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HomeMy WebLinkAboutPROSPECT HEIGHTS #1 BLK 6 LT 7A 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 NAME MAILING ADDRESS LEGAL DESCRIPTION LOCATION Well L Absorp i ~ ~ DISTANCE TO: I ~ ~ ManufaotureF I Liq' cr~i~gall~ns IF HOME~D~ Inside length ~ .. ~ DISTANCE TO' Iwell I Dwelling ~ ~ ~ Manufacturer Total length of lines Material beneath tile Depth Length DISTANCE TO: ~ 'p Length No. of line? of~i n e Top of tile to finish grade Width Type of crib Crib diameter Crib depth Well Building foundation DISTANCE TO: °'assR~~ s~ Sewer line Depth DISTANCE TO: Bu ,ldi~.nd¢ion OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER DATE LEGAL Material W dth Material Nearest I&l~ Trench width ~ inches PHONE [~NEW II APPROVED NO. OF BE~.j~OOMS PERMIT NO. No. of comp~. O Liquid depth PERMIT NO. Liquid capacity in gallons Distance between lines 7FT- :riches ;PERMIT NO. Total effective absorption area Nearest lot line Dstanceto et ne PERMIT NO. IO ¢ r-./c> ~ g 7' Septic tar~ ~ Absorption area(s)j, Total effective al?soJ'ptio~?ea DEPARTMENT Oi tEALTH ~ND ENVIRONMENTAL E jTECTION 8~5 L STREET~ ANCHOR~GE~ AK ~501 O~'-~ ....S I TE SE~---~ER ._~: t--~ELL PERI'-1 I T PERMITNO: DATE:ISSUED: 840~87 05?25/84 APPLICANTS ADDRESS: CONTACT PHONE: -TONY M LAFRAMBOISE P 0 BOX ~i08.15 ANCHORAGE, '~45-0~74 LEGAL DESCRIP: LOT SIZE: MA~ BEDROOMS: SUBDIVISION: PROSPECT HEIGHTS .LOT: ?A SECTION: t~ TOWNSHIP: ±2N RANGE: ~W . 84506 (SQ. FT. OR ACRES) 4 BLOCK: 6 LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE. · TREF]C:H DEPTH TO PIPE BOTTOM (FT.)_ 5.0 5.0 GRAVEL-DEPTH (FT.) 7.0 0,5 TOTAL DEPTH (FT.) ~2.'0 5.5 GRAVEL NIDTH-(FT. ) 2..5 20L 0 GRAVEL LENGTH (FT.) )6.0 38.0 'GRAVEL VOLUME (CU. YDS.) 25.0 28..1 TANK SIZE (GALS) .1~250.0 SOIL RATING (SQ. FT.?BR) ~25 .125 5.0 -~.0 8.0 5.0 5'~. 0 -1., 250. 0 '1.25 TANK MUST,HAVE AT LEAST TWO COMPARTMENTS I CERTIFY THAT: I BM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. I WILL INSTALL THE SYSTEM iN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS, AND IN COMPLIANCE WiTH THE DESIGN CRITERIA OF .THIS PERMIT. ~. I WILL. ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY E~ISTING WELL~ NASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. 4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR A MAXIMUM OF '4 BEDROOMS AND ANY ENLARGEMENT WILL REQUIRE 8N ADDITIONAL PERMIT. ' IF A THEN (i) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; WILL NOT BE APPROVED WITHOUT RN ELECTRICAL INSPECTION REPORT~ ELECTRICAL W0 SIGNED ~ BPPLICANT: T ISSUED BY LIFT STATION IS INSTI~LLED IN AN AREA COVERED BY MOA BUILDING CODES., (2) AS-BUILTS AND (~,,) THE  MUST BE DONE~A LICENSED ELECTRICIAN. _~ ['ATE: ~ r,~)LRFRRME:OI SE '~ ~" M SOILS LOG MUNICIPALITY OF ANCHORAGE ' ~ [] PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST PEREORMEO POR: TOt'/'/ LEGAL DESCRIPTION: LoT 2 ~,, I 4 4 9T~__J 2225-E /971 5 6 7 8 g 10 11 12 13 14 15 16 17 18 19 2O COMMENTS 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST 7At BLOC. V_ C, ' SLOPE s ~N 0 DATE PERFORMED:~ SITE PLAN / YES, AT WHAT H? Gross Date Time No PERCOLATION RATE :; 1 2.~ ~ TEST RUN BETWEEN ':' . ..- ~"" Net Time Depth to Water Net Drop FT AND (minutes/inch} __ FT PERFORMED BY: CERTIFIED BY: DATE: LOCATION OF WELL (Picnic complete either la, Anch. i~DISTANOE AND OiRECTION FROM ROA[~ INTERSECTI Alluviulni brown color and mad- Lum ha~ness. _Sand .~ Gravel: brown color~ with water. illuvium: grey-green color, ~edium hardness. Sand & Gravel: brown color~ #ith water. !elL_~'n~_n~L!j~_ completed..g~_qO' ~ill: ~[~_and hard. Alluvium: light brown color~ ~n~d aedium hardness. T__ill: grey and hard. A~lluvium:_gE~y:and medium. Bedrock: ~rey color with dark brown streak ~d med. hardness. Bedrock: dark .~rey coloL', medim ~ardness, with water; ~O gpm. MUNICIPALITY O,~ ANCHoi ---~PT. OF HEALTN "~TAL PROTE~ at lc.) I/4qtr~ I Section No. _of--of --- NS 0 12 and 2~ 28 28 40 6/~o/8 ) .... qo 60 60 90 90 ~o 110 130 ~3o ~6o ,~-"~,~ WAi'ER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologicol A GeophJsicol Surveys 16. WATER WELL CONTRACTOR'S CERTIFICATION: Fony ~ Donna LaFramboJ~: D. Oo Box 1~O815 anch., ~. 995'Q7 4 wELL OEPT' ( nam) i 5 DATE Of COmPLEtION 18z 4 - 26 -. .... ~-" I ....... 8. CASING: L~] Threaded [] Welded 9. FINISH OF WELL:o~)op, hal O~ Backfilling well ,.