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HomeMy WebLinkAboutSPENDLOVE VIEW HEIGHTS #2 BLK 4 LT 1Spendlove I--leights #2 Lot 1 Block 4 #017-401 ,-26 Municipality of AnchoragePage DEPARTMEh T OF HEALTH AN[) 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 Permit Number: ,~'cc/ 9) ~ ~7 ~ PIDNumber: ~7 ~ ~ - Name: ~e~ ~ N~y ~y Wastewater System: D New ~Upgrade Address: ¢7~/ ~p~r ~~ ~ ABSORPTION FIELD Phone: ~No of Bedrooms: ~-~/~"~I A/ ~ Deep Trench B Shallow Trench ~Bed BMound ~Other LEGAL DESCRIPTION sog Rating: Total Depth Irom original grade: Lot: 8lock: Sub livision: Depth Io pipe bottom Irom original grade: Gravel depth beneatb pipe Township: I Range: I Se .rich: Fill added above original grade: Gravel length: I I WELL: ¢~Z~ D New g Ut grade Gravel width: ~, ,5~ Ft. --Number of~ lines:~J0istancobelween~ines:t ~ Fi. Classification (Private, A.B.C): Total Dep~:' Cased To: Total absorption area: Pipe material: F Yield: IP.mp sot ~t: m c~ ...9 Height A,ovo Ground: 6P~ F,. ~,. TANK SEPARATION DISTANCES ~ Septic g Holding U S.T.E.P. From Tank Fiord Slation T~nk Sewer Lines ~ ¢~¢~ ~n ~ / wen I I ~ I~0 - _ >~¢, ~el w~,~ > ~¢~ > ~¢ - - - LIFT STATION Line ~¢' ~¢' ~ I Foundation ~, ~, - .... "Pump °n"level ~t: J "Pump °fr' level at: I High w~ter alarm ah Curtain Pump Make & Mode~Eleclrical Inspections performed by: Drain ~ -- ~ - / Remarks: ~y~A¢~ /~//~ ¢¢~ BENCH ~ARK ENGINEER'S SEAL Inspections performed by: ~/¢~ ~¢4 ~ Dates: 1st ¢/Z~/~¢ ~f'.~,~z¢,~,r~11,~;::~ 2nd~/~/¢~ Department of Health and Human Services approval '¢~ ",.t,~o~o~ ,:. Reviewed and approved by:' ~, ~ Date:.~-//-O O .,, .... PFRMIT NO: SW990272 PID NO: 017..401-26 SWING TIES: DBL, DBL, C.O. DI\ ORIGINAL TRENCH NEW SOIL ABS. TRENCHES W. 5.0' GRAVEL -L- T.H. #1 FROM: COR. "A" COR. "B" 'to: DBL. C.O. "D" 38' 66' S.T.C.O. "E" 44' 69' S.T.C.O. "F" 52' 75' DBL. C.O. "G" 55' 77' DIV. VALVE "H" $7' 78.5' TR. C.O. 'T' 134' C.O./M.T. "J" 102' 135' TR. C.O. "K" 139' C.O./M.T. %" 161' NEW HOUSE ADDI'FION PAGE 2 OF 3 NEW 1250 GAL. ~M.T. T.H. $1' ~"1" 52'  LOT 1, EILK. 4, SPENDLOVE VIEW HTS. #2 oEPTIC SYSTEM Ut GRADE 80' AS-BUILT INSPEC'rlON PLAN VIFW 124' 95' FLATTOP TECHNICAL SERVICES SCALE: 1" = 30' 143' UPPER 14530 ECItO STREET DRAWN BY TFM DEARMOUN RD, ANCIIORAOE, ALASKA 99516 NOVEMBER, 1999 PERMIT NO: SW990272 PAGF 3 Of 3 PID NO: 017-401-26 __FROM I HOUSE 88.9' 4' SOIL COVFR :: ; ;SEPTIC 88.6' 2' SOIL COVER 2" RIGID INSULATION FILTER FABRIC / $'1' LONG 'fRENCH 52' LONG 'fRENCH T.H. #2 WATER -- @ 00.4' 7/27/99 INV. 7,~L4, BUMP INV. 72.0' 5' SEWER GRAVEL ELEV. 67.0' T,FI. #1 WATER @ 0'~.8' 7/27/99 LOT 1, BLK. 4, SPENDLOVE VIFW HTS, #2 SEPTIC SYSTEM UPGRADE AS-BUILT INSPECTION PROFILE FLATTOP TECI INICAL SERVICES 14530 ECHO STREET ANCHORAGE, ALASKA 99516 NOT TO SCALE DRAWN BY TFM NOVEMBER, 1999 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WAS'rEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 11, 1999 Expiration Date: Aug 10, 2000 Permit Number: SW990272 Parcel ID: 017-401-26 !..egal Description: SPENDLOVE VIEW HEIGHTS #2 BLK 4 LT 1 Design Engineer: 0019 Flattop Technical Services Site Address: 008731 UPPER DEARMOUN RD Owner Name: James & Nancy Brady Lot Size: 49609 SQ. FT. Owner Address: 8731 UPPER DE ARMOUN ROAD Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE, AK 99516-3366 This permit is for the construction of: [~ Disposal Field E~ Septic'rank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accerdance 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 ( 18AACS0 ). 3. The engineer must notify DHHS at [east 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 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. TECltNICAL S CIVIL & ENVIRONMENTAL ENGINEERING * ENERGY CONSERVATION & ANALYS£S TIfEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 ANCHORAGE, ALAS KA 99516 July 28, 1999 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The purpose of this letter is to provide the required design narrative in support of our application for a permit to upgrade the wastewater disposal facilities on Lot 1, Block 4, Spendlove View Heights #2 from 3 to 4 bedroom capacity. Soils logs, peru test results, a site plan, design drawings and specifications are enclosed for your review. In addition to the site for the proposed 4-bedroom upgrade, a possible site for a future 1-bedroom upgrade to the original 3-bedroom system is shown. The proposed system ~vill be constructed in the vicinity of test bole # 2. As can be seen fi'om the soil log, the native material below 0.5 feet is a dense silty gravel with a measured perc rate of 6 minutes per inch. On July 27, 1999 water in the monitor tube for test hole #2 was at 10' - 11" below ground level. Using a slightly conservative soil application rate of 0.6 gpd/sq. ~. this 4-bedroom residence requires a total absorption area of(4 x 150)/0.6 = 1000 square feet. The proposed design consisting of two parallel 50-foot long trenches with 5 feet of gravel between 1.5 and 6.5 feet below ground level has an effective absorption area of 1000 square feet. The topography of the lot in tile area proposed for construction slopes down towards the southwest at approximately 10%. This construction area is an old abandoned roadbed and the topography downhill of the roadbed slopes down at approximately 25%. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space-surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. LOT 3 BLOCK4 ' LOT 8, BLOCK 4 ', (VACANT) EXISTING 1000 GALLON SEPTIC TANK (TO BE REPLACED W. NEW 1250 GAL. SEPTIC TANK EXISTING 43' LONG SOIL ABS. TRENCH CONSTRUCT 2 X 50' LONG SOIL ABS. TRENCHES W. 5' GVL. BELOW PIPES SEPTIC SYSTEM >100' FROM LOT LINE LOT 2, BLOCK 4 WELL INSTALL INSTALL DBL. C,O. #2 ~ SITE FOR FUTURE 1-BDRM UPGRADE TO ORIGINAL SOIL ABSORPTION TRENCH ABANDONED ROADBED LOT 1, BLOCK 5 8PENDLOVE VIEW HTS. #2 SEPTIC 'SYSTEM LOT 1, GOMBART S/D UPPER DEARMOUN ROAD ,. OF LOT 1, BLK, 4, SPENDLOVE VIFW HTS. #2 PROPOSED SEPTIC SYSTEM UPGRADE SITE PLAN FLATTOP TECHnICAl, SERVICES 1 INCH = 50 FEET 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 JULY, 1999 NOTE: TBIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. NEW 1250 GALLON SEPTIC TANK DOUBLE C.C. "BULL RUN" DIVERTER VALVE DISCHARGE LINE TO ORIGINAL TR. · " DIA D-3034 ., C.O. 4" ASTM D-3034 DISCHARGE LINE TO NEW SOIL ABS. TRENCHES 3 PLAN VIEW SCALE: 1" = 10' 4" DIA ASTM F-810 · PERFPRATED PIPE MONITOR TUBE CLEANOUT '~, 2' SOIL COVER-- ~-2" RIGID INSULATION ,., ;49 FILTER FABRIC 12 CONSTRUCT (2) 50' LONG SOIL ABS. TRENOHES W. A TOTAL OF 5.5' GVL. BE'R/V. 1.0' & 6.5' B.G.L. 4" DIA. F-810 PERF. PIP[" BOTTOM OF EXCAVATION-- SECTION "A - A" SCALE: t" = 5' LOT 1, BLK 4, SPENDLOVE VIEW HTS, #2 SEPTIC SYSTEM UPGRADE PLAN AND CROSS-SECTION FLA'ivI'OP TECHNICAL SERVICES 14530 ECIIO STREET ANCI IO1LiGE, AK, 99516 SCALE: AS SHOWN DRAWN BY: TFM JULY, 1999 Flattop Technical Services 14530 Echo Street, Anchorage, AK 99516 I~hone (907) 345,1355 Lot 1, Block 4, Spendlove View Heights #2 8731 Upper I)eArmom~ Road Wastewater disposal system upgrade Specifications 1.0 General: 1.1 The scope of the project consists of abandoning an existing 1000-gallon septic tank and installing a new 1250-gallon septic tank which discharges into 2 parallel 50-foot long soil absorption trenches containing a total of 5.5 feet of sewer gravel. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform with Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The existing septic tank must be properly abandoned by thoroughly pumping, removing the top and backfilling with soil. 2.2 The new 1250 gallon, 2 compartment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of I/4'" per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of i/8" per foot. A double cleanout shall be installed upstream of the septic tank, and another double cleanout shall be installed within 5 feet downstream of the septic tank. A "Bull Run" diverter valve shall be installed downstream of the double cleanout to allow effluent to be switched back to the original trench at the option of the property owner. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating two parallel 50-foot long trenches spaced 12 feet apart to a depth of 6.5 feet below the present ground level. 3.2 The long axes of the trencbes shall follow a natural contour of the land. The bottoms of each excavation shall be level, but will not be at the same elevation. Any compacted or smeared surfaces shall be raked to allow proper infiltration. 3.3 A total of 5.5 feet of approved sewer gravel shall be placed in the bottom of each excavation with the perforated distribution pipes laid level such that the pipe inverts are no less than 5.0 feet above the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. The non-perforated pipe connecting the distribution lines in the two trenches shall be constructed with a 6-inch "bump" at edge of the upper trench. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less than 3 feet, two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in addition to the filter fabric. 3.6 The top surface of the cover material shall be raised a minimum of 6 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of ail areas disturbed by the construction. 4.0 Inspections: 4.1 A minimum of 4 engineering inspections will be required during the course of the project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and grading is complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. LTEST HOLE #! FLATTOP TECHNICAL SERVICES 14530 ECHO ST, ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TES'r LEGAL DESCRIPTION: Lot_l.,_Biock 4,~pendLov_e ViewL-l~ights: Unit #2 Augus_t. ~ 1998 James Brady DATE PERFORMED: PERFORMED FOR: DEPTH (feet) SLOPE Peat and overburden SM Reddish gravelly silty loam GM/ML Brown silty gravel Oense, hard digging Becomes a little softer below 5.5' Small roots in gvl. seams to 10' 5% ~5% i0% 5% % OF ,,.,,...,. THEODORE F. MOORE I ~, ~ % CE-3589 .¢.~'~ ./'........." SITE PLAN e,*~WELL ,, : © ~ ~ T.H. Depth to Groundwater Date Seeps at 15' - 6" 8/13/98 Water ~ 15'- 2" 8/27/98 ~Water @ 12' - 6" 7~27~99 COMMENTS: Water seeps @ 15.5' B.H. Clock Net Time Percometer Net Drop Date Reading Time (minutes) Reading (inches) 8/13 ~12'~' Presoak 27 3/8 -- Add wate~ & start 10:41 __23_1/2 ...... #1 10:46 5 22 3/8 1 1/8 Add-water 10:4~:-3~- 23 9/16 #2 10:51:30 5 22 1/2 1 1/16 -- Add water 10:52 -- 23 1/2 #3 10:57 5 22 7/16 I 1/16 ~Ad~d water __10:58 23 7/16 #4 11:03 5 22 7/16 1 PERCOLATION RATE_ 5 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 7.25 FTAND 7,75 FT Test hole dug on south side of old roadway. Recommend system be desicned on basis of 0.6 gpd/sq, fi, PERFORMED BY FLATTOPTEOHNICALSERVICES. I S..,~..~-/~/'¢/-¢'~.- CERTIFYTNATTHISTESTWASPERFORMEDIN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: "~ / "L <~ /~,~ ITI:-$T HOLE FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: I.ot 1: Block 4: ,,.~p~QdIQve View Heights: LJni~#2 DATE PERFORMED: __ A~gust 13, 1998 PERFORMED FOR: James Brady DEPTH (feet) 4 5 6 7- GM/ML Brown silty gravel Dense, hard digging Light gray above 3.5' Many boulders ~ 7-8' SLOPE 2255% % 10% 5%5% "' ',' THEODOREF. MOORE ~ ~.. ~ CE 3589 ~ T~ ;'e2"........." '.~ W~ ofe ss~o:~ SITE PLAN WELL Depth to Groundwater Date _Seeps~, 15.5' 8/13/98 Water at 14' - 2" 8/27/98 10% Water seeps @ 15.5' B.H. Clock Net Time Net Drop Reading Time (minutes) (inches) 12" Presoak Add water & start 12:19:45 #1 10 1 3/4 Add water 12:29:45 --1~2:30 #2 'i2:49 10 1 3/4 Add water 12:40:20 #3 12:59:20 10 1 3/4 Reading 27 3/4 23 7/'i 6 21 11/16 23 9/16 21 13/16 23 1/2 21 3/4 PERCOLATION RATE 6 (minutes/inch) PERC HOLE DIAMETER TEST RUN BE'rWEEN 4.75 F~ AND 5.25 FT COMMENTS: Test hole dugin old roadway. Recommend system be des 9ned on basis of 0.6 gpd/sq._fl_. 6,, PERFORMED BY FLATTOP TECHNICAL SERVICES. I ,~'~'~-~,',~v,,'-- CERTIFYTHATTHISTESTWASPERFORMEDIN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: NAme Phone(s) ' ~J t IPerm~N° No of Bedrooms LEGAL DESCRIPTION MUNICIPALll'Y OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT DISTANCES ~'----'~[I SEPTIC ABSORPTION FROM ~ TANK FIELD '-/1~ I',I p -x c.j ,$';,:-~ ~.~ TANKS SEPTIC: C] HOLDING TYPE OF SYST[:M '~'rRENCH [] BED ~ W. DRAIN [] OTHER TOtal depth Irom original grade n .... FT _ _ "7 ~ I:T ~2,. Date Installed WELLS ~ELL LOT LINE FOUNRATION /id' WELL Fl FT FT PRIVATE [] OTHER fldentifv) Installel /',,.~-~ / \ i ' Date Instaded REMARKS: FT Dale Ifil~Il-~~/ 72-013 (3/85J '1" ~,~ I: C;H¢~I:'C() & WAFID¢~ Cl..Il !3Z;3:L fIF'F:'IF.t~ DE:¢.qq4flLHxI ;EAL) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN S~:.RVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 6 7 8 9 10 11 12 13 14 15 17 18 19 2O Township, Range, Section: SLOPE WAS OROUNO WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Deplh to Waler ~,lter _ ~loniloring? SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI N 72-008 (Rev. 4/85) PERCOLATION RATE //c~, ~ 7 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ F] AND /~ FT ~ ~ERTIFY :;¢;~S' ~AS PERFORMED [N : / / ~'"~ EO'ol,~D'~: fez ~..n,',. ~g~ ,. ~ ,.,.,, ,,.. ,t, I , SEWER SYSTEM 'LOCATION PLAN , ? i.? 1 0~' ~(] ~:~ SECTION/TOWNStlIP/RAN~E ' :~} ...................... '<: :~: ::Z:} ::}?::::::::~:}:{: ) ~}8::: - OF / -- , ~ '"" ": ::. ':::: .: ~]907):[~t 6t~:::...::::[.:X.:... :::. :'. ~.t~ .: MUNICIPALITY OF ANCHORAGE Hca~ and Environmental ]?roter ].'