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HomeMy WebLinkAboutGRECIAN HILLS BLK 2 LT 12 nicip H yof Anchorage P.O. BOX 196650 ANCHORAGE, ALASKA 99519-6650 (907) 343-4200 Ti~:~C. hIi(~CZ4.~S, Tom Fink, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES January 8, 1988 6 /7o73 77 Mark White 13441 Larissa Anchroage, Alaska 99516 Subject: Lot 12 Block 2 Grecian Hills Subdivision Permit ¢870008, On-site Sewer Permit A permit issued by this Department for an individual well and/or on-site sewer system has expired' as of December 31, 1987. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for do'cumentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as-built inspection report (three-part form) must be sent to this office for review and approval, and for documentation. Effective January 1, 1988, a new fee schedule is in effect. When re-applying for a new permit, the new fees are; $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. Sincerely, Program Manager On-site Services RWR/ljw enc: Copy of Permit LEGAL DEiZSCF:~ I F:' :: ANCHC)RA[.~E, AK 3 ,.'.i. 5 --" ;2. '2' 4 :;5 995 ! ,./:, !iiiU BD i V l S I O N: GE!E C ]Z AI'4 H I i_I_S SE;/C;T I E)I',I ~ 10 'I'C)NI~SI.41!1 iz' = 12N 20487 (SQ,, F:T. CZ)R ACRES) LC)T". 12 DE~P'i"H 'T'C) F::'iPIZ BC)TTC)H (1:::"I". GRAVEL DEF:'T'H (F"T,,) 'T'L-)]'AL.. DIi3:::'"I'H (F::T.) GRAVEL W!D'!'H (F:'T,.) GRAVEL LEZNG-IH (I:::'"I".) L:;RAVEd_ VC)LL)HiE (EX.J. YDS,. ) FANK SiZE (GAl_S) SOiL F;:A'i'ING (SQ,, F:"T',, /BR) .,~-,.~- ..... .... "~"~.l::"r'"~! TO ,~ ..... .l.i ,. B(:~T"i (L:'H < 4. 'U IZ'T. ,',...~ri'""*"¢ "'*""" '"' -'~- I TF:] ....... "~"'"'"'¢"""i · ":: '", ,'.. ~ ,r'~ -'r ,,' .... 7Y:; .... *' ..... r" ,:. ~:::.r'" ~*~ i. ......., c. r',-,z. ~ .? .~.'~'i ,t""~.'.~ '.75 ........ · mX- ~..,!"u.~v: ..... I..c.,~ Iii > ... F::'T,, RE!;QL.!!R.ES ~'~.;!....I ;.'",....E. ,".~..mh.. (NOT . ~" I.: EAC;H) ~..u,J'.. r~!.~:-':~ I !'"IAVEi; AT LEAS i' TWO : -", .,'r,. "r'," ~I'~(::i j.)") cOfi'qb].i.;:u"ic:¢Z, m.*i:i, tht. hE' c:l~:.'..)ti~J.(~I") c:i"it.E(,i"ia (:)~' th;i.s per'mit.. 3,, ]: t.,~:i.:l.! ?acihG:,p~>~) t.o a11 MOA ancl State !5(.m.~x~:.n',a. ge:, syst.,:::.m~ or'~ t. lt:i.s ch' any ackja(::(f~FYiL L~, Z L.U]CJIE'F'!S'i;..L~H"IcJ t[']4~'i:., t.h:i.!~ ?6::'PfT~i'('.. :LIE. va].:J.d ¢(:]r' a~. rr~T:~)4J, iT)L(m o{:' 3 bedr'ooms and ~., ' .LNg:::, I (.!lL..I...k::.i(J ANt-ir'~,:z.i.-i .... .~,.. I:::.r'~,:.b , i~.,!.-i b~..¢.mL¢..,'.~i4c., COOliES.. E]....E};CTR ! CA~ ..... .. ,.,p. ,.-, Hr ' , ............. HARK WH DEF::'T}"i 'TE} P]ZF:'E BE!T]"E})'4 (F'Y.) GFLAVEL,, DE:F::'TH (I:::'"1"~ ti 'I"OiAI... DL::PTTI (I:::'"i',,) (:D(AVE!.... NifO]'!'4 (F::"F.) GRAVEL L.ENGTH (FT.) GRAVEL Vi3L..UM,~: (CU. YDS. ) DF.']:PAR'FHEI~Ff' OF: HEAL.:i'H AND ENVIRCihJMI::]NTAL.. PROTECTION ::.!;?.5 i.. Si F;;EE i', AhiC;F.~C~RA(:iE, AK 99501 2 6 4-.--4 7 2 () DEPTH TO F']:F:'E BOTTOM (F:']-~ GF;,'AVEL DEF::'TH (F:"I.) ]'O'T'/>d_ DEF:']"F] (F"I'~) GF::AVEi... N ]: D'T H (F:'T ,, ) GRAVE]_ L.I:NGTH (F:"i",;) GFb~VEL. VOL..LIHE (CU~ YDS,, ) TANK S]:ZE (GALS) SC) I L I:~:A 1* I NG, (SC4. Fi', /BI:R ) '? ,, 0 I () ,, 5 32 ,, 0 22 ~ 3 :L, 000 ,, 0 -~..~. '~::"*'):}liiiZi:::"t"l"l '1"0 - ..r'l:::~ ~' ! I [,l'l 4. O "'~' .... r~B.i¥ F~',E:~:)~I'FFi'::: i~4 ~ ','l ......~","~ ¢'~'~'TANK MUST HAVE AT i...!EAST TW[) ( O"'PAF"I'HEFI'i'~:L :i: c e r' t. :L f y 'L h a'L :: :I.,, I am familiar' !4:i. th 'i:.l"i~:~ I'i.:,cjl.