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Home My WebLink AboutMERRYMAN LT 2 MUNiCi?ALITY OF ANCHORAC2 r~ DEPT. OF * ~ ~-' HeAth I & ~,~//~,~, ~"~"'~' MUNICIPALITY OF ANCHORAGE / DEPARTMENT OF HEALTH ~ ENVIRONMEnTAl. PROTECTIO~ ~SE~ 2 8 ~984 825L Street-Anchorage, Alaska 99501 TeleDhone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION RE NAME FHONE ~NEW MAI LING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Well Absorption area ~ ~ Dwelling ~ PERMIT NO. DISTANCE TO: p~O P6~ ¢ ~i ~ Z Manufacturer Material No. of co~artments ~ h LJq. capacity in gallons Inside length Width Liquid depth t~ '~,~ ~F HOmEMAdE: ~ ~ Well Dwelling PERMIT NO. DISTANOE TO: Z ~ ~ ~ Manufacturer Material Liquid capacity in gallons ~ Foundation f Nearest lot line t ; ~ ~ Top of tile to fin,sh grade, Material beneath tile . ,~ ~ Total effe~s~Won area 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 PIPE MATERIALS SOIL TEST RATING -- REMARKS _ ~APPROVED DATE LEGAL 72-013 (Rev. 3/78) NU[-~ I L--: I ¢'~L I T~r" C~F DEPARTMENT OF HEALTH aND ENVIRONMENTAL PROTECTION 825 L S~REET., RNCHIDRRGE., RK 99501 :264-4728 6,~4--S I TE SE~4E~: $~= ~4ELL F"i~:f-1 I T PERMIT NO: [:,RTE "-" I =,=,UED: RPPLIC:RNT: RDDRESS: CONTRCT PHONE: 848462 ~e,,.&4,.~,4 GRRY L 8ND SYLVIR J MERRYMRN P 0 BOX 4-22~]1 RNCHORRGE., RK ~950~ ~44-_~e, LEORL DESCRIP: i LOT SIZE: !MAX BEDROOMS: SUBDIVISIQN: NR SECTION: ~:~ TOWNSHIP: 12N 4q. 42F4 (SQ. FT. LF.. RCRES-) 4 LOT: E'1,.-'2 168 BLOCK' RRNGE: LISTED BELOW 8RE sYSTEM. CHOOSE THE OPTION THRT BEST FITS YOUR THE OPTIONS R'v'RILRBLE TO YOU IN DESIGNING ","OUR SEF'TIc: 1., 250. 0 *.* 8 ** 22:i. DEPTH TO PIPE BOTTOM (FT.) GRRVEL DEPTH (FT.) TOTRL DEPTH <FT.) GRRVEL WIDTH (FT.) GRRVEL LENGTH (FT.) GRRVEL VOLUME <CU. YDS. ) TRNK SIZE <GRLS> SOIL RRTING (SQ. FT./BR> B, RR I N 3.5 7.5 :5.0 i00.0 ** 74. 0 t, 250.0 ** 2~1 *:+.' =RHVEL LENGTH }- 75 FT. REQUIRES .MULTIPLE RUNS ,::NOT EXCEEDING 75 FT. :+:* TRNK MUST HRVE RT LERST TWO COMPRRTMENTS ERCH) I CERTIFY THRT: 1. I BM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND HELLS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE (MOR) RND THE STRTE OF RLRSKR. 2. I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH RLL MOR CODES RND REGULRTIONS, RND 'IN COMPLIRNCE WITH THE DESIGN CRITERIR OF THIS PERMIT. 3. I WILL RDHERE TO RLL MOR 8ND STRTE OF RLRSKR REQUIREMENTS FOR THE SET BRCK DISTRNCES FROM RNY ~s~ISTING WELL., WRSTEWRYER DISPOSRL SYSTEM OR PUBLIC SEWERRGE SYSTEM ON THIS OR RNY RDJRCENT OR NERRBY LOT. 4. I UNDERSTRND THRT THIS PERMIT IS VRLID FOR R MRXIMUM OF 4 BEDROOMS RND 8NY ENLRRGEMENT WILL REQUIRE RN RDDITIONRL PERMIT. IF R THEN <t) RN ELECTRICRL PERMIT RND INSPECTION MUST BE OBTRINECu WILL NOT BE RPPROVED WITHOUT RN ELECTRICRL INSPEOTION REPORT.~ ELECTRICRL WORK MUST BE DONE BY R LICENSED ELECTF.'.ICIRN. ' S I GNE[:, . [.',RTE: , S LIFT STRTION IS INSTRLLED IN RN RRER COVERED BY MOP BUILDING CODES.. '-" -'-' I I '-~ ',~.. H.~-EL I LT= RND ('~.:) THE DRTE: RPF'LICRNT: ISSUED, BY PERMIT NO: DFtTE ISSUED I'-ILI~'-.I I C: -Ir prelL_ I T"-r" C,F t-II'-.IL:HL--~..R ",E DEF'FtRTMENT OF HERLTH BND ENVIRONMENTFtL PRI]TERTION · ¢. :_-':,'25 L STREET., RNCHORRGE RK z~.q, 50'l ,=.