~]s drilled under my jurisdlcllon and this ~.:.,~ sFD Sox Z~8o O2-'"WR ~ 1/81~ r Copy Oistmibuli[L; Wlill'E-Slcle OGGS, PINK-O~mller, CANARY-bus~on]~ .......... ' ' '~ ...................... SI'AT'C WaTEr LEVEL: 93 f,. :4_/26/85 Above or I~ Below land i~ur(oce Equipment used; sand line. : i 12.GROUTING Well Oroeled: ~] YO~ E~ No I~. PUMP: (if available) HP I~.BE~AR[S: well originally completed to l~O' (6/~O/~ then deepened to ~8~' (4/26/85) due to low flow. ]5. Wafer T~mpera~ure ~__o ~ F ~ C AA ?pS ~ETU~N ~: Division of Geologlcal and C? :~yslcat Surveys (DGGS) / STATE OF AL~SIL~, : 3OOl Porcupine Drive [Tales ,let 277-6615) DEPARTMENT OF NATURAL RESOURCES Anchorage, Alaska 99501 WATER WELL RECORD Drilling Company Nar~ ~ :- "~ i,,: U.S.G.S. Local No. DrlI)ing Permit No. No. .OCATION OF WELL I Please complete either la, lb, or 19: ~'~'~ ..... la. Borough Subdivision Lot Block lb. Fraction Section No. Township Range Meridian ~, ~. ' :'. , / / / N/S E/W lc. Oistanc~ and Direction from Road Intersections 3. OWNER OF WELL: Address: Street Address and Area o~ Well Location ~. WELL LOG Feet BelOw 4. WELL DEPTH: (completed) Surface Elevation Date of Surface Completion Material Type Top Bottom ft. .... : i ~. E~Cable tool r~Rotary ~lDriven )--]Dug ] - [~] Auger r-] Jetted E] Bored ~ Other: ~Test Wel~ ~O~her: 7. CASING: ~ Thr~ded ~Welded in. to ft. Depth Weight lbs/fL. in. to ft, Depth 8. FINISH OF WELL: Type: Ola~ter: ,., Slot/Mesh Size: Length: Set bet~en ft. and Fittings: ~. STATIC WATER LEVEL: ft. ~A~ve ~Below land surface Type of Measur~nt: IO. PUMPING LEVEL bel~ land surface ft. after hrs. pumping . g.p.m. ~ft. after ~hrs. pumping _~g.p.m. 11. ~ELL H~D ~OHPLETION: ~ in Approved MUNICIPALI~ OF AN :HO~GE ~Pltless Adapter ~ inches above grade ................ ~, ..... ~,~ 12. GROUTING: Well Grouted: ~Yes Material: ~Neat Ce~nt ~ Other: SEP; G"'84 ,~. PUHP: (If available) "P ED Length of Orop Pipe ,,. ca~cl,y " Type: ~Sub~rslble ~Reci~rocating ~Jet ~Other: 14. REHARKS: 5. WATER WELL CONTRACTOR'S CERTIFICATION: This well was dr~]led under my jurisdiction and this report Is true to the best of my knowledge and belief: 51gned: ~ Y L ~ ~[- ~>~- Date: '. Authorized Representative MUNMPAUTY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 015-092-23 Certificate of On -Site Systems Approval Expiration Date: I— 17 -Z0 2 1. GENERAL INFORMATION Complete legal description Prospect Heights #1, Block 6, Lot 7A Location (site address) 7900 Sitzmark Circle Anchorage, AK - - _-- - -- -Walter & Linda Quigley ---- ------ (907) 229-2115 _Current property owner(s) g y Day phone - Mailing address -- -7900 Sitzmark Circle, Anchorage, AK -99507 Real estate agent Kevin Taylor Day phone (907) 244-7437 2. TYPE OF DWELLING: ❑n Single Family (w/wo ADU) ❑ Duplex. . ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF -BEDROOMS: Seven 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic 531 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ So C\/ Waiver Fee $ Date of Payment�l S fyo Date of Payment Receipt Number 016()5_0 Receipt Number COSA # 0 c5 C a 0.1 510 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 9/16/20 ✓ �. DRnGFANi J� -- lJ))jj, 1) SN1 1 By: ,� �-�- ( Original Certificate Date: 10 _/ ,� 20 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet zV .• �.•• c ag mD th ,. 6. DSD SIGNATURE �...... . ._. _. System- #1 Approved for d ................................................ e bedrooms _..._...__._.._­-­---_._.__._0_.A._MICHAEL E. ANDERSON ............._..._..._... System #2 Approved for bedrooms $���sr'•• '�O' cE-438' •�e 6�®.............. Disapproved .••' Fpm 44140'O OFESa\®��o®' rl Conditional approval for bedrooms, with the following stipulations: ✓ �. DRnGFANi J� -- lJ))jj, 1) SN1 1 By: ,� �-�- ( Original Certificate Date: 10 _/ ,� 20 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Prospect heights #1 Block 6 Lot 7A If more than 1 septic system on lot: COSA Checklist # 1 of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 4/26/85 Total depth 183 ft Cased to 131 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12 in. Date of flow test for COSA 9/15/20 Static water level at beginning of test 99.8 ft. Comments B. TANK DATA Age of tank(s) 12 years Tank type/material SEPTIC/STEEL Measured operating fluid level in septic tank 51.5 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 8/26/20 - McDonald's Pumping D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 8/4/08 ®❑ ALL standpipes present per record drawing Total measured depth from grade 10.8 