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HomeMy WebLinkAboutPARADISE VALLEY BLK 4 LT 12Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221206 PID Number: 020-411-20 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name WELSH LIVING TRUST ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 18220 NORWAY DR, ANCHORAGE, AK 99516 ❑ Other Phone7Number of Bedrooms Soil Rating depth from original grade 3 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot PARADISE VALLEY 4 12 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft z Ft. Well 100'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 5'+ _- NA Foundation 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks Separations staked prior to construction & new HDPE tank to existing field verified at 5'+. Alarm location Electrical installed by Installer QRS PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 1s' 8/2/22 2nd 8/4/22 Location and description 3'd 4th TOP OF MH RISER ON-SITE WATER AND WASTEWATER SECTION APPROVAL -= Conditional Approval: DateTH .. 49 - ....�:* �r .. ' ' ' ' ' • ' ' • • • • • • / Septic System A d' �.•• Curtis Huffman so ��� F��sl Lw Date ' • ,C10% 9890912 • ��l���pRdFESS10 �`r Note: this approval does not include well permit requirements. (Rev uoiuunu) PID: 020-411-20 PERMIT: OSP221206 A—C=24,9' B—C=19.9' A—D=47,2' B—D=22.6' A—E=50,3' B—E=21,3' A—F=52,0' B—F=20,5' SEPTIC SECTION SCALE, NTS PARADISE VALLEY BLK 4 LT 12 PREPARED FOR: WELSH LIVING TRUST 18220 NORWAY DR ANCHORAGE, AK 99516 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 FirstWaterAK©gmail.com �urruK istKvictS: OF 4Z� C * 9 TH DATE: 10/19/22 rtis Huffman SURVEY: LCG 'R , CE 128991 DRAWN: FWCS 10/1 91202W SCALE: 1" = 30' phbsSlo�AyAw r O M G) p D m m p 0 C) z �3°10'S0w `,. > No } rn _ �m G DD Z rn r� D m r o D-ovi„ DN m D n o ° o c n o m G C�i �7 m .. ��%. 2 �n n ti� rn CD �. r(D o vSi m (_� rn� (D� wp own q Oau (D fD C}. 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G S� ow m �l;N �z n V iJ CI? +� ,, W Lrl� rix Kms Z r i 9� .�' N[ W O1 z i n x z m< m f(J� Cil /-og. • `CIS,,.'•„ coo W€ Lu N 0 0 r — 0, zO O z z Di mp>Om i m� W i �< �O MUNICIPALITY OF ANCHORAGE Orr -Sime Water & W2 stewalper Program Po Boos 196650 47DO Elnvy-e Reid AndlorNu, AIaska9951N5 5D Phone: (907) *M3-79 4 Fax. (9071343-7967 ht1 p:Wemv . rr' U r1 i • u rq" 1 a On -Site Wastewater Disposal System Permit Pormit Number r= 0 P?21206 Work Type: SeptleTank Upgrade Tax Codo Nurnber: 0241120000 Site Legal Address: PARADISE VALLEY DLK 4 LT 12 G-3538 Site Mailing Address: 18220 NORWAY DFS, Anchorage Owner: WELSH LIVING TRUST i3esign Engineer: FIRST WATER CCNSUI-TING This permit is for the construction of: Ef EtIVA Cats* Expiration Date: Lot Size in Sq Ftp Total Sedroonis: 612812072 81ZD23 13437 ❑ lDiSpoKgal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Stxage All ConStMotion shall be in accordance with-, 1 _ The _attached :approved design_ 2. All requirernems spe:;ifled in Anchorage Municipal 0000 Chapters 1.5.55 and 18_65 and the Surto of Alaska Wastewater Disposal RequIeVons (1 AC72) and Drinking Nater Regulations (18AAC80 ) 3, The wastewater code requires inspsclions duvirig the installation- The engineer shall notify the Deva lnpment Services Department per AMC 15_68_ Provide noliflcstion by calling (91)7] 343-7$04 (24)7}. 