Loading...
HomeMy WebLinkAboutSUNSET HILLS BLK B LT 5Sunset Hills Block B Lot 5 #018-201-36 Municipality of Anchorage Department of Health and Human Services d1 -1h5 Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 October 22, 1992 a — o I -Z� Kimmer L. Griffith 14130 Specking Ave. Anchorage, AK 99515 Subject: Septic System Encroachment to Well on Lot -2-9', Blk B, Sunset Hills. Dear Kimmer Griffith: It has come to our attention that the absorption trench serving your residence, on Lot 5, Blk B, Sunset Hills, may lack sufficient separation to the well serving the subject lot. This was discovered during the resent upgrade of the septic system on the subject lot. Whereas the well serving Lot 29, Blk B was constructed prior to 1960 and the septic system serving Lot 5, Blk B, was constructed in July 1985, it is your responsibility to obtain any necessary waivers. Waivers must be obtained prior to your receiving approval for refinancing by this department. You will need to retain the services of a civil engineer registered in the State of Alaska. It will be necessary to prove that the existing separation will not adversely impact the water quality of the subject well. Should you wish to discuss the matter further please contact my office at 343-4329. Sincerely, Daniel N. Bolles On -Site Services cc: John Smith, P.E., Manager On -Site Services db/201 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-472.0 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE KNEW R N ?5q -6-,i 7 E1UPGRADE MAILING ADDRESS '56 HA-r-1744RV2 DR I N1 G- 99 5-1 LEGAL DESCRIPTION LOCATION—�— NO. OF BEDR OMS. Well Absorption area Dwelling PERMIT NO. - ✓ DISTANCE TO: Ioz lig 1154 96 0 0'- 2y H z Manufacturer_ Material _ No. of compartm nt Liq.capacity in gallons Inside length Width Liquid depth �-� IF HOMEMADE: DISTANCE TO: Wt'll Dwelling PERMIT NO. z F Manufacturer Material Liquid capacity in gallons O DISTANCE Well Foundation IG Nearest lot line PERMITN4 K () w= �� o ;7 UJ ii Z No. of lines/I Length of each line Total length of lines Trench width Distance between lines a w _I!_ _ __ .a rJ inches �— f. Top of the to finish grade VIz> Material beneath the inches Total effective absorption area OF Length Width Depth PERMIT NO. w 0 Q F- Type of crib Crib diameter Crib depth Total effective absorption area wa UJ Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER P, PIPE MATERIALS CAS S01 L TEST RATING '•� V I� INSTALLER rLl REMARKS W 1 �MH1 cCi Ca — - — ,� to • ,��- ,• <',ta 4 91t V•o �•ruo • a• •<l) _ a •eu ra 225-E: r.E APPROVED DATE LEGAL 72-013 (Rev. 3/78) a r LOCATION OF WELL (Please complete either lo, Ib or Is.) I Borough Sub divi Ion Lot Block Ib. I/e 1111S Sunsef Anch. Hills 5 B—of—o r—of _ Ic DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS WATER WELL RECORD STATE OF ALASKA DEPARTMENTOF NATURAL RESOURES Division of Geological 9 Geophysical Surveys D r l l lIhy Por. It No. A.D.L. No. Section No. Township No Range E Meridian __.so WF] T 3, OWNER OF WELL Don DeArmoun Signed : Authorized Representol Dote: "arm O2"NWR (11/81) Copy Distribution: WHITE -State DGGS, PINK -Driller, CANARY"Caslomgr Address: 3751 Matthews Dr. Slreaf Address and Area of Well Location Anch. Ak. 99516 _ Feet BeIDW 2. WELL LOG Surface 4. WELL DEPTH: (final) 5. DATE OF COMPLETION after hrs. pumpingkre .yam 179 ft. _ lar — Material Type Top Bottom -a5— Sand 0 5 G. U cable tool xM Rotary ❑ Driven ❑ Dug ❑ Auger ❑ Jetted ❑ Bored ❑ Other Cramp 13, PUMP: (if available) HIP Drop Pipe c Hard silty,gravelly till 18 23 7.USE:)❑% Domestic ❑ Public supply ❑ Industry ❑ Irrigation ❑ Recharge ❑ Commerical ❑ Test Well ❑ other. Sand and gravel 23 41 _Brown silt—L_P_ex 4 — a7 Grey clay 87 110 8. CASING: ❑ Threaded a welded did.. 6 1h. to179 it Depth Weight 17 lbs./n diom.`lr. to_ft, Depth Sresup_90" Brown silty sand and gravel 110 167 �ilY sand and gravel weak H2O _ 167 178 Clean, black H2O sand and gravel 178 179 g, FINISH OF WELL: Type: nen bn.tLQ Dlomdter: — � S I ot/M0 1 SI[e: Le path: Set between It. and It. Backfilling _ _ Grovel pock SGS8/26/85 10. STATIC WATER LEVEL: 64 11, 1— —D & aw 4Tw l. egofpAtvv" ec�lo Dole L] Above a1Belaw land surface vu Equipment used: dart Valve hailer Signed : Authorized Representol Dote: "arm O2"NWR (11/81) Copy Distribution: WHITE -State DGGS, PINK -Driller, CANARY"Caslomgr II. PUMPING LEVEL below land surface and YIELD 71 _ft. after 2 —hrs. pumping 12 g. p.m. PFIt. after hrs. pumpingkre ' 12. GROUTING Well Grouted: ❑ Yes Ig No Material: ❑ Neat Cement ❑ Other: _ — 13, PUMP: (if available) HIP Drop Pipe c Length of _19�r1. capacity a -10__g. P.m i Su ban. [3 Jet ❑ Contrifical ❑ Other 14. REMARKS: _—� ----_ —� Pitless depth not included in -- `— — ingth. of drop pipe 16. WATER WELL CONTRACTORS CERTIFICATION: --'- 15. Water Temperature ❑ C --a F This well was drilled under my jurisdiction and this report is true to the best of my knowledge and bellef( —DoALten DrilliM Co __ AA0512 Registered business Name Contract License Number Signed : Authorized Representol Dote: "arm O2"NWR (11/81) Copy Distribution: WHITE -State DGGS, PINK -Driller, CANARY"Caslomgr 0,­���1 E.": :1 F'" 11 ...... 