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HomeMy WebLinkAboutSOUTHFORK NORTH BLK 2 LT 2South Fork North Block 2 Lot 2 #078-141-12 e ti-.% MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION II ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 284.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME .{.� 7&A-f,-( r-nlisr PHONE &9y7tQ9t�I1q �SN EW .UPGRADE MAILING ADD S CM 5.M s �e ,N&622th14 s,ea�//9(0) .L?, i'e, LEGAL DESCRIPTION_ l % L>•' &r 2- Buz 2 5btim arc.ra 40451-D LOCATION i/� )l NO. OF BEDROOMS s Uy DISTANCE TO: Well r✓� 6sorptlon area• Z7 ! Dwelling'� /1 G PERMIT �'J r .7 (� k 2 NF Manufacturer Mateg `u No. of compartments y 4 Liq.pa achy gallons IF HOMEMADE: Inside length Width Liquid depth /DISTANCE e JU2 TO: Well ♦ / Dwelling �U PERMIT NO. _? H Manufacturer Matariai Liquid capacity in gallons = DISTANCE TO: Well (l /� �4ju' undatlon,., / /r� -t Nearest lot line / ea I. PERMIT NO. "Leif pa , Z w No. of lines / / Length o,Lp�ch/lige �3S LL TT Total Ie tio; ilnes :3 -i' Trench width inches Distance between lines /t/ F Top of tile to finish grade ,i Ji `J Material beneath tile . Z. Inches Totalgf(@ctI absorption area XX 4r'c w Length Width/ t Depth PERMIT NO. 1 w o- Type of crib Crib diameter --• - h 1V Crib depth Total effective absorption area w m DISTANCE TO: Well Building foundation Nearest lot line Class w2r D pih — 11xrSy7A/47 Driller Distance to lot line PERMIT N0. lii DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER Lbits4 ' PIPE MATERIALS fr Pit , 1 i/ /�y'l� SOIL TEST RATING ` jai / 7 s /Bp__ INSTALLER P Ocwsn <s -tea, i REMARKS elts OF At _iitiis r — s' * ' Fou Naferta.J ' rte%.e. �t1M� NO Sae ne NS 0'1% Me. lege$ ass Viensib APPROVED $ a ill )rIC11AlM1N£4 DATE ntsi I t p11V R ALASKA 0,377 1 ,/ C///% faV 72013 (Rev. 3/78) a .murircrr 9IL- I 1'1-r' 0F" flNCE4RlRaE DEPARTMENT OrtHEFILTH AND ENV /RONMENTAL ‘,...),DTECTION 825 L. STREET, ANCHORAGE, AK 99501 f 264-4720 (DIN—SX-TE SEEfl Sa MEts • PERMIT- NO: . 940300 -DATE ISSUED: 05,07/84 APPLICANT.: ADDRESS; -• .77-C;ONTACT' PHONE: DEAN CONST. S&S - ENG / NEER I NO ERGLE RIVER, AK 99577 694-2979 SUODIVIS/ON: SOUTH FORK nlet1/4 SECTION: 4 TOWNSHIP: 13N LOT: 2 RANGE: 1.14 BLOCK: 2 trim, CSG. -FT. OR ACRES) LISTED 'BELOW ARE -THE 'OPTIONS AVAILABLE-TOYOU IN DESIGNING YOUR SEPTIC CHOOSE THE-OPT/ON TWIT BEST FITS YOUR SITE. 131a1> 4. 0 0. 5 4. 5 17. 0 34. a 21.4 1, 000. 0 ** - DEPTH -TO PIPE BOTTOM (FT:->--- 4: 0 • .GRAVEL DEPTH (FT. ) ' • 6: 0 ' "TOTALDEPTH (FT. ) - 1.0. 0 -GRAVEL "GRAVELYLENOTH (FT.- 7- 32:•0. GRFIVEL VOLUME P< CU. YDS. ) 19:2 -.) TANK -SIZE (GALS) 1.;• 000-0 -*to SOIL ROTING (SQ. FT. /BR) 125 *4, TANK- MUST HAVE- FIT LEAST TWO COMPARTMENTS E>FtFI It -1 44 0 3. 5 7. 5 5. 0 41. 0 3a 3 1., est e 125 . 125 • . CERTIFY THAT: I AM FAMILIAR WITNTHE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE 'MUNICIPALITY- OF ANCHORAGE (HOPI) AND THE STATE OF ALASKA. • 2. 'I -MILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL NOR CODES AND REGULATIONS, AND- IN COMPLIANCE WITH THE- DESIGN CR I TER I OF THIS . PERM /T. 3: -I WILL FiDHERE TO 'FILL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DI STANCES FROM ANY EXISTING NELL..c WASTEWATER D ISPOSAL SYSTEM OR PUBLIC sEt4ERAGE- SYSTEM ON THIS OR ANY ADJACENT OR IcIEFIRBY LOT. 'It -.UNDERSTAND THAT THIS PERMIT IS VALID FOR Fi MAXIMUm OF 3 BEDROOMS AND • tP.t.