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HomeMy WebLinkAboutGREAT LAND ESTATES #3 BLK 4 LT 9 ) MUNICIPALITY OF ANCHORAGE ~-.,.." DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE I [~NEW MAILING ADDRESS LEGAL DESCRIPTION Well Absorption ~re~ Dwelling PERMIT NO. DISTANCE TO: ~ ] ~ ~ Manufacturer Material No, of ~ < ~~ ~~C compartments~ ~ ~ DISTA~C[ TO: ~ell D~olHn~ P~BMIT ~O. O ~ ~ Manufacturer Material LiquM capacitg in ~aHons ~ Well Foundation / ~earest lot line ~ ~fiBMIT ~O. ~ No. of lines ~ Length of each~line/ Total length~ ~ °f/lines Trench~wJdth~ inches ~ ~ ~ Top of tile to finish grade ~ / Material beneath die Total effective absorption area - ~ ~ inches Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO, Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: ' OTHER SOIL TEST RATING IN~ALLER . R.~KS ' APPROVED DATE LEGAL q 72-013 (Rev. 3/78) ~. ~ Department~ ~-Heaith-~nd Environmenta~~ ~rotection ~' ~ 825 ~" Street, Anchorage, AK. ~'~9501 ' 264-4720 * * ~ HANDWRITTEN PERMIT ~ ~ ~ WELL AND~ON-SITE SEWER PERMIT ~ ~ .~~ Mailing Address: Location: Phone Number: ~2 ~ Legal Description: ~D~/~'~~//~Lot Size: Type of Soil Absorption System Is: Trench: ~ Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: .~ Soil Rating(sq.ft/br) /~ The Required Size of the Soil Absorption System Is: ' Permit# DEPTH /~' LENGTH ~0' GRAVEL DEPTH '~'-~ WIDTH~/?oS The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /,~"0 GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED ~ * ~ Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 3L i 9 8 3 * * * Z certify that: (1) I am familiar with the requiremen'ts for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (.3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that. 3 bedroomS. ~ Applicant ~ Date: ~~ ~_~ SWP/024(1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street. Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 Su. o, SLOPE DATE PERFORMED: ~'~(~,~ SITE PLAN 10 11 12 13 14 15 16 17 18 19- 20- COMMENTS 72-008 (6/79) WAS GROUND WATER . ~ S ENCOUNTERED? , /V~) L O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN CERTIFIED DATE: Io ............ ~ ~oD~ lying adlocent thereto. ~at no im~a~e~n~ on p~ope~ lying adj~ent NATER WELL RECORD <"~/' STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Orilling Permit No. A.D.L. No. Io.llBor(~ugh, i Subdlvilion Lot Block Ih.Il, '/4qfr.. S.¢flon NO. Townlhlp N[~] Range Er--~l Meridian Anch --of--of--of -- S~ W~ Ic.~]DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS ~. OWNER OF WELL:M~e Barger 4 W L DEPT ; (final) 5. TE OF CO WELL LOG Surf=c~ f. _ _ -- Malefic.? Ty~4 - Top Bottom Botlder.' 2 4 ~g.. ~J.,,,d ~eo,~d ~ ~O,h.,= Sand, gravel, boulders, 4 59 7. usz: ~om*,,~c ~,u~uc s=pp,y ~ ~.d.,',~ Silt, sand, Erawel,'wate~ 59 $. OAS~NG= ~ Th~eeded ~ Wl~dld diam. in. t~~pth Stlckup ' ft. 9. FINISH OF WELL: Type: Diameter: Slot/Mesh Size: Length: Set belwaen ft end ft. BackflUing Gravel peck ~o. STaTic WATE. LEVEL: ~ --. / / ~ AbOVe Or ~ Below lend Surface Equipment used: II.PUMPING LEVEL bllow lend lurf~ce end YIELD I~.GROUTING Welt Grouted: ~ Yes ~ No MGtlrlel: ~ ~eaf Cement ~ Other: IS. PUMP: Cif aveUoble) HP Length of Drop Pipe ft. capacity ~g,p.m, 16. WATER WELL CONTRACTOR'S CERTIFICATION: 15. WGter Temperature o ~ F ~ C Magnuson Drill~g AA · ~d.e~: P.O. Box 770504 ~gle River, Ak. Authorlzl~ Reprll;ntOIIvl / ' Parcel I.D. # . MUNICIPALITY OF ANCHORAGE "'~%" ~'?4L ~-~ 4A/C, Vo 