Loading...
HomeMy WebLinkAboutPROSPECT HEIGHTS #1 BLK 6 LT 14 ,. ~,~o~" ~ c, \~'~ Municipality of Anchorage Page ' %(34 ~ ~ .~.~PARTMENT OF HEALTH AND HUMAN SERVICES ~.~ ~ ENVIRONMENTAL SERVICES DIVISION --~ ~ 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 un'Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~W ~O~ PID Number: ~1~-~-/7 Name: ~ ~~ Wastewater System: D New ~ Upgrade Address:~ ~ ~~ ~ ABSORPTION FIELD Phone: ~.~ ~No. of Bedrooms:~ ~ Deep Trench ~ Shallow Trench ~Bed ~Mound ~Other LEGAL DESCRIPTION ~oi, Rating: Total Depth from original grade; 1- ~ ~/s~. ~. /~ '  -- Subdiv~ion: -- Lot: / Block: ~ ~/~/~ ~/ Depthtopipebo~omfromoriginalgrade:~, 7~ Ft. Gravel depth beneath pipe~ Ft. Township: J Range: ~ Section: Fill added above original grade: Gravel length: I I ~ ~ Number of lines: Distance baleen lines: WELL: D D Upgrad Gravel width: ~ Ft. / ~ Ft. Classification (Priva~): Total Dept~ ~ased To: Total absorption area: Pipe material: . Pump Set at: ~ I Casing Height Above Ground: GPM / Ft. Ft. TANK SEPARATION DISTANCES ~ Septic D Holding ~ S.T.E.P. To Septic Absorption Lift Holding Pubffc/PrivatE Manufacturer: Capacity in gaffons: From Tank Fierd Station Tank Sewer Lines Wel~ /0~t ~ /~1~ ~ ~ ~ ~ Surface W.~e~ ~OO'~ [~'~ -- '-- /~ + LIFT STATION , / / Line j~ ~ l~+ ~ ~ /~ ~ Size in gallons: anufacturer: Foundation ~ j~t+ __ -- -- ,~ o~,a~: CudainDrain __ ~ -- -- -- Pu~ke&~ode, I E,ectr~spectionspedorme~ Remarks: ~,~/~ /~/Z ~~ BENCH MARK /~ ~, ~ ~ ~1~ Location and Descriptiom / 5. ENGINEER'S SEAL Inspections peflormed by: ~ En~:n~c~- Dates: 1st Department of Heal.and Human Se~ices app..... Reviewed and approved by: Date: (Rev. 9/91) MOA 25 AS-BUILT SYSTEM DETAILS/SITE PLAN PROSPECT HEIGHTS ~1, LOT 14, BLOCK 6 Pepmlt ~ 961 PID#015-092-17 OLD CO CO NEW FI[ MT NG TRENCH A-C=60.17 B-C=7~.98 A-D=75,35 B-D=86,56 A-E=81.18 B-E=89.17 A-F=72,88 B-F=78,78 A-G=li5.35 B-G=112,3 A-H=121,65 B-H=iO0,O4 RESERVE AREA existing tank abandoned in place SFR PORCH DWELL WOOD DECK & 160,30' CARPORT ,/ / / / SCALE: ./ 1' = 50' / SEWER ROCK 35' PREPARED FOR: MARK CEBUHAR 9800 BUDDY WERNER DRIVE ANCHORAGE, ALASKA 99515 SCALE: NTS KND ENGINEERING 20441 PTARMIGAN BLVD EAGLE RIVER, AK, 99577 (907)696 6111/F[lx (907)696-8111 DATE,il 15-96/pew,l-20-97 DRAWING SCALE, AS NOTED 96054-s1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960283 DESIGN ENGINEER:KND ENGINEERING OWNER NAME:CEBUHAR M_ARK P OWNER ADDRESS:9800 BUDDY WERNER DR ANCHORAGE, ALASKA 99515 PARCEL ID:01509217 PAGE 1 OF DATE ISSUED: 9/06/96 EXPIRATION DATE: 9/06/97 LEGAL DESCRIPTION: PROSPECT HEIGHTS #1 BLK 6 LT 14 LOT SIZE: 112385 (SQ. FT.) NUMBER OF BEDROOMS: 8 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. -FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED By: ~ND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 August 8, 1996 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Lot 14, Block 6, Prospect Heights #1 Gentlemen: The owner of the above property wishes to remodel the dwelling to a maximum of eight bedrooms. Currently the dwelling is served by a system adequate for 3 bedrooms, thus an additional area adequate to serve 5 bedrooms will be necessary. On July 11, 1996, two testholes were excavated and tested. It was found that a five bedroom upgrade will fit adjacent to the existing system. The second testhole verifies that a complete replacement system for an eight bedroom dwelling is available. 2ne existing 1,001J"g'a-l~n tank w'_'!! be 0¥~ and inspected nd,_'t~cn, a 1 250 -'all~n ta~ .... ;n h~ i~+alloH . · -~ , s .............. ?