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HomeMy WebLinkAboutLAKEWOOD HILLS LT 5 Municipality of Anchorage Page I of 5 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: SW990068 PID Number:' 015-312-1 0 ,ama: Wastewater System: [] New ~ Upgrade Byron & Diane Wilson ^d~ress: ABSORPTION FIELD 7145 O"Malle¥ Road Auchoraoe. Ak Phone: I No. of Bedrooms: 346--2010 4 X3 Deep Trench F] Shallow Trench []Bed r-[Mound []Other I LEGAL DESCRIPTION ~oi, Rating: Total Depth from original grade: 1 ~ GPD/Sq. Ft. 1 4' Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 5 Lakewood Hill~ 6 Ft. 7_ q & R Ft. Township: I Range: I Section: Fill added above original grade: Gravel length: I I None Ft. 3 6 Ft. WELL: [] New [] Upgrade Gravel width: Number of lines: Distance between lines: 3 Ft. I N/A Ft. Classification (Private, A,B,C): Total Depth: Cased TO: Total absorption area: Pipe material: Ft. Ft. 555 SQ. Ft. D3034 Driller: Date Drilled: Static Water Level:Installer: Date installed: Ft. Chuck's Backhoe 4/29 & 30/99 Yield: PumpSetat: CasingHelghtAb0veGr0und: TANK - EXISTING GPM Ft. Ft. SEPARATION DISTANCES = Septic [] Holding [] S.T.E,P. To Septic Absorption Lift Holding =ubl[c/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Greet 1500 Material: Number of Compartments: Wel~' 133 ' Steel 2 Surface LIFT STATION Water 1 00 ~ + Lot Size in gallons:I Manufacturer:. Line 10 ' I "Pump on" level at: I "Pump off" level at: High water alarm at: Foundation 1 0 ' + I Cu~ainDrain N/A Pump Make & Model Electrical Inspections pedorrned by: Remarks: BENCH MARK Location and Description: Absorption Field Upgrade Only. Corner of notch in front of front. Existing Sent'lc Tank Int~_or~v door. t Assumed Elevation: Verified as OK, Divert~r v~]v. 100 installed to access old trench at future date. ~%_ U~' Inspections pedormed by: Pinard Encj'ineering Dates: 1st 4/29/99 9...'"~-'~ ~.~~eo o 2nd 4/30/99 ~.~[~ ~ui fi. ~i.ara Department of Health~_.and Hqmar~ Services approval ~.~,,~...~ Reviewed and approved by: Date: O--. ~O .~ ~/~ROFESS~O~,, ~-"~:~ 72-013 (Rev. 9/91) MOA 25 Permit No. St~990068 Page 2 of 5 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: Lot 5, Lakewood ]{ills PID No.: 015-312-10 72-O13 A (Rev, 9/91) MOA 25 lOT 4 © ;O 0 1TI 0 Z LOT 6' Z Jo °t TEST HOLE# 2 DATE:4/30/99 JOB NUMBER: 99-013 LOCATION: Lot 5, Lakewood Hills FIELD STAFF: A.Wien PINARD ENGINEERING P.O. Box 871347 Wasllla, AK 99687 (907) 357- ENGR (3647) TEST HOLE LOG I PERCOLATION TEST DEPTH, FEET SOIL TYPE 7 10 11 · 12 · 13 · 14 15 16 SLOPE ~Sandy Silt with ~raCe gravel & some boulders. Sand pockets/ seams from 16' to 18' Was Ground Water Encountered? Yes /(~ If YES, Depth to Ground Water. PERCOLATION TEST DATA Time (minute) (inches) (inches) min. / inch Comments .4 Time Measurement Drop in Le'.el Perc Rate RATE .min/inch -' PERC HOLE DIAMETER _. ~ TEST RUN BETWEEN FT and FT in DEPTH %~...: PAU~ .._...~a~ COMMENTS; ?ti to verify BOH 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 995'19-6650 (907) 343-4744 MUNICIPALITY OF ANCHORAGE On-Site Services Program ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Parcel ID: 015-312-10 Permit Number: SW990068 Legal Description: LAKEWOOD HILLS LT 5 Design Engineer: 0811 Pinard Engineering Owner Name: Bryon & Diane Wilson Owner Address: 7145 O'MALLEY RD Date Issued: Apr 23, 1999 Expiration Date: Apr 22, 2000 Site Address: 007145 OMALLEY RD Lot Size: 33660 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 Anchorage, AK 99516-1810 