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Home My WebLink AboutLAMPERT ESTATES BLK 2 LT 16Lamp Estates Block Lot #051 -791 - 17 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181416 PID Number: 051-791-17 Dwelling: ❑■ Single Family (SF) ❑ Duplex(D) ❑ Multiple(SF and/or D) Project: ❑ New ❑■ Upgrade Name: MIKE CLUFF ABSORPTION FIELD Address ❑ Deep Trench ❑■ Shallow Trench III Bed ❑ Mound ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 1.2 GPD/SF 2.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 0.5 Ft.2.0 Ft. LAMPERT EST. BLK 2, LOT 16 Fill added above original grade Gravel length Township Range Section 1.0+ Ft. 53 Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES 5.0 Ft. 1.0 Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line 375 Ft2 Ft. Well *2001+, 200'+ 50'+ TANK 0 Septic ❑S.T.E.P. ❑Holding ❑Other Manufacturer Capacity Surface Water 1001+1 100'+ ANC H TANK 1000 Gal. Material Number of compartments Lot Line 10'+ 10'+ STEEL 2.0 NA Foundation 10'+ 10'+ LIFT STATION Manufacturer Capacity Curtain Drain UN UN Gal. Remarks * COMM. WELL Pump on level at Pump off level at High water alarm at in. in. in. Pump make and model Electrical Inspections performed by Tank to Installer PIPE MATERIAL House to tank 3034 drainfield 3034 MIKE ANDERSON, PE Drainfield 3034 CO/MT 3034 Inspector MIKE ANDERSON, PE. BENCH MARK (Assumed elevation) 103.2 ft Inspection 1z, /24/18 iLocation and description dates: 11 11/24/18 2 3`d 4", ,WOOD PAD COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL `giLikekrs�. temp _ GF . a Conditional Approval: Date • ' .•1--1 f. 17 f Pi/ � : 49TH ••.,,�rr 01 F' • 0/ *. MICHAEL N. ANDERSON ; f +� ( �'. C 9x4699 �: �`,;' Approved- I" Date I F 4:, t— s‘ xIfscO\A,--":- -Vt.-N.-v.7.--i" Inspection Report_9-1-12.doc • Permit No. OSP181416 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: BLK 2, LOT 16, LAMPERT ESTATES S/D PID No.: 051-791-17 MARK A B CO1 32 20 TC01 34 12 _ — ic02 36 12 CO2 39 18 CO3 40 18 EXISTING WATER SERVICE KEY BOX — - C04 78 50 MT1 62 66 MT2 59 50S' C05 60 68 -- I AC01 i______.- BENCH, WOOD LANDING N./ 1 IC01 rm l I T CO2 \ \ / CO3 N_ _, i - .. i- / -� // N\ / \ / J C05 • __- ----3C 4 MIf 1 • MT2 % N / 1 \ / \ / N / ,/-10' LTILITY EASEMENT - — - / 1 ASBUILT SCALE: 1"=50' .4�iss•�%. ` ol Tcof flcot cos o4.ar,.�. c.�c� ..�� OF ,4144''. J.1QZ6 ,02 I rff 2 /•�y�.AI i •ley •. y R INSIAATKM 0 Fiii '' �,J T, l'' ••.. FITER FABRIC 0.5 , !((�//\\� , 3 \ �k INSUURON GP % • f •/ Ali NALL t 0.1.14A • / 1.000 GALLON 1b1A,Ipti 97.5 STEEL TANK ♦ MICHAEL N. ANDERSON:4/my 99 4 97.} 0M II. •1 G� No.(//.rl� 9 69 fr 95..5_/ 7RRRI \95.5 B8 12. •♦�� ••.;FI 'Pi•.••*** 1 NO WATER 11-21-18 SEPTIC N:sCTION *ehl:1�SS\3 r..4 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL. PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 I_ Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl_ INSPECTION REPORT NAME MAILING ADDR'E~S LEGAL DESCRIPTION LOCATION DISTANCE TO: /~/ell ~-~ Manufacturer ~ I- Liq, capacity in gallons Absorption area /o z Inside length Dwelling Foundation~, ~ ! Total length of lines DISTANCE TO: Manufacturer IF HOMEMADE: Well DISTANCE TO: (/.~. No, of lines . L~ of each Top of tile to finish grade -- Length Width Type of crib Crib diameter DISTANCE TO: Well Class Depth DISTANCE T~~ Building founOation Material beneath tile Depth Crib depth Buildingfoundation Driller Sewer line OTHER PIPE MATERIALS SOIL TEST RATING /~O ¢¢ INSTALLER REMARKS PHONE Dwelling / Material Width ~.~'~'~¢~ L Material Neare~lot lino ~/~ Trench wid~ /i~ NO. OF BEDROOMS PERMIT NO. No, of compartments Liquid deptl~ PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance between lines ///,/22 ~/ ,~es Total effe~.