*ourth Floor West 825 L SBreet Anchorage, Alaska 99501[ 279-2511, x 224, 225 SEI:~IIC TANK: FROM WL:LI_._J ............ MANDFAC'ItJIIEll . .~'~ . MZkl'( NIAI. ¢-~ COMPARTMENTS_~z TILE [)RAIN FIELD: ( I TOTAL LENGTI I~ DIS/ANCE FROM WELL .¢O~ . IOUN( ATIDN ~O ~7.r4~ Af~ES~ [()~ LINI: ~¢ Of LINE i~ of Lines ..... I ..... D,S]ANC~¢ Id:'IWE[J4 I.INi{5 ~/6 __fRENCH WIDI,I.%.6. IN TOTAL. EFFECTIVE SEEPAGE PIT: Log Cr:i.b ....... Rin§s ...... Crib ,~:l. Ze ¢' *, ..... · DIAME1 I D ¢T1¢ --- DISTANCE FROM: WELL '10l'At L:FF'EC'I'IVE C] aSS: ~ l)e )th. Well Distance To: Lot Line in'l Bldg. ~,O Sewer Line: ; 5d Pipe Materials. ~m ~ ~ of Bedrooms: ~ Remarks: , , i' THF!: I:;i:l~:l:i:!llIl:.~'.l]!:l) '!!;I;f:l( [::)F: TI.iE: ':i;[FiII FII'i:'::'-;CH~F:"(IC[N ':'i:'.r'.':.Vl'l![l~l :[:5: Till:!: I.l::lq(!iTl-I E:,:[Hh:l",llii;ICIl",l I::!i; "l'lll:~: I..[~:I",I(:F'I-II ,:::i:1",1 I::'['::[:::T) O1:::' 'i"l"ll::i TRICNI:::I'I C[F?. [':,I:,[:i:::IIHF:'iF::I.!). II]E: i)1::[1:::"t'1-1 OF:' [:![ 'I'F;:Ii[I",IC:I-I Cfi-.?. F:']:T I::'; TI:Iii:: I:::, :t: ~'~'l"Fil",l(:::l~i: 131!F:TI,.;I.i:J~i:l",l 'l"l-"lli!~ :~L.IF~i:I':'FIC:E: OF: (:~l:,?.Cd..Ihll) FII",II) ']'IIIE I-?()T'T'(:IH I::)Fr '['I-IE lii:::'.:E:l':tVi'::l"l']:l::[l",[ ,::II",l I:::lii:tET::,. THIEF~:I::: ]2:; 1",1(3 'JSI:ET .kl]:D'i'l-I FREI[?. 'I-F?.I!:I",ICHI~:::::;. 'ri[ii!': []i[;~:l::i","['::L I)IiEF:'TH ]2:':; THi:!: f'"I]:['.,tII'.IIIH [:,I~:F:'TH OF: (!i[;?.F:I',/E:'L. L:',E':TI.,.I[~F3',] TItlE OI...I']'I:::F:II..[. I::li",li::, "l'Hti!: I::!u:iITTE[Iq [:)[:' "I'IIE: I!:',.';:E:FI',/FITIOi",I ,:iIIq liff:lCk:F:']:l I...iNG OF: FIN"? :::;"~'!i:;'i'l"!l'"i HITHCiLI'T F:IIqI::H. II'.,l~:PI}i[C:TIf:llq FII",IE:~ I'::IPF:'[~'.CI',,,'F:IL. EiF/ 'FI"II~; i-:,ii[I:'F:Ii~:'['HI:':[",I"t' H]:I_I. Iii:[!!: :i:.;I.J[~L.:[F:C:'[ TO H :[ l'-,t :i: HI .Ih'l :i.E~lli) I::F!:I~':T F:OI:;~ FI F'I:~t]:',/FITli[ HI:.I.I. ()F~: ;:i:li)E~ I::'I-!:1:~:'1' F'OF?. f::l F'LII:!:L. IC: HI~:I,.I.. HI::I,I I..Cff::i:k; FII::~:I:~: F::[E(;]I..IIF:F':D FIND HIJ:::;T 131'i: I:r::l:~:'l~l.ll:;~:[",ll~:[:.'' TO TI"t[~: I:::,F:F:'F:IF::THEN"I' HITHII",I ::.":lEI DF:i"/::!; TI.It:: HI:'ZI .L ':;;i:'"[::C ]: F' I C F~'i' ]: (:)N:5 I:::ll",tl ) I",l'J !;"i't::]1 I. F:I T Parcel I.D. # MUNICIPALITY OF ANCHORAGE Department of Heallh & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE S[;WER AND WATER FACILITY FOR SINGLE FAMILY [)WELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (b) Property owner Mailing Address (c) Lending Institution (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ~ D/L,/~j~,~.~ "~' Telepho'ne: (home) ~ ~ /~- Telephone Business Mailing Address (d) Real Estate Company and Agent . Address Telephone (e) Mail the HAA to the following address: (or check here ~if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family ~¢L Number of bedrooms ,~ 3. WATER SUPPLY Individual Well'i~ Community [] Public [] Note: If.community well system, must have written confirmation from the Slate Department of Environmental · ~0n~ervation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site"~ Public El Community [] Holding Tank [] Note: If Community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72~25 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is 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. NameofFirm "~'-~o~,.~. ~,.~,,-a~..Lo~l.~-- Telephone Address G,'7.~' ] ~ /~; v~ 6. DHHS APPROVAL Approved for_ ,~ bedrooms by Approved ~'/~ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by 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. 7/88) Bsck Page 2 of 2 A. WELL DA'~ Well Classification MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: If A, B, C, D.E,C. Approved (Y/N) ~/~, Well Log Present (Y/N) _(Ni _ Date Completed Total Depth liE; '~ ~ .Cased to ~O~ Depth of Grouting _ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot Yield Pump Set At __ ,-~¢ ~L/~,~,/ Sanitary Seal on Casing (Y/N) y Depression Around Wellhead (Y/N) ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot _ ¢~. ¢'~, ; On Adjoining Lots > I o'~ To Nearest Public Sewer Line ~/~ To Nearest Public Sewer Cleanout/Manhole 1-o Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments '~ J~ ~4 i ; Date co/; 3,,z N B. SEPTIC/HOLDING TANK DA~TA Date installed ~ Size Standpipes (Y/N) ~ _Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) _ No, of Compartments ~-- Foundation Cleanout (Y/N) Date Last Pumped /'~/'/~/ ; for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/oervice Line TO Stream, Pond, Lake or Major Drainage Course Comments To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed I"~/~ Width of Field ~'. ~" Square Feet of Absortion Area Depression over Field (Y/N) N Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation To Water Main/Service Line Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ,1~ '~,~.4 ~4 ~..