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HomeMy WebLinkAboutPROSPECT HEIGHTS #5 BLK 2 LT 5Prospect Heights Block 2 Lot 5 #015-135-13 I I. / 4 u '. 1J ILI; .3Ar_ A14 L..r U V.A UL UJ :_' LL '.- -1 J M il 1_'U i G 141) L, [ 4 -1 .2 d I A L Pump Installation Log Well Dt-iffing 'Pennit Number- SW__ U Parcel ldeatirleftfi011 Number,__. - Legal Desci-iptiotl 1 C� Date of Issuc- Pr )eryy Olvilo. Name & Address: L; Pump 111.1tallatiorl Date; puillp intake Depth Below Top of Well feel urer's Name: Pump Mallufact rufrip Model: Furrip lip Pitless Adapter Burial Dtpfll: feet Pitless Adapter Instalkr: Well Disinfinted Upoll Colllpl(;tion? y U's "E", No Njethod ot'Dishifectitill: Comments: Anchorage Pump & Well Sentice Pump Installer Name: 330 East 70th Avenue Anchorage, Alaska 99518 Phone: 907-243-0740 Fax: 907-243-0742 IC196 wee\� 0 15 - ISS- 13 Atte,16011: Thd rpL11,111) jWUZIIICrShall ')[()VidC Ll Pt',MP in.,-'oll-mion ;og to th�.' DSD with -.n 30 days, )?j'L:MP iMUli_,,Itiofl, Ju. 02,19 01:05p Anchci-nge WeH & PLmp Sai 'n072430742 p.1 Well Drilling Permit'NtiInber: Pareei Idenbricatiov. _N uraber:__015-- 135- B -#5 8Z LS Urap Instal I q ate: tion Ptln'P Intake Depth Belovy Top of Ydd fe e t PUITIP Al'ar'ftfhcfurt�rls Nam., "7 PUMP Model: C''_r v S Z purnp Size rhp Pitless Adapter Burial Drph.. feet Pitless Adapter :'Manu factjjrej_' s 'lame: tj Iq Pffiess Adapter Installer. Well, Disinfected Upon compledon? Yes 17ii No Method ofDisinfection-, Comments - Pump Installer Dame: Date of Issue: Property Owner Naine & Address- Cerj'v ' 'r- AR&n6z.;j'-;' Attention:I .- PUMP it'staiter sfla'l pravicc a rump il:�•tal'j'lli)ll ',Gj-,r re the DSD witl-iin 30days C -f PUM" instajlat'�an. Development Services bepartivent Builditiq Sur'el'y C)!�,fsjorj On -Site Water & Wastewater Program 4700 Eltre Road rvj Mark 89gich P -G, 8ox 196650 Mayor Archorcae, AK 99507 �'_IWYMUML2�� (907) 3<i-7904 Pani p Installation Log Well Drilling Permit'NtiInber: Pareei Idenbricatiov. _N uraber:__015-- 135- B -#5 8Z LS Urap Instal I q ate: tion Ptln'P Intake Depth Belovy Top of Ydd fe e t PUITIP Al'ar'ftfhcfurt�rls Nam., "7 PUMP Model: C''_r v S Z purnp Size rhp Pitless Adapter Burial Drph.. feet Pitless Adapter :'Manu factjjrej_' s 'lame: tj Iq Pffiess Adapter Installer. Well, Disinfected Upon compledon? Yes 17ii No Method ofDisinfection-, Comments - Pump Installer Dame: Date of Issue: Property Owner Naine & Address- Cerj'v ' 'r- AR&n6z.;j'-;' Attention:I .- PUMP it'staiter sfla'l pravicc a rump il:�•tal'j'lli)ll ',Gj-,r re the DSD witl-iin 30days C -f PUM" instajlat'�an. 87/88/2888 18:15 9873453287 HW DRILLING PAG~ 83/83 M-W brilling, ]:nc. eP.O. Box l10378eAnchomge, AK 99511e e907-345-4000 · 907-345-3287 Fax* Job No. 07-~.34 GROUNDWATER WELL AS-BUILT_& LOG Well Owner. Phil Haws Legal Description: . Prospect Hel~hts #5~ Block 2,. Lot 5 · 8003. Oney Circle, Anchorage 99507 Use of Well: Domestic CO NSI~.U~C~ ON Hole Depth: 4oa' Casing Size: e' Cased To: ~.oo.a?' Drill Method: Air Rot~r~ Wall: o. ~2uJ' - Well Completion: Open end X Screen/Pen'oration description: Screen Pen'omted None Material: A 53 Steel Perf. Method: Grout Notes: ( 3 ) Sack{s) of NO. 8 Dentonite granules Notes: Disinfected: Yes Method: Chlorine Tablets Well Development Method Air Surge Notes: Static water level (SWL) 92 below top of rasing {TOC~). ~' Well yield test at ~4. ';allons per minute (GPM) for~._,~' hour(s) wi~/~/~of drawdown (DD) from static leveI[SWL). Method: Air lift - Start Date: __ 07/3.6/07 Completion Date: 07/22/07 Pump Inst~ll Date: 07/3.8/07 WELL LOG Depth in feet top of caslnl~ Details of formations pene;~ated, size of material, color and misceilaneous details. 