Loading...
HomeMy WebLinkAboutSPRING FOREST BLK 2 LT 5Spring Forest Block 2 Lot 5 #015-321-25 MUNICIPALITY OF ANCHORAGE �t DEF rMENT OF HEALTH AND HUMAN SERV S U Pgr-cje— Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name n I A Ian USk-e- DISTANCES Tp FROM SEPTIC TANK ABSORPTION FIELD WELL Address Phone(s) Perm— No. of Betlrooms 3q�-355rq Fmwoq I 5 WELL +0001 + DO LOT LINE �C) ( r �--- LEGAL DESCRIPTION Lot Block Subdivision rj J' ren Foresi Township, Range, Section f ! A ^ I /� I lJ� c 'j FOUNDATION 5 5' �' --- AS -BUILT DIAGRAM driveway. water bodies, tShow location of well, etc.) septic system. property lines, foundation, TANKS LeSEPTIC ❑ HOLDING ManUlaactwerl_ ht 6hora Capacity in gallons __500 R Material � No. of Compartments I TYPE OF SYSTEM E- ohm las-12 'Ji []TRENCH [i? BED ❑ W DRAIN ❑ OTHER Depth to pipe bottom from original grade S FT Total depth from original grade S', 5 FT Q lion 5o at n — tA .� Mir ,� ' { (L 5 Fill added above original grade nC s" FT Gravel depth beneath pipe d.s FT -- Gravel length 50 FT Gravel width ��(p FT _ Total absorption area / c�(t �' S SQ Number of Imes Soil rating 8 aqa SQ FT _ Distance between Imes FT Pipe material srM 303 PUC Installer L Dale Installed NuCQQP S-u.5�LalS IAL !4S7— WELLS ❑ PRIVATE ❑ OTHER (Identify) Classihca n (A,B,C) Total Depth=Galed FT Inslalle, Dale Installed: REMARKS: all rM 51,E �r'a r+ a � �� � U P✓' S00 q al to n /IIJJ ,�• � O (� Sf-/S`FLCYf [.l.1�C�n�.PC�GI3 Oan Scale: NTS Inspections Performed by: ENGINEER'S SEAL r i --_--�� pu t C ,$ / J /� /1 :3YCi U..S a _ _ _ Dale. 8 mm, 1g87 I llll1,-C 1C . C- 11 \/�� cerlily Ilial t s inspection was performed according to all Municipal and State guidelines in ellect on this date: `� ( Health Department Approval: - -� 'u(Z Date: Y7 72-013 (3/85) PERM)T NO: DATE ISSUED: APPLlCAN[: �DDRESS: CONTACT PHONE: LEGAL DESCRlP: LOlSIIE: �PHV����������^� �ILI, I �����; 1� 11:� -�� DEPARTMENT OF HEALMH AND £NVlRDNMENlAL PROTECTION 825 L STREE[� ANCHURAG�, �K 99501 264^'4720 W& Th 1 Q X H 870O�4 �PGRADE 04/29/87 ALAN LESKE 1001 ME 11 WE DRlVE ANCHORAGE� AK 99516 346-�554 SU8DIVISILIN! : SPRING FOREST SUBD" LOT: 5 BLOCK: 2 SECTTON: ]4 lOWNSHIP: 12141 RANGE: :0.4, 48052 (SQ.FT. OK ACRES) { certi�y that: 1. I am (ami|iar wzth the requirements Ior op and wells as seL forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. l will install the !system in accordance with all MOA codes and regulations, and in compliance with the design criteria o[ ihis permit. 3. I will ODA he|`e to all MOA and State of Alaska requirements Ior the set back distances �rom any existing well, wastewater disposal system or public sewerage sysiem on \his or any adjacent or nearby lot, lF A LlF[ STATION IS INSTALLED IN AN AREA (OVESD BY MOA BUILDING CODES� THEN (1) AN ELECTRlQW. PB<MlT AND 1NSPECT1ON MUST BE OBTAINED; (2) AS-8UILTS WILL NOT BE APPROVED WlTHOUT AN ELECTRICAL INSPECTION REPORT; AND (3> THE ELECTRIC�L WORK MUST 1011 DONE BY A LICENCED [LECTRlCI&N. ,o . . S[GNED DATE: ' ��x� ���.L/��i/. T~~^—`~--'`~~~-��D-----�~----`~- APPLICANT: A / lSSUEU BY u Municipality of Anchorage a DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: \)n( I✓\'1 I: 1I t II , 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 M L so 0(,1 1o1 ENCOUNT IF YES, A I DEPTH? O J Depth to Wale Monitoring? (ENGINEER'S SEAL) _ 9 11 , DATE PERFORMED: 1� I Township, Range, Section: UND WATER SITE PLAN ERED? IV S T WHAT 0 P — - — -- E rAAj;� Date: Reading Date Gross Time Net Time Depth to Water Net Drop Apr, 1 10'.75 'SO 10 3, f0rrin5 •13 03 ML a !o" ys r0a�''s s4 Dy ra•y5 / ■1■■■■®MINIM ! 11 04 .SD II'! 0 ERED? IV S T WHAT 0 P — - — -- E rAAj;� Date: Reading Date Gross Time Net Time Depth to Water Net Drop Apr, 1 10'.75 'SO 10 3, f0rrin5 •13 03 a !o" ys r0a�''s s4 Dy ra•y5 / ! 11 04 .SD II'! 0 PERCOLATION RATE �2� (minutes/inch) PERC HOLE DIAMETER I i TEST RUN BETWEEN J• FT AND �'' FT %�rC �OI71.W> ��S�J✓t; l"��� vh �XC��; PERFORMED BY: IAI�IL�i'U l/cT%t!r I ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINY 72-008 (Rev, 4/85) lr1 1 IOG "L 6t�r �f G A14 fid._ -CERTIFY THAT TH S TEST WAS PERFORMED IN IN THIS DATE. DATE: - l� o. C �'AraA �eno} 5� /" IZeServe Seu"Iage I 5�.t5ern = �}Io x��II ��fbndo°r \ +u�U Je U:>V 1•Tye �r�7o 'i'ar K her' w%C.