~¢~'¢',~ . ~' ~.~.~... ( O/,~ ~¢~,~:~ D. LIFT STATION I*¢/~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA inspection. Signed Company Date MOA No. Receipt No. c,~ & O (--) ( Date of Payment ~ ~--/¢ ~' Amount: $ ,/ ? (~. ~ O'/ 72-026 (Rev. 7/88) Back Receipt Waiver Fee: $ Date of Payment Page 2 of 2 in the date of this Engineer's Seal MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. #__ CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1, GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) , Location (address or directions) (b) Property owner ~¢r ~c~¢// ¢/~¢/~ ~Tolophono: (homo) (c) (d) Mailing Address ~7 Lending Institution /~-L Mailing Address /(4"//~ Real Estate Company and Agent Address /(///,-'~ Telephone (e) Telephone Mail the HAA to the following address: (or cheek here~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Familyx Number of bedroorns 3, WATER SUPPLY Individual Well'O' Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site..~/ Public [] Community [] Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72102§ {REV. 7/8B} Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown bel ow, I verify that my investigation of th is 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. NameofFirm (/'~,.'",Pl,;'t.,,' ~" ,'Z)~'C/C" Telephone 6. DHHS APPROVAL Approved for ~ bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by 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. 7/88)Back Page 2 of 2 .,MUNICIPALITY OF ANCHORAGE (MOA) Health A,u, thority Approval (HAA) ~(:w,!l~: OHECI(g,i~- FEBRUARY 1984 A. WELL DATA Well Classification __pF[ Well Log Present (Y/N) _/%,[ Date Completed Total Depth//~~ Cased to ~PO Static Water Level ~7/' 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 on Lot To Nearest Public Sewer Line -Fo Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Legal Description: If A, R, C, D.E.C. Approved (Y/N) _ Yield ,~- ¢~) ~/> *~1 _Depth of Grouting 1./,~ Pump Set At ~/,4 Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots /~5'~ ' ; On Adjoining Lots _ To Nearest Public Sewer Cleanout/Manhole c/O, Comments B, SEPTIC/HOLDING TANK DATA Standpipes (Y/N) I _Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) No. of Compartments ~ Foundation Cleanout (Y/N) _ Date Last Pumped AA,,., ;for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To WaterrSupply Well //(9 * TO Property Line 2~' / To Water Main/Service Line .~ Az") ' To Stream, Pond, Lake or Major Drainage Course _/~,./ Comments .A/~,~ '7~,~/~ . '~-/1 ~ ~ To Building Foundation To Disposal Field 72-028 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ~--~, ,~' Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field ,~L,~ ~ /~- Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test /~- /~/ /?.Y SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot .'~ (~ ' To Water Main/Service Line To Property Line / ,-S' ~ To Existing or Abandoned System on ; On Adjoining Lots ,~' -5'~~) ' To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N' Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permit/lC Bedroom/Rating Against HAA'Request** I certify that,I/I, Ca~ve, check~d,~verified, or conformed to all MOA and inspection./~////'/ //~ Si'~ned ///~ [~/¢~/~7/ -' MOA No. ' effect on the date of this Engineer's Seal Receipt No. Date of Payment I'"~- ',-~-~/'- Amount: $ 72-026 (Rev. 7188) Back Receipt No Waiver Fee: $ Date of Payment Page 2 of 2 Well Classification MUNICIPALITY OF ANCHORAGE (MOA) Health Authorily Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: If A, B, C, D.E.C. Approved (Y/N) Yield Well Log Present (Y/N) ~ _ Date Completed Total [;)epth~..,~ Cased to _~-'¢2 ¢¢ Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) ~ Depression Around Wellhead (Y/N) /f'~"/ Static Water Level '~/ Casing Height Above Ground ~" / Electrical Wiring in Conduit (Y/N) _ SEPARATION DISTANCES FROM WELL.: To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /~"~ / ; On Adjoining Lots To Nearest Public Sewer Line ,/Ufg/'~ _ Te Nearest Public Sewer Cleanout/Manhole/4~ -ro Nearest Sewer Service Line on Lot ~/'~/"~'./'- Water Sample Collected by ~ ~"4¢2~Y//~t ;Date ,¢~¢'/g0.