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HomeMy WebLinkAboutZANTHA VISTA #1 BLK A LT 10 GRE' "ER ANCHORAGE AREA BO -'UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION MAILING ADDRESS "~/~/~~,~.,~,~(?y PHONE LEGAL DESC R IPT I 0 N ~/~7/V SEPTIC TANK: DISTANCE ! -~ __ MANUFACTURER FROM WELL __ MATERIAL ~-~'/Fg'-A° ~ ,~-- COMPARTMENTS INSIDE LENGTH ~ INSIDE WIDTH ~ LIQUID DEPTH_ -~ __LIQUID CAPACITY /~-O GALLONS. SEEPAGE PIT: / LINING MATERIAL ~)1,"~/~-.~ CRIB SIZE: DIAMETER [/ DEPTH ~'~ _ DISTANCE FROM: WELL BUILDING FOUNDATION (~-~,' NEAREST LOT LINE/~O''"~' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ^DD,T,ONAL ABSORPT,ON SQ. FT. WELL: TYPE ~'~l'~l//~O CONSTRUC-FION 0,' ~: BUILDING NEAREST NEAREST FOUNDATION LOT LINE SEWER LINE CESSPOOL __, OTHER SOURCES APPROVED __ DISAPPROVED__ REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TAN K SYSTEM DISTANCES:_ (~' ,~ INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No, EQ-O31 DIAGRAM OF SYSTEM GREATEr ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT NAME OF APPLICANT IN STALLATION LOCATION NOTE* THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING Of ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHO]~iTY WILL BE SUBJECT TO PROSECBTION. . ~"/~/ . SEEPAGE AREA S]:ZE MIHIMUM DISTANt:ES, REQUIREMENT~ SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK , SEEPA(~E PIT DRAIN FIELD TO NEAREST LOT LINE. TYPE WATER MAIN TO SEPTIC TAN](-- , SEEPAGE Pit DRAIN FIELD SEPtiC TANK, ~/~, SEEPAGE Pit ~//~--, [)RAIN FIELD 'fO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 fEETINTO UND[STURbED SOIL, INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGht REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. BOROUGH ORDINANCE NO. 28-68 AND THATTHE ABOVE  279-2581 1940 ~OST ROAD April 12 , 1974 ~.~0, W.O. 16584 Carl Luchsinger St. Rt. A Box 94 Anchorage, Alaska 99507 Subject: Test Holes for Seepage Pit Analysis on the S.W. 1/4, NoE. Sec. 24; T.12 N., R. 3 W., S.M. 1/4, N.W. 1/4, Dear Mr. Luchsinger: Transmitted herein are the results of the s~3surface investigation performed on the above property on April 10, 1974. The investigation consisted of two 15' test holes drilled with a Nodwell mounted solid core, continuous flight auger with the drilling supervised and 'the 'Lest holes logged by O.M. Hatch, staff geologist/senior technician. Samples ~ere taken at 5' intervals from the flights of the auger near the bit and visually classified in 'the field in accordance with 'the attached sheets 1 - 3. The test holes were located in the field per the attached sketch, and their field logs are as follows: Test Hole 1 Depth in Feet From To Soil Description 0.0 ' 2.0 ' F-4, brown ~eat 2.0' 2.5' F-4, brown sandy ~ilt, damp, stiff, 2.5' 6.5' F-4, brown gravelly sandy silt, damp, stiff, NP, 6.5' 15.0' F-l, brown silty sandy gravel, damp, median dense, GM 15.0' 20.0' F-2, brown silty, gravelly sand, medium dense, S}{ Depth of seasonal frost: 3.0' Depth of Free Water: None observed danlp, MEMBER Carl Luchsinger April ']2, 1974 Test Hole 2 Depth in Feet From To Soil Descri~%io~ 0,0' 2.0' NFS, brown gravelly sand, damp, medium dense, SW/SP 2.0' 4.5.' F-l, brown silty sandy grave]., damp, median dense, 4.5' 20.0' NFS, brown gravelly sand with a trace of silt, damp to wet, ~-~i~m dense, SW/SP. NOTE: random silty sand layers below 13.0' Depth of seasonal frost: 2.0~-4.5' Depth of free water: None observed, but wet at 13.0' DISCUSSION The emphasis of this report is directed toward seepage pit analyses. The Greater Anchorage Area Borough has established the following reconlmended values for the nun~er of square ,feet of seepage pit wall area per bedroom based on the unified classification of the soil. Unified Soil. Classification Seepage Pit Area/Bedroom GM 225 SW 125 SP 150 SM 250 ML 275 Soils classified as ~ are not accepted by the Greater Anchorage Area Borough for seepage area. Therefore, a seepage pit in the area defined by T.H. 1 would need to be buried 6.5' below existing ground. Based on these relationships, seepage pits of total depth of 15' or ].ess may be proportioned to 225 ft.2/ bedroom. In the area defined be T.'H. 2, the top of the pit could be no ].ess than 2' deep and could be proportioned as follows: Descrip.~ion Area -3' rings (8' below existing ground) ~81 ft.2/bedrpom -3' rings (11' below existing ground) 171 ft.2/bedroom For a four bedroom house the seepage pit excavation could be as follows: Carl Luchsinger S April 12, 1974 Test Hole Depth Minina~ Dimensions 1 6+~,~o~.~.=~Z,5- 37.5 x 37.5 1 D~6;~'~-~¥zr~=l*-~'5' 25 x 25 2 6-t ~..o ~.~.~r( ~ ~,o 30,5 x 30,5 2 9-~,o~-.~r~=11,O 19,00 x 1D.00 It is prudent to regard these dimensions as minimum, and dig the pit somewhat larger. Should we be o~ any further service as this. project develops, please feel free to contact our office. Very truly yours, ALASKA TESTLAB J. M. Lambe Approve 'H, R, LeeJ P.E. JML/pf PAGE PBRMIT NUMBER:SW960018 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:ROBSON MICHAEL G & KAREN OWNER ADDRESS:10961 SNOWLINE DR ANCHORAGE, ALASKA 99516 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT DATE ISSUED: 2/06/96 EXPIRATION DATE: PARCEL ID:01547210 LEGAL DESCRIPTION: ZANTHA VISTA ~1 BLK A LT 10 LOT SIZE: 49327 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: WELL 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 DRINKIN(~ WATER REGULATIONS (18AACS0) . 