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HomeMy WebLinkAboutSUNNY BLK 2 LT 1Sunny Block 2 Lot 1 #015-351-33 %.s Municipality of Anchorage Page of 7 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW930/7/ PID Number: O/S7s/33 NameL'/NZ)S. E. E•u2 1 Wastewater System: New ❑ Upgrade Aaeres30 ABSORPTION FIELD Phis..[• 9S/G No. of Bedrooms '(Deep Trench ❑Shallow Trench []Bed ❑Mound ❑Other .tJG O AGE � LEGAL DESCRIPTION Soil Rating Total Depth from original grade: ' .Opr GPD/S Ft Lot Block: Subdivision: Depth to pipe bottom from original grade. Gravel depth beneath pipe Z JBD. 3 FI .f• Fl Township: Range: Section: Fill added above original grade: Gravel length: >f -.7 Ft 96 Ft WELL: ❑Upgrade Gravel width: Number2 of lines: Distance between lines .New SFt /3 Fi Classification 'nvate A.B.C). Total Depth: Cased To. Total absorption area: Pipe material: F"O tRF7 V,47 -E-/3/ FI /?O.Z-Fl. tbp So fl IASr-*U 1>3W4 P. V.C. Driller ILLJA)C Date Drilled I/Z/�?3/17.? Static Water Level. /'t•Ft. Installer: WAX7- Date installed: 9 -22-93 Yield - Pump set at I Casing Height Abe" Ground. TANK 20 GPM FI 2 FI, SEPARATION DISTANCES XSeptic ❑Holding 0S.T.E.P. To Septic Absorption Of Holding 'ubba/Pnvaie Ma ifaeturer: Capacity in gallons: From Tank Field Station Tank $ewerLnroa E /Au,t /Zs'0 Well ,?a ' , 36 t 2-5• + Material: 57M_ Number of Compartments: Z Surface :t. 160'4 LIFT STATION Water/00 Lotr .� Size in gallons: Manufacturer Line /O f /D Foundation doe %l' 'Pump on" level at: "Pum -evel at: High water alarm at: Curtain NON KNOWN pump Mak et Electrical Inspections performed by: Drain BENCH MARK Remarks: Location and Description: n7 — MP Of CAAJCItETE ETAiN/A7% ALL Ap4UVD 77ZET�S / Mrd Assumed Elevation: ENGINEER'S SEAL A' Gl. >a l 17034 Eagle River Loop Road, No. 204 i Inspections performed by: Dates: 1 911C19 p • - �• _Eag"1Y9r.Alkska_M77_ 2n .o. "M A. Department of Healtand Huma—'K ices approval • l c��a•••Y a.w'w••. Lha ilit=\�4Rgt�, Reviewed and approved by: Date: 72 013 IRev 9x91) MOA 25 Permit NoSW9.30171 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 a Anchorage, Alaska 99519-6650 *Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal DescriptiorSPNNY SUBDIVISION, BLOCK 2, LOT I PID No.: 01535133 72-013 A (1193) * Col CO2 95. FINAL GRADE MTI C04 a z 98.5' C06 11T2 COB 5.9' . . - 947 ...... ..... ... :94.7' ......... ... ................. ...................... ........ .............................i..... ................................................................ NEW ......................................... . .. .... 02.6 1250 GAL r92 4 S.. . (tr R C0q4 :91 SR C05) (C67 XOB ........................................ .......................... .............. ..................................... ... ......... ............. ............... . .................. .... .................. 88.2 . . . . . ... .... .... ......... ....................................... ABO.2'NO WATER FOUND A TCO 50.0 15.0 COI 90.0 62.0 CO2 98.0 67.0 CO3 114.5 79.0 ;WELL C04 127.5 112.5 C05 131.0 118.0 COG 134.5 117.5 C07 143.0 124.0 C08 132.0 90.0 Ifft 124.0 110.0 )AT2 132.0 198.0 .. ...... .. ...................... . ... . ................. . ........... . . ....... . E ... . ............... ..... .......... . . . . . ........................... ...... ........ . . . . .................... . ....... . .... ..... . .. ............ . ....... ..... . . ........................... . .... ............................................................................... ............................. ...... ......................................... BDRM ......................................... . ......................................... NEW 1250 GAL. HOUSE SEPTIC TANK .............................. ........ .................. ....... -------- - . ....... ...... . ..... ....... . . ................. L co Mn B 06 co cm far, CO i- EW -TRENCHES ......... ...•.. bbarl A. She, SCAM 1' 40' CM 14-7-i 72-013 A (1193) * M -W !t. ILL IVU.7V,�4,". ' •• ---" - ---- - ............................. M -W DRILLING, Inc. P.O. Bdx 110378 • 10330 Old Seward Highway (907) 349.8535 ' ANCHORAGE. ALASKA 09511. DRILLING LOO Well Owner Linda llendrikson _ Use ofWell.I2�r Location (address of; Township, Range, Section, if known; or distance main road Lot 1 Blk. 2 Sunny Sub., Anchoravc Size of casing G' -'—Depth of Hole 131 Beet Cased to I ) 2 —feet Static water level I+ rt. (VA) (below) land surface. Finish of well (check one) open end ( X ); Screen ( ); Perforated ( 7). Describe screen or perforation .ua Well pumping test at. 0 '964 -ons Pei. (1 ) of drawdown from static level. Date of completion --1125 :111.1.. - � (minute) for 12 hours with— D .__it. ,lsbuilt Not(eS: 1) 1)ry grouted w 1/sk Bentonite grazluleo 2) Plug installed at -6' WELL LOO stop artesian flow. Depth in feet from ground surface Gi.ve details of formations penetrated, size of material, color and hardness C TO 2 TO 5 6rcani9 .- r TO? Z �1lYJC _,etfi>ZS3: brown �TO_ Cmal QXayL ,_ gqnjv r1 v .r.__— ' - 76 TO 9a Stlty'Sand; gravelly, compact )8T0125 Sands. :f;ravelly,' dirty, 'wet, -heaving T0131 tater Cravel; mediuti, sli,^,fitly sandy, ilawing; (lrtesiau CeYt\V s ai\ w 3—CONTRACTOR 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 AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930171 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:HENRIKSON LINDA J E & OWNER ADDRESS:600 WEST 58TII AVENUE ANCHORAGE, AK 99516 PARCEL ID:01535133 LEGAL DESCRIPTION: SUNNY BLK 2 LT LOT SIZE: 93972 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 1 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 (o nm 9-9-IZ DATE ISSUED: 6/21/93 EXPIRATION DATE: 6/21/94 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: RECEIVED ISSUED BY: BY Y. DATE: 6 ( 22jq3 DATE: 2' AP Owner install approved subject to the following: 1. House must be for resale. 2. Owner -only (not employee) must install. 3. DHHS must be advised not less than 2 hours before first & second inspectionby the engineer. Robert W. Robinson 9-14-93 A • �SLl •I • 7` N z� O � W � Y O ti' ��: • c o H •z G� 1 qsc s 411t « I 1 I 1 I I 1 I I 1 1 0 � N z� O � W � Y U N _> A� H N O � U G� W o o In cl) = O O U) A W � z M > in N N c N '' M', o r.j c r� Ln 1"1 WOVI = p CL Q N" z W pW W Q ®I at y j O 3 "ter W— J v N F aC73 �naNC C\i o q minril0 y ` x �rcr U z;4) 1 qsc s 411t « I 1 I 1 I I 1 I I 1 1 0 � N z� Q � W � Y 4 A� aL. �oNQ G� W o o In cl) = Gi OON U) U tO 70 z D z „ o N 11 cq r� p N \ J W m00 q vtnto z W J 2 � 1 qsc s 411t « I 1 I 1 I I 1 I I 1 1 0 Win 1 .09 = t �i % r----------- i ----------------------------- - t4\ i W i S W. � 1 N O C, li ""O> O 1 'o 1 G U 1 / i 1 u 1 to �z rn i Ix m IL N a 1 �\ µ7p C 0 1 1 1 I I Win 1 .09 = t �i Municipality of Anchorage v DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: AL NENDRICrsON DATE LEGAL DESCRIPTIOWQJNNy Ste,oT I r R.,L.A-2 Township, Range, Section: n� SLOPE z I. 3 4 5 s' 6 7- 8- 9- 1D-1 891D -�' 1, 12- 13- 14- 15-1- 16- 17- 18- 2131415161718 19- 20- COMMENTS 920 COMMENTS Mt. SP C'IU-ty SAnoy 6rv"J%4- WtTtt SAND LEruSGS T`IIUUGN -W'z GM ZICIA WAS GROUND WATER No ENCOUNTERED? 