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: PINARD ENGINEERING Paul E. Pinard Registered Engineer/AK & ID P.O. Box 871347, Wasilla, Ak 99687 (907)357-ENGR(3647) Jim Cross Municipality of Anchorage Dept of Health & Human Services Environmental Services Division 825 L. Street, Suite 502 Anchorage, Alaska 99519-6650 April 13, 1999 RE: Lot 5, Lakewood Hills Subdivision Dear Mr. Cross: In July, 1998, the owners of the referenced property, Mr. & Mrs. Byron Wilson, contracted with another engineering finn to have the water supply & sewer systems evaluated. The test on the sewer system revealed that it was unable to accept a minimum quantity of flow without a significant rise in liquid levels outside the operational limits of the system. The owners are now proceeding with an upgrade of this system. A testhole was dug, the soils logged and a percolation test performed. A monitor tube was installed and this afternoon, the site revisited to check on a possible watertable; water was encountered at a depth of 16.3' bgs. The testhole log and percolation test results are attached. A design for the replacement drainfield is also attached. My design specifies a "Deep Trench" system 36' long with an effective depth of 7', providing 504 sf of absorption area. The new drainfield will be parallel to the existing one and connected to the existing septic tank. The MOA specifications for materials, cleanouts and monitor tubes will be utilized for this installation. A design drawing is attached. Groundslopes in the area of the replacement system, as shown on the testhole log, are slight, presenting no problems to the installation of the system. Adjacent lots were inspected for possible impacts or conflicts with the replacement drainfield. None were found. The proposed system is located outside the minimum protective radius of any existing well. The owners have recently sold their property and are anxious to complete the upgrade of this system so that sale can be finalized. As such, your prompt attention to this proposed upgrade would be appreciated. The owners have completed a permit application and provided the appropriate fee, both of which are attached. Please give me a call if you have any questions in regards to this submittal. Sincerely, 4 Attachments(as) cc Byron & Diane Wilson, w/attach Paul E. Pinard, P.E. 0 LOT 4 LOT 6 o o Z : Otn TEST HOLE # I DATE: 4/5/99 JOB NUMBER: 99-013 LOCATION: Lot 5, Lakewood Hills FIELD STAFF~ A.Wien DEPTH m 10 12 · 13 14-- 15 16 17 PINARD ENGINEERING P.O. Box 871347 Wasllla, AK 99687 (907) 357- ENGR (3647) TEST HOLE LOG / PERCOLATION TEST FEET SOIL TYPE PT ML SM - Sandy Silt, occasional boulders, trace gravel. Sand seams & pockets below 14', grey & moist. BOH SLOPE SITE PLAN Was Ground Water Encountered? (~) / No If YES, Depth to Ground Water. 1 6.3 ' on 4 / 1 3 (No WT found on 4/5 ) PERCOLATION TEST DATA -- 4/7/99 A Time Measurement Drop in Le~l Perc Rate Time (minCe) (Jnches) (inch.) min./inch Comments 102 -- 0.67 --- 105~ 28 0.15 0.52 Refill Perc Hole 110 10 0.46 0.2i Refill to 0.68 111 10 0.4'8 0.20 Refill to 0.68 112 '10 0.49 0.19 Refill to 0.68 113 10 0.49 0.19 Refill to 0.68 114 10 0.49 0.19 Refill to 0.68 115 10 0.50 0.18 PM and 6 FT in DEPTH ~.... --_-_-:-- COMMENTS' 2-'~"'~c I-IDle Soaked & HT Set · · ~;"', ....... ' on 4/5/99. Watertable cnecKe~~ on 4/1 3/99. ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME -- PHONE [~NEW LOCATION DISTANCE ~ ~/'~ '~TO: ~///~;i~ NO. OFBEDR~S Liq. ~apacity in ~allons Inside length Width Liquid depth ]~ ~ IF HOME.DE: ~ ~ ~ DISTANCE TO: Well Dwelling ~ERMIT NO. ~ ~ ~ Manufacturer Material Liquid capacity in gallons ~ Well 1~ ~' F~datio~. Nearest lot line~ ~ / P~MiT~. No, of lines ¢ Length of each line_ .~ Total length o~ lines Trench wid~d Distance between lines~ -- -- · ¢¢' inches O~ ~ Top of tile to finish grade ~/ Material beneath tile ¢~ inches Total~f~t~e ~bsgrpti~ ~ ~/' ~'~' area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO, ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE~ATERIALS SOIL TEST RATING INSTALLER ~ : I' REMARKS APPROVED / DATE LEGAL . MUNICIPALITY OF ANCHORAGE~ '" Department/'"f Health and Environmenta' ?rotection ~- 825 _~ Street, Anchorage, AK. 79501 264-4720 Ii ~) . . . · -~. HANDWRITTEN PERMIT *-* * Permit. ~ ~/O~ WELL~ND~ON-SITE SEWER PERMIT Applicant: ~ ~/~d~ /~e_~"._~ Mailing Address: Location: Phone Numar: ~-- Legal Description: ~ ~ ~ot Size: Type of Soil ~sorption System Is: Trench: ~ Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) /~ The Required Size of the Soil ~sorption System'Is: DEPTH /~' LENGTH ~' . GRAVEL DEPTH d/ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minim~ depth of gravel between the outfall pipe and the bottom of the excavation(in feet). · * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~ GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and %he number of residences that the well will serve. · * * TWO(2) iNSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department~ will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from ~ private well to ~ private sewer line is 25 feet ~nd to ~ coAunity sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. · * * PERMIT EXPIRES DECEMBER 1 9 g 3 * * * I certify that: (1) I ~ f~itiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand ~n~ %he on-si~e sewer eye%em m~y require enlargement if =emo e=e _ S igne~C~P~~ ,~g~/ Issued by: ~~-~ ~_~ icant /' SWP/024 (1/81) · MUNICiPALITV' OF ANCHORAGE ' Departmen?~f Health and Environment~'~Protection ~'r.~ 825 L Street, Anchorage, AK. ~9501 264-4720 * * * HANDWRITTEN PERMIT * * Permit ~ WELL$ND/0R 0N-SITE SEWER PERMIT Applicant: ~ ~~ ~.~~~ ~a~l~n~ Address: Location: Phone Nu~er: ~ Legal Description: ~,~ ~ ~Z~ ~ot Size: Type of Soil ~sorption System Is: Trench: ~ Drainfield: Seepage Bed: Holding Tank: ~aximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) The Required Size of the Soil ~sorption System Is: DEPTH /~' LENGTH ~' . GRAVEL DEPTH ~ / WIDTH The length dimension is the length(in feet) of the trench or drainfield. Th< depth of a trench or pit is the distance between the surface of the ground a~ the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~,,.~'-~ GALLONS * * ermit applicant has the responsibility to inform this department during the .nstallation inspections of any wells adjacent to this property and the number ,f residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * ,ackfilling of'any system without final inspection and approval by this depart~ ,ill be subject to prosecution. [inimum distance between a well and any on-site sewage disposal system is 100 'or a private well or 150 to 200 feet from a public well depending upon the ~f public well. Minimum distance from a private well to a private sewer line .s 25 feet and to a con%munity sewer line is 75 feet. Well logs are required :nd must be returned to this department within 30 days of the well completion )ther requirements may apply. Specifications and construction diagrams are .vailable to insure proper installation. * * * PERMIT EXPIRES DECEMBER $1~ 1 9 8 3 * * * I certify that: (1 I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2 I will install the system in accordance with codes. (3 I understand that the on-site sewer system may require enlargement i the~ ?es-idence is remodeled to include more tha~J~edr.o__0ms. Applicant / Date: SWP/024(1/81) '~0 + ' L E!'