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SCIMITAR #3 BLK 3 LT 4
imitar Block 3 Lot 4 #051-132-87 www.sullivanwaterwells.com Pump Installation Log Well Drilling Permit Number: SW Date of Issue Parcel Identification Number: Legal Description Property Owner Name & Address Scimitar #3 Block 3 Lot 4 Harold & Linda Lawson Pump Installation Date: 10-27-20 Pump Intake Depth Below Top of Well Casing: 250 feet Pump manufacturer’s Name: F&W Pump Model: 4F07P07301S Pump Size: 3/4 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Installer: Unknown Disinfected Upon Completion? yes no Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer: Unknown Pump Installers Name: Sullivan Water Wells Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201462 PID Number: 051-132-87 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name HAROLD & LINDA LAWSON ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 20124 SOLLERET DRIVE, CHUGIAK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Fill added above original grade Ft. Gravel length Ft. SCIMITAR #3 3 4 Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line FtZ Ft. Well 99' __ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ -- NA Foundation 10'+ ILIFT STATION Manufacturer Capacity Gal. Remarks IR based on visual measurements & info provided by owner Installed without permit in July 2012. Tank insulated. Alarm location Electrical installed by Tankto PIPE MATERIAL House to tank 3034 3034 Installer Owner/ McCormick's Edge Const. dra afield Drainfield co/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection1s` 10/28/2020 Location and description dates: 2nd 3`d 4`h IBOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL OF • Conditional Approval: Date AW I . . " " " " " " " • Curtis Huffman �� Septic System Appd!� L Date �� -3"ZO ZO ��G' • CE 128991 �� �s�F�• . ,10/28/20�o•��� PROFESS4�N�, Note: this approval does not include well permit requirements. tKev ubwz/ib) PID: 051-132-87 PERMIT: OSP201462 MT M � I 1000 -GAL HDPE SEPTIC TANK INSTALLED IN 2012 W/OUT PERMIT LOT 4 BLOCK 3 EXISTING Co 10.0' �Q�� FIELDS �❑ ��OJ CO CO Co � CO ® • bD ��po D C h Y�'72 0, 0' O 0 0' +\1o' A—C=33.9' B—C=59,0' A—D=38.7' B—D=54.0' SEPTIC SECTION SCIMITAR #3 BLOCK 3, LOT 4 PREPARED FOR: HAROLD & LINDA LAWSON 20124 SOLLERET DRIVE CHUGIAK, AK 99567 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK©gmoil.com 5urruK i5trtvit;t5: OF AZ,`� r C 9 TH DATE: 10/29/2020rtis Huffman , SURVEY: JLS 2020rs CE 128991 DRAWN: FWCS 10/29/202V of SCALE: 1" = 30'olmsslo-t;' C Z A FCO B WELL No 4g 3' ® O N o � r nom, 14.0 W m g,5' Y 3: `� O N 25.0' O + U 13.0 2 , 6 2 DECK o Q O M / v V SCALE, 1' = 30 SEPTIC SECTION SCIMITAR #3 BLOCK 3, LOT 4 PREPARED FOR: HAROLD & LINDA LAWSON 20124 SOLLERET DRIVE CHUGIAK, AK 99567 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK©gmoil.com 5urruK i5trtvit;t5: OF AZ,`� r C 9 TH DATE: 10/29/2020rtis Huffman , SURVEY: JLS 2020rs CE 128991 DRAWN: FWCS 10/29/202V of SCALE: 1" = 30'olmsslo-t;' C ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-132-87 Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s) HAROLD & LINDA LAWSON Day phone 9072291593 Mailina address PO BOX 202681, ANCHORAGE, AK 99520 Site address 20124 SOLLERET DRIVE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) SCIMITAR #3 B3, L4 Legal description (Township, Range & Section) Lot Size 73071 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) M (w/wo ADU) Septic Tank El Upgrade ED Duplex (D) El Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 41 a 7 5 Date of Payment: Receipt Number: Permit No. 0 •S PQ 01 (� Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc site Work - Replace septic tank 4,082.14 4,082.14 Labor $1,325.00, Equipment $400.00, Materials $2,357.19 A Phone # Total $4,082.14 Invoice McCormick's Edge Construction Corp. r P.O. Box 67J 908 Oiugiak, AK 99567 t , su 712212012 1191 907-229-2723 j tieitigci.nat 1 Bal & Limy Lawson P.O. Box 202681 Anchorage, AY, 99520 ,s g 3 1" +de`", .h"w'..u- Moo Net 15 site Work - Replace septic tank 4,082.14 4,082.14 Labor $1,325.00, Equipment $400.00, Materials $2,357.19 A Phone # Total $4,082.14 Customer Copy Invoice REMIT TO: invoice Number 0027538 -IN Invoice Date; 7/19/2012 mama Initials: KGB PO Box 190708 LE L' Toll Free: (800) 770-8265 affirm Order Number: 0015493 Anchorage Alaska 99519 Phone.. (907) 243-2455 ' ' Order Date: 7/1912012 Isaac (907) 248-9212 Payment Type; CC 6662 Check Number, Said Job Number. DENNIS MCCORMICK DENNIS MCCORMICK 20124 SOLLERET 20124 SOLLERET Chugiak, AK 99567 228-2723 907-688-.1031 FAX Chugtak, AK 99567 Contact: ,Phone Customx-P-Q Shin VIA FOS Terms 0 Item Number Unit Ordered Shipped Back Ordered Price Amount PE1000SE EACH 1.000 1.000 0.000 101.0000 1,881.00 POLY SEPTIC 1000 GALLON WelghC 558.00 lbs PE FERNCO EACH 2.000 2.000 0.000 16.0000 3200 PE FEEtNCOCPL 1056x5+1(5.8x4.3$) Weight: 0.00 lbs /DELIVERY 0.0000 100.00 Delivery Charge Weight: 0.00 Ibs PLEASE CALL CUSTOMER AS YOU ARE PASSING FT.RICH. Total Weight: 558.00 lbs No sioldurg Invoice Total: ` $2,013.00 Recd Payment Received: $2,013.00 By; Invoice Balance: $0.00 ALL Claims and returned goads MUST be accompanied by this bill PAST DUE BALANCES MAY BE SUBJECT TO.87545 MONTHLY SERVICE CHARGES (10'.5% ANNUAL), LIMITED BY STATE USURY LAWS. "~ ~' MUNICIPALITY OF ANCHORAGE '-~; DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENI'AL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING A D D R E~. PHONE I~NEW [] UPGRADE LEGAL DESCRIPTION LOCATION DISTANCE TO: J Well ~.~. Absorption a?a I- Z Manufacturer Lq. capacty nga ohs IF HOMEMADE: Inside I..e_ngt h Well / Dwe ng ,^ Dwel 'n I + W dth DISTANCE TO: Manufacturer Well DISTANCE TO: No. of Jines ~~ J Length of e~ch~line Top of tile to finish grade Length Width Type of crib Crib diameter Well Material beneath Depth Material Nearest lot linei Trench wi~ ~) inches NO. OF BEDROOMS inches PERMIT NO. No, of compartments Liquid depth PERMIT NO, Liquid capacity in gallons PERMIT NO. . ¢ Distance between lines / Total effective absorpj~io~ area /-~-----~ '~/r~ PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line DISTANCE TO: Cl~;~(~ ~ ~,~_j ~ ~qqept~h Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorpt on area(s) OTHER PIPE M~TERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED DATE 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: 1 2 3 6 7 8 9- SLOPE DATE PERFORMED: ~*'~'~ SiTE PLAN 10- 11 12 13 14- 15 16 17 18 19 2O COMMENTS PERFORMED BY: 72-008 (6/79) / ENCOUNTERED? / IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop /,.. TEST RUN BETWEEN ~ , FT ~WATER WELL RECORD ~/ STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological ~ Geophysical Surveys LOCATION OF WELL (Please complete either Io, lb or lc.) ~-i~.lBo,ough / Suhdivie,on3 L~/ :k ~]J V, dtr.. ] .Lnc.