1 -11 " 'v" C-3 F-" 11 % 0 1[-::, 1 A 113 F;"! W.'!% EEP, N'."E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264~4720 oil 1%I --- Q 1: -T- EE E13 1=1 0A 1EE UTZ 8C tAJ EEO L. L. III WTI 1-1 J: "I, PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIp: LOT SIZE: MAX BEDROOMS: 850407 07/10/85 BRIGHAM A MORGAN 3611 MATTHEWS DRIVE ANCHORAGE, AK 99516 345~0395 SUBDIVISION: SUNSET HILLS LOT: 5 SECTION: 32TOWNSHIP: 12N RANGE: 3W 15500 (SQ^FT. OR ACRES) 2 BLOCK: B Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. �... ..... .... � ������ ��� .... ������ DEPTH TO PIPE BOTTOM (FT.) \ 4"0u/ / 4,0 4"0 GRAVEL DEPTH (FT") � 5^0~/' 0"5 3"5 TOTAL DEPTH (FT,) 9"0 4"5 7"5 GRAVEL WIDTH (FT.) 2"5 15"0 5"D GRAVEL LPNGTH (FT.) 30.0 30"0 33"0 GRAVEL VOLUME (CU,YDS,) 15.3 // 16"7 24,5 TANK SIZE (GALS) 1,000^0 **W 1,000^0 ** 1,000"0 ** SOIL RATING (SQ,FT./BR) 150,/' 150 150 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1" I am familiar with the requirements for on-site sewers and wells as set Forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2"0 will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit,. 3^ I will adhere to all MOA and State of Alaska requirements for the set back distances from Any existing well, wastewater disposal system or public ' sewerage system on this or any adjacent or nearby lot" 4. I understand that this permit is valid for a maximum of 2 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTSCAL PERMIT AND INSPECTION MUST RE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN" SIGNED �� DATE: ~ 07�.~_.���-.��.�~... APPLICANT: 850=1'11 A MORGAN - ISSUED BYDATE: -7 / [)` 6r� -~----~~~~~~^ --------_--_ ~-~/-''_ou xSOILS LOG MUNICIPALITY OF ANCHORAGE >SU L�c) 7 El DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION v 825 L. Street, Anchorage, Alaska 90501 2644720 TEST SOILS LOG - PERCOLATION TEST PERFORMED FOR: De-') �� f•t�i"4 p1� � DATE PERFORMED: VCJ /g-.��' SEC— LEGAL DESCRIPTION: LO 7 1. >vl 1?s SONS R -T E 4 I L..L & 'r IZ KI -K-Z W /� �j /'� /� j�� /� SLOPE SITE PLAN �— D Eigcc i 0R6 AN 1lr� 1 .,SVA'. T -AN LOAM 2 -1 �-w- 3-. 5 s v v %1 tvVLf% 6 ... L� 7 8 • s r '~ 9 r o 10-cp.0 11 w •� 12 13 14- liliol lU PERFORMED BY: T` 72-008 (6/79) WAS GROUND WATER S ENCOUNTERED? L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop ■ ■■ ■ �■■■E P Is „■■■711 �■� ■� No .9 No �iIN�■■■■No 0MEN WAS GROUND WATER S ENCOUNTERED? L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop p L / ISOAPERCOLATION RATE��a i% �-- (minutes/inch) TEST RUN BETWEEN ®— FT AND — FT CERTIFIED BY: DATE: Municipality of Anchorage Development Services Department Building Safety Division _ On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.fl1g-a0'-310 COSA# 0100 LAc6 Expiration Date: �? - - or. 1. GENERAL INFORMATION Complete legal description r.nt' 5• Rlnrk- 'ply C„ncet dills Subdivision Location (site address) 14130 Speckinp, Ave. Current Propertyowner(s) Kimmer Griffith Day phone 522-3849 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 2 TYPE OF WASTEWATER DISPOSAL: Individual On-site {� ❑ Individual Holding Tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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. 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of Installation. Name of Firm S & S Engineering Phone 694-2979 Address 17034 N Favle River Loon Ste, 204 Eaple River, AK 99577 Engineer's Printed Name Robert C. Cowan Date Yzac l0 C 5. DSD SIGNATURE '� s1„ adaut� c COWAN ✓ Approved for �_ bedrooms. C' CE sao► Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By; �, �o Original Certificate Date: (Rn. 11105) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw, Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onske (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIScT� Legal Description: DT Pirc�tC"QIP ' SUn�,ET ITIu�D Parcel ID: O! d -2. 01 -.