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HomeMy WebLinkAboutSCIMITAR #3 BLK 2 LT 2imitor Block 2 Lot 2 #051-134-02 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 Permit Number: ,~.~/.~,,~t~ d) l(,¢,O PIDNumber: c:)~l Name:Wastewater System: ~ New ~pgrade Phone: ~ Deep Trench ~ Shallow Trench ~Bed ~ Mound ~Other L E G A L D E S C R I P T I O N so, Raling: Total Depth from original g fade: D. ~ GPD/Sq. FI. Lot: Clock: Subdivision: Beplh to pipe bottom from original grade: Gravel depth beneath pipe Township: Range: I Section: Fill added above original grade: Gravel length: I WELL: D New D Upgrade Gravel width: Number ol lines: Distance bel~een lines: Classilication (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: .... Date Drilled: Static: Waler Level:Ft. Installer: ~ Date insta Yield: GPM ~ Pump Set at: Ft. Casing Heighl Above Ground:Ft. T~ SEPARATION DISTANCES u septic D Holding ~,S.T.E.P, To Septic Absorption Lilt Holdi~9 ~ublic/Private Manufacturer:. Capacity in gallons: From Tank Field Slation Tank S .... Lines ~ ¢~ ~: Material: Number of Compartments: su~o~ LIFT STATI O N water ~ e ~ ~ Lot Size in gallons: Manufacture i"Pump on" level at: "Pump off"~v~at: High war; al;m at: ~ :Pump Make & Model Electrical Inspections perlormed by: . Curtain &~ 0 ~ ~ Drain Remarks: BENCH MARK Inspections performed by:t.~ Dates: 1st~/~ f ~:~ Department of Hea~u~~vices approTal/ //~. /,, ~/~ Date' 7~ ~:~..~,'" :"~..~:~'~"~? ::.~:~'"" Reviewed and approved by:~¢~~~ . / '/ Y ./ 72-013 (Rev. 9/91} MOA 25 3CALE~ ]": 50 FF TOBBEN SPURKLAND P.E. II II 205 W 15TH, AVENUE ANCH. AK. 99501 (907~ g79-~916 LOT 2 BLOCK 2 SCIMITAR S/D ~ 3 TOBY & DEBRA EASTON 19855 SEIKA DRIVE I J SEPTIC SYSTEM ASBUILT DATE: JULY 7, 1994 SHEET: 2/3 GRID:NWl261 45 ~ A ! -1/4 PVC with I/8" holes at 17" ~ A SECHON A-A 6" Halfpipe I-I/4 PVC Holes Pointing Up 5 Ff. of Cover 4" Topsoil 9¥.5~_ 8" Sewer Rock I-1/4" Oist/bution Pipe M/roil 140 6" Concrete Sond $' "Valley" Sand 91.9 90.5 87.5 1-1/4" Dischorge ~edrock @ 85 1250 gal STEP tank BENCH ~fARKL: SOUTH WEST CORNER OF HOUSE BOTfOld SIDING ASSUAGED ELEVATION IOO. OOFT TOBBEN SPURKLAND P.E. 205 W 15TH. AVENUE AK. 99501 LOT 2 BLOCK 2 SCIMITAR //3 TOBY EASTON 19855 SEIKA DRIVE, CHUG/AK SEPTIC SYSTEM ASBUILT DATE: JULY 7, 1994 SHEET: 5/5 GRID: NW 1261 Halmar Electric PO Box 1864 Palmer AK 99645 Ph. 745-8883, 696-8883 To: Dean Construction SR Box 9352 Eagle River Ak 99577 Date: 07-01-94 Ref: Lt.2,Blk.2 Scimitar # 3 This is to certify that on site sewer lift station at above mentioned property has been wired in accordance with the National Electrical Code and manufactures specification. Systems were checked and performed as specified in the systems manual. Halma~lectric /G~al/Kos~lin ..,. "-"-, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940160 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:EASTIN TOBY M & DEBRA R OWNER ADDRESS:3545 MADISON ROCK SPRINGS, WY 82907 DATE ISSUED: 6/01/94 EXPIRATION DATE: 6/01/95 PARCEL ID:05113402 LEGAL DESCRIPTION: SCIMITAR #3 BLK 2 LT 2 LOT SIZE: 43558 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 343-4744 (24 HOURS) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. ISSUED BY: / SPECIAL PROVISIONS: RECEIVED BY: Tom Fink, Mayor fiaunic /pality of AncWOrage Department of Health and. Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 June 2, 1994 Tobben Spurkland, P.E. 203 West 15th Avenue #206 Anchorage, Alaska 99501 Subject: Waiver Request for Lot 2 Block 2 Scimitar 93 Waiver Request #WR940027, PID #051-134-02 Dear Mr. Spurkland: 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 2 feet. 