• cr:FilY.. ENLARGEMENT': W ILL REQU I RE AN ADDI T I ONAL PERM I T: F -A:LIFT STATION 15 INSTALLED -IN FIN AREA • COVERED BY MOA BUILDING CODES, •THEN -C1.:), AN ELECTRICAL PERMIT AND -INSPECTION MUST BE OBTAINED; (2) AS‘-BUI WaSNOTGE4IPPROVED WITHOUT' AN ELECTRICAL INSPECTION REPORT;- AND (3) THE ELECTRICAL WORK -MUST ;BE' DONE. BY LICENSED:ELECTRICIAN. DATE: SIGNED "er -• -APPLICANT: DEA inNST: 11,A f ISSUED -BY:- DATE: Spiry LTS MUNICIPALITY OF ANCHORAGE. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: DEA'J84-ie .J LEGAL DESCRIPTION: L-OT84-ie`, " .64)4"1114 4L 4 c t1 Sa4 172 J /, So SLOPE O SOILS. LOG . o PERCOLATION TEST DATE PERFORMED: I04 -t3 /figs ) 1 3 DEPTH (FEET) 6 7 8 10 • 11 12 13• 14 GP A44y & are- r..er3J 44Le DF Seat MLI fl:Ac5 Looser AAta 4Ar4N`Are. 15 _ L,rry4r a Oi doiroigewini 16 art or 4,34, ye17 01* e'� t.0,. Ciao .°0 0 oo°e ° 18 OPS ° vL r t Russell 1. Oyster 19 ;. ° ego.. 4266.E .°)` �P° • •oet°4% 204. �to �%\ LF'C�R6rO°m PERCOLATION RATE WAS ENCOUNTUND ERED? ER ,' f • • L ENCOUNTERED? __�[QD ' P E IF YES, AT WHAT DEPTH? SITE PLAN • � f 40' AL lti 4 t 4,9 7511 1 L TEST RUN BETWEEN COMMENTS SeePF flr k' '4 •—raiinLO& L PERFORMED) BY 72-008 (6/79) - t Imtnutesfnchl. FTA O —' FT "-rrsr Pot Nu 4 oe,✓cr Oec EQ,✓ 6r7®A/. CERTIFIED BY: L= too(Ntrlyende- DATE:3 -24-131-11 bate Gross Time Net Time Depth o Water Net Drop Reading dof L TEST RUN BETWEEN COMMENTS SeePF flr k' '4 •—raiinLO& L PERFORMED) BY 72-008 (6/79) - t Imtnutesfnchl. FTA O —' FT "-rrsr Pot Nu 4 oe,✓cr Oec EQ,✓ 6r7®A/. CERTIFIED BY: L= too(Ntrlyende- DATE:3 -24-131-11 )WNER OF LAND 1DDRESS ter". Coe dos .EGAL DESCRIPTION d )ATE - Started 7/=F47 Trartifith ;DriUhq Eng by DOC Co. fla SULLIVAN WATER WELLS P. 0. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 DEPTH OF WELL to 5' if 7' .? t2 STATIC LEVEL OF WATER FT liCattfrAJC, Si h' b'C <, n.%<,.t rH DRAW DOWN FT. 7/.w GALS. PER HR /d0 KIND OF CASING 6 1 0/) 'ERMIT NUMBER :IND OF FORMATION: "rom�Ft. to a Ft. From= Ft. to ; r Ft From` 9 S Ft. to 7h" Ft 0 C. 'if From Ft. to Ft. From -7C Ft. to-a—Ft. From Ft. to Ft. From. Ft. to Ft. From Ft. to Ft. From Ft. to Ft, From Ft. to Ft. From Ft. to Ft. From_Ft. to Ft. From Ft. to Ft. From_.Ft. to Ft. From _Ft. to Ft. From Ft to Ft. From Ft. to --Ft QC ifi;C d v.:0..tr /467g Jacit.-1 a). .y. fOct,t 54.1.0 6'e'9- Gc . ccJ�f gek From Ft. to Ft From Ft. to Ft. From Ft. to Ft Of ApirHORApe From Ft to From Ft. to From Ft. to Ft. .2 From Ft to Ft.R ECf 11\1-‘) From Ft to Ft. From Ft. to Ft. From Ft. to Ft From Ft. to Ft. From Ft. to Ft. Front Ft. to Ft. From Ft. to Ft From Ft to Ft From Ft. to Ft. From Ft to Ft tanctPATIYOF HEAItN & �gp FlpanTEGTIOY' e,NIRON Ft JUL 9 1966 NISCL. INFORMATION: DRILLER'S NAME /apt PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST 7r/2a! LEGAL DESCRIPTION: SUv 714 / ©ft ;44 OF 4 7,1. aa..ae S.p,Rejoe a 'L7 "se, el• sit e°a j/ UO * `1) ..;4 t of y C. Refd, Jr. lid d : V`; r -o. 2251•E 40 4Q.A...o.a 0FES5\ DATE PERFORMED: �z a 2. SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? J1( SOILS LOG kr PERCOLATION TEST z�zr=n, SITE PLAN • Reading Date Gross Time Ne Time Depth o Water Net Drop / 2-2.i S- Z 8' -9 /, 4 O Z 3:39' /0 /,S`/ Iii -r/ 0.og 3 3 Yg /0 0.07 y .3: re' /D / *Jr 0,a7 Y. y: o7 /0 1t 2s j.07 6 Y:/8 /0 / 1/ 0.07 PERCOLATION RATE (minutes/Inch) / r, TEST RUN BETWEEN `S45- FT AND 6'0 FT COMMENTS /2 7Y e aka /i / ter ite °7/d 0 w -r , PERFORMED BY: " �- A y 72-008 (6/79) CERTIFIED BY: DATE: "/-2/g? L a' e SUBM!TTAI Municipality of Anchorage NOV 2 5 2014 On -Site Water and Wastewater Program aretcilen Stuii (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 07 1 (4 (i 1. GENERAL INFORMATION Complete lipAription Se7e-iTF(-'e¢lcNar2 i N $ Lack 2 P Loc t 4rt(slteclUdreS )A ¢C 13/ D. A'2v� . t,fl rty,owper('s) :phgEN Yrc trArti s Day phone a'Nlaifi 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below; I verify that my investigation, based on procedures outlined in the 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 C{M ErJG=i✓EEeRV & Address ?Netet0 F120PHae C/6/ 1Wa Engineer's Printed Name 4?LE5 34t I -44z Z 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Phone le" $541-SSBe Date 14x17/I1't '\ * 491H *,i r• inrr #03% Charles 13.Balzarini ; 4. �� s•. CE•1385 •t OFESS0 %% bedrooms, with the following sti l{I�tyerp6sl" �\b,\.” (OFCN,rr(i AQ� i% ON SITE (cif. Z WATER AND o ;;;;;ES:TAI:\.;;;;77 i il' �G Original Certificate Date: nicipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSH) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory _Well Flow Advisory Other COSA blue sheet_f c If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: 5°v Ft NoRT N L6cK Z G o r )- Parcel ID: 07$ 141 - A. WELL DATA Well type rgTvEjr& Well Log (IN) 4#5 Date completed 7711 Qt/ Wires properly protected ($/N) Yes If A, B, or C provide PWSID # Sanitary seal ON) i&f Total depth ff° ' a. Cased to %i ' 5 ft: FROM WELL LOG Date of test _ 7l $r{ Static water level '2 f t-Or"'?e % 9 ft. Well production a0 g.p.m. WATER SAMPLE RESULTS: Coliform Arsenic colonies/100 mL Nitrate 0.311 mg/L A/D --€5A• ug/L Date of sample: ti/07/i'1 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPIK/$7 i - Tank size &690 gal. Number of Compartments . Foundation cleanout (E%N) NI Depression over tank N/19 A`O Date of pumping 7/161/14-1 Pumper TP- "S Casing height (above ground) 02 in. AT INSPECTION L t 7/2e Pt c -F 3. q g.p.m. ft. Collected by: 6 .13AL L'A-,r2T % Date installed 7/` t Cleanouts eyN) VE s High water alam(Y/0 AID C. ABSORPTION FIELD DATA Date installed 7/ Soil rating. (gfl.d.142 or ft2/bdrm) 1 ?' S Length 3a- ft ` Width 2.3 ft. Gravel below pipe System type 7RENC-F) ft. Total depth 10 ' ft Eff: absorption area 2o? (4 ft.Monitoring tube Depression over field Nd Date of adequacy test tifinigarcf Results (Fail) }55 Fluid depth in absorption field before test 904 in. Water added 4rS0 gal. Elapsed Time: LINO tpin. Fjnal fluid depth al -i• in. Absorption rate Any rejuvenation treatment (past 12 mo.) (Y/N & type) ASIA ...410(JA-'''' For % bedrooms New depth zJ 1 in. >- 450 g.p.d. If yes, give date .4j/A- D. LIFT STATION We tr P T Date installed Size in gallons _ "Pump on" level at in. "Pump off" level at Datum Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot +leo' Absorption field on lot f le' Public sewer main -ifoot Sewer /septic service line Zt $ 0' Animal containment areas -Fleo' SEPTIC/HOLDING TANK ON LOT TO: Building foundation f 5 Property line { 5' Water main 4 (or Water service line O le' Wells on adjacent lots -Lan Manhole/Access (Y/N) in. High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots 4100 " On adjacent lots 40s° Public sewer manhole/cleanout Holding tank 'l lei Manure/animal excrete storage areas +Oa' ABSORPTION FIELD ON LOT TO: Property line +W Building foundation +(ems Water Service line { (be Curtain drain + So F. COMMENTS Surface water ilea' Wells on adjacent lots f00 Absorption field -f 5 f Surface water ¢rte Water main + Io' Driveway, parking/vehicle storage ? 0 G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed dLName eA4API,e5 Ib4 WI-P.)4a Date VI7���( ISA brown sheet 10-10-12.doc .