-3 (o A. WELL DATA L Well type Rnk Jiq [i - If A, B, or C provide PW`SII*D # _ Well LoQ�J?iJ) Date completed ��'05 Sanitary seal�JY J) �g Wires properly protected (Irm) 1 E� Total depth I ft. Cased to Jj_ft. Casing height (above ground) I2 in. FROM WELL LOG Date of test Static water level ft. Well production 120 g.p.m. WATER SAMPLE RESULTS: Coliform _-L--colonies/1 00 mL Nitrate O.3-ng/L Arsenic: O mg/I Date of sample: "trot AT INSPECTION a �RR7 Lot. "lo' ft. 14 '� g.p.m. Other bacteria 0 colonies/100 mL Collected by: f dS E$J" V ( A9Q B. SEPTICIHOLDING TANK DATA % Tank Type/Material 56FTIc- / s Tit- Date installed i 1 ('�> LS S Tank sizel�G' gal. Number of Compartments 3 Cleanouts�N) q� Foundation cleanout L�/N) _Y� Depression over tank (Y(M 130 High water alarm (YRW /OO Dateofpumping 1195LOS Pumper 6t14nrn6 f0Z5f_Vlet-S C. ABSORPTION FIELD DATA Date installed 105 Soil rating (g.p.d.R o Ibdrm System type l Length 30 ft. Width 30 1XXJ+f ff! Gravel below pipe 5 ft. Cr� Total depth L_ _._ ft. Eff. absorption area � fe Monitoring tube r vc� Depression over field A) 0 Date of adequacy lest a' Resu (Pas ail) ��For —L bedrooms Fluid depth in absorption field before test 11 in. Water added % gal. New depth X13 in. a Elapsed Time: IID min. Final fluid depth o in. Absorption rate >= 340 -(- g.p.d. Any rejuvenation treatment (past 12 mo.) (Y41 9 type) 00 If yes, give date -- D. LIFT STATION Date installed 'Pump on' level at _ in. Datum E. SEPARATION DISTANCES Size in gallons ss (Y/N) at _ In. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot loo r♦ On adjacent lots Absorption field on lot ICS 1+ On adjacent lots 160 r 4 - Public sewer main 0 wk Public sewer manhole/cleanout F.1 Sewer /sepfic service line a514' Holding tank N R Animal containment areas CO + Manurelanimal excrete storage areas too + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r r Building foundation 5 } Property line r,4 Absorption field S Water main Water service line 1014- Surfaoe water r 00 I+ r Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: i r Property line (o •- Building foundation /0 + Water main ►1 Water Service line ICS r-� Surface water 105 /+ Driveway, parking/vehicle storage /0 14 - Curtain drain A9C JOF- Wells on adjacent lots _gLL-* (a q ,.rtA, R t a rf S rEo — St, L 4774 c N1d F. COMMENTS 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. %;.•• _•-• N : •r'/;I » ,+ n P,ISA RC9ER2 G,CCYlAY f ti r Engineer's Printed Name I` Q,0,tAl C • co u r If c� •.� CE 8301 %',,�~ Date ly/ aL c=tt ;?';:. ,•; COSA Fee 5_ �� C= u Waiver Fee $ �57� Date of Payment _r ,1� to Date of Payment Receipt Number `l -;31v I :B Receipt Number t7 3i( l T2-) (Rev. 11!05) e N \ - V I rE H` iH ' o �� .<•, r <. r io,�7 gv IF AL -'6%1 %S9 11 I PA NN».•L.{ N.NM... N Q Shone A. Noh i • LS 6914 . A •,AV EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON 1.L 1510 THE MfORFAIM HEREON IS FOR THE USE OF LENUMMI W TTTU• TIOFIS SFF(TF!C 1LY TO ENO."; ANY L•CNrvm BL1*Mw E1OSMIO STFiIM'TU9iS ANI? PUTTED LOI LINES OR EASEMENIS AW 6 NOT W BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENUUNES Scale : 1" = 30' AS - BUILT ( NO CORNERS SET THIS DATE ) I hereby certify that I have performed a Mortgagee's inspection of the following'described property Lot 51 Block "B" Sunset Hills Sub. Anchorage Recording Precinct, Alaska and that the Improv -ments situated thereon are within the property lines an do not overlap or encroach on the property lying adjacen thereto, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other v1st- ble,easements on said property except as indicated here- on. Dated at Anchorage, Alaska this 30th day of. Ju • 19 88 FB B — 71 HOLT b ASSOCIATES LAND SURVEYORS IEALTHALITHOWTY APPPTOMS SEWERBWATER AWNEXTENSIOfb SEWER & WATER INSPECTION ENGINEEHINGSTUMS ANDREPORTS WELLlsPECTIoN A FLOW TEST SITE PIANS ROAD DESIGN SMTEST PERCOLATION TEST STRDCTLYIAL S MECHANICAL INSPECTIONS ONSITE WASTEWATER OISPOSALSYSTEM DESIGN S& nG April 24, 2006 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 5; Block 'B'; Sunset hills Subdivision CMLENGINEERS (907)694-2979 FAX(907)694.1211 Request you grant a formal waiver for the existing private well serving lots 29 and 30; Block 'B'; Sunset Bills Subdivision to the septic Icachfield serving the referenced property at 96 feet separation. The septic system serving the referenced property was installed by Able Excavating and inspected and approved by the M.O.A. in July 1985. Subsequent Health Authority Approvals were issued on the referenced property in November 1985, May 1988, and October 1990. The well serving the house on lots 29 and 30; Block 'B'; Sunset Hills Subdivision was apparently drilled prior to 1960. Unfortunately there is no well log available for this well. However, we have obtained well logs for several of the neighboring wells (see attached) and taken satisfactory water samples from the well in question. The mitigating factors involved which support the issuance of this waiver is as follows: I. The soils log performed for the septic installation indicates the trench was installed in "fine sand with some silt" (see attached). This type of soil serves as a filtering media which strains the septic effluent and increased bacterial retention. As septic effluent migrates downward toward the aquifer, these sandy soils will have a purifying effect on the effluent, preventing contamination of the well. 2. Logs for private wells on the neighboring properties show water was not encountered during drilling until a depth of approximately 90 feet. Above this depth are several tight, clayey soil layers. These poorly permeable layers act as a barrier between the septic system and the aquifer, alleviating the migration of effluent toward the aquifer. 