�P-o.v�ov+ \ - % r1/ JOi P oro�or O IAdd one Ne�gi�1"or,•�q I ; � �SU'Jq�iicn' p I--- ,��,,c 1 / NttJ ins ollaicon bor Sbe�ito�M r `01 ,( A Q k i VIAI 'j1��11C-1 O J; S/ ER SYSTEM LOCATION PLAN LOT BLOCK SUBDIVISION !7 a Spr,r\q F�orc '+ NORTH Comin �� C C:-5::33 � ce :ACEI NOTES ' of I ; THE ACCURACY OF LOCATION OF EXISTING _ t0 PROPERTY CORNERS, WELLS, AND SEPTIC iAWN BY, SYSTEMS INDICATED IS NOT EXACT. L DIMENSIONS INDICATED HAVE BEEN DETERMINED BY USE OF CLOTH TAPE ARD NOT BY SURVEYINO TECHNIQUES. P PREPARED FOR, i n9 eert< --• DATES SHEET / OF I MUNICIPALITY OF ANCHORAGE 1A k ST- 83 �� 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 NAME PHONE KZl NEW .{,, �� f W; n te: vVi,�/� 3011 UU.PGRADE: El UPGRADE MAILING ADDRESS LEGAL DESCRIPTION prrns Z_ 1 S LOCATION NO. OF BEDROOMS Op 0,VVOIe • on 13 zl, - p" rrr,lit ``i' Well Absorption area Dwelling PERMIT NO. U Y DISTANCE TO:Ar> we c) In 8 :S 6 2.S — Ia Z Manufacturer Material No. of compartments w h �.'� rCtr 5 l 7. rn 'ILiq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth IZ �� �r0 DISTANCE TO: Well Dwelling PERMIT NO. O z Q S —F Manufacturer Material Liquid capacity in gallons Well Foundation Nearest lot li PERNO. w= DISTANCE TO: trPe11 Df` En AT J LL z No. of lines Length of eachline Total length of lines Trench width Distance between lines aZ ui 1 f> r 9 inches Top tile to finish Material beneath D(3 Total ccF of grade E tile p T onr effective abptiarea O W' t b inches Hog Length Width Depth PERMIT NO. IL C7 Q N Type of crib Crib diameter Crib depth Total effective absorption area wLLI N Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. r W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS ave. SOIL TEST RATING •,r r INSTALLER \rl v 1? REMARKS 7 rAi i- 'p - .5 7 .Vj = 5 . Re -4c i` nc 4 In 'eve s 75 �u _ 0 S /1 %' 7b /Z WeiS C/o/,?;71 / / 2h/l /Z)<S' S SIU— r! L3 Wui' C APPROVED DATE LEGAL i 5 /a/6 ?i s Pri fyj gores i 5'2- L 5 72-013 (Rev. 3/78) PIC r1� tris pc,ted 61 i3 e�re�s � �ell ��1 1 9:77'� lt�::� IL__ 1 ­ f�� IF=' ���1 � , ���03 E_ [)EPART�E@T L HEHLTH FIND -OTECTION 8�5 /L/ STREET/ HNCHORHGE/ HK99501 C.64~4720 K�CE K." I -W ll:_E� F? r -,j I~F, P�RMIT NO ( 8]025] ) HPPLI�HNT WINTER WISE INC 7400 E 20TH 99504]]]-]811 LOCHTIO� LEGAL L5132 SPRING FOREST LOT SIZE 999999 SQUHRE FEET TYPE OF SOIL HBSORPTIop.,i SYSTEM DRHINFIELD 1-117lXlMUM kILIFIBER OF �EDI7n'OIDMS 4 SOIL �ATII%IG FT/BR)= 31 THE R[��UI�E� SIZE OF' THE SOIL. ABSORPTICIN SYSTEM IS: ��"Y' F -A �5 IL_ IFE #�.Il i -P == ��� KID L_ ������ � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFTELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND HND THE B017*0,1 OF THE EXCAVATION (IN FEET). �U ... I "ll ���C� 11-11 0.4 1 1 1.: � 51.C-9 C) 11211 IF__ FE F-7-11",' THE GRAVEL. DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ���Y, 1 �1,-.§ 1-,., T E -Z �Iffu C-) ������� PERMIT HPPLICHNT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTHLLHTION INSPECTIONS OF ANY WELLS HDJHCENT TO THIS PROPERTY HND THE NUIE-CR OF RESIDU-ICES THAT THE WELL kIILL SERVE. �R-R, E-_ ��0 LJ 3E F-.-,, &_ CH BACKFILLING OF HNY SYSTEM WITHOUT FINAL INSPECTION RND HPPRO\,Ak BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTHNCE BETWEEN R WELL AND HNY ON-SITE SEWHGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET HND TO SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MWY APPLY. SPECIFICATIONS HND CONSTRUCTION [:lIHGRHM, ARE HVHILHBLE TO INSURE PROPER INSTHLLHTION � F- I ���Irl ��� I CERTIFY THHT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FORTH BY THE MUNICIPHLITY OF ANCHORAGE. 2: I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CbDES. ]: I UNDERSTAND THAT THE "N -SITE SEWER SYSTEM [FY REQUIRE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED AND WELLS HS SET ENLARGEMENT IF THE HPPLIC0NT WINTER WISE INC � ISSUE[':, - . � V40 f7ls -'L,' •_.#',lkEf: t'.. MA:,HtNRflQE, BK.. 99501 .:.�. _ _.. _ .. -. .1.-.`hz'+- _�E� __-C-i Yui.-Y._���.a�_r._Q>ay q•.l -S U'l 1 F T•{i9�i #fsaif# N►JMSEP OF 4 SO [L RA#'c NIS FT/0R):= u'-l.d! "--✓ � �?�Eii�E=�F e.�a:�. Fs�' ��-?F �S'�#.f Y4.`3��.33?.s �t��f •�`r"=T�t�# ��: 1-4 THE L E"rsT#i V. N £'elslm G It'1 FEETss OF FM TflFNJ#OH OR UtU?W an -o { f S TRE fL:�>~ 7',-tfhis: 2 �'?-i�' £�•#�sr'i !�;' �S s;�._3{r3'�t 43�;• �`� t �� ..3�I'�•;�tit� THE s1.