Loading...
HomeMy WebLinkAboutCONTOUR ACRES #2 LT 5Contour Acres #2 Lot 5 #017-451-23 t -48 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: `Jl_�c-A sc>,q) q PID Number: Name: 1141-60VC-AW Wastewater System: New ❑ Upgrade Address: ABSORPTION FIELD Phone: No.of o? S 13 ❑ Deep Trench MoeShallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: .g GPD/Sq. Ft. 110-11.5, Lot: Block: Subdivision: ". vtvU2 Depth to pipe bottom from original grade: Gravel depth beneath pipe 3. i Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel length: Ft. / Ft. WELL: New ❑ Upgrade Gravel width: Numberoflines: I Distance between lines: �~ Ft. Z' /e Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: G, 1 5 Ft. /7se/�457 Ft. 9949 SQ. Ft. /9W-14 0-303 /CJ Cleller:Dat Z, Drille 3 Static Water Level: r- Inst Iler: Date in alled: /- & l� 7 Ft. 1kol6all� ,' Yield: P mp Set at: Casing Height Above Ground: AN K GPM /�kh/ Ft. " �/ Ft. SEPARATION DISTANCES eptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding /Private Manufacturer: ,}� �/� Capacity in gallons: From Tank Field Station Tank Sewer Lines C� %/TAY/` /J02-.7 Well 75' Mateyi�l: s Numberof�C` partments: y/7�' } y//so' LIFT STATION WateSurfacr 17®r Lotr i Jif / � �jT% �- A, � Size in gallons: Manufacturer: Line �� Foundation i I > , / �. "Pump on" level at: "Pum level at: High water alarm at: Curtain—loll �Y T Pump Make &Mode -" Electrical Inspections performed by: Drain Remarks: BENCH MARK Location and Description: ` ovr 5� Assumed Elevation: /acs° ENGINEER'S SEAL 9 / //✓ � Inspections by:Dates: 1st O performed 2nd ' b11314111 .' n cllaE•l EDepartment of Healt nd Human Services approval 481 TITh I e Reviewed and approved by: Y. Date: � (��_L Reviewed C) h:p, CbtiD 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: (_ S U riI 72-013 A (Rev. 9/91) MOA 25 /. 6 2. PID No.: NE C /!I 1161/ ,1135 � N1T2� B' >al a j fi �l P -- U.0 S Ba gtl00oO ®-!" A4ichaei E. Anderson �6'' °. 40 asap - E 72-013 A (Rev. 9/91) MOA 25 /. 6 2. PID No.: NE C /!I 1161/ I op a j PO a®rim U.0 Ba gtl00oO ®-!" A4ichaei E. Anderson �6'' °. asap - E e, 0T r, 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 72-013 A (Rev. 9/91) MOA 25 L�, CouroUK Ac�Es S/t� AFy7 A I1, 7 LOT 3 N b9'n9 W 297.5' 10' UTILITY EAS ENT rN9 o LOT 5 `� co -J� �" LOT 6 LOT '4 s u 42.3' � 3 +- O 0 15.0' II l�'''�'QQ •• .. 0 IF O m N 89'59' W _ 297,5' w. PENNY CIRCLE M -W DRILLING, Inc. f,• 93-130 P.O. Box 110378 0 10330 Old Seward Highway (907) 349.8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner 11cGoyern, ! irk Use of We» Domestic Location (address of: Township, Range, Section, if known; or distance main roat Lot 5 Contour Acres Addition.No. 2 Anchorase Size of casing 6" � nepth of Hole 4 6 5 feet Cased to 158 5 4.feet 1.19 ft. Static water level (a �, (below) land surface. Finish of well (check one) , Screen ( ) ; Perforated ( g dim-, Knife Slots (k"x1k") , 12 each; Describe screen or Well pumping test at 98,110.PRf of drawdown from static Ie1 July 1 r—. -'c Date of completion- - Depth in feet from ground surface 0 TO 2 4 —TO— 4 40 TO 40 73 TO 73 73 TO 73 137 TO 137 141. - TO 14J_ 154 TQ .54 1.90 —TO - 190 1.9.3 TO 193 465 M TO TO - TO TO -- S open end ( ); 137-141, f.t.dept (minute) forte—hours wits ��tr� ft• Asbuilt Note: Well dry grouted with 1 bag { enviroplug chips. a }' WELL LOG penetrated, size of material, color and hardness s ty/Sandy Dept. Health fedrock,� a x&y� 3i'fdhone ~At91 Irf ;!