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HomeMy WebLinkAboutSUNSET HILLS WEST BLK 2 LT 3Sunset Hills West Block 2 Lot 3 #018-204-23 (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: til ,Z© t(' Z3 Legal Description t6'Qc l/95it III 3 IS 2 L Pump Installation Date: IJ I ylLflup Pump Intake Depth Below Top of Well Cas (} Ting: 7 S feet Pump Manufacturer's Name: ee� �1 � Pump Model: Pump Size / (i. hp Pitless Adapter Burial Depth: /0 feet Pitless Adapter Manufacturer's Name: Aw_47�_5161 Pitless Adapter Installer: ^01 Well Disinfected Upon Completion? Yes ❑ No Method of Disinfection: �fIlc� Comments: ape Owner ame &Address: La a Z4 1490vedlek- &--e ,Lc.r f - 9,%,575` Pump Installer Name: ANCHORAGE WELL & PUMP SERV. 330 EAST 76TM AVENUE ANCHORAGE, AK 99518 PHONE: 907-243-0740 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road ,x P.O. Box 196650 Mark Begich Anchorage, AK 99507 9 Mayor www muni org/onsitee, (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: til ,Z© t(' Z3 Legal Description t6'Qc l/95it III 3 IS 2 L Pump Installation Date: IJ I ylLflup Pump Intake Depth Below Top of Well Cas (} Ting: 7 S feet Pump Manufacturer's Name: ee� �1 � Pump Model: Pump Size / (i. hp Pitless Adapter Burial Depth: /0 feet Pitless Adapter Manufacturer's Name: Aw_47�_5161 Pitless Adapter Installer: ^01 Well Disinfected Upon Completion? Yes ❑ No Method of Disinfection: �fIlc� Comments: ape Owner ame &Address: La a Z4 1490vedlek- &--e ,Lc.r f - 9,%,575` Pump Installer Name: ANCHORAGE WELL & PUMP SERV. 330 EAST 76TM AVENUE ANCHORAGE, AK 99518 PHONE: 907-243-0740 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE — p DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 Estreat - Anchorage, Alaska 99501 Telephone 260.-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT --- ---- —' PHONE ❑ NEW NAME _`il rte. �IC,Y V&MI_R ,Ct�r—;3 l�-f1PGRADE MAILING ADDRESS _ NiCL t etNC LEGAL DESCRIPTION , 1� Lc�' l3Lur__K Z sums / ! LOCATION NO. OF BEDROOMS uy� Well Absorption area Dwelling — (Jy DISTANCE TO: PERMIT NO. 2 Manufacturer Material No. of compartments LU N H Liq. capacity in gallons Inside length Width IF HOMEMADE: — Liquid depth ❑Jz2 DISTANCE TO: Well Dwelling PERMIT NO. — 2 — FQ- _ Manufacturer Material Liquid capacity in gallons ❑ w 2 --® Well Foundation ' Nearest lot line DISTANCE TO: C0 ! 3�J PERMIT NO. W2lT7 -,ClU 'Total M IV( u Z No. of lines Length of each line length of lines Trench width Is e-kat+nepy lines inches _ I— Top of tile to finish grade ! Material beneath tile -%Z Total effective absorption area ❑ incites (' � Length __ Width Depth PERMIT NO. w 4 a Type of crib Crib diameter Crib depth Total effective absorption area LU DISTANCE TO: — Well Building foundation Nearest lot line a Class DISTANCE TO: Depth —Bung foundation — Driller Sewer line Distance to lot line PERMIT NO. Septic tank Absorption area(s) --- -- — OTHER _ PIPE MATERIALS /G t SOIL TEST RATING INSTALLER REMARKS - uen N (;Q r e 2�I u n ec)� c - 11- 2 APPROVED� DAT�E�g-� LsEGlA�(L'g �,�y�y_ II,_ �c", I 1AMS 72-013 IRdb. f7t� Permit Applicant: Location: MUNICIPALITY OF ANCHORAGE Department ` Health and Environmenta' Protection 825 Street, Anchorage, AK. .9501 264-4720 # # HANDWRITTEN PERMIT NIEl=6-111 ON-SITE SEWER PMIT ­_ Mailing Address: — i_ Y Phone Number: d Legal Description: /aj 56�1�f UD Size: Type of Soil Absorption System 7:s: Trench: �/ Drainfield: T- — Seepage Bed: —� Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: 1 DEPTH _� LENGTH � . GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the: distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(Z) INSPECTIONS ARE REQUIRED # # Backfilling of: any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer systemmay quire enlargement if e residence is remodeled to include more tha 3 bedrooms. Signed: U�'�� �L� Issued by pplicant Date: SWP/024(1/81) GREA,'R ANCHORAGE AREA BORAJGH fl Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 __ /i INSPECTION REPORT ON_ -SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS � �( �7.' -__- _ PIIONE-"'y 7`---) 1_/ LOCATIONC� - `��'" � /S' LEGAL DESCRIPTION 3-_aT 3 6 jnr Y- SEPTIC TANK: DISTANCE_ / NUMBER OF FROM WELL(O-) — MANUFACTURER_ >�Up�� MATERIAL D. _VJ _—COMPARTMENTS INSIDE LENGTH — INSIDE WIDTH_____ LIQUID DEPTH LIQUID CAPACITY �i' 4ALLONS. --7T(_/j(_ TOTAL LENGTHT DISTANCE FROM WELL L -JO 1 � FOUNDATION S_ __NEAREST LOT LINE bt OF LINES NUMBER OF LINES _ DISTANCE BETWEEN LINES ---TRENCH WIDTHJ6 IN. TOTAL EFFECTIVE ABSORPTION AREA _z �i SQ. FT. LENGTH OF EACH LINE `'� DEPTH OF FILTER DEPTH: TOP OF TILE l"O FINISH GRADE -��. MATERIAL BENEATH TILE -+N. ABOVE TILE ____ IN. WELL: �I ,,/ TYPE -t,OX CONSTRUCTION -." ��i�LQ-'�s-�' /r �T�J l:U/ DEPTH -____ DISTANCE FROM: 1"�i'fri. BUILDING NEAREST NEAREST SEPI IC r SEEPAGE FOUNDATION LOT LINE SEWER LINE , TANK SYSTEM CESSPOOL OTHER SOURCES ------.J APP ROVED _—_-.