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SUNSET HILLS WEST BLK 1 LT 12
Suns t Hill West Block Lo't 12 #018-203-12 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 I.. Street - Anchora§e, Alaska 99501 Teloplrone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT [] UPGRADE NAME ~AILING ADDRESS LEGAL DESCRIPTION -LOCATION DISTANCE TO~ I Well DISTANCE TO: Manufacturer IF HOMEMADE: Inside lengtb NO, OF BE~,~OOMS PERMI ' NO. Liquid depth Well Dwelling PERMIT NO. Liquid capacity in gallons Material beneath tile --I Tren? ~th DISTANCE TO: IWell 12 O Length f eacbline To[) of tile to finish ~ade inches inches Depth Lerlgth Width DISTANCE TO: PERMIT NO. of crih Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line Class Depth Driller Distance to lot line DISTANCE TO: Building foundation Sewer line Septic tank OTFIER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED DATE 72-013 (Rev. 3/7~) [:,E F'FIF'.T M E[",FF OF: 825 "L '" tl..-ii [Z':':: L.L. F:~ ~",ii PERMI'F NO. ,:: 8:LE'~E;(i::,4 ) FIPPI_ I CFINT ROBERT HE:I'.,I[:,ERSON ±'~:'F_-'~ EI...LE:N L. OCF:IT]:OI'.,I EIRNCOCk: [)R Flit...=, I,.E:GFII .... t..::L;;!: E,d...:,U[',I.u,E,I' ' ' .... T'T'PE OF SOIL FtBSORF'TION S'T'STEM IS: TRENCH HEFILTH FII',![:, [ENVIF::ONMEN]'FIL PF.LIEuFI J'..I ¢1) _, I RE[..'f., F N.~.} I- F.~ ~E.., RK. 995Ed. ;264-4}'20 - . ,z: ........... ;. ¢. _ / L3 :__~¢ ~ ,_,~...1~--- _.. 3:: 'TIE :E; E: II..JI EL::: I.~: ~-- IL:L.E.,.E I1 'r' "~ Lf_':IT ::~;];ZE :[.SE~EHd~ SI:;]URRE FEEl' MR,':.~IMI...IM NI. JMBER OF E[E[:'ROOFI!'~; = 4 SOIL RRTING (SQ FI',-"E~R)= 285 THE RE.'(;'ILIIF?.E[:, E;IZE OF THE SOIl.. RE~E;ORPTIObl S'.r"_-7"FEM IS: THE L.EN6"rH [:, I MENS I Obi I'/.-:: THE LE:NG'FFI ,:: I N F'E:ET) OF:' THE TRENCEI OR I'_':,IRF:I I I'.,ti-:' I EL::,. THE [:,EPTH OF R TREI'.,!CH OR PIT IS 'TH[E DI':.;TRNCE BETHEEN TIdE SURFFICE OF' THE GROUi'.,I[:) FIN::, TI.-IE BOTTOM OF' THE EXCFI',,,'FITION (:IN FEET::,. THERE: l'2; NO SET HI[:,TH F'OE?. TRENCHES. TE.IE GRFI',,,'EEL. DEPTH 12; THE M I N I MUM DEF:'TH Cfi: GRFI',,,'EL BETHEEN "I"t-IE: OUTFFILI... F' :[I:::'E Fib,l:) 'f'H[.~ .P.,OTTOi'fl OF TIdE E:qC:FI',,,'RI'ION (IN FEE]'::,. F'ERhlI T F¢'::'F:'L]:CRNT FIr:Is "f'HE RE:SF'ONS ! B I L 17"¢ TO INFORM 'f'H:[S DEF'RR'FMENT BUR I NG 'l'ltE INSTFII_I...RTZON INd;F'EC:TIONS OF:' FIN'.r' HELLS FIr:,JFiCENT TO "rills F'ROF'ERT'¢ FIN:) THE NUMBER OF RESI[:,ENCES 'f'HFIT 'T'HE HELL WILL SER',,,'E. BFICKE I L.L t NG OF f:lN"r' S"r"..STEM I.,.II'rHOUT F I NRI_ I N'..E.F'EC]" Z ON RI'.,ID RPPF,?.CI'v'RL B'r' -FH :[ S E)EF'I:::IRTi',IENT I,.!I[...L E~E SIJEL~EOT TO MINIMUM DISTRNC:E 8ETIqEEN R HELL RN[) RN'T' ON-...SI'TE SEb.tI:IGE DISF'OSlaL S'¥'STEM :l. EHZl F'EE:T FOR R PRI',/FFFE HELL OR :t58 TO 2elEI FEET FROM R PLIE~L. IC: IqELL. DEF'EI'.,I[)ING UPON THE "r'¢F"E OF' PLIBLIC HELl .... MINIMIJM [:,ISTRNCE FRON R PRIVR]"E HE:LL TO FI F'RI',,,'RTE SE:HER L.:[NE TO FI COMMUNI-r'¢ SEblER LIblE IS 75 FEET. b. IELL. LOGS RRE REQUIRE[:, FIN::, MUST E:E RETLIFtNED 'ro THE DEF'RRTMENT H ITHIN OF ]'HE klELL COMPLETION. OTFIER REQLIIREMEN-f':E; MFI'¢ FIPPL"r'. SF'ECIFICFITIOblS RND CONSTP. UCTION [:,IRGRFIMS FIRE FI'v'RILF:iBLE "FO II",ISURE PROPER INk];TRLLFIT]:ON. I CERTIF"r' THFr'F :1.: :[ Fli',I F'FIMILIFIR HI-FEi THE: REf;!UIREMENTS FOR ON--.SI-FE ~.:,EI,.IERS RND [iiiEL[..'.~.:; FI::.~; SET FOR'tH B'¢ THE i',lLINICIF'f:lil..I'l"'.t' OF RNC:FtORRi::iE:. ;F:: I HILL INS'I"FiLL TEIE S'.t"_=;TEI'q IN FIf":C:ORDFINCE HITH THE COI::,E~;. 3:: I UI'..LP..,ERSTFIN[:, THFIT THE OI'.,I-SITE SEIqEF?. S'¢S'I"EM MR'T' REI;:!UZRE ENLI::IRGEMENT Il:' 'fldE RE'.'E;II::,ENCE IS REMO[::,EL. ED 1'0 INCLUDE MORE THRN 4 BEE:,RCIOMS. V4. E~ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTR AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG-- PERCOLATION 'rEST PERCOLATION TEST · EGA..Esc.,PT,O.,_LO__T___ LOC : SLOPE HILLS SITE PLAN 13- 14- 15- 16- 17 18 19 :~, 2225-E 20 JNE 25, 1911 o.' IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE a~l~ (minutes/inch) RUN ~TWEEN .--~L FTJ~ND ..--~-~ FT / / 72-008 (6/79) t'his t:~:L¢..~Reoorts S~il;, LOq ..... ~Y_e$ ................ . ,rcolation Test .................... feet ~"'n", ,- Soil Char.;~cteri:;tics Br ol,,,n $11~ Brown Sandy Gravel j___ Silty Graver. ~ , Bottom of Test l~oie : ' what Depth? , .;, ;: .:; :- z~ .. 5-¸ Readinq Date. Gross Time Np.t :fime' aor~! A, I ?~cula'I:ion Rat, e ~Iinute ' ~F' "0. . Prrwosed ]ost~"'i-]ations St..