~vF~r~cotion area PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line I PERMIT NO. Septic tank -Absorptio~ area-(s) APPROVED 72-013 (Rev. 3/78)(~ ' ~/~ DATE LEGAL 0 & E MENT CO. ENG,NEERING & DEVELOb Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Flussell Oyster 694-2774 Performed for: Legal Description: Depth (feet) SOIL LOG Name:_ ~..~J ,~ /',]£: Mailing Address'. YL'? '/~/- '~{~ / Soil Characteristics 0 11__ 12 Earl Ellis 688-2280 PLOT PI. AN 13__ 14__ 15__ Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: ~- ~=-'7-~ ,?~_.~/v/ g/ a_ No J"~' '" If yes, what depth / Drain Field PERC. TEST • • BOW Municipality of Anchorage On-Site Water and Wastewater Program mid (907) 343-7904 s n r E r r CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-791-17 Expiration Date: 1)-(2 1. GENERAL INFORMATION Complete legal description _LAMPERT ESTATES BLK 2 LT 16 Location (site address) _22440 LAMPERT CIR CHUGACH AK Current Property owner(s) _MICHAEL CLUFF Day phone Mailing address _6976 WHITEHALL STREET ANCH AK Real Estate Agent Day phone 41111 ^ 6 78 9 2. TYPE OF DWELLING: . �' ; �>> ® Single Family (w/wo ADU) t a ❑ Duplex ❑ Multiple Dwellings (Single Family a ‘: Duplex) ,LN 3. NUMBER OF BEDROOMS: 3 L 9 s n 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual,Water Storage ❑ Holding Tank ❑ Community Class A Well ® Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: / Z ?S 4 COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ qqq-CPO Waiver Fee $ Date of Payment i t lA��1i S) Date of Payment Receipt Number # /a? L/' Receipt Number COSA# 05C/7//oaa Waiver# 4,14;--7, ,,, s ;4i .i:,ogionoptiv ;.,.„ 5. STATEMENT OF INSPE 'ION 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 Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm MIKE N ANDERSON,P.E. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON. PE Date 11/27/18 • • • 6.4 e0000eeojF', 6. DSD SIGNATURE �..°° r • • OOOO e e 0 e V. 3 bedrooms. e 5:• • n�ICHAEL N. N.D. 'cr. System #1 Approved for � C -9 69 System #2 Approved for bedrooms. d4 ``9'•!/ i t/ .•° �=.� Disapproved. k focf slfl'�^�t�� Conditional approval for bedrooms, with the following stipulations: j ON-SITE WATER ANf) R' 5 WASTEWATER o () PROGRAM ,ce 0,0 '1/7'SFR\I�� By: — Original Certificate Date: I 1 F The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10.10-12.doc • • If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system _ Certificate of On-Site Systems Approval Checklist Legal Description: LAMPERT ESTATES BLK 2 LT 16 Parcel ID:_051-791-17 A. WELL DATA Well type If A, B, or C provide PWSID#210697 Well Log (Y/N) Date completed Sanitary seal (YIN) Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height(above ground) FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic: ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 11.24.18 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN)Y Foundation cleanout(Y/N)Y Depression over tank(Y/N) N High water alarm (Y/N) Y Date of pumping NEW Pumper C. ABSORPTION FIELD DATA— Date installed 11.24-18 Soil rating (GPD/SWFT) 1.2 System type 5-WIDE TRENCH Length 53 ft. Width 5 ft. Gravel below pipe 2.0 ft. Total depth 2.5 ft. Eff. absorption area 375 ft2 Monitoring tube Y Depression over field N Date of adequacy test NEW Results (Pass/Fail) NEW For 3 bedrooms Fluid depth in absorption field before test in. Water added gal. new depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date • D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in.High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 10'+ Absorption field 10'+ Water main 10'+ Water service line 25'+ Surface water 100'+ Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain (None Known) Wells on adjacent lots 200'+ F. COMMENTS gc OF A ,�,1..t . q COMM.WATER SERVICE h'•• ••'r'. A e *: 49TH : e G. ENGINEER'S CERTIFICATION /... ••• 7:7•,..MICHAEL N. ANDERSCN . I certify that I have determined through field inspections and • f'. CE 94 •.., r review of Municipal records that the above systems are in t�+ G • / 7 conformance with MOA COSA guidelines in effect on this date. tk�PRorESStook\ Engineer's Printed Name MIKE N. ANDERSON, PE Date 11/2712018 COSA canary sheet_2-6-15.doc / GRAPHIC SCALE: 1 Inch = 30 Feet 15 0 15 30 60 e. _ ct v li - N00'00'20"E 220.00 ®BFB 25 ° ° D "V N VN O z • I— co > co i0 KQ Z CAI -10 OD O N L 0 (Dm � 11U •o 7CSEPTIC ---A(0C 26.0 n 2 p 7:DI • nl n rni 25 N00'00'20"E 220.00 _ iAir 6�OF• 46N No property corners were found or set during / et 4 , sleF. st�Nerr Bobby F. Burnett this survey. House placement is based on an • ES- 2941 'Carriage Drive As-built survey dated 11/00/2000 by Robert 1 /(-x(-4 Anchorage, Alaska 99507 C. Johnson. Improvements from previous 1` �e�'O have been Re-Certified this ` sstoNw i (907) 350-5541 survey during survey, and are as shown. lib.'11.10- Date Scale Legal Description 11/19/2018 1` = 30 1 hereby certify that the property described hereon has been surveyed Lot 16 Block 2 by me, or at my direction, and that the improvements situated thereon Grid are within the property lines and do not overlap or encroach on the NW 1459 AS-BUILT property lying adjacent thereto unless otherwise shown. That no Drawn byField Book LAMPERT ESTATES SUBDIVISION improvements on the property lying adjacent thereto encroach on the premites in question and that there are no roadways, transmission BFB ASB-2018 PLAT # 72-207 lines or other easements on said property except as shown. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL . P.O. Box 196650 A~chorage, AK 99519-6650 www.cl.anchorage.ak, us (907) 343-79O4 CERTIFICATE OF HEALTH .b, UTHORITY ,b, PPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 051-791-17 1. GENERAL INFORMATION Expiration Date: Complete legal description . LAMPERT ESTATES SUBDMSION; LOT 16, BLOCK 2 Location (site address or directions) 22440 LAMPERT CIRCLE * CHUG1AK, AK Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent CHRIS AND RENAE SPE'I'EN Dayphone 688-6802 P.O. BOX 671802 * CHUCIAK, AK 99567 Day phone Day phone Mailing address Un/ess o~herwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF 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 Munlctpality of Anchorage Development Servtces Department (DSD) 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 AJaska. Certificates of Health Authority Approval are requlred for the transfer of title (except between spouses) for properties served by a single family on-site wastawatar 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 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 er a public water system. The Municlpality of Anchorage ts not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As* cerU§ed bY'roy seal affixed hereto and as of the validation date shown below, I verify that roy, ' Invesb'ga~on, based on proced~s'~tli~ed IN th~' Health Authori~y Approv~l Guidelines for this eppflcat~on,' shows that the on-~e water supply and/or wssfewater disposal systero Is(em) safe, func~onal end adequate for the ~urobe/* df bed~ooms'and type of sY~ct~m indicated hemin. I fud, her verffy that besed on the , InformaUon obtained fmro the Munidpali~y of Anchocage files end fmro roy Inves~gaUon end Inspection, the on-site