/A: Very Sort ,A/A: Small Water Seaps In Sporadic Fractures. Bedrock c g A Gey't;o g. 1 — CUSTOMER 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:SW930212 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:MCGOVERN KIRK & MARY OWNER ADDRESS:12821 WELLSFORD CIRCLE ANCHORAGE, AK 99516-2745 PARCEL ID:01745123 LEGAL DESCRIPTION: CONTOUR ACRES #2 LT LOT SIZE: 89494 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 7/13/93 EXPIRATION DATE: 7/13/94 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL RECEIVED ISSUED B 11�-W DATE: q� DATE: ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 May 13, 1993 RECEIVED Municipality of Anchorage JUN 2 41993 Department of Heath & Human Services Municipality of Anchorage pe 825 "L" Street pt. Health & Human Services Anchorage, AK 99502-0650 Subject: Lot 5, Contour Acres Subdivision, Addition No. 2 Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: The subject lot is relatively flat with gradual slopes of 2% to 3%. Testholes revealed excellent soils for the placement of an onsite septic system with no groundwater encountered. If the system is constructed as designed the following conditions will result: 1. The system, if constructed as designed, will have no adverse impact on the wells currently in use or to be placed in the future on lots in the area. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. Sincerely, n��,f a,,4. Michael E. Anderson, P.E. Vii' 0"�S e r 3ry f 'i o k Off, t • a, a F;� �/'�o.,,.o-ve a'�u•p�mc�(uJ'�r�s���© ®rveov t. i(Q:^3 QGt. Gi pND©W©O�rBOOpSp oo A® ,It {'fir-aE `d �chao! [. Anderson 438 1 - E C �WT J v T LOT3 �Iv 1'Vlunr SE�IG 5`(S�M wo 0.0® aim®woo®ea®®o¢r�om oe� G A'!iehael E. Anderson w� 4',91 _ E t jos IPT 5. emVrm#1 _ VSs sup AJ. 41 SHEET NO. OF CALCULATED BY— r DATE CHECKED BY DATE s too Uor 3 ca�rQUt�ti� X10 1(J��U. or se:�4rH Loi we, LW 542 L�Or 5 L -or 6 v lotv 14 31 �rvl'a5�v LoT Z La,` 110 `Q\� a+07JCT 7Db, iSpY SMq 7o5•t (PMda1 Ua u¢.. GMM. MM 01471 To 0dn PRONE TOLL FREE laD-r5M xmtor5 Gamroum. Ac"s lio. Z. SHEET 40. OF CALCULATED BY DATE CHECKED BY DATE bRAiti-ro" :51tc P.Ups Jam- L - 93 5 9113 FrI P,CtUC-r/O,J rA 3' G2AVEt 1576 >c. Ob b Or-7—a-c7,PCA4 /2,600"-b osc z Nk 4 1491i.ND -ro b ",jr-i AW41 F=/XO,Nli -7—rLL-NcM 41 -D A) Avr U RA L - 9A ULF/ U. 3-0'1 .57C.4 Ile) kll RA 14 Oct L -Lb �ue- AA off 1-rolL 1s/ T-,, 4 9WPOSC;b -D Room 6" 9a -pt_ A i - Colo SCA&C) Cwpa ov r ervf) 11 js7o'b 6&cwJ o MIJ W— I joe W5 69JIMPUR_ hGkSs sul> ALJ. # SHEET NO. DF CALCULATED BY DATE CHECKED BY DATE LOT 3 , c oura K hGoS JJW1ar11W^Y�WWRI Ni'1 VioWYI /�Mi., WYY�Ww.Y1111. IpY "%m MUM Ivikaa-M ,DBor S ��rcu r� A crus Ao, L SHEET NO. OF CALCULATED 8Y DATE CHECKED BY DATE . a $Au�/ Ll. G�vrcxniE'vi A ®® 00a peso©e+s min ra3® 0, 00m'a'+®® • y11C � t{090:7D o®O60 bO,e0! 