=~.a e~,'Pf?,. Drain Fie t) eoth of In.let ................................... O~4P[N'I~;: ].00 Scl, Ft. dra:[ua53} area required p~'z_b~d~Jom ,-.Szzom.liKi.nua-~L-bo--.8~s% est Per'formed n,, pav.[~ Pa.d Data [erttflad By: CIL . DEPARTIdENT OF 14EALTH AND ENV:I;RONMENTAL PROTECTION 825 L STREET, ANCHORAGE, Al< 99501 264-4720 PERMIT hi(),', DATE I,.~ .diED, 840516 06/27/84 APPL I CANT: ADDRESS CONTACT PHONE ROBEI~T H~'~NI)ERSiON 14252 HANCOCK AN¢HORAE]E~ AK 99505 56 '.?.-,'~ 122~ I_IEGAL DESCRIP: LOT SIZE: SLIBDIVISION: ~]UlluE] HIL,L.~ WEST LOT: t2 ,.~E.[, rl[l~)l I,..,,~ TOI/JNSHIF:': :L2N R~tNGIE: ..:.W 1500() (SQ.FT. OR ACRES) E LDP, I .... I oeP'Lily that: 1. i am famil].ar' 2; with 'Ehe. nequipemenis I'cm ~]n.--s4ite. ~sewePs; and wells a~[ ~set ¢cmth by the Munic:ipality or AnchoPage (MOA) and ihe State ~ Alaska. I will. instal], the ~;ystem in ac(sor, clar~ce with all MOA codes and r'mgulat, ic]ns, arid in cC)ml:~].i~nce with tine) design C::l'item'ia o¢ this~ peer, re:Lt. I wil]. adhl~l,e t.c~ a).]. Ivl[]A al]d State of Alast<a m"equim*eme2nts fop the ~:;et. back distances Fr, of, any e~.(is{1lqg ~¢e][][~ wastewa'[.~m d:i. sl')osa] ~ysten~ (:m pub].ic 2701 Eagle Street DALLY DRILLING LOG SYREN BROS: DRILLING, INC. Anchorage, Alaska 99503 274-6437 OWNER OF ~ .......... --H--e-i-.-d---i--..-a!)--d---...Bg.-b----H-.-e--n---d-e-~-s-O--n--] ........................ ~,.,,~ ,-~ ,~-,~, 1,~l fee+ *rom g-to-,md level DE~ ~ ,,,- ,,~ ....... .-.2 .... ~ ~ .......................................... 14215 Hancock Drive 99502 345-6211 71 feet f.g.1. .a2DDRESS ........................................................................................... ;~ ..................... STATIC LEVEL OF WATER Fi". ...................................................................... `W~-L~-8~TE~"~X``S~L~-~L~Q.~%~2~.B~.`~q~k~1'~.S.~n~.~e~.~'~I2I..1~s Wes]~RAW DOWN FT ................................................................................................... ~T~--START~D ........... ~.-c..:.....2-.°..:.___5~..s--3.- .................................................... ~s. ~R m~ .............. .2.g.+...~..a.%/._m..'.n..: ....................................................... Jan. 10, 19S4 ASlN 6" A53 GRD B Steel w/shoe DATE--ENDED ........................................................................................................ KIND OF C G ................................................................................................ KItYD OF FORMATION: 1 19 hard Dan clay FRO1VI- ........................ 1'I'. TO ......................... FT ............. 2 ......................... *RO~.....~ ............. ~'~. TO--?--©- .............. ~.!~-e-.--~:--'.!~-~ ..... 20 FT FROM ........................... 5O FROM .......................... FT. .............. 50 FThard ~an (dry) TO ........................................ ± ......................... 55 hard r>an (damp_) TO ......................... FT .............. 2 ......................... TO.~.9~ ................. m?_.. ~ _d?..~.?:~/.~.y.e. ~ FRO/~ ......................... FT. TO ......................... ~ ....................................... MUNICIPALITY OF AIqCHOP, AOE FROM. ......................... FT. TO ....................... ~I...Of '~..ESL._'~....8~ ............ ENVIRONMINTAL PRO'IT-CTION FROM .......................... FT. TO .......................... FT ......................................... FROM .......................... TO ......................... ........... n~o~ ....................... VT TO .................. ~}.E.F__KL.~I [._[~ FROM .......................... FT. FROM .......................... FT. FROr¥i...: ..................... Fi'. FROM .......................... I;'T. FROI~! .......................... FT. TO .......................... ~ ......................................... 139 ~.. sandy clay/gravel/wate,~ ~ strata and water FT .......................... ~ * ......................................... FROM .......................... FT. TO ................................................................. FRO1V! .......................... FT. TO ................. : ........ FT ......................................... MISCL. INFORMATION: Good water strata, Set-grrap near bottam of well, ~h~ is 10'to 20' bottom. Pump at 10 gpm. Also: We1/ witched by ?ritz He,non. Stephen D. Syren DRILLER'S NAME .......................................................................................................... 