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HomeMy WebLinkAboutCABIN BY THE CREEK #2 LT 3Cabin B y The Creek #2 Lot 3 #015-521-44 Municipality of Anchorage Page / of 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 Permit Number: 5 L 9zo15'0 PID Number: S Name: f�f Li -t F/1 Wastewater System: D(New pgrade Address: ABSORPTION FIELD Phone: Q � 1�01� L L� �-It:.� I No. of Bedrooms: g U )CDeep Trench ❑ Shallow Trench ❑ B❑ed Mound ❑ Other LEGAL DESCRIPTION Soil Rating: f,5 Total Depth from original grade: 9 I4 0 4 GPD/Sq. Ft. Lot: Block: �aa -- Subdivision: Depth to pipe bottom from orij�anal grade: i r Gravel depth beneath pipe - [�R�i�J 8)e T1/L'' r� TV (v Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel length: �t //15 f1 Ft. Ft. WELL: %New ❑ Upgrade Gravel depth:/ & Number of lines: -7— Distance between lines: / Ft. /Z FL Classification (Private, A,B,C): P Total Depth: / L l Cased To: / Zo / Total absorption area: Pipe material: D � Ft. Ft. ! Ti to SO. Ft. Driller: /� , /ga a Drilled: Static Waaterr Level: Installer- / =Daleinstalled:4L 6t_ti A/,jtr V Z3 7z -4b Ft. HNA i4A anAt.- ! �Z Yield: I Pump Set at: I Casing Height Above Ground: TANK 10 GPM % T � !- Ft. Z Ft. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: / 6 Capacity in gallons: i _fv ` Z_ From Tank Field Station Tank Sewer Lines 1z,=� Well /S S A >/00 Material: 5T L --r— Number of Compartments: T—Ujo Surfacer Water ?Z,U() % ZOO >/rs-D LIFT STATION Lotr } qU ? �Y f ?/t:) Siz ons: Manufacturer: Line Foundation t �S : "Pump on" level at: "Pu " lev High water alarm at: Curtain Pump Make & lectrical Inspections performed by: Drain At/^ 'T �/^ +•t Remarks: BENCH MARK Location and Description: y� P ®'F L l-T�[_ ._ F-iZo, e Assumed Elevation: 00 Ft - 1�1/ 0 AtAl 7 7N G Z[< lJ Inspections performed by: � • � Dates: 1st v 7 era® ossa moos oes ee�sss L7/gzf s uenHSN ae•ae2nd ! E Anderson w% r1 ; Department of Heal h and uman Services approval =Fm��-�� Reviewed and approved by: Date:2� 72-013 (1/91) MOA 25 Permit No. sW 2150 Page -$ of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 a Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report 72'013 A (2191)', MOA 25 ...... ..... .... __ .,... ............. _ ... 1 .... _ _ , . _ .......... .......... , ; 0 _. MT i ............. ....... ........... .. .. ... ..... .... ... ... _. .�.. .... :.. .... ..... i. .... ':.. :.......... .. :. ..... .. : ... ...... .�. �6�� .. F �Q 4. vi GO s _ e gECf� 9®ebjb4coo GO: _. _._ ... _ ............... .......,.. .!...... .,t.. __. _.... .__.._ ., _. -.. ._.... _.® ••Gccres.e�e •. a ao... sA nm. / chael E. Ander n ' � i. �T a a. 4381.se �. ....... k _.�F'df•1...+«3ie��.g n ii r :J J �v+9A► 72'013 A (2191)', MOA 25 Permit No. L5w 9Z015n Papp 2 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 72-019 A IRw. 9/91) MOA 25 5_. 11-30-92 9:36 : AINCH JEEP EAGLE- 907 341 2130:$ 3/ 3 LOCATION OF WELL BOROUGH _ 'SUeON LOT BLOCK i C}« 3 LOCAT104WSKETCH: STATE OF ALAMA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WILL RECORD TECTUM; ATM WTION I Tft"W I RANOE I WW" ON OIL os ❑w WELL GINNER: • DEPTHS MEASURER FROM:Ocasing top Oground surface WELL DEPTH; OATS OF COMPLET; BOREHOLE DATA: Depth of hole; /(• / h Material Type and Color 08pthDep� of casino:�/ h / :2 3 / From To DEPTH TO STATIC WATER LEVEL: _k• -ft below [stop of casino ❑ ground surface �. /'7 Date: q ,G f: / S� ( METHOD OF DRILLING: R air rotary ❑ cable tool ❑ other USE OF WELL: Lg domestic (3 irrigation ❑ monitor O public supply D other 1417 �I r,^�-� 70• y S Ef CASING STICK-UP. ft. Diem: �im tcAbt Casing type S W / t } WELL INTAKE OPENING TYPE 2fopen end ❑ weenad ❑ perforated ❑ open tale •� /�� '�� W ;' Sy Depths of openings: --- to ft SCREEN TYPE: Diem: In. SIGUMesh Size: Lenotfi: ft GRAVEL PACK TYPE: Volume used: Depth to top: GROUT TYPE: volume: Depth: from ft ft RE ulDEVp.OPMiNT METFIOD: . Duration: / - PUMtNq LEVEL AND YIELD: hnra/S h after Ms pumping Dept. Health & Human Sery es gpm PUMP INTAKE DEPTHS ft Horsepower. WELL DISINFECTED UPON COMPLETION? n YES ❑ NO CONTRACTOR INFORMATION: eeee`e Register�d Business Name ; .r a ure of Au onzcd Respr ntative dt�a REMARK& PLEASE MAIL WHITE COPY OF LOC TO: DNR/DIVISION OF WATER PO BOX 772116 EAGLE RIVER AK 98677-2116 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW920150 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:WAYER KUBITZ NANETTE L OWNER ADDRESS:2100 NORTH STAR STREET ANCHORAGE, ALASKA 99503-1819 PARCEL ID . G1S - I = L{ fLii_L j P__�j (r LEGAL DESCRIPTION: CABIN BY THE CREEK LT 3 i�D_ LOT SIZE: 59673 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 6/23/92 EXPIRATION DATE: 6/23/93 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 (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1. PROVIDE WATER MONITORING RESULTS ON TESTHOLES C-1 AND C-2. /7 .) RECEIVED BY: DATE: ' `0 2 —/ Z ISSUED BY: DATE: & - )- 3 c y ON SITE SYSTEM IMPACT L3 BL - Cabin by the Creek Subd. #2 Installation of an on site water and wastewater system for this lot should have little if any impact on the surrounding properties due to: 1. The soil types and absence of water in the test hole monitoring tubes during breakup, as the soil provides a good condition for natural percolation. 2. The surrounding land is undeveloped. 3. Due to the topography of the lot and surrounding area there should be no impact of drainage caused by constructing an on site system on this lot. 4. The lot is large enough to easily accept the original and reserve systems. If you have any questions please contact me at 561-5829. Yours Truly, i4cck4cL c—c e2uL� Michael E. Anderson, P.E. UNDEVELOPED Lot 3 Cabin by the Creek Sub. 2 XIST[W-2 PM' -----------------------z Oi----------------------------- 4 --------------- ------©4 4 �' x m ----------------------------- ----------------- --- , — ----- i I Q 01 r7 I I w 01 I ` — ------------ --- - -- —— .------- — — — — --------- I --- 255 I '°m• j I . I Ts• �' � 0I I ' 01 I UMMOILO PEA i i i RESIDENCE 4 57 IRM 014 1750 6.L.L SEPTIC T, OUT BUILDING 10' SEPARATION WTWM 57' STEM TTP. 17' SEPARATION 5ETILEEN SYSTEMS Ty". ®F Aea mu Elope uMDEI(EL0PED 109"mo�.wmmson ame•.•a�•... •mo..o I I ;Michael E. Anderson '% •„ 4381- E . NI •.• I �`®®�R`IEEK. zs_o' I .wA5-EtllATER DISDOSAL �"I� 3`'57E. FOR L07. 3 ;5 A TRENCf4 w/ o' OF .POCK FROM 3 - ? =EET. 'RENCIH 51'57—c?'! 5HALL I I EE IIS L' iN LENGxTi . ScaLe, 1„=40 feet I �'--------------------------------i----- uMDEI(EL0PED BY ►�'_DATE 6111192- CLIENT /`Gid/ SHEET _ OF -_ CHKD. BYDESCRIPTION Lo 3 Q4EuN BkrmE c,REFg_.%A 8D *2-,10B NQ P E e. C 0, L A T) c ,&r _ RArr:.. _ O Vn i n �i %� - w. r -,Y A 0 _ W4 A r'0K. T R EAl CH $�Op L I C 4 7-10.V R.4 7-4 c 5/ S 6 R'D !j 45 n A / so r !moo _. t�3 3 3 SF- TA %K Ev�cr1 fiEs G_N _ w/_!c' /.333 �R,4QE _ NArIU E_ C1a S3�1L14P1 i� GEDTT--- XriLG F A8z� «- _O _ MF'iECD _ O.F. r+ 9 � bio ._ F�� 'fit Q''.