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HomeMy WebLinkAboutFISCHER BLK 3 LT 1DOnsite Fischer Block 3 Lot 1 D #015-292-06 On -Site Water and/or Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP161347 Tax Code Number: 01529206000 Work Type: SepticTank Upgrade Permit Effective Dates: December 12, 2016 to December 12, 2017 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: FISCHER Site Legal Address: FISCHER BLK 3 LT 1D G:2537 Owner/Address: EVEN MICHAEL & DEBORAH AKA DEBBIE EVEN 10120 EVERGREEN TREE STREET ANCHORAGE AK 995070000 Site Mailing Address: 10120 EVERGREEN TREE ST, Anchorage Lot Size in Sq Ft: 49466 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All 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 (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received B Issued By: y: Date: / �3 0q _a Date: 1Z 1L 2bl�o Municipality of Anchorage �A, A: P.O. Box 196650 0 4700 Elmore Road Anchorage Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://vvww.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV161151 COSA#: Permit#:OSP161347 PID#: 015-292.06 Legal Description: Fischer Block 3 Lot 1D Engineer: Garness Engineering Group Applicant: Michael Even Your request for a waiver of the required 12 feet horizontal separation between two existing absorption fields has been approved. The approved separation distance is 8.5 feet. This waiver approval applies to the existing absorption fields only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ®Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: 2 a01 (a Approved by: Name of Reviewer .................................. ........................ ................. "VARIAN C E[WAIVE R REVIEW **** MUNICIPALITY OF ANCHORAGE -6\ Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcell.D. 015-292-06 Property owner(s) MICHAEL EVEN Mailing address 10120 EVERGREEN TREE STREET *ANCHORAGE, AK Day phone 891-2925 Site address 10120 EVERGREEN TREE STREET `ANCHORAGE, AK Legal description (Sub'd, Block & Lot ) FISCHER S/D; BLOCK 3, LOT 1D Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (®all that apply) Initial ❑ Single Family (SF) Absorption Field ❑ (w/wo ADU) Upgrade Septic Tank ®Duplex ❑ (D) ElRenewal Holding Tank ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: WA braingclj -6 clroAn -1�4e1c Distance: `d•5/ I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: ZIGJ•Ul/ Date of Payment: <</n/9-0110 Receipt Number: � og5I1& Permit No. CIS 1_rILP G41 Waiver Fees: a 15 Date of Payment: 2 1-L 201(0 Receipt Number: 0477y G Waiver No. OSI 1(01 151 (Re, 01/11) GARNESS ENGINEERING GROUP, Ltd Adv—°T CIVIL & ENVIRONMENTAL ENGINEERS November 28, 2016 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic Tank Upgrade for Fischer, Block 3, Lot 1 D To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. Per the home- owners request, we are proposing to install a new 1250 gallon HDPE septic tank. If the burial depth is greater than 4 feet, a 1250 gallon steel septic tank will be installed. The week of 11/14/2016 ARM Services located and installed a cleanout on both end of the abandoned 1977 trench and a MT (see attached 40 scale). We are proposing to install a diverter valve after the tank to allow flow to be switched between the 1977 trench and the 1993 trench (currently in use). Per the cleanout location of the 1977 trench, it appears as though the trench is approximately 9 feet from the 1993 trench. Per the 1993 inspection report there is 6 feet of effective in the trench. Per MOA code the trenches should have a minimum separation distance of 12 feet. We are requesting that your department waiver the requirement from 12 feet down to 8.5 feet. Justification for granting this waiver is follows: Per GEG inspection on 10/24/2016 the 1993 trench is surcharged. During the installation of the MT and cleanout by ARM services, it was noted the 1977 trench was dry. In short, the 1993 trench does not appear to be directly effecting the 1977 trench. • Only one trench will be operational at a time. We are unaware of any wells or septic systems. for your assistance. adverse impacts this installation or waivers would have on adjacent If you have any questions, please contact us at 337-6179. Thank you M.S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com NOTE: THE CONTRACTOR SHALL HAVE THE ALL WELL GARNESS ENGINEERING GEG, Ltd. HAS A 8 PAGE SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LEITER CONTACT EAST 100TH AVENUE 3701E. TUDOR ROAD, SUITE 101ANCHORAGE, AK 99507' PHONE (907) 337-6179- FAX (907) 3383246 WEBSITE'. www Bamessengineenng w. I RADII FLAGGED BY A GEG. BY PROCEEDING FORWARD WITH THIS MICHAEL EVEN REGISTERED LAND SURVEYORINSTALLATION, imm THE ENGINEER, WELL DRIVER, PROJECT/LEGAL DESCRIPTION: DRAWN By CONTRACTOR AND PROPERTY OWNER AGREE PRIOR TO CONSTRUCTION. TYPE OF WORK'. THAT THEY HAVE READ THESE DATE'. \ Im SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. FISCHER, BLOCK 1, LOT 1C THE ABANDONED MOA APPROVED 1977 DRAINFIELD IS WAS LOCATED BY ARM SERVICED SEE ATTACHED LETTER FOR WAIVER REQUEST REGARDING TO SEPARATION DISTANCE BETWEEN THE 1977 TRENCH AND THE 1993 TRENCH PROPOSED HDPE TANK G.W. MONITORING TUBE