut Rtl.R 1001155001 AY Watct A WIS"WaarConsaluats Inc. Printed Dowfrieae CoUrnad pateliime OSM12000 14.01 OSR112000 16 00 CIAmt Name ProjecrName/a ProapedHe161ttsI1.2582 RetenAAerc.Tls'r P3R112000 1630 CTictit sample m Wan" born Nara gib TeckpiadbirecW Rmpbea C. Ed$ IMtris Oci'bhtiWour Ordered 11y pria <d by PWSID 0 Sunpb Remarks: atte.abI0 rrg a'slysis lMc la'dsa PU units it.wm L1sta Raw ogre Yareat Or►i Ara Sae -o lap trt 10.9 • 0.500 sa/a aitme-a RECE/VED I nt,,,1 MAR 23 ?000 Debt. /Lje r1�aLtY v/ alttl g "urn aArin8o ag es Z0 39vd A-1ddnS AlJRHI 6Z0SCDE L5:7T 0002/EZ/E0 07/15/93 16:11 M -E EMJIP04 ENTAL LAS SEPOICES COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMEN7AL LA00111ATORY SERVICES ",fi3O, REPORT of ANALYSIS Chemlab Ref.4 Client Sample ID Matrix client Name Ordered BY Project Nate Project# PWSID Sample :93.3400-1 tL25 B2 PROSPECT trM S/D :WATER is & S FYIG1NM?ING sS.S. :UA SAMPLE COLLECTED BY: S.S. IF-11111iri P10 033 B STREET ANCMORAOE AK 99S1Ie TEL: (9971 582-2343 FAX (907)Se13301 WORK Order :68278 Repc.rt Completed :07/16/93 Collected :07/14/93 @ 13:15 hr: Received :07/14/93 @ 14t20 hr: Technical Director:STEPH I EDE Released Inc Parameter Results ntual Units Cethoi --------------------------------------------------------------- Nltrate-N 6.31 ag/L FIFA 353.2/300.0 Allowable Ext. Anal - Limits- Date Date Init ------------------- 10 07/16 LLF ��6E��Si14LJCLZS�=�lIIC3SL3Lt�iibIICLiO4EG�tt•tl�C�G Y'1=�Y�.Y2T�Li/lE LL'i SY'2n�si%t 'A � U;tavailable= * See Special Instructions Above UUA = Not Analyzed ** See Sample Remarks Above U c Undetected. Reported value is the practical quantlfication limit. GT a Less sThaGreaterThan D = Secondary dilution. 08136 MemOet O1 the SGS Group (SOdet4 G0eWe Ja Survelmnee) NEW JERSEY. SOUTH CAROLINA ENVIRONMENTAL SERdICES IN ALASKA, COLORADO, UTAH. ILLINOIS, OH10. MARYLAND, WEST ViR31t11A., CHEMICAL & GEOLOGICAL L4BORATORY A DIVISION OF COMMERCIAL TESTING h ENG!'NEMING CO. Y53 I! STAF.ET ANCNOPAGE ALASKA 99518 TELEPHONE (907) 56223.3 FAX: (907)561-5701 Client 3eaple IC L2S 12 rPO)PSCT DLIGBTS PM3ID n DI Collected AOG 28 92 1 1;'00 Are. Received ACG 1? 92 6 IA:Cf hts. Ptaverned with n A9 RIMAU Analysis Coerpletsd hIG 111 92 Leborato[y Supt so[ APPj1 C. A^.L Raleeted By + 1*! ADALISIS WILTS for IYYOM t 57615 Chenlsb Reit 92.1517 SanTle A 1 N.ttis: MA11h Men! Dae. 13 6 3 IDG11111ID4 Client LccL :5143SW 1PCt : Roll Otdsced ly :1. 35I11 Sstd Report$ to, 1)3 i 3 Ca41R ut l 2) PCI s1011 11C1IPID .................................................................................................................................... Patamotet Real Ls Wts M.thoe LU oWeble MR7ts .................................. ------ 1ITRATa-D 3 ! m7l1 [PI 751.2 10 Sample ROi1TIAC SAK'LC CGL:tSTLD ATS R.J.S. Remarks: _...................................................................................... .......1 ' Taste Petleraed ••••-•�'••••'' Sea 3psetal Tnetm--tions Above QA•Qro••tlalle ID. Ron. Detected " 3se Semple Jowls Above VA. Mot Aralyved LT•Loss Tian. GI -Stetter Than Member 01 Ina 53: OrcOF (Socio6 G4r1ta'e Oe SumPlarce) 208 REO .O�nOn00nnr.nnnOnO.ii3O onnnnnncis) nnnonnnnr�n0n 7£:GI !P—an—zeal_ t, j i /�r CIAd es6cI-on. AIidIQJ woS llC- cuJ re,�,-- _ -_ - - .. •�- _ _drew . oo{� � i°""'1�'• __ G�ro�� j . - _ .. .'. __ /oioa�ic. a/ .. q/�.,'� _ '`� _ Aye-.-,•�,.,,r�� - - �O�'-1f 74_._�Nri'O'� ___ ----._�_ YO�ryr-✓v_. p�G//eL�zyiml�+�----/--_-- _.._:i-----�DD_�o�/ori/__0'1_.,�c��. wc� _. _ _ -._[.ILt� L%✓iinf _ � _ �%did PSC" _.. __. - -- rte._---- - I li t/-06Z _r0 ,1ave Rrrw�reNeF---- -—- Af 7D ._ 7>"G- _ JW741,060 OWAiC77Y qc TN•S wFtL is it "arr rem i° Lwuera * A e&or, A)r poAtM� Vi� Azt .fT tc=str _/i irou/C! --- CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. \R g 5633 B STREET - ANCHORAGE, ALASKA 99518 - TELEPHONE (907) 562-234.1 a FEDERAL TAX I.D. #92.0040440 ANALYSIS REPORT II 3WLE for Work Order 1 12040 Date Report Printed: 111 20 91 8 11:07 Client Sample ID:625: 12 PROSPECT HEIGHTS Client Mane : S i S ENGINEERING PWSID :UA Client lett : SNSENGP Collected 111 18 91 4 12:10 bre. In i PO R Received 111 19 91 4 14:40 bra. Req 1 Pteverved with :IS REQUIRED Ordered 1y : R. SHAIER Analysis Completed an 20 91 Send Reports to: Laboratory Supervisor EPREN C. RDE 1)3 6 S ENGINEERING Released 1y : 4' 2) .................................................................................................................................... Chemlab Ret 1: 910567 Lab Smpl ID: 1 Matrix: NATER Parameter Tested NITRAII-N Sample ROUTINE SAMPLE COLLECTED BY: R.D.J. Remarks: Allowable Raoult Unita Method Limits ---------------------------------------------------- 2.7 mg/1 EPA 551.2 10 .............................................................................................................. 1 Iests Performed See Special Instructions Above OA -Unavailable MD- None Detected " See Sample Remarks Above NA. Not Analyzed LT -ins Than, CT -Greater Than 1 OS V 1F 0; 8ii6s r9IG,::9 it l�:ecA - - t2` y ----- - -3;3 .,0 M3333I': Ioxtv:9ccE �nre:o'sl ��,. !d : vi 6eu9fe3 IV I33iLGAI SH {Za I:G. 9i", �D? I!10M AO. CIiB3 .62A Cf at 1 iF 5: 833 Eef29 ilo9 .::a 0?:F! ! 1? Et H33 69Y:9795 03.i:";3,i 2A: Attu Eer�9e925 ---------- ............ ............... i 0 1G73 del WOR :! 39.5 dalog.40 691691 2929P.eI i ------------------------- X-3IA.5I!A i�G3I737.197 SJSX.A° :MIIti 7F. .Iona? ----------.1�_._--------------- -- ................•.............. 691203293 e1e9i I evodA 6AIDr95 eignr2 >.,. 69»979G unix -V neri'. I91a923•36 ,nei3 62�1•I1 69:yiar.A Id! •A:! ROBERT SHAFER. P.E. ROGERSHAFER CIVILENGINEERS (907)694-2979 Febauaty 27, 1991 FAX 694-1211 HEALTH AUTHORITY APPROVALS ' Mt. Gene Si Lea ROSE PROPERTIES 341 Weat Tudors Road 0103 Anchotage, Ataska 99503 SEWER A WATER MAIN EXTENSIONS REFERENCE: Lot 25; Btock 2; PAoapect Heighta 01; 9701 Statom Drive Dean Gene, SEWER {WATER INSPECTION At yowl &equeat an adequacy te6t was pea6otmed on .the aeptic 6y4tem heaving .the te6etenced paopetty on January 30, 1991. Water wz6 added to the ayatem white uatet tevet mea6wcement6 were .taken ENGINEERING STUDIES atom the mon-ftoting tube Located on the aeepage pit. Ftom th,i.6 teat it ANDREPORTS wzs conctuded the 6eptic ayatem .L6 curaentty 6unctioning adequatety boa a bout bedaoom house. Howevea, the byatem cannot be guaranteed against aubaequent 6aL,tme. WELL INSPECTION The aeptic p tank wLa ed on January 30. y 1991 6 A* Home Setvice6. 