Loading...
HomeMy WebLinkAboutPROSPECT HEIGHTS BLK 2 LT 4PtosPir4 9,,.h4S QIGL ftow Q *0 lis " A s3r al MUNICIPALITY OF ANCHORAGE DE. .ATMENT OF HEALTH AND HUMAN SER. ES Environmental Health Division ©/ 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name 7-e R i, I 1) g1 ! DISTANCES si �r rzs/_ yet 31 TO SEPTIC ABSORPTION Address FROM TANK FIELD WELL PaP30)e WELL Phori Permit No. No. of Bedrooms A,6, -_15 L i X 7 O ,7- 0 X LOT LINE /^ p LEGAL DESCRIPTION Lot Block Subdivision /�i��5i'G Li l�G /CahKT-s FOUNDATION Township, Range, Section AS -BUILT DIAGRAM (Show location of well, septic system. properly lines, foundation, /3 driveway. water bodies, etc.) TANKS ❑ SEPTIC ❑ HOLDING Manufacturer Capacity in gallons /:5& -CD Materia FINNo. of Compartments TYPE OF SYSTEM O EXISTING WELL ❑ TRENCH BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom Nrorrf Total depth from original grade original grade 6— FT /% - FT e Fill added above original grade Gravel depth beneath pipe I 4_8 TIG/6 ELECTRIC AND PHONE SERVICE � NOUSf OOk -® FT ; FT Gravel length Gravel width FT FT � I Total absorption area Distance between linesI 16' I 560 GAL. tSEPi1C TANK SQ FTI FT 4' CLEAN OUT I Number of lines Soil rating Pipe material 81 4' MONITOR TUBE SO FT — c� /O I cas sER E I 84' -y 60LF OF TRENCH TC Installer Date Installed I 11' TOTAL DEPTH 5' OF SEWER ROCK WELLS 4' CLEAN OUT I I I LI PRIVATE -1OTHER (Identifv) I r u �,._. Classification (A,B,C) Total Depth Cased to '' 1,�-' r...:... .... .. /:.. FT FT o. z�: ; - E zs o so loo 150 Installer Date installed: '''1 GRAPHIC SCALE 1'= 50' GRID 2541 vC TDBBEN SPURKLAND P.E. LOT 4, BLOCK 2 ISEPT:C SYSTEM ASBUL" REMARKS: 203'-4. 15TH. AVENUE ANCHORAGE, ALASKA PROSPECT NEIGH (SEPTEMBER 8, 1987 (907) 279-3916 -- 1 SEC 13 T12N, R3W 'iSHEET! In %% Scale: ENGINEERS SEAL •@.e/j r le 'Ie 4 s Inspections Performed by: `- •��..`®090 Date: certify that This inspection was performed according to all �=. Municipal and State guidelines in effect on this date/: Health Department ADDroval: Date: �_ —' 0 EXISTING WELL I f I q,B rIN� ELECTRIC AND PHONE SERVICE NQUSf ��M I 16 11' I 500 GAL. SEPTIC TANK 4' CLEAN OUT B1 I 4' MONITOR TUBE fAS 3EP 84 VICE 60LF DF TRENCH I 11' TOTAL DEPTH 5' OF SEWER ROCK 4' CLEAN OUT I I • Y c 3 S b ; f,. ,: o. 2225-E• 25 0 50 100 150 • JUNE ' 1971 GRAPHIC SCALE 1'= 50' GRID 2541 TOBBEN SPURKLAND P,E, LOT 4, BLOCK 2 SEPTIC SYSTEM ASBUIL T 203 W. 15TH, AVENUE ANCHORAGE, ALASKA PROSPECT HEIGH SEPTEMBER 8, 1987 (907) 279-3916 SEC 13, T12N, R3W SHEET 1/I FAIAlf�a/isvm 4 x A C Ln Un r w O pq SOjII yOy yOy' 'yOy •yO O'y1 O .yO •/O.y yC •yO .Cy O H : H :N v v to H H H H H H H H H H H H N � rt O O O O O O O O O O O O (cl G N n'ln :Ln : W . N . _� •• W :o :r :O :In 00 - iN i0 :N Ln O O H H rt 0 m ': rfDt o x a mto e H H Q R' 0 0 Er+,IE rt 1 •/O O yO.J' /O SOI O yO O •JO Oy jO O^/ Il 1� M71 M 1a N l 17 17 C G J N H H H H H H 4 , j H H H H H H H H H H H H O O O O O O O O O O O O � O (`� W z i E �/J W N H Haiti°HDN H H m' r' C1 f G7 7 W TCA 'CS7 i �Sni I r Cx+1 UJ C ~ d � d z z ro < itl o Cr (D ?� 00 ?(D `• r :oo -4 Ev in V 00 ; N co w M c r M ro i N � N rte-• ' ? H E In Li :a :a n :w N i i w M MUNICIPALITY OF ANCHORAGE Department o[ HealLh & Human Services 825 L Street, Anchorage, Alaska 99501 343-472O ON`^SITE SEWER PERMIT Permit Numbor: S70202 Upgrade Date Issued: 08/06/87 Engineer Designed Owner Name: FIRST INTERSTATE Day Phone: Owner Address: C/O TERRI DUBEL P.O. 9OX 1207012 264-5679 ANCHORAGE, AK 99510-7020 Parce1 Id: 015-091~57 Lot Le�a1: Subdivision: PROSPECT HEIGHTS Lot: 4 81ock: 2 Section: 13 Township: 12N Range: 3W Lot Size 812O0 (sq,ft^ or acres) Max 8edrooms: This Permit: 4 Total Capacity:4 SOILS RATED AT 150 SQ FT PER BURY! FROM 6 TO 11 FEET. Issued By: r �~ DATE: �������~ ..... ..... ....