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HomeMy WebLinkAboutJOY LT 1 NAME ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL D E~)?ON LOCATION DISTANCE TO Iwe"lZ ' Ma.ufact.,'er 47/~ c~-~_ IF HOMEMADE Well Absorption area Inside ,engt~/~ Dwelhng '7'7 NO OF BEDROOMS Dwel h ng ~¢. / M at er i a~,~_~_~._ W~dth L~qmd depth PERMIT NO L~qu~d capacity ~n gallons Manufacturer Well DISTANCE TO I~,~~' No of I,ne~ Length~_~.ch hne of tile to fin h grade Length Type of crib Well DISTANCE TO W~dth Crib d~ameter ~// Mater~a] F o uiiat~n, Neare~ne Total length of h nes I ~S- .~'_Trgoch *~'~w~), ~ Mj~t~Terl¢ beneath tile Depth Class Depth Drdler Budding foundation Sewer hne DISTANCE TO Dlstan~etween hnes Total~c~abs~n PERMIT ITO ;r~b depth Total effective absorption area Budding foundation Nearest lot line Distance to lot hne Septic tank PERMIT NO Absorption area(s) OTHER PIPE MATERIALS ~.57-A4 .0 2 7 2'7 soil · EST RA TI INSTALLER REMARKS APPROVED DATE LEGAL DEF"ARIMI['.NI" OF HEALTH AND Ei',IVIROINIME]xlTAL F'ROTECF1OINI ~ ,~_..,'~..~ 825 L ol REE T, (II ICHOFd~GI:=., AK 99':"1C~ J 264-4720 ~ ~ · ~ERMIT NO: DATE ISStI[:D: -~PPL i CANT: 'qDDRESS: ~.ONTAC 'r F:'HONE EGAL. DES(]RIP: mOT SIZE: ~IAX BEDROOMS: 8409 16 J 0/?9/84 SF'ECIAL I< BIJ]LDERS F:',,O. BOX 2055 EAGI_E R fVI."]R,~ A~:: 99577 344-8042 SIIBDIVtS1ON: JOY SFCTI[]N: 8 TOWNSHII": t5N 1,,25~ (SQ.FT. OR ACRES) LOT: ~ BLOCI.::.: I'.IA RANG[:: [W DEPTH TC) P1F'E BOT10M (r T.) ~ 0 *~ 4. r, 4.0 GRAVEL DEPYH (FT.) 2.5 O. 5 I,,5 ~OTAL DEPTH (FT,,) 5.5 4.5 5,5 ~hRAVEL WIDTH (FT.) 2.5 [zl.O 5.0 SRAVEL LENGFH (FT.) 5J.() 28.0 40,0 GRAVEL VOLUME (CU,,YDS.) [4.2 ~4, 6 I4,,9 ~ANI',:. SiZE (OALS) 1,00").0 ~ 1~000.0 ~ 1~00().0 ~ SOIL RATING (SQ.F]'~ /BR) 85 85 8b DEF:'FH FO F"]I::'[" BOTT[]M ¢ 3.5 F]. REQII]I~ES TNSULATION DEPTH TO PIPF BOTTOM :: 4.0 F"T. MAY RE"[}UIRE A LTFT STATTON ** TANt< MUST HAVE' Al' I.[.AST TWO COMPARTMENTS I cer't~£y that: ~. I am ~amz]~ar w~Lh the requ~remenLs ~c:h' on-'-s~Le sewers and wells as se'~ for'Lb by ~he Mt..tnzc~pa] ~ty of Anchor'aqe (MOA) and the Stale o~ Alaska. 2. I will ]nsta]J Lhe ~:,ystc*m in aLcordance w](h all IdOA codes and rogula't and ~n comp1 lalq6~ w~th the design c:r'~ten~a of this por'm~t. 3. I will adhere, Lo all MOA and Slate of Alasl.:a r'equJrement~", For ~l'~o s(:.~,L back d~stances ~rom arty ex~st~ng well~ wastewa't, er' d~sposa] sy,stom of pul-)] sewoPage sy~,tem on thzs or any adJaCent or near'b/ lot. 4. I understand that Lhzs porm]t Is vat.id For' a max]mum of % bedrooms and any 6~n~:~rg¢~fflon{ Wl ] ] I"eqLllre~ an add] ( ~onal IF A LIFT STA]ION 1S INSTAI_L[FD TN AN AREA COVERE13 .PY MI]fi BUfLDl140 PODES. THEN (1) AN IZLECTIR1CAI. PERMZF hND INSPECTION MUST BE OBThTN[:O~i (2) AS-BUlL FS 4ILL NOT BE APF"RO~ED WIfHOU] AN EL EPTR]CAL INSPECI ION RIZt':'OF~t:i AND ('~,) ]FIE"' ELECTRICAL WOR[:: MLIS]' BE DONE BY A L.,[CENS[.D ELECI"R[C[AN. ISSUED BY ~. & ENG~,~EERS, INC. 1125 OLD SEWARD HIGHWAY ANCHORAGE ALASKA 99502 (907) 349 6561 PERFORMED FOR ~P~' f'~ /'' 13-- 14-- 15-- 16-- 17-- 18-- 19-- 20-- DEPTH (FEET) COMMENTS__ 4~---'---'~ ~) SOIL LOG SOIL LOG v" PEROO'AT,O. TEST PERCOLATION TEST BEDROOMS DATE PEREORMED