~,4-4,. OI'-,I--S 1' TE SEI-,JER .';t- I---IELL PER~'-I 1. T RPPLICRNT: HE D RE__: CONTRCT PHONE GRRY L BND SYLVIR $ MERRYMRN P 0 BOX 4-223i RNCHORBGE, 8K 99509 344-9086 LEGRL DESCRIP: SUBDIVISION: 'NB SECTION: 33 TOWNSHIP: LOT SIZE: 49420 (SO. FT. OR RCRES) MRX BEDROOMS: 3 LOT: Et/~ ±68 RHN~E 3W LISTED BELOW FIRE 'THE OPTIONS FtVFIILFtBLE TO YOU IN DESIGNING YOUR SEPTIC: SYSTEM. i':HOASE THE OPTIL']N THRT BEST FITS YLLIR SITE. TRE~-ICH BEE-", ~.-l. C, RI-I I ~-~ DEPTH TO PIPE BOTTOM (FT.) GRRVEL DEPTH (FT.) TOTRL DEPTH (FT.) GRRVEL WIDTH <FT.) GRRVEL LENGTH <FT, > GRRVEL VOLUME <CU. YDS. ) TRNK SIZE <GRLS) SOIL RRTING <SQ. FT./BR> 4.0 4.0 4.0 6.0 0.5 ~:.5 t0,0 4.~ 7.5 2.5 2-"-:.0 5.0 '58. 0 43?.. 0 75. 0 3?,4. 9 36. 6 55, 5 t., 000. 0 .'+::+: ±., 000. 0 *-* 1., 000, 0 :+::+: 231 217 23:1 :+:-'+: TFINK MUST HFt',/E RT LER_T TWO L-:OMPFtRTMENTS I C;ERTIFY THRT: 1. I RM FRMILIRR WITH THE REQUIREMENTS FOR ON'SITE SEWERS RND WELLS RS SET IF R '[HEN iWILL ELECTRICRL WORK MUST BE DONE BY R LICENSED ELECTRICIRN. : S I GNED [>RTE: HFFLIuHNT: ~PH L~D SYLVIR J P1ERE~rIRN ISSUED E:Y ~~ ~ DRTE: FORTH BY THE MUNIC!PRLITY OF RNCHORRGE <MOB) RND THE STRTE OF RLBSKR. I WILL INSTBLL THE SYSTEM IN RCCORDRNCE WITH RLL MOB CODES RND REGULRTIONS, RND IN COMPLIBNCE WITH THE DESIGN CRITERIR OF THIS PERMIT. I WILL RDHERE TO 8LL MOB BND STRTE OF RLRSKR REQUIREMENTS FOR THE 'SET BRCK DISTRNCES FROM RNY EXISTING WELL, WRSTEWRTER DISPOSRL SYSTEM OR PUBLIC SEWERBGE SYSTEM ON THIS OR 8NY 8DJBCENT OR NEBRBY LOT. I UNDERSTBND THBT THIS PERMIT IS VBLID FOR B M8XIMUM ~F 3 BEDROOMS 8NY ENLRRGEMENT WILL REQUIRE 8N 8DDITIONBL PERMIT. LIFT STBTION IS INSTBLLED I~ BN 8REB COVERED BY MOB BUILDING CODES, (l) 8N ELECTRICRL PERMIT 8ND INSPECTION MUST BE OBTBINED; (2) 8S-8UILTS NOT BE 8PPROVED WITHOUT 8N ELECTRICBL INSPECTION REPORT~ 8ND (~) THE %/¢_'___ ',.. ~, , SOILS LOG MUNICIPALITY OF ANCHORAGE C~¢:o ¢6 Z- DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION /E2r PERCOLATION TEST 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 "11 12 13 14 15~ 16- 17 18 19 2O COMMENTS ~ PERFORMED BY: SLOPE 72-008 (6/79) WAS GROUND WATER ENCOUNTERED? DATE PERFORMED: IF YES, AT WHAT E DEPTH? ~ Reading Date Gross Net Depth to Net Time Time Water Drop -.t,-qz¢' .~: 63 t. ~'"'2 ~ o:fSc' lc) , Ng' ,/$ CERTIFIED BY: DATE: SECTION 33 TI2N,R 3 W S.M. VICINITY MAP GRID 3135 16 9 ,q~)zo S,F. Ito4,73' 156 / 6 ,? __ FL-~T I£6 SURVEYOR'S CERTIFICATE I hereby certify that the following described property has been surveyed by myself, or under my supervision, and the corners shown on this drawing are existing as of the date of Survey. DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 July 23, 1991 Gary and Sylvia Merryman P.O. Box 112262 Anchorage, Alaska 99511 Subject: WALTER J. HICKEL, GOVERNOR 563-6775 RECEIVED JUL ~) 4 1991 Munic pah[y of Anchorage Dept. Health & Human Services Lot 2 Merryman Subdivision, Anchorage, Alaska, ADEC Project Numbers 9221-DW-005 and 9221-DWW-005; Review Dear Mr. and Mrs. Merryman: This is in response to a June 20, 