}ws=3im 63= rFo� s;xrtsa?jai Ws T>;' F,�sTTs_`s # QF IHS s5 T##E mrt ", Nt ~EPTH *F }sRklV £. k:'ETMEEN T`r{f rj�.}TFR3- PtPEE sit#£s THE €?LST Ms's;# tsi TtRt~«ty#iTsst# s' 1N�i>. "t + .q f J_ tv:CE#> 1�__€ jl``' — :c t_ _f_# a--3 I. . its Cifi *I --t-- Cjr-4-"n PC R#'# I Ti i! 'f't I 'ji# #'� < s s y ? 3s'}_ 1i i IL `s 1 `T` TC -1 I N OP t TH E 1 € F -PAR 7P-101 i DUR f el THF ; � ,Tt3LL1 fI�7lt 24s�s� =Ft��iF' }Jr ; 73's' �lEt_L his#>�f#:Et#T Tt� MIS Pf?f3PO4rlgf WAD THE r4tipiflEre or- p9:z fKC- WELL t-KUl ':•tit's+E. r 1-4 z fs= si 3'w T-wzEa Fzi!u t x j4f> t:-,- OF :tOF AM' SYSTEP! WITMUT F IML 'q,``':PN;K-lv'9 BY THIS '+ #4Iu. PF a1J •3 e� isT t�f sJ'�stsilFlt]�i. t°#•1 :F#r€lF3c5 s's T# i#t. .I �TLiEC: J A #•��I_i qN0 ANY f:it#•= 1TE GI;LAGE LrIS;�=ti�1#'3 'Y'5TFit IS �i FRIWITF WELL tits -I Sit ill V3 fft=T F,r>;'.$);t R 1�i113LIr +•tF:ti I}s #'�tk�Iti►3 #1 jJ€d UHE i4EU_. sn3 #s££tEit4 £�I Ti cc:t F ti PRI ITE t, i_ f'O A P.Rf'VArf 'SaIEwR LINE is 25 ANIO T{ n Cot'ttlUNIT't' r`i1^t+ -I##P £3 7:( FEET. s-Tt?i fiR TO�t�# i3L'�t i';t}>? }i'jt�t' #�o°0sf) �Pt I4 3?�i3 1- NT 4 44 d az�-! IN-, s I : #f'a r „#L 1 s Y I s THE tF 3el s j33lfr���.� )R --j i ,��fr �'� lTtlC+ IIIELL J t�� Yff y f Eyi..Fy'� is 'w : SS ffi}I I rV 11,t- i t 3 f `.f'�w:_. ice%- �3t'�i �I �i'} I ? I t'N01� c0'5TI-IM DIT THE s.s#'4-SE 0-1 WISTizt'i ?'fuss PEtR(M i NL,19R'! iMEN.T Ii" T.I,tP TO�t�# i3L'�t i';t}>? }i'jt�t' #�o°0sf) �Pt I4 3?�i3 1- NT 4 44 d az�-! IN-, s ,0I SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATIONTEST \ 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: �\� �CL/v ��<i` kms, DATE PERFORMED: -6 : z /_ LEGAL DESCRIPTION: f (c_J J.1.<,J`���I�" J� <'�t—> V Z� I__� DART SLOPE SITE PLAN P E R I i (-T 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMEN Ikl(_ i3l(u PLASTIC 510— /n l_ SaJuv�crzay s�(._T (�L 5i uKjor GfLnueu_Y 5 t_T I' L- t', s WAS GROUND WATERS Y ENCOUNTERED? /`f o L O IF YES, AT WHAT _ DEPTH? M Reading Date Gross Time Net Time ntii �� Depth to Water FY Net Drop Fi 7 06 �s PERCOLATION RATE U (minutes/inch) TEST RUN BETWEEN `� — FT AND - FT PERFORMED BY: l;.oiy/JoiG�� 0 I JA,J CERTIFIED B 72-008 (6/79) tt DATE:0_ ALASKA RUIR011WITAL COCA ROL ROMP Inc. 6nymeerinq fi 6ironmental Studies PERCOLATION TEST DATA SHEET CLIENT DATE x`31- '3 ADDRESS ZIP CODE LEGAL LOCATION ::5 ((kA U TOTAL DEPTH OF HOLE —ft ZONE TESTED ft TO V7, ft READING # CLOCK TIME NET TIME DEPTH TO NET DROP RATE (min/in) DATUM 2- Y 7 el 14- 1-1 0 FINAL PERCOLATION RATE C-, n/in) PERFORMED BY oef-vA"x f2 e 2 -�Z— "- 1220 West 25th Auem,:,, AQAoraqe, Alash 99503& (qol'1 ) 276 1361 Municipality of Anchorage.`- ` _< On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL`AA =f mir, Parcel I.D. - 015-321-25 Expiration Date: ! / 1. GENERAL INFORMATION Complete legal description SPRING FOREST S/D; BLOCK 2, LOT 5 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: 6001 WEST TREE DRIVE, ANCHORAGE, AK, 99507 PATRICK & TREECE HANLEY Day phone 227-7425 6001 WEST TREE DRIVE, ANCHORAGE, AK, 99507 MICHELLE NELSON W/ REMAX/DYNAMIC Day phone 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: 257-0466 TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class A Well ■ Community On-site LJ Public Water System ❑ Public Sewer ❑ Waiver/Variance request Received by: COSA to be release requested by the engineer. COSA Fee $ 524.0 Date of Payment 311?tI5 Receipt Number 61+_ 6 (46 COSA # 015C157O q `g Date: Waiver Fee $ _ Date of Payment Receipt Number. Waiver # Distance: 5. 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 for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. /further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municlpalilyd'Anchorzg , and industrypraclices. The reported results describe the condition of the syslem/s on the datels of the evaluation. Separation distances were measured to readdyidentiffable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may lluchime during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the systemis. These conditions can vary, and are outside the control of GEG. Saffsfactory fest results do not guarantee future perfomance of the system/s, therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail. The content of this report is for the sale benefit of the persavaudy who retained GEG. Reliance upon the information provided in this round by any other person or party including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/party who paid for this report. 