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 1. GENERALINFORMATION Complete legal description Lot 9; Block 4; Great.laDd Estates ¢3 Location (site address or directions) 19840 Dor±nda Drive Chugisk, AK Property owner Guy Soper Day phone 688-4~19 Mailing address 19840 Dorinda Drive Chucjiak, AK Lending agency... ' Mailing address · Agent Sharon'~insch/, Remax of Sagie River Day phone Address 3_6600 Centerfield Drive~9~e~" River, AK 99577 Day phone 694-420O Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well ×xx Community well NOTE: RECEIVED MAY 7 6 1957 Municipality of An Dept. He chora e Public water alth & Human Ser~g~c~es -'If community Well system, provide written confirmation from state ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer 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 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 S & S ENGINEERING Phone ]7034, Eagle River Loop Read No. 204 Address Eagle River, Alaska 99577 DHHS SIGNATURE Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 DH HS 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 ~/~_~ Municipality of Anchorage ~ Environmental Services Division /~. ~'~ 825 L Street, Room 502. Anchorage, Alaska 99501. (907) 3~-~744 Health Authority Approval Checklist Legal Description: ~r~ ~q ~l~~& [~ Parcel I.D.: D ~/~ /~ '-~ A. WELL DATA Well type ~J Log present~,N) Total depth Sanitary seal If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to g¢o / .- ~ J , ~7.~f FROM WELL LOG - Casing height (above ground) Wires properly protected~JN) AT INSPECTION Date of test Static water level Well production g.p.m. WATER SAMPLE RESULTS: Coliform ~ Nitrate /, ~,~ Other bacteria ,/ Collected by: "-~- ¢" '~ ~--~:,~U/~ ,~_ B. SEPTIC/HOLDING TANK DATA Date installed / ~ ~' ~ Tank size /,~ Number of Compartments ~:2 Cleanouts~N) y Depression (Y~)~ / High water alarm (Y/N) '/J//~- Foundat on c eanout.,.i~'N) ..... ..? . Date of PUmping i¢/~., ~- Pumper .~-/~-. C. ABSORPTION FIELD DATA ' , Date installed !~7 ~¢.3 Soil rating (g.p.d./fF o~ I~'-o ~ System type Length [~ 0 / Width ':' -~ / Gravel thickness below pipe ~ ' Total depth Effective absorption area ~g)O/~ Monitoring Tube present~N)__)~_ Depression over f eld (~?. Date of adequacy test ~"-~"~ ~ 7 Results (Pass/Fail) '/~.,~¢'-~ For / Fluid depth in absorption field before test (in.); Fluid depth ~ (ins) Minutes later: Peroxide treatment (past 12 months) (Y(~ Immediately after ~o~) gal. water added (in.): Absorption rate = 4¢ ~) b ~' .g.p.d. /,~a ~J-4f yes, give date /"~'~-- bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES *Datum Size in gallons "Pump on" level at* _ -----~" level at* Qn adjacent lots On adjacent lots SEPARATION DISTANCES FROM WELL ON LOT TO: [~e t~olding tank on lot ~ ~O Absorption field on lot \ o'~ LJ~ RECEIVED MAY 1 6 1997 Municipality of Anchorage Dept, Health & Human Servicee Public sewer main ~r~~ Sewer/septic service line '¢-'¢ Lift station SEPARATION DISTANCES FROM/~Ep'IzI~-IOLDING TANK ON LOTTO: Foundation ,.S-/ Property line /d--~ ! ~' Absorption field ~/- Water main/service line /0 Surface water/drainage /o° Public sewer manhole/cleanout SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line_ /~ I¢- Building foundation /O 14..-- Surface water /~o O / ~ Curtain drain /,,.~o ~ ~ //~zd ~ ~--¢ /¢) Wells on adjacent lots Water main/service line Driveway, parking/vehicle etorage area Wells on adjacent lots / z~9 ENGINEER'S CERTIFICATION in conformance wi~h ~t40A HAA gp~elines in effect on this date. ? 