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HomeMy WebLinkAboutSUMMIT ESTATES BLK 2 LT 3-Summit sta Block 2 Lot 3 #015-072-16 Municipality of Anchorage Development Services Department Building Safety Division : On-Site Water and Wastewater Program · ' ' 4700 South Bragaw Street 'P.O. Box 1~o650 Anchorage. AK99510'0~50 -; www.ci.anchorage.~'k.~us ' . .' , ' . -' ................ " ' (907) 343-7904 CERT. FICATE O~ HEALTH AUTILIORITY AP-PROVAL. ' '' FoRA-~- ~- :-- -~51NGLEI-AMILyY.UWELLING.,.,~: :..-~ ~- ' · , , .- · '"" :1 '"' ' '. . 'iJ . ib -. '.. Parcel I.D.'. '0'~5'0~;2 6 ...... ~ #".'. ' - ='. ~ ......-.: .............., ....,~,. ,,, -..:, --... · ' '" :" .... .--- : .ExpirafionDate:"'-.:~ ~7 ''-'! ' 1.' : GENERAL' INFORMATION ''--':-' '.~:?-:. -' '" "'~ "-''::'- .... ' ' ' " · " Complete legal description ~ 1'6t 3 BlOck 2 Summit Estates ~: ':' ::-'.' ........ ' ~'' --' .... ~ :'*" ": "~-...'.Locatio, ........... ' (site'- a~d)~ss or ~ il;~0 n S)'-' 5:'/02 E.'97m A~;ehue,';Anchora.qe~'AK '99516 ...... "" : ;d O~b S~,;~-0a'y'~ .... '" p~ ~jw.() :~... · . ,,.-...-- Currentope o er s L~a ra on · i one 346-1869 -" 5702 E. 97m Avenue~ Anchorage, AK 99516 :- ..--:.,;:-? Mailing addres ..- ~... ~Lendngagenc~ .,. :,. : .- :':..'-j '~ i" ;',~ " : :' ': ~.'-¢ Ma~hng address .'-' .':' -: Real Estate Agent, : Mailing Add~ess Prudential Jack WhitelAlene Palmer Day phone ,563-5500 3201 C Streei, Ste. 200, Anch~)'ra.cle, AK 99503 Unless o~herwise ~eq'uested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 4 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to home ownem. Certificates of Health Authority Approval am valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. 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. 5. STATEMENT OF INSPECTION BY ENGINEER · As certified by my seal affiX(ed hereto and as of the Validation date shown below, I verity that my investigation ' ': based on procedures outlined in the Health Authority Approval Guidelines for 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 bedroom§ and type of struct,',re indicated herein. I further verity 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 applicable Municipal and State codes, ordinances,, and regulations, in effect at the time of installation. Name of Firm ,Pannone En.q. Svc. '~ ' ' ' '"' ~ ....... Phone ' 272-8218 Address P.O. Box *' ' ' ..... "- ' "''~ -'" *, "* ,* ..... E,ngineer's .Printed Name ,Steven R. Pannone, P.E. Date · 712/2001 EngneersComments.~coadoctmga~adc~uacTtcst. lattcmpttopro,adcathoroul~t.m~fio~- : ~m~m. . ~Smcormg nnaIysxs of thc system m nccordaucc with MOA I~D GuidcEnc~ & Rcsu~tjon~. 'I'ne * .,' . ~.~.'~.~. 'OF :Al ~ee. the and · ', '' ,.test,..~. hondistancc~mca~torc~ly,dcnti~blcfcaturc~. ,l'heo~tion~XirebraU . ** CO..* * /[~**"~ wcl~ aha sc'phc s'ystc~s dcpcnd on the local soil condidon, gr°ux~l v~xtor levels th,at may fluctuate *..- '*r '-' ~ *" · "*. ' ;"*- ~ outsidcth¢controlof~e~va~uatorofthissvstcm .'UIs*wtcmsevca vr,,;z..~.~;.r.,-*,..~..