HomeMy WebLinkAboutNETTLETON ACRES #2 LT 10Municipality of Anchorage
Development Services Department
• --
Building Safety Division
On -Site Water & Wastewater Program, 4700 South Bragaw St. t; A_
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SWO050152 PID Number: 015-062-14
Name:
DUANE AND JULIE MAYER
Wastewater System: ❑ New ■ Upgrade
Address:
6711 PAULA PL. * ANCHORAGE, AK. 99516
ABSORPTION FIELD
Phone: No. of Bedrooms:
(907) 346-8559 4
■ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
0.8
Total Depth from original grade:
10 MAX
GPD/Sq. Ft.
rL
Block: Lot: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
— 10 NETTELTON ACRES #2
SEE DWG. Ft.
6+ FL
Township: Range: Section:
Fill added above original grade:
Grovel length:
— — —
SEE DWG. FL
65 Ft.
WELL: ❑ New ❑ Upgrade
Gravel width:
2.5
Number of linea:
1
Distance between linea:
—
Ft.
FL
Classification (Private, A B,C): Total Dep
Cased To:(BEDROCK)
Total absorption area:
Pipe material:
D 3034/ F-810
Ft.
FL
780+ so. FL
Static Water Level:
Installer.
GEG, Ltd.
Date installed:
7/8-12/2005
Driller. �X� Date Drilled:
FL
Yield:Pump
Set At:
Caetng Height Above Ground:
TANK
GPM
FL
FL
SEPARATION DISTANCES
■ Septic ❑ Holding ❑ S.T.E.P. ❑ Other
To
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
Public/Private
Sewer Lines
Manufacturer.
ANCHORAGE TANK
Capacity In gallons:
1250
From
Well
100'+
100'+
-
-
25'+
Material:
STEEL
Number of compartments:
2
Surface water
100'+
100'+
—
—
—
LIFT STATION
Lot Line
5'+
10'+
—
—
—
Size in gallons:
Manufacturer.
Foundation
5'+
10'+
—
—
—
'Pump on' level at:
ump at
High water alarm at
Curtain Drain
NONE KNOWN
Pump Make eI:
Sectrical Inspections performed by:
Remarks:
BENCH MARK
Location and Description:
OLD SEPTIC TANK WAS COMPLETELY ABANDONED
BOTTOM OF SIDING AT FCO.
PER UPC.
Assumed Elevation:
100.00
Ft.
ENGINEEIRS SEAL
Op
4,;
GEG Ltd.
Inspections performed by: Dates: 1 st 7/8/2005
2nd 7/11/2005
D :' 1
0....... ?..�...... �...:...........0
f
3rd 7/12/20050
QO
.Jeft r A. arness.: X
.
Development Services Department Approval
Ohm CE- 953 oQ
4�s ,. .�°o
p @�a /«f��
7
Reviewed and approved by: / !� Date:
(Rev. 12/01)
��Aoo
�O�dP �ofessla�000
QOO4p0�4
IPERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: I
SW050152 015-062-14
0
m
m
r.
m
T4
A B
FCO 14.94 47.05
ST1 34.50 37.17
ST2 40.50 39.47
DBL1 44.20 41.27
DBL2 45.40 42.09
C01 107.77 74.98
MT1 98.41 87.70
CO2 98.84 105.78
MT2 98.30 106.12
r
/
/
/
/
NEW 1250 /
GALLON SEPTIC/
TANK
I A. 9� go M
No,
I
GPgpG6
\\ DBL1
\\ DBL2 \
ALTERNATE SITE /\
/
/
. r'. �•`.ttf'�
•` / EXISTING /
/ WELL
I
/
/ NOTE: TEST HOLE LOCATION
FROM DESIGN WAS APPROXIMATE,
ACTUAL LOCATION IS AS SHOWN.
GARNESS ENGINEERING GROUP, Ltd.