8 FLOW TEST A wett 6tow, teat was pea6o,med on the weft aeay.i.ng the Ae6eaenced property on Febauaay 4, 1991. It wa6 detenm.i.ned the weft paoduced 4.9 gattom peA hour. SITE PUNS The wett wa6 hydao-6aactured and another 6tow teat was pea6o4med on the weft weaving the te6etenced ptopeaty on FebauaAy 18, 1991. The atati.c water tevet uta measured at 16.5 it. betow the top o6 the weft casing ROAD DESIGN and ,the 6tow turned on butt. A6tea 94 minutea the wLtet tevet was drawn down to the pump. When the wztet Levet Leached the pump, the acouaticat went paobe indicated a depth o6 appaoximatety 394 it. It appeaA6 a wett tog on 6,ite at the Munici.patity o6 Anchorage (MOA) boa SOILTEST Lot 26; Btock 2; Ptospect Height6 01 may be m.i.6tabted. The tog boa the weft dAltted by Folia Dtitting in August 3, 1979, ahowa a depth o6 399 it. Thi6 covLe6ponda to out acouaticatty measured depth. Thete6ote, we beet the 399 it. wett tog is mi,stabted. PERCTEST With the antes tevet at the pump, the pump uxz6 funned o66 and the wztea With tevet okra allowed to aecovea. The period o6 aecoveay vaaied with each tecoveay test. Each tecovety test invotved .the pump being tuAned back on a6teA an a.nteavat o6 time and the wztea tevet drawn down to the pump STRUCTURALS again white the quantities o6 wztea were pumped through a meted. Thi,6 MECHANICAL te6t waa pea6o4med three times with cona.i.stent teauM. Faom th4,a teat INSPECTIONS it wa6 detvunined the te6e4enced wett Witt produce appaox.imatety 25.5 gatton6 pea houA (GPH). This 6tow tate .c6 not guaaanteed, 6ubaequent va4.i.aatEon6 can occur. ON SITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Page Two Lot 25; Block 2; Paoapect Hetghta 01; 9701 Statom Ni.ve F¢btuany 22, 1991 water namptea were ,taken and ,tented bon nUkatea and cotibonm bacteria. The ,%uuM weae aatie6actoay. 16 you have any quentionb on i6 we may be o6 6urcthen aenvice, pteaae contact ue. P. E. r � February 21, 1979 Howard C. Ryherd 4619 Spenard Road Anchorage, Alaska 99503 Subject: Lot 25 Block 2 Prospect Heights Subdivision Approval for your individual sewer and water facilities will not be granted until the following items have been complated: (X) Expose the well for our inspection to determine proper construction, also, to insure the minimum distance requirements are met between your well and sewer system. (X) Deliver the water anabysis report to this office for our review. taotify this department for a re -inspection when descrepancies have been corrected. If there are any further questions, please contact this office at 264-4720. Sincerely, Pobert C. Pratt, R.S. Associate Specialist RCP/ljw ccs Alaska Mutual Savingsr Post Office Dox 1100 99510 S. LEGAL DESCRIPTION MUNICIPALITY OF ANCHORAGE ���uyy11��pALITY CF ANCHORAGIE DEPARTMENT OF HEALTH! ENVIRONMENTAL PROTECTtONA Ci '.'"AlL! & a-2o DC � : f/�S S:TT LCAT J /K//rY�% N /�• 925 L Street • Andwrno, AIMIM 99601 _CTION S. TYPE OF RESIDENCE ENVIRONMENTAL ENGINEERING DIVISIONFEB 2 0 lJI SINGLE FAMILY 44 Telephone 28720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEP kR(FIV-fiI9 DIRECTIONS: Complats all parts on paea 1. Insuimplees requests will not be Presumed. t'IMN45/wtla 001 dits for Proc Mn9. 1. ► ERTY OWNER PHONE r ❑ COMMUNITY Is 11Y, AILING ADDRESS depth (attach log if available.) /Z- dL &SEWAGE DISPOSAL SYSTEM t' A PROPS TY RESIDE 1If War t from abovel P AIA Deg .lor a k r% N Soot� 2; 2. BUYER NOTE: THE INSPECTION FEE MUST ACCOMPANY PHONE MAILING ADDRESS ING INSTITUTION PHONE wj4ii.v T ,v s x -us AILING ADDRESS 4. R LTO AGENT PHONE V a s 1TrJC- M (L/ING ADDRESS b T4rjAr S. LEGAL DESCRIPTION //s a-2o C t• A! G1/- f/�S S:TT LCAT J /K//rY�% N /�• S. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ One •)r Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY . .�!r INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) /Z- dL &SEWAGE DISPOSAL SYSTEM "If individual/on-site, installation date �99'>✓ INDIVIDUAL/ON-SITE" give If system is over two (2) years old an adequacy test is requir ❑ PUBLIC UTILITY by this Department. j'(Jl rr'j S IV r /� 0'RI4?' /A) 010 PROCESSING CAN BE INITIATED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE 7241013/791 0 THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED J IN ALLER SOILS RATING ❑Septi Tan or ❑Holding Tank Size: I If Tank is homemade give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL t ( 4. DISTANCES WELLTO: Saptk Holdirq ank I 0 Absorption Arm I f o rewer Lim rrest Lot Lim Absorption Area to rearm Lot Lina 5. COMMENTS 6- APPROVED FOR 4 BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE �, r— �(x — t-� (i I BY Title �_, _� ",L y LEGAL DESCRIPTION 72-010 (Rev. 9/78) GRr ER ANCHORAGE AREA BC's iUGH ®RDepartment of Environmental Quality 3330 C Street Anchorage, Alaska 99503 T INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME OwaI�D ElheD .KMAILINGADDRESS FaDQ 10V126290` -1b PHONE c�7a-4307 LOCATION!RryLCM 1_)os r LEGAL DESCR SEPTIC TANK: DISTANCE l NUMBER OF FROM WELL Ilan MANUFACTURER S4Ne-1< MATERIAL `� ` _C"L COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH I IQUID CAPACITY la`s O GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER OR WIDTH .L-, LENGTH! 2 DEPTH (11 { Cmx C, le�� 12 "vSs LINING MATERIAL CRIB SIZE: DIAMETER �DEPTH �� DISTANCE FROM: WELL )"�D+ ' TOTAL EFFECTIVE BUILDING FOUNDATIONS NEAREST LOT LINE JQ f . ABSORPTION AREA (WALL AREA) "�V� SQ. FT. ADDITIONAL ABSORPTION WELL: .I TYPE CONSTRUCTION 'F�I��IUE C�l?GUw D DEPTH r DISTANCE FROM: BUILDING -I NEAREST _ NEAREST SEPTIC SEEPAGE ' FOUNDATION ) LOT LINE SEWER LINE Q TANK !ZD SYSTEM 12- CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED REMA DISTANCES - INSTALLED BY: (1010! l Cny!