���� 11 ? pst••OF.q(���I �'t•. ••.qIt �# r, * • 491H *� 't .Ch Charles G8alzarfnF • ......•.....• low • Vw SCALE: 1" = 50' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON, FB14-0,pg 1-3 a . * 49th ��}//p *�i . '� •Irv. '.Fred Walotka, ,s ,/ c 3255- 1 t'ss"`! bc AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have pertained a Mortgagees Inspection of the following described property 10T 2 BI OCK 2. SOUTHFORK NORTH SUBDIVISION Anchorage Reooding Precinct Alaska, and tette improvements situated thereon are %thin the property gnoa and do not overlap or encroach on the property Wing adjacentthereto, that na knpmvemonla on the property Wing accacenl thereto encroach on the premises In question and that there are no roadways, transmission Ones or other visible easements on said property except as Mdlcated hereon. Gated at Anchorage, Ataaka this 7th day of August .2002 FRED WALATKA a ASSOCIATES Engineers and Surveyors MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I D # C>78— /1//-/2 HAA# ABS .'d 4-o l 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (Include lot, block, subdivision, section, township, range) I of Z get Z Sol 1. t .lJn-+ Cu/ d Location (address or directions) Crwhi•Ari e/ b iVe r -c -c (7-r Hi /anon &.zw/ (b) Property owner FAiki 4 Telephone : (home) Business j6/ -08Z8 Mailing Address ZLS( C .V-&ee4'.3 C J4nc.A AK 9'9J4.� Telephone %J/%f (c) Lending Institution Kt IA Mailing Address 1114 (d) Real Estate Company and Agent Address 1lL)%t Telephone & IA (e) Mail the HAA to the following address: (or check here , if hold for pick up.) List contact person and day phone number below: CaI( SZz- l311 2. TYPE OF RESIDENCE Single -Family Number of bedrooms 3 3. WATER SUPPLY Individual Wel Community Q Public D 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 Public 0 Community 0 Holding Tank 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/86) Page 1 of 2 5. ENGINEERING FIRM PROVIDING 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. 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 62),..LJ»I) 1 4ncc Telephone .5J22-157/ Address /000 E. Dimo,rtJ 120 5 Anch 'IL 9an Date /212 g f he 6. DHHS APPROVAL. Approved for .i Approved Engineer's Seal bedrooms by fe/ef fael Date �aa1 ».1h /91IP Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health AuthorityApproval cerificated 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 JHHSdonot 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. 72025 (Rev. 7/8e) Back Page 2 of 2 A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description- L04 2 Ke rG Z co +A t St)1 Prt -k Well Log Present (Y/N) 1 Date Completed If A, B, C, D.E.C. Approved (YIN) Jo ty /794 Yield C GPM Total Depth S0 Caged to'>SO t Depth of Grouting Un KnOwA Static Water Level i tfea Pump Set At (l.1 tnow".. Casing Height Above Ground Z Sanitary Seal on Casing (Y/N) V Electrical Wiring in Conduit (Y/N) 1 Depression Around Wellhead (Y/N) N SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot boo' .f ;On Adjoining Lots /O0 .t To Nearest Edge of Absorption Field on Lot 100 + ; On Adjoining Lots /00 ' + To Nearest Public Sewer Line Al /A To Nearest Sewer ServiceLineon Lot yZS t t Water Sample Collected by JPFS }-✓'"FSS 5th? To Nearest Public Sewer Cleanout/Manhole Nt /14 Water Sample Test Results ;Date �a/J" Comments [ _ B. SEPTIC/HOLDING TANK DATA Date Installed 49_9 Size /CtOy./ No of Compartments Z Standpipes (Y/N) S