HomeMy WebLinkAboutMOUNTAIN MANOR BLK 3 LT 2Mour)&t*r) Manor Lot a Block 3 DSO -6 71 -38 Municipality of Anchorage Page 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: SCJ 990357 PID Number: 0S4 - Coil - 38 Name %f<Iall O -5,0PI k S'SOh Wastewater System: ❑ New Upgrade Address ABSORPTION FIELD Phone. No. of Bedrooms. O Deep Trench ❑Shallow Trench ❑ [3ed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: Total Depth lrom final grade GPD/S. Ft. Lot, Block ///S,{{ubdivision Depth to pipe bottom from original grade. Gravel th beneath pipe ���� Township. Range. Section. Fill added above original grade Gravel length: 5 FL Ft. WELL: El New ❑ Upgrad Gravel width: ✓� 1/ Number of lines. Distance between lines : Ft. Ft. Classification (Private, A,B,C): Total Cased To: Total absorption a Pipe material: �l FL Ft. SD. Ft, Driller: Date Drilled: �7cL Static Water Level: Inst alle /� ICASrKusS E aDeteinstalled:- Q-�5-9� Ft. Yield: Pump Set at: Casing Height Above Ground: TANK GPM Fl. Ft. SEPARATION DISTANCES septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturemr.:A. -/ /� /Qry/" Capacity in gallons: 1060 0D0 From Tank Field Station Tank Sewer Lines /r"� • Well /DD /D� f -- Material: e Number of Compartments: SurfacWater /od �� ^— LIFT STATION Lot / / /0 _ Size in gallons: Manufacturer: Line /� t Foundation /D'4 /0'r ,_, "Pump on" level al: mp off" level at: High water alarm at: Curtain /OO t / Pump M odel Electrical Inspections performed by: Drain -f- //OD Remarks: Aae�t 4241 BENCH MARK Location and Description: �d Assumed Elevation: ENGINEER'S SEAL t- OF AV •A4•qs Inspections performed by: Dates rls : /_/ •• as ••••• •••••* '• 2nd� / ............. .. . . Kenneth M. Duff t � i' CE Ill d Department of Health and Human Services approval �fe9,.•i�:.����.W Reviewed and approved by C1 r _ Date: 11--Of (4\P\`®.�Jo•(�a►P*•e"� /i pl3 Me, 9/911 MUA %S AS -BUILT SYSTEM DETAILS/SITE PLAN Permit SW980357 MOUNTAIN MANOR S/D, BLOCK 3, LOT 2 PID#050-671-38 ink al andcned In place D SCALEi V = 50' ments based off of house. House location wasn't based on survey and is only approximate] A -C=54,5' COMPUTED: W 7tjb4 7/.bo B-C=62,O' STAKING: - CHECKED: cLEANDUT ��NOp �Jt 6pH�Jt MONITOR GRADE ASBUBT. DATE s CLEAN... /�� c A - T� - 4 7.1' lOB N°' 98120 l T CZ INS ATION FILTER FABRIC B -D=53.9' q � 1000 GAL SEPTIC 4 TANK EXISTING LD z 94,12 TRENCH 1 94.2 X W AOI� 1 * 49 TI -I KENNETH CE-7116AII a W AWr \�d I'YOFESSIOW, AV PREPARED FOR: ALAN RASMUSSEN RASMUSSON ENTERPRISES P.O. BOX 770766 EAGLE RIVER, AK 99577 FIELD BOOKS COMPUTED: BOUNDARY: _ DRAWN: KMD STAKING: - CHECKED: KMD ASBUBT. DATE 10/22, BWG. FILE GRID: NW024 ACRD IILE98120.DWG lOB N°' 98120 SCALEi NTS LEX-LI LU,j ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 907)696-6111/PAX (907)696-8111 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Sep 15, 1998 Expiration Date: Sep 15, 1999 Permit Number: SW980357 Parcel ID: 050-671-38 Legal Description: MOUNTAIN MANOR BILK 3 LT 2 Design Engineer: 0070 KND Engineering Site Address: 018816 JAMIE DR Owner Name: THOMAS B. & CHRISTI L. SWEARING Lot Size: 72811 SQ. FT. Owner Address: 18816 JAMMIE DRIVE Total Bedrooms: 3 Permit Bedrooms: 3 EAGLE RIVER , AK 99577-7916 This permit is for the construction of: [J Disposal Field [ Septic Tank n Holding Tank U Privy ❑ Private Well n Water Storage All construction must 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: Date: '�S KND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 �,�,_��u��, gar � ; . � .., G:,.�. •U°� , � ,_ ���.- (907)696-6111/FAX (907)696-8111 September 14, 1998 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Remove & Replace Existing Septic Tank — Mountain Manor S/D, B 3, L 2 Gentlemen: On Monday afternoon, September 14, 1998, we received a request from a contractor to provide services in conjunction with a collapsed septic tank. The tank had completely collapsed to the point that the system was not operational causing sewage to backup into the house. Attached is our request for permit to install the new tank. The existing tank was a 1250 Sunset Plastic tank installed in August 29, 1977. We propose to install a 1,000 gallon steel tank. The existing system was only approved for a three bedroom. We have verified separation with adjacent wells and the proposed replacement will be compliant with DHHS criteria. We will also have the contractor install two (2) post tank cleanouts. There are no public or private wells within 200' of our proposed system location except as noted. There is neither surface water within 100' nor any curtain drain within 50'. The surrounding lots are developed and we do not expect that there will be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, KI1'1U Engineering On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN MOUNTAIN MANOR S/D, BLOCK 3, LOT 2 y, ---------- iolutu LOT 2 LOT 1 \ SEPTIC \ \\oG LOT 11 \ \O NO PUBLIC WELLS WITHIN 200' OF PROPOSED SYSTEM. NO PRIVATE WELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200' OF PROPOSED WELL EXCEPT AS NOTED. � �� OF ALS � 1 'of 1 I KEN F � CE -7116 a / \ IJ A Z SIolW, AV \ f REPLAC[ CxISTIry IOoa -L. S]. tnsTAu z - Co �co c T (` \\\ExtSTING FIT, .o " E P I C LOT 3 NOTES: 1, EXISTING TANK HAS FAILED, REMOVE AND REPLACE WITH NEW TANK. 2. USE 1000 GALLON SEPTIC TANK,IF REQUIRED. INSULATE TANK IF <4' COVER. 