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HomeMy WebLinkAboutCALAIS BLK 2 LT 5 · Calais Block 2 Lot 5 #009-035-08 M UMCC PAUTY OF AmCHORAGE ' tz U Development Services Department _T Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 009-035-08 1. GENERAL INFORMATION Complete legal description CALAIS BLOCK 2, LOT 5 Expiration Date: / 0 - z© r 20w Location (site address) 3001 EUREKA STREET, ANCHORAGE, AK 99503 Current property owner(s) KIRK C HOESSLE Mailing address Real estate agent Il0l-10KICKOKC]I:S1yi(eZlUal"V1~161E:11F1 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 421 coy o Waiver Fee $ Date of Payment � - 24- 2-0 Date of Payment Receipt Number 2-1 g(233 Receipt Number COSA # 0SC W 13 9'3 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 7/23/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to r1�� these various and dynamic characteristics and are outside the control of the evaluator of the • 1 l`` well and septic system. Therefore, any estimate of how long a system will function satisfactory g�Q: • • :1� ��� for current or future occupants or guarantee that no unseen encroachments, deficiencies or J discrepancies exist can be given by First Water Consulting & FWCS ' / • � TH ......: r DSD SIGNATURE �r Curtis Huffman / System #1 Approved for bedrooms rRF'g�s.• CE 128991 00P�%\\ ...r System #2 Approved for bedrooms 1\ Disapproved Conditional approval for bedrooms, with the following stipulations: `,All !Tve%-`�itttutcrrrrrr,, o �V /V gSr`;�I�gNp m^ �J A 1 y: IM Original Certificate Date: 36 " 2_6,U 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. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory_ Well Flow Advisory Other Legal Description: CALAIS BLOCK 2 LOT 5 Parcel ID: 009-035-08 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA* ❑ Well log is filed with Onsite (or attached) Water storage tank volume NA gallons Date drilled CIRCA <1969 Well disinfected for coliform test? ❑ Yes ® No Total depth 79'+ ft ® Coliform bacteria is Negative Cased to 40'+ ft Nitrate mg/L ® Nitrate less than MRL (ND) ® Sanitary seal is functioning correctly Arsenic 24.1 ug/L ❑ Arsenic less than MRL (ND) ® Wires are properly protected = Casing height (above ground) 12+ in. Collected by NES Date of flow test for COSA 7/23/2020 Static water level at beginning of test 25 ft. Date of Sample 7/23/2020— Well production at time of test 4.4+ gpm Comments *Per MOA record docs. B. TANK DATA - NA 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 - NA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade _ft (max) Measured depth to pipe invert from grade _ft (min) ❑ N/A – pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth _ in Elapsed time min ❑ Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) If yes, enter date Gallons introduced gallons Fl�'�s Comments/Deficiencies: « <.:.,. 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' ® Yes Community Sewer Manhole/Cleanout > 100' ❑ Yes if No NA ft ❑ Yes if No 50'+ ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No *10 ft Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Surface Water > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑Yes if No *48 ft ® Yes if No ft Fromm m Septic/Holding Tank on Lot to: (Please enter distances if less than required) NA — PUBLIC SEWER Building ndations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5 ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Water Main > 10' Water Service Line > 10' \Yes if No ft Y if No ft ® Yes ifN ft From Absorption Field on Lot to: (Please enter distances