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HomeMy WebLinkAboutHYATT ESTATES BLK 2 LT 3r jypT 1W 16 ON REPORT ON-SITE SEWAGE �Mailing dress !?122 &Ac',q � ,' Ph.#.g' 77 L. -;R-7 // Legal Description Location dC1fy'/2*L�-�^ ,f rf g P on� Q SEPTIC TANK: Distance from well V0f MaterialC.:{�,, '' Number of compartments Liquid capacity ,jg gallons. Inside lengthl 4 Inside width 4 Liquid depth SEEPAGE SYSTEM: Seepage Pit: Number of pits -Outside diameter or width, length, depth, lining material Distance from well 130r, building foundation ?] , nearest lot line Total effective absorption area (wall area)__4!K__ sq. ft. TILE .DRAIN FIELD: Distance from well , foundation , nearest lot line 'total length of lines Number of lines Distance between lines Trench width in. Total effective absorption area sq. ft. Length of each line Depth: Top of tile to finish grade Depth of filter material beneath tile in. Above tile WELL: T `' yd&, depth., distance from building foundation, nearest lot line; nearest sewer line , septic tank, seepage system ® 36 , cesspool, other sources DISTANCESt &— 8-0A is -e> c 14- 6-- DATE 4--6-- DATE- APPROVEDd �` a Health Authority I ' /7 � L. i 7 1 �-.—'7-- , ( r te\ � f..: �.8 �lti.j 1 � ✓ s� ..1� L� L'i_I �. ..aW • TESTING o EXPLORATION Ci �. CAL MATERI. LS b INSPECTION HONE 272.3428 P 1940 POST ROAD ANCHORAGc', ALASKA e 99.501 Fobruary 12, 1968 Work order 8592 Mr. 'Malian 11. Crapps 909 Chugach Drive, Space 32 Anchorage, Alaska 99503 Subject: Lot 3, Block 2, Hvatt Subdivision, Percolation Test for Rel-erence (a): Conversation and site visit by Mr. Crapps and Mr. Skluto Reference (b) : F;IA #300, :ini,:um Property Standards, Page 223, Table 11-8 Dear Mr. Crapps: in accordance with reference (a), the subject test was accomplished as requested and shown on the attached sheet. The test location was governed by tree location. However, the mature birch trees on the site indicate a well drained soil of which the test location is representative. The percolation rate in the location tested is i" in 2.9 minutes. This is well above the minimum rate required by reference (b) . If you have any further questions about this report, please do not hesitate to contact our office. Approved: / ..._::y Leo, P.L. S:sb -inc ios',:-es very truly yours, ALASKA TESTLAB r-�LASKA s S T L A 3, r TE _\ i Jzt POs :oar y ' Anc"o C. g,, P.:aska Client '2.H. No. P A No, ech. — — Location, Lot = 'Block ,Subdivision PERCOIA`_ O0 1'S D'.' A Depth Soil Class Sheet of WO No. Da to l' t Visual - Unified ?ocation Skotch <:/10 -:; A/ I 1 ' at Gross i�.^.t "Mn De~ .. to ::ESO .`:et Drop . 'a" irn- Nz., 1nUt ?crcolatiJn .._ ': 1�-.r� i ? I I �I L I 1 ' at Gross i�.^.t "Mn De~ .. to ::ESO .`:et Drop . 'a" irn- Nz., 1nUt ?crcolatiJn .._ ': 1�-.r� A-V REQUEST FOR APPROVAL or INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Triplicate) Name of person requesting, approval 2 2. Name of propertyowner 3, legal, de I 4. Number-'ofbedrooms in house J" 5. Water,, Analys is - a. Bacteria], rz b. Detergent X1, 6. We" data: a. Type b. Depth c. Casing Size d. Distance from well to closest existing or proposed: 41v 1 1. Sewer line, 2. Septic tank . __ • 3. Seepage Area 4. Ces!'pool, 5. Property Line 6. Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. 