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Home My WebLink AboutZANTHA VISTA BLK B LT 1 Municipality of Ancl~orage paoe DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Name: ~U~ ~~~ Wastewater System: ~ New ~Upgrade Pi, one: ~1~ ~ ~% ~NoofBedrooms:~ ~DeepTre,ch ~ Shallow Trench [3Bed ~Mound UOther LEGAL DESCRIPTION ~oi'"~'i"~: i,~ 6PD/Sq. Ft. T°ta'D"pthfr°m°dgina'te~d~ Township: Range: Section: Fill added above original grade: [ Ft. ~ ~ Ft. WELL: Q New ~ Upgrade Grave~widtb: ~ Ft. ~ ~ Ft. Classificabon (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~dller: Date Drilled: Slatic Water Level: Installer: Yield: I PumP% ICasing Height AbOve GrOund: TANK SEPARATION DISTANCES ~¢io ~ Holding ~ S.T.E.P. To Sophc Absorplion L~fl Holding Public/Private Manufacturer: Capacity in gallons: Number of Compartments: Surface Water ~ .... ke~ LIFT STATION L~te ~' t~' ~ ~ ~ Size in gall°ns: ~Ma~tutor: Foundation ~ CurtainDrain ~¢~. - -~ Pump M~ke & Model ~ Electrical Ins~ns performed by: Remarks: ~ 15 ~ UF~¢ ~_ BENCH MARK Location and Description: RECEIVED (~,¢.~) ~ Assumed Elevation: ENGINEER'S SEAL Dept. ~ealth & Human Services ¢ Inspections performed by: ~¢~~ Dates: 1st ~¢~ ~'~' Department of Health and Human Services approval ~?,.. CE-ZZ~O ,.,.~ 72 013 IRov 9/91 ) MOA 25 Permit No. Page ~ of ~'~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: PID No ' O[5-~--~-¢_~l ( R !CFIVED S ~ 1 8 1992 Dept. Health &~-Iuman Se~ v,cee 72-013 A (Rev 9/91) MOA 25 Permit No.. 5, t/,,] c:Pr/~O'~_.- I Pa§e ~ of ~ Municipality of ^nchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONIVIENTAI.. SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Bisposal System and/or Well Inspection Report Legal Description: ¢-PcO/~-Y~- VI 5q'3~ I llgb°~'A~3 g t/ bo'T' ( ¢,/V1,: q-'O~ oF- RECEIVED SEP 1 8 1992 Iviu,~ . ,, ,, ,:)f Anchorage Dept. I.{eaiti~ & Human Services 72 013 A (Rev 9/91) MOA 25 SNOWLINE BRIVE ~86'60~ >H LO,80~ 0 S ,86'60~ <~ ,,60°80~ 0 N Date cale ~ecert Update 7/27/92 "=40' Plot Plan 340 PETTIS RD. Anchorage, Alaska 99515 (907) 349-1488 It is the responsibility of the owner or builder, prior to construction, to verify proposed b%lilding grade relative to finish grade Drawn by As-Built XXXXXXX Pescri LOT 1 Block B TlZ~ VISTA SUBDIVISION OF "]: ', LS - 7326 PAGE 1 OF 1 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 AND WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920221 DESIGN ENGINEER:MOUNTAIN ENGINEERING OWNER NAME:MATTHEWS D EUGENE OWNER ADDRESS:19411 SIERRA LINDA ROAD IRVINE, CALIFORNIA 927].5-3937 DATE ISSUED: 8/12/92 EXPIRATION DATE: 8/12/93 ,/ I / PARCEL ID:01547211 LEGAL DESCRIPTION: ZANTHA VISTA BLK BLT 1 LOT SIZE: 33000 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: y ~j THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / 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 DRINKING WATER REGULATIONS (iSAAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ~-- DATE: SNOWLINE [)RIVE Z PERFORMED FOR: LEGAL DESCRIPTION: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG --. PERCOLATION TEST Township, Range, Section: .