Building Foundation > 10' ® Yes if No ft Property Line > 10' ® Yes if No _ ft Water Main > 10' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Surface Water > 100' ® Yes if No _ ft F. ENGINEER'S COMMENTS Private Wells > 100' ® Yes if No Community Wells > 200' ® Yes if No _ If septic tank is under driveway comment below than required) NA — PUBLIC SEWER If absecption field is under driveway comment below Wells on Adja - t Lots: Private Wells > 10 ® Yes if No _ ft Community Wells > 200' Yes if No *WR86-142 & per MOA record docs and separation standards at time of well drilling (Pre 1969) See attached AWWU connect card & sketch with approximate sewer service line. G. ENGINEER'S CERTIFICATION`®N l certify that 1 have determined through field inspections and review �,LQ►: ,�• �� of Municipal records that the above systems are in conformance /'Aj •;9' i with MOA COSA guidelines in effect on this date. : • TH •,�k • • ' Curtis Huffman ' ��� �'F�; •, CE 128991 ,• ��4i ����1w"P OFESS>D��'�+��� ft ft C\j CY) oo CD o o 0 U fL IL u 2 uj 0 0 LU C, Municipality of Anchorage Development Services Department Parcel I.D. ' 009-035-08-000 1. GEN, ERAL IN. FORMA .TION Complete legal description CALAIS LOT 5,* BLOCK 2 Location (site address or directions) ,3001 EUREKA Cu~ent Property owner(s) JERI DREYER Mailing address 3001 EUREKA Lending agency Matling' address Bulld)ng Safeb/DN~slon ,On-S!te Water & Wastewater program ...... ' . . · 4700 South Braga~ SL · . . . P.O.. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us .. . (907) 343-7904 - . 'CERTIFICATE OF HEALTH AUTHORITY, APPROVAL.- FOR A'SINGLE'FAHILY DWELLING Daypho6e.~' 562 5~7~ Da~Phone' ' Real Estate Agent R~CHARD MICHAEL/COLDWD. L BANKER FORTUNE PROPERf3F~; Day phone. Mailing address 2525 'C' ST. ANCHORACE~ AK. 9950,3 562-7653 Un~sso~en/vlsemqueste~HAA~llbeheMbyDSD~rp/c~p. 2. NUMBER OFBEDRoOMS: 3 3. TYPE OF WATER ,SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ~ Individual Holding tank Community On-site ~E] Public Sewer . The Municipality of Anchorage Development SeMces Department (DSD) Issues CertJficatas 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 AJaska. Certificates of Health Authority Approval are required for the transfer of t/tie (except between spouses) for properties sewed by a single family on-slta 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 sewed by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for eh-ors or omissions in the professional engineer's wor~ [Note: ~. aska Water and Wastewatar Consultants, Inc. shall be pald $550.OO at, or prtor to closing for th~ englnsaring sarv~ provfded. STATEMENT OF INSPECTION BY ENGINEER -' · InveStigation, based on procedures outlinedin me ne~u]/~uu~,,.~,w,~ shows that the on-site water supply and/or wastewatar disposal system Is(are) safe, funCfio, nal and adequate for the numbar of bedrooms and type of s~.ucfure lnEiCa ted hereln. I furJher verify that based on the . Information obtained from the Municipality of Anch°rage files and from my Investigati°n and Insl~ction, the on-sita water supply'and/o~; wastewater disposal S~/stam is(are) In compliance w~h all applicable Munldpal . and State codes, ordinanCeS, and regulati°ns l~ effect at th. e time ?f l~nstallati°n' ; '/i ..... ' ' Phone 537-6179 Name of Firm ALASKA WATER &: WASTE'WATER CONSULTANTS, INc.'r Address 690i DEBARR ROAD, surl'£ 2B" ANCHORAd£, AK 99§64 ~/~.'