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Home My WebLink AboutPARADISE VALLEY BLK 6 LT 10 : Municipality of Anchorage Page 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: PID Number: Name: ~-~-~o~-~ 5'f'tv~1 Wastewater System: ~ New ~Upgrade Address: ~5o~ ~,~ I~ ~ ~)~ ABSORPTION FIELD Phone: No, of ~drooms: ~ Deep Trench ~ Shallow Trench ~Bed ~ Mound ~ Other Soil Rating,: Total Depth from oriainal grade: LEGAL DESCRIPTION o. ~ ~s~.~. 4' ~ Lot: ~ O Bloc~:~V ~1[~ ~ ~Subdivisi°n' Depth to pipe bottom~ from~ ~°ri~al grade: Ft. Gravel depth beneatho~ pipe Ft. Township:~ J~ ~Range:~ ~t/~Secti°~: ~ J~ Filraddedabovel ~ original~ --grade:}~ Ft. Gravel length: ~ Ft. WELL: ~ New ~ U pg ra~ Gravel w~dth: Number of lines: Distance b~een lines: IG ~ Ft. ~ Ft. Classification (Private, A,B,C): Tot~ Cased To: Total absorption area: Pipe material: Driller: ~ Date Drilled: StatJc Water LevekFt. Installer:~ ~~ Date installed: ~ SEPARATION DISTANCES ~s~pt,c ~Ho~d~ ~~.~. TO Septic Absorption Lift Holding ~Private Manufacturer: ~ Capacity in gallons: From ank Fie~d Station Tank Sewer Lines ,t ~ Number of Compartments: well ~ ~ !.~' ~J-~ ~' Surface ~t~' +~' ~,~' LIFT STATION Water Lot Size in ~allons: Manufacturer:. "Pump on" level at: "Pump off" level at: High water alarm at: Foundation ~8' ~0' ~ ~/" ~' Pump Make & Model Electrical I nspection~erformed by: Curtain ~ ~1~/ +t ~' Drain ~ Remarks: ~~ ~m~ ~' ~m~ BENCH MARK Location and Description: I Assumed Elevation: ENGINEER'S SEAL Inspections performed by: ~s~v~ ~ Dates: 1st ~-~-9~ ,~.~,~.~.~,~"~.. Department of Health"~d Hum~ervices approyal / '~',~.,~" ~ '~' Reviewed and approved by: Date: ~'[~ 72-013 {Rev. 9/91) MOA 25 PermitNo. ~CO 9~o~-~ Page 7_ of '7_ Municipality of Anchorage 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 Legal Description: PID No · 0'~0 ,~4 'Z.~ 4o pre 72-013 A (2/91) MOA 25 PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930175 DESIGN ENGINEER:CONSTRUCTING ENGINEERS, OWNER NAME:SILVEY GREGORY G & OWNER ADDRESS:6501 SWITZERLAND ANCHORAGE, ALASKA 99516 INC. DATE ISSUED: 6/22/93 EXPIRATION DATE: 6/22/94 PARCEL ID:02041215 LEGAL DESCRIPTION: PARADISE VALLEY BLK 6 LT 10 LOT SIZE: 69480 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ~~~--~ · HENRY WILSON 9601 BUDDY WERNER DR.: ANCHORAGE, AK 99516 (907) 346-2000 En November 24, 1992 Municipality of Anchorage, DHHS On-Site Services PO Box 196650 Anchorage, AK, 99519 neers CHARLES A. LANDERS HC83 BOX 192-A, MYRTLE DR. EAGLE RIVER, AK 99577 (907) 694-9098 RECEIVED D£O 1 4 199 Municipality of Anchorage Dept. Health & Human Services re: Lot 10 Block 6 Paradise Valley Subdivision Attn: John Smith, PE Dear John, As per our telephone discussion, we are hereby submitting the attached report for consideration of issuance of a CONDITIONAL HEA~TH AUtHORItY APPROVA~ for Lot 10 Block 6 Paradise Valley Sub. The existing septic system was tested for adequacy and found to be inadequate for a four bedroom house; consequently a replacement absorption system is required. Unfortunately, due to the extremely poor conditions of the roads due to the weather, we are unable to get a soils test performed in order to perform an actual design as required for issuance of a septic upgradepermit. We propose submitting a design based upon the soils tests performed for the original installation in 1982. The soils report indicates gravel with no water to 12' depth. With that information, and with our field inspection of the site, we are suggesting a new septic tank, specifically a 1500 gallon lift station, be installed and a pressurized distribution system be utilized, with a shallow bed for the absorption field. As conditions for this Conditional HAA, we suggest the following: 1) This lot should support a design such as submitted. Final design and consequent permit application/approval will be dependant upon actual soils investigations to be performed in the Spring, 1993. 2) The existing septic system is functioning at a level which does not appear to create a health hazard. There is no raw sewage running upon the ground from the system. 3) Money for the engineering reports necessary, and for the installation of the replacement system will be escrowed by Seattle Mortgage Company in order to install a new system of sufficient capacity for this existing 4-bedroom house. Refer to attached letter from Seattle Mortgage Co. 4) The new system will be completed no later than July 15, 1993. If you have any further comments or questions, please contact us. Sincerely, Chuck Landers Constructing Engineers SITE PLAN-WASTEWATERABSORPTION SYSTEM (40 Il 1 I I · ""' .... t / ~ 1 '~ ~,--~'-"~-~ ~ I I~ ." "~'" I / . h'.