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HomeMy WebLinkAboutT12N R3W SEC 23 PARCEL 26ACertified Drilling Log ® DOC CO dba BILL 8, COLE '40,MLIVAN WATER WELLS W—rPP.O. Box 670269, Chugiak, AK 99567 688-2759 OWNER OF LAND: Stacey Miller ADDRESS: 11571 Rockridge Dr. Bore Hole Data Depth From To LEGAL DESCRIPTION T12N R3W SEC 23 PARCEL 26A DATE: 9-3-19 0 2 Casing Stickup PERMIT NUMBER: OSP191362 DATE OF ISSUE: 8-20-19 TAX IDENTIFICATION NUMBER 01533107000 Is well located at approved permit location: ❑Yes ❑No Method of Drilling: ®air rotary ❑cable tool Depth of Well: 105' Casing Type: Steel wall thickness .250 inches Diameter: 6 inches, depth 104 feet Liner type Static Water Level: 50' feet Recovery Rate 20 ® gpm ❑ gph Method of Testing Air Well Intake Opening Type: ❑ open end ❑open hole ❑ Screened Start feet Stopped ❑ Perforations Start feet Stopped Grout Type: Bentonite Volume: 50 lbs Depth: from 2 feet,to 42 feet Well Disinfected Upon Completion: ®yes ❑ no Method of Disinfection: Chlorine 50 PPM Comments: 2 4 Overburden 4 15 Sand 15 48 Silty Sand & Gravel 48 80 Silt & Sand 80 95 Sandy Gravel W/ Water 95 105 Silt Sand & Gravel WATER QUAtITY TESTING Colifor, III N' Ntrates0 Arsemc 9 �► i9 Drillers Name: Cole Sullivan ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. www.sullivanwaterwells.com Pump Installation Log Well Drilling Permit Number: SW OSP191362 Date of Issue 8-20-19 Parcel Identification Number: 01533107000 Legal Description Property Owner Name & Address T12N R3W SEC 23 PARCEL 26A Stacey Miller Pump Installation Date: 9-11-19 Pump Intake Depth Below Top of Well Casing: 90 feet Pump manufacturer’s Name: F&W Pump Model: 4F07P05301S Pump Size: 1/2 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Installer: Northern Excavation Disinfected Upon Completion? yes no Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer: Martinson Pump Installers Name: Sullivan Water Wells Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Municipality of Anchorage Community Development Department On -Site Water & Wastewater Program 4700 Elmore St. ■ P.O. Box 196650 ■ Anchorage, AK 99507-6650 m w�r��.rnuni.crgfsie N {907} 343-7904 Legal Address: Subdivision Block Lot T r ZN R _ 1..3 Section _Zs Lot, fq On-site Water & Wastewater Program certified contractor performing the well deco Name: (10' 0�.t O'CA;r c Signature Company _ �iEi l ���� +'l�✓ G�3+2.G �S , Well decommissioning date: AIPL Method of decommissioning: AMC 15:55.0601.1 a. ❑ b. ❑ c. X Location: Use the space below to provide a drawing of the property showing the following items; • North Arrow • Decommissioned well, • Other water wells on the property, ® Two separate swing -tie distances for each well shown in the drawing, Note: The swing -tie distances shall be measured from either permanent structures of property corners. n� f I MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Water System Permit Permit Number: OSP191362 Work Type: Well Initial Tax Code Number: 01533107000 Site Legal Address: T12N R3W SEC 23 PARCEL 26A G:2639 Site Mailing Address: 11571 ROCKRIDGE DR, Anchorage Owner: MILLER STACEY A Design Engineer: This permit is for the construction of: Effective Date: Expiration Date X111 C''7lj G r� t)('paI-t111efit Lot Size in Sq Ft: Total Bedrooms: 8/20/2019 8/19/2020 ..::1 ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank" ❑ Privy Q Private Well ❑ Water Storage All construction shall be in accordance with: 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: To close this permit please submit: 1. Well Log 2. Pump Install Log 3. Water sample results 4. Well Decommissioning Log Received By: Issued By: Date: 2 Date: v 2 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015 - 33 ( - D 7 Property owner(s) {-14 Wj t u,t,( Day phone Cto 7 '31-7 3?4 0 Mailing address "C.