SLOPE SITE PLAN I w E s~ WAS GROUND WATER L ENCOUNTERED'~ --~-' O P E IF YES AT WHAT ! DEPTH? (~t ~"" Gross Net Depth to Net Reading Date T~me T~me Water Drop ---~, PERCOLATION RATE__V TEST RUN BETWEEN j - FT AND __ /~ FT / CERTIFIED BY DATE MUNICIPALITY OF ANCHORAGE SOILS LOG  825 L Street, Anchorage, Alaska 99501 264~720 SOILS LOG - PERCOLATION TEST PE"FORMED FOR '~ ~0~-- ~ ~ ~ DATE PERFORM~- ~ '~ ? LEGAL DESCRIPTION / -- / ~ ~ ~ ~/~ ~ / / SLOPE SITE PL~~ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 18- 19- 20- COMMENTS 72-008 (6/79) WAS GROUND WATER ENCOUNTERED~ ~'~ IF YES, AT WHAT DEPTH7 Gross .//Net Depth to Net Reading ate T~me J Time Water Drop , :/ PERCOLATION RATE ~{mlnutes/mch) FT AND , FT .T.~ST RUN BETWEEN CERTIFIED ~/ DATEJ~~¢ Th~$ well ,s prorJuc~ng/d.--'~ 0ello~'C~dte~ per hour ' I / Set pump ~et INVOICE NO ~^,~ ,///-? ,,__- ~- YOUR P 0 NUM~ItR SALEJMAN Sub '~"~ /, WELL LOG _,__ .'C~.,-----.~ ,o,- i~''- -~-:o=: 't~ ~Oe F:~ ~ ~' ~lO ato- / ~ -113 213 W '114 ~14 ,tk ~LI V rlJ ' 116 216 -- 11e 216 ' "" ISS ' t~8 228 100 ' ~L~ "'133 283 ~ ,, i~ "130 ~-- 237 ' , .~ ,,, 241 /-; ~ ~ &~ 141 - , '" 140 ~ / ;- ,. , .. ' W;'%~~' , [ v 240 / ~ 1~ -/ , ' 260 /.~ ~ . ,. / 161 ~r ~61 ~ ~ 16s ,, ~ ~ ) 262 1./~<e ]$s / ~t r~'l ~ ,,'"ssa2~ , 166 ~ ~ , ,,, 1~ ~ . 17o 210 1~ 272 ' 170 ' " 219 y it- / Ill ' I ~/' t ,.=' 1tl 298 · 194 294 - 196 206 106 ~ 296 -. i ~ 108 298 PLEASE PAY FROM T~S INVOICE . / -~ DFZF:'ARFMLN]" OF t.-IE'ALTH AND FNVJF;'(')t',tMFZNTAI PF:OT['"CTr.OI~ 825 [ S]RI'-F !",, AI\ICH(IRAGL'., Al':: 995()1. ;)6q - q/20 PERM] ] NO: 8q0967 DATE. ISSI APPLICAN]: ADDREGS: I'"'. 0,, BOX 2055 FAGL L R ] VIFR ,, At... CON FACT PHOIxlI[': 694-9125 995 ? ~ cer';L~ f y For'th by Ll~e Muntc~pa]~t.y of f~n~hor'age d~OA) and Ihe SL"~Le c)f A]a~l..~. [ will. ~nsta11 Lhe sy,lem ~n ac(:o~(luncm w~tl~ all MO~ ( ('~cJ[.~¢.., and arid ~n comp1 ~ar'l(.r, w]ll~ file cJes~qn ,"[']te~ta of this pc'mm~t, J ~11 aclhmr'o 'IL) Ct]l HOA and S'I Mc', (::)~ AJasl..a PF,~qL~I"eIiI~::.q"IL~.. ~t.)l'~ CJ'lf~ d]slal"tces ff'(:)i~ any o:.'lsL~r~g well,, we~sLewal.~,P d~c~posal s/st(,:~m or public S ] gtxlED AH'F'L. I (]AN F: ] SSLIFD BY MUNICIPALITY OF ANCHORAGE ~ . -~ .~ Department~ Health and Envzronmentalk~otectlon ~ 825 Street, Anchorage, AK. 99501 264-4720 ~ ] * * * HANDWRITTEN PERMIT * * * I Permit # ~l~ I , PERMIT /_ WELL Applicant: _~/~ / Location: Legal Description: -~d9 9 Type of So~l ~sorptzon S~stem Is: Trench: Dralnf~eld: Maximum Number of Bedrooms: _~ Mailing Address: Phone Nuraber: ~ Lot Seepage Bed: __ Holding Tank: So~i Ratlng(sq.ft/br) The Required S~ze of the Soil Absorptzon System Is: DEPTH C%) LENGTH 0 GRAVEL DEPTH (9 WIDTH The length dimension ~s the length(zn feet) of the trench or dralnfzeld. The depth of a trench or p~t is the d~stance between the surface of the ground and the bottom of the excavation(~n feet). There ~s no set w~dth for trenches. The gravel depth is the minimum depth of gravel between the outfall p~pe and the bottom of the excavatzon(ln feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE : /~/~ GALLONS * * Permit applicant has the responsibility to ~nform th~s department during