~oragd~ Sci,mi[ar t__o~__ o~o~ --I Ic.I~DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS Street Address end Area of Welt Location 2. WELL LOG Material Type ~ock ¥~ite and bro,<m rock g'>r~,r g~en ro~ green and 8re~ rock gr~ cre~ses water ro~ gre~~ green Feet Below Surface Top 8¸0 zoo 16. WATER WELL CONTRACTOR'S CERTIFICATION: Drilling Permit No. A.D.L. No. Section No.I TownehiPNO I Ronge Bottom E[--~ Merldion wE] /~,~ 6S 285 S. OWNER OF WELL; Myers & ~;yers Address: PeOe;~OX 670351 Cimgt~, JJ~ 995~7 4. WELL DEPTH; (final) 5. DATE OF COMPLETION ~ Auger ~detted ~ Bored ~ Other: 7. USE: [] Domestic [] Public Supply [] Industry [] Irrigation [] Recharge [] Commerical [] Test Well [] Other: 8. CAB½NG: [] Threaded [] Welded diem. ~') In. to~4 't. Depth Weight !? lbs./ft. c~[am, in. to__ ft. Depth Stickup__ ft. 9. FINISH OF WELL: Type: O~I). Diameter: Slot/Meeh Size: Lengrn: Set between ft. and Backfilling Gravel pack 6 ft. I0. STATIC WATER LEVEL: .~0 ft. 5 ~ /85 []Above or [~ Below land sue'face Date Equipment used: II.PUMPING LEVEL below lend surface and YIELD ~'~ ft. after i hrs. pumping t g.p.m. __ft. after __hrs. pumping ~g.p.m. lC.GROUTING Well grouled: [] Yes [~ No Material: [] Neat Cement [] Other: IS. PUMP: (if qavalloble) HP Length of Drop Pipe ft. capacity g.p,m. [] Subm. [] Jet [] Centrifica, E] Other 14. REMARKS: 15. Water Temperature o ~'J F ~ C This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief; Gene Sk~ies Well Dr~l~ug A 169~1 Re'gistered Business Name Conlroct License Number ~dd .... ; P.O. Box 67147~ Chu~Lak, _~, 99567 Form OZ-WWR (11/81) Copy Distribution: WHITE'-SfoIe DGG$, PINK-Driller, CANARY-Customer MUMMPALITY (OF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 051-132-87 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description SCIMITAR #3 BLOCK 3, LOT 4 Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: 2- -Z - Location (site address) 20124 SOLLERET DRIVE, CHUGIAK, AK 99567 Current property owner(s) HAROLD & LINDA LAWSON Mailing address Real estate agent PO BOX 202681. ANCHORAGE. AK 99520 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ 'Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the.engineer. COSA Fee $ � 1 � , 5 b (CDQ I b - 1 Date of Payment -Z d Receipt Number 2 N Z 0 1 COSA# ow ni 59 Waiver Fee $ Date of Payment Receipt Number Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 10/23/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the\k, system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of theAw P'�i • •�!`1�1�1 well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWCS ' *� �.' tTM. .....•.* LN— . .11J... ....J ... 6. DSD SIGNATURECurtis Huffman ' System #1 Approved for 3—bedrooms c/sT .. CE 128991 F�10/23(209 7, System #2 Approved for bedrooms it e PROFE8s�� Disapproved Conditional approval for bedrooms, with the following stipulations: ll�lllI1TV(r o R, WAS, %/ ,AJVtJ m A44 o� �/S�co1 nnCC,O 1\� B r Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description IMITAR #3 BLOCK 3. LOT 4 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 5/30/1985 Total depth 285 ft Cased to 44 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 10/30/2020 Static water level at beginning of test *62.5 ft. Well production at time of test *0.42 gpm Parcel ID: 051-132-87 Structure served by this system _ Water storage tank volume 500 gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 0.271 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) NES Collected by> Date of Sample 10/15/2020 Comments *SULLIVAN WATER WELLS CONDUCTED WELL FLOW TEST & REPAIRED WELL PIPING. - SEE ATTACHED B. TANK DATA Age of tank(s) 8 years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank 47" ® Standpipes/foundation cleanout per record drawing Date of pumping 9/8/2020 D. ABSORPTION FIELD DATA Which system tested (date installed) 6/1/1985 ® ALL standpipes present per record drawing Total measured depth from grade 6.1 / 4.9 ft (max) Measured depth to pipe invert from grade 3.1 i 3.1 ft (min) ❑ N/A — pressurized field C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 10/10/2020 Results N Pass For 3 bedrooms Fluid depth prior to test 37 / 0 in Water added 900 gal (TO N TRENCH) New depth 37 / 8 in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 3'/ 1.7' INTO THE 3.5' ED* Elapsed time 110 min ®Code -required soil cover over field Final fluid depth 37 / 0 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: *SIMILAR TO 1999 COSA. S / N TRENCHES. LINES JETTED: SOUTH TRENCH BASICALLY SATURATED FWES E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No 99 ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No _ Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No —ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION�i��'�'®����a�l 1 ..... •• certify that 1 have determined through field inspections and review®��`.: • •�`�� of Municipal records that the above systems are in conformance �. •;� �¢ with MOA COSA guidelines in effect on this date. • i1'1 ... ••: �� Curtis Huffman /d ���Fc�s,• CE 128991�,.o� ft ft ft ft ft ft ft ft Municipality of Anchorage R Development Services Department 44 . Building Safety Division $ A F ti'T Y ^ On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 -Arv.ci.anchorage. ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC201597 During a recent COSA on-site inspection and test of the potable water supply well on Block 3, Lot 4 of Scimitar 93 subdivision, the well's productivity was determined to be .42 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is .31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. 0 360 4Q ��� ) rn r� o NN N`13`3�50o E (13 WCQ ?nx�s co U \\ 11 00 ��: -1 C0 m ,LLJ W� o 0 o `� '• oma. ' ,s' it o �\ F 1 � 0.-, 49'3' ®�xo40Z z �0 C4 ys�O� \ sy 26.2' •Dll . V (o 00 o b 12.0' v�'yj c'cl o A ;° v .c � o o ff W 01 N8.0' ov w�3 JU C7 ® �a� [C.� om 7 20.0 w i--1 3 p >. N v> �A ?� Z c v, G Y! EAVE � a 4 A r.t o cs ro oD 43 Y FN \ o 0o W CA H¢C, s 43 u O o <OLLJ sz �4 N ti b U o ">' Fo, W C� y .N. C t1, O O D "J• O hail >.. v� s U G vi O vl �*0 w n I > p . v �� Z v�UO x>, O T r d dcrla �o=� w�0 3 N Municii ality,of Anchorage · . ["~ Development Serv,ces .Department · ,' ~'~.: ;%~-,~.%1=.4/I,., ....... ~(.'. ,'::, , '.:,Buildingsafe~Di~imo6*,;; :.,' .- ' , ~ .~ :... ,.. On~,te Water and Wastewater Program .., , ~. · _: . . ..,, : ..... :- P.O. Boxlg6650j~orage,~u9519~650 .:::;~ '.. '. :~-,::'.