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HomeMy WebLinkAboutSUSITNA VIEW ESTATES BLK 3 LT 6u sitna View Estates Block 3 Lot 6 #020-091-37 Cevelop,nent Services_ Department .—.-------_ Building Safety Division On -Site Water & Wastewater progr atn 4700 Bragaw Street P.O. Box 195650 Mark Begich Anchorage, .AK 99519-5650 Mayor www.muni.orVons i te (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW_ Date of Issue: Parcel Identification Number: Legal 7—/\/ Description / Property Owner Name & Address: /zICj36 UI"rvo 33llr�ll tP p tie-Ijoaage Pump Installation Date: t —10-;20)3 Pump Intake Depth Below Top of Well Casing: 100 feet Pump Manufacturer's Name: )? e 2� S&L� �1 Pump Model: j Cp C 311 - 85 21 Pump Size J hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: — Well Disinfected Upon Completion Yes ❑ No Method of Disinfection: Comments: s Anchorage Pump & Wel9 Service Pump Installer Name: 330 East 76th Avenue Anchorage, Alaska 99518 Phone: 907-243-0740 Fax: 907-243-0742 Attention: The pump installer shall provide a pomp installation log to the DSD within 30 days of pu np installation. MUNICIPALITY OF ANCHORAGE a 3 M B H DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION o r7 v8a 9 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT 01 33'M4 jVIhIjjAINQ41AIhI3 NAME PHON Erb H11V3H kOEIMN U� Auih�2 _1GMh0thKA0AlIAMP RARE MAILING ADDRESS '1 13 & (<G -o 'que F GbI )nn 6E 4k. 9 1 LEGAL DESCRIPTION t - LT to Blc3 SU<I -1T/A V "SE UJ &s7 T/IN (L3Lo SsL� LOCATION NO. OF BEDROOMS Well Absorption area Dw ing PERMIT NO. U TO: Y H z Manufacturer Material No, of compartments aQ - wF Liq. capacity in gallons IF HOMEMADE: Insi e �_ Width Liquid depth 6 .auz DISTANCE TO: Well Dwelling PERMIT NO. 02 F Manufacturer Material Liquid capacity O Well r Foundation Nearest lot liar PERMIT NO. = DIST 02. 3 O 75 E � u z No. of lines Length of each line Total length of lines Trench width Distance between lines Z w 1� S' 3T, 0inches ~ s h Top of tile to finish grade Material beneath tile - Total effective absorption area �' o S•J &Wj> 3.0 tJ E*JD .�wll inches 3 ngth Width Depth PERMIT NO. w U a H Type of crib ter Crib depth Total effective absorption area wd w Well. Bui in f ndation Nearest lot line DISTANCE TO: J Class Depth Driller DistanEe PERMIT NO. w La Building foundation Sewer line SepticAbsorption area DISTANCE TO: OTHER Va 6 PIPE MATERIALS ?V 3o3 y a SOI L TEST RATING S I ty INSTALLER INANE 13rLos EX 84— i5 / 3 REMARKS 1NSNLp- aU oUER- veL xNTaE�JctF ,VOTE" WeLL A'-0 c z esu 6u1 P I I, P- vag05io tv-0 Lvw.44- ill lo -e- I631 va 5C TL 'TArJC AN T 1001 fvo, Se G't pu 7 8� 1l�SQEG7�i7 �Y �a i}0717�i1% �r("U`L / EY Ys rr a ELL / cpc kE c -O APPROVED DATE LEGAL Ib LT (e Gra 3 USsTUA. vaEw 72-013 (Rev. 3/78) A) 0I t.J ! %H IC rC: I t i L _..R 'iI )' Of IF= 01 PA iCC: FA C_N FZ 01 C3 1EEE: DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION S25 I_ STREET, ANCHORAGE, AK V95± 1 264-4720 PERMIT NO: £3;?OB75 DATE ISSUED° 10/12 /3/4 APPLICANTS ADDRESS: CONTACT PHONE: LEGAL DL::viCRIP2 LOT ;SIZE: MAX BEDROOMSe RON AUTHER 4936 VIRGO AVENUE ANCHORAGE, At: 99511- 345-1036 95:1.1';545--lq 'If. SUDDIVISI.ONs SUSITNA VIEW ESTATES I_OT2 b SECTION: - TOWNSHIP; !IN RANGE:; 3W 01.17 (SG!,.FT. OR ACRES) �r Listed below are the,options available to you in designing your septic: system. Choose the option that hest fits your site, DEPTH TO PIPE BOTTOM (FT'.) 