(p!`? - , wy,- Site address l K66 ice' b(a-,:: 12rati(r k` �,1 / � ct °L 5�(P Legal description (Sub'd., Block & Lot) l /2 t/ R3W S&C �,6, 2.3 .1914 14 jq �- Legal description (Township, Range & Section) Lot Size 4 q U() Sq. Ft. Number of Bedrooms 2 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial Single Family (SF) (w/wo AD U) Septic Tank ❑ Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Sidnatu perty owner or authorized agent) Permit/Rush Fees:acQ11 _ Date of Payment: Receipt Number: e1 fry-1 Permit No. 0510 lgy:1 (0 2 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc RDCKRIDGE DRIVE -- — - Q ®�•o Q aiD ::r E a ✓ i s W 170.00'zi rl rt. w o \ • • 9AV • • i� e cy I V) (D \ Ln o p car (D 3o o f°n O w, rl (N -r-1 p+ 3 0 0 p p N (D O {' o o m < o r o N N o (D (D (D (D O p o ao 0 0 0 0 (sp (n O 0 s eeu O r s Q@ ap N N "D y ° {T J 0 J O J o o (A {' Q P O N< o Q m �w S°° Q O Q O h w Ci c 3 O O a yia C, N --h n —I (n ( O o- --h n so -7 m p 0'a Q @ (D (D (D � CD M O r o 'a o Q .-r (-r r -r rr (D O- C7 c `I j L a �° .-r .-r r+- rr tB O N �' -�--� coo '"..'� CD A• pw,,, c N W O 0 O o o o �' �D r L_ 1 -o (D a `7 (D ° rt o 4 p p p p z p O 0 �� �� _ °sem LO z � 34.6 QCf)` �;% 8.7- �3 _ N ° O. 2. 2. —'{ O _ E� �� (' ��,,, 7 ({,.yam' t� S. 3m3 0= ��no • m C �—+!�O O i° N �l N • �� OCJ Oo a o0 0 C) Q r ON7 0QJ 0 r ; OCt n (D Cil N '13D (n Lo ^ m 3 DZTQ N —co ! 0 0 (D (D (D Q p O 11.8 o ' O0mo Z Q O (D o C A D __, a a Lo co o Iq CA 00 CD = Q r C� m X S yy r o f cf� CJt Cat p O Q m*'1 cNn a `? _ 79 h �. —32.3' n°o lb � co a a # cn 16 a (b 00 ' CA z ro m } > 0-0 O ° Ct H^.a0- ? 0 --{ED I ti n (D p cn i I o m - t 170.00'J O W m o S 00°02'35" E ,9 RDCKRIDGE DRIVEAW N 00 02'35" WCO ®z°� G - gyp-- \ 170.00 t � o « w a « «-909 -P �. ;2.. ! 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O "c t "� (A O ca O @ Cd N ?1 rn O �g` �? a- CEJ O0 w W 170 00' .:. _... , x� x S 00°02'35„ E ,!'ER ANCHORAGE AREA Department of Environmental C~uality 3330 C Street 0 ( ~-- ~ Anchorage, Alaska 99503 INSPECTION REP ..... ~e DISPOSAL SYSTEM ~ - "i~ FII//c~ ~ PHONE SEPT C ~ ~~AL~eSCmPT~O~, ~ ~ . ~ ~ ~ COMPARTMENTs SEEPAGE PIT: ~ LIQUID DEPTH ~LIQUID CAPACITy~ NUMBER OF PITs ~ GALLONs~ BUILDING FOUNDATIoN:~ NEAREST LOT LINE~ , TOTAL EFFEcTIV~ ADDITIONAL ABSORPTION ABSORPTION AREA (WALL AREA) ~SQ. FT, TYPE ~ CONSTRUCTION_ BUILDING FOUNDATION ~--~, NEAREST ~ DEPTH LOT LINE~, NEAREST ~ DISTANCE FROM: CESSPooL SEWER LINE ~__~, SEPTIc -~-~-~ TANK ~ SEEPAGE A~PPROVED , OTHER SOURcEs_ , SYSTEM ~. --~ DISAPPROVED DiSTANcEs: ~~~ REMARKS_ ~ DIAGRAM OF SYSTEM NSTALLED BY: ~F N/eli 'E BATERIAL: ~ ~Q~ J ~' / , , $RF fER ANCHORAGE AREA Department of Environmental quality- 3330 C Street Anchorage, Alaska 99503 ~ INSPECTION REPORT NAME~z~ ~ ~;~ ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDR~SS~ PHONE ~ LOCATION ~ LEGAL DESCRIPTION ~ ~dd. _g; ~ ~ - SEPTIC TANK: ..... "~ DISTANCE FROM WELL ~/ ' ~ MANUFACTURER~ MATERIAL~ NUMBER OF INSIDE LENGTH~ INSIDE WiDTH_~LiQUiD DEPTH~LIQUID CAPACITY~GALLONS SEEPAGE PIT: . NUMBER OF PITS ~. DIAMETER ~ OR WIDTH~ ' LENGTH/~, DEPTH ~ / LINING MATERIAL ~ CRIB SIZE: DIAMETER~X~EPTH~ DISTANCE FROM: WELL /~ BUILDING OUNDATION~, NEAREST LOT LINE~0 ~ TOTAL EFFECTIVE ' ABSORPTION AREA (WALL AREA) ~- SQ ADDITIONAL ABSORPTION ~g ~ , WELL: TYPE /~ ~L~~CONSTRUcTION~ . BUILDING ~ -- ' DEPTH FOUNDATION /~) , NEAREST . LOT LINE /~7 /~ , NEARESL~NE /~7 ~ , SEPTIC SEWER TANK CESSPOOL ~, OTHER SOURCES APPROVED ~ ~ DISAPPROVED ~ REMARKS ~?UJ ~.