~ir'e~ilerrLs f'or on-site seu,,~er's ar'icl for'Lb by 'Ll"ie l'~unic:i.i:~al:i.t.y of Anti']or-age (HOA) and 'it. he State of' A].aska~ 2, ]; ~,,JJ.].] :[rista].]. the syst. i~)m :i. ri a(:c:cH"dai"lci; w:i.'Lh all MOA c:cx:h<,s and pegulat;i, clns, ai'lc! :i.r't c(:triip ]. J. al']l::(~:, ~,~.'k.l"i 'LI-I(~.) design c:i" iter'ia of' 'Lh:i.s per'iii:i.t, ;:;,, I u,~:i.].:[ adher, e 'i:.c~ al! MOA aFic:l State c:!f Alaska r,~:.~qL~j.j.,l~m[~r.i.l:.s f'l:!" t.l"~e s(~.:i;, back distarics~::, i'r'cilii any ex:i.s'l:.ir~g v,~ei:l., ~,~ast. e~h~tt.~:~r', d:i. sposa], syst:.~?lii c,r~ pub].ic ~B(~'!.'~lf.':')l"~/C]i.:~ sy~i'~,,(':'ii! C)i'I thJ,!B C)l" ~U"ly ~;~djac:;iEH"l't',, Ol'; l'](,~.:tl~J::iy z!.~ Z[ ur]c:!ei"s-i:.and that t. his j:)er'niJ, t :J.s va].:Ld for a maximuni c)f' 2 bedpc, oms and any en].argemen'L wi. ti. ?equiPe an addit:i.c~nai perm:i.'L. WI:L!... NDT BE AF::'F'ROVED WITHOUT At',I E:i....E[:;Tt:R!CAi... INSPECT]:ON REF:'ORT~I AND (3) THZ< LoT 4' ~lz~v e~,c - FI~p VF-RIk'Y MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION ~SEP 91986 RECEIVED DO" 203 g/15~" "C ~.,,/' L_~~ 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 DEPTH FEET) 1 2 3 4 7 8 10 11 12 13 14 18 19 COMMENTS .... SLOP-~'r DATE PERFORMED: SITE PLAN WAS GROUND WATER /I / S L ENCOUNTERED? O ~b~ P E IF YES, AT WHAT ~ DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop e///~ o 0 7" o'/ 4¢ 0'' PERCOLATION RATE ,_~f (minutes/inch) TEST RUN .ETWEEN /~ FT AND ? . FT CERTIFIED BY: 72-008 (6/79) 401 ERST FIREWEED LRNE RNCHORRGE, RLRSKR 99503-2197 (907) 276-3770 DRTFIFRX NO. (907) 279-5092 RNCHORRGE · JUNERU · BETHEL · FRIRBRNKS March 28, 1986 Municipality of Anchorage Department of Health and Environmental Protection Division of Environmental Health 825 L Street Anchorage, Alaska 99501 Attention: Susan Oswalt Subject: Lot 12, Block 2, Grecian Hills Subdivision Dear Ms. Oswalt: The house located on Lot 12, Block 2, Grecian Hills Subdivision currently employs a 2000 gallon holding tank for sewage dis- posal. The owner would like to place a standard septic system on the property and retain the holding tank as the alternate system. Last summer QUADRA Engineering performed several percolation tests on the property to locate a suitable site for the absorp- tion field. Unfortunately, only one area of the property appeared suitable for the field. ~The property owner has agreedI to perform additional soil tests "in the area of the field to assure suitable soil conditions exist over the entire area. The holding tank will remain plumbed to the sewage outlet, 'but will be drained. It will act as the secondary system in lieu of another location on the property where suitable soils may exist. A site map of the area as well as the record of the acceptable percolation test is submitted for your reference. If you agree with allowing the holding tank to be used as the alternate disposal system on this property please sign the concurrence block furnished below. Sincerely yours, Michael E. Anderson, P.E. Concur: Department of Health afd Environmental Protection PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17- 18- 20~ 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 DATE PERFORMED: '~/,~/~"~* SLOPE '7--.. SITE PLAN I .-% WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop " bo PERCOLATION RATE ~ ~ Iminutes/inch) TEST RUN BETWEEN /-/~¢/~ FT AND ~" , FT PERFORMED BY: ~'~L,,~/~ /~t_~ CERTIFIED BY: DATE: 72-008 t6/79) ANCHORAGE, ALASKA 99503-2197 ...... (9~' 27~-377~) ............................... JOB -SHEET NO. OF C~_-.. U~.