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Home My WebLink AboutGILLEAN LT 114AGilleon Lot 114A #051 - 144-49 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211386 PID Number: 051-144-49 Dwelling: X Single Family (SF) M with ADU El Duplex (D) R Two Single Family Project: R New RN Upgrade Name MICHAEL AND JULIE LAKE A ORPTION FIELD 0 D Trench F1 Wide Trench R Bed R Mound Site Address 20236 STEFFES ST CHUGIAK Other Phone Number of Bedrooms Soil Rating1 depth from original grade 3 �D/SF ITotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original Gravel depth beneath pipe Ft. Subdivision Block Lot GILLEAN 114A Fill added above original grade Ft, G el length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dis ce between lines Ft. SEPARATION DISTANCES i Tolon Septic AbsorptionHoldinSewer g Total absorption area Number of trenches Dist. between aches I Tank FieldLift Station i From Tank Line Ft2 Well 1>100' NA NA NA _Q. TANK (9 Septic El S.T.E.P. El Holding 171 Other Manufacturer greer Capacity 1000 Gal. Surface Water i>100' NA NA NA i i Material plastic Number of compartments 2 Lot Line i >10' NA NA NA NA Foundation >7' NA 1 NA NA I LIATION ff—S Manufacturer Capacity Gal, Remarks 2" insulation over tank Alarm location Electrical—inby ---- --- PIPE MATERIAL House to tank 3034 dTank to rainfield 3034 Installer JRs Septic Drainfield CO/MT 3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspdatesection 15, 6/13/2022 7/15/2022 Location and description : 2�d garage slab at point B Y1 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date ..�k 4 ------ — ------- ..too* .......... .. ..... fl .......... IZ L Septic System pate 40'% NoXE11904., Approv=:1 Date Note: this approval does not include well permit requirements. (Rev 05/02/18) Ol > s > > Z < C') m CD C7) !C m n m > —7 0 z cr) , I 0 Z C 0 > 7 --- 0'� > z Fri 0 frY NJ Fri -1 (D FT (D > z A 0 (C) --i -u C/) 0 0 > m > > > C:) cn r— M M, 71 0 c) m A cl, v ci O� cf) X 0 z m CD m m co (J) x Cl rQ 0 C) AV 30 10 0 4w ♦#417 1338iSC to 0 0- 0 0 — ----- 0 ID 9DG9 GVOaf C9AVd > > ....... ................ ........ ................................... ............... NOiM3N >1 0 -L (99MU IN31Vd) r n CL .0 0- � a - , > yE M w 0 IN3V43SV3 Sliniin piland V U) CL.- C14 04 ;7.00,Z0.0'r) AVMGV08 ),VM-JO--LHDZH IIIMOg—X- 2 0 —z0 z 0 0 0 m N - - - - - - X:z CL C: 0 E 0 CL) 0 0 0 U ——-�o 0 U) lb C) C-4 oc 1—i (n 4) C-4 C, 0 C, 0 b e4l m 00 - g to -o� - . . o M C: —C cc"i cy => 0 C> —.0 E 5 m 0 -b v 4) En CL (V < sv It -0 SS CD 16 C, > C> 7� -47 rr wl U) 0 >, —j < .- No�!.2 a. < cs Ln C,4 -0 > D C� X -ii . -z; .=a- - .< Z..- uj <oo -i -j 0 w 0 W 77- CL --J 0- 0 Nil UCJ3 0 m-- 0 X 0 cx 5 0 — C> Z: < . . . . . co U . . . ..-- C� Q ZE LLj LLJ C�, -j C CD . . ... . �E :�; -0 0 o- 2. > 1p a, r LLJ E =D CD w 0 -ld 0 Q 2oO OL - > — >0 C�- . . . o. . o E CL 0-o I lo !! cn o..- . cc o .0 E -c= .2 03 0 o o f M Co .7E! o to CD -0 2 o o Cli 3� E Z > m !Lj FR 0) '70, 00,0 4� 0 lul 1-1� �� Hi8ON C) CN 00 0 0 in P4 t4 cy,\ < LJ LLJ 4> 0 L a uj n LL, 0 b• < LLJ Ld ST w < > 3 AV : ui a m w 4s -K 0 Li 0 0 0 z m uj U) mw < CC.4 CD 5 C) tr) 4 LLI -� CL W < < w w 0 C) z 0* OSI MI.00IZO.ON) LCI) L'i U) V) :D X a- Li- 0 •Ll-; AV rW Cq 04 C14 9Z'09 I M,,90,ZO.0N cq YZ [2 10 ow W < 14-- ,1 ;7, 1 Url Q1 z (1) <3 0 0, 0, 0, >< %Vv I x 1#44 cr �� !� 1 A l -7 ✓ 1A A -7 A Lf) 1A 7�x7 x 0 0) _j L/ P I L/ V -Dv v v (7-D/ ILf y !Lj ck: < MU NICIPALITY OF ANCHOR.AGE On-Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 9951 9-6650 Phone: (907) 343-7904 Fax: {907) 343-7997 http:I/www.muni.org/onsite Effective Date: Expiration Date; Lot Size in Se Ft: Total Bedr'odms: On-Site Wastewater Disposal System Permit Permit Number: OSP21 13Bo Work Type: SepticTank Upgrade Tax Code Number: 05114449000 Site LegalAddress: GILLEAN LT 114A G:1258 Site Mailing Address: 20236 STEFFES ST, Chugiak Owner: LAKE MICHAEL K & JULIE A Design Engineer: EKLUTNA ENGINEERING, LLC* This permit is for the construction of: fi DisposalField M Septic Tank E Holding Tank ! Rrivy E Private Well E Water Storage All construction shall be in accordance with: '1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (1 8AAC72) and Drinking Water Regulations (1 SAACS0)' 3. The wastewater code requires inspections during the installation. The engineer shall noiify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24ft). 4. From October 15 to April 15, a subsurface soilabsorption system under eonstruction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing special Provisions: Locatethe beginning of the field to confirm that the 5' separation between the tankand field will be met. Received By: 9t73t2021 w23n022 451 30 a lssued By: /t,^r., 1f '{f t-r, """, ?