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HomeMy WebLinkAboutT15N R1W SEC 8 LT 185TISN RIW .8 185 #051-154-36 " Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: "¢'~" ~'~"¢'~-~"~') PID Number: ~a"'/- Uame~,~ ~ ~,~ /~ Wastewater System: ~ New ~pgrade Address: ~--~ ~4~ ~ ~ ABSORPTION FIELD No. of Bedrooms: Phone: ~-- ~ ~ ~DeepTrench ~ Shallow Trench ~Bod DMound ~Other Total Depth from or'ginal grade: LEGAL DESCRIPTION soi, .~i~,: Lot: / ~ Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe~ ] ~¢ ~ Ft. Ft. TOW~ I Range: I Section: Fill added above original grade: Gravel length: ~ ~ ~,~ Ft. WELL:~'~Now ~ Upgrade Gravelwidth: Number of lines: I Distance between lines: ~ Ft. ~ X~ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~ Driller:" Da e Drilled: Yield: Pump Set ~t: Casing Height Above Ground: SEPARATION DISTANCES ~eptic = Holding = S.T.E.P. Welb //~ / /Z~ / ~ ~ ~ Material: ~ Number of Compa~ments: SuffaCewater /~¢~ ~¢¢*// ~/~ ~/~ '~ LIFT 8TATION Line Foundation ~, ~/~j, ~ ~ "Pu m p on' level at~p ~/~v Remarks: BENCH MARK ENGIN~AL Inspoctions pe~ormed by: ~~* ~~ Dates: 1st ~/~'¢/~ ~'~ 2nd ~7 ~" ~ J'~'~" l,..~ Department of Health and Human Se~ices approval tt~;k. CE0170 72-013 (Rev. 9/91) MOA 25 Permi~ No, z] SW970250 Page 2 of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.0. Box 196650,, Anchorage, Alaska 99519 6650-Telephone 545 4.744 On-Site Wastewater Disposal System and/or Well Inspection Report I~gal Descripiion: LOT 185, T15N, RIW, SECTION PID No~: 051 154-56 © ENGINEER': SEAL 72-015 A (2/9/) MOA 25 Permit No. Leg(fl Description: SW970250 Page _5 of 4 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650, Telephone 545 4744 On-Site Wastewater Disposal System and/or Well Inspection Report LO'I 185, T12N, RIW, SECTION 8 PID No,: 05/ 154-56 b 72-015 A (2/91) MOA 25 NOTE THE SYSTEM INSTALLED WAS DESIGNED TO MEET THE NEOUIREMENTS FOR A (4) BEDROOM RESIDENGf THE OLD SYSIEM IS CONNECTED TO NE NEW SYSTEM DY A ZOBEL DIVERTER THERE IS NO CLEAN OUT PIPE FROM FLOW SPUTTER 10 GRADE ABSORPTION SYSTEM PLAN (ASBUILT) · C)O \ \ z m ~ONNA HARLEY RESIDENCE 21,540 TENADA AVENUE Lot 185, TISN, RIW, SECTION 8 Chugiak, Alaska PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970250 DESIGN ENGINEER: OWNER NAME:HARLEY DAVID E & DONNA S OWNER ADDRESS:21540 TENADA AVE CHUGIAK, ALASKA DATE ISSUED: 8/11/97 EXPIRATION DATE: 8/11/98 PARCEL ID:05115436 LEGAL DESCRIPTION: T15N R1W SEC 8 LT 185 LOT SIZE: 108900 (SQ. FT.) NUMBER OF BEDROOMS: ~ THIS PERMIT: ~W THIS PERMIT IS FOR THE~CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: DATE: ~/~ Douglas T. Kenley, PE 9960 E. Paffln Drive, Painter, Alasl~a 996<t5 (907} 746-107 6 August2,1997 Municipality of Anchorage Health & Human Services On-site Services Percolation Test Results and General Site Investigation Report of Lot 185, T15N, R1W, Section 8,Chugiak, Alaska. Owner: Mrs. Donna Harley On July 16, 1997, the above-referenced 2.5 acre parcel was inspected for the suitability of installation of a replacement on-site wastewater disposal system. The site is located in North Birchwood at 21540 Tenada Avenue. The replacement system is being designed to meet the requirements of an existing four-bedroom home. The planned system will use the existing 1,750 gallon septic tank, unless upon inspection a new tank is determined to be needed. A new tank, if required, would be a 1,250 gallon steel tank. The proposed absorption system will consist of two deep trenches, both of which are 42' long, designed in accordance with municipal standards. The existing 105' long by 5' wide by 3' deep trench will be left in place and isolated from the new system with