� love k;olj PIPE MATERIAL: LOT SLOPE: REMARKS: a i2 Ol i1»t ec�1 blv Fo,m No. EQ -031 DIAGRAM OF SYSTEM GS----�-�_ fr1�✓x well DATE -11 APPROVED � �- G.A.A.B. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274,4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT - "1 INSTALLATION LOCATI LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK SEEPAGE PIT PERMIT NO. PHONEQ--2 DRAIN FIELD OTHER TYPE AND SIZE OF FACILITY TO BE 6E VI •, FINANCED THROUGH ln�l3_LOnC -4- 2 TO BE INSTALLED BY SOIL TEST aEsu L75 ^ .3_S�� �0•.C�' 0�4� NOTE, THIS PERMIT IS NOT VALID WITHOUT SOIL TEST • 97 COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE TYPE MINIMUM DISTANCES. REQUIREMENTS t: SEEPAGE AREA SIZE / Z)()(to eA FOUNDATION TO SEPTIC TANK _Sri 1 FOUNDATION TO SEEPAGE PIT �� DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL I.S1 -- 1 SEPTIC TANK .5 SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. 1 WELL TO SEPTIC TANK ( SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. 1 WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD � SEPTIC TANK. '�� SEEPAGE PIT DRAIN FIELD TO RIVER. LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDIN INSTALLATION. G.A.A.B. OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. �[ DATE • � ., " _3 APPLICANT'$ SIGNATURE ' FORM NO. EQ -01 6 OW R&M EN NEERING & GEOLOGICAL CONSULTANTS 229 EAST 51st. AVE. — P.O. BOX 6087 — ANCHORAGE, ALASKA 99503 TELEPHONE 907-279-0483 TELEX 090-35419 . 1 Civil Encineers JAMES W. ROONEY. P. E. MALCOLM A. MENZIES, P.E., L.S. JAMES H. WELLMAN, P.E. November 15, 1973 Mrs. Kathleen Ryherd 3202 Woodland Drive Anchorage, Alaska Geologists Land Surveyors RALPH R. MIGLIACCIO Nov i 91973AM En91n»ring G.mo9ist ORLAR fnY'WM""iM 4'"711a R & M No. 36689 Re: Test Hole and Soil Log Report for Sanitary System, Lot 25, Block 2, Prospect Heights Subdivision Dear Mrs. Ryherd: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of October 29, 1973, and those procedures outlined in a letter dated September 13, 1971 by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A single test hole was put down within the Lot 25 area for the purpose of defining general subsurface soil conditions for the proposed Sani- tary system. Excavation was accomplished with a tractor -mounted backhoe and the test hole was extended to a total depth of 14.0 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M ENGINEERING & GEOLOGICAL CONSULTANTS �ames W. Rooney JWR:ph xc: GAAB / ANCHORAGE FAIRBANKS JUNEAU T. H. 1 10-29-73 ORGANICS ORGANIC SILT SAND w/Some Silt (SP -SPI) 6:..I SANDY GRAVEL w/Cobbles (GW) •• v p' O D 0 0.0 oO 0.0. O Water Table Engineering &Geological Consultants ANCHOMAOR FAIROANxa ALASKA JUNEAU DATE 10-29-73 SCALE 1"=2' OWN BY JR5• CNKD BY 1042273 0.0' 0.5' 1.0' 3.5' 14.5' T.D. KATHLEEN RYHERD LOG OF TEST HOLE Anchorage . Alaska PROJ. NO. •j(,rp0 IDWO NO. • n• I$T Municipality of Anchorage • -� Development Services Department Building Safety Division Onsite Water and Wastewater Program s y 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 r--&-tssu.e Parcel I.D. 015-09140 COSA# tDrOIP5 Expiration Date: J— Z 3 D 7 1. GENERAL INFORMATION Complete legal description Prospect Heights #1 Blk 2 Lot 25 Location (site address) 9701 Slalom Drive, Anchorage, AK 99507 Current Property owner(s) Gary & Becky Ross Day phone Mailing address 9701 Slalom Drive, Anchorage, AK 99507 Lending agency Day phone Mailing address Real Estate Agent Lori Hackenberger/Dynamic Properties Day phone 907-727.4444 Mailing Address 3111 C Street, Suite 100, Anchorage, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well r❑ Individual On-site ❑Q 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 Onsite 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 On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage 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 Finn Watkins Engineering, Inc. Phone 907-349-1851 Address P.O. BOX 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis Date January 19, 2007 b. DSD SIGNATURE 1G Approved for 1' bedrooms. Disapproved. Conditional approval for bedrooms, with the following Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Well Flow Advisory Nitrate Advisory Maintenance Agreements Supplemental Engineer's Report Other By: /L/ Original Certificate Date:_ 3 ' �% i (n.,, rift) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water t6 Wastewater Program 4700 Bragaw Street P.O. Box 198850 Anchorage, AK 9951M50 www.muN.oWonslte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST FST Legal Description: Prospect Heights 01 Bik 2 Lot 25 Parcel ID: 015.091-20 A. WELL DATA Well type Pri If A, B, or C provide PWSID 0 _ Date completed 7/2/93 Sanitary seal (YIN Yea Total depth 327 R Cased to j3 IL FROM WELL LOO Date of test July 2. 1993 Static water level 16 ft. Weti production 3.6 g.p.m. WATER SAMPLE RESULTS: Conform o coloniesn00mL Nitrate 8.78• mqfL Arsenic: 10_005 mail Date of sample: 6/31/08 B. SEP ICIHOLDING TANK DATA Van LOG (YRS Yes Wires property protected (YIN) Yes Casino height (above ground) 18 in. AT INSPECTION May 31, 2008 23 & 8.6 o.p.m. Other bacteria 0 colonies/100 mL Collected by: Cindy One Tank Type/Matedal Steel Septic Tank Date Installed 11"973 Tank size 1250 gel. Number of Compartments 2 Cleanouts (YRS Yes Foundation cleanout (Y" Yea Depression over tank (Y/N) No High water alar (YIN) WA Date of pumping 5/90/08 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 11/90/1973 $61 rating (g.p.dAI? or It=/bdrm)85 System type Concrete Crib Length 12' it. Width 12' fL Gravel below pipe 6 IL Total depth 1� (L Eft absorption area 288 Its Monitoring bye a'2^ Depresslon over bald No Date of adequacy teat May 31, 2W6 Results (Pass/Fag) Pass For 4 bedrooms Fkdd depth in absorption field before test 21 In. Water added gal. New depth 68 in. Elapsed Time: 12D min. Final fluid depth 41.5 in. Absorption rate >• 800 9.p.d. Any rejuvenation treatment (past 12 mo.) (YIN 6 type) No If yes, give date 0. LIFT STATION Date installed N/A Size in gallons 'Pump on' level at _ In. 