~.'~, _~' ~ o~ DISTANCES: INSTALLED BY: PIPE DT SLOPE: DISTANCE FROM: SEEPAGE SYSTEM _ /Z~ / DIAGRAM OF SYSTEM -', .-'. -.,, ~v, GREATER ANCHORAGe AReA BoRoUGH SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED *om teST RESULTS' {~'~v~O(,<m,q~ COMPLETION DATE ANTICIPATED /q ZL~ SEEPAGE PIT- · DRAIN FIELD OTHER NOTE= THIS PERMIT IS MOT VALID WITHOUT BOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM SEEPAGE PIT /00 /o0 / SEPTIC TANK, (~-~' / , SEEPAGE PIT - /00 / DRAIN FIELD /O~ / TO RIVER, LAKE, STREAM· CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRiB CROSSING GAp OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH D~AMETER CAST IRON SIPHON pIpES ON SEPTIC TANK AND SEEPAGE Pit FITTED WITH A~rT~GHT REMOVABLE CAPS· GRAVEL BACKFILL r~ONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR ~IFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAge AREA BOROUGH ORDINANCE NO, 28-68 AND THAT THE ABOVE IBED SYSTEM iS IN ACCORDANCE WITH SAID CODE. -~ APPLICANT'S SIGNATURE Put-formed For Mr. L~ga'l ~esc~intjon: This "One ~es* is worth a thousa, d opimioms" Rutaae]-]- Gaegel Date Performed Lot Block SubdivisionT12NR3W Seot 23 Paroel 26A Form Renorts Soils .Loq Percolation Test neoth Feet S_o_]] _C ._h_a r~a~ c~t_e._r i~s_ _t_i c~s ....... ~ · : .; S]_J ,y ,-~ ~ .... .....' " ~l ::1;id~ Oc'.:7e t,7 ::,~ , ~: >~,', rc Yes, At what Be*th'¢ ........ l{eadinq Date Gross lime Net Time Denth to H20 ............... Net Dr'on i:-::::.:-- t :--: :-c:: :-- :--: :_::: ::. :: :': ::::::::::::::::::::::::: ......... ~,., Ih?too'la%ion Rai, e Hinu~e rono'.::,,i ~nst~G~[%-i[]"~n': Ser.~,F~,:, Pit Drain Field . ~ I ..... h'l dl:,: .... 0 ,,4 .... .- ...................... i 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 m.D.# L~I~, - ~,'~ [.--O7 HAA# /"/~ 1. GENERAL INFORMATION Complete legal description TI2N~ RSW~ Sec. 23~ Lot 26A Location (site address or directions) Property owner Mailing address 11571Rockridqe Drive Mark Williams Anchora~e~ AK 11571Rockridge Driv~ Anchorage, Day phone. AK 99516 346-1434 (h) 563-1191 (w) Lending agency Mailing address Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-825 (Rev, l/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 ~ith all Municipal and State codes, ordnances, and regulations in effect on the date of this inspection. Phone Name of Firm s & S ENGINEERING 17034 EagJe River Leop~oad Address, Eaqle~/'~/-~"River' Alasl .~r~.~ex~7? /' Engineers signature ...//../ .....~'-----. -~ 6. DHHS SIGNATURE Approved for ~ Disapproved. Conditional approval for bedrooms, bedrooms, with the following stipulations: Additional Comments 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 purohasers 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, 72~25 (Rev, 1/91) Back MOA~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-/Z./~ A. Well Data Well type Log present (Y~') Total depth ~'~ Sanitary sea~,l) Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed [ '~ "~ ~ Driller Cased to ,~O r./._ Casing height Wires properly protected (~) Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septichhcld[,n,~ tank on lot Absorption field on lot / Public sewer main ~7~' / ~ Sewer service line ~ ~ 7~ FROM WELL LOG/ g.p.m. AT INSPECTION z~.