3. From a well flow test performed on the well serving the referenced property on March 27, 2006 we found that after continuously pumping the well for over 3 hours at 4.7 gallons per minute, the static water level drawdown was only 2 feet. Well logs from this well and neighboring wells estimate production of 5 to 10 GPM. These reasonably high well now rates suggest that any wells served by this aquifer would create a minimal hydraulic gradient, therefore, use of the well on lots 29 and 30 would not have a tendency to "draw" any septic effluent toward the well. 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER ALASKA 99577 Page 2 L5; B'B'; Sunset Hills S/D 4/24/2006 Water samples taken from the well located on lots 29 and 30 Block 'B'; Sunset hills by our firm on 1/11/1993 indicated minimal nitrate levels of 0.27 mg/I and no coliform or other bacteria (see attached). Water samples taken by us again on 4/3/2006 indicate even lower nitrate levels of 0.216 mg/I and zero coliform bacteria. Due to the fact that there are no coliform bacteria present, we do not believe the 17 other bacteria in the sample results are in any way related to the proximity of the septic leachfield on lot 5; Block 'B'; Sunset Hills Subdivision. Since septic effluent is very high in nitrates, and nitrates travel through soils often unaltered, it appears that after more than 20 years of septic system use the well still is not affected by septic effluent. Since this system's installation, the on-site well and supporting aquifer have suffered no ill effects and there is no reason to expect this situation to change. We therefore recommend a waiver for the separation distance between the existing private well and the existing septic leachfield at 96 feet. We do not anticipate any adverse effects on the neighboring properties by the granting of this waiver. If you have any questions, please contact us at 694-2979. Sincerely, wlt-/24�l Robert C. Cowan, P.E. RCC/ts Enclosures 0 Mayor Mark Ikgich l�Zunicipaliiy of Anchor age CO. Ik�s ]JfiGiO - Ml'IIUNgC, Ahltikll o!ti;I�Lr.(�,n - Telephone ((X)7) 3t&KU)j - Ru (()07) W.8:t(N) 4700 nragaw St met - Anchmigc, Alaska!M7 May 3, 2006 %1M.mu11Lurg Btilltling Safety Division Robert Cowan, P.E. S&S Engineering 17034 Eagle River Loop Road, Suite 204 Eagle River, AIS 99577 Subject: Waiver Request for Sunset IIills Block B Lot 5 Waiver Request WR#: 060014 Parcel ID # 018-201-36 IIA060148 Dear Robert Cowan, P.E.: Your request for a waiver of the required 100 feet horizontal separation from the absorption field and septic tank to the private well has been approved. The approved separation distance is 96 feet. A 96 horizontal foot separation from well on lot 29 & 30, Block B Sunset Bills, to septic system on lot 5, Block B, Sunset Hills. This waiver approval applies to the existing absorption field and septic tank to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there arc any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, J ood all livil Lnginccr On -Site Water & Wastewater Program Community, Security, Prosperity Municipality of Anchorage Development Services Department Building Safety Division On-Sitc Water and Wastewater Program 4700 Bragaw Street P.O. Box 1%650 Anchorage. AK 99519.6650 www.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#:060014 PID#:018-201-36 HA/Permit# IIA060148 Date Received: May 3, 2006 Legal Description: Sunset Hills Block B Lot 5 Engineer. Robert Cowan, P.E. S&S Engineering 17034 Eagle River Loop Road, Suite 204 Eagle River, AK 99577 Applicant: Kimmer Grifflth Waiver Requested: 96 horizontal foot separation from well on tot 29 & 30, Block B Sunset Hills, to septic system on lot 5, Block B, Sunset Hills Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Points: 5.93 3.59 2.20 2.00 2.84 Total:16.553 .......................................................................... Waiver is Granted: X Waiver is not Granted: List Conditions or Reasons for above: Date: 5/3/06 By: Joe Goodall Name of Reviewer Rec#: 2W Amount: $ Ji,'tQ Date Paid: $13/2006 State of Alaska: Separation Distance Waiver Guidelines for S.C.R.O. (State of Alaska Memorandum to District Office