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HomeMy WebLinkAboutLILAC PARK BLK 1 LT 8 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Envlronmenlal Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~a~ / DISTANCES SEPTIC ABSORPTION Address TAN K FIELD WELL Phone(s) Permit No. # No. o, ogres WELL Township, Range, Section ~S-BUILT DIAGRAM (Show location of well, septic syslem, property lines, foundation, Manufacturer CapaCll, in gallons TYPE OF SYSTEM ~ TRENCH ~ BED U W. DRAIN U OTHER Fiml .dded above original grade Gravel dep,. beneath pipe -- Gravel length ~ ET ~ F~ Total absorption area Distance between lines Number of lines SoiJ rating ~ PRIVATE ~ OTHER ~ldentifv) ~ssilicalion (A.B,C) Total Depth I Cased '0 ,Tm FT Inspections PeHorme~ by: Municipal and State guidelines in effect on this date: 72-013 (3/85) Drilling Permit ,No. ~ LOCA;ClON OF WELL (Pleaee complete either la,'lb or lc.) A.D.L. No.' '' Ia. Borough -' Subdlvlllon Lot Bock ~ '1/4~ re' Ra~ .. N~ I~ DISTANCE AND DirECT ON FROM ROAD INTERSECT OHS 2'WELL lOG ' ' ' ' ' 'Feet Beow 4 ' 9, FINISH OF WELL= ' ' ' .., =f~ .' 16. WATER W/LL'CONTRACTOR'S CERTIFICATION: '.~. ' -- ' ' - 15, Water Temperature · o ' 0 F ~ C ' Thl~e[l wos¢ri~Lp4~nder~y~ri¢dlcllon¢pd this report Is true t ' ' ' ~pxno ~rz~zng ~ ~,n~erprzses ~L~,~f my knowledge and belief; Eegislered ~us(ness Name Conlrecl License Number P,O,~ox 11~96 ~chora, ge, ~ 99511 Author~d Representolive ' t c % ~.),?~.',/ J:::'h(:)r'Jc-:.) :i ~t 4 (El '"' (:~ '7 E~ 9 ! '-I :,i"i::.C:T :1: CiN .(!il ¥ I'I'IE: I!ii:l'.l~ :1: htliiCEi]'~ ,, I Fl ]: ~ii~ I:"l:i[l:;J"t :1: I J: !ii~ :1: !:3~l!.)l:!i:D I::: I.]1':;: I I"IE i:::'l~i31::'L3~iiiliii:L) 4 ].:?di~:DF~:L:)13I'! S :l Iq[3l,.l~:: F' F~I'! :1: I,,..Y .!:)k'-~l:i!l.,..I,... :1: I'iE~ t3NI2'/ [:~lxl~::) I!i[Xl:::' :t: I:~:E:S DN .i. ~::'. / :::!, :L i Fry '1'1"1~.~ I ~ ~NJ].:L :i.l"~'~'.~:l.]. 't,,i~(~):, ~[y~F?..(:91i') :i.l"l ~C:(:::(:)¥'(::J~algC:~:~ ~NJ.'l:.h ,:~:~].~ 1"1(3~::1 (:::C)C:I~ and ~,~:i.].]. ~:u::ll'~al'"i~,:. 'LJ::~ a:l.], I¥JCI[.~ al'~(::l f.[H:.oC(.:,:~ (::){ ~,~:l.a~d~l-::a P~:~qL~:Lr'emeff'vL~ for' J~;~:q,.r:'~ '~[:~(~ ~y~'kC)lil C)I'i 'l:.J'"l~,~Ji Ctl'~ .~u'ly a~(::J.ja'~c::~,~.ffTk OP I'l~a~r'[:)'~ ~,:~ n :!. a r. g ~:~ m e n t. ~ :L :t. ]. r'F, qu :i. r' e:~ a r'i a d d ~ '1:. J. c~ r'l a :1, p ~.:~ r' m :i, 't .... ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite.B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET CALCULATED CHECKED BY SCALE / // OF DATE DATE ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO. OF CALCULATED BY DATE CHECKED BY DATE SCALE / ~.~- ~ JOHN HAGMEIER COMJ~ANY ~ ~ e~ 2204 CLEVELAND AVI~., SUITE 2015~; '~ ANCHORAGE, AK 995~17 ~ -- N8~o58'10"~ LEGEND O LOT CORNER '~%~)1~ DRAI NAGE ARROW X SPOT ELEVATION ?5. 00' 1o' ,~1¢c. ~ 7'ele¢o,,T/. /. G ~SAc. TH. SCALE I"-': 50' REiD, JR, -2251 ~TUM ~HOWN MEETS ALL ~UBDIVISiON COVENANTS ~Foa~*rto. SHOWN IS FRO. RECOaOEO ~~ [ ~o, ~, ~OCK DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST · PA ~ / ~ q . DATE PERFORMED FOR: / LEGAL DESCRIPTION: /. ~ G / / //~. P~ /~ ~ Township, Range, Section: 1 2 3 4 5 6 7 s 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT O DEPTH? E Deplh to Water After MonilorinD? ~' '7 Date:/°/9//¢~ Gross Net Depth to Net Reading Date Time Time Water Drop O ' : .... ~,~ ,Off- ......... /o ~:~ ..... ~','~ , o7 . PERCOLATION RATE TEST RUN BETWEEN , . (minules/inch) PERC HOLE DIAMETER . - FT AND ~'~_FT PERFORMED BY: /- ' ~ 'c~ I / ' /~'-. ' ~'r' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: / 72-008 (Rev. 4/85) ALASKA nUIRO m BTAL CONTROL $ RUIC $, InC. ~r,:linemn§ 8- ~nuironmenlul Sludies .o. ~,}], W",:TVh',\'T!