/*/z r ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 051-144-49 Property owner(s) LAKE MICHAEL & JULIE Mailing address PO Box 672149 Chugiak Site address 20236 Steffes St Chugiak AK 99567 AK 99567 Day phone Legal description (Sub'd., Block & Lot) GILLEAN LT 114A Legal description (Township, Range & Section) Lot Size 45,130 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) M (w/wo ADU) Septic Tank ElUpgrade 0 Duplex (D) El Holding Tank ❑ Renewal El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above inf rmation is correct. I further certify that this is in accordance with applicable Municipal Coc dpi (Signature of property owner or authorized agent) Permit/Rush Fees: °� 5 Waiver Fees: Date of Payment: Uzi Date of Payment: Receipt Number: 0q709'!S Receipt Number: Permit No. 0'S P I 1 1 3 8 t / 0 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc 'f 'd 'puasu/v\ol'l SlUnS'A;alacur5's1o; turpunoJrns aqt Jo slrll Jo luaudolanap arntnJ aql llaJJe lou lll/\^ uotlellelsu! pasodold aq1'%I ueql ssal Jo adols e le ]seaqlnos aql sple/v\ollltqu/v\op sadols luauare;dar Iuel aqt Jo eare ale!pauur! aql ug Ayado.td stql :Aqdeltodol '5'saqlllp a8eu;e;ppue ratem aleJJns lle uoJJ laal OOI lseal le ulelureu ;1rrn aperSdn plelJ urerp pasodold aql 'plalJutelp pue >luel orldas pasodojd aql Jo laal O0T ultlll/v\ Jale/vl af,eJJns ou sl ajeql :rale^ aleilns 'V'sau1; Apadord aql uo.t;tuelslp ,OI+ lle are stlatsAs rrtdas Sur.roqq8rau alerpauurl 'sualsAs ralernalse1 tu;roqq8;ap '€'uelsAs crtdes pasodold aqlJo ,00I ulqllm slla/v\ ou ele araql'sllem asaq] JoJ uotleluaunJopseq VO1711 'slla/v\ rale/v\ alenud Aq paruas aJe slol Sutpunollns aql pue lol sltll'slla1y1'spues A;ane.r8 are eaJe slqt ul sllos '.€I ;o qldape le palanotslpse/v\ lale/v\punorB ou pue aunl Jo qluotu aq1 Suunp tnp servr aloq ]sal V 'sllos'aultl stql 1e pace;dar aq lou ll!/v\ 1l 'f! u! ralem Jo ..6f seL,1qluarl Zg6T eql'paprnord aq lll/v\ Iuel rlldas /v\au e pue pa^oual aq llrm >luel crldas aL1I '/vlatnal rnoA.to;pesollua sr ueld alrs tuuaaur8ua uy 'alueplsar Alruuel-e;8u1s utooJpaq-€e a^Jas 111tn uualsAs pasodo.tdaq1 'Apado.rd pacua.ralar anoqe aql rot lrrurad uorlellelsu! uralsAs clldas e ]sanbar ol Sutltrn rue I9StTTZdSOlsenbau Ur.urad >1ue1ct1da5 mapvtTI lol uealll9:1:afqn5ruoo' I1eut@puesu/v\ols!u nlf,ll'8ulraaultul eulnllS,z.Tv"a'IZ0Z'TT JaqLueldes Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211386, Deb Wockenfuss, 09/23/21 NoJ--:-r-=-rS sllllrs,,,d'ruMFi t,i iN#;*f+#\I'K.1II--1-bsIh/(ovx--lr)Fo_XLiliooN.Url)Zi/-i^i-tzY] tLLI><ILELTJ LJ FcHc{:\Fl:a< /v-\r4)^\ "ot)\"Jr,vv./,-rr\.-.y))\'.s>\'>n\SoaI--3E Va<ZIv^vt7-Na;,7-===:*z>=o P A oIsF724=?--F=.,d<6P-\3p=d=ll= \-il*-ff>6v \d'a"gstr-"".-F=3d4s=laao._-:|,.)Va.b-V"u"+trJo.\v t.l=zJa--ElU.lo-LrO9tLE.LLI>F-<il=[-\LrloIE.oUm|..);-vtzIat--tIU:io-r! C)7uo_U.r!>F-<E=f,V^ai1 -<z z.Lrt-ql7-483<->5u4Alomtr<-;u-j=),2>"'A-^_!___r-ft*3offE= ts.'5f9\1I= =9".3a ,i.-94\78-*-t3fteq:i=2=,9I>Ai-u;FEU7*-6l:9s:=6-:eft=zem>t5,,, <-rv- F ]ZQ?q'5F$r,lOi.5E;- o*Zt_" OtIL:slEis-t'i69i399+Hldo-(,r)coNF()Lil<<ft<(J9 31.-,^ir'alrl-bN).1 ticD LLa(vttON=qFo)t.llt!-ao)Y$s5=rt'-i=58kfr6eo oa (Ll-(oroo)o)=Ug;<6e-lGFu<$d^sI (ur-??'ob; o:f Jizizt1;qt#pd,togv =3CANoN:lO=ftlrl--i F'{-ioZ" <.oa).O-)O['o)Z-z4qsLd =X!tr:i=<.=j Izr'-- gF>..,Y--) a-r(\n-JtOY x\,/--J -rr?-9 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211386, Deb Wockenfuss, 09/23/21 aK-o_Z.oOZ.flr:.F,n- r-lrlY>!<,rE-q';27,= " 6kX"<.-Q;q<-l=*-P6'-2Er,-*Hd?=mS*oi^ tr i,^^< o'fi;-': t9oZo>N-z=E=l:-Ao>Al- tZ TLLJO_ O >)<ao_-,,,^o=2?Z+6=YK 1=-l^F Zr,t 2aod-YZn?-=o-3?d3oabi-, Y?%qloe=Ai0o-tnl;=9=-+!!2=2.3=9 7--|._-^m)<Z,^{o=Oa-<Io_,-$*#1,?.,fi:{i i;=o*;q{ffW(o@C9NIaol-(oloo)o)iY*PJOFrl<$O-r^' -J-!l -:)<or-3-'6b;o=JP Z-r.'ZEx;q:Hpa6 6Ev'= (/)-<ocf)NoNrFinNNi-:RO]'6NNqFo)uJul-U)o)Ys$5-rLri=58Fo o aLOj(\z.ftlrli:-iF-Z=rrla) O)r\i7; o-r-Z- -z4eLLI lw,o+?3<..=)|7-:" 6 -coF >;=--JI \r/\-^COY r.-\z-- -J ;-^Tvlr I u);\o)-\rr Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211386, Deb Wockenfuss, 09/23/21 on ME ksBUILT HERESY CERTIFY -THAT I HAVE SURVEYE0 THE SCALE.' OLLOWING DESCRIBED PROPERTY: Puanie Mork SUaw4 rd Ls R)ICATEECL IT IS T� -RESPONSIBILITY OF THE VNER TO DETERMINE 'THE EYJST-zNCE OF ANY GRID: 1Y LINES. DRAWN., on ME / Puanie Mork SUaw4 rd Ls / Rick Mystrom. Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci.anchorage.ak.us December 30, 1999 MARKLEY GARY J PO BOX 672435 CHUGIAK, AK 995672435 Subject: GILLEAN LT 114A Permit# SW990038 PID # 5114449 The subject permit #SW990038 issued by this office for a single family well and/or on- site wastewater system, is due to expire 365 days after it's issuance on 23-Mar-99. If this is a well permit and you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If this is an on-site wastewater system and a licensed Professional Engineer has inspected the installation, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be snbmitted within 30 days of construction completion. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. However a new permit can be issued free of charge for a second year if the application for the renewal is received on or before the date of expiration of the original permit for which a fee was paid. When applying for a new permit after the original permit has expired or for more than a second year, the fees are: $320.00 for an on-site wastewater permit and $120.00 for a well permit. If you have any questions, please call this office at 343-4744. Program Manager On-site Services enc: Copy of Permit MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WATER SUPPLY PERMIT Upgrade Date Issued: Mar 23, 1999 Expiration Date: Mar 22, 2000 Permit Number: SW990038 Legal Description: GILLEAN LT 114A Design Engineer: 0000 None Required Owner Name: Emma Grace Owner Address: PO BOX 671288 Chugiak, AK 99567-1288 Parcel ID: 051-144-49 Site Address: 020236 STEFFES ST Lot Size: 45130 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage Ail construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AACS0 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special previsions. This permit is for supplemental water storage. 500 gallons minimum are required for well production between 150 and 450 gallons per day. 1000 gallons minimum are required for well production less than 150 gallons per day. After the water storage system has been installed, a letter shall be submitted to the Department giving the specifications of the storage system, including total gallons and location. Issued By: ~ , MUNICIPALITY OF ANCHORAGE ~,,,_,, DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 2..64-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE NAME [] UPGRADE MAI LING ADDRESS LEGAL DESCRIPTION ~E~I LOCATION ~ Well Absorption area _~ v DISTANCE TO: I ~/~O I ~7 / Manufactu rer m~ I- Liq. capacity in gallons IF HOMEMADE: DISTANCE TO: Manufacturer~j~¢¢~ DISTANCE TO: Top of tile to finish grade Well Inside length.~. I Width.__ Dwelling We~_l.l~/~1~.~ l Foundation I Lengt~.f¢ch line ,f lines Material beneath tile Dwamng/ Material Material Nearest lot line Trench width WiSth Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line NO. OF BEDROOMS PERMIT NO. No. of c~.~partments Liquid,~depth PERMIT NO, Liquid capacity in gallons PERMIT NO, Distance between lines PERMIT NO. / Type of crib DISTANCE TO: DISTANCE TO: Depth Driller ' Jndation Sewer line Distance to lot line Sept~.c tank PERMIT NO. Absorp~on area(s) OTHER PIPE MATERIALS SOIL TEST R A T I~G~..._~, INSTALLER REMARKS - A_~ROVED 72-013 (~ev. 3,78)(~ DATE LEGAL M SIGNEI I=1 E~I~I,.Y ['~i'~® 4S 47:l SIGNED SL~JD pARTS 1 AND 3 INTACT - PAINT 3 WILL BE RETURNED WITH REPLY. DATE// POLY PAK (50 SETS) 4P472 ;:IF'F:'L. ~T CFIN T LECi~L DE:PF!RTHE?',H".~ ?' i--lE!:::it...."!"!...i FIND EN'v'I'ROf',IHENTF!L.>-,.~q'.0"FECTZON 8;2.5 "' L. "' STREET., FdqC::HORFiGE., F!K. 995Et~.. 26;4-4'F2Ei :SE; EEl ~.*.~ BE ~:;~::: F" E% F.:: ~"! lie '] .... T:~SNR:J,.H i.,..ii4 S. 9 LOT SIZE '?::999:~]~:~ SQL.!FIRE FEET i"!FIXIML.!M !"&.ii¥!E~E?~: CiF:' EF:_'l'"mcr}h'l'£:: = ]..:: S0 I. ~.~ ........... RRT ! F,iG ,' %r.:, FT ...'F F?' .... ,_,'--'~= TFiE L. Ei',!6i]]'"! DZHENSION tS 'H'-iE LENGTH ,:: :iN FEET::, OF TFIE TRENCH (iR DRRtNFiEL.D. TH!E DEF'TH OF 1;::! 'TREI',E:H (:iR I::'ZT -iS THE D ZSTRi",IE:E BETI.4EEN THE SUR!-:'RE:E OF THE GROL.tF,!D FIN[:' 'T'HE BOTTOH E!F TFiE EY, CFI'v'I::Ff' i ON ':: I N FEET ). T.HE GRR',?EL.. DEPTH :~S THE M!NZMLiP! DEP"FH OF G,r',~:W,,,'EL. BETHEEN 'THE OUTFRLL F:'ZPE i::li'-,iD '!"HE E~CrT'TCff,'i OF ]"H.E EF';CFIVRTIOF,! (IN FEET). .... -..,!~, t FIF:'F'L. iE:FIi'.4T HRS 'THE i:LE'SF'ONSiEi!L. IT'.? 'T'O. I,NFOF~:!'"! '~"'"'"" !}EF'F'!RTMEI'.~T =.. I...I ~ ..... I, ~,.: 'T'F!E l H:STR!....LR'T'i ClI'-~. ................ T i"J':~ F'E Z T T E N'::; OF ~:ql'. '.¥' HE:L.L.S Ft[:,JRCENT TO TH l S PROPERT'¢ rc'",,,m'"' ~'"~, ,E'- i"g...!HE~EF4: OF RES I DENCE'.:;:; THF:!T THE HEL. L H i LL SERVE. F::i]KFT. L_iI"4(:'~ OF F!~.,I'¢ S'.?L.'T,]"EH HiTHOIJ]" F-.£ ....... t.'.JSF:'E'E:T'fOFI Fi!',E) ,-~, F.J .... THiS [,EF'RRTHEHT ..-!t,..L E:E '9 F.;FE':T T() PF:]'.SE] ..TI ]i'... HIN!'HUt"! DiS"!"F:iNCE tF...'-ETHEEI',! R HELL. FIN, f) F:iN'¢ O.N-.S:[TE SE!4F!GE D~SPOSFIL. L:i;'¢STEH ~S :i..E~Et FEE]" FCIR R F-'R!',,,'I::YFE HELL OR :tSE'i ~r(] 2tD~z! FEET i::F-::Ot','I R F'!JE~L. ZC HELL. DEF'E:'I',i[:,ING UPON THE T'¢PE OF PUBLIC HELl. .... iiiI.,!iHIJH L}ZSTFII',K}'E FREII"! FI F:'F::I,':',,,'R"FE HELl._ "ro R !::'!~:.:!"v'F!TE SEi.,.IER L..ZNE !S 25 FEET RND TO Fi COHHLt!,IITY SEHIER LINE .T.S 75 FEET. OTHER I:~:EGI.!II:.~:EMENTS !'"lfl"r' F!PF:'L"¥'. :r];F'EX::tF'ZCFtTIOHS FIND CONSTRI...iCT!Oi",! D:i:RGRFiM..S F'~RE Fi',,,'i~ .i: LFIBLE "FO ! I",!L=.;L.iRE PROPER l NSTF!LI...RT I ON. ! CER]"ZF"?' THFIT :L: i Rt"i F'FtH:[LIFIR HZ"f'H TH, E RE(;:!U:!.'REHE.NT:i~; FOF,' Oi"f-S~TE SEHEF'-'.S FIh!D !4i:EL.L. 5 RS SET FORTH B'¢ THE MUN'~CZPF!L.Z"f'":' OF FiNCHORFiGE. 