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HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 9 LT 13[] NEW [] UPGRADE 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 PHONE MAI LING ADDRESS LEGAL DESCRIPTION LOCAT,ON I~ ~ Manufacturer a~ < 6'Yc'eY ~ I-- Liq. capacity in gallons ¢o: NO. OF BEDROOMS.? Well ABsorption .~, Dwelling 6' NO~ 3£/1(/4 DISTANCE TO: /0~- / area ~ PERMIT Material ~./_¢~ / No. of compartments inside length Width ,~_.. Liquid depth ,. ~ Dwelling Iwe:lF HOMEMADE: Foundation Total length of line~-~), Material beneath tile Depth PERMIT NO. Material Liquid capacity in gallons Nearest lot line Trenchwidt~ inches inches PERMIT NO. L. Eh_~.~/_..),// Distance between lines~.~_ Well / t -7 / DISTANCE TO: J 11 / j No. of lines / J Length of each line...~, ID' J __E:t" Top of tile to finish grade .~ i~ j,~/ ngth Width TgOe of crib Crib diamater foundafioa Total effective absorption area PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line Sewer line Septic tank PERMIT NO. Absorpt on area(s) OTHER ., PE MAT,-:RIALS 12 SOIL_ TEST RATING ,NSTALLER REMARKS 72-013 (Rev. 3/78) DATE LEGAL ~F:'F'I._ I (:FINT . I:1 (::FI '[' :1:0 I",1 .E.:iFIL CURT C:RF:LE'.r' L:i: E:.?.' I'"IT F'FII:~:I-::; E':7, TFITE:S :'-;RFI E:t3X 2.;:5P 995.~.:12 LOT "h"F'E OF ~:';O:[L FEE;OI::~:F"['IOI'..I :5'¢S"l'Ef"l I2;: TRENCH Ia',,.:;IItlJi',l I'.,ILII',iE:Et',:: t3F EEI3, F.:OOI'E; = :~;O.~L F:FI'f'.tNG ,::SD F"F,.."E~R::,= ¢'HE FEt..':!U]:F.:EE:, ':?,:[ZE OF THE SO].'L RB'.:II;O,~;.:PTIOI'.4 ':":;'E;,TEf"I IL:..;: Z::, E:_' F" 1F I{--11 == ,E~ L_ E: ~-4t E. 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" Ii.o:: <Permit ~: 821173 January 31, 1983 TO: Permit Appl '[cant Subject: Lot 13 Block 9 Mountain Park Estates Subdivision 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 drilled the well, a well log needs to be sen~ to this department for documentation of the installation date and to close the permit. If a private englneer inspected khe 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/!jw eric: Copy of ~e- .... PERMI ]' NO. RPPL I CFINT LOCFIT I ON LEGRL CURT C:RF.'.LE'¢ SRR BO',:.:', 35F' RNCHORGE ~,95E~7 276-27E;:t LJ?-: B:~.~ MOLINTRIN F'RRK ESTRTES L. OT SIZE .9999k]:~ SCilJRRE FEET I"'¢PE OF SOIL FIE:'~]ORF'TION ':~;'T'STEM IS: TRENCH MRNIMUM NUMBER OF BE[:,ROOHS = SOIL RRTING ,:;SL.-.! f:"T,.."E:R)= :i.50 THE REL.]UIRE[:, SIZE OF 'THE SOIL FIE:SORF'TION S'~'STEI'"t IS: THE LENGTH DIMENSION IS THE LENGTH KIN FEET) OF THE TRENCH OR DRFIINF'IEL[:,. THE [:,EF'TH OF R TRENCH OR F'I]' IS; THE DISTRNE:E BETNEEN THE SURF'taCE OF ]"FIE: GROUND FIN[:, THE BOTTOM OF ]'HE: E,'.".',CR',,,'RTION ,::IN FEET). THERE IS NO SET NI[:,TH FOR TRENCHES. THE GRR',,,'EL. DEPTH IS THE MINIMUH DEPTH OF GRFIVEL BETNEEN ]'HE OUTF:RLL PIF.'E RN[.', THE E:OTTOM OF I'HE E',:.:',C.R'¢FITION (IN FEET). PERMIT I::IPF'LIC:taN'I" FiRS THE RESPONSIE,'ILIT'T' 'TO INFCIRM THIS DEPRRTMEN'I" [:,URING THE INSTRLLFtTION INSPECTIONS OF FIN¥ WELLS R[:,JRCENT TO THIS PRI]PERT'¢ RND THE NUHBER OF' RESI[:,ENCES THFIT THE HELL HILL SER'¢E. ~r t.,.fl rZu ,:: ;_:~ ::, ]: fl"-~ S F" E (} T ][ Cn t'..,I rE; R ~;;: E R E; ~L:.T! !J l: [~: EE [: BRCKFILLING OF BN'¢ SYSTEM I.,.IITHOIJT FINFIL INSPECTION RN[.', RPF'RO',,,'RL B'~' ]'HIS DEF'RRTMEIqT I.,.IILL BE SUBJECT TO PROSECUTION. MINIMUM I.':,ISTRNCE BE'rWEEN R NELL RND FIN'T' ON-SITE SEWFIGE DISPOSRL. SYSTEM IS :;LE4E~ FEET FOR R PRI',?RTE WELL OR :L5C~ 'fO 20E~ FEET FROM R PUBLIC NELL [:,EF'EN[:,ING UPON THE T'¢PE OF PUBLIC NELL.. HINIMUM DISTRNCE FROM El PR I ',,,'RTE NELL TO R PRI',,,'RTE SEklEF.: LINE IS 25 FEET FIN[:, TO R COMMUNIT'¢ SENER LINE IS 75 FEET. NELL. LOGS RRE REC.!UIRED RN[.', MUST BE RETURNE[:, TO ]'HE [:,EPRRTMENT 14ITHIN 2.:0 DR"r'S OF THE 14ELL COHF'LETION. OTHER REC!UIREI"IENTS MR'¢ RPPL"r'. SPECIFICRTIONS RN[:' CONSTRUCTIOIq [:,IRGRRMS FIRE RVRILFIBLE TO INSURE PF.:OPER INSTRLLRTION. F" E F=': H'"I ]: 'T E: )": F' ]:. F;; E': 2~-; [:-" E C E !"1 E: E !~: Z ::L _. ± '-=..~ :E: ~: I CERTIF'? THRT ±: I RI'"I FRMILIRR 14ITH THE RF'C!UIREMENTS FOR ON-SITE SEWERS RNB' WELLS RS SET FORTH 8'¢ THE MUNICIPRLIT'¢ OF FtNCHOF.'.RGE. 2: I 1.4ILL INSTRLL THE S'¢STEM IN F~CCOR[."RNCE b~ITH THE CODES;. ]:: I UNDERSTRND THRT THE ON-SITE SENER S'¢STEM MFI'T' REC!UIRE ENLFIRGEMENT IF:' ]'HE RESIDENCE IS REMO[:,ELED TO INE:LU[:,E MORE THRN Z.: E:E[:,ROOMS. ',,"4. 0 SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: d'/~ )/' / LEGAL DESCRIPTION: Lt)/ /~"~ 1 2 3 4 5 6 7 8 9 10 11 12 13 eL SLOPE DATE PERFORMED: SITE PLAN ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop 14 15 16 17 18 19 2O COMMENTS PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND .... FT CERTIFIED BY:_ DATE: 72-008 (6/79) MUNICIPALITY OF Development Services Department ` t' On -Site Water & Wastewater Section \� Parcel I.D. 017-391-43 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: ' -.-A 3 'aD2 Complete legal description Mountain Park Estates, Block 9, Lot 13 Location (site address) 6021 Bristol Drive Anchorage, AK Current property owner(s) Christina Hudson Day phone (907) Mailing address Real estate agent 6021 Bristol Drive, Anchorage, AK 99516 2. TYPE OF DWELLING: 0 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: Private Well W Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the. engineer. Date: COSA Fee $ L{ IZ,9y 6D U 1 0 Waiver Fee $ Date of Payment 10A1610-0 Date of Payment Receipt Number 07720.17 Receipt Number COSA # OSC Z.Ul5 7 % 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 10/9/20 OF ®4P� 44;_S4 4 ® 6. DSD SIGNATURE �, 49th'® . .. 1111...... 1111 - �..,..... C..,.......0 0..........1.11 .......... ...........'�® _X System #1 Approved for bedrooms MICHAEL E. ANDERSON ®mC'� No. CE -4381 _® System #2 Approved for bedrooms F;••.,,.10/9/20 ,,.