~- 3 - 4- 5- 6- 7 8 9 .._10 11 12 13 14- 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? SLOPE (..I'?I6COUlMT' ¢~$~:~o, IF YES, ATWHAT DEPTH? SITE PLAN Monitoring;) _ l~"' Dale: Reading Date Gross Net Depth to Net Time Time Water Drop G [~ t'l ~,~' PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN . ~'-"_ FT AND ~ FT P [ R [ O" M i D a Y : ~O m~ ~ 5~· , ~[[ ?~ *~ c [ R T I [ * Il H AT THIS TEST WAS P E [ F O R M [ ~ IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: PERFORMED FOR: LEGAL DESCRIPTION: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: DATE PERFORMED: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20- COMMENTS WAS GROUND WATER DEPTH?IF YES, AT WHAT SLOPE SITE PLAN lq..z o P .~:k ~ E ~ I L,.I" L..-IE:g~/c~'~-.~-'~ Oepth Io Water Ai ~ t / ~/ Gross Net Depth to Net Reading [)ate Time Time Water Drop ,, fl ~ ~ . flu: . ~,, PERCOLATION RATE ~' (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~" FT AND ~-~ FT PERFORMED BY: J/V[Okm~-~ ~r~12.~-i-~__ i [/v~.~_ ~)/~t~t.~./-~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: TEl 'H.NICAL,.SER 'TC ,: CIV~b & EN~IIIONMENTAL EN(;INEEII~G , ENERGY CONSERVA~30N & AN~YSm T~ODORE F, MOORE, P,E, 14S30 ECHO $T, PH~ (907) 34~.1355 July 7, 1992 ~CHORAGE, ~KA 99S16 Robin Ward Heritage Real Estate 3230 "C" Street Anchorage, AK 99503 Dear Ms. Ward: Per your request on June 25 we conducted adequacy tests of the water supply and wastewater d sposal systems serv!ng the Gene Matthews residence on Lot 1, Block B, Zantha Vista S/D, located at 10860 Sno,wtin, e, D, nye,, Cop!es of relevant backup documents are enclosed along with att involc¢ for the testing work wmcn we nave acne. We we 'e unable to locate a driller's log for the well, however the septic system inspection report on file at the Municipal Health Depm~rnent mdtcateS that the well was probably drilled [n 1971 and bas a total depth of 85 feet, On the date of our test the static' water level stood at 40 feet below the top of the casing, Dm'ing the course of our test we pumped a total of 735 gallons of water from the well at the maximum pump output of 7,9 gpm, which caused the water level inside the casing to be drawn down,to 51 feet, but no further, Based on our test data we determined that the total yield of th,e, well Is in excess of 7,9 gpm, w,hich exceeds the Municipal orlterta for approval of a singl,e family residcnce~ and also meets the FHA cut?fin that a well b,e a~ble to supply 720 gall?,ns of water wtthtn a 4 hour period, Water samples col coted on aune 22 were s, austactory, showtng 0 coliform or other bacteria per 100 mi., and 5,1 mg/1 of n trate-N, This nitrate level ts slightly over half of the max mum concenu'atlon allowable uuder state regulations. As we discussed over the phone shortly after the test, the well casing needs to be extended to be at least 12 inches a?ve ground level and a new gasketed sanitary ,seal Installed wsth conduit protecting the well wkes, '1 his repair can be done by Dave Harper of Alpine Drilling (ph 345-0202) d' ,~cc,ording