1991 submittal by Flattop Technical Services on your behalf. Mr. Ted Moore, P.E., requested approval for the on-site water and wastewater disposal systems located on the above-referenced lot as a result of upgrading from a single family residence to a Bed and Breakfast. I have completed my review of the submitted information and have l~he following comments. WASTE-WATER DISPOSAL SYSTEM From the submitted information it appears that the wastewater disposal system was installed substantially in accordance with State regulations and guidelines at the time. The results of the adequacy test also verifies that on the day the test was performed the wastewater disposal system was accepting the necessary flows. In addition, there will not be an increase in the volume of wastewater being treated by the existing wastewater disposal system as a result of upgrading from a single family residence to a bed and breakfast. Therefore, the wastewater disposal system is approved for the concerns of this Department. The enclosed signed Approval of On-Site Residential Water and Sewer Systems, constituting this approval, is enclosed for the existing wastewater disposal system. DRINKING WATER SUPPLY SYSTEM From the information that has been submitted, it appears that the water system was installed substa~ntially in accordance with State regulations and guidelines for public water systems at the time. Including the fact that there will not be an increased in the peak flow demand placed on the existing water system resulting from the upgrade (going from serving a four bedroom single family residence to a two bedroom bed and breakfast) and the analytical results for Total Coliform Bacteria and Nitrate (as nitrogbn) returned ~:~ printed on recycled paper The Final Operation Certificate, constituting this approval, is enclosed for the existing Class C Public Water System. At this time, the Department is assigning Public Water System Identification (PWSID) Numbers to all Public Water Systems in the State. As a result, the PWSID Number assigned to this system is 217225. The present State Drinking Water Regulations do not require any routine water sampling for Class C Public Water Systems; however, I recommend that you have water samples analyzed for Total Coliform Bacteda and Nitrate (as nitrogen) once a year during the month of May. If you do sample, please place the assigned PWSID Number on the lad request form so the results will be credited to proper file. Thank you for your cooperation with this Department. If you have any questions, please do not hesit~.te to cai!. Sincerely, Keven K. Kleweno Environmental Engineer Enclosure: As Stated cc: John Smith, DHHS, w/o Enc. Ted Moore, P.E., w/o Eric. KKK/skpf ,APR-16-199? 15:48 CT&E ESI Zt~__.. CT&E Environmental Services In0. ANCHORAGE 5301 F' , FJ2,'02 CT&E Ref,# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID 971744001 Pamone l~ng Sty. L2 Me~tyma~ S/D Bathroom Sink Client Printed Date/Time 04/16/97 15:18 Collected Date/Time 04/13/97 12:00 Received Date/Time 04/14/97 07:$5 Technical Dlrector: Stephen C. Ede Sample Remarks: Sample collected by: S.R,P, CT&E Microbiology Drinking Water Program certification status is provislol~al as 4/8/97. Parameter Reautta Nitrate-g 0.138 ¥otat Coliform 0 PQL Unfts Method ALLowable Prep AnaLysis 0,100 mg/L SM18 4~00-NO3F 10 max cot/100mL S~18 ~2228 04/15/97 JSL 04/15/97 TOTAL P. 02 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF ~r~.~LTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ! · (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) O/=/~ ~A~oo~/~ (b) (c) (d) Lending Institution Address Applicants Name C/%~ ~ /~f~p.M4~ Telephone - Home Business Applicants Address~~' ~- ZZ~9 ~z~c I~ ~ ~ ~-~ Applicant ts (chec~one) Lending Institutioh ~ ; ~er/builder~ ; BUyer~; Other~ (~plain); ~ Telephone (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA .to the following address: 2. T~pe of Residence Single-Family~ Number of Bedrooms Multi-Family -Other (describe) . 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 the legality and status. 4. pewage Disposal Onsite ~ Public ~-~ Community I" i Holding Tank ~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] gn~ineerin~ 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 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 regula- tions in effect on the date of this inspection. Name of Firm ~C ~ /~ ~ Telephone ~, .-~-04~-0 DHEP Approval / mpprovnd ndroo Approved ~ Disapproved Condition~ Te~s of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 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. 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 DATE: July 18, 1984 MEMORANDUM TO: FROM: SUBJECT: Bruce Phelps, Manager ~hysical Planning Division Health and Environmental Protection Special Permission to Connect to Public Sewer T12N R3W Section 33 Lot 16 W3 Tax Code #018-191-01 As we recently discussed, the Hillside Moratorium which disallows certain Hillside areas from being serviced by public sewer results in a very real health problem on T12N R3W Section 33 Lot 16 W3. This is a relatively small lot(approximately 25,000 square feet) located on the southeast corner of Lake Otis and De Armoun Roads, which is adjacent to the boundary line at the area defined in the Hillside Moratorium. There have been two(2) failures of the on-site wastewater disposal systems serving this lot and the existing system is rapidly failing. The property owner, Mr. Karl Robek, has initiated a request to A.W.W.U. for a service connection to the public sewer systems. This Department recommends that special~.permission be granted for this lot to be connected to the available public sewer system. Robert W. Robinson, Division Manager Environmental Health Division RWR/ljw 91 010 (4/76) · ',:-('i:-~(?'f'-~.?.../-'f~e?- "': ~':'., ' ' ': · '::k~ - '"-' ','-' ~? -q'%',~.' --. : · ' %.~/::.'!i:~?~. .::-.?:5:,::':?,;':.: ~- - =. - '.:"-'" . .'."- : :-'.'-~':-.~'.~:.:'.~:.~ ." ' _' 'L.~':~:~:STATE'OF ALASKA : . ~ '~" ;, ' ~' ' ~': .' '- '.1 ..V ',' ' -. -~ Division'df~G'~OJ=Ogi~el · Drilling Permit LOCATION OF WEL~ (Please complete either la, lb or lc.). ~ R.D.L. No. ~chorag, Cre~k ·, 16 ~ --of--o~--°t-- _ - sO W~ · , D STANCE AND DIRECT 0N FROM ROAD INTERSECT ONS ' ' ~. OWNER OF WELL; ' ' :' . ' ' ' B~50 t~a~ne Street aflflress. ,nd Arco of W*ll'Locofion ~chorage, WELL LO~ ' .Feet.Below 4 WELL DEPTH: (f.