3. CONTRACTOR WILL ENSURE MAXIMUM 2% SLOPE INT❑ SEPTIC TANK, 4, CONNECT TO EXISTING OUTFALL PIPE AND INSTALL POST TANK CLEANOUTS. 5, VERIFY FOUNDATION CLEANOUT, 6. ALL OTHER SYSTEM COMPONENTS TO REMAIN THE SAME PREPARED FOR: ALAN RASMUSSON RASMUSSON ENTERPRISES P.O. BOX 770766 EAGLE RIVER, AK 99577 FIFLD BOOKS COMPUTED BOUNDARY. _ DRAWN'. Scale 1'= 100' PAGE 1 OF 2 ENGINEERING STAKING CHECKED KMD 20441 PTARMIGAN BLVD. ASBUiLT _ DATE: 14 98 EAGLE RIVER, AK 99577-8736 DWG FILE GRID NW0254 ACRD FLL', 98120.DWG J0U N 98120 (907)696-6111/FAX (907)696-8111 WASTEWATER DISPOSAL SYSTEM DETAILS M❑UNTAIN MANOR S/D, BLOCK 3, LOT 2 CC REPL-ACE EXISTIN INSTALL 2 - CC MT CC Imp p o" A44 S\ �10(*49TH *� I/ KE M. S / � CE-711Alol a W \ � P OFES510�A�' EXISTING FIELD PREPARED FOR: ALAN RASMUSSON RASMUSSEN ENTERPRISES P.O. BOX 770766 EAGLE RIVER, AK 99577 FIELD BOOKS COMPUTED. BOUNDARY _ DRAWN: KMD STAKING: _ CHECKED: KMD ASHUIL I: DATE- 9Z14 DWG. FILE: GRID: NW021 ACAD FILE: 98120.DWG JOB NO: 98120 i N 1000 CRL, SIT, S El Scale 1'= 20' PAGE 2 OF 2 LSL ll LLJJ ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/PAX (907)696-8111 MUNICIPALITY OF ANCHORAGE He& and Environmental Prote on Fourth Floor West 825 L Street Anchorage, Alaska 99501 279-2511, x 224, 225 INSPECTION REPORT ON-SITE SEW ACE DISPOSAL SYSTEM NAMI-`-e-_--- MAILING ADDRESS-�_.32__" _-�• ".' -- PHONE 1 LOCATION�\C%%}Y.X_ .� LEGAL. DESCRIPTIONz-.r4/YL-E-�•� SEPTIC TANK: DISTANCE NUMBER OF FROM WLLI_ ���."_ Ill ANUFACIURER_.______..____MAEF.RIAL___.__.__.____---_ COMPAR-1MENTS_ �- r INSIDE LENGTH TILE DRAIN FIELD: DIST/\N(',[ I ROM WDLL # of Lines A[3SORP"� CN AREA _- INSIDE WIDTH LIQUID DEPTH ____ LIQUID CAPACITY."-fo- GALLONS. TOTAL LENGTH t� FOUNDATION NEARLST LGT LINfi.-OF LINC D15TANCE BETWEEN LINES ___._____._.-TRFNCI-1 WIDTfIve IN. TOTAL EFFECTIVE SQ. FT UCPTV1: TOP OI TILL TO FINISH GRADE _ SEEPACL PIT: LENGTH OF EACH LINE ___________—___—_-_._ DEPTH OF FILTER r _ MATERIAL BENEATH TILE. -_IN. ABOVE TILE DIAMETER OR WIDTH ___, LENGTEi____, DEPTH Log Crib _Rings_ Crib Size: DIAMETER ------ DEPTH._ --DISTANCE FROM: WELL — TOTAL. EFFECTIVE. BUILDING FOUNDATION._-- , NEAREST LOT LINE _ . ABSORPTION AREA (WALL AREA) -----,SQ. F'T. Well Class: Depth: I - Well Distance To: Lot Line I - a -1 Bldg: Sewer Line: Pipe Materials: # of Bedrooms: Installer: _ Remarks: 0 UnrET.__._ APPROVED ������������ �� �������� DEPHRTMENT HEHLTH HND ENVIRONMENTHL /TECTIO -M- ' 7 825 'L STREET, ANCHORAGE/ 279�2511 4�s PERMIT NO ( 5aiL) " �� HPPLIC: HNT B::<. 88 E. F.". 694 465 LOCATI ON JAMIE DR -~~ LEGHL .T. 29"-MT�MHNOR S/D LOT SIZE 72000 SQUHRE FPET TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MHXIMUM NUMBER OF SOIL RATING (SQ FT/BR)= 1]0 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ����U.-I �7­- �F�." ri J- .4 C, f�FEE.: I ��IF�:# 7" IFA �5 THE LENGTH DIMENSION IS THE* LENGTH (IN FEET) OF THE NCHOR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFHCE� OF THE GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET). THEREIS NO SET WIDTH FOR TRENCHES. ` THE GRHYEL DEPTH IS THE MINIMUM DEPTH OF QRHVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM QF THE EXCHVHTIQN (IN FEET). U,, �F__. F "I I ��P-4 V� �I .: E! IE-_ �C5 9.2-,u ������,:: ����_���_ ������� ��"�� ������ H PACKAGE PLANT MHY BE INSTHLLED AT THE PERMITTEE,,.-.-, OPTION SUBJECT TO THE FOLLOWING CONDITIONS: 1. EITHER H CLASS I OR II NSF APPROVED PLANT MHY BE INSTHLLED. 2 H CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF H MAINTENANCE HGREEMENT 15 NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL HBSORPTION SYSTEM HND/8RYOU MAY BE SUBJECT TO PROSECUTION� ` IT. L4� ��� �������1��� ���� �������� ��� BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND HPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE'" BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL WELL LOGS ARE REQUIRED HND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 DAYS" OF THE WE[ I IDOMPLETICIN. OTHER REQUIREMENTS MAY APPLY. SPECIFICHTIONS AND CONSTRUCTI0N DIHGRHMS HRE AVAILABLE* TO INSURE PROPER INSTALLATION. , ���FEZ* �E. F---:. F;e I CERTIFY 'THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS HS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTHLL THE SYSTEM IN ACCORDANCE WITH THE CODES. ' I UNDERITHND THAT THE SEWER SYSTEM MAY RE�UIRE ENLHRGEMENT IF THE RESIDENCE IS RE`MODELED TO INCLUDE MORE" 'THAN ] BEDROOMS. SIGNED APPLICANT THOMHS&DHYIS ISSUED . ..... .... ..... ... ~~�... �..... .... ..... ... ..... ..... ..... ..... ..... �..... . .... ........ _ ..... _... _..... .... ..... ..... ..... .....