__DISAPPROVE D____ REMAR KS -I DISTANCES: ✓�_" DIAGRAM OF SYSTEM INSTALLED BY: SEWER LINE DEPTH: n PIPE MATERIAL:4►� ���- LOT SLOPE: REMARKS: Form EQ -032 DATE /`�_L APPROVED ���1 iC'.-, I F--" F -)i L.- I - f - "v" iCA F�- u�:u Rvl (0 hi fit It! 60 K3 HE�: DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2516 E, TUDOR RD./ ANCHORAGE, HK. 99507 276-2221 t4 EE L. L. FIV4E> 1: H'_p F -F F", 1 11" PERMIT NO. ( 76797 ) HPPLI(_.:HNT BOX 1420 99510 277-2567 LOCATION HHNCOCK LHNE LEGAL L] B2 SUNSET HILLS SUB LOT SIZE 18000 SQUARE FEET TYPE OF SOIL HBS0RBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/8R)= 140 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: Ex EE F, w wi — AL 12 ���U73 -F FR= -.2. 7" CA ������ � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH DR DRHINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET}. ������Fr- E-,- ��F=" -1- 1 �if'-'u 1�'u 1: r=: ­-­ ��C. CA C3 FA L. I. C3 PA� _r &4 ci C ;12". _. T P- 4 � � --- L -F. C - - T E C A A A 11 ��� ��j I :: 1 9 # --. -. E J, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. �-C31ER 0fJEE: 11-1 t S' S, R F. i I CERTIFY THAI 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDEhLE.,E IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED IOHNT JERRY ULMER � �� *� ^} ISSUED BY ,���/~�'���*±�/2�����DHTE.�-__-_...�_.__. .. __ g'^ N B._ Y PAI n:._' :P F11L__.:1C 7* "v" n._ a N-- u -::w E_..4 u_l, h t N=.;:: IF:.w K:::a w::'= DEPARTMENT ur HEALTH AND ENVIRONMENTAL xOT'ECTIi_hl 2516 E. TUDOR RD., ANCHORAGE, AK. 99507' 276-2221 B_,.B FE�" R_ N__. w' -w 54 Ey C) fill — _ 1 '_N . � E II -^.N F-_ F''NiEi: F2_, 6"^'il TI= ...I-. PE:I':MIT NO. C 76793 ? APPL.ICANFEE=7.I E,IIE=:C P 0 BOX 4-172S,:'7 -,:a.;,,a:-,.-, LOCATION HANi LEGAL 1..3 B2 SUNSET HILLS LOT SIZE. 18000 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH t'll=XIt°fUM NUMBER: OF BEDROOMS =: SOIL RATING <SO FT/BR)= 1&5 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ..I... I1-1-= 1- c 9__ 1=_-11.4 11 & 1-4 °-_ 3--, - .. a. Fz, a=w ° C Y__ E.-- E FF 6_ -II ::.:: uE. . THE LENGTH DIMENSION IS THE LENGTH (IN FEF"A THE DEPTH OF A TRENCH OR PIT IS THE DISTANC GROUND AND THE BOTTOM OF THE EXCAVATION CItd HERE IS NO SET WIDTH FOR; TREE-.1CHE_';. THE GRAVEL. DEPTH IS THE MINIMUM DEFT i OF GR AND THE BOTTOM OF THE EXCAVATION CIN 'EET). F- " F1 u ._ N=:::: if w ci E_: Iz^ N__ r='w 14.7_ EITHER R CLASS I OR II I A CONTINUOUS MAIN AGREEMENT IS NOT AS_OtSPTIMI'N ::.'T_.IE_M IF A CLASS 1,I SYSTEM It USED OF THE. TRENCH OR DRAT NF'IEI-D. &BETWEE:N THE SURFACE OF TIII:: T"N"LINT MAY YOU U IS THE OUTFALL PIPE: U I RP_.DV IF R MAINTENANCE R:EiFL.I10ED TO ENLARGE THE: 'OIL.. CT TO PROSECUTION. ]:S 22.0 FEET. 1 28.0 FEET. --U- y ,,..N co :1 1k IL'4 s� N=' IF_ w:k: 11- 1 R: -".N 6 A !'_-, F-0 6 ; IF= N S E,-' n:":s I - )l 1: �� w-_ N::.-" BACKFIL..I_ING OF AN'r i YSTEM W2jjHOUT FINAL INSPECTION AND APPROVAL I:i','r TI -11:S DEPARTMENT WILL, BE. SUBJECT TO PROSECUTION. M7:I5d1:1''U.M DISTANCE BE"Efd ::I'd R bN _L Ht'dD ANY ON-SITE SEWAGE. DISPOSAL SYSTEM Is 100 FEET FOR: A PRI',�AT dEL..L O ; 2¢00 FEET FOR A PUBLIC WELL. WE.L.L.. LOGS ARE REQUIRED 4141,Mph BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. SPECIFICATION`c, AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. N. IF a in N.;.N Ti:._N.. 01 F=w L_ TC 110- F7 C3 � �' 0 P4 EE 00 EE F4 F F n: _o 1-11 I CERTIFY THAT j :1.: I AM FAMILIAR: WITH THE REQUIREMENTS FOR: ON-SITE SE:WE:R:'. AND WELLSASSE'{.E. FORTH BY THE MUNICIPALITY OF ANCHORAGE. I WILL INSTALL_ THE SYSTEM IN ACCORDANCE WITH THE CODES. I UNDERSTAND THAT T -I -IE: OI'd--":.T"EE: 5E:LJE:R: SYSTEM EEI'1 t'1FPr' F:F:ilIIIE?E EI'dl...AR:Cil't'1EN"f IF THE: RESIDENCE 15 REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED ISSUED r 4040 '13" STRFE F, ANCHORAGE, ALASKA 99503 PHONE 907279-2581 September 17, 1976 W.O. 41.7838 Maribeth K. Burd P.O. Box 4-1729 Anchorage, Alaska 99509 Subject: Subsurface Investigation for Suitability of On --Site Sewer - Lot 3, Block 2, Sunset Hills Subdivision Dear Mr. Byrd: Transmitted herein in accordance with your instructions are the results of the above referenced investigation as performed by us on September 15 and 16, 1976. The scope of this project is investigation for suitability of an on-site sewerage system. Included in this transmittal are: Test Hole Location Sketch Test Hole Log Explanatory Information Figure 1 Table A Sheets 1-3 The exploration was conducted using a Nodwell mounted Mobel Drill Model B-50 drill rig with