~. '. ~., . . · . ::,. ,? :..:: ;.. · . ..-,~ (907)~3-79~ ...... - · -- -. - CERTIFICATE OF H~LTH AUTHORI~.APPROV~L ' * : ......... ~* ' "FOR A.S NGLE FAM LY D~ELLfNG~; ' Parcel I.D,- 0 1, GENERAI~ INFORMATION '~ Complete legal de'sdription Lochtioh (site addres§ or directions) ·. Current Property..o?ner(s)· . Mailing add{e~,~ ? '::,z'. :'..' Lending agency .... ,. P'/7 ..... ._,..- -.C) I .7 · Expiration Date: ~' ° ~- O I Lot 4, Block 3. Scimitar 20124 Solleret Drive Daniel & Carol Fisher Dayphone PO Box 772202,.~Eagle-River, AK'99577 Mailing address .... Real E~tate Agent - Mailing Address Unless'otherwise r'equ~sted, HAA wi#be h~l~lby DSD for pickup. NUMBER OF BEDROOMS: 3 Day'phone 3..TYPE OF WATER SUPPLY: Individual Well Ir{dividu~i Water Storage Community Class ~ Public Water System Prudential'/Elena"Novitsky-- Day phone'727-6703 3201 C St'r'e'et',' 71200;'Anchora£e; AK'99503- " WeIl TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual. Holding tank Commumty 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 AJaska. Certificates of Health Authority Approval are required for the transfer o[ title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Cedificates of HeaIth 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 sam. pie 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 propedies served by Class A o~ 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 my investigation, ' based On procedures outlined in the Health Auth0~:ify Approval Guidelines for this application, shows that the on-site water supp y and/or wastewater disposal s~,stem is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further vet fy that based on the Information obtained from the Municipality of Anchorage tiles and fro~ my. Investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State cedes, ordinances, and regulations in effect at the time of installation. Name of Firm s & $ ENGINEERING Phone 1t0~,t I;a(31e River Loop Road No. 204 Address Eaqle River, Al~si~a 99'~'/7 Engineer's Pdnted Name Robert C. Cowan, P.E. Date 5. DSD SIGNATURE Approved for Disapproved. Conditi(~nal approval for barrooms. '~ ~?~ ..~,~ ~ ~l~.~r,..:~%?,~ ~ bedrooms, with the following stipulations: Additional Comments Attachments: HAA, Checklist X Septic System Advisory Well Flow Advisory , Maintenance Agreements 'Supplemental Engineer's Repor~ Other By: Original Certificate Date: fi"- 3' ~) / Municipality of Anchorage Development Services Department Building Safety Division On-81te Water & Wastawater Program 4700 Sauth Bmgaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (SO?) 343-n~04 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: WELL DATA Well type~[~.~ t/,~'(-*''~- Date completed ~ Total depth ~' ifA, B, or C provide PWSID # Sanltar,/seaJ (Y/N) /~'~ Weil Lo~')N) y~ Casing height (above ground) / ~-- "~in. FROM WELL LOG Date of test ~ / . Static water level ~ lt. Well production ~ g.p.m. WATER SAMPLE RESULTS: Coliform . ~)~ NilmteO.~13o mg./I. colo~lias/lO0 mi. 'Date of Sampte:*' ~f'//'~/~/ Co,ected by: B, SEPTIC/HOLDING TANK DATA Tank size ~ gal. Number of Compartments Foundation cleanout (Y/N) ,C/~.<; Depression over tank (Y/N) AT INSPECTION 41 1o, · .~7-! It. fo P'~ g.p.m. Other bacteria C) colonies/lO0 mL Cleanou~(Y/N)" ~2-~-~ High water alarm (Y/N) ~'~//,R- ABSORPTION FIE~.D DATA L~gth ~ fl. W~th ~ ff. Gravel bel~ pipe ~. ~ fl. Total dbp~fl. E~. abso~n a~ ~ ~ Mon~i · ~ Depression over field ~ ~ Da* of edequa~ .t ~/~/~/ Resul~(P.dFaa) /~5 For ~ b.r~ms Fluid depth in ,b,~pfion field b~re test ~ in. Wet, add,~g,. N~ dep~ / ?~' in. Eleps, Time: ~ ~ min. Final fluid d~ ~ ~. ~,,fi~ rate >= ~ >~ g.p.d. D. UFT STATION Date installed IT/ I 'Pump on" level at ._.~'in. Datum / E. SEPARATION DISTANCES Size in gallons 'Pump off' level at in. Cycles tasted Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements?. in. SEPARATION DISTANCES FROM WELL ON LOT TO: SepUc tank/IUt, ataa'~iT on lot Absmptlon field on lot /~ ("~ ~'/-' Public sewer main /~/A* , / S,~j~eptlc service line On adjacent lots On adjacent lots Public sewer manhole/cleanout. / /~///6- Holding tank - /~//,.~- / SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~ Property line. ~" */~ Absorption field ~" /~'- Water main /"/ Water service line /0 '~- Surface water /0 0 / ',-' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ~C") -,'- Building foundation /~") .-,-- Water main /%/' Water Service line /(~ ~- Sur~ce water /L'~('~/~/''- Driveway, padrino/vehicle storage Cu~ain drain A~V[-~.f/~/ Wells on adjacent lots /"'~'~ ~ /0/ Fo COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal reccm:fs that the above systems are/n conformance with MOA HAA guideflnes in effect on this date, Engineer's Printed Name ~)0~,~7' C. Co Date HAA Fee $ Date of Payment Receipt Number (Rev. 12/00) 300. s*'/,/o t OO~J( Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE MEMORANDUM WATER WELL ADVISORY During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot ~ Block ~ of g~;~;T~? ~ Su~a~v~s~on, tn. ~en's productivity was ~etermined to be ~'gallons per minute. The minimum well productivity required by this Department '(AMC 15.55).for a ~ bedroom residence is ~9, ~ gallons per minute. Although the subject well currently.exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies ~f the subject Health Authority Approval. IIODEII( C. COW^X, P.E. DODEII! A. SI IArErL P.E. CLIENT: WELL RECOVERY TEST DATA ~'~/-FC-'rZ/ .. "::-' CML FXGItlEErI~ (907) 694.2979 FAX 1907) 694- WELL LOCATION. IIoDal): I.Cff* ~; t'2~L Ot g- ~ : ; ~ ! ~1~'/1 ~ ~-" ~ ' TEST DATE: .'et'l~.o]O1- ' TE~TED DY. WELL DEPTIh ~ ~ WELL DRILLER: E~(~ CASI'G DEPTII: dO'~ DATE DRILLED: TEST PROCEDURE~ · 1) Draw water down lo pmnp. 2) Shut pump off 15-60 rah1. -record lime -lecord meter leading 3) 1urn pumpo,. Drawdow,. 4) Shut pump off. -record Ihne -lecord meier leading S) Calculate gal.lmht, lecovery. I~IISC DATA;' Cut,0 Ilelghh Sanitary Seal? Wires In Condull? Grading 0.1(.?. Samples Taken? ! TESTPATP,: STARTTIME: 14t~-,~ STATIC WATER LEVEL: '~' TR,AL II II '.UE' II ,.',,=TER II GAL/MIlL t ON OfF /~V ~b~.b . ~ ON 144~ orr 14~3 I OFF 3 OX OFF OFF 4 OtJ . OFF OFF . 6 OFF pESULTS; WELL cURREHILY PRODUCES: Oe ~'O (~DC'q FLOW RAIE HOT OUAnANTEEO-SUI3SEOUEHT V^m^IlO.S carl occur{. 11034 I'lOllll I EAGt E 13fv1:i'! I OOP * St lITE 2O4 ·/A~IE IIIVEIT. Parcel I.D. # 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 DWEL~_ING 051 -132-87 1. GENERAL INFORMATION Complete legal description Lot 4; Block 3; Scimitar Subdivision #3 Location (site address or directions) 201 24 Solleret Property owner Mailing 'address Chuqiak, AK Markaye Simpson Dayphone C/O Prudential Vista Real Estate 16635 689-6504 Centerfield Dr. Lending agency Mailin. g address Eagle River, AK Day phone Agent Address '.Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 '~ TYPE OF WATER SUPPLY: Individual well xx Community well · . , ~. Public water NOTE: lng to the legality and status of system, 4. TYPE OF WAS;rEWATER DISPOSAL: If community well system, provide written confirmation from State ADEC attest- xx Individual on-site NOTE: 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. ?2-025(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, l 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 this inspection. Name of Firm Address Engineer's signature Alaska Water & Wastewa¢.r ~;onsultants, lrlco Shall be PALE) $ I,~ 1"70 ~°' . a~ or prior to, c!osin9 for the Engineeri,%! Se~ices Provided. DHHS SIGNATURE ~/ Approved for bedrooms. Phone Date Disapproved. Conditional approval for bedrooms, with th-e 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 profe, ssional engineer's work. 72-o25(Rev. 1/91) ~ck MOAC¢21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) MUNICIPALi~ Health Authority Approval Checklist LegalDescription:~T~,~/~/T~ ~ Parcel I.D.: A. WELL DATA Well type '~)~ d~-(~- If A, B, or C, attach ADEC letter. ADEC water system number ~J///~- Log present .~/N) Y~ Date completed ._~- ~O -~ Cased to L/H Total depth Sanitary seal Casing height (above ground) .~o' '4- Wires properly protected ~.~N) ?'-~' FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Date of sample: g.p.m. Nitrate ,, 2. -~ ~.~//_- Other bacteria Collected by: /~Jc,~C,j ('~ ~-. g.p.m. B. SEPTIC/HOLDING TANK DATA Date installed 61[ {o~ ~'~ %'"~'~, Tank size Foundation cleanout ~N) /OO~ ¢-¢~L Number of Compartments .2_. Cleanouts~/N). Depression (Y/~i)~ ~ High water alarm (Y/~ Date of Pumping '~-H. -%c[ Pumper C. ABSORPTION FIELD DATA Date installed ~[/~' Soil rating . . . i,,,,~,,,,,v~. (g p d/fF or¢,, ,,drm) Length (~ ,~.6' = '~T~/idth ~0 Gravel thickness below pipe Effective absorption area L~r~'~ ¢¢'r~u~ Monitoring Tube present ON) ~ Date of adequacy test ~/~Jc~c~ Results P~as.~/Fail) ?¢LS5 System type ~/l /-'/~ ~ Total depth ~ Depression over field (Y/¢ For THEEE bedrooms Fluid depth in absorption field before test (in.);¢) o~y Immediately afte~5~ gal. water added (in.):(~ CD ~,$~ 9'&~-u:~ FluM ~epm~ ~y (ins) ~inutes liner: J~ ~,~. Absorption rme: ~ g.p.~. Peroxide treatment (past 12 months) (Y/~ ~o If yes, give date ~o~+, ~)~ o~y 20" ~ ~T, 72-026 (Rev. 3/96)* ~ ~ T~B~u,C~i~ ~os ~cy ~5~ g~ D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SECARATION DISTANCES Size in gallons~ '~'4~-~n['q eCel at* .Datum~_ "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main I,kJ//~- Sewer/septic service line ~'% On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation [ 6 '+' '~L Property line ! o Absorption field ~s~. Water main/service line /Or-~ %urface water/drainage /Oo'~- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: - L_~ Property line Surface water Curtain drain Building foundation / o '¥ Water main/service line Driveway, parking/vehicle storage area ~o~ Wells on adjacent lots ENGINEER'S CERTIFICATION ~- ,t~"~'%%~ ~ I certify that Ih/a~¢~m Id inspections and review of Municipal rec~~'~ ~ms are Engineer's Name ~~ ~. ~~SX ~~~; ~ Date ~[~3 ~ ~;~ ~';~ ~'~ .... ",~' ~' HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE MEMORANDUM WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO.~qqO0~ During a recent Health Authority Approval on-site inspection and test of tt~e potable water supply well on Lot 4 Block~_ of 5~ Subflivision, the well's productivity was determined to be 03~_ gallons per minute. The minimum well productivity required by this Department (AMC 15o55) for a 3 bedroom residence is .3/ gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies ~f the subject Health Authority Approval. Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2-B - Anchorage - Alaska 99504 Phone (907) 337-6179 - Fax (907) 338-:}246 Consulting Engineers March 9, 1999 Markaye Simpson c/o Prudential Vista Real Estate 16635 Centerfield Drive, Suite 103 Anchorage, Alaska 99577 RECEIVED ~A?, 1 6 1999 Municipality ot Anchorage Dept. Health & Human Services Subject: Well & Septic System Inspection at Lot 4, Bk 3, Scimitar #3 S/D. Dear Ms. Simpson: Per your request, we performed adequacy tests on the subject well and septic system. The results of the field investigation and adequacy tests are summarized as follows: A. WELL: The static water level on 3/5/99 was 72 feet below the top of the casing (BTC). Attached is a copy of the field data. Based upon the recovery readings, it was concluded that the production is approximately 0.35 gallons per minute, which meets the MOA requirement for a 3 bedroom well, which is 0.31 gallons per minute. Production of this well may vary seasonally, and future performance is not guaranteed. B. SEPTIC SYSTEM ADEQUACY TEST: The drainfield is a dual trench type system that was installed in June of 1985. According to the M.O.A documents, the south trench is 26 feet long and the north trench is 23 feet long. Both trenches are 5 feet wide and have an effective depth of 42 inches. Prior to perforating the adequacy test, 300 gallons of liquid (with some sludge) was pumped from the sump in the south trench. On 3/5/99, prior to the start of the adequacy test there was 10 inches of liquid in the south trench and the north trench was dry. Over a period of several hours, 1000 gallons was introduced into the south trench via a pump truck. This caused the liquid level to rise to 40 inches (5 inches above the invert). In addition, 568 gallons was introduced into the north trench from the well. The sump in the north trench remained dry throughout the test. Approximately 3 hours later the liquid level in the south trench has dropped 12 inches, indicating that roughly 400 gallons had been absorbed. Based upon this data it was concluded that the septic system meets the absorption requirements established (by the Municipality of Anchorage) for a 3 bedroom house, which is 450 gallons per day. CLOSING: Water samples have been taken and are being analyzed for nitrates and bacteria. As soon as the results are available we will fax them to you. If you have any questions, please contact me at 337-6179. Sincerely, ~ Jeff mess, P.E., M.S. Pres~den Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2-B ~ Anchorage ~ Alaska 99504 Phone (907) 337-6179 N Fax (907) 338-3246 Consulting Engineers March 