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HomeMy WebLinkAboutT15N R1W SEC 8 LT 212T15N RIW Sec 8 Lot 212 #051-154-41 ) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MA,L,NG ADORES¢' x 135' ; ¢' LEGAL DESCRIPTION LOCATION NO, OF BEDROOMS~ ~ DISTANOETO: ]Well ]Absorptionare~ f Dwelling PERMITNO. ~ ~ Manufacturer No. of compartments Liq.i~ gallons IF HOMEMADE: Inside length WidthTM Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~_~O ~ ~ Manufacturer Material Liquid capacity in gallons ~ DISTANCE TO: Well ,~0 ~ Foundation~ ~ Nearest lot line ~¢ l~ PERMITNO,¢ No. oflines ~ Length ~f~a~ ~e Total le tb of I'nes Trench wid~ Distance between lines Total effecti e a o~ ion ~ Topoftiletofinisbgrade ~ , Materialbene~thtge ~ inches ,~[~ ~ Length 'Width Depth PERMIT NO.' ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line m DISTANCE TO: Classr ~'~ Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER INSTALLER ~ ~ , Rev. 3/78) t1".1 t._I It'-~ ][ C: :I: P F-t L :I: T T' C, IF !-~ 1'-.! ,:: H ~-::~ IF~.' I-q "3 E / ~. 825 '"L STREET., Ai'.,ICH~RAGE, AK. . ELL ,NC. PE:,:.!:I~T NO. ,:: 8~0_-..':~± ) RPFLICP,NT CLYDE J GILBREATH F'¢~ BFOg..', LC :P,'I ION .............. LEG. AL T±51'..!R±W '=;8 L2±2 LOT SIZE ~L~'.~9 SOUARE FEET TYPE OF SOIL P,BSORPTION SYSTEM IS: TRENCH HAXIMUM NUtdBER OF BEDROOMS = 4 SOIL RATING (SQ F'T,ZBR)= 306 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEN IS: [. E~.F TI.II-- ::L~-_::', IbEi"-.i~t3TH= ::L2F_~ GF.'~/R'..."EI._ DEF'TH= ~"; THE LENGTH DIMENSIOli IS THE LENGTH (IN FEET:) OF THE TRENCH OR [)RRINFIEL. D. THE DEPTH OF P, 'FRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF 'THE GF.:OUND AND THE BOTTOM OF THE EXCAVP'TION (IN FEET)· THERE tS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE P,ND THE BOTTOM OF THE EXCP,VATION (IN FEET). i~."lE~l.T-~ U ]: F.:EE:.., .--"~;.EF=" T ][ C: TI:=II'-.I t-::.' $ T ZE= ::IL25~Z, PERMIT APPLICANT HP'S 'THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE Ii",IS"FRLLP,TIrZ~N INSPECTIONS OF ANY WELLS ADJRC:ENT TO THIS F'ROPERT~' .P,ND TF.IE , ~. -..,: ~ ,,,,, NUMBER OF RE-IE. ENEE_, THAT THE WELL I.,.IILL _ER,E. ~ / ...... "rl..~i,:~ ,:: 2 ) I 1'4"~PiC:T I ,3~"-.!:5 R~:E RE C-:., MI :I: ~:EiD ......... BACKFILLING OF P,N',r' S'T'STEM WITHOUT FINAL INSPECTION P'ND P'PPROVP,L BY THIS [)EPARTMENT WILL BE SUBJECT TO PROSECUTION· MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS ±00 FEET FOR P, PRIVRTE WELL OR :L50 TO 20~0 FEET FROM R PUBLIC .WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTP'NCE FROM A PRIVATE NELL TO P, PRI'¢ATE SE!4ER LINE IS 25 FEE;]'' TO R COMF1UNITY SEWER LINE IS 7'5 FEET. WEL. L LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN -:;0 DAYS OF ].'HE WELL COMPLETION. OTHER REQUIREMENTS MAY P'PPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS P'RE AVP'ILP,BLE TO INSURE PROPER INSTALLRTION. I CERTIFY THP,T ±: I AM FAMILIAR WITFI THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALl_ THE S'¢STEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER ~'¢STEM MRV REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLLIDE MORE THAN 4 BEDROOMS. RPF'L~CRNT ~ CLYE:'E J G I LBRERTH ISSLIED B~ .............. : ................ ~-- b -~ [ o ',/4. e i~ <Permit #: 820908 January 31, 1983 TO: Permit Applicant Subject: TL5N R1W ' ~ ' Se¢.t]on 8 Lot 212 A permit issued by this department for an individual well and/or on-site sewer system has expired as of December 31, 1982. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drllled the well, a well log needs to be sent to this department for documentation of the installation date and to close the permit. If a private engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files and documentation. If there are any further questions, please call this office at 264-4720. Sincerel~ Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/ljw enc: Copy of Permit SWP/057 MUNICIPALITY OF ANCHORAGE Department ~ Health and Environmenta ' . '825 ~ Street, Anchorage, AK. Permit % ~(~O% * * * HANDWRITTEN PERMIT * * ' ~ ~ ~ ~'~rf~/n Mailing Address: Appel ~c ant ~ /¢/f ~ Lo:cation: , ~P. ne:gal Description: Type of Soil Abs~rption System Is: Trench: ~/ Drain field: Maximum Number of Bedrooms: The Required Size of DEPTH _/L)/ . LENGTH ?~,~ ' Phone Number: Seepage Bed: __ Holding Tank: Soil Rating(sq.ft/br) the Soil $ubsorption System Is: . GRAVEL DEPTH The length dimension is the length(in feet) of the trench or drainfield. The ~epth 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. Th'e gravel depth is the minimum depth of gravel between the outfatl pipe and the bottom of the eXcavation(in feet). * * REQUIRED SEPTIC'(HOLDING) TANK SIZE = .,/~C] 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(2) INSPECTIONS ARE REQUIRED* * * Backfilling of any system without final inspection and approval by this departmen. wiIi be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee' 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 1 9 8 2 '* * * I certify that: (1) I am familiar with %he requirements for on-site sewers 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 the residence is remodeled Signe~: Applicant and wells as system may require enlargement if to include more that 3 bedrooms. Date: SWP/024 (1/81) /01 .t~ ~'~ . ORAV~ ~P~ _..~ ----- d~nm~0n ~ ~e l~h(tn fee~) o~ the t~ench or ~a~t~ld. ~th Of a ~ench Or pit ~ ~he d[st~n~ ~t~en hhe S~ of ~he ~tt~ of ~he e~c~atLon(~ fee~}. ~ere L~ no set w~dth ~o~ ~I~ g~av~ d~th ~ ~ha m~ depth of grave~ ~t~n ~ha ou~a~ ~alkation tn~i~s of any ~L[~ a~jaden~ ~o tht~ p~r~y ~d t~ r~do~es ~hat th~ ~ will s~va, ~Eill~g of ~y ~ymt~ wtt~uc ~hai ins~tton ~d a~roval by ~te de~u~ _ ~LL. ~ dist~ ~ a p~fvat~ w~ll to a p~iva~ ~t ~ Cet~ ~o ~his de~r~nt wLthtn 30 days of the ~[ cer~key ~h~t; (1} I ~ ~ilta~ Wkth the r~ic~n~ for on-si~e ~rs and ~i~ ~t ~octh by t~ ~al/ty of ~raqe. I will in.ail t~ eyst~ in ~cOrd~ vi~ a~. t~ res~eno~s ~~ to f~lu~e ~re that ] 8W~/024 (~Sl) [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 82B L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: PERCOLATION TEST SLOPE ITE PLAN 2 3 4 5- 6- 7 8 9 10 11 12- 13- 14- 15- 16 17 18 19 20- Ho. COMMENTS PERFORMED BY: 1~, .... ~RB 196X PH, 694-2979 72-008 (6/79) ENCOUNTERED? IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop TEST RUN BETWEEN ~ FT AND ~ ' FT ilS�ffl fes\'\`. ;.t ,;�,t��vp' � Y t I ,)(•�,(' WA, . WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological ~ Geophysic01 Surveys Lot a~ooh p .................. DIgTANCE AND DIRECTION FROM ROAO INT ERSECTIONB ~treel AddreBi grid Arco of Well Locution WELL LOG Feet Below B~e~ a~ ~e. ~e& 217 ~5 ~UNICIPALI~ OF ANCHO~A~ DSPT. O~ H~ALTH S OWNER OF WELL: 6 ~ Coble tool ~ Orlven ~Oug Q ~r ~'t~d ~ ~or~ ~ Test Well ~ Other; a, CAS, : ~ T~d ~Welded diem ........ ~ in to fl Oopth Weight 17 lbs • -� Municipality of Anchorage On -Site Water and Wastewater Program 2' (907) 343-7904 sg,. CERTIFICATE OF ON-SITE SYSTEMS APPRO wo �? a JUN0 2 't016 Parcel I.D. 051-154-41 Expiration Date: �- 1. GENERAL INFORMATION °L 6 s 5 Complete legal description T15N, R1X, Sec 3: Lot 212 Location (site address) _19616 Scenic Dr, ChuQiak, AK Current Property owner(s) DAN AND NANCY MCKEWIN Day phone Mailing address Real Estate Agent 19616 Scenic Dr, Chuoiak, AK 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 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 ❑ Waiver/Variance request for: Distance: Received by: 441 )h: Date: 4i / 6P COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_ . Q ® Waiver Fee $ Date of Payment Date of Payment Receipt Number ZO/ ,?