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HomeMy WebLinkAboutMELINDA VIEW ESTATES LT 8 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: ~/zJ .~./'_~t/,~'~'~' PID Number: Name: ~ t ~ ~4~ Wastewater System: D New ~Upgrade Address:j ~ J ~ ~ ~ ~' ABSORPTION FIELD Phone: Z~-- ~ ~ JNo. of~drooms: ~ Deep Trench ~ Shallow Trench ~Bed ~Mound ~Other LEGAL DESCRIPTION Soil Rating: ~OOGPD/Sq. Ft. Total Depth/. ~fr°m'°riginal grade: ~ubdivision: ~ Depth to ~ipe bottom from origins] grade: Gravel depth beneath pipe Tow.~h,.: J"~nge: Jsoo,'o.:~ ~ FiH added above original grade: Gravel lent ~ ~t. O ~. WELL: ~~~ ~ UpgFade GraveJ~h:~/~/~ Number of lines: Oistance between fines: Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pige material: Driller: Date Od[led; Static Water LevekFt. In~er:~ ~/~/~/ Date Yield: J Pump Set at: Casing Height Above Ground: ' ~.M~ .~. .~. TANK SEPARATION DISTANCES ' ~~~ ~.T.E,P. TO Septic Absorption Lift Holding =ubJic/Private Manufacturer:R --~-~ ~~ns: Surface w~r ....... LIFT STATION Lot ~ Size in gallons: ~ Manufacturer: Drain ~ ~ ~ ~7 Loemion and Description: ENGINEER'S SEAL Inspeotions performed by: /~I~1 ~ Dates: 1st J 2nd '~/~/¢/ g epartment of Healt~d~u~an Se~es approval Reviewed and approved by: ~/~/~~- Date' 7~/ (1/91) permit NO. 5/'C).~-/~/L~'d'~ Page ~ 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 of ~-~ Legal Description: ~-C') ~'- ~ C ' '77 72-013 A (2/91)MOA 25 ~ ~"~ Permit No. '5'/6~.~',~)/,~0''~ Page ~ of 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 ~ I,~ C~.) PID No.: Legal Description: EC[ VE ,JUL ,5 1991 MunicipaH[y o¢ Anchorage Dept. Nealth & Hurflan Services 72-013 A (2/91) MOA 25 ENGINEER'S SEAL 4 INSPECTION REPORT MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION 3500 EAST TUDOR ROAD INsPEcTIONS (907),.563~34~: ' I ' ,',' · "' '1 , ... f NFORMATION (907) 786-8211 ' " -- r.~" I /PERMIT~O ~t .' r~:.' / STREETADDREsS Z:f6t (,¢/~ (¢ '¢U',~ (¢~ <..',fi', ~X,%~¢ ' "~' ¢ ¢ ~HONE =./ ' -¢ CP1''~% '- LOT/. ~') BLOCK/ SUBDIV..//".¢2 ' / ~ ~ - '. / '¢ "?"('¢'~'¢~ /DATE /' '~ FOOTING [] ELEC. TEMP. [] PLBG. UNDGR.. [] FOUNDATION - [] ELEC. SERVICE ~,¢' E~ PLBG. ROUGH [] BOND BEAM [] ELEC ROUGH ~'~"" ' - ' ~ ~-~. GASTEMP, __ [] OTHER ~ ZONING [] OTHER [] ;~.~O NONCOMPLIANCE OBSERVED [] CORRECTIONS ESSENTIAL AS EXPLAINED BELOW [] WILL REEXAMINE AT NEXT INSPECTION [] DO NOT CONCEAL UNTIL REINSPECTED COMMENTS RECEIVED JUL ,5 i99i Municipali.[y of Anchora. e D¢,~- u^^,,.,., ~, ,., g ' DATE WHEN CORREC.TIONS ARE MADE, PLEASE CALL FOR INSPECTION 84-002 (Rev. 11/871 DO NOT REMOVE THIS NOTICE 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 PAGE 1 OF 1 PERMIT NUMBER:$W91013~ DESIGN ENGINEER:ROBERT KNIEFEL, P.E. OWNER NAME:MEDE WILLIAM F & TERRY B OWNER ADDRESS:14401 JOANNE CIR ANCHORAGE, AK. 99516 PARCEL ID:01709245 DATE ISSUED: 6/05/91 EXPIRATION DATE: 6/05/92 LEGAL DESCRIPTION: MELINDA VIEW ESTATES LT 8 LOT SIZE: 40496 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ISSUED BY:~ ON-SITE WASTEWATER SYSTEN DESIGN LIFT STATZON DESZGN CR~TERZA LOT 8, NELINDA SUBDZVZSZON The lift station will be appreved by the Nunicipali'by of Anchorage, Department of Health and Human Services prior to construction. Lift Station Design Parameters: Pumping Cycle 3 Bedrooms x 150 gallons per day = 450 gallons/day 450 gallons per day / 5 cycles per day = 90 gal/cycle Float Settings Set pump on/off float differential to provide 'For 90 gallon dose Set alarm float to provide for minimum 150 gallon reserve Volume to Fill Laterals = 185' of ! 