ft (max) Measured depth to pipe invert from grade 5.5 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 5.3 ❑® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 015-092-23 Structure served by this system Well production at time of test 7.2 gpm Water storage tank volume None gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 6.27 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by FORGE ENGINEERING Date of Sample 9/15/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Septic System is gravity flow. Adequacy test date 9/15/20 Results ❑✓ Pass For 7 bedrooms Fluid depth prior to test 0 in Water added 1309 gal New depth 0 in Elapsed time 180 min Final fluid depth 0 in Absorption rate '1050 gpd Any rejuvenation treatment (past 12 months) No If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0 Yes if No Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' El Yes if No ft El Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100'✓❑ Yes if No. Water Main > 10' 0 Yes if No ft Community Wells > 200'✓❑ Yes if No. Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ®✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' El Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓l Yes if No ft Private Wells > 100' 0✓ Yes if No Water Service Line > 10' ED Yes if No ft Community Wells > 200' ❑✓ Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S 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. COSA Checklist yellow sheet 00000nap� o� 9th .' p a ................ ....t�..h.....a Uzi E7e .........s n..umnunumu.nn....... c� MICHAEL E. ANDERSON p No. CE -438147 o ©Q �1 .� •• :� 7 © :��'••., � 9/17/20 p .•• �O ft ft ft ft Lot 5A Lot 6A \ 10' UTILITY EASEMENTS SITZMARK°° / — —_341.0-- — ` N 8953'25E / CIRCLE oQ — — — — - 100' PROTECTIVE RADIUS iV RETAINING — –7 WALL / �1. ., ..'`-WELL �, •.., ` I...'. -GRAVEL Lot 14 \ S ASPHALT_, ./ GRAVEL Q — — ' t �• SEPTIC PIPES 2 ASPHALT � LO., ' �h�` e� _ 1P°� Lot 7A 0 �� Lot 8A w 1.94 Acres . / N/ RETAINING WALL— o C9 Lot 13 • GRAVEL 10' UTILITY EASEMENTS 10' UTILITY EASEMENTS S 89'53'25"W 130.00' HOUSE DETAIL Scale: 1" = 30' 3G.3• Lot 1O I Lot 12 1 o 3.3'x3.6' FIRE ESCAPE I DECK w/ LADDER U S y^ ,yti o. Q2h O � 7. 2.6' 4` 0 6.1' � O � �y w. 0yi- Y O 7q 0. ry w v y N O F 19 O q p. �. _..• 2.1' CANT NOTE: THE GRAVEL DRIVEWAY ENCROACHES DECK ONTO THE ADJACENT PARCELS. 760. PLOT PLAN _ AS BUILT X SCALE 1" = 60� GRID _ Q_2440 _ Project No. _-20-569 R2 11500 Daryl Avenue, Anchorage, La n g & Associates, in C, (907) 522-6476 Phone Alaska 99515-3049 (907) 522-4625 Fax Professional Land Surve ors knAlangsurvey.come y Qpp0��40 aQ P OF AC �© ` ..... jonathanAlongsurvey.cam 0Q'.•P� O I hereby certify that i have surveyed the following described property:O OOI ' TH .7� QO * q 9TH*'* LOT 7A, BLOCK 6, PROSPECT HEIGHTS SUBDIVISION – ADDN. No. 1 (PLAT No. 67-157) Anchorage Recording District, Alaska, and that the improvements situated thereon are �" " • • • •. • • • • • • •0 within the property lines and do not encroach onto the property adjacent thereto, that improvements the lying thereto encroach the 0'p no on property adjacent on surveyed premises and that there are no roadways, transmission lines or other visible KENT! G o� Indicated hereon. easements on said property except as 0 „ .f a Dated this the ` Day of __CZ)t:{ , at Anchorage, Alaska � • S .5202.•-' �4 Fa pR O a 4Q4 OFESSIONP& It is the responsibility of the owner to determine the existence of any easements, �4ppp0o� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 Nitrate Advisory Certificate of On -Site Systems Approval # OSC 201510 Subdivision: Prospect Heights #1 Blk 6 lot 7A A water sample revealed a nitrate concentration of 6.27 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. 'xZew ��� � � ��� Ma�f�ng Atltlress P O��Box 196650* Anchorage, Alas�Ca 99519 6650 * dvww fnun org � ,� � � From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Ma�Ung Address P O Box 196650,* anchorage, Alaska 99519 6650 *www muni org Municipality of Anchorage Development Services Department'* Building Safety Division On-Site Water and 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 FAMILY DWELLING Parcel I.D. 015-092-23' 1. GENERAL INFORMATION Complete legal description .~_]z.o..Y,~A ... B]'ock 6 ..