~ ~' .g.p.m. -x~ P J; ~7-~ Iollo/?o, ; On adjacent lots ; On adjacent lots / © (D ~.~ Public sewer manhole/cleanout Petroleum tank ~-/'/- / WATER SAMPLE RESULTS: Coliform (~/~'0 © ~'~--~ Date of sample: ~'> / ! ~) / ~ ~'- Nitrate 0, ~ ~> ~////~ Otherbacteria C~,/ Collected by: <.-~t~,-~' ~C~/~'-'~--'~"~/~"~ ("" B. SEPTIC/.I,I~-I~NG. TANK DATA Date installed .~'/~'7_./"'~ Cleanouts Y~) ~'~-~ High water alarm (Y(~ Date of pumping Tank size /~0~ C~ C_ Compartments Foundation cieanout~) ~/~'j Depression Alarm tested (Y/N) ~i//'~/~L- pumper ,~ SEPARATION DISTANCES FROM SEPTIC~TANK TO: Well(s) on lot / 0 0 To property line //~ Sudace water/drainage ' On adjacent lots / 0 L~ f-/ Foundation Absorption field ZO / Water main/service line Io0 72-026 (3¢93)° Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level ~ ~-~'~CCycles tested Meets MOA electrical codes (Y/N) SEPAR~TI~FT STATION TO: ..~ On adjacent lots D. ABSORPTION FIELD DATA Date installed Length ~' c_~ Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Manufacturer ~ Manh°l~evel at Sudace water Soil rating (GPD/FF) / ~ O z~-~,,~ System type C ~/~,~-~ Width / S / Gravel thickness ~-~ / Total depth / Z~Z. Oz~' Cleanout presenl(~N) ~'/~'-~ Depression over field (Y~-'~ O0 / I ac'/~ ~b~ Results/(p'~ail) f'¢/£ ~' for '~-/l'~.~'"~J Bedrooms ff _" After test ,AJ~/...,r~' /{'/,j~.j/,~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: we, on lot /('2(9 To building foundation /0 r..~_ On adjacent lots ~--~ Surface water /Ot.~ / Curtain drain /t.)D On adjacent lots /(~.JL~ (74- Property line To existing or abandoned system on lot Cutbank /~J~,,~E- /q~E-.~E~.~7- Water main/service line Driveway, parking/vehicle storage area /0 E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, S & S ENGINEERING 17034 Eagle River Loop Read Signature Nam~0~u 'ON paoa dool aa^!a e Engineer's Date HAA Fee $ "~--~' ~ 0(~. ~ Receipt Number 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number 08/22/94 08:~1 CT~E ENUIROHHEHTAL LAB SERUICES CTaE gef.~ Cli~ag 8ample ID Malrlx (21ienl Nimle Ordered By Project Name l'roject# PWSID Commercial Testing & Engineering Co. Environmental Laboratory Services LABORATORY ANALYSIS REPORT 94.4228-1 TI2N, R3W, SEC 23 WATER ..... *O W(.)RK Order 81436 Prit)~ed Date 05!191~)4 ._ hi'a. RAY Cellecled T.)at c 08/17/94 ~; 16:25 hr~, Receiv ~1 Date 08/17/94 Co) IT:01) h r,';. IIA 'lgchnioal Direct,q .qT'EP}~N C. QC Alloy, able Exl, Anal Parameter Results Qiml Unilu Method Limits Daic Date ............................................................................. 08/!9/v4 DJS ...................................... 0.28 m~/l ]~PA 353,2/3'~0.0 Nitra(c-N 1_ A =/J lava!labia * See Special Instimclit>ibq Above NA = 'Not ~fiiyTed ** $~ Sa ~¢lu Remarks Above U = lln&tccte~ R~o~edvalt~is O~e practic~ qmniificat~oe llnliL L,l'= l,~ss 2hah D = Seco n&~i'y & lution, GY = (2~'eaier q'htm 5633 B Street, Ancho,a§e, AK 99S18-1600 -- TeJ!._(9_07~).662-2543 Fax: ........ {907) 561. ....... -aa,. 1 ................... ^... ,-r,=~ m ^[ .~q~a PAl C~RAr~(3 FLORIDA. iLLINOIS. MARYLAND NE\~, JERSEY. OHIO. UTAH, WEST VIRGINIA MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # 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 10t, block, subdivision, section, township, range) Parc~Z 26A; Sec. 23; T12N, R3W, S.M. Location (address or directions) 11511Roekridqe Road (b) Property owner Doug Serdah¢~y Mailing Address 739 "O" Street #3; (c) Lending Institutioq Telephone:(home) 278-6998 Anchorage. Alaska 99501 Telephone Business Mailing Address (d) Real Estate Company and Agent JACK WHITE COMPANY ATTN: Jan Pennington Address 3201 C Stre~ SuJ.