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HomeMy WebLinkAboutGREAT LAND ESTATES #3 BLK 2 LT 10#3 Lot 10 Block 2 #051-133-12 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 [ RONE / rNEW I D'STANCETO: ¢'..¢ Man.facturer LIq. 2~n gallons IF HOMEMADE: DISTANCETO', ]]Well Man ufactu rer DISTANCETO'. No. oflines / [Length Top of tile to finish 9ra~e Length Width ' ~ISTANCE Well TO: lCl~s Depth DISTANCE TO: Building foundation Absorption area Inside length Dwelling Width NO.~ BEDROOMS PE~2Vllf-~T NO. - . No. o~mPartments Liquid depth Dwelling PERMIT NO. Material Liquid capacity in gallons Foundation y(._.~~'- Total len~ ~irltes Material beneath tile Nearest lot line~ ~ ff Trench · ;~¢1 inches Depth Crib depth Building foundation PER~,~3/? D,stan e b;E Z line: PERMIT NO. Total effective absorption area Nearest lot line Driller Distance to lot line PERMIT NO. Sewer line Septic tank Absorption area(s) OTHER A'IN~B OV E D ~ . DATE -- LEGAL ~. ~ ~::'.:" ~ ~ ~z:~ ~. ~ F~", ........................ 'FiPF'L Z CRi',Fi' TOH?C'T?',iTH ][ Fi E:bTE:H - HFq;:.::ih'ffJH NUi'iE:ER OF E:EE:,ROOi"'IS :;: i~: :50JiL. RFFFING ,::SQ F:'T,-."EiF:::,:= 26,::I- :-~ F'~;' - , .............. _,L . ,; .... ":' " -F ':"lTl THE LENGTH D)iHENSXON XS "FHE LEHGTH "f~¢: pF'~'~- ,"zT : -r~: ~'".~ -~: c'r'~" ":~'"' ?.", ¢:.F~ '"r":: F:"T"f""? .... r:' THF' 'T'HERZ ZS NO SET i,.,LE:,TH FOR 'T'R:EF~E:F, ES. TPdc ............ G~:FCv'Ei. r.¢:'p"r~,_. , , ......... '[': THE ,:,,.,r., THE: '"' ~.,. _~ - ............. ...... :.U, : U~', OF:' THE b '.:.:;L:H',/H ~::"..... =~27 ..... ~":~ ~ ~ ~ )%[~ ~:::. ......... ~*""~. ,::::" ~::::" ~7::~ '"~"' 5" ]~ ...... '"~"- ~"-'~ ~ ~ ' --.- T' ~:;z,, ~:.: :;:::.: ' %-- ~ ..... F:'EF~ht[ET F~F:'PL.~ C:FfNT *"qc' THE P~ESPONS **'--"-' "' . ...................... r,t: F'F~'r"dz'E?T'¢ R*- F' THE; ...........................................,,..,, .,. .... ~ ! l'iqC=.' ur. r'lr<3 ':::Mc:;'i"'l::'i"i {.,.I~THOUT .r;'Tl'.lf::¢,, .... _,.,._,'r,.,:;PC,-'"r !' "lq,.. .._. · bi?',f[.:, F:I~:'F'P-P,.,hsI~,.. _ ;..~:"-' DEF'FiF-':THENT i-,.!;[LL E:E: SLIEL:rECT' TO l"! i N.T, HUH .r.) i STFi?..IOE BETh.!EEN Fi NE[L,L. FiND FIN',/ C)N-,.:5 1T'E S:;Ei,,].F:IGE E:, l SF:'OSRL S"r%'TEH i S :t.~En;:) FEET FOF: FI F'R:iVRTE !,.!E;L..L. OR ZSE~ 7'0 2(~:.iI~;i F'E~];T F?.Cff"! F~ F:'L,!E:L. IC HELL.. DE?E]',!D]:h~G LIF'ON 'I"HE "F'?'F'E OF F'LIE:L]:C HELL. !fi Z N Z HUH D Z :~"FFiNCE FR:Eff'i !::~ PF: Z'v'FiTEE NELL "i"(3 R F'R: Z 'v'RTE SEi.,.IEF: L I NE :[ S ;?5 F'EET FINE:, TO i:~ COi'ffHUHZT'?' SEF.!ER !....liNE :[:E; 75 FEE'T. I,!ELL L. OGS F:!F;:E F:EEQUtF:ED R?-.!E:, !'4iJS'T' E:E F:ZTL.tRNE:D 'TO THE DEF'FIF4:THEN-!" !,.iZ'!'l-.l:[hi ]:E~ DI::I'./S OF THE !.,.iEL. L. COifiF'L. ET]iON. OTHER F:EQL.! Z R:EHENTS hiFl"r' F!F'F'L."r'. :~;F'EC Z F Z CFFF Z ONS FiND CEU',!STRUCT :i: 01',! [::' :[~:~GF:RH% RF:E Ff,,,'RZLRE:LE TO :[N%UF'.E PROPER: ZNS"FF!L.L. FFF'ZON. ;..r. CERT Z !:'h" 'i"HFF'f' :i.: Z RM FF!H;E!...ZFff~: !.,!:[TH THE F:E~S!U:E!-;:Ei'IiENTS FOF.: ON-SiTE SEi.,.iEF:S Fii',I[)!.,.iEL. L.S FORTH E','.F THE; hIUNZCZPRLi[TV OF RNCHOP. RGE. 2: f 14:[L..L. iNSTFiL.L. THEE S'.r'STEH Zi'.,I F!CCE~F:[:,F!h!C:E i.,.!Z'T'H THE CODES. 3: ~ L!NDERSTRND TH~Y'r' THE ON-SZTE SEHEF: S'./STiEH i'iR'f F:E~;!UZRE ENLRF:EiEHEI',Fi' ;iF' THE R:ESZDENCE ;IS REh!ODH:L. ED TO ;[NCLLiDE HOF:E THRN ]: F:ff::'F'L Z CF~H"F 'TOH,.