'Pump otr level at — In. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanks ift station on lot 120 Absorption laid on lot 100'+ Public sewer main 100'+ Sewer /septic service line Sa Animal containment areas W+ Manhole/Access (YIN) High water alarm level at in. Masts alarm a circuit requvamw ts? On adjacent lets 100'+ On adjacent lets 100'+ Public sewer manhole/deanout 1004 Holding tank WA Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLOING TANK ON LOT TO: Building foundation 60 Property line 104 Absorption told 20 Water main 100'+ Water service One 100' Surface water IW+ Wells on adjacent late I W+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property One 60' Building foundation 80' Water main 100'+ Water Service line 100'+ Surface water 1 W+ Davewsy, parldnWvehide ape 1 Q Curtain drain N/A Wells on adjacent lots 100'+ F. COMMENTS: Two nitrate tests were taken. On 7/18/06 the result was 6.78 mg/I and on &311W the result the result was 10.4 mg/I. Property has a chicken coop and a barn, weh appropriate separation distances to well. 0. ENGINEER'S CERTIFICATION I cedily that I have determined through field inspections and >k/7 4 review of Municipal records that the above systems aro in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Cindy W. EllisY tN. Ellis i Data 112 -9 -Oto CIC -710577 ; COSA Fee $4301— Waiver Fee 6 Date of Payment qC Date of Payment Receipt Number QeZ168 Receipt Number (Rev. 11/45) 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 Nitrate Advisory Certificate of On -Site Systems Approval # 060495 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 25 of Prospect Heights #1 subdivision. This inspection revealed a nitrate concentration of 8.46 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet"• for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SCS Rtt# 1067394001 Client Name Watkins Engineering Project Namd# Prospect lits No 1 B2 L25 Client Sample ID Prospect lits No 1 B2 L25 Matrix Drinking Water PWSID 0 Sample Remarks: All Datts/[Imes are Alaska Standard Time Printed Dltdrime 01/03/2007 15:19 CollectedDatelrime 12/21/2006 12:30 Received Daterrime 12/21/2006 13:43 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Resolts PQL Units Method Container ID Limits Date Date snit Waters Department Total NitrateMitrite•N 9.46 0.100 Microbiology Laboratory Total Coliform 0 mg/L EPA 353.2 B (<101 12/22/06 JDS coVI00mL SN1209222B A (<I) 1281/06 DPT Parcell.D. Municipality of Anchorage Development Services Department Building Safety Division Onsite 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 015-091-20 1. GENERAL INFORMATION 44t COSA# Wb-gg! - Expiration Date: I 1 1le7 Complete legal description .prospect Heights #1 Blk 2 Lot 25 Location (site address) 9701 Slalom Drive, Anchorage, AK 99507 Current Property owner(s) Gary & Becky Ross Day phone Mailing address 9701 Slalom Drive, Anchorage, AK 99507 Lending agency Day phone Mailing address Real Estate Agent Lori Hackenberger/Dynamlc Properties Day phone 907-727.4444 Mailing Address Unless otherwise requested, COSA 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 ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite 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 fide (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 engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined In the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. l further verify that based on the Information obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-s8e 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 907-3491851 Address P.O. BOX 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis Date /0 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the foil I M I 1 1 •:1111 I 1' I lu•'.1 1 I •' •• I Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: fr6t7f, (RM IIM) Municipality of Anchorage Development Services Department Butidng Safety Division On -Site Water 3 Wastewater Program 4700 Bragew Street P.O. Box 198850 Anchorage, AK 095198650 www.muni.orglonsile (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Prosped Heights S7 Blk 2 Lot 25 Parcel ID: 016491-20 A. WELL DATA wen type PA It A, B, or C provide Pn11SID s Dara completed 7/?/93 Sanitary seal (YIN) Yes Total depth RL__t Cased to 13_ft. FROM WELL LOO Data of test July 2. 1993 Static water level 18 fL Web production 3.6 g.p.m. WATER SAMPLE RESULTS: Coliform 0 cotonles1100 mL Nitrate 8.78• myL Arsenic: 10=005 mgll Date of sample: 5131/06 B. SEPTICIHOLDING TANK DATA Wan Log (Y" Yes W res property protected (YAV) Yes Casing height (above ground) 18 in. AT INSPECTION May 31, 2006 23 ft. &6 g.p.m. Other bacteria 0 colonies/100 mL Collected by: Cirnly Elns Tank Type/Materlal Steel Septic Tank Data installed 11!30/1973 Tank size 1260 gal. Number of Compartments 2 Cleanouts (YIN) Yes Foundation deanout (Y" Yss Depression over tank (YIN) No High water alarm (YIN) NIA Date of pumping 5130108 Pumper A+ Home Services C. ABSORPTION FIELD DATA i Date Insisted 11/30/1973 Sol rating (g.p.dAe or fe/bdrn)85 Length 17 M Width 17 R System type Concrete CAD Gravel below pipe 6 ft. Total depth 10 R Elf. absorption area Z% Il' Monitoring tube=—Depression aver field No Date of adequacy test May 31, 2006 Results (Pan/Fal) Pass For 4 bedrooms Fluid depth in absorption field before test 21 In. Water added gal. New depth 63 In. Elapsed Time: 120 min. FkW fluid depth 41.6 >n. Absorption fabs >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date 0. LIFT STATION Date installed WA Size In gallons `Pump on' level at_ in. 