�3✓ msaeen za ,;kir ,«,�`°g9 d .-a 06, . ,. � owe°o m.m• mm.mm cmrm..• m.. `!Vn ¢ Michael-E..Anderson 9+' ` . 4381 - E � 0.M a•m��o® 1, Ty.PICAL -F)eEwc� s�0,7-oKJ._ . EN 1S (10/78) 2 3 4 � I sm 5 SALTY 6 'SA mb aoH WAS GROUND WATER ENCOUNTERED? A/d IF YES. AT WHAT DEPTH? at" It watr Aftw mum"? dln!JATER �0■ 110 IIIIIIII11mv NEW a m ov Co �em OOL Municipality of Anchorageea DEPARTMENT OF HEALTH & HUMAN SERVICES®®•°®°®•°® °®m 825 'L" Street. Anchorage. Alaska 99502 -MO as.mm • •••••o.•o.ao ..., •� °Mich I E. Anderson tuy SOILS LOG — PERCOLATION TEST 0�� s�� ,�81.e 0." •• ° 6� ° PERFORMED FOR: PERFB LEGAL DESCRIPTION: dAr��� G'.�?EE.� Township. Range. Section: S Z Z 7-/Z,4/3u/ DEPTH SLOPE SITE PLAN (FEET) 2 3 4 � I sm 5 SALTY 6 'SA mb aoH WAS GROUND WATER ENCOUNTERED? A/d IF YES. AT WHAT DEPTH? at" It watr Aftw mum"? dln!JATER 20 PERCOLATION RATE (mmuumwwcnl PERC HOLE DIAMETER / TEST RUN BETWEEN FT AND FT COMMENTS fiDLE �/� St?AK FO T 5T /YaLE��/ON TUBF1 / D.E�N S�r�cE 5-79 9/ PERFORMED 8Y. ��6L� _ IY1�FAr��� 1`� I /�/1CN/� EL C I"IJO TIFY THAT T IS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE 7 LZI z"�— 72-008 (Rev- 4-'881 �0■ 110 IIIIIIII11mv NEW a m 20 PERCOLATION RATE (mmuumwwcnl PERC HOLE DIAMETER / TEST RUN BETWEEN FT AND FT COMMENTS fiDLE �/� St?AK FO T 5T /YaLE��/ON TUBF1 / D.E�N S�r�cE 5-79 9/ PERFORMED 8Y. ��6L� _ IY1�FAr��� 1`� I /�/1CN/� EL C I"IJO TIFY THAT T IS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE 7 LZI z"�— 72-008 (Rev- 4-'881 %J�EN412111 AL) Municipality of Anchorage TH d ®� DEPARTMENT OF HEALTH & HUMAN SERVICES �o•e o•••° o®•°° e•000•• o°®• 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST �c� Michael E. Anderson ®G •ec• 4381-E ®Q ••••••e•••• �, � c �R PERFORMED FOR: P /� ����% DATE PERF OF` , 17Z LEGAL DESCRIPTION: L 3 CABiN ,8 y TSE Township, Range, Section: S 2 Z 7/2 A./ 9 3 W DEPTH GJRECA—, SLOPE SITE PLAN 0 E 3 41 1 SM 5 s t L ry 6 S A N.D 7 8 9 10 WAS GROUND WATER ENCOUNTERED? S 11 IF YES, AT WHAT LO DEPTH? P 12 E 13 14 15 17 18 19 Depth to Water After Monitoring? No We, Date: ®® me • ... 20 6 'r lul PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND _� FT COMMENTS PERFORMED BY: LJ �C ��DT7 Ei.l I f� r�' "—� FY THAT THI TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) •�+ ®�N SEAL) P'y�e�•••ees,�*0"0 •Q� Municipality of Anchorage f ® DEPARTMENT OF HEALTH & HUMAN SERVICES � ®o •eo •e •••a •oos3 00• •. o • 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST ? -% Michael E. Anderson a 4�QQ �6 �� • 4381 - E imp IA 9�CO pegos. eawwoe�o•, �'w PERFORMED FOR: 1114e�;EA/ DATE PER EbO •<= . `. L 2 LEGAL DESCRIPTION: Township, Range, SeCtiOn: S 2 Z 7-17- AJ ,R 3 \nj DEPTH r QFEK SLOPE SITE PLAN 1 2 3 4 51 1 Sm 6 S /LT y 7 S4Na 8 9 10 11 12 13 14 15 16 17 18 19 ., 7" // CZ WAS GROUND WATER N Q ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? P E Depth to Waler her Monitoring? Date: 20 lul PERCOLATION RATE 5 (minutesimch) PERC HOLE DIAMETER TEST RUN BETWEEN 3 5 FT AND //�``FT COMMENTS PERFORMED BY:� �-r�rUll� I �G E C'"�RTIFY THAT THISTESTWAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: clizJ42- 72-008 (Rev. 4/85) Depth to Water 20 lul PERCOLATION RATE 5 (minutesimch) PERC HOLE DIAMETER TEST RUN BETWEEN 3 5 FT AND //�``FT COMMENTS PERFORMED BY:� �-r�rUll� I �G E C'"�RTIFY THAT THISTESTWAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: clizJ42- 72-008 (Rev. 