~,~0 Engineer's printed Name J~I-I"REY A. CARNESS, P.E. Da Engineer's Comments: consdenffous engineering analysis of the s~stern In scco~ance w~n ,~.uc~ anu ~'~ DSD Gu/definas & Regulations. The repoded resu~ desc~7;~cl the porl~'nance of the,. ~ystem under the condib'ons encountered at the time of the tes~ and sepore#on ' distances measured to madi~/ Identifiable features. The oporattona] life of a~I v~fis and sep~c systems depend on ~he local sofis condiffi~n, groundwater levels that may ' fluctuate dudng the year,'and the water usage-of the family being sen~cl by the eys~m. ' These conditions are outs/de the ~tn~ of th~ eva~ster of the system. Satisfacfoq/ test results do not guarantee future perfo~rnance of the system, n~' do they guarantee that there are no hldde~ dofec~ or encroachments. AWWC, Inc. can therefore not p~7//de any warranty or future estimate of how k~ng the s~tem wfil continue to meat the oporationa/ requirements of the ADEC er MOA DSD. The content of ~hls report Is for the sole benefit of the owner listed above. Any m fiance upon or use of this report by any other persen o~ party ls not authodzed, n~ wl~l ~t confer any lega] rlght tW~a~evor. 5. DSD SIGNATURE ~ Approved for -'~ bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineers Reort Other Origlnal Certificate Date: Municipality of Anchorage Development Services Department On~ Water & W~tewater Program 4700 South Bmgaw 6L P.O. Box 196650 Anchorage, AK 99519-61~50 ~ Deacl~on: A. WELL DATA Wall ~3e PR1VAT[ If A, B, or C pmvkle PVVSID#. Date completed PRE 1969 ~lnltary~eal(Y/N) YES Total depth 79'+ FROM WELL LOG HEALTH AUTHORITY APPROVAL CHECKLIST LOT 5~ BLOCK 2, CALAIS Parcel ID: 009-035-08-000 Welt Log (Y/N) VV~s pmpedy protected (Y/N) Cas~g height (above groun~) AT INSPECTION 5/8/01 ft. 33' It. g.p.m. 4-.9 g.p.m. NO Date of test Stelto water level Well production WATER 8AMPLE RESULTS: Coliform 0 colonies/100 Date of eample: 5-8-01 B. SEPTIC/HOLDING TANK DATA YES 19" ~. Nlli'ate 0.5 mg./l.. Olherl~cteda 0 .colollle~/100ml. Collected by:. AWWC~ INC. Tank size gal. Num~~]~ Cteanoute (Y/N) ~ ~~.~_..~ ~2r. (Y/N) High water alarm (Y/N) C. U$ORPllON FIELD DATA ~ Date Wed 8oll rating ~r ~/tx:lrm) System type / Total deplh lt. Eft. ebsa~plton area ~ Depression over field, Date of edaquacy test ~~(Pass/Fell) For bedrooms Ruld deplh In ~lest In. Water add~ gal. New daplh In. nd"' mJuv~na~on tmammnt (past 12 mo.) (Y/N & type) If yes, give date ~ Cymes te~ted. Meets alarm & oln:ult requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WFI I ON LOT TO.' Septic tenl~ltt station on lot Al~orp~n field on lot N/A Public sewer main 48 Sewer/septic sendce line ~ On adjacent lots N/A On adjacent lots N/A Public sewer manhole/oleenout 50'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Bulidlng foundation Water main Property line ~ ~/ater-se~e Suxface water. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Bulldlng founda~ Water sendce line ~u~aee,~l~T~ Driveway, paddngNehlcle st~age n....C~~"--/ Wells on adjacent lots F. COMMENTS G. ENGINEER'8 CERTIFICATION ~% I cerUfy that I have determined through field Inspections end conformanCeEnglneef$ wfth MOA HAA guidelines In effect on this date. -7953 Printed Name. JEFFREY A.C.,ARNESS '~1~,..~.~..,,~.~ o,, HN~ Fee $ ,5c~,. ~'~ Date of Payment Receipt Number ~ ~'/"~ p~v. Waiver Fee $ Date of Payment Receipt Number, I~Y-I 5-01 I$:38 ,~t~, CT&E Environmental Services Inc. T-68~ P.O~/03 F-961 CT&E Rcf.# 1012401001 Client Name AK. Water & Wastewat~' Con.