~) 5 DATE OF COMPLETIONt ~e;~ ~a,}r ' . . Set-between {t.'and CERTIFICATE of SURVEY I hereby certify that the following described property has been surveyed by me or under my supervision, and that improvements situated thereon do not encroach on adjacent property, that improvements on adjacent property do not encroach on the surveyed premises, and that there are no power lines, transmission lines or other visible easements or rights-of-way except as shoWn hereon. It is the responsibility of the owner to determine the existence of any easements, rights-of-way, convenants, or restrictions which do not appear on the subdivision plat. · ,~qr~.~q'/:l "~ /L~,4. , iI ...,,., ....... I'~ ~ ~'~ B.L,M. Brass Cap Monumen~ Fnd. i~1~ Ii/1~1 IVI! Iron ~l~, ~ez _, F~d. 5/8"x 30" Rebar, Set_ ,Fnd. Survey Hub & Tack, Set ~, Fnd. ~ ~V~.~ RECORDING PRECINCT, A~SKA ASBUILT FOR UNWIN · SCHEBEN · KORYNTA * HUETTL ARCHITECTURE ENGINEERING LAND SURVEYING PLANNING DRAWN ~!J~.-- IS?ALE ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~,//~,./_~ ~ Width of Field 3" Square Feet of Absorption A~ea ~_~O~ ~ Depression over Field (Y~ Date of Last Adequacy Test Results of Last Adequacy Test /%j/l~f Separation Distance from Absorption Field: To Water-Supply Well ;~ ~ ~ To P~operty Line I ~ I Type of System Design /-A~JC I-~. Length of Field ~ 7, _~"-~' Depth of Field ~ ~) Gravel Bed Thickness ~ t Standpipes P~esent ~N) To Building Foundation ~ ~ ! Lot ~//_~.. ; On Adjoining Lots > TO Water _~ain/Se_-vice Line ~3/;-~ To Cutbarfl~(if present) ! - To Stream/Pond/Lake/o~ Major' Drainage Course 4 ~ //~ To D~iveway, Pa~king Area, or Vehicle Storage Area · Comments 1~o~ ju?/~.%,'o~ P~F- AS~-3~,.;'r To Existing or Abandoned System on LIFT STATION /~ ~ ,,Pump On,, Level at ~ ,3~P%mp Off'' Level at .... High Water Alarm Level at /~ Vent (Y/N) Tested fo~ /Pumping~les ddt ing Adequacy Test. Electrical Codes(Y/N)/ ~ ~'~ Cor~nents // ~ Meets MOA ** Check Permitted Bedroom Rating Against HA~A Request I certify that I have checked, verified, c~ ccnfo~ed to all on the date of this iD~pection. Signed /~.~ /A~ ~-~ Date KB1/d5/s [Page 2 of 2] 2-15-84 MUNICIPALITY O,~ AFar'-, ~ .... DEPT. OF HEAL~ MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PR, ...... HEALTH AUTHORITY APPROVAL (H_AA) NOV l 0 CHECKLI'ST - FEBRUARY 1984 Well Classification /DA~[b//~?-~ If A, B~ or C, D.E.C. Approved(Y/N) Well Log P~esent ~N) Date Completed f~//~[.,2~ Yield ~f Total Depth -~_~ ~7_~ Cased to ~f_I Depth of Grouting Static Water Level ~'.f' Pul,m~ Set At Casing Height Above Ground ~ ~ Sanitary Seal on Casing ~/N) Electrical Wiring in Conduit ~N) Depression Around Wellhead (Y~, Separation Distances from Well: To Septic/Holding Tank on Lot ! (5 ~ t I,) ; On Adjoining Lots >/O CO To Nearest Edge of Absorption Field on Lot / ~ ~ ~ ;~; On Adjoining Lots ~ / To Nearest Public Sewer Line ~.///~k To Nearest Public Sewer Cleancut/Manhole ~ ~ To Nearest Sewer Service Line on Lot ~ ~/./%. _ Water sample Collected By ~&%) ~ ;' Date / ! 