----_---- - CONSULTANTS & GENERAL CONTRACTORS
3701 F_ MOOR ROAD, SURE 101 • ANCHORAGE, AK 99507 • PHONE (907)337-8178 • FAX (907)338-3248 N'EMM* wmgomfwf»ngG rtrq.c
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
DUANE AND JULIE MAYER (907) 346-2559 2 OF 3
LEGAL DESCRIPTION: DRAWN BY:
NETTELTON ACRES SUBIDIVISION #2; LOT 10, R.A.L.
TYPE OF WORK: DATE:
AS -BUILT FOR NEW SEPTIC SYSTEM 7/14/2005
(Rev. Ulm)
'O 3 jJ ff e .2�. Garness.: `
CE -79,53 •' ,`c°G
�4�O�professio�ao�/
PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER:
-
SW050152 015-062-14
TOP OF TANK AT
INLET = 95.13 -
INVERT OF BUNG AT
INLET = 94.55 —
FINAL GRADE
= 99.22
ST1
ST2
1 n I
-----------I-I-----�
i u I
NEW 1250
GALLON SEPTIC TANK
FINAL GRADE
MT CO97.24-97.86
ORIGINAL GRADE
= 97.38 ,FILTER FABRIC
INVERT OF PIPE
= 93.38
`BOTTOM OF TRENCH
RELATIVE ELEVATION OF BOTTOM = 87.38
OF TEST HOLE ® 81.38 (TEST HOLE DRY)
W
GARNESS ENGINEERING GROUP, Ltd.
c -- CONSULTANTS & GENERAL CONTRACTORS •-------------- 1
3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507 • PHONE (907)337-8179 • FAX (907)338-3248 • WEBSRE r .gam ngiro rinq.wm
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
DUANE AND JULIE MAYER (907) 346-2559 3 OF 3
LEGAL DESCRIPTION: DRAWN BY:
NETTELTON ACRES SUBIDIVISION #2; LOT 10, R.A.L.
TYPE OF WORK: DATE:
PROFILE AS -BUILT FOR NEW SEPTIC SYSTEM 7/14/2005
(Rev. 01/05)
TOP OF TANKAT
OUTLET = 95.12
INVERT OF BUNG AT
OUTLET = 94.27
i..a......1...........
J flr y A� rness.
CE -7953 m�
's �• .� .••• •moo°O
` Pro f 11 si0�1\o0
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAILING ADDREZ~ / (~ l
LEGAL DESCRIPTION
- Well ,. - I Absorption area t [ Dwelling PERM T NO.
m ~ I M~nu~acturer ~_ IM~teriall ~ No. ot~ompartl~ents
~' ILiql ~al)a~ity in~allons I IF HOMEMADE I Inside length [Width Liquid depth
~ ~ / DISTANCE TO /Well I ~welling PERMIT NO.
~ [ IWell _ Foundation INe~rest ot ina ~ PE~MITNO..
~ ~ DISTANCE TO: I ¢~o~ /q ~o I /~ ~oo~m
~ ~ N /No. of lines I Length of each line Total length of~n~ I Trench width Distance b~t~..~ $,,,,s
~ ~ /To~ ot ~il~ :o ti.i:h ~ - w-~ Material beneath dl~ Total effectiv~a~sa~pJ{on area
- m /L~"gth Width Depth PERMIT NO. --
~ m
~ b /Type of crib~ Crib diarne~-~ Crib deptll~ -I Total effectiv¢~ion area
, / DiSTANCE TO: Bui dblg foundatio Sewer line I ~ptic tank
OTHER
PIPE MATERIALS
~o~ ~
SOIL TEST RATING
INSTALLER
REMARKS
_xn _
LEGAL
APPROVED DATE
PERMIT NO.