������������^��� I I F 4,8 TING HppSe ppM I I d EXISTING WELL ELECTRIC AND PHONE SERVICE EXISTING 1500 GAL. TANK I INSTALL FOUNDATION CLEANOUT TANK CLEANOUT CLEANOUT AFTER TANK 25' OF SOLID PIPE IGAS 4' CLEAN OCC UfRVI 60LF OF TRENCH I 11' TOTAL DEPTH 5' OF SEWER ROCK p TESTHOLE I 4' CLEAN OUT 4' MONITOR TUBE L.��� F C J� .49TH /�e•o •• •••O 900000 0 of J. me. •• • . o eco �� o. 2225-E 4 a'• JUNE 25, 1971 ti I I I I I I I 25 0 50 100 150 GRAPHIC SCALE 1'= 50' TOBBEN SPURKLAND P.E. LOT 4, BLOCK 2 SEPTIC SYSTEM DESIGN ANCHORAGE, 203 W. 15TH.ALSKAUE PROSPECT HEIGHTS AUGUST 4, 1987 (907) 279-3916 11 ccrr 1� r,oki rn"It , �.-.(ENGINEER'S SEAL) e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Trs 825 "L" Street, Anchorage, Alaska 99502-0650... . .. a = .. • • • • • ^, �. SOILS LOG PERCOLATION TEST o� 227_5-E ° Tt Es PERFORMED FOR:._. F1125, /NT-aeS l Arrt;E ZL ArNK DATE PERF '•°.• • �� P / LEGAL DESCRIPTION: %.r� l Ii3K 2� i�toSAe Township, Range, section: SCGl3 Ti Af�l ral W I}EPT$ FitlCat-!•rj SLOPE SITE PLAN 1 2 3 4 • �••. SIrrT�/ 5 6 14L 7 StL7'y S,4 KID g E • o S k4 9- 10- 11- 12 1011 12 • g•`� 13 • •• sty 14-- 15- 16- 17 41516 17 18 19 20 SA•N D COMMENTS V A�P-- 16 WAS GROUND WATER A' ENCOUNTERED? N'o S IF YES, AT WHAT L O DEPTH? P E Depth to Water After � Monitoring? t\10 Date: •28 Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN 6-' L Y'61.i*i u (minutes/inch) PERC HOLE DIAMETER FT AND FT PERFORMED BY: .� i�� \ t CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ( `` Municipality of Anchorage 1 DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST f, h (ENGINEER'S SEAL) r o. 222 E UNE 2� t971 e PERFORMED FOR:�N/E P_4�n I T�'��UI� DATEPERVF)QRMED;. {'' 'r✓ `�;./ LEGAL DESC IPTION:_I�I}s„,Township, Range, Section:'' i 1211 ,23 u iflIII 16P�-6ANIC5 2 3 4 /3 y l I lr'1 -S AN 5 t, 6 -Vg t 7 8-1 9 10- 11 0 11 12- 13-v 2 13 a r 14 51617 15- 16- 17 18 19 20 COMMENTS SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? P E Depth to Water After Monitoring? t�v ? . t 7 L - Date: j _ _ SITE P ----T Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT PERFORMED BY: r- (; I ETA S CERTIFY T)jiAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:- �La 7P-nnR rao„ AIAsl A N C H 0 R A G E DEPARTMENT OF HEALTH AND HUMAN SERVICES MEMORANDUM DATE, gAugust �2'6, TO: Public Wor-A.s. Building Safety 4�J2 D.N. Bolles, Orn -site S21-0 01 SUBjECT: Lot 4 EPA,. 11 Prospect Hts.I septic and well. T 1, e a b o v e r- e f e r, e ri p r- o p e r- t y h a s a ri a... r-!:) v -e d -7j n s =+5 w -a 1 arl d iseptic systeg" The as—built was r,eejv-g-d -Id arpr-o lr s .ry-ej b, this depmr,tcnerit on Nov. -4, W83. if -.�--ou have any fsjr-thier- wiestmoth= pleavie !:.alll me. at 73-4:3-4744. db/94 Parcel I.D. 015-133-21 USAI $u Municipality of Anc R' P Y ra� o � 205 On -Site Water and Wastewater Progr x (907) 343-7904 19'chen stullet< Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: Prospect Heights, Block 2, Lot 4 10500 Prospect Dr. Current Property owner(s) Mailing address Real Estate Agent Terrance Eberle Day phone 10500 Prospect Dr. Anchorage, AK 99507 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage . Community Class Well Public Water System Day phone TYPE OF WASTEWATER DISPOSAL: Fx I Individual I] ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $Jro�to— Date of Payment 1-+115 Receipt Number l9e)A9-6 COSA# 0505,11tdq Date: Waiver Fee $ Date of Payment _ Receipt Number _ Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as ofthevalidation 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the focal soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Phone (907)272=8218. Date 8/4/2015 . 