4/85) --: Municipality of Anchorage Development Services Department Building Safety Division O On -Site Water and Wastewater Program it A. " Z 4700 South Bragaw St. Public Water System P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage.ak.us / o q' f f (907)343-7904 C:FRTIFICATE OF HEAL I H AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel I.D. CJtri -521 -'aL HAA# Div 000.1 Expiration Date: 4 _ �- 1. GENERAL INFORMATION Complete legal description Le >, /041 O ��1vhael it A. " Z ❑ Public Water System ❑ Location (site address or directions) / o q' f f e'e ^ k s CP 51(p � n C:FRTIFICATE OF HEAL I H AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel I.D. CJtri -521 -'aL HAA# Div 000.1 Expiration Date: 4 _ �- 1. GENERAL INFORMATION Complete legal description Le >, S Ca �r^ ., the C'► r it A. " Z ❑ Public Water System ❑ Location (site address or directions) / o q' f f e'e ^ k s CP 51(p Current Propertyowner(s) Pie•('- Vii— Day phone 3If(o-Ufir- 3V Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 114 3. TYPE OF WATER SUPPLY: Individual Well 1� Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding lank ❑ Community On-site ❑ Public Sewer ❑ 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 behveen 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. (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 encineer'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 _ Ml -Ae el / Prone 3r-/ S Address L46t4o SQL +Aan,• Ave— AnrtIA,29,W& Date f 2 zr o S' Engineer's Printed Name Ni(4me ( is Ai4rr4on 5. DSD SIGNATURE __tG Approved for q_ bedrooms. Disapproved. Conditional approval for Additional Comments r�p��• OF. A[g'kX%01 rC7 •. Ir •k•49TH lose.../ •. ..f/'.! •. .olio MICHAEL N. ANDERSON f CE 49 bedrooms, with the following stipulations: t tt(ItLOFur<., t ON SITE lar. Aaacnments: HAA Checklist X Septic System Advisory . Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: / &/, Original Certificate Date: I— ,_— O r (Rer CIM2) Municipality of Anchorage j • Development Services Department 1�Building Safety Division a On -Site Water S wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchora g e. a k.0 s (907)343-7904 HEALTH 11 AUTHORITY APPROVAL CHECKLIST Legal Description: LjrF3 Ca7in t1ji }tic r,TrAca OL- Parcel ID:_[) rs• -5 2 f A. WELL DATA Well type i0ftwa • q, If A, B, or C provide PWSID # / Well Log (YIN) Y r 5 Date completed V_t-ar-R7- Sanitaryseal (YIN) Y Wires properly protected (YIN) Total depth 1 b ( ft. Cased to I U( fL Casing height (above ground) ZL in. FROM WELL LOG AT INSPECTION Date of test 4 - 7 S; (jZ f/0 <- Static water level ro '� ft. 7 to ft. Well production In 9 P.M. S• g 9 P m• WATER SAMPLE RESULTS: Coliform --A—colonies/100 ml. Nitrate "(I mg.A. Other bacteria, colonies/100 ml. Arsenic: --� mg.A. Date of sample: Lt -11110 Collected by: M f k tai„ 4 r.cerr B. SEPTIC/HOLDING TANK DATA Tank Type/Material t% e c ( Date installed t Tank size t 2 so gal. Number of Compartments _j— Cleanouts (YIN) y Foundation cleanout (YIN) _Y_ Depression over tank (YIN) f�4 High water alarm (YIN) / Date of pumping q G o C' Pumper T -so m •5 C. ABSORPTION FIELD DATA Date installed L Soil rating (g.p.dlftz or felbdrm) U, cI C- System type nT r ength ZCA LBC- ft. Width ft. Gravel below pipe G•o ft. otal depth ALLCffl. Ell. absorption area f q&fl? Monitoring tube Depression over field n Date of adequacy test f2 4 e A5- Results�(PasslFail) _ Al c