The URL can be used to link to this page

Home My WebLink AboutELMORE #2 BLK 9 LT 2A Development Services Department Building Safety Division aor- GE.. BG On -Site Water & Wastewater Program s �P 4700 Elmore Road P.O. Box 196650 Mark Begich Anchorage, AK 99507 s n E T Y Mayor www.muni.org/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: Legal Description Property Owner Name & Address: Pump Installation Date: Pump Intake Depth Below Top of Well Casing:/ &) feet Pump Manufacturer's Name: Pump Modell: , % 2 5 1 � Pump Size �// hp Pitless Adapter Burial Depth: '�S feet Pitless Adapter Manufacturer's Name:.G�-E'tuv`_ Pitless Adapter Installer: Well Disinfected Upon Completion? Yes ❑ No Method of Disinfection: pe tl-e 14-3 Comments: vvevl ANCHORAGE WELL & PUMP SERV. Pump Installer Name: 330 EAST 76THAVENUE �.ANCHORAGE, AK 99518 PHONE: 907-243-0740 AWPS.COM Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Name: ~ ~ ~ ~ ~ ~ Wastewater System: Q New ~Upgrade ~'~:y3oo ~, IY~~ ~, ABSORPTION FIELD Phone: ~-~ IN°'~B~r~ms: ~D~pTrenc~ ~S~a[IowTrench ~B~ ~Moun~ ~Other Loc ~ Block: oPu F,. F,. TANK SEPARATION DISTANCES ~s~pt,c = Holding O S.T.E.P. Sudace W~e~ LIFT STATI 0 N Foundation ,~, ,~ ' '~mP °n" ~e' It: l'PumP o~'~ellt: I H'g~ wate~ alarm at: D~in Remarks: BENCH MARK Elevation: ENGINEER'S SEAL Inspections pedormed by: Depadment of Health and Human, Se~ices approval ~,~$.., .,..~,/- Rev ewed and approved by' ~~/~ DatO' I~'~'~ . . Notes: 1. Thc valve installed allows only one absorption field to bc used at a time. H~USE FBUND^TI~N TEMPORARY BENCH HARK, 100FT, (TflP OF CBNCRETE BECK SUPPflRT) 100 FT, RADIUS FROM YELL / PERC TEST 0 / I I I / / / I / GROUND WATER MONITORING TUBE / \ / \ I \ I 71 FT, X 5 FT, SH^LLD~,/ TRENCH N.C.O. # M,T. N.M.T. NEW CLEANOUT NUMBER MONITORING TUBE IN OLD LEACH FIELD NEW MONITORING TUBE SCALE: 1 IN, = 20 FT, Absorption Field Upgrade Job No: 6571 As-Built Lot 2, Block 9 Elmore Subd. #2 ENVIRONMENTAL MANAGEMENT INCORPORATED DATE: 12/15.'98 I Sheet 2 of 2 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Dec 08, 1998 Expiration Date: Dec 08, 1999 Permit Number: SW980460 Legal Description: ELMORE #2 BLK 9 LT 2A Design Engineer:. 0064 Environmental Management, Inc. Owner Name: Chds Noidal Owner Address: 4300 E 145TH Avenue Anchorage, AK 99516-4101 Parcel ID: 018-173-37 Site Address: 004300 145TH AVE E Lot Size: 39520 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Pdvy [] PdvateWell [] 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to Apdl 15, a subsurface soil absorption system under construction during freezing weather must be either. A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing, 5. The following special provisions. Maximum depth of excavation = 4 feet Notes: !. Install wide drainfield in accordance with the Municipality of Anchorage 2~eplcal F/ide Drainfield Requirements and Specifications, 3/95. 2. Hand dig within 2 iL ofall utility lines. New drainfield is to be installed no closer than 2 feet from utility lines. 3. Thc drainfield must be no closer than I00 iL from the well HOUSE 4. The field must installed at least 10 iL ~ FE]UNI)^TI[gN from the property foundation. 5. Contact EMI, 272-9336, to schedule Municipality required inspections prior '?" ~'~-~ to installing fill i. -o-~. TE'~ 0\~, ' 71 FI. X 5 FI, SHALLO~ TRENCH-'b ..r. C.O. # CLEANOUT NUMBER 4 N.C.O. # NE~/ CLEANOUT (TO BE INSTALLED) H.T. NDNITBRING TUBE N.M.T. NE~/ HDN[TDR[NG TUBE ,~,-~.~: '. ,...'.~ SCALE: 1 IN, = PO FT, ~'~ ....................... .",-~' Absorption Field Location .NVmO NT MANAGEMENT Field Upgrade Lot 2, Block 9 INCORPORATED JobNo: 6571 Elmore Subd. #2 ~'^~:"~*~ I Sheetlof3 '"..7"' .... " 14~H ...."'"" EAST AVE, ...'"'"' ./ROAD 111 FT. "' ~ ' , ,' 4300 E,~'1~ o ~, .....,, ,' HOUSE 14 5 T H ~ I \ '~-- \ I I 'kl / '"~ IGARAGE / ~ PROPOSED ' ~. 7~ FT, X 5 FT. ~ SHALLOW ~ '~ -~¢~~ I .:/ ~ TRENCH * I / ". ~ I I / "%.. SEPTIC I I ..' ".. SYSTEM I I ...' "-... mD FT. I I ..'"" '"' HUUSE I I ."" 12 " ....... · ... ~4~ FT. I I .... · ' 1~ ~ ~ ...... ~0 ......... I I... ...... ........ t "1 No~: pm~ ~lis~t ofp~ I~, ~ ~. Abso~tion Field ~00 Ft. ~adius ~o~~ ~=~, Lot 2, Block 9 ~CO~O~TED ~obNo: 6571 ~ Elmore Subd. ~2 .... " 14~H .....'""' EAST AVE, ...'"'"' ./ROAD lll FT. "' / 2~8.00 vc~i ' 2 .~0 HOUSE 145TH ~ m ~ .D.~ I I 8 CAR ~HALLDW TRENCH~Y. ". I I / "'... ~D rf, I I ..'"' '". HDUSE I I .""" " 11' ' ...... 10 ........ ~ "l 5 6 7 8 10 Munlcipahty of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street, Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST .EGA. OEEDR,PT,ON:LO/2: gl.:l< ? 0,-,3,~,., ,.~. £~,-/ 1 ~,0.# ELOPE EITE PLAN WAS GROUND WATER ENCOUNTERED? Depth Io Water uJUt'~r ///~////,., ,..../~ 3 Umulm'ing? "~Y' Bal~: . 14 15 16 17 18 19 20 PERCOLATION RATE / {mlnutes,'mch) PERC HOLE DIAMETER TEST RUN BETWEEN ,'~ FTAND .'