HomeMy WebLinkAboutPROSPECT HEIGHTS #1 BLK 5 LT 7 e ? 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
OF
B ED~.~MS
DISTANCE TO: JWel]10{~ (~' Abs°rpti°nlabaO --{- Dwelling ,~__~5
Manufacturer
Li"' cT~i~ i~allons IF HOME.DE: Inside ,e~ Width / Liquid depth
~ ~ ~rial Liquid capac~s
Well Founda~o Nearest?~ PER~
length ~' Tre.ch wie /_ Dista.ce between Nnes
Top of tile to finish grade Total effective
~ ~ Materiahbeneath tile ~ inches ~r~
Length Width
~ ~ PERMIT NO.
~E TO: Well Building foundation Nearest lot line
Clas~ Depth Driller Distance to~j~ PER~ ~ ¢~ ¢/~ ,
BISTANCE TO: Building foundation Sewer line Septic tangoO Absor~tio~ area(s)
OTHER
PIPE MATER~.~ ~ ~ /
~EMARKS ~ ~ %
THE; LEI",IG "i'H C, Z ME:iq:i!; :I: 0I",1 I Si; THE L. EiqI:!iTH ,:: l t',! t:::IEE'!" ) OF THE'.' ]"l:;:l:':i:l'.,!l.:::H 01;i: DF;~:F:i Lr .hll:::' ;[ !:!:_'[ .[).
'T'H?~: DEPTH OF:' F:I ]"t;~:EI'.,ICH Oi:;;: PIT ];:5 THE; t)Z:i::7'I"F::II'.,E.':E E'JE"FHEE;I'.,I-f'l.il:E :~i;UF;:I:::'F:!C:I:ii; OF' 'THE'
Ei!:,~:OUI'.,![) F:iiq[:, THE: [.~',OT'?'O?I J~]J F:l THE
"f'H[Ei:~'.I:E iS; I'.,10 ::i.:;E-r' HI[.':,'!"H F'OI::i: TF.:I:Eh,IC:HEEL
'l".blE GI:;i:F:I',,,'EL DEPTH :[ :~; TH[ii; H ;t; I'.,! ): i"'tUh'! L'.',EI:::'TH OF' GI:;]:F:I',,,'[EI... B[ETI.,.IEZ;N "r'l-ll,~;~; CIUTI:::'I:::IL.I... F:' I F'E
r:/i'-:lD ]"HFE Ii!!:OT'I-'OH OF' THE [~;::'(CF::I',,,'F:IT [!; (]J",l ,:; ;[ !'-4 F'EI~ET ).
~"! ]: t"ll ]; i"!l..,'i'"l E:' I ?'FFIi'.,!E:IE E:I:~; 'flHEEN 1:::I !.4EZIL. FIND
:i..{!:,~I F:EET FCIF;: R F:'F;~',,,'RTE I,.![.:.';L.L..~
:'L[!!i(i~l TO 21.~ii(:~i I::'~:~%T FI:;i:OM F:I F'UE:L.i'C b. II~.:Z.L [:,EF'!Ei'.,!D];f'-,ICi I...IF:.'CthJ THE T'.r'F'E ElF' I::'UE',I.. ); C: l.,.!l!i!;l..l
HELL LOG:'~!; FIRE t:;i:tEC!LIZF;..:E[;:, FIN[> MU'.:~!;T CIE RE'TUt:;;:hlED
OF THE HELL. COHPL. E:"t"!O!'.,!.