~ . , A.)...., SYST'T:~T .X(],\i. ~,, :. c,: ...... f} i ],2 1,5 2,0 9 . '! ,3 2.i ;2.5 '_~c coitdi(io!~s o~ the ~)c~PJllJL, ;31!(~ a~1 ~pp?_~-~'.}}]e !'tt~':~ ai:d pr,~Gu=Ftt~ol:s iir Lhe Jils~allLt[lJ011 Jr,: ~:¢)t :Jnspc. ched b~ an AEC:-; np,~fii!r:mr, ,"~i(:S t,~]] COIlSL!~EUd p~'iOf tO COI~Sti?UC~i[H], i0 (]~t'F~PR!Jii{~ ~!0 iiLl~l!'.)t':/' 0¢ q .o..!C :"p,[(.l bua. rd insulitt~on. tho ~tl)Sol'})LJo!l al'el! 1200 ~est 33rJ Auenue, Suite [~ · Anchoroq¢, Alosk 99503 · [907) 276-1361 2 7 3 Q 3.2 3.G 3,8 septic tank pet' AnchoraSe Tank and WeldJns. Tnc, drx~isn, S~,e att~?h(:~d spec [f~ c~l:~ ohs. P~IINS hlade to JlISHFe that tile bottom ]!as not been contpactcd clu!'ing excax~aiiini'l. ;'Pq~lJl'.e,lelllls of HOA r:ode i5.G5.077. The dislr:ibuLion pipe shall be perforai:od ,i-inch ri{fid PVC w:lth a minimum as drain~:ield pi,m, iJ] p~pes shni[ he laid levci, and spaced accord:inS to the dPat,:iugs. 10p .4-ilion ]-igjc] PVC Asq'}~ 13-30S4, o1' cast iren. Tl~e Re~iiioi} $]H'~ql wiih sicle~ nf the pipe. or ~t SeCt. JOl~ Of re~{ll]ap perforated ~-;e~,'(~' !}~]'m may clamped Lo the solid seci:[on wi~h a Ro-ht!]) cotn)iJil~{ or {.;r}]~;,Tilk .jo]ill. P~-pfopated secllinn shaJ] lOC ]ocatr'd iii gl'~IVC] 011~¥, !'hr? pQY'{ {o!q ~3f pipe equivalenL) sh~l] ])e pieced over tho trip o:[ ?he Tho ~-;~Ho ',;!ope oF tb',~ mound :;hrt]} lm sloped J ?cml: vertical Lo ,q rook i'nrixonia! . lie ~]'asR, .2 {nlandpJpes. and dJstFiloin~on pipn. t:o venery ?'oppP installation and pns{tJon o~ !?~pes p~'iof ilo backfill. Tim thii'd Jil!~]?ection wi?] he alton fi!'la] backfJ1] anrl ,.?ad~n{l to enzu!'c Multiple Listing Service, Inc. © Rev. 6/85 EARNEST MONEY RECEIPT AND AGRE/EMENT TO PURCHASE This is e legally binding contract. Read both page,_and 2 carefully before signing. Date Sept 13, 1988 LOPhone 563-5500 SOPhone 563-5500 B. Mehner & K. Enqland ,~/ Listing Office Jack White Co Agent B. Mehner f~ SelllngOfflca Jack White Co Agent. RECEIVED FROM John Haqmeier sS# , *'~ ' The sum of _ _.~,[~~-.~.~' =~-_.-t4.~-~-!"'r3.~ ..... Dollars ($ ~ ,~'...~O~. "~ ' in the form of check for $ 'zn"+-~ cash for $ , other , note for $ , due no later than to be held in Trust by: _ JWC as earnest money on and part payment for the real property ~nd improvements situated in the ._..~Rchor a _Qe RecordlngDistrict, State of Alaska, (!escribed as: .1,.t ~,, block 1~ I,:[.lac Park .qubd and ail fixtures and equlpmsni attached to and a part of the above-described property. DOWN PAYMENT (including earnest money shown above) .............................. $ BUYER shall apply for a loan in the approximate amount of ........................................................ $ BUYER shall assume Seller's loan of approximatdy .................... $ BUYER to execute a Deed of Trust and note in the approximate amount of ................ $ payable at $ , or more, per month including % interest per annum for years payable to TOTAL PURCHASE PRICE ....................................................... $ COSTS: The costs designated below shall be paid as indicated by Buyer (B) or Seller (S): (~.ash at f~st~ draw ITEM Bank Service Fee Commitment Fee Credit Report MIP/PMI Appraisal Survey Est/Replace Reserves ITEM B S Recording Fee Owner Title ins. ALTA Title Ins. Warehouse Fee Discount Points Tax Registration Eft! ITEM Assumption Fee Assump. Transfer Fee Bank Set-Up Fee Annual Escrow Fee Escrow Closing Fee Assessments Well/Sap. Inspect. Fee B S ITEM Smoke Detectors HOA Transfer Fees Well Flow Test VA Funding Fee Br°kerage Fee °thar / T IOrher · ~ ". ' · Additional Terms and Conditions :'~' .... : ~ubiect to orooertv oass~n~ a ~erco].ation test an'd bein~ ..... ',~':..approved bytthe MunicJ. palit¥ of Anchoraqe for septic system, i!. Sub4ect to Buyer cominq to terms with orospective Buyers ' ' ~ for a home to be bui].t on It 8. block 1. Lilac Pa~k. This ';:. contingency to be removed by 30 S.eot. 1988.