~,oa~. ~~tion and the existin ' ' te, a new 2,500 gallon tank will be inst~ There is a steep slope just behind the dwelling which plateaus just northwest of the existing system. The proposed area of development is flat, with slope along the perimeter of the lot. There are no surface water sources within 100' of the proposed installation site, nor any known curtain drains within 50'. There are no private or public wells within 100' and 200' respectively. This additional development should have no adverse effect on surrounding properties. If you have any questions about the proposed upgrade, please contact me at 696-6111 or FAX 696-8111. Respectfully submitted, ~.~I1~ Engineering Kenneth M. Duffus, P.E. attachments: On-Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test WASTF-WATFR DIS?rlSAL SYSTBhl PROSPECT HEIGHTS LOT 14, BLOCK 6 × TM / 0-27. Existin9 / / / / / / / / / RESERVE CALCULATIONS 8 BDRH$ X 150 GPO = 1200 GPO tSO0 GPD/I,2 GPD PER $F = 1000 SF lO00 SF/2 X 9' GRAVEL DEPTH = 56' LENGTH DESIGN ]DETAILS 5 BORN X 150 GPO = 750 GPO 750 GPO/ 1,2 GPD PER SQ, FT, = 625 SQ. FT. 625 SQ. FT,/2 X 9' GRAVEL = 35' LENGTH TOTAL DEPTH DF SYSTEM IS 12' NOTES: l, INTEGRITY BF EXISTING TANK WILL SE VERIFIED DURING CDNSTRUCTI[]N, IF ORIGINAL TANK IS IN GOOD CONDITION, A NEV/ 1,250 GALLBN TANK V/ILL BE INSTALLED UPSLDPE FROM THE EXISTING TANK. IF MBT, A NEV/ ~,500 GALLON TANK V/ILL ~E PLACED. 2, NEV/ TRENCH V/ILL TIE INTO EXISTING TRENCH. 3. CONTRACTOR V/ILL INSTALL FOUNDATION CLEANOUT AND POST TANK CLEANOUTS AFTER NEV/ TANK. 4, UPGRADE V/ILL ADD 5 DORMS TB EXISTING 3 BI)RMS, RESERVE AREA SHBV/N V/ILL ACCOMMODATE 8 BORN REPLACEMENT SYSTEM, PREPARED FI]R: MARK CEBUHAR 9800 BUDDY ~/ERNER DRIVE ANCHORAGE, ALASKA 99515 KND ENGINEERING 20441 PTARMIGAN BLVD EAGLE RIVER, AK, 99577 (907)696-6111/Fax (907)696-81ll DATE: 7130/96 DRAWING SCALE: 1' = 100' 96054-s! Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: /~- /'~/ /'~,'/z_ /~ 7 8 9 10 11 12 13 14 15 16 17- 18 19 2O DATE PERFORME COMMENTS /'?/2~o~¢/~2~-ownship, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? L IF YES, AT WHAT 0 DEPTH? p E Depth to Water After. Meniloring? ~'~//~',,~/ Dale:'7'~/~ ' ~ SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop I .:~ll-~ ~ ¢¢¢ .~ ~ V~ .~ ~ ~ ~, i ¢ 71~ ¢ ~ ~ , ~ ~/~ ~/~ PERCOLATION RATE /' ~'~ TEST RUN BETWEEN ~, O __ (minutes/tach) PERC HOLE DIAMETER i __FTAND ~'~ FT PERFORMED BY: ./~1,2~ ~.~? ~.;~2¢~/~/-/~>? , //l'/~d Z~/z~_-~_j CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES tN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4~85) PERFORMED FOR: LEGA,_ DESCR,P'nON: 2 3 4 7 8 I0 12 13- 14 1§ 17 19 2O COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~ ~, ,~.~/'~,,~T'ownship. Range. Section: SLOPE WAS GROUND WATER . /_ ENCOUNTERED?. S IF YES, AT WHAT ~ DEPTH? p Deplh to Water After./- Monitoring? SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop / ~7./,'~L.~ ~ ~ ~ G ,, __ (minutes/inch) PERC HOLE DIAMETER __ __ FT AND "~' '~ FT PERFORMED BY: ~'~c/("'~ ~"".O¢,)z~'~-.."~ '~ I /~J ~ /'/~'~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL S'[ATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: , , 72-008 (Rev. 4/85) ~ '~.. MUNICIPALITY OF ANCHORAGE D£ RTMENT 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 ^ddress ~C~ ~-/~ ~0 SEPTIC ABSORPTION Phone(s) "F/~ ~ d~ 5' 1~ AS'BUILT DIAGRAM (Show local,on of we,I sept c sys em, propedy hnes foundahon, drweway, Water bodies, etc.) TANKS Manulacturer Capacity in gallons Material No. of Compa~ments TYPE OF SYSTEM ~ d" _ ~TRENCH ~ BED ~ W. DRAIN ~ OTHER ~ ~' i~ ...... FT ~- r FT ~ Gravel Jength Gravel w~Qth Installer . Date Installed WELLS ~ PRIVATE ~ OTHER fldentifv) Class,ficat,on (A,B,C) I 1 3 FTJ ~0 FT ~ ~C~ ceflify that this inspection was pedormed a~cording to all I,, Health Depadmen, Approval: ~ Date: AF'F'L. :i1 CANT A D I'} R E S S: ii:ONTACT F:'I :13l OCI< ~. 