6. DSD SIGNATURE ' System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for A bedrooms. bedrooms, with the following Phone 337-6179 Date 3 itf 15�' —•���OF `1`€c'ilstnitra �ryO 'i ON-SITE 70-11, WATER AND S% WASTEWATER o Jr2` PROGRAt� Original Certificate Date: 3 _- ..;Z 3-45 The Muni, pafr`�r, nc ague Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represe etat' ns given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 10/12(12) Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: A. WELL DATA Well type COMMUNITY Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE RE; SPRING FOREST S/D; BLOCK 2, LOT 5 Parcel ID: 015-321-25 If A, B, or C provide PWSID# 213564 Well Log (Y/N) Sanitary seal (Y/N)— Cased to ft. FROM WELL LOG Coliform colonies/100 ml. Nitrate mg./L. enlc: ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA SEPTIC/STEEL Tank Type/Material SEPTIC/STEEL 1250 2 Tank size 500 gal. Number of Compartments 1 Wires properly protected (Y/N Casing height Mw Collected by: 'SEE NOTE ON BACK REGARDING FCO ACCESS 5/17/1983 Date installed 5/8/1987 Cleanouts(Y/N) YES Foundation cleanout (Y/N) *YES Depression over tank (IY/N) NO High water alarm (Y/N) N/A Date of pumping `' Pumper / T C. ABSORPTION FIELD DATA BELOW EXISTING GRADE 5/17/1983 231 Date installed 5/8/1987 Soil rating (g.p.d./ft Or /bdrm 292 System type TRENCH/BED Length 69/50 ft. Width 3/46 ft. *11.8 1104 Total depth *4.3 ft. Eff. absorption area 2300 ft2 in. Gravel below pipe 8105 ft. Monitoring tube YES Depression over field NO Date of adequacy test **3/10/2015 Results (Pass/Fail) PASS Fluid depth in absorption field before test 69 in. Water added 600 gal. Elapsed Time: 120 min. Final fluid depth 84 in. Absorption rate >= For 4 bedrooms New depth 89 in. 600+ g,p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - **1983 TRENCH WAS ACTIVE AT TIME OF INSPECTION SO THE TRENCH WAS TESTED. THE 1987 BED WAS NOT IN USE AND DRY. 1983 BED SYSTEM WITH TWO TANKS IS SIZED FOR 5 BEDROOMS, TRENCH AND 1250 GALLON TANK ARE ONLY SUFFICIENT FOR 4 BEDROOMS. NOTE: SOME PORTIONS OF BED SYSTEM HAVE LESS THAN 36" OF SOIL COVER. D. LIFT STATION Date installed "Pump on" level at in E. SEPARATION DISTANCES [] Size in gallons Manhole/Access "Pump off' level at water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on Public sewer main Sewer /septic service areas COMMUNITY WELL On adjacent On adjacent lots manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 51+ Absorption field UNSPECIFIED Water main 10'+ Water service line 10'+ Surface water. Wells on adjacent lots 200'+ PUBLIC/100'+ PRIVATE SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ 100'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 104 Curtain drain NONE KNOWN Wells on adjacent lots 200'+ PUBLIC1100'+ PRIVATE F. COMMENTS NOTE: FOUNDATION CLEANOUT IS UNDERNEATH DECK. DURING INSPECTION, NO ACCESS HATCH WAS PRESENT FOR GEG TO ACCESS BUT FCO IS VISIBLE UNDER DECK. G. ENGINEER'S CERTIFICATION i certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date 3billr (Rev. 10/12/12) 4: 'f J A. ess 5 4 c%' C 7 53 ' ��♦,Oak FESSt :.•� z 4.Z " n `+i -. f ..,L 1✓3'a"; .- � ��51 B� oldr � ' °yC.p%✓C' y'L/�iTS rf o �- N a - `tA �M f y hl '� f 41 f ?s.s-0EJtv_rf— 1J,! 6a'l PLAiti 3-szjiLa -40—i ,^,j„a �'�i 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 HAA# t\r�a�a�,l� Parcel l.D.# UI' _3AB 1. GENERAL INFORMATION S >�n Funeh Subdivision Lu.l 5; BZoch 2; p 9 Complete legal description 6001 Wut Tn.ee DiLive. ---- Location (site address or directions) Anchuna e, AK Hanvor� 9 Sancti We L Day phone_ 346-1454 11 - Property owner — t�------ Mailing address 6001 We.,St TiLe.e, Dkive. Anchuna e. AK 199516 Day phone Lending agency Mailing address 3091 766-6442 Agent State, FaiLm Re2oeaV.on - Banb Benedetti Day phone —( Address 2702 IiLe2and Gnove Road Btoomingtonp IZtLnoje 61709 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: r� — 3. TYPE OF WATER SUPPLY: Individual well Community well XXX Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: XXX Individual on-site Holding tank -- Community on-site Public sewer NOTE: if community wastewater system, provide written confirmation from State AD EC attesting to the legality and status of system. 