96©�? N,ichael P. Andorson r o 4:z -i E jp- Pro poseb S gEDUOIA t+omc �nl a s CA t1E, .0 9 157,0,D 6,4(&0,4 s SERI) Q4J Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICESgi � � 0®• S �� 825 "L" Street, Anchorage, Alaska 99502-0650 4' ``' ' •°® Pa c s �eeW SOILS LOG — PERCOLATION TESTOWa p 1"AjjWoOOoe We00000W w t 'el E. Anderson <` I®� °e 4381 a PERFORMED FOR: _ Ir.4irrii�xPubi�i !'I �N�✓� �� DATE P b� U0 0•. - �f p,yUFE , LEGAL DESCRIPTION: �.Or�l.. G )1??U12 ArF.5 Township. Ranae. Section: k 1 - 2- 3- 4- 5- 6- tip? 1 8.- 9- 10- 12- 13- 14- 15- 16- 17- 18- 19- 20 - 9- 10- 12- 13-1415,617181920 C•T• „7�T�T�i �VJt�ii�l��l�Yi 2. SLOPE WAS GROUND WATER ENCOUNTERED? ---F� S IF YES, AT WHAT L 0 DEPTH? P E Depth toi WSW AqW, �a IItellileriapT l-It�- Da SITE PLAN mmmm m,-'=wwW v / / PERCOLATION RATE z (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN_ FT AND FT PERFORMED 8Y7V444 C Gi .ic-d RTIFY HA THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE - 72 -008 72-008 (Rev. 4/85) ERS UAL) • . +.r MuniCIPal)ty of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES % 825 V Street, Anchorage. Alaska g9502.ow m ASO °0n 9G 0G NBG®m G90®ooh ®moo SOILS LOG — PERCOLATION TEST �[j ors Fle mOmmo oo oma memos m0e®®'® M'g;I E. Anderson a , mE 4381 - e �S PERFORMED FOR: 44E, e�}� 40 DATE LEGAL DESCRIPTION: LOTO Township, Range, SecGOn: DEETJi SLOPE SITE PLAN 3 (FEAU NA 2 9 l� 10S ' ' � SW /Som�i 141 WAS GROUND WATER ENCOUNTERED? mmmmi ml -9 12 / IF YES, AT WHAT DEPTH? 13-. ,, B W>rrr Ilpe Moniloriap? ---Am 14 15- 16 5 16 �! 17 TsvT HaLs > 18 19 20 L D P IE u PERCOLATION RATE 7 11 (mwwwvuicl►) PERC HOLE DIAMETER TEST RUN BETWEEN _. FT AND FT COMMENTS PERFORMED BY: 0ge:t;/d/z�THAT T EST WAS PERFOiWEpIN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: 72-008 IRev. 4i85) mmmmi ml -9 u PERCOLATION RATE 7 11 (mwwwvuicl►) PERC HOLE DIAMETER TEST RUN BETWEEN _. FT AND FT COMMENTS PERFORMED BY: 0ge:t;/d/z�THAT T EST WAS PERFOiWEpIN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: 72-008 IRev. 4i85) GINEER'S SEAL) Municipality of Anchorage • A DEPARTMENT OF HEALTH & HUMAN SERVICES e ® o 825 "L" Street, Anchorage, Alaska 99502-0650�j ,'r F .0000o�qq A" e0 e e SOILS LOG — PERCOLATION TEST 00 `�go � pe °®®� �V �' soe oo oe�ee®•o eo eoe eieeatac � �t� p ' 4„ eI ic: Andcrs0n e -6- 4381 E PERFORMED FOR: bPo IT�-� �jTK�,ijr�QjJ DA4 F� LEGAL DESCRIPTION:ej Township, Range, $ectien: F- #rr I nl � p I SLOPE SITE PLAN 13 14 15 16 17 18 19 20 ��/ w/16,►j (50mr-0 U01WKH 4KAPFn rAN lw qt?L-g� t2 WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT �^ L DEPTH? P E CIO aW_"A kw "Ior47 pole �•�.t 2 (.■.� Emmummmamm ..■mil 3 fes, 4- 6 6 7 8 9 10 r. 7 12 13 14 15 16 17 18 19 20 ��/ w/16,►j (50mr-0 U01WKH 4KAPFn rAN lw qt?L-g� t2 WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT �^ L DEPTH? P E CIO aW_"A kw "Ior47 pole UPERCOLATION RAPE 7 _ (minutesnnch) PERC HOLE DIAMETER ''^ `,', J TEST RUN BETWEEN : — FT AND _, 2 FT T COMMENTS �I ROL& V�7 'l&% $t'%AKW fjvji t 'r� 'iri;eT PERFORMED BY: rr4tt,&,4 X C L(C�.ef►A•r 11 THIS EST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) WWI'.l����i���R7�! (.■.� Emmummmamm ..