-"E:"r'HTH ]: F:! BLrT'CH ' ~ MUN'I~'IPAL'I'TY OF ANCHORAGE._. ~ Departmental Health.~and Environmenta? Protection . ~ 825 ~ Street, Anchorage, AK. ~9501 264-4720 * *'~ HANDWRITTEN PERMIT * * * Pe£mit ~ q Q~,~\~ :WELL AND/OR ON-SITE SEWER :PERMIT Applicant:Zi~WV~ dW~~ ~~ Mailing Addres~:,.,~ ~6~~ %-~_ ~/ ~oc~tion:. ~ ~d~ % ~/~ Phone Nu~er: ~ ~ S~ 7y ' T~e of Soil ~sorption System Is: Trench: Drainfield: Seepage Bed: Holding Tank: Zaxim~ N~ber of Bedrooms: ~ Soil Rating(sq.ft/br) The Required Size of the Soil ~sorption System Is: ' 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 m~im~ depth of gravel between the outfall pipe and the bottom of the excavation(in feet). Pe~it applicant has the responsibility to info~ this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. ' * * * TW0(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this .department will be subject to prosecution. Min~ 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. Minim~ distance from a private well to a private sewer line is 25 feet and to a co--unity 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 51~ 1 9 8 2 * * * I certify that: (!) I ~ f~iliar with the requ'irements for on-site sewers and wells as set forth by the Municipality of ~chorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the re'sidence is remodeled to include more that 3 bedrooms. ApplicantDate: SWP/024 (1/81) ' ~ MUN[~3[PA&JW OF ANCHORA~ - g~g~~ o~ ~al~h and ~v~onm~a~ . 264-4720 ' ' ~ ~ ~ HANOWR~TT~N PERMIT . ............ WELL AND/OR O~SITE S~WSR P~RMJT ' ' ' ~a~ ~s ~~ ',3L ~ c~ify thak: (%) I ~ f~il.i~ wi~h th~ ra~'ire~nt~ for MUNICIPALITY OF ANCHORAGE 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST PERFORMED FOR: / · EGAL DESCR,PT'ON: ILIO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2o SLOPE COMMENTS WAS GROUND WATER ENCOUNTERED? PERFORMED BY: [] SOILS LOG PERCOLATION TEST SITE PLAN Robert No. 1457.E IF YES, AT WHAT DEPTH? Gross Net Depth to Net ReadingDate Time Time Water Drop / ///~a,~ 4-y ~ ~?~" ' PERCOLATION RATE r.~ 9~ Z (minutes/inch) TEST RUN .ETWEEN O''--FTAND ~.FT Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-133-12 1. GENERAL INFORMATION Complete legal description Lot 10, Expiration Date: Block 2, Greatland Estates #3 S/D Location (site address or directions) 23521 Big Sky Drive Current Property owner(s) Albert LaValley Mailing address PO Box 5434, Fort Richardson, Day phone 688-9382 AK 99505 Lending agency Mailing address Day phone Real Estate Agent Day phone Mailing Address .), ~..~.,~__~. ~_.._ Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Ho[ding Tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 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 based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address S & S ENGINEERING 1Z034 ~',~!e Rive? [u3~p~o.~/No on4 Eagle River, Alaska 99577 Engineer's Printed Name Robert C. Cowan DHHS SIGNATURE b-'"' Approved for ..~ bedrooms. Disapproved. Conditional approval for Phone (~z¢ ~¢1 -7c/ Date /a ,/24 /~ ~ ..... bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: Original Certificate Date: Reissue Date: 72 025 fRev 01 '00)' Municipality of Anchorage R E C E ! V E Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 OCT J. 6 2000 P.O. Box 196650 Anchorage, AK 99519-6650 www,ci.anchorage.ak.us (907) 343-4744 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION HEALTH AUTHORITY APPROVAL CHECKLIST Date of test Static water level Well production A. WELL DATA Well type ?