®3 Receipt Number COSA# ()5'C16 ®20 ? 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 nunl.ber 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.C. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON, PE Date 06/2/16 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved. 3 bedrooms. bedrooms. a' d r°49T, MICHAEL No ANDERSCtq cs CE/ 9 G9 ��Q9•C� �(2�i�J.°/.0 Conditional approval for bedrooms, with the following stipulations: By � - Original Certificate Dater L —� 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. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10.12 doc • 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: T151 RiN, Sec S. Lot 212 Parcel ID: 051-154-41 A. WELL DATA Well type Private Date completed 61311983 Total depth 265 ft. Date of test Static water level Well production If A, B, or C provide PWSID # _ Well Log (Y/N) Sanitary seal (Y/N) Y Cased to 48 ft. FROM WELL LOG 61311983 UNKNOWN ft. WATER SAMPLE RESULTS: 1 Wires properly protected (Y/N) Y Casing height (above ground) 18"+ Coliform NEG colonies/100 mL Nitrate 0.552 mg/L AT INSPECTION 512012016 24 ft. 2+ g.p.m. Arsenic: ND ug/L Date of sample: 5/1912016 Collected by: Mike Anderson B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (YIN) N Date installed 71811983 Cleanouts (Y/N) High water alarm (Y/N) NA Date of pumping 10.26.15 Pumper Sanitary Pumpers C. ABSORPTION FIELD DATA —1985 SYSTEM TESTED Date installed 71811983 Soil rating (g.p.d./ftZ 0c306 System type _WIDE TRENCH Length 139 ft. Width 5 ft. Gravel below pipe 3.0 ft. //,, S� Total depth 5ft. Eff. absorption area 1198 fe Monitoring tube Y Depression over field N Date of a0equacy test 512012016 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 22 in. Water added 500+ gal. New depth 30 in. Elapsed Time: 500+ min. Final fluid depth 25 in. Absorption rate >= 500+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) UNKNOWN If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum in. Size in gallons Manhole/Access (Y/N) _ "Pump off"level at in.High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 1001+ Public sewer main 754 Sewer /septic service line 501+ Animal containment areas 1001+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 51+ in. On adjacent lots 1001+ On adjacent lots 1001+ Public sewer manhole/cleanout 1001+ Holding tank M Manure/animal excrete storage areas 100'+ Absorption field 5'+ Water main 1001+ Water service line 101+ Surface water 100'+ Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 101+ Water main -"TW im 0 r ,_ Water Service line 101+ Surface water 1001+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(None Known) Wells on adjacent lots 1001+ F. COMMENTS * MEASURED AT THE END OF THE TRENCH/MT G. ENGINEER'S CERTIFICATION I certify that l 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 061212016 COSA canary sheet 2-6-15.doc OF**°4°s1! A[ 1 .. .ir ..Y,,..,.,........... 7e •. MICHAU4 ANDERSON*ft- CE%9 Fat Municipality of Anchora Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw, Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 r CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Z FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-15LI- y I COSA# UP nrz Expiration Date: 1-12-0-7 1. GENERAL INFORMATION Complete legal description f/Silk r/jV SaC• F, /-o f /-? Location (site address) _/94/1, Current Property owner(s) lfe4, cf Day phone e§Af- Mailing address PO. fnr 67/5''6 &,.4'/e !,'9.SY_ 7 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system `-- The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Phone Address !2pe)E �• i/^its 5�� ��ir..