156nnone • �/ Conditional approval for bedrooms, with the following stipulations: By: rl Original CferfifinnfA nate: Thea u pgGt chorage 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 f + c If more than 1 septic system is on the lot: COSA Checklist # + of 1 Structure served by this system + Certificate of On -Site Systems Approval Checklist Legal Description: Prospect Heights, Block 2, Lot 4 A. WELL DATA Well type Nivate If A, B, or C provide PWSID # Date completed 11/10/1978 Sanitary seal (YIN) Y Total depth 532 ft. Cased to 45 ft. FROM WELL LOG Date of test 11/10/1978 Static water level 72 8. Well production 3+ Parcel ID: 015-133-21 Well Log (YIN) Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 7/9/2014, ft. g.p.m. 0.75. g.p.m. WATER SA PLE RESULTS: Coliform colonies/100 mL Nitrate ' / 5 mg/L Arsenic f 9 ug/L Date of sample: V412-01 S. Collected by: S B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed Before 1987 Tank size 1,500 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping Pk/(1-015 5 Pumper 'T -7S A A L' f Pu m A7 /t-) (1- 1C;f-tU) tG: C. ABSORPTION FIELD DATA Date installed 9/7/1987 Soil rating (g.p.d./ftZ or ftZ/bdrm) 150 SF/BR System type Deep Trench Length 60 ft. Width 2.5 ft. Gravel below pipe 5 ft. Total depth 9.6 ft. Eff. absorption area 600 f� Monitoring tube Y Depression over field N Date of adequacy test 7/9/2014 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 630 gal. New depth in. Elapsed Time: 180 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N,& type) No If yes, give date D. LIFT STATION Date installed Size in gallons _ "Pump on" level at in. "Pump off' level at Datum Cycles tested _ E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+— Animal containment areas 50+ Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas ,100+ ,SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Absorption field 5+ Surface water .100+ Property line 10+ Building foundation 10+ Water main 1 Q+ Water Service line 10+ Surface water 100+Driveway, parking/vehicle storage 1 0+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above , systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 8/4/2015 COSA canary sheet_2-6-15.doc in. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 151419 During a recent COSA on-site inspection and test of the potable water supply well on Block 2, Lot 4 of Prospect Heights subdivision, the well's productivity was determined to be 0.75 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is 0.41 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. P py,,RKtr,+Cti ,�, I l% i9' -LOT ��77 3 Lot `7- , Block 2 Pros,�cf fah fs Anchorage Recording District, oska .WELL RECERTIFIEV Le° — ° 0 2�_ Qy L-0 T_ <,,, oF Z C � e F Easements of mord other than those shownma Sor mak the Plat of record are not shown hereon unless otherwise noted. LOT SURVEY CERTIFICATION LEGEND I hereby certify that I have surveyed the property shown and described 0 ' Brass or Aluminum capped monument hereon, and that the improvements situated thereon are within the prop- O `Iron pipe and/or rebar recovered. arty lines and do not overlap or encroach on adjacent property and that ❑ 2 x 2 hub & tack recovered . no Improvements on adjacent property overlap