Engineers dated January 3,1985) Waiver Request for: Sunset hills Block B Lot 5 Parcel ID#: 018-201-36 Waiver Request Number WR#: 060014 Waiver Requested: 96 horizontal toot separation from well on lot 29 & 30, Block B Sunset Hills, to septic system on lot 5, Block B, Sunset Hills Engineer: Robert Cowan, P.E. IIA060148 Seatic Svstem Data The septic system serving lot 5 was installed in July 1985 and has encroached the well on lot 29 & 30 for over 20 years. Since this encroachment subsequent Health Authorities were issued with -out noted encroachments. The septic system depth is a a total depth of 9' deep. Well Data The well was installed some time prior to 1960. There is no well log in record, however S&S Eng supplied well log data for adjascent lots. For th purpose of calculating points the well log for lot 32 was used due to similarity in depth, date drilled and close proximation. The water samples for well on lot 29&30 were well with -in Municipal standards. State of Alaska: Separation Distance Waiver Guidelines for S.C.R.O. (State of Alaska Memorandum to District Office Engineers dated January 3,1985) Waiver Request for: Sunset Ilills Block B Lot 5 ParcelID#: 018-201-36 Waiver Request Number WR#: 060014 ; f Waiver Requested: 96 horizontal foot separation from well on lot 29 b 30, Block B Sunset Hills, to septic system on lot 5, Block B, Sunset Hills Engineer: Robert Cowan, P.E. IIA060148 Water Table Points no Depth of well: 91 5.93 Depth of septic system: 9 82' Distance from the bottom of the system to the highest water table In feet Polnt Value 0 0 8 1 17 2 24 3 30 4 40 5 85 6 100 7 290 8 1000 9 10 • Straight line Interpolation is permitted between any two values Soil Sorbtion Points ,.s 3.59 Soil Type I Point Value 14 0 + 49 6 + 19 0 + rI 0 Clean Gravel 0 82 82 82 l 82 Fractured Rock 1 Course Clean Sand 1.5+( 1 0 + r 1 0 + r 1 0 + (0 1 0 Sand w/ Small Amt of Clay 2.5 82 J l 82 J l 82 J l 82 1 Silt 3.5 Clay and Sand Equal 4.5 0 + 3.6 + 0 + 0 Clay 6 0 + 0 + 0 + 0 'Use the predominant soil type but values can be averaged for a mixture Permeability Soil Type I Point Value Clay(will channel) 0 Silt and Sandy Clay 2 Clayey Sand 3 Fine Sand 1.5 Sandy Gravel 1 Fractured Rock 0.9 Course Sand (30 grit) 0.4 Clean Gravel 0 Points .� 2.20 f 14 [ 82, 1 + 82, f 49 3 +[ 82 19 , 1 + [—r2-] 1 +[ 0 , +[ 82, , + 8 ) , + [ 82, , 0.17 + 1.79 + 0.23 + 0.00 0.00 + 0.00 + 0.00 + 0.00 *Use the predominant soil type but values can be averaged for a mixture Gradient Points ,.a I 2 2.00 % Slope Points Value Separation -60% 030% 0 0.3 25 -20% 0.7 slopes toward well -10% 1.2 100 -5% 2 5 0% 2.93- Oat 5% 4.5 10% 6 slopes away from well 60% 7 'if the gradient is unknown, assume the wont case Horizontal Points Mn 96 2.64 Horizontal Point Separation Value In Feet 0 0 25 0.7 50 1 75 2 100 3 150 5 200 6 300 7 •Linear interpolation between two point value is acceptable. Horizontally means straight line distance to the well not the contaminate travel distance to water table which may be greater. Conclusion: Grant Waiver Total Points: 16.553 m _ 50 SITE PLAN o SCALE — r n N 4 0 0 a u I$� I IIA � o 11 s ' v // _I U� •I I i_ N I ti I I O Z� T�\ 9 n rn it��It r O O D � r D r � � � Z I � M r o� i r cn O � r O n D m � \ r O \I w (n N 2 H rn it��It �1 SCS ReLN 1061615001 All Dates/rimes are Alaska Standard Time Client Name S & S Engineeringa Printed Dale/rime 04/07/2006 8:02 Project Name/N Lot 29 Block B Sunsct Hills �il�S� K,m A(.('Collected Date/rime 04/032006 16:10 Client Sample ID Lot 29 Block B Sunsct Hills Received Date/time 04/032006 16:33 %latrix Drinking Water Technical Director Stephen C. Ede P%%*SID Sample Remarks: Allowable Prcp Analysis Parameter Results PQL Units Mcthod Container ID Limits Date Date Init Waters Department Nitrate -N 0.216 0.100 Microbiology Laboratory Total Coliform 17 OB, No Coli mg/L EPA 353.2 B (<-10) 04/04/06 ALR col/100mL SM209222B A (<-I) 04103/06 TLF 200 W. POTIER.DRIVE ANCHORAGE, ALASKA 09518 SGS/CT&E ENVIRONMENTAL SERVICES Te 007.562-2343.: . Fax 907.561 -Mi ' • I.w e -.u_ Drinking Water Analysis Report for Total'Col"Iform Bacteria 1061615 A- RM INSTRUCTIONS ON REVERSE BIDE BEFORE COLLECTING SAMPLE MUST BE COMPLETED A pPuacwATERaTBTEME>aWATERBtiPPLJEft....•.. .. .....-^_..__._...-_I I�.p�II�N�NY ' ATE INTER SYVSTEM — —•— —.— — Ipmq�10Np0 Ip®' . ATESBY ❑ Sena Rewe ❑. Sana Invoice ❑ Sena Raub' Gsem Imaica .. SAMPLE COLLECTION: SAMPLE TYPE. rrw�n;.w�`r .ews...�...+.r.�. Date; ❑ Routine . p Treated Water Time:' I y AM PMpast JJ ORepeat Sample p Untreated Water Lo"dw- • ru•1C �i' '3fw4t+T �£itt. .-� (refer to lab no. t coeactor: NGnco-P K%l w - - p Special Purpose Trweported. to Lab By: Same a9 collaf for Other TO BE COMPLETED BY LABORATORY Sample Rocaiving• Date: ❑SampkvmrSObouactd: R.aer, m...h,. ,.