1/4" plastic pipe = 27 gallons, ok since cycle volume = 90 gallons and pipes will all be filled Elevation Difference Approximately 2 feet from discharge to field elevation Field Design Parameters: Total Length of 1 1/4" Laterals = 3 x 55 = 165 feet Recommended Nole Spacing and Size (from EPA Chart) use 55' / 2 = 27,5' spacing use 5/16" hole diameter from chart spacing should be 3 -- 5 feet .U,~,~,.A.,!....8.E&~6,EE..:~/.~Ei,L..,E~.&~EZE~.,~DLE,~ II SYSTEM DESIGN GUZDELZNES AND NARRATIVE Lot 8, Melinda View Subdivision SYSTEM REPLACEMENT System Size = 3 bedrooms x 300 sf/bed. = 900 sf Pressure Distribution Absorption Bed = 15' x 60' = 900 sf All materials, construction methods and required inspections to follow MOA rules and regulations. The electrical installation for the lift station shall follow MOA code requirements for both installation and inspections. The contractor is responsible for obtaining all required electrical permits. The contractor is responsible for notifying the Engineer and the MOA at least four hours in advance of all inspection needs. Contractor will insure no additions or changes have been made to the location of wells and septic systems on the adjacent lots prior to the time of construction of this system. If any changes to those systems have occurred, the engineer should be immediately contacted for review and possible changes will be made as necessary. The....OB/Fi.I! mater~..al eil! be. ~emoyed.. ~O...th.e uode.E].yi, ng gra.~.e.!.!Y...sa~d.....mateE~!...under..a.nx, po~tiq~.o.~..~h~ bed..~Ee.~ The lot is generally flat with a slight 1 - 3% slope to the east. The installation of the system will have little or no effect on the surface drainage, ground water, or the adjacent systems in the area. The septic system should be properly maintained to include septic tank inspection and pumping as necessary on an annual basis and no use of a garbage disposal. If a garbage disposal is used the tank size should be increased to a minimum 1,250 gal tank and the tank pumped regularly on an annual basis. The lift station and electrical components shall be approved by the MOA. MOA CE 90-030 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 10 11 12, 13 14 15 16 17 18 19, 20- COMMENTS ~,~l-,t 1,J~ ~l~"~l~lTownship, Range, Section: .¢..'-¢... SLO~,E Poll 4./- SITE PLAN I I t /;' ,j s~ IF YES, AT WHAT II~ ~1~ O DEPTH? p E Depth to Water After,,,2 ~ Monitoring? f Date: Reading Date Gross Net Depth to Net Time Time Water Drop · ' ..DP ~.: ~o to . ~-o .~o PERCOLATION RATE [ '~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FTAND ~ ET PERFORMED BY: r~. ~,,~{ ~ I &, ~.4,~tl ~'"'~ CERTIFY THAT T, HIS TEST WAS PERFORMED iN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE' 72-008 (Rev. 4/85) .1,, ~ MUNICIPALITY OF ANCHORAGE ~. ~. ~[~,// DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE I ~J~N EW f~'iE5 T'"'~x/~'l~ ~ ~ ~ ~'~J ~ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION , LOCATION ~ ~ C~"~ NO' OF BEDROOMS DISTANCE TO: Absorption PERMIT NO, ~ ~ Manufacturer ~ ~ A ,~ ~ . ,o. o~ co~,~,t~.n,~ Liq. capacit~lons Inside length Widt~ Li~id depth IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O z ~ Manufacturer Material ~ -- ~ Liquid capacity in gallons Q Well Foundation ~ DISTANCE TO: ~ ~ Top of tile to finish grade ~ ~. Material beneath tile Total effective Length Width Depth PERMIT NO, ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: j Class Depth Driller Distance to lot line PERMIT NO, ~ DISTANCE TO: , Building foundation Sewer line J ~ ~ Septic tank (~ ~/ Absorption area(s) OTHER PIPE MATERIALS SOl L TEST RATING REMARKS Ill ':- ' - DEPARTMENT DF- HEAL. TH AND ENVIR. ONME.'NTAL F:'F<OTEECTiGN 82'5 L S'I"F(EET, ANCHORAGE.,, AK 99501 264-4'720 PERMIT 1'4 O .' ~'~0°"'o DATE I ~,_ U,_D, ()9 127'7 AF'PL I CANT: ADDRESS: CONTACT F'HONE: FEJE~ DEVELOF'IdlENT P 0 BOX 112-)',."9 ANCHORAGE, AK 99511 :549-8011 LEGAl_ DESCRIP: LO]' SIZE:: MAX BEDROOMS: SUBDIVISION,', MELINDA VIEW ESTATES LC)]': 8 SIZCTION: 35 TOWNSHIP: 12N RANGE: 3W 41178 (SD.FT. OR ACRES) 3 BLOCK ~ NA Listed below are the options available t.o you in designing your ,'=ept. z'-"~ system. Choose the option that best '"*- your DEPTH 'T'O PIPE BOT]'OM (F'T.) GRAVEl... DEF"'"I'H (F'T. TOTAL DEPTH (FT.) GRAVEL WIDTH (FT, GRAVEL LENGTH (F'T.) GRAVEL VOLUME (CU.YDS.) TANK SIZE (GAL~.S) SOIL RATING (SQ. FT. /BR) 4.0 4,.0 4.0 5.5 0.5 3 ,, 5 9.5 4.5 '7,5 2 ,, 5 ~0.0 ~ 5 ,, 0 44.0 38 ,, ~ 54 ,, 0 24 ,, 5 28 ,, 2 40.0 000.0 .~-* i,(tO0.O *.~ 1,000,,0 *~ 160 165 165 TAI'.IK MUST HAVE A~' L.:-.Ac~] TWO COMPARTI'IENTS %% j'" ,-~- I centi£y that: 1. I am £amiliar ~'~i'Lh the r'equirements fop on--site sewe:rs and t,~e],].s as set. for'th by the Municipality of AnchoPa.qe (MOA) and the State o¢ Alaska. 2. I will ini-]t.a].l tine system in accor'dance wi'Lin ail MOA codes and regulat:i, on~, and in compliance wi'Lb the design c:riteria of' tlnis per'mi'L. 3. I will adhere to'all MOA and State o¢ Alaska r'equirements .t'cm tlne set 'bac:I< distances fr'om any e;..'isting well.,., wastewater' disposal s'ystem of public . set,,~erage system on 'L.h:Ls oP any ad.jac~nt oP near'by lot. 4. I ur~der's'Land that this per'mit: is valid for a maximum of 3 bedr, ooms and any enlargement will. r. equir'e an addit:i, onal permit. IIF A LIFT c.'T 'T ~ ~,c:"rA ~ ~n IN AN AREA bO ..... f'.,..~, MOA BLJILDII',tG THEN (1) AN IELEC'I'F~ICAL_ F'ERMI't" ~ND 'INSPECTION ldtJST BEE OB'FAINED!; (2) AS"'<E~UII..TS WILk. NOT E~_ AFFRDVE,¢ WIIF, ObT ,~,.I J..,...CFt,I..,AL I .......... C,1Ot.I ,~E ........ t, A,,ID (:3) ,,h__ ~_LECT,~ICAL WOR[.. IIU,,T E,E. _)tJNE ..... A LIC_I.I.,ED E ..... ]RIC,.~,,. I; UED ~ ,. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage. Alaska 99501 2G4-4720 SOILS LOG - PERCOLATION TEST SOLES LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 o1. 2 3 4 7 8 10- 14 17 18 20- T/f-- .7- SITE PLAN SLOPE IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN 2,71,~__ FT AND:~ FT 72-008 (6/79) ~ ~ - / WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NAY'ORAL RESOURES Division of Geological ~ Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Please complete either la, lb or lc.) A.D.L. No. 1~.[8 .... gh [~(:~/ll'[,Subd vision.,/i.(q- 't,,~ FI ~ Lot~· BIock.,~, I~'l--of--of--ofV4qtrs'-- Section No. Township NoSO R~nge woEm Merldio, Street Address and Area of Well Location ~[[~'lt'.~f(~ C.l I1~(. 2. WELL LOG Peet Below 4. WELL DEPTH; [final) ~'5. DATE OF COMPLETION Material Type Top Bottom ~~ ~'~ ......... ~., ~ / ';,~.~ D Auger ~ defied ~ Bored D Other: ' ~--~' ':" ' ¢ ~ ~ '7 ~-.- ~Z'k.. '2 ? dia.. f~ in. to 9 /~' ft.'Depth Weight 1~ lbs./ft. __ diam. in. to ft. Depth Stickup~ ft. 9. ~INISH qF WELL: , Slot/Mesh Size: ' '"-. Length: ~ ' ~ <~' ...... ~ ~U~/~IpA~ ,~ set between ff. and ft. // / / '"' Fk.,.