to the ~s-bu.!lt!n, sp~tion r. eport on file at the Municipal Health Deparn'aeat, the wastewater ~sposm system was mStalleCt m ~eptem~r of 1971, aud consisted of a 1250 gallon septic tank followed by a 10' x 11~ x 12' deep concrete ring seepage pit with a total effective absorption area of 504 square feet, The permit ~as issued for a 4 bedroom residence and specified an absorption area of 191 square,eot per bedroom for a seepage pit constructed at the depth of this one. By our calcu at ons, the actual absorption area is sl!g. htly less than the required amount for three ,bedrooms, Nevertheless, the lnspee,tion report was .app, roveo ..... tGI 4 bedrooms and In 1978., a Health· Authomy Approval ('HAA), certificate, was ~ssued for ti 4 r>eamom ~:sdence, Itl 1988 the or~gmal 1250 gallon septic tank was replaced wttha new 1500 gallou septic tank, and the !nspection report indicates that the cygnet was thinl~,ng about enlarging the, house to 5 bedroo, ms, A,s we dtscussed over th?, phone shortly after the test, there ts a stgnlfl<:ant depression i i the grouno over me sept c tank which w~I1 have to be fi led prior to fng for a HAA certificate, th To assess the adequacy of tile wastewater disposal system we ran a tot? of 735 .gal OhS of water into e system tlu'ough the cie0.pout downstreat, n ,Of the septto tank, while momtoring flutd levels in the septic t_a~,a,nd., in the, s.oil absorpuon system .sta,t~tp~pes, before, during and, after tae flow of water was stopped. ~ne ?hu~[ fluid, clepth In the see, p.age, ptt was ! 11 inch,es and the maxtm, um depth achmved was 118 inches, t ne uum teve~ tn the seepage ptt Ilea retunlecl to Its original level within 30 mmute,,s after the flow of water was stopped Based on tins test data, we concluded that the see a . ' . p ge pit isfutlctlonally adequate fo~ as many as five bedroo,ms, Before the System could quahfy for a 5 both'OGre HAA certificate, however, the soil absorption system would either have to ~ el~larged to a $ bedroom design ¢.apac. it~y~, or n~w?ils tests ,,,~.~a n~6~ ~o d~monswat~ fl~at soils around ~ ~tstln8 system could ~ re-rat~ at too squ,~R t~t. per ~-'I[ 1~ not known wh~er or not the Heal~ Department wo~ld r,-issue ,a HAA ce~ttcat~ tot even a 4 ~oom r?ld~noe w[~out ~ ~p~ade, Since I und~rstapd ~t yo~ chents w~sh to obmm a ~ ~&o,om approval, ~t appe~s ~at soil~ testing and an ~pgrad~ design will ~ necess~ m any case, As I expla~n~l over ~e phone, my ou~ent w~rkload wou d not fllow me to, t~e ~is project on for app?ximat~ly ano~er month, soyou will probably wish to con~act w~th another engin~rlng f~m for the ad~fional se~lces ~at ~e ne~ed, In conducdng an adequacy test we attempt to provide a thorough, conseien~iou~ e~gln~ng an~ysis of th~ system, Th~ reported results doscci~ th~ p~ffo~anco ot tn~ system unaer t~),o c?a~t~ons ,ncountered ~t the time of the test, ~d ~e sepm'auon d~smncas ~ measw~ to really ~dent~iable feamros, Sansfacto~ test results do not ~ante~ f~re p~ffon~c~ of ~ system under c~fferant conditions, nor do they gu~ante~ fl~at there ~ no h~dden def~ts