~ · :::..::. - .. ,~.~o,~¥-..~c., k_..~k~.~,..~,,.,CC'v/ · ,.),[ If well depth exceeds--]:,~-,,:~, Se]~er\ to sp]zt costs with Buyer 50/50. 1. CLOSINGIPOSSESSlON.Thissaleshallbeclosedonorbefore 30 Oct ,19 88 .Possessionshallbegiv'en to Buyer: E~n dosing [] Before cio,sing under attached occupancy agreement. 2. FINANCING. Buyer agrees to apply In good faith for any necessaryloan or assumption within- - daysofSeller'a acceptance and provide all information, pay all fees and satisfy all conditions required by the lending institution for processing of loan and/or assumption application. Broker has made no representations as to availabili[y of any loans or tne~ Interes~t rates. In the event Buyer fails to obtain a loan commitment, th rough no fault of his/her b~,~, Wi[bin .... ~' ........ ~ d~.~,~'irom {l~'~l~te of this Agreement, the earnest money will be refunded, except for direct cost incurred in.process ng the.application.. When a. commitment is obtained, - additional days are allowed for closing. If purchase is not completed within specified time, earnest money shaft be forfeited by Buyer. 3, BROKER INFORMATION. Buyer and Seller authorize any lender to furnish Broker and Agents with closing statements or other information upon request. Buyer and Seller authorize all lenders, escrow agents, and. appraisers to furnish to the Listing and/or. Selling Ag ants on request any and all information and copies of docum ants conce ming the status, progress and final disposition of loans, credit, appraisal, closing, conveyance and any other matter related to this sale. 4. DUE ON SALE. If any existing loan contains an acceleration or "due on sale" clause, the lender will demand furl payment of the entire loan balance as a result of this transaction. 5.. CLOSING DOCUMENTS. Buyer and Seller agree to sign all necessary closing documents and perform the conditions required by the closing agent and/or any financing institution. "'- DEPT. OF HEALTH & ¥/Buye'r / Sel~r ENVIRONMENTAL PROTECT/ON ,, I ECEiYED Buyer Seller · uuyer .Seller ; EARNEST MONEY RECEIPT AND AGREEMENT TO PURCHASE Rogardlng property described as . ] c)t- R: bi ock ]; .'t i,'l.i.~c Park Subd 6. EARNEST MONEY--DISPOSITION. If either Buyer or Seller fails to comply with paragraph 5, above, then the other party may terminate this agreement and, as applicable: Buyer or Seller may forfeit the earnest money and/or proceed in any other legal manner. In the event that the Broker is-unable to determine to his/her satisfaction which party is responsible for failing to perform tho requirements of the contract, the Broker shall request the parties to execute an agreement for release of earnest money to one or the other or both parties, Broker need not disburse earnest mo'hey until an agreement is signed, Alternatively, Broker may: (a) with Buyer's and Seller's consent, submit the matter to arbitration by tile Conflict Resolution Center or other agreed arbitrator; or (b) I nterplead the earnest money with the courts for determination of who is entitled to the earnest money, The Broker shall be entitled to an award, from the earnest money, of reasonable attorney's fees and costs for interpleading the earnest money, PROPERTY CONDITION. Buyer offers to purchase the property in its present condition, or on