For `% bedrooms Mr/ = 4e ^ Fluid depth in absorption field before testMrin".. Water addedG/O gal New depth— in. Elapsed Time: (U Z. min. Final fluid depth Z'( in. Absorption rale >= 006 'f g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN S type) / If yes, give dale II T'Ve.0 r.e LAI( wvter v 11e.r %Lo AllT� z 7 r` FG.0 V, C4 e. rcG 0 �' �dri.t•a♦ fe.s. P. D. LIFT STATION Date installed Size in gallons "Pump on" level at _ in. "Pump off" It� Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/Iift station on lot /00 {— High water alarm level at Meets alarm & circuit requirements? On adjacent lots /OU t it Absorption field on lot I Q a 14- On adjacent lots /r)J 17- Public 7Public sewer main If/,4 Public sewer manhole/cleanout W14 Sewer /septic service line ?-S '4- Holding tank g14. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation C" r+ Property line551•l- Absorption field S I>< r Water main NGQ Water service line Z'S' f Surface water _ rUo 14 - Wells on adjacent lots too 4 - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r Property line (a % Building foundation 2v 4 Water main f+' Water Service line 7<; rl- Surface water /01 { Driveway, parking/vehicle storage 45 - Curtain Curtain drain da,,, Wells on adjacent lots (Ou 4- n ek vt F. COMMENTS G. ENGINEER'S CERTIFICATION `p��•"•••"�:gS,�IO I certify that I have determined through field inspections and 00 TN •••'� (� review of Municipal records that the above systems are in �,,, , 49 : ••// • • • • : is I� conformance with MOA HAA guidelines in effect on this date. ��OOYf7o .. . O MICHAEL N. AN0LR:CN Engineer's Printed Name 0114ac( MAA-erwn �f �.• CE•/g 46s Date_ r2/zr�dS 1,`? CrC • HAA Fee S Z/- 3 C7 Waiver Fee $ Date of Payment / Z — ;Z q — D -5— Date of Payment Receipt Number ✓r si `j Receipt Number (Rev. 12101) in. r v N N W O O PI O 0 O a 12-19-05 16:52 %R00-CTLF ESI. SGS ENV SFRVICES t ' SCS Relit 1 05 80 74 00 1 Mot!'arne M:kmN.Anderson, P.E:. Project Namera Corbin by the Creek L3 Client Sample ID Cabin by the Creek L3 Nlatrts [kinking Water Sampl: Remalks: IIME15301 T-316 P.02/C/ F-157 All Datn7fines are Alaska Standard Time Printed 1[hatb7inse 12/19/2005 113S Collected Dorm= 12/092005 1130 Received DateR4me 12/092005 14:05 Technical Direcfor Stephen C. Ede Albmbic " Analysis Puunelet Results ICL Units MmIn1 Cmwitmr ID Limits Date Data Hit Natera Department NilrawN 1.41 0.100 NicrobloloW Laboratory Talal Coliform 0 mp./L EPA 300.0 D (-10) 11,09105 JaM cOJl00mL SM209222B A K-0 111119/05 TLF 12-13-05 16:53 FRO11-CTIE FSI. SGS ENV SFRYICES 9C75EI5301 SGS/CT&E EM/I1ONME SSI 110E IF Drinking Water Analysis Report for Total Coliform Bacteria READ IN MUCTIOhs DN REVERSE 510E acrURE CGLLE(:noc SAMPLE MUST BE COMPLETED BY WATER SUPPLIER PtJUX WATER SYSrEM IDS — — — �PRNATE WATER SYSTEM C) Send Resuts Q 6" Invdce W. �'�L O iltOS c� SAMPLE COLLECTION. _ Der. C] 6edd PeauNs SAMPLE TYPE: T -34F P.03/Gd :-157 2W W. POT IER MA: ANCHORAGE, ALASKA 99518 Tel: 907 -SM -2343 Fax 907-561-6301 Lee RBI Nn 11R'K'058074 IN t] sena Mob �RoAne _ Q Treated Water Time: / ('3o AM . t Repeat Sample Untreated Watw Letallam' Cal2ol 04 ttr C % (refer to lab no. I Cmeelw: M. c ❑ spacial Pvrpoee Transported to Lab 9y: sama as collwtof Critter .w TO BE COMPLETED BY LABORATORY Temp: De0very Method: Recee4ed By. Comments: ❑SQMrA&. ver30Mrsd1x Itew41roy be dmelsale ❑ 4e fb rwaN ❑ RUSH SAMPLE Phone N Fax f .............................................................................................................................................. v - Analysts Sagan. 