a Bullmn valve or equivalent for possible future use. The developed parcel is sloped with a grade ranging from 2-6%. The immediate area that has been selected for the wastewater disposal system has an average slope of l% toward the north. The site is sparsely treed with birch, spruce, and alder. It appears that there are no obstructions that would prevent surface water runoff. On-site observation and field measurements show that there are no neighboring water wells within a 10ft radius of the proposed system. The proposed trench replacement will not impede replacement of neighboring systems in the future. No surface water was observed at the time of the inspection, and it appears that there is no potential for contamination of future water wells. Two percolation tests were performed at the site to determine an adequate location for the replacement waste water disposal system. Test hole #1 was dug to a depth of 15'. The substrata consisted of 1.5' of organic overburden overlying 4' of orange, sandy gravel with some silt. From 5-1/2' to 15', the substrata consisted of sandy gravel with some silt. Test hole #2 was dug to a depth of 14'. The substrata consisted of 1.5' of organic overburden overlying 3' of orange, sandy gravel with some silt. From 4-1/2' to 14', the substrata consisted of sandy gravel with some silt. Neither bedrock nor ground water was observed in test holes #1 or #2. MOA Lot 5, Birch RoadEstates Subd. 8/2/97 Page-2- The percolation rates were as follows: 17.8 minutes pm' inch at approximately 5-1/2' below grade for test hole #1; 9.2 minutes per inch at approximately 5' below grade for test hole #2; and 13 minutes per inch at approximately 4' below grade for test hole #3, which test was conducted by O & E Engineering in 1981. O & E Engineering reported that they ran into bedrock at 12'; on test holes #I and #2, no bedrock was encountered. There are, however, several large boulders in the area. If there should be any questions concerning the percolation rates or characteristics of the site, please call Doug Kenley at 746-1076 or 243-5372. ?ncerel,~ CE #8176 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORM LEGAL DESCRIPTION: 10- 11 13- 14- 15- 16- 17 18 19 20 Township, Range, Section: ~'~..~'.4...j~ .x~'~¢.4~ SLOPE S~TE PLAN' WASGROUNDWATER ENCOUNTERED? s IF YES, AT WHAT ~L DEPTH? p E Deplh to Water Alte~ ~'"~ ~/ Monitoring? A'"~',c~f "~ Date: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION HATE '/'~"] tm,nutes/inch} PERC HOLE DIAMETER TEST RUN BETWEEN ~'/z/~ FT AND '5~" FT PERFORMED BY: '~'"~'~'~:~ '~ ~'~'~-'?"~"~/- ~'%~" , /~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON~HIS DATEuDATE: ACCORDANCE WITH 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: DATE PERFORM LEGAL DESCRIPTION: 8 9- 10- 11 13- 14 15 16 17 18 19 20- Township, Range, Section: '7""/~%?/ ,,~'/~.,~/ ~-',...~-~.~-~,~ ,,,_/ ~ WAS GROUND WATER ENCOUNTERED? SLOPE SITE PLAN S IF YES, AT WHAT L DEPTH? '-- ~ E Depthto Water AltF Monitoring? 4.,'o .,~J~-' gate: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~ ~ (minutes/~nch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ,~x-///g, FT : ~21 ~-~ ~'~c_ CERTIFY THAT THiS TEST WAS PERFORMED IN PERFORMED BY ~'~'e~"~,~~ ~.,~-.~, -~,w..J~. ~ I 72-008 (Rev. 4/85) NOTE ~ ABSO."'T,ON sYSTE~ "'LAN (D~,~N) / / 50 FT BLM EASEMENT DONNA HARLEY RESIDENCE 21540 TENADA AVENUE Lot 185, T15N, R1W, SECTION 8 Chugiak, Alaska NOTE 1 THIS PLAN TO USED IF TH~ EXISTING TANK NEEED8 TO BE REPLACED, 2 TNE SYSTEM OEING INSTALtED BAS BEEN DESIGNED TO MEET THE REQUIREMENTS FOR A (4) BEDROOM RESIDENCE 5 THE OLD SYSTEM W~LL BE OONNECTED lO THE NEW SYSTEM BY A BUL[RUN DIVERTER OR EQUIVAI ENT 4 TNE EXISTING 1750 GALLON TANK WILL BE INSPECTH) AND REPLACED IF NEEDED BY A 1250 GALLON TANK ABSORPTION SYSTEM PLAN (DESIGN) NTS 330 00' ~ m DONNA HARLEY RESIDENCE 21540 TENADA AVENUE Lot 185, T15N, RIW, SECTION 8 Chugiak, Alaska DONNA HARLEY RESIDENCE 21640 TENADA AVENUE Lot 185, T15N, RIW, SECTION 8 Chugiak, Alaska 1 .7_~ //__, M.N,C,PA.,TV OF ANCHORACE i,~ O~[l I~..