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. o/ Robert W. Robinson Civil Engineer On-site Services ljw#7 T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 I Street Anchorage, Alaska 99501 Subject: Permit for Lot 2 Block 2 Scimitar May 23, 1994 Gentlemen; An HAA inspection and test was performed by S&S Engineering on this septic system on August 18, 1993. S&S Engineering concluded that the drainfield did not meet the requirement for a three bedroom system.' On May 11, 1994 I excavated a testhole adjacent to the drain- field. My testhole log is attached. At that date I also exca- vated into the drainfield and performed a percolation test ap- proximately 6 inches below the sewer rock. The sand was dry and showed no evidence of contamination. The attached photographs show the condition of the bed. Bedrock was found 7 feet below the top of the bed, or approximately 3 feet below bottom of sewer rock. The lot is very steep with the house and septic system located on a narrow bench along the west lot line. I suggest to excavate the existing bed, remove the rock and the top 6 inches of the sand immediately under the rock, backfill with "valley" sand, to get the required 6 feet separation to bedrock. I order to improve the filtering I also suggest to place 6 inches of concrete sand under the rock. The "contaminated" rock and sand can be buried on site. A lot line waiver is requested to two feet. Yours /Q Tob P.E. T.SPURKLAND P.E. 203W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 2 BLOCK 2 SCIMITAR 93 TOBY AND DEBRA EASTON .Bedrock at 7 feet Use Pressurized Bed Soil Rating. From test May 11, 1994 <1 min/in On site material is 94% sand See sieve analysis Use .7 gal/ft.sq Required Area per Bedroom: 150/ .7 = 214 sq.ft.. Number of Bedrooms 3 Bed Area 3 x 214 = 642 sq. ft. SYSTEM CONFIGURATION MOUND TOTAL LENGTH 43 FT. .TOTAL WIDTH 15 FT. SEPTIC TANK 1250 GAL STEP. Remove existing tank, sewerrock and top 6 inches of underlaying sand. Import 3 feet of "Valley" Sand from Quality Sand and Gravel Wasilla Import 6 inches of concrete sand 6 inches of sewer rock 3 feet of cover The installation of this septic system will not prevent wells from be installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. Septic System Design Lot 2 Block 2 Scimitar 13 pg.1 PRESSURE CALCULATIONS Total head loss: 30 ft. Pump delivery at 30 ft. From pump curve: Discharge per 1/8" hole at 5 feet of head: Number of holes: 33/0.42 = 80 Spacing of holes: 38x12x3/80 = 17[inches] 33 gpm 0.42gpm Septic System Design Lot 2 Block 2 Scimitar 23 pg. 2 " RELEASE OF GENERAL RIGHT OF WAY EASEMENT KNOW ALL MEN BY THESE PRESENTS that MATANUSKA ELECTRIC ASSOCIATION., INC., an Alaska non-profit electric cooperative corporation of Palmer, Alaska, hereinafter called "ASsociation", for a good and valuable consideration, theI receipt of which is hereby acknowledged, does rem~se and release unto ~ Toby Eastin and Deborah Eastin. 3545 Madison Dr., Rock Springs, Wyoming 82901 ~ein'~{ter ~iled','"wi'{'~'6ut reference to number or'gender, "Own~'~~nd'tO h~ heirs, executors, administrators, successors, and assigns, FOREVER, all.of the right, title and interest of Association in and to that general right of way easement over t. ot 2~ Block 2, SCIMITAR UNtT NO. 3 SUBDIVISION, .according to Plat No, 80-151~ Anchorage Recording District, Third J?dtcial ~tstrlc'b~ .. State of Alaska. . .... .