RPF'L. I CRNT
LC)CRT I ON
LEGRL
[:,EPRRTMENT m ...... FIEFI, L. TH RN[:, EN',,,',IRONME:NTFI~:., '"'"OTECTION ~l ~
PFt _ L. FI RN[:, HIZ, ME~TERE:, ~
b~ 5.8 NETTLETON ACRES S,,'D<~7''~' L.OT SIZE :1.:~.fl.68,4. S~;C~IJFIRE FEET
'TYF'E OF SOIL RBSORPTION SYSTEM IS: TRENCH
I'qRXtMUM NUMBER OF BEDROOMS
E;OIL RRTIHG ,::SQ FT,."BR:: ....
THE REtT~UIRE[:, SIZE OF THE SOIl.. FIBSORPTION SYSTEM IS:
THE LENGTH DIMENSION IS TNE LENGTH (IN FEET) OF' '['HE TRENCH OR DRFIINFtEL.[:,.
THE [:,EPTH OF R TRENCH OR PIT IS THE [:,ISTFINCE 8ETI4EEN THE SURFRCE OF THE::
GROt.IN[:, FIN[:, THE BOTTOM OF THE ENCR',,,'FI'TION ,::Ir.,I FEET).
THERE IS NO E;ET HIDTH FOR TRENCHES.
THE GRR',,,'Et._ [:,EPTH IS THE MINIMUM DEPTH OF GRR',,,'EL BETI.,.IEEN THE OUTFFILL PIPE
RND THE BOTTOM OF THE ENCR',,,'RTION <IN FEET).
F'ERMIT FIPPLICRNT HRS THE RE2;PONSIBILITY TO INFORM THIS [.',EPI::IRTMENT [:,LIRING THE;
INS]"RI._I._FITION INSPECTIONS OF FINY b. IELLS FI[:,JFiCENT TO THIS PREIF'ERTY FIND THE
I'.,ILIME,'ER OF RESIDENCES THRT THE NELL P.IILL SERVE.
BFICI<.'F]:Li..IN6 OF RNY SYSTEM NI]"HOLIT FINRL INSPECTION fiND I'-]PPROVRL. BY T'rlIS
DEPFIRTMENT P.IIL..L BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN A NELL RN[.', RNY ON-..SITE SE!.,.IRGE DISPOSAL SYSTEM IS
:.I..PiE~ FEET FOR R PRIVR]"E [4ELL OR ::LSE~ TO ;288 FEE]' FROM FI PUE~L. IC 14ELL. DEPENDINC'i
LIPON THE T'¢F'E OF: PI. JBL. I C P.IEL.L.
I"IINIMUI'4 -P.'ISTRNCE FROM R F'RIVFITE I.,.IELL TO R PRIVRTE SE!4ER LINE IS 25 FEET AN[)
'TO FI COMMUNITY SE:IqER LINE :IS 75 FEET.
b. IEL. L LOGS 8RE REC~UIRED FIND MLIS';T BE RETURNED I'O TNE DEPFIRTMENT P.IITHIN Z.':E~ DRYS
OF THE NELL COMPLETION.
OTHER REQIJIREi"FENTS MFIY FIPPLY. SPECIFICFITIONS RND CONSTR. UCTION DIFIGRFIMS FIRE
FIYFIILFIBL. E TO INSURE PROPER INSTFILLFITION.
I CERTIFY THRT
:L: I RM FRMILIFIF.: P]I]"H 'FHE REQUIREMENTS FOR ON-SITE SEI.4ERS ¢~]N[) P.IELi. S FIS :SET
FORTH BY THE MUNICIPFILITY OF FINCHORFIGE.
2: I 1.4ILL INSTRLL THE SYSTEM IN RCCORDFINCE L4I]"H THE CODE'_:;.
~: I UNDERSTFIi'.,ID THRT THE ON-SITE SE!.,.IER '-2.,Y~TEM i',IFIY REC..!UIRE ENLFIRGEMENT IF' THE
RES I[:,ENIZ:E I S..~::EMO[:,ELE[:, TO INCL. U[:,E MORE THFIN ]: BE[:,ROOM[-.].