~ FT PARCEL: 018-173-37-000-97 CA.RD: 01 OF 01 RESIDENTIAL SINGLE FAMILY STATUS: RENIIMBERED TO/FROM: 1 BURKE GILMAN DANA S ELMORE ~2 BLK 9 LT 2A 4300 E 145TH AVENUE 0 ANCHORAGE AK 99516 4101 SITE 4300 E 145TH AVE LOT SIZE: 39,520 ---DATE CHANGED ....... DEED CHANGED .... ZONE : R6 OWNER : 10/09/92 BOOK : 2180 PAGE: 0572 TAX DIST: 028 ADDRESS: 00/00/00 DATE : 08/09/91 GRID : 3036 HRA ~ : PLAT : 910048 NOTES : REF 018-173-02 .................................. ASSESSMENT HISTORY .......................... ---LAND .... BUILDING .... TOTAL--- FINAL VALUE 1994: 28,100 111,800 139,900 FINAL VALUE 1995: 28,100 101,200 129,300 FINAL VALUE 1996: 39,600 113,400 153,000 EXEMPT VALUE 1996: 0 0 0 --EXEMPTION--- ..... TYPE ..... STATE EXEMPT 1996: FINAL VALUE 1996: 0 -COMM COUNCIL- 153,000 NONE ER ANCHOR~,GE AREA BORuJGH Departme~ ~' of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL /~'~ F~'MANUFACTURER,~X-'~-r MATER,AL _ ,~' ~.SS'COMPARTMEN'rS O._ INSIDE LENGTH INSIDE WIDTH ~ LIQUID DEPTH LIQUID CAPACITY/~----~ALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL/D,~ FOUNDATION 7 /~ NUMBER OF LINES.. J, DISTANCE BETWEEN LINES J ABSORPTION AREA ~ ~),~ SQ. FT. LE~T" OF EACH LINE DEPTH OF FILTER DEPTH: TOP OFTmLE TO FINISH GRADE J ~/ MATERIAL BENEATH TILE TOTAL LENGTH ~"7- NEAREST LOT LINE /E? / OF LINES ~ TRENCH WIDTH ~ IN, TOTAL EFFECTIVE ~ IN. ABOVE TILE ~ mn. WELl CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE SEWER LINE TANK.~'*~'/UOI, SYSTEM CESSPOOL APPROVED OTHER SOURCES DISAPPROVED INSTALLED SEWER LINE DEPTH: LOT SLOPE= /~ ~'~'~' / REMARKS, Form ~[Q-032 DIAGRAM OF SYSTEM BoX: 1369, STAR ROtatE ..,t ANCIIORA(~,F~, ..,[x. Astr,~. 99~02 844=?~'14 SiX INCH WATER WELL DRILLED AND CASED OUT.TO THE DEPTH OF __~2~ feet, DRILLED AT THE FJ~TE OF ~1~?e00 PER FOOT, PROPERTY OWN£R, ' ~]'e ]~ob ~'ltlz' ~30 LOCATION OF WELL'SITE ~ ~ ~' ~ ~, ~ ~O~ ~ ~' ~ DRILLER ~l ~ ~ ~ ~~le WELL LOG: COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING." WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS I~OR THE SUM OF ~ THANK YOU VERY I~UCHo BERNIE CLAUS OF' RAMPART DRILLING WORKS L,IELL Rr-~D ,-'RMIT ~10. ( 76248 APPLICANT LOCRTION LEGRL R._OBERT R WRRNE~ END OF 145TH AVE l~lUr~l I C I.. RL I T"r' OF Rr~l¢l- !RRGE DEPRRTMENT UF HERLTH Arid ENVIRONMENTRL F ,~OTECTION "':"'~ - ,~ q/,,cc~ - 2510 E.TUDOR RD.., RNCHORRGE., RK. 99507 276-2221 o -- *rTE E,-,ER PEtE i76~ ERST 53RD RVE 344-0430 L2 B9 ELNORE SUBD #2 LOT SIZE ~9520 SQURRE FEET TYPE OF SOIL RBSORBTION SYSTEM IS: TRENCH HRXIHU~'I NUMBER OF BEDROOMS SOIL RRTING (SQ FT,~BR)= 100 THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: DEPTH== :1..'t LENGTH= :~:1 GRR~,~EL DEPTH= .5 THE.LENGTH DIHENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTO~I OF THE EXCRVRTION (IN FEET). THERE IS HO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE NINIHUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE E×CRVRTION (IN FEET). REI~U I RED SEPT I C TRNK $ I ZE= '1000 GRLLOt"I--c' BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS DEPRRTHENT WILL BE SUBJECT TO PROSECUTION. i'IINIHUr~ DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS 100 FEET FOR R PRIVRTE WELL OR 200 FEET FOR R PUBLIC WELL. WELL LOGS RRE REQUIRED RND HUST BE RETURNED TO THE DEPRRTHENT WITHIN 3(9 DRYS OF THE HELL COMPLETION. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER I NSTRLLRT I ON. PERM I T VRL I D FOR ONE '~r'ERR FROM I '=;SUE' I CERTIFY THRT 1: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELL_c: RS SET FORTH BY THE HUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. 3: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE HORE THRt~J ~ BEDROOHS. RPPLICRNT ROBERT8 WRRNER ISSUED BY ......... DRTE ..... 4040 "B" STREET, ANCHORAG'E, ALASKA 99503 PHONE: 907-279-2581 March 31,.1976 W.O. 17626 Grid 3036 Mr. Robert A. Warner 1761 East 53rd Avenue Anchorage, AK 99507 Subject: Subsurface Investigation - Lots 2 & 11, Blk 9 Elmore Subdivision - Addition ~2 Dear Mr. Warner: Transmitted herein in accordance with your instructions are .the results of the above referenced investigation as performed by us on March 27, 1976. The scope of this proje6t is. investigation for suitability of an on-site sewerage system. Included in this transmittal are: Vicinity Map Figure 1 Test }{ole Location Sketch Figure 2 Test Hole Logs Table A Grain Size Distribution Curves Sheets 1-2 .Explanatory Information Sheets 3-5 The exploration was conducted using a track mounted Mobile Drill model B-50 drill rig with a continuous flight, solid stem auger. The rig is owned and operated by Denali Drilling Inc. Drilling was supervised and the test holes logged by Mr. O.M. }Iatch, staff geologist with Alaska Testlab. The percolation test was run by Mr. Wallace Oliver, staff tech- nician with Alaska Testlab. The test holes were placed at the approximate locations shown on Figure 2. The logs