1v _ S IF YES, AT WHAT L O DEPTH? p E Depth to Water After �q Monitoring? � Dale: x(,-5-93 tR ®®mmm -WWWM�1=6 � -- ©ME .. R- �:���z���®sem PERCOLATION RATE _!h_ (mmutevinch) PERC HOLE DIAMETER �- TEST RUN BETWEEN F AND FT S & S ENGINEERING age River LOOP Road No. 204 PERFORMED BY:Eagf" r` xer Ala.sh,q95?? I ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE: 72-008 (A". 4/85) V V CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: (ENGIN R'S SEAL) • .. Municipality of Anchorage I a. s DEPARTMENT OF HEALTH & HUMAN SERVICES 825 `L" Street, Anchorage, Alaska 99502-0650 ......... SOILS LOG — PERCOLATION TEST °Vert A. 51h.4 No. 1437-F, PERFORMED FOR: • �L /'��ND21cKSoN DATE PERF21ED:%'#•y''d'"[ LEGAL DESCRIPTION: ytNNV S/!) . Lln I/ gtta Township, Range, Section: I ' f aCiit y (W4W60 S NK wra4 Fsw stu Gnti - S%L-ty SA JI y Gara�r -i>r-7 WAS GROUND WATER ENCOUNTERED? D IF YES, AT WHAT DEPTH? Depth to wrier After T Monitoring? cite: PERCOLATION RATE 1'�) (mmuteannch)PERC HOLE DIAMETER TEST RUN BETWEEN FT AND S FT COMMENTS PERFORMED 950 ver Loop oad No. 204 ACCORDANCENGI*i)iW&TAIMIW g}1971gICIPAL GUIDELIe�f 72-008 (Rev. 4/85) (, %L CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: C INDER CONSTRUCTION, INC. September 140 1993 GENERAL CONTRACTORS RECEIVED Municipality of Anchorage SEP 14 1993 Department of Health rago P. O. Box 196650 niun;ealth ry Human Services 825 L Street,Room 502 Dept. Health &Human Services Anchorage, Alaska 99519 ATTN: John Smith & Robbie Robinson SUBJECT: EXPERIENCE WITH ADEC, WASTE WATER & SEPTIC SYSTEMS Linder Construction, Inc. has always worked with the Alaska Department of Environmental Conservation. We have 13 years experience with ADEC. We have also worked with PHS in doing HUD on-site water & sewer projects. Some of our previous Water & Sewer projects include: City Water & Sewer Lines - Kenai Subdivisions: - Toyon Way - Steller Drive - Cindy Circle City Water & Sewer Hook -Ups: - Over 100 homes & Businesses - Kenai - Fish Processing Plant - Quinhagak - Hud Housing Project in Bethel On -Site Water & Sewer: - Over 100 p - Fish Proce Public Health 11 on-site it on-site 20 on-site rivate Homes Kenai Peninsula Borough 9sing Plant - Kasiloff Service: water & sewer systems Pilot Point water & sewer systems Port Heiden water & sewer systems Sand Point We have installed holding tanks, septic tanks, lift stations, infiltrator drainfield systems, HDPE, Perforated pipe drainfield absorption systems. We are very familiar with state & municipal wastewater disposal regulations. Our core crew consists of 25 Operators/Laborers who have individually many years of experience in installing water & sewer systems, in addition to their years of employment with Linder Construction. Sincerely, LINDER CONSTRUCTI N, INC. M 4 e inda . E. nr kson L i v,9A_ tf, 4L. FAX 907/561-3006.600 W. 58th AVENUE, UNITJ, ANCHORAGE, ALASKA 99519'o 907/562-1866 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. COSA# n bl Expiration Date: l — % — o 1. GENERAL INFORMATION Complete legal description Lot 1; Back 2; Sunny subdivision Location (site address) 1100 Traii End Current Property owner(s) Ham Tae Kyung Day phone 351-8400 Mailing address Lending agency Day phone Mailing address Beat state Agent te"EA1 Petxjenf ay phone 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 ❑ 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 On -Site 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 Firm s a s engineering Phone 694-2978 Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567 Engineer's Printed Name 28 wt? C • `�i�✓�l� Date r 2z/off s`. -c OF At i.:. 