a continuous flight solid stem auger. The rig is owned and operated by Denali. Drilling, Inc. Drilling was supervised, the test holes logged and percolation test performed by Mr. O.M. Hatch, Geologist with Alaska Testlab. The test hole was placed at the approximate location shown on Figure 1. The log of this test hole is included as Table A of this report, In interpreting the log it would be helpful to utilize the explanatory information contained in Sheets 1 to 3 of this report. When drilling was completed a 3/4" slotted PVC pipe was inserted in the hole to aid in determining the free water level. For the percola- tion gest, the test hole was filled with water and left overnight to saturate-, On returning the next- day, the hole was refilled with water and the drop in the water level carefully monitored over the next- 60 minutes. This procedure is not a standardized percolation test, however, we understand that the I7un:icipali.ty of Anchorage, Department of Lealth and Environmental Protection prefers tests performed in this manner to evaluate a site for a proposed on --site sewerage system. Maribeth K. Burd September 1.7, 1976 Paye 2 Using the above test, the observed minimum percolation rate was 6.7 minutes/inch. No water table was observed during drilling, but it should be noted that the free water :Level normally fluctuates seasonally and with precipitation. We hope this report meets your present needs. If we can be of further service, please feel free to contact us. MRN:rb Enclosures Very truly yours, ALASKA TESTL�A� u� I 11 r Melvin R. Nichols, P.E. Laboratory Manager U ro /6 5 s �° v' dKI 19 o � 5° a• n 20 3 22 � Y \ a`}' ``j' �f• C 'o V .3 Sy ,.� �1 r p no °• T , �% k4Q 2 4 ti° lost os x 100.1'5 2 m � iaarrx>x.irq AT �.., � DENNIS d �o A?-< , � � i 9 v o� • F j ,q2. � � �3' �'u P.I e K9.9b'- toy) 10 ° 5 ° o n I S� Lot 3, B1k. 2 Date: September 15, 1976 Sunset Hills Subdivision Logged By: O.M. Hatch W.O. #17838 Depth in Feet From To Soil Description 0.0' 0.5' Organic overburden 0.5' 3.0' P-4, brown gravelly sandy silt_, ML, damp, stiff, NP, subrounded particles to 3". 3.0' 8.0' F-4, grey to brown sandy silt, ML, with traces of gravel, stiff, NP. 8.0' 10.0' F-4, grey gravelly sandy silt, ML, damp, stiff to hard, maximum particle size to 6" 10.0' 16.0' F-1, grey very silty sandy gravel, GM, occasional boulders, many cobbles, damp, high density, subrounded particle to 12". Bottom of Test Hole: Frost Line: Free Water Level.: 16.0' None Observed None Observed Fac 1$ox 13600 STAR Rouwa A ANCIMO aAOEe ALASKA 0950T .�44-x714 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF — 110 feet DRILLED AT THE RATE OF $16@00—_ PER FOOT. PROPERTY OWNER Mr• . Jerry Ulmer gll9-2977 ¢1420 Anchorage 99510 LOCATION OF WELL SITER't9 3 Blke 2 SUb. Sunset Hills West DRILLER Bernie Claus of Rampart Drilling Works WELL LOG: 0..x.;550 HHardpa,. vithidwAsks_�.'f_sand and mebWage �— _ 5;i- Oot - --�tQO- 0 1 Wet sand. -- 109 -lilt Water baw-Ina aravol: Clean material. producing GPM with a water stand in casing to within 65 fleet of aurface. 1/2 horse sub._ pp should be installed fiw foot off eased bottom of 110 test* Cost of Drillings$19MA0 Cost of Well Seals $22.50 ILD j q1 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE. TO RAMPART DRILLING; WORKS FOR THE SUM OF $2002.50 THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS DATE—_Odd late 76 Y�� ((::: SERVICE CHARGE OF 1%a% PER MONTH WILL 8��--ll� ASSF_SSED ON PAST DUE AC O@LI T Municipality of Anchorage • Development Services Department JBuilding Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us. (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 018-204-23 1. GENERAL INFORMATION R04 -o,- C. c" HAA# -A n� 0020 Expiration Date: '�t�IRK . Complete legal description Lot 3; Block 2; Sunset Hills West Subdivision Location (site address or directions) 14321 Hancock Lane Anchorage, AK Current Property owner(s) Jesse Ray Day phone 348-7725 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 17719 Blue Spruce Lane Eagle River, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. Day phone Day phone 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Ek 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and.State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S b S Engineering Phone *694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AR 99577 Engineer's Printed Name Robert C. Cowan Date i. DL c-'%6 t— 6. DSD SIGNATURE eoaear c COWAN I/ Approved for _� bedrooms. rj++'+, QED p E ;seot Disapproved. Conditional approval for bedrooms, with the following Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: / Zt ►f (Rev. OV02) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo—, 3 B" c.c 2 su r f4 r hl kS 1,-4 r Parcel ID: A. WELL DATA Well type A_'%I AT! Date completed / ° /1 / Total depth 1/ _01t. Date of test Static water level Well production If A, B, or C provide PWSID #= Well Log &N) YAFS Sanitary seat &N) YK j Wires properly protected a) y L-3' Cased to ifOt ft. FROM WELL LOG 10 /1 /zG G S' ft. 7 g.p.m. WATER SAMPLE RESULTS: Coliform a colonies/100 ml. Arsenic: mg./l. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Casing height (above ground) /'>'t in. AT INSPECTION lb -1/03- 6- /1.1/os 60 ft. 6- g g.p.m. Nitrate 3.•-7 mg./I. Other bacteria ° colonies/100 ml. 1� /91or Collected b S i S ENGINEERING Date of sample: _ by: ver Loop Road No. 204 P')13� i L S E- w Gc Eagle River, Alaska 99577 Date installed Tank size gal. Number of Compartments _ Cleanouts (YIN) Foundation cleanout (YIN) _ Depression over tank (YIN) _ High wa arm (YIN) Date of pumping C. ABSORPTION FIELD DATA Date installed Length ft. Total depth _ ft. Eff Pumper Soil rating (g.p.d.W oyiP/bdrm) _ System type ft. Gravel below pipe ft. area ftZ Monitoring tube Depression over field Date of adequacy test Results (Pass/Fail) Fluiddepth In rption field before test _ in. Water added_ gal. min. Final fluid depth _ in. Any rejuvenation treatment (past 12 mo.) (YIN & type) For _ bedrooms New depth_ in. Absorption rate >= g.p.d. If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on' level at _ in. 'Pump off" level at g water alarm level at in. Datum Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot m /R Absorption field on lot MIA Public sewer main 7S-4 Sewer /septic service line 9 S On adjacent lots o 4- On adjacent lots J00 4 Public sewer manhole/cleanout /o- f Holding lank N AA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption Water main Wells on adjacent lots SEPARATION DISTANCE FROM Property line _ Water Service Curtai m _ F. COMMENTS G. ENGINEER'S CERTIFICATION Water service line ON LOT TO: foundation Water main Surface water Wells on adjacent lots l certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name rR odk tT C. f o.�d,.. Date1 / �-s/u5 .o HAA Fee S Ll g Date of Payment Receipt Number d C 3 00 `1 (Rev. 12101) Driveway, parking/vehicle storage Waiver Fee $ Date of Payment Receipt Number ROBERT C. COWAN CE -8801 I,ttt 01-24-05 04:59PM FROM-CTiE ESI, SGS ENV SERVICES SCS ReGN 1050359001 Client Name S & S Engineering Project NamNN 1-3 god Sunset HM West Client Sample ID U BW Sunset Hills West Matrix Drinking Water Sample Remarks: 9075615301 T-700 P.02/06 F-167 All Data rimes aro Alaska Staa4ard Time Printed Date/time 0124/2005 15:49 Collected Datdrime 01/192005 11:30 Received Date/time 01/192 5 14:10 Technical Directory St C. Ede Released' pv� ltnWn PQL volts Mediad ConuinerID Al la` c M A=s lnit Waters Department Nitwe-N 2.07 0.100 mg/L EPA 300.0 B (r-10) 0120/05 XM Microbiology Laboratory Total Coliform 0 coV100mL SWO9222B A (c=I) 01/19/05 DKC •z • � Z :% S ' »2\ G%,| :@ >ca § 9 \ 0 ' mg 0 %° 0 } � 9 0 ¥ L -i / ,c Z IM Ute @ ' mg ' o]0. ® �T\R | F N � ( � m @ ( d sow F / .2 % ,g |� 2 : g `E■ g 4q�|I 9! :� �� �#•3 !� |® cj } � 9 0 ¥ L -i / MUNICIPALITY T ANCHORAGE • �' DEPARTMENT OF HEALTH&HUMANUMAN 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. # 018-204-23 1. GENERAL INFORMATION Complete legal description Lot 3 Block 2 HAA# HA920227 Sunset Hills West Subdivision Location (site address or directions) 14321 Hancock Lane Property owner Ellen Shaw Day phone .345-6163 Mailing address 14321 Hancock Lane Anchorage, Alaska 99515-3963 Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: Two (2) 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water Day phone Day phone 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 xxxx 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 (Rev. 1/91) Front MOA U21 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 Tobben Spurkland, P. E. _Phone 279=3916 Address 203 West 15th Avenue #206, Anchorage, Alaska 99501 Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. XXXXX Disapproved. Conditional approval for Date bedrooms, with the following stipulations: Additional Comments Failed septic system has not been replaced/ upgraded. By: Z /,ez`l X__e `j�� Date June 15, 1992 CAUTI� 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. IM25 (Rev. 1/91) Back MOA p l • MUNICIPALITY OF ANCHORAGE �� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 4 C) 1B —'x0 V—a3 - -i. 1. GENERAL INFORMATION Complete legal description HAA H Location (site address or directions) Property owner —N—If-44 5 cLW- Day phone _ Vi-- 6 2) Mailing address Lending agency _ Lt�A k," Day phone Mailing address_ — Agent Pe-c2.