'Pump air level at_ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAtft station on lot 120 Absorption told an lot 100'+ Public sewer main 700'+ Sewer /septic service line Manhole/Access (YIN) High water alarm level at in. Meets alarm a orad[ rwprements9 On adjacent lots 107+ On adjacent lots 100+ Public sewer manhole/cleanout 100'+ Holding tank Animal containment areas 5(y+ Manure/animal excrete storage areas 1001+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 60 Property line 104 Absorption laid 20 Water main 1W+ Water service lone 100' Surface water 100'+ Webs on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property One 60' Building foundation 80' Water main IW+ Water Service One 100'+ Surface water !W+ Driveway, porldngMiWe serape 1 d Curtain drain WA Webs on adjacent lots 100'+ F. COMMENTS: Two nitrate tests were taken. On 7/18/08 the result was 8.78 mgn and on 5/31108 the result the result was 10.4 "A. Property hes a chicken coop and a barn, with approprlete separation distanoss to well. The 1979 well was abandoned Der MOA code. 0. ENGINEER'S CERTIFICATION �"vS 1r 1 codify that I have determined through field inspections and >�' 49TH review of Municipal records that the above systems aro in conformance with MOA COSA guidelines in effect on fhls date. Engineers Printed Name Cindy W. Ellis _W Ellis "� Date - l3•., CE.Tserr ���333 .............. a COSA Fee $ 3 ©S— Waiver Fee S DateofPsymentlozqlca Date of Payment Receipt Number 06`7188 Receipt Number (Rev. 11105) 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.orglonsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 060495 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 25 of Prospect Heights #1 subdivision. This inspection revealed a nitrate concentration of 8.78 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Nitrate Fact Sheet From Northem Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perforin an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. SCS ReO 1062760001 Client Name Watkins Engineering Pmjmt Name/t! Prospect Heights 111 Blk2 Lot25 Client Sample ID Prospect Heights NI Blk2 Lot25 1lfatris Drinking Water PWSID 0 Sample Remarks: All Dates/rimes are Alaska Standard Time Printed Date/time 061072006 8:02 CcMeeted Date/rime 05/312006 9:00 Reeelved Date rime 05/312006 10:41 Technkal Director Stephrn C. Ede Allowable Prep Analysis peruncta Results PQL Units Method cmtainam Limits Date Date Ind metals by ICP/MS Ar. is ND 5.00 ug/L EP200.8 C ("10) 06/01/06 06/01/06 SCL Waters Department Nitmto-N 10.4 Microbiology Laboratory Total Coliform 0 0.100 mg/L EPA 3532 B (<-10) col/100mL SM209222B A (<-1) 05/31/06 AIR 05/31/06 TLF SCS MOO 1063968001 Client Name Watkins Engineering Project Name/tt Prospect Rights #1 Blk2 Lot25 Client Sample ID Prospect Heights ill Blk2 Lot25 hlatrix Drinking Water PWSID 0 Sample Remarks: All Dates rimes are Alaska Standard Time Printed Date/Time 07/21/2006 11:57 Collected Date/Time 07/18/2006 10:12 Received Date/Time 07/18/2006 10:48 Technical Director Stephen C. Ede Allowable Prep Analysis Paramcier Results PQL Units hiethod Container ID omits Date Date Int Waters Department Nitrate -N 8.78 0.100 mgfL EPA 300.0 A (q0) 07/1&'0607/19106 DSII ,ti tiV �r'PA:.. 26 30• BARN Aq LOT 25 U 12B /Y 24 / / / / / / / / / / 13 PLAT NOTE: 2. ALL EASEMENTS ARE ALSO FOR HORSEBACK RIDING, HIKING, AND CROSS COUNTRY SKIING. NOTE: THIS DRAWING IS NOT TO BE MODIFIED FOR USE AS A PLOT PLAN. EXCLUSION NOTES: It to the owners' responsibility to determine LEGEND: SET FND ORDERED eY: Ns existence of any easements. covenants. or restrictions 5/e'RB w/CAPD 5/8' RB 0 Lori H a c k e n b u r g e r which do not appear on the recorded subdivision plat NOTE: 3,25' AL.MON. O MONUMENT 41) with DYNAMIC PROPERTIES, INC. Under no circumstances should any data hereon be used for NUB & TACK 0 it;F at4 construction or for establishing property lines. FENCE- —.— x — 5URVLT GERRFICATIUN: LANTLCN has conducted a physical survey of this property as shown on thls WOOD DECKS- -- drawing and that the Improvements situated there CONCRETE- f"'�� are the property and no encroach- ASPHALT- 1 '. m menta exist Other than noted. exist ed. GRAVEL- S— B U I L T O F: LEGAL DESCRIPTION: SEPTIC STANDPIPES- S WATER WU.- LAND & CONSTRUCTION SURVEYORS -PLANNERS -ENGINEERS 440 WEST BNSON626 LOT 25, BLOCK 2, ANCHORAGEEALASKALw 95 30 90(fox7)55562-5291 PROSPECT HEIGHTS SUED. ADDN. NO. 1 WORK ORDER NUMBER: OCT O6, 2006 OCT s� 1'60• "AT"" 67-2-23 eH en oCaID eT dbD MxbrA_ sooE AGF 2/1:1L�1 ��i�ri� Lim L L 2/� NRB APH 2441 457/56 Parcel I.D. # MUNICIPALITY OF ANCHORAGE AAL • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services law On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 RVvf 36z/oo CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 015-091-20 HAA# HREDOM9 1. GENERAL INFORMATION Complete legal description Lot 25, Block 2, Prospect Heights #1 Location (site address or directions) 9701 Slalom Drive Anchorage, AK 99516 Property owner John Melvin Day phone 346-1944 Mailing address 9701 Slalom Drive, Anchorage,AK 99516 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 - 3. TYPE OF WATER SUPPLY: - Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. n reass m,.. uv1> ROM MOA m I� 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S 8 S ENGINEERING /q y _ �q Phone (� C'17034 coule Rive, Lao,, Read Fla. 204% Address Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. M Disapproved. Conditional approval for Date 3/6/0o n ys ROBERT C. COV/AN CE -8801 bedrooms, with the following stipulations: Additional Comments Note: The well for this property meets existing State and Municipal Codes. .Thera are nitrates present_ It is suggested that perlodle teqtlng be performed to insure the wells continued suitability. Current nitrate �__ !_ A 7/. /1 RAA .l coricciiccd`czou z� �rr7 s<s'f s, v.i-.{ANm soncontration.-.is 1Q.A Wg 1 - More information on nitrates is available from the On-site Services Program, —mics, 343-47441 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate Is Issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rar. wn Back MOA alt ?%ECEIVED 0 Municipality of Anchorage MAR 0' , DEPARTMENT OF HEALTH & HUMAN SERVICES Mt&MLWAUTY OF „ Environmental Services Division .