~ Water Sample Test Results ~.~"4¢Z '~"~ .d. ~ ~_ Comments B. SEPTIC/HOLDING TANK DATA Date Installed /~'/~'//o~_Size Standpipes (Y/N) ¢2./ Depression over Tank (Y/N) Air-tight Caps (Y/N) Pumping/Maintenance Contact on File (Y/N) ~ Holding Tank High-Water Alarm (Y/N) /'~//~ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: No. of Compartments ,~ Foundation Cleanout (Y/N) Date Last Pumped ~E~/'- ;for To Water-Supply Well To Property Line To Water Main/Service Line To Building Foundation To Disposal Field To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Date Installed /~.,./4Z'//~C'A¢ Length of Field '~,_'~ / Width of Field ~" ~' / Depth of Field /'~¢~ / Gravel Bed Thickness 7 / Square Feet of Absortion Area ~,4:2 ~. Statndpipes Present (Y/N) Depression over Field (Y/N) ~ Date of Last Adequj.E~y Test Results of Last Adequacy Test ,/~/~-~-¢¢-/ /~¢"~//r~,¢p' ~--~',~' SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well /~¢'/' To Property Line /'~ To Building Foundation Lot ~¢ / / To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area/ Comments .,/~_/~u/ ; On Adjoining Lots To Existing or Abandoned System on To Cutback (if present) /~,///,,z~. D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions .~ //( Man~Y/N) __ __ J ~'~'- Pumping Cycles during Adequacy Test. CommentsMeets MOA Electrical Codes~ **Check Perm~.~d Bedroom R/ng Against HAA Request** I certify that,//h~e checked, ~.eri'fi~(~, or conformed to all MOA and inspecti°n'///~h ~/ -~ Signed //////~/Z// ~ -- MOA No. ~ G~ Receipt No. 4;~/'~'"/¢~-- Y 2L~"(/¢//~) Date of Payment Amount: $ 72-028 (Rev. 7/88) 8ack Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 the date of this ~ineer's Seal 6751B. DIHOND BLVD. ~NCHORAGE~ AL6SKA 99502-~9011 1~07) 2~B'SO95 LEGAL: I_(:~'l:', I ~ D1 ock 4 ~ Sj::)c,F~dl Dye) V:t I.~w I'lei gh't:~ LOCATION: OWNER: TYF'E OF WELL.: 873:L UI2)l::)er DeArm(:n.u", t:~(::~al::l I::]:')ri [;]an~f: :i le], i::l Pr :i valLF, ~ S:i. nt.t ] l:_~ F:am:i 1 'y' WELL LOG AVAILABLE: Nc] INSTALLA'rION REQUIREMEIqTS MET:Yes WELL YIELD FROM WELL LOG:: PUMP YIELD FROM TFST: Gallorls pel' Minu'l:e DA'YE OF INSPECTION: April. :2;~ :1.99 TEST PRO[]EDURE: We].l was pumped at. a c:ons't:an'l: fa'Lc whi:Le i:he t:H"[)bF~'. A'L'. 't:l"re:, I:H,~U:i. Fq'~jng (::).f 't:h(,,, 'L'.~?s'I: wa'Eer l~:~ve] ~as '~C)LII"IQ ~:t~: ~jZI. f(:?eL I]0~!(Jb~ i:(::~p C~'[: C~J.l']g. Ai: a I:]L~(ilpil'lg rat'.(:] (:)'[: :]~.~ gallclllS :il]Cl. The Na[:[~l" ].~v(.?l i'-,:.)main(:~cJ at i:'.his level 'For- the dLIl"ati(::ll~ TEST FOR E.COI_.I AND TOTAL NITROGEN: Wal:er was 'kested 'fc:n" E.[:ol:i. ~:ql(:l 't:: crt: ct l I'~i~:l'"(](:lell ~]n Api~'J, 1 4v :lgc):t I~. C()]. :i 0. 'l-(:rl:.a]. N:i. {'.l"Ogl[~r~ 3,, 2miLl/1 . Pla;-:,, a].lowable 'roi:al Ni't:rc:]g(,~l] :ti]) mci/l,, 'rEST RESULTS: 'l'hJs ~,~:)ll mec,±:s i:he requ:tl'"l~meni:.!~-~ (:)~ 'l:.he Murl~(:::i.l:~al :i.t:y o-F Anc:l~(:~l'-ag(~ TliIS WELL WILL PRI_-IDU[:E MORE THAN :3 GALLONS PER M:[INIUI'E F_"[_]t~ ~_O_R_E_ ~751 ~. ~IHO~ 8LVD, (907) 248-'5095 LEGAL: LOCATION: OWNER: RESIDENCE: WELL: SEPTIC SYSTEM: J.., o J: S:L r'~g117:, F'am:i I y, F:'r:i. vatlT.~, EJn ,ciJite FROM JvlONiCIF'AI... RE[][]RDS: 5 BecJrt.3om Sy!¢,tem TAIxlI-::],,: (]}l'-eer EH:eel 1000 Ga:L. Two Comparts. A[::~SORI::"I' I ON SYSTEM: 'Tr on cl'~ ABSORPTZSIq AREA: 602 Gq,, F:'t,, SC] ]: I,. RAJ' IIqG ~ 1130 I NSTALI.AT'):[IN [)A'TEi:',~ Dec. 19S8 DATE OF LAST PUMPING: Ar'lc:l'~.. [::ess Pool A[)r'il .q, 1991 DATE OF '[ES]-: Apr"J]. :~!;~ 1991 TEST PROCEDURE: Sys'[:em was :i, rl!~pect~.:)d and measured. 'l"ank was ¥ c}t.lr](:J w:i th 2 {-eet o.¢ cover and wi th a 1 i quid 1 eve]. o.¢ 49 i m(:)n:i.t(:)r Eul]e was 10 .[:t:. deep w:Lth 58 incl']es o'F water. J}l.l~'Jt'lg 't:hc:) nl::)x'[: Ell(::) rll:i, nu'L:e:,!s 'J:hl~ water lew,¢l J.n the monilzor cJrc:)ppl.~!d 3 inches, :[~J(::lJc:atil]g that 80 ga].].(:)ns mc)rE) or less had J:)~)l'-J ab- · L'.har~ 45CI gal Ions can be absorbed. TEST REE~IJLT: Doff) ar t. mecr[: I:he I'leal th and Social Set' v:i. ces Ithe MI.u'~ic:Lpality o'J: Aclchorage. NOTE Tile Ol~ier"a'l::i.c)lia:[ :l:[.J:e i::).J: all sep'l::Lc systems dep¢i)nd!