or encroach an the promisee i 5/8a x 30a rebar set this survey In question and that there ars no roadways, utility lines, or other visible eassments on said property eacel t as Indicated hereon. - R. L. Burton LS1192 �n' Scale d , Date _9// `J T Prepared by: R. L. SUTTON Reglslered Land Surveyor (907)279-6200 5/9 W. Eighth Ave. Anchorage A/oska 9950/ Ref. 2540, 2i F. B. No. 34-0-92- Property of. a.e MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # Ifl1'-') - t a1 1. GENERAL INFORMATION Complete legal description Loi A k H _t'�y4+5 Location (site address or directions) vrD peC4 �r.✓ Property owner &ickmoo" \,&v I C-ci y Day phone 3g1O - 3 9 L� 9 Mailing address I o Lending agency Day phone Mailing address Agent S lclse__( tae r�w«t e-Vck-�( Day phone 45 7 -0157 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: q 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: / Individual on-site 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. 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 o �(o e � Sp u � U �a "� � � )= - -- Phone a -7q Address 3 3 Engineer's signature �f Date Si Ce_-� (+��`''_(.Ii ll Vin... Vi!`, , Jam✓ 6. DH S SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: 0 Additional Comments ���/Ue- 9l1TIC 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 orderto 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 u Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo4L1,BV Q� lrc,-R,2 +tte alp Parcel I.D. A. Well Data Well type 'R, If A, B, or C, attach ADEC letter. ADEC water system number lq/A Log present (Y/N) Date completed I'l/bl%e05 Driller Total depth 32— Cased to > LIC) Casing height Sanitary seal (Y/N) -Wires properly protected (Y/N) X FROM WELL LOG AT INSPECTION Z Date of test I IO t! t n l 7 0 7/ R l a y Static water level % Z 00 2ti e9" y aLU 3 w Well flow g.p.m. g•IX f_ 011 fel Pump levell -96 > W J � 1<1 W SEPARATION DISTANCES FROM WELL TO: Cie Septic/holding tank on lot I y 5 ; On adjacent lots Absorption field on lot I f9 O ; On adjacent lots > Public sewer main N 116, Public sewer manhole/cleanout Sewer service line ) 1 b -c:,) Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate 6),/3 Other bacteria 5� / 7/ r l R `( �� s Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 1, R 7 n Tank size Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) � Depression (Y/N) High water alarm (Y/N) N�/A Alarm tested (Y/N) Date of pumping 0c,� l 11 9-3 Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I q_5 On adjacent lots i x 991 Foundation To property line 7 f O Absorption field Water main/service line Surface water/drainage N! / r: 72-026(3/93)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Surface water Date installed `Vy- 19 8 7 Soil rating (GPD/Ft)15 c7 System type Length bo Width Total absorption area (00-0 Gravel thickness -5 Total depth /0 / Cleanout present (Y/N) / _Depression over field (Y/N) Date of adequacy test 71 RL 4 �4 Results (pass/fail) TT 1`f for L/ Bedrooms Water level in absorption field before test l V After test Peroxide treatment (past 12 months) (Y/N) yes, give date / CD SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ) (o O On adjacent lots O -CD Property line } I C) To building foundation On adjacent lots i D 2-Z To existing or abandoned system on lot ME Cutbank 1\4 o 14 e__ Water main/service line i S O Surface water 0 vt 2 Driveway, parking/vehicle storage area Curtain drain D E. ENGINEER'S CERTIFICATION 7 L ! certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect onthe date of this inspection. Signature Engineer's Name S u 0_4� I� Date 7/ 2�1R y HAA Fee Waiver Fee $ Date of Payment % �L� Date of Payment Receipt NumberReceipt Number_ - - - CDU Z44 w- SINCE 1908 CT&ERef.