HomeMy WebLinkAboutT15N R1W SEC 9 LT 57T15N R1W
Sec 9
Lot 57
#051 - 103 - 21
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
\ MUNICIPALITY OF ANCHORAGE
•
r t ;
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
/ vEee 0
Ed�,���je
PHONE
EW
E UPGRADE
MAILING AD ES,Sr� /� /� ,( L /� ✓7 �i/ /� e'7
Cio 8004 O' 7 (2- 0 0 Chi -74 i'/ 4rc 993- i /
LEGAL D CRIPTION ll
z_,5-7 s 7 its k i EA./ 3-4,,,7.
LOCATION
NO. OF BEDROOMS ,?
SEPTIC
TANI<
DISTANCE TO:
Well / /
[!L
Absorptioy.areaf
r/r/
Dwelling �. /
PE MIT NO. (\��
(r! !IA A V 474
Manufacturer r 2e
-Pons
-e
R terke /
Width
No. of co artmeZ
Liq percit,�a.yn goal
F HOMEMADE: Inside length
Iitiwelli
Liquid depth
0 x
JOZ
0 � F
DISTANCE TO:
Well g
7 /I
PERMIT NO.
Manufacturer
/ /1
Material
Liquid capacity in gallons
TILE
DRAINFIELD
TRENCH
DISTANCE TO:
Well
Foundation
Nearest lot line
PERMIT NO.
No. of lines
Length of each link]
66 /
!fo I n th of lines
Trench width
inches
Distance between lines
Top of tile to finish grade
Material beneath ti le
inches
Total effective absorption area
SEEPAGE
'SC
fii D
Length ei /
Width l 9 /
Depth ft /
PE�lyl T� I,V ! `
(J Lf f�f
Type of crib
Crib diameter
h'
Crib dept
Total effective absorption a a
DISTANCE TO:
Well /2- ` 7
/,
Buildigplplpdatiotf
GG./7
Nearest lot line / `
�
11§1
CIa;,,,t rys L/
Depth . /
J
Diller
�f r7 N'-tC-uil% o
Distance to lot line
PERMIT NO.
C�IJ
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption areals)
OTHER �O2.em
Z
1--
t
`I
�
i
ni
r
PIPE MATERIALS
1\ii
SOIL TEST RATING/�
7 /F✓ e
Z�.I
C.
I
L.-4
I
�
/ 9
e
co
REMARKSS
4
to
ft
to
ac •:;Is
Qeo`O
se0
•;-
Ore •
G
face
Orlirr 1 '
40 7
/'v1
0
�
•• R�b�rt A. Shaer .d
n .r No. 145%-E�
l0
tt, R e117`, 1wN �
IhIPIEIING
APPROVED
a ,�,EN
cyR� '196X .___ DATEalb ALOA j ��� /rXii
y
Kxa f.S AIVER, ALAX \ Ca'trg[ Is -6
` pH, 69442c)/0
72-013 (Rev. 3/78)
F1Lit4I IC 1 F"AIL._ 1.'T N CISF- uC4oNic :E-N0Iwo:C%l:aEt•
DEPARTMENT -OF HEALTH AND ENVIRONMENTAL_ PROTECTION
825 L STREET, ANCHORAGE, AK 99 501
264-4720
O f I --- S I -I" N__: .'._i IE t4IE=' E?. F'=b EE IFw: Pel 1
PERMIT NO: 840684
DATE ISSUED: 08/10/84
APPLICANT: EDWARD RIVERA
ADDRESS: PO BOX 670208
CHUGIAI' . AK 99567
CONTACT PHONE: 6038-91.:32
LEGAL DESCRIP: SUBDIVISION: N/A
SECTION: 9 TOWNSHIP: 15N
LOT SIZE: ' 5A (1.10"FT. OR ACRES)
MAX BEDROOMS:
LOT: 57
RANGE: :IW
BLOCK N/A
L.ist.ed 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.) 4.0 4.0 4.0
GRAVEL DEPTH (FT.) 6.0 0.3 7.5
TOTAL DEPTH (FT.) 10.0 4.5 7.5
GRAVEL WIDTH (FT.) 2.5 14.0 5.0
GRAVEL. LENGTH (FT.) a!<""'. 0 28.0 28.0
GRAVEL VOLUME .(CU.YDS.) -`_
TANK SIZE (GALS) 1,000.0 .x.x. 1 000.0 *•x 1,000.0 xx
SOIL RATING (SG!.FT./BR) 85 85 85
** TANK MIDST HAVE AT LEAST TWO COMPARTMENTS
T certify that:
am familiar with the requirements for on-site sewers and wells as set.
