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HomeMy WebLinkAboutSUNSET HILLS WEST BLK 4 LT 9 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SFRVICES I=nvlronmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES ~r~ss TANK FIELD WELL township, Range, Section ~S-BUILT DIAGRAM (Show location ol well. septic system, property lin~ ~'"'foundatlon, TANKS" N TYPE OF SYSTEM RENCH ~ BED ~ W. DRAIN ~ OTHER Number of lines Joil rating Pipe material WELLS ~RIVATE ~ OTHER (Identify) REMARKS: ~5 ~ ~l~O~ ~~ Inspections Pedormed by: ~'~ I ~ S & S ENGINEERING ;edlly that this Irlspe~lon was pedormed according to~ 72-013 (3/85} [) ~:':Uk (:, ]i !iii!iiH .!i:!C! Ir ' .'.2) / 12." .'.)/' ':~ ' }:;'I:: V :1: Al .17 Obi I::: R(:))"l I}:I',tG 1: hli::l::i:,: ' S DIE:!3 :[ {'.',1',t F,:EQI,J :t: RES Dill' 1S AI':'PFtOVf::&. PR ]: (]1:~ I 0 {:OIxI~::~'I'RUC, J:I:ON,, NOI:I!:::Y DIIJIS PR:I:OI:~ 'JO AI.,L 3NSPIG(:;'I'[f.)hIS,, I:::XCAVAJ':I:ONS F? I RI:::S :1 .:'/3 :L/90, A I,. 1:i:::' f :'::'1 A t ]: COq RI::I:~tJ:~: I::",::R~ ,'::~',J AF:'PI:,'.OF'I:~:I:(:'I I:: E:L I::C :(::){-'L!] 1::)': I'.11(:~ ["il..trl :ic :ip,.'2 I i'L:/ c:){ Arichor',:::,.g~-.:, (MOO) // : .' Municipalityof Anchorage DEPARTMENT OF HEALTH & 14UMAN SERV{ 825 "L" St,~eet, Anchorage, Al~tska SOILS LOG -- PERCOLATION 'rES 7 8 · 9 10 11 12 ,13 - 14 16- 17- 18- 19- 20- Township, Range, Secdon: PERCOLATION RATE _ (mln~c~'i~h! pERC HOLE DIAMETER MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AN[i/OR WELL INSPECTION REPORT NAME MAILING ADDRESS , LOCATION Well Absorption are Dwelling DISTANCE TO'. ~,~ Liq. capacity in gallons IF HOMEMADE: Inside leng~th Well Dwelling DISTANCE TO: PHONE / DISTANCE TO: [Well/~.~ Length of ea h mine Top of tile to finish grade ~ · Widtb Foundation Total len~l/ines Material be~n~ath tile Length Width Liquid depth Material Nearest lot lin~/~ Trench width ~ {ge) "~' inches PERMIT NO. Liquid capacity in gallons Distance between lines Total effective absor PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line Driller DISTANCE TO: Depth Distance to lot line PERMIT DISTANCE TO: Building foundation Sewer line Septic tank OTHER PIPE MATERIALS SOIL TEST RATING NSTALLER REMARKS / ~.~ ~ CE-1516 860 West Benson Blvd., q¢207 Anchorage, AK 99503 '=~PPROVED DATE LEGAL / 72-013 (Rev. 3/78) PO, ,:~OX 6650 A~',ICHORAGE, ALASKA 99502-0650' (907) 264.-4111 DEPARTMENT OF HEALTH & HUMAN SER¥1CE$ January 10, 1986 TO: Permit Applicant Subject: Permit # 850614 Lot 9 Block 4 Sunset Bills West Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1985. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-sits sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and t:o close the permit. If a private engineer inspected the installation of the on-site sewer system the original as-built inspection report(three part form) must be sent to this office for review and approval,and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Susan. E. Oswalt Program Manager On-site Services SEO/ljw enc: Copy of Permit F't~:F;:I*I :( T D~'I'E ]:!3SUIED:I LIlT :: ~ E,I,,..LH..,I ..... .,':1. R¢~N[~E: 7.:';N :1.., :[ ','!xm f~mll:L,'~xr' ~q:i.