-.n,ee• _ � 5 ❑ RUSH SAMPLE Qth�Orte #: Fax #: Heid For Confirmation .............................................................................................................................................. Bacteriological Water Analysis, Record• SeMIOADEC: • MMO2IUG (PIA) RESULTS: ANC FSK JUN Anayab Bean: NIt �OGA//I/f, Tow Co0o= Ualamrw Amyst: 7 /' E Cot . Sant b plan[ Anaht" Method: MEMBRANE FILTER RESULTS: P honed Q Faxed Q WCount T ed CaO a Com4SHBOmL e:LTS: Dswrbn� . • IXL Membrane Filter Vamtomn: /T% G� �a�- ' 6 MMO-MUG (P/A) w. • Lam'aC t1Gtr,,'� Satisfactory . rrer { EC�i,vL p Unsatisfactory,/ Reported By: TrYm-T«Ilrr.rCwt Datemme: 'y t lc G / f. ! -/.— br. Form # FW -0053 12/1710.7 IU a inaa0l%ANK,Cx pOatatPubseo( 0MENTTORMSIeppmvedr<•aE Form 121703.dt MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 it CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # A2�9 G]lR ,-in) —,Sin HAA # 01 Q'2"-�1 1_I Q I 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 5• Btock "B": Sunset Hitth Subdi.v bion Location (address or directions) 14130 SpeckUng Avenue (b) Property owner Catheaine Fhantz Telephone : (home) 345-3932 Business Mailing Address 14130 Speaking Avenue Anchonaao. Atabha 99515 (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone , (e) Mail the HAA to the following address: (or check hereof; if hold for pick up.) List contact person and day phone number below: s & S ENGINEERING to Riv Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family Number of bedrooms 2 3. WATER SUPPLY Individual Well ix Community ❑ Public ❑ Note If community wellaystem,.must,have written confirmation from the State Department of Environmental Conservation attesting to th legality anii status. 4. SEWAGE DISPOSAL .On4te& Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/80) Pagel of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, 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 this inspection. Name of Firm Telephone �2 5;7 5 a, 5 ENGINEERING Address le River Loop Road No. 204 F. - River, Alaska 9 Date 60 A3 /e� 22 6. DHHS APPROVAL , Approved for <-7 bedrooms by - Date � Approved _Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above byan 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 oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors oromissions in the professional engineer's work. 72-025 (Rev. Uee) Back Page 2 of 2 NGNCe �5� MUNICIPALITY OF ANCHORAGE (MOA) pFv�o¢So o Health Authority Approval (HAA) p�10 .11 CHECKLIST - FEBRUARY 1984 o" ,goad 343-4744 Legal Description: /—of S• 6/oc r "A ",• A. WELLOA Well ClassificationIf A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) —Date Completed g '2 (o -F35 Yield Lo•BCaP Total Depth -LI -I -L Depth—LI—I—Cased to Depth of Grouting `/ z 5- PO Static Water Level `f b Pump Set Aty l Casing Height Above Ground 12- Sanitary Seal on Casing (Y/N) uj Electrical Wiring in Conduit (Y/N) I Depression Around Wellhead (Y/N) A% SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ( r�o / ; On Adjoining Lots ( oc) .t To Nearest Edge of Absorption Field on Lot / / 3 ; On Adjoining Lots too 7t To Nearest Public Sewer Line IJV ILa To Nearest Public Sewer Cleanout/Manhole N to / To Nearest Sewer Service Line on Lot 2 5 t Water Sample Collected by S4 SENG rte_ M ee-J i rJ ; Date Water Sample Test Results SAJiSfAC fq - E3.9CteJiF4 4- /Jcf-�4 CS Comments B. SEPTIC/HOLDING TANK DATA 7 - Date Installed%10-65Size 1000 No. of Compartments 2 Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Lq Depression over Tank (Y/N) — /J — Date Last Pumped - Z S - 9a Pumping/Maintenance Contact on File (Y/N) to I 1 ; for A.) I/ ✓i Holding Tank High -Water Alarm (Y/N) &)MTemporary Holding Tank Permit (Y/N)� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well ( r) C) To Building Foundation r To Property Line ( D To Disposal Field I b To Water Main/Service Line / To Stream, Pond, Lakeor Major Drainage Course 162 c7 f Comments ti C_ P0 AA ed bJ.4 A+ /A J'UICe 72-026 (Rev. 7/88) Fronl Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Sogr� Type of System Design 1 2e JL�t Date Installed - 18 - 8 S Length of Field 30 r Width of Field Depth of Field Gravel Bed Thickness 5 Square Feet of Absortion Area 300 `� Statndpipes Present (Y/N) Depression over Field (Y/N)rJ % Date of Last Adequacy Test ; Results of Last Adequacy Test .5A I rs fiac_-fol y 2- 3cJ✓'oo M SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well t I 3 To Property Line / o To Building Foundation to Z To Existing or Abandoned System on Lot v�tA ; On Adjoining Lots 3o F To Water Main/Service Line (o t To Cutback (if present) n2,116 To Stream, Pond, Lake, or Major Drainage Course 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 Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) - "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request' I certify that I have checked, verified, or conformed to all MOA and HAA guidelines i inspection. Signed 5 & 5 ENGINE.EWNG s g 17034 Eagle River Loop Read No. 204 s Company--,: rg, RirerrA'-*ka 99577 Date to A �ra� MOA No. Q S Ro Receipt No. O a - _� a a.