Loading...
HomeMy WebLinkAboutNEWTON LT 5Newton Lot 5 #051-144-19 b f by A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694-2588 - OWNER OF LA/N�D /,(.�%'Y'�`otJL©cl.Crt�tr{c� DEPTH OF WELL ADDRESS f f� ��^ (� l=^ STATIC LEVEL OF WATER FT. LEGAL DESCRIPTION is 1 Nf=_ til'�s� SU40 DRAW DOWN FT. r� DATE - Started eAll 7 _ Ended 4172 GALS. PER HR S PERMIT NUMBER T) % r> KIND OF CASING 6 KIND OF FORMATION: From 0 Ft. to /9 Ft.;� Y�%�! k` �'��✓ � From Ft. to Ft. From % t7 Ft. to Ft. �� P9 Y t KWQ, irl e From Ft. to Ft. _ From -`: Ft. to ;� Ft. dk'or_AjPU C'4,lY From Ft. to Ft. From aid Ft. to Ft. A` Vt'' Cc-,ld"t' From Ft. to Ft. From "tom—Ft. to Ft. 4' From Ft. to Ft From '.i Ft. to `"% &. Ft. From Ft. to Ft. From_ ` ?s Ft. to <C-? Ft. �'_ L.� S' A- 64 (-4f From Ft. to Ft. From ''r' `7 Ft. to 1 0 (, Ft. S kIIW 4h t�yLm� i � �fi r rle- From Ft: to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft MISCL. INFORMATION: DRILLER'S NAME Municipality of Anchorage CO. [ka 1901'.50.0nchomgc, Alaska 99519 -WW — 4700 Ehnom ILmd Office: (907) 3).M301 • Tac (907) US -f 200 http://ux .m=Lorg Mayor Mark I3egich Development Scr%iccs Department mcnt JU n U Q w Department 111ehmhU{'fJ I —I i 3 j I I I--- I I I �7; 111ehmhU{'fJ Hea h and Environmental Prote. ion Fourth Floor West ` 825 L Street Anchorage, Alaska 99501 264-4720 ----------- INSPECTION REPORT ON-SITE SEWAGE DISPOSAL S`(STEPA _ NAME��c %% v/ter P` ♦ = ., !�'' r 6 // F%;o/ --- r tom= ii ✓_� - 4� ` - _t�4AILiN�ADDRESS.i___ - / ._� - PHOP.E LOCATION_ ----._.----- ----- LEGAL_ DE-SCRIPTION -_-- ------ _-� O1�__-. � U� �✓ r/ j SEPTIC TANK: DISTANCEL: r% / NUMBER OF ar FROM WELL_ -- —L_._/_ MAIQIJFACTUI/ RERGkee"'�, ._r••'tnTE-RIAL__5�� �...__ ___-__COMPARTt;iENTS_ `�-- INSIDE LENGTH_-__--____ ___.— INSIDE WIDT11 _ _ _._ LIOUID DFPTH _ -__.. I_IOUID CAPACITY -434' GALLONS. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELL .-FOUfVDATION _-__— ..__.idEAREST L.OT LINE _ -_- _.__OF LINE # of Lines ________-._- DISTANCE BETV./EEN LINES ___.__._____._TRENCH V:IDTEI_--__ IN. TOTAL EFFECTIVE ABSORPTION AREA - DEPTH: TOP OF TILE I0 FINISH GRADE SEEPAGE C-11 -- SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH -FILE IN. ABOVE TILE DIAMETER _OR WIDTH LENGTH �d, DEPTH Log Crib _Rings_ Crib Size: DIAt_-1E1ER____DEPTH_ DISTANCE FROM: WELL____. TOTAL. EFFECTIVE r BUILDING FOUNDAI ION _110 , NEAREST LOT LINE .______ . ABSORPTION AREA (WALL AREA) -__ `3 SQ. FT. Well Class: Depth: Well Distance To: Lot Line Bldg: Sewer_ Line: Pipe Materials: # of Bedrooms: Installer: Remarks: rP I I ( I I- 1 l - - A - 1 . - I�� I i r if 1)ATE%0(.'4 nPPR0V I/ , - I 6-R ee 4 S( \/ DEPHRTMENl UF HLML|M MND I-_f4YlM1_INntm|�� r=o|IMG 'J.um ^ ^^ 825 'L ,STREET/ HNCHORAG�/ HK. 279��511 9,3 L:E L 1 0 -J�� Cu r.,.q E-11. 1.4 F. -E.." F=" VE, #-.I�� PERMIT NO. ( 77762 ) HPPL1CHNT uAk.lY HUMPHRY PO BOX 161 E R 694994] LOCHTION LEQHL LOT 5 NEWTUN C SUB L.OT SIZE 13000 SQUARE FEET T9PE OF SOlL HBSQR8TION SYSTEM IS� TRECH THE REQUIRED SI "L QF THE SOIL HBS0RPTlON SYS11-M IS: THE LENGTH DIMENSlQN l' THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIB~D. THE DEPTH OF H 'IHENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF YHE EXC��YHT�QN (lN F��ET) THERE W 1S NO SEI fDTH FOR TRENCHES. THE GRAVEL DEFTH 1S THE MIWIMUM DEPTH OF QRHYEL 8ETWEEN THE OU -1 -FALL. PIPE HND THE BQT[OM UF THE EXCHVHTlON (IN F'EET). ^K-���ll_:C� 1. 1.2-m�._', LH. �0�.