••''�_�� Disapproved ®®k4 tz FESS\�`�P®®®® Conditional approval for bedrooms, with the following stipulations: - Q`kl',�nF (Alyn, ,1..F ]U�/r�f` z ON-S� �p R C B \ �^- �` _ Original Certificate Date: 1 0 -.9,3 2©ZQ 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet X Nitrate Advisory Arsenic Advisory Other Legal Description: Mountain Park Estates, Block 9, Lot 13 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled May 1983 Total depth 180 ft Cased to 180 ft FOR Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) '18 in. Date of flow test for COSA 9/28/20 Static water level at beginning of test 156 ft Comments B. TANK DATA Age of tank(s) 16 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 48 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 8/19/20 - Shamrock Septic D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 9/21/04 ❑ ALL standpipes present per record drawing Total measured depth from grade 15 ft (max) Measured depth to pipe invert from grade 7 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 017-391-43 Structure served by this system Well production at time of test 5.6 gpm Water storage tank volume None gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 4.59 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by FORGE ENGINEERING Date of Sample 9/28/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Septic System is Gravity Flow. Adequacy test date 9/28/20 Results [D Pass For 3 bedrooms Fluid depth prior to test 43 in Water added 1021 gal New depth 93 in Elapsed time 1440 min Final fluid depth 58 in Absorption rate '450 gpd Any rejuvenation treatment (past 12 months) None If yes, enter date North drain field and line from septic tank to north drain field are insulated with 4" of direct bury insulation. E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' P/ Yes Community Sewer Manhole/Cleanout > 100' r, Yes if No ft Q Yes if No Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' M Yes if No Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' 2 Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' R Yes if No 0 Yes if No ft if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft Fv� Yes if No ft ft ft ft il From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' ®✓ Yes if No ft Property Line > 5' P/ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' (l Yes if No ft Private Wells > 100'✓0 Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200'✓0 Yes if No ft Water Service Line > 10' r7 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' F,71 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓® Yes if No ft Private Wells > 100' ®✓ Yes if No ft Water Service Line > 10' F/ Yes if No ft Community Wells > 200' F/ Yes if No ft Surface Water > 100' 0✓ Yes if No ft F. ENGINEER'S COMMENTS North section of absorption trench is under driveway/parking area. See Waiver. Absorption trench and septic delivery line are 7' below the surface and covered with 4" of direct bury insulation. G. ENGINEER'S CERTIFICATION l 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. COSA Checklist yellow sheet o Z •�• S 3 O 6� T o �. . _ gip. r❑n m 3 lw CD tw iFy d cn O m ID 00 ID o °m oi00C (0D, m-pn3moo0i��o Q.0D z0r Ln n233� m " mn(DD0tnm �m co O Oy D 0- O m �- A m o r -o m o n 3 �' (D U) OD n d A o Kj (D (D � ` OL , 3 O �' ° + 0 n to (o m /��'� \/� Nv p N 0fTl 0 0 -o (D ��� ti� ALO OL�a P ��m co n co Q `<. ° -o N O m S6' T9S 2S f , _❑ o n o O N �O' U) off. 5 Ola, F O CO S + ° -o O crn n { ? c,0� (�D 0 O O r f�`a Cv�' ' ° �4 O OCA CL r3\y n O ❑ r 2 �' J2� Baa °oma g r o� �' ❑ 1 , 0vCD =r o �� ``�O Qo �� r 3m ��000cx i° o(D ❑ o 3m o r CD 0 m (° (n S �9 (D C- 0 SR 2, O- C r stL O O >U)D o o CC) O I \ D C O m VN O O co 0 �ra` w oco p G7 O N co rn r 0) ND 0 o O coo Z CO -� � O W _ O O ta SHEET SIZE: 11 " X 17" MUNICIPALITY OF ANCHORAGE DEPARTMENT OF' HEALTH& HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date . GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 13~ Block 9; Mountain Park Estates HI July 21, 1988 Location(addressordirections) 6021 Bristol Drive (b) Property Owner Mailing Address (c) Lending Institution Mailing Address. [-FLTD Telephone: Home ~t111-032867-703 7~/ '~ ' ~' Telephone Business (d) Real Estate Company and Agent Address 4105 Turnaqain, Telephone 248-1717 MARSTON PROPERTIES/Ed Tolley Anchoraqe/ Alaska (e) Mail the HAA to the followina address: or: Check here:){~., if hold for pick up. List contact person and day phone number below. S & S ENGINEERING/694-2979 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 ordered by Ed Tolley TYPE OF RESIDENCE Single-Family [] Number of Bedrooms WATER SUPPLY individual Well::[~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite[~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 tRey 8/86/ Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the vaJidation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & Address 17034 Eagle R[¥er Loop Road No. 204 Date Telephone DHHS APPROVAL ~_~ Approved for ~'~ bedrooms by Approved ,/'~' Disapproved Terms of Conditional Approval Conditional CAUTION 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 fRev 8/86) 8ack MUNICIPALF[Y OF ANCHCi~(~CiPALiTY OF ANCHORAGE (MOA) ENVIRONMENTAL SERWCES AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 J~U~ ~. 1988 264-4744 Legal D~escription: ~ ~'~ '~'~ ~:~ RECEIVED t WELL DATA Well Classification ~ i'~ I'~'~',/\ ~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present ('~/N) ~-/ __ Date Completed ~' ~/'~ ~ 4~'"~ Yield Total Depth ~ (~'(:~; Cased to \ ~i~:;' Depth of Grouting Static Water Level \ ¢=~ ~' ~ Pump Set At Casing kleight Above Ground I ~ Sanitary Seal on Casing t(~:N) Electrical Wiring in Conduit ¢"~;~'N') ~' Depression Around Wellhead Separation Distances from Well: To Septic/Holding Tank on Lot ~ ~-"¢~' ; On Adjoining Lots I To Nearest Edge of Absorption Field op [7ot I ~-'~ ; On Adjoining Lots To Nearest Public Sewer Line /~ To Nearest PubLic Sewer Cleanout/Manhole t-~/~' To Nearest Sewer Service Line on Lot Water Sample Test Results _ ~"'~~~ _ ~,...._, B. SEPTIC/HOLDING TANK DATA Date Installed J~2)-\~ '"'~)'~ Size Standpipes 0ON) "¢ Air-tight Caps(~N). Depression over Tank (Y/4~P Pumping/Maintenance Contract on File (Y/N)r. Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/fi-feld~gCTank: To Water-Supply Well / ~ I To Property Line / ~ To Water Main/Service Line I Course t~. ~ ~.'~"~/-~ No. of Compartments '~'"~ "-/ Foundation Cleanout 1~4) Date Last Pumped ~ ~ / ~/~ ;for '~ ~ Temporary Holding Tank Permit (Y/N) To Building Foundatio~.