~TE~ BY .DATE ..... (~OKED BY~ ....... .D~TE ' SCALE ~oo0 ~0 WlFL~,'1-A.11 Ok,K, A55Lld~? i~IF,'~. INVB'I~T I~Z\/, A,T ~'OUkIOATION DKo? IN ,:2REP IN. I000 ~FA, L 'fAFIB rZ. pl't-I -TO R'PF. Iht P~:~H 1co f~/l:'l'ct, b'f c~y wt~<'qcl-I ff'RF,Xlc,kl Jl'l LTY IOO.: TO ! / ! .Lo1' I? WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of GeoIogicDI ~ Geophysical Surveys Drilling Permit No. A.D.L. No. LOCATION OF WELL (Please complete either la~ [b or Ic.7 .......... rlo.llBorough Subdivision Lot Block Ih.ii '/4qtrs. Section No. TownshiPN[~ Range Er-~ Meridian DISTANCE AND D,II~ECTIO~I FROM ROAD INTERSECTIONS 5. OWNER OF WEL~: Street Address and Area of Well Location Feet Below 4. WELL DEPTH: (final) 5. DATE OF COMPLETIO~, Material Ty~e TOp Bottom = t ' '~ / '-- ' 7. USE: ~ Domestic O Public Supply ~ Industry ~ Irrigation ~ Recharge ~ Commerical DEPT. OF HEALTH ~ 8. CASING: ~ Threaded ~ Welded diam. in. to~ ft. Depth Stickup ~,?. , ft. I0. STATIC WATER LEVEL: Date ~Below land surface Il. PUMPING LEVEL below land surface and YIELp -* ,~-' ..., ¢ d/~ ¢ Material: ~ Neat Cement ~ Other: ~] 15. PUMP: This we'l wes. drilled d[~d~r~yf '~r~sdz , ~.~ ~c~i°~ o~d ~ is repor, is ~rue ~o ~hee~e~ ~.. ~ ~ ~ff/~"/es of my knowledge ~nd belief; January 5, 197:? Le~ Boyko rA!~ohorage# Alaska 99507 On January 29, 19~ ~ou ~ok ou~ ~ w~ll ~r~ f~ ~this b~ approvaa. L 8~reet~ Fourth Fl~or William GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVAONMENTAL QUALITY -- -- pER_MIT NO. ~ , -- /2 ~y~t_"h.~- APPLICATION AND PERMIT /"' ~'~ FINANCED THROUGH MAILING ADDRESS PHONE . NOTE~ THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK SEEPAGE PIT SEPTIC TANK . TO NEAREST LOT LINE. WELL TO SEPtiC TANK /~)~/ WATER MAIN TO SEPTIC TANK SEEPAGE AREA SIZE TYPE DRAIN FIELD DRAIN FIELD t SEEPAGE P'T ALSO CONSIDER AREA WELLS, , SEEPAGE Pit DRAIN FIELD K SEPTIC TANK. l~0 ,SEEPAGE Pit /dO , DRAIN FIELD TO RIVER, LAKE, STREAM· CAST IRON INTO AND OUT Of SEPTIC TANK AND INTO CRIS CROSSING GaP Of EXCAVATION 5 FEET INTO UNDISTURbED'SOIL· 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT rEMOVASLE CAPS· GRAVEL BACKFILL CONFORM TO BOROUGH F~EGULATIONS REGARDING INSTALLATION· OR DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE· FORM NO. EQ-O$ 6 :~":' ' '"'- ]4, ,Y rZ_ /?: ?' Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section u/~, ~/~ P.O. Box 196650 Anchorage, Alaska 99519-6650 , ~ ~. 343-4744 1. GENERALINFORMATION Complete legal description Lot ~"g: '~" ' ~ ~' ' '"" Location (site address or directions) Anchorage, AK . Property owner Mailing address Lending agency Mailing address ~ ;" 345-723~ Jar..~e.s U,:'.sk~;'_ & Cece.,.,,,~. Dx'.emidor!~ Day phone Day phone Agent Charles Bla.?.ock / Bob Pete.rs Address VISTA REAl_ EgTATE Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: ;,.'XX Individual well Community well Public water /200 Day phone 27~-~ °° NOTE: If community well system, provide written confirmation from State ADEC attest- lng 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~)25 {Rev. 1191) 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 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 17034 Eagle Kiver Loop Road Address Eagle River ~,laska ~29577 /7 Engineer's signature ~/~['~ ' ?