CONSTt',dCTION
TEST LAB
PERFORMED FOR, WESTERN ENTERPRISES
LEGAL DESCRIPTION: Lot 10 Block
THIS FORM REPORTS: ~Visual Soils Examination
180L
W. 48TH AVE. STE. 'C'
ANCHORAGE, ALASKA 9950;5
248-1;533
DATE PERFORMED:9 / 1 7 / 80
Subdivision Nettleton Ac r e s <~I~::?_
O Percolation 'rest
DEPTH S al L
F'EET DESCRIPTION NOTES
6" TOPSOIL N/A _~
10" BROWN SILT 480
TAN GRAVEL 100 SF/B!
2' w/ Coal Chunks GW-GP
- TAN FINE SAND 150SF/BR
SP
7'
TAN GRAVEL w/ cobbles &
100 SF/B
boulders
GW-GP
16 '
BOTTOM OF HOLE
WAS GROUND WATER ENCOUNTERED NO
IF YES, WHAT DEPTH
LEGEND
® - Perc zone l(hme¥ R. o,~
® S - Sample token 3~5~: ~
BI -- Frozen zone GENERAL SITE SLOPE
~'- Water table ,~
READING DATE GROSS TIME NET TIME DEPTH TO I.t20 NET DRAINA61-'
PERCOLATION RATE:
PROPOSED INSTALLATION
COMMENTS:
DRAINAGE REQUIREMENTS'.
O SEEPAGE PIT X~3(DRAIN FIELD O OTHER
TEST PERFORMED BY:B · P ·
DATA CERTIFIED BY:Kinney R. Baxter, P.E.
DATE: 9/17/80
~ 0 0 0 0 0 0 0 0 0 0 0 0
0 : :LO
~ : :
:
0 0 0 0 0 0 0 0
: :
:
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. Ct
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1, GENERAL INFORMATION
Complete legal description
Lot 10; Net~bC. eton Acres
Location (site address or directions)
Dr. Jc~es Scw~ly
4120 Laurel Street,
6700 Paula
Anchorage, AK
Property owner
Mailing address
Lending agency
Mailing address
Agent George McCoy/ Jack White Co.
Address 5201 "C" Street S~.te 200
Day phone 562-6764
Suite 203 AnChorage, AK 99508
Day phone
Day phone 563-5500
Anchoraqe~ AK 99503
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.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev. 1/91) Fronl 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 with ail Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm s & $ ENGINEERING Phone ~ E/ z/' _ ~ ,~ 7 ~]
17034 Eagle River Loop Road No. 204
Address Ea~l/e River, Alaska 99577
Engineer's signature '-~¢'~i-¢ E'~ '~"?"--- Date 5//'~'/ / ¢/6',
DHHS SIGNATURE
\ Approved for
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date //
'The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificr~tes 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) Bsck MOA ~21
IviUNiCJPAL. ¥ 'or Ai~t~it~)r.~.~c-
ENVIRONMENTAL SERVICES DIVISION
unicipa{{ty of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICI l! C I!!V ~ D
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4'?'44
Health Authority Approval Checklist
LegalDescription: LO T lo tv~r rt~ro~ t~c/~ 5 Parcel I.D. : O~ S- ~' Oro,~ -- ))t
A. WELL DATA
Well type
Log present
Total depth
IfA, B, or C, attach ADEC letter. ADEC water system number
Date completed / o / ;~ ~ / ~' O
Cased to ~'/0 ¢- Casing height (above ground)
Sanitary seal (~q) ~/~- J
Wires properly protected ¢i;)/N) V t' y
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
FROM WELL LOG
AT INSPECTION
g.p.m. (a .~ I +
Coliform O Nitrate
Date of sample; 3 / ~- ~/o/~
B. ~OLDING TANK DATA
Date installed lO/)o /~o Tanksize /o0 o
(2, I
Collected by:
g.p.m.
Other bacteria O
S & S ENGINEERING
17034 EagJe River Loop Road No, 204
Eagle River, Alaska 99577
Number of Compartments ~- Cleanouts (5}/N) ye ?'