■mil UPERCOLATION RAPE 7 _ (minutesnnch) PERC HOLE DIAMETER ''^ `,', J TEST RUN BETWEEN : — FT AND _, 2 FT T COMMENTS �I ROL& V�7 'l&% $t'%AKW fjvji t 'r� 'iri;eT PERFORMED BY: rr4tt,&,4 X C L(C�.ef►A•r 11 THIS EST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) WWI'.l����i���R7�! UPERCOLATION RAPE 7 _ (minutesnnch) PERC HOLE DIAMETER ''^ `,', J TEST RUN BETWEEN : — FT AND _, 2 FT T COMMENTS �I ROL& V�7 'l&% $t'%AKW fjvji t 'r� 'iri;eT PERFORMED BY: rr4tt,&,4 X C L(C�.ef►A•r 11 THIS EST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Joe i0o Lc nJ ro u it- A uLc4 Ap, Z. sHE9T NO. OF CALCULATED .Y DATE CHECKED BY DATE Dag,NF, SS E C��ev4-4,70,J Ab rApD/F,r-L S' BEO.20pMs. x; ISO G. P D . 8 GPD%'t 938 Fr, z 93 5 P.-chuv-io 4 I A...crpZSB pro R. 3 ' G2AVE'L. I$? G_ x_ 5" . . 8 = lob, .S . yr T�c.H f2-cov�-D . J',Oe D2a!r► 120cs-. 140un►p N►o"F w R� �1,1, I, ►ro,L 'rlec c 4#- a A BA.UWILot. G �orExru �E' H ino46na aoo.no eea••••-.�_ __ ; - C: 6 ���'N,itflara r: Andal'son , 4j oNi1V T?*lIWPVMImsl1110101/�/�x,11001WII.IIIlI.l001M114ELOLL11((14*n a 0 TH 41 QD Prwposeb . S BEDROOM I+OME Cn1 v Sc.At, cseeu� mw .Ge I IsoO G&cio•J 0 Municipality of Anchorage Development Services Department Building Safety Division OnSfte Water and Wastewater Program 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.sk.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 017.451.23 HAA# Ot505'51i�+ Expiration Date: s2 - 1 SS - 0-&- 1. & 1. GENERAL INFORMATION Complete legal description Lot 5. Contour Acres Subdivision No. 2 Location (site address or directions) 5601 Penny Clrcie Current Property owner(s) IQ& and Mary McGovern Day phone 345.3595 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 5601 Penny Circle Anchorage, AK 99516 Day phone Barbara Michelsohn Day phone 762-5832 Prudential Jack White Real Estate Unless otherwise requested, HAA will be held by DSO forpickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Five 5 TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ED ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ 1 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, 1 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 Anderson Enoineerina Phone 522.7773 Address _P.O. Box 240773 Anchoraoe, AK 99524 Engineer's Printed Name _Michael E. Anderson, P.E. Date 1111012005 49th ra pA%Kaw+cc c AM"SON 5. DSD SIGNATURE y�%\ �r�. ter• /� ✓ Approved for _� bedrooms. ti� AE�gt Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: _//iL;e� / GA/, /_ Original Certificate Date: f'' t S' O S (Rw.12M) Municipality of Anchorage �•.• Development Services Department Building Safety Division • . r On-site water & Wastewater Program 4700 South Bregaw SL P.O. Box 190050 Anchorage, AK 9951943550 www.cLanchorege.sk.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot R Contour Acm S bdIyIslon_ Addition No. 2 Parcel ID: 017451.23 A. WELL DATA Weil type Pd1t8l4 If A, B, or C provide PWSID S _ Well Log (YM) Y Date completed Sanitary seat (YIN) Y wires properly premed (YIN) Y sir Total depth AWL Cased to 134.5 R Casing height (above ground) _ J _in. FROM WELL LOG AT INSPECTION Date of test 71141993 1028/1005 Static water level 119 tk 117 ft. Weil production 2 O.P.M. 1.9 9 - p.m -WATER SAMPLE RESULTS: Cogfonn _L_colonkWI00 ml. Nitrate 271 mgA. 6 Other bacteria _L colonies/1 00 ml. Date of sample: 10@912005 