4_ From Ceober 15 to April 15, 81 Subsurface soil absorptlon system under construction during freezing wealher shall be either_ a, Opened and Closed on the sarne day, or b- Covored, sealed, and heated to preaeni freezIng Received By, Issued ,r �ate� 612022 I- Z Date, _ 3 ON-SITE SEPTIC/VVELL PERMIT APPLICATION Parcel I.D. 020-411-20 Property owner(s) WELSH LIVING TRUST Day phone Mailing address 18220 NORWAY DR, ANCHORAGE, AK 99516 Site address 18220 NORWAY DR, ANCHORAGE, AK 99516 Legal description (Sub's., Block & Lot) PARADISE VALLEY BLK 4 LT 12 Legal description (Township, Range & Section) Lot Size 13,437 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) R Septic Tank R Upgrade X pg (w/wo ADU) Holding Tank El Renewal❑ (D) ElRenewal Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: / 5 Waiver Fees: Date of Payment: Date of Payment: Receipt Number: l 5 1 U) Receipt Number: Permit No. O S P ,�a I O n L Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com June 13, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: PARADISE VALLEY BLK 4 LT 12 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. The lot and area are served by private wells. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221206, Deb Wockenfuss, 06/28/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221206, Deb Wockenfuss, 06/28/22 Apr 19 22 09:26p Anchorage Well & Pump Ser 9072430742 p.1 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907 -343 - On -Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: Parcel Identification Number: 020_41120 Legal Description Block I Lot PARADISE VALLEY I 4 1 12 Pump Installation Date: 04 - is - 2022 Pump Intake Depth Below Top of Well Casing: 2210 Pump Manufacturer's Name: A.Y. MC©ONALD Pump Model: 7V12 Pump Size: '5 Pitless Adapter Burial Depth: 12 _ feet Pitless Adapter Manufacturer's Name: WELD -ON Pitless Adapter Installer: Well Disinfected Upon Completion? Lq Yes ❑ No Method of Disinfection: PELLETS 111 Comments: Date of Issue: Property Owner Name & Address: WELSH LIVING TRUST WELSH GERALD F & LAURA J! TTE 18220 NORWAY DRIVE ANCHORAGE, AK 99516 feet Pump Installer Name: ANCHORAGE WELL & PUMP SERVICE Company: 7640 KING STREET ANCHORAGE, AK 99518 Mailing Address: 907-243-0740 City: State: Zin: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. 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 , . PHONE ~i~ NEW LEGAL DESCRIPTION LOCATION / ~ NO, OF BEDROOMS / Wall Absorption area Dwelling 'z PERMI~ NO. ~ ~ Manufacturer No, of oo~rtmants ~ ~ Inside length Width Liquid depth Liq. capacity in gallons ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer Material Liquid capacity in gallons ~ Well Fou~ioq,~ Nearest~ot~in~ PER~IT NO. - . NO. of lines Length ~f each line Total length of.lines Trench width Distance b~ lines ~ ~ ~;~ j, ~ ,~ ~ ~ ~,~ inches /~//~' ~ ~ ~ Top of tile to finish~rade .' ' ' Material beneath tile ~ Total ef¥ctive absorp~iop area Length Width Depth PER~IT ~O. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class ~, ~ ~ ,~ Depth Driller Distance to lot line PERMIT ~O. ~ DI~TANC~ TO: Building foundation 8~er line ~ep~ic ~ank Absorption OTHER PIPE ~ATE~IALS / SOl L TEST RATING t X :'~ i INSTALLER --~ l REMARKS APPROVED r DATE LEGAL ~ I ~ ~ ~Cli 'T 72-013 (Rev. 3~78) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of. Geologicol ~ Geophysicol Surveys Drilling Permit No. lc.} A.D.L. No. Anch 12 4 _of_or_of_ sO wO 'lc~.J DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS ;5. OWNER OF WELL: Paradise Valley Addrees: Bill Ashton Street Address end Aree of WeH hocof[on Feet Below 4. WELL DEPTH: (f,nol) 5. DATE OF Cr~MPLETIO~/..~ 2[. WELL LOG SurfOCe 240 '. 9 - - Moterlol Type Top Bottom gravely~ll cobbles 0 1 5 6. ~Co~le toot ~o,ery ~Driven ~Dug gray silty ~ardpan - seep 15 25 ~Auger ~detted ~Bored ~Other: heavy ~ilty gravel 25 70 7. USE~ Domestic ~ Public S,ppiy ~ Industry seeoage~t 49' ~ Irri$otlo, ~ R,cherg, ~ CommeHcel Eray silty_ gravel 70 79 ~ ~ray silty c~ay lenses of 79 88 ~. c~s~,~ ~ ~r~.