rrth by the Municipality of Anchorage (MOA) and the State of Alaska.
I will in<st.ai]. the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit...
I will adhere to all. MCIA and State of Alaska•requirements for the set _back
distances from any existing well, wastewater disposal system or public
sewerage system an this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 3 bedrooms and
any enlargement will require an additional permit.
2.
3"
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED. BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINEDv (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT. AN ELECTRICAL INSPECTION REPORT; AND (::) THE
ELECTRICAL. WORK MUST BE DONE BY A LICENSED ELECTRICIAN..
SIGNED
APPLICANT
• ISSUED BY
EDWARD RIVERA
DATE:
SAV r ,e1 DATE:
/4.2947
yp
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
I-ihck RrUere,
Dia SOILS LOG
❑ PERCOLATION
TEST
DATE PERFORMED:
LEGAL DESCRIPTION: T 15 NJ ' ` \ V\, 1 _Se Cn on 7, LA- 5 7
SLOPE SITE PLAN
1
2
3
4
5
6
7
8
9
10
12
13
14
15
16
17
18
19
20
DEPTH
(FEET)_
COMMENTS
TDPSot` (Qecc-0
S, i(-ki, Stands S t 1
'-or L1 lvradact.4znc1 se
Cil(} (2C:2 5`„M- Oar \ePe\roocri
Wellcu-ached itrnu4_ nCl.Sond
Hs(mak\ L 4CQ Ss c SI If.
ca,C1ie r-$ It I ! 7
it
To w S }
Re,
Less tka h of a%OQ-,"
P
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
S
L
0
P
E
F
IQ
(or
DCZb
9-
1�-
(1 b
1
/
LI-
-Yn
Reading
Date
Gross
Time
Ne
Time
Depth to
Water
Net
Drop
iS
......5�c..4.
x.®1
®0
�'� adv
o.N
Or.
' E '
a- , o
. a
.rarea.
0..�.;.�$'a...
m% I
k8,
nwronce C. 1
CES225
......nv
or J c�®
1
,���.ta.
9e
�►
NO.
°m.........P
Onn rN
tir
es
Y4 f
�'
PERCOLATION RATE
I1/414
• 'miminutes/inch)
utes/inch)
TEST RUN BETWEEN
?eeamn\eInd Ins-kIIn5 s.&,,ecz t-fromch
u31t h c5rr+zlbedroom c12slq h
PERFORMED BY:
72-008 (6/79)
CERTIFIED BY:
FT AND FT
b49-I'tvU-2eri 5/o'c gt-h
Ze .666,64:4
5r63 - acre.