.,!GTI-i = TOTFiL_ DEPTH L~!.:.'.FI~v'E L DiZF'TH GI'::i'"I',: E; L ',.'(;.':L. MHE "i-I'tlE,'",rr-. '~ ..... ~:E~' .... ::,=.: ...... ~:Ei"IFJI',IT:'~; -' ~' {.'.'~,~4 '"_'3ITE .... ' '"-'="- '"""'~" ~"' " 'T',' is:r- -~ -' -,-,--- ,.......,il ........ 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PERFORMED FOR; ~, SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 g Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST LEGAL DESCRIPTION: ,Z%.., ./'I, '" 3 5 6 7 SLOPE OAT. PER.OR.ED:II SITE PLAN '~10 11 12 13 14- 15- 16- 17- 18- 19- 2O COMMENTS WAS GROUND WATER /~/ ENOO~NTERE~? Pj IF YES, AT WHAT E~EPTH? Gross Net Depth to Net Reading Date Time Time Water Drop 'z"- i~ ,Ia I$ :4,5'0 ~ /z..'r~ !,'7 3,~0. _. ~7, OO ~. ~-~,~:. o /, ~- ',Z- . · /,..,~ !~ a,~-o ¢. ~.,¢ I-~:.:.~'z -- .I, ~ · TEST RUN BETWEEN ~ FT AND '~ FT .,,.,,-t /_,~ --r ,, -'/',C _~. ,-,C ,,-- o ,r ~. ¢'r-,¢m ¢' "/',¢ I'-/' '¢~'-/', PERFORMED BY: 72-008 (6/79) CERTIFIED BY: 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 01 5-31 2-10 HAA # GENERAL INFORMATION Complete legal description Lot 5e Lakewood Hills Location (site address or directions) 71 45 O'Malley Road Property owner Mailing address Lending agency Mailin_g address Agent Address Byron & Diana WJ]~nn 7145 O'Ma]]ay Road Northland Morkgaga 2605 Denali street Day phone 346-20!0 Anoho~ag~; A~ 99516 Day phone ~74-5150 Anchorage~ Ak 99503 Mary ~f~arow/Dynam~o Raal~y Dayph0ne 522-45!7 3111.C Street Anchoraqe, Ak'- 99510 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 "., TYPE OF WATER SUPPLY: Individual well xx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XX 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 and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm pi nard Rngl neering Address PO Box 871347 Wasilla~ Engineer's signature ~ ~--~~ Alaska Phone (eh7) q57-qR~7 99687 Date 5/3/99 DHHS SIGNATURE ~/~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with th-e following stipulations: Additional Comments Date ~//(~ '9(~ The Municipality of Anchorage Department of'Health and Human Services (DHHS) issues Health Authority Approval Certificates 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 DHHS 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. 72-025 (Rm~,1/91) Back MOA~21 RECEIVED of Anchorage MAY 05 1999Z.,z Municipality DEPARTMENT OF HEALTH & HUMAN SERVICEi~JNiCiPALiTY OF ANCHC~?~. ,~.(~_~,,~) Environmental Services Division ENVmON~.NfA~$~RVlC~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: Lot A. WELL DATA Well type Private Log present (Y/N) Y Total depth 229 ' Sanitary seal (Y/N) Y Health Authority Approval Checklist 5: Lakewood Hills Parcel I.D.: 01 5-31 2-10 IfA, B, or C, attach ADEC letter. ADEC water system number Date completed 12/5/83 Cased to 229' Casing height (above ground) Wires properly protected (Y/N) Date of test Static water level Well produc,!ion 30 WATER SAMPLE RESULTS: Coliform None Nitrate Date of sample: 4/29/99 B. SEPTIC/HOLDING TANK DATA Date installed 12/5/83 Tanksize 1500 g Foundation cleanout (Y/N) Y Date of Pumping 7/1 3/98 C. ABSORPTION FIELD DATA Date installed 4/30/99 Length 36' Width 3' Effective absorption area 555 sf Date of adequacy test 7 / 11/98 Fluid depth in absorption field before test (in.); 72 Fluid depth (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) N 72-026 (Rev. 3/96)* 2I FROM WELL LOG AT INSPECTION 12/5/83 7/11/98 160' 175.4' g.p.m, by Doug Kenley, PE 6+ g.p.m, 3.40 rog/1 Other bacteria 5 Collected by: Pinard Enqineering Number of Compartments 2 Cleanouts (Y/N).