HomeMy WebLinkAboutSUMMIT ESTATES BLK 3 LT 50
Summit
Estates
Block 3
Lot 5
#015-071-27
I
-� MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Strent- Anchorage, Alaska 99501 Telephone 7.54-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
NEW
f' • >-.
_ F.. I�ra�
❑UPGRADE
MAILING ADDRESS
c> o
LEGAL DESCRIPTION
.#J
LOCATION j
NO. OF BEDROOMS
A V
Well C
Absorption area f
Dwelling
PERMIT NO.
Uy.
DISTANCE TO:
�. �
i Z
Nlan ufacturer
Material `
No. of compartments
wF
- s
/ /
N
Liq. capacity in gallons
•0
IF HOMEMADE:
Inside length
Width
Liquid depth
❑ �-'
DISTANCE TO:
Well
Dwelling
PERMIT NO.
J02
= z <
Manufacturer
Material
Liquid capacity in gallons
O
TO:
Well
Foundation j ,
Nearest lot line
PERMIT N .
w=
DISTANCE
ad
No. of lines
Length of each line
Total length of Ii es
Trench width
Distance between lines
Z w
-¢
inches
Top finish
Material beneath rile
Total effective absorption area
of rile to grade
//
_
Z'"
❑
inchesZ
'-�
Length
Width
Depth
PERMI NO.
w
t7
Q F-
Type of crib
Crib diameter
Crib depth
Total effective absorption area
w G
w
rn
Well
Building foundation
Nearest lot line
DISTANCE TO:
J
as
Depth
Driller
Distanca to lot line
PERMIT NO.
J
W
[Is
Building foundation
Sewer line
Septic tank
Absorption area(s)
DISTANCE TO:
OTHER
V4,
�
PIPE MATERIALS I
OO
NO
SOILTEST RATING
INSTALLER
REMARKS
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APPROVED
DATE LEGAL
-- -
72-013 (Rev. 3/78)
rl R-1 01 I F-. I G Q-A L_ I -I- "-s-" ®=r, 6� Fol r -A e_: 1-4 1;.�;�_ l 'a F3 CHE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
823 'L' 'STREET, ANCHORAGE, AK 99501
264-4720
14 EE K_ I- €=FIAT w r r-1— I -I-6_ = E=a IEEFAA to" E_F't 8 I -1
PERMIT NO. C 810573 :;
APPLICANT SUN CONSTRUCTION, INC. _,RA BOX ''-i7`d'E 99507 345._1089
LOCATION
LEGAL L y B 3 SUMMIT ESTATES S/D LOT SIZE 3:0000 SQUARE FEET
TYPE OF _OIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = -F SOIL RATING (50 FTIBR)= 85
THE REQUIRED SIZE OF THE SIAL ABSORPTION SYSTEM IS:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION 0N FEET).
THERE IS NO _:ET WIDTH FOR TRENCHES.
THE GRAVEL" DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL- F'IF'E".
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
p =� Ewd ALJ l" FA?" e'.- P. --A N 5-Y ®-'--.1 B ^ Ca A Y P.-- L- c@ g -w.l ! :t
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELL'_ ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCE_- THAT THE WELL WILL SERVE.
- — -)- Ili c4 < « Y I PA "TF`"" E= C -T- 1 00 4"_= FI F= ° F_ F_ E= C L3 I F' E=- E> — -- —
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
14=0 FEET FOR A PRIVATE WELL. OR. 150 TO =00 FEET FROM A PUBLIC HELL. DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL. TO A PRIVATE SEWER LINE IS 25 FEET AND
TO H COMMUNITY EWER LINE IS 75 FEET.
WELL LOG.: ARE REQUIRED AND MIST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAIL.ABLE TO INSURE PROPER INSTALLATION.
F=" E=F0 twl I -i E n F=" T FN_ EmEP EEC E PI E3 0 Fes: v lL -" 0 A E K
I CERTIFY THAT
1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWER= AND WELLS AS :SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON -'=ITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED: -----------------------------------------
-------------•------
APPLICANT SUN CONSTRUCTION, TION, INC.