�j C --ti F-0 8_ L_ IC P4�� H PHOKHGE PI HNT MAY BE 1NSTHLLED HT THE PERMITTEE'S QPTlON SUBJECT TU ]HE FOLLOWlNG CONDlTI8N5: 1IHE� II NSF HPPROVED PLHNT MAY BE INS�HLLED�EQ 2. H CONTINUOUS MHINTENHNCE AGREEMENT IS H MHIWTENHNCE AGREEMEWT IS NOT KEPT CURRENT YOU MHY BE REQUIRED TO ENLARGE THE SQIL 0BSORPTION 5Y':_ -,TEM HND/OR Y8U MAY BE S0BJECT TO PROSECWTION �94 C� �;�2 �l 1- r-4"- UZA 04-. LE ��������IEE � 8HCKFILLING OF ANY SYSTEM WITHOUT FINAL HND HPPROVHL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWHGE #ISM}SHL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR H PUBLIC.: WELL WELL LOGS ARE. REQUIRED AND MUST BE RETURNED TO THE DEPHRTMENT WITHIN �0 DAYS OF THE WELL COMPLETIUN. OTHER REQUIREMENTS MHY HPPLY. SPECIFlCHTlONS AND C0NSTRUCTl8N DIHGRF111S HRE HVHILHBLE TO lNSURE PROPER INSTALLATION. ���� � ��������� ���L� �0=4�� I CERTIFY THHT 1� l HM FAMILIAR. WITH THE REAU�REMEN[S FQR �N-SIT� SEWE��S HMD WELLS AS SET FURTH BY lME PILIN ICIPHLITY OF HNCHORHGE 2: I WILL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]� I UNDER��THND THAI THE �}N�SITE SEWER ��YSTEM MHY RE0UIHE ENLHR8EME��T IF' THE RESIQEWCE ISREMODELED TO INCLUDE MORE THHN ] BEDROOMS. SIGNED: 35' Lot 5 10' J 100' Not to Scale Distances shown are approximate and have not been measured by survey methods. 130' DW N: V22- CKD: SMH RF.M CONSULTANTS, INC. avow aae• oaoia ops re e�wwnaw• aonvavo na DATE: 7-12-77 SCALE see above Hole $1 1"=3' 0} GRAVELLY SAND w/ SOME SILT (SM) Brown 2' GRAVEL w/ SOME SAND, MANY COBBLES (al) Brown, Dry, Dense M 4.5' SILT w/ SOME SAND (ML) Brown, Slightly Moist„- Dense oist„-Dense 81 GRAVEL w/ SOME SAND, MANY COBBLES, OCCASIONAL BOULDERS (G9) Brown, Dense, Slightly Moist _l2' T. D This log represents subsurface soil conditions within the backhoe trench at the location shown. See Drawings B-01 and B-02 for planation of symbols. TRENCH LOG AND F.B. LOCATION DIAGRAM GRID GARY HUMPHREY PROJ.NO-751194 DWG. N0. A-01 R6NI CONSULTANTS, IN%. 5024 CORDOVA A BOX 6087 B ANCHORAGE, ALASKA 99562 0 PH. 90]-2]9-0483 B TLX. 030-25]60 ENGINEFRS GEOLOGISTS PLANNERS SURVEYORS July 14, 1977 R&M No. 751194 Gary Humphrey P.O. Box 161 Eagle River, Alaska 99577 Subject: Soil Investigation for Sanitary Sewer System, Lots 4 and 5 Newton Subdivision, Peters Creek, Alaska Dear Mr. Humphrey: At your request of July 11, 1977, we conducted a subsurface soils investi- gation at the proposed location of the sanitary sewer system.on the subject lot. The investigation complied with those procedures.required by the Municipality of Anchorage, Department of Health and Environmental Protection. This investigation, which was accomplished on July 11, 1977, consisted of two test holes each excavated to a depth 12 feet below the existing ground surface. The test holes were sited according to your instructions and their locations are shown in attached Drawings A-01 and A-02. Excavation was accomplished with a backhoe. Samples were taken at the depths shown on the soils logs in Drawings A-01 and A-02. The samples will be held in storage at our lab for approximately six months. In addition, all material excavated was monitored by an experienced engineer- ing geologist. The topography at the excavation site is generally horizontal. At the time of the investigation the site had been stripped of original vegeta- tion. The top of the test holes were located at original ground surface. The soils encountered in the excavations are shown in the test hole logs in Drawings A-01 and A-02. The symbols used in Drawings A-01 and A-02 are explained in Drawings B-01 and B-02. These logs display specific conditions encountered at the test locations. However, subsurface conditions may vary in other parts of the lots without any apparent surficial evidence of the change. Groundwater was not encountered in either excavation. Bedrock was not encountered. At the time the holes were excavated seasonal frost was not present. Permafrost was not encountered. Based on the visual classification of the soil and the requirements set forth by the Municipality of Anchorage, a percolation test is not necessary within the test holes on the subject lots provided that the lower strata of well graded gravels be utilized for system burial. ANCHORAGE FAIRBANKS JUNEAU