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HomeMy WebLinkAboutHUNDRED HILLS 1ST ADDITION BLK 4 LT 8Hundred Hill #1 Block 4 Lot 8 #078 - 191 - 11 Municipality of Anchorage Page 1 of Z 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:0/ 9/0022-lp PID Number. 073 L L L Name: Lie �2 O Wastewater System: N New ❑ Upgrade Address: 1I517 ofd C-,'leo n Al�aq/��v�/ ABSORPTION FIELD Phone 494/-• (P3&,CL. o. of Bedrooms: 3 0 Deep Trench X Shallow Trench 0 Bed 0 Mound 0 Other LEGAL DESCRIPTION Soil Rating: /• GPU/Sq. Ft. Total Depth from original grade: 5: 98 - 6 . 8 Lot: Bloc r.^ /b/ ubdi/vis/i/on / 04 ,r J %• it n /Vi f /..s /i ,Depth to pipe bottom from original grade: � . `JS - /.8J 6 Ft. Gravel depth beneath pipefr ,/ '7 • / Ft. Township: Range: ,e Section: Fill added above original3 lggrade: /' Ft. Gravel length: 3C"JQ Ft. WELL: 1 New ❑ Upgrade Gravel width: Ft. Number of lines: / Distance between lines: Ft. Classification (Private, A,B,C): PriVez Total Depth: /oZ. Ft. Cased To: /02 Ft. Total absorption area: 380 SO. Ft. Pipe material: /8/O C).3(734-7 Driller: II Jet 1-1-V1 it 0—w.5 Date Dr I ed : 8 /kP Static Water Level: 3/ Ft. Installer:st�L 6re-e4 �D/ii/r_ Date installed: a /q //�'/! e Yield: 9r� /2 GPM Pump Set at:at/// Glhr(f0c0 el Ft. Casing Height Above Ground: 2 Ft. _,//(i7'L. TAN K SEPARATION DISTANCES XSeptic ❑ Holding ❑ S.T.E.P. To From Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Lines Manufacturer: A. 4' gh k. Capacity in gallons: /40.0e, Welh4' /co'+ loot- -~ /OD GC--Material: Number of Compartments: Surface re /DO It /0o'+ -- -- loo'+ LIFT STATION Lint Line , lD 4 t /0 -{- - - , /Q + Size in gallons: Manufacturer: _----- --/Foundation Foundation i , "Pump on" level at: "Pu ' level at: High water alarm at: Curtain, Drain -' Pump Make el Electrical Inspections performed by: Remarks: ANolinowh Ctei-o'in Cfr'Aaii6. BENCH MARK Location and Description:. /&ID?',42.4.yLGLt�f1�O7-c Assumed Elevation: / c)(:)ES. ENGINEER'S SEAL 74 .0 .u . e 46-h Inspections performed by: /{/JD�ng,nae-rw7 Dates' 1st 9-/6-•9� 3`� �y Y I1 �Q+ 0 * ie° � a.o. °L° °.°°..a...Q U ~J 2nd 9-/4--4U p' ..p ... .,. .. 0 /Co -."/-94 Department of Heal and Human.Servicesnapproval9� hM. 00%6. Kenneth M. us : w o CE 7116 e1 ®�®�'�°° Reviewed and approved by: Jam./ ��� Date• /- /7- 9 7 ©%, ROOFESS .�o, 72-013 (Rev. 9/91) MOA 25 AS-3UILT SYSTEM DETAILS/SITE PLAN LOT 8, BLOCK 4, HUNDRED HILLS S/D Fern -Ii-( I1S1/vq606 PSN o77 -/9-i// Mr /O 7 7 • 7,9'12'2 A -C=15.6 B -C=34,4 A -D=22.0 B -D=39.7 A -E=39.5 B -E=46.9 A -F=37,4 B -F=59.3 (93,98) w 90.36 F7N/-5/71610 GRADE SIILATION FILIER FABRIC\ SCALE: 1' = 50' 2' RSVLATNN 1000 GAL SEPTIC TANK 86.28) SEWER ROCK KENNETH M. DI ern CE -7116 PT (87,95 38 <82.11) _ SCALE: NTS VARIES T T EON PREPARED FOR: LEE RAYMOND LEE'S CUSTOM DESIGN 11517 OLD GLENN HWY. EAGLE RIVER, ALASKA 99577 (907)694-8565 KND ENGINEERING 20441 PTARMIGAN BLVD EAGLE RIVER AK, 99577 (907)696-6111/Fax (907)696-8111 DATE: 1/3/97 SCALE AS NOTED DRAWING 11 96048-S1 e DRILLER'S NAME size-CET:KM r 2 o 9 9 ijo • JAY WILLIAMS DRILLING 3760447 P.02 1.4 4, 41 11-1 m W MXMM O 0 0 0 0 0 • 4 4 4 '5 • •co 1:71 Z g 4 4 4 4 4 ;--3 H :-3 T..] 0 0 0 0 0 0 0 0 0 0 0 i 0 pZTIdIaT S'aTqUES 4 4 4 = co 4 4 4 4 41 4 4 4 4 t•J f571;f6ay-Ift'E 0 •=.I !VI 1'4 , • 4 ;W TaL-EIO ES 1-1 kis t -t m '/1 4 4 0000 4 g 4 • 4 '-' '71 ;3 9 00 0 0 0 0 4 4 4 4 4 4 4 4 4 8 'C>3 '8 H 0 0 0 41 of -3 0 0 0 KIND OF CASING nit AN 19p 7 h/ niqipallty o Ani"h( Itoge 0 pt. Hopithi&I-11.imari Scirvicps E—ES—v "-IT9 aTemzsg TensTA 133.1.VM, dOlanal DILViS TM go Elam P.O. BOX 670042 — CHUG IAK, ALASKA 99567 g co 3A1:13S atA ICH D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 November 12, 1996 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Incomplete on-site construction projects Gentlemen: EWED NOV "I 4 J996 Nrunicrpamy or Anchorage Dept, Health & Human Ssrylcea As of this date we have several on-site septic and well permits which have not been completed for various reasons. This letter is to update your department on those projects and the reason for the delays in the submittal of the final inspection reports. Permit # Project Name Status SW960281 T14N, R1W, Sec 6, NE4SW4 Woodridge Sub, Blk 2, Lot 1 Winter shutdown, Upflow filter system installed; Well drilled; No foundation, no elec tricity Well and Septic installed; Have not received survey as -built or well log SW960103 SW960097 Glacier View Hts, Blk E, Lot 3 Well, Septic, and Foundation installed; Have not received as -built survey or well log SW950400 Hamann Sub, Lot 5A Well, Septic and Foundation installed; Have not received as -built survey or well log SW960195 River View Est, Blk 3, Lot 1 Well and Septic installed; Foundation not done, no as -built survey, no well log Well, Septic and Foundation installed; Have not received as -built survey or well log SW960226 100 Hills 1st Add, Blk 4, Lot 8 SW960264 Knik View Est, Blk 3, Lot 14 Septic and foundation in; Have not received as -built survey SW960325 Rouse Sub, Lot 1 Well and Septic installed; No foundation, no as -built survey SW960327 Hylen Crest #3, Blk 4, Lot 1 Septic installed; No foundation, no as -built survey Respectfully submitted, JYUIID) Engineering Kenneth M. Duffus, moi car MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ZNSP, 9 I 16l?6 P) 04-5/ 9/17/9E c / % ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960226 DESIGN ENGINEER:KND ENGINEERING OWNER NAME:LEE RAYMOND OWNER ADDRESS:11517 OLD SEWARD HWY. EAGLE RIVER, AK 99577 PARCEL ID:07819111 LEGAL DESCRIPTION: HUNDRED HILLS 1ST ADDITION BLK 4 LT 8 LOT SIZE: 91543 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 7/31/96 EXPIRATION DATE: 7/31/97 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 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 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 PROVISIONS: RECEIVED BY: (ISSUED BY: DATE: DATE: KND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 r:r.w . +ok: r.. w .o au .k ..,rt....r'�::. �:rAa,:.r:Krx.rr:<.:Ak.:f.r;0:.::r:.rw::::::.:Y..rrr:.,,,:.rr::.rr::a::.rr:.r':!:.r:•rv�::csrr:,�:•:o:::a.:::.: ::..:r::' .. t...:. L:::iS : rr:. :�.. o..,..,.�.,. ::: ,. Je .,. ::\ .:.. ..........:....:.r.:;;.+r:.x::.,;.r:.r:.:orr:r:.r:,.r;.r:.rr:a':.:::.rr::.;.::.r'.;::•.r'\:k:o:9`;`�;:�;+..vrr::'a (907)696-6111/FAX (907)696-8111 July 3, 1996 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject Lot 8, Block 4, Hundred Hills Addn. #1 - Well & Septic Permit Gentlemen: Attached are soils logs and percolation tests which we performed on the above property. Also attached is a copy of the original soil test performed at the time of the subdivision. Water monitoring was recorded for both the new testholes and the old one. This property is bisected by a 30' drainage easement. This easement has been provided to accommodate seasonal runoff. Based on our inspection of that easement, we find no evidence that there is any seasonal flow in the ditch. There are obvious signs of previous runoff flowing from east to west in the right of way ditch; that water then crossed Harp Circle through a culvert, although there was no surface water observed at the site during our investigation. As a result, we are not observing any setback to this easement. The proposed system will be laid into a gently sloping portion of the lot. There are no changes in slope in excess of 25% on this lot, and no surface water sources within 200 feet. This lot will be served by a private well. There is no public well within 200' of the proposed installation, nor any private well within 100'. There are no known curtains drains within 50'. Development of this lot should have no adverse effect on development of adjacent lots. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, KHD Engineering Kenneth M. Duff tw, P.E. attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test SI WASTEWAT PI A =R DISP SAL SYSTEM LOT 8, BLOCK 4, HUNDRED HILLS S/D rL�1„,7 E` Tote `1 070 f 1 �i ‘ \ S)^\\ ��U d O `�1 aX, .. �, OF AL\ KE ETH U FFUS d*49TH /4 CE -7116 4aAf 1 b\'�\,�a 7/q`9L /i \ pROEESS[GN' — Ik \..._+ Nod ,' /V0 We /,G D - SIS\ N I- TAILS 1. 3 DDR14 X 150 GPD = 450 GPD FLOW. 2. 450 GPD/1.2 GPD PER S0. FT. = 375 S0. F1. ADSORPTION. 3. 375 S0. FT./5' WIDE X .50 R.F. (4.0' GRAVEL) = 37.5' LONG. 4. TOTAL DEPTH OF FIELD IS 5.5'. 5. INSTALL 2' HD INSULATION OVER DRAINFIELD. PREPARED FDR: LEE RAYMOND LEE'S CUSTOM DESIGN 11517 OLD GLENN HWY. EAGLE RIVER, ALASKA 99577 (907)694-8565 KND ENGINEERING 20441 PTARMIGAN BLVD EAGLE RIVER, AK, 99577 (907)696--6111/Fox (907)696-811 DATE, 7-4-96 DRAWING 11 SCALE P = 50' 96040 -SI PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST /7-7�,'z 11A/ LEGAL DESCRIPTION: 4-22 5/10(.1',/::-.. /7( 2 - F �•v004160a •. O.t,,, an 0 00 YV 000 01090a ea 41016 000 • ..•041.41410. S se •fl•Os ten.fl0o6.t.fi a v Y. . •ava5 j .. enneih M. us : • rs✓ DATE PERFORMER Township, Range, Section: DEPTH OV /-%. /'7. 1..M(I /' //.5 -1rECT) (4/tglc,/1r,In, rte-s9✓(ja ,c,s 3 4 k i�zr; !f/ 5 - 6- 7 8 t 9 10- 11 - 12 Gc-,h/71e, G / 5�1 /2262 / `>7 1 c f%/'l'/r 3 z Z sz. Qn'Z�I.CCR� 1'17 C--/ 13- 14- 15- 16- 17- 18- 19- 20 - COMMENTS G( to Sc� ( 9 (7 6.0 C c. (c l'/5 11,.)IY Y.'YG 67J SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth la Water Aller Monitoring? 1) \ -‘) NA Date- $ 1-1 -9 S L 0 P E SITE PLAN A N to cuN Reading Date Gross Time Net Time Depth to Water Net Drop / /✓- -Q 1& /(0./.!, __ ) - . 1 /047--i' / C; / 3 /6V9 / v 3/(f 3//- G se.; 7 1/- V-)— r-14� 1_ « Altil ✓�y / U / �, . / _. 6 /CJS., / % //8 -7 1 /053 ? 