~ / 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 LEGAL DESCRIPTION LOCATION JL'q'rp~gall°ns IF HOMEMADE: Inside length Width L'quid depth ~ ~ DISTANCE TO: Well Dwelling O Well Neares~ En~ P E~'MJA N~ ~ ~ DISTANCE TO: /~ ~, /~ Foundation ~ No. ofHnes / Length,feachl,ne t' Totalleng,hoflines ([ Trench idth 1. Distanc Hnes ~ PERMIT NO. ~ [ Crib depth Total effective absorption area ~ ~ ~ Distance to lot line PERMIT NO. ~ DISTANCE TO: BuiJding foundation / Sewer line Septic tank Absorption area(si OTHER PIPE MATERIALS REMARKS L E(3i;:-~l .... LOT NFI El...['.' SOIL F~:I::I'I':[NC~ ':Z6:! FT,'"BF~'.::,~: !'"tFl:;'(]:i"'ll..Ihl I",PUt"I[~',[.:.~: Of: E:E[:'FO~':t'"I'q ,~ 6 THE I....I~Ef,IGTH [::,:[I',tEN$ I ON :[:Z; THE I...~,:: Z 1'.~ FEE'T::, i-IF' 'T'H[:' T I, E. NC..... "' I;' [::,F~N:::~ :[ NF:' I ELl::,. "I"H[E E)E'F'TFI (:~F' ~:I ~.E.f,l.::F- r'~[~' [~]:~1" .[.:, THE [..]..:,[-f.,L.E:. BE:"FI.qEE['.,! 'THI~: :,I..I.~I.-H I': OF' THE ~F... I..INI..) FI~.~[::, THE [~;O"FTOf'I OF' THE E:::<I:tF:I%,'I:¥F ]: O1'.,I < ]: ~',l FE2E'r' ::, T' ~ ~:F: ...... - ........... FIF~[) THE [/:~ZIT'T'"'~,I C)F THE E.,.,,[..H%~TZL. N (:[~'4 ..-:,, :E "":~ ...... F:'E:I:;~:I"IZT F" ~ ......... ~" ~FL..~.,~-I~.,It HPI::, THE ~'[:"::~,r'~*~::T~,- ...... :I:N:~;TF:ILL. F~TIO~-g ZN:~;F'EE::'I':[I:II'.,!5~;ElF' Fir',l%.' ~ IECLL: :E:',:I'FI-[~I'.ITT~ ...... -, :,:: ............ - - tH:L, F 1 -FL[..! ~ f:INE:, T'HE ['-,!I...If'IE;E~;P. CIF' ~[._ .[ [. [:.N~..[::, THFIT THE I'I[I..L ['J:[LL ........................ 'T' ~ ..~ C~ "::: J'"~:.~ 2:" :]2 ~ ,,~ .....,, [ ~:. L., ~ :[: ~2:~ ~'-,,~ :~:: !F:~ ~'~: ~: J -., E .......... L.II :~: F:: IE: E::::: .......................... l"tIl"4I~"lL.If,'f [:)I:{3"~?~.~(::~2: [~:F2:'T'[,.IEEf., ::1 I.,.E.....~E:, faf.%' I"' f, " ':; '[ 'T'E :'E',]F~"iE' 4 -E T%¢:'E (:F F'I... E: .. Z i:: I.,.IELL. ~ ...... I ~ UE. L I.L. I!!:.I...L.L. :. '- E;f.,tL., J. B, .: f"l:[f',l:[t"ll..Ihl L Z.., ff [I(..E. I::[~:Of,1 I:1 ~-~..[, f ] E I.,.IEL.L 'T'O I:1 I::'I;::[',,,'I::I'TE ~/E:I.,IEF: L Zi,I[E Z:Z; '":*" ....... FEET F:~!',I[::, FI I:DC]t"lr'II.3h,I:[T'~' ' ....... ]:~G -" ...E.I.,JE.[~. L. Zf',IE: ,"~!, FEET. I,.~E:LL I' '~'::: ' *'-' . -- f~F.[:. [~:EI;:!UZF~:EI:::, f:~f',l[::, [,'II..I~ST E~E F~[~:TIJ~;~f.,IE[::, TCI THE: I::'EPf:~F:'T't"tEI'.~'F !.,.IZ'T'HIN THE !.,I[{LL ~::OI"IF'LE'T']: C:lf.4. " *'"" C::E:tR T ]: F"~ : ;[ Fit'1 F ': ', ...... " TH !L, t ']'HIE i'ffl..IN ]: (:: ]: F'FtL ]: ']'¥ C:~F' ~ HZLL Zf,Lr:,f,-~ ..... ]'H[~; S'*'STE[,'I :[1",1 FIC:C:O~/E:,~a~.,IC::[~: I.,.IITH 'THE ...... O & E ENC..NEERING & DEVELG. MENT CO. Box 90, Davis St,, Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Performed for: Legal Description: Depth (feet) Earl Ellis SOIL LOG 688-2280 Name: ~'T~V~-/~I Z~ ~/~'~'~ L/:"~/L/'~'T" TeI. No.~O¢~c-2~'''~/ Mailing Address: ,~' ~)' /4~z:~'~ /~ / ~/-/C)~-;./,,,~/~./ ,,~/~/, ~'/~4'-~7 $oll Characteristics 0 2__ 3__ 5__ 6__ 7__ 8__ 9 12 Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: No ~ If yes, what depth Drain Field.