4.0 4„0 3.5 GRAVEL DEPTH (FT.) 2.0 6.5 2.5 TOTAL DEPTH (FT.) 6.0 4,,:5 it„C) GRAVEL. WIDTH (FT.) 2.5 14.0 :5.0 GRAVEL. LENGTH (FT.) 64.0 ^S. Ca 3.3, 0 GRAVEL VDI_UM17 (CU. YDS.) 14.17 14.6 18.4 TANK SIZE (GALS) 1,000-0 .#- 1;000.0 SOIL_ RATING (SQ. FT. /BR) 85 85 85 J DEPTH TO PIPE BOTTOM <.: 4.0 FT. NAY REQUIRE A LIFT STATION TANS: MUST HAVE AT LEAST TWO COMPARTMENTS ..... .... ._.. ..._ J I certify that: 1. T 'am familiar .with the requirements for on-site sewers and wells as sel_ forth by the Municipality of Anchorage (MOA) and the State: of Alaska. _. I will install the system in accordance with all MOA codes and reg_il.at.:i.onS and in compliance with the design cri.ter:ia, of this permit. 1 will adhere to all MDA :and St_at_e. of Alaska requirements for the 'set bac 1. distances from any existing well, wastewater dis:possal system or public sewerage system on this or any adjacent or nearby lot... 4. I understand that this permit is valid for a maximum o; _ bedrooms and � any enlargement wil.l rega.ri:cct an aiJd:i.ti.on:37. permit, IF A LIFT STATION IS INSTALLED IN AN AREA r04_RE7BY A BUILDING CODES, THEN 11.) AN ELECTTtICAL. PERMIT- AND INSPECT.T.O MUST BE: OBTAINED, (2) AS --BUILT. WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORTp AND (3) THE ELECTRICAL. WORK MUST BE DONE: BY A LICENSED ELECTRICIAN. SIGNED GC.DATE: 'APPLICANTe RON (LUTHER ISSUED I:{1'/f a „`, 7- DATE: SOILS LOG MUNICIPALITY OF ANCHORAGE o q d ae DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 11 PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: Z.OYJ A 1A �-k.�v DATE PERFORMED:_ J O C- O y LEGAL DESCRIPTION: L -T (p i&IG '3 S(AS-1i NA V -167W - TI+9-1- SLOPE SITE PLAN 1 I(I�1�1 it �:II'GRGANSC 2 Date Gross Time Net Time Depth to Water Net Drop Syf.'(�1 $9N 47�T.aNr 7lb4 3 G, W 1� GnAVa�-Savcl mi%cUV� Ilv 4 © T ANJ well c�..4d.otA 1�2v! ,.'`,� �tl t,4n•yAcoVibla 5 - ' a*TG' 9 0- 95 0� I Ofl -- 6 ' FJ 7 ��t ee° °a sw &P-4vQ0N 9- ,o a e A° TAN A10% >� v n.aseaaA V24, 13 10 9oc+44 006-10 111 ■■■■■■■■■■ Date Gross Time Net Time Depth to Water Net Drop ■■EW■■■■■■ NENi7-31MMME� �A-T3 N■ELIVIE■.■� MAP 7�►�aN■OEM ��t MEN 006-10 111 a OMME NE M ° t -so,+i 4 u e c 11 pjpH WAS GROUND WATER S ENCOUNTERED?� 5 L! 7b- 0 P 12 IF YES, AT WHAT E % 13 DEPTH? IO101z; 14- 15- 16- 17- 18- 19- 20 - COMME Rea Date Gross Time Net Time Depth to Water Net Drop �A-T3 J PERCOLATION RATE — TEST RUN BETWEEN Ci A40 km -AV) alle=o 4.t67 u¢ 8S T3Z�i3K ev?t 4 t1 CA 4'1 [C1 .n f PERFORMED BY: f— GOo 1De1J CERTIFIED BY: 72-008 (6/79) (minutes/inch) FT AND FT -7.r DATE: w M !1....1: r1%-9 1 IC 1 IF- go IL._ ::&. I "v'C3 p:_::r ; P4 ED 14 It_D FT go C3 E:, - DEPARTMENT S_ i:)1l"'A TMENT C]Pk EAL 'rH AND ENVIRONI"It-NT[.1L P TE::fCTInj\I .-HORAGE, AK 9950' 264-4720 I certify that: ]% . _un §cm,17_r v7Lh the requirements for ;.-= 7"S a{wrs and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. "` I will install. the System a - s e with MOA �.� ,rr �.c�rr'd:anct:. «.tl ,M ..l `.f7i1?-I rn., and in compliance with the design criteria of this permit. -. I will adhere ,0 all MOA and State of Alaskarequirements forthe sr back I distances from any existing well, wastewater di.spossal system or pu.L-;7.ii_ sewerage system on 't.hi, or any radjac:ent or nearby lot. SIG!\IED DOTE 2 APPLICANT: d ON ' HURS ISS rr_D�;y - � DATE- - _. PJ EE4 it ._ n::a: I . ¢:...' 