ISSUED BY ------------------------------ DATE ---------------- V4.0
{ �NICIPALITY OF ANCHORAGE g-
Department of Health and Environmental Protection
825 L Street, Anchorage, AK. 99501
264-4720
# # HANDWRITTEN PERMIT # # #
WELL AND/OR ON-SITE SEWER PERMIT
Applicant: _s'_P Mailing Address: elfoy y7itF
Location: &i k Ade Phone Number: �l/S AUS,%
Legal Description: L�j C�� m,'7 �S Lot Size: 30 6200
Type of Soil Absorption System Is:
Trench: �_ Drainfield: _ Seepage Bed: Holding Tank:
Maximum Number of Bedrooms:_ Soil Rating(sq.ft/br)1
The Required Size of the Soil Absorption System Is:
DEPTH LENGTH 141 GRAVEL DEPTH
The length dimension is the length (in feet) of the trench 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 width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
# # REQUIRED SEPTIC(H0tD#4&) TANK SIZE _
a SD GALLONS # #
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.
# # # TWO M INSPECTIONS ARE REQUIRED # # #
Backfilling of any system without final inspection and 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 a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community 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 3 1
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residen e is remodeled to include more that 3 bedrooms.
J
signed: i Issued by:i
pplic t 1 G/
Date: / !1
SWP/024(1/81)
` SOILS LOG
MUNICIPALITY OF ANCHORAGE
+.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
O TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: suIII (�/U4'>_ThL:--L4 fl.�OlfJ DATE PERFORMED: i
LEGAL DESCRIPTION: �.y � ]. l l oL-�� '" — eJ UYYI in f / '�S fCrJe mss
SLOPE SITE PLAN
DEPTH Tn
_11Ej T�I_1II
"f
I 111 11 1 1
1
PERFORMED
'6
2
•
Depth to
Water
Net
Drop
3
v .
4-
6-
67
7
S
•
d<.o
9
11
0
213J12-
13-
J
14-
4151617
15-
16-
17-
18-
1S1920
19-
20-
PERFORMED BY:
72-008 (6/79)
C w
®arta 0. Talbot
,_ No. 4069-E _
WAS GROUND WATER �v y} L
ENCOUNTERED? Lf
O
P
IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
�3
PERCOLATION RATE
TEST RUN BETWEEN FT AND
CERTIFIED
(minutes/inch)
FT
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• Municipality of Anchorage
On -Site Water and Wastewater Program 4' 3'
(907)343-7904 s,`E.
Certificate of On -Site Systems Approval
Parcel I.D. p s— 0— I- — y?-
Expiration Date: Z A Y /5
1. GENERAL INFORMATION
Complete legal description li umrK, F l= 5 kq
Location (site address) S t o Du L 9 �! f ti V e.
Current Property owner(s) lava IW -ri'� Day phone
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:.
X Single Family (w/wo ADU)
❑ Duplex Lo
❑ Multiple Dwellings (Single Family and/or Duplex) V 1�
3. NUMBER OF BEDROOMS:_ l ✓
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual Q
Individual Water Storage
g ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Vater Systeni ❑ Public Sewer LJ N
e
WaiverNariance request for: Distance:
Received by: '� 1 Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee It ii ZlD It (p a� I'to 0 W F e
Date of Payment it/IdA
j A C1G �y00
Receipt Number O ZO
COSA'# 015E (4 150
alver ee
Date of Payment
Receipt Number
Waiver #
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,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm l' A,AnIRvab✓)
Phone 77-7—V?fo4
Address (P ct t40r A,
Engineer's Printed Name Mtkt ks, -kcle114t4i
Date —It i/d IN
. •S:L
-34
�,.� °mac
`P_t
Ar7` •
6. DSD SIGNATURE
r�
A 49TH a'
System #1 Approved for L bedrooms.
a r
NANDERSON
System #2 Approved for _bedrooms
Y °MICHAEL •,,
$�4�!n•• CE_ -!9459
Disapproved
^`
���a�� • �t ✓�tA �f/ ,•�
Conditional approval for bedrooms, with the following stipuh3t�p'
By: Original Certificate Date i
The Municipality of Anchorag � evelopment Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
i COSA Checklist X - Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet f c
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: `;VWrr1+ F44-ee' (3 3 Lt,f S Parcel ID: Otl; -071-
A. WELL DATA
Well type eilyo, te-- If A, B, or C provide PWSID # Well Log (Y/N)
Date completed ';�tt y/ Sanitary seal (YIN)
_Y__ Wires properly protected (Y/N)
Total depth Ja3_ft. Cased to IP -3 ft. Casing height (above ground) 13 t in.