~EP~ Qp~FANcN~Dx Backfilling / ~ ~ .... Gravel pack -- ~ Above or ~ Below land surfac~ II. PUMPInG. LEVEL below Iond surfoce and YIELD ~ ~ ~,~ ft, offer hrs. pumping ~:~ g.p.m. -- fl, offer ~hcs' pumping g.p.m. 12,GROUTING Well Grouted: ~ Yes Meteri~l: ~ Near Cement ~ Olher: ~3. PUMP= (if avo[lob[e) HP  Length of Drop Pipe ~ft. c~pac[ly ~g.p,m. 0 Subm. ~ det ~ Centrifical 0 Other 16. WATER WELL CONTRACTOR'S CERTIFICATION: 15. Wofer Temperature ~o ~ F ~ C T~is well ~os drilled under my jurisd(clion end this report is true fo 1he best of my knowledge and belief; ~ ) ..]~ ,.~) Registered Business No~e Controcl License Number ,tx .... ./ '/' "' ~ ' } ' MUNICIPALITY OF ANCHORAGE , ' .. '/~'~, DEPARTMENT,OF HEALq:H & HUMAN sERViCES_.' ~ PiO. Bo~.196650 Anch~r~e;'Al~ka" ' 99519~6650 ~ 343-4744 cERTIFICATE oF HEALTH AUTHORITY ·APPROVAL, FOR'~:SINGLE FAMILY DWELLIN~ site addresS'Or:dire~tions) ':Y' ' :~' ?': :"" :'~ ,?-!:' ~'-": '" '" Lending agency Mailing address Day phone -.? :-~ Add ress NOTE: Individual well community well ' ':' ' ' ' ' "- Public water ' '-' "-' If community well sYStem, provide .written confirmation from ::. ~ i "" "-: :'- ~'lng to the legality and st~tus~of system. 4: TYPE OF WASTEWATER DISPOSAL: ._~. .... ~ ~. ,/. " Individual on-site "; ' '' ii -, .. ;.~..:.~?:.:~:.,~-r.-i ~!_ ! ",:i::":':~L', {". Holding tank- ' :'-:?: '":'; '" :~';' ::~':': ' ": .... :~:, ,r ..'~, ,.:...:: ,,, ,. ::. publiciseWer..:":: ;,.: · - ' - NOTE: ~cOnfirmation ~ :. :-- attesting ~: 72-025(Rev. 1/91) Fro[it MOA~21 ~ :-.-- STATEMENT OF INSPECTION,BY 'ENGINEER 'i' ' ; As certified by mY seal affixed, hereto andas:'0f th:e va ddt on date shown belOw, I verify.that my~' ~1~ ~'~: I I:" ~ ' I investigation of this Health Authority Appro~;a" aPi~licati0n Shows that tt'i'e on'site Water'suPPly i. i: . . and/or wastewater, d sp~3s~J System s Safe/fu'h~ti0'fial ~nd adeqUate for the number of bedroom~ '. and ~pe of structure indicated herein. I fu~he~'veri~ that based on the information obtained from ' '~"'-' .=.~-:-: the Municipali~ of.Anchorage files and from.my, nvestigation~and inspection, the omsite water '.. '; suPp y and/or wastewater:d sp0~ai-sySte~:is':~n c'~mplian~e with ali Municipal and state code~,:.:, ,"~ ' ' Ordinances, and regu at o:ns' n effect on the date Of'this inSPection.', · . ;' : ~';;: NameofFirm ~~0~ ~b/~~b Phone .... ';'"' '~ ' ' ~ ~ 'o . .... ~ .." .., ~..,. - ~:,.. . ,. .... %.~... ~o,: = ,,t~,~ ;. . '"-.:~ ' . ~ "~ O. -~e~' .~ ,~x ~ , - .; ' ,' ,':~-' ' - - · "'., ~ ~110 ~r,o g~l ~ ' :~ . 6., DHHS SIGNATURE ,.. . ~.?~o~ ~ ,,..?., :,;:~:~:.,.:':~" :, ,' "~' Approved for _.,bedroOms;.. '.:F~- ed. "",: ', .. .. : '' . :: ~ .t~.,. "c. .... ~ Conditional approval for :.,bedrooms, with the following stipulations: Additional Comments Date 4 -2 / - ~'~' ~C~The K4'Li(3icipality of ,~n~horage Department of Health and Human Services (DHHS) issues Health Authority ' j'Approval Certificate~'based only upon the represehtations given in paragraph 5 above by an independent ~pr0fessional en{ii~eer ~:egistered in the state of AlaskaJ.,The'DH HS d0e~this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain f~deral and state requirements. Employees of DHHS do not conduct inspections or analyze data before a'certificate-is'-issued. TheM unicipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91 ) Back MOA ~1 ;- .~ ,Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHEcKLIST Legal Description: /.