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HomeMy WebLinkAboutPROSPECT HEIGHTS #5 BLK 2 LT 2pect Heights lock 2 Lot 2 015-135 -10 AnchoreSs, AK 99~ Pump Installation Log Drilling Permit Number: SW____ Date of Issue: __ ? areel Identific.~tion Number: Pump 7_u.~tgLIer ~[azaa: Municipality of Anchorage Page / of 2- DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wa.stewater Disposal System and/or Well Inspection Report Permit Number: ,~[~.~O'~'Li("J~'S~ PID Number: ~ \~).- \ Name: ~n ~~ Wastewater System: ~New ~ Upgrade Address: 220~ C/~V~/~ ~0/i ?75/~ ABSORPTION FIELD Phone: 2~ --~ F~ ~ ,o. of Bedrooms: ~ ~Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION Soil Ratingo'~GPD/Sq. Ft., Total Depth from original Lot: Z Block: 2 ~,,~Subdivision: ~"' ¢5 Depth ,o pipe bottom ,romO~,n~rade:. Ft Gravel depth beneath pip~. ~ FL Township: 12~ ~W JSection: i~ Fill added above origiTI g~e: Oravellength: Number of lines: Distance between lines: WELL: ~New ~ Upgrade Gravel width: ~ Ft. J -- Ft. Classification~(Private. A.B.C): Total~Depth: Ft. Cased~oTo: Ft. Total absorption area:~}~ SQ. Ft. Pipe material: ~ Driller:~/~,0~' ~ ¢~ Date~/~Drilled: Static~Water Lev;It:.~ Installer: ~'~i~ ~- Date installed: Casing Height Above Ground: ~"m" S~8g ~ ~t. TANK Yield: ~ GPM Ft. SEPARATION DISTANCES XSe.tic U Holding ~ S.T.E.P. To Septic Absorption Lift Holding ~ublic/Private Manufacturer:~ ~ ~ I Capacity in gallons: r~o~ T,.* ri~ St,bon T~.~ S .... Un., ~¢~ /~ Well ~I ~¢~, ~ ~ ~ Material: ~/ NumberofCompartments: ~ Surface W~*e, /~ ~ W~ /~ ~ LIFT STATION Lot t Line +~0 ~0' ~ ~ ~ Size in gallons: Manufacturer~ Foundation /~' /~0I ~ ~ ~ "Pump °n"level at:~ "Pump °fl" level at:~ ] High water alarm at: Curtain Electrical Ins~ctions performed by: Drain ~ ~ ~ ~ ~ Pump Ma~e&Model Remarks: BENCH MARK Location and Description~ ~. ~.) ~ ~R~  Assumed Elevation: /00 ENGINEES'.8 SEAL Inspections performed by: ~/~r~,~// Dates: 1st ¢/*~¢ Department of Healt um~q/S es approval ~E%:,~.% Reviewed and approved by: . Date: 7~J, -,~,~-.¢,4;:,;.: 72-013 (Rev. 9/91 ) MOA 25 Permit No. , Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: /~Z, /~Z f)ro~_p~c~L //~zO~5 /~/~r~,-~' PID No.: c o 72-013A(2/91)MOA 25 LOCATION OF WELL LOCAYION/;SKETCH: DEPAiIYMENT OF NATURAL RESOURCES DiVI~ON OF WATER WATER WELL RECORD BOREHOLE DATA: Mate~ Type and CoW Municipality ot CONTRACTOR INFORMATION; I""l{t~uM surface ~epth From To DEPT~: DATE OF COMPL~rlON DEPTH T~I STATIC WATE~ LEVEL~ .~__,.ft balm~ ~-' top et r. asi~ ~] grouM ~/farA METHOD OF DRILLING: [~ air fot~V I"1 cable tool USE OF WELI,; (~dome~ I-1 irrigation r-I mo~ Depths of openings: , ,, m, ft SCREEN TYPI~ \ ~ Diam: ,, in, r~ot/Mesh Size: VMurne Depth tO tOp; GROUT TY~~-' k Volume: DEVELOPMENT Dura~iom ..~ ,"/ PUMP/NG LEVEL AND YIELD=, ~ ~¥ ~ ft after .~,/ hfs pumplna ._~ opm PUMP INTAKE DEPTH: . ft Her~epOwe~, .. Wa.t OlSelFECTED UPON COMPLET~ON~ I YES [] I~ REMARKS: R~gist. erec~ 8u,sine~ No-me /~,, .; .... , ,~ .~,/,,~,,;....., , ,,,.,¢, , ., ~iig, na~ure Of Auu~ori~ecl ~qe.