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Home My WebLink AboutT15N R1W SEC 18 LT 119Onsite File T15N R1W Section 18 Lot 119 #051-172-42 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PoBox 1yO850 47noElmore Road Anchorage, Alaska aos1o'Vnsu Phone: r 7904 Fax: (yo7)34a-7onr Permit Number: OSP211465 Work Type: SopUoTenkUpgnode Tax Code Number: 05117242000 Site Legal Address: T15NR1VVSEC 1OLT119 87154 Site Mailing Address: 19041HIDDEN HILL CT, Chugimk Owner: VVAGNONSUSAN M Design Engineer: GARNESSENGINEERING GROUP LTD This permit isfor the construction of: Effective Date Expiration Date: Lot Size in Sq Ft Total Bedrooms: 11N/2]21 11A/2O22 0Disposal Field Z Septic Tank 0 Holding Tank 71 Privy 0 Private Well 171 Water Storage All construction shall beinaccordance with: 1, The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 1555 and 1665 andth State cfAlaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) -. The wastewater ---- requires^inspections~during^the installation.^The engineer shall notify the Development Services Department per AMC 15.S5.Provide notification bycalling (g07)343'7BU4(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither. a. Opened and Closed onthe same day, or b. Covered, seated, and heated hzprevent freezing gg- ecial Provisions: eptic tank shall have a minimum 20-inohmonwoyriser tuthe first compartment (AMC 15.O5.2D5F.1) he septic tank shall b*aminimum cf5ft from afoundation supporting ashed, orsimilar structure (Exception to AMC 15.G5.2O58.1c). This does not apply to sheds supported on pier blocks or otherwise moveable. Received By. Issued By: 12 NH'C I P A L T Y OF AimCH 0R Development Seniices Department Phone. 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-172-42 Property owner(s) STEVE COLE Day phone 244-6384 Mailing address 19041 HIDDEN HILL COURT, CHUGIAK, AK 99567 Site address 19041 HIDDEN HILL COURT, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) LOT 119 Legal description (Township, Range & Section) T1 5N, R1 W, SECTION 18 Lot Size Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 Septic Tank 0 Upgrade Q (w/wo ADU) Holding Tank ❑ Renewal ❑ Duplex (D) El Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or auth,pdized agenty,:-j Permit/Rush Fees: $ � Waiver Fees: Date of Payment:// 0Z / ( Date of Payment: Receipt Number: n 5 g27G Receipt Number: Permit No. OU `a 11 A � 5 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewatefforms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211465, Rebecca Carroll, 11/04/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211465, Rebecca Carroll, 11/04/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211465, Rebecca Carroll, 11/04/21 \ a M m W J Q L] _ z r � U n co FQ ti= f�rL C3 S \ w o J m O c x F- �s.9a:00, � D a cn 00 r N ji LU H N D T 0 u � l CLO.O££ :dld0 (INV CD S3NIl ❑31O'dHlO�:1d WOad ci3indWOO SI aONViSICI Wle U -$L IVld WOI�Id 30NViSICI D IVld W18 woad ONWVI S7 _ -£G'0££ M-00 AVO oOON v } W I N \ 0 ', \ N 6 \ • drys d` \ _ QUO +a��4'frO�\ �.4 <n r�J: _Q th • Q N f � Q� Imo: _ � � � v •yp J I Q L, z rN L.L. 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U H m Z tr f 00 W N o to a V 0 � OR D f W x 00 Z LA M Q� H Ci a m< J C LL m Z = l- [� O J �y Wm f z N � H Z NW II gaf o H �<Ln �p a m= L m a ❑ ZZ Y a w 0 Lnm % y 1 co E Ln IN 0O0 _j DID kn mc � o o o U to N rZ Q LO Nom. rL• llQ Q C•i—UJ QU N U CO (L C, LLI �. l„ r LU 4 } m 0 LLIa www.sullivanwaterwells.com Pump Installation Log Well Drilling Permit Number: SW Date of Issue Parcel Identification Number: Legal Description Property Owner Name & Address T15N R1W SEC 18 LT 119 Susan Wagnon 19041 Hidden Hill Chugiak, AK 99567 Pump Installation Date: 1/12/20 Pump Intake Depth Below Top of Well Casing: 110 feet Pump