0 TO 3 casing stick up 3 TO 3.9 gravel: small, sandy 3.9 To 25 silt: dry 25 TO 78 gravel: ~mall, silbj, sandy 78 TO 96 gravel: small, sandy 96 TO 3.35 bedrock: slltsto~e argillite 3.35 TO 3.55 bedrock: fractured :[55 TO 3.70 red rock: soft "' 3.70' TO 196 green rock :[96 TO 240 red and green layers 240' TO 25-'0 black rock and quartz :250 TO 342 red and [reen layers Intermittently 342 TO 406 fracture zone TO TO TO -U-~AYNEE;-WE9TBERG, ~ t.k:onr, o No. 1000 07/08/2888 18:15 9873453287 M~ DRILLING PAGE 82/83 Pump Installation Log Well Drilling Per~it ~Number:. SW . Date of Zssne: __ Pnrcel ][deniil]ca~On ~be~ 1~ I ~ Il ~mp ~ke ~ ~ Top efW~ ~s~g: ~0 f~ ~mp Mauufac~r'a Nnme~ ~r~ / Pit]ctsASapter~urlzlDe~: 1~ feet ArCHon: The pump inatall~r shall pr~dc a pump Installa~ou leg tu the DSD within 30 days of pump iustallat~on. MUNICIPALITY OF ANCHORAGE Development Services Departmenl On-Site Water & Wastewater Program 4700 South Bragaw Streel P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Initial Date Issued: Jul 16, 2007 Expiration Date: Jul 15, 2008 Permit Number: SW070160 Legal Description: PROSPECT HEIGHTS #5 BLK 2 LT 5 Design Engineer: 0000 ZZ - NONE NEEDED Owner Name: PAUL HAWS Owner Address: 8001 ONEY CIRCLE ANCHORAGE, AK 99516-1141 Parcel ID: 015-135-13 Site Address: 008001 ONEY ClR Lot Size: 77512 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5, The following special provisions. -THE INSTALLATION OF A WATER WELL SHALL MEET ALL THE ANCHORAGE MUNICIPAL CODE 15.55. PLEASE SEE THE ATTACHED SHEET 'PERMIT REQUIREMENTS FOR A DOMESTIC WATER SYSTEM". IF THERE ARE ANY QUESTIONS PLEASE CALL THE MUNICIPAL ON SITE WATER AND WASTEWATER PROGRAM AT 907-343-7904. Municipality of Anchorage *' '-- :.-'-Development Services .Department., Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEPTIC/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Legal description (Sub'd, Block & Lot) ,~Z,~./,~'~ Legal description (Township, Section & Range) Lot Size_/~ ~ ~x~____~S(:l. Ft. Day phone .~.~.~.~._. Zip Code Zip Code Numberof Bedrooms ~' THIS APPLICATION IS FOR ([~all that apply): Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage THIS APPLICATION IS AN: Initial [] Upgrade [] Renewal [] I certify that the above information is correct. I fudher certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or ad~odzed agent) 1 Permit/Rush Fees: / ~-- ~ Date of Payment: '"~//,,:~./~ c~' Receipt Number. ~':~/Ul (Rev. 11/05) Waiver Fees: Date of Payment: Receipt Number: Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 e Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~ bJ ~,0E.~)sL PID Number: ""~": ~;M ~oa~ Wastewater System: ~w D Upgrade Phone: ~ ~O~~' D Deep Trench ~allowTrench D Bed D Mound E] Other Total Depth from original grade: Township: Range: I Section: Fill added above original grade: Gravel length; I WELL: ~w D Upgrade Gravel width: Number of lines: Oriller: Oat grilled: I~staller~ ~~. DaLai stalled: SEPARATION DISTANCES ~c a Holding a S.T,E,P. w~ ~/~o' >/o~ ~ ~ ~ LIFT STATION ~--¢7' / / / "Pump on" level at: "Pu~ High water alarm at: Fobndation Remarks: BENCH MARK Location and Description: ~ Assumed Elevation: ENGINEER'8 SEAL Inspections performed by: ~/~ Dates: 1st ~/~¢~>~ Department of Healt~and, Hfin~n ~ces approval Reviewed and approved by: 72-013 (Rev+ 9/91) MOA 25 35' Permit No.. Page ~' of ~ ML!nicipality of Anchorage "DEPARTMENT OF HEAl. TH 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: z Permit No. __~ *'~ ~b 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 1201 Ramona St. 99515 ,A,~cHOR~GE, ALASKA SIX INCH WAITER WELL DRILLED ............ -OUT TO THE DEPTH OF $~5 feet, DRILLED At THE RATE OF ~24.00 PER FOOT. Steel. cesi~]g seated out Mr. Jim Goard ?29-5400 Anchor.~.ge PROPERTY OWNI:R to 110 ft. I,t. 5 Blk. 2 Prospect Heights Sub. LOCATION OF WELL SITE DRILLER Bernie I\L.% C I V WELt. LOG: 18 - 45' Clean coarse gra, vel. Oept. Health & Human Services 4~ - 98~ Hard-'an, A cemented gr~vel, 98 - 110~ Bedrock, A soft broken rock ~oing into a herd bedrock ~t 110 £t. 35% cls.y binder. 110 - 585' Bedro~k."Ai sed!gen~ry.r0ck with. ,ha{dly_~s.ny ...... water sho,..ing in crs.cks & fissures in the rock until s little over 400 ft. Then only about ~/2 gvm. By 500 feet the water yield u~as only u? to ]/4 g'-m. !~ater yield showing a~ain at 570 feet in a ~orous ty-e rock &'mALincresse in yield with use. But 120 gallons ~er hour is the best this iVell is doin~ ~t this time. In wetter yea. rs, the Well'will increase in yield ~bout 30%. In dry years~ this Well will dro~' back somewhet in ~roduction. We. ter recovery is only b~ck u~ to 200 feet of surface. 1 1/2 horse'~ower submersible pum? shou].d be installed to about 560 feet. Charge only for 500 feet of drilling at $24.00 per foot: $~a,O00.O0 # 8 wire in ditch (~00 feet) & Mass '~itless adapter :installed & Muni Well Cap: ~525.00 $'r INCLUDES ALL ~BOR AND MATERIAL FOR COMPLY'ION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR TNE ~UM OF ~] ~ ~2~.00 ~ ~1)~ 0 d O'/ BERNIE C'LAtJS OF R~PAI~I' DRILLING WORKS _h 1~ ~o~ ..... Thi~ ~ .... 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 PERMIT PERMIT NUMBER:SW960294 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:JIM GOARD OWNER ADDRESS:15041 OLD SEWARD HWY. ANCHORAGE, ALASKA 99516 PAGE 1 OF DATE ISSUED: 9/12/96 EXPIRATION DATE: 9/12/97 PARCEL ID:01513513 LEGAL DESCRIPTION: PROSPECT HEIGHTS ~5 BLK 2 LT 5 LOT SIZE: 77512 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: September 11, 1996 MuniciPality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 5, Block 2, Prospect Heights Subdivision, Addn. No. 5 Well and Water System Design Impacts to Adjacent Properties Dear On Site Services Engineer: We are hereby applying for a permit to construct a well on the subject lot. The attached site plan shows the location of the well and the 100' protective radius. Placement of the well in this location will not conflict with the septic system to be placed on this lot or those in existence on adjacent lots. The ground surface on the lot drops from the home site toward the northwest at varying slopes from 12% to 4%. In the area of the proposed well the surface is fairly flat. Relative topographic contours are shown on the attached site plan. If the well is constructed as designed the following statements can be made: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments 2 LOCATION MAP SCALE: 1"= 200' '~..,' L~e Lois ~ NOTE: t Iii SITE PLAN SCALE 1" = 60' NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS IN THE AREA. September 11, 1996 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 5, Block 2, Prospect Heights Subdivision, Addn. No. 5 Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: We are hereby applying for a permit to construct a septic system on the subject lot. Two testholes were placed on the lot at the locations shown on the site plan. The percolation rate was determined to be between 2 and 5 minutes per inch and no groundwater was noted. We are therefore proposing to place a wide absorption trench with 4' of effective depth. The distribution lateral will be placed 5.5' below the ground surface. The ground surface on the lot drops from the home site toward the northwest at varying slopes from 12% to 4%. in the area of the proposed absorption trench the surface is fairly flat. Relative