__ Depression (Y/N) N High water alarm (Y/N) N/A Pumper Zsaacs Y Soil rating (g.p.d./fF or fF/bdrm) 125 System type Deep Trench Gravel thickness below pipe 7.5 ' & 8 ' Total depth 1 4 ' Monitoring Tube present (Y/N) Y Depression over field (Y/N) N Results (Pass/Fail) Fail For 4 bedrooms Immediately after I 11gal. water added (in.): 79.5 241 99.0 Absorption rate = g.p.d. If yes, give date D. LIFT STATION Date installed N/A Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot I 03 ' Absorption field on lot 100 ' + Public sewer main Sewer/septic service line 100 ' + Size in gallons "Pump on" level at*. *Datum On adjacent lots 1 00 ' + On adjacent lots 1 00 ' + Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 1 8 ' Property line 50 ' + Water main/service line Surface watedar~i~la~'e sEpARATION DISTANOE FROM ABSORPTION FIELD ON LOTTO: Building foundation 1 0 ' + Property line 1 0 ' Surface water 1 00 ' + Curtain drain F. ENGINEER'S CERTIFICATION "Pump off" level at* Absorption field 10' (old trench) Wells on adjacent lots 100 ' + Water main/service line Driveway, parking/vehicle storage area 1 0 ' + Wells on adjacent lots 1 00 ' + I certify that I have determined thru field ins[ in conformance with MOA HAA guidelines in effect on this date. Engineer's Name Paul. [~ina]:d Date 5/4/99 HAA Fee $. 3 Date of Payment ~-~/~'/~ Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number ,PAY=04-gg 18:10 FRO~-CTE Efl¥1RONPENTAL $$$$301 T-487 P.04/04 F-$Tg CT&E Environmental Services Inc. Drinking Water Analysis Report for Total Coliform Bacteria A,oho,,~o. ^}( 9~s~8.~6o. Tel (~7) 5~2-2]~ R~ INSTRUCTIONS ON ~VE~E ~E BEFO~ CO~ECTING SA~LE ~. 1~O7~ 561-5301 MUST BE COMPLETED BY wA~R ~UPPL~K T0 ~E COMPL~TfiD BY LAB0~TORY PUBLIC WATER SYSTEM I,D. '~e~PRtYAT£ WATER SYSTEM Arla]ysls shows l~'l~s Wa!ret SAMPLE [0 be' ,~....._Sausfacror7 S~1~ ov~ 30 ~um old, resuhs may · be Su~D mo long m ff~s~t; s~ple {ho~ld not be ov~ ~8 hours old ac ~am~non m indic~ mhabl¢ result, please A~¢~ M~h~: ~Mcmbmne F~It~ vO ~MO.MUG Nam0~ of colom~gl ~ mL Lab ~L No, ~sult' AnalySt SAMPLE DATE: Month D~y y~ar SAMPLE TYPE: ~ RoutiR~ o Tregtd W~ter ~ Repeat Sampl, [for rou~Me sample ~ Ua~d wa~r wlt~ lab reL no, o Sp~ Purpo~ TI~ Col{~ SAMPLE LOCATION Collated By T~me Client notified al unsatisfactory reSUltS: Time BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG R~ul~; Tohai Coliform £ Coil M~mbran. Fll~er: Oir~c~Couut ~ (~ ~ Coliform Cunfirma[mu - 0~'>[ t' __ Culonl~lll00 mi COLIFIRM CoIIfarmJl00 mi ENviROI4MENTA[. FACiblBE5 IN A[.A~IO~, CALIFORNIA, FbORIDA. ILUNOI$, MARYIJMqD. MICHIGAN. MISSOURI. NEW JERSEY. OhilO, WE59' vffiGIN~A ~h~Y-O4-gg 18"09 ,=RO~CTE ENVIR~/J:NTAL ~61S$01 T-487 P.02/04 F479 Sample Rem~xk~: Client PO// Printed Date/~'Lme 05104199 18:03 Collected D~telTime 04/29/99 Ifi:20 Received D'ate/Time 04/29/99 15:50 Technlc~ bic~ctor: ~ephen C. £de 3.40 0,500 ~/~ EPA $00.0 ~0 max 04/29/99 0~/~91~ S~L U~/UO./~)~J U~d;:~U t"~L,[ [~.JU~' ISAACS P,:UMPtffG SERVICE (Nor~ Tibbetta~ O~ner) ' 6218 Quinhaeak Street ANCHORAGE, ALASKA @9507 Phone E63.3300 THANK YOU Parcel I.D. # 1, 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 GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 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. 