~prese~ta~ive PLEASE MAIL WHITE COPY OF LO~'TO; DNRIDIVISION OF WATER PO I~OX 772116 EAGLE RIVER AK 695'27-9.116 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 , 'oo ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940023 DESIGN ENGINEER:POLARCONSULT OWNER NAME:HAGMEIER JOHN & JUDITH A OWNER ADDRESS:2204 CLEVELAND STE. 201 ANCHORAGE AK 99517 DATE ISSUED: 2/04/9~~ EXPIRATION DATE: 2/0q/~ PARCEL ID:01513510 LEGAL DESCRIPTION: PROSPECT HEIGHTS #5 BLK 2 2 LT LOT SIZE: 104344 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: THE ATTACHED APPROVED DESIGN. 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 (18AAC80). THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 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 THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ~//~ /~ ISSUED BY: -JO[~ ~/~'fT~' DATE: DATE: polarconsult alaska, inc. ENGINEERS · SURVEYORS · ENERGY CONSULTANTS January 12, 1994 DHHS, Environmental Services, On-site Services P.O. Box 196650 Anchorage, Alaska 99519 Attn: Permit Review Officer Re: Design and Construction Approval for On-site Sewer System at Lot 2, Block 2, Prospect Heights Addn.//5 S/D. Dear Sir or Madam: Please accept the following design for review and permitting. The proposed system does not affect the current use of the adjacent properties and will have minimum future impact. If you have any questions, please give me a call. Sincerely, Matthew Korshin POLARCONSULT Attachments: On-site Sewer/Well Permit Application Site Plan, Sheet 1 of 4 System Design Calculations, Section, Sheet 2 of 4 Percolation Test, Sheet 3 of 4 Percolation Test, Sheet 4 of 4 ~'/5/a2"' $B~20 Check for Permit Fee 1503 WEST 33RD AVENUE ', SUITE 310 · ANCHORAGE, ALASKA 99503 PHONE (907) 258-2420 · TELEFAX (907) 258-2419 polarconsult alaska, inc. · 1503 West 33rd Avenue · Suite 3].0 ANCHORAGE, ALASKA 99503 (907) 258-2420 Fax (907) 258-2419 polarconsult alaska, inc. JoB , ' 1503 West 33rd Avenue · Suite 310 SHEETNO.. ~' OF. ANCHORAGE, ALASKA 99503 C^LCULATEO.¥ '"f~fY--'- DA~ (907) 258-2420 Fax (907) 258-2419 CHECKED BY DATE SCALE / //= 3 / Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3 4 5 6 7 8 g 10 11 12 13 14 15 16, 17 18 19 20- COMMENTS Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT O DEPTH? p E Depth to Water A,er.-~ _ j//~ j,.,,. Monitorino? t~"Y)/ Date:. 7 /2'1' Reading Date Gross Net Depth to Net Time Time Water Drop ~E$o,~K Illo ~ -- _ _ I ~o 0 ~,', - I" ~ V/o ~o ~ IO ~,~ ~" ~" ~ VI~ .~o ~,~ /O~,~ Z~~ V~" PERCOLATION RATE +0 (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN 5 ~ FT AND FT PERFORMED BY: po/"~,~z,/~ ' ~ ~--~ CERTIFY THAT THIS TEST WAS PERFORMED IN AC6ORDANCE ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE: I//~///~ WITH 72-008 (Rev, 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST l 2-- 3 4 5 6 7 13 ~4 17, 18 lO 20 COMMENTS Township, Range, Section· SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p ~ E Depth to Water After.--.r. .0.,,0.,.07 u y .a,,: Reading Date Gross Net Depth to Net Time Time Water Drop ?