2: i H!'LL. ;[N.'.:.Tr'FIL.L. 'THE S'..,'STEH ZN RCCOF. t£)RNC:E HZ'TH 'T'HE CODES. ]:: Z UNDERSTFtND Tf4FIT THE O!'.4-SZTE SEHER S'¢S'T'E!"! .HFI'.¢ F..:EQUt'.r,?I.:i: ENLRRGEMENT TF THE F.:ES i DENE:E I :E; REHODELED TO i NCL. LtDE i-'!ORE 'T!...IFIi'.4 ~: · ....... ................. ........ F:IF:'PL.. :[ E:F!H'T !,.! ! LE',UR D i "["FE',RENDER ............ ~ ............... ~'- ........................... 7'? 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 5 6 8 9 10 11 12 13 14- 15- 16- 17- 18- 19- 20- Z- 7 '?- /3 -st/9 SLOPE SITE PLAN WAS GROUND WATER /~Z/~, S ENCOUNTERED? L O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE COMMENTS (minutes/inch) TEST RUN BETWEEN FT AND -- FT 72-008 (6/79} PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 ~ "~' ^ r~,~l~l~zl_~l O ~NICIPALITY OF x~CHu~-P~m~Y F ~EPT, OF ~2,-Li~ & DEPARTMENT OF HEALTH AND ENViRONME~B~~NfLC~ ~ 825 L, Street, Anchorage, ~laska 99501 264-4720 98/ 2 SOILS LOG - PERCOLATION TES~U/ WAS GROUND WATER ENCOb NTERED? SLOPE SOILS LOG PERCOLATION TEST 12 13 IF YES, AT WHAT DEPTH? RECEIVED DATE PERFORMED: S ~E PLAN 0 P E- 14 15 16 17 18 19 20 ~ert A. Gross Net Depth to Net Reading Date Time Time Water Drop I PERCOLATION RATE ~'~/~/~ Iminutes/inch) TESTRUN BETWEEN FTAND -- FT COMMENTS PERFORMEO BY: i~ & ~ EnqineeH~ 72-008 (6/79) [:6:.!PP~F;t'T'P!E?,FF ' HEF¢../T'H !::,d",!C, E!'.P,,,' I F:Oi',ffqEHTFiL. OFEC: ! ! S;2E; '"',i:~-~ STF;.:EET., F!,~-,!Ci".~ORFK~E., F¢:::. 9S~.:.dii ;26,4-472~D .::?PL IF::F~'-, ......E,q~l:~::'.r' EiiL. L. EFI?-~£ 9.4':~-:2 P::'./OF~i~'J'-:; "2:'.%}J:.-:!';::";L9 ..... m' 'r n?,! L,.EGFIi..., T!Shi~'.:2HrS, 9 LJ.:t4. LOT Si;:i'E 4. Z:'.S~Sf3 :E;r2UFff.-'.':E F'EET i',~IN):HL!H Di::.:;T:,,:~I'~C:E E:ETHFJE'.,'~ R HELL ±~30 F'EET FOR F! !::'R!V!~TE t4EL. L.. OR i:50 TO ;2t:~iFJ FEE'T' F'F,.':O,M R PLJBLiC' NEL. L DEPENDING UF'ON THE T"'r'F'E E!F: F:'UBL. ZC HELL.. ]'"!IN!'?!UH DI:E';q-F¢,!CE FROM f::i F:'?.i',/R'TE .HELL 7'0 R F:'Ri?RTE SE.HE.[~: LINE lei; 2!5 FEET F:~ND TO R COP'!.h!UN:,r.T? :E;ENER LiNE :[!5 75 F'EET. HELL. LOGS FIRE: F~:EX;:RJ!FRED F~i'.,IE:, i"IUg.;T E:E RETi. JF.:hlED TO THE DEPRRTPIENT NITHI?',! :i.':E~ DR'T'S ElF' 'Tb!E .HEL.L E:E~HF'L.ET!ELN. EO."HEF?, REi;!U l RE.EP'!EF4TS PtF:i"r' RF:'F'L.'¢. SPEC: l F I CRT ! CS,IS RhtO E:ON%'TRUC:T I ON D i FHS~:F:iP'!:E; RRE R',/R!L...F!BLE TO INSURE: F:'RCff:'ER INSTRL. L..RTI OWNER OF LAND ADDRESS LEGAL DESCRIPTION'- DATE - Started " " PERMIT NUMBER by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX272, GHUGIAK~ ALASKA 99567 · TELEPHONE 688-2759 DEPTH OF WELL :,-., ~ ~, ? .'. ~./-~ ~"? ,-5 ",' ¢~-' Y'~TATIC LEVEL OF WATER FT. · ? ·', '-.~ . t ~ DRAW DOWN FT. Ended Y"" '~ · ': GALS. PER HR ~ -: KIND OF CASING d.~ J' :. ~' ' KIND OF FORMATION: From__ From __ From__ From -- From__ From__ From __ From __ From From From From From· From· From From Ft. to : Ft. Ft. to -" Ft. · Ft. to Ft. to Ft. to .Ft. to Ft. Ft. to Ft. Ft. to___Ft. .Ft. to Ft. Ft. to. Ft. Ft. to.__Ft. Ft. to Ft.. Ft. to Ft. Ft. to.__.Ft. ~ Ft. to Ft. Ft. to Ft. Ft. to Ft.. Ft. "~,- ~' Ft. From Ft. to. Ft From Ft. to Ft From Ft. ro Ft From Ft. to Ft From--Ft. to Ft. From Ft. to__Ft. From__Ft. to Ft. From_ Ft. to Ft. From__Ft. to Ft. From _Ft. to Ft From__Ft. to Ft From Ft. to Ft. From___Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to__Ft. From Ft. to Ft. MISCL. INFORMATION: DRILLER'S NAME (ger -ifieil by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX272, CHUGIAK, ALASKA 99567 · TELEPHONE688-2759 OWNER OF LAND L' LEGAL DESCRIPTION-':'. DATE-Started_ ' ' Ended PERMIT NUMBER DEPTH OF WELL ,,~ . ~.,~:.:~. ~. ~ c,, ~_ '.v '~ STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS, PER HR KIND OF CASING KIND OF FORMATION: From Ft. to From From From ' From From From_ From__ From From From From - From _ From From .. From . From Ft. to / Ft. to Ft. to .Ft. to . Ft. to _Ft. to_ Ft. to ' - .Ft. to' Ft. to.-- Ft, ~ - .Ft. -';;:': Ft. to Ft. Ft. to Ft, Ft. to .Ft. Ft. to Ft. Ft. to Ft. .Ft. to Ft._ From _Ft. to. Ft. From Ft. to__ Ft. From__Ft. to Ft._ From_ Ft. to Ft, From--Ft. to_ Ft. From Ft. to Ft._ From Ft. to_ Ft. From Ft. to Ft, From Ft. to_ Ft. - From Ft. to _Ft._ From Ft. to Ft. From_--Ft. to_ Ft From_ Ft. to___Ft. From Ft, to Ft From__ Ft. to__Ft. From__ Ft. to Ft. From Ft. to_--.FL MISCL. INFORMATION: DRILLER'S NAME Municipality of Anchorage Development Services Department Building Safety Division O~-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak, us (907) 343-7904 CERTIFICATE OF HEALTH .AUTHORITY .APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 051-144-49 1. GENERAL INFORMATION Expiration Date: Complete legal description ClLLEAN SUBDMSION; LOT 114A Location (sIte address or dira~ons) 20236 STEFFES STREET * CHUGIAK, AK 99567 Current Property owner(s) G~,RY MARKLEY Day phone 474-3835 Marling address Lending agency Mailing address Real Estate Agent Mailing address Day phone RICK DAVIDS w,/ SUN PROPERTIES Day phone' 272-6336 Unless othenytse requested, HAA will be held by DSD for plckup. 