~e I00~ Ane_horage~ Ak. 99505 Telephone 563-55¢,0 (e) Mail the HAA to the following address: (or check here~ if hold for pick up.) List contact person and day phone number below: $ & S ENGINEERING. 17034 Eagle Ri,ve~ Loop Road Ne_ ~'~ Eagle Rivet', Alaska 99577 Single-Family ~ Number of bedrooms 3. WATER SUPPLY Individual Well,~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of, Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site/(~r' 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. 72-025 (Rev. 7/88} Page 1 of 2 ~ ,to ~ 8~ed leAo~ddv leUO!~!puoO ¢o sw~e/ leuo!~!puoo pe^oJddesK] .~ peAo~ddv ~,, ~oj peAo~ddv 'l~'AO~dd~' SHHO '9 // / euoqdele.I. 'uo!loedsu! s!ql ~o e3ep eql uo ~,oe~e u! suo!~elnDeJ pue 'seoueu!pJo 'sepoo e)e3S pue led!a!un!AI lie q~!~ eoue!ldU~oo u! s! Lue~,s/,s lesods!p Je~eA~e~seA~ Jo/pue ,~lddns ~e~eA~ e~is-uo aq3 'uop, oedsu! pue uo!~eS!3se^u! ,~LU LUO~J pue Sel!~ eSeJoqou¥ ~o /q!led!oiunR eq3 uJo~ peu!e~qo UOgeLU~OJU! eq~ uo peseq 3eq~ ,~!~e^ ~eqpn¢ I 'uie~eq pe3eo!pu! e~nionJ3s 3o ed/q pue sbuooJpeq ,~o Jeqt.unu eq~ ~o~ e~enbepe puc leuo!iaunj 'e~es s! ~ueis,~s lesodsip Je3e~e~se/~ Jo/pue ,~lddns ~e),e/~ e~!s-uo eq~ 3eq~ SA~OqS le^oJddv ,~3poq~n¥ q~,leeH s!4~ Jo uo!~,el.~!;lseAu! XLU :leq~/~!JeA I 'MOleq UMOHS e~ep uo!~ep!leh eq~ ~o se pu~ o~aJeq pex!J~e lees ,~w ,~q pei~!~Jeo sV NOI.L'CtNI~O4NI ON¥ ¥J.¥O 'klOld~¢~S t114 '$IS~J. '$NOI.LO~idSNI 9NIOl^Oad INI:II_-I 9NIbI~NIgN=I '9 ~ ~x°~ MUNICIPALITY OF ANCHORAGE (MOA) ,-,~ ~'¥',~i~,~.' ~ Health Authority Approval (HAA) * I Descriptiom ~ ~ ~u~ A. WELL DATA Well Classification ~ ;~ ~ ~ ~', ]~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) /~ Date Completed ('~ Total Depth-X-~.~ Cased to No'/' Depth of Grouting Static Water Level Casing Height Above Ground f Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot / O To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line AJ/~ To Nearest Sewer Service Line on Lot Yield %~ I~ ff p ~, Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ( OO II "'¢ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole AJ/~ Water Sample Collected by ~ ~ ~ z~Je/,l~,~¢lcJ~ 'Date / O - ~- ~ O Water Sample Test Results ,~.~'~t~,-~.C.~--~£t~ -- ~2~d:~c''-]--~¢?~ ~ ~"~'-~-~'~5 B. SEPTIC/HOLDING TANK DATA Date Installed / '~ "~ Size f O¢O?¢1No. of Compartments Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact 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 To Stream, Pond, Lake or Major Drainage Course Comments Foundation Cleanout (Y/N) /,J O Date Last Pumped ! o- [ I - ~ O AJ//A ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field 72-026 (Rev, 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test ~¢/,0.~ ~2~ Type of System Design ,.Length of Field 2. o ~--~(->~ lDepth of Field (' 0 Gravel Bed Thickness 0~ Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot [ cP ~- To Water Main/Service Line 2o ') To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To,Cutback (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at ~ ,~.~ Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **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 inspection. Signed S & $ Ft'~C'INI~F--~ING 17034 ~agJe River I. oop Road No. 2,04 .~ ~.:~ Company Eagle River,~,~aska ~/~5~7 ~<,.. MOANo. ¢¢ ~¢~ Receipt No, ~:~'~O~' Ek.