Y Air -tight Caps (Y/N) / Foundation Cleanout (Y/N) $7,— Depression over Tank (Y/N) I.1 Date Last Pumped l21Z9Iir Pumping/Maintenance Contact on File (Y/N) WA ; for Al /A Holding Tank High -Water Alarm (Y/N) AI /p Temporary Holding Tank Permit (Y/N) )J in SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well /oo r -F To Property Line /0' To Disposal Field 8 i To Water Main/Service Line % r ' + `' )j To Stream, Pond, Lake or Major Drainage Course AL. ,!n Comments To Building Foundation /{"' 72-028 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /Z• jc i$)$Jr+,' Type of System Design ! tAA:14 Date Installed Jame /9t4 Length of Field 3z Width of Field <0 Depth of Field /0' Gravel Bed Thickness (� ` Square Feet of Absortion Area 38.4 sf 421- Statndpipes Present (Y/N) V Depression over Field (Y/N) 'y Date of Last Adequacy Test Results of Last Adequacy Test -CPPM/-71C7Oiet/ SEPARATION DISTANCE FROM ABSORPTION FIELD; To Water -Supply Well /Uc) / "r To Building Foundation 3C To Property Line )O To Existing or Abandoned System on Lot fu/A ; On Adjoining Lots 30 To Water Main/Service Line -'fir' To Cutback (if present) AJ /,i To Stream, Pond, Lake, or Major Drainage Course Al %IAF To Driveway, Parking Area, or Vehicle Storage Area 201 -I-- Comments Comments D. LIFT STATION IV 1 Date Installed Dimensions Size In Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments "Check Perm! jd Bedroom ating Against HAA Request" /': iftrt,•pr1 I certify that = check>• -rifled, or conformed to all MOA and HAA �..yy� Mesa , a,qnithhon the date of this inspection. �gv'S4aao0oo®a•ooQ1 N Signed - �_ ��,-" °` ssv' `°a_a04e�0 a Compan Brae' ik Date rr:r MOA No. Receipt No. Z 6 ! d ��/ r Receipt No 6.6 Date of Payment /nl r3 -t r r Waiver Fee- $ Amount' $ 6 . 0?') Date of Payment •••• oe� J. COMill • CE -5283 pROPFOIVZi' ineer's Seal 72-026 {Rev. 7/881 Back Page 2 of 2 NORTHERN TESTING LABORATORIES, INC. 600 UNIVERSITY PLAZA WEST, SUITE A 2505 FAIRBANKS STREET FAIRBANKS, ALASKA 99709 907479.3115 ANCHORAGE, ALASKA 99503 907-277.6378 Corwin & Associates 1000 East Dimond, Suite 205 Anchorage, Alaska 99516 Attn: Jerry Kress Source: L2-82 Southfork North Sample ID#: A122188-16 Date Arrived: 12/21/88 Time Arrived: 1425 Date Sampled: 12/20/88 Time Sampled: 1530 Date Completed: 12/27/88 Parameter Unit Result ADEC MCC* Nitrate -N mg/1 0.18 10 Reported By: Date: 12/28/88 Francois Rodigari, Anchorage Operations Manager * MCC = Maximum Contaminant Concentration 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 1. GENERAL INFORMATION (a) Application Date 6/a r/,s Legal Description (include lot, block, subdivision, section, township, range) .. SO ri 2-'r /C /?fur rA Lot 2 sP%aA- . 71-/ al iw _re,. 4 Location (address or directions) Sou rA ,F...r' (b) Applicant Name r/ d,sv 7Le// Telephone: Home Xq4,-,r2i 7 Business .f54'—.t 797 Applicant Address Cie 9 3 & r Ecs 4ei = A- 9 SS', (c) Applicant is (check one): Lending Institution 0 ; Owner/builder Buyer 0 ; Other 0 (explain): (d) Lending Institution ./,/, Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: is It L,„0, a'emu/ n t.e r. 2. TYPE OF RESIDENCE Single -Family Multi -Family 0 Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well Community 0 Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank 0 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 72-025 (11/84) 4. •. 