Collected by: AH iI B. SEPTICIHOLDING TANK DATA Tank Type/Material SeoddSteel Date installed 711511993 Tank size JJW gal. Number of Compartments j Cteanouts (Y/N) Y Foundation cleanout (Y/N))[ Depression over tank (YM) H High water alarm (YIN) N Date of pumping 11142005 Pumper NofMland Pumping Servke. Inc. C. ABSORPTION FIELD DATA Date Installed 711=5 Soll rating (g.p.d.R or fe/bdnn) A GPOBF System type S VVlde Trench I' i Length 110 fL Width 5 ft Gravel below pipe 3 ft Total depth.0 fL EB. absorption area $L,fe Monitoring tube Y Depression over field t( Date of adequacy test 101282005 Results (Pass/Fal) Pass For I bedrooms I Flukt depth In absorption field before test jA in. Water addedj)U gat. New depth= in. Elapsed Time: IM min. Final fluid depth m4 in. Absorption rate 750 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date Installed 'Pump on' level at _ In. Datum Size in gallons Manhole/Access (YIN) -Pump ofr level at _ in. High water alar level at In. Cycles tested Meets alarm 3 eimuff requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankMft station on lot MW Absorption field an lot XW Public sewer main _ MIA On adjacent lots 3,100' On adjacent lots MW Public sewer manhole/cleanout _NIA Sewer /septic service line > T Holding tank _NIA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 3,S Property line 3,' Absorption field >s' Water main NIA Water service fine >10' Surface water >IW Wells on adjacent lots MW SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main >10' Water Service line >10' Surface water MW Ddvewey, parkkWnhide storage >4S Curtain drain None Noted Wells an adjacent lots MW F. COMMENTS G. ENGINEER'S CERTIFICATION ��P��» ^' I carry that t have determined through bid inspections and ° 9th review of Municipal records that the above systems are lo oontwmance wlfh MOA HAA guldeiines in effect on this date. aoNa c NWW Engineer's Printed Name Afiehsel E Anderson. P.E. a-aer Date 11110fY000 s�he.flCBEtclv"a HAA Fee $ a 0 Date of Payment If -/P -os Receipt Number :112664 'S�LATN (Rev. 12rae) Waiver Fee $ Date of Payment Receipt Number I1-07-05 01:23PM FROM-CUE ESI, SCS ENV SERVICES LSW SCS Ref# 1057294001 Client Name Anderson Engineering Project Nome/N Lot 5 Dlk 1 Contour Acres Client Sample 1D Lot 5 [Ilk 1 Contour Acres Matrix Drinking Water Sample Remarks: 9075615301 T-196 P.02/03 F-751 All Datcs/rlmei are Alaska Standard Time Printed Daterrime 11/04/2005 13:05 Collected Date/rime 10282005 15:02 Received Date/rlme 10282005 16:17 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Nitrate -N 2.71 0.100 mg/L EPA353.2 D (o-10) 1028/05 AZS b(icrobiology Laboratory Total Coliform 0 col/IOOmI. SM209222B A (<-I) 1028/05 TLF v+ v o r� ioDCno Z Q Oro N 00 P C.M Z -.. N � �y v+ v o ioDCno Z Q Oro 00 P C.M Z -.. N � �y :03 rnDD�j 0 ii y ' � (to C N N V10 0 o Co c 9 9 08a. 'mm ' p m F). 0 o m 0 LOT 4 N 00 O O M 0 M �:� 49g� •.•y� n TITo ...• .0 .