~ . ~ / '-' To Disposal Field ~ ~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 026 IRev 8861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field "~ Square Feet of Absorption Area Depression over Field (Y~ Results of Last Adequacy Test Separation Distance from Absorption Fiel¢: To Water-Supply Well Lot /~ To Water Main/Service Line \ ~ 'P To Stream/Pond/Lake/or Major Drainage Course To Driveway, Par~ing Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present ~[:~ZN) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots '"-~ ~ J/~, To Cutbank (if present) ~ Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Pumping Cycles~dequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ha¥'e checked, verified, or conformed to all M ©A and HAA guidelines in effect on the date of this inspection. Signed ~,,s -'-iNF. F..,~|,%L.q Date Compan~?n~4 Eagle River Loop Road Eagle Rlver~ Alaska ~ Receipt No. ~5-~/ Date of Payment Z "/-~ 72 026 fRev 8/861 BacA ~~ . CHEMICAL & GEOLOGICAL LABORATO ES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 ANALYSIS gg?OgT g~ SAMPLE for Work O~der # 8102 Date Report Printed: JUL 28 88 8 11:15 Client Sample ID:LI3, 59 MTH. PARK EST, PWSID :UA Collected JUL 25 88 ~ }Irs. Received JUL 25 88 ?~eserved with :COO[, Client Name : S ~ S gHGIHEERIHG Client Acct : SNSENGP P.O.~ HONE REC'D Roq ~ Ordered By : Analysis Completed :JUL 27 88 Send Reports to: Laboratory Supervisor :STEPHEN C. EDE l)S ~ S ENGINEERING Released By : Special Instruct: Chemlab Ref l: 1943 Lab Smpl ID: I Matrix: Watez Allowable Parameter Tooted Result/Units ~ethod Limits NITRATE-N 1.3 mR/1 EPA 353,2 10 Sample ROUTINE SA~4PLE Remarks: SAMPLE COLLECTED BY R.P. Tests Performed ° See Special Instructions Above UA-Unavailable None Detected "See Sample Romazks Above Not Analyzed LT=Less Than, GT=Greater Than CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 _ Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER E] PUBLIC WATERSYSTEMI.D." : I I I I I I ~,,~:~RIVATE W:R SYSTEM Name ) ~.f.~o n e No. City SAMPLE DATE: State Mo. Day Year Zip Code SAMPLE TYPE: [/~ Routine Check Sample (for routine sample with lab ref. no. [] Special Purpose __) [] Treated Water [] Untreated Water SAMPLE NO. LOCATION Time Oollected .. TO BE COMPLETED BY LABORATORY saSis shows this Water SAMPLE to be: tisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received '~ - ~ z)'-'~ Time Received / ¢c~) Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* Analyst FIEAD INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD tMembrane Filter: Direct Count _ :,Verif cat on: LTB. TNTC = Too Numberous To Coun Coilformll00ml RGB 0 Time: CoilformllOOml PART I OF 2 OB = Other Bacteria REMAINDER TO FOLLOW 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) Legal Description (include lot, block, subdiv..~ s on, section, township, _.-¢---range),~ Location (address or directions) d,, ¢,Z- / (b) Applicant Name d~'¢~'F"" ~¢/I Telephone: Home -"q¢~' "'~"~ F"~ Business ,2.-¢~' '-.2-?