-:~ on the ]l.c:)(:::a~]. soil c:ond:Lt:Lons, gl.-'C)L.(i](:lt~t(~l'' :I. ev(~:~ls thai: may I:luc:tua[e c:JJ,l~"i r~(] thE, y(,:.~aK ,~ al]cC '['.J ~(::) W[:~'~.C~'i" I,l~[~ag(~~ o'~ '['.J'JE] '~: I:)y the sysL-.E)m. 'J'l~osJz, condJ t ions are (:)ul::sicle 'E. he oval ual: o~' o'1: I:his s~.)p't::i.c:: E~ys'L:(z,m. W[:e car', 'l::J"~c~:,l"(::~,fOl"(~z, rto[: C:]J. vE, ally estJ mat(-:~ o'f how lont] I:hJ. s system wi 1 ]L .Func'l:ion f:ia c::cu"r~.?n't: c:tr ~Fcvt:~u'e CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633 B STREET ANCHORAGE, ALASKA09518 TELEPHONE (907)592-2343 ANALYSIS REPORT ET HAHPLE tot WOgKordert 32993 Date Neport Printed: APg 5 9i B 16:50 FAX: (907) 561-5301 Client Sample ID:POTABLE WATER L1 Ed SPENDLOVE Client Hame :TOBBZN SPURKLAND, P.E. PWSID :UA Client Acer :IOBBENS Collected APR 3 91 @ 11:00 hrs. EPO # PO % NONE RDCEIVED Received APR 3 91 @ ll.:4O hrs. Req # Preserved with :AS REQUIRED Ordered By Analysis Completed :APR 3 91 Send Neports to: Laboratory Supervisor :STEPHEN C. EDE 1)TOBEEN HPUREI, AND, P.E. Chemlab RoE #: 911214 Lab Smpl ID: i Metrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N 3.2 mg/l EPA 353.2 10 Sample HAI~LE COLLECTED BY: T, SPUNELAND. I Tests Performod ' See Special Instructions Above DA-Unavailable ND- None Detected "See SampLe Remarks Above NA- Not Analyzed LT-Loss Than, GT~Oroator Than CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TO BE COMPLETED BY WATER SUPPLIER {~ PRIVATE WATER SYSTEM Name Phone No. Mailing Address Drinking Water Analysis Report for Total Coliform Bacteria "~'"'~'~ ,-% TO BE COMPLETED BY LABORATORY Zip Code City State SAMPLE DATE; fo-F?l Mo. Day Year .) [] Treated Water ~ Untreated Water SAMPLE TYPE: .~J;~ Routine [] Clleck Sample (for routine sample with lab ref. no. Lq Special Purpose SAMPLE NO. LOCATION R CEIVED Time Collected J .Il: Collected By Analysis shows this Water SAMPLE to be: ~)~Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: 4 L Membrane Filter * No. of colonies/lO0 mi. Lab Ref. No. Result* APR 1 2 1991 Munici ~ahiy ct Anchorage Dept, F ealth & Human Services t:IACTERIOLOGICAI. WATER ANALYSIS RECORD Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter: Direct Count Verification: LTS FRlenpa:rtMe:mT~.~r~~, TNTC = Too Numerous To Count OB = Other Bacteria BGB Collformtl0s mi Coliform/100 mi Time: /7/-- z~//- q/// a.m. p.m, lllltllII "/~ C_HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 Dat., ~:,coo) t 3m,q)lo kOUii l~ CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER Name /- Phone No. Mailing Address SAMPLE TYPE: ~' Routine ~ Check Sample (for routine sample with lab ref. no. [] Special Purpose .) ['d Treated Water ~3 Untreated Water SAMPLE NO. LOCATION 1 I ? .... ~.' ,'". /~ - 2 [ 3 Il REA[) INSTRUCTIONS Time Collected Collected By TO BE COMPLETED BY LABORATORY Date Received Time Received Analy;tical Method: Analysis shows this Water SAMPLE to be: ~Satisfactory [] Unsatisfactory [] sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results, Please send new sample via special delivery mail. Membrane Filter * No, of colonies/lO0 mi. Lab Ref. No. Result* / BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Analyst BEFORE COLLECTING SAMPLE Verification: LTB Final Membrane Filter Results Reported By TN'tO := Too Numberous To Count OB = Other Bacteria BGB Coilform/lOOml PART t OF a REMAINDER TO FOLLOW ISAACS PUMPING SERVICI:: (Norm Tibbetts, Owner) 6218 Quinhagak Street ANCHORAGE, ALASKA 99507 Phone 563-3300 Corwin & associates,inc. Consulting Engineers 1000 E, Dimond Blvd. · Suite 205 · Anchorage, Alaska 99515 · (907) 522-1311 I~IClPAIITY OF ANCI'IO~GE DEPT. OF HEALIH & ENVIRONMENTAL pROTECTION DEC 2. 2 ~98fl RECEIVE[) MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # /-'~\~ - HAA# 1. GENFRAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner ~/~ /~ ~~: (home) Mailing Address (c) Lending Institution Mailing Address Business (d) Real Estate Company and Agent ,~_~.z¢,¢~/' ~_/~'//~/1<;;~ Address 2~ ~'~ ~p ~//~. ¢¢ .¢O~ (e) Mail the HAA to the following address: (or check here ~old for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDE. E.E~ Single-Family r~ Number of bedrooms ,~"~ 3. WATER SUPPLY / Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status, 4. SEWAGE D~SAL On-site []/ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Roy. 7/88) Page 1 of 2 5. 