Auuuno
FROM WELL LOG
Date of test 4f I Sf
Static water level ! . ft.
Well production g,p,m,
WATER SAMPLE RESULTS: 22
Coliform colonies/100 mL Nitrate /-it �/mg/L
Arsenic. ug/L Date of sample:
aw
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material _ 4,t- -e
Tank size 1 ��D. gal. Number of Compartments 7i
AT INSPECTION
Z l ft.
g.p.m.
Collected by: IAN -4.
installed 1
Cleanouts (Y/N)
Foundation cleanout (YIN)
_Y Depression over tank (Y;N) High water alarm (YIN)
Date of pumping i t)Ayf'" Pumper L li
C. ABSORPTION FIELD DATA
Date installed '1 r, Soil rating (g.p.d./ft or ftZ/bdr Ss ,- System type n-rrgoI "W(
Length fo ft. Width Z, S ft. Gravel below pipe ft.
Total depthgV- ft. Eff. absorption area t 3 2ftZ Monitoring tube _ Depression over field
Date of adequacy test t p 9v fa Results (Pass/Fail)Ods For q bedrooms
Fluid depth in absorption field before test 7? 2,_ in. Water added `'?-00 f gal. New depth 1-(q in
Elapsed Time: f LVO min. Final fluid depth -It, in. Absorption rate >= VD '- g.p.d
Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date
� �NHt p EXI�w06 $! � /3LYDiv �aTTr»'i of /24fyLr .
D: LIFT STATION
Date installed Size in gallons
Pump on" level at in. " Off" level at
in.
Datum Cycles tested
E. SEPARATION DISTANCES
WELL ON LOTTO:
Septic tank/lift station on lot /Ar9
Absorption field on lot-�-
Public sewer main tJ .
Sewer /septic service line SO �-
Animal containment areas 1(2 D t
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation _ fts- r.A
Water main
Wells on adjacent lots / U 0 r.l
ABSORPTION FIELD ON LOT TO:.
ManhOle/ACcess (YIN) _
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots (l90 r iL
On adjacent lots
Public sewer manholetcleanout J�_
Holding tank ___a I
Manure/animal excrete storage areas lad r✓=
Property line S- f,F Absorption field__J r�
Water service line5 0 j Surface water 10004
Property r
P nY line ( 'L Building foundation L0 Water main Sa N A,
Water Service line 5 0 14- Surface water 100 ` � Driveway, parking/vehicle storage 3 - S �
Curtain drain -i_ Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
confonnance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name 64L,4r•r"(A-(,4" J,Pt 1,W
Date
COSA brown sheet_10-10-12.doc
g� QF � �.•tu.h
T
. a � �rd - IFS r•
A•• MICHAEL N. ANDERSON•;;
♦'r s . C - pp469
Jew MA")
Municipality of Anchorage B�Zr��; --••
Development Services Department
Building Safety Division
Onsite Water 8 Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
www.d.enchorage.sk.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 015-071-27 HAAs#
1. GENERAL INFORMATION Expiration Date: 05
Complete legal description SUMMIT
ESTATES
SUBDMSION•
BLOCK 3 LOT 5
0
Individual On-site
Location (site address or directions)
5600E
98th AVE. ►
ANCHORAGE. AK 99507
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
KIETH AND SUSAN JANNUSCH Dayphone 346-2977
5600E 98th AVE. • ANCHORAGE, AK 99507
Day phone
RANNA FEKRAT / PRUDENTIAL JACK WHITE Day phone
762-5815
3801 CENTERPOINT DR. B 200 * ANCHORAGE. AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑❑
Public Water System
❑
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 4 by an Independent professional civil
engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(aro) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of Installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
✓ Approved for 1� bedrooms.
Disapproved.
Conditional approval for
Phone 337-6179
Date 2
bedrooms, with the following stipulations:
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineers Report
Other
By: fit/. t Original Certificate Date: %- - 0
(Rev. 11101)
Municipality of Anchorage ,. ..
• Development Services Department
Building Safety Division
O"Ite Water b Wastewater Program
4700 South Bragaw, St.
P.O. Box 196650 Anchorage, AK 99519-6850
www.cLanchorege.ek.us
MM 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: SUMMIT ESTATES SUBDIVISION; BLOCK 3, LOT 5 Parcel ID: 015-071-27
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSIO# N/A
Date completed X11/1981 Sanitary seal (Y/N) YES
Total depth 63 ft. Cased to 63 ft.
