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HomeMy WebLinkAboutELMORE #1 BLK 6 LT 1Elmore #1 Block 6 Lot 1 #018-172-07 MU NI CIPALITY OF ANCHORAGE �I 1 + e i ,II!{1; fi Y DEPAR7PIE T OF HEALTH& ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION j 825 L Street - Anchorage, Alaska 99501 Telephone 204-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME �'iiEW L❑UPGRADE [ I/41 S� �[/ `� / �'�S MAILING ADDRESS A ,AX 315 = s LEGAL DESCRIPTION LOCATION - - NO. OF BED D MS TO: Well `pa 7 Absorption area 7 Dwelling PER MIT N. UyalDISTANCE 0 UT! Al/ D a n~. Z Manufacturer Material No. of compartmer7fs yH Q �� Liq. capacity myallons IF HOMEMADE: Inside length Width Liquid depth lJ s dOZ DISTANCE TO: Well Dwelling - PERMIT NO. 2 2 F Manufacturer - Material Liquid capacity in gallons O DISTANCETO: Well r 00 Foundation Nearest lot lin / PERMIT J7 _/ w= 1 N fJ� J LL Z No. of lines / Length of each line Total length of lines Trench width Distance between line F Z ¢ inches h Top the to finish Material beneath file Total F of grade f r effective absorption area D 411l Length Width Depth PERMIT NO. w Q F Type of crib Crib diameter Crib depth Total effective absorption area wa U) Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J W Building foundation Sewer line Septic tank Absor re DISTANCE TO: CA OTHER — PIPE MATERIALS SOIL TEST RATING C i&t INSTALLER 1' 1.v }, k,. REMARKS II'F �Ift. II>� *rti : O d gi3 t; A'! ih 'i,I ;7 r r, A, APPROVED DATEEGAL 21 72AJ 1 11ev. 31781 I I$OY 1e 699 SWAM aa0U—rU- ES1 A: CHOMAGE, ALASKA 00502 344-'7714 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF _ 116 TPot- DRILLED AT THE RATE OF _$19.00 PER FOOT. PROPERTY OWNER ffk- Ua ScheV-e t4 437-1096 - LOCATION OF WELL SITE. / Bik. /o Sub ECMURE # / DRILLER Belt Clava Ram.RalLt DAZLt mg, blorU4 WELL LOG: 0----16' gwue- and trould &4. 16---58' San4 9,tweL ort th 3N . 58---88' R met 4=4 a alz- 15% gwveC. R 4mad t amount olt mater at 88 Leet but veJt4 4=4 and 44U4. 88--177' Oet C,&4 math 20% ghavet, to -/ 4xat.Paa. 711-176' Clean mai4&i beading 9`twe,G 4homdn4 a pnoduc�a of 209.P111 ata 40 deet o� match 4#and in. ca -i n,g. 1/2 tiod4e Sub. punIA 4hauW be Uwtatted 10 Peet of bo t tans. C04t 0.4 Drai,U,t . $2204.00 C04 -t a-� G7eU, Seat.: $22.00 �GoZ i j s COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF $2226.00 THANK YOU VERY MUCH. BERME CLAUS OF RAMPART DRILLING WORKS DATE _l—bL-19.th„ 7979 ' SERVICE CHARGE OF I Va% PER MONTH WILL BE ESSENN C�P T DUE ACCOUNTS. Pe 4e EATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT CASE N 327 EAGLE STREET q S �(� ��698 qJ`S o/ ANCHORAGE, ALASKA 99501 Dalley ExdaYa_Vf'ou (eon -P Performed For —,am/ti2rILS j / [BwneY) Date Performed v Legal Description: Lot j Block divis,.onp This Form Reports a: Soils Log �/ - percolation Test Depth Feet Soil Characteristics Location Sketch l 'Q a� Si 17�y Sa rrd y 6r¢ v� Z yr i2plia 3 ; ' ; Sand 4 p, 4 Sand y G'rq ve / CG �S/) 4, 8 ' .D 9 ' y t3 r'I j° / Was Ground Water Encountered? A%, c Ao/ If .Yes, At What Depth Reading y Ps_a Cross Time Propised TT) tz.1Seepage Dep-�h Of .In -C ��� . COMMENTS: r . t -F _.0 _ Test Performed By; AA5 K % s j'f Net Time I Depth To H Dep0 Net Drop ___ 2 P Data Certified By:- tj J. I �, a Date: Drain Field it Or Trench j y _ 1%1 t-1 I I L__ a I.0,2 A eF= F=l r-4 E 1/# FiciE__ DEPARTMENTC EALTH AND ENVIRONMEP•fTHL F'PWEi_TI :Pd =25 `L'STREET: ANCHORAGE, AK:. 