~ ..... Section 10 Township granted to the Association by ...... ],SN Range 1W , S.M,, William A. Platzek and Mildred I. Platzek on June 18 19~ , as wi)l more fully appear in that c~rtatn right of way ~ase~ent" rec6rd with-~'he Recorder for the Anchorage ... Recording District, Alaska, in Volume .752 ..... at Page""~.O08' IN WITNESS WHEREOF, Matanuska Electric Association, Inc., acting by and through its duly authorized General Manager, or his representative, has caused this remise and release to be executed this 20th day of May , lg 9z~ . MATANUSKA ELECTRIC ASSOCIATION, INC'. ..... UNITED STATES OF AMERICA) SS STATE OF ALASKA ) IHIS IS TO CERTIFY that on this 20th day of May 19 9~ before me, the undersigned, a No~blic in ~'~'He st~te'"Of Alas-~-~-, duly commissioned and' sworn as such, personally appeared Robert G. Ylvi~dker ~ MatanusKa ~'~'riC , General Manager, or his r'epre'~ent~'~ive~. inc., an Alaska corporation, known to me to be the General Manager, or his representative, of the said corporation; and that he was duly authorized to do so for the uses and purposes set forth therein, by .......... express authority .of its Board of Oinectors, on ~ecord in. its corporate flles,.~, ~¢. . - .: ,~!,~:.'. IN WITNESS WHEREOF, I have .hereunto set my hand and affixed my official seat the day and year in t~ts certqficate first above written. PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ownship, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E COMMENTS Depth to Water After./ Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ [ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN '~ FT AND ''~ ~/'[,.- FT . PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUlDELINES IN EFFECT ON THIS DATE. DATE: ~/~r~ &c.~j /¢ ¢¢ 72-008 (Rev. 4/85) 45 ~ A I -lJ4 PVC with 1~$" holes at 17" 0 al SECTION 5 Ff. of Cover 4" Topsoil 6" Halfpipe 1-1/4 PVC Holes Pointing Up 8" Sewer t~ock 1-1/4" Distibution Pipe Idirafi 140 6' Concrete Sand 5' "Valley" Sand 91.5 90.5 87.5 l - l J4" Discharge Bedrock @ 85 1250 gal STEP tank TOBBEN SPURKLAND P.E. 203 W 15TH. AVENUE AK. 99501 LOT 2 BLOCK 2 SCIMITAR //3 TOBY EASTON 19855 SEIKA D£1VE, CHUGIAK SEPTIC SYSTEM DESIGN DA TE: MA Y 24, 1994 SHEET: 5/5 GRID: NW 1261 / I £OAD / I I I I I / I I I I III //~ ~ REWOVE EXIST. TANK INSTALL 1250 GAL STEP RE, rOVE CONATWINATED ROCK AND SAND REPLACE BED BOTTOIW OF ROCK ~ 91 TOP OF BED @ 95 EXIST GRAVEL ~iiiI 50 75 i00 SC/~LE: U = 50 125 lbo TOBBEN SPURKLAND P.E. II 20.5 W 15TH. AVENUE ANCH. AK. 99501 {'907l 279-5916 LOT 2 BLOCK 2 SCIMITAR S/D TOBY ~ DEBRA EASTON 19555 SEIKA DRIVE I I SEPTIC SYSTEM DESIGN DATE: MAY 25, 1994 SHEET: 2/3 GRID: NWI2$1 5O 0 5O i00 150 / ~00 ££ALE; 1" - lO0~ / / / / / / LOT 4 ~ / LDT 5 / I / LOT ~ / i I I LOT ~ / L~T ~ / / ! TOBBEN SPURKLAND P.E. II 205 w 15TH. AVENUE ANCH. AK. 99501 (907~ 279-3916 LOT 2 BLOCK 2 SCIMITAR S/D TOBY & DEBRA EASTON 19855 SEIKA DRIVE SEPTIC SYSTEM DESIGN DATE: /dAY 7, 1994 SHEET: 1/3 GRID:NWl261 k~.) MUNICIPALITY OF ANCHORAGE ~'---~' ) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE I~_EW LEGAL DESCRIPTION LOCATION NO, OF BEDROOMS Well Absorption area Dwelling PERMIT NO, DISTANCE TO: ~ ~ Manufacturer Material No, of compartments ~ ~ Liq. capacity in gallons Inside length Width Liquid depth / ~OO IF HOMEMADE: ~ ~ ~ DISTANCE TO: Well Dwelling ~ PERMIT NO. ~ ~ ~ Manufacturer Material Liquid capacity in gallons ~ Well Foundation Nearest lot line PERMIT NO. ~ Nc. of lines Length ofeachline Total lengthofl. /~ Trench width Distance between lines _ inches ~ ~ ~ Top of tile to finish grade Material beneath tCJe Total effective absorption area ¢ inches Length ~ / Width /~, Depth %~j ~ ~ PERMITNO. ;, Typeofcrib ~ Cribdiameter -- Cribdepth __ Tota]effectiveabsorptionarea ~ Building foundation Nearest lot line Well i J DISTANCE TO: //~ ~ z w ~ ~ ~ ~ Class Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS SOiL TEST RATING INSTALLER "' fCC REMARKS ~ ... 