~ V'/~ If A, B, or C provide PWSID # Date completed _~ Sanitary seal f'~' Total depth"'"'~ ft Cased to ~"~- ft FROM WELL LOG ~,~f g.p.m Parcel I.D.: ~:)~'/:- /55- )Z Well Log Wires properly protected Casing height (above ground) / ~'¢- in. AT INSPECTION ,J~)o ~-~ g.p.m WATER SAMPLE RESULTS: Coliform O colonies/100 mi Nitrate "~.!~' mg/I Other bacteria o colonies/100 mi of sample: JO/(' z~'/f/~) Collected by: s & s ENGJNEER,NG Date ! 17034 Ea//le River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alask~ 99577 Tank Type/Material ,,~ftC ~¢7~ ! Date installed ~//~" Tank size /~"'~) gal Number of Compartments __~ cleanouts(-~-'~-~-¢ Foundation cleanout//V'$/~~ Depression over tank /v'r.-~ High water alarm __ · Date of pumping /0//Z../C'U Pumper -~-.~ ~' C, ABsoRPTION FIELD DATA Date installed -~'/~-- Soilrating (g.p.d./ft2or~ ~-~¢~LCSystemtype Length (~¢7'~fft Width ~/ ft Gravel below pipe ~/ff Total depth I ~ / ft Effective absorption area/~'D~fF Monitoring tube¢(-~ Depression over field Date of adequacy test ~'/¢~¢,/~ Results ~/Fail) ~[~;:),'~ For -.~ bedroo~ms/ I I J / Water added'~,.-gal. Newdepth~_-,/~, in. Fluid depth in absorption field before test in Elapsed Time: IIZ min Fina/I'~ fluid depth ! /]0//in Absorption rate >= ~ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) ,/V/¢/~/'~- ~t/,CT/f/'A/' If yes, give date 72-026 (Rev. 01/00)* D. LIFT STATION / Date installed ~_./~ Size in gallons , .// on" level at~l at "Pump Datum _.¢.---'~ Cycles tested E. SEPARATION DISTANCES Manhole/Access High water alarm level at in Meets alarm & circuit requirements SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/li~n on lot '~'"'~' / /(~('~/"f' Absorption field on lot /'0~/¢- /~O ''/- Public sewer main /',,///I A S"6m~r/septic service line Z~- t /V/ -F Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: On adjacent lots On adjacent lots Public sewer manhole/cleanout Building foundation ~- (f Property line '~ /'/- Water main /,J/A- Water service line /IQ ~ Drainage ~© /.,c_ Wells on adjacent lots /~ ~ Absorption field ~'-- Surface water ./f_.,-z_) /~- F. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ,/0 /.-/- Building foundation .,/~ '~" Water main Water Service line ,/~ ~¢' Surface water Curtain drain/'¢/2,,Y~ ,~,4/~f//V Wells on adjacent lots COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Date )O (/'/~ /co Driveway, parking/vehicle storage / o/..,- HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 0~/00)* 10-23-§0 14:41 FRO~-CTE ENVIRON~NT^L §GI530! T-807 P.O1/O2 F-8~9 CT&E Environmental Services Inc. Laboratory Division 200 W. Potter Drive Anchorage, AK 99518 Tel: (907) 562-2343 Fax: (9137) 56%5301 CT&E Reft #: Client Name: Project Name: Client Sample ID: Matrix: 1006429001 S&S Engineering n/a L10 ii2 Graatland Drinking Water Client PO#: Pdnted DatefTime: Collected Date/Time: Received Date/Time: Technical Director: PWSID n/a 10/23/00 14:38 10/13/00 10:45 10/13/oo 18:00 Stephen Ede Sample Remarks: Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Total Coliform (MF) 0 co11100 mi SM9222B 10/14/00 KAP Nitrate 3.'18 0,5 mg/L EPA 300 10,0 10/13/00 SCL MUNICIPALITY OF ANCHORAGE MEMORANDUM WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot ~ O Block ~ of _~RE~7~/9~O ~%~_~Subdivision, the well's productivity was determined to be _~,7~ gal!ohs per minute. The minimum well productivity required by this Department (~C 15.55) for a ~ bedroom residence is O0 2]~g, ga!lons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are a~vzses that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH&HUMAN SERVICES Division of Environmental Se~ices On-Site Se~ices Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # (~,~\ -- \ -~-'23--~,-~ NAA # ~=.~C~O~. e e Location (,s, it~e address or directions) ~,+~: ,,~.. .. ~ ~.:. .?.~:.,,. p~y:owner ~Z'~r ~~ Day phone ~.Le~ding agency "'7"'"~' Day ~hone ':~'?~:',. , . .. : ..:. ~,~ ~ling. -. address._ ,' Agent · Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ ..... " TYPE OF WATER SUPPLY: Individual well 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 5. S?ATEMENT 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 ~ra~u~.~_!.~!~ Phone ~ 17o;34 Eagle River Loop Roac~ No. 204 Address ~-~ ~,: ......... Engineer~ssignature /~'-~'"/ _. ~..,,//_- Date DHH8 SIGNATUFIE J'""'" Approved for Disapproved, Conditional approval for bedrooms. r~ed. ro.o~s, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Sen/ices (DHHS) issues Health Authority Approval Certificates ba.<~ed only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements, Employees of DH HS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. xtCEIVEu Municipality of Anchorage AUG o DEPARTMENT OF HEALTH & HUMAN SERVICEw~uN(cm^u~, OF Environmental Services Division ENVIRONMENTAL~ERVICES( 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744 Health Authority Approval Checklist Legal Description: ~.7''~ /~! .~)~' ~:~ ,~ ~'~~) Parcel I.D.: If A, B, or C, attach ADEC letter. ADEC water system number A. WELL DATA Well type Log presen~/~N) Total depth ~-~ ~- / Cased to Sanitary seal ~1) FROM WELL LOG Date of test Static water level Well production O~ ..~'- g.p.m. Casing height (above ground) Wires properly protected~) AT INSPECTION WATER SAMPLE RESULTS: Coliform O Date of sample: ~/~/~'¢ B. SEPTIC/HOLDING TANK DATA Nitrate Collected by'. Other bacteria S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Date installed Foundatioh'~i;;nout (Y~)~ Date,: , ng. C. ABSORPTION FIELD DATA Eagle River, Al~.a 99577 Tank size /~)Z~c'~ Number of Compartments Cleanout.s~fJN) Depression (Y~ /t~) High water alarm (Y/N) x"~/,~'" Pumper Soilrating (g.p.d./fFor~ z~Lf'""~S/ystemtype Gravel thickness below pipe ~ Total depth /// Date 'inst~ll~d Effective ab~0rption area /~?~)(~ ¢ Monitoring Tube present(~N) ~' Depression over field (Y~) Date of adequacy test ~/~-~/~ Results~Fail) /~'~/~-~ For ~'~,,~ bedrooms Fluid depth in absorption field before teat (in.); / 0 Immediately after~Zgal, water added (in.): Fluiddepth ///0/r (ins) Minutes ater: //~- Absorption rate = ~-~ 7~- g.p.d. Peroxide treatment (past 12 months) (Y/N) ,~/~W'~-~XA/~,~/V' If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed /[//,'~- Size in g~JJens / (Y/N) '~el at* Manhole/Access High water alarm level at* ~ *Datum Cyc~~'~ E, SEPARATION DISTANCES "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjacent lots Absorption field on lot /~O/~ On adjacent lots Public sewer main A~/-/"~/ Public sewer manhole/cleanout / Sewer/septic