0 5'i i / v''/1/ / 1/� 3/4 5/ts' CY / 1 /v 55 % '7 5A8 '//S 0/ PERCOLATION RATE 2 -15 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 3 D FT AND /7L FT PERFORMED BY I"..1V V Yreec\Ul(\ 1 vdery ,, vAS ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE (0`F;)9lt' PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST t 47 fP•�• a' ��++}y�A® moo„/ 49 Ai fit, o• •.n a • Po • •• • e o• aa• 9 Kenneih M. Dui. ,1%3'c •• • 6• ••e•• s ?v.?Ce // / DATE PERFORM E�94`0(8'•;/ y•ea (� tf PROFFSSW� �• /C2 LEGAL DESCRIPTION: ""ti I (Si '6;/`2:j- ' DEPTH (FEET) 2 - 3- 4- 5 - 6- 7- 8- 9- 10- 11 - 12- 13- 14- 15- 16- 17- 18- 19- 20 - COMMENTS Township, Range, Section: A/12r(d 44/(5 z rri a.k�-� SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? Date. S L 0 P E SITE PLAN T N Reading Date Gross Time Net Time Depth to Water Net Drop / In -2941„ /0:z j — 5 -/t,, _. ie) / / �'7•/ /°L- /f- , 0 3z / '-; I/ ? %/ 4- , ,om tFola9C / O 33 / .er, '% / O i'% 2 '16 •'/8 Y /a0/ j ,..2,/L- 'fid (7 / i91/-/ •2 _� L., S// (2 5 G. PERCOLATION RATE z n d'e2"J (minutes/inch) PERC HOLE DIAMETER L TEST RUN BETWEEN ,7 FT AND 8 C FT PERFORMED BY tK/„jo 1 ll Ek..) CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 72-008 (Rev 4/85) (n I z a\4L PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST GI e_ ea -r -z LEGAL DESCRIPTION:/�, L3/c2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH (FEET) C/1ve„ re -4416&6/7 /e co•Sf , COMMENTS .1,f1,7:0":"../It6Iiii ff* ' "", e 1: :- ). . i I A ' 'V wO • 0 o ••R000aeoe11a •0e 0000 mous. 0 if 6s 61, • Kenneih M. I ,'/js • w •tP a • \. dCl DATE PERFO R f� 4GI.FQ E S " ON,— A Township, Range, Section: cc.),-Pee- , V,14e �) 0Srt� r , SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? arc/ Date. 7 - 7-y9.6 S L 0 P E SITE PLAN N Se e. \ PI Reading Date Gross Time Net Time Depth to Water Net Drop 0 ?---, tC 30 — '3'1& — / I \C' 31 1Ant i,\ '- k 1Y& Z t0' 31. ,, 51r.• YE' 3 I 10 33to '5/6 UJ.koer \0 • 3y 1 PAPA '3'1C WIZ- - ,3k a7 tt%'-3J L 6 10'-3.16 ‘b -i 31'i 7 to 3F " 7 3/s/ 8 J, i0. s<, .7 3/l 3/% PERCOLATION RATE TEST RUN BETWEEN /42. /� /,;. (minutes/inch) PERC HOLE DIAMETER FT AND `L) FT PERFORMED BY Y: -.NO ECynQQ1't1r0 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE Io-aF>--%(p VE1 Engineering. Architectural and Surveying Consul(an(s Serving All o/ Alaska PERFORMED FOR: Hundred Hills Sub' (I, First Addition LEGAL DESCRIPTION: 4"R 7 , LY 2' Topsoil with P.O. Box 774649 Foyle Rriter, Alaska 99577 (907) 694-3574 DATE PERFORM---�J"j—�.�/87 T wn-sitip. Rorigere-ei+est. R SLOPE Boulders Organics Mixed with Silty Gravel .GM, Silty Sandy Gravel with Cobbles, 4" Minus Same as Sample #21 Silty Gravel with Cobble & Boulders to 2 Ft. Bottom 16 7j- 11\' OF 44. %.1c;1 +` 17 i 19 ". Vernon L Roel{z � S 20 No.CE5107 �t J� 'k nfOr-Ess'p COMM[N1S f. Pt. #328", WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? No S 1 0 P E TE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop Monito~ 1 7/21/8 7//8? 1:34 12.36 vo Water No Wa er 224 PERCOLATION RATE TEST RUN BETWEEN Visual, no perc test (Minute-1/inch) PEHC HOLE DIAMETER FT AND F1 PLR(ORMED BY. WL D�r�" 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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. Name of Firm s s s Engineering Address 15861 S. Birchwood Loop C Engineer's Printed Name 5. DSD SIGNATURE 1/°- Approved for Disapproved. Conditional approval for Phone 6942979 bedrooms, with the following stipulations: ,o(ti(wr rig .g • • ON -;ITC WATER AND ••m? WAS FEWAILK : • PROGRAM • Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory By:r� (Rev IIAS) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other L r Original Certificate Date: $ -2 7- 03 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: ler 8/BLax ,ftr'/, b �Ius1/ Parcel ID: 078- 91-/1 A. WELL DMA Well typeW' V If A, B, or C provide PWSID # _, Well Loge5) \ISS Date completed Sanitary seal Y J) 1 Wires properly protected &1) `16 . Total depth a ' ft. Cased to /42 ft. Casing height (above ground) /9 +riin. AT INSPECTION Date of test Static water level Si ft. 33 • ft. Well production 1,2- O 9 P•m• 6; 7 g.p.m. WATER SAMPLE RESULTS: FROM W LL OG Coliform 12 colonies/100 mL Nitrate te,e5,15mg1L Other bacteria 0 Arsenic: AS ug/L date of sample: 11 0 Collected by: /; S 61,41VEZEIV6 B. SEPTIC/COTANK DATA Tank Type/Material 56�L/�EL Date installed g�_ Ib /16 J `lE Tank size �(%0� gal. Number of Compartments Cleanout Y ) Foundation cleanoui�J) tt Depression over tank (Y6) y ✓ High water alarm (Yin Date of pumping " DQi colonies/100 mL Pumper 611/017/ / Tn1pECS C. ABSORPTION FIELD DATA ....—.— Date installed 9l/4 -11118 Soil rating (g.p.d.lft2 •r ft2/bdrm) l .a System type ISH -ft fX0 I nr/txH Length 'fit ft. Width 5 r ft. Gravel below pipe 4.1 ft. Total 1pm wpm _ rt.. Eff. absorption area 0 ft 2 Date of adequacy test 8/11'48 Results Fail) Ta For 3 bedrooms r Fluid depth in absorption field before test a in. Water added 63Rgal. New depth 1" in. rl Elapsed Time: 0 min. Final fluid depth D in. , ^ Absorption rate :>= 1460 t g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/0 type) N0 If yes, give date 'a— Monitoring tube *51 Depression over field�D D. LIFT STATION ,viii Date installed Size in gallons .. . elA s /N) 'Pump on' level at _ in. 'Pu r . • • - 'e at _ in High water alarm level at in. Da um Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 10011- i 00rfr Absorption field on lot 100 -E Public sewer main 4/3 Public sewer manhole/cleanout On adjacent lots /0" 4- / On adjacent Tots /C '- Sewer /septic service line Animal containment areas AG 14 - Holding tank Manure/animal excrete storage areas IQ"Q", fel SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: / Building foundation S ' Property line ' 4 Absorption field S 14- Water main OM Water service line /D �/- Surface water /00 t I, Wells on adjacent Tots CO/ „ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 44- Property line /0 r1- Building foundation /0 'f" Water main 'J 1I Water Service line tX 42,490/t7 *' Surface water /�7 1, I, Driveway, parking/vehicle storage 10 'f' I Curtain drain /42,490Welis on adjacent Tots //Z) 4t F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined throu review of Municipal records t at th conformance with MOA COS • . ide Engineer's Printed Name Date field inspections and above s ste': are i• COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) as1°O ,yam, 0 3SAD Waiver Fee $ Date of Payment Receipt Number A>49/%B Ere -97. cic;oriti1/ ASBUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: fol-fewi :snitc.fuevs-CeOdlorB s"• AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBD1 VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SCALE: SEWARD & ASSOCIATES LAND SURVEYING 694-0829 DATE: GRID: _Cu" v.v.-2C° FB: DRAWN: ;n ?.