VALDEZ WASILLA ll I P M CONSULTANTS, INC, 5024 COROOVA 0 ©OX 6087 0 ANCHORAGE, ALASKA 99562 S PH, 907-279-0483 9 TLX. 090 25360 ENGINEERS GEOLOGR3TS RL�NNGRS SIJRVEVGRS July 19, 1977 R & M No. 751194 Mr. Gary Humphrey P.O. Box 161 Eagle River, Alaska 99577 Re: Soils Investigation for Sanitary Sewer System Dear Mr. Humphrey: The following is our invoice for professional services rendered on the referenced project. Invoice No. 751194-1 Professional Services Rendered July 11, 1977 through July 13, 1977 Soils Investigation for Sanitary Sewer System Peters Creek, Alaska Professional Services Senior Geologist 1 1.0 hour's @ $35.00 $ 35.00 Staff Geologist 2 1.5 hours @ $26.75 40.13 Staff Geologist 1 .5 hours @ $23.50 11.75 Draftsman 1.0 hours @ $20.50 20.50 Subtotal Professional Services $107.38 Incurred Expenses Mileage 76 miles @ $.25 $ 19.00 Subtotal Incurred Expenses $ 19.00 Total Invoice No. 751194-1 $126.38 Please note our invoice number on your remittance. Should your have any questions concerning this invoice, please contact me or the Project Manager, Mr. Gary Smith. Thank you. R & M CONSULTANTS, INC. C. G.,Siver Anchorage Business Manager CGS/mrb ANCHORAGE ( AIR©ANKS JUNEAU VALOEZ VJA5ILLA 9 N I 35' Lot 5 10' 100' Not to Scale Distances shown are approximate and have not been measured by survey methods. UVI N° VeZ CKD SMH R&M CONSULTANTS, INC. DATE 7-12_77 .«a,«...... e.,.r...««......,o.. ,SCALE: see above 130' Hole ul 1"=3' 0' GRAVELLY SAND w/ SOME SILT (SM) Brown -- -- — 2' GRAVEL w/ SOME SAND, i✓ANY COBBLES (al) Brown, Dry, Dense — — — — — 4.5' SILT w/ SOP E SAND (nL) Brown, Slightly Moist, Dense 8f GRAVEL w/ SOME SAND, MAPaY COBBLES, OCCASIONAL BOULDERS ((7.9) Brown, Dense, Slightly Moist 4b9 12' T. D This log represents subsurface soil conditions within the backhoe trench at the location shown. See Drawings B-01 and B-02 for explanation of symbols. TRENCH LOG AND F.B. LOCATION DIAGRAM GRID GARY HUMPHREY PROJ.N0 751194 DWG.NO. A-01 Lot 4 Not to Scale. Hole #k2 111=31 "=3' e.;.. 0' GRAVELLY SAPID w/ SOi1E SILT (SM) N Slightly Moist, Medium Dense 9 21 dopa GRAVEL w/ S014E SAND, I ANY COBBLES (GI) 6 0 oao. Brown, Dry, Dense 30 ' X25' � I - L_ Distances shown are approximate and have not been measured by survey methods. — — — — — 4.5' SANDY SILT (PL) Brown, Moist, Dense - — — — — — 7.5' GRAVEL w/ SOr'IE SAND (GW) Brown, Slightly hoist, Dense 'T. D. This log represents subsurface soil conditions within the backhoe trench at the location shown. See Drawings B-01 and B-02 for explanation of symbols. w•✓iv. y,e.G "Yv V F. 8. CKD:TRENCH LOG AND Sh9H R&M CONSULTANTS, INC. LOCATION GRID DATE: 7-17_77 o,„.... o.o o..,....„„... . DIAGRAH - GARY HUMPHREY PROJ.N0.75I194 SCALE= see above, �. ., SOILS CLASSIFICATION?, CONSISTE%CY AND SYMBOLS CLASSIFICATION: Identification and classification of the soil is accomplished in accordance with the Unified Soil Classification System. Normally, the grain size distribution determines classification of the soil. the soil is defined according to major and minor constituents with the minor elements serving as modifiers of the major elements. For cohesive soils, the clay becomes the principal noun with the other major soil constituents used as modifier; i.e. silty clay, when the clay particles are such that the clay dominates soil properties. .'Minor soil constituents may be added to the classification breakdown in accordance with the particle size proportion listed below; i.e, sandy silt w/some gravel, trace clay. no call - 0 - 3% trace - 3 - 12"' some - 13 - 30i SOIL CONSISTENCY - CRITERIA: Soil consistency as defined below and determined by normal field and laboratory methods applies only to non -frozen material. For these materials, the influence of such factors as soil structure, i.e. fissure systems, shrinkage cracks, slickensides, etc„ must be