�_�� ' �d4r' Day phone Address . Unless otherwise requested, HAA will be held for pickup. ?.. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well _ Public water `'/,c) 19z 71.!�- NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. A. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 12-025(Ray. I/91) Front IAOA M21 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 Name of Firm /• c� U l-4 Address Q-3 �5 t — this inspection. 0 Engineer's signature 13 U -r- V� 0..1.1J'a-LL 71t" L"0 av1 au -k ^^ f+Inpoln , 9 t/amu"cpm I Iwo CJe� 7 /_HeLa. c�aQ d �prV.e t o e� t` u t t e. eu�7J In . 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. 4�— Conditional approval for Additional Comments Phone - M _16 Date z1I019I 2— bedrooms, with the following stipulations: Date - - - CAUTIN 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 (Rev. 1/91) Back MOA 921 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL. CHECKLIST Legal Description: 3/1 4 11-21 _ Parcel I.D. e)IS -aO9 "'a3 A. WELL DATA Well type R_ If A, B, or C, attach ADEC letter. ADEC water system number NSA _ Log present (Y/N) Date completed 10 r Driller T?��AA ec Total depth )t( _Cased to —Casing height - 1A1 J Sanitary seal (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG ro//lY�b Wires properly protected (Y/N) _ x AT INSPECTION PT g.p.m. �( g.p.rrr-- C� SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Ic% ; On adjacent lots I Absorption field on lot 105 ; On adjacent lots 19tJ Public sewer main N1^ Public sewer manhole/cleanout Sewer service line j AS- Petroleum tank N b WATER SAMPLE: RESULTS: Coliform Nitrate 1. 7 —Other bacteria x Date of sample: /� t Collected by: —_aVW r" )F Nc� B. SEPTIC/HOLDING TANK DATA --_- Date installed 11 _Tank size GD _Compartments__ Cleanouts (Y/N) Foundation cleanout (Y/N) _ ' Depressiioon�(Y/N) High water alarm (Y/N) ----Alarm tested (Y/N) Date of pumping Pumper _ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s)onlot tq'D d- On adjacent lots Icy+ Foundation- ID To property line_ 10 f Absorption field 110 Water main/service line >2d— Surface water/drainage _ N 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION / Date installed (� Size in gallons Vent(Y/N) High water alarm level _ "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water _ Date installed I//1!!7� t t—_ �y�/g3 Soil rating j System type Length 3/+6S Width 3 Gravel thickness 7 S- L Total depth /.2 Total absorption area Io 56 Cleanouts present (Y/N) , Depression over field (Y/N) I1/ Date of adequacy test Zl! i'L— SuY�GG/'Y Results (pass/fail) r,i, for 1r12 bedrooms Peroxide treatment (past 12 months) (Y/N) _ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot )D 7> On adjacent lots /0-C) 4 Property line 5 To building foundation A�_ To existing or abandoned system on lot N1q On adjacent lots > 3o Cutbank tq/161 Water main/service line 025 Surface water 10 Driveway, parking/vehicle storage area 10 Curtain drain N�2 E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature �� �k�y,'�C�a�C Engineer's Name I � ,e.� � 1 � Date HAA Fee $ Date of Payment Q '� Receipt Number 6 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL I& GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 51248 Chemlab Ref.# 92.0650 Sample # 1 Matrix: WATER Client Sample ID 14321 HANCOCK LN 3/2 SUNSET HILLS PWSID UA Collected FEB 17 92 8 hrs. Received FEB 18 92 # 16:45 hre. Preserved with AS REQUIRED Analysis Completed FEB 19 92 Laboratory Supervi��a,��oorr STEPHEN C. ED/E, Released By : � Com. 1(1/ Client Name :TOBBEN SPURKLAND, P.E. Client Acct :TOBBENS BPO# PO# :NONE RECEIVED Roq# Ordered By :TOBBEN SPURRLAND Send Reports to: 1)TOBBEN SPURNLAND, P.E. 2) .............. ........................................................................................................................ Parameter Results Unite Method Allowable Limits ----------------------`-------------------------------------------------------------------------------------------------------------- NITRATE-N 1.7 MG/L EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: UA. Remarks: ........,...............................................................................,........_.........................._.......