manufacturer’s Name: F&W Pump Model: 4F07P05305S Pump Size: 1/2 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Installer: Unknown Disinfected Upon Completion? yes no Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer: Unknown Pump Installers Name: Sullivan Water Wells Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. ~(-i'-~ MUNICIPALITY OF ANCHORAGE 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 / NO. OF BEDROOMS ~ ~ Manufacturer Material No. of compartments Liq. capacity ~n gallons Inside length Width Liquid depth I~,¢ IF HOMEMADE: ~ . ~ ~ DISTANCE TO: Well ~welling PERMIT NO. O Z ( Manufacturer ........ Material Liquid capacity in gallons Nearest otli ~ Well I.~ Foundation ~ PERM~ ~ ~ ~ Trench idth Distance betw~ No:~ ----~ength of~, Total lengt~e, ~O*inohes ~ ~ ~ ¢~p of tile to finish grad~ -- ~ Material beneath tile Total effecti e a ' area ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building four~ation Nearest lot line ~ DISTANCE TO: ~ Dlas~x. / ~%/ p~h Driller Distance to lot line PERMIT NO. ~ ~ DISTANCE TO: Building foundation Sewer line Septic tank Abs~pdon area(s) OTHER PIPE MATERIALS SOIL TEST RATING 72013 Rev 3/78 '~ .... DEF'ARTMEI~IT 0~ '~IEAt..'f'H AND ENVIRGNMEI~'I"AL r ~'ECTIGN 825 L.~ ,dTREE]", ANCHORAGE, AK 995~.. ~ 264-4720 F'ERMIT NG: , '='""=' DATE I SGLJED: 06/25/85 AF:'PL. I CANI" ADDRESS CGNTACT PHONE: % S&S ENGINEERING GLEN SEBALD SRB 196-X EAGLE RIVER, AK 995'7'7 694-'2979 LEGAL DE. SluR I [-. LGT SIZE: MAX BEDROGMS: SUBDIVISION." N/A SECTION: 18 TGWNSH I P." ;I..25A (SQ.F'I". [IR ACRES) 4 LILT: 1].9 BLOCI .... N/A 1~5N RANGE.", 1W Listed below al"e the options available 'Lo you in de)signing your septic: system. Choose the option that best fits your mite. [~EP'T'H TO r-'ZPE BOTTOM (PT.') 4.0 GRAVEL. DEPTH (FI".) ~4.0 O. 5 TOTAL DEPTH (FT.) ~ ~]'~-~ 8RAVEL. WIDTH (PT.) ''~ GRAVEL LENS'T'H (FT.) ~:3..() 32~ 0 ~ 48.0 GRAVElZ VOLUME (6LI. YDS. ) 22. 1 19.0 ~ 22.3 TANK SIZE (GAL..G) 1,25().0 ** SGIL RAT]lNG (SQ.FT./BR) 105 85 ~8~ ** ]"ANK MUST HAVE AT' LEAST TWO COMPARTMENTS certify that: 1. I am familiar' with the requ:l~'ements fop on-site ~ewe..rs and wells as set, for'~..h by the Municipality oF An~:horage (MOA) and the State oF Alaska. I will install the system in acr, ordance with al;[ MOA codes and r'egulat:ions, and in compliance wi.th the design cr'iter, ia oF this per'mit. I will adhePe to ali. MBA and State of Alaska requirements fop the set back distances from any existing well., wastewateP disposal system on public sewePage system on this or any adja(:ent of near'by lot. I under, stand that this permit, is valid for a maximum of 4 bed~-ooms and any enlar'gement will r, equir, e.an additional permit. : IF A LIFT S'T'A'T'ION IS INSTALLED IN AN AREA CGVERED BY MOA BUILDING CODES, THEN (l~ AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBIAINED; (2) AS-BIJII...'T'S WILL. NOT BE APPROVED WI]'HOUT AN ELECTRICAL INSPECTION REPORT; AND (5) THE ELE[:,'TRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SOILS LOG PERFORMED FOR: LEGAL DESCRIPTION: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 826 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST 1 2 3 8 9 10 11 12 13 14 SLOPE PERCOLATIO TEST DATE PER FORMED:~~ SITE PLI WAS GROUND WATER W(~) S ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop 'J//'1-. 15 16 17 18 19 2O COMMENTS PERFORMED BY; 72-008 (6/79) (minutes/inch) PERCOLATION RATE TEST RUN BETWEEN CERTIFIED FT AND FT "~REATER ANCHORAGE AREA BO~ JIGH /' ''< HEALTH DEPARTMENT ~T? ? 8 2 327 EAGLE ST, ANCHORAGE, ALASKA 99501 279-25! 