�.,,�,u $ 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: LOT AF b L O C K a Parcel I.D.: O I S - O 9/- a O fL,)JPicT #4014/1rJ A. WELL DATA Well type 0,414 R TL If A, B, or C, attach ADEC letter. ADEC water system number Log present (y)N) YES Date completed n 1 / 9 3 Total depth 3 1`116 -7 r , Sanitary seal &N) Date of test Static water level Well production N4J Cased to 13 T ° 4 bo 2 i Casing height (above ground) FROM WELL LOG 7/;lL/ti 3 WATER SAMPLE RESULTS: Colitorm 0 3.S Wires property protected (&N) Y Af J AT INSPECTION I a' �-4 g.p.m. g.p.m. Nitrate 01.111 Other bacteria u I }y oo S i 3 ENGINEERING Date of sample: Collected by: .e R IvatLoop Road No. 204 B. SEFnC/HOLDING TANK DATA Ewe Rte, Alaska 99577 Date installed 30 73 Tank size I >- S- O Number of Compartments X Cleanouts &N) %141 Foundation cleanout &) �jjYYA f Depression (Yo rJ ° High water alarm (Y& v o Date of Pumping Z//! Pumper /3 t Noy., s sr.ev0 c. i C. ABSORPTION FIELDDr "_ DATA Date installed 1/ h o / 7 Soil rating (g.p.d./R' or g.i- System type CR Length ) i Width 1 , Gravel thickness below pipe 6' Total depth j D I Effective absorption area 7- fr%7 f / r Monitoring Tube present &N) YIEJ Depression over field (Y4& ^r Date of adequacy test a` / y�10 Results as 'Fail P# rJ For 'f bedrooms I/ / N Fluid depth in absorption field before test (in.); � a ti Immediately afterAL/gal. water added (in.): � Fluid depth (ins) Minutes later: Z 9 Absorption rate - 6 0 0 + O.p.d. Peroxide treatment (past 12 months) (YIN) 1" ° " 4- 'ic If 0 If yes, give date 72.026 (Rev. 3/96)' D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at' E. SEPARATION DISTANCES Size in gallons 'Pump on" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer /septic service line off' level at' On adjacent lots /00 -1-- On adjacent lots /00 r+ Public sewer manhole/cleanout N A Lift station r✓ 1.4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 1 Foundation $-0 •f- Property line 0 + Absorption field Water main/service line 10 �4- Surface water/drainage /dy r f Wells on adjacent lots / o 0 L SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line T 0 ,f Building foundation VO '-I'- Water main/service line 10 Surface water 100 14- Driveway, parking/vehicle storage area S , -t- Curtain drain T1 J N i K N O Wr Wells on adjacent lots 100 4- F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal in conformance M A HAA gulines in effect on this date. u Signature /)�-•�✓�. % Engineer's Name �g et QT C . CO wR AI Date 3 6 / 00 HAA Fee $ 0001 OO Date of Payment SY-7l eb Receipt Number S%%O 72-026 (Rev. 3/96)' Waiver Fee $ -^�'S RCCERf C. COWAN Date of Payment Receipt Number are MUNICIPALITY OF ANCHORAGE • ^• DEPARTMENT OF HEALTH & HUMAN SERVICES �t 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.# niti -X11-a(i HAA# 1. GENERAL INFORMATION Complete legal description Lot 25; Btock 2; PROSPECT HEIGHTS 01 Location (site address or directions) 9701 Statom DRtve Anchorage, AK Property owner STATE OF ALASKA Day phone 561-2220 CIO H.R.T. REALTV Attn: John Vkbene Mailing address 341 W Tudor Rd Suite 103 Anchorage, AK 99503 Lending agency Day phone Mailing address Agent John Merle/ HRT Reatty Day phone 561-2220 Address 341 W Tudor Rd Suite 103 Anchotage, AK 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (S". W) Fm t MOA N21 (UYOW 3x8 (161L A&d)%ZOZL ,Tom slaau!6ua leuo!ssoloid atll w suo!ss!wo jo slam jol olq!suodsai IOU st 96ejoyouV to A1!led!o!unyl ay1 •panssi si eleoggiao a elolaq elep azdleue jo suo!loadsui lonpuoo IOU op SHHO;osooAoldw3•sluawaj!nbaialelspuslejapa;umpoo AlsilLsof opiou!suo!lnlRsu!6u!pualnaylpue sawoq to siasegoind of Rsalinoo a se SIM saop SHHO 9q1 T)IselV to WIS agl u, pajals!6aj jaau!6ua leuo!ssalad luapuadapu! ue Aq a"oge S ydw6und ui u9n!6 suo!leluasaidai ayl uodn Aluo paseq saleo!;!lia0 ls"addy Al!joglnV ylleaH sonss! (SHHO) sao!niaS uewnH pue ylleaH;o luawlieda0 o6ejogouV;o Al!led!o!unyq a41 :suo!lelnd!ls 6u!mollo; eyl ql!m 'swoojpaq �r- 1• j.. tf ele0 6 auoyd sluawwo0 leuo!l!ppV .(o; lenadde leuop!puo0 •panaddes!O •swooapaq Jo; panaddV 3Hn1VNJIS SHHO LL566 on9eIV „"!a alcu3�.yemleu6!s s Jaau!6u3 ssalppV U111:1 10 aweN •uo!loadsut s!yl;o gvreyl uo loa)fa u! 6uo!leln69j pue 'saoueu!pio 'sapoo olelS pue led!o!unn Ile yl!m aoue!Idwoo u! s! walsAs sOd�p lalemalsem Jo/pue �llddns jalem el!s-uo egl'uo!loadsu! pue uo!le6!lsanu! �(w LL pue la e6ejoyouV;o p!led!o!unlnl eyl woj; pau!elgo uo!lewjo;ut ayl uo paseq lsyl A;uanjaylin; I •u!ajay poleo!pui ainlonuls;o ad 4 pus swoojpaq;o jagwnu eql .(o; elenbape pue leuo!loun; 'a;es s! wags (s lesods!p Jalemalsem Jo/pue Alddns jalem ol!s-uo ayl leyl smogs uo!ieo!idde IenaddV Al!aoylnV ylleaH s!yl;o uo!le61lsanu! Aw leyl I!;uan I 'molaq umoys olep uollep!len eyl;o se pus 01019y pax!;le leas Aw Aq pa!pvao sy '9 U33NION3 AS N01103dSNl d0 LN3W31V.LS 'S ® Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT ZS t3LJ< Z 110 40,110 cr Parcel I.D. E/6rtTS S/� A. Well Data Well type p Z(t1A1-6 If A, B, or C. attach ADEC letter. ADEC water system number A -1A Log present &) J) 7h5 Date completed ZI Driller ASA/V Ia21cc / �G a FNI Total depth 32-9 / _Cased to 13 '(66p1COG`-) Casing height / 'f - Sanitary seal&) /ES Wires properly protected cam) FROM WELL LOG AT INSPECTION Date of test Static water level ToP oFCAS/.yG N � Tn N P Well flow 3. S g.p.m. g.p.m. Pumplevelt Z7 rTt C SEPARATION DISTANCES FROM WELL TO: Z Nsu 45W r / Septic/holding tank on lot "/ZC)On adjacent lots /C?U Absorption field on lot 100,4- : On adjacent lots (QO f Public sewer main N�✓c /°26-rcN r Public sewer manhole/cleanout A-uNe.-f- 0,t61 •tel" $ewer service line 2i t Petroleum tank Ajbo jt;- KEW wa OLD �i�� -Croe.+��.I ►�cs..�coSFa. s�a�e� f �000 D[r� 1rc.E WATER SAMPLE RESULTS: Coliform. UU Nitrate • J /` Other bacteria S & S ENGINEERING Date of sample: Collected by: 37=4 E-4tAlum r 6p Ro.a No. 204 Eagle River, Alaska 99577 B. SEPTIC/1,11=08-TANK. DATA Date installed 91 Tank size /U6 Compartments Z Cleanout (Y/ ) - (� 1 Foundation cleanou (Y ) yef-s Depression (Y@ .