72.025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INS, XTION 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 furtherverify 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 S & S ENGINEERING Phone (' �� f i 17034 Eagle River Loop Road No. 204 Address P-MIARlvw_ A1..4. Carrs Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. -- �— bedrooms. Conditional approval for Additional Comments Date I�_/r3 lei s... 007G OF In RONERT C. COWAN 1,(0 4,x,'•, CE - 8801 ' I4W bedrooms, ,with the following stipulations: ne Ivlunicipainy 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 (Rev. 1/91) Back MOA N21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 0 Anchorage, Alaska 995010 (907) 343-4744 Legal Description: � O 7— Health Authority Approval Checklist B L K2- 5 f N 4 �",)� ( s sP reel I.D.: © I S -3 d — S A. WELL DATA � Well type `I If A, B, or C, attach ADEC letter. ADEC water system number D 13 Log present (Y/[) Cv m nu r? Y Total depth _ Sanitary seal (YIN) Date of test Static water level Well production WATER SAMPLE TS: Coliform to of sample: Date completed Cased to FROM WELL LOG Nitrate _ Casing height (), c grun ) t Wires pr By protected (1� Wires INSPECTI�,�.� g.p.m. Collected by: Other bacteria g.p.m. B. SEPTIC41OL-DING TANK DATA / 'k 117 h 3 c ),13-0Date installed5 447 ``7 S Tank size S'b o Number of Compartments Z Cleanouts 0Y N) y If S Foundation cleanout 6)IN) _ i S Depression (YO ay High water alarm (Y4 I '161 Date of Pumping It y./� S Pumper } N° �" 5ER 7.c� 5' j' S -vitf ratio E,:T C. ABSORPTION FIELD/ DATA a6-- Date installed 5 /� / 3 Soil rating (g.p.d./ftZ o ft`/bdri/ System type Length `I Width 3 Gravel thickness below pipe Total depth Effective absorption area t ° `� Monitoring Tube present&jj/N) YDS Depression over field (Y/6) ^/ c Date of adequacy test `ts 1 / Resultsas /Fail) JS For /� bedrooms Fluid depth in absorption field before test (in.); Immediately after y�gal. water added (in.): Fluid depth _ -?y / (ins.) Minutes later: ) S - y 6 Absorption rate = / q A y g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date _ / , / , J S` -?(- /i- � '� ,3- i- q 7- t £i , c /-1 0� i y n � �� �.2 r f..2 /i �� i< l N S i A � � g t3 A /3 t; 7- 1, CC �- � 7_�-/L' (wU S�P7, "r/7 j` /)NA C,J-P 7.eEN")I �i. coNNkc7 L1 rf j 7 zFo)- D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm levet E. SEPARATION DISTANCES Size ill level at* "Pump off' level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/liolding tank on lot Absorption field on lot Public sewer main Sewer /septic ice line adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTICINOUDWA3 TANK ON LOT TO: Building foundation S / Property line / D / Absorption field_ r r Water main/service line 16 a Surface water/drainage ) o ° Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ) v t Water main/service line / Surface water J o o -)�- Driveway, parking/vehicle storage area Curtain drain z ° ^ f NoLv t Wells on adjacent lots to /AProperty line ° 1 - i A/ 1A a S� F. ENGINEER'S CERTIFICATION �ett I certify that I have determined thru field inspections and review ofNlunicipal reco C. eOahoq in conformance ivith IOA HAA guid 'nes in effect on this date. .� t� �A Signature ��� `, » •• Engineer's Name A 4Z le t in iR� ti' soil 47 Date 1 Jl3I95 I�IrF:+. r ��t*a HAA Fee $_� Waiver Fee $ Date of Payment 1 -? — 1 3' % Date of Payment Receipt Number Receipt Number Rev. 8/95 OSS: haa.40's 6 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services M 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. # )A 1-a) HAA # I�M_'�-moot 1. GENERAL INFORMATION Complete legal description Lost 5; Block 2; Sph,%ng FoneAt Subdivision Location (site address or directions) 6001 p1ut Tkez Dkive., Anchwtage Property owner Michaet 9 Pat 0loode_U Day phone 346-2995 Mailing address 6001 Went Ticee, Drive., Anchorage,, AK Lending agency Day phone Mailing address -- Agent Naome, Fuller/VISTA REAL ESTATE Address 3000 "C" Sticeet, Suite 101 _ Day phone 562-6464 Anchorage, AK Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 5 I 3. TYPE OF WATER SUPPLY: Individual well Community well XXX Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. 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. 