1.~. APPROWD ~ ~ ~ ~IN~ DAT~ . LEGAL :i. ~ ()C:, (). () .>i..::~. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ~_ SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: L..-.- ~>'~ ~ 4 § 7 8 ~0 11 12 13 14 17 18 20 DATE PERFORMED: SLOPE SITE PLAN COMMENTS WAS GROUND WATER ~¢ ~_ ENCOUNTERED? O O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop FA~N (minutes/inch) D -- FT PERCOLATION RATE TEST RUN BETWEEN CERTiFi ED ~f~'~'~/' WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES -~' Division of GeoIogicnl a Geophysical Surveys C~C';:" Drilling Permit No LOCATION OF WELL {Please complete either la, b orJc.) A.D.L. No. la.l[8orough Subdivision Lot Block I-"~.I '/4qfre. Section No. TownshiP N [-'] Rongo ED Merldiao Ic.lJDISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 5. OWNER OF WELL: Myers & Myers Address: PeO. ~x 670351 F~ef Below 4. IL DEPTH f[nel) 5, DATE OF COMPLETION 2. WELL LOG Surfoc~ ~~,. rock green 20 ~5 [ 7. us'E:. ~ Domeltic , ~ Public Supply ~ Induitry rock grey dark ~d w~te rock ~rev and black soft 78 ~3 a. CAS'NG: ~ Threaded ~ Welded ~ { ~ ~ 8ackfillin~ Gr~vel pock  ~ Dote ~., ~ Above or ~ Below land surface ""~ ~l,~ II. PUMPING LEVEL below land surface and YIELD IZ,GROUTING Well Grouted: ~ Yes ~ No I~. PUMP= (if ovoJloble) HP Length of Drop Pipe ft. copoclty g.p.m. t~. REMARKS: 16. WATE~ WELL CONTRACTOR'S CERTIFICATION: 15. Water Temperature o ~ F ~ C This well w~s drilled under my jurisdiction and this report is true to the best of my knowledge and belief; ~m.a~ 5kvles We%l Municipality of Anchorage Development Services .Department -. -'~ .,'...;..' '. ..BuiIdingSafetyDivis,on . .... . , ,-.' i..~-i ".~:'~ On-SiteWaterandWastewaterProg~n · '' ' P.O. Box 196650 Anchorage~ AK 99519-6650 .. ? ,' ....... www.cl.anchorage.ak.us ·' o ..... "':. .'-.- . (907)343-7904 . . ,CERTIFICATE OF. HEALTH AUTHORITY AppROvAL :' : "' FORA SINGLE FAiVllLY DWELLING . Parcel I.O~ "0'51 '- [77 t~-~ 1. GENERAL INFORMATION .completd leg~al description Expiration Date: ,/0 -,.q-.~-O I Current Property Owner(s) Mailing addie§s~ Lending agency . Mailing address .Real Estate Agent ' ~.~,tA,cc,-~ '" Mailing'Address Un/ess otherwi's~ requested, HAA will be held by DSO for pickup. 2. NUMBER OF BEDROOMS: '~e.~[t~.,t FJ'?.Day phone 3. TYPE OF'WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well [] [] [] 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 (HAA) based only upon the representations given in paragraph 5 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 end may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for 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. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that m~; investigation, ;baSed on procedures outlined th the Health Authority Approval Guidelines for this app cation, 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 hereifi[ I further verify that based on the information obtained from the Municipality of A~chorage files and from my investigation and inspection, the on-site water supply and/or, wastewater disposal system is(are) in compliance with all applicable Municipa! and State codes, ordinances, and regulations in effect at the time of instaIIation. Name of Firm Address Engineer's Printed Name 5. DSD SIGNATURE ~ Approved for bedrooms .... - Disapproved Conditional approval for bedrooms, with the following stipulations: ?' · i; ~ ' ' ~: ' .,itl · ~,¢,-:~v nl~ ,~ ..'.~¢~;-. ~ .- '.. ~/~'... Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (Rev, 1Z~O) Municipality of Anchorage Development Services Department Building Safe~/Division On-Site Water & Wastawater Program 4700 S~uth Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 ww~.ci.anchorage.ak.us (S07) 343-7~04 HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: ~.e'l' ~ ['~(~ ~C_ll..4i.~-/~l,~ ~t-},,'~ ParcellO:O~l-t, 3, q-6"z- WELL DATA · Well type ..~ , ' Date completed ~_~.~ Total depth ! q~.-- ff. Data of lest Static water level Well production ff A, B, a. C provide PWSID # . Smlitan/seaJ (Y/N) %/ FROM WELL LOG g.p.m. *Well Log (Y/N) y Wires pmpedy protected (Y/N) Casing height (above ground) AT INSPECTION I, ~ g.p.m. WATER SAMPLE RESULTS: Coliform (~ colonies/100 mi. Nitrata' ~) Data of .mp,e: ~/~'~/", co,e'~: Other bactari~ (~ colonies/100 mi. SEPTIC/HOLDING TANK DATA Tank Type/Material ~t~'-[~ ~ Tank size le~.-~L~ gal. Number of Compadments _ Cleanouts (Y/N) y 'Fou~datio?deallout(Y/N)....~._ Depreselonovertank(Y/N)~ High,~__~.wataralarm(Y/N) \/ Data of pumping tO -~.~/--U C.~ Pumpe~ ~ C. ABSOR[-~IION FIELD DATA Date installed ~./r~ Soil rating (g.p.d./ft~ ~;~ ~; '7 System type 'P/IX~, ~-~ Length H '~ ft. Width ] ~ ft. Gravel below pipe ~ ft. Total depth ~ ff. El. absorption area ~J'~. ~ Mortifying tube ? Depression over field Data of ad~quaw ta.t ~'~ZI,~ ! msu,. (Pas~Fai0 "~ For, ~ ~e~rooms Fiukl depth in absorption field before test ._~ in. Water added ~V,'~)gel. Now depth._~_ in. Elapsed Time:],.~l~ min. Final fluid depth ~ in. Absorption rate >= -;z/~-- ~ , g.p.d. Any rejuvenation treatment (past 12 mo.) (YiN & type) ~ If yes, give date V~*' D. LIFT STATION Date installed 'Pump on" level at '7~ in. Datum I~0t ,i~ ~ E. SEPARATION DISTANCES Size in gallons 'Pump off' level at 7~' in. C~cles tested Manhole/Access (Y/N) y High water alarm level at ~ ~ in. Meets alarm & circuit requirements? ___.~ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot : I O/c:) Absorption field on lot ] J ,.~ Public sewer main ~4/L On adjacent lots '~' / ~ On adjacent lots "~ /0~) Public sewer manhole/cteanout ~_/o( __ Holding,--,,,. Sewer/septic sendce line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Property line ~ Water service line ~' ,-~ Building foundation ~-7 Water main I"1'//~ Wells on adjacent lots _~' ,/~ Absorption field 5 Surface water r~ J 1::) Water main D~veway, parking/vehicle storage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line. o~ ~ ~(~'~' ~ Building foundation ~' 7 Water Service line '~ ~"O Curtain drain ~/~ Surface water I'~ Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems ere/n conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name '-"~ ~J)'~ ;"/ ~ ~ I/1' ~Z.. IAi4 ~ Date ' HAA Fee $ Date of Payment Receipt Number (Rev. 12/00) J &, Waiver Fee $ Date of Payment Receipt Number Jt~-zg-ell 09:25 FI~T4E E~I~IR~N;AL SRV Z1 CT&E Environmental Ser~lcof Inc. 9CTSEI$301 T-~6G P.01/C6 F,-416 Sample Remarks: Olmt ~ Pre-Paid Coli~NO3 Printed Dat~/'llme 06/27/2001 15~4 CoI~ ~t~e 0~1 14:30 ~ei~d D~ 0~1 16:16 TKknlcal Dior Sle~m C. ~ PQL Units Mc~bod Limim D~ Ikt~ Init 0.~00 U 0.500 r~/L EPA 300.0 ('Cl0) 06/22/01 SCL ~tc~:obiolo~I' r. abor&bory Total Coliform 0 0 col/lOOmL SMISgZ2~Z] 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 GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner ,~_.~ J~;m ~ I ~ Io ...(, Mailing address _~,~ % ~'( ~ ~'~ ~ Lending agency Mailing address Agent ~L;~ ~o Address ~¢ ~ ~¢~ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ Day phone Day phone Day phone TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verifythat 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 -~--~- t~ u '- ~.'-L- [.~ ~~-/ Phone r¢-~7 ~- ,-S ~ //° Address ,2_0 ~ ~ /,~ ~o ~ 'I~ ,~-~.