7. Sewage disposal system. a. Age of system 2 /4/ b. Septic tank capacity in gallons 4 e!57 c. Name of septic tank manufacturer 1. If "home made" show diagram on reverse side of this form. d; Disposal field or seepage pit size and type 1, Distance to property line to house foundation r e. Percolation, Test msult-s f. Percolation Test performed by — Use the.reverse,side of this foram to show diagram. Diagram should include ,",the following information: property lines' -well location, house location, 'aapt.ic tank location, disposal area location, location of percolation test, aT direction of ground slope. 9. The inlorznat.ion on this form is true and correct to the best of my knowledge. 0 Signature of Applicant Date Signed TO BE PILLED OUT BY HEALTH DEPARTMENT PERSONNEL The above described sanitary facilities are hereby approved, subject to the ­_Mllowing conditions: Conditions: Q The above described sanitary facilities are disapproved for the following reasons; Signature of Mf s & :i.a " x Datet r —7 'Approval �:. Approval is valid for one year following the date of approval. CP3:cw April 29y loss Mr, Walden L. trapper 989 Chugach Drive SAp Anahomps Alaska 99SO3 SUbJ ECT s Lot 31, Hlook 2• Hyatt tatates Subdivision Dear Vii=. Crapps t Sanitary water supply facilities are not presently available to the subjoct property and under current Borough planning will probably not be available within the next tears yeah. Sincerely, DAVID Re le, DURCANO Me D• medical Director DYs C MM;; 0Vol, Environmental Health Director CPJlsrr i April Ss 1969 � L d Mr. aea 909 ChuSaah Drives 032 tb`arage, Alaskan 99699 SLMJZCTt Lot 9# Black ?, ityatt tetatea Subdivision Dean "r« t Sanitary sewage disposal facilities arm not presently available to the subjeot property and under current Borough planning will probably not be avai.laLIA within the nest tea yes!", Sincere ly r CPJ/srr DAVID Ra L. tytWCAN,# Mo A. Medical Director BY: CIT? Or 4k 799# .: �► Chief Sanitarian February Is) 1960 mr. Walden L. Crapps 909 Chugach Drives 6 Space 62 Anaboroge$ Alaska 99603 SUBJSCTt Plat of Lot 36 Block 2$ Hyatt Subdivision, Showing Proposed 1 1!2 Stcry$ S Bedroom Houses Well and Septic Tank 'Disposal rield Dear Mr. Crapps s The Greater Anchorage Area Borough Hsalth Department has reviewed the subject plat for ,safety and adequacy of water supply and sewage disposal facilities. The Department will give its approval to the installation as shown on theyplat including a 16200 gallon septic tank and properly located and installed disposal field containing, the minimum of 600 square feet of seepage area. This letter is to serve as preliminary approval. Final approval will be granted only after an on-site Inspection of the installed water supply and septic tank disposal field has been asde by this office prior to bsokfill. Sincerely$ DAVID R. L. DUNCAN6 W. D. Medical Director BXa o . u *"0; ,0 Chief sanitarian CPJlsrr 'F�GE BU ® •-f Municipality of Anchorage ° ! On -Site Water and Wastewater Program (907) 343-7904 5 >> E Certificate of On -Site Systems Approval Parcel I.D. 014-101-04 Expiration Date: 1. GENERAL INFORMATION: Complete legal description HYATT ESTATES; BLOCK 2, LOT 3 Location (site address) 6906 Hyatt Street *Anchorage 99507 Current Property owner(s) Pat & Patricia Acosta Day phone 310-3817 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: © Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer Waiver/Variance request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ o� Date of Payment 512 I Receipt Number © 9 / S -5 G COSA # _n S C ; 11 2 (� Date: Waiver Fee $ Date of Payment Receipt Number 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. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 i Engineer's Printed Name: JeffreV A. Garness Date: b v/)-2-1 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD -SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the followin #AECC884 \QP�1ZY 0F( 01 ON-SITE WATER AND m c pu r_v, ATER z; PROGRAM rO1 9 "v)_SER\AL - :1'- Original Certificate Date: (:�, ' / r � % 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. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: HYATT ESTATES; BLOCK 2, LOT 3 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑® Well log is filed with Onsite (or attached) Date drilled '968 (?) Total depth *64.2+ ft { Cased to UNKNOWN ft Sanitary seal is functioning correctly [� Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 5/8/21 Static water level at beginning of test 16.6 ft. Comments *PER GEG INSPECTION B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ax) Measured depth to pipe invert from gr e ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to botto of effective. If not, state depth into effective ❑Code required s 'cover over field El Sys tem pr baked (Required ' acant for greater than 30 days prior to (2Fvt 5%6 61t 12 7 Parcel ID: 014-101-04 CT Structure served by this system _ Well production at time of test 4.2+ gpm Water storage tank volume N/A gallons Wel /disinfected for coliform test? E]Yes N Nc Coliform bacteria is Negative Nitrate mg/L - [Nitrate less than MRL (ND) Arsenic (o >ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 5/7/21 C. LIFT STATION ❑ Required maintenance Age of lift station Lift station material Comments: rs Adequacy test date Results ❑Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) date of st) If yes, enter date ilons introduced gallons Omments/Def ciencies: AWwU SEWER COSA Checklist yellow sheet 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' N/A Community Sewer Manhole/Cleanout > 100' 50'-+- 7 Yes if No ft ❑ Yes if No ft Neighboring Tank > 100'✓❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No *UNK ft Absorption Field on Lot > 100' ❑ Yes if No N/A. ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑✓ Yes if No ft ✓❑ Yes if No ft ❑ Yes if No ft If septic tank is under driveway comment below 50 Manure/Animal Excreta Storage > 100' Building Foundation > 10' ❑ s Community Sewer Main > 75' ❑ Yes if No ft [71 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes o ft Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑ Yes if No ft Private Wells _ 0' ❑ Yes if No ft Water Main > 10' r-1 Yes if No ft unity Wells > 200' Yesif No ft P��N�IC Water Service Line > 10' ❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please e r distances if less than required) Building Foundation > 10' ❑ s if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water S Ice Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft 96, rface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS yr q, *NO REQUIRED SEPERATION AT TIME INTAI I_ATION G. ENGINEER'S CERTIFICATION 1 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 #AECC884 J J In ff t'� ti N � CL 1 C GO cr------- m = — -- t ` v fi 11 � Fn t t � t K) t U_ z3: Oo zJ m U• In ff N � CL C GO cr------- m = — -- v fi 11 � Fn t 11 I zJ m U• NOW un 0 I tJ !pQ o N S I I 3ON33 4- ,"O,8WN N I I I I 1 o 1 I I ON�- ,-.