service line ~S/-7z- Lift station / SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK ON LOT TO: Foundation ~'-/'/'- Property line ~'/TL Absorption field /~' / Water main/service line /~ 'TZ~Surface water/drainage //2D/'-/~ Wells on adjacent lots /¢/.) SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /0/'/- Building foundation /~2 /,/- Water main/service line Surface water ,'/¢0/v/- Driveway. parking/vehicle storage area tel"/z-- Curtain drain /(/,¢/V~~- ,/~"t,/,CY/t./','~/ Wells on adjacent lots / o o f-~--- ENGINEER'S CERTIFICATION HAA Fee $ Date of Payment Receipt Number Waiver Fee $. Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE MEMORANDUM WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO. ~0V3~~-~ During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot Block _~ of ~/~7-Z~/~D E3~.~;~ Subdivision, the well's productivity was determined to be ~o7~ gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a ~ bedroom residence is ~o 3/~ gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be a~tached to all copies of the subject Health Authority Approval. CT&E Ref.// 994578002 Client Nme S & S Engine~ering Projeet Name/# N/A CHant Staple ~ L10; Blk 2: ~tl~d Est ~ ~tr~ Dfi~ing Wa~r Ord~ By PWS~ 0 ~mple Remarks: Client POn Printed I~,,e/Thne 09/01/99 16:03 Collected ~,ate/Time 08/27/99 08:15 Receivea D4telTlme 08/27/99 17:00 Teetmical .ireetOr:.Stephen C. Ede ALLowabLe prep Anatysi$ Rethod Limits Oa:e Date In(~ ', ToTaL Cotiform 0 cotllOOmt Sill8 9~B flitca,e-N 3.09 O.SOO ~g/L EPA 300.0 08/27199 JOT 10 max 08/28/99 08y2B/~9 SCL MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date~ 1. GENERAL INFORMATION (a) C~/~DLegal ~escription/~(include tot,¢?.block, s~n, t~c,ns~ Location (address or directions) / , (b) Applicant Nam~'~-"~--~ ~ ~"'~-~'~- TelePhone: Home ¢ ¢¢¢~,r.~_ 2./3 5-- Business Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/-b'ditder]~; Buyer []; Other [] (explain); (d) Lending lnstitution ,~-,~=,~.~ ~-,~; /~'~,~. Telephone Address - - ' /¢-~~~ - Rea, Estate Companyand Agent Address .T. elephone (f) ~he HAA to the following address: TYPE OF RESIDENCE Single-Family~/ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Welt~/ Community [] Public [] , Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite'J~ Public [] Community [~l Holding Tank [] Note: If community well system, must have written confirmation from the State Department o! Environmental Conservation attesting to the legality and status. 72-025 (11184) ENGINEERING FIRNI 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 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 ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection.,.,,,e~,6~ Address ¢.. :,.3.~¢ ~. G~9'l~__ Date Telephone DHEP APPROVAL Approved for 7W¢'~-~¢.~ bedrooms by Approved /~ ' Disapproved Conditional Terms of Cond~bonal Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. ']-he DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees 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. A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Well Ciassification~'~C- Well Log Present(~/,N')" Total Depth L~'~* Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit ~ Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) Date Completed ~- lr./-,~ .2-- Yield Depth of Grouting Pump Set At Sanitary Seal on Casing~,N')' Depression Around Wellhead (.,v..