-i.. ~>-':.~'". "-. -- -, /' '~'~' '~ /'C~s''' / /' ' ~ -.e / ~ ",, / "/ ,k ,~*'L,~ -~ .,- ¢ ~ e'~ SITE PLAN DETAILS PROPOSED WASTEWATER ABSORPTION SYSTEM LOT 10 BLOCK 6 PARADISE VALLEY SUBDIVISION PREPARED FOR: RICHARD WILSON 3215 ADAMS ST FAIRBANKS, AK, 99709 SCALE: I" = 100' DRAWN BY CAL CONSTRUCTING ENGINEERS346-2000 9601 BUDDY WERNER DR 694-9098 ANCHORAGE, AK, 99516 11-24-92 DRAWXNG # 92-S1-11-1 ABSORPTION SYSTEM DESIGN SITE P~,N DETAILS PROPOSED WASTEWATERABSORPTION SYSTEM LOT l0 BLOCK 6 PARADISE VALLEY SUBDIVISION PREPARED FOR: RICHARD WILSON 3215 ADAMS ST FAIRBANKS, AK, 99709 SCALE: 1" = 50' DRAWN BY CAL CONSTRUCTING ENGINEERS3&6-2000 9601 BUDDY WERNER DR 694-9098 ANCHORAGE, AK, 99516 11-24-92 DRAWING # 92-82-11-1 ABSORPTION SYSTEM DESIGN DETAILS--BED SYSTEM SCOPE OF PROJECT: This absorption field is designed for a four (4) bedroom system. Lot is served by a private well. Due to difference in elevation between existing house plumbing and proposed septic system location, it is will be necessary to install a lift station to access the absorption bed system. ABSORPTION ABEA CALCULATIONS: Minimum Required: 4 Bedrooms x 150gpd/bedroom = 600 gpd capacity Soils rating, proposed addition, 0.8 gpd/sf (AVERAGE BASED UPON 1982 SOILS TESTS USED FOR ORIGINAL DESIGN) Minimum sizing: 600 gpd % 0.8 gpd/sf = 750 sf absorption area Use 20'W x 38'L x 1' D = 760 sf minimum for bed. IMPACT ON ADJACENT LOTS: There are no private wells within 100' of this proposed absorption system upgrade. The proposed absorption system has no impact upon any adjacent lots as shown on attached site diagram. ..... E'~GINEER S SEAL SITE PLAN DETAILS PROPOSED WASTEWATERABSORPTION SYSTEM LOT 10 BLOCK 6 PARADISE VALLEY SUBDIVISION PREPARED FOR: RICHARD WILSON 3215 ADAMS ST FAIRBANKS, AK, 99709 NOT TO SCALE DRAWN BY CAL CONSTRUCTING ENGINEERS 346-2000 9601 BUDDY WERNER DR 69&-9098 ANCHORAGE, AK, 99516 11-24-92 DRAWING # 92-S3-11-1 ABSORPTION SYSTEM DESIGN DETAILS--BED SYSTEM CHANGES IN SUBMITTED DESIGN DUE TO SOILS INSPECTION/PERCOLATION RESULTS~ RESULTS OF SOILS TEST: In-situ soils percolation rate less than 1 min/in require a filtration layer installed between the bottom of the absorption bed an the receiving native material. Filter materials shall meet specifications of AMC 15.65.060 (D). MODIFICATION OF PRELIMINARY DESIGN DETAILS: I ,.,I SCOPE OF PROJECT: This absorption field is designed for a four (4) bedroom system. Lot is served by a private well. Due to difference in elevation between existing house plumbing and proposed septic system location, it is will be necessary to install a lift station to.access the absorption bed system. ABSORPTION AREA CALCULATIONS: Minimum Required: 4 Bedrooms x 150gpd/bedroom = 600 gpd capacity Filtration layer rating: 0.8 gpd/sf Minimum sizing: 600 gpd % 0.8 gpd/sf = 750 sf absorption area Use 15'W x 50'L x 0.5' D = 750 sf minimum for bed. IMPACT ON ADJACENT LOTS: There is no adverse impact to adjacent lots as shown on original drawing submitted for conditional Health Authority Approval. ~' '~'"~:' ' ENGINE! SEAL MODIFIED DESIGN DETAILS PROPOSED WASTEWATERABSORPTION SYSTEM LOT 10 BLOCK 6 PARADISE VALLEY SUBDIVISION PREPARED FOR: RICHARD WILSON 3215 ADAMS ST FAIRBANKS, AK, 99709 NOT TO SCALE DRAHN BY CAL CONSTRUCTING ENOINEERS 34,6-2000 9601 BUDDY WERNER DR 694-9098 ANCHORAGE, AK, 99516 Origiant. 11-24-9~ Modified 6-14-93 DRAHING # 92-S3-11-q (Hod) ! hereby certify that a survey of LOT 10 ~nCK6 PARADISE VAII~YSUBOIVISION was made on OCTOBER I?, 1992 and that the improvements situated thereon ere within the property lines and do not overlap or encroach on the property lyin§ adjacent thereto, that nc improvements on property lying adjacent thereto encroach on the premises in questio~ and that there are no roadways/ transmission lines or other visible easements on sai¢ property except as shown hereon. It is the responsibility of the owner to determine the existence of any easements, covenants or restrictions which do not appear on the recorded subdivision plat. Under no circumstances shouLd any data hereon be used for construction or for establishing boundary or fence Lines. Dated in. Anchorage/ AK/ OCTOBER 17, 