6 23,. 0 3zl.. 4 .I.: O0(),, 0 .* ..... I ~ O()(),, O ~-.~. _,..:,, [",Aye: A T'i.. ::.r- c:* , TI/4C} L, LIHI-'PiI,iIVI,r:~.I\IIb il/ (:::('.:.) r t :i. 3' y 'i'. h a t ~: :l.,,I am i:'ami!:i, ar v,~:i.',":.h 'N'-m.:, requiremerrLs f'(:)i., or'i.....s:i, te sewers and ~.'~eIll. s as se-L f(:::,rth by 'Ll'~e lfiunicii::ia].:i.t.y of Anchc:)rage (HOA) and ti"m) State of Alaska. ;P.,: ]: ~.~:i.:i.I insta].1 'Lhe syst. 6:,in :i.n ac:ccmdar'Ice b~i'i'..l'i ail MOA arid in c:cmipZi.:i, aric(e ~,,~itl] l:.he design cr'iter:[a of this pe:,rm:i.t,, 3;. .!: ~,~:i.:l.:!. ac:iher'¢,:.;, 'l:.c, a].:l. HSA and SLa'I:.6:, [:if' Aias!<a PE.:'qL.I:[i'"E.:,iiii:.'..~r'I'I2'[B {'(:iP '(:h(+:.) si.':-:,'L bat:l< d ist. ances f rem .any ex is'L ir'v[] v~:<,:l. I, ~z)ast. E,i.~.::~.'LeH- cl:i.s]posal sys'h:::,m or pub 1 ic I und~:{,r's'Land 4:.ha'L 'Lh:i.s per. mit :i.s vaiid for' a maximum c}l' 3 bedr'c,c, ms arid .i~ii"p:/ ~}l]].&if~jE)lii({,],l"i'['. i,~/:~,].], pei:jli:J.t"e ai"i adi::l:i.'L:icmia]. ifF:' A L. iiiI::'T S'I'ATION 1:8 ]:NSTALI...ED IN AN AREA COVERED BY PIOA 8LI]iL. DItq(~Xi CODIES, THEN ( I ) AN I~:L.i~IiY!'R ]:CA!.. F'ERMiii'T' AHD :I:IXlSF'ECT I ON MUST BE OBTA !NED~i (2) AS--'BUiiiI...'TS U 11: I...L. Nilri" BE: AF:'F:'ROVED W! 'T'HOiJ'I" AI\I Ei....ECTF{'. ! OAL I IqSI::'EIiTT' I ON I::UEF:'OI::;rI" ~i AND (3) THE AI:::'F'L i[2Alq]~',', DAV Z D ki. HOL. DSWOF?.TH Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 /'- '~/ 3 4 7 8 9 10 11 12 13 14 15 16 17 18 19. 20 COMMENTS DATE PERFORMED: 2 Township, Range, Section: ~'/~/.~ ~ 0"/~? SLOPE SITE PLAN WASGROUND WATER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? P E 0epth Io Water Affair.,:=, ,/ Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ TEST RUN BETWEEN -- (minutes/inch) PERC HOLE DIAMETER FT AND __ FT PERFORMED BY: , ~ ~"~J1 ~ I /~'/J~ ~.lj 6~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH~A~L STATE AND ~UNIOIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE' 'ffe,"~/ 72-008 (Rev. 4/85) LEGEND: ~ ~rvey Hub & Tack ~ Subdivision, Anchorage Recording Precinct, Alaska, ,~. ~ib~l~ty ~~~.i~c~tr~~p~s~ buddmg--Ioca~le~lot~-grade~-.a~d~il~ty~ennec~ien~to ......... t. Dated at ~nchora~o~ Alaska this da~ o~ CONSTRUCTING ENGINEERS, INC. 9601 Buddy Werner Dr. Anchorage, Alaska 346-2000 694.9098 PLOT PLAN SCALE 1" --/¢-~' GRr-e. TER ANCHORAGE AREA BOROtr~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS PHONE SEPTIC TANK: DISTANCE FROM WELl /;~'-)/ / LIQUID CAPACITY / ~) ~;:~ ¢,~ _MATERIAL ,~" 7-~/~--~Z:.~/.~ NUMBER OF COMPARTMENTS / ~'~'-;,~-~¢.,¢~. //~,~,,~,,~X?/~-~,~(~/~,,~ ,~,~¢.'.,~ LIQUID gALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PiT: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE OUTSIDE DIAMETER '~ OR WIDTH //~ / ~ ~'P~'()-/~.)-~ ,.~,~ tO~?/~(,' . DISTANCE FROM WELL / ~/ / TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) LENGTH. //S~ /' , DEPTH BUILDING FOUNDATION.. ¢) ('~ ~' SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE TOTAL LENGTH , OF LINES IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE. WELL: TYPE /~.4'~1"~.~ ~':~ DEPTH I t3 DISTANCE FROM / ' , BUILDING FOUNDATION. 