OTI'iEE!:;~: REE;!U}:F?I[':!'HEi",IT:!i~; P1F:!"¢ F:IF:'F:'L."¢.'-'~;F:'Ei:C:[I:;t]:CF:!TZOI",I:!!i;
I:::F,/F:!];L.F:IE[L[!: TCI :[f',l!~;l...l[;;:E F'FeOF'[~:[';i:
'-{ C:EZ.':T :[ F"r' T!-IF!T
:L: I F:ff'! .r.::IFiM :[ [... :[ F:if;: RI!TI.I THE: Fi:E:(;!U:[RIEplfEI',IT:~: I=OFi: O!",F..I:E;ITE SE:HE:R~.~; FIND I.,iEI...[...~:~; i:::iS :~;ETr'
F:'Cd:;;:'I'H E?T' THEE h'it..If',!]:C:IF't::IL. IT'.r' OF'
:~::: Z i.,.I Z !.L :[ hlS~;T!:::IL.L. THE:
::i¢:: Z I...IN[:,EF~::YFIat'.,!D THI::~T !"t'i[E Cff',t'"..E;):TE ::~;E;!.,]E:R :~?'r'2YFE:PI l'"t¢a'.r' [~:E(Z.I :[ !:;;:E [ENI....F:I[(:Ei[~:h'tEN'I" :[F: THE:
F:I~._ Z CFIh!"I" ..]'OHI'.,I ~:~',1~;~;I...
~ER, FORMED FOR:
212 E. INTEJ~TIONAL AIRPORT ROAD ~TEsTPERCOLATION
DESCRIPTION: Lo~' "~ ~)IK'O("~("' ~'
1
2
3
4-
5-
6-
7-
8-
9-
10-
11
12
13
14
15
16
17
18
19
20
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES. AT WHAT
DEPTH?
PERCOLATION RATE -- (L'ninutes/inch) i
-
COMMENTS · ~ .._- ~-~," . '
~'~ ~ , cERTIFIED BY~~~E:~
72-008 (7/76)
Gross Net Depth to Net
Reading Date Time Time Water Drop
__ WELL LOG DEPTH WELL LOG
O' !0 Ci~¢
ALL RJLL ' IG
Anch6rag~Alaskr, 9950~'
'Phone ~4-&--
COMPLETE
START1'7 ~'¢~p~ 79 DATE I+OcTT~
ADDRESS
CITY PHONE
~CHORAGE
',. HUMAN SERVICES
~ntal Services
~ Section : '
~, Alaska 99519-6650
TH AUTHORITY
FAMILY DWELLING
Day phone
Day phone
Day phone
'or pickup.
Individual on-site
Holding tank
Community on-site
Publi8 sewer
rtten confirmation from State ADEC attest-
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
Municipality of AnchOrage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAHILY DWELLING
Parcel I.D. 015-091-27
1. GENERAL INFORMATION
O ol -G
Expiration Date:. "~- ~ - 0 .~
Completelegaldescription PROSPECT HEIGHTS SUBDMSION #1, LOT 7, BLOCK 5,
Location (site address or directions) 9300 SLALOM DRIVE * ANCHORAGE, AK 99516
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
GREG BROWN & MARE ROSENTHAL Dayphone .346-2777
9300 SLALOM DRIVE * ANCHORAGE, AK. 99516
Day phone
Day phone
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
[] Community On-site
[] Public Sewer
,.
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
Note: Alaska Water and Wastewater Consultants, Inc, shall be paid $ at, or prior
to closing for the engineering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as'of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ALASKA WATER &: WASTE'WATER CONSULTANTS, INC. Phone
Address 6901 DEBARR ROAD, SUITE 2B * ,aNCHORAGE, AK 99504-
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Dat~
337-6179
Engineer's Comments:
In conducting this evaluation. AKWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis cf the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results desc/fbed the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. 7'he operational life of all wells and
septic systems depend on the local so~Ts condition, groundwater levels that may
fluctuate during the year, and the water usage of the farmTy being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future perfon'nance of the system, nor do they gu.~rantee that
there are no hidden defects or encroachments. AKWI/VC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal fight whatsoever.
5. DSD SIGNATURE
× Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the fllowing stipulations:
NOTE: The well for this property meets exist~n=~ State
are nitrates preseB~, It is su~e~te~ thnt p.r~n~ e,~:f"{n~.1~.
insure the wells continued suitability. Current nitrate concentration is 6.46 mg/1.
EPA maximum concentration is lO.O mg/1. More information is available on nitrates
from the On-Site Services Program, at 343-7904.