- Prosp,ct ~et Ehts ~'1 ".Location (site addreSs'0rdirections) 7elFin ,qt ~'-mnrtr P.t r. A-~'hnr_ng~, ~ oq 019;9 Expiration Date: ~ '- /' tO '" 0 ~ . .'Current Property owner(s), Mailing address Lending agency Mailing address Steve & Sharon Butterwort Dayphone 346-1461 same Day phone Real Estate Agent ...... Mailing Address · ' Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: 4 Day phone TYPE OF WATER SUPPLY: · TYPE OF WAsTEWATER DISPOSAL: Individual Well Individual WaterStorage community Class Public Water System Well' [] 'Individual On-site ~ F-I Individual Holding tank D D i Community onsite [-'1 r-I Public Sewer D 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 pdvate or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a pedod 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... 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 'S & S Engineering Address 17034 N, Ea8le River Loop Ste. 204 EaEle Phone 6'9/,-2979 River, AK 99577 Engineer's Printed Name DSD SIGNATURE · ..~, Approved for L/- Disapproved. Conditional ,;pproval for Robert C. Cowan Date' ~" ' ~'-' m~ roVE "~; WATER AND : bedrooms. %.~:'.. ..' ' //lJlj 1) )D' . ' ' bedrooms, w~ ~he follo~n~ ~tipulations: Additional Comments Note: The well for this property meets existing State and Municipal Codes. There are nitrates present.~t-i~gHggEgg~-that periodic testing be perlormea tO insure the wells continued suitabiil~ty. Current nitrate concentration is information on nitrates is avaiiabie from ~he On;Siiu Survlcu~ Ps~ug[a-,, al o,,a-,~v~. Attachments: HAA checklist Septic System Advisory Well Flow Advisory By: (Rev. O1/O2) Maintenance Agreements SupPlemental Engineer's Report Other Original Certificat~ Date: ,.~'" / 0- 0 L~ A. WELL DATA - Well t~,pe, P~tv~-T-~ IfA, B,'or C provide Date ~ompleted i- .. Sanitary seal {~N). Total'~epth~ J ~ ft. . Cased to 131 i~ FROM WELL' LOG : Static,~water [level Well ?reduction ~: ,/ WATE'R SAMPLE REsuLTs .... ~Colifor~n · O' .colonies)100ml. 'Nitrateli.~. Arsen~ : '' Date o~ Sam pie: ~{~,,)o¥ B. SEPTICIHOEDING TANK DATA ' Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. ~ P.'O. B0x 196650 Anchorage, AK 99519-6650 : ' ::www.ci.anchorage.ak.us (907) 343-7904 iHEALTH AUTHORITY APPROVAL CHECKEIST TankT~Pe/Material "5~;It.r'/c- /$r$~'~t..~; Tank size I '~o"~al .... .! 'Number~,,,.._~:_/i : . · · - · .' ~.. ~,~-,u, nparimems '~:~ '- 1"' ' '- ' ' : :'. , ',' !' ' ' ~ i~.,.: Foundation cleanout {~N),.¥~-,r ;. DepreSsion ~3ver tank Date °{pumping ~'~* Pumper C. ABSORPTION FIELD' D~A' ~'';'' ~: ; ~ ~, ~ :~1 : ~ .,j~ . .'; : · . ~ :~?P'~:~F. or~/Dormj. ,, . . ' .., '.~,, -- ' ,,~. .,: .. ..._,~.: .... Total d?th ,~ .. ft.- - Eft. absorpbon afea:~o~ ft Fluid.depth in absorption field before testg~'~n : ~ater-a~a)O~-~', ~ ,',. - ..' g ..~ ~,,z" ..... ' . . . .~. ,~' · ~ --~. ~,. ,~. 'Newaep[n~ ~in. Elapsed~Time..~[ mm. ~ Fmalflui~dep~h Any rejuVenatiOn treatment (past 12 mo.)(WN ~ type) //r-$ .~:/ p.~rd[ei ID: O! ,.,~-o ~. -~-3 Wires proPerlF Pr~eCted C~sin~ height (~b~ve ~round) ! ~ ~ in. AT> INSPECTION ~.p.m.. ,. ?~ 4 ~,~,~ Other kacte~ia i o colonies/~O0 mi. Collected b~: Eagle ~iver~ Alaska 99577 Dateinstalled"l ~/I ~'/ ~V :...,. D. STATION = '. ' * "Pump on" level at in. "Pump off' leve~ater a_lar, m '~ve' al ~ ~ ,n. Datum ~_ ~ - * - ' Meets alarm & circuit requirements? E. 'S~R ANCES . . ·. , SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift Station on lot ! O O +-- : *,. On adjacent 10ts Absorption field on lot Public sewer main Sewer/septic service line ~- .,~ .'/''' - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT .TO: Building foundation ~/+'' Property line 5'- / Water main /'//A- ~. Water service line ,/0 C/_ Wells on adjacent lots / 0 O -/--- ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property lin~ j o -/- Building foundation I O ~- Water main Water Service line /0 .Surface water ') 0 o curt.ain..drain. Po ~.- :/c ~,,o~,H Wells on adjacent lots 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 da~e. Engineer's Printed Name /'~/~,¢_.~:7- C ~'~,~ Date . ~ / ~/O ~ " HAA Fee $ Date of Payment Receipt Number ,(Rev. 12/(~) ! On adjacent lots 'Public sewer manhole/cleanout Holding tank Absorption field Surface water /dO ~-.~- ' Driveway, parking/vehicle storage ROBERT, C. ,COWAN CE Waiver Fee $ Date of Payment Receipt Number~ ' [ r MAY-10-2004 11::39 S~S EIx~INEERIh~ 907 694 1211 P.01/01 2~ ~U~ ~C~C ~T ~ PA~ 84, 80~ ~6. ~~ .-~ ............. ~,/ ~~~ ~~ // , .....~ ,/ ~~ ~ /,~. .. .. , A ~':~ ~~'~:::"'F_":~.~ ~~'~'.'./ / /~- LOT 7A SA= 13 ' IOA · .c~,~ .~ ,~3 c,~).z-~. LOT 7A, BLOCK 6, __ _ ~,-.,-,,_ ,~ Ic,.),,,:,~ PROSPECT HDGHTS ~D. NO. 1 TOTAL P.O1 SGS Ref.