99501 � F N 264-'47.0 LY S L-A E= L_ 9._ i=L r-4 E_ CA r-4 — a I T E_ " E= L,.E F F" F• E= F" r•9 I PERMIT NO. 790268 ;? Ib.4.5or�iV1 APPLICANT JAMES E. SCREFERS SRA BOX 25-5 344-4 1%1 LOCATION TETON & NATRONA Bblci_ ibL_?_ LEGAL L1 B6 ELMOR'E #1 LOT SIZE 32000 SQUARE FEET '"n TYPE OF SOIL AB SORBTION SYSTEM IS: DRAINFIELC MAXIMUM NUMBER OF BEDROOMS _ _ SOIL RATING (SQ FT'BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS F--EEF�-r FA= -4 L_E_rAA:3-F"= 2:v_r ClF"F�f% `E=L_ CHEF• -F "- THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE'TRENC:H OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT I_ THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). 'T"EE T F? E= r -a C:- H L•-9 I Ca -F" I 15: C-11211DFE=E T. THE GRAVEL DEPTH IS THE MI?IMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). E_.1 -m A_L I F" E= rti !H; E_ F• T I 1_- T L--1"6 -: I ` E f A_ -b CI Ei PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTION'_ OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER' OF RESIDENCES THAT THE WELL WILL SERVE,- — - -- T L-1 Cl a I r-4 a ` E_ 0 -T I C, r•JS3 t=i F' E F' E-= C! L_1 I F' E 6-"• — — BAC:FILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ONt SITE SE14AGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL; OR 150 TO 200 FEET FROM A PUBLIC: WELL DEPENDING UPON THE TYPE OF PUBLIC GJEL.L.. WELL LOGS ARE REQUIRED AND MUST BE RETURNEE) TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIA13RANS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F FEF "r•1 I'T E_�= .F• I F"E°= I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR 'ON-SITE SEWER._ AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE 15 REMODELED TO INCLUDE MORE THAN BEDROOMS. � fZ SIGNED: _ --------------- PPLI,C:ANT JAMES E CHEFERS G Lf— ISSUED BY__�____.-----`ATEs_�(-_��_ '.'_'. 2 l,t� '? ' S'� � ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION • Pouch 6650, Anchorage, Alaska 99502 276-2221 SOILS LOG - PERCOLATION TEST SOILS LOG ❑ PERCOLATION TEST PERFORMED FOR: W\ Mo� sDATE PERFORMED: 1 r LEGAL DESCRIPTION: "''� 1 �1 Vim'" \ ✓ `�"`O ve >'�^'V EP SLOPE SITE PLAN D TH (FEET) ' 1 0' G`( we- 3- —� 4 5 6 GvJ 7 8 _ 9 10 Date Gross Time 11. Depth to Water WASGROUND WATER S' ENCOUNTERED? OLS 12 ��t P IF YES, AT WHAT ���v/,,,.CGG' E DEPTH? 13 14 15 16 17 18- 19- Reading 819 Reading Date Gross Time Net Time Depth to Water Net Drop 20 PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS 72-008 (7/76)- • � Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 rrr± CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 013-172-07 Expiration Date: _i (5 1. GENERAL INFORMATION Complete legal description Elmore !® 41, BLK 6 LOT 1 Location (site address) 4600 Natrona. ANCHORAGE, AK 99516 Current Property owner(s) Wayne Hibbeln Day phone Mailing address 4600 Natrona. ANCHORAGE, AK 99516 Real Estate Agent Day phone 3p5byB 2. TYPE OF DWELLING: 1 19 ° c ® Single Family (w/wo ADU) ❑ Duplex a �r ❑ Multiple Dwellings (Single Family and/or Duplex) Z(21 C a � 3 3. NUMBER OF BEDROOMS: 4 6 L g 9 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: MZJ, : Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5-46 t (90 - f- 46 Date of Payment 6 rsyy L — ✓ a / Receipt Number a6.2yy COSA # CSC/CO/ z --7-5y Waiver Fee $ Date of Payment Receipt Number Waiver # 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 MIKE N ANDERSON. P.E. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON, PE Date 07/5/16 6. DSD SIGNATURE �� nicHnFt N. aft�rescN System #1 A rovedfor_ bedrooms. ��✓f ° CF -v 69 .