~--~:2'~ ) Date of Payment Amount: $ 72-026 (Rev 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA99518 ° TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS RZPORT BY SAMPLE for Work Order ~ 29190 Date Report P~inted: OC~ 14 90 ~ 15:06 Client Sample ID:PARCEL 26 "A"; SEC23; T12N; R3W;SM PWSID :UA Collected OCT 9 90 @ 16:30 hrs. Received OC~ lO 90 @ 14:00 hrs. Preserved with :AS REQUIRED Client Name : S & S ENGINEERING Client Acer : SNEENGP P.O.~ NONE RECEIVED Req # Ordered By : R, SHAPER Analysis Completed :OCT 12 90 Send Reports to: Laboratory Supezvisgz~EN C. EDE 1)S & S ENGINEERING Special Instruct: Chemlab Ref ~: 904179 Lab Smpl ID: 1 Matrix: MATER Allowable Parameter Tested Result Units Method Limits NITNATE-N 0.17 mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY R.D.$. 1 Tests Performed ' See Special Instzuctions Above UA=Unavailable ND= None Detected ** See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT-Greater Than CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~,, TELEPHONE (907) 562-2343 ~) 5633 S Street : t~l'~('~ ' Anchorage, Alaska 995:18 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER S &SI~Glhf-z:KING Mailing Address 17034 Eagle giYe~ Leep Eagle EiYer, Alaska City SAMPLE DATE: i "-.,~. ' 'SAMPLE TYPE: .. "~ Pa3utine .' ~ wthlab~t. State Day Year Zip Code '.[Dr' Treated Water ID,. Untreat~LWater · NO. LOCATION :.,~ I~~' I ~ollected TO BE COMPLETED BY LABORATORY Analysis shows this Wate~ SAMI~LE-~ be: ,,~tisfadtory I-1 Unsatisfactory I-]. Sample'~oo long hllransff; sample should ' not be over 30 hours old at examination to indicate reliable results. Please send /:new sample wa special delivery mail. :DateP.,ece~_ed .Time Received Analytical Mett~d:" Memb.,,~Filt~ '? ,No. of cblonie, s/100 mi. t.a~' Ref. NO. ;:" 'Res~l~ ".'' A~atyst ~°-4~.~4. i!. r-t-~'_ , BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter;, Direct Count (~ Coliform/100 mi BEFORE Verification: LTB BGB Final Membrane Filter Results CollformflO0 mi ~.,~,COLLECTJNG SAMPLE :' ~",,~,,-,.,,..: ~ ~-,~"~---~,Z'~--''. .~. :~' :,,~-//- OB = Other Bacteria { P,,.~-r or~ o; ~ : o .:.... · ~l/dr~'~ TO FOLLOW 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 Application Date 7/I GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name '~)L~,].~~ !o,--s '"4~0- J,,c~/~Telephone: Home ."~,4~- ! Applicant Address .,/~J~,¢ '/~- (c) Business ~ "/' Applicant is (check one): Lending Institution []; Owner/builder/[;~; Buyer []; Other [] (explain); (d) Lending Institution ~1~ ~ ~,-,~_,~. Address Telephone (e) 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 ~ WATER SUPPLY Individual Well.~ Community [] Other Public [] Note: If community well system, must have written confirmation from the State Department bf E~vironmental 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. 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 inspection. Name of Firm /~ ~) '/-~F ~ ~' ~.~ ~ r-:~.~ Telephone Address 7}~-~ ~ ~ ~_,~ WATER WELL NOTE: Th~s Hea~th Authorft~ Approval inspection me~el~ certifies that the subject ~ate~ well p~oduced [50 ga]Ions pe~ bedroom pe~ day a~d that certified l~bo~ato~ tests sho~ed no presence of co?