# Client Name Project Name/# Client Sample ID Matrix 1042058001 S & S Engineering Lot 7A, Bik 6 Prosl~ect Hts a~ t Lot 7A, BIk 6 Prospect Hts ~-I Drinking Water Sample Remar 'ks: All Dates/Times are Alaska Standard Time Printed Date/Time 04/30/2004 11:54 Collected Date/Time 04/26/2004 12:00 Received Date/Time 04/26/2004 12:50 Technical Di~ ~n C. Ed. Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limit~ Date Date Init Waters Department Nitrate-lq 5.15 0.100 mg/L EPA 300.0 C (<=10) 04/27/04 JMP Nitrite-N 0. I00 U 0. I00 mg/L EPA 300.0 C (<=1) 04/27/IM JMP Microbiology Laboratory Total Coliform col/100mL SMI8 9222B A (<=1) 04/26104 DKC Parcel I.D. # 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 DWELLINGS 1. GENERAL INFORMATION Complete legal description r~0S~P~r'--~ }-~% ~-~ 5~/'¢.~ ///.-o'( 74, /~ Location (site address or directions) Property owner Mailing address Lending agency Mailing address gem ) r~, ~ 7 A d d r e ss~'/~~-r~t~,~,'T ;~,~ Day phone Unless otherwise requested, HAA will be held for pickup. Day phone Day phone NUMBER OF BEDROOMS: 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. 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 o 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'oi 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. Phone ~ ~2'7- -/7 ? ,, / Alaska ,¥at~& ~ ~!asmwater Sg]vi(?s/"~./" Name of Firm Address Engineer's signature -- DHHS SIGNATURE . Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: 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. 724325 (Rev. 1/91) Back MOA #21 Legal Description: A. WELL DATA Well type Log present Total depth Sanitary seal (Y/N) Municipality of Anchorage Environmental Services Division L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4~z~/"Z,,, Health Authority Approval Checklist IfA, B, or C, attach ADEC letter. ADEC water system number Date completed ~5,~---~- p Cased to I,~1 ' Casing height (above ground) FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform / Date of sample: Wires properly protected (Y/N) AT INSPECTION //2' Nitrate g.p.m. · ~--o,~ g.p.m. 4' ~' ~,/~ Other bacteria Collected by: '~, ~. (J'~' B. SEPTIC/HOLDING TANK DATA Date installed ~//[/~f Tank size Foundation cleanou~ ~.o ~-'C~(~ Depression (Y/I~ /~ Date of Pumping ~f/,/~)¢:~' Pumper ~/~ /'~cl~ C. ABSORPTION FIELD DATA Date installed Length Width Number of Compartments d9/9,. Cleanouts~__~N) ,~ High water alarm (Y/~-)) /%)//~ Soil rating (g.p.d./fF or~ff~/bdr~) Gravel thickness below pipe Effective absorption area ~0~ ,~F Date of adequacy test el/lO Fluid depth in absorption field before test (in.); ~ Immediately after'~'.~, gal. water added (in.): System type Total depth ,)Z-///~ /~//~. Monitoring Tube present Y,~) ,~ Depression overfield(Y/~_~ Results (l~s/Fail) ~:~.. For ~I-0U 17.- bedrooms Fluid depth ~I'-L~,' (ins) Minutes later: ,~ Z~u~J, Absorption rate = (~OOt g.p.d. Peroxide treatment (past12 months) (Y/~ ~,~o7 ~J6"~ ,fyes, givedate /~//~ 72-026 (Rev. 3/96)* ~ ~ in gallons Manhole/Access (Y/N) ~~ "Pump off" level at* High water alarm. Jevef~* *Datum ~-~ % E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /(~6 Absorption field on lot /OO C- Public sewer main Sewer/septic service line r~ r./~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation t0 4-- Propertyline IO '4- Water main/serviceline /0 '+~ Surface water/drainage / SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Surface water _ On adjacent lots _ /0D ~L On adjacent lots JO(~-1L- Public sewer manhole/cleanout __ Curtain drain _ Absorption field_ ~ ~4- Wells on adjacent lots. /O0 ~ Property line /~ '~ Building foundation /0 LC. Water main/service line - t O0 '~ Driveway, parking/vehicle storage area J~c/~_ /(..~"-~ We~ls on adjacent lots 10(~ ~ ENGINEER'S CERTIFICATION ,///~ I certify that l ha, c~dete i. eon,orr an Signature Engineer's Name Date ~/l ~/~ field inspections and review Jelines in effect on this date. Id '¢ HAAFee $ ~ ' ~'~ Receipt N umber ._~~ ~3/¢/~ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment _ Receipt Number · ~ i CT&E Envlranmenral Services I~e CT~ ~.# CHeat Nmue 975402001 AK Water & Wast~water ,Services Lt 7A,Iilk 6,Prospect HI-IS S/D Lot 7A,BIk 6,Prospect Drltdda/Water 0 C{ient PO// l~rinted Date/Time 09/12/97 16:36 Co]lecteel Date/Time 09110/97 I2:50 R~e~lved D~t~ti~ 09/10/97 13:25 T~ ~or{ Stephen C. ~d~ · Reau{~s ~SO 0,00 PQL 0.