2701 EaSe Street DALLY DRILLING LOG SYREN BROS. DRILLING, INC Anchorage, Alaska 99503 27416437 ADDRESS ................................................................................................... Lot 12, Blk. i Sunset Hills WELL - SITE ......................................................................................... : ..... 7-21-81 DATE - STARTED ...................................................................................... 7-21-81 DATE - ENDED .......................................................................................... DE~ .VTH OF WELL ......... ZL.- ...................................................................... A roE. 0' from round STATIC LEVEL OF WATER FT......P.~. .............. ~. ....................... ~=~ ....... ~e-¢el DRAW DOWN FT ....................................................................................... GALS. PER HR/MN........7. ............................................. i ............................. KIND OF CASING ........ f..':../.~.g-.._~.~.../..~,.d..,......B....~.~.?...~...]: ...................... KiND OF FORMATION: silt ~w/s ome FROM .0. FT TO ....~. ....... FROM ........................ FT. TO ....................... FT ................................... FROM.. 5 FT TO 15 ....... ZT..S.,~...~...~.~.....S...~.E~.[...~Tavel FROM ........................ FT. TO ....................... FT .............. .... grave .x w/.sm~-i zD F ~ amount oz sl t FROM ........................ T. TO ....................... FT .................................. FROM ........................ FT. TO ....................... FT ................................... FROM 22 FT TO 60 wTSilt, sand, gravel FROM ........................ FT. TO ....................... FT,...: ............................. <~ ~ szlt w/small FROM ........................ FT. TO ....................... FT ................................... FROM 70 o. d~mo blue clay ........................ FT. TO.......°.2 ............ FT..W./.~.~._.8~,..Z...;~t~.12.i: gravel FROM ........................ FT. TO ....................... FT ................................... - w}ter. FROM....~ .............. FT. TO.....~Z ........... FROM ........................ rT. TO ...................... ~T ................................... FROM ........................ FT. TO ...................... ~T ................................... FROM ........................ FT. TO ....................... FT ................................... FROM ........................ FT. TO ...................... ~T ................................... FROM ........................ FT. TO ...................... ~T ................................... FROM ........................ FT. TO ....................... FT ................................... FROM ........................ FT. TO ....................... FT ................................... FROM ........................ FT. TO ....................... FT ................................... FROM ........................ FT. TO ....................... FT ................................... FROM ........................ FT. TO ....................... FT ................................... FROM ........................ FT. TO ....................... FT ................................... MISCL. INFORMATION: DRILLER'S NAME ........... .K. ~...:~. ,J':.~ .. D. Y.....~. ~/.~.e..~ ................................. Municipality of Anchorage. Development Services Department :Building Safety Division On-Site Water and Wastewatei' Program 4700 South Bragaw St.' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ~/,,,¢' ,~,~,-3' 1,3_ GENERA'L INFORMATION Complete legal description Location (site address Or directions) Current Property owner(s)_ '.Mailing address Z ~) 7 ~ Lending agency - Mailing address Real Estate Agent '?~,,/_, V Mailing Address 'HAA# (~ Expiration Date: /~I A-c~ Day phone Day phone -/~ _~,o~f'~r'~ ~Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: ~ e 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 Depadment (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Cedificates of Health Authority Approval are valid-foi'-90-d~i~g-fr~-m--th~--d~it~-~f ~s'i~U-~for properties servedby a priv---~t~--6-CCla--~'-C w----~l al~-'~d may be re~ssued'~ith 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. e STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as'of the validation date show'n below, I verify that my investigation, based on procedures outlined in the Health Authority-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 watei"'~;upply 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 ~ ~_~, ,,,m~t~',,~.