- V]�0 GREATER ANCHORAGE ARCA BOROUGH d'T O 4y DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 iTELEPHONE 274-4561 4 - SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT INSTALLATION LOCAT LEGAL DESCRIPTION PERMIT NO - �7 MAILING ADDRESS s PHONE aid/,4 5-� INSTALLATION OF: SEPTIC TANK C--.._ SEEPAGE PIT DRAIN FIELD OTHER �` TYPE AND SIZE OF FACILITY TO BE SERVED ,/ 60tp-R*" FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED %. oma© 0 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. SEPTIC TANK SIZE 62 TYPE S -_i— SEEPAGE AREA SIZE 117 MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK —15 - FOUNDATION TO SEEPAGE PIT ^U (/ , DRAIN FIELD '(J ' SEPTIC TANK TOSEEPAGEPIT WALL SEPTIC TANK - L SEEPAGE PIT, DRAIN FIELD 42 TO NEAREST LOT LINE. WELL TO SEPTIC TANK '9 a6) , SEEPAGE PIT /eal DRAIN FIELD �y / ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK ` SEEPAGE PIT 4Q DRAIN FIELD. �U SEPTIC TANK, /00 / SEEPAGE PIT DRAIN FIELD 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 DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER TYPE DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE ��^7 APPLICANT'S SIGNATURE 0 €t E GEO" CHNI CAL £t DEVEL 'HENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Soils & Foundations Land Development Performed for: Name: T/fd•4l4:�; ?-�' D.grris Tel . No. Mailing Address: P eP. l o yc gam, ��4e z E /krtf�,c_; /%K: r / --77 Legal Description: -"Lir. A11-71Vb1z _5Gieb. Death (feet) Soil Characteristics 0 1 /T/%L �i' 2 3 4 5 6 7 8 9, 10 11 P A J 4- 7`0 Y�4`NSSE 12 1�a 7-7-2M,, 13 14 15 16 Ground Water Encountered: Yes- No /-� If yes, what depth Proposed Installation: Seepage Pit Drain Field Comments: Performed by: // > a -"t- �f",'&L Date: 17.7 �J r� /'A/4", 'eq. 1,51`)401C. - HI IH1.nmriVI r SWEARINGEN a -. <, a w t= c 000000000000 H h F- [- H I- F F Ew„ w w w w w w w w w w w a .t O t1l. a a ® u : 3 91. o o o 5 5 i O aa Y x E' A oa' oOG 0.p' pa' a 0 a a a a y , 4 d Z w w w w w w w w w w oOG w w V w a w a d Q a C7 aZ a v W � NLLI WoX yy Gni Y� O O O O O O O O O O O O w w w w w w O tiG p � G � H Q a F Ow w O � �' Z w O O r O O O S O O O O z W CO) u„ O w w w w w w w w O O O w w w w a 4 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 275 feet DRILLED AT THE RATE OF $20.00 PER FOOT. PROPERTY OWNER Mrs John Thomas 694-9465 LOCATION OF WELL SITE Lte a2 Blk. Sabi DRILLER Bernie Claus Of Rampart Drilling Works WELL LOG: ' gravel and cobbles,` 33---52' Small boulders and gravel with a 30% clay binder. ' Bedrock. A sedimentary rook. 135-141' A granular rook showing signs of water. Production of a possible quart per min. 141-170' Sedimentary rook. 170..173' Porous rook showing signs of water♦ 173-255' sedimentary rook, 255-275' Some granular rook showing more signs of water in a sedimentary material. Total production of wells 800 gals of water per 24 hour time frame. This well should also improve in production with use. Water recovery within 70 feet of surfacee Cost of Drillings $20 X 275 Foots $5500900 Well Seals $24400 Pump should be installed 5 feet off bottom* COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF _ $5524.00 THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS DATE Aug. 14tho77 r SERVICE CHARGE OF i %a% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. �c Municipality of Anchorage OAC► B Development Services De artirnent Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. : `. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTI H AU T HORiTr APPROVAL FOR A SINGLE'FAMILY L)M LLING Parcel I.D. 050-671-38 1. GENERAL INFORMATION HAA #�� O 1_q Q' Expiration Date: ___10 -d23-O3 Complete legal description Lot 2; Block 3; Mountain Manor S/D Location (site address or -directions) 18816 Jamie Dr. , Eagle River, AK _ Current Propertyowner(s) Tom & Christi Swearington Day phone 694-2983 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address C/0 Janice @ Prudential—Vista 4241 B St., A/A 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 _Day.pl .onzi Day phone TYPE OF WASTEWATER DISPOSAL: The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Individual On-site U ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site.water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage fifes 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 Engineering ri)UnC694-2979 Address 17034 N. Eagle River Loop RD., Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Date 7/1.9/03 = . ........ ., nil RfJBERT C COWAN 5. DSD SIGNATURE g CE .8801 Approved for bedrooms. ,�t1"== Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments WASTEWATER Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory X_ Other By: Original Certificate Date: % — 3" 037 Olf (Rev. 01!02) Municipality of Anchorage Development Services Department Building Safety Division ` On -Site Water & Wastewater Program 5 ` `T 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHE—UKLIST Legal Description:L�� �LD M�'uNT�9�N /j/OX Parcel ID: A. WELL DATA tJ Well type �Z If A, B, or C provide PWSID # _ Well Log (Y/N) 7 X 2) Date completed���/Q�� Sanitary seal (Y/N)Wires properly protected (Y/N) _/ Total depth 4,4-pft. Cased to A-ift. Casing height (above ground) / min. FROM WELL LOG � AT INSPECTION Date of test e=-,�'L—/� D 3 Static water level ft. 0 ft. Well production 9.p -m. 0° So g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate mgJl. Other bacteria colonies/100 ml. Arsenic: mg./I. Date of sample: /O/03 Collected by: S S C-�./ C- (AJ L-efC B. SEPTIC/HOLDING TANK ,,. /DATA Tank Type/Material ,e / rG / ' iTKIL-1, Date installed Tank size /077-0 gal. Number of Compartments Z� Cleanouts (Y/N) % _ Foundation cleanout (�Y,/N) Depression over tank (Y/N) /� High water alarm (Y/N) 'J Date of pumping Y-/ I o 3 ;Pumper /2's C. ABSORPTION FIELD DATA Date installed' Soil rating (g.p.d./ftZ or ft2/b �0 System type Length �� ` ft.' Width 7 ft. Gravel below pipe S ft. Total