• __�1 �S'�•1 ..:' 4° r • 4��r'•. is-. (4.4 • �+ r r rr SCS Refit Client Name Project Name/H Client Sample II) Matrix P\\SID 1084218001 S 8 S Engineering L8,134,1lundred I lilts NI 1.8,134,1lundred I lilts NI Drinking Water 0 Printed Date/lime Collected Date/Time Received Date/Time Technical Director 08/22/2008 11:33 08/11/2008 17:00 08/12/2008 9:00 Stephen C. Ede Sample Remarks: Parameter Results POL Units Method Allowable Prep Analysis Container ID Limits Date Dale Init Metals by ICP/MS Arsenic Waters Department Total Nitratc/Nitritc-N Microbiology Laboratory Colony Count Total Coliform Fecal Culifonn ND 5.00 ug/L EP200.8 C (<10) 08/16/08 08/19/08 NRI3 0.525 0.100 mg'L SM204500NO3-F 13 (<10) 0 0 0 col/100mL SM2092220 col/100mL SM209222O col/100mL SM20 922213 A A A (200) (<1) (<1) 08/21/08 JD7. 08/12/08 DLC 08/12/08 DLC 08/12/08 DLC 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 Parcel I D # :':;'7' `9 /1/ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # �1 DJC \ OLSv 1. GENERAL INFORMATION Complete legal description LSF- 8 ,t31 k �/ 1-1 c red t tis 1'r4old Location (site address or directions) NSA/ IAIo1-P `L a i ✓Pr/ Property owner I- d e 7?a.y r1 K)d Day phone 64 `/ " 6'367 471 J /eni7 Mailing address 115 17 v (r{ eajie %Z (✓et 4K 4? 77 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 Community well Public water 3 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 X 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 N21 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm KND Engineering Phone %‘o /1/ 20441 Ptarmigan Blvd. Ea le River AK Address Engineer's signature Date /0L2- ���� OF A. 4.;12.4:11111. 4:7y40* 9TH ; 0 0Ke f h'p .l.l be ld,i 00 • K;nne?h,Ce:71 c �% * ®� '. CEE..am6. DHHS SIGNATURE444.1 II1 eh `/''•701P��V�� ® "ROFESSI0N4'® X Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date / - / 7 - 97 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 RECEIVED DEPARTMENT OF HEALTH & HUMAN SERVICES - Environmental Services Division JAN 6 199J 825 L Street, Room 502 • Anchorage, Alaska 995Q,j1,•r,;490.{ftp 3A ; ;age Dept. Health & Human Services Health Authority Approval Checklist Legal Description: //73!/8 ttu-,,td veo tn is Add I Parcel LD.:D7S - i Q- i. A. WELL DATA Well type �` 1 If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ! Date completed Fel ?!o -a c1 c.r r Total depth /D 2 Cased to /O Z r Casing height (above ground) Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test 8/9 Static water level -3`11 Well production /2 g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate 6). Z8 Other bacteria Date of sample: /Z J8/9G B. SEPTIC/HOLDING TANK DATA Date installed Collected by: %'A/L. iHce/-cy Tank size /COO Number of Compartments Z Cleanouts (Y/N) Foundation cleanout (Y/N) Date of Pumping C. ABSORPTION FIELD DATA Date installed Co/940 Soil rating Depression (Y/N) /( High water alarm (Y/N) /V Pumper or f12/bdrm) / System type 54a `Go w <;ern et Length 38' Width 5 / Gravel thickness below pipe V. / Total depth 7. L/ - 8. 3 Effective absorption area 380 Monitoring Tube present (Y/N) / Depression over field (Y/N) N For bedrooms Date of adequacy test Results (Pass/Fail) Fluid depth in absorption fi:: before test (in.); Im Fluid depth Peroxide tre diately after (ins) Minutes later: Absorption rate gal. water ad. -d (in.): ent (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* g.p.d. D. LIFT STATION Date installed Size in gallons , 't.,, Manhole/Access (Y/N) 7' "Pump on" level at* "Pump off" level at* Z,, High water alarm level at* *Datum ‹0 ham- -„ Cycles tested : T s'r E. SEPARATION DISTANCES /n 4:. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /06 1 -f On adjacent lots /00'4- Absorption 00'+Absorption field on lot / 00 t -t-• On adjacent lots I CSO ( -"1-- Public Public sewer main /Oo '-+' Public sewer manhole/cleanout / 00 + Sewer/septic service line /60 (+" Lift station NA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r i � Foundation 5 'r" _ Property line /0 -F- Absorption field /0 4 Water main/service line ID � Surface water/drainage /OD 4" Wells on adjacent lots /on ' +" SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /6 Building foundation /0 +- Water main/service line / 0 Surface water /DD ' + Driveway, parking/vehicle storage area /01 Curtain drain ' 50 f (/?\%., %wnca.on cwrl-u/n Wells on adjacent lots /00'÷ ciy-a-c.:4, 5-) F. (fid-1- F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal record lQh li �,sgl g1s are in conformance with MOA HAA guidelines in effect on this date. ®kOr CO '0e :folte Signature 4i lOo ee eao- e, eeee "" o Engineer's Name e-hrie �� /nA " a g ®®�°e�n�cP°a1'e1Ken�n�esii Mbu -CE17 AO1i Date �°a°`7.e7 4e.0 v11, "urkSs01\\ HAA. Fee $ Date of Payment l — —9'7 Receipt Number LAS 7 ) 0_3,72 Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment NORTHERN TESTING LABORATORIES, INC. 3330 11.11 )1 0101 A AVChlul-_ 800:, 001 it MN 0;1 RLL All 313ANKS A(.0 h1'�i'::'1 ANCHOR; AC,f__ rU ASRA 09818 (907) 45(1 110 • I AA (907) 349 1000 • ' AA 1.#i7- IlllG KND Engineering 20441 Ptarmigan Blvd. Eagle River, AK 99577 Attn: K. Duffus Our Lab #: Location/Project: Your Sample ID: Sample Matrix: Comments: Lab Number Method A148501 100 Hills Water Parameter Units Report Date: Date Arrived: Date Sampled: Time Sampled: Collected By: ** B = H = E _ M = D = MDL = Definitions Present in Blank Above Regulatory Max Estimated Value Matrix Interference Lost to Dilution Method Detection Limit 12/26/96 12/18/96 12/18/96 1600 K. Duffus ** Date Date Result * MDL Prepared Analyzed A148501 SM 4500E Nitrate -N Reported By: Anthony J. Lange Chemistry Supervisor mg/L 0.28 0.10 12/20/96 NORTHERN TESTING LABORATORIES, INC. 33:3.0 INDUSTRIAL_ AVI NUI' 8005 SCHOON SI RLFT FAIRBANKS. ALASKA 99701 1907) •1!.+-3 I 10 • I -AV ANCHORAGE. ALASKA 99`010 190/1 0.30- 1090 • 1 .AA .1031 DRINKING KND Engineering 20441 Ptarmigan Blvd. Eagle River, AK 99577-3736 Phone No. Purchase Order No. Collected by: KND Sample Type: Routine WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA Method of Analysis: Membrane Filtration Comments: Public Water System I.D.# Date Received: Date Analyzed: Date Reported: Next Sample Due: Comments: S = U = POS = ND = TNTC = CG = HSM = SA = Old = R= NT = 12/19/96 Time 12/19/96 Time 12/2.3/96 Time Received: Analyzed: Reported: 16:00 12:52 Satisfactory Unsatisfactory Positive Test Result None Detected Too Numerous To Count (>200 Colonies) Confluent Growth Heavy Sediment Masking, Results May Not Be Reliable Sample Age >30 Hours But <48 Hours, Results May Not Be Reliable Sample Age >48 Hours, Too Old For Analysis Resample Required No Test * # Colonies/100 ml Sample Sample Total* Fecal* Other* HPC** Date Time Coliform Coliform Bacteria Result Lab# ** # Colonies/ml Location Comments 1 12/18/96 16:00 0 cr- Julie Schaefer Environmental Analyst ND 0 NT AB4049 100 Hills/Outside Satisfactory Faucet