9, 1999 Prudential Vista Real Estate 16635 Centerfield Drive, Suite 103 Anchorage, Alaska 99577 Attn: Lynda Banner Subject: Well at Lot 4, Bk 3, Scimitar #3 S/D. Dear Ms. Banner: As stated in our report to the property owner dated 3/3/99, the actual production of the subject well is around 0.35 gallons per minute. Since static water level in the well is around 72 feet, and the total depth of the well is 285 feet, there is about 320 gallons of water stored in the casing/boring. It is my understanding that Ms. Simpson installed a new 500 gallon water tank in the garage on 3/6/99, bringing the total volume of stored water to around 820 gallons. The well production (0.35 gallons per minute), in conjunction with the storage ava'dable, will allow for a peak flow demand of over 3.5 gallons per minute for a period of about 4 hours. If you have any questions,.please Sincerely,~/~ //~ contact me at 337-6179. ....... ':- '~-'~: ..... ~:-'~'~:'-'~';~"~'~; '~ On~i{e S~'~iC'~S'Se~ti0n'' ~'~ ~:~.~e-.-..:~. ~:. :.-~,.~?:-- "" ~:~ .... ' ~' '-': P.o'~ B~ ~g6650.:'Anchorag~,:AI .......... .: ................ 3~7 ................ .......... ; ~ CERTIFICATE OF H~LTH AUTHORI~ .......... ~ ............. ~ ........... APPRovAEFORA SINGLE FAMILY DWELLING '- . Parcel-~D.-~' "~-:7:0'51=~52=8~L:= "~.'~ ...... n~:~?~H~. ~ HA 950577 ......... ~ 1.' ~..GENERAL iNFORMATION -~' ...~_ -~ .' '~;?~' ~':~' ,~.4~ .~ :~_;~.,~.: ~.,;;-_ ~'Complete legaLdes~ription ot 4i- ~ock 3~ S~ Sab~v~ion ~3 ~_- _. --:~." ?cation~[~te'adi:Jress ordirections) )'. ~'L+. ~';~:~%;' ".' ""~'Aii~'~Aaa~'"'~"-P, O,' ~o~ 67~46 ' C~E. AK 99~67 : ....... ..'. ~}?~)~.' 'E~'hdiOg a~'~n~: ~ :: ~ :-' ":: ~ . .Day phone ~~ . .,L.;~&.:; ~- n=,-:.-?- ,: ...~. . ~g:;qf;Maflmg, addres~ :" ~' ':.' ' L.. 7-:/~'.. ;;' . .L - '-- ....... · .,g~;,;;~,;::~::~.~'LF,::.;~;;¢-[~dlvIdUa[W~It4,{~G.{~;:~F,:?.. .~::~ - ...... ,;~,_.:..~._.. ..... '..:.-_: _.-;:..;:~:: ,~&:,:. ::-: ~-' - :---:~..~ ;?-.- · 4." ~PE OF WASTEWATER DISPOSAL' ....... ,:.~Communl~onls!te, -.~ :....... ...:,-.:.,..:..-:..,.:..-..--.=.~.. : ..,,~.. ::~ .¢2." i ~.~ ' .. ~_':~ "NOTE' if 8ommUni~ Wastewater system, prowde wn~en confirmation from State ADEC -; .. - . : a~esting to the legah~-and status of ~ste~..- ;¢~ :-~:~ :.;-;'~ '....-~?:;~..:,}~};~}.¢~':~?}~.?:{~75'::2. :,:=:;~. _ As ce~ifled by my seal affixed hereto and.*asofthe, vahdat~on date shown, below, ~ ven~ that my investigation ~°f this Health AuthoriW Approval'application shows that the on-site water supply and/or wastewater disposal system is ~fe, functi0aal and'adequate for the number of b~rooms and Wpe of structure indicted herein. I fu~her veri~ that based on the information obtained from the Municipali~ of Anchorage files and from my inves~ation and insp~tion, the on-site water supply and/or w~tewater dispo~l system is in compliance with all Municipal and State codes, ordinances, and r~ulations in eff~t onthe date of this insp~tion. Name'of Firm 17~4 E~le River ~ Reed Ne. 2~ Addre~ E~e R~r, ~a~ka ~ - The'Municipality of Anchorage Department'of Health and Human services*[DHHS) issues Health Authority Approval Certificates based only upon the representations give'~ilin 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 institutic ns in order to satisfy certain federal and State requirements. Employees of DH HS do not conduct ,i,nspectio,ns or analyze data before a certificate is issu?cl. The Municipality of Anchorage is not "*i:espon§ible for erro~ or omissions m the professional engineer's work. ~ " 72~25 (Rev. 1/91) Bac~ MOA ~21 - ' W~R ~Ln m~V~SORZ HEALTH AUTHORITY APPROVAL NO. ~//~ ~'-d'~f~'7 During a recent Health Authority Approval on-site inspection and test~of the potable water supply well on Lot ..4 Block of ~)~/~,~-~.f~ Subdivision, the well's productivity was determined to be ~ gallons per minute. The minimum well productivity required by this department (~C 15.55) for a ,2J bedroom residence is ~,5/ gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of noncritical water uses such as washing cars and Watering lawns and gardens may be required. This advisory must be attached to all copies of t~e subject Health Authority Approval. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental ~lervices Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343~4744 Health Authorit A royal Checklist ~ Y PP A. ~LL DATA Well e ~ kt~ ifA B otC attaCh~ECleaer ~ECwater stemnumber Log presented}C4') ,q Date completed Total depth 2--~'~ ~ Cased to ~Oc ~ Casing height (above ground) Sanitary seal ~q) ~ ¢,--3 Wires properly protected FROM WELL LOG AT INSPECTION Date of test '~-'~c> -~ fi' Static water level ~'~c3 ' c~-7 Well production ~ ~ O g.p.m. 0,~-~ g.p.m. WATER SAMPLE RESULTS: Coliform ~ Nitrate O ,7-7_.- Other bacteria db Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed /~ ~ I- ~6'- Tank size ~ o c>r> Number of Compartments 7,~ Cleanouts Foundati:on ~lean0ut~q): x/ Depression (Yt~J> ~-\ High water alarm Date-ofPum'Ping , /,~5/°[3~Pumper * ,~. Co Fluid depth ~- o Minutes later: o" (in.) Absorption rate = Peroxide treatment (past 12 months) 0[~:>. t,J o ~,.l~i l&Jou.),~fyes, give date ABSORPTION FIELD DATA Date installed {..0~/~5'- Soilrating (g.p.d./ft20rft2/bdrm) ~'~J~/t~2~ Systemtype Len~g~h t-Icl ~ Width ~- I Gravel thickmess below pipe ~ ,~'~ Total depth Effective absbrpfiofl'~ea t~ ~'od~ 4- Monitoring Tube present~fl~ ~ Depression over field (Y~). Date of adequacy test ~-"2-7,-~q ~' Result~l) f:>O<;c~ For '~ bedrooms Fluid depth in absorption field before test (in.); ~ ~ ~ Immediately after 50o gal. water added (in.): ~3~0 .4- g.p.d. D. LIlT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump on' level at* ....~ump ofF' level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ~,c2 c:;> : On adjacent lots Absorption field on lot \ ~-~ ~ ~ '~ ; On adjacent lots Public sewer nmin [/x Public sewer manhole/cleanont Sewer/septic service line '7,--~ \ 4- Lift station SEPARATION DISTANCES FROM SEPTiC/I4OblM-N~ TANK ON LOT TO: Foundation qO t ~ Property line \ O\ ¥ Absorption field Water main/service line I t9 ~ [' Surface water/drainage ~ o o ~ lc Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~3--~.~ t ~ Water main/service line \ t~ Surface water ~, o~ ~ J~ Driveway. parking/velficle storage area Cnrtain dram b~ ]/5. Wells on adjacent lots [ C>e, F. ENGINEER'S CERTIFICATION I certify that I ha~e determined thrufield inspections and re Jew ofMuni ipal in conformance ~ith 3~OA [~.~M guidelin~n effect on this date. Engineer s Name ~tO/fi4~ F k. kOg.