depth q ft. Eff. absorption area-4�/Z ft2 Monitoring tube V Depression over field Date of adequacy test Results (Pass/Fail) �r�SS For 3 bedrooms Fluid depth in absorption field before test in. p Water added 6 -11 -gal. New depth"in. Elapsed Time: CJ 1 min. Final fluid depth � in. Absorption rate >= 14,97 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) IV If yes, give date 7t-r-12Gfll /\40A r2E-00 fZ D .s/4'-_:0AP-M 5 D. LIFT STATION Date installed NI A "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) _ "Pump off"level at _ in. High water alarm level at Cycles tested SEPARATION DISTANCES FROM WELL ON LOT. TO: Septic tank/liftion on lot Absorption field on lot iG ��- Public sewer main Public sewer manhole/cleanout A,1 S er /septic service line Z%5 7" Holding tank N /F SEPARATION DISTANCES FROM SEPTIC/HOODING TANK ON LOT TO: Building foundation i Property line S t Absorption field r Water main N Water service line-- Surface water r Wells on adjacent lots 0 t - Meets alarm & circuit requirements) On adjacent lots X60 On adjacent lots /be / t in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r � Property line Building foundation j� '� Watermain N " Water Service line Surface water / �� t Driveway, parking/vehicle storage Curtain drainAjkL&K^/e L✓nI Wells on adjacent lots _ �d� 41— F. F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in ' conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name PC8g e I C • �O w�N Date 7 1 1q/ _ HAA Fee $ 3'7-!P. J Date of Payment -7/A I A 1 Receipt Number O (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number P 4C ! ROBERT C. COWAN i CE -8801 /*--i 4f `� t Municipality of Anchorage ,. Development Services Department Building Safety Division SA [lY On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Health Authority Approval # 030344 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 3, Lot 2 of Mountain Manor subdivision, the well's productivity was determined to be 0.80 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. I EAl111A111MMY MrnovAi S SEWEnA WAIEn VA41"Ifts0ls SEWEnS WA1En f1SrECp(wf EIMKEMIGSI11NES A110 nt ronls WEU WIC11011 &tIOW IESI S11E M AMS r(MOnES G11 804 IE51 11991 AIM HSI SIn11C11n AL S EIECI w ECAL rsrrClKxiS 011511E WASIEWAIEn tNSr(SA18Y51FA1 COMM S& SN ' WELL RECOVERY TEST DATA CLIENT: WELL LOCATION (legal): L2 r_A"S TEST DATE: 4- 1 WELL DEPTI I: 13 CASING bEPTI I: 4U 't - IES PROCEDURE; 1) Draw water down to pump. 21 Shut pump o11 15-60 min. 1 2 9 -record lime 5 I1'7/� /R34 -record meter readhltl 3) turn pump on. Drawdown. 41 Shut pump on. -tecord lime -recotd meter reading 51 Calculate 031.1111111. recovery. A -n1 U /Z TESTED BY: ,[ WELL DRILLER: . DATE DRILLED: HSC )A A: Casing llelght: Sanitary Seal? Wires In Condull? Or81111)0 O.K.? Pump Dept,: Samples Taken? Dale: tI noDEnl C. COWAI). P.E. 11013enl A. sl IArm P.E. CIVIL VIGMEEns 1907) 694-2970 FAX (907) 694.1211 JEST A A; START TIM[: / S 57• STATIC WATER LEVEL: -� TRIAL PUMP TIME METER GAL./MIN. 1 2 9 OFF ON OFF/� OFF ON OFF- OFF ON OFF 5 I1'7/� /R34 0060 r A /, 4 6 OFF ON OFF OFF ON OFF BESIILTS; WELL. CURRENTLY PRODUCES: i 7-18-03; 3;38PM; ;907 5815301 CT&E Environmental Services Inc. 200 We Potter Drive Anchorage, AK 99518-1605 Telephone: (907) 562-2343 Facsimile: (907) 561-5301 M 11/ 13 -.--•rte ' 200 W. Potter Drive Ciriking Water Analysis Report. for Total Coliform $asteria Anchorage. AK 9951.8-1605 Tel: (907) 562-2343 READ71y,Q,1tUjqIIRNSONXEMSI'=AV •!�PC�COLLECTINOSANXE Fa:c.907).581-5301 ze•r na MUPLETFD BY WATER SUPPLIER TO BE COMPLETED BY LABORA'T'ORY D PUBLIC WATER SYSTEM I.D. 'Y'. 1 1 1 1 1 1 1 n PRIVATE WATER SYSTEM V Send Reser! Serfd Invoice _ 1 A, Wow ytbm ,r . IN n ice Those NUMUST a Send Results p Send Invoke cwnpany Naina t bb 0 ,iy SAWLEDATE:' .0H. �•M' WN Month; Day Year SAMPLE TYPE: : �Rotine o Treated Water ' ❑ Repeat Sample (for rnyfine satripie ❑ Untreated Water wlth`lab ref. -ho - Analysis shows this Water SAMPLE to be: Satisfactory a Unsatisfactoy D Sample over 30 hours old, results may be unreliable ❑- Sample: too I61tg iti transit; sample should not be ovetSaours old'at examination to indicate reliabae results. Please send .neNq,setnple via special delivery.mail. Date Received Time Received Analysis Began Analytical Method: xo�Mcmbnne Filter a MMO-NWG � + TBimhcr of co]onies1100 ml. 1034109 '`��' Result* I�UI�I�� i �Vlilu� Cl Spec a urp_ Time Collected SAMPLELQCATIOPI Colleeteii By _Z f �7 �'l� n�7.ti^ /hFI�� 7i Please hitt :omments: Analyst Anch Fbks Jun ❑ Fazed Date: Time: Client notified of unsatisfactory results: ❑ ❑ Phoned Spokewith Fazed Date: Time: BACTERIOLOGICAL. WATER ANALYSIS RECORD NIAO-MUG Result: Total Coliform E Cofi Nlembrane Filter: Direct Count © C6lonies1100 nil VeriRcatlam LTB _ BGB COLIFIRM Fecal Coliform Confirmation Final Membrane)Filter Results O Coliform/100 ml ry%%GR3S Member of the SGS Group (Soci6t6 G6ndrala deSurveillance) TNTC- Too Numwur T@ Count OB -OtherBecfai• 7-18-03: 3:38PM: :907 5815301 a 5/ 13 SGS Ref.