~,~~ Date 7/~ / ~ ~ Engineer's signature DHHS SIGNATURE X. Approved for -~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 (Bev. 1/91) Back MOA ~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number \/ Date completed /~/~'/' ~ ~ Driller ~/'¢ ~ -~JzY'/~ / I c~ ~ Cased to ~--~/'r-,~ c ~'~ Casing height c-~ / '?/ Wires properly protected (Y/N) / Date of test Static water level ~ L~ / Well flow Pump level1 /~ ~Z"~I SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I D ~, Absorption field on lot l I ~ Public sewer main ~///-~ Sewer service line ~ ~2 O FROM WELL LOG g.p.m. ATINSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: ~/~ Nitrate /. I Other bacteria Collected by: ' B. SEPTIC/HOLDING TANK DATA Date installed ~//2-/~ Cleanouts (Y/N) / High water alarm (Y/N) Date of pumping Tank size 1~'/'~ ~) Compartments Foundation cleanout (Y/N) "/ Depression (Y/N) / Alarm tested (Y/N) Pumper /"'///'~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /~ ~ On adjacent lots To property line ~_~4~ Absorption field Surface water/drainage /"V/o ,~ '~ Foundation Water main/service line 72-026 (3/93)° Front CONTINUED ON BACK PAGE C, LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot I O ~ On adjacent lots Manufacturer ,/-'~I ~ Manhole/Access (Y/N) Z- "Pump off" Level Cycles tested /'"'/ Surface water /~ o ~ ~__ D. ABSORPTION FIELD DATA Date installed Length ¢ -?:> Width Total absorption area ~ ¢.2_ Date of adequacy test /~.//,/~' Soil rating (GPD/Ft2) Gravel thickness Cleanout present (Y/N) /'"/' Results (pass/fail) ~ System type ~ ¢~' Total depth ~ Depression over field (Y/N) /k..// for -~ Bedrooms Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / / To building foundation On adjacent lots Surface water ~, Curtain drain ~ On adjacent lots ~ / ~ Property line To existing or abandoned system on lot Cutbank /'%,/~/~ Water main/service line Driveway, parking/vehicle storage area ~ E. ENGINEER'S CERTIFICATION I cern'fy that I have checked, verified, or conformed to alt MOA and HAA guidelines in effect on the date of this inspection. HAA Fee $ Date of Payment 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number CT&E Reft// CLient Sample ID Matrix ClientName Ordered By Project Name Project# PWSID Commercial Testing & Engineering Co. Environmental Laboratory Services LABORATORY ANALYSIS REPORT 94.3119-3 19835 SEIKA DRIVE SEMITAR LT2 BLK2 WATER TOBBEN SPUKKIANI), P.E. TOBBEN SPURKLAND UA WORK Order 79737 Printed Date 06/25~94 ~08:23 krs. Collected Date 06/22/94 ~ 15:15 hrs. ReceivedDate 06/22/94 ~ 17:00 hrs. Technical Director STEPFIEN C. EDE Sample Remarks: ROUTINE SAMPLE COLLECTED BY: BJORN. QC Parameter Results Qual Units Method Allowable Ext. Anal Limits Date Date Init Nitrate-N 0.10 U mg/L EPA 353.2/300.0 10 06/23/94 MCE * See Special Instructions Above ** See Sample Remarks Above U = Undetected, Rep orted value is the practical quantification limit. D = Secondary dilution. UA = Unavailable NA = Not Analyzed LT= Less Than GT= Great er'Ihan 5633 B Street, Anchorage, AK 99518-1 600 -- Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section; township, range) Lot 2; B~_-ck 2; Sc,'_m;~.-?. #3 Location (address or directions) (b) Property owner B¢i~n- Mailing Address 129 (:L ~*'~ (c) Lending Institution Mailing Address' (d) Real Estate Company and Agent Telephone: (home) Telephone Aurora Prop~rti~/ Nancy Stahly Business Address P.O. Box 671923, Chu~iak, Alaska 99567 Telephone 688-4939 .