of these test holes are.included as Table A of this report. In int~rpretting the logs it would be helpful to utilize the explanatory information contained in Sheets 3 to 5 of this report. When drilling was completed a 3/4" slotted PVC pipe was inserted in each hole to aid in determining the free water level. For the percolation test, the test hole was filled with water and left overnight to.saturate. On returning the next day, the hole was refilled with water and the drop in the w~ter level carefully monitored over the next 60 minutes. ~ert A. Warner 31, 1976 ~age 2 This procedure is not a standardized percolation test, however, we understand that the Anchorage Department of Environmental Quality prefers test performed in this manner to evaluate a site for a proposed on-site sewerage system. sing 'the above tes~, the observed minimum percolation rate~ or L~t 2'was 2.5 minutes per inch, and for Lot inch. \3.3 m~nutes per'' - Because the ~ater level was detected at 1~L=5 feet on~ ' { Lot 11, we drllled a second hole down t? a depth of 7.5 feet ~-- four f6et above the water table. Th~s was the hole that ~t~e per,elation test was run in, not the 15 foot deep hole ~sted in Table A. . To further back up this data we performed a mechanical sieve analysis on the material from 2.0 feet to 5.0 feet (sample 1) and on the material from 5.0 feet to 15.0 feet (sample 2). The results of these tests are shown on Sheets 1 and 2. It should be remembered that the free water level will fluctuate with seasonal and climatic conditions and may vary considerably, on occasion, from that found on the day of drilling. -. We hope this report meets your present needs. If we can be of further service, please do not hesitate to contact us. Very truly yours, A L A S.KA T E S T L A B Melvin R. Nichols, CE Laboratory Supervisor MRN:mm Attachments Test Hole Depth in Feet From To 0.0 I .0 1.0 3.0 3.0 15.0' on LOT 2 TABLE A W0~17626 'Date: 3/27/76 Logger: OMI{ SOIL DESCRIPTION F-4, brown ~eat, Pt, damp, soft. F-4, brown Sandy Silt, ML, damp, stiff, NP. NFS/F-l, brown Silty Sandy Gravel, GP/GM, damp, medium to high density, maximum subrounded particle size 6", sample shy on coarser gravel. Bottom of Test Hole: Frost Line: Free Water Level: 15.0 ft. 2.0 ft. None observed SA. Type of Dry · NO. Depth Blows/6" M% Sample ~Strength Group Unified 1 5.0' ..... G .... GM 2 7.5' ..... G .... GM 3 10.0 ..... G .... GM 4 12.5' ..... G .... GM 5 15.0' ..... G .... GM Remarks: /,/,CT 1) 2) 3) 4) 5) 6) Type of Sample~ G=Grab, SP=Standard Penetratio~ Dry Strength: N=None, L=Low, M=Medium, H=High Group refers to similar material this study only. General information, see Sheet 1. Frost..& Textural Classification, see Sheet 2-3 Unified Classification, see Sheet 4. Test on LOT 11 Depth in Feet From To 0.0' 2.0' 2.0' 5.0'' 5.0' 15.0' TABLE A W0~17626 Date: 3/27/76 Logger: OMH SOIL DESCRIPTION F-4, brown Peat, Pt, damp, soft, orggnic over- burden. F-4, brown Sandy Silt, ML, with trace of gravel, damp, stiff, NP. NFS/F-l, brown Sandy Gravel, GP/GM, damp, medium density, maximum subrounded particle size 3". ~ottom of Test Hole: Frost Line: Free Water Level: 15.0 ft. 1.5 ft. -~.1125 ft. SA. NO. Depth Type of ' Dry Blows/6" M% Sample Strength Group Unified ..... G ..... ML ..... G ..... GP J5° -- GP ..... G ..... GP I 5'.'0' 2 ~.5' 3 10.0 4 12.5' 5 15.0' Remarks: 1) 2) 3) 4) 5) 6) Type of Sample, G=Grab, SP=Standard Penetration Dry Strength: · N=None, L=Low, M=Medium, tl=High Group refers to similar material this study only. General information, see Sheet 1' Frost & Textural Classification, see Sheet 2-3 Unified Classification, see Sheet 4. · 1,15 Ih Ave ~ - , ,~,b,--9 ~.~? 7~ ~:~- - -/-z~z ~.,; ..... ~ I - -- '--z~ ~ o ........ ~¢¢ ~ ........ ~ ........ ~a>~ ~ ] '¢~ ~"~ ' _1 I . ,~ .~ , ~ J ,~I~ . ,~~ I~ - . ~ .... ', ,I ....... ~ ',. I, ' 'x'"' "147 th Ave. '-.Xx . ' ' . . · ' " ' I ~~..~ ' · ~ . .. Development Services Depari:ment Building Safe~y Division On-Site Water and Wastewater Prog,'am 4700 South Bragaw ~* P.O. Box 196650 Anchorage, AK 99519-6850 ~At~v.ci.ancho:age.ak.g,s (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMII..Y DWELLING GEN ~P~AL iNFORI~.,1ATION Comp!e!~ legal descrilSt[gn Expiration Date: Losation (site adaies~ Or'directions) _.~0 E~{s~ ~¢~ ~¢~ Current Prope[[y.owne~(s) ~ J;~ ~ B~h Mailing addr~'s. ~ ~O0 ~¢ Day phone Lending agency Ma!ling address Real Estate Agent Mailing Address 0-"o h Lev_X- Unless other~vise requested, HAA wB be held by DSD for pickup. 2. NU1VIBER OF BEDROOMS: ,-~ Day phone TYPE OF WATER SUPPLY: Individual Welt Individual Water Storage El Community Class ___ Weii Public Water System [] 'F'/PE OF WASTEWATER DISPOSAL: Individus! On-site individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Serv!ces Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an indeoendent pro~essional civil engineer registered in the .State of Alaska. Certificates of Heekh Authority Approval are required for the transfer of ti,.'ie (except between spouses) for properties served by a single-family on.