7Z Signature /~ ~-~ ~~ Engineer's Name A ~ ~ /~'~ C. ~; ~,~ HAA Fee $. ':::::~' ~ Waiver Fee $ of, ,m.nt Receipt Number. . ~ Receipt Number 72-026 (Rev. 3/96)* CT&E Ref.# 972256001 Client Name S & $ Engineering Project Name/// N/A Client Sample ID L9 B4 Greatlsnd #3 Matrix Dfil~ng Wat¢~ Ordered By PW$1D Client PO# Printed Date/Time 05/12/97 ~3:05 Collected Date/Time 05106/97 14;50 Received Date/Time 05/06/97 16:00 Technical Director: Stephen C. Ede Released BY_ .~~-~n f~ Sample Remarks; CT&E Microbiology Drinking Water Program certification status is provisional as of 4/8/97, ResuLts P~L Units Nitrete-g 1.93 0.100 gg/L ~o~at Cotiform 1 OB g/O COLI ¢0L/100 ~L ~ L~mi~s , Date.~ Dat~ $~18 4500-NO3F 10 max 05/07/97 JBL 05/08/97 RAM 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 9; Block 4; Gr~land Estates #3 Location (site address dE directions) 19840 Dorinda Driv~ = 94. Property owner '2 G_regory ~ Peggy Gebhart Day phone Maiiipgaddress,. - 1805 Parkside Driv~ Anchorage, Ak. 99501 Lending'agenCY'-'" '"' Day phone Mailing addre~s~,~ ~" i' ::~ Agent L~: B~e~;;: ~ENTURY 21/COLONIAL Day phone' 696-8600 Address BusineSS Blvd. Eagle River, Alaska 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well XX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer 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 'XJo/~ speau!Bue leUO!SSejo~d CHi u! suo!ss!uJo ~o sJoJJe Joj elq!suodseJ )ou s! el3e~oqou¥ jo X~!led!o!un~ @q/ 'penss[ s! e],eoU!:peo ~ eJo~eq e~ep eZ~leUe Jo suo!),oedsu! ~onpuoo ~ou op SHHO ~o se@/,Old LU3 'S~UeLUeJ! nb@J ~)~e~9 pub le~epej u!e~Jeo/gs!~es o~ J@pJo u! suo!)n~!)su! 8u!puel ~!eql puc seLuoq Jo sJaseqoJnd 03 Xse~Jnoo e se s!q) seop SH HO eqJ. 'e~SelV jo e3e~S eq~ u! p@Je~,S!beJ JaeU!Bu8 leUO!SSejOJd ~uepuedepu! ue Xq e^oqe g qdeJbeJed u! ue^!8 suop, e)ueseJdeJ eql uodn XlUO peseq se)eoy!MeO le^oJdd¥ /qpoqm¥ qiteeH senss! (9HHQ) seo!A~es UeLUnH puc q31eeH jo ~ueLu~JedeQ ebeJoqou¥ jo/q!ledp!UnlAI eq.L s3uewwoo leUO!]!ppV :suo!jelnd!js ~UIMOIIOJ eH3 H3!M 'SLUOOJp@q Joj le^oJdde I~uo!)!puoo 'SLUOOJpeq _~ 'pe^oJddes!O Joj pe^oJdd¥ --~- :al:ln±~NSlS SHHa eJn)euB!s s,Jeeu!BuB sseJppv "9 .g Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-'¢"¢cl ~?LV.-~' A. WELL DATA Well type ~¢~'J A'¢~,,- Log present.N) Total depth ~,c, ~ Sanitary seal (~/N) If A, B, or C, attach ADEC letter. Date completed Cased to L~O ~ FROM WELL LOG Date of test ct ~ct ' ~'~ Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line t~ ADEC water system number c~ ~t ~ Driller t-~ 5,~ ..[ Casing height Wires properly protectedd~/N) AT INSPECTION L~- ~ ~-z_ g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ ~'~ ~'~ o~,-.~ Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ~ o - ~5"5 ' Cleanouts ~.~N) High water alarm (Y/~) Date of pumping Collected by: Other bacteria S & S ENGINEERING 17034 Eagle River i. oep ~.,;,~-d ,%'c. 204 Eagle River, Alaska 99577 Tank size ~Z.~"O f_..c,z~-~ Compartments -'7....- Foundation cleanout ~N) ~/ Depression (Y/~ ~-~ Alarm tested (Y/N) ~'[ ~/~ Lc, --~ ~_ Pumper ..7~'-~..~,¢~ ~ ~ ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /. cC> ~'~ On adjacent lots To property line ! D Absorption field Surface water/drainage J ~z5 ~ ~' /'z::;~c, / ~' Foundation ,~' ~ Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes ,(~v~ SEPARA~~ROM LIFT STATION TO'. Welfon lot On adjacent lots Manufacturer Manhole/Access (,~'/N) ~ "Pump on" level at .