~ ' ~ ..... ~"*~ ......... ~""*'*~"*-~ ...... ~. -.,- . . t~l,~ ~'r ......... · "-~' ' ' ~ ' '~' ',~,~,~.X *,~ ',.", .?uxts do not b,~arantec ~utur~ perform~ or thc ~ nor do thc'y ~anice ~t th~';c'arc no' ' ~, ~;' ................. ~.... hiddc~dcfccuor~cr~achmcuts.P""E~c~thcrc£~r~tpr~v~dca~yv~u`rant~or~ut~c~1~ormancc ~ ~%Steven R nor 8Jvc aay estimate ofhow I. oas the s'~st~m wUl cont~ue to mcct thc__ o,-__ho._ ...~,Gm" b;,l ~;~,i;,-~,~' .......... ,~**~,r*~,~' .-.'~ 5'~'-.-.*...,~. '.;-.¢,. 'r~ .~ ";"*-;"~,.,~ A.D...EC ~ MOA DSD' Thc c°ntc~t °f I~'ds relx)rt Is for thc sole Ixmcfit of thc ow~cr lJstcd above A~v ' 6. 'DSD SIGNATURE, . ~t~,~ .: ~ ' Approved for. /../L bedrooms. ·, - Disapproved. : Conditional approval for- __ bedrooms, with the following stipulations: X Additional Comments Attachments: HAA Checklist Septic System Advisory , Well Flow Advisory Maintenance Agreements Supplemental Engine(~r's Report 'Other Expiration Date: / 43 - ,/q-o / Odginal Ce~ficate Date: Reissue Date: 7 o / Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bregaw Street P.O. Box 19~50 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type p_ Date completed Total depth 70 Lot :~ ~lock 2 Summit Estates If A. B, or C ixovlde PWSIO # ~ Sanitary seal Y Cased to 70 h FROht WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform .~--~.~'~"- colonit~/lO0 mi Date of sample: 6/2912001 B. SEPTIC/HOLDING TANK DATA It g.p.m Collected by: Parcel I.D.: 015-072-16 Well Log N Wires propedy protected Y Casing height (above ground) 12 AT INSPECTION 6/2912001 6.21 'g.p.m iD. Other bacteda '~ colonies/lO0 mi Ppnnone Tank Type/Material ' Date installed ~ Tank size 12~0 gal Cleanouts Y~s Foundation cleanout Yes Delxession over tank No Date of pumping 612912001 - Pumper A+ Home se~icos C. ABSORPTION FIELD DATA ~ ~3 --. ume Ins~alled'8t~ff~ Soil rating (g.p.dJft or It/bdm~) Length 35 & 24 It Win'th 2.fl It Number of comPartments ~_ High water alarm No system type Trench Grovel below pipe {I & 4 It To*al depth 14 ff Effective absorption area 711:~ f.(2 Monitoring tube Y De~reSsio~ over field N Date of adequacy test ~1:~/2001 Results (Pass/Fail) Pass For 4, bedrooms Fluid deplh in abserp~iofl field before test I:)rv in Water added$00 gal. New dep~hDrY in. Elapsed Time: 0 min Final fluid deplh Dn~ in · Absorption rate >= 600+ g.p,d. Any rejuvenation treatmer)tr(past 12 mo.) (Y/N & type) NO If yes. give date (Rev. 11~) :L D. UFT STATION Date Installed · 'Pump on' level at Datum Size in gallons in'Pump off' level at Cycles tested E. SEPARATION DISTANCES SEP^RAT ON DISTA"CES FROM WELL ,O* 'TO: Manhole/Access High water alarm level at in Meets alarm & circuit requirements? Septic tank/lift station on lot 108' Absorption field on lot 120' Public sewer main 100'+' Sewer/septic service line ;~5'+ On adjacent lots 100'+ On adjacent lots t00'+ Public sewer manhole/cleanout 100'+ Holding tank NI,'~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 15' Property line :~4' Water main ;~lF+ Water service line Drainage 100'+ Wells on adjacent lots, 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 14' Building foundation, ~+ Water Service line ~'+ Surface water 100'+ Curtain drain lQ0'+ Wells on adjacent lots 100'+ Absorption field t6' Surface water 100'+ Water main. Driveway, perking/vehicle storage 60'+ F. COI~MEI~TS . ,~ · I 'lmm Pa ¢* ~ ' - i'ni -.' ' n ~- re~ of M~ ~s ~ ~ ~ sy~ms ~ in ~'"~'~ ....... ~-'~ ~ ~ MOA H~ ~l~s E--in,ds Pd~ Name S~ .... '&'¢~ ~ ¢~- ':~ ~'~ ,~ ~n K. Pannone, y.