~ SS- ! ; 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 Water Sample Test Results ~ SEPTIC/HOLDING T~NK DATA Date Installed ~--~'8~ Size Standpipes ~ Air-tigh¢Caps ~/~ ~ Foundation Cleanout~ Depression over Tank (~ PU mping/Maintenance Contract on File~Y/N) Holding Tank High-Water Alarm (~ Separation Distances from~ePfic/Holdipg Tank: TO Water-Supply Well ( ~ To Property Line ~ To Disposal Field To Water Main/Service Line Course Comments ~ Page 1 of 2 jo,cc.-- To Stream, Pond, Lake, or Major Drainage Square Feet of Absorption Area Depression over Field,{-YY~ Results of Last Adequacy Test ABSORPTION FIELD DATA Soils Rating in Absorption Strata c~./o q.l(~ [ J~ ~ Date Installed /~' ~' Width of Field ,.~ I Gravel Bed Thickness ~-O1;~ Standpipes Present Date of Last Adequacy Test Separation Distance from Absorption Field: Type of System Design Length of Field (O'~ Depth of Field To Water-Supply Well To Building Foundation L~ Lot t'q'/jtP To Water Main/Service Line .~o ~ '~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line I O ~ To Existing or Abandoned System on ; On Adjoining Lots ...~o ' ~ ./ To Cutbank (ifj:)resent) ,,-,/,,/_ Comments 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 checked,_ve.rLfLed or conformed to all MOA and btAA guidelines in 8 & 8 E~I~IINE~.J:JJ~[~ ' '-7//,~/~.,, ,~ effect on the date of this inspection. Signed . aRB "196X . Date /// '/ ~ ,) Receipt No. 3,Lt. Date of Payment "-") Amount: $ Page 2 of 2 72-026 (11/84) / l DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICt OFFICE 437 "E" STR.F~.T, SUITE 303 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR 274-2533 July 17, 1985 S & S Engineering SRB 196X Eagle River, Alaska 99577 SUBJECT: Horizontal Separation Waiver Between Well and Septic Tank, Lot 10, Block 2, Greatland Estates, Peters Creek, Alaska 8521-WA-012 Dear Sir: The Department has reviewed the subject waiver request and hereby con- ditionally waives the horizontal separation between the well and septic syst~m~ to !5~!~feetI on;~h~ ~subject~property for ~ 3 bedroom single f~m~ly residence only. ~ApProv~liof~his waiver is ~ontingent upon an engineers.insPection of - : ~ rif in its structural and watertight integrity~i~ the sept!c tank ~ve y g ............... .., ¥.~.~.~.~,~ ~. ,.,~.~,..~,~-. ::..~, : ,.~ ~ . addition: to C~lderi~?'~Oupl!~S :' or ~ equiv~Ient: on !n~e~ an~ outlet. Sincerely, S~teve Eng, P~. District Engineer SE/dd " APPLI(-NT FILLS OUT UPPER HA['--' ONLY Phone PC°per tY Owner "~To ~-'~ %-': (~-~'[ CI'~ ~ ') i C~ L, ~c~ ~ ~ ~- Buyer Address Zip Code Lendinglnstitufion I~ ~)Q~I'~C~t ~r'~( O~~ ~'~I~Q~ ( [~'~C~i~ ~C,~J~ Phone Realty Co, & A~nt Phone Address ~ Zip Code Ty~ ~ Resi~nce ~Single Family ~ Multiple Family No. of Bedroo~ ~ ~ Other waLeZupply ~lndividual · A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Se~e~isposal ~ ~n~iv~ Year ~ndiv~ua~ ~nsta,ea: ~ ~ ~ ~ Public Utility When Connected to Public Utility: ~ ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date~ Da Insp~tor Insp~tor I.,p~t~o ~ Field Notes:,[~. MUNICIPALI~ OF ANC ORAGE D?'r C~ ( ~) APPROVED BEDROOMS 'OONDITION8 OF APPROVAL ( ) DISAP~OVED ( ) OONBITIONAL ~PROVAL' Soils Rating Date ~wer Installed Well To ~sorption Area F ~ Well Log Received ~ "' ~ L~ Well to Tank ~ Septic T~k Size