FROM WELL LOG
Date of test 8/11/1981
Static water level 18 ft.
Well production 15+ 9 -
p.m -WATER SAMPLE RESULTS:
Coliform _r_ colonies/100 ml. Nitrate457 mgJl.
Well Log (YIN) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
7/22/2005
22 ft.
3.78 g.p.m.
Other bacteria _Mcolonies/100 ml.
Arsenic: N/A mg./L. Date of sample: 7/22/2005 Collected by: GEG, LtD.
B. SEPTICIHOLDING TANK DATA
Tank Type/Material STEEL Date installed 1981
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (YIN) N/A
Date of pumping 7/2005 Pumper ROTO ROOTER
C. ABSORPTION FIELD DATA
Date installed 1981 Soil rating (g.p.d./ft2ort([!jj�) 85 System type DEEP TRENCH
Length 36 ft. Width 2.5 ft. Gravel below pipe 6 ft.
Total depth x8.3 ft. Eff. absorption area 432 fe Monitoring tube YES Depression over field NO
Date of adequacy test 7/22/2005 Results (PasslFail) PASS For 4 bedrooms
Fluid depth In absorption field before test 36.5 in. Water added 603 gal. New depth 53 in.
Elapsed Time: 180 min. Final fluid depth 40 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date
*BELOW EXMnNG GRADE, Mr EXTENDS 51.3" BELOW GOMM OF INVERT
D. LIFT STATION
Date installed
"Pump on" level at _in.
Size In gallons
High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?,
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/llft station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/MOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption Held 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 3'
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in •""•' • • ' ""' • . • •' •"' •...
conformance with MOA HAA guidefines in affect on this date.
...... .. ..................
e e A. omess.
Engineer's Printed Name JEFFREY A GARNESS C7
Date "1'3"7
T Wln_jD�ns..dned
HAA Fee $ Lim
Date of Payment
Receipt Number
(Rw. 12101) \ .
Waiver Fee $
Date of Payment
Receipt Number
OT -28-05 01:49AM FROM-CT&E ESI, SGS ENV SERVICES 9075615301 T-583 P.04/04 F-382
—"' SGS/CT&EENVIRONMENTAL SERVICES
.SG
Drinking Water Analysis Report for Total Coliform Bacteria
READ aIBTRLX=NS ON REVERSE BIDE BEFORE CpLLECTNG BIIa1PLE
MUST BE COMPLETED BY WATER SUPPLIER
[] PUBLIC WATER SYSTEM IN
tdPWATF WATER SYSTEM ��nvoka
M Send Randa51
SAMPLE COLLECTION:
CAM way.«)
Transponad
to Lab BY XSame BS Collector Other:
E3 Sand R..um
SAMPLE TYPE:
TO BE COMPLETED BY LABORATORY.
Semple Receivina! 7
Data: ` -'C3� ❑ Sanipl°.a+r So Inva old:
Q Regula may be uaatlaW
Time:
Temp: ❑ 4e Hou WRKW
Delivery Method:
Raceived By.
w-
200 W. POTTER DROVE
ANCHORAGE, ALASKA9951S
Tel: 907-5M-2343
Fax 907-581.5301
Lab Ref Na
1054503--
El
osasoa-
Q Sano Anoka
❑ RoWne E3 Treated Watar
Repeat Sample . E3 Untreated Water
(rofer to lab no.�
❑ Special Purposs
i
❑ RUSH SAMPLE
Phwe M
Fax p- -
cam onts:
.......................................................
Sem to ADEC:
Bacterioloolcal Water Anelve(a Record: IAMO-MUG IPIAI RESULTS: ANN FSK JUN
Ana"Is Began7/
Total Caron
• D.te/TYne:
M.yak T
Ana""t Method:
8--membrane FIIW
mMO-MUG (PIA)
E. CoA:
.
. Sant a CaerR
Phoned C3 Fayed �]
MEMBRANE FILTER REBIA.IB:
Died CountL �o^I°N10Mm.
�7
a wan
VMtleaaore
rwe«,
(Satisfactory
BG8
LLl
❑ Unsatisfactory
rw.or.w { E
07-28-05 OTABAII FROM -CUE ESI, SGS ENV SERVICES
SCS Refg
Client Nome
Project Name/#
Client Sample ID
Matrix
Sample Remarks:
1054503001
Gamess Engineering Group, Ltd.