*Lla ]:F J.~ I...]:F:'T ,r3TI-YI'ION ]:S :I:Iq~YT'/.~L.I..EI:) ]:lq AN [~RIEA &I]VF-'I'E.D BY I~1(3~ ELJ[I,D]IqB [.,ODI::,,~ 'l"ldEl~l (1) ~N EI...IECTI:~]:C~/I.. I:::'EITVI]:T ~lklD 'fhI~3F:'IZC'T'~[]N flUS-I' EdE tg]:L.I.. NEFF EdZ AF'F'ROVED bJ]:TH[]LI'f' ¢~lqEd...E.(,' ...... f~l U-/I.. :[N~I:::'E:f;',TZI3N. REFE)I I,"" "' ;"~"" ~l~ll:) C:S) THE; I~H_.IEE;TIR]:C¢.~L.. ~(:)~:~t::{ I'IUST' EriE; [>E)I~IE I'3Y~ I_.]:CEIqS[E[) ' .~ll. ' SOILS LOG MUNICIPALITY OF ANCHORAGE " DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION F1 PERCOLATION TEST PERFORMED FOR: LE A,. DESCR,PT ON:__.h"I 4 :' 12 13 14- 15- 16- 17- 18- WAS GROUND WATER ~ ENCOUNTERED? ...~0 pO IF YEE, AT WHAT DEPTH? Gross Net I DePth tO Net Date Time Time Wa~er DroD ,.., ~', ,.~., ,,, GRE'?ER ANCHORAGE AREA BOr' ;UGH Q Department of Environmental Quality 3330 C Street /~C9,~,/4//~/¥ }~?(:)/-3, Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~' "7~:'~'~>C) ~ PHONE [~ - , -- MA~L~N~ ADDeeSS~r~~ *~ .~ ~ SEPTIC TANK: DISTANCE FROM WELL · _ MANUFACTURER NUMBER OF COMPARTMENTS~/ INSIDE LENGTH ~ __ INSIDE WIDYH --- LIQUID DEPTH '~ .LIQUID CAPACITY /¢~,~.'~") GALLOI~S. SEEPAGE PIT: NUMBER OF PITS~/ , DIAMETER --- OR WIDTHcz~,4~', LENGTH/~,~f DEPTH ~_ LINING MATERIAL ~/~'~f?-.~. _ CRIB SIZE: DIAMETER ;/~'~ DEPTH~ DISTANCE FROM: ~ ~ TOTAL. EFFECTIVE BUILDING FOUNDATION/~(2 ADDITIONAL ABSORPTION WELL/O2 NEAREST LOT LINE ,,,~/~'¢". ABSORPTION AREA (WALL AREA) .SQ, FT. WELL: TYPE .~////~/.) ___ CONSTRUCTION__~)' /~', DEPTH BUILDING ~ NEAREST I NEAREST ] SEPTIC FOUNDATION ---.'~" _, LOT LINE "-~' ., SEWER LINE /'¢9 "/~ TANK CESSPOOL. APPROVED OTHER SOURCES .... DISTANCE FROM: SEEPAGE , SYSTEM _ DISAPPROVED REMARKS DISTANCES: INSTALLED BY: 7~/~/~¢'-~ PIPE MATERIAL: LOT SLOPE: REMARKS: Form No, EQ-031 GREATER ANCHORAGE AREA BOROUGH S£WAGE DISPOSAL SYST£M -- ,APPLICATION AND P~,RMFr PHONE FINANCED TrHRougFI TO Bm INSTALLED BY CON1pLETiON DATE ANTiCiPATEi) __- /~'~' /~ _~ Well TO SEPTIC 'rANK WA'ret MAIN TO SEPTIC TANK DRAIN FIELD Municipah[Yoi Anchorage P.O. B~.., 196650 ANCHORAGF, ALASKA 99519-6650 (907) 264-411 '1 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES March 19, 1986 Wayne Henderson, P.E. Peninsula Engineering 440 West Benson Boulevard, Suite 206 Anchorage, Alaska 99503 Subject: Lot 9 BLock 4 Sunset lltlls West Subdivision Waiver Request, WR86-037 Dear Mr. Henderson: Your request for a waiver of 100 foot separation distance required between the well and septic tank on the subject lot has been'granted. This distance has been waived to 93 feet. This waiver is valid for a four bedroom single family dwelling only. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/lJw ~I-W DRILLING, Inc. P.O. Box 10-378 · 10300 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 86-122 DRILLING LOG Well Ow:er Great Lakes Construction Use of Well Domestic Location (address of: Township, Range, Section, if lmown; or distance main road Lot 9 Block 4 Sunset Hills West Size of casing 6" Static water level 87 Screen ( ); Describe screen or perforation Well pnmping test at 50 gallons per 0it~lrr~ of drawdown from