= System #2 Approved for bedrooms.,, Disapproved. Conditional approval for bedrooms. with the following stip dations By: IA � Original Certificate Date:--7- The ate:-7-The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) 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. �altt t, 7. ATTACHMENTS: �eP�\�Y OFgNCy,-. COSA Checklist X Nitrate Advisory ��' O Septic System AdvisoryArsenic Advisory ITE AND R Well Flow Advisory Other Gg;rE{FlrATER o: COSH blue sheet_10-0n42.tloc to PROGRAM p � "/7-SER�WC� s 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: Elmore S/D #1, BLK 6, LOT I Parcel ID: 018-172-07 A. WELL DATA Well type Private If A, B, or C provide PWS1D # _ Well Log (YIN) Y * Date completed 5119179 Sanitary seal (YIN) Y Wires properly protected (YIN) Y Total depth 116 ft. Cased to 116 ft. Casing height (above ground) 18 FROM WELL LOG AT INSPECTION Date of test 5119179 71112016 Static water level 76 ft. 76 ft. Well production 20 g.p.m. 5+ g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate lq,2Ymg/L Arsenic: ND ug/L Date of sample: 619/2016 Collected by: Mike N. Anderson �. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL Date installed 6128179 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping 61912016 Pumper Around the Clock C. ABSORPTION FIELD DATA —1985 SYSTEM TESTED Date installed 6128179 Soil rating (g.p.d./fe or fe/bdrm) 85 System type DEEP TRENCH Length ft._ Width 60 ft. Gravel below pipe 2.0 ft. Total depth 5,6 ft. . , , :Eff absorption area 255 ft2 Monitoring tube Y Depression over field N Date`.of•adequacy test '6129/20_ Results (Pass/Fail) PASS * For 4 bedrooms Fluiddepth.in absdrpti6ri,field.b6f6re test 0 in. Water added 600+ gal. New depth 6 in. Elapsed Time:, 360 m}rr.{ Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) UNKNOWN If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons Manhole/Access (Y/N) in. "Pump off' level at in.High water alarm level at _ in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 100'+ Public sewer main 751+ Sewer /septic service line 50'+ Animal containment areas 1001+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+' Property line 501+ On adjacent lots 1001+ On adjacent lots 1001+ Public sewer manhole/cleanout 1001+ Holding tank 100' Manure/animal excrete storage areas 1001+ Absorption field 10'+ Water main 1001+ Water service line 501+ Surface water 1001+ Wells on adjacent lots 1004 ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10'+ Water main NA Water Service line 254 Surface water 1001+ Driveway, parking/vehicle storage 104 Curtain drain 100'+ (None known) Wells on adjacent lots 1001+ F. COMMENTS * WELL LOG IS MISSING FROM THE MOA FILE, SEE PREVIOUS COSA BY GARNESS ** BE AWARE SYSTEM IS OLD (1979) NO ASSURANCE ON LONGIVITY, G. ENGINEER'S CERTIFICATION 1 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 Name MIKE N. ANDERSON, PE Date 071412016 COSA canary sheet 2-6-15.doc OF At,�s 11 .............. 70! MICHAEL N. ANDERSON ; f•. C 9 9 NATRONA AVENUE OF •. �. 49th • 9 � � *: 00 0-0 / .Fred Walatka: ff w `� ss� • 3255 — S / 'PFO '. •, , .'aQ `' � �OFeS510NA�- �P � SCALE: I"= 40' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. FB 16-7 pg 15-17 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection of the following described property' LOT 1 BLOCK 6 EI MORE SUBDIVISION ADDITION -NO Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 171H day of - JUNE , 2016 FRED WALATKA & ASSOCIATES MB(907-248-1666) Engineers and Surveyors •: 0 co 0 Cl) 30 N 89046'30" E 178.71 preen `' Lf_ house well -. wire fence . he . -.gravel- ..1 ootid en. /, - 00 W 00 6te.