2/~./~ [~ ~ Water Sample Test Results B. SEPTIC/HOLDING TANK DATA Date Installed 7//6/~,~ Size 3'% CO No. of C~t~artments 7~ Standpipes ~/N) ' I Air-tight Caps ~j/N) Foundation Cleanout (~N) Depression over Tank (Y~ Date Last Pumped M~//~ Pumping/Maintenanoe Contract on File (Y/N) AJ/J4~ for Holding Tank High-Water Alarm (Y/N) /%//iq-- TemIx)rary Holding Tank Permit (Y/N)4{/~ Separation Distances f~om Septic/Ho,lding Tank: , TO Water-Supply Well I O ~ ~ ~') To Building Foundation ~ I ~ To Property Line ~ ! '"L I To Disposal Field ~ 1 TO Water Main/Service Line /tf/jzg To Stream, Pond, Lake, c~ Major Drainage Course ,¢//lq Receipt Date Paid: Amount: [Page 1 of 2] 2-15-84 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING APR 2 1 RECEIVED 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Maiiing address %)- c~ ,'~ o Y Lending agency Day Phone Mailing address Agent Address Day ahone 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: Jr)r;!`? !!'al on-site Heir: ,~) tank Coml,:unity 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. 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 applic.ation 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 verifythat 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 Address ~o, Engineer's signatqcp~ ~ Phone Date DHHS SIGNATURE Approved for Disapproved, Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments B Date r~~' 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. 72~25 (Rev. 1/91) Back MOA#21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority ApproVal Checklist Legal Description: L~_- j"~-~'zr~'r'hAA,,U 'S/'z~ Parcel I.D.: ~1~ - ~ Well type ~A~ If A, B, or C, attach ADEC letter. ADEC water system number Date completed !~/~ ~ ~ Cased to ~ ~ 'z_ Casing height (above ground) Wires properly protected (Y/N) '~ Log present (Y/N) Total depth ~_. c~ '7__ Sanitary seal (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level /,5-- g.p.m. g.p.m. Well production WATER SAMPLE RESULTS: Nitrate O · I ~ ~:~ Other bacteria Collected by: ~ - Coliform - Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ~/lO/ Foundation cleanout (Y/N) Date of Pumping Tank size '~_ Depression (Y/N) Pumper Number of Compartments ~ Cleanouts (Y/N) '~ h-4C~ High water alarm (Y/N) C. ABSORPTION FIELD DATA a~-'~',Yc~,ttt-~ ~'~'r;hl~'ceA~e'''J~''~'~'~' 0..~e,,,~ Date installed ~/lc~/~ q . Soil rating (g.p.d./fF or fF/bdrm) ~-~ I System type Length ~-~..~ ' Width ~ ~ Gravel thickness below pipe Effective absorption area ~'.3o ~1= Monitoring Tube present (Y/N). Date of adequacy test ~//t'z / ~' ~- Results (Pass/Fail) Fluid depth in absorption field before test (in.); /z/~' Fluid'depth ,~'" (ins) Minutes later: /Z Peroxide treatment. (past 12 months) (Y/N) ,/,~c~ ~ ~ Total depth l ~ ~ __ Depression over field (Y/N) ~ D .,~ For ~' bedrooms Immediately after~;c~c~ gal. water added (in.): ~3 '~ Absorption rate = ~,c~o +' g.p.d. If yes, give date ~ 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "~~ "Pump off" level at* High water alarm lev~~ *Datum