~0~- I/~o .... ~ ~,4o o ~,'~. - ~/~" - z ¢o I ~,~, / ~,'.. f~Z~" ~" ~ ~ ~ ~,'~. I ~,'.. I ~" ~A~" 5 ~ ~ ~. I ~,.~. I ~" ~,, c ~* 5 ~,',. I ~,~. / ~" ~G~" ~ ~ s ~,.,,. ~ ~,~, z ~;" ~,, PERCOLATION RATE ~' ~ (minutes/inch) PERC HOLE DIAMETER P ERF O RMED ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: l/~//~- 72-008 (Rev, 4/85) Municipality Anchorage P.O. Box 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES May 18, 1987 Gary Web 7000 Mc Lin Circle Anchorage, Alaska 99507 Subject: Lot 2 Block 2 Prospect Heights Subdivision On-site Sewer & Well Permit #860128 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of May 16, 1987. Your permit expired on the date of issue basis by authority of Municipal Ordinance existing at that time. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. The new permit will come under the calendar expiration date as per the Wastewater Ordinance (effective May 20, 1986). If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as-built inspection report (three-part form) must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 343-4744. Program Manager On-site Services RWR/ljw enc: copy of permit :OEF'AR'H"IENT OF HEAL. TId AND ENVIRONME:NT'AL I='ROTECTIOI',I 825 I_.. STF;']EET, ANCHOIRAGE, AK 9950 :i. 264-'4720 ADDRESS '7000 ANCHORAGE, AK 99507 LE;GAL. DiESCRiP: LOT: 2.:'. 1'~¢ t,IG~::.. 3W EL EICK~ 2 i...isted bCr~,!c:m~ ape t. he c:,pt, ior/s available to you in designing your septic: system,, Chc, c::,se the c:d:)'Lion that best t'i'Ls your sit. e. "]'" ~: E~i: ~'",41 ~l=~ tk"~ ib'~ ~. ~:1~ F;: ~:~ :iE "%" DEI::)t"H "! 0 F:'IF'IE BO'I"!'OM (F:'i".) 4.0 iSI':?.AVEI..., it)IEPi'H (F:T.) 6.0 'I'O'f'AL. D!EP"I'H (F"!'.) 1(),, 0 GRAVEl._ W]:DTH (f='f.) 2,5 E~FiRVE!... L,,Etqt3TH (i:::"1' ,, ) 66~ 0 BRAVIEI.... VQI_UMIE (CU. iDS,, i 39.8 TANK SIZE (GALS) 1,750,0 SOIl.... RA'f'iNG (SQ,F:'I', /BR) 132. ....... E.,* [,t:::.[:L I NG 75 F'T lEACH ) · x-.~ GRAVI:ii:L i....ENS-[H > /5 F'I". RIEE.!UIRIES MUI...'I"ZF:'I....tE RUNS (NOT '"" ......... ) . ~"i~ f¥4NK MUSI" HAVE AT L.E,~.,,~] TWO COMPAI::,:TMENTS r ¢=.i". 'I' 'i i ',, ~ ...... t.: :I.,, t am familiar ~.,J:i. tl"l 'Lhe cequ:i.r'ernents {cir' c:fn-.site se~er's ancl ~,!e].:t.s as set l-orth .... ~* the h'!(nJcJ.:a] t¥ oi' Arichc::,r'age (MOA) and 'Lhe State ot' ~asl.::a,, , - 't - C:CICIE.)5 al]El r'(.=,l:j~ ~]. at :[ ~i"l,:J J. lt cc)mp.i.~arice witl'i t.h~;.;.~ des:i, gn cr:i. ter:ia of t.h:i.~ pe~m:i.t, '5.. ]: ~4i]1 adtiere 'i'..(::~ ail MDA arid St-;~.':,:::.'¢ o{ Alaska r'equ:i, nements for the set l:::,;~cl.:: (::l ;i ~ltal'll:::~:qB [ I' Oiil al~y E,X i st J.l']~] t,,)E,]. ]. ~, ~ktas'lt.i~.:~,~)atel~ d i ~c)sa ]. ~F)/~BtE'(D or' pt..dj ~ i C 4,, :ii i. tndel'sL.:~dicl that t. his i:)e;'fi~it :i.~ 'v'a].id /,::~f' a maxJ. rilt.tm of 6 I:){<~,dr'ooms arid ;l.l.:: 4-s I_.I;F:I ,.~,,.-.,,~.£.,I,i iS :fI',tS'fAI....I...Ei:D IN AN AREA ROVF:RF~'D BY MOA BLJI!