1 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION SEPTIC TANK: MAILING ' '* ' t · DIS 'ANCE EROM WELL LIQUID CAPACITY ~' ~ -4~'~) .GALLONS. MATERIAL -~*~: ~/'=J ,NUMBER OF COMPARTMENTS / ~'~'~/C"~ ~/~'~¢--"< ~/~ / ~ '~'"~'~ LIQUID INSIDE LENGTH INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER '~ OR WIDTH //~2- / LINING MATERIAL ~'~*C~(;~ 5~:~'~,~'*/~///~ DISTANCE FROM WELL. L/~~ / / NEAREST LOT LINE ~ /~' ~- . TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA} LENGTH /~ / , DEPTH , BUILDING FOUNDATION ~'/ SQ. ET. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELL ~ ,~7*FI~N NEAREST LOT LINE ,OF LINES NUMBER OF LINES / DISTANCE BETWEEN~ ABSORPTIO SQ. Ff. LENGTH OF DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: TypF_~/y/Z=/~ . DEPTH ,~C~, ' DISTANCE FROM .__ WATER j/), ? ~2 , BUILDING FOUNDATION SAMPLE/~'~ ~z . NEARES1 ~ / NEAREST SEPTIC S'~/ ~ ~ LOT LINE ~t ~' .~' ~. SEEPAGE OTHER . SEWER LINE , TANK , SYSTEM. , CESSPOOl .... , SOURCES DISTANCES: /~/~7~,:~, ' DATE DIAGRAM OF SYSTEM APPROVED GRE~FER ANCHORAGE AREA BOROUGH DEPARTMENT OP ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6*650 ANCHORAGE, ALASKA 99502 TELEPHONe 279-8686 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO, iNSTALLAT]ON LOCATION ' '// SEEPAGE PIT DRAIN FIELD OTHER SOIL TEST RESULTS COMPLETION DATE ANTICIPATED NOTE: THIS PERMit IS NOT VALID WITHOUT SOIL TEST FOUNDATION TO SEEPAGE PIT ,DRAIN FIELD SEPTIC TANK TO SEEPAGE PiT WALL ~/~ SEPTIC TANK , SEEPAGE P , DRAIN FIELD TO NEAREST LOT LINE. ~ ~ WELL TO sePTIC TANK SEEPAGE P[T DRAIN fIELD ALSO CONSIDER area WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD SEEPAGE PIT SEPTIC TANK, ., SEEPAGE PIT TO RIVER, LAKE, STREAM. DRAIN FIELD iNTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVAT[ON 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. DIAGRAM OF SYSTEM CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. GREAT ',ANCHORAGE AREA OROUGH ORDNANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED YSTEM IS iN ACCORDANCE WITH Sale} CODE. Was GPOU~O ~ater E~eountered'~ /, Depth To t!2!:) Net Drop MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 0,5~/-' /7z- -~ZZ-.."' HAA# ,/c,/---¢~ ~ ct 272~- 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot I19~ Sec. 18~ TI5Nt RIW, S.M. Location (address or directions) 19041Hidd6n Hi&l Court (b) Property owner Mailing Address (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent MARSTON PROPERTIES ATTN: DcJ[16ne Address 4105 T~rna~ain Blvd. Anchora~6, Alaska 99503 Telephone 248-1717 (e) Mail the HAA to the following address: (or check here (~f. if hold for pick up.) List contact person and day phone number below: 17034 Eagle Ri~ver Loop Road No. 204 Eagle River, Alaska 2. TYPE OF RESIDENCE Number of bedrooms Single-Family ~ 3, WATER SUPPLY Individual Well,~ 4 Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality 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 legality and status. 72-025 (Rev 7/88) Page 1 of 2 5. ENGINEERING FIR[~ PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As ce trifled by my seal affixed he reto and as of the vaiidati on 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 Address S & ~ ENGINEERING 17034 Eagle River Loop Road No. 20~ Date ~_~le River, Alaska 99577 .// //// ~ ''~ 6. DHHS APPROVAL Approved for ~4~)oedrooms by ~o~,-~._~ ?~_~4~ Approved ~ Disapproved Conditional Date 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 ar~ independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev 7/88) Back Page 2 of 2 ..,~.4\c~.51~I.CIPALITY OF ANCHORAGE (MOA) .~\o~r'~"l Health Authority Approval (HAA) ~ '~9 ~ 343-4744 A. WEbL B~T~ Well Classification ~; ~ ~.J~- ~ ~ ~ I ~ Well Log Present (Y/N) ~ Date Completed ~ [~ Total Depth ~ Casedto ~'¢ Dept~ofGrouting Static Water Level ~' ~¢~;~ PumpSetAt Casing Height Above Ground ~1(~ ~ Electrical Wiring in Conduit (Y/N) h~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot I O ~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /,J /lA LegalDescription: ,/_.