~ vine . ~/~l~( ., : , 'ee~ ...... ~,~- Date of Payment Receipt Number (Rev. ,Waiver Fee $ Date of Payment Receipt Number J~-OS-0t 08:18 FRCIi-CTE £NVII~t~VENTAL  Envlronmer~a! ~ervlGo~ Inc. CT&E 0075615301 T-621 P.0Z/03 F-730 CI'&E Re f,;~ 1013883001 Client PO~ ProJect.~ame/# Lot 3 Bk 2 S~t ~tes ~l~d De,lee ~9~001 I ~:C0 O~t Seraph ID ~ Hoseblb ~elved DatiVe ~9~001 1~:2~ Ma~x ~iag W~cr Technical D~tor ~ep~ C. Edt O~ered By Total NJtra~e/~it.-it e To:al Coli~'onn 3.69 0.500 mB?L £PA. 3CC.O 07,~3/01 SCZ, 0 col/1OOmL SMllr'~.2O (<l) 06/29/01 KAP ) !, M.N,C!.A..T~ Or ANCHORAGE DEPAR~NT OF HEALTH & ENVIRONMENTAL PRO~I~CTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE ~ NEW MAILING ADDRESS LEGAL DESCRIPTION NO. OF BEDROOMS ~,~,~,o: I~" I~°~°~ ~" ~,~ ~ Eiq. capacitg in flallons Iff HOM[MA~[: Inside Ionflth ~idth kiquid dopth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer Material Liquid capacity in gallons O Well Foundation Nearest lot line PERMIT NO. No. of lines Length of each bne Total length of lines Trench wldtb Distance between lines Top of tile to finish grade Material beneath tile Total effective absorption area Length Width Depth PERMIT ~ W Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Dri[[~ Distance to lot line PERMIT ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(si SOl L TEST RATING INSTALLER REMARKS ~ SEP 2 o '.. RECEIVED App~licant: LOcation: Legal Description: Type of Soil Absorption System Is: Trench: ~ Drainfield: Maximum Number of Bedrooms~ ~UNICIPALITY OF ANCHORAGE L]~'% Department~ ' Health and Environmenta] ~rotection 825 ~ Street, Anchorage, ~ .~ 264-4720 ~ * * * HANDWRITTEN PERMIT * * * WELL AND/OR ON-SITE SEWER PERMIT · ~y~K~ Mailing Address L Phone Nurober: ~ ~"-- ~&C~~ Lot Size: Seepage Bed: __ Holding Tank: Soil Rating(sq.ft/br) I~~- The Required Size of the Soil Absorption System Is:' DEPTH [~2~{ LENGTH ~ . GRAVEL DEPTH ' WIDTH The length dimension is the length(in feet) of the trench or drainfield. The d~pth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = ~ GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for-a private well or 150 to 200 feet from a public well depending upon the type of:public well. Minimum distance from a private well to a private sewer line is:25 feet and to a community sewer line is 75 feet. Well logs a~e required andJmust be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * * I! certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the r~idence is ~emodeled to include more that 3 b~d~ooms. S~gne~: ~ Issued by: Applican~ ~ - ~ ~ Date: ~'-- ~-- ~ % SWP/024(1/81) / oGREA~.~ANCHORAGE AREA BOR~.~..~,I Anchorage, Alaska ggB03 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL-S~STEM LOCATION . LEGAL DESCRIPTION PHONE SEPTIC TANK: .j~ DISTANCE j,. ~ ,~ ~ p,/u-~ ~,.~..~ NUMBER OF FROM WELL-P MANUFACTURER' 'g' "' '- TERIAL " COMPARTMENTS / ~J INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY/~''O'~ GALLONS. DISTANCE FROM WELL~)/''~)u FOUNDATION.