static level, Date of completion December 11~ 1985 . Depth of Hole__16l feet Cased to 161 feet ft. (~B~-~X) (below) land surface. Finish of well (check one) Perforated ( ), (minute) for ] open end ( X ); hours with 1 Off% WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, eolor and hardness ft. 0 2 18 46 95 124 151 .TO TO TO __TO_ TO TO TO. .... TO __ _TO 2 C,a~in[~ ~tlc~.p ___TO 18 Silty sand & gravel __.TO 46 _ Silty sand _TO 95 Gravelly hardpan __ .TO 124 Silty gravel .TO 151 Silty sand _TO 161 Water bearing grave]. q iqWW.t,,~er t!fl~,~t C%ntrmetor Cerit£teate No's, 814 & 973 1 -- CUSTOMER INVOICE N° ', 3 1 5 1 IVI-W DRII_LING IN(,'. DATE k'.u, DUA IIU.1/O UNIT ANCHORAGE. ALASKA 99511 QTY. MATERIALS PRICE AMOUNT PHONE 349'8535 DESCRIPTION OF WORK All charges shall be paid in full within ten days unless other arrange,ments are made prior to drilling. The customer shall pay in- terest at the rate of 1 ~ % per month on any amount not paid within ten days, Failure to pay tnay result in a lien agafiTst the property. CUSTOMER SIGNATURE OUT Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St, P,O, Box 196650 Anchorage, AK 99519-6650 www,ci.anchorage.ak,us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 018-203-26 1. GENERAL INFORMATION Expiration Date: I _ O Complete legal description Location (site address or directions) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address 14220 MIKE KELLY 14220 HANCOCK SUNSET HILLS WEST SUBDIVISION; LOT 9~ BLOCK 4 HANCOCK DRIVE * ANCHORAGE~ AK * 99515 Day phone 345-0596 DRIVE * ANCHORAGE, AK * 99515 Day phone WENDY THOMAS W/ REMAX PROPERTIES Day phone 2600 CORDOVA * ANCHORAGE, AK * 99503 222-8800 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well · IndiVidual Water Storage r-] Community C!ass Well D Public Water. System r-] TYPE OF WASTEWATER DISPOSAL: Individual On-site . I Individual Holding tank I-'l Community On-site D Public Sewer D The Municipality of Anchorage DeveloPment Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by ah independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for propedies served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for propedies served by a priva~te or Class C well and may be reissued with new water samples. (Cedificates may be reissued for a period of up to one year with valid water samples.) Cedificates 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 engineer's work. 4. :STATEMENT OF INSPECTION BY 'ENGINEER Se 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 Health Authority 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: .' In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance With ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate durfng the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee futura performance of the system, horde they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or futura estimate of how long the system will continue to meet the · operational requirements of the ADEC orMOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by a~y other percon or party is not authorized, nor will it confer any legal right whatsoever. Phone 337-6179 Date ...... .... DSD SIGNATURE ~ Approved for ~ bedrooms. Disapproved. bedrooms, with the fllowing stipulations: · ' '. . ,,~ ee ~. -~_ ~- ;.WASTEWATER: . ~.