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HomeMy WebLinkAboutTONJESS ESTATES BLK 1 LT 6Tonjess Estates Block 1 Lot 6 #051-831 -12 r• /�/ f i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH R ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT -4( �� • / / NAyE .JOA s SW- r.2)9-0' .2)9-ON-SITE AUPW � UPGRADE MAILING ADDRESS - / 1)1 c1, 4K LEGAL DESCRIPTION 1-cr i-!ILK I TONQ"2 s S'\nvef LO- LOCATION "de Ss-ee Cf- NO. OF BEDROOMS SEPTIC TANK DISTANCE TO: WellAbsorption area / / Dwelling / 9 PERMIT NO. 'S'03S-a ' No. of compartments Lig. capa�yjngallons IF HOMEMADE: Inside length Width Liquid depth d Y ==F DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons TILE DRAINFIELD TRENCH DISTANCE TO: Well / Foundation Nearest lot line PERMIT a 1o3 S,, No. of lines / jiailririMgliiiiiiMEIMEMN Distance between lines Top of tile to finish grade t� r Total eflect�ye absorptionD/rea SEEPAGE PIT Length Width Depth PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J ij J Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption arealsl OTHER DA ' c queer F- PIPE MATERIALS P VC F1 C1 WC_ IIS SOIL TEST RATING 'S ? / $NIZM INSTALLER JD a PS CNA sir u l7 o„ . ' '- •Clenile REMARKS r k a.t.ck l +re,tc�� 1 r.c k ALU I le t Id - LI i — Car.047' S rc . P /Lr?J, Je s vI 104,4, Co i' r . J S Jt an rs 3• -CU.? f ii id. /LWb 41 r.'s in C Avile IllrG� d APPROVED // - DATE LEGAL J / / 7-- 3-�Z- �n Jes5 Z-Slr'YCr 2 6 ✓S/ ev. 3/7 PERMIT t-1 I C I F•FiL I TY or Fit•JCHQF:FIGE DEPARTMENT GF HEALTH AND ENVIFOHMEHTALOTECTION 825 ( STREET, ANCHORAGE, AK. 9_ 31 264-4720 'WELL PIED. OtJ—S=ITE SEI'LEF: F•EF:t1 I T NO. C 820352 ) APPLICANT JOHN SHORT LOCATION JESSE LEE ST. LEGAL LOT 6 BLK 1 Tongess Estates S/D 401 E. 36 AVE LOT SIZE 279-0491 4300 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CS0 FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E'>EF TH= F LE140TH= .-.2,3:e3 rF:Ft%,. EL E>EE Thi= 2a THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THE TR: Er -.ICH 1-+4 I 1,7r VA I s O. CI[_i�-, FEET_ THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). F:Ec!u I F:EE> 1EF•T I C TFit-JF, . 5I 2E= 10O0 GRLLON5 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TWO <2> I NE:F ECT I Ot-4S --- EACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM I5 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER. INSTALLATION. F F: tel I T E -CF• I F: S_ pECEFIE:EF: -=2. •cji I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MA'r' REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TQC*. UDE MOR HAN 3 BEDROOMS. 4, SIGNED: APPLICA!i! JOHN SHORT ISSUED BY V4.0 • PERFORMED FOR: n n X SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST Lar/ C!. nse./,Cz/- LEGAL DESCRIPTION: ;tiesrE&Wes BlorJr / SLOPE ayereci gravel rated @ 85 ❑' 8R COMMENTS WAS GROUND WATER O PERCOLATION TEST DATE PERFORMED: Cc"' /S 52 _ ee�� ENCOUNTERED? no O IF VES, AT WHAT DEPTH? E SITE PLAN —2s 61 Y Reading Date Gross Time Ne Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) FT PERFORMED 8V: 2— /'Le -r f1 1 72.008 (6/79) CERTIFIED BY: DATE:ri/�7' Cflrr tfirh Dritthtg'lQng by OWNER OF LAND NJ Nj DOC Co. (Da SULLIVAN WATER WELLS P. 0. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 6882759 G S. t.ci ADDRESS did t F.. 3‘7,9 g4 cSay LEGAL DESCRIPTION Z G /44K /i o NJFS,J ps % DATE - Started < / ' Ended C/r )- PERMIT NUMBER y DEPTH OF WELL ego // STATIC LEVEL OF WATER FT DRAW DOWN FT GALS. PER HR • / a 6 o KIND OF CASING G a Q KIND OF FORMATION: , From (% Ft. to F Ft. %' .JO 641A7.—i L 5/ From Ft to Ft From Ft. to Ft. /30 v4 Ot"CJ' From Ft to Ft From �� Ft to r2 r Ft s 4 ^-1,0 CI At .1 t-74 From Ft to Ft From Ft to Ft //a f✓ `OCtCS C4 if From Ft to Ft From Ft. to_ Ft or tee O , From Ft to Ft From -2C Ft to ?C. Ft. Cie of i 'J (•cam✓ee- From Ft to Ft From _ S 1, Ft to 3 7 Ft. l t<ea T r.¢. -j o From Ft. to Ft From 3`/ Ft to'7 7 'Ft i>'< L. t C < of 1# From Ft. to Ft. From % 7 Ft to rF 1 Ft SR —J O ‘.f4.1 4..1— . From Ft to Ft From Ft to Ft. £ K/ TC X. From Ft to Ft From Ft. to Ft. ' From Ft to Ft From Ft. to Ft From Ft to Ft I From Ft to Ft From Ft to Ft I I From Ft. to Ft From Ft to Ft I 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 P. i • ?49 1 1 1 I 1 1 1 1 1* 1 s •N TT SHALL et THE NEs.O.*SIDILITY OF (HE a7DlfA OR BUILDER TO FROVICZ EASEMENT DEECRIPTIEKS, COVENANTS AND RESTRIC. w TIOSIS WHICH CO NOT Ka -EAR ON THE RECORDED suatievis3ost PLAT AND TO VERIFY PROPOSED WILDING Gam RELiTNE TO FINISH GRADE AND UTIUTY COCIAEC IONS o. 0 1 11 i 1 1 crTOF 41.4#7:h3 rte'' T��Y". 49th, 1"; Tom Fink. Mayor t; `7i:9 'i+,. , 14;4"; .:.,i ' va .``•,;;;V. .:..x. Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage. Alaska 99519-6650 343-4744 October 31, 1989 Bruce Corwin, P.E. Corwin and Associates 1000 East Dimond Boulevard Suite 205 Anchorage, Alaska 99515 Subject: Waiver Request for Lot 6 Block 1 Tongess Estates Waiver Request #WR890063, PID #051-831-12 Dear Mr. Corwin: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 7 feet of south property line. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, Robert W. Robinson Civil Engineer On-site Services DJR/ljw#7 MUNICIPALITY OF ANCHORAGE ENM"ON; CENTAL SERVICES DIVISION OCT 2 ' 1989 RECEIVED '�;' �®ral� Consulting Engineers 1000 E. Dimond Blvd. • Suite 205 • Anchorage, Alaska 99515 • (907) 522.1311 October 26, 1989 Mr. Dan Roth Department of Health and Human Services Municipality of Anchorage 825 L Street Anchorage, Alaska 99501 SUBJECT: REQUEST FOR LOT LINE WAIVER LOT 6, BLOCK 1 TONJESS ESTATES NHN JESSIE LEE COURT, CHUGIAK, ALASKA Dear Mr. Roth: According to municipal records, a septic system was installed in 1982 on the above referenced property. We performed an adequacy test on October 17, 1989, and discovered that the distance between the septic system standpipe and the front property line is 8.6 feet. We request a waiver for septic system to property line setback of seven (7) feet. There is 60 feet of road right-of-way along the front property line. We do not anticipate that this waiver of setback distance will cause any adverse affects for this property or for adjoining properties. Very truly yours, OR4 N & AS OCIATES, INC. 46C7 ---------- Bruce • Corwin, P.E. Presi ent BJC/lb/ 41-- os - n7/16 V7 370 00 MUNICIPALITY OF ANCHORAGE • •:r DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION w ?' ENVIRONMENTAL ENGINEERING DIVISION 1 - 625 L Shaet • Andtmra. Alaska 99501 TetapltMW 264.4720 j...-, ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT i -71, `:5Nc12 r t...e HONE if— 40 MAIUNO ADDRESS :%;377Lin, r.3H/ A..1. �,�• LEGAL DESCRIPTION -T k i7 1 Tr 11/41 J' LOCATION ?Y.1 SS2f c C '• 1 • DISTANCE TO: Manu/corer C-1 et Lao. int/ je `• DISTANCE TO: Marrlacrrar WNl s c, at LTJ !• twaPADE NO. OF BEDROOMS 11� IF HOMEMADE: Nell Aatatp7.On nit Inde length Dwelling twit is DISTANCE TO: /+ No. of dna , I Length of ISM lens H' T till ttt file:/' grade • r Lava Tape el crib 1. Width Gib dwneter Founwt.on Total length of torn 31 ett te• Depth beneath Ola Gib depth Dwelling it • IP 3, w. PERMIT NO. 8ac357. Mend Width N. DISTANCE TO: Wok Depth Building foundation Connor 'A: DISTANCE TO: Building foundation ', = OTHER APE MATERIALS ^ . p�c C Sean/ litrt BOIL TEST RATING r;,.i: , CIS ( / IRDIZA1 INSTALLER. `tart cz ltd (s n& i t 4rc+u1• 1.4 ' Ankh 3+' " ' MWrily Cc' i�1cct1� • • aw%ure L-Icc- Ccere42b lc a No. of w.vrw-- . t - Litlttid tarn '. Liquid a estteM IMIti .+t:: PERMIT�{Q'., �j .tf 3 S� .. alai • feet PERMIT Nl sWineleall i Total affective florption VM � •t Ntenat lot Inn OnttnOt to lot lone Scow tank QDAA PERMIT N0. ;,• .. t :3 AEa otien anal r1:.' • __,. n., .n.-. 1 .a. GATE ;)'i l LEGAL .�< •Ije' 1 S teen- ' . • • Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater 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 FORA SINGLE FAMILY DWELLING Parcel I.D. 057— 8'/ — ,r 1. GENERAL INFORMATION Complete legal degcription . 7 5 s .Ean4res Ca.c • r 1 Location (site address or directions) %qr..r'/ Tis 3.c 4n- cT 49 Current Property owner(s) N,c cev l CAelite PeNAcr Day phone ,24'0 — 3vyo Mailing address Lending agency • • Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. urency0enchatz_ et, ti HAA# 057w5 Expiration Date: • do - ..9 - 05 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class _ Well Public Water System TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site ❑ Individual Holding tank ❑ Community On-site' ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (yAA) 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. 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. (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 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 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 Eagle River Engineering Services 10421 VFW Rd., Suite 201 Address Eagle Rive AIC 99V7 Engineer's Printed Name Sees r. R as° Date 1I /ZZ/D Phone G5N-si1S • 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following s Additional Comments tt1fOFrriinfr `e J am'_ ON-SITE ?•_� WAItiANU •: "' • WASTEWATER : . PROGRAM •; c By: • '••.•••' Attachments: HAA Checklist X Maintenance Agreements • Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other (R.vv.0VV2) (v. /2,4-- Original Certificate Date: 3 -a 9 - 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.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST • Legal Description: .Cor ne- arae Se i Parcel ID: cis" — 8' a - /2_ A. WELL DATA Well type P.