__... I Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than v EESMS Member of the SGS Group (Soci9t(5 GdnArale de Surveillance) -V - Q V L-11- r 9 I-- F "o V,11-.) I .. CH 203 NEST 15YH. AVENUE SUiTE 206 ANCHSRASE, ALASKA 99502-3904 19071 279-3916 SEPTIC SYSTEM ADEQUACY TES's 0M. A_ t•:,, LEGAL: L.ot•. .::, B1or_4: 2 Sunset. Hi.1]. Weal: �.;. LOCATION: 1.4321 Hancock: lane OWNER: Ellen and David Shaw Xh_n Spuddond C .2225 prro�Essi�°�� RESIDENCE: Single Family, Bedrooms ��N; WELL.: Private, On Site SEPTIC SYSTEM: FROM MUNICIPAL_ RECORDS: 3 Bedroom System TANK: Greer Steel 1250 Gal. Two Compartcs. ABSORPTION SYSTEM: Trench ABSORPTION AREA: 1056 Sq. Ft. SOIL.. RATING: 140 INSTALLATION DATE P x976 and 190:;1, DATE OF LAST PUMPING: Anc_h. Cele, Pool Feb. 18, 1992 DATE OF TEST: February 18, 1.992 TESL' PROCEDURE: System was inspected and measured. lank was found with 4.5 feet of cover- and with a liquid level. of AG inch -- es. Trench clean out was E6.5 feet deep ;:and dr -y. Trench monitor tubes wore 169 inches deep with 94 inches of water and 148 and E91. Both trenches had water to or ,.above the distribution pipes. 580 gallons of clean waiver was added to the trench while the water levels in the hank and the monitor tube were monitored. The water- level .in the tank did not change, while the level in the monitors rosea 12 and 13 inches. The next day the water level in the monitor- tubes were checked. The water level had dropped 7 inches in both pipes, indicating that approximately 300 gallons of water had been absorbed. TEST RESULT: This sygteam clous not meet the code require- ments of the Health and Social Services Department of the Munici- pality of Anchorage. NOTE The operarti.onal life of all septic systems depends on the local sail conditions, groundwater- levels that may fluctuate during the year, and the water usage of the family being served by the sytstem. 'T'hese conditions are outside the control of the evaluator of this; septic system. We can therefore not give any estimate of how long this system will function =satisfactory for current or future occupants. !FaF"' - E---.� 203 WEST 15TH^ AVENUE SUITE 20b ANCHORAGE, ALASKA 95502-3904 (907) 279-3916 RESIDENTIAL- WELL INSPECTION WEGAL: Lot 3, Block 2 Sunset Hills West LOCATION: 14321 Hancock Lane OWNER: Ellen and David Shaw TYPE OF WELL: Private, Single Family WELL LOB AVAILABLE: Yes [� ` INSTALLATION REQUIREMENTS MET:Yes WELL YIELD FROM WELL LOG: 7 Gallons per Minute PUMP YIELD FROM TEST: DATE OF INSPECTION: 7 Gallons per Minute Febrvary 18, 1992 � TEST PROCEDURE: Well was pumped at a constant rate while the drawdown was monitored with an acoustic prnbe^ At the beginning of the test water level was found at 61 feet below top of casing. At a pumping rate of 7 gallons per minute the water level dropped tn 77 feet after 65 minutes of pumping and remained at that level for the duration of the test" A total of 5B0 gallons were pumped. The well recovered 100 % to 61 feet after, 20 minutes" TEST FOR E"COLI AND TOTAL NITROGEN: Nater, was tested for E.Coli and total nitrogen on Feb. 19, 1992 E.Coli 0, Tnta] Nitrogen 1"7 mg/l^ Max, allowable Total Nitrogen 10 mg/l^ TEST RESULTS: This well meets the requirements of the Municipality of Anchorage. THIS WELL 'WILL. PRODUCE MDRE`THAN3GALLONS PER MINUTE FOR MORE THAN FOUR HOURS The Municipal requirement for well flow is 150 gallons of water per bedroom per day. This well exceed this requirement. The assessment of the condition of the well applies only t the conditions as of the day tested. The flow rate may change due to subsurface conditions that may not be observed from the surface, and changes in the land usc and other factors that may impact the aquifer feeding the well. CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 AIIALYUS P,0ULT'3 for IUVOIUP !'r 52155 cho"Jab Rei.$ 92.1997. 301112.10 B 1, Ilatxiz: NATER U.innt Sample ID 3/2 SUBSET HILLS (Dont Hm;ic :'T%b?,U 5PURUM11). P.F. PWSM : UA ('Hint Acct :TOBBIA18 Collected Q hxu. PTO[) POII:I10U'. RRC&IVEA "cotved APR SO 91. '? J.%:UD h,_c. Req Necrved nitl-1 hS RRQUIRp'D Ozdexed By :T0B11EU 31"By' 1010 Ai101yeis (;Qlopl0t'.d WR .13 92 Send Ropoxts to: I aboyatory Supo) ns z _STENIEH C BE 1)TOULU SI'UIIILId1U, P.P.. ricl.,a..s o By ._ ':J: aIOL•t C): R23UIC9 HI)li.S i let110,1 ALIOWabI_n Llln{tA 17I9'RA'I'E-!; 1..6 i,g/1 Y'PA 353.). 1.0 REC.EIVFD APTI 2 01992' Municipality 01 Alwin i. a90 Dept. Health & 1-luman Serv'.ces Sa1np7.0 ROUPI,M SAI•TU COLLGCTM) B'i: 01,. 110, TU' FOR TIIIS SA1fI'U. Acmerlla: .._ Testy I'ni f.n?mad in^- ;Ipocio] i.nc txuett nnR Above J7 U1 -rru7. ic'W e 1M llonn I)etcctod See :3�lnple Romni:ks Abovo IIA= lios: 2nelyzad JALczs 'Than, C'1'-:k.oete, 'Phan es.IS Member of the SGS Group (Soc!W 06n6rale de Surveillance) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION ON-SITE WASTEWATER DISPOSAL SYSTEM INSPECTION ENGINEER FIELD AUDIT DATE: TIME: LEGAL DESCRIPTION: X21) y f ENGINEER: EXCAVATOR: AUDITOR: COMMENTS: SIGNATURE AUDITOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OI' HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL51fU_ OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date I qi a 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lerr 3 a ie 4, s N & e r 444 u s L✓// ;F . i a ,G C_ 34t T 12, N *S L, / Location (address or directions) (b) Property Owner .P41VLGN%°✓ Telephone: Home Business _ Mailing Address 1 N�-/ 1-iAt/L�( PC?C�[ .qM i9a (c) Lending Institution v ++r>>q N.