~,.,,~'~,~.~~, , .~.~' . Address /o ~/,~J ~/F-~ ',,~-_~.. .~'z,~:~ ' ~/¢~.' ~'/,~ Engineer's Printed Name .~-~/.~'7-t~/>~:~e_ ~.. tMOob 'bedrooms. Date' -~'- 0, '-' Q ~ DSD SIGNATURE l//" "Approved for DisapProved. Conditional approval for Additional Comments ......... ~ttachr~ents: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report' Other Original Certificate Date: ,~-'- (Rev, 01/02) :Legal Description: A. WELL DATA Well type '.Date %~ple!e.'.d Total depth 1(4 ! ft. Date of test Static water I&vel Well pmdu¢ii0n IfA, B, o.'r C provide PWSlD# casedt0 Iq! ft. : FROM WELL:LOG Municipality. Of .,Anchorage Development Services Department ~ Building Safety Division On-Site Water & Wastewater Program ~ 4700 South BragawSt.'-. P.O. Box 196650 'Anchorage, AK 99519-6650 www.ci.anchorage.ak, us . ~- (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIS'I'. '~ I., ~ I P, arc~llD: Well Log: ~)IN) Y' Wires'Properly pr6tected I~IN) · )/ 71 : ft.¸ :.g.p.m. Nitrate O,'7..?>? mg./I. WATER SAMPLE RESULTS: .Coliform! :i'0! Colonies/100 mi. Casing heigh~(a~.ove ground) t h b __ er acterla ft. g.p.m. , C) colonies/100 mi. in. Arsenicii D[~'ii,: ; mg./I. Date of sa m pie: q/Z~/Ot.J : = ; Collected ~y:i. '1Jl~ J>./~1-. 'l~/'z-"~7-&-7~.,O B,' SEPTIC/HOLDING TANK DATA : Tank Ty~e/Maierial IS T ~ L~ ' ' ~ : ~ r :Date insta![ed~, -7-A7/../'- . _Tank Si~. ~ ~~~ '~ ~:an0Ut. (~ .. ~ ~::~'De"~ression~over tahk (¢~ Date Of p~'mping C. ABSORPTION'FIELD DATA',:;::' .: ';'[~ : ' ~ J J ' : Date'in~!~)?~~ ;7/Z7/~'] . S~il'~"ing (g.p.d.l"'o~'Z~* SysteCt~e ?~-'~/~ ' Length'2]'j211-37 ...... =.~ ~al ,dept~ ~~ .Date of adequacy test q/17/oq ": . Results(Pads/Fail) P~ff ~ . .For ~ bedrooms . Fluid depth m absorpbon field before test . Elapsed~ime::l]~ min. . ' Final fluid depth ,~%'in~ } Absorption ~ate' >= : ~ g p d Any rejuvenation treatment (past 12 mo.) (y~ ~pe)' . ~ ~ o ~- Ic,.~j~.]f y~ s, give date Date of.payment' ,ReceiPt Number D. LIFT STATION : ,. : Date installed . Size in gallons ' " Manhol _. _" 'Pump on' at. ' "- e --'" , -?.- . , . ~L¢.- : r level i~wat r alarm level'at Datum . : Cycles tested . : Meets alarm &circuit requirements? E. SEPARATION DISTANCES ':, SEPARATION DISTANCEs FROM wEL'L ON LOT TO: Sel~ticiank/Jiftsta'ti(Jn'onlot ~; - . .. Onadjacentl0tS' '.-h Io'o Absorption field on lot /O~' On adjacent !ots ~/c,'O ' Public SeWer main ' "/'/~O 'l' Public sewer manhole/cleanout ~ ' " ' . Holding tank t-/fDd) I SeWe'r,/§ePtic service line :. +' 'Z~' t , , . . . . SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON'LOTTO: Building'foundation 4-~: ! Property line ~lO AbsorPtioh field ;/~. I, Water main: "/'¢0 t ~ ' ' "' ~Water service line' ~1~ ~ StJrfaceWater W IIs` on ad entlots +'1~o ;., 'ac SEPARATION DISTANCE FR~DM ABSORPTION FIELD ON LOT.TO: .'- Property, line /0 Building fobndation 4~0 Water main :: ~ / wate~i':servi~e line 'Pi0 ' ' ' ..... : surface water ,J-(d'~ ¢ · ' DriVeway, parkir~g/vehicle ~tomg'e !' ~ ' ',,f-c~)' ' ' ja ' : ,' Curtain~dr'aih .:'~o~,-~ells on ad c~n~ lots "'~C,'~P ~ ' F. COMMENTS ,:, ', =, ,..:, ";" i.:.' ' ' ' I t'~l hav®'ddtermine through fieldi~Specti°ns and" "' Waiver Fee $ ~--:..~ Date of Payment Receipt N.u.m. ber NAY-O6-2004(THU) 18:51 EAGtE RIVER ENSINEERIN8 (FAX)907 694 8297 P. 001/001 Eagle R ver Engineering Services Clefs 'tophe~ R. Wood, P.I~. 10421 VizW Road S:~t, 201 (90~ 694-~19~ t~] Eagle ~r, ~ 995~ ~.caglez~ng~g.~m (907) 694-3297 {~ May 6, 2O04 J~ Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 SunsctHills W. Bl LI2 Health Authority Approval Notes Dear Mr. Cross: Eagle River Engineering Services has performed a Health Authority Approval inspection at the above referenced property. The property was vacant, and the leaehIield dry, $o 1200 gallons of water was used ~o charge thc system. Upon comp[etlon of thc char~qng o£the system, a well flow and septle adequacy test was performed. The septic system appears capable oraeeepfing the 600 gallons per day required by the MOA i'or a 4 bedroom house. Several anomalies were found during ~he course of this inspection. It appears that there is 52 inches of gravel beneath the file, as measured from the invert. This brings the total absorption area into question. Perhaps rocks were dropped into the sump/monitor tubes at some time, or they never went full depth. All of thc septic standpipes were found to bo loose, and/or offset. A contractor was called in and repaired/glued the standpipes into place. A tank integrity check was performed, and the tank's condition was found to be acceptable. After completion of the adequacy test, and befor~ the standpipes were repaked, a rlsd in liquid level of several inches was noted. It appears to be from snowmelt, or melting ground m 'aking its way into the system via the loose standpipes. This condition has been repaired, so further infiltration of surface runoffinto the septic system should not happen again_ If you have any questions please call our office at 694-5195. Sincercly, Principal 04-2T-04 O?:33Ag FROg-CT&E ESI, SGS~LI~ SERVICES SCS Ref.