11 - _ I PERMIT NO: 840964 DATE ISSUED; 11I28/84 'APPLICANT: RON f;l° THURS ADI?RESS2 1601 E. 84TH. SUITE 106 ANCHORAGE, AK 99507 CONTACT PHONE: 349-7214 !LEGAL DESCRIP: SUE3DIVISION: SUSITNA VIEW EST. LOT: 6 SECTION: 3 TOWNSHIP: 11N RANGEg 3W LOT SIZi_.e 1,.24A (SQFT. OR ACRES) I certify that: ]% . _un §cm,17_r v7Lh the requirements for ;.-= 7"S a{wrs and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. "` I will install. the System a - s e with MOA �.� ,rr �.c�rr'd:anct:. «.tl ,M ..l `.f7i1?-I rn., and in compliance with the design criteria of this permit. -. I will adhere ,0 all MOA and State of Alaskarequirements forthe sr back I distances from any existing well, wastewater di.spossal system or pu.L-;7.ii_ sewerage system on 't.hi, or any radjac:ent or nearby lot. SIG!\IED DOTE 2 APPLICANT: d ON ' HURS ISS rr_D�;y - � DATE- - ���U lumillipCD WIMMO MAW ]BOX 1360go SWAlt ROUTE A ANciaomAcuo ALASKA 99502 344--7714 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 375 Teet. DRILLED AT THE RATE OF 924.00 PER FOOT. Gw,,ige AE 300 She 106 PROPERTY OWNER ion fllrth G1onk oAdehed by, M, fete Te4-te2 349-7214 LOCATION OF WELL SITE Lot 6 Bik 3 Su4.itna Uteur Fi,t. DRILLER BeAnte Ctaa4 o� RanD2t.Glan Oo414 WELL LOG: o----23' sa tt* jan4 g&ava. 30'16 c o4 bdnden. 23---59' Coa&ue q wuett urd th 15/ c ao. Sevena.L 4ma.Ll, bou.Ldevu. 59--375' Bedrock. R 4edtmRntaA* nock mate tat. iia urate& pnoductLon 4hourdn4 unti.L 215 .to 218 �,t. 1/2 Will UeA# 4mait amount oj� waters piton 86 to 88 A. hi4o a uvw, 4mait amount at 137 to 139 A. good Wduct on at. 371 to 374 A. The Tort urate& Waducaon 4houLd be ua astound 90 ga L xne ae z howl Thi ureU 4hauW a f4a .iac�tea4e uritis cue. IJateJt hcr� been pum>Zed fort 4eve�toC d�t¢� & t� aGao4t cLest. Stitt a ittiLe. 4 i i t in the urate�i. One Hague Pun 4hou td be irucr U ed0 340a at. a .Lowet.twas the coate�t urd.LL pump quite 4t i4. lute& &ecoveW come4 back up. to ur.Ltiu.n 50 A o-� 4UAf=e. 1.6 ga, arw of- wateJt rye& A .in &"eave. Ouez 500 ga.Uon4 .incA4bW on demand. MUNICIPALITY T. OFOHEALTHH&RA08 ENVIRONMENTAL PROTECTION RECEIVED One Thou4and DoVa a dour& pa,�/1�n"I t an Weei.��Lnnbnny.,,ppla�. R'oa At tnha" �' 764 I UD'Egp"A' tLbgg0`R'4AR�48 E:R 4-V R'"Cbr� dYf8A OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF 96200.00 S'm i HRI•� `i¢o�°tiE�t 'i188Y because o.� the exce44,Lve depth. 300 A orU4 BERNIE CLAUS OF RAMPART DRILLING WORKS DATE Decembers ltd, 1984 SERVICE CHARGEOF 1V,% PER MONTH WILL BE ASSESSED ON PAST DUEACCOUNTS. Municipality of Anchorage • Development Services Department 0 Building Safety Division u " On -Site Water and Wastewater Program` 4700 South Bragaw St. g" "" P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-091-37 HAA #_�� 1. GENERAL INFORMATION Expiration Date: _, .'aCa'7l01C01 Complete legal description Susitna View Estates, Blk 3, Lot 6 Location (site address or directions) 4936 Virgo Ave., Anchorage AK 99516 Current Property owner(s) Kevin Greenfield & Tamera Oswald Day phone 440-1291 Mailing address Lending agency Mailing address 4936 Virgo Ave., Anchorage Day phone _ Real Estate Agent Tammy Oswald "" Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. TYPE OF WASTEWATER DISPOSAL: ✓❑ Individual On-site ❑✓ ❑ Individual Holding tank ❑ . ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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 Watkins Engineering, Inc. Address P.O. Box 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments The On– does not assumed the septic tank was Phone 349-1851 Date g21'64 bedrooms, with the following stipulations: 1975. The tank consctruction materials, numoer of cow a,-=. separation distance from the absor tion field are unkno Mnaclyrle�� tank, the remaining life expectancy may be limited. HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory_ Other By: (Rev.0=) 'i— 6ld Stfi E • I Irrn AAIn 4/a7/a�� Original Certificate Date:_ — Municipality of Anchorage Development Services Department Buildmg Safety Division '° On Site"Wa'ter 8 Vt%astewater Program �„ r a =r r gaw St �, uni.org/onsite Parcel ID: 070-00­87­ V 20-00Y87"„""If A, B or C provide PWS)D # wnitary seal (Y/N) Y ' Wires properly protected (Y/N) �Y Cased to 40+ ft. Casing height (above ground) 23 in: • ' n t i .. aSri.vw .tW� "��G6('Me.^a'+k t3^-a.+.ww:ra'r�w. 'R•: 4/19/04 :vel �, ft. 134 ft w a.n.m, -a: -; .% 'r •••..,,�� �+uueytcu uy. clnaY t1113 �, .,. .._i��"1�k.S �9 i5u' F Yr.": C J yn a `` +..,...=..r ..,w'tw Date installed unknown '°/i75'� �, Number of Compartments' �� Qleanouts (Y/N) Y Depression over tank (Y/N) N High water alarm (Y" NA e ... Pumper A+ Home Services:' sorl rating (g.p.d./ft or ft'/bdrm) 85 System type shallow trenoh ft: WidfK 5.0 ft. Gravel Tielow pipe 2 5 ft ,5 _ ft. Eff absorption area 273 ft' Monitoring tube Y v Depression over field N Depression quacy tes 9 Results (Pass/pail) PASS For 3 bedrooms � 5 in absorption field before test 12 6 in Water added 1180 gal New depth 4 25 �� �Y � v k x, pt m Pinai fluid depth 12.6 in. Absorption rate > 600 d anon treatment (past i'2 mo) (Y7N" type) N If yes give date Fo4�'.5c''will heiN G. Clot✓ .. ut yaurnia a Pump off level at m ater alarm level at ' &circuit requirements. Cycles tested + ,�aM " Public sewer' manhole/cleanouf 100+ 30 Pfisorpfion field Unknown P tY• . : N]ater sex _ .. te .. service line 80 Surface war 100+ Mx i a T>F~.:.. w. •~SE,.:Ar,• Ii Mss `k". 'P ui�ra S" `tT -M ..f.MSn) 4Nix.^vhtir rtc:`tt.5 14f4nJr ,.S f , ots 10b+ TANCEFROM A$SORPTION FIELD ON LOT Building foundation 20+ Water main , 1Dnvew-.a, y._•parkin gNehice`storage 00 Water -00+ uy:�' w r'3x�"i an r' •'.L �etermrned�fhrough field inspections antl records that the above systems are in * 49TH a.. 10A HAA guidelines in effect on this date >+ ..... Ci'ndy�IV Ellis' V'6me ndy W. Ellis ~ ...., .......!. r Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Health Authority Approval # HA040489 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 3, Lot 6 of Susitna View Estates subdivision, the well's productivity was determined to be 0.61 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.3125 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. (-, f etc/%.� Gi/✓F � U r1Z \ •p �= p _�� �fl � JIw rq \ •p p g n P 0 0 -' <_ O Z (`tom O � � � \ ti t n w � P -i �ii�t�• a �r• m P c ' o� ..ate° _� �� P.