# Client Sample ID Matrix ChentName Ordered By Project Name Project# PWSID Commercial Testing & Engineering Co. Environmental Laboratory Services®������oo®®voo�®�®®�©�®�®®�®®®®®®®® LABORATORY ANALYSIS REPORT 94.3648-1 LOT2BLOCK4 WATER TOBBEN SPURKLAND, P.E. TOBBEN SPURKLAND UA Sample Remarks: ROUTINE SAMPLE COLLECTED BY: LARS SPURKLAND. QC Parameter Results Qual Units ------- ----- ---- ----- —---- ---------------- Nitrate-N 0.13 mg/L WORK Order 80543 PrintedDate 07/21/94 @ 15:58 hrs. Collected Date 07/19/94 @ 13:00 hrs. Received Date 07/19/94 @ 13:50 hrs. Technical Director STEPHEN C. EDE Released Bye ,g$ Method EPA 353.2/300.0 Allowable Ext. Limits Date 10 * See Special Instructions Above UA=Unavailable ** See Sample Remarks Above NA=Not Analyzed U = Undetected, Reported value is the practical gaantification limit. LT= Less Than D=Secondary dilution. GT=Greater1han ft t u.. 5623 R Straat Anehnrano AK 99.ri1R-1 Ann — Tal- /Q071 FR9-93A7 Fav• K071 rA1-r'4n1 Anal Date Init 07/20/94 CMR ENVIRONMENTAL FACILITIES IN ALASKA. COLORADO. FLORIDA_ ILLINOIS MARYI AND NFW.IFR3FY OHIO I)TAH WFST VIRMNIA C)l (5 133 MUNICIPALITY OF ANCHORAGE ✓ DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES �gg_ Gl qC3 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 / p Application Date NL ` 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lo -F y ak 2 �voSp !�-�.; alter, Sec�l3 r it`IIv--- Location (address or directions) p i 0 '✓ rt -v � r n 4 D -rpt � r�, �/ '�- i (b) Property Owner �D L Telephone: Home V�CAN I Business 7g6 - ;73S7;- Mailing 3S;-Mailing Address re.44' a E01 we vin C'&o (c) Lending Institution 61 H A _V i H g r, Telephone Mailing Address Fifo a ()J�/ I t._ QLo r (d) Real Estate Company and Agent 4u" " C t� r i n cCL X Address �@4"a (20, V-04✓ A Telephone P- � (o X-7 G (e) Mail the HAA to the following address: or: Check here E), if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms - 3. 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. Page 1 of 2 72-025 (Rev 8/861 Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this insp ction. Name of Firm Telephone �7 Address s 3 cel 15, �'/ Date O F° � / v Lj�.t • w... \cuff +`J -/� /°� mei •) � :q��r� Y^ T tj ' .. .:. Engineer's Seal f?.�• N°. 2225-c l .ti.�•• Jul1r, 25° 197i s 6. DHHS APPROVAL Approved for Abedrooms by / Date Z Approved Disapproved Conditional Terms of Conditional Approval 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 (Rev 8/86) Back %\I'( RVIci O �1S ON M MENt �N�IRON 3 1900 REC�r� t� . A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 2 e aa. F� O1vt Legal ^Description: Ln f 4. 1B K A - I s IEC- f 3� r r �N, 3 L41 Well Classification If A, B, C, D.E.C. Approved (Y/N) N/A Well Log Present (Y/N) Date Completed I o I Z 8 Yield Total Depth 551- Cased to i q l-) Depth of Grouting N ON l5 Static Water Level 5 Z Pump Set At J Z?! Casing Height Above Ground > f 2 it Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) _y Depression Around Wellhead (Y/N) T� Separation Distances from Well: To Septic/Holding Tank on Lot j L+5 ; On Adjoining Lots > / 0-0 To Nearest Edge of Absorption Field on Lot ( LrO ; On Adjoining Lots > �a To Nearest Public Sewer Line tq To Nearest Public Sewer Cleanout/Manhole A To Nearest Sewer Service Line on Lot > r Water Sample Collected by �S ; Date µ q4:n. - t Water Sample Test Results Comments B. SEPTIC/HQUD#4 ,TANK DATA Date Installed r q '76 