¢)../u j ~ .~ %~¢_. I~ To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results If A, B, C, D.E.C. Approved (Y/N) ,,_~ J~A Yield (9- O c7 ~ N~. Sanitary Seal on Casing (Y/N) "1 Depression Around Wellhead (Y/N) ¢0 ; On Adjoining Lots ,/Co ~' ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole /-~ ~ .~b ~ ~ ~¢~ ;Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed (~-..2~/-~'Size Standpipes (Y/N) '-~ Depression over Tank (Y/N) I.~'-~0~¢~1 No. of Compartments Air-tight Caps (Y/N) ~1 Foundation Cleanout (Y/N) ~) Date Last Pumped Pumping/Maintenance Contact on File (Y/N) k)/~ ;for /~ / iPI 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 f O '~' To Water Main/Service Line ! ~ "~ To Stream, Pond, Lake or Major Drainage Course Comments -~e.~/'¢-~ ~OO N~ ¢~d JC~L~ To Building Foundation /-¢ '~ / To Disposal Field ~' 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test ./O "~ ~/~ Type of System Design SEPARATION DISTANC[ FROM ABSORPTION FtELD: To Water-Supply Well / I ~ Length of Field Depth of Field ~ Gravel Bed Thickness /"/'~ Statndpipes Present (Y/N) Date of Last Adequacy Test To Building Foundation Lot ~-~O To Water Main/Service Line / To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~ ~ ¢ -/' To Cutback (if present) 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 l have checked, verified, or conformed to all MOA inspection. S & S ENG~N~RING Signed 176~4 ~-~,~ Company Date MOA NO. ~ ~ ¢¢ ~'~ ~ Receipt No. Date of Payment ~mount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 Tom Fink, Mayor unicip lity of nchor e Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 September 26, 1990 Mr. Robert J. Strasenburgh III P. O. Box 100171 Anchorage, Alaska 99510 Subject: Separation Waiver #WR890071 Dear Mr. Strasenburgh: As you know, this office has been holding your Health Authority application pending the resolution of waiver problems on Lot 120, which is next to yours. That resolution has occurred today. The separation waiver from the well on Lot 120 to your absorption trench has been reinstated. This waiver was previously granted to 85' and is reinstated to that distance. Your Health Authority Approval Certificate is attached. have any questions please contact me at 343-4744. If you Sincerely, J~o/hn Smith, P. E. Program Manager On-Site Services cc: Lee Browning, Mgr. Env. Services Div. cc: Susan Oswalt On-Site Services /327 Tom Fink, Mayor /Vlunicipality of Anchorage Department of Health and Human Services 825 "L" Street P,O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 February 28, 1990 Robert A. Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for T15N R1W Section 18 Lot Waiver Request ~WR890071, PID ~015-172-41, 120 HA~HA890517 Dear _M_~r. Shafted: - Your request for waiver of the required 100 foot separ~ti'O-~-of · em to a private well has been approved. The/ a sept~ syst -ion d~stance is 9O feet from well approve~ separa~ ~Lot 120 and 85 feet from well(Lot 120) to leacl~f~ield on This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, /' ~/~_ .... Robert ~. Robinson Civil Engineer On-site Services Concur: / ~ ~rogram Manager On-site Services ljm:~6 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 BSTREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907)562-2343 FEDERAL TAX I,D, #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order # 25032 Date Report Printed: JQL 3 90 ~ 12:02 Client Sample ID:L119 S18 T15N R1W PW$ID :UA Collected JUN 20 90 ~ 09:15 hrs. Received JUN 21 90 @ 14:i0 hrs. Preserved with :AS REQUIRED Client Name: S & S ENGINEERING Client Acct: SNSENOP P.O.# NONE RECEIVED Req # Ordered By : R. SHAFER Analysis Co~leted :JUN 22 90 Send Reports to: Laboratory Superv!ssr~EPHEN C. EDE 1)S & S ENGINEERING Released By: .