~"r' ~,/3/J C-~.JNbA j~w.U ~'r-E~ Parcel I.D. A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC water system number Date completed /'~/ZS-/~ Driller Log present (Y/N) Total depth Sanitary seal (Y/N) Cased to '~7 ~ Casing height FROM WELL LOG , -ZS" Date of test Static water level Well flow Pump level1 Wires properly protected (Y/N) b ~-'~ LL~ ~J ~ Y g.p.m. AT INSPECTION ~., 5'-' g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot / 5/0 / / Absorption field on lot >/~, O Public sewer main Sewer service line ..; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: ~) Nitrate Coliform Date of sample: z./'/t / ~ ~ t0 ~.~/L. Other bacteria 0 Collected by: ~. ~L~ B. SEPTIC/HOLDING TANK DATA Date installed /1/~' ~ Cleanouts (Y/N) ~ High water alarm (Y/N) Date of pumping Tank size 1~ DOD Foundation cleanout (Y/N) ~_~/F~. Compartments y Depression (Y./N) Alarm tested (Y/N) Pumper ~' ~1C. ~' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /5/0 / l ~ / To property line 5j',-? / /Z. / Sudace water/drainage On adjacent lots Absorption field Foundation Water main/service line CONTINUED ON BACK PAGE 72-026 (3/93)° Fro~t C. LIFT STATION Date installed Size in gallons Vent (Y/N) ¥ High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer /'~NOZ.~I~./~2.~N cO Manhole/Access (Y/N) "Pump off" Level at .Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot /-5'~"'~z' / On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed / Length ~ 0 Total absorption area Date of adequacy test $/~ ~/~ ¢ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Width / ~'" / Gravel thickness [/' -r'o /0/' Total depth Cg)D ~'~ Oleanout present (Y/N) Results (pass/fail) D Depression over field (Y/N) for ..~ After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ' /~, 7 I On adjacent lots /0 ~ Bedrooms ! Property line To building foundation ,~,I~~ / To existing or abandoned system on lot On adjacent lots > ~-Z) ' Cutbank /',/'//~ Water main/service line Surface water ~'15"cO/ Driveway, parking/vehicle storage area Curtain drain ,'~J'~ ,~/~" E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effe..,ct_og, t,_h.¢,date of this inspection. Engineer's Name /'~/~-/,4/~t. Date HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back (", ',:i', ~, 438 ] - E o Waiver Fee $ Date of Payment Receipt Number CT&E Ref.# Client Sample ID Matrix Client Name Ordered By Project Name Project# PWSID Commercial Testing & Engineering Co. Environmental Laboratory Services ~~z~.~7~z~/-~,,q/zZ/~7~z LABORATORY ANALYSIS REPORT 94.1405-1 L8 MELINDA VIEW ESTS. SUBD. WATER ANDERSON ENGINEERING ALAN ANDERSON UA WORK Order 77113 Pr'rated Date 04/05/94 609:24 hrs. CollectedDate 04/01/94 ~ 10:31 hrs. Received Date 04/01/94 ~ 10:50 hrs. Technical Director STEPHEN C. EDE Released By: ~~. ~ Sample Remarks: ROUTINE SAMPLE COLLECTED BY: A.H. QC Parameter Results Qual Units Allowable Ext. Anal Method Limits Date Date Init Nitrate-N 0.10 U mg/L EPA 353.2/300.0 10 04/04/94 LLH * See Special Instructions Ab ove UA=Unavailable ** See Sample Remarks Ab ove NA = Not Analyzed ,~. U = Undetected, Rep orted valt~ is the practical quantification limit. LT= Less ~han ~; D = Secondary dilution. GT= Greater Than t,!. §633 B Street, Anchorage, Al{ 0951 9-1 600 --lei: {907) 662-2345 Fax: {907) §61-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (.sit,e address (~r. directions) Property 0w.ner:'~ Lending:agency Mailing address Agent Address Day phone ~'~-~ -- 7¢~'-~ Day phone Day phone g NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Unless otherwise requested, HAA will be held for pickup. NOTE: Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA ¢21 = STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the omsite 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 flies 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. NameofFirm ~-~/',,..) ~~ ~-t',J¢..