Summit Estates L5, E3
Summit Estates L5, B3
Drinking Water
9075615301 T-583 P.02/04 F-382
An Dates/risnes ore Aluka Standard Time
Printed Date/rlme
07272005 11:24
Collected Date/rime
07222005 9:30
Received Date/rlme
0722/2005 14:10
Technical Director
Stephen C. Ede
Allowable PreP Analysis .
Paremnn
Rnalts PQL Unim Method Contauam ID Limits Date Date Init
Nitrate -N 4.57 0.100 mg1L EPA 3532 B ("10) 0722/05 PCW
Microbiology Laboratory
Total Coliform 0
coIll00mL SM209222B A (<-1)
0722105 TLF
011
07/27/2005 10:58 9072432081 FRED WALATKA & ASSO PAGE 02
E.98th Ave. _
o
M / o
� / M
N89059'00"E //120.00
Gravel Driveway w WeI10
' I
1 i tt
Loth ; (� sof o o" I
0p 10 1 0� o oy p I
36.
•Y O m
c O . o c?p
c O •�OQac s ^hh ���
C
o �� a
Z
LOT 5
(J
i V
_ _ 1 10' Utility Easement
I N89057'30"E 120.00
Lot 13 Lot 5
1 Rampart
r.•
x
f1 k ; ii•d W"latlr
9 s � tVp. 2]dg.>! !
64
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED BE
PLAT ARE NOT SHOWN HEREON. Fb054p9 49.50
CD
CD
L6
M
>r
0
M
CD
0
Q
0
..
Lot 4
SCALE: lot= 30'
j Lot 4
Subd.
AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortgagee's inspection
of the following described propertT..J_ot 5 Block 3.
Summit Estates
Anchorage eco mng preconcl, AjasKa,n
Improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no Improvements on the properly lying
adjacent thereto encroach on the premises In question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this 25th day of LJb 2005
FRED WALATKA & ASSOCIATES
Engineers and Surveyors
P
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
C 9A -dc 'di,�ce�
(b) Applicants Name�2[ /n Telephone
Applicants Address sk/r
(c) Applicant is (check one) Lending Institution Oran uildere ;
Buyer Other � (explain);
(d) Lending Institution 'Telephone
Address
(e) Real Estate Co. & Agent
Address
Telephone
2. Type of Residence
Single -Family tEf
Multi-Family F:J Other (describe)
Number of Bedrooms 7
3. Water Supply
Individual WellComnunity Public
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
Is the well adequate for the number of bedrooms specified in this HAA (Y )
4. Sewage Disposal
Onsite Public F-1 Comity r_—_t Holding Tank
Is the wastewater disposal system adequate for the number of bedrocros ( /N)
[Page 1 of 21
2-15-84
5. Engineering Firm Providing Inspections, Tests, Data and Information
I certify that I have checked, verified, or conformed to all FOA HAA Guidelines in
effect on the date of this inspection.
Nacre Of
Address &UO Gtr �✓ �f /�'J1t r is �/`0�0_
Signed by _
Date��
(ENGINEER SEAL)
6.D� rp oval
Approved for bedrooms
Approved Disapproved
Terms of Conditional Approval
Date l/ /��_
e
ByDate
Conditional
The Municipality of Anchorage Department of Health and Environmental Protection does
not guarantee the continued satisfactory performance of the water supply and/or the
wastewater disposal system. This 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 wastewater disposal system is safe and func-
tional
unstional for the number of bedrooms and type of structure indicated.
(DHEP SEAL)
7. Mail the HAA to the following address:
KB2/d5/s
(Page 2 of 21
2-15-84
yl
ALASKA hIROfIO nTAL COnTROL SCMIUS, InC.
6ngineerinq & Enuironmental Studies
June 7, 1984 �
y'
Department of Health & Environmental Protection
825 L. Street
Anchorage, Alaska 99501 If
Attn: Keith Brandt �0/1.
Legal: Summit Estates Lot 5 Block 3®HJN b�y-V'O
ap yo d�odi
Dear Keith:
A conditional approval was granted by DHEP in May 1984 contingent upWon
the well wires being placed in approved conduit and the well seal being
secured (see attached copy). On June 4, 1984, we re -inspected the well
and determined that it met all requirements.