~~"Pump off" level at ~ Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed Length Total absorption area Depression over field (Y~'~ Results ~'-~fail) Peroxide treatment (past 12 months) (Y~) /¢~/~ Soil rating I~"¢ ~/6¢--, Gravel thickness Cleanouts present~/N) Date of adequacy test for ~ /¢~r ~2 ~¢_. /4','~,~ If yes, give date System type '-r"¢~¢----,-& ~ Total depth 20 ~ bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /¢D ~'~ To building foundation On adjacent lots ~¢ ~ ¢"- 3utbank Surface water Curtain drain _ On adjacent lots / ,~ '~ Property line To existing or abandonedsystem on lot Water main/service line Driveway. parking/vehicle storage area _ E. ENGINEER'S CERTIFICATION' I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature __ Engineer's Name Date S & $ ENGINEERING Eagle River, Alasl(a 9957Z HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 · /1~ CHEMICAl., & GEOLOGICAL LABORATORY 5033Fl STREI~T ANCHORAG£, ALASKA. 99518 T~E (907) ~,$2-~343 FAX: (907) 501-5301 P#SlD B?O{ ; ................................................... L:,:C" 'J;,, ..... && ' "';°-;"~;&;' -- - ~,.~,m .2::% ............................................................... 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 10t, block, subdivision, section, township, range) Location (address or directions) D::/~/,,~L~/-t /p/~/~..'E--., :-//z:7- ~~ o~/ ~/ ~ ~ T_, ~ ~ ~ ~/~ ~b) Property owner~2 ~/~ ~ Telephone: (home~~? Business ¢~¢ MailingAddress ~-~ ~7/~ ~/~,~ (c) Lending Institution ~~ ~~-~ Telephone ~/~-~-7~- Mailing Address ~ r~/~ ~/~ ~ ~/~/~/ ~~/~.~- (d) Real Estate ComPany and Agent ~~ ~ ~ ~ /~ , Address /~ ~O ~~/~ ~ ~/~ ~/ ~ ~~ Telephone ~ ~ ~ o (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 ~ Number of bedrooms ~- 3. WATER SUPPLY Individual Well E)/ 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 E~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-o25 (Rev. 7/88) Page 1 of 2 · ~Jo~ s,.~eeu!6ue leUO!Ssej, o.~d eql u! suo!ss!~o Jo sJ oJ.~e Joj elq!suods@J ~,ou s! eBeJoqouv j.o .~Jled!o!u nlAI eq/'penss! suo!loedsu! lonpuoo ~.ou op SHHQ j.o s@e~old Lu~] 's~.ue~eJ!nbeJ elels pub leJepeJ. 6u!pu@l J!eql pue seuJoq J.o sJeseqoJnd ol ,~sepnoo e se s!ql seop SHHQ eqj. 'eHselV Jeew6ue i~uo!ssej, oJd ~.uepuedepu! ue,~q e^oqe ~ qdeJ§e.md u! ue^!6 suoRm, ueseJdeJ eq~. uodn llUO peseq peleoN.!Jeo le^oJddv,~.poqlnV q~.l~eH senss! (SHHQ) seo!^JeS ueLunH pue qlleaH jo lueLul.mdeQ eBeJoqou¥,to/q.!led!o!unR eq/ le^oJddv leUO!l!puoo ~o SWJ@/ leuopjpuoo peAoJddes!a ~ peAoJdd¥ ..~ ,Io~. psAo.Jdd¥' "IYAOI:I~d'¢ sHHa '9 .NiQ~I~I~Q~Dk~A~F ANCHORAGE (MOA) oNMENTA~P_,~tfJ~rA~b~I~t~I Approval (HAA) CHECKLIST - FEBRUARY 1984 2 0 19~ 343-4744 Legal Description: ~ If A,-B, C, D.E.C. Approved (Y/N) ~./~/,¢'_..~ Yield ~ (~,,~'//// Pump Set At --~-<~' ' Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) WELL ,DATA Well Log Present (Y/N) '~// Date Completed Total Depth. ~'~'/ Cased to .-~'~? Casing Height Above Ground ~. ,4::2 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 /~.~ · ' TO Nearest Public Sewer Line '/(-//~ ' To Nearest public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ~/"~¢,4¢-~-~''~' ; Date Water Sample Test Results Comments ~/E~~ ~ ~ ~ ~ SEPTIC/V~LD;N~ TANK DATA Date Installed /~/~ Size /Z~. No. of Compartments Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Cont~c~ on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line ; On Adjoining Lots /~7,,~ Temporary Holding Tank Permit (Y/N) FOundation Cleanout (Y/N) ~ Date Last Pumped /~/-~"/,¢]~ ,~ ~¢' ; for To Building Foundation To Disposal Field To Stream, Pond, Lake or Major Drainage Course Comments ~,4,~ ~,~,.,~'~'~¢' ~ ~ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /~:~ 5'-,~'//~¢,~/','~¢~'¢'~ Type of System Design Date Installed /~//,~,~¢.