^/rrr, f 9>l�/_�� Engineer's Printed Name 7` Date 1b ' I ( • 66D IY• 5. DSD SIGNATURE 1'r2 .ST.tZ"ZY Approved for bedrooms. tff''r•• o Ziiu19 Disapproved. Conditional approval for bedrooms, with the following stipulations: i Additional Comments .0., OFA 4 WASTEWATER Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: �t_Original Certificate Date: 10— 1% Ow (Rev. 11105) Municipality of Anchorage ... !� Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 198850 Anchorage, AK 99519-8850 www.muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: r/ --/V . If /N 5ee. 'F /-a 7-e 1 la Parcel ID:6 s / — / -)/ -.44 / A. WELL DATA Well type pri i,,? !e If A, B, or C provide PWSID # Date completed l/9/P3 Sanitary seal (Y/N)-j/ Total depth AL f ft. Cased to FROM WELL LOG Date of test G /3 /83 Static water level cf � kn n zu n ft. Well production O' S 9— p.m-WATER SAMPLE RESULTS: Coliform oolonies/100 mL Nitrate 0.3" mg/L NO Arsenic: $ mg/I Date of sample: f u/t/o el B. SEPTIC/HOLDING TANK DATA Tank Type/Material 5!54 b 6 f 5 /G c Tank size /Dao gal, Number of Compartments Well Log (Y/N) Y Wires properly protected (Y/N) 'L_ Casing height (above ground) a y in. AT INSPECTION 9� • P ft. /. 9— p.m- Other bacteria O colonies/100 mL Collected by. F�cd fire /e y Date installed 711P F3 Cleanouts(Y/N) y Foundation cleanout (YIN) _�/ Depression over tank (Y/N) Al High water alarm (Y/N) dYi9 Date of pumping /01y/G! Pumper C. ABSORPTION FIELD DATA / Date Installed 741/9 Soil rating (g.p.dJft2 or ft2/bdrm) 306 System type Cdr d a firnc h Length 19q ft. Width 3" ft. Gravel below pipe 1:7 ft. Total depth _]kYA J-4- ft. Eff. absorption area f/9�ft2 Monitoring tube i Depression over field Al Date of adequacy test /D/3 le6 Results (Pass/Fail) /+s5 For 3 bedrooms Fluid depth in absorption field before test _ in. Water added fV gal. New depth %/ �in. Elapsed Time: /Oj//min. Final fluid depth 19 in. Absorption rate >= '/SA g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed `Pump on" level at _ in. E. SEPARATION DISTANCES Size in gallons "Pump off" level at Cycles tested Manhole/Access (YIN) at in. Meets alar & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /o�% 'i ft On adjacent lots Absorption field on lot // v f Jor Public sewer main HSA Sewer /septic service line -:� St iT Animal containment areas /co r //.- On t On adjacent lots / o o t FT Public sewer manhole/deanout Holding tank AV -22 Manure/animal excrete storage areas /o o t 1'7- SEPARATION 'r SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 > f �' Property line 3 n t fT Absorption field I/ Lr Water main //'/A Water service line Surface water on f i Wells on adjacent lots / o o t // SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line -4-0 f Lt Building foundation o't tf Water main IV1/%' Water Service line /c'o r " Surface water Driveway, parking/vehicle storage No�•c K^awn /OGt Curtain drain s, cxr s t Wells on adjacent lots f'r F. COMMENTS G. ENGINEER'S CERTIFICATION b�p• •••��'f� I certify that I have determined through field inspections and s!• .*49TH • • • , • .. - . •; � review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. •P Engineer's Printed Name J Ge4t 1e—" r/. `CE1176 1 Date COSA Fee $ Y3D 4 /-Is- 12"V - Date of Payment 1-10& Receipt Number?y (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number ASBUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: cor ziz fcr, � >is�v�iw AND THAT NO ENCROACHMI<NTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OFFENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SEWARD h ASSOCIATES LAND SURVEYING 694 - SCALE: � OFAL DATE: o' � 9`rfi`1 T „� GRID.