__ Performed by: PLOT PLAN No PERC. TEST ""2 ~tI. JNI¢I~AUTy , EN DE~T. 0 V~RON~4EN UAY ~ RECE - Municipality of Anchorage Development Services Department Building Safely Division on'Site Water & Wastewater Program · . · , . '4700 South Bragaw SL P.O. Sox 196650 Anchorage, AK 995196650 www.ct.anchorage.ak, us (907) 343-7904 · CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR'A SINGLE FAMILY DWELLING ' Parcel I.D. 051 - 154;36 1. GENERAL INFORMATION Complete legal description Expiration Date: ~"- ~ ~ -O ! LOT 185; T15NI RlW~ SECTION 8 Location (si!e address or directions) Current Property oWner(s) Mailing address Lending agency ' ' Mailing address · 21540 TENADA DRIVE * CHUGIAK~ AK MAMIE PHILLIPS Dayphone. 21540 TENADA DRIV~ * CHUGIAK~ AK 99567 Dayphone 688-6655 Real Estate Agent Mailing address LINDA HARTER w,/ COUNTRY REAL'Ih' Day phone. P.O. BOX 671923 * CHUGIAKt AK 99567 688-1236 Unless otherwise requested, HAA will be held by DSD forplckup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATEI~SUPPLy: Individual Well Indivldual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Indivldual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered In the State of Alaska. Certificates cf Health Authority Approval are required for the transfer of titJe (except between spouses) for properties sewed by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeoWners. Certificates of Health Authoflty Approval are valid for 90 days from the date of Issue for properties sewed by a pflvate or Class C well and may be reissued with new water sample results less than 30 days old. (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 ls not responsible for errors or omissions In the professional engineer's work. Note:Alaska Water a.nd Wastet?atar Consuitants, In~ shall be pald $ 4cC~.OO at, or pdor to cieaing for the eng~nesring sorvfcas provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto end es of tho validation date shown below, I verify that my investigation, based on procedures outlined In the Heal~ Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastawater disposal system Is(are) safe, functional and adequate for the number of bedrooms aed typo of st~ucture indicated herein' I further verify that based on the Information obtained from the Municipality of Anchorage fi/es and from my invesb'gation and inspection° the on-site water suppfy and/or wastawater disposal system Is(are) in compliance with all al~plicable Municipal and State codes, ordinances, and regul~tions in effect at the time of installation. Name of Firm ALASKA WAFER &: wASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE. AK 99504. Phone 337-6179 Engineer's printed Name JEFFREY A. CARNESS, P.E. Engineers Comments: In condu~ng this evaluation, At4'I/YC, Inc. a~femptsd to provfde a thorough, consdontleus engineering ana~fsis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reposed results descnT.~d the performance of the system under the conditions enccuntsred a! the time of the test, and sol, oration distsnces measured to readily Identitiable features. The operational life of all ~ells and septic systems depend on the ~ soils conclition, groundwatsr lewJs that may fluctuate durfng the year, and the wa tsr usage of the family being served by the system. These conditions are out'de the control of the e~'alualor of the ~tem. SatisfaCfory test results do not guarantee futore performance of the sTslem, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore net provfde any warranty or future estimate of how long the system w~ti continue to meet the eperetional requirements of the ADEC or MOA DSD. The c~tent of this report is for the sole benefit of the owner listed abev~. Any refiance upon or use of this re~rt by any other pe~on or l~ady Is not author'.ed, nor ~ti it confer any legal #ght whatseever. PeP SIGNATURe or L-"" Annmved for L./- bedrooms. ~" ~ Disapprove(3 -- ~ .' · Conditional approval for ,. bedrooms, with the tllowing stip~tioa, s:WASTEWATER : - Attachments: HAA Checldist Septic System Advisory Well Flow Advisory Manltenanca Agreements Supplemental Engineer's Reort Other Original Certificate Date: Municipality of Anchorage Development Services Department Bull(ling Safety 0Mslon On-SEe Water & Wastewater Program 47130 ~3uth Bmgaw S~ P.O. Box 196650 Anch~age. AK gg519-6650 Lngal Des~pUon: A, WELL DATA Well type PR~VA~[ Date completed Totaldapl~ 22§ HEALTH AUTHORITY APPROVAL CHECKLIST LOT 185; T15N, RlW, SECTION 8 Parcel ID: 051-154-36 I,ASSUMED TO BE TO BEDROCKI flA, B, orC provide PWSID~ N/A Ca 3/22/82 Sanlta~ ~eal (Y/N) YES It, Casedt~ .15 It. FROM WELL LOG Date of test 3/22/82 Static water level 100 .It, Well producllon _~3 .g,p.m WATER ~M~I~r.E RESULTS: ~ Well Log (Y/N). YES ~ I~Pe~ pmt~tnd (Y/N) Casing height (above ground) AT INSPECTION 6/27/2000 168 .[ **0.26 g.p.m. Date of ~ample: ' 2/13/01 COII~ by:. AWWC, INC. t,q~vo ~sr T~C CO, NOT V/tmON S I 8~O~ING T~K DATA D~ I~ High ~r ~ ~) JR'S PUMPING [MT1/~2] ~ mU~ ~r ~) 0.6 ~m ~ 2 ,~ Gm~l ~1~ pl~ ~ed~ 6/28/2000 ~a~a~, P~ ~da~a~mfleld~ 0 ~. W~radd~lOOO~. ~/ ~ ~: 960 ~n. ~1 flu~ da~ ~ mJ~ ~e~ 12 ~.) ~ & ~) NONE KNO~ Tank Type/Material Tank elze 1250 gal. Foundation deanout (Y/N) Date of pumping 6/28/2000 ABSORPTION FIELD DATA Date ~R~te~8(] e//1997 43'/45' Length 88' TOTAL lt. YES 12 In. colonies/100 mi. STEEL 8/1997 Number of Compartmente 2 YES Depression over tank (Y/N) NO N/A Pumper TRENCH 6 ff. Depression over field, NO For 4. bedrooms 600+ g.p.d. yes, give date - O. UFT STATION Date installed. Size In gallons · Pump on' level at in. 'P~e~'"""~ High water alarm level at ~ _~~ Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: SepUo tanYJllft station on lot 1 oo'+ Absorption field on lot. 100'+ Publlo nswar main N/A Sewer tseplJo eswlce line 25'-~ On adjacent lots 10o'+ On adjacent lots lOO'+ Public sewer manhole/ctsanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Bulldtng foundation 5'+ Property line 5'+ Absorption field Water main 10'+ Water ~ervlce line 10'+ Surface water Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:. Water main 1 o'+ Driveway. peddng/vehlcle storage 50'+ Pmpen'y line 10'+ Water ese, Ice line 10'+ Cmtaln drain NONE KNOWN F. COMMENTS Bullding foundation 10'+ Surface water 100'+ We~s on adjacent lots · 100'+ G. ENGINEER'S CERTIFICATION I certify that I have determined ff~rough field Ins~e end review of M~mlclpal ri;cords fhat the above systems are In conformance with MOA HAA guidelines In effect on ~hls date. Englnse;'e Printed Name JEFFREY A. GARNESS HAA Fes$ Date of Payment Receipt Number (~. l=oo) Waiver Fee $ Date of Payment Receipt Number. WATER WELL ADVT. SORy HEALTH AUTHORITY APPROVAL NO. During a recent Health Authority Approval cn-site inspecticn and tess cf the potable water supply well cn Lot ~ Block -- of -/-~/. jR l.~{//~¢,~Subdivision, the well's productivity was determined to be j ~ gallons per minute. The minimum well productivity required by this Department (D~!C 15.55) for a ~ bedroom residence is ~_~ ga!!ons per minute. Although the subject well currently exceeds this minimum requirement, all'parties ccncerned are advised that the production capacity of the well may fluctuate. Restricticn of ncn-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory mu£t be attacked to all copies of the subject Health Authority Apprcva!. 