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 1!5 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. 1 OF 2/06/97 SPECIAL PROVISIONS: RECEIVED BY :~ ~.~m~~/ DATE: 5 100 150 200 SCALE: l' -- ]05 Fl, J TOBBEN SPURKLAND P.E. 203 W 15TH, AVENUE ANCH. AK. 99501 (9o7/ 279-3916 [ LOT 10 BLOCK A ZANTHA VISTA fl [ WELL SITE PLAN 10981 SNOWLIflE DRIVE I DATE: JAN. 2J, 1996 MICHAEL ROBSON SHEET: Il1 GRID: 2640 From ~ PlLPII'IE DRILL 90? 345 0282 ?0',. z,., '9q~ FI9 - ~. 1 ..... 4'E: HH PO1 STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES 90-02-23 10: 14 RCVD DIVISION OF MINING & WAT6R MGMT WAI'ER WELL REOORD LOCATION OF WELL LOCATION/SKY,H: WELL OWNE~ DEPTHS MEASURED ~ceeing top [~]ground surfsce i;IOREHOLE DATA: Meterial Type and Color Depth F~'om To WELL DEPTH: Depth of hole:. _~ '",/ it Depth of casing:.~l~.~Z._ .... ft DATE OF COMPLETION ¢__. DEPTH TO ,~TATIC WATER LEVEL: _~_.,~ .... it bolow ~li~toP 0f cesin0 [] ground sutfnca METttOD OF DRILLIN(3~ ~[~'air rotary [] cable tool other uae OF WELL: .J~ domestic FI irrigation D monitor [] public supply [] other. CASING STIOK;UP: ~ it. Diam'. ~ in. tc~/~_~t~ WELL INTAKE OPENING TYPE: ~ open end ~ screened ~ pedorated ~open hob ~,~ Depths of openings; to ____ ft SCREEN 'tYPE: .___~. Blare: in. Slot/Mesh Size: "~ Length: ~ _. ft ORAVEL PACK TYPI:: ..~,.,,_ .................................... Volume used: .............~ Depth to top: ............... OROUT 'FYPE: ~.~.._ Volume: Depth: from .......... ~ ftto .. __ it D~ELOPMENT M~ HOD; (~.~'L. , PUMPING L~EC AND YIEIrD: ~ ft aftor y hfs pumpin05~ opm PUMP INTAKE DEPTH, tt Horsepower. WELL DISINFECTED UPON COMPLErloN? ~ Y6S ~ NO REMARKS: PLEASE MAll. WHITE COPY OF LOG TO: Df. Ii;/DIVISION O~ MINING & WATER MGMT 3h01 t F;t, Suite BO0 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # __~)'/,~ -- £/7~ -/¢ NAA # ~,~\ ¢& GENERAL INFORMATION Complete legal description l. eT /C'I lYLoei _ ZtNT -J-A V'/gT, ff w \ Location (site address or directions) ... / L~ ,? ~.~ / Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day pllone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE-' OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State AD£C attesting to the legality and status of system. 72-025 (Rev 1/91) Front MOA ~r21 J 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. / Address Engineer's signature DHHS SIGNATURE ~ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By: 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 DHHS does this as a courtesy to purchasers of homes and their lendi ng 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 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502. A.chorage, Alaskh 99501. (907)343-4744 R Health Authority Approval Checklist Legal Description:/4,¢'T" lO/ ~:~14'.-/~1 '7~/¥/k/~¢/~ VI B[~,Parcel I,D.: A. WELL DATA Well lypc Log present (Y/N) Total depth "Z~,~3-O Sanita~, seal (Y~) If A, B, or C, attach ADEC letter. ADEC water system nnmber Date completed Mo L ¢,~tO ~ ~ l q~t Cased to ~.r~.roo~, _ Casing height (above ground)_ Date of test Static water level Well production Y FROM WELL LOG g.p.m. AUG 22 1996 MtmiCioalJt,, of ^.,^t._._ Wires properly protected (Y/N) AT INSPECTION g.p.m, WATER SAMPLE RESULTS: Coliform __ / Date of sample: ] ~ '/fl~' Nitrate Collected by: '~, ~' SEPTIC/HOLDING TANK DATA Date installed 7~..~ V_Tanksize /r~6...O NnmbcrofCompartmcnts ~ Cleanouts(Y~)__ y ~_. Dq,ression (Y~)_ h( _ High water alarm (Y~) N/~ Foundation cleanoat (Y~) ~ . Date of pompmg./~Sfl*,F Pumper ABSORPTION FIELD DATA Ddt, installed 7l/ Soilratiog (g.p.d./ft2orft%drm) ~-~g5 Systemtype_~avqd. ~°""cl'b Length vq,_(a I Width a.0-.'~.' t Gravel thickness below pipe ~ I Total depth ---Lq. ~-' Effective absorption area ~ Mooitoring Tube present(Y/N) x./_ Depression over field (Y/N) __~'~1 i~5 -- -!:> ~ Date ofadequacy test Z~Z,L/q3'- Resalts(Pass/Fail) Y For__ ~ _bedrooms Fhdd depth in absorption field before test (in.); ~/ Fhdd depth ¢?~.~ (ills.)Minutes later:_q(,,~) Feroxide treatment (past 12 moaths) (Y/N) ~ N Inunediately a£ter~/~ gal. water added (ia.): Absorption rate = ~ ~'/,.~'O g.p.d, Il'yes, give date D. LII~ STATION Date iustall~d Size in gallons Manhole/Access (Y/N) "Pump ou" level at* "Pump ofF' level at* High water alarm level at* *Datum Cyclestested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: t '4' Septic/holding tank on lot / Absorption field oo lot Public sewer nmin Sewer/septic set, ice liue : O11 adjacent lots Oo adjaceot lots Public sewer manhole/cleanout Lift statiou SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Buildiog foundation ~,~,~.t3~ I Property line y / 0 I Absorption field Water main/service line ~ ~tg~(~ ~ Surface water/drainage ~/~5/5? '" Wells on adjacent lots Building foundation Surface water Curtain drain SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: I t Water main/service liue Y / ~ Driveway, parking/vehicle storage area Wells on adjaceat lots '~,~ /~.) Property line in conJbrmance with MOA IIAA guidelines in~f/ect on this date. ato F. ENGINEER'S CERTIFICATION l certi/.P that l have determined thru field inspections and review of Municipal records that the above a:vstcm.