¢.v.irr 1f A, B, or C provide PWSID # Date completed 6/CZ Sanitary seal (9N) yrs Total depth 37 ft. Cased toyo'; "ft. Date of test Static water level Well production FROM WELL LOG OAT' 2_ S'9 ft. .t0 g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Arsenic: /4 mg./I. B. SEPTIC/HOLDING TANK DATA Well Log (9N) ycs Wires properly protected &N) yfiz3 Casing height (above ground) 30 in. AT INSPECTION 70 ft. �✓, ie g.p.m. Nitrate<o:S mg./l. Other bacteria df colonies/100 ml. Date of sample: iv/.r/e y Collected by: . 109L5 c4'nF tc.L2 wzy/o S SA -Can enc+r $ Tank Type/Material a rsc. Date installed 7/25Jrz. Tank size /?SO gal. Number of Compartments x Cleanouts CPN) y.63 Foundation cleanout (9N) yt5 Depression over tank (Y/19P Nd High water alarm (Y( Date of pumping /D//ems' Pumper S IC ' /�� ,�,.✓t C. ABSORPTION FIELD DATA Date installed 7/5s/ta Soil rating (g.p.d./ft2 o System type ,n—.den Length 5ea- ft. Width 3 ft. Gravel below pipe a. [o ft. Total depth A Sft. Eff. absorption area .15-51t2 Monitoring tube yam_ Depression over field.vv Date of adequacy test ///9/e9 Results(nir0Fail) a•- ses For 3 bedrooms Fluid depth in absorption field before test fiff in. Water added±a0 gal. New depth cl in. Elapsed Time: 05 min. Final fluid depth 0 in. Absorption rate >= 4' O g.p.d. Any rejuvenation treatment (past 12 mo.) (Y(t * type) .c'a c•F If yes, give date "/- D. LIFT STATION Date installed Size in gallons 'Pump on' level at _ in. "Pump 9045k/el Cycles tested `7" E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1/ 3' Absorption field on lot i? ' Public sewer main > 3S' Sewer /septic service line ra€ ' Manhole/Access (YIN) 19 water alarm level at in. Meets alarm 8 circuit requirements? On adjacent Tots t /d0 On adjacent lots dc' ' Public sewer manhole/cleanout rice Holding tank #/e9c' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT T0: Building foundation SIF" Property line ?3'' Absorption field i3' Water main a is ' Water service line -fee • Surface water give ' Wells on adjacent lots r,sC' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation .a & ' Water main ria ' Property line 7 �`�' 9 Water Service line do ' Surface water If 0(.9 ' Driveway, parking/vehicle storage eb 5 ' Curtain drain ,' O' }'.vi. da .t..isww F. COMMENTS Wells on adjacent lots '.'ac' ]„rats FLer.J Tcsi both: 8/ Chun: e-At4 G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name cc..ara,' Date 11 l'7 /0 1-/ HAA Fee $ Qp p5 Waiver Fee $ Date of Payment Receipt Number Date of Payment Receipt Number (Rev. 12/01) 3/ec/�c05 3-25-05;15:22 ;CT and E SG S/CTE ENVIRONMENTAL SERVICES*, Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPLIER ❑PUSUC WATER SYSTEM IDS 1PRIVATE WATER SYSTEM SAMPLE Dete: D • Sand Rely ;581530, 0 2/ 2 200 W. POTTER DRIVE ANCHORAGE, ALASKA 99518 • Tel:9O7-562-2343 • Faxi907-561-5301 1 .h o.. u. 1051573- Yrrr ar.r Olsons arum,, Sew Pm.,. Ea.00 tzl�v-; thetr.t•,rr- .. C.v.a Mr. Cj`'SS - ( 01124 V Fki RJ ,,,, nem SV i to 7.-019 I?.MoM 07— 6911r32`t7 w tit R.40— ; . i"` eek I z`cet l7 Ter PM tam mu Locetlon: T? IU3 E SS ESTiertE S n isiM ni1r•,r D i'�aLycl Gln • Transported' i to Lab ay: XSeme as collector Other. TO BE COMPLETED BY LABORATORY Sample Recelvina: ' Date: 3-24-x5 • Time: SAMPLE TYPE 0 Routine 0 Treated Water E Repeat Sample 0 Untreated Water (refer to lab no. ) . 