7~-'/ WATER · SAMPLE /J/'~.~ , NEAREST NEAREST ¢~/~ / SEPTIC / SEEPAGE / OTHER LOT LINE , SEWER LINE , TANK /~')/ , SYSTEM / ~'"~ / , CESSPOOL '~ SOURCES DISTANCES: DIAGRAM OF SYSTEM DATE APPROVED. GAAB-HD-~ GREATEI~ 'ANCHORAGE AREA '~'~ROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 Case N o. SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT. /,/~ RESIDENCE ADDRESS LEGAL DESCRIPTION. APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH ~'<,~ Z~ ~' ¢~'/~/~"~,~ILING ADDRESS~-,~¢,,~ 2~-~,~--/ PHONE NO. LOCATION OF INSTALLATION SEEPAGE PIT. , DRAIN FIELD_. , OTHER TO BE INSTALLED BY PERCOLATION TEST RESULTS //,,/~Z~ ANTICIPATED DATE OF COMPLETION / BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT AS DESCRY,ED ,ELDW. SI~E OF ,NIT TO ,E SERVEO_ 'P~DP sEPTIc TANK s~zE _/P~'?(P TYPe_T'~d sEEPAsE AR~z -~ DIAGRAU OF SYSTEM DISTANCES: '-7'0 ~ ~ Health Authority certify that I am familiar with the requirements of Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATE. , APPLICANTS SIGNATURE ]REATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT 32? EAGLE STREET ANCHORAGE, ALASKA' 99501 CASE # Depth . Feet- c.. Soll ChaPactepistics - ' Location Sketch Was Ground Water Encountered~ /~(~ .__ If Yes, At ~that Depth G~oss Time Net Time Depth To H20 Net Drop Proposed Inst al~See .... n~'* , -- .~_~ ...... ' ~'~= ~a~ u/ _ DPain Field ' Test Perf d By ~~~ ..... ~ .......... '' Data CePt~f~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.# ~:~,/-~"'~:)~¢-,' /~7' HAA# ~ E:J~L~'O~'~-~ 1. GENERAL INFORMATION Complete legal description Lot 14 Block 6 Prospect Heights Subdivision ~ I Location (site addreSs or directions) 980O Buddy Weaner Property owner Dave Schu~tz Day phone (907) 248-3636 Mailing address 9800 ]~tddy Werner, Anchorage, Alaska 9951 6 - Lending agency' ''' N / A Day phone Mailing address Agent Mike Messick Day phone (907) 257-0110 Address Remax Properties 2600 Cordova, Suite 100, 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: · NOTE: Individual well x 4. TYPE OF WASTEWATER DISPOSAL: Community well Public water If community well system, provide written confirmation from State ADEC attest- .'. lng to the legality and status of system. ..~, Individual on-site x - ~!~ ~ '3 HOlding tank ~ '; ',' ~'i' '.'" Community on'site ";:!..,, .. " , If community wastewater system, provide Written Confirmation from State ADEC attesting to the legality and status of sYstem.' :~ ' ?' :' ' NOTE: . Public sewer 72-025(Rev. 1/91) Front MOA~21 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 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 DHI Consultinq Enqineers Phone (907) 345-1385 Address P.O. BOX 1 Engineer's signature DHHS SIGNATURE · (/'/Approved for 5 bedrooms. Disapproved. ' Conditional approval for bedrooms, with the following stipulations: Additional Comments Note: State and Municipal Codes. continued suitability. Nitrate The well for this'property meets existinq There are nitrates present. It is wells EPA ~erferme~_ to insure the concentration is 8.19 mg/1. Date --~/ tion .... 0. --" ~ -~-The t.._, .