terms itemized and made a part of this Agreement, Buyer understands that Broker Is unable to independently verify the condition of any aspect of Seller's property, Including well and/or sewage system. Any representations about the condition of property are based upon Seller's representa- tions and Seller's attached property information sheet. Both Seller and Buyer hold Broker harmless from representations :contained in this Agreement or leading to sale. In the event any improvements on the property are destroyed or mated ally damaged prior to closing, this contract shall, at Buyer's election, immediately become.null and void and earnest money shall be returned to Buyer on demand. 8. TITLE. Seller shall convey title by statutory warranty deed, and will provide proof of marketable title at tlr~o of closing by a preliminary commitment to issue title ins urance, Title shall be clear of encumbrances except conditions, restrictions, reservations and rights-of-way, easements and covenants of record. 9, PRORATION. Taxes, interest, Insurance and prepaid rents and Home Owner's Association fees, if applicable, will be Pr°'rated as of the date of closing. Security deposits shall be transferred to Buyer. 10, ASSiGNABiLiTY. Seller's acceptance of this Agreement is based upon Buyer's apparent ability to qualify for this purchase within the agreed time and according to the agreed terms, This Agreement is not assignable without the express ,':dtten consent of Seller, , 11, BROKER. It is mutually agreed by all parties that the Brokers shall not be held liable in any manner whatsoever for damages ,. arising from defaults or acts by or upon the part of either party to this agreement, Buyer acknowledges that the Broker represents only the Seller, and not th~ Buyer. 12, SQUARE FOOTAGE, Brdl~er makes no representations as to the sq ua re footage of the improve merits or land, If this is important to the Buyer, the Buyer rn~ust independently verify or measure tho square footage. · 13, CODE SAFETY COMPLIANCE, Broker makes no representations that house or other improvements meet current building code safety or other requirements. Broker shall not be liable for the cost of any work necessary for Building Code requirements, 14, ENTIRE AGREEMENT. This document and the referenced attachments if any consisting of 2 pages contain the entire Agreement between the parties. It may not be modified except in writing and signed by the parties. 15. PERIOD EXTEI~ON T me Is the essence of this contract but either Broker may, with written notice, extend for a period not to exceed -~ :) days the time for the performance of any act hereunder except the time for the acceptance hereof by · Seller. NAME OF SELLING OFFIC~,,~ ~ Jack _W.h it (~ DATE 9 ./13 / ~-87'"'~ ' ' -TIME 2~1 ...... ' AGENT PHONE 563-5500 i/we agree to purchase and pay for. the above described property on the terms and conditions herein stated. Receipt of a copy of this Agreement s hereby acknowledged I~e understand t~s is a legally binding contract. Said Agent is granted the exclusive and irrevocable right for 2 days from date~n an acceptance of this offer failing wh ch earnest money depos t shall be returned, BU~~ ~~-z~~ BUYER P~ to be on closing documents: ADDRESS PHONE: Home Office. SELLER ACCEPTANCE, I/We accept the foregoing offer and agree to sell and convey the property described on the terms and conditions herein stated. I/We understand this is a legally binding contract. If the sale is not completed, INVe agree to pay for preliminary title report. Seller's Disclosure: Seller certifies that there are no known problems with: the well, if applicable; the foundation or basement walls; the roof; the septic system or sewerage system; the heating or plumbing; drainage in the yard; the fireplace; water in the crawl space; or other except as noted herein, TAX ADVICE. Seller acknowledges he/she has been advised to seek counsel of a tax attorney or Certified~Public Abcountant for income tax consequences of this transaction. // COMMISSION /We agree to pay forthw h at closing to the above named Broker a commission of $ ,,',,z_ /- / ?.