topographic contours are shown on the attached site plan. Conditions on this lot are ideal for the treatment of septic effluent. If the system is constructed as designed the following statements can be made: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserved sub ' any lots located in the area. space, either surface or surface, on The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.I=_. Attachments .. J NOTE: _SJl'E PLAN SCALE 1" -- 60' NO CONFLICTS WITH WELLS OR sr.'PTIC SYSTEMS IN THE AREA. SYSTEM PLAN EN 15 LOT 5, BLOCK 2, PROSPEC'r' HEIGHTS SUBDIVISION, ADDN. NO.. 5 r)ES~GN FACTORS: Four Bedroom Home Perc. Rate: 2 Min./Inch Application Rate: 1.2 GPD/SF SYSTEI~ REQUIREMENTS: Wide Trench System 1,250 Gallon Septic Tank 4' Drainfield Rock 4 Bedrooms X 150 GPD / 1.2 GPD/SF = 500 SF of Absorption Area 500 SF/5 LF X .5 (Red. Factor) = 50 LF L.ength of Trench Therefore: Construct a Wide Absorption Trench With One Lateral 50' in Length. Distribution Pipe in Trench Placed at 5.5' Below the Original Ground Surface. NOTE: TYPICAL WIDE TRENCH SECTION (NO SCALE) Grade Area Over Trench to Drain Away, (ENGINEER'S SEAL) Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825"-"L Street Anchorage, Alaska 99502-0650 ~ . ~ :;; i, :;~,~,:~ ~, i::: SOILS LOG -- PERCOI.ATION TES r fl i~' , "'~'~ .......... ~ {,: ~,, P~RFORMED FOR: ~ ~ LEGAL DESCRIPTION: LO¢~; ~Z) P~ Township, Range, Section: 9- 5 r WAS GdOU D WA*ER ENCOUNTERED7 IF YES, AT WHAT Depth le Water A~r Gross Net Deptl~ to Net 14 Reading Date Time Time Water Drop ~/,5' /~ y~' z ~/,~" 16 ,~0~ O~ ~H~.O Z:/~ 7" 18 ~N~ Z~J '? 19 20 PERCOLATION FIATE ~__ {minutes/ich) PERC HOLE DIAMETER ~ /~ TEST RUN BETWEEN 7 _ FT AND ~ FT PERFORMED BY: . -~, ~/,~.~,~ ~..,,Z~ , ~/~, ~'~c~_~E.h~,r~T H AT T Hi/~ T~ST WAS p ER F OR M ED i N ACCORDANCE WITH ALL STATE AND MUNICiPAl. GUIDELINES IN EFFECT ON THiS DATE DATE' 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LFGAL DESCRIPTION; OL. 1 2 6 Township, Range, Section: 12 SLOPE WAS GROUND WATER ENCOUNTERED? 13 14- 15- 16 - {,~o'ri' o ~v~ ~'o 18- 19- 20- COMMENTS ENGINEER'S SEAL.) SITE PLAN S IF YES, AT WHAT DEPTH? PE Depth to Water Afl, er Monitoring? /~J"~J ~" Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE /"~' (minutes/tach) PERC HOLE DIAMETER __ TEST RUN BETWEEN /~ ~/2... FT AND '? ///'' FT ACCORDANCE WITH ALL STA'rE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: 72-008 (Rev. 4/85) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street  P.O. Box 196650 ~5,~ ~ Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D: "O[5 -.t~ -I.~ 1, GENERAL INFORMATION COmplete leg al .description LOcation (site address) Current Property oWner(s) Mailing addrSss Lending agency Day phone Mailing address Real Estate Agent Mailing Address Day phone 'Z 50 - O g 3 (~ Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: ~ = TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer [] [] [] II The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the 'transfer of title (except between spouses) for properties served by a single-family on-site wastewater.disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my. investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspegtidn, ,,the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. N~me of Firm ~k Address ~.0[, I~/. Engineer's Printed Name. DSD SIGNATURE ~./" Approved for Disapproved. Conditional approval for bedrooms. Phone bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11/05) X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: r'¢~' ~ '-' / jr' Municipality of Anchorage Dev~elopment.Services Department Building Safety Division on-site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650. www. muni.org/onsite (907) 343~7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST LegalDescription: P¢o-~)ec'~ ~1(,-[4T5 ~,5 ~IK. ?.. Lo~5 Pardi ID; O1~-J~ ~LL DATA Well ~ ~;.