_D]:NG !'HtEN ( :I. ) AN EL..E:C'TRtCAL. PERMI"I' AND INSPEC"I':I:ON M.IST BIE [I.'STAINED; (;:}]) AS-BUILTS WI!...L N' i' :( ....... APF'ROVED W;!:THOUT AN It:.'l EC'H::;t]..AI_ II',ISPECTION RIEF:'ORT~ AND (3) 'THIE l~iil...l.'ii:i:;'t"l::;'. I C¢::fl.. WORI< t ......... I ""-' I: c D[INE .U ¥ A L I CiZNSED f.L:'I_EI:::'t"R I C.,. AN. S ]: (:..:.i t'4 E :0 AI:::'I:::'L I CANT = GARY DATE EICGINEERING GEO ' G Y Consulting and Services, Arctic-Subarctic P.O. Boz 110186, Anchorage, Alazka 99511 [9°.7] -~49-4942 PERFORMED FOR: LEGAL DESCRIPTION: P+ oL 1 3 4 $ 7 9 5P 12 2P 13 14 ~6 ~7 18 19- 20- [] SOILS LOG ~PERCO LATION TEST· ENCOUNTERED? · ' 1.2. "-- /'~' ~'~/~e. IF YES, ATWHAT Reading Date Gross Net Depth to Net Time Time Water Drop · I ~'/7/g~ /2~35 (3 o o 2. " 1..-~ .' 3 (:, / ,~//~" ' ~," s ,, / ~.'~7 / ~" & ,, ~ " /~,'~t ~ IX~" F." ~ ,, zz~+l 2 /&,, ~," ~ ,' z2,, +~ ~ ~" ~,, 7 ,' /~:~ ~ 2~" ~," ~ ,, /2,'~ ~ ~" ~" I 0 " i~ ;Zo I 3 ~/4" ~/~" PERCOLATION ~ATE ~ ' ' (minutes/inch) , 4' TEST RUN BETWEEN FT AND .~,t FT COMMENTS ~.~ p~,-~, t-I'o1¢ . ~,, PVC. P,.~. M~ P~.~ ~. ~R t ~ /~'~/ /x \ / SOILS LOG - PERCOLATION TEST DATE PERFORMED:,' ~/'~/,~ SLO~ ~SITE PLAN ~ Fnd. No. SRebar El. 920.2' [( Fnd. No. 5 Rebar El, 917.5' /o-f' PROPOSED WOOD FRAMED HOUSE NOTE: All Elevations are Assumed Fnd. No. 5 Reb(~r- El, N 89°55 '07"E '53.27' / I ScaPe I": I00' Fnd. No. 5 Rebar El, 977.. 4 ' 30o25'59"E 40.82' Fnd. No. 5 Rebar EI.975.4' CERTIFICAT. E OF OWNER ,.:' " I, GARY WEBB, THE UNDERSIGNED, HEREBY CERTIFY THAT, TO THE BEST OF MY KNOWLEDGE, NO EASEMENTS, COVENANTS, OR RESTRICTIONS LEGALEY EXIST.ON THIS PROPERTY WHICH I HAVE NOT REVEALED TO THE SURVEYOR OF THIS TRACT, NAMELY LOT 2, BLOCK 2, PROSPECT HEIGHTS SUBDIVISION, ADDITION GNATURE OF OWNER-J .ENG12VEER12VG GEOLOGY Consulting and Services, Arctic-Subarctic P. O. Box 110186, Anchorage, Alaska 99511 DATE /.~. --.--.V~ / / Fnd. No. SRebar ~ EI. gZo. 2' [! Fnd. No. 5 Rebar El. 917.5~ PROPOSED WOOD // FRAMED / HOUSE F.F.=gSO.5 NOTE: All Elevations are Assumed Fnd. No. 5 Reber-EI N 89'55~07"E / '5;5.27~ / t Scale I"= I00' Fnd. No. 5 Rebor El. 977.4' .~5'59"E 40.82' ~.Fnd. No. 5 R e bar EI.975.4' CERTIFICATE OF OWNER I, GARY WEBB, THE UNDERSIGNED~ HEREBY CERTIFY THAT~ TO THE BEST OF MY KNOWLEDGE~ NO EASEMENTS~ COVENANTS~ OR RESTRICTIONS LEGALLY EXIST.ON THIS PROPERTY WHICH I HAVE NOT REVEALED TO THE SURVEYOR OF THIS TRACT~ NAMELY LOT 2~ BLOCK 2, PROSPECT HEIGHTS SUBDIVISIONs ADDITION NO. 5. . SIGNATURE OF OWNER] DATE ENG:~i'EERING GEC~ OG Y ', C'o!~l. tihg and Se~v4ces, Arct~c-Suba~Hc P.O. Box 110186, Anchorage, Alaska99511 SOILS LOG- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: P+ OL 1 4 7 5P 10 12 [~] SOILS LOG ,~J~'~P ER CO LATI O N TEST e /.,2.'-- /'i~' ,,~';~'~e. IFYES, ATWHAT 'DATE PE".O.MEO:. o SITE 'PLAN 13 14 15 16 17, 18- 19 20 Reading Date Gross Net Depth to Net Time Time Water Drop .2, " 1.2,."3~ / ~lb" '~" ~ ,, /~:~ / ~" , ~" ~ ,, /~;~ ~ /~" ~ ,, ~ ,, /~:+~ ~ ~ ,' ~,, 7 " /~; ¢5 ~ 2P~'" ~," ~ " ]~g S 3" ~" ~ ,, ,~,,~¢ , ~%~, ~" I o " /~;~0 I 33/4 z/~; PERCOLATION RATE ~' ' (minutes/inch) , TEST RUN BETWEEN FT AND FT ] unicipali[Yof Anchorage P.O. BO,, 'i96650 ANCHORAGE, ALASKA 99519~6650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES June 23, 1986 Gary Web 