E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / Absorption field on lot / Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation '~,-~ Property line ~-o ' Absorption field Water main/service line F~o ' Surface water/drainage /co '+ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ o ~ Building foundation -~---~ ~ Surface water / Curtain drain F, ENGINEER'S CERTIFICATION Water main/service line '2~~'- 'f- Driveway, parking/vehicle storage area Wells on adjacent lots / ¢¢ I certify that I have determined thru field inspections and review of Municipal in conformance with MOA HAA guidelines in effect on this date. Signatur~~~'~ Engineer's Name ~q-~-,*J Date HAAFee $ ~L~'/ .D~ Date of Payment ~- Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Mer'r'yman Lot 2 #018-282-21 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 wv~v.cLanchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 018-282-21 1. GENERAL INFORMATION Expiration Date: Completelegaldescdption MERRY,{AN SUBDMSION; LOT 2 · Location (site address or directions) 3540 SHANDY COURT * ANCHORAGE, AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address WES STOECKER Day phone 345-4940 3540 SHANDY COURT * ANCHORAGE, AK 99516 Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ~ Individual On-site Individual Water Storage Individual Holding tank Community Class Well [] Community On-site Public Water System [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid [or 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. Municipality of Anchorage Development Services Department Bu#cllng Safety Division On-Site Water & Wastewater Program 4700 South Bragaw ~t. P.O. Box 196650 Anchorage, AK 99519-6650 www,ci,anc~orega.ak, us (~07) 343-7904 Legal Description: WELL DATA Well type PRIVATE If A, B, or C provide PWSID~ Date completed 10/15/1984 Sanitary seal (Y/N) YES Total depth 292 ff. Cased to 292 HEALTH AUTHORITY APPROVAL CHECKLIST MERRYUAN S/D~ LOT 2 Parcel ID: FROM WELL LOG Date of test 10/1,5/ 1984 Statio water level 55 ft. Well production 15 g.p.m. WATER SAMPLE RESULTS: Nitrate 0.524 mg./L. Date of sample: 4/25/2002 STEEL Number of Compartments 2 YES Depression over tank (Y/N) NO Coliform 0 colonies/100 mi. Arsenic: N/A mgJL. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size 1250 gal. Foundation cleaneut (Y/N) Date of pumping 6/18/2001 Pumper Soil rating (~3r ft~rodrm) 251 Width 3 ft. We~ Log (Y/N). Wires pmpedy protected (Y/N) Casing height (above ground) AT INSPECTION 4/25/2002 4.1 ff. 5.75 g.p.m. 018-282-21 YES YES 12+ in. C. ABsoRPTIoN FIELD DATA Date installed 7/lO,/Ig84 Length 77.5 ff. Total depth **1o.7 ff. Eft. absorption area 950 It' Monitoring tuba *YES Data of adequacy test 4/25/2002 Results (Pass/Fall) PASS Fluiddepthinabsoq:)t~onflaldbaforetast 9 in. Watoradded 971 gal. Elapsed Time: 25 min. Final fluid depth 9 Anyrejuvenation treatment (past 12 mo.) (Y/N & type) *~TO Be'ri'OM OF SUMP System type DEEP TRENCH Gravel below pipe 6 ff. Depression over field NO For 5 bedrooms New depth 16.5 in. 450+ g.p.d. in. Absorption rate >= NONE KNOWN If yes, give date *MT ONLY EXTENDS 44" BELOW