1992. CONSTRUCTING ENGINEERS AS-BUILT SURVEY 9601 Buddy Werner Dr Anchorage, AK, 99516 346-2000 694-9098 SCXL~I'= ~0' SURVEYOR~ S SEAL Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13- 14- 15 16 17 18 19 2O Township, Range, Section: ~'~/~' -~ ti SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT - DEPTH? ~ O .P E Depth Io Water After Monitoring/ ~ Date: ~--i~r'~.5 Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE "',' ¢minutes/inch) PERC HOLE DIAMETER ^CCORO^'~CE W,T, ^LL ST^T~ ^,~0 M,~N,O,P^L ~,~,OEL,,~,N ~P~EO'~ 0,~ T,~,S,~^~-E. DAT~: 72-008 (Rev. 4/85) T~ST RUN BETWEE~ ~ ~' FTAND ~ FT SEATTLE MORTGAGE Alaska Branch 560 East 34th Avenue Suite #100 Anchorage, AK 99503 (907) 562-5626 Fax (907) 562-7798 November 23, 1992 John Smith Municipality of Anchorage Department of Health & Social Services Division of Environmental Services P.O. Box 196650 Anchorage, AK 995i9-6650 RE: Lot 10, Block 6, ParadiSe Valley Subdivision Greg Silvey and Arlanda Crail Dear Mr. smith: Please be advised that in consideration of a conditional approval, Seattle Mortgage Company will hold an escrow as assurance of completion of remedial action to the sewage disposal system serving the captioned property. Richard E. Dolman Loan Officer · . ' '-"' M ~ ' '~* =W DRILLING, Ino, · ~ '" °" 85-230 ...' P.O. Box 110378 t 10330 Old 8ew&~ Hlghwiy ANCHORAGE, ALASKA 99511 Well LoeaUon (&ddre~ of: Township, P.~uge, l~ctfon, ff ks~own; or distance m~ roe,i. · tlfl~. B6..Paradise Val!gV, Anchqya~e~Ak, 31.5 ,, feet Size o~ ~t~g _ S" _Depth of Hol~eet C~ed t~ ~ (. :);, ~.~o~,~..~ ..:',; I~ .... Z:)ev4wibe .e~*m~ or surface. F~f_._h_ of weU (check one) open end ( X ); Depth in feet from ~ound stlrf&~e _. n .._~, ? , ~, m~ _ 2~ TO160 160 .~60 T~ (minute) fo~- .~.. hours WILL LO0 penetrated, aize of material, color and _TO Certificate N'o's. 814 & 97~ 'I ,~ ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONIVIEN'I'AL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~::~UPGRADE MAI LING ADDRESS LEGAL DESCRIPTION Zo ;7-/0 LOCATION DISTANCE TO: BEDROOMS Well ~'T ~A.) Absorption area DwellJng/&~ I F HOME.DE: inside lengt~ Width facturer DISTANCE TO: Well DISTANCE TO: No. of lines J Well /IJ'~ ~' Foundation ! Length'---- Jr- ~' ;~f lines"'/L- tile Top of tile to finish grade Length Width Material i "re"c w .ches inches Depth Crib depth Total effective absorption area Building foundation Nearest lot line No. of compartments Liquid depth PERMIT NO, Liquid capacity in gallons Distance between li,~/'//Ot Total effective absorption a_?La PERMIT NO, Type of crib Crib diameter Well DISTANCE TO: Class DISTANCE TO: Driller Distance to lot line PERMIT NO. Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOl L TEST R,aFi'l NG INSTALLER REMARKS SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF Al/) DRILLED at The RATE OF ~78.00 PEr FOOT. C_Jza2~¢ f.~ 370 ~ PROPERTY OWNER ~. ~o~ ~ LOCATION OF WELL SITE ~- !~ ~- ~ ~' ~/~E DRILLER B~ ~m,~ O~ ~p"~ ~~ WELL LOG: · ~ 375--381~ ~ ?o~ ~o.~ ~ ~ ~ ~ ~ ~ o~ ~. 381--410' S~ e. vc..L ~d, th .~om.e .o,t.,'t. exz~ o~ p~,~oua m~Ae,~z,L, ~,~oduc, t, Lon. ,~- c.~ea,~ect so~e~ha~ ~o~.~ 7a.~.a,L I~a,t.e~ ,a,,~~n. otro~ 800 ~ per dau~ ~ The ,trrc,~_a. oe o~ uae ~t~oud. ct .~ho~ c,l, aae /co 1000 ~ ~ dmt,, 370 X $18.00:$6660d00 $22.00 COST iNCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAiD DRILLING. WRITE CHECK PaYabLE TO RamPart DRILLING WORKS For THE SUM OF $66~'2.00 DATE. THANK YOU VeRY MUCH. bERNIE CLAUS OP RAMPART I:~ILLING WORKS ~ERVIC:E CHARGE O F IV~% PER MONTH WILL BE A~$E~SED ON PAST DUE AC:COUNTS. PERMIT NO. tlLiN I m_~ I P! L I T'T' OF 8r~C~-HmZ !8,ZJE DEPARTMENT OF HEALTH 8ND ENVIRONMENTAL PROTECTION 825 'L'" STREET, ANCHORAGE., BK. 9950i 264-4720 ON ..... ~ I TE SEL4ER PERM I T 780954 > APPLICANT LOCATION LEGAL ROBERT MAHAR L10 B6 PARADISE VALLEY SRB 196X EAGLE RIVER LOT SIZE 6.~4 '"'~ 17424 :.t...!URRE FEET TYPE OF SOIL 8BSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING ,.'.S~ FT?BR)= 8.. THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= 8 LENGTH= ~--~ GRAVEL DEPT:~,'= ~ THE LENGTH DIMENSION IS THE LENGTH (IN FEET'.> OF THE TRENCH OR [:,RGINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE E,~',CAVATION (IN FEET>. THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION <IN FEETX RE[~L! I RED SEPT I C TGr~K S I :TE= 1250 GRLLONS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. T~O (2) I ~SPEC:TI CmNS PRE ~Em~lJI ~ED BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION 8ND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR 8 PRIVATE WELL~ OR i50 T0.