Attached is an ammended copy of the Health Certificate for your use. If
you have any further questions, please contact me at 561-5040.
Siinnjcerely, JVO'7�
Turner
Or A I����
6f i e (j
eroy Md, Jr. i�$9
Scientist
1200 West 33rd Anne. Suite B • Anchorage, Alaska 99503 • (907) 561-5040
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date'
(a) Legal Description (include .lot, block, subdivision, section, township, range)
Location (address or directio s)
GP CY4� E$c s{ A
(b) Applicants Nam 10.1
Applicants Address? 1�G !/YtGl�zcrVL1y ff/� �j c �/
"`rj
(c) Applicant is (check -one) Lending Institution wnpr/builder ;
Buyer [::Ip-::- ; Other F (explain) ; _
(d) Lending InstitutionTelephone
Address
(e) Peal. Estate Co. & Agent tj -
Address
Telephone
2. Type of Residence
Single -Family l' !/'Multi -Family Other (describe
Number of Bedroom
3. Water Supply
Individual ill Community Public
Note: If cc munity well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
Is the well adequate for the number of bedrocros specified in this HAA 6�N)
4. Sewage Disposal
Onsite Public Community Holding Tank F--�
Is the wastewater disposal system adequate for the number of bedrooms N)
(Page 1 of 21
2-15-84
l
5. ngi1neering Firm Providing Inspections, 'lists, Data and Information
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in
effect on the date of this inspection.
Signed �9t LmL B' _ Dated 8
Nacre of.j'rrn �/ C_�--tG_ Telephone
AddressEJ a OF
fC�l c:i?•c�alf� LldrriCcT Crn 4 e� /
E
Signed by
6.DHEP Approval
Approved fol-4-v—
at�rl /z, X�Q ee�)l>z�✓� 7'D / e o
(."C!eY✓YYt.� �CZ. d;mss OI��Zt�2y �aFYi�
55
e >�
)y C. Rcid,,ier•
No. 2251-E
Approved Disapprovedf:::j conditionals
Date A/�
d `
The Municipality of Anchorage Department of Health and Environmental Protection does
not guarantee tlra continued satisfactory performance of the water supply and/or the
wastewater disposal system. This approval indicates that, as of the validation date
shcswn above, based on the data and information furnished by an engineer registered in
the State of Alaska, the water supply and wastewater disposal system is safe and func-
tional for the number of bedrooms and type of structure indicated.
(DHEP SEAL)
7. Mail the HAA to the following address:
KB2/d5/s
(Page 2 of 21
2-15-84
MUNICIPALITY OF ANCHORAGE (MOA) G++ ID2V
HEALTH AUTHORITY APPROVAL (HAA)Zidd
CHECKLIST - FEBRUARY 1984
Aq i�iLtl" .40 3p 64th
A. WELL DATA d0 AWdo"W
Well Classification dadilvi4UJ If A, B, cr C, D.E.C. Approved(Y/N)
Well Log Present YN) Date Completed Yield /-
Total Depthn3� Cased to Depth of Gr/rt
'routing tin/ft
static Water Level ��� Pump Set At 0. 401e%[o
Casing Height Above Ground Sanitary Seal on Casing )
Electrical Wiring in Conduit (Y/N)� Depression Around wellhead
Separation Distances from Wall:
To septic/Holding Tank on Lot 1601--k On Adjoining Lots /2 �7
To Nearest Edge of Absorption Field or, Lot -L)` t On Adjoining Lots `nQ � �
To Nearest Public sewer Line �+— To Nearest Public Sewer
Cleanout/Manhole V -ATo Nearest Sewer Ser
Line on Lot
Water Sample Collected By, r _ _ t Date A -Z
Water Sample Test
Comments 0 190
M
Date Installed size % No. of Co�artMr.ts Z
�-
Standpipes A-- Air -tight Caps /N) Foundation Cleanout 4)
Depression over Tank (Y Date Last Pumped
Pumping/Mainterance Contract on File (Y/N).0 , for
Holding Tank High -Water Alarm (YIN) 1) Temporary Holding Tank Permit (Y/N) A)
Separation Distances from Septic/Holding Tank:
To Water -Supply well To Building Fcundation:�X
To Property Line / To Disposal Field t (LM
To Water Main/Service Line (J 14 To Stream, Pond, rake, or Major Drainage
[Page 1of21
��SC�`O;led opt/ apeke,i'5T Da n(oT
a,J H.4A .