Foundation cleanout ~/N) x/,~ 5 Depression (Y~ /,/O High water alarm (Y/~ /,/ o
Date ofPmnping,5'/,~ ,~-/~6 Pumper ~' 3- //o,,,~ 4_ 5'~ v/c:r; .1%'4
C. ABSORPTION FIELD DATA
Date installed /~/-:~ o
£
Length 3 0 Width
Effective absorption area ~/ ¢
Date of adequacy test
Soil rating (g.p.d./ft2 or~.-1
3 Gravel thickness below pipe
Syste~n type
Total depth
Monitoring Tube present(~/N) V~ ~r Depression over field (Y/I~ ~v c,
Results (Pass/Fail) f6 ,if For -~ bedrooms
6 i
Fluid depth in absorption field before test (in.); I q Immediately after6 *'-] gal. water added (in.):
Fluid depth ~ t 8'" (ins.) Minutes later: ,:1 3 ~¢~ ¢ Absorption rate = t4 5' o q- g.p.d.
Peroxide treatment (past 12 months) (Y/N) t~,./~ tc,,u,~ ~ If yes, give date ~
Do
LIFt STATION
Date installed
Manhole/Access (Y/N)
Hidh water~
E. SEPARATION DISTANCES
Size in~
level at* "Pump off" level at*
*Datum
Fo
SEPARATION DISTANCES FROM WELL ON LOT TO:
~T~holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
(
; On adjacent lots / o 0 ~-
/
.; On adjacent lots ! 0 o --/-
Public sewer manhole/cleanout A//~
Lift station /~/,~
SEPARATION DISTANCES FRoMisEPTIC}HOLDING TANK ON LOT TO:
Building foundation l ~- / ~- Property line ~' 0 r4- Absorption field
Water main/service line 30/4- Surface water/drainage./0o /'P Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Surface water
Curtain drain
Property Line ~'o -p Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots / 0 0 ~ wt.
ENGINEER'S CERTIFICATION
I certify that I have determined thrufield inspections and review of Municipal rec~.
Signamreinc°nf°rman~:"'OAH'/~guideliq'exineffect°nthisdate'
Engineer's Name
Date ~/?/
Date of Payment
eceipt umbcr /'7 / ¥ (?o 7
Waiver Fee $
Date of Payment
Receipt Number
Rev. 8/95 OSS: haa.wk.doc
03/29/95 16:49 CT&E ESI ANCHORAGE * 90?6941211 N0.814
CT&E Environmental Services Inc.
Laboratory Division ,~',~',e~r,~',e,~'ara~a~,~,,v-j,~e~aer~r~a
Laboratory Analysis Report
CT&F, Ref.//
Client Sample ID
Matrix
961015.7947
L[O NI3TTI,ETON S/DJ 10[$.01
Drinking WRier
Pwsm o
Sample Remarks: '"
Collecled Date 03/25/96
Technical Director
R~leased B y.~., --T,~_.,__ .,...,.- ......