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 on-site water supply and/orwastewater disposal system is safe, functional and adequate for the number of bedrooms and type ofstructureindicated herein, lfurtherverifythatbasedontheinformationobtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Phone Engineer's signatur D/,~.HS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does th is as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~25 (Rev. 1/91) Back MOA ¢21  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~Le'/L' ~' /_.~h~-..~'¢..~o~ /-~/~ Parcel I.D. A. WELL DATA Well type /~$ A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ~/ Total depth Sanitary seal (Y/N) Date completed Cased to 'z/'O"/' Casing height ~. · Wires properly protected (Y/N) . ' FROM WELL LOG ..... ; ' ' AT INSPECTION Date of test /~ _ ..<-_~ /q _ /~/.. c/~... Static water level /~o O Well flow ,,~ g.p.m. ~" '~ Pump level '~ /';,',',',',',',','~'~ ~ y Y SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /G,~ · ~ / Absorption field on lot /~0''~ ' Public sewer main /'-/,Pt' Sewer servic'e' line /O 0¥- ; On adjacent lots ; On adjacent lots Public sewer manhole/cleaoout Petroleum tank "~ ,~c WATER SAMPLE RESULTS: Coliform '~ Nitrate Other bacteria Date of sample: Collected by: Date installed . '1,.~-,5'-~ Cleanouts (Y/N) " Y' High water alarm (Y?N) B. SEPTIC/HOLDING TANK DATA · Tank size /,~'-dO Compartments ~-- . Foundation cleanout (Y/N) ~ Depression (Y/N) /-/~r : Alarm tested (Y/N) Date of pumping . /~ T~'-~'~.., Pumper ~',,~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /~),~'-~' ~' On adjacent lots /4)0+' Foundation /~ To property line ~, '.~ Absorption field Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION ~ Date installed Manufacturer Size in gallons Manh~s (Y/N) Vent (Y/N) "Pump on" lev....~.y.~"~_ _ _ "Pump off" level at High water alar Cycles tested rical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent I'ots ' Surface water ' D. ABSORPTION FIELD DATA 444~44~¢.¢ ./-~ .O e~.,4 ,'//' ~ i0~0 =~ ~/~ ~ m¢~ Date ..... in'stalled J~-~-8~ Soil rating /~ System type 'Leng'th Width Total ab¢'or[~tion area DePression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) · ',~// Gravel thickness <~ / Total depth ,~¢ /~,,,~ / /,~-~'<~ ',$~' Cleanouts present (Y/N) y 'A,/ Date of adequacy test for '¢ bedrooms If yes, give date -- - SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /<9C)''F' On adjacent lots / ~O-l- Property line To building foundation ,~.O/_4-- To existing or abandoned system on lot On adjacent lots ~ /'~O'4' Cutbank /.//0¢' Water main/service line Surface water /¢/¢r Driveway, parking/vehicle storage area Curtain 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. Signature~~ Engineer,s Name~J "~ ~(.,~ HAA Fee $ /-'~ '~ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number ~ ~, , ~, ~ ~ I SHIPPING UNIT NO, ~l]['-- SALES NO. I DATE OF SALE ISELLING STORE NO ~.~ .