2.e /S/0 J� /8/s AnalyC 77:- Analyllcal Megod: Membrane Filter MMO-MUG (PIA) Reported By: f i7uars / MMtNeUG (P'A1 RF3LLT3: Tow Corforn E Col. MEM NAME FILTER RESULT3. oyectew,c CwManu)ml wdw yr ►.�..� �LTD� DGD: N..r.... ( Er. 0m to ADEQ ANC FDK JUN 7-p- 12113 o sen n pan LPhmad Q Fixed �. »'rZ3,/cS 43/ .* Satisfactory UnsaWactory 1nfC. TY ..M O ate.. tr •oa.ema F0M $ FW Oa53 1211743 TweeslnasOtVSNKGroup0ata%OubidDO00MEt4WORMMappm Cr-CoNFam 121n3 ate 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.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Mike N. Anderson Legal description: Cabin by the Creek #2 Lot 3 The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on ❑ Calculation error in design. _ ❑ Additional soils information needed. _ ❑ Water monitoring results inadequate. _ ❑ Discrepancy in information submitted. _ ❑ Topographic information missing or inadequate. _ ® Incomplete; missing Distance absorption field to driveway/parking area? ® Incomplete; missing Total depth of absorption field. ® Additional adequacy test information needed. Poor recovery. ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. _ ❑ Locations of all soils, percolation and water monitoring tests not shown. ❑ Proposed system too deep for soils information submitted. ❑ Well log required. _ ❑ Omission in narrative. ❑ Insufficient fill over tank or field._ ® Other. Name of reviewer: Date: Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK . 7 ,a 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. # L ! HAA # W RSA Q CS20 I. GENERAL INFORMATION i //►► -� 4 ` " ` nn Com tete legal descriptiont�Ccl�- Location (site address or directions) - Property owner Z� Gci�1 j Day p one 6�,J- 06'0 Mailing address 3'97-0 (jiN C,NCST-47RL Loop AN U4. , 44L 94n7 Lending agency Day phone Mailing add Agent Address Day phone Unless otherwise requested, HAA will rrbe held for pickup. 2. NUMBER OF BEDROOMS: `-t 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. 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 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 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 �NDCRSo►� E�JG��1C2_'R-►^1� Phone`�y- Address P a , Box Z 4/a 9 9 s- Z Engineer's signature Date i�IL/C1 L. OF A1� AN • 7V%% • Michael E. Anderson �® J.'. d381 E : Z ® Q 6. DHHS SIGNATURE �q� PROFESSO��.w� ... _� Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By; Date CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificatespased 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. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services AOL HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 107- 3 6"i gy T� CtA---W'_L Parcel I.D. 0/5 -/Li Z96 A. WELL DATA Well type P1L J A 7'C-' If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 17-319L Drillers/^� r r/ Total depth / & f Cased to /1,Casing height Sanitary seal (Y/N) Date of test Static water level Well flow Pump level Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION j MUNICIPALITY OF ANCHORAGE hDtLRQWENTAL SERVICES DIVISION 8 ` :. �i C 0 3 1992 /0 9 156 t - 9.p.m.1f6 IV ED C'S f, SEPARATION DISTANCES FROM WELL TO: r Septic/holding tank on lot 15-57" ; On adjacent lots /� 0 >� r Absorption field on lot /& S ; On adjacent lots } /Q a Public sewer main /0 /C<zS