° —c s 3 �I 5 6 O Cc a q V Q 3 y+ q = P JIE C i OVA Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Watkins Engineering. Inc. GS z ,s SA ETY Legal description: Susitna View Estates Block 3 Lot 6 The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on _ ❑ Calculation error in design. _ ❑ Additional soils information needed. _ ❑ Water monitoring results inadequate. _ ❑ Discrepancy in information submitted. _ ❑ Topographic information missing or inadequate. ❑ Incomplete; missing _ ❑ Incomplete; missing _, ❑ Additional adequacy test information needed. _ ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. _ ❑ Locations of all soils, percolation and water monitoring tests not shown. _ ❑ Proposed system too deep for soils information submitted. _ ❑ Well log required. _ ❑ Omission in narrative. _ ❑ Insufficient fill over tank or field._ ® Other. The department does not currently have any documentation on the septic 1 The department requires undocumented systems be investigated and as -built drawing provided with the Certificate of Health Authority Approval request. Name of reviewer: Julie Makela, P.E. Date: 9/24/2004 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK / a MUNICIPALITY OF ANCHORAGE ' DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 \ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# 0,7�-0 09f --3% HAA# _HA9406r14 I. GENERAL INFORMATION Complete legal description Lot 6 • B2ociz 3 .. S. ' Location (site address or directions) 4936 V. 4 o Avenue Anchaaa e, AK Property owner ASSOCIATED BROKERS Attn: SaLidu Day phone 258-RSBs Mailing address 2509 E.ide S.tAeei Suite #4H1 °'e 6tad AnchoKa e AK 99505 Lending agency Mailing address Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. - 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. ' 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: if community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system 72-025(Rev.1/91) Front MOAN21 — " - 5. STATEMENT OF INSPECTION BY ENGINhER' As certified by my seal affixed hereto and I verity that my as of the validationcon shows that the on-site site water supply osalsyste Investigation of this Health Authority Afe, functional and/or wastewater structure Gated herein. I further verriify thatased ontthe information obtained from and type the Municipality of Anaterrd disage posal system s n compliance with all Munles'and from my investigation and icipal and Sttion, th ate codese on-site , supply an ordinances, and regulations in effect on the date of this inspection. 6 k N%7 Phone Name of Firm S & S ENGINEERING 17034 Eagle River Loop RT 04 I Address Date 6 / Engineer's signature g, DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for --- bedrooms, with the following stipulations: l ✓EG -c - Additional Comments Date 120 6�z • paragraph 5 above by an independent The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority Approval Certificates based only upon the representations given In p 9 to purchasers of Apprprofesoval Ceral ngineerregisteredIntheStateofAlaska.TheDHHSdoesthisasacourtesy of Anchorage is not and their lending instituroanalyze data before artcertfcateain listlssued. The Muniicipalate requirements* rioyeesofDHHSdonot conduct inspections fo responsible far errors or omissions in the professional engineer's work. 72-025(Pay. 1191) Back MOA 021 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L,)%� SU-S/TN14 Parcel I.D. UZd oq 1 3% We4i 6s-7A72n 5-/0 A. Well Data Well type I (/ %Zr If A, B, or C, attach ADEC letter. ADEC water system number A- A i 2r�1✓u%f/�✓t i viz/cc �ulr Log presen (Y ) �� Date completed �/ 2�Z�1A� Driller Total depth / Cased to 3?, / Casing height �� S Sanitary seal 1' JV) Wires properly protected6N) l�/N) !?C__ FROM WELL LOG Date of test Static water level Well flow Pump levell SEPARATION DISTANCES FROM WELL TO: AT INSPECTION _<_� SZ/ z°Z 6, Z D g.p.m. o 3S-0 ,� m O T tp°Z`�Ir�l' C Z ti .gyp 2 / e° O C 6 / Septic/heldiag tank on lot �y '� ; On adjacent lots C) e R / Z Absorption field on lot ; On adjacent lots ! (D b / Public sewer main %S Public sewer manhole/cleanout /<)J 1� Sewer service line Zs /-h Petroleum tank lfW�5- l W&u�J WATER SAMPLE RESULTS: Coliform C/ / itrate 0 /!