-site wastewate;' disposai and/or water supply system. DSD also issues HAAs upon request to homeowners. Ce,,iificates of Heaith Authority Approval are valid for 90 days,from the date of issue for properties served by a private or C!ass C well and may be reissued with new water sample results. (CeAificates may be reissued for a period of t.:p to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B we!Is or a pubIic water system. The Munici;ality of Anchorage is not responsible for errors or omissions in the p;ofess~onal engineer's work. 4, STATEMENT OF INSPECTION BY ENGINEER DSD SIGNATURE )L ' Approved for~ ~ Disapproved. Conditional approval for 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 Health Aufhority Approval Guidelines for tills application, shows that the on- site water supply and/or wastewater disposa! system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. ! 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 al applicable Municipal and State codes, ordin'a~cds, and regulations in effect at the time of installation. Engineers Printed Name ~ ~*~ E~( .... bedrooms. bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ~/Z / ///~)Z (Rev. HA,~ee:.. $ Date Recei~'Namber (Rev. '12/01) N0¥--29--2002 0~:24 PM 261 P.01 AB-BUILT NO CORNERS 8ET THIS DATE I - lO - I h~mby c~rllf~ that I have peKmrmed .a M0rtgagse's InSPeoflon ' of the following described property: L.~ T' ~.4. ~ Anchorage Recording Precinct. Alaska, and that the improvements situated thereon are within the property line~ and do not overlap or enc.'oach on the property lying a~aCent' thereto, that no improvements on property lying adjacent thereto encroach 0~ the premises in question end that there am no road~lye, Iral~,misBIon line~ or other visible easements on said ixoperty except as Indicated hereon, Dated ~ Anchorage. Alaska FRED WALATKA & A,.~SOClATES (907) 248-1668 Engineers a~d Surveyors Ref. No: G $55802020 11-25-02 15:54 FROM-CT&E ENVIRONMENTAL SRV ,~t~__ CT&E Environme.tal Services 9075615301 T-§31 P.02/03 F-498 CT&l: ReL# Client Name Pru.]ect Name/# Client Sample ID Matrix PWSlD 0 Sample Remarks: 1027978001 Envh'onmantal Mgrm lnc (EMI) 4300 E 145th Ave 4300 E 14$th Ave Drinking Watex All Dates/Tim~s are Alaska Standard Time Printed Dateffime 11/25/2002 9:32 Collected Date/Time 11/21/2002 14:40 Received Date/Time 11/21/2002 15:10 Technical ~~ Direct Released By PQL Unim Method Allowable Prep Analysis Limits Date Da~e Init Waters Department Ni~rate~N 0.449 0.200 mg/L EPA 300.0 (<=I0) 11/21/02 ~S MicrobLolo~ Laboratory Total Coliform 0 col/100mL SMI8 9222B (<=1) 11/21/02 KAP ( MUNICIPALITY OF ANCHORAGE . DEPARTMENT,OF HEA{.TH & HUMAN SERVICES · Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage. Alasl~a 99519-6650 - 343-4744 ' CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # (~)\~ - \ ~,~-,~'"~ HAA# ~'\~'~O~t('~ 1. GENERAL INFORMATION Complete'legal description Lot 29 Block. 9, Elmore subdivision Location (site address or directions) Anchoraqe~ AK 99516 4300 E. 145th Ave. Property owner Mailing address Lending agency Mailin. g address. Chris Hoidal Day p~one 348-0223 Day phone Agent John T~vy_ ' Address "341 W. Unless otherwise requested, HAA will be held for NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well x Community well Public water :" ' NOTE: ~ickup. 3 Day phone 561-2220 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. x TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer i NOTE: If community waStewater system, provide written confirmation from State ADEC attesting to the legality and status of system. STATEMENT OF INSPECTION BY:ENGiNEER ? As c,ert~he~d by my.s .e.al afl,xed hereto and as of the*~al!dation date shown below I verify that my invest gat oh o~ this'Health AUt~o~it~*A~p~:~,al* ~*p~licati~n *~h0ws that the on-site W;~ter*suppiy and/or wastewater dispoSal system s'Safe, fun~:t o'na and adequate for the number of bedrooms and type of structure indiCated hm*ein. I further verify that based on the information 6brained from the Municipality of Anchorage files' and from**, my i,n. vestigation and inspection, the 0n~site water supply and/or wastewater ~isi~sa~ S~s*tem is in compliance With'all Municipal and State codes, ordinances, and regulations in effect ~ the date of this' inspe,~tion. Name of Firm Environmental Hanag~ment ~'r~c.-. ' Phone 272-9336 Add~ess 206 E..Fireweed L~n~, Suite 201 Anchora~'e~ AK 9950~ Engineer'; signature~~----~~ Date /~..//-~..//'.