~ Phone Date '7 / S /¢(~ __ DHHS SIGNATURE /~/ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date 7-/,.5'-- ~'~' The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1191) Back MOA ~21 ~ Municipality of Anchorage ((~'~L~i~(~-~/} DEPARTMENT OF HEALTH & HUMAN SERVICES ~ Environmental Services Division .,~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (90~'~3-47~ Health Authority Approval Checklist Legal Description: Z J~ , /~-~ ~¢',,~¢~'C~/.~,R/~' //,z--Z~£--(/~Parcel I.D.: E'~J ~¢ / / A. WELL DATA Well type /¢'~-~L~ ~/~ Log present ~)N) Total depth Sanitary seal ~/N) 7~' If A, B, or C, attach ADEC letter. ADEC water sYstem number ~/Z~"~- Date completed ,-~ ~/'¢ :~°C'~ '7 Cased to //;7¢ / Casing height (above ground) / 'lc,- Wires properly protected (~N) ~"~.~' Date of test Static water level Well production FROM WELL LOG AT INSPECTION /?" 7 6' g.p.m. g.p.m, WATER SAMPLE RESULTS: Coliform Date of sample': B. ~I~I:~/HOLDING TANK DATA Date installed Nitrate Tank size~¢'¢, O ~'~Z. O. I Other bacteria Collected by: ~U/~/~F''~k- ~' ~'t)(-,,,,-"¢,4-"' S & S ENGINEERING 17034 Eagle River Loop Rea6 No. 204 Eagle River, Alaska 79577 Number of Compartments / Cleanouts&~/r~). Foundation cleanout (y/._~r~, /¢¢] Depression (Y,~ /~'O High water alarm ((~N) ¥ ¢ 5 Date of Pumping 7/ $ /~6, Pumper i?dT° r~e 'T~,~ ~C;--~.BSORPTION FIELD DATA Date ins-'s-'~'atalled. ----- Soil rating (g.p.d./ft2 or ft2/bdrm) System type Length· ' ~"~W. Ldth __ Gravel thickness below pipe. __ Total depth ~ Effective absorption area~MrMonitoring Tube present (Y/N) Depressier~~N)~ Date of adequacy test ' Resu~lts-(P..as~s/Fail)¢¢¢ ~-~¢* For__bedrooms Fluid depth ~n absorption field before test (in.); ~.~¢lmme'd~ t~ after~ gal. water added 0n.): Fluid depth (ins) ~[inut~'~tter: Absorpti~=.. g.p.d. :~~9~~onths) (Y/N) I, yes, give date~'---~..~ D. ' ~'"- LIFT STATION *'~'---_ ~~-~'~ Date installed Manhole/Access (Y/N) __~.~j~o'd-n" le-~'el~....~ "Pump off" level at* __ High water alarm ;evet .~~'~ .Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line Lift station On adjacent lots On adjacent lots j~¢~--~ ' '/- Public sewer manhole/cleanout SEPARATION DISTANCES FROM .~.~/HOLDING TANK ON LOT TO: Foundation J~ ''/~ Property line ~'~:? '¢ Water main/service line //~/'~ Surface water/drainage/'~ov~ Absorption field J~'~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ..... ~ Building foundation Surface water ~i~rlveway, parking/vehicle storage area Wel I~'~a~jac.~n t lots ENGINEER'S CERTIFICATION I certi~thatlhavedeterminedthrufieldinspectionsandreviewofM~nicipalrecordst~ ~~~0 .... in conformancewithMO~HAAguidelines*effectonthisdate.~~ ~ Signature ' E ngineer'sName ~0d~ ~' ~' ~; ~ Date ~ / ~ / ~ ~ HAAFee $ ~'~ ¢ ~ Waiver Fee $ Date of Payment Receipt Number Date of Payment Receipt Number 72-026 (Rev. 3/96)* CT&E EnvirOnmental Services Inc. Laboratory Division Laboratory Analysis Report CT&E Ref.# Client Sample ID Matrix PWSID 0 962509.962509002 Lot 12 Block 2 Grecian Hills Drifting Water Collected Date 06/21/96 Technical Director: Stephen C. Ede S~pleRem~: Nitrate-N Iota[ Coliform Results QC Qual. 0.100 U 0 PQL Units Method Allowable Prep Analysis Init Limits Date Date 06/23/96 Elizabeth 06/21/96 TAV 0.100 mg/L EPA 353.2 0 co[/100mL SM18 9222B U - Undetected LT - Less than GT - Greater than D - Secondary Dilution J - Below the calibration range 200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tel: (907) 562-2343 Fax: (907) 561-5301 3180 Peger Road, Fairbanks, AK 99709-5471 -- Tel: (907) 474-8656 Fax: (907) 474-9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) LOT" /~, E~k',.