DATE: // -7-:-'/('
cit01
murncIrno_Imv or nr4coAnc;?4-1GEE
DEPARTMENT HEALTH AND ENVIRONMENTAL 3TECTION
825 /L. STREET/ ANCHORAGE, AK. 995b1
264-4720
106N—SIM "a7.16WIR
PERMIT NO. ( 830062 )
APPLICANT EDWARD RIVERH PO BOX 208 CHUGIHK 99567 688-9132
LOCATION
LEGAL T15NR1W S9 L57 LOT SIZE 999999 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 3
SOIL RATING (SQ FT/BR)= 85
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
��e-T-FA— so IL_Ir4ort-u= 22 oFrAiRma �Erm— fes
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELC\
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
rnw< sIc=u. selee Inso_u_ovAs
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
--- two <2> INIspariorqs np:fla FzImiluIlFzur> ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND
TO H COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F,"IFzlES
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
SIGNED:~..����~�
APPLICANT EDWARD RIVERA
ISSUED BY_
V4.0
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
XX SOILS LOG
❑ PERCOLATION
TEST
PERFORMED FOR: Linda Rivera DATE PERFORMED: 7/15/82
LEGAL DESCRIPTION: T15N. R1W, Section 9a Lot 57
Topsoil (Peat)
Silty Sands, SM
Poorly Graded Sand, SP
Well Graded Gravel and
Sand with Small Streaks
of Silt, Boulders to 1'$,
GW Soil (85 sq. ft. Per
Bedroom)
Bottom of
Test Hole
COMMENTS Recommend installin
PERFORMED BY:
72-008 (6/79)
SLOPE
r
WAS GROUND WATER
ENCOUNTERED? •NO
IF YES, AT WHAT
DEPTH?
N/A
SITE PLAN
Reading
GRAVEL
Gross .y"ili1•
Time s'�'
{`
i
i.. 4 AA°Q
R
AD
- Ca9''
!. ••°••p0)
Existing
4\�.•OY•!00!••0
Lawrance
C. L �yar 7
lije 1
Cabip
�C
B
'Proposed
1111pHOFESS1O\,e41"
1Fouee
'Eitc
.~/y'
`
I
'
�'6r
5S
4B�I'
Hole
cot
Outhouse
Reading
Date
Gross .y"ili1•
Time s'�'
{`
i
i.. 4 AA°Q
Depth to
Water
Net
Drop
- Ca9''
!. ••°••p0)
y�y
0 14
p• •0N94o
4\�.•OY•!00!••0
Lawrance
C. L �yar 7
lije 1
B
1111pHOFESS1O\,e41"
PERCOLATION RATE N/A (minutes/inch)
TEST RUN BETWEEN
see.a•e tren
FT AND FT
h between 5' and 10° depth wtth 85 ft2/bedroom
CERTIFIED BY
DATE: 7/15/82
DAILY DRILLING LOG
.3
2
4,
A
KIND OF CASING
nJ
t\.
Ih1
ss1/4
1/4)
2
0
0
4
1/4„,
t
0 0 0 0 0 0
E H H
X P.
o
0
;co P. P.
O 0Ii
E El
F.1
0 0 ▪ 0
g
L•')
0
c';)
0
O 0
F.( E
t t
a
O 0 0
H H
t t t
X X X X
0 0 0 0
fg 44 44
P. P. Lk P.
O 0 0 0
H H
0000
• ;i4 44 44
t t
t
O 0 0 0
H (.0
X X X X
O 0 0 0
C4 C4 C4 C4
• {14 1¼ Ch
MISCL. INFORMATION:
PlUK119 T��y jr: 1- �� #��������
DEPARTMENT -- HEALTH AND ENVIRONMENTAL (xTECTION
825 STREET. HNCHORHGE, HK. 9 �1
264-4720
1T4FP1 11. FFA7-1E111 I: 1-
PERi1IT NO. ( 820585 )
APPLICANT LINDA RIVERH
LOCATION
LEGAL T15NR1W 59 L57
t ;��,
PO BOX 208 CHUGIAK 9567 66 &.-92.31
LOT SIZE 999999 SQUARE FEET
MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND
TO H COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
• OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTHLLHTION.
1 ����I- F7�Fr." }ENE: FT; DOE: CAE: VI IBIE FP"
I CERTIFY THAT
i: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
• 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
• SIGNED:
8P1....ICHNT LINDA RIVERH
ISSUED BY. .DTE
,
/cft`--~ ' - �~-
� �
���
�
�
~ ^
V4.0
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 I.D. O Si— /0 3- cosA # O G O 3 7
;.