~200 FEET FROM 8 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PER~qlT EXPIRES DECEMBER I CERTIFY THAT l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS _.ET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THA~ THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE I N SIGNED: ___~~-~ APPLICANT ROBERT MAHA. ;; rlL F4 T C Z ~ ,--IL T T'i~ OF II-lr-I~.-H !RRI3E .~-~ .~ n -- / ., DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIO~~/c ~,'7, 8~5 'L~' STREET., ANCHORAGE, AK. 99501 264-4728 O~--S I TE SELdER F"ERP1 I T PERMIT NO. ( 78~54 ) APPLICANT :LOCATION LEGAL ROBERT MAHRR L10 B6 PARADISE VALLEY SRB 196N EAGLE RIVER LOT SIZE 694 29?9 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING <SQ FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:.EPTI4= 8 LE~41_]TH= ~JD m_~Ri3~'FL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET>. THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET>. REmZ4LI I RED SEPT I C: T~NK $ I ZE= 125£1 6RLL,:.~..I$ PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. T~lO (2) I NSPEC:TIONS ARE RE~UI E:E~. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION 8ND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL 8ND ANY ON-SITE SEWHGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELLs OR 150 TO 200 FEET FROM 8 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC HELL. OTHER REQUIREMENTS MAY 8PPLY. SPECIFICATIONS 8ND CONSTRUCTION DIAGRAMS HRE AVAILABLE TO INSURE PROPER INSTALLATION. F'ER)P1 I T E×P I RES I CERTIFY THAT l; I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS 8S SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM M8¥ REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. S I GNED: APPLICANT ROBERT MAHAR V~. 2 PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5' 6--- 7 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-2224 SOILS LOG -- PERCOLATION TEST [] SOILS LOG PERCOLATION TEST SLOPE SITE PLAN 10 11 12 13 14 15 16 17, 18- 19- 20- WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~74 ~ (minutes/inch) TEST RUN B-~WEEN '7 FT AND ~ ~ PER.OR.E";:,"": ~"-'</~--/'"'"-:~'r.'X--" CERT, E,ED" ' 72-OO8 (7/76) ?Z DATE; ~.. (~' ~-~7 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. # CERTIFICATE OF HEALTH AUTHC RITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Day phone Lending agency Mailing add ress Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 4 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community o n-site Public sewer NOTE: If community wastewater system, provide'written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91} Front MOA #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 all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~'~ 5-t-~.-~'-- ~rcj ,~o..~ Address A.-.~v>_.~;~. ,~ ~9~1~ Engineers signature ~~~ Phone 5zt~-Z*cx~ Date ~. % ..... ,Apprgved.,for,.., ..... I bc~drooms~ g~s~proved. Conditional approval for bedrooms, with the following stipulations: ~J(¢ .: .................................... . ,. Additional ,':~' ...... ,"?4T,:, ~- ,_ ~ . ..... , < , .......... ;~'" .... ' I "., ' , qll~ ',~:~.',iC~o~(i()i~ ~;~i~:; L~(.)~A~= U~:%~W ~ '.,,(~'~,, ;," ~ The Mun c pali~y of Ancho[_~ge Department of Health and Human serVices (DHHS) issues Health Authority ApproVa "Cert'f~d~tes, base~d only _upon ,the representations given, in paragraph ~5~above. ~y an independent professional engiloee, ri~egis..ter,e,~ ip~h,e.~State of A!~sl~.. ~he DHH~d,o ,es,.t~,is,a~s[a~cou,[teSy~tp pur.c..hasffrA 0:[,, homes and thei'~:i:~in'{I institutions in °rderto satisfy certain fe~i~ral and state requirements. Employees of DHHS do not conduct ins. pe,qti(~r)s o~ ¢~ga Yze dat~. before .a. certificate is !s~ued,..~be_.l~l_unicip~!.i,ty of Anchorage is not responsible for errors"or omissions in the professional engineer's wOrk.. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lie KG ~e,'z~,~.~).ol~ Parcel I.D. O7.~ A. Well Data Well type ?~v~-TE If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ~ ~&~ Date completed ~-~-o~ Driller Total depth ~roo' Cased to '51,~ Casing height Sanitary seal (Y/N) Y Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test t Static water level /co Well flow c~,< .g.p.m. Z.4 Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main --~7o~ '. Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: ~-~ o-_9~ B. SEPTIC/HOLDING TANK DATA Nitrate Other bacteria Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping SEPARATION DISTANCES FROM SEPTIC/H~NK TO: Well(s) on lot ~nt lots To property line ,...~ Absorption field Surface water/dra' agm~e Collected by: C_~T~z.,~ <'~,.~4,- C--,..~-/~ Tank size Comp~ Foundation cleanout (Y/N) ..~pression (Y/N) Foundation Water main/service line 72-026 (3/93)' Front CONTINUE D ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) t" "Pump off" Level at '~<5"' Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date installed Length ~ ) Width Soil rating (GPD/FF) Gravel thickness o. 8, System type d~,' Total depth Total absorption area <~A, ~.~ Date of adequacy test r~""~ ~'~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Cleanout present (Y/N) Results (pass/fail) Depression over field (Y/N) for - Bedrooms After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I ~o' To building foundation ~<~' On adjacent lots Sudace water Curtain drain On adjacent lots +too' Property line To existing or abandoned system on lot Cutbank -~c:~' Water main/service line Driveway, parking/vehicle storage area ~O' E, ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effech Signature '~, ~~ ~ Engineer's Name Date Z- /~, ~'.~ HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)° Back Waiver Fee $ Date of Payment Receipt Number NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE 2505 FAIRBANKS STREET FAIRBANKS, ALASKA 99701 ANCHORAGE, ALASKA 99503 (907) 456-3116 · FAX 456-3125 (907) 277-8378 · FAX 274-9645 DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA Constructing Engineers HC 83 Box 192A Myrtle Drive Eagle River AK 99577 Collected by: DW Sample Type: Routine Untreated Method of Analysis: Membrane Filtration Public Water System I.D.# Date Received: Date Analyzed: Date Reported: Next Sample Due: Comments: S = U = POS = ND = TNTC = CG = HSM = 08/1!/93 Time Received: 10:26 08/11/93 Time Analyzed: 17:00 08/13/93 Time Reported: 10:27 SA = Old = Comments: R = NT = Satisfactory Unsatisfactory Positive Test Result None Detected Too Numerous To Count (>200 Colonies) Confluent Growth Heavy Sediment Masking, Results May Not Be Reliable Sample Age >30 Hours But <48 Hours, Results May Not Be Reliable Sample Age >48 Hours, Too Old For Analysis Resample Required No Test * # Colonies/100 ml ** # colonies/mi Sample Sample Total* Fecal* Other* MPC** Location Date Time Lab# Coliform Coliform Bacteria Result Comments 1 L10 B6 Paradise 08/10/93 19:30 AB1998 0 NT 0 NT S Valley/6501 Switzerland Susan C.Tifental Microbiology Supervisor NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE 2505 FAIRBANKS STREET FAIRBANKS, ALASKA 99701 ANCHORAGE, ALASKA 99503 (907) 456-3116 ° FAX 456-3125 (907) 277-8378 · FAX 274-9645 Constructing Engineers HC83 Box 192A Myrtle Drive Eagle River AK 99577 Attn: C. Landers Report Date: 08/16/93 Date Arrived: 08/11/93 Date Sampled: 08/10/93 Time Sampled: 1930 Collected By: DW Our Lab #: A125240 Location/Project: Paradise Valley Sub. Your Sample ID: L10, B6 Sample Matrix: Water Comments: Lab Number Method Parameter * Definitions * B = Below Regulatory Min. H = Above Regulatory Max. E = Estimated Value M = Matrix Interference D = Lost to Dilution MDL = Method Detection Limit Units Date Date Result * MDL Prepared Analyzed A125240 EPA 353.3 Nitrate-N mg/1 2.5 0.5 08/13/93 Reported By: Anthony//'Lange Senior Chemist MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) (c) Property owner Mailing Address ,:~ 7,~x; i' ':' 'r~Business Telephone (home) : Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Telephone (e) Mail the HAA to the following address: (or check here E~'if hold for pick up.) List contact person and day phone number below: TYPE OF RESIDENCE Single-Family E3 Number of bedrooms '/-~ -.' WATER SUPPLY Individual Well'E~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7'/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is sa[e, 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 Date Telephone Approved Disapproved Conditional Date Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph $ 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. TheMunicipalityofAnchorageisnot responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D, A. WELL DATA Well type ~'~,~T~ Log presen~q) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed . ~-;~ , Driller 'dr 60 Cased to ~ )' ~' , Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level IOO~ Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot AT INSPECTION ~ ~ ~'%~,-~"~ I-r1 "', g.p.m, g.p.m. Public sewer main Sewer service line On adjacent lots ; On adjacent lots public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ,~' Date of sample: Nitrate Collected by: B. SEPTIC/HOLDING TANK DATA "to ~o6 ~,ECLP~ce¥.