~ .. .. ~-, :,'.,/"' '<Om..; . - Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other (Rev. 1~11 Original Certificate Date: Mun cmpality of nchor age Deve!opment Services Depa me ':' , Building Safety Division On-Site water & WaSteWater Program Ii ;~.. .' ~., '.. 'P.O. Box.196650Anchorage, AK99519- 650 , , : '~ ~ ~, .w~vw.ci.anchorage.ak.us HEALTH, UTH Rim : APPROVAL CHEC,,fflST Legal Description: SUNS~ HIL~ ,WE~ ~SUBD~ISION; LOT9~ BLOCK 4 :',P~rcel ID: 018-203-26 ~ [ .... Well" ::'type' '~=; r :PRNA~[ ' ' "If ~ B,';o~ C r0vide PWSID~ '" :Well Log (WN) YES Date completed 12/1 i/1985 :Sanita~ s~ai (Y/N) YES . Wires prope~l~ ~rotected (Y/N) , YES ' "' ~ ']~ ~:' ' ;.161 ff. Casing heig~t (above ground) 12+" in. Total~ePth 161 ~ ff. ~;Cased ' ~'[ [ [;: ' , FROM WELL LOG ,. ,AT INSPECTION . , ' ' 5/5/200 S i W~ter level' :~187 : ~72 ~: .ff. Well;PfOdu~ion , :i50 : ~ ~g.p.m. ,, L .,3.8~ ~ g.p.m. Arsenic:: ~N/A mg./L. : ~,~ :~ :- Date,of sample: 5/5/2004: CollectedbY:.~. .GEG, Ltd. __ TankType/Matenal ~EP~IC ~E~ ' ' . Date installed : 12/17/1985 Tank ~i~e~ 1250 gal. - Number of Compa~ments, 2 [- Cleanouts (YIN) :- · YES Foud~a~io'h cleahout (YIN) YES '..~ Depres'~io'~ over tank (Y/N)' NO ~ High ~at~r~alarm (YIN) ' N/A Date of pumping 5/4/2004, . . Pumper. · ROTO -~ROOTER ABSORPTION FIELD DATA ' :~' ' : ~ :~BELOW EXI~ING G~E ~ ,~.: I ~ ', ' , Date'ih{talled' 3/20/1990 Soil rating (~.p'.d./ff~or~*~O ~ .. SySt~type_' DEEP TREECH _ Total depth *8,0 ~, Eff.'abs'orption area**486 ~ Monitoring tube YES ,,, ~ Depression over field NO Date of adequacy test ' 5/5/2004 . .,~ j JResults (Pass/Frei) PASS , :;', · ,For 4 bedrooms Fluid depth In absorption field before test J15 ~n. ' Water,added,736 gal.': New depth , ~n. ElapSed Time: 647 mtn. ' ~: Final fluid dePth 15 In.' .' ,'; AbsorPtiOn'rate >= 600+ . g.p.d. Any rejuvenation treatment (pastil2 mo.)'(WN & type) NONE KNOWN :;:: ~ :~, if yes, give date - D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES. ·; Size' in gallons. " Manh~ "P~ .... High water alarm level at ,Cycles tested. ' · Meets alarm & circuit requirements?. SEPARATION DISTANCES FROM WELL ON LOT.TO: Septic tank/lift station on lot '95'+ ' 'Absorption 'rfield on lot /- -'100'+' Public sewer main N/A On adjacent lots 100'+ °n~adjacent lots" .'- *'98'+ Public sewer manhole/cleanout . :N/A' sewer/septic service lin~ 25'+ ... Holding tanl:( " SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:" Building foundation ! 5'+ ~ "Property line Water main N/A .Water service line 10'+ Wells on adjacent lots 100'+ . SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT-TO:" Property line 10'+' . .... Building foundation "10'+ Water service line 10'+ Surface water 100'+ Absorption field Surface water 100'+ Watermain N/A.