-_'~'z .,- (e) Mail the HAA to the following address: (or check here FI, if hold for pick upl) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family {~ Number of bedrooms 5 3. WATER SUPPLY Individual Well,~ Community [] Public [] Note: If community well system, must .have written confirmation from the State Department of Environmental Cons;grvation attestin~ t° th leg'alitY'a~id'statu~ ' ' ': ' ' 4. SEWAGE DISPOSAL On-site,~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) 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, Iverifythatmyinvestigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional.and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm $ & $ _~NGINEER!NG 17034 Eagle River Loop Roaa Ad dress Date Telephone 6.'DHHSAPPRO, VA L Approved for ~.-~ ~bedrooms by _ -. Date Approved ~ Disapproved .Conditional Terms of Conditional Approval TheMunicipalityofAnchorageDepartmentofHealthand Human Services(DHHS) issuesHealthAuthorityApproval 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 DHHSdonotconductinspections 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. 7/88) 8ack Page 2 of 2 ' ~h~,';~- ,~UNICIPALITY OF ANCHORAGE (MOA) ~ ,, r*~/~;~'!',~`~©' Health Authority Approval (HAA) ~.~[~ , .,, . : ' : LegaIDescnpbon: L~ Well Classification ~ A~ tJ ( ~~ Well Log Present~) ~Date Completed ~ ~ ~ ~ ~ Total Depth ~ Casedto'~ Depth of Grouting Static Water Level ~ Pump Set At ~ Casing Height Above Ground ~ ~ ~ Sanitary Seal on Casing~N) ~ Electrical Wiring in ConduitS/N) ~ Depression Around Wellhead (Y~ SEPARATION DISTANCES FROM WELL: If A, B, C, D.E.C. Approved (Y/N) Yield To Septic/Holding Tank on Lot I To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by ~,¢~' Water Sample Test Results Comments ~ ~-~:~ ~;' B. SEPTIC/HOLDING TANK DATA Date Installed "~ "}''z'-~;~ Size ~ No. of Compartments Standpipesd[~!~N) "~ Air-tight Cap~dC~N) ~ Foundation Cleanou~:~N) ~ Depression over Tank (Y~j~ Pumping/Maintenance Contact on File IY/%/.¢' Holding Tank High-Water Alarm (Y/N) S. Ep~.RAZi.,ON DISTANCES FROM SEPTIC/HOLDING TANK: ,' ' :To Water-Supply Well I fo~ I, To Building Foundation .. '._ . . t 4- To Disposal Field · 7;oP'rop~rtY Line ' , To Water Main/serv ce Line ~ ~:~ To Strea~n, P°ndl Lake or Major Drainage Course D/ate Last Pu m ped / \ '" '~"'" ~ 1~/, ~ ;for Temporary Holding Tank Permit (Y/N) r"t//~ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ ~ \ ~ Width of Field I. ~ I ~-'¢~'c:~'~:'/t:''r'~''--~ Type of System Design -- ~::~ ~ Length of Field "2"~~ I Depth of Field Gravel Bed Thickness C~ Square Feet of Absortion Area _ ~ ¢----'~¢¢ ~ Statndpipes Present (:~J;~N) Depression over Field (YA[C~P Date of Last Adequacy Test Results of Last Adequacy Test ~¢--~;~~ ~ ~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ ~. ~ To Property Line ~ ~ To Building Foundation ~:~ ~ To Existing or Abandoned System on Lot ~ /¢' ; On Adjoining Lots .-~ To Water Main/Service Line. \ ~ 1.w To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Cutback (if present) D. LIFTSTATION /,~ / Dat Installed. 'Pump On" Level at Dimensions Manhole/Access (Y/N) "Pump Off" Level at High Water Alarm Level at ~ Vent (Y/N) Tested for '~'~h:m~;~g~ycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ~ **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S & $ ENGINEERING 17034 Eagle River Loop Road No. 204 Company ~-~r, ^~.b. oqJ~?7 Date MOA NO. ReceiptNo. C>~,,/'-~7~--~ ~ 2d¢%~) ~ Date of Payment ' Amount: $ //,7~--'2'- 0 C~ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. /~--:~ 5633B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907)562-2343 FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT 8Y SAMPLE for Work Order $ 17977 Date Report Printed: NOV 5 89 @ 16:08 Client Sample ID:L2, B2 - SCIMITAR $3 PWSID :UA Collected OCT 31 89 @ 15:30 hrs. Received NOV 1 89 @ 16:15 Preserved with :AS REQUIRED Client Name : S & S ENGR Client Aect : SNSENGP P.O.