� 7 deo 2 story a C:) frame - Z p house m o O r CD M� lot 2 W 0 ° clean t H C:) 0.5'wcod/ o retaining wall 11.3 g g Z LOT 1 7 .0 ry�5 32— 7, septic vent\e' monitor tube\a deck chain link fence 30 10' Utility asemen N 89046'30" E 178.71 lot 13 lot 14 OF •. �. 49th • 9 � � *: 00 0-0 / .Fred Walatka: ff w `� ss� • 3255 — S / 'PFO '. •, , .'aQ `' � �OFeS510NA�- �P � SCALE: I"= 40' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. FB 16-7 pg 15-17 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection of the following described property' LOT 1 BLOCK 6 EI MORE SUBDIVISION ADDITION -NO Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 171H day of - JUNE , 2016 FRED WALATKA & ASSOCIATES MB(907-248-1666) Engineers and Surveyors •: Municipality of Anchorage 1 Aim -, Development Services Department Building Safety Division, / OnSite Water b Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us (907)343.7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING /,,�I Parcel I.D. 018-172-07 HAA#���ft �ID q /,�7 � 1. GENERAL INFORMATION Expiration Date: Complete legal description ELMORE SUBDIVISION 41: LOT 1. BLOCK 6 ' Il• Individual On-site Location (site address or directions) 4600 NATRONA AVE. ANCHORAGE, AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address GREG JONES Day phone 265-5509 4600 NATRONA AVE. ANCHORAGE, AK 99516 VICKI GREER Day phone Day phone PRUDENTIAL. JACK WHITE, 3201 "Co ST. ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Il• 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 5 by an Independent professional dvil 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 less than 30 days old. (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 wails or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. Note. -Alaska Water and Wastewater Consultants, Inc. shall be paid $1000.00 at, or prior to closing for the engineering sendces provided. 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 invesstigation, 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. 1 further verify that based on the Information obtained from the Municipafrry of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUITE 2B " ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: in conducting this evaluation, AWWC, Ina attempted to provide a thorough, consolentlous engineering sneysis of the system In accordance with ADEC and MOA DSD Guldeffnes d Regulations. The reported resutls described the performance of the system under the conditions encountered at the time of the tag and separation distances measured to readllyldentlfiable fee hires, The operational Ate of all Mails and septi systems depend an the local Bolls condrbon, groundwater levels that may fluctuate during the year, and the water usage of the famlty being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that Uwe are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or future estimate of howlong the system will continue to meet the operational requlrements of the ADEC or MOA DSD. The content of tits report is for Me ade benefit of the owner Ested above. Any rsAance upon or use of Mls report by airy other person or paq Is not authorized, nor wff It confer any legal right whatsoever. 