Attachments:
HAA Checklist ~ Manitenance Agreements
Septic System Advisory Supplemental Engineer's Reort
Well Flow Advisory ~ Other
trey. 12;01)
Original Certificate Date:
Municipality of Anchorage
Development Services. Department
Building Safety Division
On.Site Water & Wastewater Prograrn
4700 South 6mgaw St
P;O. Box; 196650 Anchorage, AK 995196650
www.ct.anchorage.ak.us
(907) 3437904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal OescrlPti0n:pROSPECT HEIGHTS SUBDMSlON l~1; LOT 7t BLOCK 5 Parcel ID:
A. WELL DATA
C,
015-091-27
Well:type ~,i~/A~ IfA, B~orCprovidePWSlD# N/A
Date completed 10/14./'/g Sanlta~/seal'(Y/N) YES
Totaldepth 146 ,fL 89 fL
Date of test
Stati~water level ,,, 56
Well .production 1.5
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi.
Arsenic: N/A mgm.
SEPTIC/HOLDING TANK DATA
Cased
FROM WELL LOG
o/ 4/ g79
Well Log(Y/N) ..... · YES ,,
wires properly protected (Y/N) YES
Casing height (above ground) ,, ,12+
AT INSPECTION
1/28/'2003
fl. 79 fl.
.... g.p.m. 0.49, .~ g.p.m.
-150 GN.LONS OF STORAGE IN CRAWl.SPACE
Nitrate .6.46 mgJL. Other bacteria.
Date of sample: 1/30/2003 Collected by:
Tank Type/Material , ,, STEEL, , _
Tank ~tze, :~ 000, gal. Number of Compartments 2
Foundationcteanout (Y/N) YES Depression over tank (Y/N) NO j
Oateofpumplng, rl/29/2003 , , Pumper , , CHUGACH PUMPING
Jrt.
ABSORPTION FIELD DATA I'Jq:LOW' nNAL
Date installed .~o/16/t979 Soil rating ~r flYedrm) ,100,
[;ength .22 ft. Wldth , , 3 fi.
0 , colonies/100ml.
AKWWC~ INC.
Date installed 10/16/1979 .
Cleanouts (Y/N) YES
High water alarm (Y/N) , N/A,
System type .... DEEP TRENCH
Gravel below pipe 8,
Totaldepth ,*14-4 ,fL EI~. absorption area ,352 fl' Monitoring tube ,,YES
Oata of adequacy test .j!28/2003. Results (Pass/Fail) PASS
Fluicl<lepth lnabsorption field before test .42 in. Water added 500 gal.
Elapsed Time: ~ 65 min. Final fluid depth 33 In.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
Depression over field NO
. For 3,..bedrooms
New depth ~ in.
Absorption rate >= 4.504* g.p.d.
.NONE. KNOWN If yes, give date - ,
D. LIFT STATION
Date installed Size in gallons ~
"Pump on" level at in. "Pump off" in. High water alarm level at .in.
~ ~ Cycles tested Meets alarm & circuit requirements?.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
On adjacent lots 100'+
Absorption field on lot 100'+
On adjacent lots 100'+
Public sewer main N/A
Public sewer manhole/cleanout N/A
Sewer/septic service line 25'+
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ 5'4.
Water main N/A 10'4.
Wells on adjacent lots 100'4.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Water service line
Property line 10'+
Water service line 10'+
Curtain drain NONE KNOWN
COMMENTS
Building foundation t 0'+
Surface water 100'+
Wells on adjacent lots 100'+
Absorption field
Surface water.
100'+
Water main N/A
Driveway, parking/vehicle storage 10'+
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 HAA guidelines in effect on this date.
Engineer's Printed Name
JEFFREY A. GARNESS
HAA Fee $ ~75-~
Date of Payment 4' z~. OS
Receipt Number 333 '7
(~. ~o~)
Waiver Fee $.