~.. ~c.~,~ HILLg. Location (address or directions) (b) Properly Owner ~A~ ~[ F~ Telephone: Home ~q-~ Mailing Address ~ ~ ~ ~ 1 L~J~ (c) Lending Institution ~~ ~~ Telephone Mailing Address ~~ ~ ~ (d) Real Estate Company and Agent N ~ ~ Business Address Telephone (e) Mail the HAA to the followina address: or; Check herexJ~ if hold for pick up. List contact person and day phone number below. / TYPE OF RESIDENCE Single-Family~ Number of Bedrooms WATER SUPPLY Individual Well N Community [] Public [] Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. , .' _ SEWAGE DISPOSAL [] Public [] Community [] Holding tank~ ., Onsite Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 (Rev 8/861 Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my sea[ 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 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. /2 Name of Firm Telephone Address / Date Engineer's Seal DHHS APPROVAL Approved for ~""~'/L,~) bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes 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. Page 2 of 2 77-025 fray 8/861 Back MUNiCiPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION MAR 2 3 1987 WELL DAR E C E I V E D Well Classification I~ MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: J--~ ~'/~ /~' ~.., ~ ~/~ ~ / If A, B, C, D.E.C. Approved (Y/N) ~//t~.. Y Well Log Present (Y/N) Total Depth ]/"J/m Cased to Static Water Level &'7' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To ~'cF.t!:/Holding Tank on Lot To Nearest Edge of Absorption Field To Nearest Public Sewer Line Date Completed ~'~ ¢1 ~ ~°'7 ~ Yield Depth of Grouting i'~OH I,~ Pump Set At ~ "r~'~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by ~.~. Water Sample Test Results Comments B. ~¢~.¢~¢HOLDING TANK DATA Date installed Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from .~/Holding Tank: Size,.~4~¢ No. of Compartments C~I~ Air-tight Caps (Y/N) ~'* Foundation Cleanout (Y/N) Date Last Pumped ~/~.S/g7 '-~. ~ K~ ; for Temporary Holding Tank Permit (Y/N) To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/841 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well 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 Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request I certify that I have ~ec. ,k~d,~e:ili~d, ,(,~ conformed to all MOA and HAA guidelines in effect on the date of this inspection Signed "~. ~'/~4.(-r.¢~4 ~ Date Company MOA No. Receipt No. '¢~ - O 0 / -(-~O/3 Date of Payment C-~'~::r~ ~ -- 0¢ 7 Amount: $ //O ~ Page 2 of 2 72-026 (11/84) Engineer's Seal CONSULTING ENGINEER TELEPHONE: (907) 279-3916 RESIDENTIAL WELL INSPECTION LEGAL: LOT 12, BLOCK 2, GRECIAN HILLS LOCATION: 13441 LARISA OWNER: MARC WHITE TYPE OF WELL: SINGLE FAMILY WELL LOG AVAILABLE: YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: 6- 10 GALLONS PER MINUTE PUMP YIELD: 5+ GALLONS PER MINUTE DATE OF INSPECTION: MARCH 20, 1987 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 3 GALLONS PER MINUTE FOR 15.5 HOURS. TEST FOR COLIFORMS: WELL WAS TESTED FOR COLIFORMS ON MARCH 20, 1987. TEST WAS NEGATIVE. TEST RESULT: THiS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE, AND FHA CRITERIA. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The FHA requirement is 3 gallons per minute for 4 hours, or 720 gallons in four hours or less. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well.