~ - ' Driveway, parking/vehicle storage 10%t- cudain drain .NONE KNOWN. Wells on adjacent lots[ 100'+ F. COMMENTS *WR86-057 **WR000071 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 HAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date: HA,& Fee $ Date of Payment Receipt iNumber (Rev. 12/01) Waiver Fee $ "Dale of Payment R'eceipt' Uumbei- in. r BY:PACIFIC NW TITLE-AK '~uL-,~I-UU l'{UN LFE:I ( Fi'{ ; 7-81-0 ; 4:02PM ; P,Xq' ALASKA-TITle F~ NO, .~,, iAl~J{kf{ O~ IICOID, OT~II lkOSE Id~ ON PLAT, A~E NOT BO7 888 8246;# 2/ 2 P. 02 ./ 1# · 20' ~t 9, IL~ 44 ~JET kILLS tr~lell~ &l~l, or other Vflibll ~y~ 05-11-04 11:50AM FROM-CT&E ESI, SGS ENV SERVICES 90?5615901 T-275 P.02/03 F-881 SGS Ret# Client Name Project Name/# Client Sample ID Matrix 104227500 l Gamess Engineering Group, Ltd. Sunset Hills West Lot 9. B4 Sunset Hills West Lot 9, B4 Drinking Water Sample Remarks: All Dates/Times are Alaska Standard Time Printed Date/Time 05/10/2004 15:07 Collected Date/Time 05/05/2004 12:40 Received Date/Time 05/05/2004 14:40 Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Waters Dspartment Nitmle-N 0.416 0.100 mg/L EPA 300.0 B (<=10) 05/06/04 JMP Microbiology Laboratory Total Coliform 0 coV100mL SMISP222B A (<=1') 05/05/04 DKC MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF'INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t,'block, subdivision, section, township, range) Lot .~ Block 4~ Sunset Hills West Location (address or directions) 14220 Hancock (b) Property owner ~6~dy~4c. eft 29- 606146- 8C Telephone: (home) Mailing Address Business (c) Lending institution Mailing Address Telephone (d) Real Estate Company and Agent JACK WHITE COMPANY ATTN: KJ~S Kurtz Address ___~0J~~~~~a~&~ 99503 Telephone __Z~_-~ (e) Mail the HAA to the following address: (or check hereE~ if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle Ri,vet Loop~o. Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family Ek Number of bedrooms 3. WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to tE I~gality and status. 4. SEWAGE DISPOSAL On-site ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ~' As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigatic~n of th i~" 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 Fir & a., ............. 17034 Eagle Ri'~er Loop I~oad No. 204 Address ...... . .~taska 9~577 Telephone Date Approved for ~/~ bedroomsb~~/~ Approved_ /V',~ 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 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 o25 IR,,,. ?/e~) e~c~ Page 2 of 2 ~. ~.~^UI¥1~N,f~J~[/~F¢ OF ANCHORAGE (MOA) ~ ENTAL SF.~,~II~P~[~ity Approval (HAA) CHECKI..IST - FEBRUARY 1984 MAR 2 ? 1990 343-4744 Legal Description: %~' ~:~ RECEIVED A. WELL DATA Well Classification Well Log Present (~)N) __',,~ Total Depth_/(-~t ~ F Case~to Static Water Level Casing Height Above Ground /'~'l~r'-- Electrical Wiring in Conduit ~N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Fiel.dto~.Lot To Nearest Public Sewer Line Date C..o m pleted ~t~. Depth of Grouting '~¢-~ Pump Set At __ If A, B, C, D.E.C. Approved (Y/N) Yield _ Sanitary Seal on Casing (¢~/N) Depression Around Wellhead (Y/_J~ To Nearest Public Sewer Cleanout/Manhole ; On Adjoining Lots ~, ~ ; On Adjoining Lots To Nearest Sewer Service Line on Lot Water Sample Collected by ~--~; ¢¢r¢-~ ~..