· . Mun[c~pahty of Anchorage Department of Health and Human Services (DHHS) issues Health Authority . . Approval ce~tificate~'based only upon the representations given in paragraph· 5 above by an independent profession .a,I engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and thei¢ i~·nding institutions n 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 profess onal engineer's work. 72-O25(Rev. 1/91) Ba~k MOAF21 · Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~ot 14 Block 6 Pros[:~ct Heights#plarcel I.D. A, Well Data Well type Individual Log present (Y/N) N Total depth 165' Cased to If A, B, or C, attach ADEC letter. ADEC water system number t,1/A Date completed 10/01/69 (~ Driller 40' ~ Casing height .8' Sanitary seal (Y/N) ¥ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION 10/03/94 ~ Date of test / Static water level / 1 ~- 35 ~> Well flow / g.p.m. 5+ (~) Pump level1 ,/ - SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 100+ (~ Absorption field on lot 100+ (~ Public sewer main - Sewer service line - y® ; On adjacent lots 100+ ; On adjacent lots 100+ Public sewer manhole/c eanout - Petroleum tank WATER SAMPLE RESULTS: Coliform 0 Date of sample: 10/03/94 Nitrate 8.19 Other bacteria Collected by: F,,a~k ~rickson B. SEPTIC/HOLDING TANK DATA Date installed 10/69 ~ Cleanouts (Y/N) Y ~ High water alarm (Y/N) Date of pumping 10/10/94 Tank size Foundation cleanout (Y/N) 1000® Compartments Depression (Y/N) Alarm tested (Y/N) N Pumper Denali Sewer & Drain SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 100+ (~ On adjacent IotsO-'- 1 oo+© Foundation 53.5' To propeAyline 4o' ~) Sudace wate~drainage 72-026 (3/93)' Front Absorption field N Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed N/A Manufacturer Size in gallons /~anhole/Access (Y/N) Vent (Y/N) "Pump on" level~t~ "Pump off" Level at High water alarm level ~' Cycles tested Meets MOA electrical codes (Y/N>// SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Sudace water D, ABSORPTION FIELD DATA Date installed · 10/07/86 ~ Length 45 ' (~ Width Total absorption area~50' ~ Date of adequacy test 10/03/94 Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) 1 ® .System type r[~'ench 3' ~ Gravel thickness 5 (~ Total depth Cleanout present (Y/N) Y Depression over field (Y/N) Results (pass/fail) ?ass for 3 8' - 5" ® Aftertest 8'-6" N If yes, give date N/A Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1 O0 To building foundation On adjacent lots 100' Sudace water N/A On adjacent lots 100+ ~ Property line 68 ' ® To existing or abandoned system on lot ~ Water main/service line Cutbank ~5 ' Driveway, parking/vehicle storage area Cudain drain Ur~uo~ ~ ~ ~H~5 g~co~PS E. ENGINEER'S CERTIFICATION (~ 0~- ~se~uA~to~ I ce~'~ that I have checked, verified, or ~nTo~ed to all MOA ~d H~ guidelines in finginooes mamo ~e H~ ~at~ 40'+ 100'+® 10o date of this inspection. Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number CT&E Reft# Client Sample ID Matrix ClientName Ordered By Project Name Project# PWSID Commercial Testing & Engineering Co. Environmental Laboratory Services ~~jf~,.~,..~.e.j~-~.~-~.~arf~ LABORATORY ANALYSIS REPORT 94.5051-1 L14 BLK6PRoSPECT HT8 #1 WATER D HI CONSULTINGENGINEERS MARK ERICKSON WORKOrder 82699 PrintedDate 10/07/94 622:05 hrs. CollectedDate 10/03/94 612:30 l~s. ReceivedDate 10/03/94 613:05 t~s. UA TedmicalDirector Released By: STEPHEN c. EDE Sample Remarks: Parameter Nitrate-N ROUTINE SAMPLE COLLECTED BY: M.P. QC Results Qual Units Method 8.19 #/lOOml Allmvable Ext. Anal Limits Date Date Init EPA 353.2/300.0 10 10105194 MCE UA Unavmlable * See Special Instructions Above NA = Not Analyzed ** See Sample Remarks Above LT= Less qlmn U = Undetected, Reported vahe is the practical quantification limit. GT = Greater Than D = Secondary d~lution. 