~' Length of Field ~' ~::) Width of Field ~"'¢~// Depth of Field Gravel Bed Thickness Square Feet of Absortion Area ~z~::) ~'.¢~, Statndpipes Present (Y/N) Depression over Field (YIN) ~:: . Date of Last Adequacy Test /~//~/~ Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well /~/ To Property Line To Building Foundation ~ To Existing or Abandoned System on Lot ~/~ ; On Adjoining Lots /~¢ To Water Main/Service Line /¢O ¢ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course ~¢~ '% To Driveway, Parking Area, or Vehicle Storage Area ~ / D, LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) , Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guid..,,eJ~_ _--""~i~,~Jfect on the date of this inspection. . . / ¢ ~ ¢'%~¢,,,,,,,=.;4% .... ~.....-.&.._,~ngineer's Seal MOA No ....... ~ John D. Receipt No. 0~' ¢0"7L~ y ,~ Receipt No, Date of Payment l 0 "~0'-¢¢ Waiver Fee: $ Amount: $ /~ O.~) Date of Payment 72-026 (Rev. 7/88) 8ack Page 2 of 2 LOT CE I'IFICATE OF SURVEY I hereby certify that I have surveyed the following d~cribed .property; Lot 9, Block 4, Greatlend Estates Addition No. 3 S~i. visim. Ancl~orage R~cording District, Alaska, and that the tmm~ments situated thereon are within the property lines and cio r~t overlap 'or encroach on the property lying adjacent tl~to, that n~ imomvemeots on property lying adjacent thereto tmcroac~ on the premises in question and that there are no .r~ys. transmiSSion lines or other visible easements on said property except as indicated hereon. ~ CHEMICAL _&_ GEOLOGICAL LABORATORIES OF ALASKA, INC. / ~~\- ~ ~'~-~ ~^~~ ~-~ ~ ~"'t~'o;*,~',~'% FEDERAL TAX ID # 92-0040440 & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE £or Work Order $ 9785 Date Report Printed: OCT 17 88 ~ 15:42 Client Sample ID:L9, B4 GREATLAND ESTATES ~3 PWSID :UA Collected OCT 11 88 @ 06:20 bxs. Received OCT il 88 $ 14:00 hrs. Preserved with :4 DEG. C Client Name : BATES, HARRY Client Aeet : BATENC P.O.~ NONE REC'D Req $ Ordered By .: Analysis Completed :OCT 14 88 Send Reports to: Laboratory Superxi;~TEPNEN C.~[DE 1)BATES, HARRY Released By : ~ ~-'. ~ 2) Special HOLD FOR PICK UP AND PAY~NT. Instruct: Chemlab Ref g: 2974 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result/Units Method Limits NITRATE-N 1.8 mS/1 EPA 353.2 LO Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY H.B. 1 Tests Performed ' See Special Instructions Above HA~Unavailable ND= None Detected "See Sample Remarks Above HA~ Not Analyzed LT=Less Than, GT=Greater Than ~ MUNICIPALITY OF ANCHORAGE ~ DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF m~ALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR ~ALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ~//7~'~ (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name ~,~/-z~/ ~z~ Telephone - Home Business 27~ -O-C/7 Applicants ~dress ~/ ~-/~ ~ ~~~/ ~ ~~ (c) Applicant is (chec~ one) Le~ing Institution ~; ~er/b~lder ~; (d) Lending Ins =itution ~~ ~ ~L~ ~ ~. elephone ~3 - 3~ (e) Real Estate C0. & Agent Address Telephone .f'6/- Z ~c~ (f) Mail the HAA to the following address: Type of Residence Single-Family~ Number of Bedrooms 3. Water Supply Other (describe) e Individ l Well o=unt y f-q Public f--[ 'Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Sewage Disposal ~ 0nsite~ Public ~-~ Community ~-~ Holding Tank ~ Note: If community well system, must have written qqnfi~mation from the Sta~e Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. En$ineerin$ Firm Providin$ Inspections~ Tests~ File Search~ Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of- this Health. Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein.- I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site wmter supply amd/or wsstewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. DHEP Approval © Approved //'~ Disapproved - Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES ~'~ALTH AUTHORI~f APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGR~ 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOI~ES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. RR4/ej/D18 [Page 2 of 2] (DHEP SEAL) 7-19-84 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification _c/~/~/f/~'/~T~ Well Log P~esent (Y/N) >/ Total DEpth ~ / Cased to NOV 71gl : RECEIVED Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances frc~a Well: -- ~-. O ~. Pump Set At 3'~ ' 3~ Sanitary Seal on Casing (Y/N) y DEpression A~ound Wellhead (Y/N) ~/ 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 /f//~ To Nearest Public Sewe~ Cleanout/Manhole /~ . To Nearest Sewer Service Line on LOt Water Sample Collected By /./,,/~-,~~--~''5~ ; Date Water Sample Test Results SEPTIC/~t4~9 TANK DATA Date Installed /d/)/~--~ Size /~ ~/~ No. of Ccrapa~tments Standpipes (Y/N) ~/ Air-tight Caps (Y/N) ~/ Foundation Cleanout (Y/N) ~/ DEpression over Tank (Y/N) /6/ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High-Water Alarm (Y/N) /~'~ Temporary Holding. Tank Permit (Y/N) Separation Distances fram SeptiC/Holding Tank: To Water-Supply We 11 / To Property Line To Water Main/Servioe Line co~se ~ ~-~ To Building Foundation~/ To Disposal Field ~-/ To Stream, Pond, Lake, a~ Major Drainage Counts [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD ~ATA mt Soils Rating in Absorption Strata /~5-~ ,%~.'~A/Type of System Design Date Installed /~/~/~5~3 ~nG~ of Field Width of Field 3~ ~ ~p~ of Field .... G~a~l ~d ~ick~ss S~e Feet of ~s~ption ~ea ~ J~ Stan~i~s ~esent (Y~) ~p~ession ove~ Field (Y~) ~/ ~ of ~st ~a~ ~st ~sults of ~st ~a~ ~st ~~ ~ ~p~ation Distan~ f~ ~s~pti~ Field: To ~te~-Supply ~11 /~ / To ~o~ty Li~ / To Building Foun~tion ~3 To Existing o~ ~ndo~d System Lot W/~ ; ~ ~joining ~ts To Wate~ ~in/~vi~ Line /~ '~ To ~t~( if ~e~nt) To St~e~ond~ke/~ ~jo~ ~ai~ ~se ~ ~ To ~iveway, Pa~ki~ ~ea, ~ Vehicle St~a~ ~ea ~ z LI~ STATION Date Installed Size in Gallons "Pump On" Level at High Water Alaz-m Level at Tested for Electrical Codes(y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Con~nents ** Check Pe~mittedBed~ocxnRatingAgainst HAARequest certify that I have checked, verified,'c~ confc~med to all MOA HAA Guidelines in effect on the date of this inspection. Company .~F~v~ . ? - [Paw 2 of 2] Date MOA No. ~ ~/'/ENGI~E~ '. ,'~ ~ John 2-15-84 ~3 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTM~J~NT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR h~_~J~TH AUTHORITY APPROVAL CERTIFICATE (a) Legal script~on (ioclu.