# Client Hame Proj cci Nam Client Sample ID Matrix 1041848001 KND Engineering Sunset Hills W. BI, L12 Sunset Hills W. B1, L12 Drinking Water Sample Remarks: 9075615301 ~ T-114 P.02/03 F-609 All Dates/Times are Alaska Standard Time Printed Date/Time 04/26/2004 15:27 Collected Date/Time 04/20/2004 ] 0:40 Received Date/Time 04/20/2004 10:55 Technical Direc~.~- Step)(en C. Ede Results PQL Units Method Allowable P~ep Analysis Container ID Limits Date Date h Waters Department Nit~nte-lN 0.239 0.100 mg/L EPA 300.0 B (<ri0) 04/20/04 Microbiology Laboratory Total Coliform col/lOOmL SMI8 9222B A (<=1) 04/20/04 t 04/16/2004 88:83 ANCH CHRISTIAN SCHL PAGE 01 I 5432 Il. Northern Lights Blvd, Suite//466 Anchorage, Alaska 99508 (907) 338-4476 /'~ '~"~7'-'5:'~'~'-'.3)~5" ' Invoice# 2 1 8 1 , / Phone: e ]Cuslomer. P.O. Numbs: Cont~:l Pe~on: Description Price ,....;. Amount Sludge in tank .. Leach treatment Water level in leach Cap on Stahd' Pipes.,, Total 1.5% interest will be cha~ed monthly on unpaid bills until paid. Municipality of A,,chorage Development Servlc s Department Building Safely Division On-Site Water and Wastewaler Program 4700 Souih Bragger St. P.O. Box 196650 Anchorage, Al< 99519-6650 www.cLanchorage.ak.us (907) 34;{-?9O4 ParcelI.D. 018-203-12 1. GENERAL INFORMATION Comj. plate legal descript!on Lot -1_~ ._, Location (site address or .directions) 1 Current PropeHyowner(s) Roland Wiggans M~ilingaddress PO Bo× 2328/+/+ ^nchoraRe, Lendifig agency CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY'DWELLING Expiration Date: Sunset Rills West Subdivision,' Dayphone 229-9626 AK 99523 Day phone Mailing address Real Estate Agent Viral an Wi~?~nn Day phone Mailing Address Unless otherwise requested, HAA will De held by DSD for picflup. NUMBER OF BEDROOMS: /+ TYPE OF WATER SUPPLY: Individual Well Individual Water SIorage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site I--~, Individual Holding tank [] Community On-site Public Sewer [] The Municipality of Anchorage Developmenl Services Department (DSD) Issues Certificates of Health Authority Approval (I. IAA) based only upon the representations given In paragraph 5 by an Independent professlonal civil engineer registered in the State of Alaska. Certificates ot Heallh Authority Approval are required for the transfer ot lille (except between spouses) for properties served by a single family on-site wastewaler disposal and/or water supply syslem. DSD also Issues HAAs upon request to homeowners. Certil~ca~es of Health Authority Approval are valid tot 90 d~ys from the dale of Issue for properties served by a private or Class C well and may be reissued wilh new water sample results less [hen 30 days old. (Certificates may be reissued for a period of up Io one year with valid waler samples.) Certlfic~les are valid i'or one year for properties served by Class A or B wells or a public water system. The Municipality ot Anchorage Is nol responsible for errors or omissions In the protesslonal engineer's work. 4. STATEMENT OF INSPECTION BY EJ',JGi~JEER As cerfified by my seal affixed hereto and as et Ihe validalion date shown below. I verify Ihat my Inves~Igatioh. based on procedures outlined In the Health Authority Approval Guldellnes for this application, shows Ihal Ihe on-site water supply and/or wastewater disposal sy§tenl Is(ara) sar,e, functional and adequate for the number of bedrooms and type of' structure Indicated heretn. I further Verify tha~ based on Ihe Informalion obtained from the Munlctpali[y of' Anchorage files and from my Investigation and Inspeclion. the on-site water supply and/or waslewater disposal system Is(are) In compliance Wilh all applicable Municipal and Stale codes, ordinances, and regulations In effect at the time of installation. S & S ENGINEERING Name of Firm 1~34 Eaalq River Leap Road No. 204 Address F..~le RIYer, Alaska 9~577 Engineer's Printed NameRobert. C. Cowen bedrooms. 