taken into consideration in making any correlation with the consistency values listed below. In permafrost zones, the consistency and strength of frozen soils may vary significantly and unexplainably with ice content, thermal regime and soil type. Cohesionless Cohesive N"(blows/f t) Relative Density T- (tsf) Loose 0 - 10 0 to 40» Very Soft 0 - 0.25 Medium Dense 10 - 30 40 to 70% Soft 0.25 - 0.5 Dense 30 - 60 70 to 90'; Stiff 0.5 - 1.0 Very Dense - 60 90 to 100% Firm 1.0 - 2.0 "'Stand.ad Penetration "N": .Blows per foot of Very Firm 2.0 - 4.0 a 140 -pound hammer falling 30 inches on a Hard - 4.0 2 -inch OD split -spoon except where noted. DRILLING SYtiIBOLS WO: Wash Out WD: While Drilling WL: Water Level BCR: Before Casing Removal WCI: Wet Cave In ACR: After Casing Removal DCI: Dry Cave In AB: After Boring WS: While Sampling TD: Total Depth Note: Water levels indicated on the boring logs are the levels measured in the boring at the times indicated. In pervious unfrozen soils, the indicated elevations are considered to represent actual ground water conditions. In impervious and frozen soils, accurate determinations of ground water elevations cannot be obtained within a limited period of observation and other evidence on ground water elevations and conditions are required. L a N/A C KD G_ L, B. F7 E. T/1 COiVSULYAIVTSgItV C. GENERAL NOTES 3-11=72�o,�.... e.o =N/AD—rTE S Ai_2 N/A i STANDARD SYMBOLS titiN ORGANIC MATERIAL ® COBBLES & BOULDERS CA, j IGNEOUS ROCK SPOON SANDY SILT HAMMER CLAY 0p04 CONGLOMERATE _ METAMORPHIC ROCK Ss SILT GRADING TO SANDY SILT ® SILT SANDSTONE n= ICE, MASSIVE e o SANDY GRAVEL, SCATTERED ED COBBLES ATTEOCK MODIFIED SHELBY TUBE SI .... 2.5° SPLIT WITH 140# SAND MUDSTONE ICE -SILT MOO a SAN YYERED GRAVEL ND 0o°oo GRAVEL ® LIMESTONE ® ORGANIC SILT � SILTY CLAY w/TR.SAND SAMPLER TYPE SYMBOLS St ..... 1.4" SPLIT SPOON WITH 47# HAMMER Ts . .. . SHELBY TUBE Ss ..... 1.4" SPLIT SPOON WITH 140# HAMMER Tm.... MODIFIED SHELBY TUBE SI .... 2.5° SPLIT SPOON WITH 140# HAMMER Pb .... PITCHER BARREL Sh .. 2.5" SPLIT SPOON WITH 340# HAMMER Cs .... CORE BARREL WITH SINGLE TUBE Sx ..... 2.0" SPLIT SPOON WITH 140# HAMMER Cd .. CORE BARREL WITH DOUBLE TUBE Sz ... .. 1.4" SPLIT SPOON WITH 340// HAMMER Bs .. BULK SAMPLE Sp ..... 2.5" SPLIT SPOON, PUSHED A. . . . AUGER SAMPLE Hs .. . .. 1.4" SPLIT SPOON DRIVEN WITH AIR HAMMER G..... GRAB SAMPLE HI .. . .. 2.5" SPLIT SPOON DRIVEN WITH AIR HAMMER NOTE: SAMPLER TYPES ARE EITHER NOTED ABOVE THE BORING LOG OR ADJACENT TO IT AT THE RESPECTIVE SAMPLE DEPTH. Ol'/ML.D.S. TYPICAL BORING LOG BOR/NG NUMBER-�T H. 30-15 Elev. 274.6' ELEVATION IN FEET DATE DRILLED�10-21-70 All Samples Ssa'SAMPLER TYPE GRID N/A 0 PROJ.NO GENERAL ORGANIC MATERIAL I ° Coasid. Visible Ice 0-7 ICE+ML _ ICE -SILT SAMPLER TYPE Estimate 65% Visible Ice Ss r- 56.2 STRATA CHANGE O 90, /O .... WATER TABLE 7' 9�c -_ _ SANDY SILT GRADAT/ONAL CHANGE_�APPROX/MATE STRATA CHANGE o.o.. Ovo; 6:9'0.0 _ _ _ — 12' Little to No Visible Ice 13' 30' V —ICE x DESCRIPTION 6 CLASSIFICATION :-: oC Ss ¢9. 2 72,57.1%,85.9pcf, 280 GP (CORPS OFENGINEERS METHOD) q°OoQ a ® '-UNIFIED OR FAA GLASS/.F/CAT/ON OF b0', 0 :' ' FROZEN GROUND —�' o o b° \ TEMPERATURE, DRY DENSITY WATER CONTENT op o 4 0p °oo BLOWS/FOOT 02 SAMPLE NUMBER SANDY GRAVEL 1' ^aqo 26 Cd 3 95 SCHIST ®—GENERALIZED SOIL OR ROCK DESCRIPTION ` SAMPLE LOCATION 30'—DRILL DEPTH �E WD. -WHILE DRILLING, A.8. -AFTER BOR/NG Ol'/ML.D.S. or. o R& V1 COrUSULTAIVTS,INC. `"°""°" "`�""° "`""`"° °". """° EXPLANATION OF SELECTED SYMBOLS F. B. N/A CKD G.L.B. GRID N/A DATE: FEB. 1972 PROJ.NO GENERAL SCALE NONE DWG. NO. 8-02 _ AS -BUILT I hereby certify that I have, surveyed the following described property:: `{ i A,1 j t.t. i 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 prop- erty 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 Eagle