~W~ ............................................................................................................ ......... HAA Fee $ ~DD ' c~ Waiver Fee $ Receipt Number /ZqC ~ '~7 ~) Receipt Number Rev. 8/95 OSS: haa.wk.doc 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. # .~,'~\ - /.:~)~-%"-~ GENERAL INFORMATION Complete legal description Lot 4~ Block 3~ Scimitar Subdivision #3 b¢~&~i~n' (site address or directions) ~ Brad & Kathy Wol~ property owner Mailing address P.0, Box 672246 Lending agency 20124 Soller~t Chuqiak, AK Chugiak, Day phone AK 99567 Day phone 688-9653 Mailing address Agent Address Day phone = Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: $ " TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest° lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and s~atus of system. 72-025 (Rev. 1/91) Front MOA #21 5, STATEMENT OF INSPECTION BY ENGINEER o 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 inves.tigation 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 ~ & ~ ENGINEERING 17034 Eagle River Leop Read Ne. 204 Address ·. _,_ ,,:.~ ~4..~.. ~s/7 ~ Engineer's signature ~_ , _. .~ Phone DHHS SIGNATURE Approved for .,~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following Stipulations: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA HEALTH AUTHORITY APPROVAL NO, ~//~ ~dP_~y During a recent Health Authority Approval on-site inspectio~ and test~of the p~[~l~ water ~upply w~ll o= Lot J B~O¢~ ~ of ~/,wT,~/~f . Subdivision, the well's productivity was determined to be ~.~ gallons per minute. The minimum well productivity required by this department (AMC 15.55) for a -~ bedroom residence is ~,~/ gallons per minute. Although the subject well currently exceeds this minimum requirement, .all part'ies concerned are advised that the production capacity of the well may fluctuate. Restriction of noncritical water uses such as washing cars and Watering lawns and gardens may be required. This advisory must be attached to all copies of t~e subject Health Authority Approval. ROBERT C. COWAN, P.E. ROBERTA. SHAFER, RE. HEALTH AUTHORITY APPROVALS SEWER&WATER MAiN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECH4NICAL INSPECTIONS ON SITE WASTEWATER C~SPOSALSYSTEM DESIGN WELL FLOW TEST DATA' LEGAL DESCRIPTION: ~¢),,3_,.~ '~...~ ~e~y4,1../~ S/~ WELL DEPTH: 2-~5 ~ CASING DEPTH: ~-)1¢1 ~ DATE DRILLING COMPLETED: CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MISC. DATA: CASING HEIGHT: ~ 7.~~[ ~ SANITARY SEAL: WIRES IN CONDUIT: %/~-S GRADING O.K.: BACTERIA AND NITRATES/AMPLES COLLECTED (date): TEST DATA: METER PUMPING DEPTH TO CLOCK READING RATE WATER REMARKS TIME (GAL) (GPM) (FT) t~ ',~ ~ ~ ~ ~ ' ~ ~ ~ oo ~ ~ ~7 7 ' 'tJ~k, RESULTS: WELL CURRENTLY PRODUCES O,5'S GPM WITH A FLOW RATE NOT GUARANTEED-SUBSEQUENT VARIATIONS CAN OCCUR, 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ROBERT C. COWAN, RE. ROBERTA. SHAFIER, RE. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANE) REPORTS WELL INSPECTION & FLOW TEST SiTE pLANS ROADOESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN CIVIL ENGINEERS WELL RECOVERY TEST DATA WELL LOCATION (legal): TEST DATE: ~ ~ 2.-'7.- -~ WELL DEPTH: CASING DEPTH: ~ (907) 694-2979 FAX (907) 694-1211 TESTED BY: WELL DRILLER: DATE DRILLED: TEST PROCEDURE: 1) Draw water down to pump. 2) Shut pump off 15-60 min. -record time -record meter reading 3) Turn pump on. Drawdown. 4) Shut pump off. -record time -record meter reading 5) Calculate gal./min, recovery. TEST DATA: START TIME: MISC DATA: Casing Height: Sanitary Seal? Wires in Conduit? ~.*~ Grading O.K.? ~,S Pump Depth: Samples Taken? Date: /.0', '?...,c> STATIC WATER LEVEL: ~'~ t TRIAL II PUMP II T ME II METER II GAL/MIN. OFF I ON ,_... --- 0."/?.- OFF 2 ON --- " ~ ,"7 o OFF OFF OFF OFF 0 4 ON ___. OFF c~ ,.-~o ~.~, ~) OFF C~'. 5 ON ~ --~ 0,~ RESULTS: WELL CURRENTLY PRODUCES: c~..~.._ ~;~I~-.E-- \ ~ \ FLOW RATE NOT GUARANTEED--SUBSEQUENT VARIATIONS CAN OCCUR. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 4; Block 3; S~mitar Subdivision, ~3 Location (site address or directions) 20124 SoZZer¢.t. Chugiak Property owner Andr¢.~ Hass and Te~r~ SpigcL~y¢~ Mailing address Day phone ..... Lending agency Day phone Mailing address Agent Donna Gunn Vista Re.~Z E~;f:o~f'~. Day phone Address 3000 "¢" Street. Suite 101. Anchorage. Al~ka 99505 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 562-6464 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. XXX TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 fRev. 1/91) Front MOA ~21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Phone Name of Firm Address Engineer's signature ~!NGINEERING River Loop Road No, 204 Alaska 99577 DHHS SIGNATURE Approved for .~.,*,-Z,-~'~',~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments /3,>? 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. 72~725 (Rev. 1/91) Back MOA#21 (~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-~'T ~ ~-¢- '-~ ~---,~'-¢~L~\c~'~-~ Parcel I.D. ~)~'~/-]~--d'~ A. WELL DATA Well type ~¢-t'J ~ Log present(~)/N) ~ Total depth ?-" ~'~ Sanitary seal (~N) If A, B, or C, attach ADEC letter. ADEC water system number ~--~/ Date completed ~'- ~'~c~ - ~' Driller Cased to ~ Casing height "~ ~ Wires properly protected ~/N) ~ FROM WELL LOG Date of test Static water level ~"C, t Well flow \ Pump level g.p.m, AT INSPECTION ENviRONMENTAL SE~V CE~ DIVJSi ~ SEPARATION DISTANCES FROM WELL TO: . Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ~'~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform -(.~ ~..o~ J ~.~o¢~ .q. Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed I_~ Cleanouts ¢._~/N) ~ Foundation cleanout (.~N) High water alarm (Y/~ Date of pumping __ \\~ Collected by: Other bacteria $ & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Compartments ~ ~ Depression (Y~) Alarm tested (Y/N) ,~l ~. Pumper ;~'.[Z-, C.-¢-~ ?~ ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \~,o ~ To property line Surface water/drainage Foundation /--~c~ Watermain/serviceline_ L~o ~ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level ~'~Cycles tested Meets MOA electrical codes (Y/N) ~ SEPARA~IFT STATION TO: We.~JJ..edqot On adjacent lots Manhole/Access (Y/N) ~ Surface water D. ABSORPTION FIELD DATA Date installed bo~\ ~ ~ ~" Length ~ ~ '--- Width ,~.1 Total absorption area '¢d¢~''4-~ ~ Depression over field (YI~ ' ~ Results~fail) ~?./k"'¢~,> Peroxide treatment (past 12 months) (Y~..~ Soil rating ~ravel thickness Cleanouts presentd~N) Date of adequacy test ~,~._ \\.~c~.?