or encroachments, Please feel fre~ to give mo a call If you hav~ any qt~estions on this report, Sincerely, T~ Moo~, P,E, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-si'rE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT DISTANCES ~ SEPTIC ABSORPTION WELL Address TANK FIELD Phone(S) Per~Jt NO. -' NO TANKS TYPE OF SYSTEM origifl~l grade FT FT :ill Bdded above oToinal grade Gravel dopll~th pipo FT / FT FT -- WELLS ~ PRIVATE ~T~R fldentlfv~ Municipal and Slate guidelines In elfect on Ihls (late: 72-013 (3/85) 0 N .... S I T Ii:( S E F' T :1: C '1' (~ N I< F' E R M l' "F IJpg r acl[¢~ JEAN I~IA'I"'I'HIEN![ii / 19411 ...... ' .... I F/V IIqE., I:] f.~ 92'715 Day F'ar eel Id." Loi'.. L..ega:l,: Subd:i, visiorl:i Z(4N:T'H~ VISTA I,:~'L~ 1 Bloc:k: Se(:::t, i on Il I,,..ot. S:i.z(~ 0,75 ~:~ r':apac:i'L¥.'.' 1~25() ga:l. lclr'~.~, I:ii:ach Depth to top i::lf' !i~eDt:i.l: tank(~) < 4.0 IIqEFI'(-IL..I., F'ER EIqGIiqLR'ER![J ):)IZSII:,)N., 1()()' I::q:~l]M NELl .... 'I'HIE~ I~?~:F~]:'l' I~ZXI:::'II:r~ES :l.[~:'./:% 1 '~'H]:S I::~EF~I'~ZT :[~[~i F[)R (~ (4) l:::(31,Jl::~ DE~:DROOFI SIIxI[,]LE F~IvlIL.Y DNIZI...LING CINI_.Y. ANY I~]xll...(~[:/l)~l~:lxtT TEl 'I'H:[Ei SYS"I"EH i4]:l..,I... RE:QI.I]:F/I[E 'THE 'l"O-I"(.~L SE[I:;rI'[C SYSTEM TO EH~[ Effil]lJ[,',iHT INTO EXIS'FINI~.) [',(]DE. I CEI::CFII:;Y 'H..iAYf'." FoF.'Lh by t.h~? IqL~niCi, l:]a],ity oF {,~r'H:::horag~ (I"IOA) arid thee EH:. al:, ~ oF arid :in (:(::)mpl:iarlci(:~ 14J.'[,ll '[.h~2 cl(~:i.~]rl i::l',J.'[.[eri~ of' CI"iitB ::;.~;,, ]: Ni].l acll'~:.H-~:~ 'Lo a].I MO(.1 ,:~nd El'Lat~:~ of ~:l.a~H,;:a pc.~)qL~:[r~mervl,~s for' Zl.,, I Lu'ld¢er~tar'~d tha'L Cl'lJ,~ pc.~rcn:Lt :Lii~ valid For a max:l~l]L~m of 4 I:)('~cll"oom~h, a[[EiC) l.,(r)d(:f)r~B'L~l'~d 'Lhat /:.h~ c:apac:ity oF 't,l'l~,~ Co'Lal s;y!~tlem lis 4 I::)(a(::R"cH::HIHEi aF'ICI ALASKA ENVIRONI~CNTAL CONTROL SERVICL . INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561.5040 S,EETNO.-- / o~ CALCULATED BY. CHECKED BY. DATE DATE-- L 4 '4 Gl rER ANCHORAGE ARIiA BOROI '-I DLPAFI'ril/IENT OF ENVIRONMENTAL QUALil v 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME ,.-~- ~"~%~ ,.'x~),~.ZS~/~- ~')J'" ___ADDRESS LOCATION ~ ~/~_~~ LEGAL DESCRIPTION~ SEPTIC TANK: DISTANCE FROM WELl ..... ,~ LIQUID C A P A C I T Y ~/~-~-),-,-_~''~ GALt. ONS. NUMBER OF ~ MATERIAL ~'- '-~T'7~ COMPARTMENTS INSIDE LENGTH _ ~-z~____INSIDE WIDTH_____ DEPTH______ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS___ / OUTSIDE DIAMETER OB WIDTH___.. ~:/'~/~ LINING MATERIAt~'"~/./f/'~Z~J~ ~---'~'/-~----~'-~-~'~'"-'~J DISTANCE FROM LENGTH // __, DEPTH · BUILDING FOUNDATION '~'"/-'/ /, NEAREST LOT LINE ~"J/J/."~, TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)__,.~'~'~'~'~~'' SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELT TOTAL LENGTH FOUNDATION , NEAREST [0¥ I.INE , OF LINES NUMBER OF LINES~ ~'~Z)'I~ANCE BETWEEN LINES -"'~'%~. __ TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTIO..,~A~A__ SQ. FT. LENGTH OF EACH LINE'~ ~___~. ~...~~ .... ~ DEPT :~"~OP OF TILE TO FINISH GRADE DEPTH OF FILTER MA]ERIAL BENEAD"I TILE __IN. ABOVE TILE W E L L :~/~..