~ ' 6..D~SlGNATURE Approved for'~'~ DiSapproved, Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: Date [Z*[~'(~ ' 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 DH HS does this as a C°u rtesy to ~urchasers of homes and their lending institutions In order to safisf~ certain federal and state req uimmmlts. Employees of DH HS do not, conduct inspections or analyze data before a' certificate is Issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work~ RECEIVED Munlclpal!tyof~Anchorage DEC 1,5 1998,~ DEPARTMENT OF' HEALTH & HUMAN SERVlCF.~a~.~u~y o~,~:..(~l~'~:l~k~ Environmental Services Division ee,~3N~.~ s--- --,.-- 825 L Street, Room 502 · Anchorage. Alaska 99501 · (907) 343-4744 ~,,:~s ~ Health Authority Approval Checklist LegalDesoripflon: Lot 2r Block 9, Elmore Subd $2 ParcelI.D.: WELL DATA Well type Private Total ~e~th. 127 ft. Y If A, B, or C, attach/%DEC letter. ADEC water system number Date completed Casedto 127 ft. Y FROM WELL LOG Date of test &latlc water level 36 ft. Well production 15 WATER SAMPLE RE~ULT~: Coliform 0 col/100 ml Date of ~ample: 11/19/~8 6/17Am Nitrate B. SEPTIC~IOLDING TANK DATA Date Installed 12/14/98 Foundation eleanout (Y/N) Dam ~ C. ABSORPTION FIELD Date bmlalled 12/~ /98 Length 71 ft. Width, Effecave absom~on ama 408 ftz' Dateofadequaoyte~t New Field F~ ee~ m a~oq~on ~el~ be~m ~t 0n.): June 17, 1976 Casing height (above ground) 3 ft. Y Wires properly protected (Y/N) AT INSPECTION 11/19/98 . 30 ft. Soil m~ng (O.p.ddg'orltmAxlrm) 375 f~/bd~/stem ~Wide Trench 5 ft. ..Gmv~lt~okne~belowplDe12 in Tot~de~ Oepresslon aver field (Y/N) __ Monitmlng Tube presem (Y/N) Y Restore (P~) Immediately ~fter For gel. v~a~,r added On.): N .bedrooms Ruid deplh (ins) Minutes late~. Pe~.x,,i(te ~mem (pa~ 12 mona's) (y/N) 72.;26 ~ev. g.p.d. 2 Gleanoute (Y/N) Y High water ~ (Y/N) N Tank~ze 1250 qal. Number of Oompmlmente __ Y Depression (Y/N) N Pumper New Tank .434 n~,/L Olherbactefla 0 col/100 ml C.x~l~l~l by: Chad Helqeson g.p.m. 5 g.p.m. D. UFT STATION ~/A Date installed ~hdie/Ac=e~ (Y/N) High water alarm level at' Cycles tested E. SEPARATION DISTANCES Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic sel~ice line Size in gallons "Pump on" level at* *Datum "Pump off' level at* Receipt Number 724326 (Rev. 3/96)' Waiver Fee $ Date of Payment Receipt Number R ENGINEER'S CERTIFICATION I cerdfy ~! I have determ/ned mru field tnspec#ons and review of Munlc/pa/~a~.:ltlb ~)OV~L~ ere Date SEPARATION DISTANCES FROM WELLON LOT TO: 108 ft, On adjacent lots 12(} +ft. 101 £t. Onadjacentlote 120 + ft. N/A Public sewer manhole/cleanout N/A 9 ~' ~%. Uft 8ta~on N/A SEPARATION DISTANCES FROM SEPTIC,/HOLDING TANK ON LOTTO: Foundation 13 £'c. Property line 20 + £'c. Absorption field 6 £'c. Water maln/sewtce line N/A Surface water/dndnage N/A Wells on adjacent lots 115 £t. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Propertyline 20 + £t. Bulldingfoundat]on 11.5 £'c. Water maln/servtce line N/A Surface water ~ Obse. cvec~ D~,eway, parldng/vehldestomgearea 20 + Curtain drain 1~7ae Obse. rve~ Wells on adjacent lots 108 Ft. MUNICIPALITY oF ANcHoRAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343--4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# [')\~- ~"t ff-~-'~'{"~ HAA# ~-~'~'~c~(,'l 1. GENERAL INFORMATION Complete legal description Lot 29 Block 9 El.more $/D I~,~. 2 Location (site address or directions) ~bbit Creek Road. Property owner Mailing address Lending agency Mailing address 4300 E 145th Ave. off Elmore Rd. and Gilman Dana Burke 4300 E 145th Ave. Anchorage, Day phone AK ~9516 Day phone 345-8253 Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherw!se requested, HAA will be held for pickup. 3 NOTE: Individual well x Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: x 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. 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 compliance .with all Municipal and State codes, ordinances, and regulations In effect on the date of this inspection. Name of Firm Environmental M~na<~emen.t, Inc,/'? Phone 272-9336 ----- // ,p // Address 206 E. Fireweed'I~ne/ AnC.hora~r' A]aska' 99516 ' ,:.., ....... . /' ' ~ ,<' % C[-ECbl ':,',.~. ..... ' ,- .' Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: 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 professlonal engineer's work. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division I[I 825"L" Street. Room 502e Anchorage. Alaska 99501e (907) 3~-~1 I¥ Health Authority Approval Checklist APR 1 1 1996 Legal Description:LOt 2A, Block 9 E].more S/D No. 2 Parcct I.D.: A. WELL DATA Municipality o! Anchorage Dept. Health & Human Services 0 Well type Private IFA. B, or C. attach ADEC Icttcr. ADEC water system number N/A Log present (Y/N) Yes Datecomplcted ,.Tune 17, 1976 B+ Total dcpth 127 ' C. ascd to 127 ' Casing height (above ground) 24" Sanitary. seal (Y/30. Yes ",Vires properly protected (Y/lO Yes Date of tcst Static water level Well production WATER SAMPLE RESULTS: Coliform 0/100 ml FROM WELL LOG June 17, 1976 AT INSPECTION Hatch 15, 1996 36' 25' 15 g.p.m. 4-5 Datcofsamplc: March 15, 1996 SEPTIC/HOLDING TANK DATA Nitralo 0.332 rog/1 Othcrbactcria 0/100 mi Collected by: Simon Sch.