2. NUMBEROF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (H/SA) 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 requlred for the transfer of tiUe (except between spouses) for properties served by a single family on-sita wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Ce~ficates of Health Authority Approval are valid for g0 days from the date of Issue for proposes served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. Tho Municipality of Anchorage Is not responsible for errors or omissions In the professional engineer's work. Note: Alaska Water and Wostewat.~r Consu. ltants, lnc. shall be pald $1,110.OO at, or prtor I to dosing for the engineering ee~ces pro~ded. 4, STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, I varify that my investigation, based on procedures outlined in the Health Authofi~y Approval Guidelines for this application, shows that the on-site water suppb' and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and ~ of structure indicated herein. I further varify that based on the Information obtained from the Municipality of Anchorage files and from rny Investigation end inspect/on, the on-site water supply and/or wastewater disposal system Is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations In eff~"t at the time of installation. Name of Firm ALASKA WATER & WASTE'WATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504. Date Engineers Printed Name JEFFREY A. (;ARNESS, P.E. 337-6179 Engineer's Comments: conscientious engineering ana~sls of the system In accordance idth ADEC and MOA system under the conditions encountered at tho lime of the test and separation septic systems depend on the Ioce! soils condit!on, groundwater levels that may · These conditions are outside the cont.! of the evaluator of the systom. Sat]sfacf~y test , resu~ do not gusrantee future performance of the s~!sm, ~' do they guarantee that thsre are no hiddsn dd~:fs or anc~oac~msn~s. AWWCo lnc. cen thsrefore not Fovfde any warranty or f~ure estimate of how long the s~tom ~ continue to meet the opera~tonal requlremonts of the ADEC cc MOA DSD. The con!on! of this relx~t Is the sote benefit Of the owner listed abo~. Any refiance upen cc use of this report by any ~,~_( rr rrr~ other person or Imrty Is no t a uthodzed, nor ~il it center any legal right wha tscever. . 5. DSD SIGNATURE Approved for ~ bedrooms. . Disapproved. Conditional approval for bedrooms, with the fllowlng stipulations.'~,.e~,, tlote= Ihe ~ell for this property meets existing State and l~untcipal are nitrates present, It is s6~;e;ested that periodic testing be performed insure the wells continued suitsbilitv. Current nitrate co~ee~tt'nt{o~ EPA maximum concentration ~s lO,Omg/1, Here information on nitrates ~s available from the On-.c;lte gervlee~ program- ~t Attachments: HAA Checklist Septic System Advlso~ Well Flow Advisory Manltenance Agreements Supplemental Engineer's Reort Z/;,'-/',-.- Odgtnal Certificate Date: {Ra~. 1 Municipality of Anchorage Development Services Deparlment On-Site Water & Westewater 4700 ~outh Bragaw St. P.O, Box 196650 Anchorage, AK 99519-6850 L~I Da~tpfion: A. WELL DATA HEALTH AUTHORITY APPROVAL CHECKLIST GILLFAN SUBDIVISION; LOT 114A ParcollD: 051-144-49 Well type PraY^TI Date completed 4/82 Total depth 86 ft. Date of test If A, B, or C provide PWSID~ N/A Casedto 40+ f~ FROM WELL LOG 4/82 SteUe water level 30 Well produclion 2 WATER ~M~/IPLE RESULTS: Coliform ~ colonies/lO0 ~. Date of sample: 3/50/2001 B. 8EPTICMOLDING TANK DATA Tank Type/Matedel STEEL Tank~ze 1000 gal. NumberofComparlmenls Foundetlon cleanout (Y/N) *YES Da~ of pu~p~ 3/8/04 ¢. A~SORPTION FIELD DATA Wall Log (Y/N) Y~S Wires pmpeffy protected (Y/N) YES Casing halght (ebeve ground) ~2+ In. AT INSPECTION 5/ 4/2ool lt. 54 .ft. g.p.m. ,0.16 .g.p.m. *THREE (5)THREE-HUNDRED GA~I._.ON STORAGE TANKS IN BASEMENT: go0 GAI.~ONS TOTAL. Collected by:. AWWCt INC. *INSIDE FOUNDATION. Date Installed 7/82 2 Cleanouts (Y/N) YES Dapmsskm over tank (Y/N) NO High water alarm (Y/N) Pumper JR'S ~*ea.,ow ~ m~,DE · U.T~ Date Installed 7/~2 Soil rating (g.pzlJft~or~ 85 Lang~. 