¢¢~r~./,,,.~/../~./,~,~...~,m.,-~'~, z,~,~'Z,~/'~, T Y P E ,~ ~.~'~'~r~,/-~,'z~~:' , DEPTH ~)~*~'~/~' NEAREST .., /~ SEPTIC LOT LINE ~_j..,) /.~z.- , SEWER LINE.-~z.~'~ ?'~ , TANK DISTANCE FROM - J WATER , BUILDING FOUNDATION.._~"~'~)~'~ -SAMPLE ~..4J'.~, NEAREST / SEEPAGE /~L~ ~ / OTHE-R'~'-~"~":-~ ~'" , SYSTEM.__/~ ~ , CESSPOOL/~:~'~ SOURC~ DISTANCES: 7~,~;,.= ?~, DIAGRAM OF SYSTEM G.A.A.B. / GREAi~ER ANCHORAGE AREA BON,JUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONE 2:79-8686 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. /~'~'~ INSTALLATION OF: SEPTIC TANK [/ TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SO,L TEST .ESULTS ~-'~-//~/-~ COMPLETION DATE ANTICIPATED ,/ NOTE~ TI'IlS PERMIT I$ NOT VALID WITHOUT BOIL TEST FINAL INSPECTION= 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY BYBTEM WITHOUT FINAL INBPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE BUDJECT TO PROBECIJTION, SEPTIC TANK ., SEEPAGE PIT~-{'¢ DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK ,-~¢---'~ , SEEPAGE PIT SEPTIC TANK,----~'~' , SEEPAGE PIT J~ ., DRAIN FIELD TYPE ~"~'~'~'~ SEEPAGE AREA SIZE DIAGRAM OF SY~BTEM CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC 'rANK AND SEEPAGE PIT FITTED WITh AIRTIGht REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. HEALTH AUTHORITY OR LICENSED DESIGNER I CERT]FY THAT I AM FAMILIAR WITH THE REQUIREMENTS Of GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 ANO THAT THE ABOVE DATE. APPLICANT'~ SIGNATURE GRD' 15R ANCHURAGE AREA BOROUGH DEPAR..ENT OF E~i~:'iRO~E~TqL 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 CASE # Performed For Eugene Matthews Legal Descrip~-]on: Lot 1 Block__ This Form Reports Soils-[-d-g x Date Performed 8/31/71 B Subdivision Zant~Vista Depth Feet Soil Characteristics Tan silty sand (SM) Gray + brown silty sand (SM) Sand and silt intermixed Gray sand (SW) with occasional silt lenses Gray sand and gravel (GW) Was Ground Water Encountered? no If Yes, At What Depth? .I to H20 Net Dro Reading Date Gross Time Net Time I Depth T Percolation R~'{e ~3nute Proposed Insta]']a-~"~: Seepage Pit x Drain Field Depth Of Inlet ~___Depth To Bottom Of Pit ~r Trench COMMENTS: 190 square ~eet o~ drainage zs required per bedroom with the cylinders ~'t from a depth o~--5~--E-~'-l-'/'. (~161 square ~t per ]~-~d'~o'bm-~s required i~ s~t trom /_'i~', iT~--depth2, ~fest Perfor¢e--d--tT~ R. E. Car~f-i-~i& -~Certified ~':'Natzon~-~ervices, In~ Date: 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. # 0154723 1, GENERAL INFORMATION Completelegaldesoription Zantha Vista, Lot 1, Block B Location (site address or directions) 10860 Sno~l ine Property owner Eugene Matthews Day phone 907-562-1500 Mailing address 19411 Sierra Linda Road, Irvine, CA 92715-3937 Lending agency Maiiing address Day phone Agent "Robin Ward~ Heritaqe 'Address 3601 c Stree~, AnchoraJ~,[:[~ 99503 Day'phone 345-6955 Unless otherwise requested, HAA will be held for pickup. Please!hold for P/U by H~unbain Engineering 2. NUMBER OF BEDROOMS: !:1 5 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 ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Mountain Enqineerinq Address 3868 Sha~/cle, Anchoraqe, Engineer's signature ~~_ ¢----~ Phone 562-1500 AK 99508 Date 8/20/92 Approved for 6/¢ bedrooms. Disapproved. ;:' ': ;'. :. ' " Conditional approval for ~' ...... bedrooms, with the following stipulations: By: AdditionalComments Note: The well for this property meets existinq State and Municipal Codes. There are nitrates present. It is continued suitability. Nitrate concentration is 5.3 mg/1. EPA Date ~- ~ / ~ ¢ ~ 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 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. 1/91) Back MOA ~21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: Zantha Vista,Lot 1, Block PParcelI.D. 01547211 A, WELL DATA Well type Private If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) , Total depth Sanitary seal (Y/N) N Y Date completed Unknown Driller Cased to ~//72 / .-~ Casing height Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG g.p.m. AT INSPECTION 8/16/92 41 ' . 7.5 Unknown SEPARATION DIS'TANCES FROM WELL TO: Septic/holding tank on lot 115 ' Absorption field on lot 130 ' ; On adjacent lots ; On adjacent lots 150'+ 150'+ Public sewer main None Public sewer service line Nome WATER SAMPLE FIESULTS: Coliform 0 Date of sample: ~'1 ~ ¢}'1¢}'''z'- Nitrate Public sewer manhole/cleanout None Petroleum tank. None 5,3 Other ' Collected by: Hou~ba~n B. SEPTIC/HOLDING TANK DATA Date installed 5/31/88 Cleanouts (Y/N) ¥ High water alarm (Y/N) NA Date of pumping Tank size 1,500 Compartments 2 Foundation cleanout (Y/N) Y Depression (Y/N) Alarm tested (Y/N) NA' N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 115' To property line 50' Surface water/drainage Onadjacentlots_ 140' Absorption field 30 ' None Foundation 15 ' Watermain/service line None 72-O26 (Rev. 3/91) Front MOA21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed NON~ Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Cleanouts present (Y/N) Date of adequacy test for SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA DateJnstalled 8/14/92 (new upqd)SoJlrating 1.2 GPD/SF Length 17' Width 3 ' Gravel thickness Total absorption area 200+ est 500+ (old crib) Depression over field (V/N) %! Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) N SEPARATION DISTANCE FROM ABSORPTION FIELD Wellonlot 130' On adjacent lots 32' 65' To building foundation On adjacent lots Surface water None Curtain drain None E. ENGINEER'S CERTIFICATION Surface water System type Total depth Y R./16./q2 5 Trench 11' bedrooms If yes, give date Property line 15 ' To existing or abandoned system on lot None Cutbank None Water main/service line None Driveway, parking/vehicle storage area 90 ' I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature ~ _.