5. DSD SIGNATURE Approved for� bedrooms. Disapproved. 337-6179 Date 8 d t) D Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort 10 ON-SITE WATER ANU WASTEWATER PROGRAM By: Original Certificate Date: (Ftw• 12W) ..�,.. Municipality of Anchorage Development Services Department OnSits tew prNi am 4700 Satyr Bragaw SL P.O. Baa 198850 Andarage, AK 99519 850 WNW .d.andwrage s us (907) 343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal DeNdpilon: ELMORE SUBDIVISION #1: LOT 1. BLOCK 6 Parcel ID: 018-172-07 A. WELL DATA Wen type SATE HA. B. or C provide PWSID# N/A Date completed 5/19/79 Sanitsry seal (Y/N) YES Total depth 116 g Cased to 116 it FROM WELL LOCI Date of test 5/19/79 Static water level 76 It, Wen production 20 g.p.nL WATER SAMPLE RESULTS: Wen Log (YM) YES Wires properly protected (Y/N) YES Casing height (above ground) 18'+ In. AT INSPECTION 8/22/2001 75 It, 5.7+ g.p.m. Conform-_.colonies/100 m1. Nitrate r" 2mgA. Other bacteria --o_colonlesMOOmi. Data of sample: 8/22/2001 WeCted by: AWWC. INC. S. SEPTIC/HOLDING TANK DATA TankTypelMatertsl GREER/STEEL Date Installed 6/28/79 Tank ams 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation deanout (YB4) y Depression over tank (Y/N) NO High water at= (YM) N/A Date of pumping 8/4/2001 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date Installed 6/28/70 Solt rating .pd fP/bdrm) N5 System type TRENCH Length 40 fL Width 60 JL Gravel below plpe 2 fL Total depth s.a 1t Ell absorption area255 ft' Mw t ft tube YES Depression over fleld NO Date of adequacy teat 8/22/2001 Results (Pass/Fall) PASS For 4 bedrooms Flud depth In abswptlon field before test'22.5In. Wer wed 750 gal. New depth•30.5In. Elapsed Tine: 991 min. Final Auld depth'22.5In, AbaOM5011 rate ;0 600+ g.p.d. Any re)Uvenetion treatment (past 12 mo.) (Y/N & ti") NONE KNOWN 9 yes. give data — *INVERT OF DISTRIBUTION LINE AT 28' ABOVE BOTTOM OF MT D. LIFT STATION Date installed Slae in gallons 'Pump on' level atn. E. SEPARATION DISTANCES High water alarm level at In. Lyda tested Meets alarm 6 dreug requlrementsT SEPARATION DISTANCES FROM WELL ON LOTTO: Septic tankAig station on lot 100'+ Absorption geld on lot 100'+ Public sewer main N/A Sewer /septic service One 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/deanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTICMOLDING TANK ON LOT TO: Building foundation 5'+ Property One 5'+ Absorption geld 5'+ Water main N/A Water service One 10'+ Surface water 100'+ Wells on adjacent loos 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property One 10'+ Building loundaUon t 0'+ Water main N/A Water service line 101+ Surface water 100'+ Driveway, parldng/vehide storage 15'+ Curtain drain NONE KNOWN Wells on adjacent Iota 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION cord& that I have determined through field hrspecBons and review, orMun/c/pa/ records that the above systems ars In conformance with MOA NAA guldellnes In etfed on this date. Engineer's Pri N JEFFREY A. GARNESS Demo D! HAA Fee $ 300 • o 0 Date of Payment q T �r 1 Receipt Number 9 598 Sm. 12W) Walver Fee $ Date of Payment Receipt Number. U 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.# 012—17Z—o% HAA #-.. i-(AR406SS 1. GENERAL INFORMATION Complete legal description Lot 1 Block 6 Elmore subdivision # 1 Location (site address or directions) 4600 Natrona Property owner Greg Jones Day phone Mailing address 4600 Natrona Anchorage Alaska 99516 Lending agency Mailing address_ Agent N/A. Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Day phone Day phone 94168 Individual well x Community well Public water NOTE: If community well system, provide written confirmation from State ADEG''_ att<est- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: =r Iridividual on-site X :..-Hnlriinn tAnlr , - �••��••••y w uro icyauty attu slaws Or system. - 72-025 (Rw.1/91) Front MOA 021 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Phone (907) 145-118S Address P.O. 11134 Anchors 99511-1349 1 �G Engineer's signature Date / Dee 59[> 6. DHHS SIGNATURE- - Approved for = bedrooms. Disapproved. Conditional approval for ' bedrooms, with,the following stipulations: Additional Comments Y. \1 - Date - " 7 CII,1 A 2T"AW 1, 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 oranalyzedata before a certificate is issued. The Municipality of Anchorage is not responsible for errors or ornisslonsin"the professional engineer's work:. 1 i�cs> a3ll i it>b7. - MM(Rw.1,21) Swk "MOA 821 v„W7A Hfa,} {{q?i':543i1 .4}aS 94168. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L 1 B 6 Elmore Subdivision # 1 Parcel 1. D. A. Well Data Well type Individual If A, B, or C, attach ADEC letter. ADEC water system number N/A Log present (Y/N) Y Date completed 05/19/79 Q Driller Rampart Drilling Total depth 11`6' Q Cased to 116' p Casing height 18" Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION Q Date of test 05/19/79 11/09/94 7v Static water level 76.' 65' Well flow 20,S=g.p.m. 2.6 9 -p.m. t'71y _.. co (.0 Pump levolif _X ` 106' SEPARATION DISTANCES FROM WELL TO: Q 108.5' Septic/holding tank on lot ; On adjacent lots 100'+ Absorption field on lot 110' Approx. ; On adjacent lots 1001+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer service fine N/A Petroleum tank N WATER SAMPLE RESULTS: Coliform. 0 Nitrate 3.22 mg/L Other bacteria 0 Date of sample: 11/15/94 Collected,by: Dustin High B.,SEPTIPIHOLDINQ TANK DATA Date installed 06/28/79ci Tank size 1250 Compartments 1. Cleahouts (Y/N), Y Foundation cleanout (Y/N) Not Egund ® Depression (YIN) N C High watdr alarm.(Y/N) NIA Alarm tested (Y/NNIA Date of pumping 11/11/94 Pumper A+ Home Serviced SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Weli(s) on -lot 108.5' On adjacent lots 135't Q Foundation 4.4 _Q To property line 74.3' ® Absorption field, Water main/servica line N/A Surface water/drainage None 72.026tWl'Frdnt CONTINUED ON SACK PAGE C. LIFT STATION Date Installed Size in (Y/N) Vent (Y/N) "Pump on" level at / "Pump off" Level at High water alarm level , / Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE Well on D. ABSORPTION FIELD DATA LIFT STATION TO: On adjacent lots Surface water Date Installed 06/28/79 Soli rating (GPD/Ftz) 85 0 System type Trent Length 4.0_ 0' � Width 60" � Gravel thickness 2' Totaldepth 5.5T5.1 @ M.T.2 Total absotption area 255 I Cleanout present (Y/N) Y 19 Depression over field (Y/N) N Date of adequacy test 09/11/94 Results a sHa0) Pa so for _ 4 Bedrooms r. v, a) F Water levetjn absorption Ilaid before test ` z Atter test ., Peroxide treatment (past 12 months) (Y/N) N ' 0 yes, give date N/A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 110'+ On adjacent lots 100 + Property line 20' + To building foundation 25' Est. To existing or abandoned system on lot None On adjacent lots 70'+ Cutbank None © Watermain/service line N/A Surface water 100'+ © Driveway, parking/vehicle storage area 25' Curtain