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below. I verifythat 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. I further verify that based on the information obtained from the Municipallty 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 Telephone Address EAGLE RIVER, Aft OW Date Ver P.O. BOX 773294 894.51!5 6. DHEP APPROVAL Approved for Vw/at_4? t Pl.s14�[t pe4ce*sot1,Uj'e� 8;oast oo s aaaae • . 6 OA9 % Louis A. autera / tVJ Rk' CE•6736 ,.° �0 % �® g��PRBFE as(et" t. it bedrooms by Engineer's Seal Date c/ a't/"S Approved r Disapproved Conditional Terms of Conditional Approval 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 professio engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their len" ;institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspecti^• analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omission^ tonal engineer's work. A. WELL DATA Well Classification rb ✓a it DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) JUN 21. 1985 CHECKLIST - FEBRUARY 1984 284-4720 RECEIVED. Legal Description• sok j -A Leet a al/dr . rivn' ofuu/ Sec. L-/ for /t RJor 71%. If A, B, G, D.E.C. Approved (Y/N) 14 Well Log Present (Y/N) Y Date Completed if PY Jr" 17 Yield / do n Cr,,o, m p N�sr Total Depth Si' Cased to gi Depth of Grouting Static Water Level Ar.ie s'4.1 Or 9 ' Pump Set At s Casing Height Above Ground ay Sanitary Seal .on Casing (Y/N) Y - Electrical Wiring in Conduit (Y/N) / Depression Around Wellhead (Y/N) /2-1 Separation Distances from Well: To Septic/Holding Tank on Lot MO 4 • On Adjoining Lots /00 t To Nearest Edge of Absorption Field on Lot /61-.); On Adjoining Lots di.) 7- To Nearest Public Sewer Line 2''h '9.- To Nearest Public Sewer Cleanout/Manhole nicrn'e Water Sample Collected by gin,,n.-e r • Date 6// t4s Water Sample Test Results SGt'f ic `tory Comments To Nearest Sewer Service Line on Lot a s B. SEPTIC/HOLDING TANK DATA Date installed 61/4 q/ Size %vo 11'No. of Compartments Standpipes (Y/N) y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped 4'e...., en.,JYrt,c74-00,.% Y Pumping/Maintenance Contract on File (Y/N) '404 ; for Holding Tank High -Water Alarm (Y/N) 444 Temporary Holding Tank Permit (Y/N) %v�f Separation Distances from Septic/Holding Tank: To Water -Supply Well /CO To Property Line /a % To Disposal Field 8 r / To Building Foundation is To Water Main/Service Line a S To Stream, Pond, Lake, or Major Drainage Course Nom' Comments Page 1 of 2 72-026(11/84) .C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /9 if y Width of Field 30 7e Type of System Design Length of Field Square Feet of Absorption Area 354' « Depression over Field (Y/N) /4-1 Results of Last Adequacy Test Depth of Field a /0.r Gravel Bed Thickness 6 Standpipes Present (Y/N) Date of Last Adequacy Test /2t eta. S ?Lena /-sea. — eve {m+t /1/e�e.eJ Com ,r Y`rae Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation Lot .01/0,1, e_ / ex) t 30' To Water Main/Service Line /0 To Property Line /o To Existing or Abandoned System on ; On Adjoining Lots To Stream/Pond/Lake/or Major Drainage Course 3a' 7o Cutbank Of present) 'Von To Driveway, Parking Area, or Vehicle Storage Area /0 Comments D. LIFT STATION /1/4/ 1 4!%% '" Date Installed Dimensions Size in Gallons Manhole/Access (YIN) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments *" Check Permitted Bedroom Rating Against HAA Request " I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed a Date /a71n-- Company /'a -s' deva^ E"s/ . MOA No S r a 6 C Receipt No. s469 - -a1\15 Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) L� fm. Engineer's Seal