~00 mg/L ¢o{/~OOmL Method Limlts Oat~ Date ~t SH18 4$O0'NOSF 10 max 09/12/~7 dBL 8M18 9~ 09/10/97 thai Al{ask W /;er & Wa /;ewater 8471 Brookridge Drive ~ Anchorage ~ Alaska 99504 Phone (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers September 15, 1997 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Subject: HAA for Private Well & Septic System. Lot 7A, Bk 6, Prospect Heights #1 S/D. 7900 Sitzmark Circle. To whom it may concern: The subject lot has a 4 bedroom house on it which is served by a private well and septic system. The results of the field investigation and adequacy tests are summarized as follows: A. WELL: On the day of our inspection (9/10/97) the static level was 112 feet below the top of the casing (B.T.C.). Water was pumped from the well at an average rate of 5.8 gpm for 171 minutes (992.5 gallons). During the first 42 minutes of the pumping period, the water level dropped 14 feet in the casing, and remained at that level throughout the rest of the test, indicating that the well was recovering as fast as the water was being pumped out (5.8 gpm). Based upon this data it was determined that the capacity of the well exceeds the Municipal requirements for a 4 bedroom house (600 gallons per day). B. SEPTIC SYSTEM ADEQUACY TEST: The drainfield is a 2.5 foot wide trench, that is 36 feet long, and has an effective depth of 7 feet. Prior to starting the adequacy test the sump (monitoring tube) was dry. Water was added into the trench at a rate of 5.8 gpm for 127 minutes (736 gallons). At the end of the pumping period the sump was still dry, indicating that the water was being absorbed as fast as it was introduced. Based upon this data, it was determined that the absorption rate of the trench exceeds 600 gallons per day, as required for a 4 bedroom house. NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not limited to, seasonal surface water infiltration, groundwater variations, septic system maintenance (frequency of septic tank pumping, usage of biological additives), condition of drain pipe and pipe joints (which can be damaged by seismic activity and deteriorate with age), type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects.), and the amount of water being introduced on a continual basis. Consequently, the results of this adequacy test are only valid for the specific day of the test. Furthermore, because of the limited nature of this investigation, it is possible that there are hidden defects which may not have been detected. No warrantee is made regarding the future performance of this well or septic system C. CLEAN-OUT AT BEGINNING OF TRENCH: According to the 1984 inspection report, there is a clean-out at the beginning of the trench; however, we were unable to find it during our field investigation. It is possible that the clean-out is buried. Regardless, if it is necessary to "snake" the line, they should be able to access the entire run from the sump. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. Sincerely,~ ~/ ~M Jeffrey,~ Ga .S. Princip, c.c. Clair Ramsey, Jack White Real Estate Carol Douthit at RE/MAX Properties MUNIcIPALiTY OF ANCHot,~OE ENVIRoNmENTAL SERVIcEs DIVISION $£P ? 6 1997 RECEIVED MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. Cf CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~j \~ .. (.~_,O~ .~=,.. ~_~.'~ HAA# ~i-\'f'~ ?~Ot ~- '} -i LO 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) (b) Mailing Address (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Location (address or directions) Property owner ~ r~ Telephone: (home) ~/-2ZC~/ Business Telephone Telephone Mail the HAA to the following address: (or check here,~', if hold for pick up.) List contact person and day phone number below: (e) 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 th legality and status. 4. SEWAGE DISPOSAL On-site/~ Public [] Community [] Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 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 investi'gation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional end 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 ~_,.©E,L~/~ &( ~ ~<~CC'i¢~¥¢-'r' . Telephone -'~'~ - Address /.__~O(-," ~ ~5'" .~, , /4 67 '5</5 Date 6. DHHS APPROVAL Approved for Z// bedrooms by Approved /'~_ .. Disapproved Terms of Conditional Approval . Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 inspe, ct!ohs or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or ormss~ons in the professional engineer's work. 72~25 (Rev. 7/88) Back Page 2 of 2 ~ MUNICIPALITY OF ANCHORAGE (MOA) MUN ~_)/IICIPALI ORAGE Health Authority Approval (HAA) -,vmv':;:;'~'NMENITA~'EI~J~S DIVI$IONC'HECKLIST' FEBRUARY 1984 . MAR 6 1989 RECEIVED A. WEll. DATA Well Classification Well Log Present (Y/N) y Date Completed Total Depth /~a Cased to /~'/ 343-4744 Legal Description: If A, B, C, D.E.C. Approved (Y/N) / ¢~' '-J~ Yield Depth of Grouting (_,/'n Static Water Level Jd_)O ' Casing Height Above Ground 7 ~ Electrical Wiring in Conduit (Y/N) ~/ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ?,'00 ~ To Nearest Edge of Absorption Field on Lot Pump Set At Sanitary Seal on Casing (Y/N) \// Depression Around Wellhead (Y/N) ; On Adjoining Lots· / O0 ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by ~ ./m?~fZ J ~ /~ To Nearest Public Sewer Cleanout/Manhole N,//~ B. SEPTIC/HOLDING TANK DATA. Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pum. pi. ng~'Uaintenance Contact on File (Y/N) I~/,~ Holding Tank High-Water Alarm (Y/N) Z y Foundation Cleanout (Y/N) ? ' Date Last Pumped ,.~--~' "~ Temporary Holding Tank Permit (Y/N) J~//~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ~'~O '~ '/- To Building Foundation To Property Line .'~) ~ '~- To Disposal Field To Water Main/Service Line ~'O~ To Stream, Pond, Lake or Major Drainage Course /~'/~ Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ,'~--~ To Building Foundation '~-P Lot /[,l///~ TO Water Main/Service Line _~c3 ? + To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area /,R~-J~-~, Type of System Design · Length of Field .~'(::~ ~ ~ Depth of Field /Z- ! Gravel Bed Thickness ~ ~ ~ Statndpipes Present (Y/N) Date of Last Adequacy Te§t To Property Line ._A~d) ~ To Existing or Abandoned System on ; On Adjoining Lots /¢)0' + To Cutback (if present) Comments D. LIFT STATION Date Installed X"k, Size in Gallons "Pump On" Level at High Water Alarm Level at ~eeSet~:Mf~A Electrical Codes (Y/N)'~% Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroon~Rating Against HAA Request** I certify that?l~¢ ,cl- ,ck~l,'~rified, or conformed to all MOA and HAA~ inspection.////~// Signed ~/~{~ // MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back effect on the date of this Engineer's Seal Receipt No .... Waiver Fee: $ Date of Payment _ Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. '~ ? p-:~.'o~ml.~,.',EIs'~ FEDERAL TAX ID # 92-0040440 '"' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL~__~ ~-'I I OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date '~ ~'~"~ '/~ °¢ ''~ GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) (b) (c) Location (address or directions) Property Owner '~o~'! L¢~',-~,~,~.~.~.. Telephone: Home Zy'~ %~a~ Business Mailing Address ~-~,' ~;~u.-=:4,---~";~ ~0 .~0 ~ ~1 0 ~t ~ Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the followina address: or: Check here~ if hold for pick up. List contact person and day phone number below. / TYPE OF RESIDENCE Single-Family~ Number of Bedrooms WATER SUPPLY Individual Well ~ Community [] Public [] Note: If com munJty well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL ' OnsiteV Public [] CommUnity [] Holding Tank [] Note: If comm unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-o25 CRev 8/86~ Front 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 ins ep,~ion. /'7 Name of Firm ~'' Address Date Telephone Engineer's Seal DHHS APPROVAL Approved for /~,~z/,,) bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional Date CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 fRev 8/86) Back WELL DATA r~u.lc~^u'n' oF ^.C.ORAGE <MOA~ ~.~6~-r.oRrrY Ar..ROV^~- mAA~ ~ECKLIST - FEBRUARY 1984 264-4720 Legal Description: _LoT Well Classification "~ .F.~ If A, B, C, D.E.C. Approved (Y/N) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata _ Date Installed_ ¢/::~¢/J ¢ Width of Field _ ~O 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 To Water Main/Service Line __ ~ ! O To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots - To Cutbank (if present) -- Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimenmons Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** · I cerbfy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this · ~'~?~ · · / ~/~ Date ~ Signed ~ ~~-- ' MOA No. Company Receipt No. . ~/..