the I ~nstallatzon mnspectzons of any wells adjacent to thzs property and the number i of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system w~thout f~nal inspection and approval by th~s department will be subDect to prosecution. _M~nzmum distance between a well and any on-szte sewage d~sposal system zs 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum d~stance from a private well to a private sewer l~ne is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to th~s department within 30 days of the well completion. Other requirements may apply. Specifications and construction d~agrams are available to ~nsure proper ~nstallatmon. * * * PERMIT EXPIRES DECEMBER 31, 1 9 * * I certify that: (1) I ~ f~llar with the requirements for on-site sewers and wells as set forth by the Munzclpallty of Anchorage. (2) I w~ll install the system ~n accordance with codes. (3) I understand that the on-s~te sewer system may require enlargement the residence ~remodeled to ~nclude more~ ~~~~-a-~,~-'~ edrooms. Slgne~: ~ Issued by:~ Applicant/~-~ / Date: SWP/024 (1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES D~wsion of Enwronmental Services On-S~te 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 -/~"~" - 5'".~ ~ haa # ~l ('~0~ ~('~/~'~l~(~ 1. GENERAL INFORMATION Complete legal descnpbon Locabon (rote address or d~rect~ons) Property owner Malhng address Lending agency Day phone Day phone Mmhng address Agent Ad dress Day phone Unless otherwise requested, HAA will be held for p~ckup NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Ind~wdual well Commumty well NOTE Pubhc water If commumty well system, prowde written conhrmatton from State ADEC attest- ~ng to the legahty and status of system TYPE OF WASTEWATER DISPOSAL' Indlwdual on-rote Holding tank Commumty on-rote NOTE 72-025 (Rev 1/91) Front MOA #21 Pubhc sewer If commumty wastewater system, prowde written conhrmat~on from State ADEC attesting to the legahty and status of system STATEMENT OF INSPECTION BY ENGINEER As cerhfled by my seal affixed hereto and as of the vahdabon date shown below, I verify that my mvesbgabon of this Health Authority Approval apphcatlon shows that the on~site water supply and/or wastewater d~sposal system ~s safe, funcbonal and adequate for the number of bedrooms and type of structure ~nd~cated here~n I further verify that based on the ~nformabon obtained from the Mumc~pahty of Anchorage files and from my ~nvesbgabon and mspecbon, the on-rote water supply and/or wastewater d~sposal system ~s ~n comphance w~th all Mummpal and State codes, ordinances, and regulabons m effect on the date of th~s ~nspect~on Name of Firm David R. Dayton P.E. Phone 20210 Donalar St. Address Chugiak, Alaska 9,~67 Engineer's s~gnature / Date DHHS SIGNATURE ~/~.. Approved for "~~J bedrooms D~sapproved Cond~bonal approval for bedrooms, w~th the following shpulabons Additional Comments The Mumc~pahty of Anchorage Department of Health and Human Services (DHHS) ~ssues Health Authority Approval Cemflcates based only upon the representations given in paragraph 5 above by an ~ndependent profesmonal engineer registered in the State of Alaska The DHHS does th~s 