7000 Mc Lin Circle Anchorage, Alaska 99507 Subject: Lot 2 Block 2 Prospect Heights Subdivision On-site Sewer & Well Permit #860128 - Issued May 16, 1986 On May 20, 1986, The Anchorage Assembly approved a new ordinance regulating on-site wastewater disposal systems (septic systems). All septic systems constructed after the effective date of this ordinance are subject to the provisions of this ordinance. Our records show that you currently hold a permit for the installation of a septic system. We strongly urge that you contact this office prior to constructing your system. Any changes in the code that could impact the construction requirements of your septic system will be identified and brought to your attention. Please contact the Environmental Services Division at 264-4720. Thank you for your cooperation. Sincerely, Susan E. Oswalt Program Manager On-site Services SEO/SSM/ljw 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 Parcel I.D. 015-135-10 1. GENERAL INFORMATION CERTIFICATE .OF HEALTH, AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: G - ~ 3 "O ~ Complete legal description PROSPECT HEIGHTS '#5 LOT 2r BLOCK 2 ~t~E~'~; ANCHORAGE, AK. 99567 LOcation (site address or directions) ~ PROSPECT Current Property owner(s) MARK HENNICK Day phone Mailing addres{; 8040 PROSPECT CIRCLE * ANCHORAGE, AK. 99567 Lending agency Day phone Mailing address Real Estate Agent Mailing address BILL EMPIE w/ DYNAMIC PROPERTIES Day phone 3111 "C" STREEt * ANCHORAOE, AK. 99505 261-7600 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 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 E~] community on-site ~-] Public Sewer O 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 pr°perileD served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Cedificates of Health Authority Approval are valid for 90 days from the date of issue for propedies served by a private or Class C well and may be reissued with new water samples. (Cedificates may be reissued for a period of up to one year with valid water samples.) Cedificates 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. Legal escription: HEALTH Municipality ofAnch0rage DeVelopment Services DePartment i ',Building Safety Division , OmSite Water & Wastewater Program i ,.,. ~. i ,4700 South Bragaw St. , ~ ~ ~ :t,.,. P.O. BOx 196650 Anchorage, AK 995'19-6650 ~ www.ci.anchorage.ak:us ; (907) 343-7904 'AU,' iTY THOR ;APPROVAL CHECKLIST 015-135-10 Static water level Wieli production - ,g.p.m. :68[ :: ft. 4.8,' ,g.p.m. ii B. SEPTIC/HOLDING TANK DATA W~T,E.,RSAMPLERESULTS:'" ::.' ~" ~ . Col form, c010nies/100 mi. {_ Nitrate 0.1 mg./ ; Ar~r~ic: ,iN/A mgJL.'I . : :.i Date'.°fsample:' 3/0;4-/04 . . ,: ; ,, j,;~ :;: Other bacteria, 0 colonies/100 mi. .Collected,by:. : .OEO, Ltd. Ta k T /Material ' '" ' ' STEEL: . t; ; ';;2 i:':! ;.! :[ DateinSt~jled, ;7/12-13/1994 Ta~ki~i'z~~ 1250 gal.~i ii, Foundabon cleanout (Y/N) YES De3ress~on over tank (y/N). NO :! , 'High ~ater;~larm (Y/N) N/A I iI :" ' ": · : " ..... ' .... "'"'*':', ~ MCDONALDSI PUMPING ' ' Date of p?mp,ng 3/11/2004 Pumper. -Cleano, Dts (Y/N) ' YES C. ABSORETION FIELD DATA .