��__I,Telephonet^��d,L�� %— :aD 3l Mailing Address " 1. S (d) Real Estate Company and Agent Address 'Telephone (e) Mail the HAA to the following address: or: Check here, if hold for pick up. List contact person and day phone ^number below. 19 lk� 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY Individual Welly] Community ❑ Public ❑ Note: Itcommunity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. ; 4. SEWAGE DISPOSAL Onsite Public ElCommunity El Holding Tank ElNote: f communitywell system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev BMW Frons 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 Slate codes, ordinances, and regulations in effect on the date of this inspection. 9�7 Name of Firm 2 7 _^^�' Telephone _ o� ` ` � ql k, Address __ ago -S 44-I s_y — Date fl F° At, riteni T H 1 IA l.,. W46°°•Yoo• �.�.• o 22•• � Q''• U.NE 25,26-Et971',i 6. DHHS APPROVAL Approved for �� ^� C3 edrooms by ,� I V v o zo' Date Approved zl__ Disapproved Terms of Conditional Approval Conditional CAUTION Engineer's Seal 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. Page 2 of 2 _ 72-025 iBev 8/061 Back Ge MUNICIPALITY OF ANCHORAGE (MOA) L4lEALTH AUTHORITY APPROVAL (HAA) JoL\o�QCtON�A�QY,, CHECKLIS264- 7BREUARY20 1964 Legal Description _( L.� I1 ��2 �-- A. WELL DATA��' Well Classification : If A, B, C, D.E.C. Approved (Y/N) — K� Well Log Present (Y/N) y Date Completed 10111-16-1 Yield _/Vvn Total Depth I IP Cased to f _ Depth of Grouting __ Static Water Level . `J // — Pump Set At r Casing Height Above Ground —_� ` Sanitary Seal on Casing (Y/IV) — y Electrical Wiring in Conduit (Y/N) _fir Depression Around Wellhead (Y/N) _ N1 Separation Distances from Well: To Septic/Hekyned Tank on Lot — I m-.) t ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot — I On Adjoining Lots To Nearest Public Sewer Line D t t-� To Nearest Public Sewer Cleanout/Manhole _ ) To Nearest Sewer Service Line on Lott > 1 (2 Water Sample Collected by — T~ ; Date , n , Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed �) I r �z _ Size �� 15 /-3 No. of Compartments ^�^ �/ Standpipes (Y/N) © N Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) Depression over Tank (Y/N) NI �, _Date Last Pumped 1.4 �'lT'b Pumping/Maintenance Contract on File (Y/N) N ; for—W/fit--•�/— Holding Tank High -Water Alarm (Y/N) rr/ Temporary Holding Tank Permit (Y/N) MA Separation Distances from Septic/Holding Tank: To Water -Supply Well — 10 <<o _ To Property Line To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/84) /0 To Building Foundation - r V To Disposal Field 10 To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ) t40 Type of System Design Date Installed �7 I I / Length of Field 3 'F Width of Field rr Depth of Field f I f Gravel Bed Thickness Square Feet of Absorption Area IQ `a (I Standpipes Present (Y/N) - Y Depression over Field (Y/N) fIll Date of Last Adequacy Test Results of Last Adequacy Test ��a d) moi 1'_,r / 13 r leg f�'v_�re e ci C,— Separation Separation Distance from Absorption Field: To Water -Supply Well 1 U 3 To Property Line a To Building Foundation To Existing or Abandoned System on Lot To Water Main/Service Line > �O To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION N0110_ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrica Codes (Y/N) Comments On Adjoining Lots 7 z� c) To Cutbank (if present) tvonit3 — Dimensions Manhole/Access (Y/N) "Pump Off' Level at — Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or Mformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed �l� �,�Date r�/P3�fz1% Company i MOA No. Receipt No. / U O/ U a b Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) o. 2225-E 'r )UNE 25, 1971 1, Engineer's Seal VO CW G � �QCSdG�G�D� Po�O 2 ANCHORAGE, ALASKA 99501 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 R E S I I) E N T I A L W E L L I N S P E C T I 0 N. LEGAL: LOT 3, BLOCK 2, SUNSET HILLS LOCATION: 14321 HANCOCK LANE OWNER: DAVID SHAW fa"Ey;•' y �� Oil' ,k; f'7 M TYPE OF WELL: SINGLE FAMILY ••••• ... .� s 0 WELL LOG AVAILABLE: YES �2225-E ; �{�i?j, JUNE 25, 1971 •:,�;,A INSTALLATION REQUIREMENTS MET: YES !,`?S' � fey v 1 w'q.s ` WELL YIELD FROM WELL LOG: 7 GALLONS PER MINUTE PUMP YIELD: 6.75 GALLONS PER MINUTE DATE OF INSPECTION: DECEMBER 18, 1986 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 6.75 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE: THE WELL WAS PUMPED TILL THE DRAWDOWN STABILIZED. STATIC WATER LEVEL WAS FOUND AT 74 FEET BELOW TOP OF CASING. AFTER 20 MINUTES OF PUMPING WATER LEVEL WAS AT 92 FEET AND REMAINED AT THAT LEVEL FOR ANOTHER 40 MINUTES. A TOTAL OF 500 GALLONS WAS WITHDRAWN. WELL RECOVERED 100 % IN 10 MINUTES. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON DECEMBER 16, 1986. TEST WAS NEGATIVE. TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. D v � ESV Glr `G3G�dQ�]D9 Ol7o 2 ANCHORAGE, ALASKA1 203 UTE 99601 CONSULTING ENGINEER --- TELEPHONE: (907) 279-3916 S E P T I C LEGAL: LOCATION: OWNER: REISIDENCE: WELL: SEPTIC SYSTEM: DATE OF PUMPING: DATE OF TEST: S Y S T E M A D E Q U A C Y LOT 3, BLOCK 2, SUNSET HILLS 14321 HANCOCK LANE DAVID SHAW SINGLE FAMILY, -..THREE BEDROOMS PRIVATE, ON SITE T E S T FROM MUNICIPAL RECORDS: TANK: GREER STEEL, TWO COMP. 1250 GAL. ABSORPTION SYSTEM:- TRENCH ABSORPTION AREA: 1056 SQ. FT. SOIL RAPING: -140 INSTALLATION DATE: 1976 & 1983 DECEMBER 18, 1986. ANCHORAGE CESSPOOL PUMPING. DECEMBER 18, 1986 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH 4 FEET OF COVER AND A LIQUID DEPTH OF 48 INCHES. CLEAN OUT TO TRENCH WAS _FOUND 10 FEET DEEP AND WITH 78 INCHES OF LIQUID. 500 GALLONS OF CLEAN WATER WAS ADDED TO THE TRENCH WHILE THE WATER LEVELS IN TANK AND TRENCH WERE MONITORED. TANK LEVEL REMAINED AT 48 INCHES .WHILE THE TRENCH LEVEL ROSE 10 INCHES. IN -THREE; HOURS THE -LEVEL IN THE TRENCH DROPPED 2 INCHES INDICATING AN ABSORPTION RATE OF 100 GALLONS PER THREE HOURS. TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. b�Q�• � f. �Y,k� *• .49TH`+✓ o •.� • ........ e� 2225-E o. ,f1d 1 N E 25. 1971 ��0 A. s 72020 Im921 -o f.t— hm APPLI AT FILLS OUT UPPER HA JNLY Proped Dwnsr��r�- (�' C Phone Mailing Address _ 5liu (� (L�. 2_, (� /•.-�'1 t'A, Zip Code G C - 21 — !'17 -Y c- 1-1—rte— - 1I �\ _ >� _ Buyer Address Zip Code Lending Institution Date Phone Address Zip Code Realty Co. & Agent Phone Address Zip Code ,I Legal Description I -O I- 1" 1 2 ��3'Ot: lc.. �, 3c -i V'1w. •J Street Location L'> _ �.n 4Y� Type of Residence Inspector Single Family ❑ -� Multiple Family No. of Bedrooms—0- — ❑ Other Water Supply EIndividual ATTACH WELL LOG. A well log Is required for all wells drilled since June 7975. Community For wells drilled prior to That date, give well depth (attach log If available). ❑ Public Utility MUNICIPALITY ANCHORAGE /?� 4 l Sewer Disposal y-' k T Individual Year Individual Installed: _ _ (7 Public Utility _— When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72020 Im921 -o f.t— hm Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: ll-,�4 MUNICIPALITY ANCHORAGE /?� 4 l DEPT. OF :`.ALTfI i� H ENVIRONM1NTAL PROTECTION (�) APPROVED BEDROO J ���//�,_ f'CONDITIONS OF APPROVAL ft O 'CSS (�) DISAPPROVED f -"'""`4 tp�Aa4.. 1 ('c,,d.'t�9�• ( ) CONDITIONAL_ APPROVAL- DATE BY: Soils Rating Date Sewer Installed LWell Weil To Absorption Area / CA -O =WIllUgeceived to Tank / ok Size 72020 Im921 -o f.t— hm December 12, lfrts3 Jerry E. Ulmer max IU142U Anchorage, AK 99510 subject: Lot- 3, Block 2, Sunset hills, blest APproval for the individual sewer and water facilaLies cannot he granted until the following items have been completed: Qxposcd electrical wires, to the well head are in violation of the, Municipality of Anchorage codas and must be encased in conduit. Please notify this Deprartment for a rei.nspoetion when the noted discrepancies have been corrected, If thorn are any further questions, please call this offices at 264-4720. Sincerely, Cory Willis, R.S. Acting Sower. & Water Program Hanayer. CW72/Q/El October 24, 1963 Jerry A. Ulmer Box 101420 Anchorage, AX 99510 SuDjectg not 3, Block 2, Sunset Hills, West Appcoval for the individual Power and water facilities cannot be granted until the following items have Kenn completed. A011) The septic tank pumped with a receipt submitted to this department. 0 P,11 adequacy test needs to be poriormed on the exiBtin�j 3eaching area. This Lest will determine & the system is adequate according to National Standards. A liming of private firms performing the test is enclosed. This reporc. needs to be submitted to this okLico for our review. M A welL log sunwittod to this office for: our tiles and C11C.- review. The top of the well casing should he scaled so that it is water tight. Exposed electrical wires to the well head are in violation of the Municipality of Anchorage codes and must be encased in conduit. Please notify this Department for a reinspoction when the noted discrepancies have been corrected. It there are any further questions, please call this office at 264-4710. S incerely, Jim hoberts Associate Environmental SpnGiallst jRbl/nj/E2 Enclosure