---.-r.— In ff Municipality of Anchorage Pipe Types ABS Acrylonitrile -Butadiene -Styrene AC Asbestos Concrete CC Concrete Cylinder CI Cast Iron CIPP Cured In Place Pipe CMP Corrugated Metal CN Concrete CU Copper DI Ductile Iron FC Formed Concrete GI Galvanized Iron HDPE High Density Polyethylene MLC Mortar Lined Concrete PE Polyethylene PVC Polyvinylchloride RC Reinforced Concrete ST Steel TC Techite LINK Unknown VC Vitrified Clay WS Wood Stave WST Welded Steel NP No Print 40186 Private System N 0 150 300 Feet Map Created: 01/12/2021 Legal: SE 1/4 Sec 5 T12N R3W •r l+nJ -�” 8DI 4593 10187 3957 tx0 0 Q 3792 O N cV _ - O O .O _ CO 16396 soo 8DI 10047 LO CO �p �'i 4581. N _74thAv=n e \0 3669 �� �� 4704 5780 10DI 10048 v -- --- IQ �. ro wr, < 8DI `.. -4582 - 8DI __ 7ethMenc tib :10048 . M N i� 0 00 0 40186 co co ���, .. _. .. ..:_._ ...I^. LO t o....a a 8DI ti t i� _ 00 .... n (b: n:,r. � , O h� to e •� ;, ti E d _. > s,7 p M 00 N7 / > _ ; 00 o 8DI T r5 3792 !� : , t.�,a Lin Circe b, i... ;.: . 5533 ti _. K,EUNACRES 714, 1t _8DI = _._ __. - _ 8DI 8DI ' ,:., 5.543.... _ 10187 3957 tx0 0 Q 3792 O N cV _ - O O .O _ CO 16396 soo 8DI 10047 LO CO �p �'i o �a 8DI _ Nnb � 12195;1,3 Wastewater Collect 4581. N _74thAv=n TODI 5780 10DI 10048 -- --- wr, < 8DI `.. -4582 - 8DI __ 7ethMenc tib :10048 . M i� 0 00 0 40186 co co LO t o....a a 8DI o �a 8DI _ Nnb � 12195;1,3 Wastewater Collect stuawwo:) JO i ca b M L O 4— z A3I-lti i-_ His 0 aloyuow 10.+Ju03 }o u011030-1 Mot's gOi8� S ,(g 11011030-1 GUI-I @OIAJa5 11233dO8d NO,, . . SERVICE CONNECTION RECORD Lot.. Date | ne— 60 � ` Block inspector ' ' Subdivision or Add itio Property Owner tr. Address HaterSizepermit YesNo#_______ lewerSize 4 Permit YesN U________ LOCATION SKETCH 01 1-f-101—ov t 6.t _ 3 0 • NOJ A19 ONOO -:]SH h1S Z T ._.1-7 __ l� i SO I .5 0,5, nn d4 Q4.3 4a ; a O 0 r LL - 4 -'A 71 • O` d� ra 4-3 el I} A 'L3 Pam 1��,(s�..;��,•�'�J�t�s® � M LO o rn - r -f C6 4.3 m ol +?S�too G? d 9 to a o s, s«-tH o to ria OMv r P4 U Q v y 3sW 0 w,JCI ,G m Cd 4-� .ri 41) X m Ci rd vi C, - i cD �1 44al r f R Q r-! U 4 h r -i V2 G 0i El d a o rd o s4 d c . P-4. ° V. o ,43 bo vd 2J 0 Uri F4 H r -i ,C M > U O o v A -a r-{ t� cCc�.) d 03 o ' vi tq omi -u ,mi "'-i (;.I .0 G z r a -P ® R v o m,� t7 C ci cis S-4 cd 04-) H r� m CS U a H St d 0 04 o i 4a +� odo m , s : •d t� bO ins 43 -P d .?: cis U 4i ri O U S� 43 %+ t1 O U ci ® -P i~ P U ® >~ o -i-D Cd 5 e 7 i+ O 4-) s� O®as~ • CC _ 4 a p P, � y - � ° p� ov Cd m ,C � La H ci « 143 m q , � M LO o rn - r -f C6 4.3 m ol +?S�too G? d 9 to a o s, s«-tH o to ria OMv r P4 U Q v y 3sW 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. 01q -101 - 09/ 1. GENERAL INFORMATION HAA # D30 Lk'�; 1 Expiration Date: 1,2- -S 0 3 Complete legal description Let 3, B /v c k K y Yu ft- Z;Ii5 ESk-C)+Q_�S Location (site address or directions) Community Class Well 690 6 /fxa 14 SA Current Property owner(s) lc%r_tc&7 4. Crunps Day phone 7 /- 3 Y37 Mailing address 6906 /-/yacf-f S40 kncAorQ'!