# 1034109004 Client Name S & S Engineering Project Name/# Various Client Sample ID L2, B3, Mountain Manor Matrix Drinking Water All Dates/Times are Alaska Standard Time Printed Datealme 07/15/2003 10:01 Collected Date/Time 07/10/2003 12:00 Received Date/Tlme 07/10/2003 16:30 Technical Director Stephyt .Ede Reltased�u„�r// C Sample Remarks: I Qualifiers Results P L Units Method Container Allowable prep Analysis Parameter Quali Q Limits Dstc Date [nit Waters Department Nitrate -N 0.301 0.100 mg/L EPA 300.0 B (<=10) 07/11/03 JJB Microbiology Laboratory Total Coliform 0 col/100ml. SM189222B A (c=1) 07110103 JS 1 x r ^�,\ titeL r �'in Y�r ♦.; F.: t cr , ZVI ... •.,•, x.11 .(.� r I,C 47 G d� 11 r 1 hereby certify that i hate surveyed j1he following described property-..-. let Anchorage Recording Precivet, Alaska, and that the improvements situated therein nre within the property lines and do not overlap ur eerrouh on the properly lying adjacent thereto, thnt no iniprnvemeats on pro - hrty lying adjacent Iherrto encroecb nn the premises m tucsfion and tbat there are no ro•idways, transmisslon Ines or other viiible casements on said prnperty except !s indicated hereon. Dated at Eagle River, Alaska hiss -i= _day of_' `f I 1RO13F.RT C. JOHNSON SCALE' Registered Land Surveyor No. BRO-1z Box 456 Ear -le River, Alaska Phone e94.2543 0 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION MR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, tavnship, range) (Ar Z til.ot� W1Qw*s[Ri�v �Mftwor� Sw'/4 on address or directions) o4( IM/P AquP ( n.Q w; xi._. F.,.l_ D.. (b) Applicants Name jo `Jw��AQiN -,a Telephcre6Q�( ZRkT Applicants AddresspX 7310{ `� ��_ mss, /� fac,ye Ak_ CSC 97 (c) Applicant is (check ore) Lending Institution; Owner ilder ; Buyer Other f::::l (explain); (d) Larding Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone 2. Type of ?%sidence Single -Family Multi -Family Other (describe Number ;. Water Supply, individual 4Ye11 Community Public Note: If c"wtunity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Is the cell adequate for the number of bedrooms specified in this HAA ('i/N) YES 4. Sewage Disposal Onsite Public_ Community Holding Tank Is t_he wastewater disposal system adequate for the number of tedroans (Y/N) 4 ;Page 1 of 2.1 2-15-L4 5. Engineering Firm Providing Inspections, 'Tests, Data and Information I certify that I have checked, verified, or conformed to ail MDA HAA Guidelines in effect on the date jef--this inspection. Signet Date 3Z / E?,¢ Name of Firm �r ► }q p,�,�cs I �C • Telephone Address t ! o7 E, 74 'rl* f�+, At. 4g5oz S igned by e0wA-2D 01 A<.Kl Date 5 ( (ENGINEER SEAL) 6,DHEP Approval_ T he Municipality of Anchorage Lepartment of i3ealth and Enviror ental Protection does not guarantee the continued satisfactory performance of iJ-re watar supply and/or the wastewater disposal system. This approval indicates that, as of the validation date sham above, based on the data and information furnished by an engineer registered in the State of Alaska, the eater supply and wastewater disposal system is safe and func- tional ungitional for the number of bedrooms and type of structure indicated. (DHEP SEAL) 7, Mail the HAA to the following address: KB2/d5/s [Page 2 of 21 TH `.i . ED AR 8 MACK n �Abe 0E - 3816 •• fn • •• Qp�4V cam p�tessiona� ®®® 2-15-84 �� Date Approved for bedrooms By ti ���' Approved Disapproved r�-- r} conditional Terms of Conditional Approval 7.L cam, ,-. ✓ ��}�--Yt.,c-� z-.-� T he Municipality of Anchorage Lepartment of i3ealth and Enviror ental Protection does not guarantee the continued satisfactory performance of iJ-re watar supply and/or the wastewater disposal system. This approval indicates that, as of the validation date sham above, based on the data and information furnished by an engineer registered in the State of Alaska, the eater supply and wastewater disposal system is safe and func- tional ungitional for the number of bedrooms and type of structure indicated. (DHEP SEAL) 7, Mail the HAA to the following address: KB2/d5/s [Page 2 of 21 TH `.i . ED AR 8 MACK n �Abe 0E - 3816 •• fn • •• Qp�4V cam p�tessiona� ®®® 2-15-84 -MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA MUNj�IP F�y°NCHORAGE fTgg ,�JFti'iL'ALTH & ENVIR NMENTAL tTECTIOt4l Leri` Z BL VY1 o u •�Alf� 9�R RECHVED Well Classification TR-tyqw_ If A, B, or C, D.E.C. Approved(Y/N) N,/4 Well Log Present (Y/N) Ye -S. Date Completed � Z " 5� 6 I Yield /. 6 GrPw►' Total Da th ` %`�'" aa.�� P 4-48 ; " C�,,se�d oto NkNo�va�1 �� Depth of Grouting -E)-- Static Water Level E3 57 , �I7own, Pump Set At (,ihatL2qbyy0 Casing Height Above Ground ' Sanitary Seal on Casing (Y/N)YE'S X_ Electrical Wiring in Conduit (Y/Nj' No Depression Around Wellhead (Y/N) uo Separation Distances fran Well: To Septic/Holding Tank on Lot rz(� On Adjoining Lots )004 - 00 -To To Nearest Edge of Absorption Field on Lot x33 On Adjoining Lots I oo f To Nearest Public Sewer Lire N/Pr To Nearest Public Sewer Cleanout/Manhole N/A To Nearest Sewer Service Line on Lot KA Water Sample Collected By T_71 qq , Date 6 �¢. Water Sample Test ' Results, ,-,A.t ' s Camments (..JELL LoGr INDIGii $�_ "� GrP�nj `j yowsv�.7a: T'z'r Jz4Mwiya $IiOW 1. 6 Or", y / B. SEPTIC/HOLDING TANK DATA >- 4 .