~ ~ W.~.~ silt H20 ~. 5 ~". ~o !40 ". o.,,~ w.~, '~,./". ~raz brn silty clay 88 106 ~. tight gravel~ 1 gp~ 106 110 ,. ~,,,s, cemented till w/gravel 110 128 Type: btu t~] 1 ~ravelv 128 155 Slot/Mesh Size; Length: ~edrock g.?~y ~rn seep ~140' 135 195 s~ between f,. ond ft. light gray ~ 195 20~ ~,~H,.~ ~r~., b~n gr~=~8'-220' fractured 203 240 ,o. s~,c w~. ~w~, -. / / Dote well producing 1~ gpm ~,~,~..~ u,.~: II. PUMPING LEVEL below Iond s~rfeee end YIEL~ ' O~ ~ )x~" ft. ~fter hrs. pumping $.p.m. ~}~p'~. D~ ~Em""'~,:c[~O~ IE.GROUTING Well Grouted: ~ Yes ~o ~V~l~v,~ '" Motertol; ~ Neat Cemenl ~ Other: ~, Length of Drop Pipe ft. copocity ~g.p.m. O "C ~.~ U~ 0sub,' 0 der 0 gentrificol 0 Other ~ well~rforated 104'6"-108' Alaska~'~ ~' Now-Well/Vern' s'~ d~"~d ~.d~r ~ ~r~O.Drilling~h~ ~,o~,&i~ ~t~o ~ ~t of ~y ~,.~ 1~41 Avion St. ~chorage, Alaska ALASKA e, iUII OFImenTAL COFITIgOL $1 I OICI $, IFIC. ~§l~¢¢rl,q 6 ~nuwonmentaJ SIudies December 21, 1984 Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 Subject: On-Site Sewage Disposal and/or Well Inspection Report During 1984, a number of septic systems have been installed and inspected, prior to the establishment of the foundation(s). AECS has contacted (or attempted to contact) the applicants concerning the installation of foundation clean-out and pipe from the foundation to the septic tank inlet. In many cases, construction will not resume till in the spring; therefore, precluding any further inspections. Since the end of the year is near, with the expiration of permits, AECS is forwarding the inspection reports without a foundation cleanouts to your office. We understand that this will not eliminate this situation; nonetheless, the reports reflect the actual inspected installation at this time. We recommend you accept these as is. The Health Authority, site evaluation for these properties can confirm the installation of the cleanout. Conditional approval, based on required installation in the spring, may be required during the interim. ~/\~-~ If this office can be of further assistance, please contact us at 5 1-5o4o. /a Sincerely, L. D. Montgomery Supervisor, Environmental Department Approved By: .MUNICIPALITY OF ANCHOI~AOE DEPT. OF HEALT''~, & ENVIRONMENTAL PROTECTION RECEIViD 1200 I. Ucst 33rd /~ucnue. SuJI¢ [~ · Anchoroq¢. /~laska 99503,[907) 561-50~10 ~ ~MUNICIPALITY 0f ANCHORAGE ~ Departmen~ .f Health and Environment?--%Protection 825 = Street, Anchorage, AK. 39501 264-4720 * * * HANDWRITTEN PERMIT Permit ~ ~2~7 WELL AND~ ON-SITE SEWER PERMIT Location: ~/~o~ ,/~/~ ~?~/~ Phone Number: ~ , Legal Description: Jo~/~/~¢~. ~D~ ~ Type of Soil Absorption System ~s: Trench: Drainfield: ,~._ Seepage Bed: Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) /~- The Required Size of the Soil Absorption System Is: DEPTH q-d '~ LENGTH ~/~ ~ GRAVEL~DEPTH 3~ ~- WIDTH ~__ ~ · . The length dimension zs the length(in feet) of th~~ or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set ~idth for trenches. The gravel depth is the minim~ depth of aravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~dO GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adDacen~ to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without f~nal inspection.and ~pprov~l by this dep~rtment will be subject to prosecution. Min~ distance between a well and any on-site sewage disposal system is 100 fee~ for a private well or 150 to 200 feet from a public well depending upon the t~pe of public well. Minim~ distance from a private well to a private sewer line is 2.5 feet and to a co--unity sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8~* * * I certify that: (1) I a failiar with ~he requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the syste~ in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the r~sidence is remodeled to include more that 3 bedrooms. - ~ ~ '~-... Lot Size: /3)~ Holding Tank: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMEI~TAL PROTECTION 925 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12- 13 14 15 WAS G ENCOL IF YEE DEPT~ PERC* [] SOILS LOG [] PERCOLATION TEST SLOPE SITE 6L~N ROUND WATER NTERED? AT WHAT 16 17 18 19- 2O Gross Net Depth to Net Reading Date Time Time Water Drop _ATION RATE TEST RUN BETWEEN COMMENTS PERFORMED BY: ~i~-~/~) CERTIFIED BY: minutes 'inch) · FT FT AND . DATE 72-008 (6179) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST [] SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 3 4 · O/Zq~n,'c DATE PERFORMED: SLOPE SITE ¢L~N _,% 10 11 12 13- 14- 15- 16 17, 18 19 2O COMMENTS PERFORMED BY: WAS GROUND WATER S ENCOUNTERED? ~ ~ P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN CERTIFIED BY: FT AND .. FT 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4'744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description J-- 0 7- / /f fl N Location (site address or directions) Property owner /'V?/'~' _~ ~' If / ~'}~'-/"0/~-~ Mailing address Day phone Lending agency Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: Individual well ' · Community well NOTE: Public water 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 ,o 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) Front MOA #21 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 '-/~--/'~'~ ~ ~:-~__,¢/¢¢~:~/'//¢/~ Phone Address _~~_~-- ~~~/~/~/~/~_..~',.,.¢~_ .,,/ Si DHHS SIGNATURE ~ Approved for T-H/~--F_-C~') b ed ro o m s' Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments -~ ' ~_- /::~7-F;,-4~6~O 'Yi' (/ Date C~/.),~/)( "" Ith and Human Services (DHHS) issues Health Authority ' Approvel 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. 72~32~ (Rev. 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HE/~LTH & HUMA~ SERVICES Environmental Services Division 825 L Street; Room 502 · Anchorage, Alaska 99501 · (907) 343~4744 Health AuthoritY Approval Checklist Lega~Description:J_lZ~pj,~p~,j~r~V~J/Cy~'~.Parce~l.D.:L*'3~C~_Mi~\~C~U~3 01 1996 A. WELL DATA Well type / ~/~ ~__.~ if A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ~'~ Date completed ? ~ ~ ~(~ '~ Total depth ~--/--J" O Sanitary seal (Y/N) Date of test Static water level Well production Cased to FROM WELL LOG WATER SAMPLE RESULTS: . / ¢ ~ Casing height (above ground) Wires properly protected (Y/N) ~ ' ' __ AT INSPECTION RECEIVED ..m. ~, ~ g.p.m. Coliform C~) Nitrate ! · ~ Other bacteria Date of sample: ,,,]t£ '~ 7 ~_ / (~, 'Collected by: ~ Date installed ~'//~ 1~ Tank size [~0~ ~umber of Compa~ments ~ Cleanouts (WN) Foundation cleanout ~/N) ~ Depression (wN) ~ High wate~ a arm (WN) Date of Pumping ~;~) ~ Pumper ~~ ~ ~ C. ABSORPTION FIELD DATA ~ · Date installed ) ~-. Soil rating (g.p,dJff~ or ft~/bdrm) Length -.~ ~ ! .Width .~ Gravel thickness below pipe ~-~(~' Total depth '7~.~ Effective absorption area ~ ~ ~' ~ / Monitoring Tube present (Y/N) '~ 'Depression over field (Y/N) ~ y test. ~ ~ Date of adequac ~_ [~, _.C~ Results(Pass/Fail) ~2:..