~,are ~' El~ill~gring Seal Here, HAA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number Rev. 8/95 OSS: haa.wk.doc Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICI--S Environmental Services Division D r 825 L Street, Room 502. Anchorage, Alaska 99501. (907) 343-4744r' ~' TM Health Authority Approval Checklist Legal Description:. A. WELL DATA Werl type Log present (Y/N) \/ Total depth /-'// Sanitary seal (Y/N) / Parcel I.D.: AUG 2 2 199(; Municipality of Anchor~e If A, B, or C, attach ADEC letter. ADEC water system number Datecomp,eted Cased to _ t2'~ "7 j easing height (above ground) FROM WELL LOG Date of test Static water level ¢ ~ j Well production / ~ g.p.m. O. $1 *"'Collected by: Wires properly protected (Y/N) y g.p.m. Other bacteria AT INSPECTION /' 'Cleanouts (Y/NI ~ . _ High water alarm (Y/N) WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: ~/~ B. SFPTIC/HOLDING TANK DATA Date installed ~/7~ /'7 V Tank size_/~ 0 Number of Compartments . Foundation cleanout (Y/N) 7 Depression (Y/N) ~1/ I~ .- . Date of Pumping .~/~/~ _ Pumper /~ ~. ~ C. ABSORPTION FIELD DATA Length ~/p t Width ~ ~/__ __ Effective absorption area _ ~ ~ Monitoring Tube pre~nt (Y/N) Depression over field (Y/N) Fluid depth in absorption field before test (in,); ~/__ Immediately after~/~ gal. water added (in.): Fluid depth ~ (ins) Minutes later: ~ Absorption rate = > ~) g,p,d. Peroxide treatment (past 12 months) (Y/N) t~ ~ If yes, give date fForft~/bdrn~)x' ~;~" ~ * , Soil rating (g. ip.d,! System type ¢¢4//d- ~/~ ¢'~/.¢ I _Gi.avelthiSkeessbeloW;pipe ~! Totaldepth //~,~ ) N bedrooms /¢ 72-026 (Rev, 3/96)* D.. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested 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 ! SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ ~ I Property line Water main/service line >,~0! Surface wateddrainage Absorption field ~,.~' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ) 10 Building foundation ,f--/,~- t Water main/service line Surface water Curtain drain Driveway, parking/vehicle storage area Wells on adjacent lots ~/~ F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal in conformance with MOA HAA guidelines in effect on this date. Signature are HAA Fee $. Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 RECEIVED JUL 1 5 1996 Municipality of Anchorage Dept. Health & Human Services James Williams Municipality of Anchorage Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: HAA Lot I0 Block A Zantha Vista PID # 015- 472-1- HAA HA950581 July 12,1996 Gentlemen; A conditional HAA was issued for this property on Feb. 23, 1996. collected and results submitted to DHSS. The results are enclosed. Please issue an unconditional IIAA. Yours T. Water samples need to be CT&E Environmental Services Inc. Laboratory Division ~'~,¢~'.a~J.~-~ir~-~,',~'~-~~~e.~'~j~jj~jjNfj~f~j~ Laboratory Analvsis Report CT&E Ref.# Client Sample ID Matrix PWS~ 0 962665.962665001 Lot 10 Bk A Zantha Vista Drinking Water Collected Date 07/01/96 Technical Director: Stephen C. Ede Released By~,~.~.~.~ ~ ~ Sample Remarks: Nitrate-N Nitrite-N Total Coliform Results QC PQL Qual Units Method 0.531 0.100 mg/L EPA 353.2 0.100 U 0.100 mg/L EPA 353.2 0 0 col/lO0mL SN18 92228 Allowable Prep Analysis Init Limits Date Date 07/02/96 ESC 07/02/96 ESC 07/01/96 TAV U - Undetected LT - Less than GT - Greater than D - Secondary Dilution J - Oelo~ the calibration ran! RECEIVI:'D dUL 1 5 1~ Municipality of Anchorage Dept. Hea(th & Human Services 200 W. Potter Drive, Anchorage, AK 99518-1 605 -- Tel: (907) 562-2343 Fax: (907) 561-5301 3180 Peger Road, Fairbanks, AK 99709-8471 -- Tel: (907) 474-8656 Fax: (907) 474-9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA 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 CERTIFICATE OF HEALTH AUTHORITY A.PROVA: FOR A SINGLE FAMilY DWELUN6 1, GENERAL INFORMATION ~ Complete legal description ~ z3 (o~ ~ ~ Z~,~¢,. Location (site address or directions) ~ o_~¢~~ ~o_~ fi'*¢ 8~'~;" ¢ Property owner -~ ¢~<'~ Ro6 sa,~ Day phone Mailin9 address ~ ~ ¢ ~ C~ o~ fi~ 0~ ~cAor~ e~ A Lending agency ~¢r~ ~¢ ~( _ Day phone Mailing address~~, ~ R~ ~¢¢4p¢~ ~ 9e¢0~ Agent ~. ~ ( Re ¢~.~ ~ _ Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual wetl Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Indtvi¢lual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State A[3EC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA #21 Engineer's signature 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. NameofFirm l~(~(-~? ?--.-c4~f g'~*'~,c'~,,- Phone_ 3' 5'5-~ /3'5-,¢ Address 1~ 5" ~o DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following 'stipulations: Additional Comments By: ,,~"~ ~ Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues H~alth Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employe(Js 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. 