- y Date Installed 8/7 7 Size ( Z50 C, -&I . No. of Canpartments Standpipes (Y/N) `(c5 Air -tight Caps (Y/N) %S Foundation Cleanout (Y/N) `%z - Depression over Tank (Y/N) t,)o Date Last Pumped Y- Pumping/Maintenance Contract on File (Y/N) N c) ; for ----- Holding Tank High -later Alarm (Y/N) w�& Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Wa11 I Zd To Building Foundation S To Property Line. ] r To Disposal Field; To Water Main/Service Line t4/p, To Stream, Pond, Lake, or Major Drainage Course N/A- Cats, nts; A- Comtents ` -c tF�An'1 P,� (Paga 1 v„ n s of 21 tom, 3 2-15-84 � y / o 2 (Paga 1 v„ n s of 21 tom, 3 2-15-84 James B. Roberts, P. E., R. L. S. Engineer and Surveyor 1207 East 74th Avenue SEPTIC SYSTEM ADEQUACY TEST Anchorage, Alaska 99502 (907) 349-2526 Date: Jan. 30, 1984 CLIENT: Mr. Tom Swearingen Box 7364, Jamie Dr. Eagle River, AK 99577 LEGAL DESCRIPTION: Test No. S-84001 Telephone: (907) 349-2526 Lot 2 Block 3 Mountain Manor Subdivision (Eagle River) SEPTIC TANK: ABSORPTION FIELD: ABSORPTION TRENCH: Material: Fiberglass 40 L.F. of trench 8 ft. deep with Size: 1,250 gal. __________________ 5 ft. of gravel TEST DATA: Number Bedrooms: 4 Required Tank Size: 19250 gallons. Test Surcharge: 480 gal. water; 0.80(150 gal. x no. bedrooms)min Rate of percolation: 1280 gallons per day Sludge condition in tank: normal & functional Remarks: System is Adequate Septic tank and absorption trench data obtained from files of Municipality. Soils rating is 130 s.f./BR as reported to Municipality by Earl Ellis, P.E. T� / _Va 4— I//Z07 E. 74r—W PA4E o%Qw aF Tt.w� MTIVC170C�{� I Pry-As14► qy5m. Zg: (aT Z &L 3 M0%4%frRi1-4 MM�2 WAML wQLL AflECZNgcy Tesr = 4MVW R=UEM`L-( PE1zFor-w►m Prm ADEq�Agcy 'TeST C:*� T}tE' wELL of T E' ArgcAw D8'1.f-jgED PftoPERT`(, 3tsim oN THE ro�ww�Ncr Z�vE Dtjr�Nl�NIr� IT TU PWQpMCC CTO �M,N, DeAWDOWiJ AT 4: t5 sT,l;c wmmv- to- r35' PuAV"p P&AmPS RT %,0 CJAA AT 4;5z ST*f%e- wAwr- os—b 177' 4.5z 177' .. 4 : _ as' 27 (.,., CpASIN/(e CaNTRI� 11.4!}I� CT •,• / z, %\ 1,4-4 - 134.12- 2-7 � M 1 S7 cr*LLO"s Paoac (PMwnftD) �Pva+P6p� — 134,3 tua,.�s nenwoorw,a ,54,-7 4AuONS we"- P� ctD 54, 7 Z7 VN IN/ "L. — Z O cla y/ N P.O. BOX 3-4016 • ANCHORAGE, ALASKA • 99501 'P4W z mP z C.errex -rte "TTm R.Erov�^�.Y AT' S' 33 ST*T is tv*wv. @ 19z tnrA OFF PgYr S : 43 SSIc �..I+rL 181 5- ¢3 19Z" —S'33 _16►� TO _ we7 11 �� eec 3/oe'<L 4G ">"FT n G�AI %Gcov 7 (o CrOrL I Q {MIN �6H�Ts V1 SE ftAx;=oV'm' r P.O. BOX 3-4016 • ANCHORAGE, ALASKA 9 99501 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562.2343 ANCHORAGE INDUSTRIAL CENTER ..owwrowiea 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER 11 TO BE COMPLETED BY LABORATORY WATER SYSTEM: I (*) See h on back I.D. NO. t2'. C IBC Water System Name Phone No. S#464 .Box /7K.3 Mailing Adl(ress A city State SAMPLE DATE: I I E' Mo. Day Year Fslib Zip Code SAMPLE TYPE: -Routine ❑ Check Sample (for routine sample ❑Treated Water with lab ref. no. ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected 2 3 4 5 Analysis shows this Water SAMPLE to be: (� Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. '�3 Date Received S ' % b� ` Time Receivedy Analytical Method: O Fermentation Tube VMembrane Filter Lab Ref. No. Results Analyst � I m � I m ET -1 *No of colonies/ 100 ml or No of Positive portions 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collected READ INSTRUCTIONS Date BEFORE 24 48 Hou" EMB _ COLLECTING SAMPLE MultI01e Tube Report: btembrane Filter: Direct Count Verification: LTB Final Membrane Flits Rssu a. ` Reported By Time Received Broth 24 Source A.M. p.m. Lab. No. — 10m1 I 10m1 I 10ml 1.0ml I 0.1ml _Broth 41 hours: _20ml Tubes Positive/Total 10ml P0rtl0n6 coliform/100rn1 BGB Coliform/l oomi Dare j ` c Time• 7 if0 -iq-� PI P.m. 5. LEGAL DESCRIPTION DATE RECEIVED /< �r4C/L INSPECTION APPOINTMENTS , TIME TIME TIME f5� SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ MULTIPLE FAMILY ❑ Two ❑ Five CH' Three ❑ Six DATE DATEDATE * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) INSPECTOR INSPECTOR INSPECTOR (cow ❑ PUBLIC UTILITY MUNICIPALITY OF NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOI'(ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 MAY 14 1981 ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow. ten (10) days for processing. 1. PROPERTYOWNER PHONE MAILIN�G ADDRESS P17r%J.K ,/� r5lg k4; le. R`tv�R-i'4k ?91`7-7 PROPERTY RESIDENT (If different from above) PHONE N 14N 2. BUYER PHONE A\k0. t po 2Y3r/67 MAILING ADDRESS C-9 I Svz 3. LENDING INSTITUTION PHONE J + ati / BL1r' _ Cp MAI LING ADDRESS / *--tivc7L- ! 4. REALTOR/AGENT PHONE ¢ I I eve— MAILING ADDRESS 5. LEGAL DESCRIPTION At II -N' V Kir! /< �r4C/L STREET LOCATION "r 2- 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS f5� SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ MULTIPLE FAMILY ❑ Two ❑ Five CH' Three ❑ Six 7. WATER SUPPLY 05' INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) SYSTEM 8. SEWAGE_ DISPOSAL In INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY `] NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 2-010 (Rev. 6,79) 4N / Il.( fpm �,.