5. DSD SIGNATURE ~ Approved for L~ 'Disapproved. Conditional approval I'or Phone Date, //3'5'-/0% /z,-,__ bedrooms, with Ihe fo owing stipulations' Additional Comments Altachments: HA& Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements St~pplemen[al Engineer's Report Other Original Cedificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchomge.ak, us (goz) 343-7g04 HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescfiption:/-4)T 1~ I~cec~ I $~',.$~.r- ~,.~.$ ~/(J'/- ParcellD:Ol~-~o~-13. A. WELL DATA Wa, type Date completed ;~//,=A~¥ Toteldepth ~/'//) ft. Date of test Steflc water level Well produ~on If A, 8, or C provide PWSID # - Well Log ~1) Sanlteryseal (~N) ¥¢J' Wirespmperlyprotected{~l) y4~J Cased to ~d ~- ft. Casing height (above ground) I ~ ~' in. FROM WELL LOG AT INSPECTION ?p ft. -'ti · -, '~, ~ 4-- g.p.m. ~,. v g.p. ra WATER SAMPLE RESULTS: Coliform . 0 .colonies/lO0 mi. B. SEPTIC/HOLDING TANK DATA TankType/Mateflal~ Jt,,~2'l~. / Nil]ate 0.~ "~ mgJI. Date of ~ample: I/~/~ 9.- Tankeize )~-,~'0 'gal. Number of Compartments Foundation cfeanout (~N) ~ ~,,~t Depression over tank (Y~[~J~ ~" 0 Date of pumping (o//OI Pumper C. ABSORPTION FIELDDATA Date installed "//3.-//el Soil rating (g.p.d./~ O~ Length -../o/ ff, Width I 'j~. ff. Other bacteria 0 colonies/lO0 mi. collected by: $ & S ENGiNEeRING ~Eeed N~, ~ Date installed '7//~- ? / $ I Cleanouts (~N) 3, ~ High water alarm (Y,~) ~., O Systemtype '/'Re:,-, ~-~ Gravel below pipe I~11¥ *~, -I~ Totelded~ ~'~ ft. Date of adequacy test //I q / o :3.- Resulte-~Feil). P~'$-~ Fluid depth in abso~fion field before test I)A~ in. Water added 6 3. / gal. Elapsed Time: ~/~ min. Final fluid depth)~/4 in. Any rejuvenation treatment (past 12 me.) (Y/N & type) ~/e,,,L Eff. ahsorpfionareajlO(-~ Monitodngtuba ¥a$ Depression over field ~,o For I./ bedrooms New depth t ~. in. Absorption rate >= ~oeO' g.p.d. ~<,~e~v .~ Ifyes, givedate. ~ D. UFT STATION Ee Date installed Size in gallons Manhole/Access_.~ "Pump on" level at in. 'Pump off' level a~rm level at Datum ~Y~s ~stecl Meets alarm & circuit requirements? SEPARATION DISTANCES in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septtctanldllffstatlononlot ~ '7 /~'~,/~q~o~.o) Onadjacentlots Absorption field on lot /05' / On adjacent lots Public sewer main ~'~"/A Public sewer manhole/cleanout ~'~/"q Sewer/septic service line ;L ~-' ~. Holding tank /V/,4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation '~' x'F' Property line__E- ~' Absorption field 20 · Watermain ~ lA Water sewice line /O +' Surface water /oo -~ Wells on adjacent lots / o o ~-~- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line )o Building foundation /o '~- Water Service line ) o 4~ Surface water ) o o -~ Curteindrain/~a~'t ~'~.'~ Wells on adjacent lots /0o-/ F. COMMENTS Water main Driveway, paddng/vehide storage ~o Y- HAA Fee S. Date of Payment Receipt Number (R,,. ~2~) )/~.,f'/e a.- Waiver Fee $ Date of Payment Receipt Number JAN-24-02 08:13AM FROM-CT&E EflVIR~I~NTAL Slav ,~tr~_ CT&E Environmental Services Inc. 9075615301 T-830 P.02/03 F-111 CT&£ Ret.# 1020380001 Client Name S & S Engineering Project Nnme/~ Sunset Hills West ~ Client Simple ID ~Ot 12 B~ l Matti,, Drinking Watt.r Ordered By PWSID 0 Sample Remnrks: Client PO# Printed Date/l'lme 01/22/2002 19:42 Collected DsterPime 01/21/2002 8:45 llecelved DateJTIme 01/21/2002 9:]5 P~me~r l~l~ PQL [,Mits Mc0aod Allow~blc Prep An~yslS Limits D~tc Date Init Nitrate-N 0.474 0,200 mg/L EPA 300.0 (<lO) 01/21/02 JDT Total Coliform 0 col/100mL SMI8 9222B (<1) 01/21/02 KAP SI~,~SET .HILLS LOT 12 WEST FOLLOWINg DESCRIBED P,ROPERTY: o,,, e AND THAT NO ~ "* ''"*' *t ,~ ENCROACH~[tJT~ EXI;T /XCEPI~ *. q~ ~ '. ~ WHICH DO NOT AP~AR ONTHE R[cORDED SUB~4~',, ~-~1 ,*'~Z STRUCTION OR FOR E~TABLISHINO eOUNDARY q~-- MUNICIPALITY OF ANCHORAGE DEPARTMFNT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # _j~ - .¢~F'~ - \ ~.. __ NAA# 1. GENERAL INFORMATION Complete legal description Lot 12; Block I; Sunse~ Hills We. st Subdivision Location (site address or directions) Property owner Mailing address He~di Pollard 14215 Hancoc~ Drive A~¢h~ra¢¢, AK Day phone 14215 Hancock Driv~ Anchorages, AK 99515 (h) 345-3152 (w) 564-5338 Lending agency Mailing address. Day phone Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 4 N Individual well XX× Community well Public water /" NOTE: TYPE OF WASTEWATER DISPOSAL: NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. XXX Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and es 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 $ & s ENGINEERING Phone 17034 Eagle River I. oop Koaci i'~o. Address Eagle River, Alaska 99577 Engineer's signature Date DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date ~"'--////-~'--"~ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type PR. Iv'?'