~¢orm bacteria fna samp]e of that water. No o~ certification ~s expressed or implied concerning the long term adequacy or safety of the uater supp]5. ON-SITE SEWAGE DISPOSAL SYSTEM NOTE: This Health Authority Approval inspection merely certifies that the subject on-site sewage disposal system accepted at least 150 gallons of water per bedroom per day as determined by methods approved by the Municipality of Anchorage Department of Health and Numan Services. No ~¢arantee or certification is expressed or implied concerning the long term adequacy of the on-site sewage disposal system. Construction data reported on buried system components is from MOA files and was not verified during this inspection. DHEP APPROVAL Approved for /]~ Approved ,~ 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· · :~:: ,;·,· ;,: i MUNICIPALITY OF ANCHORAo~ DEPT. OF HEALTH & FNVlRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: ~"'~" PumpSetAt ~ J-E~'~ I~U~t Sanitary Seal on Casing (Y/N) ~-,~ Depression Around Wellhead (Y/N) ~ WELL DATA Well Classification ~/~2'~¢/~(~' If A,I~, C, D.E C Approved (Y/N) Well Log Present.~Y_.~/I)) ~/ D~e.C,o.mpleted ~ Yield ~ // Total Depth ~:~-..~.-%-. Cased to ~J~-:!'~/,,~'.~.~-I~th of Grouting ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on ;Date Static Water Level L),~ ~.~, Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from W¢I: To Septic/Holding Tank on Ld~ /~" ' To Nearest Edge of Absorption Field on Lot //;~7 · To Nearest Public Sewer Line Cleanout/Manhole /¢,¢?/~ Water Sample Collected by Water Sample Test Results SEPTIC/HOLDING TANK DATA ~ Date Installe~ Size ~/"um f~¢c'/~2OONo, of Compadments . Standpipes (Y/N) ¢¢ Air-tight Caps (Y/N). ~ Foundation Cleanout (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 ,~I~"/ '-~:2 · To Water Main/Service Line '~) / ¢, Course Date Last Pumped ? -~k.~-- ,'~_~ ;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) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed . ."~?p.~*'.?~ Width of Field ~ Square Feet of Absorption Area Type of System Design Length of Field (-,/.,n. Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well _,//."~_ To Building Foundation .,~¢)C2" Lot ,,f/¢/V~ To Water Main/Service Line . To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Date of Last Adequacy Test To Properly Line To Existing or Absndoned 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 ! h~,cCk~d/er' '.¢d.~d~nformed to all MOA and HAA guidelines Signed Company ~*~* ~ ~OA No. Receipt No. 7 Amount: $ Page 2 of 2 in effect on the date of this inspection. 72-026 (11/84} NI~AWTHORNE~ENGINEERING ..J-~ Jy 907-344-4711 --7--/2>,/ J~ ~]~l 'L . GREATER ANCHORAGE AREA BOROUGH -. ' ~ ~ ~/ J Department of Environmental Quality ~ 3330 ~'C" Street, Anchorage, Alaska 99503 274-4561 ' ~5..~ .~ ~ Date Received ~a~a~ 18~ 1977' 0~~~ ~d- Time of Inspection ~~?l . ~ - ~ ' Date of Inspection ~ ~ ~ ~ /~r~IVIDUAL SEWER & WATER FACILITIES ~.~.~ { ~1~~ ~l~q~: ~} ~ FOR ~:lr~'~ ~1~` Cony. ].. Approval· requested by: ~laska Mutual Savings ~ank 2 Debbie Johnson Mailing Address: 601 West 5th ~venue Phone: 2V4-3561 x 216 Property Owner: Mailing Address: William/Sandra Bittne~ Phone: 278-4671 -\ 1236 West 5th Avenu~partment ~1 3. Legal Description: 4. Location: 5~ Type of facility to be inspected 6. Well Data: A. Type Individual C. Construction · : iq/ 7. Sewage Disposal System.¥-~$~te A. Installed /F~/d4 ~ ¢?3 C. Septic Tank: . 1. ~iz~ D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines T12N R3W SectiOn/23 Parcel 26A No. of bedrooms 2./ Single Family B. Depth D. Bacterial Analysis system B. Instal]er 2. Manufacturer 2. Material 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines , Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION JAN 1 8 1977 RECEIVED 1. Type of Inspection: CMRO VA. FHA 2. Property Owner: BITTNER, Uzllza~ q~'.