~,':' .,I' 7/1;ji/94 '.sOiiraiing f¢/bdrm) ;;45 .:!. . SYstem;type TRENCH Date :installed r Le~oiht'l], .79 , -' ft., : ,' ',¢ Width; ,: '3 .,:,; ,:, ;!;ttft. i,' fa?el below pipe 8.6 ft. iL '""' .... ~-~- ' '~ : ' , ':,,,I[:': i Depression over field NO To I d~l~:t'h: 12;2 fl. :Eft. absorption area 1335 fl , Monitoring'tube Y Date :of adequacy test .3/04/04-., .':, ::Results( i! .[;:. : For' 4- bedrooms Fi: id ;dePth in absorption field before test: DRY in. 613 !. [ - ! New depth Elapsed ,,T~me: 28 m~n. ' · Fin'al fluid depth '"'0 Any rejuvenation treatment (past .12 mo.)'(Y/N & tYpe) '!]:~ l, I I. : ' ~,; !, ~, ' ;!NONE KNOWN '. i~ If yesi give date 11 in. g.p.d. pROSPECT, HEIGHTs S/D #5; LOT 2,' BLOCK 2 : Parcel'lD: A. WELL DATA :. ', ': .WelItype]'PR~VATE: '. .IfA, B,o'rCpr°videPWSlD# N/A'Ii WelI,Log(YIN)~ Date Comi~leted 5/15/94 ' Sanitary Seal (YIN) YES .; :" i ·Wires Pr°PedY Pr°tected (Y/N) Total.! ,depthi o~u ft. ' ;'.. Cased to :70 ft..~-i . ~:; i:.~ i .'Casing hei;gh! (above ground), I' ""- FROM WELL LOCI' . !i : ;', 'ii'I" AT INsPECT!ON : · ... D~t;0f:t'est-] "5/15/94 ::' 65'; ';,: ~ft. YES ~24 in. YES 3--15--04; ;907 5615301 GS Ref.# :lient Name 'roject Name/// :lient Sample ID Iatrix 1041107001 Gamess Engineering Group, Ltd. N/A Prospect Hts, L2, B2 Drinking Water WSID 0 ample Remarks: All Dates/Times are Alaska Standard Time Printed Date/Time 03/15/2004 12:56 Collected Date/Time 03/04/2004 14:15 Received Date/Time 03/04/20!~4 14:44 TechnicaIDirector ~ Stephen J2. Ede . Allowable Prep Analysis arameter Results PQL Units Method ' Container ID Limits Date Date Init ~ters Department Nitrnto.N 0.100 U 0.100 mg/L EPA 300.0 B (<=10) 03/04/04 SJB ' icrobiology Laboratory Total Coliform 0 col/100mL SMI8 9222B A (<=1) 03/04~04 DKC lllz .r ¢o ~o 'i 'd tS~'o~l 8~819qL08 'ON 'Pll 'dnoJo fttl!188u!~u3 ~,~u~o U~ ~l~VS~:Otli~OO1 'gl'~l~ 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. # O) ..¢ ~ ~35~ 1. GENERAL INFORMATION Complete legal description Lot 2; Block 2; Prospect Heiqhts ~5 Lo~ation (site,.address or directions) 8200 Prospect Pl'ace Anchorage, AK ,Pr.6pertyowner Nell Dietderich C/O]U.S. Toxic Substance '{Mailing address ao4 Lending agency Mailing address . Agent Day phone 276-4441 Testing Bureau So~]~mpffon, PA 18966 Day phone Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ % TYPE OF WATER SUPPLY: Individual well xxx 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. 72q)25 (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 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 reg~ll&t~!~JrNe'Ceet~)n the date of this inspection. :'" ' . : ' : !..~op Road No. 204 Name of Firm Ea.,ia ~w,~ ~,~,,t,,,~ Phone 6 ~'t W - -.'~'~ '7 'i 17034 Eagle River Loop Road No. 204 Address Eagie Kivert Engineer's signature -'3~' '-_~'~ /. //~.~ ~_ ~-~- Date c) / :;;;z '7 / q' ;~ DHHS SIGNATURE ./~'/' Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ~__,,~'/~--~ Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representat.ions given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91 } Back MOA ~Y21 Municipality of Anchorage __ DEPARTMENT OF HEALTH & HUMAN SERVIC~P 29 1997 Environmental Services Division 9~7~,~..b 825 L Street, Room 502. Anchorage, Alaska 99501-( .