�le. Ak 99s -o7 Lending agency Fe rrf Atu f l Qun L; Day phone '2'7e<-6'300 Mailing address P.O. a& >C jeo 7 20, AncAc,recM, Ak 99St6 Real Estate Agent Along - I .S 6d Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. P t -ease 'car /t co w n e r @ 3 411 --T1137 2. NUMBER OF BEDROOMS:'" 3. TYPE OF WATER SUPPLY: Individual Well 19 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank ❑ Community On-site ❑ Public Sewer 19 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of Installation. Name of Firm Flo kyr %c4o/7i«/ Sfr;fror Phone Sys -/3s5 - Address / IYS 30 E ctio SA, An c6orrrye, A --h 91S -115e Engineer's Printed Name - �iAeoG9c1z' P. r -+core Date Sep/. 2' Zoo T ryy� �.••••'•�' f, ENGINEEF !; �' ;' -f! '•.:` 'TAMP 5. DSD SIGNATURE4;v •; •• • •Y:••;.*.•.- �• �� *TKEODORE F. RSOORE ; Approved for _ bedrooms. • : CE • 3589 •.~ �' • i {„moo • • .., Disapproved. `' f.%Y�r"", •N,z."Y a Conditional approval for bedrooms, with the follow ing'stipulations: Additional Comments ttt�tiV i ON-SITE •: -kILINMINU 11I STEWATER rcu�t�AM �/JJJ1))tI Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: " $ " 0:3 (Rev. 12100) Municipality of Anchorage ' Development Services Department t :r t t 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 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L o P 3 /oc Is 2 11tx e Parcel ID: A. WELL DATA Well typeP✓f. . If A, B, or C provide PWSID #t/. A. Well Log (Y/N) N Date completed 1966 " Sanitary seal (Y/N)Wires properly protected (Y/N) Y Total depth 93 ft. Cased to_ft. Casing height (above ground) 2,y in. FROM WELL LOG AT INSPECTION lDate of test 8/ fl / u/U3 Static water level ft. H / ft. i Well production 9.p -m- 7 + g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 ml. Nitrate 40.1 mg.11. Other bacteria 0 colonies/100 ml. Arsenic: — mg./l. Date of sample: Collected by: Fla Fk►n itc4 S"C W'—Z'7 / 0? j B. SEPTIC/HOLDING TANK DATA AJ 4. C A u/ wu Tank Type/Material Date installed Tank size gal. Number of Compartments _ Cleanouts (Y/N) j Foundation cleanout (Y/N) ` Depression over tank (Y/N) _ High water alarm (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA P. A. b4ww44 Date installed Soil rating (g.p.d.M2 or ft2/bdrm) _ System type Length' ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area ft2 Monitoring tube Depression over field Date of adequacy test Results (Pass/Fail) For _ bedrooms Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in. Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date i D. LIFT STATION N• h - Date installed Y Size in gallons Manhole/Access (Y/N) "Pump on" level at _ in. "Pump off" level at _ in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? _ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot _N• A AU-1wa Secue1) On adjacent lots V. h. Absorption field on lot N• A• On adjacent lots N• A• Public sewer main * SS Public sewer manhole/cleanout IIS -0 Sewer /septic service line > 25" Holding tank N. 14. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: N• A. Building foundation Property line Absorption field Water main Water service line Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: M A. Property line _ Building foundation Water main Water Service tine Surface water _ Driveway, parking/vehicle storage Curtain drain Wells on adjacent lots F. COMMENTS �t .