�.,�,,. �J LYS'— _� _' 'gsGM -OOT` ugancS 'gaaagS 'T CZp qp soOT jO ano O- aLU00 SO G:,TJ=O sTu--r gOPquoO c^S2aTd 'papaa'v. uo7gpwaO-TIT ,10 SUOT;Sanb .S^cuganz feu-' 'Igaadoad au; oq qab oq mou UO SUOTgoaaTp PUP awPu aauh�O Tga@dOad 'UcTgdTaOsap TpbaT auq :aaP buTTTPo ueq.m papaou squawaaTnbag •0ZLt-�97_ aagwnu auogd 'uoTgoag aaqutl pule aar,aS 'guawgaPd@C uoTgoagoad TPquawuoaTnug Pup ggTPaH au,I, •agpa uoTgdaosgP 7c sbuTppea quanbesgns buTxP4 PUP aagaw aagPM P buTsn swaT3 buczaauTbua panoaddr iq pagonpucD sT gsag au,L 'paaTnbaa sT gsag agPa mOT3 P soT-;sTaagoPapuo UbTSap anbTun u,gTr, suaaP uoTgdaosge aaugo ao PT9T3uTPaP PUP oTgdas P 3o sgSTSUOo wagSAS aar,aS au,q aaaut,: saouPgSUT UI 'D 'aaur,oawou aug 30 AgTTTgTsuodsaa aug ST gsag qTd aug buranp quasaad sT aogoadsuT up oansuT oq quawgapdap agg pup %onaq aa)dwnd Toodssao aug 30 uOTgPTaaaOD 'uoTgoadsuT aug T,q paaTnbaa SP suOTTPb 000'T aug 3o uOTgaod P SnTd panowaa suOTTPb paapunu,-anT3 aug buTsn qubrau gTao wnwTxPw aug og paTTT9 qTd aug pup uas,Pq SquawaznsPaw 'gTd aug W033 panowea aq TTTr abPm,;s so SUOTTPb paapung-anT2 'agTs aug oq zaq-em 14saa3 30 sUOTTe5 000'T buTbuTzg zadwnd Toodssao aug iq pagonpuoo aq TTTM gsag qTd aqj *qTd aug uO gsaq aqua uoTgdaosqu auq buTgonpuoo oq aoTad sanou, (tZ) ano3-Aquemq padutnd xNvL OIZdES aug 2�gNO anPu gsnw TTn3 ',TaPau aaP u,OTuM sgTd abPdaaS 'Q •poTaad anon (�Z) ano3-iquaDmq au,g buTar,p pa40a33P qOu ST gsag gid auq aansuT oq pup sesodand aouPuagUTPw a03 padumd -%upq oTgdas auq 'qTd abPdaaS aug oquT pabaPuoSTP ST aaqum 30 sUOTTPb 000'T au,l •gSaq auq 5UTanp quasaad sT aogcadSUT up aznsuT oq guawgaPdap aug ugTM PagPTaaaoo HE LLsnw awTq IaanTTap au,l 'SAPPTa,3 buTPnToxa 'awT4 paT3Toads P gP PaaanTTap aagPr. aug buTgsanbaa pup aadwnd Toodssao P buTgopquoo Tq aaqur, usaa3 Jo SUOTTPb 000'T bu'rzapao -JO ngTTTgTsuodsaa auk seu zaur,oawou, ales poTiad znou (j7Z) ano3-Iguan:l P aano uoTgdaOsgP 30 agPa sqT buTanspaw PUP gTd abPdaas agg og aagPr: gsaa3 3o uOTgTppp a -'I �a •asn oq auo uOTur, agou TTTM aogoadsuT anOW 'SPougaw (0)aaauq buTr:oTTo3 auk 30 (T) auo buTsn i�q pagonpuoo sT gsag ai-I , PaaTnbaa ST gsag agPa uoTgdzosa,P UP 'wagsns aar,as aug agPnTPna oq aapao ul •pasodxa aTOuuPw aug anPg gsnw uOTgoadSUT UcTgPTTPgsUT up Iq paquaum -oOP qcu S_�[upg oTgdas anPu, goTur, swagsz�s aar,as aaPTO 'wagsfs aug 3o quauodwoo uapa Oq SsaooP apTnoad oq paainbaa eap sadTdpupgs 'huPq oTgdas aTgTssod PUP qTd uoTgdaosgp up 30 S4STSUOO wagS.�S aaMas anon uauy, Ggaadoad znoh SuTaaes -&T uTTop3 aar,as auq anoaddle puP aqunTPAa Oq paD.sanbaa uaaq sPu uOTgOagOad TPguawuOaTAu,i pup ggTPaH 30 quatgaPCaQ au,l OZL�-t9Z gsag wagsfs zar.aS agTS-UO a0--1 suoTgOnagsul �OIJU�SUad IFIL �i^<i 02iI7i�� Q.I?t' HS,i EH 3U J,I WL2JVEEQ �U�NOHO':f 20 nZirIVEIDIlUOW CINE WAL. A GEOLOGICAL LABORATORIES OF ALASKA+ INC. 4649 BUSINESS PARK BLVD. P.O. BOX 4.1276 ANCHORAGE, ALASKA 99M Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY LABORATORY TO BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM: I. D. No. F— SAMPLE DATE: C1�—� C( e Mo. Day SAMPLE TYPE: ❑ Routine El Check Sample (for routine sample) E-1TreatedWater with lab ref. no. ❑ Untreated Water ❑ Special Purpose SAMPLE NO. LOCATION Lj---- " K -I- 2 I y^,� i Yn A AN C= � 3 4 5 Time Collected Collected By 12qi 4 TELEPHONE (907) 279.4014 LABORATORY: NAME --- ADDRESS CITY Date Received Time Received"aD Pm Analytical Method: ❑ Fermentation Tube �4 Membrane Filter Lab Ref. No. Result' . A n Ilyst i m m No. of C0100166I too ml. or No. of P011111"port"mi)., 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Sburce Date collected a.m. READ INSTRUCTIONS Time Receivetl p.m. Lab. No. Date Received loml loml loml loml loml 1.0ml 0.1 m1 Presumptive ___ 24 Hours 48 Hours BEFORE Confirmatory 24 Hours 48 Hours - Broth 48 hours:_ --- -------" Broth 24 hours:_ EMB � loml Tubes Posltive/Total loml Portions COLLECTING SAMPLE Multiple Tube Report: Collform/100ml Membrane Filter: Direct Count BGB------�— Verlficatlon: LTB–s�Coliform/100mi Final Membrane Filter Results 7r1C-P/►� Date Reported ev �!� a.m. Form No. 18.310 (3.78) Time: P.M. May 1-9, 1931 1 -,()WT y G. 11110t I po 0 1 F 1 C, 0 BOX 878 -1-7 Nagle, River, cubL .1, 3 �.qountatn J'Aal'017 Subcl-ivibion ' v "or, LOP W&VIdual. SCASY.- and cannot h' vt(J Coa_l,jj W,( --C"- lt'7 1.1 C om 1) "d (I rPhc t,() t, r7;"s, needs 1`O o1: 'c f 1- oill Cilel-0 Taj), be 5633 suhmilucki 11 St fol-. of pi-ivaLcl 7 .)ns periorma,ng -) d to Lhis of.[ice (2) Tho ser to t -his tic ofvic(=. nc(lls I � I-submitted I-eview. u(- aS --hP stions, -0- C� Ar q ""s of'!'-lce If e any Ljyc, are at 2611-4720. Cf sillcm-oly, q Ara) cWinnNrM ENT M MiOl' ClICNI Of HFAI May 1-9, 1931 1 -,()WT y G. 11110t I po 0 1 F 1 C, 0 BOX 878 -1-7 Nagle, River, cubL .1, 3 �.qountatn J'Aal'017 Subcl-ivibion ' v "or, LOP W&VIdual. SCASY.- and cannot h' vt(J Coa_l,jj W,( --C"- Leslneeds wdcrmine i -f C om 1) s Nations ql-andayds. (I rPhc t,() t, r7;"s, needs 1`O o1: 'c f 1- oill Cilel-0 Taj), be 5633 suhmilucki 11 St fol-. of pi-ivaLcl 7 .)ns periorma,ng -) d to Lhis of.[ice (2) Tho ser to t -his tic ofvic(=. nc(lls I � I-submitted Robert C. llral-t, B—S', Associate RC P / I i w cc: security P0 C TA01- t q q ti t) be on the CX3`L,-'114 (3) 7�j adequacy Leslneeds wdcrmine i -f the 3y�3t(rff s Nations ql-andayds. clare(' A i',ti adequate ac cording to the t0st i.r; (DITICIOSC(l- his of pi-ivaLcl 7 .)ns periorma,ng -) d to Lhis of.[ice for nc(lls I � I-submitted I-eview. u(- aS --hP stions, -0- C� Ar q ""s of'!'