INVERT Date installed 7/10/1984 Cleanouts (Y/N) YES High water alarm (Y/N) N/A A+ SERVICES Other bacteria 0 colonies/100 mi. Collected by: AWWC, INC. CERTIFICATE o! SURVEY I hereby cerUty Ihat the following described properly has been Sur;eyed by me or under my super'~lsion, end that Improvements slluated thereon do ilot encroach on adjacent property, Iha! Improvements on adjacent property do not encroach on Ihe au~ayed premises, and that there are no power lines, Iransmleslon lines or other visible eesemenls or ~'lghts.01-way except as shown hereon, ti res onslblllty of the owner to determ ne the existence of any easamenta, rights.of.way, con?~ants, or ~estr[cflon~ ~hlch do not appear on the aubd[vlslon plat. .;. , : ~,1~,'~ /~.7~' 7,~,. ~' .,~ .,,..": Ix I I I ~ / '~ ~ , I / u / ~ ~ ' ~,'~"? .~ I~ ~~.'~ '¢7 I ~ ~:[~.....:~...~...,, LEGEND. ~. ~ ~o~,t. s,t _. F~._ ~-E ~- ~ G SUBDIVISION I ~"l ~' Rtbll, Sll --, Fnd,~ ~{'~ RECORDING PRECINCT, A~SKA . ASBUlLT FOR ~ UNWlN · SCHEBEN · KORYNTA · HU~ ~L ARCHITECTURE ENGINEERING LAND SURVEYING PLANNIN~ 4-29--02; 2:44PM; ;907 561 530t ~ 2/ 3 ZtK CT&E Environmental Se~lcee Inc. CT&K Ref.# Client Name Project Namd# Client Sample ID Matrix Ordered By PWSID 1022143001 AK. Water & Waatcwater Consultants Inc. Lot 2. Merry Man Out~ide Hose Bib Drinl~ng Water Sample Remarks: PQL Units McO~l All Dates/Times are Alaska Standard Time l'rlnted Date~lme 04/29/2002 8:28 Collected Date/Time 04/23/2002 1';:20 Received Date/Time 04/24/2002 14:00 AHow~ble Prep Anal/s;* Limits Date D~te ]nit NitTate-N 0.324 0.200 mg/L EPA 300.0 (<lO) 04/24/02 M:[cz'ob:[olof~y' Total Coliform col/lOOmL $M18 9222B (<l) 04/24/02 CT&E Environmental Services Inc. 200 W. Pot~er Drive )~inking Water Analysis Report for Total Colifmm Bacteria ^.ohore,.. AK S9S~..~6oB Tel: (907) 562-2343 ' READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING S/~MPLE Fax: 1907) 561-5301 MuST BE COMPLb I gD BY WATER SUPPLIER TO BE COMPLI~ I ="u BY LABORATORY PUBLIC WATE~ SYSTEM I.D. # ' F PRIVATE WATER SYSTEM Send Results n Send ln~ite Cky RD.. SAMPLE DATE: Month Day Year SAMPLE TYPE: Routine O Treated Water ~ Repeat Sample (for routine sample ~1~ Untreated Water with lab ret'. no. .) O Special Purpose Time Collected SAMPLE LOCATION Collected By alysls shows this Water SAMI~LE to be: Satisfactory o Unsatisfactory O Sample over 30 hours old, results may be unreliable [3 Sample Ioo long'in transit; sample should not be ovcr~ours old at examination · to indicate r~liable results. Plea:;e send new sample via special deliver~ mail. Date Received Time Received Analytical Method: t'~dcmbranc Filter va MMO-MUG · Numberofcolonies/100 mi. Lab Ref. No. Result* Analyst -gent lo A.D.E,C. Anch Fbks Jun Dale: Time: Client notified of unsatisfactory results: '?honed Spoke with [] Fazed BACTERIOLOGICAL WATER ANALYSIS RECORD [~IMo-MuG Result: Total Colit'orm E. Coil P, tembrane Filter: Direct Cou~t . Colonies/100 mi Verification: LTB BGB COLIFIRM FecaICollformConfirmation · Comments: Time: Final Membrane Filter Results (~ ReportedBy _.~:~;;.~_Doti t~JL~Ut~rime Coliform/tOO mi l~3o_ hr, Fazed