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewatcr Program
4700 Bra§aw Street
P.O. Box 196650 Anchorage, AK 99519-6650
xvww. ci.anchorage.ak.us
(907) 343-7904
Water Well Advisory
Health Authority Approval # 030126
. During a recent Health Authority Approval on-site inspection and test of the
potable water supply well on Block 5, Lot 7 of Prospect Heights #1
subdivision, the well's productivity was determined to be 0.49 gallons per
minute. The minimum well productivity required by this Department (AMC
15.55) for a 3-bedroom residence is 0.31 gallons per minute. Although the
subject well currently exceeds this minimum requirement, all parties
concerned are advised that the production capacity of the well may fluctuate.
Restriction of non-critical water uses such as washing cars and watering
lawns and gardens may be required.
This advisory must be attached to all copies of the subject Health Authority
Approval.
02-03-03 10:43 FRO~FCT&E ENVIRON~NTAL SRV
~tK CTIE Environmental Sorvices Inc.
9075615301
T-628 P.02/03 F-702
CT&I~ Ref. t~
Client Name
Project Name/'4
Client Sample ID
Matrix
1030544001
AK Water & Wastewatcr Consultants Inc.
Prospect Hie~hts S/D gl L7 B5
Prospect Hicghta S/D #1 L7, B$
Drinking Water
All Dat~Flmes are Alaska Standard Time
Printed Dategfime 01/31/2003 16:57
Collected Date/Time 01/29/2003 16:08
Received Date/Time 01/30/2003 12:45
Technical Director
Sample Remarks:
Allowable Plep Analysis
Parnmcter Results PQL Units Method Limits Date Date Init
Nitrate-Iq
6.46 0.200 mg/L EPA 300,0 (<-10] 01/30/03 JS
Micz'ob J. olog'y' 'r.ah oz'at o~*y
Total Coliform 0
col/100mL SMI8 9222B (<--1)
01/30/03 KAP
.... N~.m_.e. of Firm
· :,~: !;- - '" Address
STATEIVIENT 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 tine number of bedrooms
and type of structure indicated herein. I further verify that based on tine 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.
Phone
Engineer's signature
Lot 7 Block 5 Prospect Heights Subdivision #1
DHHS SIGNATURE
'/~ Approved for
bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Note: The well for this property meets existing State and Municipal Codes.
There are nitrates present. .LC is suggested Lh~L ~iudlu L~Li~ b=
performed to insure the wells continued suitability. Current nitrate
concentration is 5.88~ mg/1. EPA maximum concentration is 1o.o mg/±.
More information on nitrates is available from the On-site Services Program,
])~HS, 343-4744.
Additional Comments
~' :i~ '~; ' ::.'-"~:~ ' ' .
The M~ici:~ality of A~h~rage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificate~:baSed Only upOn :the representations given in paragraph 5 above by an independent
ProfeSSional engir~eer cegistered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
and';their lending inStitUtions in Order to ~tisfY certain federal and State requirements. Employees of DH HS do not
'conduct inspections or analYze data before a'certificate is issued: The Municipality of Anchorage is not
responsible for errors or om ss ons in the Professi6nal engineer's Work.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
Legal Description: Lc Jr '7 '~t/~' ProbO~.¢ ~-~¢'JF~ Parcel I.D.: OJ~:~-Oc/(
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to ~1
Casing height (above ground)
Wires properly protected (Y/N)
FROM WELL LOG
AT INSPECTION
g.p.m.
WATER SAMPLE RESULTS:
Coliform /
Date of sample: //-/0 ~ ~'
B. SEPTIC/HOLDING TANK DATA
Nitrate
Collected by:
Other bacteria
Date installed /D-/~ ~ 7~ Tanksize /DDO Number of Compartments ~ Cleanouts (Y/N)
Foundation cleanout (Y/N) L/ Depression (Y/N) /~/ High water alarm (Y/N)
Date of Pumping //-/L)- ¢7 Pumper
C. ABSORPTION FIELD DATA
Date installed
Length ~--,~ / Width ~ /
Effective absorption area ¢~',~ /
Date of adequacy test //- ~'/--¢7
Fluid depth in absorption field before test (in.); ~//
Fluid depth ~ / F2L (ins) Minutes later: / *7
Peroxide treatment (past 12 months) (Y/N) /
g.p.m.