~ Date installed i'o-7; ~-~- Tank size Other bacteria Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) Alarm teSted (Y/N) Date of pumping Pumper o o SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: + t°°~ [~ Foundation Well(s) on lot On adjacent lots To property line ' Absorption field W~ter main/SerViCe line Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Man Ufactu rer "Pump on" level at Manhole/Access (Y/N) "Pump off" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed Length Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots Cycles tested Surface water Soil rating Gravel thickness Cleanouts present (Y/N) Date of adequacy test for If yes, give date System type Total depth bedrooms Property Ii ne To building foundation On adjacent lots Surface water Curtain drain To existing or abandoned system on lot Cutbank Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelinesin effect Signature Engineer's Name Date /Z, / ~, ~, of this/nsp, ection. HAAFee$ ?.'~ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 10; Block 6; Paradise Valley Anchorage Location (address or directions) 6501 Switzerlan~ (b) Property owner Claire Helgelien Mailing Address 6501 Switz~rland~ (c) Lending Institution ' (d) (e) Telephone: (home) Business Anchorage.. Ak. ~ ~-~ '~:1 Telephone Mailing Address Real Estate Company and Agent JACK WHITE COMPANY ATTN: DaZe Murphy Telephone Mail the HAA to the following address: (or check here J~ if hold for pick up.) List contact person and day phone number below: 17034 Eagle River Loop Road No. 204 Eagle KJYer, 2. TYPE OF RESIDENCE Single-Family E~(X Number of bedrooms 4 3. WATER SUPPLY Individual Well ~ Community [] Public r-I ~Note: f community well system must have written confirmation from the State Department of Environmental ,-* (~on~ervation attesting ~) th legality and status. ~'~'"'"':'"~ ' ~' · 4. SEWAGE DISPOSAL :On-site ~;~ Public [] Community [] Holding Tank [] Note: If community welt system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 {Rev. 7/88) Page I of 2 ~ ~to ~ O6~d '~OM s,Joeu!Bue I~UO!SSeloJd oql u! suo!ss!mo ~o sJo~Je ]oj elq!suodseJ ~ou s! e§~Joqou¥ jo fi~!l~d!o!unw eqi'penss! s! e]~o!~!lJeo ~ e~ojeq m~P ez~leU~ ~o suo!~oedsu! lonpuoo ]ou op SHHQ jo seeXoldUJa 's~ueLueJ!nbeJ ele~s pu~ I~Jepej u!~lJeo ~Js!~s ol JepJo u! suo!~nl!lsu! §u!puel J!eql pu~ SeLuoq ~O sJes~qoJnd ol ~se~Jnoo ~ s~ s!ql seop SHHQ eq~ '~S~l¥ jo ele~S eq] u! peJelS!§eJ Jeeu!5ue I~UO!SSeloJd ~uepuedepu! u~ ~q e^oq8 ~ qde~Be~ed u! ue^!§ suo!~ueseJde] eq~ uodn XlUO pes~q pe~o!~peo I~^oJdd¥ ~poqln¥ q~leeH senss! (SHHQ) seo!^Jes U~LUnH pue qll~eH ~o lueLul~deQ e§~Joqou¥ jo ~!l~d!o!un~ eqL I~UOp,!puoo / ~<r~,~ _// o,~a ~ ~ le^o~ddv leUO!Upu.oo to suite& pe^o~dd~s!o ~ pe^oJddv ~q smooJpoq~Jo~ poAoJddv 'IYAOI:IddV SHHa '9 euoqdela~ ssoJppv LUJ!~ ~.o oLUeN · uo)loodsu! s)q) ~o o)~p oq) uo ~.oo,go u) suo!lgln6eJ pug 'seou~u!pJo 'sepoo pus I~d)o~unw IlS q))~ eousHd~oo u~ s( ~e)s~s I~sods)p Je)s~e)ss~ Jo/pus ~lddns Je)e~ e))s-uo aq) 'uo)loedsu) pug uo))g6)lseAu~ ~ ~oJ~ pug Sel)~ e6gJoqouv jo ~))lgd~o)un~ aql moJ~ peu)gtqo uo))g~Joju) eq) uo pesgq )gq1 ~tpaA Jeq)Jn) 1 'u)eJeq pelgo)pu) eJn)onJ)s to ed~) pug s~ooJpeq ~o Jeq~nu eq) Jo~ elgnbepe pug 'etas s~ ~e)s~s lesods~p Je)e~elss~ Jo/pue ~lddns Je)s~ el~s-uo eq) )eq) s~oqs leAoJddv ~)poqlnv qlleeH s~q) JO UO~TS6~JSOAU~ ~ l~qT ~J~JOA I 'MOleq UMOqS ei~p UOI)eP!IEA eq) Jo se pue oJeJeq pex~jj~ leOS X~ Xq pe~J~TJoo s NOl~VflaOdNI aNY v~va 'HOaVaS 311d 'S~S3~ 'SNOI~O3dSNI ONlalAOad Wala ONla33NION3 A. WELL DATA MLINICt~ IiYOF 'l k ~ ~" , ~,,,,~,~ ~_r~i~AL TY OF ANCHORAGE (MOA) '!' ..... Y'."j"J~,~ ~L:'~vI""~S ~l~i;~lAuthority Approval (HAA) ~) ~. CHECKLIST- FEBRUARY 1984 ~,~ ~ ~[~ 343-4744 Well Classification Legal Description: ~- \ ~ '"~:~"~ ~ If A, B, C, D.E.C. Approved (Y/N) /'~ Well Log Present ~)'N) V Date Completed ~"~ -- t.~ -~s'~' Yield Total Depth ~' Cased to ~epth of Grouting ~ Static Water Level ~ ~ Pump Set At ~ ~ Casing Height Above Ground ~ ~ Sanitary Seal on Casin~) Electrical Wiring in Conduit) ~ Depression Around Wellhead SEPARATION DISTANCES FROM WELL: · ~'~ Lot ~ To Sephc/Pfe~.