28 .ft. Width 5 Total deplh *9.4 It. Eft. absorption area 280 fl" Mollltering tube YES DateofedeClUanytest 5/14/2001 Restd~ (PasslFall) , PASS Fluid depl~ In absorption field before test O in. Water added 790 gal. Elapsed Time: 264 min. Final fluid depth 5.5 In. Ab~n rate Any mJuvenafion treatment (past 12 mo.) (Y/N & t~3e) NONE KNOWN System type TRENCH Gravel below pipe 4 ff. Depmsalon over field, NO For 5 bedrooms New depth 16 In. 450+ g,p.d. If yes, give dete - D. UFT 8TA'nON Date inst~;ed Size In gallons 'Pump on' level et ~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM W~ I ON LOT TO: Sep~c tank/ll~ station on lot 100'+ Ab~o~p~on 6eld on lot. 100'+ Public sewer main N/A Sewer I~eplJ~ serv~e I~ne 2§'+ High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots. 100'+ On adjacent lots. 100'+ Publlo sewer manhole/c~eanout Holding tank N,/A SEPARATION 01STANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundaUon 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on a,~]acent lots 100'+ SEPARA'noN DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field 5'+ Surface water 100'+ Prope~ line 1 o'+ Water service line 1 o'+ Curtain drain NONE KNOWN F. COMMENTS Bulldlng foundation 10'+ Sun'ace water 100'+ Wells on adjacent lots. lOO'+ Water main N/A Odveway, par~nofveNcle ~orage 5'+ G. ENGINEER'8 CERTIFICATION I ceraly Ihat I have determined ~hmugh field Inspec~ns and revfew of Municipal recon~s that ~he above systems are In conformance wlffz MOA HAA guidelines In effect on 6~ls date. Engineer's P~d tame JEffrEY A, GARNESS H Fee$ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHOP~.GE M E M 0 R A N D U M WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO. ~ ~ 01013~ During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot Block -- of ~/LL E~/ Subdivision, the well's productivity was ~etermined to be ~,/~ gallgns per minute. The minimum well productivity required by this Department '(~IC 15.55) for a ~ bedroom residence is ~ 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 attached to all copies ~f the subject Health Authority Approval. ,4/o"l'¢-: T~ & We, !1 ~pp rover,[ ,,.,',7'~. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.C Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY A'PPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# 051-144-49 1, GENERAL INFORMATION Corn plete'legal description Lot l14A, Gillean Subdivision Location (site address or directions) 20236 Steffes Street. ~,~.P,~bperty owner?-E~ma Grace "/'Maili~,~'addr~§s ]['0 ox 671288, %~.,.Lending agency ....... "~gent-- ' ' ' Add tess Day phone 688-9619 Chugiak, AK 99567 Day ~hone · ,Day phone. Unless otherwise requested, HAA will be held for pickup. 3 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well XXX 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 XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev, l/91) Front MOA~21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and aa 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 d!sposal 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 & $ ENGINEERING 17034 Eagle River Loop Noad r~o. ~u4 Address Eagle River, Alaska 99577 Engineer's signature ?/~/d2 ~/~---'~ Phone DHHS SIGNATURE /Ap. proved for "-/-/'7//:~ gE bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Rote: The well for this property meets e×ist±n§ State and Municipal Codes. performed to frisk, re cae -,cells contfnned suitabt].lt¥. Current nftrate More information on nitrates is available from the On-site Services Program, DHH~S, J~o-4/44. Additional Comments 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 orderto 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. RECEIVED Municipality of Anchorage /~,.A~I~\ DEPARTMENT OF HEALTH & HUMAN SERVICES SiP 20 1999 ~ Environmental Services D v s on . [I;DJTIFL~) · · · 'p ' fAncno,~... 825 L Street, Room 502 Anchorage, Alaska 99501 (~7~'~umanServices Health Authority Approval Chgcklist Legal Description: L.~7" I I~1~,,~ ~__l-lLC~'7~ Parcel I.D.: A= WELL DATA Well type Log present ~) Total depth Sanitary seal ~) (-~-~- '-~ If A, B, or C, attach ADEC letter. ADEC water system number ~ mpl ate co eted Cased tO ~ /7z- FROM WELL LOG Date of test Static water level Well production ~'- g.p.m. / Casing height (above ground) Wires properly protected ~)N) AT INSPECTION B= C= WATER SAMPLE RESULTS: Coliform ,~ Nitrate ~,, '~7_7_~ ~ Date of sample: ,'_~./~:p/..l~? ~.N/7'7'4/F~ C(~llected by: SEPTIC/HOLDING TANK DATA Other bacteria /. ,~. Cleanouts~N) Date installed '~/~-///,~¢:~2~Tanksize ,/~"'~ Number Of Compartments __ ' / ~ (Y/~) ZV'(~ High water alarm (Y~_ Foundat on c eanout (~ ~ Depression Date ofCP~n~'"": ~/~/~ Pumper ga[e.:,nstailed~ / Soil rating (g.p.d./fl' ~ ~ System ~pe ~/~ E~ngth" ~ ,~idth~ ~ Gravel thickness below pipe ~ Total depth Eff6~{iVe absorption ar&a ~ ~ ~ Monitoring Tube present) ~ Depression over field (Y Date o~'adequacy test ~ Results (Pass/Fail) ~ For '~ bedrooms Fluid depth in absorption field before test (in.);//~,~llmmeaiately after ~al, water added (in.): Fluid depth ~ /~t/ (ins) Minutes later: ~ / Absorption rate = ~ ~ g.p.d. Peroxide treatment (past 12 months) (Y/N) ~P~E ~P/~/ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) ~~level at* "Pump off" level at* High water alarm ~ *Datum Cycles..Jeet~d E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot On adjacent lots On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line ~- ~- £ '7~ Lift station /I///)- / SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation "~ / Property line ~-/cc Absorption field Water main/service line /(~ "/ Surface water/drainage /O~/~ Wells on adjacent lots /O0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /'~) Surface water Curtain drain Building foundation /O ~Z Water main/service line Driveway, parking/vehicle storage area ~/O '~L ,/~"A./O/.