0Z-20-01 11:25 FROU-CTE ENVII~'~kENTAL · d~K CTIE Environmental Servlcea Inc. 5615301 T-O04 P.0Z/03 F-477 cr&£ Ret,# Client Name Project Hame/Al Client Sample ID Ordered By PWSID Samplc 1010717001 AK Water & Wastewater Consultants Inc. Lot 185 TIJN P,.IW SecS Outside Hose Bib Drinking Water Client PO# Printed Dat~/'rlme 02/20/2001 ll:lg Collected Date/Time 02/13/2001 15:30 Received Date/Time 02/14/2001 14:40 Released By ~ Nitrntc-N 0.50OU 0.500 mg/L EPA 3OO.0 Atto.abte Prep A~aiysfs Limits Date DaTe Init I0 max 02/14/01 SCL Mierobioloo'v' L&borator~_ Total Cnliform 2 OB. Nn C01/ COI/I OOmL $M18 9222B 02/14/01 KAP OZ-ZO-OI II:Z6 FR(N--CTE ENVIRO~I~KTAL 5515~01 T-O04 P.03/03 F-477 zTF= CT&E Environmental Services inc. Laboratory Division 200 W. Porter Drive Drinking Water Analysis Report for T~tal Colifo.p BacteriaTel:^m'h°'°''l~071 56Z-=~3 ^~ 9.~8.~805. READ INSTRUCTIONS ON REFEILVE SIDE ~EFORE COLLECTING $.4MPZE Faa: (g071661-5301 MUST BE COMPLETED BY WATER SUPPLIER D PUBLIC WATER SYSTEM I.D. # I lillll ~1~ PRIVATE WATER SYSTEM CONSULTANTS' D SesdlteM~ f2 Sesdls)~ce SAMPL£ LOCATION SAMPLE DATE: Month SAMPLE TYPE: Routine Repent Sample (for routine sample with lab ref. no. ) Special Purpose Day Year Treated Watt Untreated Water Time Colletted Collected By ~::~of,~. TO BE COMPLETED BY LABORATORY ,.n aly sis shows this Water SAMPLE to be: Satis fettory O Unsat~sfKmry Sample over 30 hours old, results re. ay be unreliable Sample too Ion~ in transit: sample should not be over, ii, ours old at examinatmn · 'v to Indicate reliable results, plane ~.na ...... new sample via special delivery mail. Date Reeelved Time Reteived Analysis Began Analytical Method:/~_ Membrane Filter n MMO-MUG e Number of colonies/100 mL . · ....... Result* 1010717 %uc~ Fbkl AnalyR ..... Client notified of unsatisfactory, results: ?bMud Spoke wftk Date: Time: BACTERIOLOGICAL WATER .ANALYSIS RECORD MMO-MUO Ra~uit: Total Callfarm r_ C~i MembrBne FJlten DIre~ Count (~) CoJouiel/lO0 mi Verification: LT8 BGB COLIFIRM Fetal Coliform Confirmation Final MembrH. ['liter R~lt ' ~) 'Time~-~hr; ~~ M~ M the SOS Group'lSma~i GMMroM de Sun~e"ence) el~l~iice;TAt SACIUTIES IN &LASK.~ CALIIcORNIA, FLORIOA. ILUNOIS. MARYLAND. MICHIGAN. MISSOURI. NEW JERSEY. 01410. W~ST VIR{~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 Parcel I.D. # 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Location (site address or directions) ~,'¢-.~'~ ,-~-.,,~,.,¢/.~,,¢,¢..,~. ~,,,¢.,~.,.¢,~,. .¢.,~.. Property owner Mailing address Lending agency Mailing address Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: /7¢ TYPE OF WATER SUPPLY: Individual well ~ Community well 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: I.ndividual on-site ~ Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~:;~o~-.~_.¢.~- ' ,:~-'.~-'".c~,~_._~y __ Phone~¢~ ~-/I ~-~.~:-.-o ~'~; Address ¢¢~;~ ~--~,-¢~J,~',~;'-,-~ ~:.?,f_z, /~z--.'-~'E~_.. ~/-;~/.~ Engineer's signature ~L~.. ~ _ ~ ~ _Date DHHS SIGNATURE - ^ proved for Disapproved. Conditional approval for - bedrooms. bedrooms, with the following stipulations: Additional Comments 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 DH HS 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. Municipality of Anchorage '~u~v~o~ DEPARTMEN, T OF HEALTH & HUMAN SERVICE~j'/,,~oN,~Lz~sor_~ Enwronmental Se~ices Division ~V~c~ 825 L Street, Room 502 · Anchorage, Alaska 9950J · (907) 345~ Legal Description: Z~ ~/~ ~ ~ ~. ~ Parcel I.D.: ~ ~/- x A. WELL DATA Well type Log present (Y/N) Total depth ,-~ Sanitary seal (WN) Date of test Static water level Well production Ifa, B, or C, attach ADEC letter. ADEC water system number Date completed /-~'~. Cased to '4'/~ FROM WELL LOG WATER SAMPLE RESULTS: Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION /~,~/? ~/. g.p.m. ~ ~ ~ g.p.m. Coliform ~- Nitrate Date of sample: B, SEPTIC/HOLDING TANK DATA Date installed ~5/~'~' Foundation cleanout (Y/N) Date of Pumping ~"~',~',~/ Pumper -- ,d./'~ Other bacteria Collected by: Tank size /-~*'"~ ~"-¢-' Number of Compartments ~ Cleanouts (Y/N). Depression (Y/N) ~ High water alarm (Y/N) C. ABSORPTION FIELD DATA Date installed Length x/.