5633 B Street, Anchorage. AK 99518-1600 --Tel: (907) 562-2343 Fax: (907) 561-5301 ............. c, r~o~r~^ II t IMCIIf:; MARYLAND. NEW JERSEY. OHIO. UTAH. WEST VIRGINIA MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner I~/¢~1I~ ~¢:~-~ Telephone: (home) Mai!ingAddress ~ -¢'~4;:> '~-~V ~ (c) Lending Institution Telephone Mailing Address Business (d) Real Estate Company and Agent i L.--L~ ^)./:~ ~,.¢ --~ ~ / Address '~'O ¢-/¢~'~¢P '~:~Z::>L~-~/ ~O, ~~ ~~, Telephone ~ ~ ~ (e) Mail the HAA to the following address: (or oheok hereOf, hold for piok up.) List oontaot person and day phone number below: S & $ ENGINEERING 17034 Eagle Rib, er Loop E~ad No. ;~04 Eagle River, Alaska 9~5~ 2. TYPE OF RESIDENCE Single-Family~ Number of bedrooms 3. WATER SUPPLY Individual We.H.-~~ Community [] Public [] Note: If community we system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. ' 4. SEWAGE DISPOSAL On-sit~ 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 Name of Firm Address Date 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 th is 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, ordiqances, and regulations in effect on the date of this inspection. Telephone 17034 Ea~e River Loop Road No, ~agle Rwer, ,'~77 6. DHHS APPROVAL Approved for Approved //:~., Disapproved Terms of Conditional Approval Note: The well for this Conditional __ Date property meets existing State and Municipal Codes. There are nitrates'present, however, it is suggested that periodic testing be performed to insure the wells continued suitability. Nitrate concentration is 6.1. The Municipality of Anchorage Department of Health and Human Services (DHHS) issuesHealthAuthorityApproval 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 DH HS 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 (Rev. 7/88) 8ack Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) ,:~,;',:':'~:(~ea~h KAut horit y Approval (HAA) WELL DATA r Well Classification [t--k~ \ ~ ~,.b ~--L.~ Well Log Present (Y/~ ~-~ Date Completed Total Depth_ ~/-~ Cased to 'z~, ~r- Depth of Grouting Static Water Level Casing Height Above Groufid \ '-Z--. Electrical Wiring in' Conduit(C~;N). SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot \ /~;~¢,~&~lf A, B, C, D.E.C. Approved (Y/N). Yield ~'-, '~- (-.m~t-'l. Pump Set At O[ Sanitary Seal on Casing ~)' Depression Around Wellhead (Y~d~j~ ; On Adjoining Lots \'~ ! ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole To Nearest Edge of Absorption Field or~ Lot To Nearest Public Sewer Line r'~/¢:~ To Nearest Sewer Service Line on Lot ~_,.~1 ~ Water Sam'¢e Co"ected by % Date Water Sample Test Results ~'~ ~["~-~ -- Lc,,\ Comments_ ~ '~,(::;¢7/¢~ \ ---'z~c~- ~ , Date Installed \"~/~ Size Standpipes~N) _. Depression over Tank (Y~¢) B. SEPTIC/HOLDING TANK DATA I ~ No. of Compartments _Air-tight Caps4CZ:R4) kc' Pumping/Maintenance Contact on File (y/N~/G Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK: To Water-Supply Well To Building Foundation To Property Line To Disposal Field To Water Main/Service Line ~.,,:::~ To Stream, P ' t ond, Lake or Ma~or Drainage Course Comments ~'"~ ~"~r~ ~--=~j~\ ~...~::~.~ Foundation Cleanout ,~e Last Pumped I-"% ;for - Temporary Holding Tank Permit 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata \"~'~' ~'~~ Type of System Design ~ Date Installed \ ~:~ '~ '~ ~ ~:~' Length of Field ~ / Width of Field ' "~ Depth of Field \ ~ 1 Gravel Bed Thickness ~ I Square Feet of Absortion Area ~'¢'J Statndpipes Presen~N) V Depression over Field (Y/~5~' r-~ Date of Last Adequacy Test Results of Last Adequacy Test ~.~'~.-"1~ ~-~-..~'z.