1/91) Back MOA #21  Municipality of Ancl~orage Department Of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: l.. I~)/ ~[(~-.4, Z~'/~ ~/~ :/'~ ParcelI.D. ~) ["~- A. WELL DATA Well type P~'~¢¢~'~- Log present (Y/N)  Total depth ~ ~/5-¢ ' Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Datecompleted (,I. nl< (. ~ ~1~1)_ Driller ~r ~u~ ~ Cased to Ge~c~ ~Casing height FROM WELL LOG Date of test Static water level Well flow Pump level Wires properly protected (Y/N) g.p.m. AT INSPECTIO~dNiCiPALFfy OF ANCHORAGE 37~ ENVIRONMENTAL SERVICES DIVISION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main /'4./~, Sewer service line ; On adjacent lots ';> ¢oo' ; On adjacent lots ;> too ' Public sewer manhole/cleanout Petroleum tank _ ~ (gE ' WATER SAMPLE RESULTS: Coliform 0 ¢c,(/;oo~ ,~ Date of sample: ~-/(f ( .9 ~ El. SEPTIC/HOLDING TANK DATA Dateinstalled :7/~.2-/ 7~ Cleanouts (Y/N) ~ High water alarm (Y/N) Nitrate '&lr~ /-~' Other bacteria _4 Collected by: /¢1~/-/-¢,? -'/-¢c~. Date of pumping ¢- / I¢ / ¢ ,P- Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Tank size I ~-.5"d.) ~/' Compartments / Foundation cleanout (Y/N) Depression (Y/N) ~, ~. Alarm teated (Y/N) ~/. A. Well(s) on lot ~ /yin' Topropertyline ~- '7~' Surface water/drainage On adjacent lots Absorption field_ (¢/~2~ Foundation Watermain/serviceline. >' ~'o' 72-026 (Rev, 7/91) From CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed Length ~ ~ Width Total absorption area Depression over field (Y/N) Results (pass/fail) On adjacent lots Peroxide treatment (past 12 months) (Y/N) No,~ ~ Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water Soil rating ¢-~,5' Gravel thickness Cleanouts present (Y/N) Date of adequacy test for f<~"~"~ ~'~' If yes, give date System type 5'e¢?,~,¢~ Total depth /~' y- SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ t 76" To building foundation On adjacent lots Surface water Curtain drain I~¢,~ ¢ bedrooms On adjacent lots "~ too' Propertyline To existing or abandoned system on Cutbank ,'4, A, Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. HAA Fee $ Date of Payment Receipt Number ~ ~ ,/ 72-026 (Rev, 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGIC..,.~L LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 At;A[JBIS i%~:,SO[/fS for IIIVOIC~: !~ 51019 ,hanh~B lief.8 92,0539 gal,tp),o ~! I lf,atl:i~: ~) l,loth,)d £ , 1.21 ].'<f/1 BI'ii 353.2 Member of the SGS Group (doci6t~ G~n~rale de Surveillance) NW u~ , $~C. 2~I T~x Areo Code D Assessor's Parcel No. 0 Assessor's Block No, : 0/5- 47 - x/CC'-: //~ / :2 L .... I.._1 ...... :': i~) '{'" ~ssessos Map Bk. 0/5 Pg. 417 Greater Anchorage Area Borough CWIL & ENVIRONMENTAL ENGINEERING ,,. ENERGY CONSERVATION &ANALYSIS TIIEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 Mike and Karen Robson 10961 Suowline Drive Anchorage, AK 99516 Dear Mi. and Mrs. Robson. February 20, 1992 R I! C I! FEB 5 199 Municipality ct Anchorag. e Dept, Health & Human Serwces Per your request on February 11 we conducted adequacy tests of the water supply and wa~tewater disposal systems serving your residence on Lot 10, Block A, Zantha Vista S/D. I will enclose the Health Authority Approval (HAA) certificate ind other relevant backup documents along with this letter after the HAA is signed by the Municipality. .-.. We were unable to locate a d lller s log, however other documents on file at the Municipality indicate' that the. well was probably drilled in 1981. According to the puma installer the mtn! ,;~nch ,~e ~h,. pprommately 450 feet and there is a PVC liner m the bedrock portion of the well. Water fi'om the well is pumped by a 1 horsepower submersible pump into a 750 gallon storage reservoir located in a room adjacent to the garage. The domestic water pressurization pump then draws from that tank. At the start of tile test the static Water level stood at 37 feet below tile top of the well casing, which means that there were approximately 600 gallons of water stored in the well, in addition to the water in the indoor storage tank. ,We.pnmped a total of 650 gallons of water from the system causin,, ,h ..... ~- ~-.....~ :- o~-^, ~,1~ ,~,,~,,, uuw, [u J.o.>, ut wmcn nme the Well pump was manually shut off. Over the next two hours we tracked the water level inside the well as it gradually recovered to 149 feet. Based on these measurements .~l~idetermined that the well roduction is 0.36 allon ' ' - ~,~,~,,,~,4,,~,~,-:-: . P. . . ~. .s.pe.rm!nu[e, whmh equates to 518 gallons per day. .......... .~,,~u ~a just anequate to meet the Mummpat criteria of 450 gallons per day for a fla{ee bedroo.,m residence, and is slightly greater than the 0.34 gpm which I measure.d for this. well in January of 1988..water samples collected on the date of our test were satisfactory, showing 0 cohform or other bacteria per 100 ml., and 0.21 rog/1 of nitrate:N. . he ~gstewater disposal system was installed in Julv of 1974 n ann~let'e ~C.~ ~,gqn cmH p tauK followed by a concrete nng seepage pit with an effective absorption area of 936 square feet. To asses, s d}e adequacy of this system I added 650 gallons of water directly into the seepage pit while momtormg fired levels there and in the septic tank before, during and after adding the water. This amount of water caused the fluid depth in the seepage pit to increase from 79" to 106", and after the flow of water was stopped the fluid level receded at a more than adequate rate for a three bedroom residence. In couducting adequacy tests we attempt to provide a thorough, conscientious engineering analysis of the system. The reported results describe the system's performance u der the condittons encountered at the time of the test, and the reported eparatlon distances are measured to r .... S ' eadily identifiable features. atlsfactory test results do not guarantee future performance of the system under different conditions, nor do they guarantee that there are no hidden defects or encroachments. Please feel free to give us a call if you have any questious on this repom Sincerely, Ted Moore, P.E. EASEMENTS OF' RECORD, OV~"l[iR '<"-lAN THOSE SROWN ON THF: Built PLAT, ARE NOT SI4OWN III![~EC.N. No' Corners Set This Date ~klrHA VI~A ~.