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Expiration Date: / / '- / SJ 0 G
TIS rI sC 1 14 SEL fl 5 1
..a.4.5 3Q-5 FriRrK�Sl,i CHWs_
Current Property owner(s) EdrNard t2; vc. ra Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Po 13ex G-1 I?'.O . acAgia% , fi-K ele1201
Day phone
RRotin,tvJ 1-/arc/twin Day phone (")'J 4? -.I S
Iro(.oO C.c.-+4-t,--PtJet Br. it- an1, t=w_. Alk cinS-ri
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank
Community On-site
Public Sewer
0
0
0
1
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineet registered_inlheState c!Alaska_Certiricates_of On -Site 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 engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. 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.
Eagle River Engineering Services
10421 VFW )ia., Suke [OT
Eagle Pivot, AK QQ577
Name of Firm
Address
Engineer's Printed Name CJnri t%riolne r r2. t.tiloori
5. DSD SIGNATURE
1/ Approved for 3 bedrooms.
•
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Phone riC1'! -SII
Date gilt/ O(c
\c.tttLStYrOFANrl.
QP
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
J` ON-SITE
`z ••WATER AND n'
: WASTEWATER
PROtiitAM
O
.• •
se,
,J� J '91TI7SE$ )\
/ /)))111j11
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Uther
By: 4c/�� 4l Pe -t- Original Certificate Date: g - / St 0 io
(R.v. 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/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Tlsr l le I tnl SEC -9 LOT Si -
A. WELL DATA
Well type "R -i vorf - If A, 5, or C provide PWSID #
Date completed / tl SC- Sanitary seal ON)
Total depth 4SO ft. Cased to 1 R0 ft.
FROM WELL LOG AT INSPECTION
Date of test re/ 1 / I92� -7/31/?oofa
Static water level `T 5 ft. 1 o a ft.
Well production 020 g.p.m. + 4 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0' colonies/100 mL
Parcel I D: O S'/ - 10 3-.2 /
Well Log ON) We -4-
I
Wires properly protected ON) fits -
Casing height (above ground) 3c-) in.
Nitrate -0 mg/L Other bacteria el colonies/100 mL
Arsenic: ,' ug/L date of sample: -7 //t5/0(0 Collected by: riftr{ci '13ct.F.2ar-inr
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Sc fi c.1 S4 ..c_tJ Date Installed Si 84
Tank size 1, WO gal. Number of CompartmentsoZ Cleanouts (Y)N) (des-
cUl i
Foundation cleanout (YN) tic.¢- Depression over tank (YtN '7?n High water alarm (Yd®
Date of pumping %/(lr7/00r7.00J6 Pumper Tit s "�tiw Pin
C. ABSORPTION FIELD DATA
1
I
Date installed R / DI Soil rating (g.p.d./ft2 or /bd ) 2' f System type rxd
Length a -g ft. Width 1 N ft. Gravel below pipe 0.15 ft.
Total depth 7.3 ft. Eft absorption area $9.,f12 Monitoring tube We)._ Depression over field _Ado
I
Date of adequacy test 7 /3/Ms. Results 4711" ail) 5S For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 4150 gal. New depth a in.
Elapsed Time: 5 min. Final fluid depth 0 in. Absorption rate >= 450 I g.p.d.
Any rejuvenation treatment (past 12 mo.) type) hOY1e kz-now If yes, give date i^ f
(Y Oi
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at _ in. "Pump off" level at t1 L\eUg water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 101' On adjacent lots 4100 '
Absorption field on lot +t Cb' On adjacent Tots 4 100'
Public sewer main 4 100' Public sewer manhole/cleanout +-ico'
Sewer /septic service line + 100' Holding tank + -iS '
Animal containment areas t t OO Manure/animal excrete storage areas+104, 100'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation S' Property line +S' Absorption field +Ip'
Water main
t 10 Water service line + IC1'
Wells on adjacent lots +100
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line +10'
Surface water I X10
Building foundation *101 Water main + 10 '
Water Service line 4 101 Surface water + t 00 Driveway, parking/vehicle storage SIO'
Curtain drain * SO'
F. COMMENTS
Wells on adjacent Tots 4 I CX>'
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name C /f R. SToPq nt R - LJ�,p ? R
Date q/// ! b 6 MAW
COSA Fee S 13 0 Waiver Fee $
sof, (7
Date of Payment
Receipt Number B `i6 SS
(Rev. 11/05)
Date of Payment
Receipt Number
AUG -08-2006 10:31 AM
P. 01
N et ' d7''€ .77e . / r t'ec)
ASBUILT-NO CORNERS SET THIS DATE.