ME EXISTING HOME mT not show✓V) p,� Gon�rmed b D.J.G II 1977 TRENCH; q.RMS RVICEI T LOCATED ANN INST LLEDA INSTALL FD FOR EXISTING TRENCH AND 1977 TRENCH (TO BE CONNECTED BY ARM SERVICES) r PROPOSED HOPE11250 GALLON SEPTIC TANK INSTALL DOUBLE CLEANOUTS BEFORE AND AFTER TANK EXIS ING SEPTIC TANK �TO ETD COMMISS ONED PER UPC FCO /I /I D _lam 1�wI '�� GARNESS ENGINEERING 8 CIVIL & ENVIRONMENTAL ENGINEERS 3701E. TUDOR ROAD, SUITE 101ANCHORAGE, AK 99507' PHONE (907) 337-6179- FAX (907) 3383246 WEBSITE'. www Bamessengineenng w. I PHONE NUMBER: PAGE NUMBER: MICHAEL EVEN 891-2925 imm 1 OF 1 PROJECT/LEGAL DESCRIPTION: DRAWN By FISCHER; BLOCK 3, LOT 1 D D.J.G. TYPE OF WORK'. � N DATE'. \ Im 11/24/2016 m I -i /I /I D _lam 1�wI '�� GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS 3701E. TUDOR ROAD, SUITE 101ANCHORAGE, AK 99507' PHONE (907) 337-6179- FAX (907) 3383246 WEBSITE'. www Bamessengineenng w. PREPARED FOR: PHONE NUMBER: PAGE NUMBER: MICHAEL EVEN 891-2925 1 OF 1 PROJECT/LEGAL DESCRIPTION: DRAWN By FISCHER; BLOCK 3, LOT 1 D D.J.G. TYPE OF WORK'. DATE'. SEPTIC SYSTEM DESIGN UPGRADE 11/24/2016 ILI] m m ^X^ UJ X m m z X m m /_ *1..49 ' A. G me s ♦ C -7953 %M #j P'•..11�28�11a'Fi LICEN� ,,�,' S\\\\� ��••1 #AECC884 Municipality of Anchorage Page —I_of_21___ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 9 Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 6LuCP50 %Q;;,2— PID Number: 0/ 6Z q �0� Name: I Wastewater System: ❑ New Upgrade Address: 6 ABSORPTION FIELD Phone: Z96 - 3104 No. o edrooms: �1Deep Trench ❑ Shallow Trench El Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating ,nal Total Depth lro original grade Ty rS GPD/S Ft Block: bdivisio�n:�r Depth to pipe bottom from orriginal grade: Gravel depth bene Ih pipe 117 t.ft Ft Ft Township: Range: Section: Fill added aboveoriginal grafde: Gravel length: f Ft Ft. WELL w ❑ Upgrade Gravel width: n Number lines: Di51an ^b�twym lin Ft Ft Classmcab nvate, A,B.C1: Total Depth: Cased To: Total absorption area: Pi material: ugZE Ft. FC SO FI Driller: Dale Drilled: Slahc Water Level: Installer:va p . i � 1f. Date lnstallet Ft. Yield: Pump Set at: Casing Height Above Ground. TANK GPM Ft Ft. SEPARATION DISTANCES Seplicr Holding ❑S.T.E.P. To septic Abwobon 411 Holding ubl.VPnvale Manufacturer: Capacity In gallons) From Tank Field Slabon Tana Sewer Linear,(Zeal Well OJ r O r ` �r Material: [� Number of Ggmpanmenls: Water 106'4 opE -- — — LIFT STATION Lotf� fk '— Size in gallons: Manufacturer: Line Foundation I,H 'Pump on" level al: mp off' level at: High water alarm at: 5f ..i Curtain ��. 0�� 'ump Make oel I Electrical Inspections performed by: Drain Remarks: Ti ax. Hp BENCH MARK �-. s NG S _nnc >Nr- t Location and Description: T�� r —6 /a Assumed Elevation: 00 Ft Ejj!;JAi 1{e.SEAL p To W 6 NS7PA0 �� OF �'v.. n, 6 f w1i FFF — Dur 76 LAW9vumn &q;o-oF T a : •„eapl uwee+aarMallrH Inspections performed by: —Dates: 1st_ ' � � ~ a' 2nd �db.R ti sa.ra. No. 1157.E Department of Heal and uman Services approval It Date: 5-2141 Reviewed and approved by: 77-03 (Rev. 9191) MOA 25 Permit No. SW930103 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal uescnpuon: i Cot CO2 FINAL GRAD193.5 T 100.3' 1001 ... -.. 94.1 EMSPING 1000 CAL 93.9' SEPTIC TANK 87.5' N.S.S. A' 82' GROUNDWATER FOUND EVERGREEN STREET 10' UTIL. ESMT. -------------------------------------- SWING TIES COL 10' 29' CO2 15.5' 30' too, 1 CO3 18.5' 30' C04 19.5' 30' S _.__- _- _ _ C05 47' - 31' T. 1000 GAL C06 98' 74' CD• S PTIC TANK MT 91.5' 69.5' CDG __DO5 0 r .G • TH <13H �Cx .13 -�—�-� 1i n I.�TY.I myn-(a { VNl1 YL{V 113iV� Tom crop Or MOOD =10 :M ENGINEER'S SEAL-^.•.,�.:% .: { WE t OStlr:.. PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930103 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:WEAVER DAVID E OWNER ADDRESS:10120 EVERGREEN ST ANCHORAGE, ALASKA 99515 PARCEL ID:01529206 LEGAL DESCRIPTION: FISCHER BLK 3 LT 1D LOT SIZE: 49466 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 5/14/93 EXPIRATION DATE: 5/14/94 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 (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: r L" J RECEIVED BY: DATE: �CI _122 ISSUED BY: .✓ C DATE • -'�, __ /t/ `9 3 HEALTHAUTHORITV APPROVALS SEWER& WATER MAIN EXTENSIONS SEWER 8 WATER INSPECTION ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 Aprkl 10, 1993 FAX 694.1211 unicipality of Anchorage EPARTMENT OF HEALTH AND HUMAN SERVICES 25 L Street .0. Box 196650 nchorage, Alaska 99519-6650 Fischer Subdivision, Block 3, Lot 1D PERCOLATION TEST YauresOEneer 1(i�am`Aon�� v STRUCTURAL& MECHANICAL INSPECTIONS ON SITE A. Shafer, P.E. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 equest you issue a permit to upgrade the existing septic system on the referenced property. An adequacy test was E DIREPPORRNGSTUDIES erformed on the system and the absorption capacity was found TS o be inadequate for a three bedroom house. From the data collected during the adequacy test we have etermined that the existing trench has the absorption WELLINSPECTION &FLOW TEST apacity of approximately 240 gallons per day. To utilize the emaining absorption capacity of the existing trench the roposed trench is to be tied into the existing trench. SITE PLANS test hole was excavated and a percolation test performed on 1, 1993. The ground water monitoring tube showed water t the 17.5 depth on Apr4l 8, 1993. ROAD DESIGN 4e do not anticipate any /adverse effects on the neighboring roperties by the installation of the proposed septic upgrade. f you have any questions, or require any additional nformation for your review, please contact us. 500. TEST PERCOLATION TEST YauresOEneer 1(i�am`Aon�� v STRUCTURAL& MECHANICAL INSPECTIONS ON SITE A. Shafer, P.E. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 LEGAL DRAWN DESIGN CRITERIA: 3 BDRM = 450 GPD SOILS = 0.8 GPD/SQ FT 450/0.8 = 563 SO. FT. REQ'D SHT. DEEP TRENCH: 12' DEEP 7' EFFECTIVE 40' LONG 3 Fr/a+ Aoki A. SA■ta• Na WI -E ------------------------- EVERGREEN STREET 10' UTIL ESITT. -- ----- ------------- -- PROP. TRENCH 'y ME INTO MUST. TRENCH '— C 1000 GAL TIC TANK i H DPTEGRTfY) M co co Tx c GARAGE j 9 DRN I H USE 100' WELL RADIUS V�•` ,O WELL I I I NO SEPTICS WIPRIN 100' �0F EXIST. WELL 1 I I ti & .OXO 0 I LOCATIONSTREAH I v tr�� o ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Fischer Subdivision, Block 3, Lot 1D GENERAL: 1. The scope of the project consists of installation of a 40' long soil absorbtion trench containing 7' of sewer gravel between 5.0 and 12' below ground level. 2. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. page 2 Fisher Sub., Blk 3, Lot 1D 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed - up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. page 3 Fischer Sub., Blk 3, Lot 1D MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the ;200 sieve. 7. When sand is being used as a filter material, it's gradation specifications must conform to AMC 15.65.060D. page 4 Fischer Sub., Blk 3, Lot 1D INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. C PERFOF LEGAL 1 ! d d o 6-p 2- 3- 4- 5- 6- 34 56 . Cw//t 7 Gt.EQN SAND wlum& 41 Sac? LZ44= THRaauroL.'t . 8 9- 10 l `fes a �f f 13 1 14-( 15- 5 • ['� �r 16-. 16 1 17 L' `• 18 •� , P•�. e 19 SLUYh ENCOUNTERED? WATER 1�� ENCOUNTERED? ��JU IF VES, AT WHAT DEPTH? Depth to Water Alter Monitoring? Date: JI It: PLAN 20 -{ �Q .. III PERCOLATIONRATE � (minutesiincQn) PERC HOLE DIAMETER -� TEST RUN BETWEEN D V , FT COMMENTS • O ld lz VE �/O ALONG. INEERING 17014 gftk Rf, it Road EE� River, Alaska 99577 0, PERFORMED BY.'9" 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELIN EFF, T ON THIS DATE. DATE: 72-M (Rev. 4/85) ✓// NAME z GRD cR ANCHORAGE AREA BOR_ )GH u3Department of Environmental Quality it 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM AILING ADDRESS LOCATION J45 -k s ex) -SIT • LEGAL DESCRIPTION SEPTIC TANK: PHONE5'q DISTANCE NUMBER OF FROM WELL 60 MANUFACTURER ��Qy-♦'^' MATERIAL COMPARTMENTS INSIDE INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY/w6GALLONS. TILE DRAIN FIELD: .f4_ TOTAL LENGTH DISTANCE FROM WELL QD FOUNDATION NEAREST LOT LINE 2� OF LINES l6 NUMBER OF LINES_ DISTANCE BETWEEN LINES V-lA TRENCH WIDTH >La IN. TOTAL EFFECTIVE ABSORPTION AREA Od SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE 36 IN. ABOVE TILE �1=6 _ IN. WELL: TYPE ��[dr5 CONSTRUCTION G �� G �� -DEPTH DISTANCE FROM: BUILDING NEAREST / NEAREST SEPTIC SEEPAGE FOUNDATION . LOT LINE__[!�^�._=, SEWER LINE , TANK, SYSTEM CESSPOOL- OTHER SOURCES APPROVED t! DISAPPROVE DISTANCES: J — 1,9D / is C_ -- INSTALLED INSTALLED BY: &:;- e, SEWER LINE DEPTH: ll PIPE MATERIAL: n P- (� . 17. (� LOT SLOPE: '• REMARKS: Form EQ -032 EMARKS DIAGRAM OF SYSTEM DATFK-5�-Z.7 APPROVED G.A.A.B. . �_: r71Jt 1 I �� I✓�HL I T'T CSF= 1=i! aC:1� �r=:t th�L !: X01` • DEPARTMENT HEALTH AND ErlVIRONMENTAL OTE :TIiiN g,a 17 2515 E. TUDOR RD. ' ANCHORAGE, On. 9:='rj0 i_ 2rE-221 •-i E ' L. FA til C• i=i rA — _• 1 T i- in E hl E F: F' E= rZA0,11 ill PERMIT 1J0. t 767 11 > ID.c APPLICANT F1 QnN PEDERSI-!-f SRH BOX 1718 � a'»- lz3S LOCATION JHCK_•UN _I LEGAL LID B3 FISCHER LOT SI`E 49500 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = = SOIL EATING <SO FTrER)= 100 THE REQUIRED 5I2E OF THE SOIL ABSORPTION SYSTEM IS: CHEF='TF-;= c LEt•a�3Ti-i= .^_�• ��F=:r=i'-.� EL_ G•EF'TF-I— �• THE LENGTH DIMENSION I5 THE LENGTH CIN FEET> OF THE TRENCH OR DRAINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION <IN FEET). THERE I_• NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE E:CAVATION (IN FEET). ;<:i=1.-tl-' Y F:Ec• L.EH: F•T I t_ Tr=1t-Jr=` _ I M:E= :JL ill ClCi 13 FA _L_'rA_= "i-1-•.10 e,_ :_ :• I t -a- F'EC--T I ill til F. HF=:E F.*EC!1_i I hEC• PACKFILLING OF ANY SYSTEM WITHOUT FINAL'INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 11:0 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOG_ ARE REQUIRED AND MIST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAY_, OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'E_F:rl I T I C• F= C3 F=: 'T EHF: I =• -1_1E I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. -. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. _. I UNDERSTAND THAT THE ON=SITE SEWER SYS=TEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN I BEDROOMS. APPLICANT ELDON PEh-ERSON 2,4,e - ISSUED BY- _ ___DATE --- -------- ,50 ------S 0 �_ i donthuction E7csf -fab "One left is worth a thoumnd orWons" 2204 Cleveland Anchorage, Alaska 99503- Performed 9503Performed For Pederson Construction Co Date Performed 9/7/7F Lenal Descrintion: Lot lb Blocl: 3 Subdivision Fisher Subdivision This Form Renorts Soils Lon yes Percolation Test_ tenth Feet 2— 8 haracterist Sandy Gravel 10— :: :�,•; `.Brown Silt, moist 12 — 14— Bot;. om of Test Hole 16 — I, '. 18 20— Was fround'Water Encountered? -No_ Jj' 'OP If ves, At what Depth? 71 rM�MM • M wR. f� Readinq Date Gross -Time: Net Time Depth to H2O Net Drop' F_ Percolation Rate Minute Proposed Insta ation: Seenaae Pit Drain Field Depth of Inlet Dept o ottom Of Pit Or Trench CnMNENTS: 100 square feet drainage area required Per bedroom. M1 Test Performed By c_ • _ Certified By: CONSTRUCTION TEST Neal A. Hausam Date: 9/7/76 LAB Parcel I.D. k MUNICIPALITY OF ANCHORAGE ' . • ' DEPARTMENT OF HEALTH & HUMAN SERVICES O Division of Environmental Services -0n-Site Services Section P.O. Box 196650' Anchorage, Alaska .99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 015-292-06 HAA ti \nab naii°1 1. GENERAL INFORMATION Complete legal description Lot 1 D; Block '3; 'Fischer Subdivision Location'(siteaddress ordirections) 10120 Evergreen Street Anchorage, AK . Property owner Mike & Andrea Meche Day phone 346-4476 Mailing address 10120 Evergreen Drive Anchorage, AK 99516 Lending agency Mailing add Day phone Agent Janet Daley/Dynamic Properties Day phone 261-7621 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XX NOTE: If community well system, provide written confirmation from State ADEC attest - Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site,, Public'sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legalityand status of systema 72-025 (R«.1/91) F a MOA Y21 S. STATEMENT OF INSPECTION BY ENGINEER . As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Mas/P Phone 7 —6/7 Address 7320/Eash ster it Ie Engineer's signature Date 7 3 210 8 ALASKA WATER & W STEWATER SERVICES WILL BE PAID .00 AT CLOSING FOR SERVICES PERFORDIED. 6. DHHS SIGNATURE � Approved for TPREF bedrooms. Disapproved. Conditional approval for g Additional Comments M M bedrooms, with the following stipulations: Date9 - SSR 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 purchasersof 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 engineers work. 72-=(Rw.191) B.k MOAm gECEI`ti'ED Municipality of Anchorage AUG 0 31998 DEPARTMENT OF HEALTH & HUMAN SE19,1t'iQtl ,&TY of Aw1O"O' Environmental Services Division4YWx#*t4A"Rv0'Ml 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: �C,/ /-P, a/ack 3, Fisc -A Parcel I.D: r / 5- 2 9a - ®6 A. WELL DATA Well type -Z'� �� It A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) A/ Date completed AWY*a7V. /1'17 Total depth 60 e- Cased to of Casing height (above ground) ,vk*"F asto a.- 0-48 Sanitary seal (YM) Wires properly protected (Y/N) Date of test Static water level Well production FROM WELL LOG g.p.m. AT INSPECTION /7` a7'OR 7.74" WATER §fMPLE RESULTS: ColiforM 46 Nitrate :204X M41k Other bacteria Date of sample: ' 44 Collected by: S• Psui,a L# �i}cc'6c�5 B. SEPT104HOLDING TANK DATA Data Installed k - 9 - 7 7 Tank size 147 c d Number of Compartments 2- Cleanouts (Y/N)-4L— Foundation cleanout (Y/N) Y Depression (Y/N) A% High water alarm (Y/N) /✓14 Date of Pumping 7-2-1-48 Pumper C. ABSORPTION FIELD DATA Date installed 5 - / 6- y 3 Soil rating (g.p.d.W or tt°/bdnn) D. 8 System type De o p 4e' `'h Length 71 Width 2-.6" -•S" Gravel thickness below pipe ` r Total depth «- y Effective absorption area S� `/ Monitoring Tube present (Y/N)—Y— Depression over field (YM) Date of adequacy test 7 - 2 7 - 4 d Results (Pass/Fail) 4AP4 For - •h cc e, bedrooms Fluid depth in absorption field before test (in.); 2 -a -V Immediately atter 6 3p gal. water added (in.): 8.75 If Fluid depth 40 2Sn (ins) Minutes later. 30 S Absorption rate = 45D+ a.p.d. Peroxide treatment (past 12 months) (Y/N) wo�ro If yes, give date N /A k^k�j•/ 72-028 (Rev. 3/98)' , r___ .. _. D. LIFT STATION Date installed _ `Pump on" High wa�Kalarm level at" Size in @fcies tested E. SEPARATI& DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / 2 C- .O. On adjacent lots / 00 f Absorption field on lot 00 On adjacent lots / c O" Public sewer main AIA Public sewer manhole/cleanout A/A Sewer /septic service line ZS Lift station NA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 9,5' 7o L•o, Property line /a " Absorption field 2 S Water main/service line Lb r' Surface water/drainage /GG/f Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ,ON LOT TO: _ Property line 3c Building foundation �" Water main/service line 2!;'0' - Surface S'rSurface water a7 �" Driveway, parldng/vehicle storage area Curtain drain Wells on adjacent lots / Oy r " #NCTI.I =1 4iR3'i 4172-11a7q-� 1061 I certity that I de,��jNnHeld inspect/ons and review of Munkipa/ rec in conlomran wi 4 A !defines in effect on this date. r I Signature Engineer's Name Date J& 98 HAA Fee S 6E"' O Waiver Fee $ _ Date of Payment -� o Date of Payment Receipt Number �� 4 Dl �ff '� Receipt Number 72-026 (Rev. 3/96)• JLL-31-90 12:41 FR% -CTE EWVIRMWE'1TAL a�- ME Ernrironmental Services Inc. CT&£ Rtt.r 983921001 Client Name AIC Auer & Wasmwa:er Servicei Project Namur LID 83 Fixher 10120 Evtq tea Chen Sample lU LID B3 Fischer 10120 Evergreta itiatria Drinloaj water Ordered By Toter cotifore C co:/100M 5913 9222a PWSID 0 5615301 T-003 P.02/02 F-012 . Client PCA# Printed DateMme 07/3I/98 1139 Collected DatelTime 07!27/98 C8:58 Reverted Date/Time 07m/98 3-.:30 Technical Director: Stephen C. Ede Released By utaeete Prep AnatrsSs Parameter Rewtti POL Units Metnoa Nmita Date Date :ric Toter cotifore C co:/100M 5913 9222a 0/27M Tmu Nitrate -0 2.1.2 0.100 e9/L EPA 770.0 10 teen C7/UM 0T/23/98 GCPP I • r I 1 O O TH � _ AVENUE W (JACKSON AVE.) i CCt N 89'58'26" W 164.82' 30' I H O rI'1 LOT 1D Ln I < N 1 c ^' C CIO 8 O � I; N I T 1� � MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services go On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6050 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # %� (�Sq SIS L `L1 Parcel I.D.# nY"D—agQ.-0Q 1. GENERAL INFORMATION Complete legal description Lot 1D.; BYock 3; F.i.6cheA Subd.rv.i.e.ion Location (site address or directions) Property owner David WeaveA Mailing address 10120 Ev2n.gaeen S.tn.eet Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone Day phone Day phone 346-3397 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-02$(R..1/91) Fwl YOAF21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Eagle River, Alaska Engineer's signature 6. DHHS SIGNATURE X Approved for Disapproved. Conditional approval for Additional Comments By: bedrooms. Phone & - Zr/Z 7 Date .woe e: Y: •-. N4�' i,., , 4�•.�M �e� bedrooms, with the following stipulations: Date J ' 20- Z2 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 certai n 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 engineers work. reran (AW.11911 Balk MOA Rt Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /—D7 1p &4L3AF9FWA S� Parcel I.D. A. WELL DAT IUft FF Well type T If A, B, or C, attach ADEC letter. ADEC water system number/ N/� I' Log present (Y/ la No Date completed " I� }4 VI Driller NK Totaldepth W' PFA 198 ' Casedto lfl' PFA flet` N.A.4. Casingheight q6 Sanitary seal (g`N) Wires properly protected &N) WS /l �Pe�op i n r o FROM WELL LOG AT INSPECTION + FLAR70 7C-0* SCA"KeS Date of test J�N AvA-t( 11 y--A0-?3 Tf5S7F�O f-;c�3 Static water level Well flow Pump level f SEPARATION DISTANCES FROM WELL TO: r A !6•S 70 g.p.m. N 4,;;L+ g'FA. 6* Ow i r Q 105 O d tl t lad 1 R 0 w fi m� i Septic/holding tank on lot, n a lacen o s I Absorption field on tot 1 y0 ; On adjacent lots /00 Public sewer main tilA Public sewer manhole/cleanout r Sewer service line ar 4 Petroleum tank Alwe w^' WATER SAMPLE RESULTS: Coliform O Nitrate kg e Other bacteria Date of sample: ti -19-53 Collected by: RA_-rroP %EcH Svc. B. SEPTIC/HOLDING TANK DATA Date installed Tank size 1�� — Compartments f" Cleanouts (9N) Two Foundation cleanout&N) yrrC, Z• Depression (Y1 `�o �Y%6 �•;�� fJ�i4 Alarm tested'.t,•,�:_ :WA.rcr High water alarm (Y/0 ___LJ of pumping q-0:119-133 Pumper A4 !7O LIQ ✓/ S O�f1 CmrTOk�kn ' SEPARATION DISTANCES FROM SEPTIC/GTANK TO: �. Well(s)onlot adjacent lots 106r k Foundation r 6rt To property line f Absorp.ionfield 3 Water main/service line" Surface water/drainage 72,026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level Manufacturer Manhole/Access (Y/N) mp off' level at ycles tested Meets MOA electrical codes (Y/N) SEPARATION DI E FROM LIFT STATION TO: W of On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed —� S` (� • Soil rating �1� SF System type P 62crt(f Length y4 Width Gravel thickness b r Total depth 0 Total` absorption area -t ( SF Cleanouts present VN) Depression over field (Y/�1 P` )o Date of adequacy testa Results (pass/fail) IJAA N F_w Sys for 3 bedrooms t: Peroxide treatment (past 12 months) (YA7,0 N If yes, give date MSA SEPARATION DISTANCE FROM ABSORPTION FIELD TO: �o Well on lot ti(J On adjacent lots 166'* Property line To building foundation t•f To existing or abandoned system on lot �y r On adjacent lots oZ54" Cutbank PIA Water main/service line Surface water foo r� Driveway, parking/vehicle storage area as�f Curtain drain Nt)NF_ r_rb ,v.7 E. ENGINEER'S CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA S & S ENGINEERING Signature Engineers Name agle River' Alaska 99577 Date guidelines in effect on the date of this inspection. HAA Fee $ —176' '420 Waiver Fee: $ _ Date of Payment fr—/7 — 9 3 Date of Payment Receipt Number 24YZ12 r7 9 241/ � Receipt Number 72-0291Ra. 3/9118. k MOA 21 l3/ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: AO t ! D Sloe k31- F'rscl rr S/b Parcel I.D. A. WELL DATA Well type P v f If A, B, or C, attach ADEC letter. ADEC water system number N, A - Log present (Y/N) N Date completed x t9'? 7 Driller Un k Totatdepth 'll' Ncr 1967 HHA' Cased to 9r' pe 1967 MnA Casing height ysy Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Wires properly protected (Y/N) AT INSPECTION 9.p -m. -7.2+ g.p.m. !An k Septic/holding tank on lot. l'OS; On adjacent lots > too ' Absorption field on lot 126 c. °• ; On adjacent lots > r oo , Public sewer main N, A. Public sewer manhole/cleanout N. A. Sewer service line 9S , Petroleum tank None Seen WATER SAMPLE RESULTS: Coliform D col' 1100 ml NitrateI �b -e Otherbacteria 110ne "t,oC& r.( Date of sample: `/ 1 t9 /9 3 Collected by: Flafly� Tech Svc Date Cleanouts (Y/N) High water alarm'(Y/N) Date of pumping SEPARATION DISTANCES FROM SEP OLDING TAN Wells) on lot On adjacent lots Tank size Foundation cleanout (Y/N) — Alarm To property It water/drainage field Compartments De ion (Y/N) s /N) er dation Watermain/servic 72-026 (Rev. 7191) Front CONTINUED ON BACK PAGE LIFTSTATION . D installed Size in lions Vent(Y/N) High water alarm E Meets M9 electrical Manufacturer Manhole/Access (Y/N) "Pump on" level at LIPump bff' level at Cycles tested SEPARATION 61STANCE FI Well on lot D. ABSORPTION FIELD DATA (Y/N) Date Installed Length Width — Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 r SEPARATION DISTANC Well on lot To building fou ation _ LIFT STATION TO: �Oh adjace}1t lots i .1 Grav ickness - Date for _ Surface water:_' System type _Total depth present (Y/N) - (adequacy test 9 /N) If yes, `ve date M ABSORPTION FIELD TO: _Onadjacentlots Propertyline To existing or abandoned system on lot On adjace ots 6water _ n drain —Cutbank Water main/service line Driveway, parking/vehicle storage area I E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines In effect orbtk� date of this inspection. o Weil Taj f Only _- .. of Ai `!.. bedrooms Signature jW 49T►I r .................... ..d Engineer's Name Tlntocdor•e F. Moo e%e 10 Date �i/� e3� 24„ /993 I MOORE:t�. � THEODORE F. AIJOFE IkT @'; ••. a-35,09 ;+p v'' '• HAA Fee $ Waiver Fee: $ Date of.Payment Date of Payment Receipt Number Receipt Number 72-M (S v. ]/91) 8. k MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING 6 ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561.5301 {YOYIM. 1' REPORT of ANALYSIS Chemlab Ref.# :93.1661-1 Client Sample ID :L 1D B3 FISCHER S/D KITCHEN SINK Matrix :WATER Client Name :FLATTOP TECHNICAL ERV Collected :04/19/93 @ 14:55 hrs. Ordered By :T.F. MOORE Received :04/19/93 @ 15:10 hrs. Project Name WORK Order :65141 Project# s Report Completed :04/22/93 PWSID :UA Technical Director :STEPHE4 C. EDE Released By : % lJ Sample Parameter NITRATE -N : ROUTINE QC Results Qual. ------------- 3.28 . T T.F. MOORE. Allowable Ext. Anal Units Method Limits Date Date Init •-------------------------------------------------- mg/1 EPA 353.2/300.0 10 04/21 LLH saxaaaaaxxxxxcxsxssaaaxxxxaxxaaaasvav=xassaaaaaaaaaaxxaxxaaaassaa— :aaxsxxxxaxsaaaaaaasasaxxxxx * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above IIA = Not Analyzed U - Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT x Greater Than �' �®,.cE3S Member of the SGS Group (Soci6t6 G6n6rale de Surveillance) COMMERCIAL TESTING & ENGINEERING CO. AK DIV CHEMICAL & GEOLOGICAL LABORATORY .�.=+•A+• TELEPHONE (907) 562.2343 5633 B Street Anchorage. Alaska 99516. Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM LD, 8 Q PRIVATE WATER SYSTEM Fluf�o� Te�ti.,�cAf Se��uy 3 ys—t3s'S N.nr Pnw+lb. Iys-3a EcAo Sy ua:q Aftm AA cAor'ayC . � 99S�G CRYsw. ap co" SAMPLE DATE: Mo. SAMPLE TYPE: IDay 9 year Q Routine ❑ Check Sample (for routine sample with lab ref. no. i ❑ Treated Water. ❑ Special Purpose [$ Untreated Water SAMPLE Time Collected No. LOCATION Collected By 1 1 !. c F I D rI*3�i�ts e/t tr- S/IpSu e/t sr- s/Ip� 2:U±r7 2 1 3 1� 4 5 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: satisfactory ❑ Unsatisfactory ❑ Sample too long In transit; sample should not be over 30 hours old at examination to Indicate reliable results. Please send new sample via special delivery mail. Date Received f4/I,,) Time Received 26k Analytical Method: Membrane Filter No. of colonies/loo ml. Lab Rel. No. Result' Analyst 93.1661 EM Z m Um L J m i m A.D.E.C. H-2- -9-31 W C— BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count el Conform/100 ml BEFORE COLLECTING SAMPLE Verification: LSB BGB Fecal Coliform Confirmation Final Membrana Filter Results Collllforrm/1DO ml Reported By_�� Date �z0 TNTC = Too Numerous To Count Tuns! 1A � a.m. OB = Other Bacteria PART ONE OF TWO (ENSGS Member of the SGS Group (E REMAINDER TO FOLLOW ~ ` MUNICIPALITY OF ANCHORAGE n to/ S zq O DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH Ng7 U3/5 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ' OF ON-SITE SEWER AND WATER FACILITY 264-4720 3. WATER SUPPLY Individual Well 13/ 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 Cd" Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Pagel of 2 72-025(11184) Application Date 1. GENERAL INFORMATION ' (a) Legal Description (include lot, block subdivision, section, township, range) oT i't i"il oCIC 3 t�A- �i scJs� Location (address or directions) . 1012o FVFe_he66M ST• �k .. (b) ?JAJiO lit&AVE)Z 346-3397 a69'Sy�9.. Applicant Name Telephone:• Home Business Applicant Address' J o/ZO vEe 602EAN• 6r ` Applicant is Lending Instdution ❑ Owner/builder ❑ Buyer tS Other O -(explain); (c) (check'6 ne) , , (d) Lending Insjt i TeIephor1e ng 1 A ole 6E r V Q Address' ;Z94 q6lo (e) Real Estate Company and Agent f G .• Address" err: ..... a�... <�. .. ,.♦ .... . .. .....: _ .: .--. ;, .. .:..:.. ;. . :• ' — Telephone = (f) Mail the HAA to the following address: bAv;b lt7'AvE/L ST 4. dnti fnva64- dY _ 995/6 3. WATER SUPPLY Individual Well 13/ 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 Cd" Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Pagel of 2 72-025(11184) 5. ENGINEERING 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 regulations in effect on the date of this inspection. � Name of Firm I�h"iT��e'*+��' ftylpu Telephone 007,LZ.2y'7r.1( Address .'tao w itY� OF -7-1-7 icdSftt2prht�44 K*F ?f03 Date LOAE� L60 /f&Z Y CAUTION ;. r The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. 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 responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-M (11,84) MUNICIPALITY Of ANCHORAGE (MOA) MUNICIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL. SERVICES DIVISION CHECKLISTT-- FEBRUARY 1984 jUN 19 1987 Legal Description: g4c.4 ' RECEIVED- A. .r.rrnA. WELL DATA Well ClassificationyIm rE% If A, B. C, D.E.C. Approved (Y/N) A Well Log Present (Y/N) NQ Date Completed 6«A'40Af&Z& Yield Total Depth � Cased to ��� Depth of GroutingR Static Water Level /s� Pump Set At 9AIWMda Casing Height Above Ground $ Sanitary Seal on Casing (YIN) y� Electrical Wiring in Conduit (Y/N) Yes Depression Around Wellhead (Y/N) JIM 1V4 Separation Distances from Well: To Septic/Holding Tank on Lot has ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot �2� , ; On Adjoining Lots /412:5 To Nearest Public Sewer Line To Nearest Public Sewer �y Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ��% ; Date 6-P-97 Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed -9-77 Size IOM z ,+L No. of Compartments ?,- Standpipes (Y/N) ye -S Air -tight Caps (Y/N) VG 5 Foundation Cleanout (Y/N) �lGS Depression over Tank (Y/N) ND Date Last Pumped 46-&-87 Pumping/Maintenance Contract on File (Y/N) for ti�A Holding Tank High -Water Alarm (Y/N) -WIleY — Temporary Holding Tank Permit (Y/N)� Separation Distances from Septic/Holding Tank: To Water -Supply Well �aS' To Building Foundation 7 1y 10 To Property Line 30 To Disposal Field - �r To Water Main/Service Line 30 To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �m Ad�P1 Type of System Design rA5fil/CK Date Installed —47"x1-97 Length of Field Width of Field IfIr Depth of Field 7 Gravel Bed Thickness —3 Square Feet of Absorption Area d00 Standpipes Present (Y/N) Ydts Depression over Field (Y/N) ND Date of Last Adequacy Test -x-11'87 Results of Last Adequacy Test — Ao T/.4 M Separation Distance from Absorption Field: To Water -Supply Well �Zg� To Property Line _Z©�'` To Building Foundation To Existing or Abandoned System on Lot i tWel s ASD ; On Adjoining Lots /aY r� To Water Main/Service Line Sb To Cutbank (i1 present) To Stream/Pond/Lake/or Major Drainage Course--ldllA To Driveway, Parking Area, or Vehicle Storage Area / yg Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments Dimensions Manhole/Access(Y/N) "Pump Off" Level at Check Permitted Bedroom Rating Against HAA Request •' Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certifylLaN a ke eril , or conformed to all MO and HAA guidelines in effect on the date of this inspection. Signed Date I 0040A 9^1 em I Compy PJV^77& MOA No. Receipt No. r ob l "oo l b Date of Payment (0 - l4 Amount: $ 1 QbM Page 2 of 2 Rickard C. auMoa CE 5031 72-026 (11,84) Seal n ^ 0,111 . GEOLOGICAL LABORATORIES OF ALASKA, INC. 1'L- cnEnncrtL PM 5633 B Street ' TELEPHONE (907) 562.2343 Anchorage, Alaska 99518 •-•�-•• Drinking Water Analysis Report for Total Coliform Bacteria TNTC = Too Numberous To Count TO BE COMPLETED BY LABORATORY TO BE COMPLETED BY WATER SUPPLIER O PUBLIC WATER SYSTEM I.D.N Analysis shows this Water SAMPLE to be: C PRIVATE WATER SYSTEM l-" Satisfactory sig/-- ❑ Unsatisfactory vnone No. C1 Sample too long in transit; sample shout Name not be over 30 hours old at examination /O/2 �` to indicate reliable results. Please send Mailing Address �/ new sample via special delivery mail. / State Zip Code - I � ; ! %. ��i±�' City Date Received SAMPLE DATE: �]J / 2 rZ2 Time Received _�- Mo. Day year Analytical Method: Membrane Filter SAMPLE TYPE: Routine C Check sample (for routine sample I L Treated Water No. of colonies1100 ml. with lab ret. no. rUntreated Water_. Special Purpose Time Collected Lab Ref. No. Result' Analyst SAMPLE Collected BY N0. LOCATION 7 ✓(7 2 3 ► LTJ m 4 I U m 5 BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter. Direct Count Colllormno0ml Verification: BEFORE Final Membr COLLECTING SAMPLE ROL: t° Y Reported By p.m. TNTC = Too Numberous To Count 4 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. - 5633 B STREET ANCHORAGE, ALASKA 995518 TELEPHONE (907) 562.2343 FEDln1 LYS1Jl{ u�ltli 44 LE Cl lent POS : VEPV..L Peg S: Cl lent Smpl ID: LT 10 B-3 FISCHER S/D Sample Read : JUN 11 87 Ordered By • REPOPTS ADDRESS S1 w:AVER. DAVID 10120 EVE?CPEEN ANCHIGRAGE. AL. 99516 Special ROUTINE SAMPLE COLLECTED 6/11/87 Instruct: CneaaDPet S: 6545 LaoSmal ID: 1 matrix: Water Pa:a.=eterTested Result/Units ------------------------------------------------- TOTAL COLIFORM 0 col/loom) work Order ho. : 1049 Cl lent Account : wE4'IDC Date keport Printed: JUN 16 67 a 11:15 P.eleasedBy : SCE�� REPORTS ADDRESS $2 A!lo4aDie Cethod Limits ----------------------------- Sample P067INESA."..PLEB Remarks: AI;ALTSIS L%MPLETEU:- LABCFATOEYsUPE?VISO?:STEFHEiC EDE� C sxxxzzazxxzxsss:czxzzzaxx:azxzzccxz szxzxzasss:ccc=sxzszxszazxzzzszz�—zczszs=x.ns.z=� 1 Tests Pertotmea a See Special Instructlonsbove ND= None Detected e► See Saa�le RemarKSADove M= Not Analysed LT=Less Than. GT -Greater Than r^ h CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. \ 5633 B STREET ANCHORAGE. AA � KA 99518 TELEPHONE (907) 562-2343 FEDE rdt�.. IC_�J9r.12f1 Snr.i'LE Client Kit : VERBAL Req t: Cl lent Smpi ID: LT 10 6-3 F1St'hEP S/D Saplekeca : JJ'111 87 Oraerea By Prr71'S ADDP.wS tl w A:ER.IWID 10120 EVERGRE3 ANCHMUH, Al. 99516 ' Special RDiTTINE SAP.PLE COLLECIEDVII/67 Instruct: Mork Omer No. : IUV Cl lent Account : W:.A''DC Date Deport Prfntea: JUN 16 67 S 17:15 Pei easecby : SCE J'z1f kEP kTS ADDPESS 82 Cnexiac Ref t: 6545 Lan Smpl ID: 2 Catrlx:Water Paramete.-Testec Result/Units hetnoa ---------------------------------------------------------------------- NITPATE-N 1.2 W/l AllvaDle Limits 10 Saple Remark9: xzzzsxzz:zxazazzxrzxxxzzzxxzczzxczzzzzxxx----__=•szxxz:zzxsxzzzxxxxsxzsxxczzzsxxzzzzx 1 Tests Performeo * See Special InstructiensAoove ND- None Detectea +* See Sample Remarks Aoove kA= liot hnaly:ed LT -Less Than, GT=GreaterTnan R Mow, ET U R N -- O SUBJECT C�c f l fJ �P�c 3 F/tiu ��D DATE MESSAGE L✓� ve r�.i,c_✓�� 6.. lcl t+.� ' � .,� �< f n / f Tc..• s p.��.. � l" 15 `` � .Gtr c�...� � ,tom: /.mac ��� fio� /C �1�s7 �/ 'j 't.G ��.�G ��Sf C-�r.• . V vV V c�= r RETURN TO SIGNED REPLY SIGNED DATE 45 479 sem PARTS tum a INTACT POLY PAX (SO SETS) 4P472 PUT S WIU as "TURA wim 6my. Time APPLIC" W FILLS OUT'UPPER HAL^ONLY Property Owner S arorn lac i l tams Phone ,f ': g Mailing Address _ Zip Code Inspector Buyer Inspector Address Field Notes: Zip Code Lending Institution 1/� \ /'- ol he J n \J `jJ I<-f� ar Phone Address 'CONDITIONS OF APPROVAL Zip Code Realty Co. Q Agent /h Crown H rOw \ eo I Phone Address Ijl Zip Code Legal Descrlptbn Date Sewer installed Street Location Septic Tank Size G — Well to Tank Type of esidence Ingle Family Multiple Family No. of Bedrooms ❑ Other Water Supply _ Cr..tndividualTF ACH WELL LOG. A well log Is required for all wells drilled since June 1975. O Community wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Se weJ Disposal (jT� Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time M 30 I l lir e1 Date Date Date Date 10 3I Inspector Inspector Inspector Inspector Field Notes: 1,11 ( 'APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' Z Ir DATE BY: _ Soils Rating Date Sewer installed Well To Absorption Area Well Log Received Septic Tank Size G — Well to Tank n n ALASKA bUIROnEnTAL COnTROL SRICCS, IX Enginterinq & Enuironmental Studies IIONA REESE 1205 E INTERNATIONAL AIRPORT ANCHORAGE AK 99502 FEBRUARY 15 1984 SELLER — IIONA REESE BUYER — MCWILLIAMS SUBDIVISION — FISCHER BLOCK — 3 LOT — 1D ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 300 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 675 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 2 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON FEB 15 1984 . SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 2 BEDROOM HOUSE. OF -4�4111 *:.49Ta1 *! :._ OY .Reid, Jr. f•� ! 2251-E C�,e �, �ryF •c. ;gym = West 33rd Auenue. Suite B 9 Warage, Alasko 99503 • (907) 561-5040 n h . 'L�ez�r a �zieei�r� � �ntezpzidea STAR ROUTE A - BOX 1560 - ANCHORAGE. ALASKA 99507 - (907) 345.4417 2-3-84 L1D, B3, Fisher Subdivision 10101 Evergreen 2-2-84 Test pumped well ten hours. Well pumping 3} gpm at start of test and pumping 34 gpm after ten hours of steady pumping. Total water pumped 2,100 gallons. 1-�' CHEMICAL & GE, OGICAL LABORATORIES I) ALASKA, INC, TELEPHONE (907) 562.2343 ANCHORAGE INDUSTRIAL CENTER 5633 8 Street /40-2 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER, TO BE COMPLETED BY LABORATORY WATER SYSTEM: `. Water System Name Meiling Address Photr No. �a • City. -- Sura zip cocw —'C- SAMPLE DATE:Mo. Day SAMPLE TYPE: �f Routine r�. f • Check Sample (for routine sample with lab ref. no t = ❑ Treated Water t, ❑ Special Purpose❑ Untro .laxedWater .. «. r I � SAMPLELOCATION ,�� 4 r, . "Tlme _ , `Collectf/d ColiW&d By 2 r /sf/ E? 3 s �» 4 4 �..t 1 �M�`� i .rl A alysis shows this Water SAMPLE to be: Satisfactory I. ❑ Unsatisfactory ❑ Sample too long in transit: sample should not be over 48 hours old at examination to indicate reliable results. Please send .r..._.new.sample...4_..._ _ k_ .. Date Received Time Received 1�Z> L Analytical Method: t , ❑ Fermentation Tube .1 Membrane Filter 'C Lab Ref. No. Result* Analyst E n„ saiaTt* m .� ' m _Ia I m \It {fly a sob /100 nN a No of Po41M 1> 1'W' P , BACTERIOLOGICAL WATER ANALYSIS RECORD... .......... a Rer. 1p7S Dale CWIMed Sourm READ INSTRUCTIONS S.M. dto Rese14M Time R."wed 0ln. Lae. No. PretumptM loam 10.1 10ml loml 10.1 ID" 0.1.1 24 Noun 1 BEFORE 44 r nwmetery EMR erom 24 hours, erotb 44 awn, COLLECTING SAMPLE rwltsom Tube ;% p n, 10ml Tubes PaelttWltow 10M Portlarn MnnbrMu Peter, Direct Cwnt Calearm/100m1 VMlfkatlon, LTR BOB PIMP Membrane Filter Reauki I Collfonn/100ml Ae ted BY onto p.m.