drain None Notes: ID Information Prom DHHS Microfilm Records E. ENGINEER'S CERTIFICATION 0 Measured by DHI Consulting Engineers, 11 /9/94 ®owner States Additional fill has been added overtop I certify that / have checked, verified, or conformed tAl I6Al9nff#W�u `idel/nes,Peale of t is inspection, Engineer's Name HAA Fee $ 3lb e dZ) _ Waiver Fee $ Date of Payment -Z Date of Payment Receipt Number 5�o 6 c / _ Receipt Number I2-02,4 (393)• owk MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE I. General Information Application Date 9 -,W —64 (a) Legal Description (include lot, block, subdivision, section, township, Location (address or directions) 60, "NE=B AP -MI-ON PLACE 4#' iyf}}7-)?oNq r yyt4ue (b) Applicants Namet4JEEdi 'SONES Telephone — Home3-%usinesss' 3 �204/Q Applicants Address S A4 Arr,c ?311—Cr, 99SO % (c) Applicant is (check one) Lending Institution ; Owner/builder• Buyer E --:j ; Other E�l (explain); (d) Lending Institution ���5�(q lIj57A Telephone Address (e) Real Est Address Telephone (f) Mail the HAA to the following address: ♦/ �� 2. Type of . -. Single—Family Multi—Family Number of Bedrooms 3. [dater Supply Individual Well � Community Other (describe) Public = 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 Eu Public M Community M 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] 5. Engineering Firm Providing Inspections, Tests, File Search. Da As certified by my seal affixed hereto and as of the validation date shown V,t y. 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 regula- tions in effect on the date of this inspection. Name of Firm W Address Telephone ,% Date (ENGINEER SEALS s ,amu••.=•••••••°••j• �® iV, i• Gordon D. Un■in j g 1936E C�dLm 6. DHEP A royal , Q�9F'►....•PyF�s ( 0®®®RO FES Approved fo Y bedrooms By ,1Lu-� Date Approved X Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. 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 ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 M MUMCIP U t C' .I \C1-ORACI- DE C iL" L1VIR0XviENT ,L MUNICIPALITY OF ANCHORAGE (MOA) Sip 21 19$¢ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 REC E 19 I C WELL DATA Legal Description: �ro_ NSI t VoLeX $Ix LY/�o2G SGfBA, AINDN LVD ONO Well Classification If A, B, or C, D.E.C. Approved(Y/N) AW tT 1/ y Well Log Present (Y/N) gS Date Completed-/�- 79 Yield Total Depth /)& W, Cased to Depth of Grouting Static Water Level 76 4-i: Pump Set At /Q6 H, Casing Height Above Ground .1Q m&[4me, Sanitary Seal on Casing (Y/N)yrzj�, Electrical Wiring in Conduit (Y/N) No Depression Around Wellhead (Y/N) No I Separation Distances from well: To Septic/Holding Tank on Lot jQQ ri: 4- ; On Adjoining Lots 100 4 - To To Nearest Edge of Absorption Field on Lot LX f!:t ; On Adjoining Lots ldo-kf,4- To Nearest Public Sewer Line NfA To Nearest Public Sewer Cleanout/Manhole 81A. To Nearest Se _ Line on Lot Water Sample Collected By dHEfAI6f L 66Lf.RBOIFATOVA-M-a K. ;�= Water Sample Test Results !� _ Comcents Wet& Lp T-i'AG�f= AL A'f"n9@ FYF�l� Dft'1'ED 7--30-Al' B. SEPTIC/HOLDING TANK DATA Q Date Installed ,/�-, -79 .-Size /a5® mg— No. of Compartments 600 Standpipes (Y/N) Air -tight Caps (Y/N) j99 , Foundation Cleanout (Y/N) ye-�2 Depression over Tank (Y/N),No Date Last Pumped L- Pumping/Maintenance Contract on File (Y/N) No ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) N A Separation Distances from Septic/Holding Tank: To Water -Supply Well 100 To Building Foundation_ 0 To Property :Line /QQ-jrf, To Disposal Field jp syt, ± To Water Main/Service Line N/A To Stream, Pond, Lake, or Major Drainage Course W NSA Comnents Receipt a1 Date Paid: Amount: 41'y ad [Page 1 of 21 2-15-84 C�\CLY►TCi,JI�i►?