-~ _/. -- ~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~, '~' To Property Line To Building Foundation "~..c~ ' To Existing or Abandoned System on Lot '~-~ ~'~- ; On Adjoining Lots ~' ~.'-'-'-'-'-'-'-'-'-'=' ~-d~ To Cutback ((f present) To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking A~_or Vehicle Storage Area Comments ~ ~--~z:::::~l.~_~ / D. LIFT STATION D~Ued Size in Ga-Trons--~_ "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at N~uring Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company 17034 Eagle Ri~er Loop ~oad No. 2~ Eagle R~ver, AlasEa ~5~ Date MOA NO~ Receipt No. (~)~ Date of Payment Amount: $ ,,/~-)-- 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~.~ 5633BSTREET ANCHORAGE, ALASKA99518 TELEPHONE(907) 562-2343 ~ FEDERAL TAX ID # 92-0040440 ~ ANALYSIS REPORT BY SAMPLE for Work Order ~ 11487 Date Report Printed: JAN 31 89 @ 14:04 Client Sample ID:L14. B6, PROSPECT HTS $1 PWSlD :UA Collected JAN 30 89 @ 14:10 h~e. Receiyed JAN 30 89 @ 16:00 hrs. Preserved with :NONE Client Name : S & S ENGR Client Aect : SNSENGP P.O.~ NONE REC'D Req # Ordered By : R. SCHAFER Analysis Completed :JAN 31 89 Send Reports to: Laboratory Superv%%or,:STEPHEN C. EDE 1)S & S ENGR Special Instruct: Chemlab Ref $: 4103 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result/Units Method Limits NITRATE-N 6.1 mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY gP. 1 Teste Performed * See Special Instructions Above UA=Unavailable ND= None Detected ** See Sample Remarks Above NA= Not Analyzed LT~Less Than, GT=Greater Than 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Nam~¢¢/~ ~ J¢oJ~o¢~elephone: Home ~¢¢ { ~ ~ Business APplicant'Address ~,~C"OO ~ c~¢J¢c¢~ /--~'~/¢~ ¢" '/~' /¢',dO/l~ /¢)'/~'~, .¢~. ,~"~/C (c) Applicant is (check one): Lending Institution~:]; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution Address Telephone (e) Real Estate Company and Agent Address . :.. Telephone (f) 'Ma I the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family[] ~ WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite.,~ Public [] Community []' Holding Tank FI 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 PROVIDII~ 'INSPECTIONS, TESTS, FILE SEARCH, D~.,. 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. 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 Address Date ~ Approved for ~ bedrooms by~ Approved ~-~- Disappro~ Terms of Conditional Approval ~-~¢~'~'~¢ ~ate Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority · Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements, Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Descriptio.n~. ~-~'/'/~' I~UNIClPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OCT 141 3'/3 WELL DATA Well Classification Well Log Present (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) /v Separation Distances from Well: ~ If A, B, C, D.E.C. Approved (Y/N) /tJ Date Completed '/'~ -/- ~'~ Yield Cased to 4- ~f"~:)" Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) ~ Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ~'_,'~T~. (._ ; On Adjoining Lots ; On Adjoining Lots .A To Nearest Public Sewer A./,~ To Nearest Sewer Service Line on ~ ~:~' ; Date B. SEPTIC/HOLDING TANK DATA Air-tight Caps (Y/N) Date Installed Size Standpipes (Y/N) /~'- / Depression over Tank (Y/N) Ad Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) '&'//ct Separation Distances from Septic/Holding Tank: To Water-Supply Well /~ ' To Property Line ~//'O ' To Water Main/Service Line Course ~.. r't20 t No. of Compartments / Foundation Cleanout (Y/N) Date Last Pumped /¢ - 7- oc~.