River, Alaska day of l vi - 19 '' 1 ROBERT C. JOHNSON >" ' SCALE: Registered Land Surveyor No. 880 -LS 1' = y_c>- Box 456, Eagle River, Alaska Phone 694-2543 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICE$ Division of Environmental Services t 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. # CSJ— - �'� 1. GENERAL INFORMATION HAA # kA Q'A �)C .J -I Complete legal description 40T 5 NGw>o" Sud O)VI z is Al Location (site address or directions) 22021 N6w-rvy 4giVr, C4qu61AW Property owner Gh��-� LICC_r _�l._� Day phone Mailing address ) C C, ( Lending agency Day phone Mailing address Agent &ATH y Q ieAG I Day phone 6 9'/ Address I I Y// DLO 646AI/V H/6HWAY , CAUC F—WEA Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 < 3 n c 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOA#21 6 z 3. TYPE OF WATER SUPPLY: r7 = z Individual well� ^� r- _ �, y C Community well _ < n < Public water CO m M Cr' 0 V; G' NOTE: If community well system, provide written confirmation from State ADEZ0ttest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOA#21 5. a By: STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm TRYGK N yMAN IYAY" /NG Phone 2 79- O Tjvz Address I// Wt3 T (d tN Engineer's signature DHHS SIGNATURE _ Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments a11TIC — Date 06126195 f J; bedrooms, with the following stipulations: Date 7—s -Zr- The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (RW. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 407-S OW NI TUBO. Parcel I.D. A. Well Data Well type G If A, B, or C, attach ADEC letter. ADEC water system number dd 1?3Z/ - rA03 -7 Log present (Y/N) 1445 Date completed 09/0//121 Driller A TL D9/6G/N6 Total depth 106, Cased to OWWOWM Casing height A9 Sanitary seal (Y/N) ye -5 Wires properly protected (Y/N) vles WATER SAMPLE RESULTS: Coliform FROM WELL LOG AT INSPECTION Other bacteria O Date of sample: 06AP/I t �9 06 AZ /,Is z < � M Date of test �� 93 m Static water level Well flow Jr g•p•m• 6 �D� /0/ C < D Pum levell Pump r ( m n cn O O SEPARATION DISTANCES FROM WELL TO: yc q 9 1 lots 7 X00 m Septic/holding tank on lot / ; On adjacent Absorption field on lot 1 / 0 1 ; On adjacent lots 130, Public sewer main IVIA Public sewer manhole/cleanout Al /A Sewer service line A100PAo4- d'2 Petroleum tank NSA WATER SAMPLE RESULTS: Coliform 0 Nitrate y E8 Other bacteria O Date of sample: 06AP/I t Collected by: -5#A 9 SIMS AAGVft B. SEPTIC/HOLDING TANK DATA Date installed 1,21144117 Tank size 1250 6AL Compartments Cleanouts (Y/N) ye5 Foundation cleanout (Y/N) N Depression (Y/N) FA 0 High water alarm (Y/N) NO Alarm tested (Y/N) N A Date of pumping 06 &/9s Pumper TNS 56191/4 PUMP/N6 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 611 / On adjacent lots % loo * Foundation To property line 710, Absorption field /0, Water main/service line Surface water/drainage NONt /N AK£A /0' 7/0• 72-026(3/93)• Front CONTINUED ON BACK PAGE C. LIFT STATION NA Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed /)-//,Z / 77-Z Length qy Width On adjacent lots "Pump off" Level at Cycles tested Surface water _Soil rating (GPD/Ft2) UN/iN0WA1 System type 3 Gravel thickness r! Total depth Total absorption area 320 *420 Cleanout present (Y/N) yez 12, Depression over field (Y/N) No Date of adequacy test 0611219,5 Results (pass/fail) Psi sS for -25 Bedrooms Water level in absorption field before test 0 After test Peroxide treatment (past 12 months) (Y/N) NO SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1 1 0 On adjacent lots If yes, give date NSA Property line > To building foundation 3 U To existing or abandoned system on lot NIA On adjacent lots ;p / d Cutbank NIA Water main/service line % /o Surface water ,NONe /N A06A Driveway, parking/vehicle storage area �U Curtain drain IV . E. ENGINEER'S CERTIFICATION l certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect o .4hq q date lf.this inspection. ,r !e Signature , Engineers Name Sfl/lWN SN/SAL°ENIT© / / �6269� Date HAA Fee $ Waiver Fee $ Date of Payment i�0� Date of Payment Receipt Number J� ( 9vJ Receipt Number. 