~ ~o~ If yes, give date System type'~ ~ Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot \ ~ ~ ~ To building foundation On adjacent lots ~-~::~ Surface water ~,"~ Curtain drain On adjacent lots ~ ,=, c:~ \'~ Property line To existing or abandoned system on lot Cutbank ~ [,~.., Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this insp"~on. Signature Engineer's Name Date [iNGINEERING 99577 HAA Fee $ /~7~ ~'~ ~ Date of Payment //~/;~ -- ~9 2~ Receipt Number .~2/-/'~ z// 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number S & S ENGINEERING 17034 Eagle River Loop Ro~d E~gle River, Alaska 99577 uPA MUNICIPA~.ITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~)~1 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ¢'~'~ ~ ~-~_?/~C~Telephone: Home Business~:J~ Applicant Address P,O, ~;'2oC. g~ '~"! (~'?~1._}~tl/%,¢__ i /~z% (c) Applicant is (check one): Lending Institution []; Owner/builder,,~Buyer []; Other [] (explain); (d) Lending Institution Address Telephone (e) Real Estate Company and Agent Address Telephone (f) I~t'the HAA to the following address: ,$~F;~ B 196X TYPE OF RESIDENCE Single-Family[i~ Multi-Family [] Number of Bedrooms 5 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, Page 1 of 2 SEWAGE DISPOSAL Onsite¢ 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. _.~fl~ 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 regulations in effect on the date of this inspection. Name of Firm Address Telephone DHEP APPROVZ _. ~ Terms of Conditional Approval~ Conditional Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval 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 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 JCUNICIPAUTY OF ANCHC)P. AGE DEPT. OF HBALTH 8, ENVIRONMENTAL PROTECTION 'JUN 2 4 lqR, 264-4720 LegalDescription-L---~:-~'T~ ~C WELL DATA Well ClassificatiOn ~ ' ~, If A, B, C, D.E.C. Approved (Y/N) Well Log Present. N) Date Completed ~' *~L~-¢ '~5.~' Yield Total Depth '~"~;¢¢~ f Cased to ~' Depth of Grouting Static Water Level :~'~) ' casing Height Above Ground Electrical Wiring in Conduit t~ZN) Separation Distances from Well: To Septic/Ho!d;.m!~Tank on Lot Pump Set At ;~¢"~:;;~ j Sanitary Seal on Casing(~N) Depression Around Wellhead (Y~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~ ~'j~ '~ On Adjoining Lots ' ~'~ (~ To Nearest Public Sewer To Nearest Public Sewer Line¢o/ Cleanout/Manhole /~ To Nearest Sewer Service Line on Lot ~O - Water Sample Collected by ~F~¢, ~ ~,~& (.~',-..%~::::(27--f~.~k~..; Date ~o Water SampJe Test Results ~,~,~ ~ I¢,~,.¢.~¢r~ ¢~-.4 ~ Comments /k~ {.~ F~_..o~..) .7~_~.7-- 2/.~;~,/~.o ~ ~J~_~_.~. B. SEPTIC/~TANK DATA Datelnstalled (~2'k~'¢~Si/~ze II~:~ No. of Compartments ~' Standpipes ~_.~) Air-tight Caps./N) Foundation Cleanout (~)N) Depression over Tank (Y~) Date Last Pumped /"-J~'~"-J ~/ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) t.~/¢,1/ Separation Distances from Septic~Tank: To Water-Supply Well To Property Line To Water Ma=.~./Service Line Course //~' ; for ~'- Temporary Holding Tank Permit (Y/N) o Building Foundation ~ icc,. To Disposal Field ~ ~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 q5 72-026(11184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width 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 [ ~..'~ tcr Type of System Design Length of Field ~ I Depth of Field ~'~ I/'7~ ' Gravel Bed Thickness ~ ~4 Standpipes Present (~N) Date of Last Adequacy Test To Property Line ( f..'~ ~¢ To Building Foundation ~.~%.--;~ I ~ Lot To Water b~m'r/Service Line ~:20 14¢' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) ~/~. Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles 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 Signed .... Date ~ Company ..... ~'~ ~.~!'~E~[['' ~'~ MOA No. Receipt No.~H~ Date of Payment Amount: $ Page 2 of 2 72-026 (11/84} effect on the date of this inspection. MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) ~ CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: DEPT. OF ~ALTH & ENVIRONMENTAL PROTECTiOi~ ,JUN WELL DATA Well Classification __ ~ ' ~, Well Log Presentl~N) Total Depth .~.¢~ i Cased to Static Water Level __ ~'(;~) ' C~sing Height Above Ground Electrical Wiring in Conduit tl~N) Separation Distances from Well: To Septic/l~Tank on Lot IfA, B, C, D.E.C. Approved (Y/N) Date Completed ~' ~'~O'~ ~' Yield Depth of Grouting Pump Set At ;;g~-~O ¢ Sanitary Seal on Casing~N) Depression Around Wellhead (Y~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot JL.~'t~!~ .~ On Adjoining Lots _ ~(~.-~ ~"~ (~. To Nearest Public Sewer To Nearest Public Sewer Line¢.~/ Cleanout/Manhole /~. To Nearest Sewer Service Line on Lot ~O Water Sample Collected by ~¢¢ ~ ~-~(~ '~/',~fi-',....~.; Date ~ ~ ~ ~ Water Sampie Test Results ~:~,~-'¢l S ¢*/"~- '~"~ ¢~ ~ Comments /¢~ ~.~¢¢:2,-~ F:g-~v'~ '7'7~--"~ 2~/.4o~,)~'O ~ B. SEPTIC/~ANK DATA Date Installed (42--~,~'¢~/~ I (~ NO. of Compartments Standpipes ~'q) Air-tight Capsd~/N) Foundation Cleanout (~N) _ Depression over Tank (Y~) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) _ Holding Tank High-Water Alarm (Y/N) ¢'~/,¢'~) Separation Distances from Septic/H~Tank: To Water-Supply Well To Property Line To Water Mcin/Service Line Course ; for Temporary Holding Tank Permit (Y/N) To Building Foundation ~ I¢¢- To Disposal Field ~ 0 To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /~O ~ I ~ ~::~" Width of Field fL~._.~ TM Square Feet of Absorption Area Depression over Field (Y/~? Results of Last Adequacy Test Separation Distance from Absorption Field: '-~ff-~ ....... Type of System Design Length of Field _ Depth of Field ~ Gravel Bed Thickness Standpipes Present ~N) Date of Last Adequacy Test To Water-Supply Well To Building Foundation ~..--~ I ~ Lot I,~ [1,~ To Water M-afrr/Service Line !~::20 14¢' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ( ~ &' To Existing or Abandoned System on ; On Adjoining Lots -2~ ~-r-- To Cutbank (if present) _ ~//& Comments 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 ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and. I-fAA guidelines in effect on the date of this inspection. Date Signed ~~ _ ~ /~ ~-, Receipt No.~*H. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) 7: ~ - DATE RECEIVED ~. INSPECTION APPOINTMENTS DATE MUNICIPALITY OF ANCHORAGE MUNICIPALI~ OF ANCHORAGE DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTECTI~PT- OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P2OTECTION ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 DIRECTIoNs: Complete al~ parts on page 1. Incomplete reques~ will not be proceed. Please aJlow ten (10) days for processing. 