�JO High water alar (Y f/F')) N41 Alarm tested (Y/N) Nr/� Date of pumping.1;7-/1.31 cl3 Pumper t HoM'E S6xV/C..6 C SEPARATION DISTANCES FROM SEPTIC/ 081!Bl G TANK TO: -4Z0" Mew L)FLL . �S Well•60s) on lot !00' o cJdLL- On adjacent lots /UU Foundation To property line ?--0 S�- Absorption field 20 r� Water main/service line --40 /f' Surface water/drainage itZ,✓E P2 cELrr- 72-0201M'Front CONTINUED ON BACK PAGE C. uFT STATION ll)JjE P2�E,Vl� Date installed Manufacturer Size In gallons Manhole/Access (YIN) Vent (Y/N) High water alarm level 'Pump on' level at "Pump Meets MOA electrical codes (YM) SEPARATION D. ABSORPTION FIELD DATA LIFT STATION TO: adjacent lots Surface water Date Installed 93 Soil rating (GPD/FI2) U. SZ System type GtZ'6 Length I Z Xvdh I Z Gravel thickness Total depth /Z Total absorption area ZL?(Frf Cleanout present 67N) _'i Crr Depression over field NO 14-11b Date of adequacy test s�13 / ti 3 Resultpas a0) }�A fS for ouK Bedrooms Water level in absorption field before test U After test n Peroxide treatment (past 12 months) (YM) .(b Uc-- ktiowAJ If yes, give date 14A_ -f SYSTEM HEAul(-y 2CXX 4ao.#jSt. SEPARATION DISTANCE FR3M ABSORPTION FIELD TO: /toe W[�� Well on lot '00 0;4-�� � ) On adjacent lots 100 �Property line Mo..� /°iCe3ENT To building foundation LTO existing or abandoned system on lot r On adjacent lots % Cutbank e4-61SCU'rWater main/servloe line ZS 4 -- Surface water 1C bA,4e5 e2Q97-Jr Driveway, parking/vehicle storage area ZO" Curtaindrain NINE Pk(=SrIJ'r c, E. ENGINEER'S CERTIFICATION YY\�. I cern7y Mat I have checke/dy�verilied, or conformed to all MOA and HAA guidelines in effect olr//�tAte ari��dI UNs inspection. Signature i r, Engineers N es GINEERING 7034 Eagle Rlver loop oa No. 204las? Date glel�tyrr Alcska99577 ::z T, 93 so••" ,,..!la`�`�•' DOFF sly' HAA Fee $ /70 Date of Payment Receipt Number 72-026 (=)• eaca Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY ANCHORAGE O DEPARTMENT OF HEALTH 6 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.tf C-�122"nC\I'aQ 1. GENERAL INFORMATION Complete legal description Lot 25• Btoch 2• Paoapect Height6 Subdiviaion 01 Location (site address or directions) 9701 Statom P ive Property owner Empt oy eeAtaRs2hLa rtFeonn2n;C FFuPnd Day phone Mailing address Lending agency Day phone Mailing address Agent H R.T. REALTY ATTN: John DiSene Day phone 561-2220 Address 341 Wet Tudoa Road Anchonaoe Ata6k=99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 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: XX 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. 72-025(Rm. 1191) iwm MOA 121 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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S A S ENGINEERING Phone 17034 Eagle River Loop Road No, Address P! . Wye , •I&A995/72 Engineer's signature 6. DHHS SIGNATURE Approved for �aT r bedrooms. Disapproved. Conditional approval for Additional Comments Date '5' I'92 bedrooms, with the following stipulations: By: /11_c� (L_«-x.t•1 Date �— d — 9Y The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(R".1/91) 8Kk MOA 121 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 2S Parcel I.D. �Fvzc�e2:,r mi -54-I A. WELL DATA Well type' If A, B, or C, attach ADEC letter. ADEC water system number —' Log presentom Y Datecompleted g'3"79 Driller FOSS Total depth t Cased to 2-7,Casing height 12t+ Sanitary sea1o7N) Wires properly protectedd5J)�` FROM WELL LOG AT INSPECTION Z rQ Date of test8' 2 - I $ H `" Uj m Static water level 1 GtPH $ u:t Well flow Q-P'Mr. fp Cl- V• Pump level p a uj & LJJ C4 SEPARATION DISTANCES FROM WELL TO: r Septic/holding tank on lot" " -4' ; On adjacent lots t� r; t t m X Absorption field on lot oe(� ; On adjacent lots Public sewer main a L' Public sewer manhole/cleanout r1 A Sewer service line —Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate 3 8 "O/ Other bacteria Date of sample: e5 Collected by: S S U,P1�DD`T+E B. SEPTIC/HOLDING TANK DATA Date Installed —Tank size Compartments Z Cleanouts6)N)—foundationcleanout(6!J� ) Depression(Y High water alarm) _ Alarm tested/(�Y%N) Date of pumping �Jl9 9 Pumper YTS 1�wk1CSS SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s)onlot \1211c> Onadjacentlots I C)t.:> '�- Foundation (oS I 1 To property line lo` H Absorption field Water main/service line A- Surface water/drainage �I -I 72.026 (Rev. 7/91) From - CONTINUED ON BACK PAGE C. LIFT STATION Date Installed Size In gallons Vent (Y/N) "Pump on" level at _ High water alarm level Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) _ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA 'Pump off' level at Cycles tested Surface water Date installed V ��iY7—�3 Soil rating System typer—p�� Y) r t 1 Length - _ �" ' Width 12 Gravel thickness !�t Total depth 1<21 Total absorption area - Z� Cleanouts present MN) - Depression over field (Yit ` Date of adequacy testI Results (CJ79i�/fail) for 4 be Peroxide treatment (past 12 months) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: T✓G��}, Well on lot �1�71� On adjacent lots iC:)�Ir Propertyline Io V - t To building foundation To existing or abandoned system on lot • 1 On adjacent lots Cutbank Water main/service line K 'r 1 Surface water (�'� Driveway, parking/vehicle storage area 'Zot Curtain drain tJot i6 V--rJoWF4 " E. ENGINEER'S CERTIFICATION I certify that I have checked, 'verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & S ENGINEERING q.(-- OF -411, 17034 Eagle River Loop Road No. 20.1 y'tQ�•'•1•�•••�1j 0 Signature i • • + s astaR�.-n�.�_sssn J* •s9 e� Engineer's Name � a. 1.... N. M.NI. N.N •Ia� Date 2 a .. I — 9 d �+ t • RO.,�R J. WAFER t W No. 15 ! q N HAA Fee $4170. Waiver Fee: 3 Date of Payment C1Z Date of Payment Receipt Number % d �. �s�a') Receipt Number 72-M (Ft". 