~Sa~{~ ~. Mailing Address: 1236 ~. 5th &~',,<~pg-?~::#1 Day Phone: 3. ~ame of Buger: SE~AHELY, ~d~l~ J:i ~nd Shelley HI¢¢I~8 Mailin~ Address: N~*'Stqnyb6°°k Day Phone: 4. ~ame of kendin~ Ins~i~t[0hi,:'~ Alaska ~utual Sau~ngs Bank Mailin~ Address: ~' W. 5th Phone:_ 5. Name of Realtor or Agent: N/a Mailing Address: 6. Legal Description: Parcel 26A, Sec. 23 T12N R3W Location: CONV 278-4671 278-9551 274-3561 ext. 216 Debbie Johnson Type of Facility to be Inspected:. Phone:_ 2 Water Supply Type of Supply: Public Utility ,Individual If Individual, number of dwellings presently served i If Individual, depth of well Sewage Disposal System Type of System: Public Utility Individual (on-site) x If Individual, date of installation 72-OO3(3/76) 2oof two pages - Re,' 'st for Approval of Individual .~r & Water Facilities L.~al Description ~l'2N R3W Section 23 Parcel 26A Comments , Approval ~Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental. Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) ., GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 Date Reoeived // --~0 ~7~.. Time of Inspection ~,'0~ Date o~ ~ns~eoUon f/.'-~0~?~-- REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Approval Requested By: ~ Address: 2. Property Owner: 7~ ~-~ 5. Type of Facility ~o be Inspected: e Phone: Phone,~ Number of Bedrooms: Well Data: ~ 0 z C. Construstl on_~.~ ,/'J.~'~ ~/~f~D. Ba~terial ^nalysis' ~ Sewage Disposal System: -/<.~ d:C,'~"e~"~ m~ ~~'~ A, Installed /~/ B. Installer C. Septic Tank: 1. Size 2. ~anufacturer D. Seepage Pit: 1. Size 2. ~aterial E. Disposal Field: Total Length of Lines . .- Distances: A. Well To: Septic Tank__ __, Absorption Area ,., Sewer Lines , Nearest Lot Line · Other Contamination B. Foundation to Septic Tank ,.~i> Ab'~orption Area C. Absorption Area to Nearest Lot Line }~equ~st for Approval of Individual Sewer & Water Faoilit~es Page Two Comments: ,.~/~,[. Aporoved Disapproved Date Approval Valid for One Year From Date Signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTE~ I certify that the information contained in this request for approval to be a true and accurate repr~seBtation of the subject ~ewer and water fsci!itie~ located 972 Ancilorage, Alaska A rcv~&,~ ,;:,~ the sew~:r ~ ~ ~r: water ~C.'-..cl'iities fur Cn~ s~bjec~ b.~mrt~;~en~ c~m appruve the sewer and wa~er facilities, the <~bov~ ~ru~n,J sufficiently to prevent possible con~a~dnm'cioa. tim well casing, or by extending the casing 12 inches above bhe 9roun~i lev~,l. The water ana'Iysis pr~veJ satisfactory. nc~,s~r'ed aC aF, proxi}~a~ely L~] fee~, ~aKin~,~ it l~possib]e Co s~:u[ in a septic t~nk and use this cesspool as a seepage The distance required between ~he well ~nd s~pd~ge pi~ is lO0 feet. It ~,ill be necessary t~ tnstt~lt a co~,ple'ce on~si~e sewer syste~;~ Co ~eet the Greater Jmchuraue Area borou,jh require,;~mnts. A copy of escrow of funds for this system to be instati~d by July l, 1973 will be accepted by ~his DeparCi~.ent and a[)?roval will be granted for th~ conventional lo~n office a'~ Alaska Hutual Savi~gs Bank. ~combe~ 14, 1972 Poge Two A pert~tit Lo install an on-site sewer sys:m~ must be obtained at this office prior to, installation. All i3orough specifications for ,this systee~ v~ill be included when the permit is ~btained, Thank you for your cooperation in tills ~a~er. if you have any re~)m, rdim:~ this ~ac~er, olease do not hesigate ~o contact this office. S'i):cerely,