~5; ~:~ Anchora~ recording Prec, mct, lAlaska, and that me improvementl I~tustea ther~n are within the property {~ne~ end do not over~ap Or Ikok No. ~'~ 'Page NO. CZ! MUN C PA'TY OF ANC,O.AGE © t4 "? DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEAL'rH AUTHORITY APPROVALiI OF ON-SITE SEWER AND WATER FACILITY 264-4744 AppLication Date ~'"~,~ I(~ I?N<~ GENERAL INFORMATION /MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, townshi.~L range) Location (address or directions) (b) Property Owner E,~,tc.I,I¢ I' 7"'rc¢eter' Re&:Telephone: Home Business Mailing Address '~?o N, (.z.'~c i'cer ¢)r.a _¢~ ,.Lc I lffo~/ ~(~,~a ~ g~l{ (c) Lending Institution ~'ofnmon~(/fi /"forJ'~'czv¢/~ Telephone ~'~ Mailing Address ~ ( ~" ~, / ~c~¢ ~/~ / /~ Address ~'{O 0 /~¢ ~ef( ~ d ~nc ~Or~ Telephone ~ ~ -O ~O { (e) Mail the HAA to the followina address: or: Check here [~, if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms WATER SUPPLY Individual Well [] 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 [] Community i-I Holding Tank [] Note: If community well system, must have written confirmation h'om the State Department of Environmental Conservation attesting to the legality and status, Page 1 of 2 72-075 trey 8/861 Front '~JOM s,Jaau!iSua leUO!SSajoJd aq{ u! SUO!SSiLUO JO sJoJJa JOj elq!suodseJ {au s! aSeJoqau¥ jo ,q!led!o!unv~ aqJ. 'panss! sf ama!J!pao e eJo~aq amp ez,qeus JO suo!~oadsu! janpuoo ~ou ap SHHQ jo saa~OldLU3 's~UaLUaJ!nbaJ a{els pus leJapaj uleiJa9 ,~js!),es o] Jap JO u! suoBnu~su! 8u!pual qaq{ pus sauJoq ~o sJaseqoJnd al ,~sepno3 e se s!qi saop SHHQ sql 'e~iSelV jo a~eJS aqi u! paJa~s!eaJ Ja@u!6ua leUO!SSajoJd ~uapuadapu! ue ,~q a^oqe c{ tideJ§eJed u! ua^!5 suo!jeiuasaJdaJ aql uodn /ilUO p@seq le^oJdd¥ ~{!JOqin¥ qlleaH sanss! (SHHQ} saoi^JaS uecunH pu~ qUaSH jo jUaLUpedaQ aSeJOqaUV jo ,~Uled!o!unh{ NOI.LnVO leUO!l!puoo leAoJddv leUO!Upuoc) jo suJjaj_ paAoJddesiQ /~ pa^oJddV ,~q suJooJpaq ~_ Jo~ pa^oJdd¥ '1'¢A O I:Jdd ¥ SHHQ leaS s,JaaU!6U~{ ~L?g I -~A ~ auoqdelel ~ ¢~ )~¢IU~ ~)~1 wJlaJoaweN 'uol~oedsu! sfql ~o amp ua ]3GJJ8 Ul suof]elneaJ pub 'SGOUBU.pJo 'sapo3 ele)S pUB led.o.unw e q]!~ 82Uelld~O3 ur 9~ ~8~s~s lesods!p Jo/pus Xlddns Jem~ al!s-ua sql 'uol~oedsul pub UOfle6BseAul ~ ~oJj pus sellj eeeJoqouv jo ~llledp!un~ aql paumlqo UO!)BBJOJU~ sql ua peseq 1Sql ~,JaA ]eqpnJ I 'u[eJeq pamo!pui eJn~onqs jo ed~l pus s~ooJpeq jo ~aq~nu eq~ e{enbep~ pus reuollounj 'ajes si ~e sxs lesodmp JGjEMG{SBM Jo/puB Xlddns JGieM si.s-ua aU1 leU] SMOUS leAoJddv XlpOqlnv qil~aH 9{q1 ~o uo{l~¢BseAu{ X~ leql X~.JeA I 'MO eq UMOUS e~ep uoimPf eA eq{ 10 se pus olaJaq pax JJe leas X~ Xq paj.pao sV NOliV~MOJNI aNY vzva 'Hgufas ]ql~ 'SZS~& 'SNOI~O~dSNI 9NIQIAOBd ~lJ .g AHT¥ or ^i~ll~!,~~I:~LITY OF ANCHORAGE (MOA) MUNICIP ' ~ ..,v~Hi~'rHOFIITY APPROVAL (HAA) r. NV~ONMENTAL ........ ~ ~CKLIST - FEBRUARY 1984 264-4744 Legal Description: WELL DATA Well Classification ¢t~ u Well Log Present (Y/N) Total Depth ~/,~-0' /~',"/, Cased to Static Water Level ,5-1 ' (' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: If A, B, C, D.E.C. Approved (Y/N) ["/, .*'J. _ Date Completed ~n ~' ~ 19~1 Yield ~O, 5'~/¢;,z¢¢~ To Septic/Holding Tank on Lot Depth of Grouting Pump Set At :".~ 'Yoo ' Sanitary Seal on Casing (Y/N) ~' Depression Around Wellhead (Y/N) IV ~ i~d' ¢~'. er.f,, ; On Adjoining Lots _'7:~ fOOl To Nearest Edge of Absorption Field on Lot ~- I ~'5" ~ ¢';°~n Adjoining Lots I¢O' + To Nearest Public Sewer Line J"J//J- To Nearest Public Sewer Cleanout/Manhole ~&. To Nearest Sewer Service Line on Lot ¢¢/~. Water Sample Collected by ~(~ ~ ~ ; Date ~ ~ Jg~ B. SEPTIC/HOLDING TANK DATA Size _! ~5-O~~ t Date Installed Standpipes (Y/N) ~' Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) _ Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well .... To Property Line 'ro water Main/Service Line Course ~ I~-O' No. of Compartments t ¥ Foundation Cleanout (Y/N) Date Last Pumped .~'"o~,a ~, 19z~ F*,v .'-~.~'~c~¢'.~ N,//', ; for N,/~-. Temporary Holding Tank Permit (Y/N) N, __ To Building Foundation d......F ~ To Disposal Field .3',~"' b,z,C~ c'. c~..~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 026 fRev 8/861 Fronl C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well '~' f To Building Foundation ~ ~-~"' Lot To Water Main/Service Line ,~1,/I. To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field e¢¢ Depth of Field _ I ~i/,,.'j' Gravel Bed Thickness ? ' Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line "'~ To Existing or Abandoned System on ; On Adjoining Lots '~ -'¢~ ' To Cutbank (if present} D. LIFT STATION J~, .J.~. 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 MOA and HAA guidelines in effect on the date of this inspection. Signed ~'~_~,~'"-'~- ¢~- ~ Date Company F~,/¢~ T,¢¢4 %~/,~ MOA No. Receipt No. /~) 0 ~' d~)~.~ / Date of Payment ~/~/r ~ Amount: $ /~ ~ Page 2 of 2 Engineer's Seal CHEMICAL & GEOLOGIC~ I~O~OR ~;~:~,~ FEDERAL TAX ID , 92-0040440 ~ ga~l]te Rec'd : JAW 6 OD Ordered By t Deed Reports I'o: ~LNrl'OD 'f~iCtINICAL 8F, RVICg Work Order No, : 4611 Clietlt Meouet : FLATTOT Date Eeport Pti,ted: J~/t.