~',~ , NUMBER OF LINES / DISTANCE BETWEEN LINES ABSORPTION AREA O'""g~ SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER / DEPTH: TOP OF TILE TO FINISH GRADE ~ MATERIAL BENEATH TILE NEAREST LOT LINE /O'"" '~ TOTALoF LINEsLENGTH'~ ~4'"' / TRENCH WIDTH \~ IN. TOTAL EFFECTIVE / ' WELL: BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST NEAREST SEPTIC LOT LINE __ SEWER LINE TANK OTHER SOURCES DISAPPROVED REMARKS DEPTH __ DISTANCE FROM: SEEPAGE , SYSTEM DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: REMARKS: . Form EQ-032 DIAGRAM OF SYSTEM GREATER ANCHORAGE ArEA BorouGH SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION LOCATION ~/~- /~/~ ~:~/~'~/~/ ~'~ FACILITY TO BE SERVED . . ~/d~ FINANCED THROUGH TO BE INSTALLED "Y ~/~/~ SOIL TEST RESULTS /~ ~ ~ ~~ NOTE~ THIS PERMIT IS NOT VALID WITHOUT SOIL TEST PHONE SEPTIC TANK, J~ SEEPAGE Pit /~., DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION ~ FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. 3RAM OF SYSTEM GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF CREATE ANCHORAGE AREA OROUGH ORDINANCE NO. 28-G8 AND THAT THE ABOVE Legal Description: /f'~ / .~ ,f~/~ This form reports: Soils log GREATER ANCHORAGE AREA BOROUO~' ~_~.~.)artment of Environmental Qu~_~,~ 3330 "C" Street Anchorage, Alaska 99503 SOILS LOG - PEROLATION TEST Date Performed__?~/~//h.2- Percolation test Depth Feet 2- 3- 4- 5- 7- 8- 9- Was ground water encountered? If yes, at what depth? Reading Date Gross Time Net Time _~epth to Water Net Drop Percolation rate minute. .Proposed installat--T~-~--~b~-ge Pit Drain Field !)epth of Inlet Depth to bottom of pit or trench CO,,1,'.!EI'ITS: .......//~-----7'~-'-- __- ~7____ .............................. EQ-040 (6/74) [¥1LLIAM A. EGAN, GOVERi~OR $OUTHCENTRA£ REGIONA£ OFFICE MACKAY BLDG. 338 DENALI STREET ~arch 21, 1973. Mr. Carl Jem~ings P. O. ~' 4984 Anchorage, Alaska 99505 gJTg-ECF: Lot 5, Block 2 --Su~mit Estates Dear Mr. Jennin~s: We have reviewed your situation in light of the interpretation of the 40,000 Sq. Ft. -20,000 Sq. Ft. requirement contained in Section 18 ~AC 72.030 of the Department of Envirorm~ental Conservation Waste Water Regulations. It is our finding that since you had ox~nership of the lot on or before February 5, 1973 and that you intend to construct a private residence for your personal use, that this particu- lar Section of the Waste Water Regulations is not applicable in your case. }ge would however advise you that of course all existing Borough Regulations are in effect m~d are applicable in all cases except where State requirements are more stringent. Yours truly, yle w. ct Regional Environment al~ Eng~neer 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. # ~/~--~ 0'~ 1~ HAA# 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency ~4/~ /=eoCero/ Mailing address /-(oo ~ ~r~ Agent C~r~ ~}r~ V'~ Address Unless othe~ise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Co ri ~q-e-,~;~r Day phone Day phone Day phone 9q5-o~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the iegality and status of system. TYPE OF WASTEWATER DISPOSAL: I ndividual on-site Holding tank Community