¢"~-- J Engineer's Name Hark: Pearson Date R/? ~ / q ~ HAA Fee $ / 7¢ Date of Payment Receipt Number 72-026 (Rev, 3/91 ) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAl. TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALYSIS RESULTS for INVOICE # 57229 Cher~ab Rof.t 92.4258 Sample ! i ~at~lx: WATER FAX: (907) 561-5301 Client Sample ID PWSID Collootod ReeolYed Proeervod with SNOWLINE DR, Client Name :EOUNTAIN ENGINEERING UA Client Acct :~TNENGN AUG 17 92 @ 18:30 hfs. BPOE : POW :NONE RECEIVED AUG 18 92 @ 08:53 hru. Req~ : AS REQUIRED Ordered By :BRENT EATON Anelyeie Completed : AUG 20 92 Laboratory Supe~viorVCL~_3~PHEN C. SDE Roleaeed By: ~i/(-~C.'~ ~ Send Reporte to: I)~OUN~AIN ENOINESRI~G 2) Parameter Roeult~ Unit~ gothod Allowable Llndta }IITRATE-N 5,3 ~/1 EPA 353.2 10 Sa]eplo ROUTINE SARPLE COLLECTEO BY: B,E. Romrke: 1 Teet~ Performed Soo Special Inst~uetionH Above UA-Unavailable ND- None Doteo~ed "See Sample Remarke Above NA= Not Analyzed LT-Lo~e ~han, GT-Greater Yhan Member of the SGS Group (Soci~tO G~n~rale de Surveillance) '~UNICIPALITY OF ANCitORAGm OF hEALTH AND ENVIRONME~ PROTECTION L ~reet, Anchorsa~. Alaska 99501 :t2: 264-4720 Date Received: __February 24, 1978 Time #3: Time Date Date Insp Insp REQUEST FOR APPROVAL OF IND]'~AL SE~%~D WATER FACILITIES Lending Inst±tution Request: Firs~ Federal Savings and Loan Association= Mailing Address: Post Office Box 4-2200 99509 _ Phone: 274-6561 2. Property Owner: D. Euqene/Ann C. Matthews Phone: 276-34.83/w. , .~' Mailing Address: Box 2213 99516 344-8278/h __ 3. Legal Description: Lot 1 Block B Zantha Vista Cubdivision 4: Single Family Residence: (x~ Number of Bedrooms: .Four Multiple Family Residence: ( ) Number of Bedrooms: Well System: Permit ~ Construction Individual Well ~x~ Community/Public System ( ) Depth of Well 85' Well Log on File B~cterial Analysis 6. Sewage Disposal System: On-site System (x~ Public utility ( ) Permit Septic Tank Size ~k, ~n~ f'--,¢, ~ ~,prY',%, Manufacturer Absorption Area ~uI~, Soils Rate Installed ~972'~ \~h ~ Installer to Septic Tank ~ql Nearest Lot line Distances: Well to Sewer Line Material ~,,~[o~ ~, to Absorption Area ~ct~ Absorption Area to Nearest Lo~ Line Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal D~scription: Lot 1 Block B Zantha Vista Subdivision Com/~ents: ]Disapproved: Letter Attached: ( Date: Department Worksheet: (aSe~sod snld) ,>Og--qlV~J d31JIJLU3[I UOJ 1¢11303U MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type o1: Inspection: CMRO VA 2. Property Owner: D. Eugene & Ann C. MATTHEWS Mailing Address: Box 22]3, Anchoraqe, 99510 3. Name of Buyer: n/a ~ refinance FHA CONV XX Day Phone 276-3483 Wk 344-8278 hm Mailing Address: ~.. Name of Lending Institution: Mailing Address: Box 4-2200, Anchorage, 99509 5. Name of Realtor or Agent: n/a Mailing Address: Day Phone First Federal Savings & Loan Assn. Phone Phone 274-6561 6. Legal Description: Lot l, Block B, ZANTHA VISTA SUB. Location:__ NHN SnozLlJ/le Drive (second let off O'Malley Road) 7. -Fypeof Facility to be inspected: _~Single Family R~sidence 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well __135~ 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation 1922 No. Bdrms. 4 Individual XXX Inclividual (on-site) Please return to attention: EQ 037 (1/74) Fran Agut