{y � so* Mark S..rd I Duw FB: DRAWN: � Axa 7kw'r� 14 wqiE�Jl SCS Ret# 1065956001 Client Name Douglas Kenley P.G. Project Name/# Daw Client Sample ID T15N RI W Sec 8 Lot 212 Matrix Drinking Water All Dates/rimes are Alaska Standard Time Printed Date/rime 10/132006 10:06 Collected Date/time 10/032006 18:00 Received Date/time 10/042006 9:05 Technical Director Stephen C. Ede Sample Rcmmks: ICP/MS Arsenic Parameter Allowable Results PQI. Units hiedwd Container ID Limits Ptcp Date Analysis Date [nit Metals by ICP/MS Arsenic Waters Department Nitrate -N Microbiolocy Laboratory Total Colirotm ND 5.00 0.342 0.100 0 ug/L EP200.8 mg/L EPA 353.2 C (<10) 10/05/06 10/11106 TK 0 (<I0) col/100mL SM209222D A (<I) 10/04/06 ALR 10/04106 DPT DEPARTMENT OF HEALTH & HUMAN SERvI( ~ Division of Environmental serViCes ~., ,' '; ~.:; On-Site ServiCes Sec < ,. 196650 Anch°ragel AlaSka 9951! "~ :' ~ ; "~: '~ ~'' r IE.ICATE.OF HEALTH ~MILY nity well '.,' IJu'blid Water ' c~mmunity well system,-~rovide written confirmation from State ADEC attest- to the legality and status of system. DISPOSA '~':~- -, unity on-site Public sewer NOTE:- If community wastewater system, provide written cony attesting to the legality and status Of system.'-; tion fr~)m State ADEC 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. ,-u.. %=, .qg Name of Firm ~'~' "'~ ...... ~:,,'~,i ~'~arm:gan mva. Phone /~ ¢'~ - ,/~/// Address E~;;,I~ ~f;'er. AK 99577-8736 Engineer's signature DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments "'he Munic'pahty 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 pu rchasem of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or 8missions in the professional engineer's work. 72-025 (Rev, 1/91) Back MOA~21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744 Health Authority Approval Checklist Legal Description: L=/':~I2 ~,~ ~ 7'/d'/V,~ I ~/ Parcel I.D.: A. WELL DATA Well type //,~/ Log present (Y/N) Total depth .~. ~ ~'" Sanitary seal (Y/N) Date of test Static water level Well production If A, B, or C, attach ADEC letter. ADEC water system number Date completed G/3/~' ~ Cased to. /'/~' / Casing height (above ground) FROM WELL LOG . WATER SAMPLE RESULTS: Coliform ! Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed 1/~'/~°,~ Tank size ~ / Foundation cleanout (Y/N) y Date of Pumping C. ABSORPTION FIELD DATA Date installed / / Length /.~ / Width Effective absorption area Wires properly protected (Y/N) Date of adequacY test AT INSPECTION £:~.~ , Nitrate 4~),/z// Other bacteria C~llected by: / /~ Number of Compartments ~ Cleanouts (Y/N) . Depression (WN) Pumper Soil rating (g.p.d./fF or ff~/bdrm) .~, ~f' ystem type ~ ~ Gravel thickness below pipe ~ Monitoring Tube present (Y/N). ~/ · ,~' /' Total depth ~,~ · . Depression over field (Y/N) For ,~ bedrooms Fluid depth in absorption field before test (in.); ~ Immediately after//..r~TJgal, water added (in.): _~_~ Fluid depth __~__ (ins) Minutes later: /~ ~v~.'~ Absorption rate = /-/~"~ '+ g.p.d. Peroxide treatment (past 12 months) (Y/N) ~JD If yes, give date ~ 72-026 (Rev. 3/96)* D. LIFT STATION High water alarm level at* ~ *DatumS., J , SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot / Public sewer main. Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station . , SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation .5'~ ~4- . Property line /C) ~ ~ Absorp?on f e, d Water main/service line ,.5"'43 ' + Surface water/drainage _/DO' ~ SEPARATION DISTANCE FROM ABSORPTION FIELD, ON LOTTO: Property line / C)' '+ Building fpundation ,~) / -~ Surface water. /~C~ ' ~- Curtain drain lDO ~ '~' F. ENGINEER'S CERTIFICATION Wells on adjacent lots Wa!er main/service line Driveway, parking/vehicle storage area Wells on adjacent lots / D O ~ ~ in conformance with MOA HAA guidelines in effect on this date. Signature ~. ~ ~,~...