~ . If ~ B, ~ C ~ovide PWSID ~ -- Date~et~ ' ~ ~1~o~ S~.~al (WN) ~ : .... ; ' ~gs~ ' t~'~ Total depth ~ ff. ~to I~ ff. Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) FROM WELL LOG AT INSPECTION Static water level ~30 ~JT.. ff. l"{'5 ;~ ~',.~ *ff. Well production ~, ~PlK g.p.m. I,[ ~B!~~ g.p.m. WATER SAMPLE RESULTS: ~r~or~ bi~ e~ Coliform Ne(~, coloniesll0OmL Nitrate O,'Z~IZ, mg/L Arsenic: J~/D ug/L date of sample: ~lzs/ll Depression over tank (Y/N) Pumper ~,~ ~G B. SEPTIC/HOLDING TANK~DATA Tank Type/Material /~lor~t T.~i~ / Tank size [~'i ~i gal.' Number of Compartments Foundatior{ cleanout (Y/N) Date or,pumping Au~q~t' ~ C. ABsO~pTt~'PIELD'DATA Date installed ~/zS] %, Soil reting (~ or ~/bdrm) Length ~ fi. Width Date installed' 7/Z~/ Cleanouts (Y/N) High water alarm (Y/N) Total depth'Tr',9, ~. ~'" Eft. absorption area J~00 ftz Monitoring tube . Date of adequacy test '+lZ{'ll( Results (Pass/Fail) Fluid depth in absorption field before test ~ in. Water added (~00 gal. Elapsed Time:/~) min. Final .fluid depth Z.5. in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) JVoat k~o~ in. System type Sh~,l[~,a -~.ck Gravel below pipe ~ ff. Depression overfield /V' ,For ~, bedrooms 'New depth ~.$,5 in. (~o0 If yes, give date g.p.d. D. LIFT STATION Date installed "Pump on" level at ,//~'n. Datum :E. SEPARATION DISTANCES Size in gallons ~ Manhole/Access (Y/N) "Pump off" level High water alarm level at in. Cycles tested Meets.alarm & circuit req ? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot I Absorption field on lot Joe Public sewer main /V/A, I Sewer/septic service line 'r ) Animal containment areas 50 On adjacent lots J0o 4 On adjacent lots Ioo Public sewer manhole/cleanout Holding tank /V'['A, .... Manure/animal excrete stOrage arms SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~ + main Wells on adjacent lots 100 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 5 ~ Absorption field Water service line Surface water Property line Io '~ Building foundation !o'-~ Water main /V'/A Water Service line J0~ ~ Surface water J00'~ ('/V. 0..,) Driveway. parking/vehicle storage Curtain drain 501+ (~/. 0.) Wells on adjacent lots J00 rF~ COMMENTS , --- OF A G. ENGINEER S CERTIFICATION ,.., Date · " COSA Fee $ Date'of Payment Receipt Number (Rev. 4/10) Date of Payment Receipt Number DRIVE W 522.15' 80.00' Z Z 0 ,o0'OC~=~ ZZ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Divi,'~ion of Environmental Services (:)n-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL. FOR A SINGLE FAMILY DWELLING 1. GENERAl.. INFORMATION Complete'legal description ___Lot 5..- B].oc.k 2..- Location (site address or directions) Property owner Mailing address Jim Gourd 80010ney Circle Anchoraqe¢ AK Day p~one 868-5111 C/O Prudential Jack White Real Estate Lending agency Mailir!g address Day phone Agent Address Greq Moore/ Pr__udential Jack White · Day phone 727-7158 Unless otherwise reqgested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well Community well Public water xx NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. xx NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 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 s~,~r~aisC~f~fr~liahSe with all Municipal and State codes, ordinances, and regulations,i.n, ef[ect o,n~ th..e date ~th. is inspection. was~e~ [er c;onsu Itlts, Itt~. Name of Firm ~n~ ~'Rnr,~ ,t,~ ~ Phone Address / /~ :h¢~,/~l~' ~4 Engineecssignature ~ /~/ f~ -- Date: //~ Waslewater Consultants, Inc. Shall be PAID $//~ °-'E-° or prior to, closing for the Engineering'Services Provided. 