5. DSD SIGNATURE °Pra�tRceC. stoi;nr+ Approved for _�L__ bedrooms.'f�� l Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X_ Septic System Advisory Well Flow Advisory Nitrate Advisory 'tktl..ry nFrA : ON-SITE TER AND •; m= recTC�e�TrP = PROGRAM 0 "4,,EMS Vr111�`O Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By; 1I//,/—z /L/, ✓ 1 Original Certificate Date: 7 (R.v. 7105) Municipality of Anchorage V , Development Services Department Building Safety Division MUR On -Site Water &Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: �� � �'� SUA)VII 6/6 Parcel ID: 015-35)' 33 A. WELL DA Well type If If A, B, or C provide PWSIID # = WellLoo J) g Date completed ( 25193 Sanitary seal (ON) At & Wires properly protected(&)J) L r Total depth ✓•3 ft. Cased to I,2 ft. Casing height (above ground) in. FROM WELL LOG AT INSP CTI N Date of test I Z 2 �L Static water level % I ff• a3 r ft Well production g.p.m. S• �* g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate & /// mg/L Other bacteria colonies/100 mL Arsenic: A D ug/L date of sample:23 C� Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material GPT►C �St>✓eC Date installed .0 Tank size 1� gal. Nu bar of Compartments / � Cleanouts�tJ) Foundation cleanout(ON) LOS Depression over tank (Y /t/4Z' High water alarm (Y& All Date of pumping / 7 0 PumperC. ABSORPTION FIF2LD 9ATA Date installed ZZ' 93 Soil rating (g.pof .d.mF r ft'/bdrm) 0.8 System type f fMUINO Length 95 ft. Width S /Gravel below pipe Total depth 6d"Eft EK. absorption arearft' Monitoring tube TES' Depression over field Date of adequacy test - 0 $ i Result Pas Fail)6 For bfrMl= %I S MTI= ';`1p c Z•a . 6. New de G in. Fluid depth in absorption field before test�'2-Dm. „Water ad�� gal., p nrrr T /4 „ 40.E Elapsed Time: �i3 min. Final fluid depUf:Oin. Absorption rate >= 6 g.p.d. Any rejuvenation treatment (past 12 mo.) Cq type) I Jo If yes, give date D. LIFT STATION lr7 Date installed 'Pump on" level at _ in. Datum E. EPARATION DISTANCES F. Size in gallons `Pump off" level at tested SEPARATION DISTANCES FROM WELL ON LOT TO: r Septic tankfift station on lot ICO4- r Absorption field on lot 1004 Public sewer main 14 Sewer /septic service line 0 C t f Animal containment areas 60 'f' Manhole/Access Water alarm level at in. Meets alarm & circuit requirements? r On adjacent lots On adjacent lots /00 :!L Public sewer manhole/cleanout U Holding tank A.) /,9 Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r r ! Building foundation f' Property line 6 4- Absorption field 6 � Water main Water service line /O t Surface water 109,4- / Wells on adjacent lots /00 4 - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: I t rl Property line /C) 4- Building foundation D } Water main /O Water Service line Surface water /00 '� Driveway, parking vehicle storage r Curtain drain A",Vt; Wells on adjacent lots �� f * MTJ o vuf 16, G. E�'fb GINEER'S CERTIFICATION I it I certify that I have determined through field inspections and ' IL review of Municipal records that the above systems are in ✓ r _ 'p conformance with MOA COSnA guidelines in effect on this date. ! ', Engineer's Printed Name K d Q �2 T C- W xl, °I� F} ROBERT C."tOWAN f c f Date r /J If Il++�l` 4 C�-8801 f� �a COSA Fee $ Waiver Fee $ Date of Payment qhal 6Date of Payment Receipt Number. 