~TE Log present ON) Total depth 1 4- I Sanitary seal ~.~N) Date oftest Static water level Well flow Pump level Parcel I.D, __If A, B, or C, attach ADEC letter, ADEC water system number ~/~'.~ _Datecompleted ]//0/~' Driller .-.%'/~'~E/,,J Cased to / ~ I ' Casing height I Wires properly protected ~N) FROM WELL LOG AT INSPECTION ..... g.p.m. SEPARATION DISTANCES FROM WELL 'FO: Septic/holding tank on lot ~7 Absorption field on lot /'0~4''" ; On adjacent lots / ~'~' / Public sewer main Sewer service line '~/~" ' _ Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate O'?~r~ ~/'~ Other bacteria_ Collected by: ~-'~>~-~- B. SEPTIC/HOLDING TANK DATA Date installed rT/Z? / ~'l Cleanouts ~_~N) ~'4 High water alarm (Y(~ Date of pumpin9 Tank size [ ~..~-O Compartments Foundation cleanout ~-"~N). ~'¢ . Depression (Y,~ ...<-Jo Alarm tested (Y/N) __ Pumper ~Io~cPfl ~,~ ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~__ On adjacent lots /oO~p Foundation "-14- To property line_/0 t¢ Absorption field /0 / . Water main/service line Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE N'C:-UF..T STATION /Jo,'d~/¢¢~..EsE'/.JT-' Dat~ Manufacturer Size in gallons ~ ' Manhole/Access (Y/N) ~ Vent(Y/N) "~ ~_ .---'-'~ level at . High water alarm level J ~_ Cycles tested ___ Meets MOA electrical codes (Y/N) ~ ~ DI~IFT SEPARATION STATION TO: ~ adjacent lots Surface water On D. ABSORPTION FIELD DATA Date installed ~/~'?/~/ Length ~O/ Width / Total absorption area / Depression over field (Y(~, Results ((~/fail) .,¢2,,~ Peroxide treatment (past 12 months} (Y/N) Soil rating ~-~ff~'~/~5'¢' ?~ / System type Gravel thickness 7 ?O '/ Total depth Cleanouts present~Y~N) Date of adequacy test Z¢/2. o / %.7 for bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: 'RE) Well on lot ,/(_~.5' / On adjacent lots /00 fO- Propertyline /O To building foundation 4.. ~O" To existing or abandoned system on lot ~otJE On adjacent lots Z.o 'y- Cutbank /fJ"/"'¢ fo, v-~Jgz°/'~Water main/service line ~'o re-- Surface water /L'~o.'~'°'¢' //0,¢4-~r5-'5-/--/7~ Driveway, parking/vehicle storage area ~-¢ Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect, o~t~ date of this inspection. ,:~";~;, ~ %, , ." !; ,.'.,,~ ENGINEERING :' ~ ~ S17034 & S Eagle River Loop Road No. 204 ~.,.,,h ,~" ,, ,-,: h'~ :~, ~,~ Signature E_.t¢~, River, Alaska 99577 :'-:? ' :,~-?.~E~ '.¢;~ "~ ;; ' Engineer's Name ~ ~. HAA Fee $ / ~7¢,~,..6~:~ - 0ate of Payment + '- ,~k'~--? - C'/-EU~2 Receipt Number Z ~ ff'7~5~) 72-026 (Rev. 3/91) B~Ck MOA 21 Waiver Fee: $ Date of Payment Receipt Number CIVIL ENGINEERS APPROVALS LOCATION OF ~ (Legal Desori~tion) ROBERT SHAFER. P.E. ROGER SHAEER. P.E. NZSC · DATA[ CA$IllO HEIOHT I / ~ SANITARY SEAL? t %/K~ WI~S.IN CO~UiT?~ OILING O.K.?t ~ BACTERIA a NIT~TE S~PLES CO~ECTEDI~ MECHANICAL ~~ r D~ INSPECTIONS ~S~TBI ~.T, ~y PRODU~S , ~ GPM WI~ A ~ 17034 EAGtE RIVER [OOP, SU%TE 904, EAGLE RIVER, ALASKA 99577 04/21~93 15 03 CT~_,E ENUIROHMENTAL LAE ,r_,_,ERUi CE.~ '~ NO. 40~ D06 Client Name ~$ & S ENGIN~RXN6 Collected :04/19/93 @ 12:00 hfs, O~de3:ed By :R. SI,IAF~R Received :04/19/93 8 12:30 hr~, Project Name : WOP~ Order ~65133 ProJect~ : Re~l:t C~D] e%~ 104/21/93 PWSID :UA Tee~ical Director :STEP~ C. ~ QC Allowable Ext. Anal Paramete~ Re~u].ts QLlal. Units ~{et:hod bimit~ Date Date ~nit N~T~.~TE-N 0,17 rog/1 6~A 353,2/300,0 10 04/3.9 LL~ w See Bp~clal Inztruction~ ~bove [IA · Unavailable · * See 6ampler' Remarks AboVe NA = Not ~alyzed U = U~e~ect~d, R~t~rted value it~ %h~ p~actical ~antifieation limJ. t. LT = Less Th~ D = Seco~%ary d~].utton. GT = Gre~ter T~ Tom Fink, Mayor uni ipality of Anc .orage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 May 11, 1993 Roger Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 12 Block 1 Sunset Hills West S/D Waiver Request ~WR930020, PID #018-203-12, HA930213 Dear Mr. sharer: Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are a private well to the septic tank of 87 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services Concur :,~~ Program Manager On-site Services ljm:~6 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services ~ection Waiver Review Worksheet WR~ WR930020 PIDa 018-203-12 Date Received: April 30, 1993 Legal Description: Lot 12 Engineer: Roger Sharer, P. 17034 Applicant: Heidi HA# HA930213 Permit Block 1 S~s~t Hills Wes% Subdivision E.