~ I~l~ ;Date Water Sample Test Results ~/~~~_ Comments ~ ¢~'~ ¢(~ B. SI"PTIC/HOLDING TANK DATA Date Installed ~ /L~' Size [¢,~'~"-'~ No. of Compartments Standpipes/C~/N) ',¢ _Air-tight Caps fC~'N) Depression over Tank (Y~f;) ¢"~ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water A arm (Y/N) r-t//~. SEPARATION DISTANCES FROM SE,P.T)AC/~OLDING To Water-Supply Well '¢~"~" ~ To Building Foundation To Property Line \ ~::'tJr To Disposal Field To Water Main/Service Line ~ o I~ To Stream, Pond, Lake or Major Drainage Course \ Comments ~ ~:2!-''''-)c¢ -~--~"'"~--' d~-~r'~'~,/~d-~'~ ~'" Foundation Cleanout ¢~N) "-/ E}ate Last Pumped Temporary Holding Tank Permit (Y/N) TANK: 72-026 [Rev. 7/88) Front Page 1 of 2 C, ABSORPTION FIELD DATA Type of System Design~"'~ Soils Rating in Absorpti~on Strata \ ¢~6;~"¢¢/¢¢/f~'' Datelnstalled '~'~ ~' /~. _~ Length of Field Width of Field .~ {.-~r, Depth of Field '¢~ X'~ Gravel Bed Thickness Square Feet of Absortion Area t~,';:2~'cr' '"~ Statndpipes Present ~.~¢~'N) Depression bver Field (Y/.~ f4 ~ Date of Last Adequacy Test Results of Last Adequacy Test ~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well \ c;~ ~-" ~ To Building Foundation ~ I Lot "¢~¢;' ~ ~¢' TO Property Line To Water Main/Service Line To Existing or Abandoned System on ; On Adjoining Lots h To Cutback (if present) I~/'~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments '~ O ~2~ ¢'/>¢//=--~ ¢¢¢-~"~or~-%, D. LIFT STATION /X~ /~r Date Installed Size in G~ "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) ~ ~s 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 in inspection. S & S ENGINEERING Signed .................. Company Eagle RJver~ Alaska date ~Si;'tbis ~eal Receipt No, Date of Payment Amount: $ 72 026 (Rev. 7/88) Back Receipt No Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDE'RAL TAX ID # 92-0040440 ANALYSIS REPORT BY SA[,IPLE for t'lo~k Order ~ 20445 Date Repo~t Printed: ~AR 20 90 @ ID:09 CLxent Sample ID:SUNSET HILLS P¥1$ID :UA Collected MAR 16 90 6 i5:45 Received MAR 16 90 @ 16:15 PresezYed with :AS REQUIRED Client llane : S & g ENGR Client Acct: SNSENGP P.O.~ NONE RECEIVED Roq ~ O~detod By : ROBERT SHAEER Analysis Completed :MAR 19 90 Send geport8 to: Labczatozy Supezwxs~r,:STgPNgN C. EDE L)S R S ENGR Special Chemlab ge[ ~: 900501 Lab Smpl ID: 1 ~atrix: WATER Allowable NITRATE-N 0.57 lng/1 EPA 353.2 I0 Sample ROUTINE SAMPLE Remarks: SA14PLE COLLECTED BI R.P. I Tests Perfo~ned See Special Instructions Above UA=UnaYai].abla ND= None Detected "See Sample Remarks Al)owe NA= Not Analyzed LT-Less Than, G'f=Groater Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTFCTION DIVISION OF ENVlRONMFNTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date_ "~J*~/~=~:~ GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) .. Applicant Name .~~~ Telephone: Home Applicant Address Applicant is (check one): Lending Institution (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: . ~ . ~ - TYPE OF RESIDENCE Single-Family,~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well(~" Community [] Public FI Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding Tank [] / Note: If community well system, must have written confirmation from the State Department ol Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025(11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ,,. ' t .! 