-/ for services in this~ranssction. In the event of a'for e lure of the deposit as above provided, the sa d depos t shall/be pa d to or rata'ned by the real estate firm to the extent of the agreed upon commission with residue to the Seller. I/We authorize said real estate firm to pay out of the cash proceeds of sale the expense of furnishing evidence of title, of recording tees, if any, as well as any encumbrances on said premises payable by me/us at/or before closing. I/We acknowledge receipt of a copy of tl~is earneut money receipt bearing my/our signature(s) and that of the Buyer(s) named above. CLOSING AGENT. I/We hereby appoint our true and lawful attorney, to have prepared on my/our behalf all legal do~cuments necess~,ry~ to complete this tra_osaction. DATE . ~(J'~*'~- Print names a~o be on deed: ADDRESS PHONE: Home. Office DELIVERY TO BUYER OF COPY OF ACCEPTED OFFER BUYER RECEIPT: The undersigned Buyer(s) acknowledges receipt of a futly signed copy of the foregoing Agreement. DATE .'~/- , .? .~;~L TIME M. ,_BB~/~ /~. ~:. , ....... ~YER Page 2 of 2 Parcel I.D.# 1. GENERAL iNFORMATION Complete legal description MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services .... On-Site Services Section P'O' Box 196650 ...Anchorage~iAlaska 99519-6650 CERTIFICATE OF HEALTH AUTHORITY APFROVAL FOR A SINGLE FAMILY DWELLING Lot 8, Block {'Lilac Park Subdivision Location (site address or directions) 12030 Lilac D~ive off Huffman Road Property owner Mailing address Lending agencY ,~.. Tref~ Day phone 356-1971 12030 Lilac Drive, AJ'~choL-age, AK 99516 Mailing address Agent · Bonn±e Mehne Address Jack White Compan?. Unless otherwise requestedl HAA will be held for pickup. NUMBER OF BEDROOMS: 4 ':: TYPE OF WATER SUPPLY: Individual well x Community well " Public water' ' lng to the legality and status of syste.,m. TYPE OF WASTEWATER DISPOSAL: '- '-' :" Individual on-site x ' '- Holding tank - ' Coh~rnunity On-site "" Day phone , ._ -. Public sewer NOTE: Day phone 762-3t71 72-025 (Rev. 1/g1) Front MOA#21 ' ' ' ' ' NOTE: If community well system, provide written confirmation from State ADEc attest- .,'-' .,,:V. !. I¢.I,, ,,, ,. ,' ~;~ , - · -'~', ' '.;~ ~-/~ ,' If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply an d/or wastewater disposal system is safe, functional and adequate for the number of bedrooms an d type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance .with all Municipal and State codes, ordinances, and regulations in effect on the date of tills inspection. Name of Firm ~virom~enta]zTMana~ement. In~7 Phone ?7?-9336 Address 206 E~. Firewee/~T~3ne, / - / ~ ~' ~ ,,~,~. ., .,.. . ~ ~ John E,r[ Simpson ~,~ . DHHS SIGNATURE.. ~ -~.,.~..~ " .' ~. Approved fo~ Di~pproved Conditional approval ~or bedrooms, with the following stipulations: Additional Comments ('~he Mun,d~lpal~,~.~nchorage Department of Health and Human Serv ces (DHHS) i~ues H~ th Author ~"" :.