~ S & S Enqineerinq Ea$1e River Loop Road, Suite 204, Eaqle River, Alaska Pollard 99577 Waiver Requested: Well to septic tank - 87 Feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: Other: Waiw~r ~s Granted: /~_ Waiver is NOT Granted: List Conditions or Reasons for abcve: ~ /~C~f~ Name of Reviewer Rec ~: ~ ~gf Amount: $ 410.00 Date Paid: - L,£LL ~g7~Fh ~ 2.? 2...4- /8. 2 / Munlclpa±l~y of Anchorage ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS 2 8 ,, 19 9 3 (907) 6!)4-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER {NSPECTiON ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST ROAD DESIGN SOILTEST STRUCTURAL& MECHANtCAL INSPECTIONS DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street PO Box 196650 Anchorage, Alaska 99519-6650 N~UNICtPALITY OF ANq'fOP, AGI~ ENVIRONMEN'~AL $~R;'IC~S DIVI~SlON ,',PR ,3 0 RE(!EiVED REFERENCE: Lot 12, Block 1, Sunset Hills West S/D 14215 Hancock Drive, Anchorage Request you issue the attached Health Authority Approval and grant a waiver for the horizontal separation distance between the well and septic tank located on the referenced property at a distance of 87 feet. According to the current owner and Municipal files, it appears the original well on the referenced property collapsed in 1983, lodging the pump in the wello That welt was abandoned and replaced in 1984 by the well currently serving the referenced property. Our investigation shows this well to be 87 feet from the septic tank on the referenced property. A waiver of the Separation distance down to 87 feet should be granted for the following reasons: A slope of roughly 10% provides good positive drainage away from the well. Effluent will not travel toward the well in the event of effluent surfacing from the septic system. The wel~L has been in place for nine years and shows only trace levels of nitrates (0.27 mg/1) and no coliform bacteria. This indicates the septic systems on the referenced and surrounding properties have had little or no impact on the well serving the referenced property. The well log indicates the aquifer serving the referenced property is confined by 55 feet of "hardpan" and "clay". Such strata inhibits effluent migration into the aquifer. ON SITE WASTE WATER DISPOSAL SYSTEM 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVEFI, ALASKA 99577 Page Two April 28, 1993 Lot 12, Block 1, Sunset Hills West S/D The well log indicates water was encountered from 103 to 141 feet during drilling. The current static water level is at 68 feet (see attached flow test). This further verifies the existence of confining soil strata above the aquifer. A well flow test performed on 4/20/93 shows the well to produce 6.3 gpm after four hours with only a 2 foot drawdown, such a low drawdown indicates a low hydraulic gradient toward the well. In effect, use of the well will not tend to "draw" effluent toward the well. A soils test on file for the referenced property shows the septic system receiwLng soils to be rated at 285 sq. ft. per bedroom. This type of soil is generally very effective in filtering harmful effluent contaminants as the effluent travels through the soil. If you have any questions or require your review please contact us. Sincerely, SCOTT W. SWENOR ENVIRONMENTAL ENGINEER additional information for ROGER J. SHAFER, P.E. SUNSET HILLs LOT 12 P, 2/2 A8 I~UILT A,, ,,~,~ ~ ~,~ ~,... , ..~, TH~OWN~ TO DETER~;N~, THE EXI~T~II~E ' s~ou~o A~Y O~ta ~o~ ~7~UOTION O~ FOR [9~A~LI~HfN~ 8DLiN~RY:. Date Inspector Comments Time Date Date Date Sewer Installed Soils Rating Property Owner Mailing Address Inspeclol Conditional Approval Inspector Permit No. Well To Absorption Area Well to Tank Septic Tank Size Holding Tank Size Well Log Received APPLICANT FILLS OUT LOWER HALF ONLY Phone Buyer <~,/v,e- ~-, ~',~o~.>~ Address Lending Institution ~o~ ~ eekco, A~ c~ '~ ~ )-o.~ Phone Address Phone Realty'Co. & Agent Address Street Location Type of Residence ~ Single Family [] Multiple F:amlly No. of Bedrooms [3 Other Water Supply ~ Individual [3 Community [] Public Utility ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. For wells drilled crier to mat date. give well desth (attach ~og If available.) Sewage Disposal ~, Individual · Public Utility [] Holding Tank Year Individual Installed: ~ When Connecte(l to Public Dtll NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN SE INITIATED.