� O LS -7625 °r �ln 7.. ... •_Lyv� N 89'59' W 1297.5' 10' UTILITY EASEMENT LOT 5 O S Os O OO Y 42.3' ;a u EXISTING HOUSE a 46.5' d• r jr N 89'59' W PENNY 0 297.5 CIRCLE LOT 3 0 M LOT 61 0 0 N EXCLUSION NOTES: It Is the owners determine responsibility to deteine LL4Lry U: JCI rrvu owoswco •n PAUL MICH ELSOHN the existence of any easements. covenants. or restrictions 5/57R8 W/CAPOO 5/e' RB O rhich do not appear On the recorded subdiision plot. NOTE: 3.25' ALI10N. MONUMENT AV with Mithelsohn k Daughter Const. Under no circumstances should any data hereon be used for HUB k TACK O Constmctlon or for establishing property lines. FENCE- —X— X — SURVEY CERRFICATION: LANTECH has conducted a OVERHANG- — physic. survey of this property as shown on this WOOD DECKS- "��m .rowing and that the improvements situated there CONCRETE- on ore rithin the property lines and no encroach- ASPHALT- O ® ments exist Other than noted. GRAVEL- AS—BUILT OF: LEGAL DESCRIPTION: 5EP11C5TANDPIPES- Q WATER WELL - LAND k CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS EALASKALw ANCHORAGE 9503 (907) 562-5291 LOT 5 - WORK ORDER NUMSER:'Art: KAP OEC 21, 1993 ,'_50' �G�I'.. ceo'AA7uAeLe: fax 561-6626 () CONTOUR ACRES 2nd ADDITION 93-L-4108°"„u�' ,�,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. # 017 -- 45-1 — Z,3 HAA # b� �L'► -1(n 1. GENERAL INFORMATION Complete legal description Loi �� COAJ7-001L AC-0,CS, SCJ 9_b )V ISiO1\j� 4o6Ii /Otj Ao. Z Location (site address or directions) 5601 Paws `l Gtt. �E Property owner Vy Mc. CnbLDein rN Day phone Mailing address Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well X).0 Community well Public water k-50 `-50 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 furtherverify 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 4 j)c1LSr)PJ Enj 6)tJ 057ZJA) 6 Phone E44— LiSSI Address HO 'box 4Y-0773 AN'-40"6CE Ak- ggszq Engineer's signature E Date % 1q 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. � r A vi ° Cy^ c. c. x•1��°O F P N,ichacl E. Anderson e �� atr+r °z 4381 - E ri Q� •,•cur Conditional approval for bedrooms, with the following stipulations: Additional Comments BY; Date / f 2— CAUTION 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. 72-025 (Rev.1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT'J CowT2urL HQWi AID, -1-Parcel I.D. d)-1"' `-Sf" Z-3 A. Well Data Well type PX%Q _rS If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 7 :3 Driller M - W b JlJ L L) j J6, Total depth k1p s- / Cased to $ S Casing height `/ Sanitary seal (Y/N) y Wires properly protected (Y/N) A Date of test Static water level Well flow Pump levell FROM WELL LOG 7[/,j lqy /l9 Z_ g.p.m. Uig V-P't D Lo ti) SEPARATION DISTANCES FROM WELL TO: AT INSPECTION Septic/holding tank on lot no ; On adjacent lots Absorption field on lot /,g ; On adjacent lots 3 MC Public sewer main /✓i 1 1,4;-s Public sewer manhole/cleanout 1A t 1,c5 Sewer service line ? 57�0 Petroleum tank 4J1,4 WATER SAMPLE RESULTS: Coliform o Nitrate /• 5 M61L_ Date of sample: _&/Z,0 �g� Collected by: B. SEPTIC/HOLDING TANK DATA Other bacteria A9 Date installed 711 S bq Tank size 1500 6A -C • Compartments --rw O Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y"—Depression (Y/N) High water alarm (Y/N) q / A Alarm tested (Y/N) A/A Date of pumping Al e- • j CO AJ S -7—/w c770 Pumper J 1A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot //0, / a On adjacent lots >/D0 Foundation To property line '> —Absorption field �� Water main/service line ? 