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 ~s issued The Mumc~pahty of Anchorage is not responmble for errors or omissions m the professional englneer's work 72-025(Rev 1/91) Back MOAi~21 Mumclpahty of Anchorage Department of Health and Human Serwc~es HEALTH AUTHORITY APPROVALCHECKLIST Legal Description A Well Data Well type j~&l ~'~,-rE- Log present (Y/N) Total depth Samtary seal (Y/N) If A, B, or C, attach ADEC letter ADEC water system number Date completed /')/E'~ Dnller /V~.~O ~'~C)'f- Camng height ~" W~res properly protected (Y/N) 'Y' Cased to Y Stabc water level (~ / Well flow ~ ~:> Pump level1 /,t~-. SEPARATION DISTANCES FROM WELL TO Sepbc/hold~ng tank on lot Absorption field on lot Pubhc sewer mmn gpm Sewer service hne AT INSPECTION ~' gpm , On adjacent lots , On adjacent lots Pubhc sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS Cohform O N~trate Date of sample Other bactena ~:) Collected by ~ B SEPTIC/HOLDING TANK DATA Date installed /~ / Cleanouts (Y/N) Y H~gh water alarm (Y/N) Tank raze I 7_ 5"'~) Compartments '~- Foundation cleanout (Y/N) ¥ Depress!on (Y/N) A,)//'J- Alarm tested (Y/N) Date of pumping Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO Well(s) on lot I 7~' On adjacent lots /'0 ~'~-- To property hne ~ '~ Absorpbon field Surface water/drmnage I Foundation ~= ~/Z Water maln/servme hne CONTINUED ON BACK PAGE 72-026 (3/93)* Front C LIFT STATION Date installed S~ze ~n gallons Vent (Y/N) H~gh water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO Well on lot On adjacent lots Surface water D ABSORPTION FIELD DATA Date ~nstalled / Length -~; © W~dth Total absorption area Date of adequacy test Water level ~n absorpbon field before test Peroxide treatment (past 12 months) (Y/N) Sod rating (GPD/Ft2) ~..h' ~ ¢/,¢/4 Gravel thickness Cleanout present (Y/N) )/ Results (pass/fad) :~'¢:~'~ System type ¢, .b Total depth Depression over field (Y/N) for After test If yes, g~ve date Bedrooms Well on lot To budding foundation On adjacent lots Surface water Curtain dra~n SEPARATION DISTANCE FROM ABSORPTION FIELD TO /'/'¢~ On adjacent lots / ¢'~/- Property hne /~ '¢- ///' To ex~st~ng or abandoned system on lot /'¢>'~/- Cutbank /f-J~-' ~- Water main/service line /'~ ~' ~ Dnveway, parking/vehicle storage area ~ ,'~ E ENGINEER'S CERTIFICATION Dawd R. Dayton P.E 20210 Donalar St Signature ,., ...... I cerhfy that I have checked, venfied, or conformed to all MOA and HAA gu~defines I¢¢ effebt on the date of this inspection HAA Fee $ ~_ 7¢ ( ) ~:_ ) Date of Payment 72 02g (3/03)~ Back Waiver Fee $ Date of Payment Receipt Number D. R. DAYTON, P.E., 9956? 20210 Donalar October 21, 1993 _WELL FLOW TEST Legal Descrfptfon: Lot 1, Joy Subdivision Date of Test: October 21, 1993 Well Depth: 104' Static Water Level: 5.8' RequlrementS: FHA - 3 gpm for 4 hrs. Test:T~e well was tested with the exl¢lng pump through an outslde hose bib. Volume and~drawdown wer~asured at regular intervals. rate of 5.7 gpm. Results: The well produced 1363 gallons ~n 4 hrs. at a The maximum drawdown was 15'. The well fully recovered w~th~n 10 m~n. after pumping was~stopped' The well ~s currently producing adequately for a 3 