� L Other bacteria Date of sample: Collected by: G - /„,TR. rALi. B. SEPTIC/HOLDtNG'TA JN,�K DATA �v Date installed U! 4_ _ _Tank size �C 1 �� 6_R � Compartments Z Cleanouts(/) �6n Foundation cleanout (y.9 �J° Depression (y High water alarm () (J)-) �� Alarm tested (Y/N) Date of pumping �//Pumper t l 5e2oC-� SEPARATION DISTANCES FROM SEPTIC#*6DMG-TANK TO: Well(s) on lot ��// u On adjacent lots U u / To property line G�� �� Absorption field / Surface water/drainage Z60 72-026 (3/93)' Front Foundation Water main/service line `O /-J- CONTINUED ON BACK PAGE C. LIFT STATION Nl Date installed Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical codes "Pump on" level at SEPARATION DISTANCE FROM LIFT STATION TO: D. ABSORPTION FIELD DATA Manufacturer "Pump off" Level at Cycles tested On adjacent lots Surface water Date installed U ��(/ Soil rating (GPD/Ft2) System type w• niql AJ LengthWidth S r Gravel thickness 30 Total depth G S Total absorption area 2Z Cleanout presentY/ ) YL Depression over field ()/N X06 Date of adequacy test 3 % Results1 ail) O �;S.S for Bedrooms Water level in absorption field before test After test Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot (`/_ On adjacent lots _ 4 U / _/__ Property line 6 (—J To building foundation / co To existing or abandoned system on lot 1(11A On adjacent lots 2U r-� Cutbank 10 Water main/service line / O Surface water Driveway, parking/vehicle storage area -{— Curtain drain Wblr�I N Jca_. G (JMJU(7� /P SCOn G(G eW,76� idbd c J ZS% — IT EL L (/AG 4 —1-'u 61e('Al< E. ENGINEER'S CERTIFICATION Signature 4" Engineer's Name17034 Eanlo River Loop Road No. 204 Eagle River, Alaska 99577 qy Receipt Number 72026 (3/93)' Back Date of Payment MUNICIPALITY OF ANCHORAGE M E M O R A N D U M WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO. HA940674 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot 6 Block 3 of Susitna View Estates Subdivision, the well's productivity was determined to be 0.5 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 bedroom residence is 0.3 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. ` l MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 3("C_f O `' (a) Legal Description (include lot, block, subdivision, section, township, range) 1_-T//, (i'L� ;� LUC-L J Location (address or directions) 4'3ln kl`(4C� AUr (b) Applicants Name Loi t /+vztkLAyS Telephone _ Home Business Applicants Add V (c) Applicant is (check one) Lending Inst tutioa* n` ; Owner/buil-der ; Buyer Other (explain), (d) lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single -Family CEt Number of Bedrooms Multi -Family Other (describe) 3 3. Water Supply 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 F::] Holding Tank E] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. age 1 of 21 r 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 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 regula- tions in effect on the date of this inspection. Name of Firm 6. DHEP Approval Approved for 3 bedrooms Approved _4�(V_ Disapproved Terms of Conditional Approval 2 No. 2251-E Telephone S LP /- SO C-/ d ` �� i .LI Conditi..