72-026 (3/93)' Back JUII Gu JJ ClV' JJlll l I l I L !"1I 1V11V1\rIVL • . . NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 • FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277.8378' FAX 274-9645 1 DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA Tryck Nyman Hayes Inc. 911 West 8th Ave Anchorage, AK 99501 Phone No. Purchase Order No. Collected by: Sample Type: Routine Method of Analysis: Membrane Filtration Comments: Public Water System I.D.# Date Received: 06/13/95 Time Received: 15:20 Date Analyzed: 06/13/95 Time Analyzed: 17:00 Date Reported: 06/19/95 Time Reported: 08:30 Next Sample Due: Comments: S = Satisfactory U = Unsatisfactory POS = Positive Test Result ND = None Detected TNTC = Too Numerous To Count (>200 Colonies) CG = Confluent Growth HSM = Heavy Sediment Masking, Results May Not Be Reliable SA = Sample Age >30 Hours But <48 Hours, Results May Not Be Reliable Old - Sample Age >48 Hours, Too Old For Analysis R = Resample Required NT = No Test * # Colonies/100 ml ** # Colonies/ml Sample Sample Total* Fecal* Other* HPC** Location Date Time Lab# Coliform Coliform Bacteria Result Comments ------------------------------------------------------------------------------=---------------- 1 06/13/95 AB7807 0 ND 0 NT S 9Env1io c aefer mentalAnalyst NORTHERN TESTING LABORATORIES, INC. i F'AIRDANK6, ALASKA 99109 (907) 456-3116 • FA)' 956.3925 I t = o 3330 INDUSTRIAL AVENUE ANCHORAGE, ALASKA 99503 (907) 277-8378 • FA}: 279'8645 2505 FAIRBANKS 5TRErT - «»•�^-��'^" Juno 23, 1995 PRELIMINARY RESULTS REPORT Lab✓R customer 90 Method Parameter Units Result Customer Name -----•--•---------�-• _ _--...__..------ 4.68 TrycK• Nyman & Hayes F150128 Lot 5 Newton EPA 353.3 ------------------------------------------------------------ mg/L Nitrate x/Nierite w STATEMENT JR's Septic Pumping 16718 Mercy Drive Eagle River, Alaska 99577 (907) 694-6454 =_"eASe ;ETURN Try PUB V,:'H ICUR R1,!1UA�\CE. eCUR CANCELLED CHECK IS %00.:7,ECEIPT. 7 DATE DESCRIPTION CHARGES CREDITS BALANCE (� C5 W�.�� JR's Septic Pumping 16718 Mercy Drive Eagle River, Alaska 99577 j PAY LAST AMOUNT IN BALANCE COLUMN RELdFCRM. 3S874,8P874 POLvPHx cso SETS; CARBONLESS SPEEDISE, DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 555 CORDOVA STREET ANCHORAGE, ALASKA 99501 June 30, 1995 Mr. Robbie Robinson Municipality of Anchorage Dept. of Health & Human Services On -Site Well & Septic P.O. Box 196650 Anchorage, AK 99519-6650 TONY KNOWLES, UUMKIVUK (907) 269-7505 RECEIVED JUL 51995 Municipality of Anchorage Dept. Health & Human Services RE: Lot 5 Newton Subdivision;. Septic system waiver for an on-site single family residential dwelling to a Class "C' public water system. Dear Mr. Robinson: A review of the files in this office indicates that a waiver granting a lesser separation distance of 110 feet from the well to a septic system was granted by this Department on July 26, 1982. Based on the materials on file it would appear that the septic tank for this system was inadvertenly left off of the submitted drawing and later added, however the intent of the waiver was for the complete on-site system. So long as there have been no modifications to the system since the operation and waiver approvals were granted, the existing waiver remains applicable to the on-site wastewater disposal system (septic tank and absorption field) serving the above referenced lot. Thank r- your cooperation with this Department, if there are any questions regarding the above please do not hesitate to call. Sincerely, Michael Lu, E.I.T. Environmental Engineer MLU/cf x CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION. PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of Ali W-ro A) SU 1?.M,. L 6.rs L.T. public water system located in ! Q I ;;r Alaska, submitted in accordance with 18 AAC 80.100 by C! Yl (i�G L A Ic fY have been reviewed and are Q( approved. ❑ conditionally approved (see attached conditions), j TITLE _ V DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contract order no. Approved by Date or descriptive reference) - W P �� �' o C e � �-t c � I S?Cr to c_�P %.y U UP ct t d / % d �� �` 2 ` "•r sG:, loa Sa� 041✓t s co,VcC?