bedroom home. D. R. DAYTON, P.E., R.L.S. ~:~J~l~)~l~ Chugiak, Alaska 99567 20210 Donelar 696-2417 October 21, 1993 ADEQUACY TEST Legal Description: Lot 1, Joy Subdlvzslon Date of Test : October 21, 1993 Septic Tank: 1250 gallon, 2 compartment, steel tank Absorption System: 15' x 30' bed Soils Rating: 85 sq. ft. per bedroom RequIrements: 3 BR -450 gallons per day Test: Water was pumped into the seepage bed whlle measuring volume, time and water level r!se. A After pumping was stopped, the water level drop was measured. Results: The seepage bed accepted 677 gallons w~th no r~se in the water level. The monitor tubes were dry at the start of the test. After the test, the tubes were slightly wet. The depth was so slight it was not measurable. The system is currently functioning adequately for a 3 bedroom home. BORATORY SERVICES Chemlab Ref.# :93.5587-! Client Sample ID :L1 JOY SUBD. Matrix :WATER Client Name :DAVID DAYTON, P.E. Ordered By :DAVID DAYTON Project Name : Project# PWSID :UA REPORT of ANALYSIS 5633 B STREET ANCHORAGE AK 99518 TEL (907) 562 2343 FAX (907) 561 5301 WORK Order :72336 Report Completed :10/22/93 Collected :10/19/93 @ 20:00 hrs Received :10/20/93 @ 12:00 hrs Technical Director:ST~FHl~N ~ EDE ,. Released By .'~ ~ Sample Remarks: ROII~I[~ SAMI~ COLLECTED BY: D.R.D. gc Parameter Results Qual Unlts Allowable Ext. Anal Method Limits Date Date Inzt Nitrate-N 2.69 mg/L EPA 353.2/300.0 10 10/21 LLH * See Special Instructions Above ** See Sample Remarks Above U = Undetected, Reported value is the practical quantzfication lzmit. D = Secondary dilution. ~SGS Member of the SGS Group (Soclete G~n~rale de Surveillance) UA = Unavailable NA = Not Analyzed LT = Less Than GT = Greater Than ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA Parcel I D # {~ MUNICIPALITY OF ANCHORAGE Department of Health & Human Services ~ DIVISION OF ENVIRONMENTAL SERVICES 343-4744 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 lot, block, subdlws~on, secbon, township, range) Lot I; Joy Subdivrsion Locabon (address or dlrecbons) 19950 Scenic (b) Property owner Sharon Minsch (c) Telephone (home) 4,~8-904,~ Bus~ness 694-4~00 Mad~ngAddress p. 0. Rny A70717 ~h.g./nb; A~. 9q~;~7 Lending Institution qCm~].Cy T].¢~¢. Telephone Mad~ng Address (d) Real Estate CompanyandAgent Rp_./M,~x nf F,~g~?_ ~_z,,~,~ ATTN~ qb~O~ ~]~q~ Address 16~¢ ~n~f]~d D~,,~ ~20~ F~g~ R,u~. 4k~ q9577 Telephone 694J~ 20 0 (e) Mad the HAA to the following address (or check herex~, ~f hold for p~ck up ) L~st contact person and day phone number below S & S ENGINEERING 17034 Eagle R~ver Loop Road Eagle Rwer, Alaska 99577 TYPE OF RESIDENCE ,/' S~ngle-Famdy~ Number of bedrooms 5 WATER SUPPLY Ind~wdual Well.