-0 `,,, L Date of Payment `F - 9 y CUD Receipt No. Waiver Fee: $ Amount: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 this 4 No. (4V -k -. pyANOfVINOFHq CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. Ys ♦h s �s •�••*o• •• 5633 B STREET • ANCHORAGE, ALASKA 99518 • TELEPHONE (907) 562-2343 4ass'� FEDERAL TAX I.D. #92-0040440 ARALYSIS REPORT BY MIPLE in Thik Mex (I 27562 Date Rspoxt !'Onted: OCT 1 90 Q 13:20 :"tient 5arnple tZ . LO'TSDLOCR 'R" SUtiS6'P liiLLS SD. MID :UA �:oaieeted Slip 2' 90 @ .13:50 Ia's. "welyerl SEP 7.5 90 3 1.3:1-0 bee. plovivod I,ith :AS ROUIRED AnaJ.yej.s Cumplotod :SEP 28 90 Laboxatoxy Suueuiapx :STEHEII/C. HE Relaasod Ey ir%yr�-- ! "j1/._ :ipec J, II'IB txllc t Cliont Rome _ S G, 9 41"WHOING Client kct : IiRSERGP P.D.A 1:011I7 RECEIVED Boa 4 Otde2ed Dy : R. Sllht'Elt Bend Bepoets to: 1)3 F. S ENGIREEFJRG 2) Cheminb Rof II. 907860 Lab Snip) ID: G I:`etxix: WATER hllori¢ Au iol,-metol Tested. Besv)t Units t;othod Liiuts RITBATE-N 0.26 1 EPA 3G3.% 10 SrogAt, ROUTINE SAMPLE. Awn Q I's : 1114VI:E COLLECTED BY RIJd. 1 Tonta Poxioxmod See Spacial Instro(Axolis Ahove UA Unava.ilohlo iD• done Dotectod Soo Salaplc floelFxks Abmra RA, Not Aualysod LT -:Lone Than. CT,Gxootex Thou MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date g' -7-e) -:`r 0 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) G0'r5r &'Oek )5 5-4,,d3F7- A// -Li % iz1✓ r` -'3w -ce 3;— Location (address or directions) - 1 13a � �ECKyr�% (b) Property,Owner/�6fli' ��' Mailing Address 70V/�'_is (c) Lending Institution Mailing Address _ (d) Real Estate Company and Agent Address _J�✓ Telephone (e) Mail the HAA to the following address: or: C List contact person and day phone number 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms _ ne: Telephone here P'if hold for pick up. Business 3. WATER SUPPLY Individual WeII)�j 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: It community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72 025 rne� a/nsi Fmnl 4 3r- 3,q iGNSFi Ib Lt f 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verity 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 verity 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 f Telephone Address 17-00 j3 SGi7--" /3 IfAmW y 99sL3 Date OF A4 V A '(u••• •....u•• •••. ..•y,7 ROY C. REID, JR. AT CE-TYali.eto rS3al 6. DHHS APPROVAL Approved for bedrooms by__ZVI ZA;Z//Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION 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. Page 2 of 2 72-025 (Rev 8/86) Back A. WELL DATA OF At"POPAtl�LITY OF ANCHORAGE (MOA1 MdNICIPN01" SRRVI�L'MATHORITY APPROVAL (HAA) ENVtRDNM�N CHECKLIST - FEBRUARY 1984 264-4720 1AAY 2 61980 RSC' VES 0 /6 - 24/-3� Legal Description: GafS Ote& B 1eix49-c-T lh4cy Tan/ X310 iEt 3y Well Classification ��✓/�w If A, B. C, D.E.C. Approved (Y/N) ,J�,4 Well Log Present&N) Date Completed ` Yield hfYM .4 Total Depth _ __/�ir Cased to X79 Depth of Grouting Static Water Level % % Pump Set At Casing Height Above Ground — Electrical Wiring in Conduit (Y N) Separation Distances from Well: Sanitary Seal on Casing ON) — Depression Around Wellhead (YO To Septic/Holding Tank on Lot /0'0 1 ; On Adjoining Lots /00 7 r To Nearest Edge of Absorption Field on Lot //3 ; On Adjoining Lots looIt To Nearest Public Sewer Line To Nearest Public Sewer r Cleanout/Manhole — A) To Nearest Sewer Service Line on Lot Water Sample Collected by G5 �' Uf/V'" Date -5-'/0 8g Water Sample Test Results N/%a�r3 d, ?4 Comments A ul - Actio %Z57` 5`10-0. /994MAig� B. SEPTIC/HOLDING TANK DATA Date Installed T��`' Size No. of Compartments Standpipes) Air -tight Caps(Y ) Foundation Cleanout(Y/ ) Depression over Tank (Y(N) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) J/%t for Holding Tank High -Water Alarm (Y/N) _—"J14 Temporary Holding Tank Permit (Y/N') AA_ SeparationDistances from Septic/Holding Tank: r To Water -Supply Well /" To Properly Line /G fi r To Water Main/Service Line %o '1'_ r Course Comments Page 1 of 2 72-026(11/84) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Gr yra lja'T 444% C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed %-/41'45' Length of Field i� r r r Width of Field Z. irDepth of Field % _r Square Feet of Absorption Area Depression over Field (YON Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation / 67- Lot yLot ,✓�i4 r To Water Main/Service Line /U y To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION nstal led Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) _ Comments Gravel Bed Thickness — Standpipes Present 6N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on / On Adjoining Lots /, 7- - To Cutbank (if present) �/✓ FA Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Cycles during Adequacy Test. Meets MOA I certify that I hav e%�d, ver fled, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed` `'� Date -� �+ ,r� p,�,ipavietF,�4 Company Ll�"f —/� `� MOA No. ��L �OF At e8pv VJ i'�s"ooaa �j�Q J .oe so_Ytl) Receipt No. / ®y.4�• '^,,'( Date of Payment J 6 �,;;; ..