~oc~ler Dateinstallcd,.lul¥ 8, 197f:ranksizc1000 gal NumberofCompanmems 2 Clcanouts(Y/N) Y Foundation cleanout (Y/N) ¥ Depression (Y/N). N High water alarm (Y/N). No DatoofPumping Feb 28, '96PumpcrIsaac's Pumping C. ABSORPTION FIELD DATA Date installcd July 8, 1976 Systemtyp¢ Bed Length 100' Width 3 ' 6" Total depth 48" Effective absorption area 300 SF Depression over field (Y/N) N Date of adequacy test. 3/15/96 For 3 bedrooms Fluid depth in absorption field before test (in.); 5.5" Immediately after 450 gal. water added (in.): 12.0"** Fluid depth 250 Minutes later: 8.0" (in.) Absorption rate = 830 g.p.d. Peroxide treatment (past 12 months) (Y/N). N . If yes, give date N/A ~ l~o+t-o,~ ~ H,I-. ~'~'" B,I,~ ~ro,,-,,,l I.~,,.-I/l~ .~" e,,lo,,.,/,..,,,.-,'--,.o,..+~_l P~+o Soil rating (g.p.d./ft: or fi:AMrm) 100 Gravel thickness below pipe Monitoring Tube present(Y/N3 ¥* Results (Pass/Fail) Pass D. LIFt STATION '-; 12 · Date installed ManholedAccess (Y/10 High water alarm level at* Cycles tcstcd SEPARATION DISTANCES N/A '""% Size in gallons '~-,, ~"Pump on~ level at* ~Pump off level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 100 ' + : On adjacent lots 100' + Absorption field on lot 100' + .; On adjaccnt lots 100' + Public sewer main 'J0O' + Public sev,'er manhole/cleanout 100 ' + Sev,,er/septic service line 100' + Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 8 ' Property line 40 '. Absorption field 5 ' Water main/service line 10' + Suffacewater/drainage N/A Wells on adjacent lots 100' + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Building foundation 20 ' + Surface water l&3nc Cb.~rv~-.~./{~ 7/ Water main/service line 10 ' + Driveway, parking/vehicle storage area 30 ' + Ft. HAA Fee $ Curtain drain None Observed Wells on adjacent lots 100 ' + Property Line 19 ' ENGINEER'S CE$ FIFICATIO~ l certify that l ~ave fa ,effmned/~/u fieId mspecttons and revtew of Muntclpal recps~ {'.~...$&~r~ ln conformande with fOA tlA/l ~uidelines in effect on this date. /..-. ¢;~: I ~ '"'~:'~'.i~,,. ~ ~ .-.. ,/,' ,, s~g=ure , ·/./"-"'-'-'-~ Engin mc John Sx~oson _ // ,.,~,.~ /'~,x c~-gc6i 46'3 / / / '%%>'. ......... .......:. / / ~,' ~. -' ...... ... Waiver Date of Payment Date of Payment Receipt Number Receipt Number Rev. 8/95 OSS: ~3a.wk.do~ L£v£~ ~T (l l. S - I o. 'O rr = John Esrl CE-SO~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P,O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # (~ - ~-~- L'-"~ HAA# 1. GENERAL INFORMATION Complete legal description Lo.~ Z; F~och. 9~ E.~,no~te. $ctbc~uZ~sZon. #~ Location (site address or directions) 4300 E~ Property owner l~obe.~t ~ ./~m~. ~]~ut~t~. Day phon. e Mailing address z~nn F,~ 14~.~'~ Au~',t~': A~'~n~¢., A~- qq~l~ Lending agency Day phone Mailing address Agent Address e Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3' '~ TYPE OF WATER SUPPLY: Individual well Day phone Community well Public water NOTE: 4..'TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community well system, provide written confirmation from Siate ADEC attest- ing to the legality and status of system. X~ 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 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 Address E .... 17034 Ea.;lo River Loop Roa;J No. 204 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. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. A. WELL DATA typ~ If A0 B' or C, attach ADEC letter. Well Log present (Y/N) ct 0 Date completed Total depth { ~ ~ Cased to Sanitary seal (Y/N) ADEC water system number ------ /-~O -/- Casing height Wires properly protected (Y/N) FROM WELL LOG Date of te~t Static wa~er level ' () (~' Well flow I ~'~ V/g p.m. Pump level SEPARATION DISTANCES FROM WELL TO: Nitrate AT INSPECTION Septic/holding tank on lot. Absorption field on lot sewer mai~ ' Public Public sewer se~ice line .. WATER SAMPLE RESULTS: "' On adjacent lots ; On adjacent lots ; Pul~licsewermanhole/cleanout Petroleum ta: k · Collected by: C.~ Other bacteria Date of sample: Cleanouts (Y/N) ~ High water alarm (Y/N) Date of pumping R. SEPTIC/HOLDING TANK DATA Date installed "~ -~)'- '7 (o Tanksize t Foundation/cleanout (Y/N) f',)//~ Alarm tested (Y/N) SEPARATION DISTANCEs FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ( ~o ~ Onadjacentlots To propertyline I1~ 'f' Absorption fie!d SuHace water/drainage Compartments Depression (Y/N) Foundation Water main/service line '/2-02~ (Re~. ~,~1} Fro~t MOA 21 CONTINUED ON BACK PAGE Date installed Size in gallons Vent (Y/N) "Pump'S' level at High water alarm level Meets MOA electrical codes (Y/N) ' ' "'SEPARATiO~J D'i~T~NCE FRoM LIFT' STA'TI Well on lot On adjacent lots D. ABSORPTION FIELD DATA -. Length _Ta,,~_~Width ' Total absorption area · Depression over field (Y/N) "' fJ Results (l~ass/fail) p I~r ~-~ Peroxide treatment (past 12 months) (Y/N), Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DI'STANCE FROM ABSORPTION FIELD TO: , ,~ Well on lot t r3t"2. On adjacent lots .' Property line To building fo?n,d,ation · On adjacentlots Surface water I · , ".:* ! Curtain drain E. ENGINEER'S CERTIFICATION Surface water Soil rating ~ ~01~/~. System type "~c.. ~ Gravel thickness l? '! ~*~erZ ~ · u~(~ Total depth Cleanouts present (Y/N) Date of adequacy test ~ - [ 0 - for ~ bedrooms · If yes. give dat; ~,,//~ ' To existing or abandoned system on lot Cutbank /~/f~ Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. · , . , ~ , ' ,.; * ; . Signature <_ ~ ~ FNGINEERING t7034 Eagle R|Yer Loop Road No, 204 Engineer's Na~!, ~v,,r. maska 99577 Date ~/~/~/ _ HAA Fee $ '/9('), Date of Payment Receipt Number. '~..~~i;~.~*'" .~1'./ .......... ,.,.. ..... ,,. Waiver Fee: $ ' ' Date of Payment Receipt Number 72-02~ (Rev. 3~1) ~aCk MOA 21 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 34:3-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot ~ B~ock 9; E~or~ Subdiul6lon #~ Location (address or directions) 4300 E~t 145th (b) Property owner Mailing Address Bob £ San~ Warner 4300 Ea6t 145th Telephone:(home)"'~=~o~cs~J,,Business. Ancho.~g~, Ak. 99516 (c) Lending Institution Mailing Address ",' Telephone (d) RealEstateCompanyandAgent SZMP$ON CO. REALTORS ATTN: Beth Simp6on Address 12641Sh~b~rn~ Ro~8, Ancho~cg~, Ak. 99516 Telephone $45-6644 (e) Mail the HAA to the following address: (or check hereY~, if hold for pick up.) List contact person and day phone number below: 17034 Eagle Ri, Yet' Loop Road N:.,. 2. TYPE OF RESIDENCE Single-Family~ Number of bedrooms 3. WATER SUPPLY Individual Well ~x. Community cI Public t 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 I~ Public t-1 Community r-I Holding Tank I-1 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72'~25 (RW. 1/~8) Page 1 of 2 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 ndicated here n. 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. Telephone '~:~' ~" ~'~'~ Name of Firn~ 170:14 Eaglo R[v~' Loop Road No. 204 Address Date 6. DHHSAPPROVAL Approved for '~ bedrooms b Date Approved J/~' Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 fo r errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) 'Z~, Health Authority Approval (HAA) ~"~'~---'~, .~I~ONME~ALSERVICESD~44 ~ - .~ . " ,, AUG 1 6 1990 Legal Description: ' L..,,3'T" ~-. t~,o~..l~' ~ Well ~lassification ~u~~ if A, B, C, D.E~C. Approved (y/N) ~ Well Log Present~). '~ D~te completed 'G- i~, ~ ~ Total Depth ~ Cased to ~ Depth of Grouting ~ Static Water Level ~,f~ Pump Set-A.t~- Yield Casing Height Above Ground iT.-)t ~- Electrical Wiring In Conduit J~N) y. SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~,C) t~t4' Sanitary Seal on Casing~N) ' \/ Depression Around Wellhead (Y~). ; On Adjoining Lots t~ To Nearest Edge of Absorpfi'~n Fieid on Lot .... ~ ~ ~, D t~ ~ ~ ; Or~ Adjoin'lng LOts '" To Nearest Public Sewer Line ~ ,h" To N~a~'es~ Public Sewer Cleanout/Manhole ~,. To Nearest Sewer Service Line on Lot ~.~- t -t- Water Sample Collected by ~'~ -~ ~::~,~,¢,~¢.,r--,J~,-..~. ;Date Water Sample Test Results ~,~-t-'--t,~ ~,~...~.-~ - ~ Comments SEPTIC/HOLDING TANK DATA Date Installed ""'J_.~_.~.~_ Size Standl~i~es I~N) y Depression over Tank (Y/(~ J ~ ~ No. of Compartments Air-tight Caps'/N). Pumping/Maintenance Contact on File (Y/N) Hold!rig Tank High-Wat'er Alarm (Y/N) ~J/~" y Foundation Cleanout ~N) y Date La. st pumped ~ - 1~3 - .~'~ ~"/~'- ; for '-'" Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water. Supply Well TO Property Li'ne , J To Water Main/Service Line To Building Foundation ~ ~' ' } To Disposal Field -" ',t~' t To Stream, Pond, Lake or Major Drainage Course 'Comments 1.).~ Page I of 2 Soils Rating In Absorption Strata ~ ~ Type of System Design Date Installed '"~"~ -~ ~ Length of Field ~'5~ ~' ~.~' ~ Width of Field~ "- ?>~," Depth of Field ,'1~, t , .' - - '- Gravel Bed Thickness Square Feet of Absortion Are /4:~c:~ ~ C. AL.~, ' ..... ~' -~ - _ St.atndp~p~s P~'esent~N) y Depression over Field (Y~) /~J Date of Last Adequacy Test · ' Results of Last Adequacy Test ~'~.-r..~t'~,~..~'-o ~.u ~ ~-- '~ SEPARATION DISTANCE FROM ABSORPTION FIELD: · - . - ', ~, ....... , i . '~ ~::~s~-~.- · ' To Water-Supply Well t (3 ~ ~ e- To Property,Line To Building Foundati'or~ = ~!~ ~-.,~'~' ' To Existing or Abandoned System on Lot ~, .~'~" -' ' ;On Adjoining i:(~tS ' ,~:~ t ~- To Water.Main/Service Line lC) ~-i. To Cutl~ack (if present). To Stream, Pond, Lake, or Major Drainage Course to ~ ~ ~' To Driveway,' Parki.ng Area, or Vehicle Storage Area -' Comments ~ '~ ~' ,~--~C~-/::::~/'7°,/"J ~ ~J~J ~ ,_" D. LIFT STATION >- : _ ~ . :~, · : - . Date Installed . Dimensions ' ;' ' ' : ' Manhoie/Access Gallons Size in (Y/N) "Pump Off" Level at , High Water'Alarm Level at ~ Tested for ~ng Cycles during Adequacy Test. Meets MOA Electrical Co~.