005b5D Receipt Number (Rev. 11105) SCS ReLN 1081632001 Client Name S R S Engineering Project Name/N LI;B2; Sunny S/D Client Sample ID LI;132; Sunny S/D Matrix Drinking Water PWSID Sample Remarks: All Dates/rimes are Alaska Standard Time Printed Date/time 05/012008 10:13 Collected Date rime 04232008 13:40 Received Date/rime 04232008 14:07 Technical Director Stephen C. Ede Allossable Prep Analysis Pammetcr Results PQL Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 Waters Depart rst Total Nitrate/Nitritc-N 0.111 0.100 Microbiology Laboratory Colony Count 0 Total Coliform 0 Fecal Coliform 0 ug/L EP200.8 C (<I0) 0428/08 04/30/08 NRB mg/l. SN12045DONO3-F 11 (<10) 0428108 LCP col/100m], SN1209222B col/IOOmL SM209222D col/IOOmL SM209222D A (<200) A (<I) A (<I) 0423/08 DLC 0423108 DLC 0423108 DLC 0 WIr a I O Iz I qN I I O� J'� t CZ \. \� :��zEc. � TEGECOMS�F_ASEMF.t/T s o°04 Qe "w. 295.85 �aEc.) S 0°O2�lO"W. 296.0701sAs) I (D G. q H O Y•• N - rtNW£ 0 0 G Y w N I.- 0 r r r a0 rrw (�D DOi N 3 r7+w n d N O C (D CU (D M x w r r+• 7 O (D N M M $ " n rr A G97W/ o rt N O rr (D N7ti ti G(D En 00 V 7 N rrK £ N K A 5 0 W O£Or* rr 7 7 W M CD V £"wK w (D N V Orr w rr H (D�>v cr rr O w CDD w rr n aNM rrrH V rr O. a I `J T r 0 w x t CZ \. \� — �� >•Yo= zIN. Py.. �r �u� - o n p p- p s ^ � . > s 3 r fn 01 > \ Z to ^' [off 1� > • . r •, w n e '» o o I o n v lk `• M p> •= 4 w r I (D G. q H O Y•• N - rtNW£ 0 0 G Y w N I.- 0 r r r a0 rrw (�D DOi N 3 r7+w n d N O C (D CU (D M x w r r+• 7 O (D N M M $ " n rr A G97W/ o rt N O rr (D N7ti ti G(D En 00 V 7 N rrK £ N K A 5 0 W O£Or* rr 7 7 W M CD V £"wK w (D N V Orr w rr H (D�>v cr rr O w CDD w rr n aNM rrrH V rr O. a I `J T r 0 w x MUNICIPALITY OF ANCHORAGE rs ✓ • DEPARTMENT OF HEALTH & HUMAN SERVICES. ® Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY ' APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # Of5 -3S/ — 33 HAA # 1. GENERAL INFORMATION Complete legal description Lot 1; BP_ocf 2; Sunny SubdiviAion Location (site address or directions) 11830 Tnaitz End Rd. Property owner AL Henda ickaon Day phone 345-6257 Mailing address 11830 Thait,6 End Rd. Ancho4a4e. 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. OF WASTEWATER DISPOSAL - �`��l' : ;= , / ,` .; 4.' TYPE } ' Individual on-site XXX -, r 1 '","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-M Mw. V91) Front MOAF21 ; .... .i:,• •r ".S.j.,� . 5. STATEMENT OF INSPECTION BY ENGINEER " '" f• `` ' 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 -'X and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms ancitypeof structure Indicated herein. I further verify that based onthe 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, oedinpnces, and regulations in effect oajhQ date of this Inspection.. 535ENGINEER I �.`'� ..1:=•-C..� Name of Firmb Phone A 9 .. Address Eagte Rlver Engineer's signature Date ef Z q1ei � r 9 b µo.141' 74 ... _ __ _ _ _ __ ,asp •.,; •,,�� 6. DHHS SIGNATURE "bedrooms. Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: t Additional Comments By. .