~Itants Inc. Project NameJ# Cah/s S/D Client Sample ID Lot 2 ]~Iock 2 Mafdx DHnking Water Ordered By PW$1D 0 "Sample Remarks: Client Printed Date/Time 05/15/2001 13:33 Collected Date/Tim~ 05/08/2001 13:00 Received Date/Time 05/09/2001 16:55 Technical Director Stephen C. Ede Re eased Paramct~ Resahs Ni~atc-N 0.500U PQL Uniu Methyl Allo',vabk Prep .Analysis Limits Date Date Init 0,500 mg/L EPA 300.0 (<10) 05/09/01 SCL Mlcrobi. ologlr Laborat:o~/, Total Coliform 0 0 col/100mL SMI8 9222B 05/09/01 ]G~P ~0 'd 9~9919~ 'OFI ~d 05/02/01 08:36:15 AM MU.,C,PA', OF A.C.ORAGE 0 o DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORI~ APPROVAL OF ON-SITE SEWER AND WATER FACILITY I !~ 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) (b) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Property Owner I.~I~_F_.. ~--t~I.l.) I T~/' Mailing Address (c) Lending Institution 7'/.1/,,// P-..:~ uM Telephone: Home Business Telephone Mailing Address (d) Real Estate Company and Agent 34~1;(,.t-'/ t~,HIT~--, l~a,-~-~. T'~.-.//,,~' Address ~ ~1 i1~" ~ ~ Telephone ~ ~ ' ~ ~ (e) Mail the HAA to the followina address: or: Check here~ if hold for pick up. List contact person and day phone number below. -- TYPE OF RESIDENCE Single-Family~ Number of BeOrooms WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL [] Public/~ Community [] Holding Tank [] Onsite 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 72-025 (Rev 8/86~ Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND 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 regulations in effect on the date of this in s~n.~ Name of Firm Address Date ~-~-.~'~ / Engineer's Seal DHHS APPROVAL Approved for ~ bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional Date 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. Page 2 of 2 72-025 (Rev 8/86~ Back WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) ,H~,F~LTH AUTHORITY APPROVAL (HAA) C~ A MUH~CIPAU~,¥ _ ~ ~.,¢HECKLIST- FEBRUARY 1984 c: '_./, Legal Description: Well Classification Well Log Present (Y/N) Total Depth ~ Static Water Level "~ If A, B, C, D.E.C. Approved (Y/N) ~'~ O Date Completed .' .'~"~-- ~ q ~ Yield Cased to ~),,~ Depth of Grouting ~ 0 NE '~ Pump Set At ~ g 0 / ~ ~ Sanitary Seal on Casing (Y/N) Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by '"~'-.~, Depression Around Wellhead (Y/N) Water Sample Test Results Comments · On Adjoining Lots ;On Adjoining Lots ~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot · Date '2Z/.5-/~ B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Size No. of Compartments Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, o,[conformed to_ali, MO~ and HAA guidelines in effect on the date of this inspection. Company MOA No. Receipt No. Date of Payment ~--'/'~/~:~ ~", Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) (b) (c) Application Date Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name _.~.m,4~,~,~,f~ Telephone: Home ~'~/- ~ O~ ill Applicant Address "~O'~3 J ~ I.~,~ ~ Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); Business (d) Lending Institution Telephone (e) Address Real Estate Company and Agent Address (f) Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~' Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well~ 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 [] Publi(~% 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 I of 2 72-025 (11/84) ENGINEERING FIRM PROVIDII~,.. INSPECTIONS, TESTS, FILE SEARCH, DA,,~ AND INFORMATION, As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Htealth 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 regulations in effect on the date of this' ~-"7~ "~ ~/'~ Name of Firm Address Date ,..,i~_ .... ,' ,"' JUNE 2~. [971 .' ; En ' ~, '. · . '~ gmeer's Seal '...i DHEP