//.)-//-~- 7¢ Soilrating (g.p.d./ff~orff~/bdrm) /OO Systemtype}~'~/K~c/
~' / Total depth /
. Depression over field (Y/N)
· Gravel thickness below pipe
Monitoring Tube present (Y/N)
Results (Pass/Fail) ~c-c,5~ For
Immediately after 77/j~gal. water added (in.):
Absorption rate z/',~2)
= g.p.d.
If yes, give date
bedrooms
72-026 (Rev. 3/96)*
LIFT STATION
Date nstalled
Manhole/Access (Y/N)
//~ Size in gallons
~"Pump on" level at*
High water alarm level at* /////,-//// *Datum
Cycles tested
~"Pump off" level at*_
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot /DOt 4-
Absorption field on lot i I O t _p
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout "~
Public sewer main
Sewer/septic service line ~..~ I ~ Lift station ~'~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation 2~ I Property line ,/O' '+ Absorptior~ riel . $/~/ ,2'-~1
Water main/service line
Surfacewater/drainage /004- Wells on adjacent lots /~O -~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line .~O Cd- Building foundation zT/~) ~ nc. Water main/service line ~-
Surface water / ~)/~ ~ 'P Driveway, parking/vehicle storage area / :5
Curtain drain /DD/.F (/",4/an¢ ~/';,~,(x.,,~ ~ Wells on adjacent lots //O O ~
ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal records
in conformance with MOA HAA guidelines in effect on this date.
Signature ~
Engin ee r's N a'N'N~m~'/~ r~ ~-[~ }~/~'J. ~-'~ '~'~ ~
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96}*
Waiver Fee $.
Date of Payment
Receipt Number
NORTHERN TESTING LABORATORIES INC
DRINKING WATER ANALYSIS R,-Po~ ~ FOR TOTAL COLIFORM BACTERIA
KND Eqgineering
20441 Ptarmigan Bled
Eagle R~ver AK 99577-3736
Phone Number:
Fax Number:.
Collected by: SD
Sample Type: Private Writer Systems
Method of Analysis: Membrane Filtration (SM 9222
Comme~lt~
Semele Sample Total* Focal Other*
Date Ti;no Coliform Cotifotm Bacteria
11/1 Dig7 09.40 0 ND
Date Received: 11/10/97
Date ArlalyzerJ: 11/11/97
Date Reported: 11/13/97
Next Sample Due:
Co,ql f~eots
8 = SatisfacteP/
U -- Unsatisfaoto~
POS = PosiUve Test Result
ND _-
TNTC --
C(3 =
HSM ~
SA _-
O1~
R =
NT -- No Test
~..# c~_oLo nies/lp.._O__ml
HPC**
Result Lal~
Time Received: 16:40
Time Analyzed: 17:00
Time Reported: 12:53
None Detected
Too Numerous To Count (>200 Colonies)
Confluent Growth
Heavy ~ediment MaskinQ, Results May NOt Be Reliable
Sampte Age >30 Hours But <40 Hours, Results May
Not Be Reliablc
~ample Age >48 Houm, Too OId For AnalySlS
Resar~lplc Required
** # Culenies/ml
Location Comments
NT AC588g L'I as, Pro&~ect Heights
NOV ~5
20441 Ptarmigan Bird,
Eagle River, AK
Attn: Ken or Dee
NORTHERN TESTING LABORATORIES, INC.
SC~OON STREET ANCHORAGe, ALASKA 99~18 {907i ~4~-1000, F~ 3~,-~16
Cllcnt ID;
Client Project #'
Sour.ce:
Sample MatJ
Comments'
99577-~73o
Lot 7 Block 5 l~ospect Heights
A153056
Water
Units
?al'amCtCT
SM 4500 E
Nitrate
Report Date: 11/25/97
Date Arrived; 11/).0/97
Sample Dale: 11/10/97
Sample Time:
Collected By: $.0.
** I~gcnd **
pt~it ~t N~
~ma~ Valu~
~ow bICL
~ To Dil~i~
Date Date
5.S8 1.25
11/20/97
,'.;' // ·
~o~ted t'¥: lorma K.
/Chemistry
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, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name "'o~--~-SY /~,'N'~.c,.~Telephone:Home ~,~.&..~,~ ~O(
Applicant Address c) ~ ~4 ~,,~. & o~w,~ ~f~..
(c) Applicant is (check one): Lending Institution []; _Own?..~r/builder'j~; Buyer []; Other [] (explain);
(d) Lending Institution /~-/~- Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
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,
Page 1 of 2 72-025 (11/84)
ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA. A 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. ~ 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
Date 7- ~'~'
Telephone
'0~' $~ 'g~ Engineer's Seam
DHEP APPROVAL
Approved fo; "~'3C~ bedrooms by
~'/~L~
Approved /~ Disapproved¢/ ConditionAl-'
Terms of Conditional Approval
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.
Page 2 of 2
WELL DATA
MUNICIPALITY OF ANCHORAGE (MO,~/
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
DEPT. OF HEALTH &
Le ltRt¢~t~il:/~
JUL 3 1 1986
I f A, B, &~E.~. FA'!prVove~d~( YIN )
Well Classification
Well Log Present (Y/N) y Date Completed ] ~" ~D~_ -r~ let'/e1 Yield
Total Depth | 4'(~ ~"'~%~ Cased to ~ I='"~. Depth of Grouting
Static Water Level ~¢'~,~ Pump Set At I '~'~t' ~ ·
Casing Height Above Ground ?.~d:~ ~' Sanitary Seal on Casing (y/N) ~'~
Electrical Wiring in Conduit (Y/N) ~f2 Depression Around Wellhead (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot ~ O ~, ~"~' ~ ; On Adjoining Lots _~ ~ 4..
To Nearest Edge of Absorption Field0n Lot J ~ ~ ~; On Adjoining Lots
To Nearest Public Sewer Line ,'~ ~ .To Nearest Public Sewer
Cleanout/Manhole ~ ~ To Nearest SeWer Service Line on Lot
Water Sample Collected by l["C."tc-I'~--,- ~--,,~'~d~. ~,-~..~'V-,4~ ;Date
Water Sample Test Results
Comments j¢/~.~ ~/~"~ '~.~'.4~"T~
WA-
B. SEPTIC/HOLDING TANK DATA
Date Installed q -! 7~ '~
Standpipes (Y/N) ~ Air-tight Caps (Y/N)
Depression over Tank (Y/N) /%f
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
Comments
Size ~¢O~ ..~l No. of Compartments
Foundation Cleanout (Y/N)
Date Last Pumped '~ -
~ ; for
Temporary Holding Tank Permit (Y/N)
lO'L. icc...
To Building Foundation 7_~ '7 ~'7~'.
To Disposal Field ~ ~ ~-¢~ .
To Stream, Pond, Lake, or Major Drainage
Page I of 2
72-026{11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date installed G/_ ) '7 -
Width of Field -~F~"
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ~ [ :~ ~ ~ -
To Building Foundation ~""~2;~ ~_'
Lot ./~ /~
TO Water Main/Service Line /~ /~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
'~ ~' Z.. ~. ~.. Standpipes Present (Y/N)
/'~ Date of Last Adequacy Test
To Property Line ~"/~¢ ~ '
To Existing or Abandoned System on
; On Adjoining Lots "~ Co ~-
To Cutbank (if present) /'~ ,~
D. LIFT STATION
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 certify that I have checked, veer conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signe~ ~,-/~~~'- -~ Date
Compa.y
Receipt No.