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, Ive rify that my investigation of th is 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 re~,ulations in effect on the date of this inspection. ineer's Seal 6. DHHS APPROVAL Appro'yed for_',~ bedrooms by Approved ~' Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DH HS) issues Health Authority Approval cerificated 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, 7/88) Back Page 2 of 2 &~'HEMICAL & GEOLOGICAL I. ABORATORIES OF ALASKA, INC. Cbmalab Re!. ~: 7778 Lab S~!,pl. ID: 1 HaCrlx: M]owablo Par mnoter Tos~;od l{(,~ult/Onlt ~ [~otbod I, Jmlts EITRADb'E 2,~ ~;~.~/t ~iPA 353.2 B 'J'ost~ Por£orlfod See Spoclai Instructions Above Ul,,Un!~vailahlo HD~ ~lono f)cioctod "' :4e,~ ~al~plo l/e~,~rk~ Above CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER © PUBLIC WATER SYSTEM I.D.# [ I I I I I J [] PRIVATE WATER SYSTEM ,, ,~ Mailing Address City State Mo. Day Year Zip Code RoLE TYPE: urine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY tis shows this Water SAMPLE to be: is factory Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received ~'-- ~c~-°~"~' Time Received /~ ~ ~/) Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* I -777 '--g-I Analyst 18AC'rERIOLOGICAL WATER ANALYSIS RECORD //~'~/'~--~ READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter: Direct Count {~ Verification: LTB BGB Final Membrane Filter Results ~ Collform/100ml Time: z/~.-~'~ a.m, p.m. TN'rC = Too Numberous 3'0 Count OB = Other Bacteria DEPARTME · 82 REQU Mai] ing Addr(:,.~s Pz'~I?ei:ty Owner Ma :i. [Lin~t Addreas MUNICIPALITY OF ANCHORA¢,- OF HEAI_TIi AND ENVIRONMEN', PROTECTION L S%re¢,~:, Anchorage, Alask~] 99501 279-25!1, exu. 2214 or 225 Date Recelved ~,t2: Time ItS: Time Date Da t o. 'l: n a p ...................... 1 n s p 'iNDIVIDUAL SEWER AND WAq_.ER }7ACILIT£ES Reque,qt: National Bank of Alaska Post Office Box 3-3859 99509 Phone: 279-2506 Aurora Contractors/Builders Phone: 276-8004 Box 4-814 99508 L~,gal Dosc,riptien: Lot 1 Block 4 Spendlove view Heights Subdivision Re..~ldenc~. (x) Numbe× of Bedrooms: _JlW_q Single Fa~i].y ~, ' · - ,n_ · Multiple, }?ami:ky Residence: ( ) Number of Bedrooms: Well Syscol~ Individual Well k ) Co!/~munJty/Public Syskem ( ) Permit ~f L .... ' Depth of Wei:l.l~_~ ...................... Well Log on File ( ) Bacterial Analysis Cohstruo%:L('m ............... ~ Sewage Disposal ,~ystem. On-.~ite Sysr. em (x) Pub]~ic Utility ( ) / Septic Tank Size _[,~~.~..~ Manufacturer .~2~.~L ......... Ab~orpt. ion Area . ~,.~a .... Soils Rate ...... ff~_,...~ ..... Material 7,, Distances: Well. t:o Septic Tank Area Absorption Area Department of I]ealth and Lnv.,..onmentaJ Ruotection l~quesk for Approval of ]'ndiv:idual Sewer and Water I,'acilJtJ. es Lot 1 Block 4 Spendlove View Heights Subdivision it Attached: ( ) Letter Attached: ( ) _8~pp~ow~d: · Date .'. .~partmsnt Wcu"ksheet: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 825 "L" street 279 253.1 825R'~b~.~tl~f-'~)R APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA Mailing Address: ~:~L (7/- f/¢ Mailing Address: _'~ ? :'_~C") (.~--~ /~: .~)~ FHA CONV / Day Phone o~'~ -'?(~0 4. Name of Lending Institution: .i i,g A dre ,: ( 80 5. 'Name of Realtor or Agent: M,ilJng Address: ~V~O 7. Type of Facility to be inspected: ~ ,[~/('(' 8. Water Supply Type of Supply: P~blic Utility If Individual, number of dwellings presently served If Individual, depth of well _ /~"~0 ,~ 9. Sewage Disposal System . . Type of System: Public Utility If Individual, date of insteJlation ~//~?/'~ ~) , Individual (o~-site) _. EQ-037 (1/74) AL, .,,A DEPARTMENT OF HEALTH AND SOCIAL SE~,,CES DIVISIOI~ OF PUBLIC HEALTH INDIVIDUAL AND SEMI-PUBLIC BAC'I'ERIOLOG I CALi WATER ANALYSIS NDIVIDUAI. SEMI-PUBLIC [] CHLORINE RESIDUAL PPM___ REPORT RESULTS TO CITY._ ZIP CODE__ ~ESOURCE / I .,' COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY )AEE COLLECTEO _ _~ (L~I ¢ '_~'~__ THAI COLLECTED /(' 'r ' SOURCE ~ Spnng ~ CIslem ~ Other ~ q Bosempnl ~ BasemenlOffse ~ Under Hous~ Diomeler of We [~ Of W~ [] OlDer J PURPOSEOTEXAMINATION:IIIressSus[)cled9 []Yes [] NOI (' :~:~' '- k 5 ~, ~,l~ BACTERIOLOGICAL WATER ANALYSIS RECORD / 48 Hours Brd ,onl Oreer READ IfNSTRUCTIONS i REVERSE! S DE 24 Do.r~ 48 Hour~ [] Questionable SANITARIAN'S REMARKE EMB _ BEFORE ladose Brai 24 hrs Coliform Dens MF Renu rs COLLECTING SAN_.~L.~E