~)¢'~'¢_~,¢-~- Phone U77~-~"-(~0 Address C.~ CF/ ~)~ 6T, Engineer's signature ~~ ~~/ Date ¢~'¢ DHHS SIGNATURE ~ Approved for /~42 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anehorage Department of Heal`[h and Human Serviees (DHH$) issues Health Au`[hority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer regis`[ered in Jhe State of Alaska. The DH H$ does this as a ecu r~esy `[o purchasers of homes and '[heir lending institutions in order`[o satisfy certain federal and sta`[e requirements. Employees of DHH$ do not conduct inspection8 or analyze data before a cer~ifiea`[e Js issued. The Muni¢ipalib/ of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOAC¢21 Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST I A. WELL DATA Well type Log present (Y/N) Total depth If A, B, or C, attach ADEC letter. "~ ~:;~ Date completed ~7-7 Cased to '-7 7 ADEC water system number ~J/A / 0/~ ~ Driller ~ ~'~//~.~ ,~'~ Casing height. ~ ~ ~ Sanitary seal (Y/N) Date of test Static water level Well flow Pump level Wires properly protected (Y/N) ~/¢' % FROM WELL LOG AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ ~ '~ ~ Absorption field on lot &- /"~ ~ Public sewer main '/L~/r~r'- Public sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform 0 Date of sample: ~/~'/~/ Nitrate ~ (-.~, Ia Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA //~d~,,~, ~ .,,,.~q-~_ Date installed . :,~7/;~'(/~ C eanouts (Y/h):'::~L, ..~':-.. Foundation cleanout (Y/N) ~ Depression (Y/N) High .ate ',' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s)oniot ~/.~:~:':~:~ Onadjacentlots /~ / Foundation To property line Absorption field / ~ ~ Water main/service line Surface water/drainage 72-026 (Rev. 3/01) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in §allons Vent (Y/N) High water alarm level ./,"~ ? Meets MOA electrical codes (Y/N) y~'~ "Pump on" level at Manufacturer Af, J Manhole/Access (Y/N) ~. r "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot / ~¢'¢ ! On adjacent lots Surface water D. ABSORPTION FIELD DATA ~ ~..~ Date insta,,ed 7/~ Length (¢' (~ Width Total absorption area 40 O Depression over field (Y/N) /',J Results (pass/fail) ILl PeroxMe treatment (past 12 months) (Y/N) Soil rating O Gravel thickness 5; ~//~ System type G --!U Total depth Cleanouts present (Y/N) Date of adequacy test for ~/A If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /~ ~' / On adjacent lots //~/ / Property line //-) To building foundation 3: '~/ To existing or abandoned system on lot ~ ! On adjacent lots 7 /~-~) ( Cutbank /'--J' /A Water main/service line Surface water ~) /~ Driveway, parking/vehicle storage area ~ '7 / Curtair, drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Engineer's Name HAA Fee $ /?(~, ~7~ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 ~'~..~ MUNICIPALITY OF ANCHORAGE ~.~.