4 0 Special Pur ae MIM./ Mawr Tamp: G.. fa Delivery Method: Received By: Comments: a . —a PheM Wow ❑ Sanaa over SO bola. alt Rawl may be uxalabla ❑ RUSH SAMPLE Phone #: Fax p: Dacterioloalcal WaterAnelvele Record: MMOaaUG (PIA) RESULTS: Analya4 Dean: 1 •/A, S 1300 Total Cmkrm: / Analyst E. Col: Analytical Method: • Membrane Filter MMO-MUG (P/A) MEMBRANE FILTER RESULTS: Med Count Coloniewtooml Vedaoapx Tem ea. {LTB: BGB• Peal Cana { Reported By: `i)_s,� Soren o ! f Datemme: "5,%25/01 Opelta1pubtlalDOCUMENTIFORMSwic?%Coll Ftbm.xts SSM b ADEC: ANC FBI( JUN Oatelme: Sams Client Phoned Q Dalsllme: Faxed Spola%vier Cg -Satisfactory 0 Unsatisfactory TRC -Too Ita.wll. M Comm O .ell. boosts Foran a FW 0053 1024.03 • 2004 3:48PM Garness Ensineerins Group, Ltd. flier No.2088 P. 6 Meat -Su Test Lab of Alaska Water Quality Testing Mile 33 Palmer-Wea111s Hwy. Mldtnwn Community Business Parc Phone: (907) 7454003 Emelt: mat-sulestiabX fO0arahamem P.O. Bot 2749 Pakrwr,Alt. 91145 Fax: (907) 74.34010 Client SGS Environmental Attn.: Forest Taylor Client ID: 1040887001 PWSID 0: Source: M,S.T.LI: 2004928 Semple Matrix Comments: bate Arrived: 10/12/04 Report Date: 10/13/04 Semple Date: 10/11104 Sampo Time: 0820 Collected By: r Method Parameter: Units Reedit MOX Date Prepared Date Analyzed MCI SM 4500-NO3-E Total NO3,4• 03 002 mp/L Icnjssg E3 .tts ND Lon/ 61oc-i'-ia LOpsrtl: MRL - Method Report Level MCL • Mu. Contaminate Levet B . present to Method Blank E Esllmated Whig H -Above MCL ' b Lost to Dilution R La • ti s—'t—c orted By Jon Paul Campbell Supervisor • • • • 0.50 0.50 10113/04 10/13/04 10.0 JRs Pumping PO Box 773415 Eagle Rivcr, AK 99577 (907) 694-6454, 111111111;Information Claire 6 Mickey Depart Po Box 671663 Chuglak, AK 09567 (907) 688-5320 Job Site Information Mid 24851 Jesse Lee Court CIWglak,AK 99567 (907) 688-5320 688-1483 fax Service Type Rock peen out Extra charge for pumping rocks Septic Service Under 2k Qty 1 1 Additional Locaeon Comments: Blue, to on house. Inside dogs. Septic on north side of house • pipes starts at left end and go towards swing set. Job Description: 11000 P.O. Number. Terms: Net 30 Salesrep: Nikale Map Boole i Cross Streets: Job Comments: Service Agreement Number, 015100 Order Date: 13-0d-2004 Service Date: 16-0et.2004 12:00 am Technician: Tony Job Type Repeat Map Grid: 24 . - Settlers Drive 'Last Sery 11/12/02 1100g — `Pump olds to 6elo• have rocks M them' —Call ace when finished. reed to fax • selling home— Pump Tank - Heavy Solids • rocks in outflow • elo Tax Percent 0 Price Each x 2 Man Tax 535.00 NO No 5120.00 No No Diagram: r....._... t/0 • J Extension Actual 535.00 5120.00 Gallons Planned: Gallons Actual: 1250 Hose Length: 2.3 Double Tank: [_ Pump System: YI Baffles Inlet rj Baffles Outlet 0 ` NonTaxabla Total Estimated Charges: 5155.00 Actual Charges: Taxable Total 50.00 Customer agrees to the terms and conditons printed On the beck. THIS IS A BINDING AGREEMENT. Signature and T1W of Customer Representa0va Tax Total $0.00 Grand Total 6155.00 Dale Accepted by JRs Pumping Dale Accepted For you added Convenience we accept American Express/ DicoveryNisa and Master Card payments over the phone. After 30 Days 1.5% Will be charged or THERE WILL BE A DELIVERY 525.00 For NSF Checks Returned sr -4;i4- .rzo ve .