�, CAUTION TUE tNNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 ( U MUNICIPALITY OF ANCHOP.AGE v D`PT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENV] F.ONMENTAL P2OTECTION HEALTH AUTHORITY APPROVAL (HAA) OCT] - CHECKLIST - FEBRUARY 1984 EW)EQ Legal Description: LL Srsa7wA-Uzc��f A. WELL DATA Well Classification _teiu P If A, B, or C, D.E.C. Approved(Y/N) All - Well Log Present (Y/N) _P-Az�-6 L14>e> Date Completed -�-r o1470 Yield d,l%qaa3 Total Depth Y-6� 53SCased to 'icy SSI/ Depth of Grouting 4-tN )- Static Water Level 717 ` Pump Set At � (,i vk, Casing Height Above Ground I,5-1 Sanitary Seal on Casing _0 Electrical Wiring in Conduit nIYN)S� Depression Around Wellhead (Y Separation Distances from Well: To septic/Holding Tank on Lot - On Adjoining Lots-7/(jt)( To Nearest Edge of Absorption Field on Lot JO'),6t' On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected By 6- ot'D 6 bQ ; Date ;20 s e Water Sample Test Results Fomes& Well l u Comments -I(- B. SEPTIC/HOLDING TANK DATA Date Installed (,ANV_ Size /000 -No. of Compartments Z Standpipes Y ) y� Air -tight Caps fi�N). Foundation. Cleanout (Yen Depression over Tank (Y o_0 Date Last Pumped Pumping/Maintenance Contract on File (Y/N) for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well '- '5V To Building Foundation i- 1 1 , 3 To Property Line 2,11 To Disposal Field /y,81 To.'Water."MainZServioe Line W4- To Stream, Pond, Lake, or Major Drainage Y 10> IS 41 (Page 1 of 21 Receipt # Date Paid: Amount: 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata uw1K Type of System Design _j)a 7 Date Installed + uNv - Length of Field �4 urulL Width of Field 4 c,iui�- Depth of Field •1F-uiulf- Gravel Bed Thickness-uuk Square Feet of Absorption Area K a rjr Standpipes Present Depression over Field (Y ,0((-b Date of Last Adequacy Test an s�p Vic/ Results of. Last Adequacy Test G=W po-;le o Separation Distance from Absorption Field: To Water -Supply Well �(-Y- p 7 , (o c To Property Line To Building Foundation �O( g I• � To Existing or Abandoned System ai Lot n q_ On Adjoining Lots _ G- ( / o u To Water Main/Service Line ,U 4- To Stream/Pond/Lake/or Major Drainage _ To Cutbank(if present) rv. 9 - Course &T ((Jo, To Driveway, Parking Area, or Vehicle Storage Area Comwnts S[,.s("Qw OLPFwwn LAX,6A.0-,DQ_ # KI) 0rri+nw (tg �Jaf 01+rn _ - NAS h—SUrlE✓Jyuow 5"1 io w n i ✓�P� S _�_ D. LIFT STATION Date Ins'ta1led Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Comments Dimensions Manhole/Access (Y,/N "Pump Off" Level at Vent (YIN) Pumping Cycles dur . dequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request k* I certify that I have checked, verified, or cOnforrff,-d to all MCA HAA Guidelines in effect on Signe dat� e� — Signed Date 3 d C Z, C/ Company && o,Sp �J MOA No. Iy_-o'L KB1 /d5/s (Page 2 of 21 L*MY C. RNd, Jr. No. 9461•! 2-L5-84 e AFc CIPALITY OF ANCHORAGE S ALASKA hIROI1 nTAL COnTROL SCRUICCS, MCDEPT. OF HEALTH & a Engineering 6 GnuirOnmental Studies ENVIRONMENTAL PROTECTION DEC 2 6'1984 1200 West 33rd Auenue Suite B • Anckorage Alaska 99503 • (907) 5615040 TO ..._....�iN�i d 4K _..._, DATE o'lU A6L g�_ _W SUBJECT,,, L T (a Bk3__S y SY TN.h_V 2Eu/g NEW WELL- c 8 -Fcuit.DS. 114E. Fo(to oq y zn Pbnw,FT1Q)U TVMth VEw will._ -10 .�46.a+ml+`ah_�i��c�__t S 1(o lob ` 6ld wo