~ For bedrooms Fluid depth in absorption field before test (in,); ~ // Immediately afte~-O~ gal, water added (in,): ~) Fluid depth (ins) Minutes later: . Absorption rate = '~ '-~(~) g.p.d. Peroxide treatment (past 12 months) (Y/N) ~ · If yes, give date 72-026 (Rev. 3/96)* LIFT STATION Date installed~'~ S '~._,_i~ Manhole/Access (Y/N) ~ "Pump on" level at* High ~vel at* Cycles tested "Pump off" I/evel at* / E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main ~ ~(~ Sewer/septic service line C~r_~ Public sewer manhole/cleanout Lift station On adjacent lots On adjacent lots SEPARATION DISTANCE,~ FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~7 Property line J ~ f Absorption field Water main/service line (~ t Surface water/drainage ~J0/~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Curtain drain Building foundation ,." ~. c~, / . Water main/service line Driveway. parking/vehicle storage area '~r lO0 Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records th~ ~vstems are in conformance with MOA HAA g~delines in effect on this date. '" '"-' -" ' Eng,neersName Jc~P"~. ~,~') ~ ~£~-~:>~P~tr~::> ~ ~~~.~ H~ Fee $ ,~' '~ Waiver Fee $ Date of Payment ~ ~ /~ Date of Payment Receipt Number ~ ~/~/~ ? ~OOOipt ~um~sr 72-026 (Rev. 3/96)* 5! E i,! 0 R 2: N D U M ADVISORY HEALTH AYi!iORITY ~es~OV~L NO. ~z~ zrY:.~-% DurL~_~ a recenu l..'ea!~-'-~ _--.uthcrltl,~ Approval on-site znspec~ ~o~ . ~ Notil~ie water supply well on Lot and test os Block___ of ~5~ ~l-~ ~v~on, the we~!'s p"~ .... ~ .... ~y det~::r.'~:~e~ %o be 0,6' calions per minute The minimum well o;-;cJk~c~--~_~v;_~l, '-~:~:_~u__~di ~e by_ this Department (AMC !5 ~' Vet ~ ~ bedroom - ' ~.s .~ ...... residence ' 0,%~ ga~ ions per minute. ~ ~ ~'~ '- -}-~ - -.~.-e ' .i .............. s2bi ..... well currently exceeds thzs mL~_m~.~ recu~remext, Ril parties concerned are advised that ' ~ -~ Re~ ~r~ ,~icn prod:!c%Ion ~;:~-'!t!' o tile well ma1 .......... ~I u~en.~ t~. ~- ~ ~= of ncn-crlhical water uses such as washing cars end watering lawils and cc~rdar s_~ may he =-~o~,,~u=~ ~d~.,. ~ ' ~,s~' ,~-.-~ m~s{- ha a%tachei ~-~ all copies of the sub~ ~,.=, lS~: i ..... DeC`- (I]AI]33 I WELL FLOW TEST LE(~AL: LOT/& BLOCK ~ SUBDIVISION METER TIMR FI ;OW TOTAl, VOl, STATIC I-IF, AD '~0 / i c/o RECOVERY TIME STATI~ I4-EAD F'ZT~ ................................................... ':---f-¢~-~ ............................ J__._ ................................................................ Z.z~,_ .............................. CT&E Environmental Services Inc. Laboratory Division ~'~-~~-~e-~-~JfJ~J.~'J~-.~:~:~'J~ CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID 963112001 Sizemore James 18220 Norway Drive 18220 Norway Drive Drinking Water 200 W. Potter Drive Anchorage, AK 99518-1605 Tel: (907) 562-2343 Fax: (907) 561-5301 Client PO# Printed Date/Time Collected Date/Time Received Date/Time Technical Director Released By 07/26/96 08:40 07/22/96 14:40 07/22/96 15:00 Sample Remarks: Parameter Results PQL Units Method Allowable Prep Analysis Limits Date Date Init Nitrate-N 1.80 0.100 mg/L EPA 353.2 07/23/96 EMB Nitrite-N 0.100U 0.100 mg/L EPA 353,2 07/23/96 EMB Total Coliform 12 OB W/O COLI SM18 9222B 07/22/96 TAV ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA CT&E Environmental Services Inc. Laboratory Division ~'~'JJ~'~~"~'~"~' Drinking Water Analysis Report for Total Coliform Bacteria 200 w. Potter Dr~ve Anchorage, AK 99518-1605 READ INSTRUCTION$ ON REYE~E SIDE BEFORE COLLECTING SA~PLE Tel: (907) 562-2343 Fax: (907) 561-5301 MUST BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM I.D. # { [ [ I [ [ ] *mVATE WATER SYST~,M Send R~sults [~ Send Invoice SAMPLE DATE: SAMPLE TYPE: SAMPLE LOCATION Month Day Year Routine Repeat Sample (for routine sample with lab ref. no. ) Special Purpose Treated Water Untreated Water Time Collected Collected By TO BE COMPLETED BY LABORATORY ~Analysis shows this Water SAMPLE to be: Satisfactory Unsatisfactory Sample over 30 hours