~=.:'~ ~? , ~ ~ ~ (Mo) (DayJ (Yr) o 1 2 3 5 ~ 7 OE~Y B LL DATE . · SCCLC CASH COa DC MCA SC/NIP SHIP MONTHI DAYicol MONTH ACCOUNT NUMBER .... ~ ...... ~: ~' ' NAME (PRiN~ ' ' ~ ~ STREET ADDRESS C]TY~ iELIVERI DATE ROUTE NUMBER MO. DAY I I I This credit purchase is subject to the terms of my SearsCharge agreement which is incorporated herein by reference and identified by the above account number. I grant Sears a security interest or lien in this mer- chandise unless prohibited by law, un- til paid in full. If the sale is on Sears Home Improve- ment Plan (SHIP), use applicable con- tract form. Cardholder acknowledges receipt of goods and/or services iR the amount of the total Shown hereon and agrees to perform the obligations set forth in the Cardholder's Agreement with the Issuer identified hereon. X PURCHASED BY QTY. SPECIAL INSTRUCTIONS IPmMARY PHONE ('~'l/:[/') i'l/:~l/I-I '~1~ I," r.~ STOCK NO./ DESCRIPTION REGULAR SELLING SELLING MISC. ACCT. PRICE REDUCTION PRICE SALES TAX · DEPOSIT · BALANCE · 16082 _Rev. 12./.89 . 7. CUSTOMER I PE Mol_SHIP FF~OM ..... Il THIS IS PART DEL. CODE STORE [ ISTOOK I IWHSE. CFA ~]CMC ~--~S~+E. [PART ORDER NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 · FAX 274-9645 Tony Barter 10461 Hampton Drive Anchorage AK 99516 Attn: - Report Date: 10/08/92 Date Arrived: 10/06/92 Date Sampled: 10/04/92 Time Sampled: 1600 Collected By: TB Our Lab #: Location/Project: Your Sample ID: Sample Matrix: Comments: A120874 L5 Lakewood Hills Water MDL = Method Detection Limit Flag Definitions B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Date Method Parameter Units Result Flag MDL Analyzed R~p~ted By: Susan c. ~ifental Microbiology Supervisor NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 - 907-456-3116 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907-277-8378 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIENT [] PUBLIC WATER SYSTEM I.D. Cf xt~ PRIVATE WATER SYSTEM Mailing Addj~siN/C '~ AK Sg~ CiW State SAMPLE DATE: 1 0 '~ ~ '?'"Phone 5 ~ Mo. Day Year Purchase Order No. SAMPLE TYPE: Routine [] Special Purpose Zip Code [] Treated Water [] Untreated Water [] Check Sample (for original contaminated sample with lab reference no. ) Sample Time g . Location Collected LS- ~.o~, ~11,. 2 3 4 5 6 7 8 9 Signature of Representativ~-~'~ Laboratory Ref. No. CASH FOR LABORATORY US~%ONLY CHARGE PREPAIO TR/~SMITr,~r ~ SPECIAL INSTRUCTIONS MAIL HOLD FOR PICKUP TO BE COMPLETED BY LABORATORY Received at: ~//Anch. [] Fbks. Date Received/t/O [ ~/C~,~. Time Received l ~ Next Sample Due COMMENTS: SATISFACTORY UNSATISFACTORY RESAMPLE OTHER BACTERIA TOO NUMEROUS TO COUNT Date Analyzed Time Analyzed ~,~embrnae Filter Direct Verification Count LSB BGB © --- U R OB TNTC 10/05/92 1645 Final Result* Comments Reported by I .~ [ 100 mis. 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 'F/z- /./~''' ~ 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~-~ (J-~, J5o/¢. Telephone: Home 3~, '00 ] 0 Business Applicant Address · 7}G ~ O~,~,~-LL~y ~j~) ?q,~/(¢ (c) Applicant is (check one): Lending Institution []; Owner/builder [~; Buyer []; Other [] (explain); SEc, (d) Lending Institution Address ] ~' O (e) Real Estate Company and Agent Address ~ ¢OO Telephone ~'~ ' 7 (-¢ ~'~ (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family [~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well [~r' 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 ~r' 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 I of 2 72-025 (11~84) 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 Approva~ shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address 1'2-OO Telephone ApprovedDHEP APPROVALfor ~,,)b/''''-- ~5?bedrOOms by/k~ Approved ,~ Disa .p, prov~Z Co" Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates 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 MUNICIPALITY OF ANCHORAGE (MO~ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~-O7' MUNICIPALI1Y OF ANCHORAC~I~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 3EC, ¢¢ WELL DATA Well Classification Well Log Present (~/N) Total Depth ,::~2_ ~' / Cased to Static Water Level Casing Height Above Grou?