°'-"t J• / ,•, ire • • r h "• fly . Y.Pll5esryGN/%/�/f/ / /lamL�''� .S'-9 •`S H �'�QO• ASBUILT-NO CORNERS SET THIS DATE. ARD b ASSOCIATES LAND •SURVEYING 688-4566 .TESS sZ C oe./47 I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: Tonjess Estates Subd.,Lot 6,B1k.1 AND THAT N0 ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, OR RESTRICTIONS APPEAR ON THE RECOItDSUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SPCIJLD ANY DATA HEREON BE USOF FENCE LINES,OR FOR ESTABLIIFORNSHHING �BOUHD- ART LINES. SCALE: 1"=30' DATE• 11-27-89 GRID: NW 1462 • FB: 10-5 DRAWN: DMS ry •rte:,......•...' I ..e:• •'°•' I A Duane Mar!: SSNa/d : ,44 M ii I .;••• LS -671a • .ef �' b - n n MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTME.NT•CF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date / (a) Legal Description (include lot, block, subdivision, section, township, range) Cn r L ern // oe s s f. 7 4 r r - Location (address or directions) �Po r Lee l n .-± (b) Applicants Name rnr Applicants Address Jet . chgfnAl Telephone - Home Business (c) Applicant is (check one) Lending Institution ; Owner/builder lI Buyer ; Other El (explain); (d) Lending Institutionf,C6r tornowAL RA.v)s' Telephone 6961-2/0 3 Address {fid. !kK S'S/R' FAf.Lr e,, 4 e4! Aft . c191S 77 (e) Real Estate Co. & Agent EA ti L. ( HA Address Telephone G, 9q - ij 9 9 cl . (f) `ei2he HAA to the following address: per+ 3 C. : �K. tSa ,( /2 G i x„C.Lb I1IVON. ALASK\ •_ . 4-4 le k.ver / AK '99vt'i 2. Type of Residence Single -Family 15 Multi -Family J Other (describe) Number of Bedrooms 3 3. Water Supply Individual Well rriCommunity Q Public ni Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite 1 X 1 Public In Community El Holding Tank ni Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. (Page 1 of 21 r n M 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm ti &t EACIThi=cgi:C 1 Address •'c 1 RES 130:: YH. e95-2c7a' , y" Date Telephone (ENGINEER SEAL) 6. DHEP Approval Approved for bedrooms By Approved Disapproved Terms of Conditional Approval .41t Conditional CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS LIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE 15 ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A. WELL DATA Well Classificati Well Log Presen Total Depth f'1 MUNICIPALITY CF ANCHORAGE (MQA)vNICIPALITY OF ANCHORAGE DEPT. OF HEALTH 8 HEALTH AUTHORITY APPROVAL (HAA)ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 OCT 1 11284 %� RECEIVED ,;E'/UlC->`C If A, B, or C, D.E.C. Approved(Y/N) Date Catpleted 6/9 Z Yield EA- ,c4f‘ / Cased to 90'7 f! Depth of Grouting // Static Water Level 53? / Pump set At U Li( Casing Height Above Ground Electrical Wiring in Conduit Separation Distances frau Well: To Septic/Hoitzag Tank cn Lot // 9 1f Sanitary Seal on Casing Depression Around Wellhead (W ; On Adjoining Lots /004 - To Nearest Edge 'of Absorption Field on Lot/90 To Nearest .Public Sewer Line Cleanout/Manhole /1 I On Adjoining Lcts /00 .,' To Nearest Public Sewer To Nearest Sewer Service Line Water Sample Collected By $ iS <i// PPJ/!?y ; Date /9// fJ 6 Water Sample Test Results 5-/A / Comments /LJO ^J E Lot /0 / B5' B. SEPTIC/ TANK DATA Date Installed %,23/4 2 Standpipe=L© ) Size S-0 No. of Campartmments 2 - Air -tight Air -tight Ca•<� Foundation Cleanout (Y/N) Depression over Tank (IILT Date Last Pumped /l7/e/e 4' Pumping/Maintenance Con act on File (Y/NyLV/fl ; far i(// Holding Tank High -Water Alarm (Y/We/in- Temporary Holding Tank Permit (Y/NTV /f Separation Distances from Septic/Holding To Water -Supply Well // B To Property Line jet) 1 To Water Main/Service Line /0 t Course /J / Yom' Tank: / To Building Foundation / To Disposal Field // To Stream, Pond, Lake,' or Major Drainage Comments (Page 1 of 21 4Sc moi' 36rr1 cc l \d-�►-�y 2-15-84 • C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed % i9 2 Width of Field 6 " Square Feet of Absorption Depression over Field w l� Date of Last Adequacy Test Results of Last Adequacy Test , ciq 7 SFAs n14 , Separation Distance from Abscrptiop Field: / To Water -Supply Wall /3c) / To Property Line /0 ' To Building Foundation 20 4- To Existing or Abandoned System cn Lot i.) ONE ; On Adjoining Lots /v o +- To Water Main/Service Line /O f To Cutbank(if present) Xf /i4 To Stream/Pond/Lake/or Major Drainage Course %U/ To Driveway, Parking Area, cr Vehicle Storage Area 37) f Caments /v D nI Alt Type of System Design 77ho y Length of Field 56 Depth of Field �Z Gravel Bed Thickness Standpipes Present D. LIFT STATION ** Date Installed Size in Gallons Dimensions Manhole/Access (Y/N) "Rump On" Level at Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Electrical Codes(Y/N) Caments Pumping Cycles cuing Adequacy Test. Meets tPA Check Permitted Bedroan Rating Against HAA Request" I certify that I have checked, verified, cr conformed to all on the date of this inspection. �i Signed $ & SR.a10:QN8HC/Ea1tvC Date / O --�1 g/ Company SiVei.EartatV TC577 MOP. No. KB1/d5/s [Page 2 of 2] MOA HAA Guidelines in effect 2-15-84 APPLIrnNT FILLS OUT UPPER HACONLY Property Over �% 0 71 ti S » 0 F r 4 Mailing Address 40 / E. .7 c T N ve , ZIPCode 99f0 3 Phone D79'O99/ Buyer .�j 0 Se p /1 /I rid. 5/9A R 0 nJ a Q e Address zip Code Lending Institution 944 sk11 Mt,7z,, A. 8 J%N g Address /� zip Code Phone Realty Co. a Agent C,-, e3 i h//9 N S-40 ,) Ceti 4. 7-7 S N L Address 4 o / i • ? 6 T N 4 ✓e zip Code q QS 03 Phone 279- 0 991. Legal Description Jo T G,3 % / o ex, r 70A/3 -e C S EsrAlIt . Street Location 2 Tt-e S' S� • L e•e C T Type of Residence A Single Family O Multiple Family No. of Bedroom 3 - O Other , Water Supply XIndividual - O Community ❑ Public Utility ATTACH WELL LOG. A well tog Is required for all wells drilled since June 1975. W7 For wells trilled prior to that date, glve well depth (attach log If available). Sewer Disposal ' ' O Individual O Public Utility O Holding Tank Year Individual Installed' When Corrected to Public Utility: Soils Rating NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time DateDate -ate 7-02 2 Date Date Inspector Inspector Inspector Inspector Field Notes: cy I .,— ef"'ve^'t"- (3) APPROVED BEDROOMS ( ) DISAPPROVED ( ) CONDITION L AP R9VAL' DATE -1-a j— 'CONDITIONS OF APPROVAL • BY• Q C Soils Rating Date Sewer Installed Well To Absorption Area Well to Tank Well Log Received Septic Tank Size 73023 WW1