-...o Tank on ; On Adjoining Lots To Nearest Edge of Absorption Fiel~/~ot ~ '-Z~'Z~' //~ ; On Adjoining Lots I ~r-~l'"lr- To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ~1 Water Sample Collected by ~" ~'p ~ ~~~-~1, ; Date Water Sample Test Results ~['~ [~--~~ --'~::~ Comments. B. SEPTIC/HOLDING TANK DATA Date Installed ~ O-'~ ~'l~ Size S t a n d p i p e s ~r,,.,.,.,.,.,.,.,~ N ) Depression over Tank (Y?~:~ Pumping/Maintenance Contact on File (Y/Ni~/. Ho ding Tank.High-Water Alarm (Y/N) ~.Y~"~O No. of Compartments Air-tight Caps CF/N) '7' Foundation Cleanout ¢2'N) ~ /Date Last Pumped , ; for Temporary Holding Tank Permit (Y/N) To Water-Supply Well To Property Line To Water Main/Service Line SEPARATION DISTANCES FROM SEPtIC/HOLDING TANK: \ O~ To Building Foundation / ~ I ~ To Disposal .Field To Stream, Pond, Lake or Major Drainage Course I, ~ 't~i~- 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption St~..a Date Installed /~2/7 Width of Field Square Feet of Absortion Area Depression over Field ('Y~ Results of Last Adequacy Test ~' ~'- ~/'~ ~-, Type of System Desig~~ Length of Field Depth of Field ~'2'~ ~/~ravel Bed Thickness ~¢~ / Statndpipes Present,~N) Dateof Last Adequacy Te~~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well TOLotBUilding Fo u n d al~o/j[i To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) pA D. LIFT STATION ~ lA~ Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Tested for Meets MOA Electrical Codes (Y/N) Comments ~ ~.~.~ing Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines inspection. S & S ENGINEERtNG Signed !7n~,1 Eagle Ri~er Loop Road No. Company Eagle River, Alaska 99577 Date /.//Z-',¢'//)~ ~ MOANo. Date of Payment Amount: $ .,/ 72-026 (Rev, 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 ~ CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~,..~~,,~ 5633 B STREET ANCHORAGE,FEDERALALASKATAx ID #9951892-0040440TELEPHONE (907)562-2343 ANALYSIS REPORT BY SAMPLE for Work Order # 18286 Date Report Printed: NOV 18 89 @ 13:28 Client Sample ID:LIO B6 PARADISE VALLEY PWSID :UA Collected NOV 15 89 @ 15:00 hrs. Rscelved NOV 15 89 @ 16:00 P~ese~ved with :AS REQUIRED Client Name : S & S ENGR Client Acer : SNSENGP P.O.~ NONE RECEIVED Req # O~deYed By : RJS Analysis Completed :NOV 17 89 Send Repoxts to: Laboratory Supe~v~s~x'.~j~F~PHEN C. EDE 1)S & S ENGR Released By: ~~_~/~ 2) Special Instruct: Chemlab Ref #: 8543 Lab Smpl ID: I Matrix: WATER Allowable Pa~amete~ Tested Result Units Method Limits NITRATE-N 4.1 mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE. Remrks: SAMPLE COLLECTED BY RJS Tests Performed ' See Special InstYuctions Above UA=Unavailable None Detected "See Sample RemaYks Above Not Analyzed ET=Less Than, GT=Gzeatez Than DEPT. OF HEALTH & ENVIRONMENTAL PI~OTECTIOJ*I, MUNZCZPALZ'r OF NCHO AGF APR 't I, DMSION OF ENVIRONMENTAL HEALTH APPLICATICN ~OR HEALTH AUTHORITY APPROVAL CERT!FICA~~ ~' i. C~ne~al Information Application Date (a) Lega~.ipti~ (i~clude J~t, blo~k, subdi/~,ion~,/sect, ion, towpship, range) , Loeation (addmess or directions) '' ' Applicants Address pO (c) Applicant is (che~ one) ~nding Institution ~; ~r~uil~~ Buyer ~; ~her ~ (e~lain); (d) ~ndi~ InstituticnZ/~ ~r~ ~7~ Telephc~ (e) Peal Estate Co. & Agent Address Te le phone 2. T~e of Pesidence Single-Family ? Number of Bedrocam 3. Water Supply Individual Well Multi-Family Other (~scribe) Public~-~ Note: If ccnmunity ~11 system, must ha~ written c6nfirmation frcm the State Department of Environmmntal Conservation attesting to the legality and status. Is the ~11 adequate for the number of bedrccms specified in thi~H~b~ 4. _Sewage Disposal Onsite ~ Public ~-] Coranunity ~-~ Holding Tank ~ -' , Is the wastewate~ disposal system adequate for the ~mber of b~drocms , [Page 1 of 2] 2-15-84 5. Engineering Firm P~oviding Inspections, I~sts, Data and Information I certify that ~.~ checked, verified, or conformed to all MDA HAA Guidelines in effect on the/date ~j~J~h~s/i.