« %tQe-ig tekc>° y The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the <1-1 ii 1,—rlr- i water system was completed on % 2 1 T Q (date). The system is hereby granted interim approval to operate for 90 days following the cpmpletion date. BY TITLE - - DATE As -built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to ogeiate. I r BY - j TITLE DATE �f f Time Time is Date Date Date �)- - D- - (<1�' D (-11�" - ) - -� - ff / 2&"'l e�� Inspector Inspect Inspector Comments t,t, OWL (Je, I 'V, 'er- Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Solis Rating Well To Absorption Area r Well Log Received qlf� Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner _j a rwe--5 C" cr, 19 e Phone Mailing Address SM 60-4 e/()!5 Buyer O�7e- �7-/— Address Lending Institution Phone Address dozz",ev, z-/ Realty Co. & Agent Me /-'0/'10 47Z� Phone Address Legal Description Street Location Type of Residence Single Family Multiple Family No. of Bedrooms 11 Other Wal%�pply dividual ATTACH WELL LOG. A well log is required for all wells drilled since June 11 Community 1975. For wells drilled prior to that date, give well depth (attach log if El Public Utility available.) Se"�aqe Disposal ,�.Individual Year Individual Installed: - 7 El Public Utility When Connected to Public Utility:— El Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Received From Lw �otlars $9" Address For NOW PAID- (<�' ACCOUNT DpsHOF AC OUNT CHECK I AMT. PAID MONEY i BALANCE ORDER BK806 January p, 1082 :lame : u .,i ane z;a?-n s.t?n 7tnchorago,` AK, 119 9307 /."30 F!,Ub1ect Lot 5., �-to:wton Sub:-livision C'huniak, Al'. 7E, ,r `'{r. k- "1rs. T:a}re n.nnroval for the inAividual ge-wor an{l 1>>ater facilities cannot he granted until the `ol_lowincl items have beenromnl.eterl: • rxnosed electrical wi_rns to the P*^11. he.a(I are in violation of the munici.*-)a! its, of Anchorage cordes and must he encase-? in conduit. ° The septic tang. Pumped ,with a receipt submitted to this department:. ° An adeauacv test needs to he perf-OrMed on the existina leaching arefI. This test will determine if the syster1 is add-auat:e actor(Iina to Mational Stanelarris. n l.istina or private firms per for-inq the test is encloSnrl. This report noods to he suhmi.ttc<l to this office for our review. O � toutside water tans were frozen. Please call this r office to make arrangerients for this r3enartment: to obtain a sample. please notifv this tlnnartment for a reinspection when the noted r1iscrenancies have been corrected. 7t there are any further questions, -please call this office at 2€4--4720. Sincerely, Robert C. Pratt Associate rnvir_onlnentF l Specialist Enclosure TRYCK Head Office/7.. street Anchorage, Alaska 99501 /907-279-054,.able TNHANCAK/Telex 090-25332 NYMAN &HAYES ENGINEERS/PLANNERS/SURVEYORS 0000.0 February 2, 1982 James E. and Diane M. Lake SRA Box 2105 Anchorage, AK 99507 Ref: Adeguacy Test Lot 5 Newton Subdivision Sec 9 T 15N R 1W S.M. Ak. Dear Sir: We performed an adequacy test on the septic system/drainfield located on Lot 5 Newton Subdivision located within Sec 9 T 15N R 1W S.M. Ak. on Jan 30, 1982. The test was done in accordance with the guidelines setforth by the Municipality of Anchorage, Dept. of Health and Environmental Protection. For a three bedroom residents, considering two persons per bedroom and 75 gallons per day per person of sewage effluent, average sewage flow would be 450 gallons per day. The adequacy test checks the capability of the septic system to accept the average flow. The septic tank had been pumped in early January 1982. At the time of the test the septic was at normal level. Water for the test was provided by an on-site well with a rate of 5 gallons per minute. 