NitrateQI 0.100 U ' 6',~ ~g/'"~=~ EPA 353.2
Attowab[e Prep Analysis Init
03/~6/96 EM8
200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tel: (907) 562-2343 Fax: (907) 561-5301
3180 Poger Ro~O, Fairb~!rik$, AK .99709-5471 -- Tel: (907} 474-~650 Fax: (907) 474-9685
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS. MARYLAND, MICHIGAN. MISSOURI. NEW JERSEY, OHIO, WEST VIRGINIA
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # bO ! ''~-- 0 b,~g- --/
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) 6711 Pau~a Place
Property owner Curt Dawleq
Mailing address 6711 Pau~a Place Anchorage,
Day phone
Alaska 995~6
346-2448
Lending agency
Mailing address
Day phone
Agen~2amelia Buschman FORTUNE PROPERTIES, INC, Day phone_ $46-1685
Address 3000 A street #101 Anchoraqe, Alaska 99503
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
XX
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:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
XX
72-025 (Rev, 1/91) Front MOA ~2t
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
Address
Engineer's signature
S & $ ENGINEERING
17034 Eagle R[¥er Loop Road No. ~
Eagle River, AJasl(a 9~527
Phone
DHHS SIGNATURE
~ Approved for f~'.,¢¢¢~.) bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By:
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Oertificates 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. ~/91) Back MOAt21
Municipality of Anchorage
Department of Health & Human Services
HEALTHCUTHORITY CPPROVAL CHECKLIS'r
A. WELL DATA
Well t y pe/'<"~'1~
Log present(¢~4)
Total depth
Sanitary seal
If A, B, or ~, attach ADEC letter. ADEG water system number
Date completed ~ c:~- ~.'~ ~ ~,o Driller
"(,, ,
'~"~' Cased to ~ Casing height_
'"'( Wires properly protected(CC)fN) y
Date of test
Static water level
Well flow
Pump level \~'
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main ~
Sewer service line
FROM WELL LOG
g.p.m.
AT INSPECTION
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~5;> ~::~/~ Nitrate
Date of sample: //'- /g¢'-':~ 1
13. SEPTIC/HOLDING TANK DATA
Date installed [ET~~:~ Tank size . .
Cleanouts~N)
/
High water alarm (Y/N)
Date of pumping
I'~ .'~,
Collected by:
Ot~er bacteria
\ ~__.,~_,~d:~ Compartments %
F u dation cleanoutd~N) _ V Depression (Y~ ~
Alarm tested~Y~.~) , / '---'-'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
To property line
Surface water/drainage
On adjacent lots
Absorption field
Foundation ~ ~
Water main/service line ~,Of ~"'
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date ins~ta te.~ Manufacturer
Size in gallons % Manhole/Access (Y/N)
Vent (Y/N) "P~I at "Pump off" level at
High water alarm level ~ ~....~tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Meets MOA electrical codes (Y/N) ~
Surface water
D. ABSORPTION FIELD DATA
Date installed ~¢- ~<::~ ~'~::::~ Soil rating
Length '"'~ ~::~ Width L.~
Total absorption area ~
Depression over field (Y~)
Results (pass/fail) ~~
Peroxide treatment (past 12 months)(V~
Gravel thickness '~
Cleanouts present4~)
Date of adequacy test
for ~
/~'~\'~t.'D'J If yes, give date
~4--
Total depth ~,'~.~ --
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellonlot ~, C?~.¢~-I~'~ On adjacent lots / ~ ''~ Propertyline
To building foundation ..~_/I~ To existing or abandoned system on lot
On adjacent lots '~ -~r'- Cutbank I"~ L*") ,-J ~..~ Water main/service line
Surface water ~1 ~f mt-- Driveway, parking/vehicle storage area
Curtain drain ~--~c:~ I-~ ~--1~ ~-~
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on; of this '
S & $ ENGINEERING
Signature 17034 Eafjle River Loop Road No, 204
Eaule River, Alaska 995~t~,
Engineer's Name
Date \~,,~_.~ ~ ,c::~ [ ¢i~
HAA Fee $ //'70,
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMM["RCIAL TESTING & ENGINEERING CO.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
ANALYSIS REPORT BY SAMPLE for WORKordar~ 40275
Date Report Printed: NOV 15 91 ~ 16:11
FAX: (907) 561-5301
Client Sample ID:NETTLETON ACRES #2 LIO
PWSID :UA
Collected NOV 14 91 @ 14:00 hrs.
Received NOV l~ 91 @ 16:02 hrs.