~ Engineer's Name ~ Erlg~eri~g // ~, ~ n~*~ * ~/ /~/ EageRJver A~ go;~** ~ t.~'~ . Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $, Date,~f Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF iNSPECTiON FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACiLiTY 264-4720 Application Date ~-- GENERAL INFORMATION (a) (b) (c) (d) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directior~) ,.~ , _ ~ ~ ~.., ~-~~ ~__~-/~ Applicant Name ~~~;~ne~e ~-~ Business ~~ ): ding Institution ~; Owner/builder~; Buyer ~; Other ~ (explain); Lending Institution ~L.Z.,~/_ ~/.~..~_ Telephone (e) Address ~ Real Estate Company and Ageni Address Telephone (f) ~f~e HAA to the following ~ddress: -- TYPE OF RESIDENCE Single-Family ~ Multi-Family L~ Other Number of Bedrooms WATER SUPPLY Individual Well¢~' Community [] Public [] Note: If corem unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public [] Community l'-I 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 72-025 (11/84) 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, fu nctional 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. ..... ~ Telephone ~ ~ ~ ~- ~ ~ Address ~ /¢~ ~. /~ ~ Approved __ [.,--'- .__ Disapprov~ -~-~--~_ Conditional Terms of Conditional Approval CAtJTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 264-4720 LJ~-0 0 2 1~~ Legal Description: ~ 'Z..~ ~,~---~-~ae~ ~ I% WELL DATA Well Classification Well Log Present Total Depth '~J~'.~' Static Water Level Casing Height Above Ground Electrical Wirlng in Conduit ~'N) Separation Distances from Well: To Septic/J;~g Tank on Lot ~' ~[~' If A, B, C, D.E.C. Approved (Y/N) Date Completed (,p - ~. ~5'~ Yield Cased to _ Z.~-~/,/' Depth of Grouting '--'-- Pump Set At Sanitary Seal on Casing ~/N) Depression Around Wellhead (Y~' ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~ ~="~ ' '~ ; On Adjoining Lots To Nearest Public Sewer Line ?/~ To Nearest Public Sewer Cleanout/Manhole ¢5,/~, To Nearest Sewer Service Line on Lot _ Water Sample Collected by _.'~-~ '~ ~ (~',-~,,[¢,,..~=:¢:::~¢~4,,,-~..~ ; Date Water Sample Test Results ~,e,-.1-~,¥F-~ ~ Comments ] B. SEPTIC~G TANK DATA Date Installed Standpipes (~N) Air-tight Caps ~N) Depression over Tank (Y/4~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/~ol¢ih~ Tank: To Water-Supply Well To Property Line [,¢,. ~-~-- To Water Main/Service Line Course . // Comments Size ~ No. of Compartments ~ Foundation Cle a n o u t~i~ N~.....~- Date Last Pumped _ _~\~ , for _ ~ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ - ~- IE,'~ Width of Field Loc:~ To Water-Supply Well To Building Foundation Lot Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field: ~"~'fl:~/~'t'""' Type of System Design Length of Field Depth of Field (_~ ~"1 Gravel Bed Thickness Standpipes Present Date of Last Adequacy Test To Water Main/Service Line L ~=, ~ ,~ To Stream/Pond/Lake/or Major Drainage Course To Property Line ,\ ~-~ t N To Existing or Abandoned System on ; On Adjoining Lots '~%'P To Cutbank i(if present) To Driveway, Pa~qg Area, or Vehicle Storage Area ~:'~ ~"~- Comments .~L'~t,Jrc~-~'¢~, '~"n~.~ ~~~~ ~ ~ ~~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "l~ump Off" Level at /,~ Vent (Y/N) ~l~/'~'~1'~ Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check, . ,.~/.~__P.ermi/tt~-.¢/ /. Bedroom Rating Against HAA Request ** I certify t~ n~e~, verified, or conformed to all MOA~nd HAA guidelines in effect o~ the date of this inspection, Signed ~ ~ Date ///~ ~/~ Receipt NO. ~ ~L[ I q ~ Date of Payment J~- ~-~ ~ ~ Amount: $ ~ ~ Page 2 of 2 72~026 (11/84)