~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION* DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date /o -/O -L~ 5~ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) (c) Applicant Name /-/~/c,,~ i,~./~d~-~,~,~ Telephone: Home ,- Business Applicant Address Applicant is (check one): Lending Institution I-I; Owner/builder []~/; Buyer [] ;tJther~''x (explain); (d) Lending Institution Address Telephone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family [~lulti'Family [] Number of Bedrooms '~ ' Other WATER SUPPLY Individual Well ¢ Community [] Public [] Note: if community weli system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite/~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-o25 (1 ENGINEERING FIRM PROVIDII~....~iNSPECTIONS, TESTS, FILE SEARCH, D.8,%~,~ AND INFORM,~TiON ~. : As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation ol Ih~=, t~e~ii~" ~,uthority Approval shows that the on-site water supply and/?r wastewater disposal system is safe, fu nctional an~ ad~:cl[J~ for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Mun'icipaiity 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 ,4E'(.~' Telephone ~ ! ,~o 5'o Address /.ZOO ~,1 3 ~rd Av~ A,~cA,:,,-,? e AK ? q' $-o I Date Engineer's Seal Approved for ~'¢/(~"/~) bedrooms by /~./ ~:~r~V;~conditi/o~al Approva~isappr°v'e~//' Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval c~'tificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11 ~84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 1985 WELL DATA Well Classification Well Log Present ~)N) Total Depth ~ ~ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit Separation Distances from Well: If A, B, C, D.E.C. Approved (Y/N) Date Completed /o - 2-V ~ G~/ Yield ~- 2r Depth of Grouting -- /3? Pump Set At -- Sanitary Seal on Casing (~N) Depression Around Wellhead (Y/~ To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line -- Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date /'~ - B. SEPTIC/HOLDING TANK DATA Date Installed //- Standpipes Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well / To Property Line To Water Main/Service Line RI'- IO Size /~o~ No. of Compartments ~ Air-tight Caps ~q) Foundation Cleanout ~5~) Date Last Pumped ~ ; for ' ' Temporary Holding Tank Permit (Y/N) To Building Foundation /~/ To Disposal Field To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(1~/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /;./~ 3 © -- Width of Field 2. ~ ~ Square Feet of Absorption Area 2~ o,c, L3' Depression over Field (Y/~_.~. Results of Last Adequacy Test ~ - Separation Distance from Absorption Field: To Water-Supply Well ,/ 5- ¢%. To Building Foundation 2- .5~ Lot ~ To Water Main/Service Line ~' T ! 0 To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field ~5- ' Gravel Bed Thickness d" Standpipes Present Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~ z- .70 To Cutbank (if present) ~ T D.~r.,., LIFT STATION Size in Gallons ~ "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments ~ Dimensions Manhole/Access (Y/N) '-~~. "Pump Off" Lev~ -- ( ) .~..~...~~ Pu~acy Test. Meets MOA I certify th,~e checked,~ verified, or Signed ' ~'"'~'-~"~' -~'~,¢-¢¢'¢"~ --"-~ ' Date ** Check Permitted Bedroom Rating Against HAA Request ** conformed to all MOA and HAA guidelines in effect on the date of this inspection. MOA No. f Company ./'/~- Receipt No. Date of Payment / Amount: $ ~2.,~'. (~ 0 Page 2 of 2 72-026 (11/84) JUL 08 ~91 14:1~ MTL-~MCHOR~E 907 ~74-~64~ P.B×B NORTHERN TESTING LABORATORIES, INC. ~ INDUSTRIAL AV~NU~ FAIR~J'JI~, ALASKA ~701 (907) 4~6-~t8 * FAX ~5 ~ FAIR~K,~ ~TREET ANCHORAGE, ALA~SKA ee,,5(~ (~o7) '~77..8378 · ~'AX 274-~t64~ RECEIVED d~.L 8 19~ b~unicip~l~y ,5'?/:\ncho~age Dept. H~,alth & Human Services