Preserved with :AS REQUIRED
Analysis Completed :NOV 15 91
Laboratory Supezvis~EPNEN C. EDE
Client Name
Client Acct
BPO $
Req t
Ozda:ed By
:S & S ENGINEERING
:SNSENGP
PO ~ NONE RECEIVED
:R. SHAFER
Send Reports to:
I)S & S ENGINEERING
2)
Chemlab Ref #: 916166 Lab Smpl ID: I Matrix: WATER
Allowable
Parameter Tastad Result U~lts Method Limits
NITRATE-N ND(O.IO) mE/1 EPA 353.2
Sample ROUTINE SAMPLE COLLECTED BY: LYNDA,
Remarks:
Tests Performed ' See Special Instructions Above UA-Unavailable
None Detected '" See Sample Remarks Above
Not Analyzed LT-Less Than, GT-Greater Than
Member of the SGS Group (Soci~t~ G~n~rale de Surveillance)
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
264-472O
Application Date_ '. -
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name ~..~t¢-'~ ~")~-.""( Telephone: Home [-~-6 '-~<¢r~'~ Business ;'-~(-¢¢-
Applicant Address ~, ~, '~'~X' Ii '~--~ % ~' / fl~,-~(',~-~¢.,.~' RE.. ~:7 ~'~/~
(c) Applicant is (check one): Lending Institution [],; Owner/builder/J~Buyer []; Other [] (explain);
(d) Lending Institution Telephone
Address
(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
Other
WATER SUPPLY
Individual We!lc.J~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4, SEWAGE DISPOSAL
Onsite~.,~~ 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 (11,,84)
Page 1 of 2
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seai a:ifixed hereto and as of the validation date shown below, I verify that.my investigation of this
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequ~,
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtainet~
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposat system is in compliance with all ~unicipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm (~ '~'~ ~F~ ~F~ ~[~elephone ~ ~ 7 ~
Date ... 7
DHEP APPROVAL
Approved for ,2~/,-'.~_ ~?~'}b e d ro o m s b y
Approved ~ Disapproved
Terms of Conditional Approval
Conditional _
CAUTION
Tile IVluncipality 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.
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
WELL DATA
Well Classification ~""'~--I ~J ..¢¢T~'~ If A, B, C, D.E.C. Approved (Y/N) ~"~
Well Log Present (Y/N) ~'¢~, Date Completed ~/~ /"~O yed~.
Total Depth ~'~:~'~- ' Cased to Z.,~.~ ~' Depth of Grouting
Static Water Level (=~'¢~.~"
Casing Height Above Ground ~
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
Pump Set At ~'~%~4 ~6
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N) N~:~
; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot __[ ~ t ~._; On Adjoining Lot,,; ( ~(~.~i
To Nearest Public Sewer Line ~ ~' ~ To Nearest Public Sewer
Cleanout/Manhole ~""'~ I ~Or To Nearest Sewer Service Line on Lot
Water Sample Collected by ""'T'~'~¥',~ .1~, .r~: r...c4¢,.~; Date '?/J ~/
Water Sample Test Results
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N) "(_~:'~ Air-tight Caps (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 '7'~"
TO Water Ma~'/~ice'~i~e _ Course ~/'~
I ~b/'~-~f'~:)_ Size ~,~::;5'.-..'~.~ C¢'¢/'L.
No. of Compartments
Foundation Cleanout (Y/N)
Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N)
Comments
To Building Foundation _ "~.%~
To Disposal Field _ ;~'~- f
To Stream, Pond, Lake. or Major Drainage
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field I~
Square Feet of Absorption Area
Depression over Field (Y/N)
Last Adequacy Test "~ '~~
Results
of
Separation Distance from Absorption Field:
To Water-Supply Well j.~ t ..~,~_
To Building Foundation ~ r...~.
Lot / ¢r
To Water Main/Service Line ~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments ~'~¢ $~
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line "Z~- / '"[''-
To Existing or Abandoned System on
; On Adjoining Lots r~ ( ~
TO Cutbank (if present) ~,,5/¢2~F
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
THiegsledW~;~r Alarm Level at//'~'~.,/
Electrical Codes(Y//
Comments /
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
/.~g Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checke(~, verified,'~r conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~'"~--l~,~,-,. (J~-,'-N~xOf,,~~ Date ~/~
Company g~~ ~ ~o.