~~ ~ 2) Special CALL BOB SHAFER BEFORE RELEASING An INFORMATION AT 694-2979. Instruct: Chemlab Ref #: 901994 Lab Smpl ID: I Matrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N ND(0.10) mE/1 EPA 353.2 10 Sample ROUTINE SAMPLE. Remarks: 1 Tests Performed * See Special Instructions Above UA=Unavailable ND=- None Detected ** See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greatsr Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICA~I E OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-S~TE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) (b) Legal Description (include lot, block, subdivision, section, township, range) j T-/a--,w Location (address or directions) L Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/builder,E~; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address ~ephone the HAA to the following address: SRB 196x TYPE OF RESIDENCE Single-Family,~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Well,,~ Community [] Public [] Individual Note: If community well system, must have written conlirmation from the State Department ct Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsit~ Poblic [] Community [] Holding Tank [] Note: If community well system, must have written confirmation lrom the State Department of 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 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 tbe 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 thc date of this inspection. Name of Firm $ 8, $ Engineering Telephone Address Date E.gle ~,iver, Alaska ~9~77 Approved for /-~"/'"<C bedrooms by r~' '~? ~- -'- C~Date Approved /:y Disapproved Conditional~'~-J 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 regislered 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 de not conduct inspections or analyze date 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 A WELL DATA MUNICIPALITY OF ANCHORAGE (MO~j HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~/"/~/~// Well Classification '-~¢--~ ~¢¢T'~- If A. B. C, D.E,C. Approved (Y/N) Well Log Present (N'~) Date Completec /,4,~ Yield Total Deptrt ~f/~ Cased Static Water Leve _/5 / ~ Casing Height Above Ground Electrical Wiring ~n Conduit Separation Distances from Weu: To Septic/Holding Tank on Lot Depth of Grouting Pump Set At Sanitary Seal on Casing~Y4~) Depression Around Wellhead : On Adjoining Lots To Nearest Edge of Absorption Field on LOt TO Nearest Public Sewer Line /k.~/~. Cleanout/Manhole ~'~/4-. ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments : Date B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes t~/.N) Air-tight Caps Depression over Tank Purr rang/Maintenance Contract on File CY/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Su 3ply Wel /~:)~-~ ' To Property L~ne /Z~ To Water Main/Service Line Size ,/~,G'''~ No. of Compartments Foundation Cleanout (:~N')- Date Last Pumeeo : for Temporary Holding Tank Permit To Building Foundation z../,_~"-' To Disposal Field ~ ~ Course To Stream Pond. Lake. or Major Drainage Comments Page I of 2 72-026{11184 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ('o- ~-c~- ~ Width of Field Square Feet .of Absorption Area Depression over Field ~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well / TO Buii~ling Foundation Lot To Water'Ma~/Service Line lb t ~- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, 0r Vehicle Storage Area Comments, MUNICIPAUTY OF DEPT. ~ E~I~ T~f Sy~t~esign Length of Field DRE I VED Gravel Bed Thickness 'c/'2~' ~' Standpipes Present ~,~ Date of Last Adequacy Test ~'¢ '------------------~'¢' To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~'~ TO Cutbank (if prese~)~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MO,~ and H~A guidelines in effect on the date of this inspection, Signed . ~. e ~,~~.