5 & 5 ENGINEERING Name of Firm n re. 204 Phone Address eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE —62�. Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Date bedrooms, with the following stipulations: Date 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 (Rev. 1/91) Back MOA 021 Municipality of Anchorage Department of Health & Human Services w+ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L6_16- aU< Z F626ST Parcel I.D. 0 3ZL. `Z6/ A. WELL DATA Well type A If A, B, or C, attach ADEC letter. ADEC water system number Z 1 3S 6 4, Log present (Ya C'J 1" M JNI7Y Date completed Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level Cased to FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/he g..tank on lot 7—y0 rL Absorption field on lot 000 rf Driller Casing height Wires properly protected (Y/N) AT INSPECTION On adjacent lots On adjacent lots G��'�yNITY Public sewer main G°^ M uw (TY Public sewer manhole/cleanout GCSV" A4 c)N I T`>' Sewer service line LUM �'t�� �`i' Petroleum tank Gc>M,(9U/ 9(iY WATER SAMPLE RESULTS: 1_6-(7en or'— vM�LIf}NGE �TI�1Gf(Ev Coliform Date of sample: B. SEPTIC/. 4N6 -TANK DATA Nitrate Collected by: Other bacteria Date installed 45191L +5r//i1?3 Tank size SoU `f- /ZSD Compartments Z °` Z- CleanoutsY N yGS Foundation cleanou (Y/ ) YCS Depression (Y& Nv —,11 High water alarm (Y&1 /"C Alarm tested (Yo - Date of pumping �Vz Z j q3 Pumper NovzwU4N/�) SEPARATION DISTANCES DISTANCES FROM SEPTICS TANK TO: r 2UUr� ✓ / Well(s) on lot t�� N On au,acent lots l ^/(��^" r I Foundation S f rz S / ZS To property line 20 'f' _Absorption ;field Water main/service line Surface water/drainage A101JE elzes'�_A_ �/ 72.026 (Rev. 7/91) Front CONTINUED ON BACK PAGE (.71 Ice ..c Ile g.p.m. ' z On adjacent lots On adjacent lots G��'�yNITY Public sewer main G°^ M uw (TY Public sewer manhole/cleanout GCSV" A4 c)N I T`>' Sewer service line LUM �'t�� �`i' Petroleum tank Gc>M,(9U/ 9(iY WATER SAMPLE RESULTS: 1_6-(7en or'— vM�LIf}NGE �TI�1Gf(Ev Coliform Date of sample: B. SEPTIC/. 4N6 -TANK DATA Nitrate Collected by: Other bacteria Date installed 45191L +5r//i1?3 Tank size SoU `f- /ZSD Compartments Z °` Z- CleanoutsY N yGS Foundation cleanou (Y/ ) YCS Depression (Y& Nv —,11 High water alarm (Y&1 /"C Alarm tested (Yo - Date of pumping �Vz Z j q3 Pumper NovzwU4N/�) SEPARATION DISTANCES DISTANCES FROM SEPTICS TANK TO: r 2UUr� ✓ / Well(s) on lot t�� N On au,acent lots l ^/(��^" r I Foundation S f rz S / ZS To property line 20 'f' _Absorption ;field Water main/service line Surface water/drainage A101JE elzes'�_A_ �/ 72.026 (Rev. 7/91) Front CONTINUED ON BACK PAGE LIFT STATION /V0/U6_ Dateinstalle Size in gallons Vent (Y/N) High water alarm level /5/2 E.lE uJ "Pump on" level at Meets MOA electrical codes (Y/N Manufacturer Manhole/Access (Y/N) SEPARATION_Q4& INCE FROM LIFT STATION TO: n lot D. ABSORPTION FIELD DATA On adjacent lots Cycles ump off" level at Surface water Date installed 5 z2ZO02 Soil rating Z Z type —System t Length Sd Width �U f 6.11 ?hickness Total depth S S Total absorption area Z Z Ds, Clean outs present &y N) tL f Depression over field (Y No It -J2 Date of adequacy test Results ass ail) _Sljsj for - Cr--1V6r) F bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1'J 6_SeC (JTOn adjacent lots Zo'fi `d"144uN�Property line /O /' / A'�NhX>oNC� To building foundation (s f— To existing or abandoned system on lot 3d C<<wcH On adjacent lots Zo Cutbank �y�ti'c PrZ�fENTWater main/service line 2S �-& Surface water r Driveway, parking/vehicle storage area O ?' Curtain drain �i� /�✓��S�a1S� E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. or fig S FRJGINFF►21NC �. u°eamcaoaeaoao 17034 ragle River Loop Road No. 204 0 el Signaturee River, Alaska o e !P V e06`B ®8Y®a0p(�gp oS�OU N B Engineer's Name �111rf 1/ /� q�L e aoenaeroo uoo ew aQ Date110G R J. 'HAFER �d6J°e° No. 8'15 HAA Fee $ �`Waiver Fee: $ Date of Payment Date of Payment Receipt Number $ Receipt Number 72-026 (Rev. 3/91) Back MOA 21 WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 March 31, 1993 Mr. Scott Swenor S & S Engineering SUBJECT: Spring Forest Subdivision Class "A" Public Water System, PWSID 213564 Dear Mr. Swenor: (907) 349-7755 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: 1. The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on March 12, 1993. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. 2. 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. 3. 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. - 4. 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. Mr. Scott Swenor March 31, 1993 Page 2 If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. II s ' MUNICIPALITY OF ANCHORAGE DEPARTME(. t OF HEALTH AND ENVIRONMENTAL PR, VECTION L) .� DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL _ 14 U — ct4 I q OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. " GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, rang� ) p G 5� 2, /7 fro SGI f%6f/l�/yrs! Location (address or directions) � acs / t✓2 r/' �2��1�© (b) Applicant Name ��� Telephone: Home Business Pe `/(LQ�IVs�i Applicant Address (c) ' Applicant is (check one): Lending Institution ❑ ; Owner/builders ; Buyer ❑,; Other ❑ _(explain);,.' �(d) Lending Institution ,]`t $ Telephone — — '' :Address (e} Real Estate Company and Agent �[ KI E. 1 Address Telephone (f) the HAA to the following address fg' ,Mail 41 r4 1 ra= iW 4(s�?ri tp Q10 '�+ 2.. TYPE`OF RESIDENCE • '—, rl tit 5 iuq% � Iti Ori . - �-t Single -Family Multi?Family ❑ Other ( �e 5 l ` `, Number of Bedrooms , -/ � 3.�'11 WATER SUPPLY / 1 ry` 1 , q4{(!N Axl{- :• (: �- r Individual Well ❑ Community Public ❑ a �, A // Note.;lf community well system, must have wntten confirmation from the State Department of Environmental Conservation attesting to the legality and status s 4 ' SEWAGE DISPOSAL Onsite Public El community ❑ Holding Tank 11 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. - - - - 72-025 Page 1 of 2 5. ENGINEERING FIRM PROVIDIf NSPECTIONS, TESTS, FILE SEARCH, D, AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of thisins ection. Name c. Firm � lkp0r Telephone D¢�—f�U Address ZLE20(ezllko� 44& / p / SSS Date `o G Q /1!a`�fl 7oe.�'� 9..e e�eee na � MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SLRVICES DIVISION AUG I 1198 % A. [U-- L( DJTA E D MUNICIPALITY OF ANCHORAGE (MOr.1 HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Well Classification _ �iwift&6n 1*124 If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) _ Date C mpleted Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground — Sanitary Seal on Casi�/ ) Electrical Wiring in Conduit (Y/N) Depression Ar Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots To Nearest Edge of Absorption Field on Lot ;On Adjoining Lots To Nearest Public Sewer Line _ To Nearest Public Sewer Cleanout/Manhole _ To Nearest Sewer Service Line on Lot _ Water Sample Collect y — ;Date Water Sample st Results Comme B. SEPTIC/HOLDING TANK DATA 5-�7--c�g Date Installed 5-6-4P7 Size No. of Compartments �f 5c.)04uPak K Standpipes (Y/N) — Air -tight Caps (Y/N) Foundation Cleanout (Y/N) A Nelms/ Depression over Tank (Y/N) — Last Pumped Pumping/Maintenance Contract on File (Y/N) /Date A / �" ; for -_ Xv, Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well 7�� To Building Foundation 3e.'> To Property Line To Disposal Field To Water Main/ServiceL'n))e//�� To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata .Type of System Design Date Installed �/ ���7 Length of Field 5 / Width of Field Depth of Field •, Gravel Bed Thickness �✓ r Square Feet of Absorption Area Boo Standpipes Present (Y/N) Depression over Field (Y/N) �J Date of Last Adequacy Test Results of Last Adequacy Test A24 Separation Distance from Absorption Field: To Water -Supply Well l!�b To Property Line f® / To Building Foundation; To Existing or Abandoned System on Lot �� / ; On Adjoining Lots �Vx+ To Water Main/Service Line �w ,{T/o`Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course �r To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N Comments ** Check Per tied Bedro I certify tha I ec Signed Company Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) — Dimensions Manhole ess (Y/N) "Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ng Against HAA Request ** or conformed to all_M A and HAA guidelines in effect on the date of this inspection. Date MOA No. 5- 767 -- OD l O 016 ld U $ F Y" oacoor� Engineer's Seal � - c i w 3 cw SBam0 �� ur C J. Cormn CE -5283 ,�'4 e STEVE COWPfR, GOVERNOR OF a s a DEPT. OF ENVIRONMENTAL CONSERVATION/ ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 DATE: _d//?