$ NONE RECEIVED Req # Ordered By : Analysis Completed :NOV 3 89 Laboratory Supe~rv/spr ~ST~PHEN C. EDE Released By :~"J '~~~'.~ Send Reports to: lis & S BNGR 2) Special Instruct: Chemlab Ref $: 8353 Lab Smpl ID: I Matrix: WATER Allowable Parameter Testad Result/Units Method Limits NITRATE-N ND(O.IO) mg/1 EPA 353.2 10 Sample ROUTINE SA~PLBS. Remarks: SAMPLES COLLECTED BY R.3.S. I Tests Performed * See Special Instructions Above UA=Unavailable ND= None Detected "See Sample Remarks Above NAr Not Analyzed LT=Less Than, GT=Gzeater Than MUN C PAUTV OF A.CHORAGE DEPARTMENYOF HEALTH AND E.WRON E"T^' DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, Location (address or directions) ~L,~,.~j~ ~ Telephone: Home t~,-~tCJ~-~' Business ~'~:~ (b) Applicant Name Applicant Address - (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) IV~,I the HAA to the foll(~wing address: .,. ~ ·, :':7! i;:;F ?. ( ~ .!~: :., TYPE OF RESIDENCE Single-Family,,t~L Multi-Family [] Number of Bedrooms ,2~ Other WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite J~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72~o25 (11/84) ENGINEERING FIRM PROVIDIN(~SPECTIONS, TESTS, FILE SEARCH, DA'i~..¢iND INFORMATION ~s certified by my Seal affixed hereto and as of the validation date shown below, I verify that my investigation of thi~' Health. Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. ~ ', ,-¥ ~'-~,-~ .~- -;'~,.'- - Telephone Name of Firm ~,; :- ~' · ,~ ,-, Date ....... A p p rove d f o r~-/~ ~'~-" (~,/~d r o o m s ~y~~~ Terms of Conditional Approval CAUTION The Muncip. ality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approva certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 I~EPT. OF Ht~^LI'H & JNVIRONMENTAL PROTECTION Legal Description: WELL DATA If A, B, C, D.E.C. Approved (Y/N) Date Completed /"~ ~ ~ ~ Yield ~¢1~..- ~ Depth of Grouting Pump Set At t5 ,¢._, Sanitary Seal on Casingdj~N) Depression Around Wellhead (Y/-~ Well Classification Well Log Present~;)N) Total Depth 14:::~~-'~ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit g~1'4) Separation Distances from Well: To Septic/Meld~ Tank on Lot To Nearest Edge of Absorption Field To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~---~ ¢*~ S ¢¢:~-~-~t ~ ~ ' ;Date B. SEPTIC,~ANK DATA Size \ ~ No. of Compartments ~ Foundation Cleanout ,d~/N) Date Last Pumped ~ ~- ; for ~/~ Temporary Holding Tank Permit (Y/N) Date Installed Standpipes CC/N) Air-tight Caps (~) Depression over Tank (Y/,I~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/T~Tank: To Water-Supply Well I ~ ~ "" t To Property Line To Water Main/Service Line Course To Building Foundation ~ 1~ To Disposal Field ~, ~ To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72 026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata '~ ~---'-~i'~'~J ~ Type of System Design Date Installed r~ ~ I'~ ~:-~ Length of Field Width of Field ~ ~E~5' · Depth of Field Square Feet of Absorption Area Depression over Field (Y/~- Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ~ //L To Water Main/Service Line ~. c:~ ~ 4¢ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Gravel Bed Thickness LC Standpipes Present ~/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots "'2"~-¢~ '~ I. To Cutbank (if present) ~ ~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test, Meets MOA Comments v ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Company Receipt No. Date of Payment Amount: $ Date MOA Page 2 of 2 72 026 (11/84)