ReceiptNo. ~O~' O~ J~
Date of Payment ~ ' ~-~
Amount: $ ~ ~ ~ Seal
Page 2 of 2
72-026 (11/84)
./
A+Hot,,~ Se~ices
15900 Francesca Drive
Anchorage, Alaska 99516
345ot890 * 345.2444
DATE
L
DESCRIPTION
PREVIOUS BALANCE
CREDITS
i cHARGES
BALANCE DUE [~
BALANCE
If this statement does not agree with your records please notify us at once,
$ TA TEMEN T
-,' DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
~NSP~C~O~ ~NSP~CqOR
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF H~ALTH & ENVIRONMENTAL PROT~C~ICIPALI~ OF ANCHORAGE
B2~ L Street - Anchorage, Alaska 99501 DEPT. OF HEALTH &
ENVIRONMENTAL p;~OTECTION
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 JUL 1 0 1981
..ou s A...OVAL O.
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing,
1. PROPERTY OWNER I PHONE
MAILING ADDRESS
PROPERTY RESIDENT (If different from abovel ' ' PHONE
2. BUYER PHON~
MAILING ADDRESS
3, L~NDIN6 INSTITUTION
MAILIN~ADDRESS
4. REALTOR/AGENT / PHONE
M~I El ~ G ADD~ riSS
5. LEGAL DESCRIPTION
STREET LOCATIQN -. /.~. .
6. TYPE OF RESIDENCE NUMBER OF.,BEDROOM~,~
[~"'~SI N G L E FAMILY [] One I~1~ I~ o~[l~r
[~,/Two [] Five
~ MULTIPLE FAMILY Three ~ Six
[] Other
7, WATEr. PLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC U"FI LITY
* ATTACH WELL I_OG. A well Icg is required for all wells drilled
since June 1975, For wells drilled prior to that date, give well
depth (attach Icg if available.)
8. SEWAGE DISPOSAL SYSTEM
I~"-~NDIVIDUAL/ON-SI'['E** ./~"'~) YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FFE MUST ACCOMPANY EACH REQUEST BEFORE PROCE881NG CAN BE INITIATED,
72-010(Rev. 6/79) ~ /
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVI DUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVl DUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY I~
Connection Verified _ INSTALLER
[]Septic Tank or []Holding Tank
Size: JO(~ ~) If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER ~
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line I Nearest Lot Line
WELLTO:
I
I
Absorption Area to nearest Lot Line
5, COMMENTS
[~"~APP ROV ED FOR -~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY
72-010 (Rev. 6/79)
July 17, ].98i
Wes'tern Enterprisest :Inc.
4101 Arctic~_~r,)u~ ].evard, h(.,o,,)--m 203
Anchorage, Alaska 99503
Subject: Lot 10 Nekt].eton Ac:es Subd. iv:i_sJer~
The sewer system on tb.e subject property wz-:s desigrtcd
and installed has a three(3) bedroom single i-amJ_].y
The request fo': approval for bank financing
four (4) bedroom sincle family
Therefo:e, before approval may he granted, a 500 9'ali_ohs
septic tank will need -to be instal]ed and an additional
ten(l) feet of trench with eight({;,) feet of gravel backffJ.ll
will be needed.
_ ~/'/ , The water analysis report needs u~ be sttbm:J_tt, ed to ~- '~'
~,&(~of'fice from tho Cl',em Lab, 5633 B ..... ,~- = ~
ol.r(_:[.~ ~O/2 ,)tlr .Fevic'w,
If -there are any further ques'tions, please, ca]l this ozV"'.~:zce
at 264~-4720.
Sincerely
Robert C. Pra'tt, R.S.
Associate Specialist
RCP/ljw
cc: Alaska Pat'[fit Bank
i01 Benson Beulevard
99503