~,x -F.~ ~'Width '~ '~-~ Gravel thickness below pipe Effective absorption area /~'~ ~'/¢ Monitoring Tube present (Y/N) Soil rating (g.p.d./ft~ or fF/bdrm) '~' ~: System type "/'~',<~';~--~g,~ ~/~'~. Total depth Depression over field (Y/N) Date of adequacy test ..~'~,~',,-~ Results (Pass/Fail) For bedrpg~ms Fluid depth in absorption field before test (in.); Im~j~,~di~added (in.): Fluid depth (ins) Minu._i.i.i.i.i.i.i~~. Absorption rate = g.p.d. ~onths) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (WN) High water alarm level at* Size in gallons "Pump on" level at*. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station Surface water Curtain drain SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation '~"~' ~'~'~ Property line ~5"~:~ Absorption field Water main/service line go~ -~,z-/Surface water/drainage _/o~ ,',~/z Wells on adjacent lots / z~) ~,~-~. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ,/-/~ ,,c/-, Building foundation ?/,,c-/. Water main/service line ,.~- +,~-'/. Driveway, parking/vehicle storage area F. ENGINEER'S CERTIFICATION Wells on adjacent lots ! certify that I have determined thru field inspections and review /n conformance with MOA HAA guidelines in effect on this date. Engineer's Name ,.~,/~,~,~.~ Date ~- HAA Fee $ ~/~. Date of Payment. ~/~//~,-~ Receipt Number ~ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number ~t~=_. CT&E Environmental Services Inc. CT&E Ref.# Cliem Name Project Name/# Client Sample 1D Matrix Ordered By PWSID 972952001 Douglas Kenley P.E. Lot 185 Sec 8 R1W TI5N Lot 185 Sec 8 RIW T15N Drixfffng Water Sample Remarks: Client PO# Printed Date/Time 06/16/97 09:55 Collected Date/Time 06/08/97 15:30 Received Date/Time 06/09/97 13:50 Technical Director: Stephen C. Ede Results PQL Units Method Allowable Prep Analysis Limits Date Date Init Nitrate-N 0.100 u 0.100 mg/L SM18 4500-NO3F 10 max 06/10/97 JBL Total coliform 0 col/100mL SM18 9222B 06/09/97 RAM CT&E Environmental Services Inc. Drinking Water Analysis Report for Total Coliform Bacteria 200 w..o~,r Drive Anchorage, AK 99518-1605 RE. AD fiYSTRUCTIO,¥S Oil: REVER.~E $ID£ BEFORE COLLECI'ING SAMPLE Tel: (907) 562.2543 .... '" . · - - - ' ;: '- ;: :Fax:(907}561-h301 MUST BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM I.D.# [ I ] [ I ~'PRIVATE WATER SYSTEi~,I S~td R~uh~ I'~ II ~Send Results D Stnd Invoke S A.", ~ LE DATE: Month SAMPLE 'I~"P E: [~ Routine ~ Repeat Sample {for routine sample with lab ref. no. ) D Special Purpose Day Year D Treated Water D Untreated Water S.~,~LE LOCATION Time Collected Collected By TO BE COMPLETED BY LABOKATORY Analys s shows th s Water SAMI~LE to be ~ S~isfactory D Unsatisfactory. D S~rnple over 30 hours old, results ma), be unreliable not be over 48 hours old at examination to indicate reliable results. Ple~e ~end new s~mple via special d~liver~ m~il. Analytical Method J~-qMembrane Filter D NlM O-MUG Number 0f col~,nie~/100 mi. Result* 7.2052 Sec Aneh Fbk~ Analyst Jun Da:e: . Time: Client notified o;' unsatisfactory results: Faxed [] Date: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MIdG Result: Total Coliform £. Coil Membrane Filter: Direct Count..~) Colonies/100 mi Verification: LTB BGB CO LIFII~M Coliform Confirmation ColiformlI00 mi ~-IO~q'~ Ti,,,, _/Ce '. rs-o t, rs PART ONE OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DWISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF ~NSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ,~'h-~- GENERAL INFORMATION (a) (b) (c) Legal DeN~.