~ED Health AUthority Approval Checklist Parcel, I.D.i 0/.5'- /~- Legal Description: A. WELL DATA Well type P~ Log present Total depth IfA, B, or C, attach ADEC letter. ADEC water system number Date completed S // ~/'3 ~ Cased to '70 Casing height (above ground) Sanitary seal ~/N) ~/fc 5 Wires properly protected f~N) ~' ¢ J Date of test Static water level FROM WELL LOG AT INSPECTION 07 7 ~ g.p.m. ~- -~ Well production g.p.m. WATER SAMPLE RESULTS: Coliform 0 Date of sample: ~1 / ~ ~//~'7 B, SEPTIC/HOLDING TANK DATA Date installed Nitrate ~7 //3/c'?V Tanksize Collected by: Other bacteria $ & S ENGINEEEING 17034 Eac;|e R;ver Lnn~n _D_O_~ Eagle River, Alaska 99577 Number of Compartments ~'- Cleanouts (~/N)_ Yz-; Foundation c eanout,~;~/n) Y' £ 5 Depression (WI~) C. ABSORpTioN FIELD DATA Length ~: ':7~/ Width Effective absOrption area i L~ Date of adequacy test (~'/~/~ 7 Fluid depth in absorption field before test (in.); Fluid depth ~ ~ (ins) Minutes later: '~ -7 High water alarm (Y/,.r~ ~ ¢ S0il rating ~~r fF/bdrm) ¢. '~ J- System type Gravel thickness below pipe ~'- & Total depth / ,~, Monitoring Tube present ~YN). ¥¢ -~ Depression over field (Y/~ Results (Pass/Fail) /0'7 ~'-£ For Immediately after7 ~-~ gal. water added (in.): Absorption rate = ~ © 0 + .g.p.d. Peroxide treatment (past 12 months) (Y/N) '~ '"~- ~',~'¢'¢'~/ If yes, give date bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cyge~ E. SEPARATION DISTANCES Size in gallons ~ "Pump on" level at* ~f" level at* *Datum F, SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station /00 .too ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation £ '/'- Property line 5~ ')'- Absorption field /o /o O Water main/service line Surface water/drainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ! o ¢ Building foundation ] 0 ¢-- Water main/service line Surface water [ 0 o ~ 4~. Driveway, parking/vehicle storage area Curtain drain jv o~,~ tc ~o ~ ~ Wells on adjacent lots ! O0 ENGINEER'S CERTIFICATION . ~inc;~inff~;hma; ~n hceavw~tdh e~4~r~edA~ t;ruui~iee~/dn ie~sipn eec~ie~cnts~anntdhi;e~iaet~ of Municipal r~~stems are ...... . b,;,, ~-nglneer S l~ame v - '~' -'~¢ _. u, ~, .~ [ RO Date HAA Fee $. Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* SEP-25-1997 16:48 CT~E ESI ~NCHORRGE CT&E Ref.# Client Name Project Name/// Client Sample ID Matrix Ordered By 975735001 5; & S Engineering Lot 2,Blk 2,Prosper Hgts No.5 Lot 2,Blk 2,Prospect Hgt~//5 Drinking Water Clieut PO// Prluted Dat¢/Tim~ 09125197 15:05 Collected Date/Time 09/23/97 13:15 Received Date/Time 09/23197 14:33 Technical Director; Stephen C. Ede Re~ul ts P~L Un{ ts alto~abte Prep AnaLysis Method Limits Date Date init Mitrate-M Tote( COLiform o.1oo u m 0~/ 100 mi/ No COL! O.lOO mg/L EPA 300.0 10 max 09/?.3/9T GGP $~18 9ggZa 09/23/97 T~ 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner. "~-~/~. /'~.