50 Surface water/drainage AO V 6- 72-026(3/93)'Front CONTINUED ON BACK PAGE 'M rn C. cw A i7 g.p.m. ('i 2 z� f'1'1 ® _J m Int co n Z ! ® 4* y C /00 c Public sewer main /✓i 1 1,4;-s Public sewer manhole/cleanout 1A t 1,c5 Sewer service line ? 57�0 Petroleum tank 4J1,4 WATER SAMPLE RESULTS: Coliform o Nitrate /• 5 M61L_ Date of sample: _&/Z,0 �g� Collected by: B. SEPTIC/HOLDING TANK DATA Other bacteria A9 Date installed 711 S bq Tank size 1500 6A -C • Compartments --rw O Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y"—Depression (Y/N) High water alarm (Y/N) q / A Alarm tested (Y/N) A/A Date of pumping Al e- • j CO AJ S -7—/w c770 Pumper J 1A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot //0, / a On adjacent lots >/D0 Foundation To property line '> —Absorption field �� Water main/service line ? 50 Surface water/drainage AO V 6- 72-026(3/93)'Front CONTINUED ON BACK PAGE — G. SIFT- STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Date installed ?/��193 Soil rating (GPD/Ft2) In r �� Length Width S Gravel thickness Total absorption area 1=T z- Cleanout present (Y/N) Date of adequacy test tih1 6VN5'r Results (pass/fail) Surface water �r System type 5J44 UVW 7�eN VL " _Total depth /% � _ l t VL Depression over field (Y/N) t1A SS for Bedrooms Water level in absorption field before test A0^16- After test Peroxide treatment (past 12 months) (Y/N) AJ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /01 1 On adjacent lots y f b b , Property line A)0,1J 6 >5O i To building foundation 7`0To existing or abandoned system on lot // A On adjacent lots ? Cutbank /lo Al ts" Water main/service line ?S® Surface water A10140' Driveway, parking/vehicle storage area � �© Curtain drain /\/0 ^J 1-5- E. 0^/(-5- E. ENGINEER'S CERTIFICATION I certify that t have checked, verified, or conformed to all MOA and HAA guidelines in effect on,,,th&.,&,, f this inspection. L �o Signature " �1 �} ! eA �--� Engineer's Name /V I i UM - L �`f � sON n ^r=.-ar5o, %1 - Date q() 670HAA Fee $ Cy Date of Payment l Receipt Number 72-026 (3193)* Back Waiver Fee $ Date of Payment Receipt Number `* OMMERCIAL TESTING & ENGINEERING CO. le::ENVIRONMENTAL LABORATORY SERVICES SINCE ,aoe 5633 B STREET REPORT of ANALYSIS ANCHORAGE, AK 99518 C'heml ab Ref . # :93.6811-1. TEL: (907) 562-2343 Client Sample ID :PRIVATE WELL, WATER/L5 , CONTOUR ACRES FAx (907) 561.5301 Matrix : WATER Client Name :ANDERSON ENGINEERING Ordered By ;UA (Project Name Project# PWSID -.UA WORK Order, -.7433'1 Report Completed :12/23/93 Collected :12/20/93 @ 16:00 hrs. Received :12/21/93 @ 11:10 hrs. Technical l)irector:STEPHC. EfOE -.7---- Released By Sample Remarks: SAMPLE COLLECTED BY: A.H. wk SURD. NO. 2. QC Allowable Ext. Anal. Parameter Results Qual Units Method Limits Date ©ate lnit. Nitrate -N 1.5 mg/L EPA 353.2/300.0_._._._ 10 12/2: CMR k See Special instructions Above UA = Unavailable * See Sample Remarks Above NA Not Analyzed U = Undetected, Reported value is the practical quantificatiot-1; limit. LT = Less Than D = Secondary dilution. GT = Greater Than 5GB Member of the SGS Group (Soci6te GAnBrale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA