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Home My WebLink AboutSPRING FOREST BLK 1 LT 8 MUN,C,PAL,T¥ Or ANCHORAGE ~ ~,~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION . ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDRESS ~ ~l~ ~ / ~ / ~EGAL DESCRI. PTION~ ~ - ~ /~ , W~)I ~ Abs~r~t~o~a r~a Dwelling PERMI~ N~./ Mate' - ' ~ No, ofcg~artments ~ ~anu~o~ur~r ~ ~7~.~ Inside length Width Liquid. depth Liq gallons IF HOMEMADE: ,~- .... ~ ~ DISTANCE TO: Well "Dwelli~ ' / PERMIT NO. ~ ~ ,//~ OZ< Manufacturer ./[.~/ I'f . Material Liquid capacity in gallons PER I NO, Wel~ , '/ Foundatio~ / ~ = DISTANCE TO: ~¢~ ~ ~:Zf .earest~/~ / ~X?/~ ,-~Z" ~--mo No. of lines / U g ~ny ~ Total len~y~lin~s Trencb~iCh,_o ~ inches Distan~2/~lines-- - PD ~ ~ ~ Top of tile. to finish gra(~ / Material b~neath tile ~'/ '~- Total e'ffec~¢vEsbsor~ Length ~idth Depth PERMIT~O. ~ Type of crib Crib diameter C2 d;p, Total effective absorption area ~ Well ~i~l j~un~o Nearest lot line ~ DISTANCE TO: / ~ il lng( un ~ Class Depth / Distance to lot line PERMIT NO. ~ Building foundation Septic tank Absorption area(s) ~ DISTANCE TO: OTHER / , SOILTEST~ATING~ / / ' ~ ~ ~ ~' / ,~ 72-013 (Rev. 3~78) MUNICIPALITY OF ANCHORAGE Department = Health and Environment8 ?rotection 825 ~ Street, Anchorage, AK. J9501 ¢~.~t~ /~' 264-4720 * * * HANDWRITTEN PERMIT * * * Permit ~ ~ON-SITE SEWER PERMIT Applicant: ~~_ /~<~ Mailing Address :~ ~ ~ Location: ~D~ ~ ~/~ ~f~ Phone Nu~er: '~ 33 - Legal Description: ~-C .~'3~ / //~d ~ ~ Lot Size: ~..~"~ Type of Soil ~sorption System Is: Trench: Drainfield: Seepage Bed: ~olding Tank: Maximum Number of Bedrooms: ... ~ Soil Rating(sq.ft/br) The Required Size of the Soil ~sorption System ~s: DEPTH ~ LENGTH C~_ GRAVEL DEPTH/~ 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 %he excavation(in feet). ~ * REQUIRED SEPTIC(HOLDING) TANK ~'~ <-~,~ i', ~S Permit applicant has the respo~~'- ~ ~( '- .~.. during the { ~,,~ ~¢~ d the number installation inspecti~ . ~ &.~ -~ of residences th~ ~ ........ ~}~:~,~ Backfilling of an' ~,~.. ~', will be subjec% %~ ?:~ '' ~" % .:~ Minimum distance b ,',~-~ '~: for a private well ~' of public well. ~ ;','~V2 ¢ ~ ~ 'S is ~5 feet and to a .... i¢{,~%~· a=d must be returne, ~.%, ~ '~'-'7' ~ Other requirements, ~7 ~ r~ '*" , [~,3¢:,,? available to insure I certify that: '~-,'-¢ (1) I ~ f~ili ~;'~ ~..~ requirements for on-site sewers and wells as set forth bi 5ne Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require en~rgement if the residence ~s remodeled to include more tha~ 3 bedro~ Date: / SWP/024 (1/81) this department em is 100 feet pon the type ~ewer line required ompletion. ns are PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15- 16 17 18 19 20 SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PFRCOLATION TEST SLOPE../' ENCOUNTERED? DEPTH? [] PERCOLATION TEST DATE PERFORMED: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop / _ PERCOLATION RATE (minutes/inch) . , A /q ! ~EST RUN BET~.~N/ . FT AND ,. FT COMMENTS ~ / : ~ :~ . ~ K:l ? ~, , ,l ': ~ - '//~::~ . .~ . ,,. PERFORMED BY: ~ ~:?~:::I::~' CERT[ FlED BY:/~ ' DATE: :'~ / /, ~ r · Reading Da(e' .'.' Gr0~s ',:.':::: 'rNet ,"'.';.' D;pih to. :. Net" ' ' r Time ':. '.'i ;Time:. : ' ' Water . ?,Drop' · ' ''; t ' · ''~.' ~' '. '"" .... "~'. "" ':; '' '" / . NI~ SOILS LOG / MUNICIPALITY OF ANCHORAGE ' . ~5 L. Strut, A~horage, Alaaka ~501 2~720 SOILS LOG.- PERCOLATION TEST .~FORMED FOR: ~({[ / ~' LEGAL DESCRIPTION: Water Drop 14 15 16 17 'C. Reid, Jr. 18 ). ~51-E 19 20 ~ - PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT F~Sr~'/kl._, 6,-+~. :5' ~,~ ~' J~¢+,,~,~ ':/"z' ,,.3 q' PERFORMED BY: "~¢'-"'"""-\ CERTIFIED BY: DATE: 72-008 (6/79) MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-321-12 Legal description SPRING FOREST BLK 1 LT 8 Site address 5930 WEST TREE DR Anchorage AK Current property owner(s) LANGE Expiration Date: 2-,-_ X The On -site system(s) is/are approved for 4 lbedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: IZZ Original Certificate Date: 6/17/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 iq� 111111 Development Services Department❑Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-321-12 Complete legal description SPRING FOREST BLOCK 1, LOT 8 Location (site address) 5930 WEST TREE DRIVE, ANCHORAGE, AK 99507 Current property owner(s) MARK & FRANCES LANGE - Day phone 2. ON -SITE SYSTEMS SIZED FOR BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well R Private Well serving 2 dwelling units D Private Well serving 3+ dwelling units Z Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: Z Private Septic F-1 Private Septic serving 2 dwelling units R Holding Tank El Community Septic or Public Sewer 5. SEPTIC TANK: Z Steel F] Plastic E] Concrete F] Fiberglass Age 9 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: 0 AWWTS R Bed Z Deep Trench R Wide Trench El Seepage Pit Waiver request for: Expedited review requested: F] Distance: By applying for this entitlement, this property is subject to inspection by municipal On -site staff to verify the accuracy of the information provided. COSA Fee Date of Payment 6L COSA # 0 5 C 2- 'y /,/ g � Waiver Fee $ Date of Payment Waiver # COSA Appliration.doc COSA Checklist Legal Description: SPRING FOREST BLOCK 1 LOT 8 Parcel ID: 015-321-12 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA - PUBLIC WOR CLASS "A" WATER ................ ❑ Well log is filed with Onsite (or attached) Well production at time of test gpm Date drilled Total depth ft Water storage tank volume NA gallons Cased to ft _.. Well disinfected for coliform test? ❑ Yes ® No ❑ Sanitary seal is functioning correctly ❑ Coliform bacteria is Negative ❑ Wires are properly protected Nitrate mg/L ❑ Nitrate less than MRL (ND) Casing height (above ground) in. Arsenic ug/L ❑ Arsenic less than MRL (ND) Date of flow test for COSA Collected by Static water level at beginning of test ft. Date - -. Comments B. TANK DATA C. LIFT STATION Measured operating fluid level in septic tank 47" ❑ Required maintenance completed Date of pumping 6/3/24 Age of lift station years ❑ Required maintenance completed, if AWWTS Lift station material Comments: Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 6/10/2015 ® ALL standpipes present per record drawing Total measured depth from grade 12.4 ft (max) Measured depth to pipe invert from grade 6_3 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ® Monitor tubes (MT) go to bottom of effective (ED). If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 6/4/2024 Results E Pass Fluid depth prior to test 7 in Water added 1510 gal New fluid depth 17 in Elapsed time 1410 min Final fluid depth 8 in Absorption rate 600 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 70 in (MOA s.s' ED) Effective depth used 8 in (Final Fluid Depth) Effective depth remaining 62 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximate. COSA Checklist.docx E. SEPARATION DISTANCES From- .Private Well on Lot to: (Please enter distances if less than required or if community well on lot) - NA Septic Tank/LiftStation on Lot > 100' Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes 'if No. ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft "' Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No ft 0-Yes - if No ft ® N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Tank to Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on -site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350.9566 Engineer's Printed Name CURTIS HUFFMAN PE Date 6/11/2024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FKS OF A Ape ... ......... .... ....�....�.. 1' r Curtis Huffman % ��'��•., CE128991 ..•��,,w JT • . 06/11/24 .c` ,., F4 PROFESSO�' . COSA Checklist.docx 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 AU'I'HORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # (~\¢~ ~ - \ ~ 1, GENERAL INFORMATION Complete legal description HAA # Location (site address or directions) Property owner Mailing address 'Lending agency Mailing address_ Agent A-/~ w, I Address ~d'~Q Cor,~Zc,~,~ -f ~. .~ Unless Othe~ise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: Bom b¢~,~ rn',c~ Day phone 3¥6' =l ¥ y~ R~ ~ pf~r~/~ Day 3hone ~7~-~7~( Individual well r'r-i · ~' ~ ,~ .... , .._. ,oo ,~ ~: ~ [,./,,~,'.. Community well ~ . ~" .~.', ,~',~\;, ~ > ' % ,' ,.-..~.-~.r"rl ~..~ ~ ~ '. Public water :' c-~ -~', ~ o i,D . ". ,' ~t~', ~ ~ ~,. ', If community well system, provide written confirmation from Statb~ ~D~C att~ ~ ,~ ~'.~ : ' lng to the legality and status of system. ,; ~: .... TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 o .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 inves_ti_gation 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 I=:/~/'J'~p '"T~c/~o'lc~l £~,"w;c~/ Phone 3¥~- Address.. t"15.3o Ec4o 5¢'.j A'~cl~o,"~'e., .41~ ingineedSsigr~ature ~'~ ~' ~ Date DHHS SIGNATURE .Z~.,..~ . Approved for' bedrooms. Disapproved. ' - Conditional approval'for bedrooms, with the followi'ng'sfiPula(ions: ' '~ 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, 72-4)25 (Rev. 1/91) Back MOA ~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL OHEOKLIST Legal Description: /-~ A. Well Data Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) Parcel I.D. ~)" If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to FROM WELL LOG Driller Casing height Wires properly protected (Y/N) AT INSPECTION Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~n ~'. Cleanouts (Y/N) ¥' High water alarm (Y/N) Date of pumping ~/ Tank size 1~.¢O k~/ Compartments ~. Foundation cleanout (Y/N) Y' Depression (Y/N) ~/ Alarm tested (Y/N) tv. 4. Pumper ~-~-~ ,~ c_.(' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /~/. To property line Sudace water/drainage On adjacent lots Absorption field Foundation ,¢ Water main/service line CONTINUED ON BACK PAGE 72-026 (3~93)* Front 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 Dateinstalled C~nl¢. Poe- lg,~y Length "/~ ' Width Total absorption area ,¢ 7 Z Date of adequacy test dr / ~/ / Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) Gravel thickness Cleanout present (Y/N) Results (pass/fail) No I.¢O ~='/E~Xr~ System type 7're~ ~¢' Total depth I Depression over field (Y/N) for After test R'o" If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot N. ,4. To building foundation On adjacent Iols Surface water >, Curtain drain On adjacent lots '-,> ?_ Oo' Property line '7¢ ' To existing or abandoned system on lot tv', ,4, Cutbank IV. 4. Water main/service line ';> Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effe~e~,','th~t~t~of this inspection. Engineees Name Date ~ne HAA Fee $ 3~'42 oo Receipt Num=r Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)" Back MUNICIPALITY OF ANCHORAGE DEPARTMENT 01: 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 Lot ~; Block,?1; .Sprin~ .For~t Subdivision Location (site address or directions) 5930 Wo~t Tro, e Drive Anchorage, AK Property owner Mailing address Lending agency Mailing address Agent Address William and Jennifer Christian Day phone 762-3171 C/0 Jack White Co. Attn.. Bonnie Mehner 3201 "C" Street, Suite 100 Anchorage, AK 99503 Day phone 762-3171 Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: XXX Public water 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 NOTE: XXX 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 eleo s~uewwoo leuo!:I.!PPV :sUO!lelnd!ls 8U!MOIIO~ eq~ ql!M 'SLUOOJpeq 'SLUOOJp@q JO,t le^oJdde leUO!l.!puoo 'peAoJddes!a //~ JoJ. p@AO,Jdd¥ S-~HQ ~anJ.VN!DIS , / '9 'uo!loedsu! s!ql ,to elep eH), uo ),oejce u! suo!lelnSeJ pue 'seoueu!pJo 'sepoo e~e~S pug led!o!unlAl I1~ q1!~ eoue!ldLUOO u! s! LUelS~S leSods!p Je3eMe~se~ Jo/pue ~lddns ~eleM m,!s-uo eq~, 'UO!lOedsu! pue uop,~B!lse^u! XLU LUOJJ pue Sel!J e6eJoqou¥ jo ~l!led!o!UnlAI LuoJj peu!elqo UO!~eLUJOJU! eq~ uo peseq ~eq~ ~Jpe^ JeqlanJ 1 'u!eJeq pe~o!pu! eJn~on~ls,to edX~ pue SLUOOJpeq JO JeqLunu eq), Jo~ elenbepe pue leUOp, oun,~ 'ej~s s! LUe~SXS lesods!p Je),eMelSeM Jo/pue ~lddns Jele~ el!s-uo eq~ 3eq~ SMOqS uo!~eO!ldde le^oJdd¥ 4~poq~nv q~leeH s!q~ jo uo!l~8!lse^u! /~LU ~eq~ XJpe^ I 'MOleq UMOqS e~p uo!~p!le^ eq~,to se pue OleJeq pex!jJe I~es ~LU Xq pe!j!peo s¥ I:I~NIIDN=I AB NOI.LO~ldSNI 40 .LN:BIN~.LV.L$ 'S Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /,..pc /E(../ ~',.,~/'Cf/..~ ~¢.z~Y'"%'/'/~ Parcel I.D. A. WELL DATA Well type_. /~ 1~'~9, or C, attach ADEC letter. ADEC water system number Log present (Y/N) -~ Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) - FROM WELL LOG AT INSPECTION g.p.m. Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS~'~''''~ Coliform ~.--"'"'"'"'~ Nitrate ~ato._~~ple: B. SEPTIC/I=i.C,4.OtNC~TANK DATA Date installed 6'~//'~ / oO ~ ~ / Cleanout (s~N) High water alarm (Y~J.,~ ; On adjacent lots ; On a~ Public sew.~nhole/cteanout ~~otroleum tank Other bacteria Collected by: Tank size /2--''~,-~ Compartments Foundation cleanou~__~y'N) _ ~".J Depression (Y/~..~ Alarm tested (Y/N) ..,A~,~ Date of pumping ~'"/~- _~ / ~' '-~ Pumper SEPARATION DISTANCES FROM SEPTIC/~ANK' TO: well(s) onlot z'/~/a/('''&¢'' Onadjacentlots ~o¢'f"- Foundation To p, operty line //0'~ Surface water/drainage Absorption field Water main/service line /'¢/y-' 72-026 IRev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION /CJo/C,/(~~'~ ~alled Manufacturer Size in g~~ Manhole/Ac~ Vent (Y/N) ~~ ~ "Pump off" level at High water alarm level~ Cycles tested Meets MOA electrica~ SEPAR~NCE FROM LIFT STATION TO: ~e~n lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~?//~//O~ Length z:¢-- ~ / Width Total absorption area (/~ Depression over field (Y/~.~ Results~ail) Peroxide treatment (past 12 months} (Y/N) Soil rating //._~O Gravel thickness Cleanouts present~fl) Date of adequacy test for .. If yes, give date System type Total depth bedrooms Well on lot ~'~'~ f~ To building foundation On adjacent lots ,¢~(;::>('/~ Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD TO: On adjacent lots ---~--~(¢~ Property line 4 (/'~ [ To existing or abandoned system on lot /G"//~ Cutbank .~'//¢~J' Water main/service line //O /~'o/J~ ?~-.r~ Driveway, parking/vehicle storage area '~ / Curtain drain .,(_/,-¢-z,/'-----------------~~ E. ENGINEER'S CERTIFICATION I certify that lhave checked, verified, o~MOAandHAA guidelines in effect on the date of this inspection. ~. . S & S ENGINEERING /// blgna[ure 17034 Eagle River L~O, Engineer's Na~gle River, Alaska ~77~ Date ,'~ ~ . '~' "t~.~' '~' d; ?.;:.,' ,-" :'. Waiver Fee: $ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3t91) Back MOA 21 Date of Payment Receipt Number STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION APPROVAL OF ON-SITE RESIDENTIAL WATER AND SEWER SYSTEMS PROPERTY DESCRIPTION Lot, 8lock & Subdivision or U.S, Su~ey Lot 8, Block 1 (5930 West Spring Forest Subdivisoin PWSID 213564 Tree Dr.) This approval does not constitute a guarantee of any kind, explicit or implied, as to the performance of the water supply and wastewater disposal systems. WATER SUPPLY A recent water sample was tested and found to meet Dep~trtment of Environmental Conservation drink- ing water standards for total coliform bacteria, Name Title Environmental Date 1993 WASTEWATER DISPOSAL The dome~%o,~'tewater system was: [] inspected by th"e.~epartment of Environmental Conserva~ound to be in compliance with applicable req uire~zo'~f 18 AAC 72; [] inspected by a Profession~..Engineer who c_.eC(ffies that the system complies with applicable re- quirements of 18 AAC 72; ~ ....... [] install~ that the system complies with applicable requirements of 18 AAC 72; or ~ ~ _ [] tested ~~he p~rfor.m, a~ce of the system is satisfactory and the{ the .~complies with the mi~mum~ation dislances specified in 18 AAC 72. Thisa~.~isvalidfora[] single familyLJ multi-flmft~withatotalof ___ bedrooms. Name Title ~, Date 18-0404 (Rev. 8/85) DISTRIBUTION: WHITE--BANK/LENDING INSTITUTION; CANARY--APPLiCANT; PINK--DEPARTMENT WALTER J, HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 (907) 349-7755 May 25, 1993 Mr. Scott Swenor S & S Engineering SUBJECT: Lot O Block 1, (5930 West Tree Dr.); Spring Forest Subdivision Class "A" Public Water System, PWSID 213564 Dear Mr. Swenor: I have completed a review of this office's files concerning the monitoring status of the above-referenced Class A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on May 10, 1993. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on January 28, 1991. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last Radioactive Contaminants Sample results were submitted to the Department on February 12, 1993. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were submitted to this Department on June 16, 1992. Based on analysis of the previous VOC samples results have been satisfactory. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above-referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. Unless otherwise noted, this letter is valid for 30 days and is for the specified legal description noted above only. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Environmental Eng. Asst. II 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 GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name "i~. ~,. _¢~[.~. Telephone: Home ¢)/¢.0 ~ '5'~'i~¢O Business Applicant Address ~:-~")PLP g,.~.-¢¢~, _j~_. ~ ~ .~f~-kc;¥c,~ ,./NY-.-. Applicant is (check one): Lending Institution I-I; Owner/builder~'; Buyer []; Other [] (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) M"a/1 the HAA to the following address: 5 &_S~cNGINEERI NG 17034 Eagle R~ver Loop Road NO, 204 Ea~lge River~ Alaska 99577 ~'\ ~-'~-~¢ ~ J~q~f~¢~'~.--' Telephone TYPE OF RESIDENCE Single-Family.~ Multi-Family [] Number of Bedrooms /l' Other WATER SUPPLY Individual Well [] Community [] Public,~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite~. Public [] Community [] 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 (11/84) Page 1 of 2 ENGINEERING FIRMPROVIDIi INSPECTIONS, TESTS, FILE SEARCH, D. AANDINF:ORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with ali Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Address 17034 Er~§le_J~ve,' Date Eagle River, Alaska g9577 Telephone DHEP APPROVAL ^pproved for ^pproved ~ Disapproved Conditional Terms of Conditional Approval Date /- /'(:' - ~" ~ 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 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOP,) ~c.¢O~.~cALTH AUTHORITY APPROVAL (HAA) · , CHECKLIST- FEBRUARY 1984 284-4?20 Well Classification /~ If A, B, C, D.E.C. Approve~N) Date Completed CaSed to Well Log Present (Y/N) Total Depth Static Water Level ' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/l~g Tank on Lot '~u::, ~ '~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line .. Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments '~¢*¢'~ ~ ~¢--'~ ¢-~ Yield Depth of Grouting /~_ Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/N.GL-D'I~'G TANK DATA Date Installed Standp~pes(C~l/N) Air-tight Caps(~) Depress on over Tank (YI~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Se 3arauon Distances from Septic/t--~m~l/l~Tank: To Water-Su pply Well To Property Line ._~ LO TO Water Main/Servme Line No. of Compartments Foundation Cleanout(~_~'4) Date Last Pumped I~ A ;for Temporary Holding Tank Permit (Y/N) To Building Foundation I To Disposal Field ~" ~' Course To Stream, Pond, Lake, or Major Drainage Commems Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field ~U'2~ Depth of Field Gravel Bed Thickness Square Feet of Absorption Area L,~"~ "~ ''~ Standpipes Presentd~N) Depression over Field (Y~) Date of Last Adequacy Test Results of Last Adequacy Test 5/~¢"~-.~¢:: ;~'~__.~'~.~ -- Separation Distance from Absorption Field: To Water-Supply Well "2.--~:~:;, I~ To Property Line To Building Foundation Lot ~ /eL ; On Adjoining Lots TO Water Main/Service Line 1 ~:~ '~ /To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course ~/~ (I ~:n:;:;:~"-~ To Driveway, Parking Area, or Vehicle Storage Area ~ I,..~ To Existing or Abandoned System on Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certif~tJ2a.t Lbave checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ~ ~*~ ENGINEERING ///, / /¢ ? Signe~7034E~[v~L--- ~ .... Date // / ~/ ~ / Com~e RIV~, Alalka 99577 MOA No. ~ ~O ~ ~ No. Date of Payment Amount: $ ' /~2~ Page 2 of 2 72-026 (11/84) / DIEI~F. OF ]~;NV[RONM~NTAL CONS~i~/AT~ON ANCHORAGE/WESTERN DISTRICT OFF[CE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 DATE: January 12, 1987 PWS I.D.# 213564 To Whom it May Concern: According to records on file in this office the SUBDIVISION Water Regulations SPRING FOREST Water System 'is in compliance with the State Drinking Sincerely, Michael P. LewJ_s Environmental Engineer (h~neral (a) Legal ]),epcritlti9n (include lo,t, block, subdivis~ion, s~ction, township, range) '2'/?~/.- ~ ~,~ '- :')~ :.~ji~.zf. '~- ~- ,'~,~ '(c~l~?~'/· ,%~x~.~ ~//~/~'~ .t:.'~[L:~f, )-c~ t~\ Location (address or directions) u~me ~ ,/Zi~Z_: ~/ (b) Applicants L--~.,. Applicants Address (c) Applicant is (check one)Lending Institution Buyer ~_~ ; Other [~Z (explain); (d) Lending Institution Telephone" Home~-~2~siness ':"'~ TM ~'~' [? ; Owner/builder Telephone Address' (e) Real E'sfate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type. of Residence Sing].e-Family~_~,~ Number of Bedrooms 3. Water Individual Well blul ti--Family ~_~ Other (describe) Community ~ Public Note: If community we].l system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite ~ Public L21~i! Community ~ Holding Tank ~ Note: If community well system, must have w['itten confirmation fz'om the State Department of Environmeutal Conservation attesting to the legality and status. [Page 1 of 2] Engineering Firm Providin~_~I_n_s~.p~.ections~__T~.s_~_~s_~. File $earch_~ Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval sho~.