/ -!PL-------•-------- PWSID: --------------- To Whom It May Concern: According to records on file in this office, the 5DRY21-11___—_— o2�1S Water System is in compliance with the State Drinking Water Regulations for monthly bacteriological sampling only.* Sincerely, 9 Ronal S. Klein Environmental Field Officer •NOTE: Alaska State Drink.''Ing Water Regulations require that sampling for primary inorganics be taken at prescribed intervals. Since this is a groundwater system, primary inorganics saipling is required every three (3) years, The last samr:-le was received _��"� -------- 4 Please submit a current sarnp1e in order to bring your system into compliance with the inorganics siimpling requirements. APPLK NT FILLS OUT UPPER HAI ONLY Property Owner - %>.// i / /„ / (' Phone Zi l%il Code li l l`/ Mailing Address p Buyer Time Address //CJ �.� /S -',-i; / �(:' - - %l/ // Zip Code Date Lending Institution Phone / ' Zip Code Address j:7,-/�r./ (-/!�"�'"!r� /J/!L/SfJ�- Inspector /`` Phone Realty Co. & Agent .. Inspector Zip Code Address Legal Description��r Street Location _//%lf Field Notes: Type of Residence Single Family jNo. Multiple Family of Bedrooms— ❑ Other _ Water Supplyo�q LOG. A log is required for all wells drilled since June 1975. 1:1Individual ,�✓ fj]: Community C— r� ATTACH WELL well For wells drilled prior to that date, give well depth (attach log For if avallable). ( ) DISAPPROVED ❑ Public Utility ( ) CONDITIONAL APPROVAL' Sewer Disposal �I� Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72029 (3182) /' C Time Ti ne Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: G (,SRC MUNICIPALITY OF ANCHORAGE LA DEPT. OF lic.LTH f: ENVIRO\f,t_NIAL PROTKT!ON 3fr , t IN TI -1) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' Soils Rating Date Sewer Installed Well To Absorption Area,WellLog Received ' 7 e Well to Tank `-- " Septic Tank Size / © 72029 (3182) /' C CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT" OF ENVIRONMENTAL CONSERVATION . PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of '��� r n� <-' rJ ( (_. C.i l.< r'' /( 1_ KZ I LLpublic water system located in ��//..t i C �, o i- c, <' <' �f Alaska, submitted in accordance with 18 AAC 80.100 by f� 1 G� t 1 1� ! t - / f > a C 1 C P c have been reviewed and are ,0. approved. !/ ❑ conditionally approved„(see attached conditions). TITLE CATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contract order no. Approved by Date or descriptive reference) The "APPROVAL TO OPERATE” section must be completed before any water is made available to the public. APPROVAL TO OPERATE �... >7, The construction of the water system was completed on y �' (date). The system is hereby granted interim approval to operate for 90 days following the cpmpletion date. DATE As -built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. , - ;j ref; '.-' '- _ �."'"•r..... ...e r F f , � .,? �_;x TITLE - DATE a R,w ALASKA CI dROnMenTAL COnTROL SHUNS, InC. 6ngineerinq & Enuironmental Studies October 31, 1983 Department of Health & Environmental Protection 825 L. Street Anchorage, Alaska 99501 Attn: Cory Willis Dear Mr. Willis: This letter is to offer my humble apologies for incorrectly writing up certain parts of the inspection report for Spring forest Block 2 Lot 5. I had previously stated that the material beneath the tile was 144 inches. In fact, it was only 96 inches, as the total effective absorption area indicates. I also failed to explain why I re—designed the trench from what the permit called for. I did so because the drill log implied that the strata encountered was a silt which changed properties at various layers. However, the excavator dug to a depth of 12 feet to show that actually the soils were the same. Being suspicious, I climbed down into the trench, imperiling my very life for the sake of an accurate soils log, and found that, indeed, it was the same formation all the way down, not siltier or more plastic with depth. I then explained that they would need to dig down to 16 feet to show that there was no water, and naturally they proceeded to do so. I regret that I did not explain this on the report and beg forgiveness. Sincerely, Darcy Sevens Engineering Geologist 1200 West 33rd Avenue, Suite B • Anchoraqe, Alaska 99503 • (907) 276-1361