~'// (c) Applicant is (check one): Lending Institution []; Owner/builder"~; Buyer []; Other [] (explain); .. (d) Lending Institution Address Telephone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: ' d..I TYPE OF RESIDENCE Single-Family'"'~ Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual Well"~ Community [] 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'~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72 025 (t1~84) Page 1 of 2 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 hlealth Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional a~d 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 ~ ~' Telephone ~'~' ? ''~-'''~ Address //~'¢-¢ 't¢/ "~ ~'~f~ICLI'/E~' Date ~ ~Z'? ~ ,~'"(~ Approvedfor-~, bedroomsbyT~'"Ct['~x'l I~-A'/'~b'%-'~-~ate ~'~7~4~) ~;rpi.~v;~ ~o n d ~al~A p p rova~iSa p p rove U' Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Pnnn P nf D MUNtCIPALrTY OF ANCHORAGE (MOA) HEALTH AU'rHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: MUNICIPALITY OF ANCHORAGI~ DEPT. OF HEALTH 8, ENVIRONMENTAL PROTECTION WELL DATA If A, 13, C, D.E.C. Approved (Y/N) _ Date Completed Well Classification Well Log Presentl~"~C~N) - Total Depth /~¢~'~ '~ Caged to _ Static Water Level ~ Casing Height Above Ground Electrical Wiring in Conduit ON) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot ,/ To Nearest Public Sewer Line __ Cleanout/Manhole __-- ~/'~ Water Sample Collected by _/~ 5 Water Sample Test Results Comments ~. .~-/"7 - ~'..,~ Yield Depth of Grouting Pump Set At __ Sanitary Seal on Casing ~1) Depression Around Wellhead (Ye ; On Adjoining Lots I'//' ' ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot · ~J/g-,z/' ;Date . 13. SEPTIC/HOLDING TANK DATA Date Installed ~ -'/~ Standpipes I~N) Air-tight Caps(~N) Depression over Tank (y~l Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line ,/~ '~' To Water Main/Service Line _ Course Size /',2.~ ~/~ No. of Compartments ~ Foundation Cleanout~l) Date Last Pumped .~' ",2-~12~'~'~ Temporary Holding Tank Permit (Y/N) To 13uilding Foundation ~'-~ / To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field To Water-Supply Well To Building Foundation LOt To Water Main/Service Line ,'~//,/~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Square Feet of Absorption Area Depression over Field Results of Last Adequacy~Test /~"~'~'~'~/"-~"'-- Separation Distance from Absorption Field: /,//' Type of System Design Length of Field Depth of Field Gravel Bed Thickness ¢ / Standpipes PresentON) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) Comments LIFT STATION Size in Gallons "Pump On" Level at Dimensions Manhole/Access (Y/N) "Pump Off" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments ~(Y/~N)cles during Adequacy Test, Meets MOA ~ump~~ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ha.a.a.a.a.a.a.a.a.~he~ed, ve,~i~fied, or conformed to all MOA add HAA guidelines in effect on the date of this inspection, Signed ~¢',~- (.~' ~.-4~.-..~ Date ...~Z.