`i.�fi�T►7►111 Soils Rating in Absorption Strata Fj'/gd, Type of System Design Date Installed _(p— 2p` —%9 Length of Field #Q 5-t, Width of Field 60 /Ne1+0,!5 Depth of Field Sia ft, Gravel Bed Thickness Square Feet of Absorption Area 360 ,�+, Standpipes Present (Y i Depression over Field (YM) NO Date of Last Adequacy Te Results of Last Adequacy Test f}7 wr:� D AASs>ju6 6 Separation Distance from Absorption Field: To Water -Supply Wall /QO _ °+, + To Property Line _JOS}', + To Building Foundation Hi t To Existing or Abandoned System cr: Lot. N 1 ; On Adjoining Lots /50 , + To Water Mair./Service Line NIA To Cutbank(if present) AJ@AWN�f} To Stream/Pond/take/Cr Major Drainage Course A0RL_JLM To Driveway, Parking Area, or Vehicle Storage Area /w-4. + Connents_ EXIST, !, 5A;M) /5 iN A&?�-r WMH AN,2�PIFOrION E!ZftmT" Rwrep 6 -AB 79 /Ay,-maprrlo w P&xMrr 7?au 9- A-irhalisp, D. LIFT STATION NIA Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Ccaments Dirensions Manhole/Access (YIN) "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 e checked, verified, or conforted to all MOA HAA G�jts ^n effect on the date inspection. �aooa, °pe"�yJ R"�n Date Signed 9:,-8y ,v s�.tyrlD®, Company MOA No. KBl/d5/s R . Gordon D. Ynwln �S NO. WS&E ; _?�,e (Page 2 of 2] 2-15-84 AK 411111111111 -W DINWRECEIVED _ INSPECTION APPOINTMENTS TIME �A7 'a/did TIME TIME SINGLE FAMILY El One ❑ Four ❑ Other ,., /p`' t l �/ C'J AA4_'L "_k 'A_ - DATE Three ❑ Six DATE -i DATE INDIVIDUAL* ' ATTACH WELL LOG. A well log is required for all wells drilled 1 1 INSPECTOR depth (attach log if available.) INSPECTOR INSPECTORn CINDIVIDUAL/ON-SITE" VX YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION ENVIRONMENTAL SANITATION DIVISION JUL 24 1981 Telephone 264-4720 SERE CC [[''��� REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SERF. ILIf&B DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER PHONEZ7e- 5!;/- -5 DD MAILING RESS S. / 731-,11. i%ri, y95o PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILIN ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE A/ 7Y4 � MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION T T rY �A7 'a/did 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS SINGLE FAMILY El One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY INDIVIDUAL* ' ATTACH WELL LOG. A well log is required for all wells drilled COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM CINDIVIDUAL/ON-SITE" VX YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79)/ 4�Q ik F-1 AL 72-010 (Rev. 6/79) ow THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLEFAMILY ❑ MULTIPLEFAMILY NUMBER OF BEDROOMS - ❑ ONE ❑ TWO. ❑ THREE ❑ FIVE ❑ OTHER ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 'n T 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE EJ PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED -" INSTALLER ❑Septic Tank or ❑ Holding Tank Size: / QL_�O If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER f TOTAL ABSORPTION AREA MATERIAL i 4. DISTANCES WELLTO: Septic/Holding Tank lAbsorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS t— APPROVED FOR �_ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompa ce ificate) El DISAPPROVED DATE BY 72-010 (Rev. 6/79)