> 6e) 0 Amount: $ er' al 9 •eo• , , LER C. REID, JR. � �n.'. E -2251 '`S r' Page 2 of 2 72-026 (11/84) 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 _'w®V — I j kL 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) OT 5� R. K �� _ N S t=. i t-1 t e_ 3,Q i1a IV 5 a�/ Location (address or directions) 1141 ';�(D <,-'P f=r (b) Applicant Name Dovl I:)eQ, Wtv✓+-i Telephone: Home 11619h Business Applicant Address — ih113o S>00/2V e2 _ (c) Applicant is (check one): Lending Institution ❑ ; Owner/bufl4erj9:; Buyer [J ;Other ❑ (explain); (d) Lending Institution Address (e) Real Estate Company and Agent __N OK 6 Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family g Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well )4 Community ❑ Public ❑ Telephone 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 rq Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025(11,04) 5. ENGINEERING FIRM PROVIDINu INSPECTIONS, TESTS, FILE SEARCH, DA1 H 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 sate, 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 0 n 419e h Au 1'k laIltnlTelephone �Z-72 - -3 21.6 Address c2�3 1 ✓—z'9 Date ©fenl/�,,�l�f�r :Engineer's Seal �.n°• Jo. 2225-�L JUNE 25. t911 6. DHEP APPROVAL Approved for «0 ?j bedrooms by ^� `��`t Z'� Date ��— ✓, b'� Approved_ Disapproved Conditional _ 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 72-025 (11/84) MUNICIPALITY OF ANCHORAG.a DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL. PROTECTION HEALTH AUTHORITY APPROVAL (HAA) Nov 1 CHECKLIST - FEBRUARY 1984 264-4720 0. UPI P I E P Legal Description: ke? 7 �t tJS� / [///, 4!�9 c 3 '/E /A,\// R a t t% A. WELL DATA Well Classifications If A, B, C, D.E.C. Approved (Y/N) P//A Well Log Present- (Y/N) Date Completed �' ' fr=' Yield Total Depth -1 Cased to / 77 Depth of Grouting /)/6)4_ Static Water Level 6 y Pump Set At Q Casing Height Above Ground — Sanitary Seal on Casing (Y/N) y Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) n� Separation Distances from Well To Septic/Holding Tank on Lot ) 0 O On Adjoining Lots > !O� To Nearest Edge of Absorption Field on Lot —L1 �L _ ; On Adjoining Lots > f 0Zc To Nearest Public Sewer Line h("�' IA G To Nearest Public Sewer Cleanout/Manhole N�eK- �+ To Nearest Sewer Service Line on Lot i 10 Water Sample Collected by _ �• -' II Date Water Sample Test Results �0-taA a 0 4.vY Comments B. SEPTIC/HOLDING TANK DATA Date Installed - yf/85 Size /B o�-P No. of Compartments _ 7_1,1'/C) Standpipes (Y/N) 7 l`/D Air -tight Caps (Y/N) Foundation Cleanout (Y/N) y 7 Depression over Tank (Y/N) �Date Last Pumped N f= LkI Pumping/Maintenance Contract on File (Y/N) N% ; for N/A Holding Tank High -Water Alarm (Y/N) tl//�. Temporary Holding Tank Permit (Y/N) 14/A Separation Distances from Septic/Holding Tank: To Water -Supply Well too To Property Line To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/84) To Building Foundation i To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design T IZNLfd Date Installed 711e%35 Length of Field u c) Width of Field .3 C) Depth of Field Gravel Bed Thickness Square Feet of Absorption Area 3 Ot' Standpipes Present(Y/N) Depression over Field (Y/N) N Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well (( To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course td To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION NDN Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments of Last Adequacy Test N E To Property Line To Existing or Abandoned System on On Adjoining Lots To Cutbank (if present) Dimensions Manhole/Access (Y/N) Pump Off' Level at "" Check Permitted Bedroom Rating Against HAA Request " Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA Icertifyth Ihave chocked, venf' ,or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed _ Date NO✓lar Iv -5 Company MOA No. Receipt No.��� i Date of Payment I I a ^ F Amount: $ �i h +' )d Engineer's Seal (�� — e `PAl.49TII 6; Qom• o. 2225-G • Page 2 of 2 ff JUNE 25, 19/1 • \ .'yA adhfs .. 12-026(11,84) �� Date �-