/1
41X- I gaC'o 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type of System Design
Date Installed `� � / Length of Field 2-36,
Width of Field 1,5 Depth of Field . /0
Gravel Bed Thickness
Square Feet of Absorption Area 7.�3 Lf Standpipes Present ry/N)
Depression over Field (-Y iii Date of Last Adequacy Test �� d
Results of Last Adequacy lbst f C< rll
Separation Distance from Absorption Field:
To Water -Supply Db11 /Oy/ )F To Property Line /,-2 i;;)e—'
To Building FoundationTo Existing or Abandoned System on
Lot N I,!{ ; On Adjoining Lots _e)
To Water Main/Service Line U /+- To Cutbank(if present)Il) /[—
To Stream/Pond/Lake/or Major Drainage Course /U IA-
To Driveway, Parking Area, or Vehicle Storage AreaD
D. LIFT STATION --- Q oti1 t✓
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(YM)
Dimensions
Manhole/Access (YM
"Pump Off" Level at
Vent (YM)
Pumping Cycles during Adequacy Test. Meets MDA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conforlred to all MOA HAA Guidelines in effect
on the date of this inspection.
Signed 1 11 2l/ItL'J� Date cl( "`�'. • c1 °°:s�p84
Company CC %tC_ MOA No. �T%.-b)�� c�, ` zF RS 's�` Q�
f�0.n.ao ■.... .........i..
KB1/d5/s I"Q
eroy C. Reid, Jr.
No, 2251E
[Page 2 of 21
2-15-84
FJ; CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
�. TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER
5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM: - F—TT:I= (> See It on back
I.D. NO. ^
Water System Name Phone No.
Mailing Address
city State zip code
SAMPLE DATE: 1l1 tom-]
Mo. Day Year
PSA PILE TYPE:
outine
Check Sample (for routine sample t ❑ Treated Water
with lab ref. no. El Untreated Water
El Special Purpose
SAMPLE Time
NO. LOCATION Collected
t I �fyrnmu� f<zC�a 233
3 I �1 CJt'r a c �1G7 t
a �� I
3
READ INSTRUCTIONS
BEFORE
TO BE COMPLETED BY LABORATORY
""
alysis shows this Water SAMPLE to be: i.
Satisfactory.
❑ Unsatisfactory
❑ Sample too long in transit; sample should
not be over 30 hours old at examination to
indicate reliable results. Please send new
sample via special delivery mail. r�
Date Received ell d v
Time Received /_3
Analytical Method:
❑ Fermentation Tube
Membrane Filter
Lab Ref. No. Result' Analyst
®_
I Q7
I I m
I I m
I I ❑]
+No. of colonies/100 ml or Noof potlions.
961220(b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1993
Membrane Filter: Direct Count
Verification: LT8
Final Membrane Filler Results
Reported By�.
COLLECTING SAMPLE TNTC = Too Numerous To Count
Coilform1100ml
Coilforml100ml
Time: a.m.
p.m.
Time
APPLK VT FILLS
OUT UPPER HA(.ONLY
Time
.
Time
p y�
- ProPertY'Dwner -
-
-
TPh,ne
Mailing Address '
� �--tom; �j/VN c• /�
- y � y �— SK7Q Zip Code cr —
;-1/d 4'C/
Buyer j
Inspector
Address -
Inspector
Zip Code
Lending Institution�;�
Phone
Address
1
Zip Code
•- �
Realty Co. & Agent
�Y
Phone
Phone
Address
Zip/Code
Legal Description
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
Street Location
Type of Residence
DATE
Single Family
BY: L ��
Multiple Family
No. of Bedrooms
Soils Rating
❑ Other
Well To Absorption Area 11g
Well Log Received
Septic Tank Size
Water Supply
Individual
-
ATTACH WELL LOG. A well lag is required for all wells drilled
since June 1975.
Community -
For wells drilled prior to that date, give well depth (attach log
if available).
❑ Public Utility
Sewer Disposal
D] Individual
Year Individual Installed:
O Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
p y�
Date
-
Date -
Date
Inspector n
Inspector
Inspector
Inspector
1
Field Notes:
(�) APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE
BY: L ��
Soils Rating
Date Sewer Installed
Well To Absorption Area 11g
Well Log Received
Septic Tank Size
0-81
Well to Tank 109
n0f31�et1