~roval Ce~ifl~bas~ only upon the representations given in paragraph 5 above by an independent '' "~r~(~al e ~¢~ registered in the State of Alaska. The BHHS does this asa cou~esy to purcha~B of hom~ and their lendih¢ i~stitutions in order to ~tis~ ce~ain federal and state requirements, Employes of DHHS do not conduct inspections o'F'anal~e data before a ce~ificate is ~ued The Muni~i,p~li~'~Anchorage is not respons b e for e~om or °m ~i°ns'in the profe~ ona eng n~s work' ': .'..-~-: -~ ~ ~.:.':'.,'~'~'~.~:'~.';~ i"-; 7 - ' ..~; ::~;: :.: Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 8, Block 1 Lilac Park S/D A. Well Data Parcel I,D. Well type Private If A, B, or C, attach ADEC letter. ADEC water system number N/A Log present (Y/N) y Date completed ] ?,/7/8S Driller Alpine Total depth 193 ft. Cased to 193 ft. Casing height 28 inches Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y FROM WELL LOG i2/7/88 Date of test Static water level 126 ft Well flow 20 Pumplevell 185 ft SEPARATION DISTANCES FROM WELL TO: 123 ft. Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ATINSPECTION 9/16/94 114 ft. g.p,m. 6.6 g.p.m. unknown ; On adjacent lots 100' + 143 ft. ; On adjacent lots 100' + 100 ft. + Public sewer manhole/cleanout i00' + 100 ft. + O Petroleum tank none observed WATER SAMPLE RESULTS: Coliform 0 colonies/lO0 ml Date of sample: 9/16/94 Nitrate O. 32 mg/L Collected by: Other bacteria Simon Schroeder 0 colonies/100 ml ri. SEPTIC/HOLDING TANK DATA Date installed 11/18/88 Cleanouts (Y/N) Y High water alarm (Y/N) Date of pumping /2~ Tank size 1250 gal Compartments 2 Foundation cleanout (Y/N) Y Depression (Y/N) N/A Alarm tested (Y/N) N/A / ¢) 0)/¢ Pumper /~jf ~ d ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 123 ft. To property line >58 ft. Surface water/drainage On adjacent lots 168 ft. + Foundation 49 ft. Absorption field 13 ft. Water main/service line >10 ft. > 100ft. 72-026 (3,/93)* Front CONTINUED ON BACK PAGE 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 Manhole/Acoess (Y/N) "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 installed Length 54 £t. 11/18/88 Soil rating (GPD/FF) 0.75(201ft2/bdrm~ystem type Bed Gravel thickness Cleanout present (Y/N) y Results (pass/fail) Pass 2 inches Width 24 ft.., Totalabsorption area 1296 ft2 Date of adequacy test 9 / 16 / 94 Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) N 1 fit Total depth 4 ft. Depression over field (Y/N) for 4 After test 5 inches If yes, give date N/A N Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 143 ft. To building foundation 61 ft. On adjacent lots 75 ft. Sudacewater none observed Curtain drain n~,',~ nh~p rvpd On adjacent lots >180 ft. Property line To existing or abandoned system on lot Cutbank N/A Water main/service line Driveway, parking/vehicle storage area 1 E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or cc/nnformed to all MOA and HAA guidelines in effect on the date of this inspection. Engineer'S Na/me John ,-E/~./S'~ii~p s on, P.E. Date~, ~'/~ ~ ~ - HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number John Earl )son ~q'~ C~--8C61 ,'~' :;.7 ', , r .r' 72-026 (3/93)' Back CT&E Ref.# Client Sample ID Matrix Commercial Testing & Engineering Co. Environmental Laboratory Services ~r~-,e-.~c'~~,~'~'~-~g~,;~'..~:~-,~-~¢;~-~-~. LABORATORY ANALYSIS REPORT 94.4770-1 OUTSIDE FAUCET WATER ClientName Ordered By Project Name Project# 6298 PWSID UA ENVIRONMENTAL MGIvrr INC (EMI) SIMON SCHROEDER WORK Order 82340 Printed Date 09/21/94 ~ 13:08 lu's. CollectedDate 09/16/94 ~ hrs. ReceivedDate 09/16/94 ~ 15:00 hrs. TechnicalDirector STEPIq~N C. EDE Released By:~...,~.