Water supply and/o~'wastewater disposal system Is(am) in compliance with all apPticable MunidPal . Name of Firm ALASKA WATER &: WASTE'WATER CONSULTANTS, INC. Address ' 6901 "'DEB,~,RR 'ROAD. SUITE 2B * ANCHORACE, AK 99504- Engln~er's Printe~ Name' JEFFREY A.' CARNESS, P.E, Phone, 337-6179 Dat ~i -~ Engineer's comments: ' In conducting this evaluation, AWWC, lac. attempted to provide a thorough, conscientious engineering analysis of the sysfem in accon:lance with ADEC and MOA DSD Guidelines & Regulations. The reported msulls described the performance of the system under the conditions encountered at the time of the test, end separation distances measured lo madRy IdenUfiable feeluras. The operational life of all walls and septic.systams depend on the Ioce~ soils condifibn, gtoundwater levels that may fluctuate dudng the year, and the water usage of the family being served by the ay'stem. These conditions am our,dale the c~ntrol of the eve/uator of the system. Satisfactory test results do not guarantee fufum peffotmance of the system, nor do they guarantae that them era no hMden defects or encmachmenta. AWWC, Inc. can therefore not pmvide any warranty or future estimate of l'~ow long the $~'stam will continue to meet the operational tequlrementa of the ADEC or MOA DSD. The content of ~hl$ report Is for the sole benefit of the owner listed ebove. Any relisece upon or use of this report by any other peraon or party ls not author/zed, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE Approved for ,-~ bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowlng stipulations: Attachments: I-IAA Checklist Septic Systaro Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: ! 0 - ~ - ~ ] Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program P.O. Box 196850 AncO, AK ~951g-6850 HEALTH AUTHORITY APPROVAL CHECKLIST LegalDesc:dpUoo: LAMPERT ESTATES SUBDNISlON; LOT 16~ BLOCK 2 Pa~allD: 051-791-17 A, WELL DATA .... ~ Well type ct~s 'A' ifA, B, otc provide ~~~ -- Total depth It. sed to It. Casing halght (above ground) In. FROM ~ LOG AT INSPECTION Date of test 6tali¢ water level Well i~xlucllon WATER .SAMPLE RESULTS: Coliform - colonies/lO0 mi. Oate of ~ample: - B. SEPTIC/HOLDING TANK DATA p.m. /J g.p.m. Nitrate - rngJL. Other bacteria - colonies/100 mi. Conected by:. - Tank l~)e/Mate~l S~'[L Tankldze, 1000 gal. Number of Compertmente 2 Foundaliondeanout(Y/N) YES Depresalonovertank(Y/N) NO Dam of pumping 10/6/2oo0 Pumper C. ABSORPTION FIELD DATA ~t~ Wed 7,/$/lg82 Leng~ 59 ~ Wk~h 5 .ft. Date Installed 7/6/1982 Ckmnouts (Y/N) YES High water alarm (Y/N) N/A JR',, PUMPING Total depth 4~+/- It. Eft. ebsc~tbn area 578 ItI Monltoltng tube YES ' Oato of adequacy test 11/4/2000 Results(Pass/Fall) PASS Fiulddeplhinabso~ptionllaldbaforetest ¢ i~ Water added 710 gal. Elapsed'rlme: 1100min. Rnalllulddepth 7.5 In, Absor~on rate >= Any mJuvenaUon treatment (past 12 mo.) (Y/N & type) NONE: KNOWN System type TRENCH Grawl below pipe 1.5 fi. Depression over flald NO New depth 14.5 In. 450+ g.p.d. If yes, give date - D. LIFT STATION ~ Instelted. 8lz. eln gallons ~ 'Pump on' level et In. 'Pump n. High water elmm tevel at In. Da..~.l.l.l.l.l.l~m Cycles tested Meets elann & circuit requirements? E. SEPARATION DISTANC~ SEPARATION DISTANCES FROM W~ ! ON LOT TO: COMMUNITY Septic tenk/llff station on lot Abeorpllon field an lot Public sewer main WATER On adjacent lots Public sewer manholeldesnout H~d~g tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property llne lO'+ Water esn4ce line 10'+ Curtain drain NONE KNOWN F. COMMENTS Bulidlng foundation 5'+ Properly line 5'+ Water main · 10'+ Watsr eswlce line 10'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:. Bulidtng foundation 10'+ Surface w~tsr 100'+ Wells on adjacent lots 2oo'+ Abeorplion field 5% Surface water 10o'+ Water main 1 o'+ Driveway, parldng/veNde stemge 1 '+ G. ENGINEER'S CERTIFICATION I ceriEy that I have determined through field In~ end review of Municipal mconfs that the above systems ere In conformance with MOA HAA guidelines In effect on this date. Englneel'~ Printed. NaCre JEFFREY A. GARNE.