1. PRObiTY OWNER ~ PHONE MAILING ~DDRESS / ~[~/~ PROPERTY RESIDENT (If different from above) PHONE 2, BUYER PHONE MAI LING ADDRESS 3. LENDING INSTITUTION PHONE ~AI LING ADDRESS 4~ REALTOr)AGENT _ ~ PHONE M~ILING ADDRES~ ' ' 5. LEGAL DESCRIPTION /or / sv o/I,IG STREET LOCATIO~ 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four J~ SINGLE FAMILY [] Two [] Five ~ MULTIPLE FAMILY J~ Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* COMMUNITY [] PUBLIC UTI LITY. * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available,) 8. SEWAGE DISPOSAL SYSTEM [~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] ~NDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [~ I NDIVI DUAL/ON -SITE [~¢0 B LIC UTILITY Connection Verified []Septic Tank or [~]Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: NUMBER OFBEDROOMS [~ ONE D THREE E~ FIVE FI TWO [] FOUR [] SIX [] OTHER PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLE~ NSTALLER SOILS RATING MANUFACTURER MATERIAL Septic/Holding Tank Absorption Area Sewer Line INearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS DATE APPROVED FOR _ 1~ BEDROOMS ~DITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79) #1: Time 9:3, Date 55~ Insp _ .DEPARTME[ OF HEALTH AND ENVIRONMEN- ' PROTECTION 8~5~-~ Street, Anchorage, Ala~. 99501 279-2511, ext. 224 or 225' Date Received: May 6, 1977 t~Monday %2: Time Date Time /,'~ Date REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Mailing Address: Property Owner: Terry C. Jordan Mailing Address: 9261 Shorecrest Drive Phone: Phone:243-3275 3o Legal Description: Lot 7A Block 1 Seacliff Subdivision 4: Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: 3 Number of Bedrooms: Well System: Permit # Construction Individual well ( ) Community/Public System (x~ Depth of Well Well Log on File ( ) Bacterial Analysis 6. Sewage Disposal System: Permit % Septic Tank Size AbsQrption Area On-site System ~ Public Utility ( ) Installed 1971 Installer Manufacturer Soils Rate Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Comments: Lot 7A BloC~ 1Seacliff Subdivision Af fadavit Attached Approved: ~ Disapprove~ Letter Attached: ( ) Date:. O--~fIq 7 7 Date: Department Worksheet: /i..'....'~ /:? _, .~, t,,...>:. . .... , ,, / , ,,,; / / z.' ./ /~_CC .... I ' ~ MUNtCIPALiIY Ok ANCHUHAtJ? '~'~"~-,' 1 f}epar~men-'L~mf Heaith and Environment(~' .P'~iF~"NN/ ' 825 L street, }~nchorage, Alaska .... ~,~,,A~,',~,-~,.,~,O~A.~ ~roperty Owner: ~5~,~' d ~/~,~z/. P/~u, :;~~,,_.~,~,~' Mailing Address: ~)~ec~ej~?- .~?~ _ Phone: Name of Buyer: Mailing Address: Phone: Lending Institution: Mailing Address: Phone: Realtor/Agent: Mailing Address: Legal Description: Stree~ Location: Single Family Residence: Multiple Family Residence: Phone: (Np//~Number of Bedrooms: X~ ( ) Number of Bedrooms: Water Supply: *Individual Well ( ) Public/Community System If Individual Well, well depth If Co~mmunity System, name of system S._~g~ Disposal System: On-site System ( ublic Sysuem If On-site System, date of installation: _ /.~/ ( ) *NOTE: A well ]_og is required on ALL wells drilled since 6/75. 3/77 ~EPARTNENT O~F ~'iVIROi'.~EI'.iTAL ~UALITY 3500 TL~OR ROAD /~i.:CHORAGE, ifi~ASKA 995o7 I~SPECT: REQUEST FOR APPROVAL OF IFDIVIDUAL SB'F~R Al9 !'lATER FACILITIES FOR / ~IUI~BER OF ~E, DROO~B,. 5, Wm.' . ~ATA, TYPE B, DEP~[ C, SIZE, D, CO[,ISTRUCTIO[i_ E, BACTERIAL Ak"ALYSIS. SI~,'IAGE DISPOSAL SYSTm: SEPTIC TAiL, N( (IF HOM~qI~E, SHOW DIAG~q ON DAC~ 1, ._s~.z~ /~ 2, ~ APPROVAL '"'~" ':°" B'~" " ~,~ U~..,~I FOR ~ ~ :::R : '~YER FACILITIES PA~E 'f~ .~0 J J, o~,=,AG~ PIT C, DISPOSAL FIELD 2, TOTAL LENGTH,__ i'~OU I R-ED EASUREJqENTS B,' !FLL TO SEEPAGE PIT C, ~'~ELL TO SE'J',ZR LIllE. ~. D, HELL TO PROPER~ LI:]E 5~L~1 .... F, FOU[~AT]O~.-] TO SE~[C TANK ~-~ FOUFDATION TO SEEPAGE PI~ SEEPAGE PIT TO PROPER~ LINE APPROV~ DATE .~rOi~ O:!E YEt'.,'', FT"::]ATE:,,.; SIn:EL AREA 20ROUGH DEPAR,1T'IE[ff OF r~!VIRO~'IE~CI'AL eUALIW FHA I%rm 2573 U. S. OE PARTklENT OF HOUSING AND URDAN DEV£LOPMENT ~ Form Approved FEDERAL HOUSING ADMINISTRATION Budget Bureau No, 63.R0296 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER ,SUPPLY AND ,SEWAGE DISPOSAL 5Y`STEM PART I.--TO BE COMPLETED BY FHA INSURII~G OFFI~ MOR?GAGEE ' ' SERIAL NO. ~e First National Ba~ ] of Anchorage 111-012~10~20~ ~;.~ Mo'~a!es, RUben D. & Celia C. 92~1 Shorecrest Drive, ~nc~orage J L~.G u. vs UO.~.S J ,*,.S ~S.~ IXI New znstallat,on . ' a~lb~m,? ). ' ~ ' ' ','. 'PART II.~TO BE COMPLETED BY HEALTH DEPARTMENT It is the opinion:of the:[-] State: [-'] County [~r] Local Department;of Health' that this individual water-supply system it is [--] is not satisfactory as a domestic water supply for property. : It islthe OPinion 0f the [-']1 State ['-:] C°unt~ ~']' LoCal Departmentilo~ Health that this individual sewage-disposal sys- tem with proper.maintenanCe: - - i : ~ · ; ; -' , : [~1 :Can be expected t° function sat~factor!ly, and ['-1 Cannot be expected to function SatisfaCtorily ? L_~ is:not likely tO create an insanitary Condition : ' . : : DATE : SIGN RE ':5 .... ::~ i ;'.. ]TITLE : : ~ ' ; " i'~ ~ ~ :; "OTE: Th~/~l~ .uthorit~ ,No,Id Complete the ,pprop,l,,o opl,ion statement above ..d a~x date. Signature .nd title in the [ USe of, e~bov, grid for Health: Department InspectOr s sketch os well as us° of the back of this farm is at tho option of th° / health aulhorlty~: - : " i ' i: · , /' ' / pA% ih,--FoR uSE OF FHA OmCE : . ~': ,hat, e reVieWed th~ foregoing and the pertinent FHA C0mpliaqce InspeCtion R~P~rt,i and rec0mmend that the , , Individual wate}-supp!y System be considered F1 Acceptable [] Not Acceptable ' ;:4:: ;; :.. Sewage diiposal.. . be c°nsidered F'] Acceptable:. F'I Not Acceptable. . · ii ' · : ; i { ' . ' : : :~5 :,': ;: -:; II " i : ' : : · ~ " i : ' . DEpUTYFO~CHEFARCt, f~EcT :- ' , HEALTH AUTHORITY APPROVAL :. FHA ~orm'2S73 ': ' ' ' INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM: GREATER ANCHORAGE HEALTH DiSTRiCT ANCHORAGE, ALASKA 5 May 1964 Mr. Jack R. Rhodes P. O. Box 1947 Anchorage, Alaska 99501 Subject: Well Site Approval Seacliff Subdivision Dear Mr. Rhodes: An inspection was made by this department on April 29, 1964, for the purpose of determining the location of the proposed well at Seacliff Subdivision. The area described is hereby approved by this department with one mod- ification: We request that the road adjacent to the proposed well be curved and set back at least 20 feet at the Lot 7 location. Also, we must have a copy of the easement given you by Mr. Huff for the required additional protected area for the site of the well. Sincerely yours, DAVID R. L. DUNCAN, M.D. biedical Director Donald H. Penner, RoS. Sanitarian DHP:rsa Air Mail to Alaska Is Faster