~s that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Ymnicipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection~ (ENGINEER DHEP AD,royal / Ap proved .~__ Disapproved ..... Condit io Terms of Conditional Approval. C AUT I O N TtIE M[fNICiPALITY OF ANCHORAGE DEPARTMENT OF ItEALTH AND ENVIROb~.IENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED _S..O~_I::~f UPON THE REPRESENT~' ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAl, ENGINEER REGISTERED IN THE. STATE OF ALASKA° THE ])HEP DOES THIS AS A COURTESY TO PURCIiNkSERS OF [{ObIES AND THEIR f~ND!NG INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AN]) STATE REQUIRE~' MENTS. ~MPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONS£!31LF, FOR ERRORS OR OMISSIONS IN THE PROFESSIObliL ENGINEER'S WORK. (DHEP SEAL) RR4/ejtDI$ [Page 2 of 2] 7"-'], 9--$4 ae MUNICIPALITY OF ANCHORAGE (MOA) HEALTH ALFI/qORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICiPALiTY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION .RECEIVED Well Classification ~/7F/7:/:/~:~/ If A, B, ~ C, D.E.C. ~ove ) ~ _ Well ~ ~esent (Y~) ~. ~ ~te ~le~d '~-- Yi~d --~ Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances f~cm Well: To Septic/~R~]~a¥~ on Lot Pump Set At Depth of G~outing. ~ Sanitary Seal on Casing (Y/N) "f Depression A~ound Wellhead (Y/N)~ joinin ,ots TO Nearest i~ge of Absom~tion Field on Lot-/-/.~-~ x ; On Adjoining Lots ~//_~'~ / To Nearest Public Se~r L~ne' ://~-~ To Nearest Public Sewer Cleanout/Mar~hole /~/>. '~ To Nearest Sewer service Line on LOt - / / . Water Sample Test R~Su].ts ~'///1-' . , . ' Be SEPTIC/HOLDING TANK DATA Date Installe~ ::/? ~f/~9~O/] ~ Size ./>3~ .?(L--~. NO. of C~3a~tmsnts StandPiPes _~I/N) Ai~-tight CaDs:.~) Foundation Cleanout ~) DePression over Tank (.y~: Date Last P~um~ ~ K~- Pumping/Maintenance Con~aat on File (,Y,~)'/://>; for ' Holding Tank High'Water Alarm (Y/N)//:/P- ' ~mpora"y Holding Tan~ Permit (Y/N) Separation Distances f~.om Septic/Holding Tank: To Water-Supply Well -g-- . To Building Foundation TO th~operty Line ::-~ , TO Disposal Field_ To Water Main/Service Line ~/~) x To Stream, Pand, Lake, c~ ~aja~ D~ainage [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Ir~talled /_//~ '~/~/JJ~ · Width of Field : / Depression over Field Results of Last Adequacy Test ~//~, / Type of System Design Length of Field ~/~3 < Depth of Field ~/ Gravel Bed Thickness ~/ · Standpipes P=esent:./~//>--'~Y~')''//~r~ Date of Last Adequacy Test / Separation Distance f~om Absorption Field: To Building FouQdation ~t~ To Existing or Abandoned ~ystem cn Lot J//n-../'/ ; On Adjoining~/ tbank(lf 'resen, t)/:,~, To Wate~ Main/Service Line '-)~) "~ T~oo~ , p To Stream/Pond/Lake/or Majo~ D~ainage Course ~///~, / - To D~iveway, Parking A~ea, or Vehicle Storage Area' D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Ac~Y~) "Pump On" Level at "~/.~Of~' Level at High Water Alarm Level at /./_ ,_l ..41 Vent (,Y/N) , Tested for w.-P~ing ~y~lgs~ing Adequacy Test. Electrical Codes(Y/N) ~ /I/I P ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all on the date of this inspecti, on. //. ~ f' / C '~ Company ~]~: KB1/d5/s [Page 2 of 2] Meets MOA 2-15-84 IDEPT. OF IENVIRONMENTAL CONSERVATION SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR 7~lephone: ($07) Address: 274-2533 To Whom It May Concern: ~f~ ~T~ Water System is in compliance with~he State Drinking Water Regulations. Sincerely,