¢~ Electrical Wiring in Condui!l(~,/.N) Separation Distances from ~V~II: 1 To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /,/~ D~ ~/I D ~l/~-D If A, B, C, D.E.C. Approved (Y/N) Date Completed / ;~/,~/,¢~-''~ Yield Depth of Grouting Pump Set At ~ ,~ / Sanitary Seal on Casing (~N) Depression Around Wellhead (Y~ 6p/v/ ; On Adjoining Lots I 0¢ ~'"7~ ; On Adjoining Lots To Nearest Public Sewer / oo'+ Cleanout/Manhole Water Sample Collected by Water Sample Test Results To Nearest Sewer Service Line on Lot ;Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (~N) Depression over Tank (Y.~ Size Air-tight Caps (~N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well J (~.-~ i / To Property Line ~' To Water Main/Service Line Course I PO / ~ Comments ~"i -~ E E C Et~ 7'1 ¢:! c./~.TE 1~00 NO. of Compartments Foundation Cleanout ((~,N) Date Last Pumped ,/~///~ ;'~¢' ~¢'//:~'- ;for Temporary Holding Tank Permit (Y/N) To Building Foundation ! Od) / To Disposal Field / ~ To Stream, Pond, Lake, or Major Drainage oP Page I of 2 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field 2 ,---.~ Type of System Design Length of Field 5,,.~ / / Depth of Field / ~ Gravel Bed Thickness ~ / Standpipes Present (~N) Date of Last Adequacy Test Square Feet of Absorption Area Depression over Field (Y~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot Water Main/Service Line /'¢/~ To To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ~ To Existing or Abandoned System on ; On Adjoining Lots / ~)0/~t~- To Cutbank (if present) ¢/'//~ fO0/-¢- Comments D. LIFT STATION Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments // Manhole/Access (Y/N) / "~~r,~ ------Pump Off" Le la~t _ /~Pu~n~i~'g'~;:l~SS during Adequacy Test. Meets MOA ** Check Permitt~.~edroom Rating Against HAA Request ** I certify that..I ha/~cg,e~?o-~...~d,,;}verifi,ed, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Q ..~.~.~"~.~(~..~/.~,~ Date ,~Z /~P4 ~ Company CJJ~¢~% /~, MOANo. ~'O¢~ ReceiptNo. %7~9~ Date of Payment ~' ~ ~' ~ Amount: $ 4, ~7~ Page 2 of 2 72-026 (11/84) ALASKA ENVIRON~IENTAL CONTROL SERVI( '!, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 S Street ! Anchorage, Alaska 99518 Drinking wa, ter Analysis Report for Total Coliform Bacteria TO BE COMPLETED By WATER SUPPLIER [] PUBLIC WATER SYSTEM I.D.# ,~ PRIVATE WATER SYSTEM Name /Zoo Mailing Address City MO. Phone No. State Zip Code Day Year SAMPLE TYPE: ~ Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose .) [] Treated Water ~;~ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 31 J 4 I 5 I I TO BE COMPLETED BY LABORATORY naSlysis shows this Water SAMPLE to be: atisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received ¥/S0/--' Time Received Analytical Method: Membrane Filter * No. of coloniesll00 mi. Lab I~f. No. Result* I I I-F1 I I--F1 I I-T-I BACTERIOLOGICAL wATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter:. Direct Count Verification: LTB Final Membrane Filter Resutts~ Reported By ~~ TNTC = Too Numberous To Count OB = Other Bacteria BGB Date Time: Coilformll00ml Coilform/100ml · p.mo :21 L~J