~;~ Commumty [] Pubhc [] %Note' If ¢~mnl, pp},ty welJ system,, ~.ust have written con?rmabon from th, e State Department of Environmental Conservabon attesting to th I~gaht~"and status .... ~ SEWAGE DISPOSAL On-s~teJ~ Pubhc [] Commumty [] Holding Tank [] Note. If commumty well system, must have written confirmation from the State Department of Enwronmental Conservation attesting to the legadty and status 72-025 (Rev 7/88) Page 1 of 2 5 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ' As certified by my seal affixed hereto and as of the valldatmn date shown below, I verify that my ~nveshgatmn of th~s Health Authority Approval shows that the on-rote water supply and/or wastewater d~sposal system ~s safe, funchonal and adequate for the number of bedrooms and type of structure mdmated hereto I further verdy that based on the mformahon obtmned from the Munm~pahty of Anchorage files and from my mvest~gabon and mspechon, the on-s~te water supply and/or wastewater dmposal system ~s m comphance w~th all Mummpal and State codes, ordinances, and regulahons ~n effect on the date of th~s ~nspechon Name of F~rm Address S & 5 ENG!.HEER!NG 17034 Eagle R~ver Loop Road No 204 Date Telephone Approved for __ bedrooms b Approved ~ Dmapproved Condmonal Terms of Conditional Approval The Mumc~pahty of Anchorage Department of Health and Human Serwces (DHHS) ~ssues Health Authority Approval cer~flcated based only upon the representahons g~ven ~n paragraph 5 above by an independent professional engineer registered m the State of Alaska The DHHS does th~s as a courtesy to purchasers of homes and thmr lending ~nst~tubons ~n order to sahsfy certmn federal and state reqmrements Employees of DHHS do not conduct ~nspect~ons or analyze data beforeacertff~cate~s~ssued TheMumc~pahtyofAnchorage~snot responslbteforerrorsoromlsmons m the professional engineer's work 72 025 (Rev 7/88) Back Page 2 of 2 r.~ ~iqxd;~ ~ MUNICIPALITY OF ANCHORAGE (MOA) ~.?o~.~ ,,, (~'~) Health Author,ty Approval (HAA} OX,. ~ ~ ~// CHECKLIST - FEBRUARY 1984 ~p, O~v, , ~. ~ ~ 343-4744 %~ ~ ~ v Legal Sescr, pt,on ~e~ WELL D~~ Well Class,hcat~on ~; .... ~ ~ ~ ~, J u, If A, ~., O E C Approved - ~,0 ~. Well Log Present (Y~~Da~ompleled { 0 -- Z~ ~ V~eld (~ ~_ ~ , . Tola Deplb ]~ Cased ~o { ~ Depfh of Groulmg S1abc Wafer Level ~ ~ ~ Pump Sef Al ~_)~ ~ Casing He~ghl Above Ground ~ ~ ~ $amlary Seal on Camng (Y/N) Electrical Wrong m Oondu~t (Y/N) , ~ ~/ Depression Around Wellhead (Y/N) SEPARATION DISTANCES FBO~ WELL To Sephc/Holdmg Tank on Lo1 {~ ~ ' ~ , On Adjoining Lo1~ To Nearest Edge of Absorpl~on F~eld on Lot { ~0 ~ , On Adlommg Lot~ To PuU,o Une To P b ,o To Neare~l 8ewer Serwce Line on Lol ~ ~ + Waler Sample Collecled by ~ 4 ~ ~.~m ~ ~e ¢~ ~ , Date ~ - I ~ Water Sample Test Results ~ ~0'. -- Aa~f;A + Comments B SEPTIC/HOLDING TANK DA.~T.A Date Installed ! 0 Standpipes (Y/N) uI Depression over Tank (Y/N) Pumping/Maintenance Contact on Fde (Y/N) Holding Tank H~gh-Water Alarm (Y/N) ./_.~ =~"O No of Compartments A~r-hght Caps (Y/N) ~ Foundahon Cleanout (Y/N) fO Date Last Pumped _.~__. ~ ~] ~ ~'0 AJ//O, ,for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK To Water-Supply Well ! To Property Line To Water Mmn/Serwce Line ,/ To Building Foundation To Dmposal F~eld To Stream, Pond, Lake or Major Drmnage Course 72-026 (Rev 7/88) Front Page 1 of 2 C ABSORPTION FIELD DATA Sods Rahng m Absorphon Strata Date Installed W~dth of F~eld Length of F~eld ~:~ ~:2 Depth of F~eld ~ ~' Gravel Bed Thickness .... (9 Square Feet of Absortlon Area ~ ~"O" / Statndp~pes Present (Y/N) Depresmon over F~eld (Y/N) ~ Date of Last Adequacy Test Results of Last Adequacy Test___~'~-tz-'~ .