~ ~./~:~ Date of Payment -- Amount: $ -- Page 2 of 2 72-026 (11/84) inspection. Engineer's Seal CONSULTING ENGINEER 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99.501 TELEPHONE: (907) 279-3916 INSPECTION L E GAL: LOT 7A, BLOCK 6, PROSPECT HEIGHTS LOCATION: 7900 SITZMARK CIRCLE OWNER: TONY LAFRAMBOISE TYPE OF WELL: SINGLE FAMILY WELL LOG AVAILABLE: YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: 10 GALLONS PER MINUTE PUMP YIELD: 6 GALLONS PER MINUTE DATE OF INSPECTION: MARCH 25, 1987 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 6 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED TILL THE DRAWDOW~ SLEAB3~LIZE__D. STATIC WATER LEVEL WAS FOUND AT 101 FEET ~EL~ TOP OF CASING. AFTER TEN MINUTES._QOF~P_UJ~PING THE WATER LEVEL WA__~S 115 FEET. LEVEL DID N6T~ROP IN THE NEXT 20 MINUTES. WELL RECOVERED 100% IN 10 MINUT~S~, TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON MARCH 25, 1987. TEST WAS NEGATIVE. 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. CONSULTING ENGINEER '-'~'~ 203 W, 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 ADEQUA S P?I -- LEGAL: LOCATION: OWNER: RESIDENCE: WELL: SEPTIC SYSTEM: DATE OF PUMPING: TEST LOT 7A, BLOCK 6, PROSPECT HEIGHTS 7900 SITZMARK CIRCLE TONY LAFRAMBOISE SINGLE FAMILY, FOUR BEDROOMS PRIVATE, ON SITE FROM MUNICIPAL RECORDS: TANK: GREER 'STEEL, TWO COMP. 1250 GAL. ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 504 SQ. FT. SOIL RATING: 85 INSTALLATION DATE: AUGUST 1984 MARCH 25, 1987, ISAACS PUMPING SERVICE DATE OF TEST: MARCH 25, 1987 TEST PROCEDURE: sYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH FIVE FEET OF COwER AND 46 iNCHES OF LIQUID. 4-INCH SUMP WAS 13 FEET DEEP AND DRY. 18.0 GALLONS OF WATER WA____S ADDED TO THE SUMP. NO WATER COULD BE MEAS-~RED IN THE SUMP. "TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, groundwater 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 septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL ~ALTH DEPARTMENT OF NEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1 o General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) · . ~._ ..~ k~_~l~_~hone - Home Business (b) Applicants Name -I ~b4 ~ ¢ ~'~ · Applicants Address ~ ~ /~ (c) Appliqant is (check one) Lending Institution ~ ; Owner/builder ~; Buyer ~--~ ; Other ~ (explain); .~. (d) Lending Institution A 9~A ~C I~, ~ Tele hone Address Lol zl (e) Real Estate Coo & Agent Address (f) Telephone Mail the HAA to the following address: 2o T_~y~e of Residenc_~e Single-Famtly~ Number of Bedrooms Multi-Family Other (describe) 3. Water Suppl~y_ 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 Dis,posal Onsite ~ Public ~--~ Community ~-~ Holding Tank ~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attestin8 to the legality and status. [Page 1 of 2] 5. Engine_~ering 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 regula- tions in effect on the date of this inspection. Name of Firm 7~_~ %~of~C~~.~ Telephone~ ,. Address 0 ~ ~ ~ W ~-- ~ ~.,' . o -?:.,. '. ~ ~ 6-zk.. ju~w ~, ..~,~ 6. DHEP Approval / ., ~,,~2. ..~ Approved ~ Disapproved ~ Condition~ Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMEI~AL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 S~&TE REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 [page 2 of 21 7-19-84 EHVI~ONMENTAL P~OTECTION M~ICIP~I~ OF ~C~GE (MOA) H~ ~O~TY ~PROV~ (~) - R [ ! V D If A, B, or C, D.E.C. Approved(Y~) ~/~ Date ~leted ~/~ Yie ld~ Card to ~D ~ ~pth of Grouting N ~ N ~ Sanit~y ~al on Casing (~)Y ~p~ession ~ound ~l~ead (Y~) ~/ _ ~ ; ~ ~joining Lots I~ ~ To ~arest Edge of ~sorption Field on ~t ~ ; ~ Adjoining ~ts I~ ~ To Nearest ~blic ~ Line ~ To Newest Public ~r Clean. t/Manhole ~ ~ ~ To ~est ~ ~rvice Li~ on ~t ~ + Water S~le Collected By ~ ~ ~ ; ~te ~/~ WELL DATA Well Classification -~%//%T ~ Well Log P~esent (Y/N) ~ Total Depth ~O ~ Static Water Level q Casing Height Above Ground Electrical wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Cc~ments B. SEPTIC/HOLDING TANK DATA Date Installed 8/1%1g~ Size I'~,,~C:) NO. of Compartments Standpipes (Y/N) ~ Air-tight Caps (Y/N)~ Foundation Cleanout (Y/N) Date Last Pumped N ~ ~/ Depression over Tank (Y/N) N Pumping/Maintenance Contract an File (Y/N) ~/~ ; for ~/~ Holding Tank High-Wate~ Alarm (Y/N) ~//~ , Temporary Holding Tank Permit (Y/N) Separation Distances f~om Septic/Holding Tank: To Water-SupplyWell ~ To Property Line ~ TO Water Main/Service Line Course ~ To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major D~ainage Comments Receipt ~ Date Paid: Arno un t: [Page 1 of 2] 2-15-84