-lce If e any Ljyc, are at 2611-4720. sillcm-oly, Robert C. llral-t, B—S', Associate RC P / I i w cc: security P0 C TA01- t q q ti 5. LEGAL DESCRIPTION DATE RECEIVED , INSPECTION APPOINTMENTS TIME 61+x Ta r- awaL ig6, TIME TIME E] One ❑ Four ❑ Other M' SINGLE FAMILY 1 DATE Three ❑ Six DATE DATE (71 1?0' INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well INSPECTOR depth (attach log if available.) INSPECTOR INSPECTOR L INDIVIDUAL/ON-SITE** Ry! IM YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MUNICIPALITY OF MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOIfNVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 0* MKY 14 1981 ENVIRONMENTAL SANITATIONDIVISION Telephone 264.4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests willnot be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE e,... oT►' Z S"l L MAILING ADDRESS PC),jadtc PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHO E S -t e -A 6L to 2 Y3 r/ a -7 MAILING ADDRESS 1 �N CJITe/L 3. LENDINGINSTITUTION I PHONE Se-.Jr2�+ r sc' r elt l MAILING ADDRESS C C t.M V*G 7� 4. REALTOR/AGENT PHONE I I Gre-• MAILING ADDRESS 5. LEGAL DESCRIPTION H- N J``�, .'ee STREET LOCATION P l..roT 2. k� /� /C 61+x Ta r- awaL ig6, 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS E] One ❑ Four ❑ Other M' SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY 1?0' INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) S. SEWAGEDISPOSAL SYSTEM L INDIVIDUAL/ON-SITE** Ry! IM YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) M 1n fl f ,.— G„O, THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ TWO ❑ FOUR ❑ SIX ❑ OTHER 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septi Tank or ❑ Holding Tank Size: �' If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ❑ APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) DISAPPROVED DATE BY M 1n fl f ,.— G„O, THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: L TYPE OF RESIDENCE '1] SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO FOUR ❑ SIX 2. WATER SUPPLY --9:1 INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM -ED INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ElSeptic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK �s MANUF CTURER TOTAL ABSORPTION AREA k MATERIAL l/ p 4. DISTANCES WELL T0: Septic/HoldingTank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. -COMMENTS t-, APPROVED FOR ' BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE (�-C-,II BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE (MOA,) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA MUN17yFALTHH& RAGE ENVIIRR NM,E(EN�TAL tTECTION Lr 2 SL ►m o u � �V1� RECEIVED Well Classification T' -Neve- If A, B, or C, D.E.C. Approved(Y ) NJ4 Well Log Present (Y/N)Ye-S. Completed /� field /.6 Grrm' (1Date Total Depth t�.-¢ $ ; F ' �Csed Z1w�1�Now�1�1 Depth of Grouting -�-- J Static Water Level _ 85� owN_ Pump Set At ld►tl hUK&e)b ` A -X,41 Casing Height Above Ground 3 Sanitary Seal on Casing (Y/N)YeS X. -Electrical Wiring in Conduit (YM No Depression Around Wellhead (Y/N) nro Separation Distances fran Wzll: To Septic/Holding Tank on Lot pZ ( On Adjoining Lots l o 04 - To Nearest Edge of Absorption Field on Lot j,J ; On Adjoining Lots IOo-t *A� To Nearest Public Sewer Lire N/ To Nearest Public Sewer Cleancut/Manhole N/A, To Nearest Sewer Service Line on Lot N/4 Water Sample Collected By �-__Isa. feZ Date _N 6�84- Water Sample Test -Results S S ISS Coamlents LoELL LoGr 1 ND 1 CAM � ' 3 CTPw%) q Ho wavkm 17zsr RAN CTS S Ho W 1 r 6 4rM9. n __ _ __ n ..J r\ . _. _ ._✓—_ I _.11 1 / \vt..-.� C B. SEPTIC/HOLDING TANK DATA iJ'? -{, f ` C_{_�a•, Date Installed Size 1 Z5y C,,, L.No. of Canpartments Standpipes (Y/N) "fees Air -tight Caps (Y/N) i� Foundation Cleanout (YM) %fog Depression over Tank (Y/N) �10 Date Last Pumped * 1 `f+ Pumping/Maintenance Contract on File (Y/N) No ; for ----- Holding Tank High -Water Alarm (Y/N) W J A Temporary Holding Tank Permit (YM).1�� Separation Distances from Septic/Holding Tank: To Water -Supply WallZj To Building Foundation To. Property Line.I (I f To Disposal Field. 1 �- To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course M/A Comments TYYNv c ev<_azxS .1 0 13; F'A M P -i, a [Papa 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 30 Type of System Design Date Installed CC) z Length of Field Width of Field ¢g" Depth of Field _ tANkrv%3w� Gravea. Fled Thickness - �i OK Fi ttrz ,�..r.r Square Feet of Absorption Area 4.15'U lb Standpipes Present (Y,/N) ` ioS De -pression over Field (Y/N) uo lata of Last Adequacy Test Results of Last Adequacy Test Gn/-}-� �7jr�Y Separation Distancz frcar,Abscrption Field; To Water -Supply Mll 33 To Pr_ope-,ty 'Line 1 �6 To Building Foundation 7-S To Existing or Abandoned System cn Lot a On Adjoining Lots _�V�� jam` TO Water Main/Service LineTo Cutoank(if cresent) To Stream/Pond/take/or Major Drainage Course lsfq To Driveway, Parking Area, Cr 174hicle StCrage Area ( o v Cotta, nts *%632i;c— D. LIFT STATION Date Installed Dinensions Sim in Gallons Ma ole/Access (YIN) °Fame Or." Level at Off" Level at High Water Alarm Level at Vent (YM) Tested for �irg Cycles 3-irirg Adequacy Test. Meets 'IDA Electrical CmxCn Y/N) CcMi eats ** Check Permitted Bedroom Rating Against HAA Request I certify that I I keds verified, or aonfarmd to all MMA HAA. 'ti l '^in effect on the date of i inspection.. s .• •• AV • ••� Signed®40. 1- Date - 3 0 ¢ �0 9T •••� .� Company ►troxv� _ 1 v MOA No. KBl /d5/sj ® m ••. CE - 3816 N a ®®aprofessiona\ {Page 2 of 21 2-15-p