~spection. Nar~ of~irm Telephone ¢.77/~'Z--t~--~/ Signed by __' ....... ~ ............. ,~ Date ( ENGINEER SEAL) 6. DHEP A~oproval . Approved for ~/ bedrocms Approved~ / Disapproved ~-] Terms of Conditional Approval The Municipality of Anchorage Department of Health and Enviro~nental P~otection does not guarantee the continued satisfactory perfo~£~nce of the water supply and/or t~he wastewate~ disposal system. %~nis approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewatem disposal system is safe and func- tional for the rnmber of bedrocks and type of structure indicated. (DHEP SEAL) 7. Mail ~he~HAA ~o t~e~followin~ ad_dress: KB2/d5/s [Page 2 of 2] 2-15-84 A® MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (FAA) CHECKLIST - FEBRUARY 1984 Well Classificati~ Well Log lhresent ( i ~/~ Total Depth ~ ~0 ! Cased tO Static Water Level Pump Set At _~)6) Casing Height Aboge Ground 50 t~ Elec~i~l Wi~ing in ~n~i~ ~p~ation Distance ~ ~11: To ~ptic~a~ on ~ /O~ ; ~ ~joini~g ~ts /O~ ~ To ~a~st ~ of ~s~ption Field on ~t /~ ~ ; ~ Adjoining l~ts./~ ~ To ~est ~b!ic ~ Line ~ /~ To ~est ~blic ~ Clean~t~a~ole. ~/~ ~ ~t '~ ~vi~ ~-~on ~t-~ ~ Wate~ S~le Collected By ~ .~1~/; ~te ~--~--~ ~ Wate~ S~le ~st ~sults ~ ~/~ ~ ~ ~ C~nts , Sanitamy Sea{ on Casing(~ Delm:ession Around Wellhead (~)~/. B. SEPTIC/HOLDING TANK DATA Standpit~es~ Air-tight Caps ~ Foundation Cl~anou ~/~ Depression over Tank (Y~ Date Last P.u;~ped ~--0~---~//~' ~ ', Holding Holding Tank High-Wate~ AlaFm (y~//z~ Temporary Tank Permit Separation Distances f~om ~eptic~Tank: TO Water-Supply Well /O~'-' ~ To Buildip~ Foundation /O ! TO' ~4~%£Se~vice Line Course Comments To Disposal Field ~ / To Stream, Pond, rake, cr Major D~ainage [Page i of 2] 2-15-84 Ce ABSORPTION FIELD DATA Soils Rating in Abs~orption Strata Date Installed ~/O- ~' ~ ~ 7 ~ Width of Field 2 ~ '/ Square Feet of Absorption A~ea ~ Depression over Field ~ Type of System Design Length of Field ~ / Gravel Bed Thickness Standpipes Present ~Y.~ 'Date of Last Adsquacy ~Test Separation Distance frcm Absc~ption Field: To Water-Supply ~l~ /2'~ ~ To ~operty Line To Building Foundation ~ ~7 ' To Existing or Abandoned System cn Lot ~ //~ , ~ ~joi~ing ~ts TO Wa~z--~Service Line ~ ~- To Cutbank(if ~reseht) TO Stream/Pond/Lake/c~ Major Drainage Course ~/~/~ To Driveway, Parking A~ea, or Vehicle Storage A~ea Co. rents D. LIFT STATION Date Installed .... On" Level at/ -- //~ High Water Alarm ~1 at~' Tested for Dimens ions Manhole/Access (Y/N) "Pu~p Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Electrical Codas(Y/N) Meets MOA C~ents ** Check Permitted Bedroom Rating ~gainst HAA Request I certify tha~ha~ checked, verified, or confc~med to all MOA HAA Guidelines in. effect o~ ~e dat~.~ thi~i~'~. """~" ...... ~ - Cc~g a MOA No. KB1/dS/s [~H, 68~,~2~7.~ " [PaGe 2 of 2] 2-15-84 ~ ' MUNICIPALITY OF ANCHORAGE ENVIRONMENTAl- PROTECTION ~~~) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~ ' 82§ L Street- Anchorage. Alaska 99501 JUL 9 1979 ENVIRONMENTAL ENGINEERING DIVISION Telephone ~4-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complote all parts on page 1. I~oomplete request~ will not be proo,~$e~. ~ ~as~,a I~w ton l~0}}de~ IPHONE MA, L,NGADDRESS t ? P.ONE PROPERTY RESIDENT ,,,'difTeren, from above, ~S/, [ 2, BUYER ~ PHONE MAILING ADDRESS PHONE MAILING ADDRESS 4. REALTOR/AGENT I PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE [] SINGLE FAMILY r-- MULTIPLE FAMILY 7. WATER SUPPLY [~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY NUMBER OF BEDROOMS [] One []~ Four [] Other__ [] Two [] Five [] T~ree [] Six * ATTACH WELL LOG. A well log is required for ail wells drilled since June 1975, For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM **If individual/on-site, give installation date ~ ~c.) . E~" INDIVIDUAL/ON-SITE** If system is over ~wo [2) years old an adequacy test is required [] PUBLIC UT LITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010{3/78) · . THIS SIDE FOR OFFICIAL USE ONLY ~ DATE RECEIVED · INSPECTION APPOINTMENTS TIME / TiME TIME DATE DATE · DATE INSPECTOR" INSPECTOR INSPECTOR ,' [~1 R ECTIONS:' ' 1. TYPE OF RESIDENCE _ NUMBER- OF BEDROOMS [] SI'NGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] · SIX 2. WATER SUPPLY ~ERMIT NUMBER . ~[] INDIV,I'DUAL DEPTH OF WELL , [] ~COMMUNITY DATE DRILLED. · .. - [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3. ~EWAGE DISPOSAL SYSTEM PERMIT NUMBER [~INDIVIDUAL/ON-S TE 'D~TE NSTALLED Connection Verified INSTALLER [~Sept~ or [] Holding Tank ~ Size: ~ ! If Tank is homemade SOi~LS RATING , 'TYPE'0FTANK . , MANUFACTURER ~ TOTAL ABSORPT..ION AREA ' k~ATERIAL .. Absorption Area to ~earest Lot Line 5. COMMENTS ' ' FPRoVED FoR .EDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION ~-' 72-010 (Rev. 3/78)