~ Date ~ HAA Fee $ -~)~"~ -':' ~ Date of Payment ~ Receipt .u be Waiver Fee $ Date of Payment Receipt Number. Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Sen4ces Section P.O. Box 196650 Anchorage, AJaska 99519-6650 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 051-791-17 1. GENERAL INFORMATION Complete legal des~.,rlpfion I~MPERT ESTATES S/D: LOT 16. I~LOCK 2. LocatiOn (site address or directions) 2~440 tAMPERT CIRC[F CHUCIAK. AK Property owner DAN AND DEENA UAU$ Day phone~ Mailing?ddress P.O. E0X 671534 CHUCIAK. AK 99567 Lending ~gency Mailing address Day phone Agent Day phone Address. Unless otherwise requested, HA,A will be held for pickup. 2. NUMBER OF BEDROOMs: 3 3. 'I~'PE OF WATER SuppLY: Individual well Community well xxx Public water NOTE: ff community well system, provfde written confirmation from State ADEC attest- lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding Tank Community on-site Public sewer NOTE: ff communib, wastewater system, provide written confirmation from State ADEC lng to the legality and status of system. 72-025 (Rev. 1/91) Fro~t MOA #21 Computer Ve~lon 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verh'y that my Investigation of this Health Authority Approval application shows that rite on-site water supply and/or wastewatar disposal system Is safe, functional and adequate for the number of bedrooms and bjpe of structure Indicated heroin. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my Investigation and Insl:x~fion, the on-sita water supply and/or wastewater disposal system Is In compliance ~ all Munlcip, aiyand State codes, ordinances, and regulations In effect on the date of this inspection. Name of F,rm ALASKA WA'J~ &l ,'A/S~',~TER CONSULTANTS. INC. Phone (907)337-6179 6,o, OES^.. 4OAD/S I:.O OE.^LASKA ggs0 , Englneer'sSignatum ~ 4~ ~/ ~'~-I Date [z.//p/~:o ' system in accordance ~ ADEC and MOA DI~ ~S Guidelines & Regu~aUons. The repon'ed resu~ de_~_/bed pedormance of ~he system under lhe cone"talons encountered et lhe time of the tesL and sspara#on distances measured to readi~, ldentifiable features. The operaffonal life of all wells end septic systems depend on ~he Iocal so~ condition, ground water leve~ lhat may flucfuate dur~n~ the year, and the water usage of lhe famlly betng sen~ed by lhe system. Thesa condffions are outskle lhe contml o! the evalua~or of the system. Sa#sfacto~y lest results do not guarantee future pe~ AWWC, Inc. can therefore not provlde any warran~y for fu~re estimate ofhow long the system will conffnue to meet ff~e operaUonal requirements of lhe ADEC or MOA DHHS. The content of thls report ls for the sole bene~ of the owner llsted above. Any reliance upon or use of this report by any off, er person or party is not author,.ed, nor wlll It confer any legal fight whalsoever. 6. DHHS SIGNATURE ~ Approved for, "~ Disapproved Conditional approval for, bedrooms, with the following stipulations: Additional Comments Date /-,~--- ~''O O The Municipality of Anchorage Department of Health and Human Servlces (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 AJaska. 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 cedJficete Is Issued. The Municipality of Anchorage Is not responsible for errors or omissions In the pmtessional engineer's work. 724325 (Rev. 1/91) Bad( MOA #21 Computer Version RECEIVED Municipality of Anchorage DEC 0 6 ZOO0 DEPARTMENT OF HEALTH & HUMAN SERVICES ErMronmentel Sendces Olv~lon u~,~,,,~ ....... Date of test Static water level Well pmduc~on g.p.m. WATER ,SAMPLE RESULTS: Coliform - Nltmte Date of ~ample: - B. SEPTIC/HOLDING TANK DATA Date Installed 7/6/1982 Tank size Foundation claanout (Y/N) Y~:S Date of Pumping 10/6/2000 ¢. ABSORPTION FIELD DATA Date Installed '//6/1982 Length 59' Effect~ abeoq~tion area Date of adequacy test Fluid depth In absorption aetd before test 0n.); 4" Fluid Cepm 7.5" (Ins) Minutes later:. 110q Peroxide tmalment (past 12 months) (Y/N) N/A 72.~2~ (R.v. Mmy' Camp~ v. mm FROM WELL LOG Wires pmpafly protected (Y/N) AT INSPECTION .~J g.p.m. Other becte~ 1000 Number of Compartments 2, Ctsanouts (Y/N) Depression (Y/N) NO Hlgh water alarm (y/N) Pumper JR'S PUMPING Immediately alter 710 Abeorption rate = If yes, give date Soil rating (g.p.dJfl2 or~--"~ 1 ~Z0 System type TRENCH ~ ~' Gravel thickness below plpa 1~" Total depth 4.5'+/- ,:378 SQ.FT, MonitodngTubepresent(Y/N) YES Depresslonovertield(Y/N) NO 11/4/2000 Resul~ (Pass/Fall) PASSED For 3 Bedrooms gal. water added (in.): 1 450+ Health Authority Approval Checklist LegalDescdption: LAMPERT ESTATES S/D; LOT 16, BLOCK 2, ParcelI.D.: 051-791-17 A. WELL DATA Well Type CLASS 'A" IfA, B, or C, attech ADEC latter. ADEC watsr system numpar. 210697 Log present (Y/N) Date completed ~ Total depth Cased to ~.-----'-'---~ height (abeve ground) D. UFT STATION .------'~ *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorpfion field on lot Public sewer main COMMUNI'Pf WELL Public sewer manhote/cleenout Mit station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foonda~n 5'+ Property line ,5'+ Absorption field 5'+ Water maln/senf~ce line 10'+ Surface water/drainage 100°+ Wells on adjacent lots 200'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property I~e 10'+ Bulidlng foundation 10'+ Water maln/sendce line 10'+ Surface water 100'+ Driveway, parl~ngNehlcle storage ama , 5:+ Curteln drain. NONE KNOWN ~ Wells on adjacent lots 200 + Engln.,eName~EFFREY A. C..ARN.$ HAA Fee · ~-~ '~"~ ' -"- WaKer Fee $ Date of Payment' ~ ~~~z~ Date of Payment ...,..am.. MUNICIPALITY OF ANCHORAGE Department o! Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ('~'.; ~'~\- ~ql - i"~ NAA# 1. GENERAL INFORMATION (Musl be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) LOT 16; BLOCK 2; LAMPERT ESTATES Location (address or directions) NHN l am?.,~.~ (b) Property owner A~F¢# 3~$92 Mailing Address 520 East 34th Avenue, (c) Lending Institution Telephone:(home) Anchorage, Alaska 99503 Telephone Business 5~1-19flfl Mailing Address (d) Real Estate Company and Agent RE/MAE OF EAGLE R?VER ATTNr Fua Ioken Address !660~ Cen~er~ie~d Drive Su~e #20!, Eag6e River, AK_ 99577 Telephone 694-4~00 (e) Mail the HAA to the following address: (or cheok here~ if hold for piok up.) List contact person and day phone number below: S & S ENGINEERING 7034 Eagle R[¥er beole Read Ea~lle River, Alaska ~9577 2. TYPE OF RESIDENCE Single-Family~ Number of bedrooms 5 3. WATER SUPPLY Individual WelIx~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~( Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 ')]JOM s,J@eu!Sue leuo!sse~oJd eql u! SUOISSlLUO .JO 9JOJJ@ JO]. elq!suodseJ lou s! eBeJoLIouV ~o ,~l!led!o! unv~ eqJ. 'p@nss! s! e~eokH],Jeo e eJo~eq e~ep ez,~leUe Jo suoilo~dsu] ~onpuoo lou op SHHQ ~o see/~OldLU=l 's~ueLueJ!nbeJ e~els pue leJepeJ u!e~J@o/~Js!les o], ~epJo u! suop, nl!~su! bu!puel qeq~ pue seLuoq ~.o sJeseqoJnd ol ~sel~noo e se s!q~ seop SHHQ eq/ 'e)tselV jo elelS eq~ u! peJe~s!l~eJ ~eeu~6ue leUO!SSejoJd ~uepuedepu! ue/~q e^oqe B qdeJSe~ed u! 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WELL DATA Well Classification Well Log Present (Y/N) Total Depth Cased to __ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL. MUNICIPALITY OF ANCHORAGE (MOA) t'l_e~h~,o_ rity Approval (HAA) iCIPALI'~Y O~/',l',4~m~ · - ;~ ~ ~.~I~,~)%F E B n UA n Y 1984 · , , :, () ].,:;,¢~,t"j Legal Description: L~-~-~'T" RI:,C E IVE D Date Completed Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) If A, B, C, D.E.C. Approved~p~4'4) ~__ / Yield To Septic/Holding Tank on Lot ~'-~,_c,~;> I --F ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot _'?~=~=, ~ ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ~ tJ'-~, ~ ; Date B. SEPTIC/HOLDING TANK DATA / Date Installed ~'/~'?-'-' Size _[ Standpipes ¢J~;~N) --,/ Air-tight Caps ¢~N) Depression over Tank (Y~i~ r'~ Pumping/Maintenance Contact on File (Y/N) , / Holding Tank High-Water Alarm (Y/N) No. of Compartments y Foundation CleanoutCN) [~ate Last Pumped"~' ~:::~ -~...-~ 1'4/'z~ ; for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments ''~ .¢I;;;i~;:O~¢, ~ ~ 72-026 (Rev. 7/88) Front To Building Foundation To Disposal Field Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption S~trata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/~ \~ '¢/¢¢'-- Type of System Design Length of Field Depth of Field '~ ,~-''' Gravel Bed Thickness ~, ,~'- -'"'~'"~ E~ '¢' Statndpipes Present.N) r'~ Date of Last Adequacy Test L¢~ - ~") -~-~;~ Results of Last Adequacy Test ~:=~~~ ..--. SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well '~ Yr~ To Property Line --~--1~=~ To Existing or Abandoned System on ; On Adjoining Lots ~ ~''~-' ~ ~=. t ~ To Cutback (if present) ~/'~' To Building Foundation Lot \ ~::~ '~ To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments / D. LIFT STATION [~/~:::~ Size in Gallons ~ "Pump On" Level at ~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ~_ Vent (Y/N) ~'~-~.. _~.~ing Cycles during Adequacy Test, **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ""~ Signed S & S ENGINEERING 17034 Eagle Ri~er I. oop Roa~ No. 204 Company Date ~-~ /¢ ~'' MOA NO. / Receipt No. ~ .//-'~ ~ //~"~ ~'~'/ Date of Payment O/,.._~...~-~-"/ Amount: $ / ~' ~ 72-026 (Rev, 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 A~CHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 563-6775 DATE: _~~ PWSID: 210697 Requested By: S & S Engineering According to the records on file in this office, the McKinley View ~/D Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, Cindy Thomas Envi~?on~ntal Engineer APPL NT FILLS OUT UPPER ONLY PropertyOwner(.,~/~Tl'~_.~ [-~'1 C '~} (-']~/t ~'N(.~-'~"]Z]L'~-,--~ ~_,/~1 /"~ /N' ~.-.' ~[ Phone MallingAddre~ ~ ~ 1~ ~ ~ ~:-~'~C~, -- ZlpO°de~S~ " ' Lendinglnstitution I ~¢[- ~AfflO~' A'~ (~/~ N IA' Phons /Address ~A~L~-' ~.~ 0~' (~._ ZipCode .......... Street Locati~ ~'~ ?'~-7 7 ~ ¢ /-"t ~'~2 "~' Type of Resi~nce Single Family Multiple Family N~. of Bedrooms ¢~ ~ Other ~ Water Supply ~ Individual A~ACH WELL LOG. A w¢l Icg is required for all wells drilled since June 1975. Communily For wells drilled prior to, hat date. give well depth (attach Icg if awilable). Public Utility ~ S~ Disposal Year Individual Installed' ;~ Individual When Connected to Pub'lic Utility: ~ 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 Date Inspector Inspector Inspector Inspector Field Notes: {_~ ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received 72.023 (3182~