~~''~'''- ~'"~ ~......~ Comments ~ ' ~ "' g A~ainst HAA R e, st " **Check Permitted Bedroom Ratin equ ** - I certify that I have checked, verified, or conformed to all MOA a'nd HAA guidelines in effect on the date of this inspection. Signed Company Date MOA No. Receipt No. Date of Payment Amount: $ 17034 Eagle River Loop Roa,~ Eagle River, Alaake ·'Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907)562-2343 FEDERAL TAX I.D. #92-0040440 Client Sa~pla ID:L2 D9 EL~OIE 82 P~ID :UA Collected AUG 9 90 ~ IR:tS leceivad AUG ID 90 ! 13:40 P~ese~ved with :AS ~EQUIIED Client Nalte Client Acct: leq ! Ordered By : Analysis Completed :AUG lO 90 -~end lepoEt8 to: Laborator! Supervieo! :S~EP~M C. RDE 1)3 ~ $ ENGI~ERIIIG Special Ir~tzuct: Chonlab lei J: 902969 Lab Smpl ID: I Matrix: WA?El Allo~ablo ~a:ameter ?sated Result Chits Method Limits NIYRA?E-N 0.31 ~/1 EPA 353.2 10 ~ample SAMPLE COLLECTED B! RAY Remarks: ROUTINE SAMPLE I Tettt Performed ' See Special Instructions Above UA-Unavailable ND- None Detected '* See lhmple Remarks Aboye lA- Not Analyzed LT-Les, ?hn. GT-Czeater Than CASE NUMBER: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION Environmental Health Division CASE REVIEW WORKSHEET DATE RECEIVE~ COMMENTS DUE BY: SUBDIVISION OR PROJECT TITLE: ) PUBLIC WATER AVAILABLE ) COMMUNITY WATER AVAILABLE COMMENTS: ) PUBLIC SEWER AVAILABLE 71-014 (Re~. 5/63) MUNICIPALITY OF ANCHORAGE ECONOMIC DEVELOPMENT AND PLANNING P,O. Box lg66§0 Anchorage, Alaska 99519-6650 pRELIMINARY PLAT APPLICATION OFFICE USE REC'D BY:. VERIFY OWN: . A. Please fill in the Information requested below. Print one letter or number per block. Do not write in the shaded blocks. I.Vacation Code S 9036 MAR 2, 5 19~'1Tax'dent''icati°nN°' 3, NIEW abbreviated legal description ('r12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34). II /-III III '1111111 4. £XlSTING abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34) lull legal on back page. II ' //111111111111111 5. Petitioner's Name (Last - First) 6. Petifioner'~ Representative I~IH,~I~I~-I No~lei~ ~I-H~,W I~I'%I'TI~I I I I I I I I I I I I I I I I I I IIIIII IIIIIIII IIIII 7. Petition Area 8. Proposed 9. Existing 10. GridNumber "11. Zone Acreage' Number Number Lots Lots I herebycedi~ ~at~ am)~ have been au~orized toact for)the owner of the prope~describedabove and ~at I desire to subd[vlde Ilin conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. I unders~nd ~at payment of ~e basic su~ivis~on fee subdivision. I atso unders~nd ~at additional lees may be assessed if the Municlpafi~'~ costs to process ~ls application exceed ~e basic fee. I lurer unders~nd ~at assigned hearing dates are lenitive and may have lo be pos~oned by Planning S~ff, Pta~ing ~ard, Planning Commission, or ~e ~sembly due to administrative reasons. Signature *Agen~ must provide wrJffen pr~f or authorization. ,.% VACATION OF RIGHT-OF-WAY OR OFFICE USE EASEMENT APPLICATION · Munlclpalily of Anchorage R£C'D DEPARTMENT OF COMMUNITY PLANNING ?,.,, -z V£R~FY OWN. P.O. BOX 6650 · Anchorage, Alaska99502-0650' ' ' ~; '~; :~'" ' ' '** :~ '"' ' A. Please fill in the information requested below. Print one letter or number per block. Do not write in the shaded blocks. 0. Case Number (IF KNOWI~) t"t /'t"-//: ,i · ' .' 1. Vacation Code .;: - r · . 2. Abbreviated Description of Vacation (EAST 200 FEET SOME STREET) I~;.1~1~1' Iol~l~l~kl~,lold~l~l I~=l~l~l~l~bh I,:'1. ' 3. Existing abbreviated legal description' (T12N R2W SEC 2 LOT 45 OR SHORT SUB eLK 3 LOT 34). I iIIL~,~ 14411~o~1-41~1, ~l, billed ~.1 I I I~1 I'1'11~l:l.'l't~l'~l. I~!1:t~1~: :'. ~' ': :~. ~,'d 4. Petitioner's Name (Last - First) i~1.1~1~1~"-I I~lo I~ ~l.-I~l ,I~l~ Address City }~/c,,/.{- ' State Iof'~ Phone No..~z].._~' .. j~, ~: Bill Me 6. Petition Area Acreage .~ . 7. Proposed Number 10. Grid Number 11. Zone 5. Petitioner's Representative Address 4~-0 ~'. b~_Oso,~ "' 8. · Existing Number Lots City '~ ~J~/"J' State /~rq' Phone No. -~'~'~- '~'~q [ Bill Me .'-~9.-; Traffic'~,naly~i~ ~'one 12. Fees }~(~' ~ C~ 13. Community Council vacate it in conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. I understand Ihat payment of the basic vacation fee is nonrefundable and is to cover the costs associated with processing this application, that it does not assure approval of the vacation. I also understand that additional fees may be assessed if the Municipality's costs to process this application exceed the basic fee. I further understand that assigned hearing dates are tentative and may have to be postponed by Planning Staff, Platting Board, Planning Commission, or the Assembly due to administrative reasons. 2-zz- q I " Date: Signature 'Agents must provide written proof or authorization.