~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, PonO, Lake, or Major Drainage Page 1 of 2 72-026111/84) ~ ABSORPTION FIELD DATA / Soils Rating in Absorption Strata / ~-("~ / Type of System Design Date Installed / ~ - 7- ~ ~ // Length of Field 47/$- 3 / /// Depth of Field Width of Field ~ Grave~ Bed Thickness -~-" Square Feet of Absorption Area /_1/~--O 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 /~.O · To Property Line To Building Foundation ') O ' To Existing~or Abandoned System on Lot '-~ ~ ; On Adjoining Lots .¢. /~ · + 70' To Cutbank (if present) To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area 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 h. ave. checked, verified, or conformed to all MOA and HAA guidelines in effect on the~ate of this inspection. Signed ¢/)/'d~/~/~ ~"~"- - Date · Company (~¢~'~' (::~T~ ~.~'I'("--MOANO. 5¢ ~--0~2~ ,'""'" Receipt No. ~ ~ ~ ~t ~-f,~,~ ~ Date of Payment lb ~! q Amount: $ 6 ~ Page 2 of 2 .. A~,I E~ OF HEALTH ~,S ~NV~R(...I,.k..~, t RO,~CT10~ 825 L SEree~,~ ~ Anchoraar~, Alaska 99501 ~2: Time Da'he Date Insp Insp FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FAC!LIt?IES ....... ~ .... g Institutien Request: Lomas and Nettleton Company !'4aiiing~?~,~,~-~.~.u.;_~so~ 4449 Business Park Boulevard Phene: 274-7661 Property Owner: Mailing Address: David M. Holdsworth Phone: 344-4147 Star Route A Box 46C 99507 3. r~a~l Lot 14 Block 6 Prospect Heights Subdivision ..... .~_ Description: Single Family Residence: ( R Multiple ' ~ ]}am..ly Residence: ( ) Number of Bedrooms: Number of ~ ' ~,ec~ r ooras Well System: Permit i~ Co~l~ ~r u.c.t 1. oI1 Individual Well (x) Communiczy/Public System ( ) ,,Depth of Well Well Log on File ( ) .................................. Bacterial Analysis Sewage Disposal Sysbem: On-site System (x) Public Uhility ( ) Permi~ ,/~ Installed /0'~/~6 ~ Installer Absorption Area .~96 ............ Soii~ R~t~ -i ~S- M~t~ri~l Lm~ah,_eo: W'e!i to Septic Tank /OI tO Sewer - {~-, } ...... e Nearest Lot line ~h .... u. ot Lot Line ho Absorption Area ~3' [ Absorpbion At-ca · A4uNICIPALITY OI- ~,~r,~,,..--'~ IUNICIPALITY OF ANCHORAGE' '~ [NVi~ONMENI'AL~ROI'[' ur" Depar~men~ of Health and Environmental Protection .. ~ ~ ' 825 L Street, Anchorage, Alaska 99501 [~0[/ ~'~7[ 279-2511, ext. 224, 225 4th Floor _.~,~.~ Property Owner: Mailing Address: N (RefiDanced) ame o t ~x~: Mailing Address: David M. Holdsworth SRA 46C, Buddy Werner Drive Phone: 344-4147 Anchorage, AK 99507 SRA 46C, Buddy Werner Drive, Anchorage, AK SRA 46C, Buddy Werner Dr., A.A. Phone: 344-4147 Lending Institution: The Lomas.& Nettleton Company Mailing Address: 4449 Business Park Blvd., A..A. Phone: 274-7661 Realtor/Agent: Mailing Address: Legal Description: Street Location: none Phone: Lot 14, Block 6, Prospect Heights Subdivision o Single Family Residence: (X) Number of Bedrooms: 6 Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: * Individual Well (X) If Individual Well, well depth If Community System, name of system Public/Co~m]unity System Sewage Disposal System: On-site System (X) Public System If On-site System, date of installation: ( ) *NOTE: A well log is required on ALL wells drilled since 6/75. 3/7 7 Pa.ge Two ~' Department of Ilea!th and Environmental 'I'rotectAon Request f~r Approval of Individual Sewer end Water Facilities uescr~p~on: Lot 14 Block 6 Prospect Heights Subdivision Affadavit Attach20 ) Disapproved: Let-her Attached: ( ) Da'he: Department Worksheet 825 k 3E~zee~ z/~6~t £Aoor ,qnchor~e, Ak., ?~50Z ~ec. ?, ~777