Public sewer manhole/cleanout r✓)r L4P_ 5 - Sewer service line ` t Petroleum tank A1/A WATER SAMPLE RESULTS: Coliform 4Nitrate 3 q G1- Other bacteria Date of sample: lrl 7-3I q Z' Collected by: � � 449444 B. SEPTIC/HOLDING TANK DATA Date installed w 1-2- to 97— Tank size IZ6Z) CO -A-' Compartments %1.10 Cleanouts (Y/N) Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) 4A Alarm tested (Y/N) Date of pumping /J C- UJ CD #.i -S;-" C37 a N Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: r r Well(s) on lot /�'� On adjacent lots woo Foundation I To property line %S -"-t:: Absorptionfield ILI Water main/service line Surface water/drainage A/o^) C-1. 3B r so ' 2. 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed ` 9 Z' Soil rating Length "Pump off" level at Cycles tested q5 //$ Width Gravel thickness Total absorption area Depression over field (Y/N) /41(. hT. L AJ GP Surface water System type be % uq Total depth 9 YL 1 7,tm / Z) Cleanouts present (Y/N) Date of adequacy test dI-'1-4J CtJ S't"YW (�.Wd''J Results (pass/fail) _P45S for 4 bedrooms Peroxide treatment (past 12 months) (Y/N) AI If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots >/00 Property line '!5 To building foundation s$ / To existing or abandoned system on lot A]0^ta, On adjacent lots 'J0 "15-- Cutbank A10,^,J 4E Water main/service line 70 '~ Surface water nJ0IN JiA Driveway, parking/vehicle storage area 25 t Curtain drain 40riC E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. 4 O Signature�r"�``�Cr �— ,� Engineer's Name n4/cuA� /,0 ar-soh% ®'� ��► "eem6s �ae6T tlb oas xoea em 0n• s C� Date oce�c,aoe��000 oeeoo oe aao oo o+o 00 v11m ft'chael E. Anderson 9-1 tr a�G 4,81 - E rIR R C ®ce®ion'......r . `car► �i Q HAA Fee $ / Waiver Fee: $ Date of Payment�,/ 9 Date of Payment Receipt Number C— `a 48 � 3-9Receipt Number 72-026 Rev. 3/91) Back MOA 21 s.` GIN RING CO. AK D ;. R GICAL ORATORY �W TELEP E ('907) Affl43�^` 5633 B Street orage. Alaska 99518. Drink! Water Analysis 4Report ,fob Total. Colifo Bacteria..-- _ . - . TO BE COMPLETED BY WATER SUPPLIER TO E COMPLETED BY LABORATORY O PC WATER SYSTEM I.D. C RIVATE WATER SYSTEM ,., y Analysshows this Water SAMPLE to be: mz!� rA4(,�t'. /)!, Satisfactory Phone No. ❑ Un"factory x ❑ S " P46-166 long in transit; sample should y~` �iI V 7�5 Y n over 30 hours old at examination cry to. irate reliabAe results. Please send I s Tie sample via special delivery mail. ,1 � .I SAMPLE DATE. �D Date Received } j�._ tp,;c,�a,,=• _ Da �.:�r,::�Ysar sty-• -! tc.s. ..�t:� .. - SAMPLE TYPE: Time Received Gd Routine Analytical Method: Membrane Filter ❑ Check Sample (for routine sample with lab ref, no. 1) 11 Treated Water°C ❑ Special Purpose' ❑ Untreated Water -1 - Nc ;f colonies✓1 oo ml. SAMPLE Time ~ Collected k, Lab Ref. No. Result* No. , }OCATI i Collected B Analyst Cf 3 5 I m BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count O Coliform/100 ml BEFORE verification: LSB BG8 l Fecal Coliform Confirmation COLLECTING SAMPLE v Final Membrane Filter Resul s Collform/100 ml r; Reported By TNTC = Too Numerous To Count Time: a.m. OB = Other Bacteria z p.m. I ��1 S Member of the SGS Group (Soc*6 Gdndrale de Surveillance) F o Page No b)4 3 .2i3 Q �a o S o , d 23. , SZ X =- S % - t Q. S t�D p,� n . S B 2 0,Lt 3 2 41 ! l O o.I o • . o 355 .Z�.S 0.61. ' t• D V q SZ o� tLO �o rt -- .g q To Page No. Witnessed & Understood by me, Date 9v Invented by Date Recorded by