~e~lqt, blcck,~Su~div/isipn,jsec~io;~~ township, range) Locat~ion (add~ess or directions) (d) Lending Institution ./~ j~/~t~ ~./~/~-~Telephone~/ (e) ~eal Estate Co. & Agent Adck. ess Telephone 2. __Type of t~sidence S ingle-FamilyJ~] Number of Bedrcoms 3. Water Supply Individual ~11~ Multi-Family ~-~ O~er (~s~i~) Public Note: If community w~ll system, must have written ccnfirmati~n ~cm the State Department of EnviroDa~ntal Conservation attesting to the legality and status. Is the well adequate fo~ the number of bedrccr~s specified in this HAA6~/N) 4. _Sewag~ Disposal Is the wastewater disposal system adequate fcr the number of b~dr [Page 1 of 2] 2-15-84 5. Engineerinci Firm Providing Inspections, Tests, Data and Information I ~rtify that I have checked, verified, or conformed to all MOA HAA C~idelines in effect on the date of this inspection. Nam~ of Telephone Signed by , 6. DHEP Approval Approved for Appro~d ~ ( ENGINEER SEAL) Disap.p~oved~-~ Conditional~ Temms of Conditional Approval The Municipality of Anchorage Department of Health and Environmental R_~otection dces not guarantee the continued satisfactory ~erfc~mnce of the water supply and/o~ the waste%~ater disposal system. This approval indicates that, as of the validation date shown abo~, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal s~Istem is safe and fun~~ tiomml for the Dnmber of hedrcc~s and type of structure indicated. ( DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s [Page 2 of 2] 2-15-84 MUNICIPALITY OF ANCHO~GE (MOA) HEALTH AUI~ORITY APPROVAL (FAA) CHECKLIST - F~BRUARY 1984 Well Classification Well Log P~esent ~/~Y)/N) Total Depth (~f Cased to Static Water Level ~ ~3 Casing Height Above Ground Electrical Wiring in Conduit ~N) Separation Distances f~cm Well.- To Septic/Holding Tank on Lot ~/00 ; On Adjoining Lots To Nearest Edge of Absc~ption Field on Lot ~/06 ~ ; On Adjoining Lots To Nearest Public Sewer Line ~/~- To Nearest Public Sewer Cleanout/Manhole lq ~ . 'To Nearest Sewer Service Line on LOt Wate~ Sample Collected By J~ ; Date 3~i~ ~' Water Sample Test l~sult~ Be SEPTIC/HOLDING TANK E~_TA Date Installed ~)¢~- ~-~ [~3 Siz~ Standpipes ~/N) Ai~-tight Caps ~) Depression over Tank (Y~ /Date Last Pu.~ed Pumpir~/Maintenance Contract On File (Y/N) ~i~-; fo~ Holding Tank High-Water Alarm (Y/N) /J/~- Temporally Holding Tank Permit (Y/N) Separation Distances f~cm S~.ptic/Holding Tank: No. of Ccmpa~tments ~- Foundation Cleanout ~/N) ' To Water-Supply W~ll To P~operty Line To Water.Main/Se~vi~ Line To Building Foundation ~. ' ' To Disposal Field ~ s~! ~' ~/~ To S~eam, Pond, Lake, c~ Major D~aina~ [Page 1 of ] z 2-15~84 - C. ABSORPTION FIELD ~ATA Soils Rating in Absorption Strata Date Installed ./o Width of Field Square Feet of Absorption Area Depression over Field (Y~ Results of Last A~equacy Test · ! Length of Field Depth of Field Gravel Bed Thickness '~(~ Standpipes P~esent ~/~,! Date of Last Adequacy Test~J[ Separation Distance from Absorption Field: To Water-Supply Well >/O~! To Property Line To Building Foundation ~ ~ ~/~ To Existin~ or Abandoned System cn 'Lot ?L~/,~ ; On Adjoininu Lots To Water Main/Service Line TO Stream/Pond/Lake/or Majo= Drainage Course ~J~ To Driveway, Pa=king Area, or Vehicle Storage Area Date Installed Size in Gallons "P~,p On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Ccm~ents Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles ~ing Adequacy Test. ~cts MOA ** Che~k Permitted Bedroom ]~ating A~ainst HAA Rsquest ** I certify that I have checked, verified, cr conformed to all MOA HAA Guidelines in effect on the date of this inspection. , :'"" ~Ler¥~' C. Re,d, Jr.t/~ ~P~ ....... .,~X ~. [Page 2 of 2] ' 2-15-84