SEWARD &
ASSOCIATES LAND SURVEYING 688-4566
1 HEREBY CERTIFY THAT I HAVE SURVEYED 'THE
FOLLOWING DESCRIBED PROPERTY:
8:11 Lot 57,Sec. 9,T1SN,R1W,S.M. AK.
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT I5 THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
Or FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
SCALE:
1"■50' .
DATE:
1-29-91
GRID:
NW 1359
FB:
18-44
DRAWN:
DMS
r...'..Is*4
1 -• .•w
;t.' 7,$
aj r M{
•
# T Du... MyKS.+cd : t
4441:. l5•}41R' i
I. C'I:tkxs. �:•
gintea*
ASBUILT-NO CORNERS SET THIS DATE.
SEWARD
1 HEREBY CERTIFY THAT 1 HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
BLM Lot 57,Sec. 9,T15N R1W,S.M. AR.
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS •
WHICH 00 NOT! APPEAR ON THE RECORDED SUBDI
VISION PLAT. IUNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES. I
SCALE:
1"-50' .
& ASSOCIATES LAND SURVEYING 688-4566
DATE:
1-29-91
GRID'
NW 1359
FB:
18-44
DRAWN'
DMS
•
.y
.��,•%
tPR� OF• ...,4 *
�.4�TNe�� I'•',y1
.• ••0
Du.n M..1 Speen!
Cr
, •.• 15 -6* * 8 i
14;,x,.,"
SGS
SCS Ref."
Client Name
Protect Name/N
Client Sample ID
Matrix
1064214001
Eagle River Engineering
T15N RIW Sec 9Lot 37
T I5N R I W Sec 9 Lot 37
Drinking Water
All Dates/Times are Alaska Standard Time
Printed Date)Time
Collected Date/Time
Received Date/Time
Technical Director
08/032006 13:33
07252006 11:45
07252006 16:55
Stephen C. Ede
Sample Remarks:
Parameter
Results
PQL
Allossable Prep Analysis
Units Method Container ID Limits Date Date Unit
Metals by ICP/M3
Arsenic
Waters Department
Nitrate -N
Microbiology Laboratory
Total Coliform
ND
ND
0
5.00 ug/L EP200.8
0.100 mg/L. EPA 353.2 B (<10)
C (<10) 07/28/06 08/02/06 MI1
col/100mL SM209222B A (<I)
07/26/06 ALR
07/25/06 TLF
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1.. General Information Application Date fZ
(a) Legal Description (include lot, Nock, subdivision, section, township, range)
/0-r ,c---'7 s&z_ �� Aft/ /-ns-di 7C� W, 5/ AA<
Location (address or directions)
F.)/.-/> ie,;-/- SI Iii'
Ione --`ii3z 4,I¢ - di -gets
(b) Applicants Name /jn//'A ERIVE/A Telephone - Home Business
Applicants Address
7, 0, sty l0 YO;z0S' - 0/1061,44
(c) Applicant is (check one) Lending Institution
Buyer ; Other (explain);
(d) Lending Institution , 054 ,C 44, Telephone /No/ -2-800
Owner/builder, ;
Ads s
Cfpe ,-r OAF Du 13LVS,
(e) Real Estate Co. & Agent
Address
Telephone
F(9L4
(f) Mall the HAA to the following address:
/-PPL/cshn./T /LL Pice
UP ,&r rt OA) /G/ PA4.-
2. Type of Residence
Single -Family, Multi -Family pi Other (describe)
Number of Bedrooms 3
3.. Water Supply
Individual Well 1.:t Community ET 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 f Community
Holding Tank 1_,4
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 21
•
J
5. Engineering Firm Providing Inspections, Testa, 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 regula—
tions in effect on the date of this inspection.