Size 156'6-0 6'6-0 No. of Compartments V—L<"a Standpipes (Y/N) TSO Air -,tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) 1- Date Last Pumped �/ 9� &-7 �Sa aGS Pumping/Maintenance Contract on File (Y/N) Y/4 ; for N// Holding Tank High -Water Alarm (Y/N) WA Temporary Holding Tank Permit (Y/N) Irq//°c Separation Distances from Septic/Holding Tank: To Water -Supply Well 14-S To Building Foundation To Property Line To Water Main/Service Line Course Comments Page 1 of 2 72-026 (Rev. 8/861 Front Lt -0 I-. Io Kt1�z To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Lr Date Installed 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 Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certifythat I havechecked, verifiedeprconformedtoallMOAandpHAAguidelelinesineffectonthedateofthisinspection. Signed Date o j lLet O -p Company / MOA No. Receipt No. ( / Date of Payment Amount: $ i 7 %7 •�� p t 03 7 Page 2 of 2 72-026 (Rev. 8/86) Back ,.Ilk C?_ Al kk Engineer's Seal 22,2,5 7' JWJE i�, .971 �'Fi 4{ •� / 50 / N C /4 Soils Rating in Absorption Strata Type of System Design '?h 18 (0 0 Date Installed % Length of Field Width of Field Depth of Field 9 Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present (Y/N) / Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test/ / Separation Distance from Absorption Field: To Water -Supply Well (2-0 To Property Line 3 0 To Building Foundation A 2� To Existing or Abandoned System on Lot j ; On Adjoining Lots i 5 Z) To Water Main/Service Line % / To Cutbank (if present) " O N L;;7 To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Lr Date Installed 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 Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certifythat I havechecked, verifiedeprconformedtoallMOAandpHAAguidelelinesineffectonthedateofthisinspection. Signed Date o j lLet O -p Company / MOA No. Receipt No. ( / Date of Payment Amount: $ i 7 %7 •�� p t 03 7 Page 2 of 2 72-026 (Rev. 8/86) Back ,.Ilk C?_ Al kk Engineer's Seal 22,2,5 7' JWJE i�, .971 �'Fi 4{ •� I .; MUNICIPALITY OF ANCHORAGE i DEPARTMENT OF HEALTH & HUMAN SERVICES 0 1 , DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL L11, v OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) LOT W,13K 2, �roSD��-� �tl� �s Sem 13 71 aNP 3 tY� Location (address or directions) 1050-0 f SOSf'PF_C. Df2)✓F� TeeP_ I Av 13c= -L (b) Property Owner R 12ST I Nrap_STATi�_ Telephone: Home Business Mailing Address 'PO.BOX. 12070/2 AN(_W !U /!7 — 70/a- (c) 0/2 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent GC/lI,4 K 1 _.M411 -Q Address Telephone t5" (e) Mail the HAA to the followina address: or: Check here if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single-Family/l � Number of Bedrooms 3. WATER SUPPLY rN Individual Well Community 13 Public ❑ Note: If com unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite J29, Public ElCommunity ❑ 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 fRev 8/861 Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone A747 3 �l Address v2D 3 Ui Date 6. DHHS APPROVAL Approved for Approved A!! Jt ie.i . • • • •N Engineer's Seal yy 10 .... i•o. 2225 -E -r 197 bedrooms by ` A '"' * Date Disapproved Conditional Terms of Conditional Approval clhtis 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 courtesyto 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 (Rev 8/86) Back I MUNICIPALITY OF ANCHO PAGE MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL SERvicES DIVISIO EALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 RZF Legal Description: r � IQ r'osPe tttic9Iit5 ECE A. WELL DATA Well Classification FSK If A, B, C, D.E.C. Approved (Y/N) , --v Well Log Present (Y/N) Date Completed 1 t1f011s7g Yield 3 Total Depth .732 Cased to > 40 Depth of Grouting N o U L Static Water Level 52 Pump Set At __ > 0277 Casing Height Above Ground > /2 Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot 14 t; ; On Adjoining Lots �) /o -C--> To Nearest Edge of Absorption Field on Lot /60 ; On Adjoining Lots > //r -a To Nearest Public Sewer Line No ME To Nearest Public Sewer Cleanout/Manhole NO N L To Nearest Sewer Service Lineon ( Water Sample Collected by �S ; Date 7 Z2 Water Sample Test Results// �• �1r / N% _ . r2v2 'Vk Comments yell cv�- e, 1�C�J ✓a G111� /w B. SEPTIC/HOLDING TANK DATA >/D Date Installed /sad Size ib�P�r� No. of Compartments 1 tyD Standpipes (Y/N) TuO Air -tight Caps (Y/N) Foundation Cleaangut (Y/N) 1 Depression over Tank (Y/N) t� Date Last Pumped l �/�'1 /Sa Pumping/Maintenance Contract on File (Y/N) ' r/A ; for Holding Tank High -Water Alarm (Y/N) %�i Temporary Holding Tank Permit (Y/N) wlla4 Separation Distances from Septic/Holding Tank To Water -Supply Well /60 O To Building Foundation % To Property Line `f0 To Disposal Field To Water Main/Service Line > /a To Stream, Pond, Lake, or Major Drainage Course N 0 N t Comments Page 1 of 2 72-026 (Rev. 8/86) Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata SSD Type of System Design 7-R H Date Installed ' 7/ff7 Length of Field 60 Width of Field 30 Depth of Field q" Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present(Y/N) x Depression over Field (Y/N) Date of,Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Property Line ✓- 0 To Building Foundation `� �" T E ' t' Ab d d S t Lot o xis mg or an one ys em on On Adjoining Lots > 45 O To Water Main/Service Line >/y To Cutbank (if present) �0N6E To Stream/Pond/Lake/or Major Drainage Course UQ� To Driveway, Parking Area, or Vehicle Storage Area Comments s D. LIFT STATION N 0 M fs Date Installed 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 ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verifie r conformed to all OA nd HAA guidelines in effect on the date of this inspection. Signed Date wiz&7.-7 Company SOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (Rev. 8/86) Back �u F a ro .fir o'' {•sem;j. JUNE 2221971 En, �;�,'� •'' • • •' ��`�`°sem Engineer's Seal AV"C" SUITE 203 ' c�l/`� o 0 5��ld`6r^3V'� U e�e--\20A CHORIAGEEALASKA99501 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 R E S I D E N T I A L W E L L I N S P E C T I O N — — — — — — — — — — — — — — — — — — — — — — — — — LEGAL: LOT 4, BLOCK 2, PROSPECT HEIGHTS LOCATION: 10500 PROSPECT DRIVE OWNER: FIRST INTERSTATE BANK t, OF �p TYPE OF WELL: SINGLE FAMILY WELL LOG AVAILABLE: YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: 3 GALLONS PUMP YIELD: DATE OF INSPECTION: 225-F.' ;'aa A PER MINUTE. •°c.`'; 8 GALLONS PER MINUTE JULY 28, 1987 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 8 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED TILL THE DRAWDOWN STABILIZED. AT THE BEGINNING OF THE TEST WATER LEVEL WAS FOUND AT 52 FEET BELOW TOP OF CASING. AT A PUMPING RATE OF 8 GALLONS PER MINUTE THE WELL STABILIZED AT 277 FEET. TOTAL WELL DEPTH IS 532 FEET. RECOVERY WAS MONITORED FOR 20 MINUTES. DURING THIS PERIOD WATER LEVEL ROSE 63 FEET FOR AN AVERAGE RECHARGE RATE OF 4.75 GALLONS PER MINUTE. TEST FOR COLIFORMS AND NITRATES: WATER WAS TESTED ON JULY 29, 1987. E.COLI 0, NITRATES .22mg/l TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well.