6. DHHS SIGNATURE ~ A.p. proved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments S£1E /¢ Tl'/~ ( H ~D I/" /¢ ~' ~ ~ u., e c c By: Date The Municipality of Ar~chorage Department of'Health and Human Services (DHHS) issues He'aJth 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 DH HS 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 MEMORANDUM WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL During a recent Health Authority Approval on-site inspection and test of tl~e potable water supply well on Lot ~ Block i of R~£6T~/~ Subdivision, the well's productivity was determined to be o~ gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a ~ _ bedroom residence is °~ gallons per minute. Although the subject well currently exceeds this minimum requirement, ali. parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. Kt:CI:iV U Municipality of Anchorage I~OV 1 7 199~ DEPARTMENT OF HEALTH & FtUMAN SERVICES ...... Environmental Services Division ENVIRONMENTAL SERVICES 825 L Street, Room 502, Anchorage, Alaska 99501 · (907)343-4744 Legal Description: A. WELL DATA Well type PRIVATE Log present (Y/N) Total depth 585' Sanitary seal (Y/N) Health Authority Approval Checldist PROSPECT HEIGHTS, LOT 5, BLOCK 2 Parcel I.D.: If A, B, or C, attach ADEC letter. ADEC water system number YES 10/24/96 015-135-13 Date completed Casedto 110' Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION 11/5/99 Date of test Static water level 200 Well production 2 WATER SAMPLE RESULTS: Coliform 0 Date of sample: 11/9/99 B, SEPTIC/HOLDING TANK DATA Date installed 9/23/96 Tank size Foundation cleanout (Y/N) YES Date of Pumping 11/5/99 C. ABSORPTION FIELD DATA Date installed 9/23-25/96 YES FROM WELL LOG lO/24/96 YES 135 0.42+ g.p.m, g.p.m. Nitrate 0.618 mg/L Other bacteria 0 Collected by: A.W.W.C., INC. 1250 Number of Compartments 2 Cleanouts (Y/N). YES Depression (Y/N) NO High water alarm (Y/N) N/A Pumper OLD McDONALD'S Soil rating (g.p.d./fF or~:~' 1.2 System type SHALLOW TRENCH Length 50' Width 5' Gravel thickness below pipe 4' Total depth Effective absorption area 500 SO. FI' Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO Date of adequacy test _ 11/5/99 Results (Pass/Fail). PASS For 4. bedrooms 19.5" 14-.25" Immediately after 754 gal. water added (in.): 60 Absorption rate = 600+ .g,p.d, NONE KNOWN If yes, give date - Fluid depth in absorption field before test (in.); Fluid depth 17.5" (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3~96)* D. LIFT STATION ~ Date installed Size in gallo Manhole/Access (Y/N) ~ "Pump off" level at* High water alarm level at* ~ *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 1 O0'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 1 Public sewer main N/A Public sewer manhole/cleanout N/A Sewer/septic service line 25'+ Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Water main/service line Property line 5'+ Absorption field ~ NONE 10'+ Surface water/drainage KNOWN Wells on adjacent lots 5~+ 100% 10'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water 10'+ Building foundation 1 O' Water main/service line · ~ Nr~NF ~N~WN Driveway, parking/vehicle storage area 50'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. ENGINEER'S CERTIFICATION I certify that l h/a~etfCr~ ,in inconforman~ewit~.~l~~ Engineers Namd Y J. I ~ield inspections and review of Municipal felines in effect on this date. JEFFRF¥ A. (2ARNESS Date Waiver Fee $ Date of Payment Receipt Number HAAFee $ ¢'~ (:r'D Date of Payment //?/'~ / Receipt Number "~"~'7~ 72-026 (Rev. 3/96)* recor,~'~t ¢~,~.1~..~r ' ms are :'/f