Name of Firm
Address
Date
E:7G(MtL•RINC
SAB 196X
Telephone
6. DEEP Approval
Approved for :7-) bedrooms
Approved
Terms of Conditional Approval
Disapproved
Conditional
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DEEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT—
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DEEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE—
MENTS. EMPLOYEES OF DEEP 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.
(DEEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
A. WELL DATA
Classification s I r'
Log Present ®/N)
Total Depth b f
Static Water Level
Well
Well
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
o1u�
1 eit OFOHE CIIOt4
ENvtgoNMENTAL
s;A
RtC,E1V ED
Legal Description: S`%) 3 e 9
s/J / %Z) w SI m,
If A, B, or C, D.E.C. Approved(WN) A/A
Date Completed
- / - 82- Yield . ShFMk
Cased to /60' Depth of
q2 / Pump Set At V, /1,
Casing Height Above
Ground 24 A,
Grouting
Electrical Wiring in Conduit ON)
Separation Distances from Well:
To Septic/He± fTU Tank on Lot
/OIL
To Nearest Edge of Absorption Field on Lot /Z /
To Nearest Public Sewer Line v0/4
Sanitary Seal on Casing c$/N)
Depression Around Wellhead (MI'S))
On Adjoining Lots AOC 7-
On Adjoining Lots /OD /-/-
To Nearest Public Sewer
Cleancut/Manhole 41/4 To Nearest Sewer Service Line on Lot
Water Sample Collected By Srs ; Date
Water Sample Test Results 5-kericir,o-c-memi
Comments A We1A- Pt-ow-r,ssi- S14h8kfCO TWA W&ZI.� TO
PR 0 oc r /iv excess &r . S l -i pM .
eo �-f-
B. SEPTICAHO W TANK DATA
Date Installed 9 -3O 034 Size
/Ott, 64L. No. of Compartments
2 -
Standpipes 1) Air -tight Caps ( ) Foundation Cleanout
Depression over Tank (YAP
Pumping/Maintenance Contract on
Holding Tank High -Water Alarm (Y/N) Temporary Holding
Date Last red , Jt -"J
File (Y )/A ; for
OrAq
Separation Distances
To Water -Supply Well
To Property Line
from Septic,Qg Tank:
Tank Permit (Y/N)"YA
To Building Foundation ,
5"-�
/t, '-" To Disposal Field
To Water Main/Service Line 41/74 To Stream, Pond, Lake, or Major Drainage
/04
Course
Comments
Receipt #
Date Paid:
Amount:
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD DATA
Absorption Strata 85 17%1 Type of System Design
S-30— Sy -
Soils Rating in
Date Installed
Width of Field
"4
Square Feet of Absorption Area
Length of Field
Depth of Field
REQ
Z
Gravel Bed Thickness (o `14,vgagium'are
',g'q2- Standpipes Present QC'N)
Depression over Field (YeDate of Last Adequacy Test A �
Results of Last Adequacy 'list / e
Separation Distance from Absorption Field:
To Water -Supply Tell
To Building Foundation
Lot 4),/d ; On Adjoining
To Water Main/Service Line 'Vit! .
To Property Line
/o 'f
To Existing or Abandoned System on
Lots '3o /4-
To Cutbank(if present) l/A
To Stream/Pond/take/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area Sb
Comments
D. LIFT STATION
*
Date Installed
Size in Gallons
"Pump On" Levei at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
'Pu
Off" Level at
Vent (Y/N)
Pumping C cies during Adequacy
A
Test. Meets MOA
Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified,
on the date of this inspection.
Signed
Company
KB1/d5/s
[Page 2 of 21
8 &v EVGIW ERIN i
LE RIVER. nisAj46M
AH. C04-u/Q 9577
or conformed
to all MOA
Date /2.24C-CY
MOA No.
HAA Guidelines in effect
2-15-84