-? ~r¢. ,, Company /¢'~' MOA No. Receipt No. Date of Payment Amount: $ _ Page 2 of 2 72-026 (11184) ALASKA b,..dliqOlqm }lqTAL CORTROL IRC. ~nqineerin§ $ ~nuironl,aenlol 51udi~s 03/2~/~6 CURT CARLEY 67/47 DOUBLE TREECEURT ~ALASKA 99516 60131 SELLER-O. JRT CARLEY CURT CARLEY 67/47 I::~XIBLE TREE O3URT ANC. tKY. A~ ALASKA 99516 MUNICIPALITY OF ANCHORAG;': DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION ,,.:AR 2 8 1986 LEGAL:MT PAI~< ESTATES BL(N3< 9 LOT 13 RECEIVE[) ADEQU..nCY TEST FOR SEWER SYSTEM ADEQIJ/~Y TEST DATE-3/27/86 THE TYPE CF ABSCRPTION SYSTEM IS A TRENtZH WITH AN AREA CF /480 SQFT. THE SYSTEM IS CAPABLE CF A2CEPTING /450 GALLONS CF WATER PER DAY. THE SURGE CAP,~ITY CF THE SYSTEM IS 694 C_,~LONS. BASED UPON THE TEST DATA THE SYSTEM IS AEIT~PT~LE bT:l0. A SEPTIC TAi~ ADEQU,%~ THE EXISTING SEPTIC TAt~ VOLIAVEOF 1250 IS ADEqtJATE FCR THIS 3 BEDRCCM HOUSE, THE SEPTIC TAt~/P..~ PLANT WAS PUMOEDON 3/28/86 , THIS REEK2RT lYeS NOT VERIFY THE [NTEORITYCF THE PlPING FORTHEWATER SUPPLY OR WASTEWATER SYSTEM, FLC~TESTON ?,~LL WELL FLO~DATE-03/27/86 A FLOfiTEST WAS PERFORIW~D ON THE'~LL, 69/4 CAL~S CF WATER WAS PUtvPED AT A RATECF 5,3 C~qVlOVF. R ADLJRATION OF 2,2 HCURS, ~'lg BRA~ WAS 1,7 ' WITH A REOD~SRY TIUEOF 10 MINUTES AND ~{E STATIC WATER LEVEL WAS 15/4 FEET, THE 'vW..LL IS ADEQI.IATE FUR THIS 3 BEDROCMFIZI'VE., 1200 ~Uesl 33rd ~ucnu¢. 5uii¢ B */~nchoroqe. /~loskn 99503 *(907) 561-5040 WELL DRtLLtblG P, EPORT TIME DEPTH FORMAT ION .~ ,., .~ II I 'I/OW EXACT BUT £Z [ OWNEP, OF WELL HOUSE # ~/~0..¢ / /-~P/ ~ / POST OFFICE EXACF LOCATION DRILLING COMPANY DR~LLER IIELPER ~ ~ ~ INSPECTOR DRILLING METHOD ~/~o/~q'/t" CIRCULATION MATERIAL MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & E NV-FROlq/~qT'AL PROTECTION 1986 RECEIVED DR ILL I NG STt\RTED ,4,,,~ V /~,/?PJ ENDED ,w-/M y / 2,/?? ~ DEPTH RECORD ' PERFORATIONS [ FROM ? TOI ' MEASURIltG ~IHD CAS I biG BITS GROUTIHG u6~e GRAVEL PACK ,F."~ FROH TOiSiZE ' SCREENS USED Z/~zw e STATIC WATER LEVEL /~/0 CAPAC I fY .~ 6 c"F,,~ /, ./~c/r /~t .d ItOW DETEP, MI NED DATE ALASKA ENVIRON~"~NTAL CONTROL SERVIL ;, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO OF CHECKED BY. DATE SCALE / [''~ MUNICIPALITY OF .ANCHORA, DEPT. OF HEALTH & ENVIRONMENTAL PROTECTIC ~AR 2 8 1086 RECEIVED APPLK NT FILLS OUT UPPER HAl ONLY Zip Code '/ .~ Mailing Address .~ ~.' .; /,, , ~ ? ;- , -" . Buyer Address Lending Institutioe Address i ,, ..~ Zip Code Zip Code Realty Co. & Agent Address Zip Code Street Location /,.,. ]; ,/ ,,' ¢' ' · Type of Residence 174'/~in gle Famiiy FI Multiple Family No. of Bedrooms ii C_. Other Phone Phone Waler Supply g-"l~dividual Community Public Utility ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available). Sewer Disposal ,~] Individual ~ Public Utility ~l, Holding Tank Year Individual installed: Wbee Connecled to Public Utility: NOTE: THE iNSPECTiON FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Date Date Date Inspector Inspector Inspector j- Time Insp6(;tor Field Notes: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECflON AU6 2 3 RECEIVED APPROVED BEDROOMS DISAPPROVED 'CONDITIONS OF APPROVAL Soils Rating Date Sower Installed Well To Absorption Area ,/,/ ~7 Well to Tank / ~ '~ IW~el~ll --Log R~ec_eiv~ed Septic Tank Size 72.023 (3/82)