~, 88 ~ .... Eepoct~ Addre~ ~2 14580 ICHO S'i' ANCHORAO~, A~, 99516 Special COLL)]CT~D 1-6-88 BY ? [,IOOR~ IIla~ruct: Chemlab Ref l~t 8764 [,ab ~]pl ID: 1 Hatclx: 9ater Allowable Parameter Tested Readt/Unlt~ llethod Limits NITRATb-N 1,1 mg/I t0 MUNIOpALll¥ OF ANCmO2AGE ENViP, oNMEN [AL SERVICES DIVISION ' ~" 1 2 !888 RECEIVED Sample ROUTINg ,~AHPLE LABOI,AfORY 8UiP, RVI~R, ~l'~PHgfl C, g~g fl~ I 2'es~ Performed ~ gcc Special Isotructions Above I~D~ ~one Detected ~ 8ce 8~)lo l~emark~ ADove NA: No~ Mai~ged LT::Le~u '[Dali, 6'l'=6reater 'f{lau MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date "~- GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) LoT t t -/' Location (address or directions) Owner ~d;/Cal/',,,'9 Telephone: Home S ~.b - t g ~ ~ Busines~ (b) Properly Mailing Address (c) Lending Institution ~ ~/~ ~/~c*~ Telephone Mailing Address (d) Address Real Estate Company and Agent Telephone (e) Mail the HAA to the followine address: or: Check here,[~ if hold for pick up. List contact person and day phone number below. / ' TYPE OF RESIDENCE Single-Family~ Number of Bedrooms ___ WATER SUPPLY Individual Well~.~ 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 OnsiteK Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72 025 fRov 8/861 Fronl ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verity that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further 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 Address Date Telephone Engineer's Seal DHHS APPROVAL Approv, ed'fo'r )2 ~ '~ Approved ~.i ', ',, Disapproved Terms of Conditio?al Approyal bedrooms by Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes arid their lending institutions in order to satisfy certain federal and state requirements. Employees of [:)HHS 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 trey 8/861 Back A. WELL DATA ~'~'~ MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHI"CKLIST- FEBRUARY 1984 264-4720 Legal Description: L.~"~ /~,, Well Classification Well Log Present (Y/N) ~ _ Total Depth ..~¢'~¢' ''~' Cased to Static Water Level I '~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) . Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results If A, B, C, D.E.C. Approved (Y/N) Date Cornpleted ¢~ ~3.~t ¢v,.4.1 Yield Depth of Grouting ~,] ~ ~4 Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lois __ To Nearest Public Sewer To Nearest Sewer Service Line on Lot Comments B. SEPTIC/HOLDING TANK DATA Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well / ~ O To Property IJne I ¢ To Water Main/Service Line . Course /'"¢ 0 Size /,,¢--~t~ No. of Compartments Air-tight Caps (Y/N) ,~ Foundation Cleanout (Y/N) Date Last Pumped I h/Z/,"~ ;for 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) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ,.~-..~ Date Installed ~ I ~7/"z/ Width of Field Square Feet of Absorption Area ~ "~.~ Depression over Field (Y/N) ~/ Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ! To Building Foundation Lot ~/¢/N/.~-~ 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 Cutbank (if present) h/oN Comments 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 car tify t h at~_ .c.ke. d~,v~.ifi, e!.,~r conformed to iI M,O,~,.an~ guidelines in effect on the date of this inspection. Signed L,,'. Date ~'~ ' Company // MOA No. Receipt NO. ¢/O O ,/ ~)(~ ~ Date of Payment / 2-"'/2"/ 0C ¢ Amou.,: ' Page 2 of 2 72-026 (11/84) Engineer's Seal I¢IPALITZ OF A CHORA E DIWSiON ENVZROmm An DEPAETMENT OF HF~ALTH AND ~I~O~NT~ mOTECTION ~PLICATION FOR ~ALTH AUTHORITY ~PROV~ CERTIFICATE I. G~j~r~l~uf_~nation Application Date ~ ~ (~O L~gal Description (include lot, block, subdivision, section, to.ship, range) Location (addres~ or directions~ (b) Applicants Name Applicants Address Telephone - Itome Business (c) Applicant is (check one) Lending ~nstitntion ~ ; O~er/builder~-~; Buyer.~-~ ; 0ther~ (explain), (d) Lending Institution_ ~g~ ~ . f.~.~ J~.~z Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. T_y~.e___of Residence Single-Family~ Number of Bedrooms 3. Water Su_~ly Individual Well Multi-Family~_.~ Other (describe) Community~ Public~---~ Note: If community well system, must have written confi~ation from the State Department of Environmental Conservation attesting to the legality and status, S~ewage ~is~os~a! 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] 5. Engineering Firm Providin_~jinspeetion~.~ Tests_______~ File Search, Data and Inf~o~ip~ As certified by my seal affixed hereto and as of the validation date shown belaw, verify that my investigation of this Health Authority Approval shows that the water supply and/or ~stewater disposal system is safe, function~ and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the info~ation obtain~ from the ~nicipality of ~chorage files and from my investigation ~d inspection, the on-site ~ter supply and/or ~stewa~er disposal system is tn compliance ~rlth ~1 Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm '. Approved for ~ bedrooms By ~UA~ +e'~,' ~ 'J'o' ~' ",.,'Da~e'" ~:~//~'' q~ ~/~O ~- ~ ~ ~.