` 111��,af/1 •: '�Q. Date ,,. !4 .'L x . c' •t CAUTION ; `.The Municipality of Anctiorage Department of Health and Human Services (DHHS) Issues Health Authority Approval Certificates based only upon the representations in paragraph 5 above by an independent-,.: professional engineer registered in the State of Alaska. The DHHS does this ase courtesyto purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not condu-1 1ct'inspections or enalyte.data before'a certificate is issued The Municipality of Anchorage is not responsible for errors or omisslons in the professional engineer's work . s' , ; %,; ;;;.• ; • , , 72IM5 w+r•e.m 1640A 021 '. . ..F •, ..t Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SUAYy SUaD1 pLoch,ZI Larl Parcel I.D. -- - 0/ 33 A. WELL DATA Well type a/V,472= If A, B, or C, attach ADEC letter. ADEC water system number 6 Log present &N) Vr'S Date completed 12127423 Driller /P -l(/ /PSI L IA16— Total depth /3/ Casedto 170.2 Casing height Z•''' Sanitary seal ®N) Wires properly protected ©N) YCE Date of test Static water level Well flow Pump level FROM WELL LOG � 2,33 2.6 g.p.m. SEPARATION DISTANCES FROM WELL TO: AT INSPECTION Septic/holding tank on lot /700 ; On adjacent lots 100 ,4 Absorption field on lot /yo 1 ; On adjacent lots /ad 1 t Public sewer main 2S't'F Public sewer manhole/cleanout Sy / Sewer service tine ;2S /t Petroleum tank 6i, A WATER SAMPLE RESULTS: Coliform Z!*Nitrate /•23 A1,��4 Other bacteria Date of sample: 9'//"9y Collected by: B. SEPTIC/HOLDING TANK DATA Date Installed qAM 4? Tank size /2S0 Compartments Z Cleanouts y@N) YES Foundation cleanout (DN) YES Depression (YO AJ0 High water alarm (YJ@ Alarm tested (Ya Date of pumping .0 eFw TPr-A)1 Pumper SEPARATION DISTANCES FROM SEPTIC/HOLD NG TANK TO: Well(s)onlot /20• On adjacent lots /Do OI Foundation 60' To property line /d •f Absorption field /L/I Water main/service line /6 SIL Surface water/drainage /ac �4- 72026 (Rev. 7191) Front CONTINUED ON BACK PAGE C. LIFT S;TAttGN Date Installed Size in gallons Vent(Y/N) High water alarm level "Pump Meets MOA electrical codes SEPARA Manufacturer Manhole/Access (Y/ at ` "Pump off" level at Cycles tested FROM LIFT STATION TO: On adjacent lots _Sprface water D. ABSORPTION FIELD DATA Date installed - c7 /��q3� --r-- Soil rating�• P G -p -AZ FT System type A&n%F' W TR F Length 9 Width S Gravel thickness 3 r r Total depth � Total absorption: area PIP So, Fr. Cleanouts present QN) `de's Depression overlield (YQ .Jo Date of adequacy test ,Vew SxrTEM•— m Results (pass/fain for -- bedrooms Peroxide treatment (past 12 months) (Y(W .y0 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots /Dort Property line ,o ' �- - /A - To building foundation �� To existing or abandoned. system on lot ._1 / On adjacent lots /00 Cutbank TZ) 14' Watermain/service line /y 7t - Surface water /C�o 70-- Driveway, parking/vehicle storage area /a 't Curtain drain A)LIAJE ,t.4)6unU E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in affection t �„ter Signature 5 a 5 ENGINEERING 17034 Eagle River Loop Road No. 204 �• Date • . Engineer's NamE A'. 01297 d �Z� GL// / T r” HAA Fee $ _JC0• cy— Waiver Fee: $ Date of Payment $ -'� Date of Payment Receipt Number .'Zo�S usd Receipt Number 72-026(Rn. 3/91) Owk MOA 21 he date of this inspection. If tAIr rs• 14:74 j I n MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 �%/,, Application Date a �+ `4 1. GENERAL INFORMATION AV -asC (a) Legal Description (include lot block, subdivision, section, township, range) rl L2 S//A/Nrl Sc/R. 515C. Lel T/?N 93CO Location (address or directions) 1173/ i66I4-5 END RD (b) Applicant Name Al .6196 LEY Telephone: Home Business Applicant Address <_3,5-o N/F_ L SDN klASl _ 19 -NWA. _411' (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder 19; Buyer ❑ ;Other ❑ (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the jorlowing a( 2. TYPE OF RESIDENCE Single -Family Ef Multi -Family ❑ Other Number of Bedrooms -3 3. WATER SUPPLY Individual Well EZ Community ❑ Public ❑ Telephone Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Cd Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 n-025(11-84) a, 1 1 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Cd Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 n-025(11-84) urns-..+uiviv / JNv 5. ENGINEERING FIRM PROVIDIr4G INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. l further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm RE CS //t/G. Telephone -0 e'Q Address /zoo w 3 -S RYE S ANCA gra-03 Date 6. DHEP APPROVAL Approved'f' 1' I bedrooms by ate /2 —2-7—F6 Approved �'' �" ',Disapproved Terms of Conditional Approval, Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. Page 2 of 2 72-025111/841 t. A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: P,1 L7 S[IA(" 511A, Tl11V R31a Well Classification PA►✓ATE If A. B, C. D C. pproved (Y/N) I✓�A Well Log PresentDate Completed Yield �9t Total Depth L (� Cased to ZA) Depth of Grouting U•' k'•, e ti Static Water Level ^ ' alt Pump Set At Casing Height Above Ground 2•,5 Sanitary Seal on Casing (&)N) Electrical Wiring in Conduit ®N) Depression Around Wellhead (Y,® Separation Distances from Well: q To Septic/Holding Tank on Lot! ; On Adjoining Lots loo ' f y /f To Nearest Edge of Absorption Field on Lot I 06 ;On Adjoining Lots I oo ' To Nearest Public Sewer Line ff M To Nearest Public Sewer /y�i9 Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by J, a/ %C N UCK ; Date Water Sample Test Results SATISFACM9 "/ Comments B. SEPTIC/HOLDING TANK DATA Date Installed %g Size 1250 No. of Compartments Z Standpipes &N) Air -tight Caps (4)'N) Foundation Cleanout 6)N) Depression over Tank (Y® Date Last Pumped 4��_ Pumping/Maintenance Contract on File (Y/N) hitt ; for I Holding Tank High -Water Alarm (Y/N) — N,14 Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well 1I � � To Building Foundation 3, To Property Line 20 To Disposal Field _7 7 To Water Main/Service Line N/H To Stream, Pond, Lake, or Major Drainage Course Inn /--I Comments Page 1 of 2 72-026(11,84) 61 t -z .5a1V1VY5u6. C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design SEO Date Installed V/pc, Length of Field 3� i Width of Field (9 Depth of Field Gravel Bed Thickness �. Square Feet of Absorption Area Standpipes Present Q/N) Depression over Field (Y/9 Date of Last Adequacy Test N�A Results of Last Adequacy Test Separation Distance from Absorption Field: i To Water -Supply Well 100 f To Property Line 70� i To Building Foundation To Existing or Abandoned System on Lot On Adjoining Lots �D / YL To Water Main/Service Line N�� To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course lot) f To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed . Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments — Dimensions _ Manhole/Access (Y/N) _ "Pump Off' Level ent(Y/N) Check Permitted Bedroom Rating Against HAA Request •• Pumping Cycles during Adequacy Test.Meets MOA Icertifythatlhav e ed. verifie orcomormedtoallMOAand AA guidelines ineffect o Signed Date ZZ Company � �� //)�C. MOA No. -- AZ 0 Receipt No. Date of Payment 12 ' 12 Amount: $ 6 S�— Ar/acNmE.vrs Page 2 of zl 6dA�E SANulE 72-026 (11,84) Sf r4