~C-.'~L'C9¢~ -- .~ ~:>¢-~3/¢"O~ aA SEPABATION DIS~fANCE FROM ABSOFlPTION FIELD To Property L~ne ___ __Lo ¢' To Ex~sbng or Abandoned System on , On Adjo~mng Lots / OC) t~ To Cutback 0f present) ~h~ Fo Water-Supply Well __ _ / ~4' 0 To Budding Foundation ! ! '~ [ot To Water Ma~n/Serwce L~ne ! ¢ '/' To Stream, Pond, Lake, or Major Drainage Course ~Io Driveway, Parking Area, or Vehmle Storage Area Comments D LIFT STATION Date Installed '~ D~mens~ons _ S,ze ,n Gallons ~ Man,~ole/Acce:s (Y/N) "Pump On" Level at -- ~N..~ Pump Off Level at H~gh Water Alarm Level at __? ~' Vent (Y/N) Tested for ~.. __ Pumping Cycles dunng Adequacy Test Meets MOA Electrical Codes (Y/N) Comments **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 mspecbon S~gned S & S B'Nb~ ~ t ',' 11034 [ Company __ E~ Date _ _ MOA No _ _ Date of Payment t///O Amount $ _ Receipt No Waiver Fee $ Date of Payment 72 026 (Rev 7/88) Back Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ' >~-,~ FEDERAL TAX ID # 92 0040440 ANALYSIS REPORT BY SA~LE for Work Order ~ 1993~ Date Report Printed FEB 22 90 ~ 17 57 Client Sample tD L1, JOY S/D ?WSID UA Collected 2EE 19 90 e 15 30 ks Received FEB 20 90 @ 13 13 his Preserved with AS REQUIRED Client Name S & S ENGR Chent Acct SNDENG? P 0 $ NONE RECEIVED Req ~ Ordered By R SHAFER Analyszs Completed FEB 21 90 Send Reports to Laboratory Supervi$o~ ~TE?HEN C EDE 1)S & S ENDR Released ~y ~ & ~ 2) Special Instruct Chemlab Ref ~ 900154 Lab Smpl ID 1 Natrlx WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N 2 3 ~/1 EPA 355 2 l0 Sample ROUTINE SAMPLE Remarks SAMPLE COLLECTED BY RDJ Tests Performed ' See Special Instructzons Above UA-Unavailable None Detected "See Sample Remarks Above Not Analyzed LT-Less Than, CT=Greater Than 1. General InfO~mation ~ MUNICIPALII"f 0P ANCHORAGE ~ DIVISION OF ENVIRONMENTAL ~R. ALTH DEPARTMENT OF ~.ALTH AND EN"JIRONMENTAL PROTECTION APPLICATION FOR ~R. ALTH AUTHORITY APPROVAL CERTIFICATE Application Date February 19,1985 (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1 Joy Subd. Sec. 8 T15N Location (address or directions) Mlchelle Lane, North B~rchwood (b) Applicants Name Special K_ _Const. Applicants Address c/o GEOLAB 1131 E. (c) Applicant is (check. one) Lending Institution Buyer ~; Other [-----[ (explain); (d) Lending Institution Alaska Mutual Bank Ad~ss Telephone - Home Business694- 9125 76th Ave. %101 Anchorage, AK ~--~ ; 0wner/builder~; Telephone (e) Real Estate Co. & Agent Red Carpet-Great Land Realty Terry Krueger Address Mi. 14 Old Glenn Hlghway Eagle River (f) Telephone 694-9] 25 Mail the HAA to the following ~dress: c/o GEOLAB 1131E. 76th Ave. Suite 101 Anchorage, Alaska 99502 2. TTpe of Residence Single-Family~ Number of Bedrooms 3. Water Supply Individual Weil~--~ Multi-Family~--~ Other (describe) Community ~-~ Public ~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite ~ Public ~-~ Community ~-~ Holding Tank ~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] Ensineerin$ Firm Providing Inspections~ Tests~ File Search~ Data -~_ 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 re§ula- tions in effect on the date of this inspection. Name of Firm GEOLAB Address 1131 E. DaCe February 19, 1985 DHEP Approval~ Approved for ~t.e3 bedrooms Approved CoT~t Disapproved Terms of tonal Approval Telephone 344-8042 76th Ave. Suite 101, Anchorage, Alaska 99502 ~. -;- -~ . / I ? %7.'