~,/',,/ Wells on adjacent lots /~_O F, ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records that tl~ems are in conformance with 1~10.¢ H~4~A~guidelines in effect on this date. -., Date HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Parcel I.D. # 0512144-49 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 HAA # MAY 12 1999 UNICIPALITY OF ANCHORAGE RONMENTAL SERVICES DIVISION 1. GENERAL INFORMATION Complete legal description Lot l14A, Gillean-S/D Location (site address or directions) 20236 Steffes Street Property owner - · E~t..a Grac~ Mailin£9 address Po Box 671288, Chugiak, AK 99567 Day phone688-9619 Lending agency,,.'" Mailing address. Day phone Agent Address · DaY phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well Public water 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 tanl~ Community on-site xxx Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. [Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by myseal affixed hereto and as of theval[dation 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, functionaland 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 River Loop Road No. 204 Address Eagle River, Alaska 99577 Phone DHHS SIGNATURE ~/"' Approved for T/-//~ ~'/~ bedrooms. Disapproved. Conditional approval for bedroom% with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration is 6.13 mg/1. EPA maximum concentration is 10.0 mg/1. More information on nitrates is available from the On-site Services Program, DHHS, 343-4744, Additional Comments The Municipality of Anchorage De::~rtment 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. 1/91) Back MOA ~1 MAY 1 z 1999 ~INICI?ALI]~ OI; AMCHr.)P,,~Oi~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SE~{~III~NT^LSEIWiCEs DIVI~I Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist LegalDescription: ~-OT )Ih( ,~ C.~I.L~,~ A. WELL DATA Well type Log present ~/N) Total depth Sanitary seal (~/N) Date of test Static water level If A, B, or C, attach ADEC letter. ADEC water system number Date completed L// Cased to ¢-/0 ¢- Casing height (above ground) Wires properly protected ~N) FROM WELL LOG AT INSPECTION O~G ~ g.p.m. Well production g.p.m. WATER SAMPLE RESULTS: Coliform 0 Date of sample: I / ~ ~i' B. SEPTIC/HOLDING TANK DATA Date installed ']/~ / ¢/- Nitrate (~. i.3 Tank size )0e 0 Collected by: Other bacteria S & S ENGINEERING 17024 ~.~'~ Eagle River, Alaska ~577 Number of Compartments__Z C eanoutsd~/N). Y'~ Foundation cleanout (Y,~. ~ Depression (Y~.~ Date of~Pumping ~',/~/~ ~ Pumper T 4_ ~ C. ABSORPTION FIELD DATA : Date installed ] //')' I / ~ 7,_' Length ~ ~ ~ Width ~ Effective absorption area '~0 CT Date of adequacy test L//'~-O / ~1 ~ Fluid depth in absorption field before test (in.); .I '7 ]/~ Fluid depth. '/~- (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) .to a ~ ~- High water alarm (Y~, /¥ o Soil rating (g.p.d./ft2 o~ ~' J' System type Gravel thickness below pipe ~/ Total depth Monitoring Tube present (~/N) ¥~r Depression over field (Y/~ ,',-' o Result~Fail) /a/~ j-.,~ For ] bedrooms Immediately afters' ~. gal. water added (in.): ~ / $ ~/~- Absorption rate = L/..C O -~ .g.p,d, ,t~wxJ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) "Pump on" level at* High water alarm level .at* ~ Cycles tested E. SEPARATION DISTANCES Size in gallons .~~u~p off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: / Septic/holding tank on lot ,) O O '+- On adjacent lots Absorption field on lot / 00 "f- On adjacent lots Public sewer main /v' / ,¢- Public sewer manhole/cleanout Sewer/septic service line ~ ~- ! ~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~7 Property line &- ~P Absorption field Water main/service line /'0 ~ Surface water/drainage ? 0 0 Wells on adjacent lots Joo SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / 0 ~ Building foundation ) 0 -¢- Water main/service line ) 0 Sudace water ) 0 0 / Driveway, parking/vehicle storage area Curtain drain N ~ ~ ,Z_ ,~ ~' o w ,~' Wells on adjacent lots ENGINEER'S CERTIFICATION I certify that l have determined thru field inspections and review of Municipal in conformance with MOA HAA guide~es in effect on this date. Signature HAA Fee $ Date of Payment ~-' / '~ q q Receipt Number OL(o°-~c~ 6~-~'3 Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE M E M 0 R A N D U M WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO. q~ O~ ~ During a recent Health Au~horl=f Approval on-site inspection and test of the potable water supply well on Lot / /~ ~ B~oc~ -- of C~ / L £ g ~ S-~div~sio~i the w~'s productivity was determined to be 0~ ~ gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a ~ bedroom residence is O~'~i ~ gallons per minute. Although the subj~= =~ well currently exceeds this minimum=e~l_em~.~'r ~, 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 attached to all copies ~f the subject Health Authority Approval. 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 GENERAL INFORMATION (a) (c) Application Date ~//?/~:::~ ~' . Legal Description (include lot, blqck, subdivision, section, township, range) Location (address or directions) , (b) Applicant Name ~-'~~~ Telephone: Home deg- g~'/~ Business Applicant Address ~) ~ ~ ~~ ~- Applicant is (check one): Lending Institution ~; Owner/builder~; Buyer ~; Other ~ (explain); (d) Lending Institution ~ /'~-~.~, /~-'"..~/~4., ~-~. Telephone Address ~/ ~ ~-~~/~~ (e) Real Estate Company and Agent Address Telephone (f) ~/-'°-~' the HAA to the 'following address: 2. TYPE OF RESIDENCE Single-Family/~ Multi-Family [] Number of BedrOoms ~ Other 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. SEWAGE DISPOSAL Onsite/~ Public [] Community [] Holding Tank [] Note: I! community well system, must have written confirmation from the State Department of Env ronrnental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PR~)VIDING 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 regulations in effect on the date of this inspection. Name of Firm 5 & S E,,~j;i~,;~l~ Telephone Address SEE, 196x ~.~,~,. m E~gle .~iver, A/aslca 99~77 ?_ _ ~ ~-- _ ~, ~ Date ADapEr~Ae~ ~RrOV~-- bedr°°ms bY ~'~~/-~t~ Approved /~... Disapproved Conditional Terms of Conditional Approval The Muncipality of Anchorage Departme"~t 'of Health and E~vi~'~nmental Protection (DHEP issues Health Authority Approval certificates based solely upon the represen~fibns 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 requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not res ponsible for errors or omissions in the professional engineer's work. . Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA~ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description; WELL DATA Well Classification Well Log Present~,N')" Total Depth ~' / Cased to Static Water Level ,.~ 2_.. ~ Casing Height Above Ground /~-//~' Electrical Wiring in Conduit ~ Separation Distances from Well: To Septic/Holding Tank on Lot I O~"4"- To Nearest Edge of Absorption Field on Lot [ ~5 ¢ ~ MU1qlcIPALllY OF ANCHORAL~i~ DF-PT, OF HEALTH & · ENVIRONMENTAL PROTECTION "--?.~! \!A-- ,.-r-~ If A, B, C, D.E.C. Approved (Y/N) Date Completed '~//'//~ ~ Yield Depth of Grouting Pump Set At Sanitary Seal on Casing~¢~.~ Depression Around Wellhead,-(--Y~ To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ; On Adjoining Lots On Adjoining Lots / ~k To Nearest Public Sewer ~ /'--- To Nearest Sewer Service Line on Lot · %~ ~[ ~~G ;Date Z~] B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (:~'/J~' Air-tight Caps Depression over Tank ~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well / ¢2~ ! '~' To Property Line ~ 1 To Water-Ma4cr/Service Line Size /,¢~O No. of Compartments ~' Foundation Cleanou~" Date Last Pumped ~-,~-~.J~:~, ~J~/~ ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed '~ ~./~ Width of Field Square Feet of Absorption Area Depression over Field-('¢~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water MCJrq/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Gravel Bed Thickness Standpipes Present (~/~ Date of Last Adequacy Test Type of System Design Length of Field Z..~ Depth of Field ~ To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~ To Cutbank (if present) 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) /~/ump 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, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ¢ & 5 Engineering Date .2 -- ~. ~<'-'- ~' .¢ Signed 5,,~i5 i~× CompanyE~gie Receipt No. ~ Date of Payment Amount: $ MOA NO. o°*'~-- ~-~' Page 2 of 2 72-026 (11/84) APPLI NT FILLS OUT uPPER HA[ ONLY ~ Phone Buyer Address Zip Code Lending Institution ~J~s)C~ ~')~0. ~ Phone t ' ' Phone Realty Co. & A~nt ~ ~ Zip Code Address Type of Resi~nce - Single Family Multiple Family No. of Bedroo~ ~ Other Water Supply A~ACH WELL LOG. A w~l log is required for all wells dr[fled since June 1975. Individual Community For wells dritled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal Individual Year Individual Installed: 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 Inspector Inspector Inspector Inspector Field Notes: ~L~ ~,~ _'Tc~.~;~~ ;~::~ ,--"~ '~ ~' q'- (.~ ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CON DITIONAL.~PPROVAL f DATE Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received 72.023 (3/82)