�retra{Tdn pcUrernCl ukY ��Gr � �.+iC SP...4�Cr' fJt/iX inf%a//ro/,n 19�j G. ENGINEER'S CERTIFICATION 1 certify that l have determined through field inspections and `�' •�� " •'• `' t ♦ i i• PS' 1 review of Municipal records that the above systems are in `� • T}I °. ' "v P y conformance with MOA HAA guidelines in effect on this date. n ................ ..:,...� ?X F. Ptvc,.-� .................... Engineer's Printed Name epp/dee f)0 �l �THEODOPE F. MOOREDAf Date 2 ?.00 3 CE - 35Eq HAA Fee S 37i Waiver Fee S Date of Payment 9 /3 /0:1 Date of Payment Receipt Number L Receipt Number (Rev. 12/01) Sop -02-2003 11:14im yll.' Walden L Crapps 69W Hyatt From - T-226 P.001/001 F -T60 NORTHERN TESTING LAQ®RAT®MIES, INS. 3334 INnOSTRIA1, AVENVF FAIRBANKi, ALASKA 99101 (9011156.3114 - FAx .IS6.317S 5761 611NERACQ WAY; UNIT N ANCHORAW , ALASKA "SIE 1937) 349 1(00 • FAX 3.19.116 rpUCM ;40043 FRUGHOE BAY, ALASKA99734 19071 ee7.2teR. FAA AS9 2116 DRINKING WATER ANALYSIS REPORT FOR COLIFORM BACTERIA Anchorage AK 99507 Phone Number: (907)3443437 Fax Number. Collected by: TFM Sample Type. Untreated Routine Date Received: 8/27/03 Date Analyzed: 8/28/03 Date Reported: 9/2/03 Next Sample Due: Time Received: 16:30 Time Analyzed: 11:55 Time Reported: 11:19 Comments S a Satisfactory U = Unsatisfactory POS = Positive Test Result ND = None Detected TNTC = Too Numerous To Count (>200 Colonies) CG = Confluent Growth Method of Analysis: Membrane Filtration (SM 922Y 8) HSM = Heavy Sediment Maskinq, Results May Not Be Reliable TLIT = Sample Age -30 Hours, Too Long In Transit Comments: R = Resample Requited NT = No Test 4 V Colonies/100 ml w Colonles/mt Sample Sample Total* Fecal* Other* HPC— Date Time Coliform Coliform Bacteria Result Lab# location Comments 8/27/03 15:45 <1 <1 <1 NT AX4260 L3. Bik Z Hyatt Sly Sacs wkwy Ke" A. Lrich EmirmftnWAnalyst Orl/Ocf Nor0wrn Tasting Laboratories, Inc Aro0mrage, AK SGS Ref.# 1035010001 Client Name Flattop Technical Srv. Project Name/# Hyatt Est L3, B2 Client Sample ID Hyatt Est L3, B2 Matrix Drinking Water All Dates/Times are Alaska Standard Time Printed Date/Time 08/13/2003 16:53 Collected Date/Time 08/11/2003 13:00 Received Date/Time 08/11/2003 13:40 Technical Director Stepn C. Ede Released 01�/" Sample Remarks: Allowable prep Analysis Parameter Qualifiers Results PQL Units Method Container ID Limits nate Date ]nit Waters Department Nitrate -N 0.100 U 0.100 mg/L EPA 300.0 B (<=10) 08/11/03 JJB Microbiology Laboratory Total Coliform 20 OB, No Coli cot/100mL SM189222B A (<=1) 08/11/03 JS i V) vat o. O A/0 /O' Uii/, -.3 - ped F•-a..-�� f�ouri N /V0,67J W - /SS.00' 74 AS -BUILT SURVEY a O I hereby certify that I have surveyed the following described property: LOT 3, BLOCK 2, HYATT SUED. as recorded in the Anchorage Recording Precinct, Alaska, and that the irT.rovements situated thereon are located as shoem on this plat, and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska, this 13th day of Jan. 1969. OF Al, %I Fre ..s at a, .. eg s Bred ng neer F, 4P Fred Palatka & Associ-utes ,A .n.NO.1267•E ; Q/ well lt-*Cee/L 7un Engineers & Surveyors O -4. ;Pfi '�v4; 0/11 a T�K`�Ancho�tAvenue age�Alaska99503 +1,1`S�IO14AL S;44 i