~:,.-, Date Company SRB 1~6x MOA No. Date of Payment q~ / ~ ~ 3 Page 2 of 2 72-026(11184} MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CER1 IFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON~SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ,, · , __ (b) A p plica n t N a m ~_~_-~ ~" ~~1'' f-~ j) Telephone'Home ~C/~' ,~ ~ ~ ¢"'~ B uEm ess ...... Applicant Address_ ¢ ~ ~___ ~-_~-~__'_~"~ ' J~'-- ~'~.~_~¢~__~/'/ ....... (c) Applicant is (check one): Lending Institution I-]; Owner/builder,~; Buyer []; (~ther [] (explain); (d) Lending Institution Address Telephone (e) Real Estate Company and Agent __ Address Telephone (f) r'l~ the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family~ Number of Bedrooms Other WATER SUPPLY ~ Individual Wel~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite,,~ Public E] 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(11/84) 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 4tct~J~[z_E¢~l~ Telephone Address _____~:, ,'~L~-~I~;4 .... ~ ~ DHEP APPROVAL ^pproved tot bedrooms Approved /~ ' Disapproved Terms of Conditional Approval __ Conditional __ CAUTION The Muecipality 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 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 /~JI~I~CIPA[IT¥ OF AN(~OP, AGE ~.PL OF HEAL'iH & L~it~JVI!~/~IMEN TAL PROTECTION Legm Description: WELL DATA Well Classification Well Lo§ Present (Y~ Total Deoth Static Water Level Casing Height Above Ground Electrical Wiring m Conduit(~N) Separation Distances from Well To Septic/.I.4eN~'~ Tank on LOt To Nearest Edge of Absorption Field on Lot f A, B, C, D.E.C. Approved (Y/N) Date Comoleted (..,),/4', Yield Depth of Grouting Pump Set At (.)l/~. Sanitary Seal on Casing(~N) Depression Around Wellhead (Y/~) · On AdJo~mng Lots /C~O l.~ On Adjoining Lots /'~ /~ To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by ~ :~ '~ ~r~')~'~/A~:"~--'/'~; Date Water Sample Test Results Comments '"r'/..~l ~ ! To Nearest Public Sewer To Nearest Sewer Service Line on Lot "~" ~ /~ B. SEPTI~ TANK DATA Date Installed (.¢- ~"¢~"~'-¢' Size /'~5"-0 No. of Compartments ~. Standp~pes~N) Air-tight Caps4C~N) Foundation Cleanout~¢[~) "~ Depression over Tank (Yf~ Date Last Pumpeo ~ Pure a~ng/Maintenance Contract on File (Y/N) ~//2¢ : for ~-' Holding Tank High-Water Alarm IY/N) ~/,'~' Temporary Holding Tank Permit (Y/N) Sel)arauon Distances from Septic/4.teN~J Tank: To Water-Sb pply Well To Property L~ne To Water ~ Service Line /O '~"/" To Building Foundation To Disposal Field To Stream Pond. Lake. or Major Drainage Page t of 2 72~026 11/84) C. ABSORPTION FIELD DATA Soils Rating ~n Absorption Strata /O~''~ ~)/"~¢~ ,,~'~/~__r/, Type of System Design Date Installed (.¢) - Z-~ - ~G"" Length of Field '~/~) · Width of Field ~ ~ Depth of Field ~' Sq Jare Feet of Absorption Area '~ Depression over Field (Y~ Results of Last Adequacy Test Separation Distance from Absorption Field To Water-Su pp~y Well To Building Foundation '~ ' To Water M~in, Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Gravel Bed Thickness Standpipes Present~N) Date af Last Adequacy Test To Property Line ,,/-~O ~' To Existing or Abandoned System on : On Adjoining Lots ':5~ ~'P To Cutbank (if present) /~')/,~t Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at H~gh Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) /~ /"PumpOff"Levelal /~ Ve~t (Y/N)cles dunn' /,~ Pump'ng Cy g Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Req Jest ** I certify that I have checked, verified or conformed to all MOA and HAA guidelines in effect on the date of this insoect~or 8RB 196: __ MOA No. Date of Paymem Amount: Page 2 of 2 72-026 11/841