- . .. ,." ' Approved Disapproved Condition~ CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) 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 DHEP 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 DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MTJNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN TIlE PROFESSIONAL ENGINEER'S WORK. (DI{EP SE;J,) RR4/eJ/D18 [Page 2 of 2] 7-19-84 ae MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 WELL DATA Well Classification '~ ~ Well Log l~esent (Y/N) N Total pub ~a~,~ C~ased to Static~ Water Leve]~ ~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances frcm Well: To Septic/Holding Ta~k on Lot TO Nearest Edge of Absorption Field on Lot To Nearest Public Sewe~ Line Legal Description: !,O7' IO~ ~ ~ ~ If A, B, or C, D.E.C. Approved(Y/N) ~//A Date~a~leted Yiel~ q~ U~i~jl~pth of Grouting ~~ Sanitary ~al on Casing (Y~) ~ ~pression ~ound ~llhead (Y~) ~ ; On Adjoining Lots 7 5 On Adjoining Lots To Nearest Public Sewer Cleancut/Manhole ~ 6~q ~_ To Nearest Sewsr Service Line on Lot Water Sample Collected By . ~ ; Date Water Sample Test Results Conl~ nts ~ O?~ ,% l.~ ~ ,~.~.. I O 'f B. SEPTIC/HoLDING TANK DATA Date Installed ,,~,~[~'7~ Size ;Q.B~ NO. of Compa~tmsnts ~D~-- Standpipes ,(Y/~) 0N~ Air-tight Caps,) ~ _ Foundation C]~anout (Y/N) ~ ~pression ove~ Ta~ 3Y~) N Date ~st P~d_ /~.~.~ P~ing~aintenan~ ~n~act on File (Y~) ~ ; for ~/~ Holding Ta~k High-Wate~ Ala~ (Y~) ~/A '~rary Holding Tank Permit (Y~) ~/~ Separation Distan~s f~ ~ptic~olding Tank: To Water-Supply Well I~ To Property Line To Water Main/Service Line Course M C> N Con~ents To Building Foundation g ~ To Disposal Field ~ To Stream, Pond, Lake, or Major Drainage [Page 1 of 2] Receipt 9 Date Paid: Amount: 2-15-84 C. ABSORPTION FIELD DATA Soils P~ting in Absorption Strata Date Installed ~d~.. ~ ~7 ~ Width of Field ~L~_~ 0~6 ' Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design 5,.,..r~o.s},~ Length of Field ~/~ ~pth of Field Gravel ~d Thickness Standpi~s Present (Y~) ~te of ~st A~qua~ Test ~-~.~ Separation Distance from Absorption Field: To Water-Supply Well 175 + To P~operty Line To Building Foundation ~ To Existing or Abandoned System on Lot RI O~- ; on Adjoining Lots To Water Main/Service Line I~ j- To Cutbank(if present) To Stream/Pond/Lake/or Majo~ Drainage Course To Driveway, Parkin~ Area, or Vehicle Storage Area Coran~nts D. LIFt STATION N ON ~- Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dir~nsions 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 conforn~d to all MOA on the date of this inspection. Co. any / Sm/d5/s [Page 2 of 2] MOA NO. 2-15-84 APPLIC IT FILLS OUT UPPER HAL DNLY Prop~rtyOwner. Jeffrey & Jilt Jensen Phone Mailing Address Zip Code Buyer Address Zip Code Lending Institution Phone Address Zip Code ReaSy co. & A~nt Elliot C. Lawson, Jack White Company Phone Address 3~1 "£" ~i~.= .~lHte 100= Anchn~'.g~= AI~ ZipCode 99503 277-1~ teoalDescdptl°" Lot 10, Block A, Zantha Vista #1 ~?m /2'~3 ~d O;~L/~ q ~ ~,/Y¢ ,,~l,/~ ~/,/ Street Locaticn NHN S~ow!ine- Drive ~ Single Family Multiple Family No, of Bedrooms__ ~ Water Supply [~ Individual ATTACH WELL LOG, A well log is required for alt wells drilled since June 1975, ~ Community For wells drilled prior to that date, give well depth (attach log If available), ~ Public Utility ~ Individual Public Utility When Connected to Pub~b/Utllity: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN SE INR'IATED. ~UNf~lmAdl~ Field Notes: 'CONDITION8 OF APPROVAL ( ) DISAP~OVED ( ) CONDITIONAL APPRO~* Soils R~ting ..¢¢ Date ~wer Installed Well To Absorption Area ~ t Well Log Received ~ 2- .~ CON;SULTING ENGINEER TELEPHONE: {§07) 279-3916 WELL INSPECTION LEGAL LOT 10; BLOCK A, ZANTHA VISTA LOCATION 10961 SNOWLINE DRIVE OWNER: COLLINS TYPE OF WELL: SINGLE FAMILY WELL LOG AVAILABLE: NO INSTALLATION REQUIREMENTS MET: YES DATE OF INSPECTION: DECEMBER 1, 1986 TEST PROCEDURE: WATER WAS DRAWN FROM THE 700 GAL. STORAGE TANK AT A STEADY RATE OF 6.5 GPM. THE WATER LEVEL IN THE WELL WAS MONITORED. THE WELL PUMP KICKED IN AFTER 50 GALLONS. THE WELL LEVEL WAS FOUND AT 17 FEET BELOW THE TOP OF CASING AND HAD DROPPED TO 128 FEET AFTER 200 GALLONS. AT THAT LEVEL THE ACOUSTIC PROBE GOT STUCK. AN ADDITIONAL 430 GALLONS WERE WITHDRAWN. THE WELL PUMP WAS STILL RUNNING AND WATER WAS DELIVERED TO THE STORAGE TANK. A HAND LINE WAS USED TO PROBE FOR WATER LEVEL AT THIS TIME. THE LINE GOT STUCK AT 200 FEET WITHOUT HITTING WATER. NO WATER COULD BE HEARD ENTERING THE CASING~ TEST FOR COLIFORMS: TEST RESULT: WATER WAS TESTED FOR COLIFORM BACTERIA ON DECEMBER l, 1986. TEST WAS NEGATIVE. THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.ThUs well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The' flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. CON,3ULTING ENGINEER 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: {907) 279-3916 SEPTIC LEGAL: LOCATION: OWNER: RESIDENCE: WELL: SEPTIC SYSTEM: SYSTEM ADEQUACY 10, B '0c x,i Z.ANTHA WSTA 10961 SNOwLINE DRIVE COLLINS SINGLE FAMILY, THREE BEDROOMS PRIVATE, ON SITE FROM MUNICIPAL RECORDS: TANK: ESPINOZA CONCRETE, 1250 GAL, ABSORPTION SYSTEM: CONCRETE RINGS ABSORPTION AREA: 936 SQ. FT. SOIL RATING: 225 INSTALLATION DATE: JULY 1974 TEST ONE COMP. DATE OF PUMPING: DECEMBER 1, 1986. ~NCHORAGE CESSPOOL PUMPING DATE OF TEST: DECEMBER 1, 1986 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH A TOTAL DEPTH OF 8 FEET AND 30 INCHES OF LIQUID. CRIB WAS 14.5 FEET DEEP AND WITH 64.5 INCHES OF LIQUID. TOTAL DEPTH OF CRIB IS 9 FEET. 630 GALLONS OF CLEAN WATER WERE ADDED TO THE CRIB. THIS CAUSED THE WATER LEVEL TO RISE 30 INCHES. IN 30 MINUTES THE LEVEL DROPPED 7 INCHES EQUIVALENT TO 230 GALLONS. THIS SYSTEM WAS TESTED ON 1/25/83 AND 12/16/84. THE DEPTH OF LIQUID IN, 83 WAS 51 