old, results may be unreliable 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. Date Received Time Received Analysis Began Analytical Method: .,l~Membrane Filter g MMO-MUG Number of colonies/100 ml. Lab ReL ~0. Result* Sen~ to A.D.E.C. Anch Fbk~ Jun Date: Client notified of unsatisfactory results: Phoned Spoke with Date: Time: Faxed Faxed BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total Coliform Membrane Filter: Direct Count Verification: LTB Fecal Coliform Confirmation Final Membrane Filter Results BGB E. Coli (~ Colonies/100 mi COLIFIRM/ Coliform/100 mi Time / .~'"~'Z3 hrs Comments: TNTC = ~m, Numerous '~'~ Caunt MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, btock, subdivision, section, township, range) / Location (address or directions) (b) Applicant Name ¢//'[ ~¢~'~ Telephone: Home (c) Applicar~t is (check one): Lending Institution []: Owner/builder~]; Buyer []; Other [] (explain); (d) Lendinglnstitution '~t~-%'~/~ '~-~ Address ¢O ~,~ ' ,~y~.' (e) Real E~tate Company and Agent Address Business 5-~-/?~ -~ Telephone Telephone (f) Mail the HAA to the following>d/~: ~¢ TYPE OF RESIDENCE Single-FamilyJ~ Multi-Family [] Number of Bedrooms -"~ Other WATER SUPi~LY individual Well,[~"Community [] Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite,~ 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-o25 ¢ 1/84~ Page 1 of 2 ~ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, D/4TA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm /~¢~-C' ~ , ~-)~,~ , Telephone Date [~ -'? - ~ %~ DHEP APPROVAL Approved 2~ ' Disapproved Terms of Conditional Approval Conditional Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MO,-,/ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION WELL DATA Well Classification ¢ Well Log Present(~N) Total Depth ¢'~ ~ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Condui (t~N) Separation Distances from Well: To Septic/Holding' Tank on Lot To Nearest Edge of Absorption Field, on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results If A, B, C, D.E.C. Approved (Y/N) Date Completed '¢- ?- ¢'~' Yield Depth of Grouting Pump Set At -- Sanitary Seal on Casing (Y~) Depression Around Wellhead (Y/~__~- : On Adjoining Lots C7"- /~ /~'~ , On Adjom~ng Lots To Nearest Public Sewer To Nearest Sewer Serwce Line on Lot Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes Depression over Tank (Y/(~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well Size ~ No. of Compartments ~ Air-tight Caps(~N) Foundation Cleanout(~) Date Last Pure ped ~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation ~ To Property Line fo To Water Main/Servige Line Course '~ To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026 11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~-~ Width of Field Square Feet of Absorption Area ¢¢¢'~ Depression over Field (Y/~ Results of Last Adequacy Test -- Separation Distance from Absorption Field: To Water-Supply Well /'(~:7~' To Building Foundation ~ ~ Lot To Water Main/Service Line /0 C- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Length of Field ~-.2 Depth of Field .~___.~___.~___.~__~,, 5-- Gravel Bed Thickness ~.. 5'- Standpipes Present (~N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~'~- To Cutbank (if present) /00 D. LIFT' STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/~ ~ Xp Off" Level at - Vent (Y/N) _ ~mpin~ Cy'cles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I cerlify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~ .~¢~¢'~--";) .~,~.~_ Date //~ 5'- ¢ S- Company ~;~ -~-~" ~ MOA No. ¢~ ~--¢D¢ Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Z m mm.,'.,: