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HomeMy WebLinkAboutKASILOF HILLS BLK 1 LT 2K silof Hills Block 1 Lot 2 #015-161-08 O MUNICIPALITY OF ANCHORAGE DEPARTMENT OF NEAI~TH & ENVIRONMENTAL PROTECTION ENVIRONIVlENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT "~AM E - ]PHONE ~NEW ~EGAL DESCRIPTION Nb. OF BEDROOMS J Well J ~bsorpti a Dwelling PERMIT NO. ~ ~ DISTANCE TO: kO O o~a~ &l ~ ~O h~q ~<~ Z Manufacturer ~ ~ S~ Material~ ~r G~ ,o. of compartments ~ Liq. capacity in gaHons Insidelength ~ In ~ ~h __ ~ X~ ~OO¢) IF HOMEMADE: Width Liquid depth S~ DISTANCE TO: We'li~ X Dwelling PERMIT NO. ~ Manufacturer k ~ Matorial ~ Liquid ca&city in gallons ~ Wall Foundation Nearest lot line ~ PERMIT NO. ~ No. of lines Length of Total length of lines Trench width Distance between lines ~ ~' ~ ~ Top of tile to finish grade ~ ~1 Material beneath tile (~ ~ ~1 Total effective absorption area __.= G O , inches Length Width Depth PERMIT NO, ~ ~ Type of crib C ter Crib depth Total effective absorption area m Wel~ t ~ Building foundation Nearest lot line ¢ DISTANCE TO: ~"~'~0 ~[~ Depth Driller Distance to lot line PERMIT NO. ~ O~q ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s} OTHER '~-- SOIL TEST RATING -- 5o _ ~NSTALLER S ~ ~ REMARKS ~OV~~ DATE LEGAL M-W DRILL NG, iNCo Well Owner DRIlL[lNG Mark G. Meehleis .__Use of Wel] Do_~. Location (address of: Township, Range, Section, if known; or distance main roach_ Lot 2 Block 1 Kasilof Hills Subd., Anchor~._ge Size of casing. Static water level Screen ( Depth of Hole 40' ft. ); Perforated ( 320 feet Cased to_ 37,3 _feet (below) land surface. Finish of well (check one) open end ( xx ). Describe screen or perforation N/A Well pumping test atO. 5__gallons per (kcMg) of drawdown from static level. (minute) for 1 _hours with ].00% Dale of completion_ 9/!2~_78 WELL tOG Depth in feet from ground surface ' Give details of formations penetrated, size of material, color and hardness ); 0 .TO_ 2 .... _2____TO. 3 3 .TO_ 35 _--35 TO 320 TO___ __ TO __TO .TO. .TO. .TO. 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Ot',l'"':!i;J;Tt:iil '_"i;I;!i!.,ll;iZl:;;::iii; I:::I1",!t) I,.IEL. l..:-ii; l:::l::i ::ii;ill/! I:: (i;II;,?. !'H l:!:"r' 'i"H!i!i Ptl...Ii",!Z!;C:XI::'FII iI;i"? OI;: ;:;!:; ]1; I,I ;!i !..!.. ;IZ t",I'.~!;TI:::It..I... 'Fill]; :!?'r':!i;-117H ;ii i",t FtCC:(1)I:;i:I')I:::II',I(;:I:;i; I'! .~ TH 'ii"11:? ii:~:: ;t; t..iI",IDI::!ZI:;?.:~i;TFII",I!;) '[HI:':IT '/'HEi Ot",l"":.i;]Z !'l:!il Stiil.,.tl;ii;l:;i: :ii;"r'i:!i;'l'l~]l'l I"IFI"/ !:;;'.!iX.;!l..I.t;t:;?.Iii; ~:ii',1l I;:lI?.G!:i;Hl!i!il",l'! !i!::' THE I:;i:E::!!i; :t: !)ti~'.t',!C:l!::( ~1: :!:; I;;:i:i:l"'tCff)[~l...[:::l:) '['0 :I: I',[(;:L.IJ1,)I!!: f'iOl:;;:l'.!: 'TI II:':lhl :!!: ~erform~d For__ .eoal ~escriotion: Lot e~. Blocl: This I~orm Reeorts Soils [ocl ./~_S 2204 Cleveland Anchorage, Alaska 99503' ~rR ~k~e~t~ ~ate Performed Percolation Vest nenth Feet --- 8 - Soil Characteristics Was Ground Water Encountered?__ I~ Yes, At what Depth? Readinq I Fercolation Date ate Grnss Time !tinute Net Time Depth to H20 Net Droni Prnnosed Installat~o6: Seenaoe Pit Drain Field Deoth of Inlet Depth To Bottom Of Pit Or Tne~h Test Performed BY ~~'~~ Data Certified ~: Date:~~/~ _ Municipality of Anchorage Development Services Department,.~ Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. COSA # GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address ., Lending agency 05c.. Expiration Date: L,~i"' ?.,, ~ t¢,,~ I,t I.~ I"'~,~ ~ 1~ ~ ib,I Ir' I'~,~*-~ ~,~l¢,~ Day phone ~ff~ -7 7~ Day phone Mailing address Real Estate Agent A¢~,,-¢~ I"k¢, lwo'-~¢,, f).f'~,~.,.~ -~)),.,.~,,,D~y phone MailingAddress ~ i l1 ~ * ~'h, ~ ~ 0~ ~~,- ~ ~ Unless othe~ise requested, COSA will be held by DSD for pickup, i~ i ~¢z¢ ~t~ il NUMBER OF BEDROOMS: ~ ~ ~'~ ,4 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 On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems 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. (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. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work, 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 Address l ~.t ~'" Engineer's Printed Name DSD SIGNATURE ~ Approved for ,_'~. Disapproved. Conditional approval for bedrooms. bedrooms, with the following Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Rev. 11/05) Municipality of Anchorage'. Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST LegalDescription: £~/"2. ~/oc~ I, /~c~.,, ,/o~ · A. WELL DATA Well type r~/- IfA, B, or C provide PWSID #. ~-' Date completed.~ / I'~./7~ Sanitary seal (Y/N) Totaldepth 32.~, ft. Cased to $ 7, .~ ft. FROM WELL LOG Date of test c) ! ~ / '7 ~ Static water level ~/~' ft. Parcel ID: Well Log (Y/N) Wires properly protected. (Y/N) casing height (above ground) AT INSPECTION , / Well production WATER SAMPLE RESULTS: g.p.m. 3,9 -t- g.p.m. Tank size .l OO~' gal. Foundation cleanout (Y/N) ~' · Date of pumping d~/l?l 1~ · C. ABSORPTION FIELD DATA Date installed ~ ! z.Z/?~' Soil rating .. Coliform /~) colonies/100 mL Nitrate ~, 35- mg/L 'Arsenic: .~'- ug/L date of sample: ~ / I&',/t~ · B*- SEPTIC/HOLDING TANK DATA Tank Type/Material .~...~/~i ~ / /=', ~ ~,~".,?' · Number of Compartments Depression over tank (Y/N) . Pumper. ,~* Length ~ ~ Total depth j~. ft. Date of adequacy test Other bacteria Collected by: --- 'coloniesll00 mL (g.p.d.lft~ or ft%drm) ~ System type ft. Width ~. ~ ft. Eft. absorption area ~__~ftz Monitoring tube __ ~' / I~ ,) t~,, Results (Pass/Fail) /'>,~,,, Fluid depth in absorption field before test i¥,,~ in. Water added~'¥2, gal. Elapsed Time: ~ ~ min. Final fluid depth t~, ~'in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) ~t GraVel below pipe. 4~ ,~; ft. Depression over field · ~ For "] bedrooms New depth_.~ in. ~ g.p.d. If yes, give date tv. ,'1', Date installed Cleanouts (Y/N) High water alarm (Y/N) D. LIFT STATION Ee Date installed "Pump on" level at~ in. Datum SEPARATION DISTANCES Size in gallons "Pump off" level at. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot I0 Absorption field on lot · Public sewer main. ~- A.. Sewer/septic service line '~ Animal containment areas _'~ i~,~,, in, Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. On adjacent lots '~/c;,c,, On adjacent lots. ~. Public sewer manhole/cleanout Holding tank ~'/' Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation '~ ~' ' Property line Water main ~. ,4-. Water service line .. ';> l~, · · Wells on adjacent lots '~. ~ ~,,~, ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field Surface water Property line. I I Building foundation ,.5"~ ' Water Service line "~ l~,' Surface water . '~ loc, Curtain drain I~¢,n / ~'~'~,,~ Wells on adjacent lots... COMMENTS Water main /~J- · Driveway, parking/vehicle storage G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name. '"~~3,~,~ /':'. ~"-/c,o,--E COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number SGS Ref.# 1102727001 Client Name Flattop Technical Srv. Printed Date/Time 06/22/2010 11:13 Project Name/# Water Samples Collected Date/Time 06/15/2010 13:10 Client Sample [D Lot2,Blk 1 KasilofHill Received Date/Time 06/15/2010 14:30 Matrix Drinking Water Technical Director Steohen C. Ede PWSID 0 Sam01e Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 06/16/10 06/16/10 KDC Waters Department Total Nitrate/Nitrite-N 3.25 0.100 m~JL SM20 4500NO3-F B (<10) 06/20/10 AYC Microbiology Laborator~ E. Coli Negative I 100mL SM20 9223B A 06/15/10 DLC Total Coliform Negative 1 100mL SM20 9223B A 06/15/10 DLC Lot ?A J 1 gO.O0' 10.2' 2 STORY J BARN R~mENCE BALCONY J # ~ RErNNING Lot g PLOT PLAN Lot 2 28,500 s.f. F AS BUILT N 90"O0'O0"W 190.00' 2¢.0' Lot 1 ~X SCALE: 1' = 40' GRID SW 2641 Z I / ~ I 0 I I Project No. 10-097 Lang (90?) 5~-647~ Registered Land Surveyors (907) s22-4s2s kglangla~ala=ka.net / JclanglsOalaska.nef &: Associates, inc. ;~500 I)~ryl Avenue. An©borage, Alike 99515-3049 Phone Fox I hereby oerfif~ ~hof I have surveyed the following descrlbed ~f 2, Block 1, Kaellof Hill= Su~. (Pl~ ~. 66-96) ~chomge R~o~lng w~ln the pm~ Iln~ and do not enoch no lmp~emen~ on ~e pm~ ~ng adjacent ~ ene~ch on t~. =u~ed pmml~ and th~ ~emen~ on .old pmpe~ ex~pt as indited hereon. ~d ~ls ~e ~. ~ of __~ .. ~ ~ ~ ~homge, Alaska ~ I. ~e ~s~n.ibill~ of ~e owner to d~e~ine ~e exl~ence of any easement, covena~, or re~Hcflons which do not ap~r on the ~o~ su~i~slon pl~. Municipality of Anchorage Development Services Department Bullding Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6660 www. cl.anchorage.ak, us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 015-161-08 t. GENERAL INFORMATION Expiration Date: "~" ~2, - O I CompletelegaldescflptJon KASILOF HILLS SUBDMSION; LOT 2, BLOCK 1, Location (site address or dire~ons) 11100 STROGANOF DRIVE ANCHORAGE, AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address RON BLAIR Day phone 346-1353 ANCHORAGE, AK 99511 . Dayphone P.O. BOX 111722 BROOK ST]L'I~£R w/ REMAX OF EAGLE RIVER Day phone 694-4200 16600 CENTERFIELD DRIVE EAGLE RIVER, AK 99577 Unless o~herwise requested, HAA w/I/be held by DSD for plckup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL'. Individual Well ~ Individual On-site Individual Water Storage Individual Holding tank Community Class Well [] Community On-site Public Water System [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered In the State of A~aska. Certificates of Health Authority Approval are required for the transfer of tit~e (except between spouses) for properties served by a slngle family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water 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 proper'des served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the professional engineer's work. STATEMENT OF INSPECTION BY ENGINEER AS certified by my seal affixed hereto and as of the vatidab'on date shown below, I vedfy that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supp~ and/or wastewaler disposal system Is(are) safe, functional and adequate for the number of bedrooms and ~ of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage tiles and from my investigation and inspection, the on-site water supp~' and/or wastewater disposal system is(are) In compliance ~th all applicable Municipal and State codes, ordinances, and recjulations in effeat at the b'me of installation. Name of Firm, .ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone Address ..6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504- Engineer's Printed Name JEFFREY A. (~ARNESS, P.E. Date 337-6179 · Engineer's Comments: In conductlng this evaluation, AWWC, Inc. attempte:t to provfde a thorough, conscientious engineering ana~ls of the system in accordance ~th ADEC and MOA DSD Guidelines & Re~julations. Tho reported results descriL'~l the performance of the system under the conditions encounter6d at the time of the test, and separation distances measured to readi~' ldentlfiable features. Tho o~erational life of all wells and septic systems depend on the local so#s condition, groundwater levels that may ~ucfuate du#ng the year, and the water usage of the fami¥ being sen/ed by the system. These conditions are ou~;fde tho conb'ol of tho maluator of the system. Sa#sfactoo/ test results do not guarantee future perfoffnance of the system, nor do they guarantee that there ara no hidden defects or encroachments. AWWC, In~ can therafore not provide any warran!y or future estimate of how long tho system v/ill continue to meet the operational requlrementa of the ADEC or MOA DSD. The content of this report Is for tho solo benefit of tho owner listed abo~e. Any reliance upon or use of this report by any other peraon or par~ ls not authoriz~l, nor wlil lt confer any legal rlght whatsee~er. 5. DSD SIGNATURE Approved for Disapproved. ~ bedrooms. Conditional approval for __ ~: ON-SITE ~ ~'~ WATERAND · mm bedrooms, with me fllowing sUpulation~ WAST~ATER ~ ~ ~ PROG~M ; ~ ~ · ,.'~..~ Attachments: HAA Checldist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Original Certiticate Date: L/,/- ,.Q..., ~) ! . Municipality of Anchorage Development Services Department Off-Site Water & Wastewat~r Program 4700 6ou~ Bragaw St. PoD. Box 196650 Anchorage. AK g9519-6650 Legal Oescrlption: A. WELL DATA Well type PR~^Tg Date completed Toteldepth 320' lt. Date of test Static water level Well preducben WATER 8AMPLE RESULTS: HEALTH AUTHORITY APPROVAL CHECKLIST KASILOF HILLS S/D; LOT 2, BLOCK 1, ' IN BEDROCK IfA, B, or C provide PWSlD# N/A 9/12/78 Sanitary seal (Y/N) YES Cased to *37.3' lt. FROM WELL LOG 9/12/78 o.5 g.p.m. Parcel ID:, 015-161-08 well Log (Y/N). Wires pmpedy protected (Y/N) Casing height (above ground) AT INSPECTION 1/17/Ol 49 ~ 3.5+ g.p.m. Coliform ~ colonles/100mL NttreteO.-~ mg./L. Otherbectetle Date of aample: .j~ol Collec~edby: AWWC, INC. YES 12+ in. . colonies/100 mL B. 8EPTIC/NOLDING TANK DATA Tank Type/Material FIBERGLASS (SUNSET) Date Installed Tank$1ze 1000 gal. Number of Comperlmente 2 Cleanouts (Y/N) Foundation deanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) Date of pumping 1/50/01 Pumper DENAU SEWER & DRAIN C. ABSORPTION FIELD DATA ~ea. ow ~N~. CR~D~ Date installed e/22/78 Soil reting (g.p.d~ 200 Length 38 E Width 2.5 .if. TotaJdeplh 12 +/- ff. Eff. abeoq~Jonama 456 ft= Monltedngtube YES Date of adequacy tsst 1/17/01 Results(Pass/Fall) PASS Fluid depift in absorption 6eld before test ,*2 In. Water added 736 gal. ElapsedTlme: 10 min. Flnalflulddeplh 2 in. Abeorptionrete>= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN 9/22/78 YES I**MOSTLY SLUDCEI System type DEEP TRENCH Gravel below pipe 6 It. Depression ever tleid NO For 3 bedrooms New depth 34. In. 450+ g.p.d. If yeS, glv~ date - D. UFT STATION Data Wed Size In gallons "Pump on" level at .in. '?_~_,~a~----~[ Hlgh water alam~ level at ~ ~ Cycles ~ Meets alarm & ol;cult requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WFI I ON LOT TO: On adjacent lots 100'+ On adjacent lots 100'+ Septic tank/Eft station on lot 100'+ Ab~on field on lot. 100'+' Public sewer main N/A Sewer/sept]c sewlce line 25'+ Public sewer manhole/cteanoat N/A Holding tank N//A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Bulidlng foundatlon. 5'+ Property ~ne 5'+ Absorpfion field~ 5% Water main 10'+ Water 8ewtce line. 10°+ Surface water. 100'+ Wells on adjacent lots 1 OO% SEPARATION DISTANCE FROM ABSORPTION fiELD ON LOT TO: Pmpert~ line 10'+ Building foundatioft 10'+ Water main. Surface water 100'+ Wells on adjacent lots 100'+ Water sewloe line 10'+ Curtain draln NONE KNOWN F. COMMENT8 G. ENGINEER'S CERTIFICATION 10'+ Driveway, parldng/Vehlcte storage 50'+ I certify that I have detormlned through field inspac~ne and review of Municipal records that the above systems ere/n con~mance v/~h MOA HAA gu/c/e~nes In effect on this date. In. E.o,.ee?. JEFFREY A. ~NESS HAA ee$ Oata of Payment Receipt Number Waiver Fee $ Data of Payment Receipt Number. 11:20 FI~g-~TE ENVII~Nt[NTAI. ~ CT&E Environmental Services Inc. 5615301 T-?gg P.0Z/03 F-$2g CT&K Ret'.# Client Sample ID Or~r~ By PWSID Sample Remmks: 1011379001 AK Water & Wastewater Consultants Inc. KasilofHills S/D; Lot 2 Bk 1 KasilofHills S/D; Lot 2 Bk 1 Dtlnking Water Client Printed Date/Time 03/23/2001 12:0~ Collected Dar e/Tlme 03/20/2001 12:55 Received Datr./Tlme 03/20/2001 15:10 Te¢l~nlcal Dlrt~tor Stephen C. £de Released By Wa~ers Depar~men= P.~al~ PQL Units Mcd~xl Analysis Date Init 0.500 U 0.500 I~q~L EPA 300.0 10 max 03/20/01 SCL Microbiology L~borat:ory Total Coliform 0 ~I/I OOmL $MI8 ~222B 03/20/01 K.AP Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH & HUMAN SERVICES ~LITY OF ANCHORAGE Division of Environmental Services EN NTAL SERVICEs DIVISION On-Site Service's Section P.O. Box196650 Anchorage, Alaska 99519-6650 J~JJG 0,5 ]~}97 343-4744 RECEIVED GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone '-- Day phone ,)-'7 ~ -- ~'75-,.~.0 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: i,~ ''~ TYPE OF WATER SUPPLY: Individual well ~ Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. 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 corn ordinances, and regulations in effect on the date of t Alaska Water & Name of Firm w-_~ ..... ,.¢ ~.'~.~o~s "FY ..... .'.' ........ ~'~ ' 84'.'iJT.~okri~fDr. Address /~cl~.,~K~ 4 / ~/ EngineeCs signature ? ( DHHS SIGNATURE . i/ ppro ed *or Disapproved. bedrooms. ~liance with all Municipal and State codes, ~is inspection. Phone Date Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality 0f Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72.~25 (Rev. 1/91) Back MOA .MUNICI?At. IT( OF ANCHORAGE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES~UG Environmental Services Division 825 L Street, Room 502. Anchorage, Alaska 99501. (907)~~V E D Legal Description: A. WELL DATA Well type I0 V "~" Log present (Y/N) Total depth Sanitary seal (Y/N) Health Authority Approval Checklist ~,td--~.) ~/~¢~'~LOI¢' /nL/~'('~ ParcelI.D.: If A. B, or C, attach ADEC letter. ADEC water system number V~-''~' Date completed cfi/' Z-/ Casedto ¢7, ~ IA [F~ Casing height (above ground) Wires properly protected (Y/N) Date of test Static water level Well production FROM W/~LL LOG ! 4o WATER SAMPLE RESU~: Coliform Date of sample: '7/?- ~/¢~ '~- Nitrate g.p.m. /. ~ ~ '3'2- mc.d/JZ Collected by: AT INSPE~;TI?N Other bacteria _ Date installed q/7"2'/7'~ Tank size iDOC) Number of Oompartments '7_ Oleanouts (Y/N).__ Foundation cleanout (Y/N) '~ Depression (Y/N) ¢JO High water alarm (Y/N) /%//,4 Date of Pumping '-7/(¢/¢°F- Pumper c. ABSORPTION FIELD DATA Date installed Soil rating (g4xd~~ orft2/bdrm) /~-O Length 2~) ( ~=_~ ' Width ~- o Gravel thickness below pipe ~ Effective absorption area ~ Monitoring Tube present (Y/N) ~ Depression over field (Y/N)__ Date of adequacy test ~/.~ I/~ ~ Results (Pass/Fail) ¢~ For ~ Fluid depth in absorption field before test (in.); ~ 7 Immediately after JOOf~al. water added (in.): Fluid depth ~O, ~ (ins) Minutes later: ~ Absorption rate ~ '~ = .g,p,d. Peroxide treatment (past 12 months) (Y/N) ~o~ ~ If yes, give date ~ System type J~-----~-'~ 'TfTJ:%¢¢¢l Total depth I ~- ~ 4- bedrooms 72-026 (Rev. 3/96)* D. L'~'I'-C~T~TI 0 N ' Date installed~"'"~'~""~_~~.._ ~'~"~Size in gallons Manhole/Access (Y/N) __~ "Pump off level at* High water alarm level at~ *Datum %_ Cycl. ~ed ~ E. SEPARATION DISTANCES F. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation '~ O ;~ Water main/service line Property line ~O / '~ Surface wateddrainage I OO/4- Absorption field Wells on adjacent lots I OO/'~- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line [ O ! '~' Building foundation ~'O Water main/service line Surface water IoO L~. Driveway, parking/vehicle storage area Curtain drain Mo~.~-- ~/.~,~o~.¢,"J Wells on adjacent lots I OO/+ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $. Date of Payment Receipt Number Akl[als]k W l :er & August 3, 1997 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 8471 Brookridge Drive ~ Anchorage ~ Alaska 99504 Phone (907) 337-6179 ~ Fax (907) 338-3246 Consultiag Engineers Subject: HAA for Private Well & Septic System. Lot 2, Bk 1, Kasilof ltills. 11100 Stroganoff Drive. Anchorage To whom it may concern: The subject lot has a 3 bedroom house on it which is served by a private well and septic system. The results of the field investigation and adequacy tests are summarized as follows: A. WELL: On the day of the inspection (7/31/97) the static level was 46 feet below the top of the casing. Water was pumped from the well at an average rate of 1.61 gpm for 254 minutes (409 gallons). During the first 15 minutes of pumping the water level dropped to 62 feet BTC, and fluctuated between 62' & 65' throughout the rest of the test. In short, it was recovering as fast as it was being pumped out. Based upon this data it was determined that the capacity of the well exceeds the Municipal requirements for a 3 bedroom house (450 gallons per day). B. SEPTIC TANK: The existing septic tank was installed in September of 1978 (approx. 19 years old). According to the MO.A records, it is 1000 gallons, has two compartment and is made of Fiberglass. No warrantee is made regarding the future life of the septic tank. C. SEPTIC SYSTEM ADEQUACY TEST: Prior to beginning the test, the sump had 27 inches of liquid in it. One-thousand (1000) gallons of water was introduced into the cleanout past the septic tank (over a period of 60 minutes) and the liquid level rose 11.5 inches, to 38.5 inches. Three-hundred & thirty (330) minutes later the level had dropped 8 inches, indicating an absorption of approximately 700 gallons. Based upon this data, it was determined that the absorption rate exceeds 450 gallons per day, as required for a 3 bedroom house. NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not limited to, seasonal st#face water infiltration, groundwctter variations, septic system maintenance (frequency of septic tank pumping, usage of biological additives), condition of drain pipe and pipe joints (which can be damaged by seismic activity and deteriorate with age), type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects), and the amount of water being introduced on a continual basis. Consequently, the results of this adequacy test are only valid for the specific day of the test. Furthermore, because of the limited nature of this investigation, it is possible that there are hidden defects which may not have been detected. No warrantee is made regarding the future performance of this well or septic system If you have 1-800-481-1162. T Sincerely,, / Jeff '~arness,. any questions, please contact me at 337-6179, ~ank you for your assistance. or on my digital pager at C.C. Prudential Real Estate, Lyn Garrett MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING O } ,~ ~/,~l O ~ HAA#. 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) (b) Location (address or directions) Property owner A %.L ¢/~ Mailing Address Telephone: (home) Business (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone ....... (e) Mail the HAA to the following address: (or check here E~if hold for pick up.) ' - List contact person and day phone number below: '% ac_V-- 2. TYPE OF RESIDENCE Single-Family~ Number of bedrooms 3. WATER SUPPLY Individual Well ~ Community [] PuNic [] 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 writter~ confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-o25 (Rev. 7/88) Page 1 of 2 .'. . ~ ~.o i~ e~ed ')~JOM s,Jeeu!l~ue leUO!SSejoJd eql u! suo~smuuo Jo sJoJJe Joj elq!suodseJ ),ou s[ e!~sJoqouv jo ~l!led!o!un~ eqi 'penss. s. el~o!jRJ@o e eJojeq ~Sp eZ~leU~ Jo suoi~o~dsul lonpuoo lOU op SHH(] jo seeXoldLUq 's~ueLueJmbeJ e~81s pu~ I~Jepej U!elJeO ~js.~es o~ JepJo u suo!~nlqsul 5u!puel J!eql pue seuJoq ~o sJes~qoJnd ol XSelJnoo e se s!q~ seop SHHQ eqL 'e>tS~lV ~o e~elS eql u! peJejs!l~eJ Jeeufl~ue iI~uo!ss@~oJd 1uepued@pu! u~ Xq eAoqe ~ qde~SeJed u. UeA!I~ suo!l~ueseJdeJ eqj uodn ~lUO peseq pm,~o!j!Jeo leAoJ'ddv/q!JoqlnV qlleeH senss! (SHHQ) seolAJeS ueuJnH pue q~ ~eH jo lUeLUpedeC] el~eJoqou¥ ~o ,q!ledp!unv~ eq/ leUOR!puoo legs s,~eeu!Su=J · uo]oedsu! s!Lp, ~o e~ep eLjj uo ~oe~e u! suo!l~lnSeJ pue 'seoueu!pJo 'sepoo m,m,S pue ledp!unlAI lie ql~M eou~HdLuoo u~ s~ LUe~SXS lesodmp Je~MelS~M Jo/pus ~lddns Jel~M e~!s-Uo eLp, 'uol~oedsu~: pub UO.jB~]jSeAUl ~-~OJ~ pUB Sel!t eS~Jo~ouv ~O ~l!l~d!o!un~ e~j ~oJt peu!~lqo uo.~Jo~u~ e~j uo pes~q ~BH~ ~JeA Jeq~Jn~ I 'u!eJe~ pel~o!pu! eJn~onJ~s ;o ed~l pu~ s~ooJpeq ~o Jeq~nu eq~ Jo~ e~nbepe pue"l~UO!~oun~': 'e~Bs s! melsXs IBsods!p']bieMeiSeM Jo/pue Xlddns JeleM e~!s-uo eq~.leqJ SMOHB I~AoJddv Xl!Joqlnv qlleeH ....... s.ql ~o uo.leSRseAu~ ~ ~eq~ ~!J aA I 'MOleq UMOqS elep UoRBP!IeA eq~ jo s~ pue o~e~eq pexiJ;e lees ~ Xq pe!~!lJeo sV NOI~V~aOdNI aNy v~va 'HOMVtS 3~ld 'S~S3~ 'SNOI~OtdSNI 9NlalAOMd ~alJ 9NIB~NIgN3 'g A. WELL DATA Well Classification Well Log Present (Y/N) __ / MUNICIPALITY OF ANCHORAGE (MOA) Health Aulhority Approval ("AA) ~CHECKLIST- FEBRUARY 1984 Legal Description: L0% \// Date Completed ~ - Total Depth _~2¢0 Cased to '-~'?,~ Depth of Grouting Static Water Level '~ / Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments If A, B, C, D.E.C./ApEroved (Y/N) Pump Set At Sanitary Seal on Casing (Y/N) Y ¢'' ¢ Depression Around Wellhead (Y/N) /kj o ; On Adjoining Lots '"~ 100 / ~'~" ; On Adjoining Lots '7l¢0 / To Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TANK DATA Date Installed ~%'~¢ Size Standpipes (Y/N) '~/' _Air-tight Caps (Y/N) Depression over Tank (Y/N) ~ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) /"'-J 1 fA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line Y Foundation Cleanout (Y/N) Date Last Pumped I ~, ~ ~ ~ /'/A~ ;for ~/'~ Temporary Holding Tank Permit (Y/N) To Water Main/Service Line /k_)' / ~ To Stream, Pond, Lake or Major Drainage Course Comments ¢ ~ t..~, O'M(¢ L~ ~,~ ~ To Building Foundation To Disposal Field 72-026 (Rev 7/88} Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed [ ('~ "-~ ~ Width of Field Type of System Design Length of Field '~ ~ Depth of Field 1 ~- Square Feet of Absortion Area ,~-..,c-~ zT~ Gravel Bed Thickness ~ / Statndpipes Present (Y/N) Depression over Field (Y/N) /k,,/ Date of Last Adequacy Test Results of Last Adequacy Test .~ /"Jdl~)C~v,/.v.~ t¢-~ T'IL~£-%~ SEPARATION DISTANCE FROM ABSORPTION FIELD: / To Water-Supply Well \ ~-,~'-' / To Property Line To Building Foundation O~---~' To Existing or Abandoned System on Lot /k~/,,~ ; On Adjoining Lots '~ ,~¢~t ¢' TO Water Main/Service Line ~/,/~ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course /4...///~ / To Driveway, Parking Area, or Vehicle Storage Area ~ ~'O Comments D. LIFT STATION ! Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Cod.~es...fcY-/N) Comments Dimensions Manhole/Access (Y/N) "P u m ~0 f f/M_o-~veiat ~-~ vent (Y/~) Pumping 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 guide j,nes in effect on the date of this Signed ~'"~" - Company //~dzc--c.C~Y6~ ~/~/",,_--~.~4~ . . '' ' ' Date ~ ~1- ~O ~/~~~'.,/~, ~-' ~ MOANo. ~&~ ¢0 '- ¢~O ' ' Receipt No. ~ /77;~0~J3 ) Receipt No ,.."- ' Date of Payment ~ --~ -~ ~ / Waiver Fee: $ Amount: $ ------~,~. ~ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 Engineer's Seal NORTHERN TESTING LABORATORIES, INC. 2505 FAIRBANKS STREET ANCHORAGE ALASKA 99503 907-277-8378 * FA>,' 27,4-9645 600 UNIVERSITY PLAZA WEST. SUITE A FAIRBANKS ALASKA 99709 907~479 3115 · FA>: 479~0547 Acn'-e age Systems P.O. Box 112848 Anchorage, At(. Attn: Tamara ,,9u11--848 Pat e Arrived: 03/20/90 Time Arrived: 1330 Date Sanpled: 03,,/20/90 Time S~pled: 1245 Date Cempleted: 03/22/90 Source: L2,B] l{asi lof Sm~ple ID#: A032090-2 Parameter Unit A032090-2 ADEC MCC* Nitrate-N mg/'l 2 o ,o , ~,/.. 0 10 Reported By: ¢~ \~ Date: 03/23/90 Francois Rodigari, Anchorage Operations Manager * MCC = Maximum Contaminant Concentralion ItI'-iAI,T[t AI. ITII. ORITY ",'~ ........... ~. L~,U L .t ,~ AMD J') ['i;ra :E bi k',. ~.-l, (~ Iii,,, MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH& ENVIRONMENTALPROTECTIO~EPT. OF It~ALI'H & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION OlT'r :3 4 1980 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264,-4720 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allOW ten I10) days for processing, 1, PROPERTY OWNER ] PHONE MEEHLEIS STEEL OF THE NORTH, INC..~ 344-4364 MAILING ADDRESS P.O. Box 10603 South Station, Anchorage, Alaska 995].1 PROPERTY RESIDENT (If different from above) ~HONE Stroganof Road none 2, BUYER PHONE Reginald and Charlotte Richardson 274-5819 MAILING ADDRESS 529 E. 25th Avenue, Anchorage, Alaska 3, [.ENDING INSTITUTION I PHONE None MAILING ADDRESS 4, REALTOR/AGENT I PHONE Totem Realty, Inc. I 272-0571 MAILING ADDRESS 15th & Gambell Streets, Anchorage, Alaska 5, LEGAL DESCRIPTION Lot 2, Block 1 Kasilof Hills Subdivision STREET LOCATION Stroganof Road, Anchorage, Alaska 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS E~ One [] Four E~] Other [] SINGLE FAMILY E~ Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7, WATER SUPPLY [] iNDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG, A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** **l'f individual/on~site, give installation date 9/22/7 8 I'f system is over two [2) years old an adequacy test is required [] PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FFE MUST ACCOMPANY EACH REQUES~ BEFORE PROCESSING CAN BE INITIA'rED. THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [~ SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [~ MULTIPLE FAMILY [] TWO [] FOUR [] SIX 2. WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED ~/~/ 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E3 INDIVIDUAL/ON -SITE DATE INSTALLED [::]PUBLIC UTILITY Connection Verified INSTALLER [:]Septic Tank or ~Holding Tank Size: /00ii If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: / (-~'0 r Absorption Area to nearest Lot Line 5. COMMENTS [~//APPROVED FOR -"~ BEDROOMS [~. CONDITIONAL APPROVAL (letter must acco~¥ cer~tificate) D AT E~DISAPPROVED ~ 72-010 (Rev, 3/78)