3101) Back MOA 21 MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services �,. P ,99��/ DIVISION OF ENVIRONMENTAL NTAL SERVICES 8 Eg 2 F RSITE CATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF NSEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel LD. # ��� — �� I — ac) HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) LegalDescripticn (include lot, block, subdivision, section, township, range) Lo.t:25: Beocl Location (address or directions) 9701 SEat6m Wve n # (b) Property owner State 04 Alaaka :Son ip crelephone : (home) Business Empt.oyee6 Rewtement fund Mailing Address (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent ROSE PROPERTIES ATTN. • James Silte6 Address 341 wat Tudoa Road #103 AnchonagQ Ata6ha 99503 Telephone 561-7550 (e) Mail the HAA to the following address: (or check here W9 hold for pick up.) List contact person and day phone number below: S & 5 ENGINEERING 17034 Eagle River Loop Road No 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family MX Number of bedrooms 4 3. WATER SUPPLY Individual WeIIXX Community ❑ Public O Note: If community.well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site EXx Public 13 Community D Holding Tank O Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. n-025(R".TIM Page 1 of 2 Z 1 Z 86ed vote leve»m szov •Tom s,Jaau!6ua leuo!ssa;ad ayi u! suo!ss!wo jo siwna io; olq!suodsai iou s! a6ejoy0uy;o Aiped!o!unVq ay1'panss! sl aleolpliao a ajolaq a;ep azAleue io suo!loadsui lonpuoo lou op SHHO ;o saaAoldw3'sivawannbaj aieis pue lejapal u!elin Als!ies of iapio u! suo!3ni!lsu! 6u1pual nays pue sawoy ;o siaseyand of Aselinoo a se s!yi saop SHHO sy1 'eNsely ;o aieis ayi u! paiais!6ai jaau!6ua Ieuo!ssolwd ivapuedepu! ue Aq aaoge g ydeiBeied u! uan!6 suo!ieluasaidai ayi uodn Aluo paseq paleo!;uao IenaddyAiuoyiny yileaFl sanss! (SHHO) sao! vag uewnH pue yileaFi;oivawliedaO e6ejoyouy;o A;!led!o!uny�l a41 = NOdnvo �vai.ntsY / OTf'o l,.ctlr �vn��',(a �i�nt,>• �� �ciil b�c�rvd GO�oA+�luv0 ,-„Js/y! '�D71�fpani>d �.�iifn'.�.s.n, (/ly �� ���� ��rn '7�..•r �yc f.'+u✓ C!74 •.boyo vi Pvt.�rva v ,Inst/ cy4 O OY.-" O O S/ //� M - / ~j�,p 7la�O�.i .r sf�•! .TGO� ��'�r ri f/ %/��S.:Sl' 7*: � 7Y�to • �j1)J• �ivi'sit�v 6y�rYPs�r �L •+lJsa�f j�° o S'•r./nnfo,�s w..n..w lar rs� Sh'I, is 01 -sa ,7y,a[/vccv,,�o "v^ J �x01V !enoiddy !euop!puolO;o sW7a1 leuo!i!puop panwddes!O panaddy e3e0 q swowpaq Jo; panaddy C•/ /� 1VAOHddV SHHO '9 y . d:�: Z•Lr+l r0000p • f Mb ; .tsys4S Y V • �.i.«.. 2 ..•.5800 �? - tea^�47�w`t+�~ euoydalal LLS66 e)l40ltl'J0"!jl 9lBe3 ele0 ssajppy 9Nill33i:i�N3 5'J S wnj;oaweN •uo!ioadsui S141 10 step eyi uo ioa;le ut suo!leln6aj pue 'saoueu!pio 'sapoo e3e3S pue led!o!unVi Ile yl!m aoue!Idwoo ui si walsAs lesods!p jaieme;sem jo/pue Alddns jalem eps-u' ayi 'uopoadsu! PUB uo!ie61is8nu! Aw woj; pue sal!; a6ejoyouy to Apled!ownyy eyi wal pau!eigo uo!lewjo;uf ayi uo paseq ieyl A;!Jan jayiJn; I •umay paieo!pu! einionuis;o adAi pue swowpaq;o jagwnu eyl Jol alenbape pue leuo!ioun; 'e;es sl waisAs lesodslp Jaiemaisem jo/pue Alddns jalem ei!s-uo 6yl leyl smogs Ienwddy Aiuoy3ny yileaH s!yi;o uo!ie6!isanu! Aw ieyl A;uan I'molaq UM04S aiep uo!iep!len 041 10 se pue olaJay pax!;le leas Aw Aq pa!;!pao sy NOIIVWHOdNI ONV VIVO'HOHV3S MIA'S1S31'SNO1103dSNl VNIOIAOHd WHId ONIH33NIJN3 •S MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 ? co 1� O Legal Description: �-a— 5— r �� ��f ier�h is D'►- A. WELL DATA t.6 _ Well Classificati ;0Q4 • h -R 116 IW If A, BB, C, D.E.C. Approved (YIN) Well Log Present (YIN) &I_Date Completed 1 Yield Z S Ste\ 12-18-rtl 1 Total Depth-ZL!WCased to :�J� t Depth of Grouting -- Static Water Level (I., • I Pump Set At t Casing Height Above Ground / 2 / + Sanitary Seal on Casing (YIN) Electrical Wiring in Conduit (YIN) Depression Around Wellhead (YIN) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot On Adjoining Lots / DO To Nearest Edge of Absorption Field on Lot �n i� ; On Adjoining Lots 00 1� To Nearest Public Sewer Line _ j&) — To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by S l s ENG 1A%erJiAfti ' Date �p��-Fe's Sample Test Results - Q .) X11111 �1 _�, I • �� B. SEPTIC/HOLDING TANK DATA Date Installed 11-30-7 Size No. of Compartments Z Standpipes (Y/N)—Air-tight Caps (YIN) 11 Foundation Cleanout (YIN) Depression over Tank (YIN) Date Last Pumped II - -_-. % O - 9 Pumping/Maintenance Contact on File (YIN) ;for Holding Tank High -Water Alarm (YIN)1 1A Temporary Holding Tank Permit (YIN) w SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: 1 1 To Water -Supply Well I Oil l To Building Foundation To Property Line /n f To Disposal Field Z o To Water Main/Service Line ( o To Stream, Pond, Lake or Major Drainage Course ( 00 r f Comments 15�) C nf* ipuwy0ed b)(4 {g t 1�Onae �etrvlC�S n -M (A". i/W) ROM Page 1 of 2 - . 1 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design rj76gr- A, f Date Installed - / - , Z Length of Field - 1.2 Width of Field / Z Depth of Field _ Acpx Gravel Bed Thickness Square Feet of Absortion Area -_ Statndpipes Present (Y/N) N Depression over Field (Y/N) I Date of Last Adequacy Test Results of Last Adequacy Test SA 715.1 ►9 CTo (u - SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply - t PP Y Well � 00 r To Property Line - (O "IL To Building Foundat'on /e To Existinp or Abandoned System on Lot J ; On Adjoining Lots - --J, O -1 To Water Main/Service Line / o f To Cutback (if present) !!5Z_0 �f i To Stream, Pond, Lake, or Major Drainage Course r e)r7 r t To Driveway, Parking Area, or Vehicle Storage Area =7 n Comments D. LIFT STATION Date Installed . Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at — Vent(Y/N) _ Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in inspection. S & S ENGINEERING Signed 17034 Eagla River Loop Road No. 204 Eagle River, as a ,+ Company Date `L — 2, .0 / MOA No. r- r -O d?h - 10 fl 3 ReceiptNo.'o-2,52L, `7` ic7 Date of Payment n2Z` Amount: $ l 7 D e - Receipt No. _ Waiver Fee: $ Date of Payment 77-026 (Rev. 7/88) Beck Page 2 of 2 ettect o e date of this •.•h• ap En�ihee s1Seal ............... 1. aob.n A. shaf,....: No. 1457-E p't�FESSfON�;,7