Date of Payment
Amount:
Page 2 of 2
72-026 (11/84)
Architecture * Engineering * Land Surveying * Planning
Anchorage '~
Fairbanks
Project Title -/4-~:~ ~o-~[q~.~_..F'F~v ~,~-~,~J.~l ~a~e Title ~5~~ ~,~ ~~/
W.O.~ ~~ Date ~-~/-~ By ~ ~ Page
Architecture · Enginee~ng · Land Surveying · Planning
Anchorage '~- ,' Fairbanks
Project Title ~ ~1'~ ~'~olr.-,"~ /~_.o~j~ I Page Title
I"i ~ . RECEIVED
D/~TE
INSPECTION APPOINTMENTS ~ ~./_~'
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION~EPL OF Hi',LTH
825 L Street - Anchorage, Alaska 99501 ENVIRONMeNtAL ~,~:'i'~CT~ON
( ) ENVI"ONMENTAL SANITATION DIVISION /~ ~J {:; 8 1980
Telephone 264-4720
REQUEST FOR APPROVAL OF I~DIVIDUAL WATER AND
DIRECTIONS: Complete all parts on page ~. Incomplete requests will not be processed. Please allow ten {10) days for processing.
MAILING ADDRESS
PROPERTY RESIDENT (If different from above) PHONE
2. BUYER PHONE
MAILING ADDRESS
3, LENDING INSTITUTION
MAI~I~G
4. ~RL I g~ PHONE
MAILIN DRESS
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
~ SINGLE FAMILY [] One [] Four
[~]//Two [] Five
[] MULTIPLE FAMILY ~ Three [] Six
7. WATER SU~Y
L'~ INDIVIDUAL*
[] Other
* ATTACH WELL LOG. Awell log is required for all wells drilled
[] COMMUNITY
[] PUBLIC UTILITY
t
8. SEWAGE DI.~P'OSAL SYSTEM ~/ INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
PERMIT NUMBER
3. SEWAGE DISPOSAL SYSTEM
[] IN DIVI DUAL/ON -SITE DATE iNSTALLED
[]PUBliC UTiLiTY /~ -[G - -2 ~
Connection Verified INSTALLER
Tank or [] Holding Tank C~%
[]Septic
Size: IOOO If Tank is homemade SOILS RATING
live dimensions: I ~
TYPE OF TANK MANUFACTURER
TOTAL A'BSORPTION AREA MATERIAL
4. DJSTA"CES Septic/Holding Tank Absorption Area IS. r Line J Nearest Lot Line
WELL TO: ~ ~ /~
I
I
Absorption Area to nearest Lot Line
5. COMMENTS
~ CO~DITIO~Ak APP~OVAk {letter must a~om~an~
~ DISAPPROVED ~ , / /
DATE ~~
ANCHORAGE, ALASKA 9950,/!/
(907) 264-4111 , ~/~),
GEORGE M. SULLIVAN,
MAYOR
DEPAI~ I'Mt~N] OF HEALTi! AND ENVIRONMENTAL PRO'rECT!ON
August 14, 1980
re: Corwin Matthews Property
National Bank of Alaska
Mortgage Loan Department
Pouch 7-025
Anchorage, Alaska 99510
Subject: Lot 7 Block 5 Prospect Heights Subdivision
Approval for the individual sewer and water facilities
cannot be granted until the following items have been
completed:
(1) The top of the well casing sealed with a sanitary
seal so that it is water tight.
(2) The depression or pit around the well casing needs
to be filled with impervi0use type soil so that it
slopes away from the well casing.
~ ~ .~ !(3) sam le was not taken at the time of the
A water P .... :n~ muddy The lines
~__~0/w~ 'ns ection due to the water D~ ~ ·
1 p ....... ~ ~nother appointment made
/~.~ ) need to De ~lusnea
when the water has cleared.
~>~?/ ~ there are any further questions, please call this
O// If
department at 264--4720.
Sincerely,
Robert C. Pratt,
Associate Specialist
RCP/ljw
cc: General Contractor
Post office Box 10-2157 99511