~ Sample Remarks: ROUIIi'rE SAMPLE COLLECTED BY: SIMON SCH1/.OEDE1L QC Parameter Results Qual Units Method Allowable Ext. Anal Limits Date Date /nit Nitrate-N 0.32 mg/L EPA 353.2/300.0 10 09/19/94 CMR * See Speciat Instructions Above ** See Smnple Remarks Above U = Uudetected, Reported value is the practical quantification limit. D = Secondary dilution. UA = Unavailable NA = No t Analyzed Lq'= Less 2hmt Gl' = Greater 2hah 5633 B Street. Anchorage. AK 99518-1600 --. Tel: (907) 562-2343 Fax: (907) 561-5301 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # (~.Z..,~_ ~ \\_ ~-Zk.~ HAA # GENERAL INFORMATION· Complete legal description ~'-~/' Location (site address or directions) I~0 Property owner Mailing address Lending agency Mailing address Agent ~j~r-~ ! / Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Day phone Day phone .~-~/~/ Day phone TYPE OF WATER SUPPLY: NOTE: Individual well / Community well 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. 1191) Front MOA fl21 m, uewwoo leUO!j!PPV :suop, elndljs 8U!MOIIO~ eLIJ ql!M 'swooJpeq "9 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L.~, %l lILAC ~'AgK. Parcel I.D. A, WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) _ If A, B, or C, attach ADEC letter. ~" Date completed // Cased to I~2 ~' ' Date of test Static water level Well flow Pump level FROM WELL LOG _ i~' 7 /8,¢ ~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 1~3' To ¢.o, Absorption field on lot tqH~ vo C.o, Pubtic sewer main ~lOO' - Public sewer service line ~/oo · ADEC water system number ~ ~ Casing height Wires properly protected (Y/N) ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform (~ co ( / (co/h/_ Nitrate Date of sample: ~/~'[/9[.~ 6'/f7 (~! Collected by: Other bacteria SEPTIC/HOLDING TANK DATA Date installed II / ~ d ~¢ Tank size Cleanouts (Y/N) Y Foundation cleanout (Y/N) High water alarm (Y/N) ~,/~, Date of pumping o~/'ll Compartments Depression (Y/N) .Alarm tested (Y/N) ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~,' ~'¢.~ ¢.o, On adjacent lots ~/o~¢ Foundation 35' Topropertyline ~,9'~¢ Absorption field IHt ¢,0.'r~ Co, Water main/service line Surface water/drainage ~ 1°O~ ~'~% ¢d C. O, 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE 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 Manhole/Access (Y/N) "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 installed II / i¢ / ,¢ ~t Soil rating ~_o ¢ ~'¢'6'~x,',~ System type Length ,5'¥ ~/ Width ~ ~' / Gravel thickness I' Total depth Total absorption area / ?--~' c/' L~ Cleanouts present (Y/N) Depression over field (Y/N) N Date of adequacy test Results (pass/fail) ?¢~.¢ for Peroxide treatment (past 12 months) (Y/N) ~ If yes, give date bedrooms SEPARATION DISTANCE F/ROM ABSORPTION FIELD TO: / Well on lot JqqJ To building foundation On adjacent lots 7,5' ¢ Surface water ~ /oO c,o. On adjacent lots ~'/00 Propertyline f _(ct F~o~. C,o, To existing or abandoned system on lot Cutbank ~, ~' Water main/service line Curtain drain NoNe Driveway, parking/vehicle storage area ~/co' 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. Signature ~~ Engineer's Name '7"'/~ Date ~"c4~ ¢_ HAA Fee $ ./~("~, c'~) Date of Payment ~/2 '_~,?~ ~//' Receipt Number ~,, ¢~-~ O 72-028 (Rev. 3/91) Back MOA 21 '~ · THEODORfi F. ~OORE ~ ~,.>... ~ CE 0089 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL 'rESTING & ENGINEERING 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ~I M,L~ ,, i~':P01~,'' ~,Y . ,d. I:, ,~ Y;~?,?,ord<,:, ~" 1):d:e '&:po~:t ~rintml: JIHJ 5 91 q 1.6:2!~. FAX: (907) 561-5301 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMA'rION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, .township, range) Telephone (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here'S, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE /- Single-Family"~ Number of bedrooms 3. WATER SUPPLY Individual Wel~' Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site'CC. Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 {Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, lverifythat 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 syste~n is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ,~"d.~' Telephone Address /¢/2~ ¢~ ..,~ ~ ¢~¢' /¢¢-,,,,/~/ ~ 6. DHHS APPROVAL Approved for ~' bedrooms by Approved ~/~ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services(DHHS) issues HealthAuthorityApproval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHSdonotconductinspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88)Back Page 2 of 2 A. WELL DATA Well Classification Well LogPresent r~N) Total Depth /~ Cased to Static Water Level _ .//"~ Casing Height Above Ground ,/ Electrical Wiring in Condui[~'4) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ////~ To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results ~ MUNICIPALITY OF ANCHORAGE (MOA) ,~C(~,~¢~.=~ ANO-~O~,f'~[ta,l!h Authority Approval (HAA) rcu,~ ..... ~F_RvtC~S O~V~ECKLIST - FEBRUARY 1984 ~ON 343-4744 Legal Description: If A, B, C, D.E.C. Approved (Y/N) Yield ,¢o ~/~,,~ Date~ Completed /~. /~-'~ Depth of Grouting Pump Set At /J/,~ Sanitary Seal on Casing(~) Depression Around Wellhead (Y(~ ; On Adjoining Lots /':f- ~" ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Comments B. SEPTIC/HOLDING TANK DATA Date Installed ///-/¢¢'-¢'~' Size Standpipes{~N) //_..-~'"o No. of Compartments Air-tight Caps(~N) _ Foundation CleanoutC~N) Depression over Tank (YN~'~ ./ Date Last Pumped Pumping/Maintenance Contact on File (Y/N)./ ~/A ;for ~/~, Holding 'Ta~j~h,~ter Alarm (Y/N) ~ Temporary Holding Tank Permit (Y/N) _ ~ ~, ,, ~.~ ~,~ SE~T~]~$~¢~$ FROM SEPTIC/HOLDING TANK: T?~[Dr-~¢~l~,-E~i~' j ; To Building Foundation ~ -,%.;* ~- ~'~ ~;~5~'4~~ ~, : :, / ~0. ~,¢~Oe¢[~fi~t~"'~' '" L ~ % To Disposal Field TO Strea'm, Pon-d,"~ke oCM~jor Drainage Course /¢¢ ¢ Comments, .~ ,...", ~ .¢ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed {/-/~"~ Width of Field Z-~S/ Square Feet of Absortion Area Depression over Field (Y~,~ Results of Last Adequacy Test ,,d/~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field .:¢'¥' ' Depth of Field /,~' Gravel Bed Thickness Statndpipes Present (~N) Date of Last Adequacy Test ; On Adjoining Lots To Cutback (if present) ,,,,~/~4- / / /¢,-¢ ,¢-- / To Property Line To Existing or Abandoned System on /0 Comments D. LIFT STATION ~ Dimensions Size in Gallon~'------~ Manhole/Access (Y/N) "Pump On" Level at "---"'-'-'-----~_ "Pump Off" Level at High Water Alarm Level at ~ Vent (Y/N) _ Tested for ~"~'~'---~_.~Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) ~ ~~ Comments inspection. Signed Company Date MOA No. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Wozk Ordoz ~ 12614 Date Report Printed: APR 13 89 8 09:07 Click; Sample ID:LB, Bi, LILAC PARR PWSID :UA Collected APR 7 89 0 11:i0 hfs, Reeeivad APR ? 89 @ 13:20 hrs. Preserved wi%h :AS REQUIRED Client Name : A E C S Client Acer : AKECSNP P.O.# NONE REC'D Req ~ Ordered By : A. MIEN Analysis Completed :APR 10 89 Send Reports to: Laboratory SupeL~so~PHEN C. EDE I)A E C S Released By : ~~, ~ 2) Special Instrust: Chemlab Ref #: 4813 Lab Smpl ID: I Matrix: WATER Allowable Parameter Tested Result/Units Method Limits NITRATE-N 0.19 mS/1 EPA 353.2 10 Sample ROUTINE SAIPLE. Remarks: SAMPLE COLLECTED BY i Tests Performed ' See Special Instructions Above UA-Unavailable ND~ None Detected *' See Sample Remarks Above NA- Not Analyzed LT=Less Than, GT~Greatsr Than