INCHES AND~ IN 8~ 62 INCHES. THE FILLING CURVES WERE IDENTICAL ALL~iTHREE TIMESJ TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational lifeZof all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. CONSULTING ENGINEER 203 W. 15th AVE 'C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (90'7) 279-3916 MR. RICHARD H. MATTHEWS 10961 SNOWLINE DRIVE ANCHORAGE, ALASKA 99516 DECEMBER 27, 1984 WELL LOT 10, BLOCK A, ZANTHA VIEW LEGAL: LOCATION: 10961 SNOWLINE DRIVE OWNER: RICHARD H. MATTHEWS TYPE OF WELL: RESIDENTIAL WELL LOG AVAILABLE: NO INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: NOT AVAILABLE PUMP YIELD: 4 GPM. DATE OF INSPECTION: DECEMBER 26, 1984 TEST PROCEDURE: This residence has a 750 gallon storage tank in the garage. This tank supplies water to a /j~f~_~ '~ · ~ 40 gallon pressuretank. The storage tank is 5 ~,~,~i~eet high and has a diameter of 5 feet. Water ///f~?~[ ~ [ ~ ~ ~ was drawn from the tank at a steady rate of 7 ~' "~ /~.~' ~? ~ gal. per min. After 90 minutes the water ~'~~...~~'~'~'~ level in the tank was down 20 inches, ~~[~zm~r,~ indicating that the tank had supplied 245 ~/~,~ ~c. gallons.- The remaining 355 gallons came from ~Y-~'~.~/~-~.~[[[~# ~,~_ the well. The minimum pump yield is therefore · TEST FOR pOSIFOR~S: Water was tested on December 17. Test wa., fa-L~f negative, The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of 'this date. The flow rate of 'the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. CONSULTING ENGINEER TELEPHC, NE: (907) 279-3916 MR. RICHARD H. MATTHEWS 10961 SNOWLINE DRIVE ANCHORAGE, ALASKA 99516 DECEMBER 27,1984 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: OWNER: RESIDENCE: WATER SYSTEM: SEPTIC SYSTEM: DATE OF PUMPING: DATE OF TEST: TEST PROCEDURE: TEST RESULT: LOT 10, BLOCK A, ZANTHA VIEW 10961 SNOWLINE DRIVE RICHARD H. MATTHEWS THREE BEDROOM, SINGLE FAMILY ON SITE WELL FROM MUNICIPAL RECORDS: TANK: 1250 Gal. Espinoza Concrete,One Comp. ABSORPTION SYSTEM:Concrete Rings, 4 ft. Dia. 9 feet deep ABSORPTION AREA: 936 sq.ft. SOIL RATING: 225 INSTALLATION DATE: July 1974 December 26, 1984 December 26, 1984 Tank was pumped and water introduced into the crib at a steady rate of 7 gallons per minute. The water level in the crib was monitored. After adding 600 gallons the waterlevel rose 24 inches. After 17 hours the waterlevel had dropped 25.5 inches. The system had absorbed all the water put into it. In 17 hours th:Ls system absorbed more than 600 gallons of water. The Municipal Code requires that septic systems absorb 150 gallons per bedroom per day, This system exceed this requirement. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requirements of the Municipality and State. 1st Driveway on left...common drive for .both houser the one on the RIGHT as you go up the a,~ve is the correct one.,.has greenhouse, natural wood siding,' DeArmoun Area Reference MaD-Pt4 178 179 185 ~®~.- 12 195 186 }i'obrl~ary _1.4~ 19J3 3201 "C' ~It.~ 'Juite 100 Anchorage ~ AK 99503 ,.m})3cc., Lot ].0 Approw~l for th. '{.il~]lvl('{ua]. sewer and water facilities cannot be cjt'a~te({ t~l~tJ.]. ,.hc fo.tlowtt~J items tlave been cma}>].eted: ' ' ' tha offic~ .._~.om the Chore Lab, 5633 B L;treot, for o~lr review. The top of the well ca~;ing should be sealed no that it water ti(Iht. Exposed e].actrica. 1 wires to the w~)].l head are in violation of the Nurlicipality c~f Anchorage codes i. tnd must b~) encased in conduit. The septic tank l,umpe~] %,;itl] a receipt .,-mb;~itted to this department, An adequacy t(~t needs ko be perforlaed on the c~xJ. stino leachinq sues. 9'hi:q test will determine if the adequate accord:i, n9 to tlati, onal Standnvds. A lJ.~%inq of private ~irms porforc~ing the test needs to be m]bmitted to this office for our review. o 'Phe second well no~,c,..%,~' to be properly abandoned. - .inc].ude; ]/4" ,,,.e..1 platte, on top o~ ca,q~nq. Please notify thi~7~ D¢:})artment for a 'l:elrl:~pectio% when noted discrepancies have })eon corrected. If there are any fu'r:ther quotations, please call th].s offic~ at ,~ illcek-oly t JRgo/p/Elll Jim Robort,'~ Associate Envi~'3np. lo, atal Speci~ Ii. st CONSULTING ENGINEER 203 W, 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELl=PHONE: (907) 279-3916 Elliot Lawson Jack White Company 3201 C Street Anchorage, AK 99503 January 27, 1983 RECEIVEi.) S[:'WER ADEQUACY TEST LEGAL: LOCATION: OWNER: RESIDENCE: WATE ~,: SEWER: DATE OF TEST: TEST PROCEDURE: Lot 10, [3lock A, Zantha View S/D On Snowtime Drive Jensen Four-bedroom, single family On-site well From Mumcipal Records. Tank - Concrete, Espinosa, 1,250 gallon, one compart- ment. Absorption System - Concrete crib, 4 feet diameter, 9 feet deep Absorption Area - 936 square feet Soil Rating - 225 Installation Date - Ju y 1974 January 25, 1983 System was inspected on January 20, 1983. Crib is 14½ feet deep containing 52½" of liquid. Tank is 9 feet deep with 30 inches of liquid. On January 2B, 1983, tank was pumped and crib charged with 1,000 gallons of water in 250 gallon incre- ments. The following measurements were taken: Tebban Spurkland P.E. TEST RESULT: Water Volume Water Level 0 51 250 64 500 78 750 92 1,000 104 After 4 hours 73 In four hours this system absorbed 580 gallons. The Municipal Code requires that a four-bedroom system ab- sorb 600 gallons in a 24-hour period. Clearly this sys- tem meets that requirement. -2-