~n__---"'~¥-~=~" (includeff o¢ ..~l°t' block,,~C -~'~--~_--------¢-rc'~subdivisi°n' section,~township, range)~/~ ~ _ ~ ~ J ~ Location (address or directions) A¢;~i;an, NSme 7~~~% Telephone: Home Z~-~_ Business Applicant Address Applicant is (check one): Lending Institution ~; Owner/builder~; Buyer ~; Other ~ (explain); (d) Lending Institution ,~ L.~/,JO ~ Telephone Address (e) Real Estate Company and Agent Address Telephone (f) 1~1 the HAA to the following address: TYPE OF RESIDENCE Single-Family,,~ Multi-Family [] Number of Bedrooms ___ Y Other WATER SUPPLY Individual Well,~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmenta~ Conservation attesting to the legality and status, 4. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, Page 1 of 2 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 Heaith 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 '~ & ~o E.;,I(~Ii~E,,EJ~[JE~ Telephone. - Date -- Approved ,o, ~ bedrooms by Approved - ~ ~ Disapprove~ Terms of Conditiona~ Approval CAUTION The Muncipaldy 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 reqoirements. 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 WELL DATA MUNICIPALITY OF ANCHORAG,'=: MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH ENVIRONMENTAL PROTECTIOhJ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST-FEBRUARY 1984 I~i,;~¥ ~ 0 1985 264-4720 Legal Description: Static Water Level Casing Height Above Ground Electrical Wiring in Conduit~N) Separation Distances from Well: Well Classification ~, ,,C'~, If A, B, C, D.E.C. Approved (Y/N) Well Log Present~)N) , ~ Date Completed ~-'~;~. ~ Yield~ · ~.~ ~ ~l ~- Total Depth ~-~ ~ ~ Cased to ~/~ Depth of Grouting / Pump Set At ~), ~ Sanitary Seal on CasingS) Depression Around Wellhead (Y~. To Septic/F~e~lm~-Tank on Lot To Nearest Edge of Absorption Field on L~ot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by ,~ Water Sample Test Results Comments ~ ~ ~.,,~¢Z.~/~ /'~,--,~b~.J '7'"'~-~' ; On Adjoining Lots /(~:) ' ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on B. SEPTIC/J,I~L,~W~I~CTANK DATA Date Installed ~"' Z '7-¢~' Size //"~'~'~ No. of Compartments Standpipesl~N) Air-tight Caps~7~N) Foundation Cleanout(~;~N) Depression over Tank (Y~ Date Lasi Pumped ~'- Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic,q4e4d~ Tank: To Water-Supply Well To Property Line To Water Main/Service Lin/e Course ~'~'/,4. Temporary Holding Tank Permit (Y/N) To Building Foundation ~--~ /~ To Disposal 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 -- //~¢~'~:) ~/'~ '~ Date Installed Width of Field - Square Feet of Absorption Area -- Depression over Field ~(Y~- Results of Last Adequacy Test -- Separation Distance from Absorption Field: TO Water-SupplY Well -- /~c~ / To Building Foundation - ~'~'~ Lot To Water Main/Service Line _ To Stream/Pond/Lake/or Major Drainage Cou'rse - To Driveway, Parking Area, or Vehicle Storage Area Type of System Design ~ ! Length of Field Depth of Field Gravel Bed Thickness Standpipes Present~N) Date of Last Adequacy Test _ ~"'~' / _ To Property Line ~'0 To Existing or Abandoned System on ·; On Adjoining Lots To Cutbank if present) Comments D, LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at _ Tested for _ Dimensions Manhole/Access (Y/N) -- _ ~ ~ _,~ump Off" Level at ~ / ~'~ __ Vent (Y/N) .-- 7/~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Sinned ~ ,~, ~ ~,~_iNE~[~:N~ Date ~ -- . SRB 196X , MOA No. Compab~Y'~ Receipt No. ~-~-~;'~'~ Date of Payment ~" Amount: $ ~,..6 o,..~,_ Page 2 of 2 72-026 ¢1/84)