~m~.1'¢-.¢' Day phone Mailing address Lendi~g age~'c~ '~~/~ ~'~ ~~ay phone Mailing address ....... Agent Day phone Ad dress Unless otherwise requested, HAA will be'held for pickup. 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 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 ~//~r~¥,~,/7/- Phone Address /~'O.~, ~/' ~-~"~ ~(/~2/O,~"-~ Eng'neers signature ~ ~" ~--/~""~'~"~'~ Date DHHS SIGNATURE ~ Approved for /' Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-oTL .2, ~/~. 2/ Pr~/mc~ ,~-~Parcel I.D. If A, B, or C, attach ADEC letter, ADEC water system number - Date completed ~ZS',/~ z// Driller Cased to ~zO I~7~, Casing height 2 Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION / 3 .g.p.m. --- .g.p.m. A. Well Data Well type Log present (Y/N) Total depth '~ ~'7-. Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: ! Septic/holding tank on lot / / Absorption field on lot Public sewer main Sewer service line / +/o~) ; On adjacent lots / ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate o.I Collected by: Other bacteria 0 ,. SEPT,C/.OLD ,G T^.,< DATA Date installed ~P ~/~'/7" Tank size Cleanouts (Y/N) Y Foundation cleanout (Y/N) High water alarm (Y/N) Date of pumping /'~,/ /25"0 ~j-,/. Compartments ~:~' ~ Depression (Y/N) Alarm tested (Y/N) -- Pumper -- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ! / Well(s) on lot I -~ ~ On adjacent lots '¢-/00 To property line ~ ~'0 / Absorption field /~) / Surface water/drainage ,,~zz,~ ! Foundation / ~ Water main/service line /'~ 72-026(3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer ~ Manhole/Access (Y/N) -- "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot -- On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~/~//~.z/' Soil rating (GPD/FF) O. ~' Length ~Z ~ ~ Width '~ r~7-. Gravel thickness (~. ~ Total absorption area //~3~'/~% z Cleanout present (Y/N) ~/Y .System type FcT'T Total depth // ~ /~ Depression over field (Y/N). Date of adequacy test /'u/£~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Results (pass/fail) for After test If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ z-'/L~ To building foundation On adjacent lots Sudace water ,~ On adjacent lots -/- /(PO / Property line To existing or abandoned system on lot Cutbank /''t'/~ Water main/service line Driveway, parking/vehicle storage area ~O / Curtain drain //~/'~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in Signature ~ ~ ~' Engineer's Name Date ~//~ 5',/~'~/ HAA Fee $ ~g) Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number Commercial Testing & Engincm'ing Co. Environmental Laboratory Services ~ LABORATORY ANALYSIS REPORT 'l~hn~czJ l~irector STF_gH-H-H-H-H-H-H-H-H-HKN C. F. DE lqitr~Ce-N 0.10 U mg/L ]~PA 353.2Y300.0 10 07/15/94 CIvlR * 8o¢ Sp~sia] Instngtio~ Above UA = Ihmvailabl¢ ** S~Smuplel~. Above NA =~ot~Myzed ~. ~ = ~ '~ $ D=~n~ ~Eh~io.. 5633 B Street, An=horago, AK 99518-1600 -- Tel: (907) 562-2343 Fax: {907) 58t-5301 ENVIRONME~AL FACI~ES IN A~SKA, COLOSAOO, FLORIDA, ILLINOIS. MARY~O. NEW JER$EY, OHIO, UTAH, WEST