750 gallons was input into the septic tank on the first day of the test, there was no rise in the water level in the septic tank during the test. Test results indicate that the system is adequate. Sincerley, YCK, NYMAN & HAYES Martin Kje ad, P.E. tlh OF 444 ®1® @p ee e e ally ®a : .14 j k'Y �g`r� L � j >S se rn Ba vo• a ae a•eoo co rst Martin O.A. jelstad ivy CE -4916 a '' ���®4 - OFESS% MUNI(,If AL1 I Y Ur AINUNUKHtlr ® � DEPAR',., T OF HEALTH AND ENVIRONNI� AL PROTECTION K 825 L Street, Anchoraup- Alaska 99501 264-4720 Date Received: February 15, 1978 #1: Time 2:30 p.m. #2: Time #3: Time Date 2-16-78 Thursday Date Date Insp Pratt Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Alaska State Veteran'a Administration Mailing Address: 907 West Northern Lights Blvd. Phone: 274-7555 2. Property Owner: Wayne Cousineau Mailing Address: % Susan Gallion, 694-9555 3. Legal Description: Lot 5 Newton Subdivision 4: Single Family Residence: (X) Multiple Family Residence: ( ) 5. Well System: Permit # Construction Phone: 694-2140 Number of Bedrooms: Possible 4 Number of Bedrooms: Individual Well (X) Community/Public System ( ) Depth of Well 106' Well Log on File) Bacterial Analysis 6. Sewage Disposal System: On-site System (X) Public Utility ( ) Permit # Installed 1977 Installer Septic Tank Size Ja<`Q Manufacturer Absorption Area Soils Rate Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Page Trao Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 5 Newton Subdivision Comments: Affadavit Attached: �()) Letter Attached: ( ) Approved: Disapproved: Department Worksheet: Date: D-- F Date: REQUEST FOR APPROVAL OF INDIVIDUAL SE!dER & WATER FACILITIES 6. Legal Description: Lot 5 Newton Subdivision Location: Birchwood Area, Chucfiak 7. Type of Facility to be inspected: Private Residence No. 3dr s. 2 f ini 8. Water Supply Potential for 4 Type of Supply: Public Utility Individual X If Individual, number of dwellings presently served 1 If Individual, depth of well 106' 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) X If Individual, date of installation: Summer, 1977 AREA MC. REALTORS ❑ Anchorage ❑ East Anchorage Eagle River "C" St. Office Eastgate Office Parkga:e Office aEAuoR 3300 C Street 5437 E. Not Lights P.O. Box 249 Ir'/171 77n n7` 1n`1 'l11 IF`1 "n'l fine nrrr, 12 State 1. Type of Inspection: CMRO VA X FNA CON': --- 2. Property Owner: Wayne Cousineau Mailing Address: Day Phone 694-2140 3. Name of Buyer: James E. and Diane M. Lake 753-F N.M.S.H. U. of A. Mailing Address: Fairbanks, AK. 99701 Day Phone 479-2347 4. Name of Lending Institution: Alaska State VA Mailing Address: Phone 274-7555 5. Name of Realtor or Agent: Susan Gallion - AREA Inc Real ors P. O. Box 249 Mailing Address: _ Eagle River, AK 99577 Phone 694-9555 6. Legal Description: Lot 5 Newton Subdivision Location: Birchwood Area, Chucfiak 7. Type of Facility to be inspected: Private Residence No. 3dr s. 2 f ini 8. Water Supply Potential for 4 Type of Supply: Public Utility Individual X If Individual, number of dwellings presently served 1 If Individual, depth of well 106' 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) X If Individual, date of installation: Summer, 1977 AREA MC. REALTORS ❑ Anchorage ❑ East Anchorage Eagle River "C" St. Office Eastgate Office Parkga:e Office aEAuoR 3300 C Street 5437 E. Not Lights P.O. Box 249 Ir'/171 77n n7` 1n`1 'l11 IF`1 "n'l fine nrrr, 12