APPROVAL Approved for -/~'~"~'~' Approved ~ '~' ~/'/~ Date bedrooms by , Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations 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 requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11/84) WELL DATA Well Classification MUNICIPAUTY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST' FEBRUARY 1984 264-4720 Legal Description: ~ Well Log Present (Y/N) Total Depth ~',~ Cased to Static Water Level _~ ~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) If A B C, D.E.C. ~pproved (Y/N) .~.~r Date Completed 'L~ut.~~'~ ¶~cj Yield Depth of Grouting Pump Set At /¢ Sanitary Seal on Casing (Y/N) y Depression Around Wellhead (Y/N) ~// Separation Distances from Well: ~_/,~ TO Septic/Holding Tank on Lot /~/~ Adjoining Lots To Nearest Edge of Absorption Field on Lot - /-, ' On Adjoining Lots To Nearest Public Sewer Line ,t3/~; II--d~/ To Nearest Public Sewer Cleanout/Manhole Collected by . ; Date /../_ Water SampleResultst~¢, Water Sample Test -~----- Comments 4(- B. SEPTIC/HOLDING TANK DATA Size Date installed Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Air-tight Caps (Y/N) No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified,,~3r conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed '~~ Date Company MOA No. ~,,, ~~ Engineer's Seal Page 2 of 2 72-026 (11/84) Receipt No. ,4 ~ Date of Payment C~_ ,~q Amount: $ of nchora ¢ P,O. BOX 6650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES. MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES October 3, 1986 Tobben Spurkland, P.E. 203 West 15th Avenue "C" Suite 203 Anchorage, Alaska 99501 Subject: Lot 5 Block 2 Calais Subdivision Waiver Request, WR86-142 Dear Mr. Spurkland: Your request for a waiver of the separation required between the community sewer line and well on the subject lot has been granted. This distance has been waived to 48 feet. The separation requirement at the time of installation was 50 feet. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/ljw · CONSOLTING ENGINEER '"' 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 RESIDENTIAL WELL INSPECTION LEGAL: LOT 5, BLOCK 2, CALAIS SUBDIVISION LOCATION: 3001 EUREKA OWNER: SHARON SHIPPY TYPE OF WELL: SINGLE FAMILY WELL LOG AVAILABLE: NO INSTALLATION REQUIREMENTS MET: YES PUMP YIELD: 6 'GALLONS PER MINUTE DATE OF INSPECTION: SEPTEMBER 17, 1986 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 6 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED TILL THE DRAWDOWN STABILIZED. STATIC WATER LEVEL WAS FOUND AT 33 FEET BELOW TOP OF CASING. TOTAL WELL DEPTH WAS FOUND TO BE 95 FEET. AT A CONSTANT FLOW RATE OF 6 GALLONS PER MINUTE THE WATER LEVEL STABILIZED AT 80 FEET AFTER 40 MINUTES OF PUMPING. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON SEPTEMBER 18, 1986. TEST WAS NEGATIVE. TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. ,m,,~y:..- ,%, -. ,,~'- .~. ~...~ .... ~.~- .... · ~.,~',',(5/'~ ~.-:. W. ~o ~ENSON "4 I I-" ' -- W. :z AWE. 7 3 ,'6 1, I=_1 I:1 Apr~ lEI 2801 '£" fCALA 15 3ZOI c ST. I CAbAl5 3301 c GR. 1630 Spenard Area Reference Map--P7 67 82 ~):,- 84 96 83 COPYRIGHT 1985 JMR CONSULTING ENGINEER 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 6-6650 ANCHORAGE, ALASKA 99501 OCTOBER 2, 1986 SUBJECT: REQUEST FOR WAIVER OF SEPARATION DISTANCES FOR PRIVATE WELL. LOT 5, BLOCK 2, CALAIS SUBDIVISION Gentlemen; We are requesting a waiver from the separation distances stated in Title 18, Alaska Administrative Code Chapter 80.020 for lot 5, Block 2, Calais Subdivision. Yours Tobben Spu~land P.E.