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. Date ~ Engineer's Seal DliEP APPROVAL Approved for '~'" Approved bedrooms by ~ ~:~' Disapproved Conditional Date .5 --~ ? -- ~'~, Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certific, ates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHf:P 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) WELL DATA MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MO~, DEPT. OF HEALTh & ENVIRONtvENTAL PROTECTION HEALTH AUTHORITY APPROVAL (tIAA) CHECKUST- 264-4720 Legal Description: Well Log Present (Y/N) _~ $ Date Completed __ / ~//'¢'/~¢"'.-~'"' Yield / Total Depth L~ / Cased to / ~/ ~ Static Water Level ~ 7 / Casing Height Above Ground .~r?~ ¢ ~ Electrical Wiring in Conduit (Y/N) ~---¢ Separation Distances from Well: To Septic/Holding Tank on Lot '¢~ /' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer t_ine _ /*~2~,¢..¢~., Cleanout/Manhole Depth of G routing ,~'*~' ~ ~ Pump Set At /"~"~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) _ · r On Adjoining LOtS To Nearest Public Sewer ~ ~O/-~.. On Adjoining Lots Water Sample Collected by Water Sample Test Results Comments ¢~'/~,¢~' ~---.. Tc Nearest Sewer Service Line on Lot ~ ~ ~'/.-~¢/~,.'~'~ t~ ~'~ Date "',¢~-~/,'//~'"~ ~ B. SEPTIC/HOLDING 'rANK DATA ~ ~'~/~'~ Size /~-,~"~ ~ No. ol Compartments -~"- Date Installed Standpipes (Y/N) _ Air-tight Caps fY/N) ¥'~-'~ Foundation Cleanoul (Y/N) Depression over Tank (Y/N) ~'~ Date Last Pumpea . ~'/~ Pumping/Maintenance Contract on File (Y/N) /f'/'/~ : for ~ Holding Tank High-Water Alarm (Y/N) /"¢'/,~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank To Water-Supply Well To Property Line To Water Main/Service Line Course /C:, ~ To Building Foundation '.,~'~' / To Disoosal Field _ ~ / To Stream Pond. Lake. or Major Drainage Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata /'~'~ Type of System Design Width of Field Depth of Field Gravel Bed Thickness ~'O~ Standpipes Present (Y/N) Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Date of Last Adequacy Test To Property Line Separation Distance from Absorption Field: To Water-Supply Well / ~ O f To Building Foundation ~:~ · Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Existing or Abandoned System on ; On Adjoining Lots -,~ ~ ~""~" To Cutbank (if present) Comments Dimensions ~ize in Gal, l, ons ~'~'~'~_ Manhole/Access(Y/N) Pump On Level at ~"'"'"~-~ "Pump Off" Level at High Water Alarm Level at ~ Vent (Y/N) Tested for __ __ ~ng Adequacy Test. Meets MOA ~1; Cmt rmi Ceal t~ od es (Y/N, ~ ~.~_ ** Check Permitted Bedroom Rating Against HAA Request ** I certify theft I b/~ve c,~,~ed/yv~ied, or conformed to all MO~_~n~AA guidelines in effect on the date of this inspection. Signe~ Date ~/~///~::~'~' Company ~ Receipt No. ,:~,-7 ~p~ .~, ~ Date of Payment Amount: $ ~ (r~°,~ Engineer's Seal Page 2 of 2 72-026 (11/84}