. 2~4~-~ .' ~-,~ Co~i~ion~ ~ADTION THE MUNICIPALITY OF ANCHORAGE ~EPARTMENT OF ~r~.ALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES m~.ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS 0R OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEF SKAL) RR4/eJ/Di8 [Page 2 of 2] 7-19-84 ae MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: Sec. 8 T15N R1W Well Classification Well Log Present (Y/N) Yes Total Depth 101 ' Cased to Static Water Level 2' Casing Height Above Ground 2' Electrical Wiring in Conduit (Y/N) Yes Separation Distances frcm Well: To Septic/Holding Tank on Lot 128' To Nearest Edge of Absorption Field on Lot 140' To Nearest Public Sewer Line N.A C!eanout/Manhole Water Sample Collected By Water Sample Test Results C~t~ents Individual If A, B, c~ C, D.E.C. Approved(Y/N) NA Date Completed lO1 ' Pump Set At ~ Q/22/84 Yield 15Gpm , Depth of G~outlng NA 10' Sanitary Seal on Casing (Y/NYes Depression Around Wellhead (Y/N)No ; On Adjoining Lots 100' + ; On Ad3olnlng Lots 100'+ To Nearest Public Sewer To Nearest Sewer Service Line on Lot NA DA Stanley ; Date 2/12/85 Satisfactory SEPTIC/HOLDING TANK DATA Date Installed 10/31/85 Standpipes (Y/N) Yes ~ze 1250 No. of C~,¥artments 2 Air-tight Caps (Y/N) Yes Foundation Cleanout (y/N)Yes Depression over Tank (Y/N) No Date Last Pumped new system not ~n use Pumping/Maintenance Contract on File (Y/N)NA ; for Holding Tank High-Water Alarm (Y/N) NA Temporaz-y Holding Tank Permit (Y/N) NA Separation Distances f~cm Septic/Holding Tank: To Water-Supply Well 128' To Property L~ne 63' To Water Main/Service Line Course NONE Co~,~%~nts NA To Building Foundation 84' To Disposal Field 23' To Stream, Pond, Lake, or Ma]or D~alnage Receipt ~ ~%?{oq~.~ Date Pazd: ~ -o9~ --~ Amount: H ,,~, ~;c~, [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption St. rata 85 sq.ft./BR Date Installed ] 0/~1/8~ Width of Field l 5 ' Type of System Design Length of Field 30' Depth of Field 3.5' Gravel Bed Thickness Square Feet of AbsorptIon A~ea Depression over F~eld (Y/N)No Date of Last Adequacy Test Results of Last Adequacy Test NA Separation Distance from Absorption Field: To Water-Supply Wall 140' To Property Llne 3d' To Building Foundation 117' To Existing or Abandored System on Lot NA ; On Ad]olnlng Lots 100' + To Water Main/Service Line NA , To Cutback( if present)hTA To Stream/Pond/Lake/c= Majo~ Drainage Course MA TO Driveway, Parking Area, c~ Vehicle Storage Area 25' Cora~ents . 45Q sc.ft. Standpipes Present (Y/N) ~ D. LIFT STATION Date Installed NA Size in Gallons "Pump On" Level at High Water Ala.r.:m Level at Tested for Electrical Codes(Y/N) Dime ns ions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Co~t~t~nts ** ** Check Permztted Bedroom Rating Against HAA Request I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. S~gned ~>~/>~-{~,~F Date , / , ~,/~ ~ .... Company~GFO1,AB~-- ! ( MOA No.sT 5-_~ [Page 2 of 2] 2~15-84