on-site Public sewer NOTE: 49 / ~,' ,j ,, If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance .with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm F/~ ~ ~/~ 7'~cA,~ ~'~c, f _~ ~.,' ~,,'r ,,.f Phone ~'f,.C- Address /~/5'30 ~c-Ao ..q~ /0-mc,~o~'~'J~ ,~r-/~ EngineeCssignature ,~~ ~"~. ~ Date DHHS SIGNATURE b'//~Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: /~:' i ;. , *.The Mun cfpality 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 ...... ' ' The DHHS does this as a courtesyto purchasers of homes profess~o .n, al engineer registered m the State of Alaska. and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. · Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription:/-o/'3~ ~ll, c~-/ ~u~,? ~g~. ParcelI.D. A, Well Data Well type 17 Log present (Y/N) Total depth '7~' Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed 19"/~- Driller Cased to ~ '7~ ' Casing height FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line Wires properly protected (Y/N) g.p.m. AT INSPECTION '~ 3. ~)-' ~ ~ ~ ~ g.p.m, ri"1 o~~o~ ; On adlacont lots ~ ~ oo, ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform o co/ ~./0~ ~,.,.~ Nitrate Date of sample: ~/'z?19¥.~ ~o/~/?'7' 3./o~n~ {..~. Other bacteria /~,,,~¢ Collected by: ~ F'. /~o~-~ B. SEPTIC/HOLDING TANK DATA Date installed 5' / '7 ,~' Cleanouts (Y/N) Y' High water alarm (Y/N) Date of pumping Tank size I '~ .~'0 d-~/ Compartments Foundation cleanout (Y/N) ¥ Depression (Y/N) N. A-. Alarm tested (Y/N) hi, ~/~-/ <~ ¥ Pumper A + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I o ~ ' To property line ~ Y Surtace water/drainage On adjacent lots >. loo' Absorption field I ~' O0~ 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) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LiFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed 5-/75- ~,,,~r~d¢~ ,~j On adjacent lots ~'~'~ Soil rating (GPD/FF) Manufacturer Manhole/Acoess (Y/N) "Pump off" Level at Cycles tested Sudace water 72-026 (3/93)* Back HAA Fee $ Date of Payment Receipt Number Cudain drain 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 inspection. Date 0~ Well on lot I ~d To building foundation On adjacent lots '1> Sudace water '1> Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: On adjacent lots > ~ o o ' Properly line /q' To existing or abandoned system on lot N, A, Cutbank N.A. Water main/service line "~ '~ 5" Driveway, parking/vehicle storage area Waiver Fee $ Date of Payment Receipt Number Length 35"~- 8'~' Width ~,5' Gravelthickness ~' ~ ¥' Totaldepth I~' Total absorption area '7.5- 8 r-J' Cleanout present (Y/N) "~ Depression over field (Y/N) Date of adequacy test '~ / a.'7 / ? ~' Results (pass/fail) ?~s.~ for Waterlevelinabsorptionfieldbeforetest 5'9'~a go" Aftertest Cz"a ac" Peroxide treatment (past 12 months) (Y/N) No,~ ¢ ~,~ o ~,,-, o.r" If yes, give date /',5 ,4. 1-45- o'/~,,-~., Systemtype CT&E Ref.# Client Sample Matrix ClientName Ordered By Project Name Project# PWSID Commercial Testing & Engineering Co. Environmental Laboratory Services ~,~'~'~'~'JJJ~'~:~'~'Jf~'J~ LABORATORY ANALYSIS REPORT 94.4954-1 L3 BLK2 SUMMITESTATE8 REAP, HOSE BIB WATER FLATTOP TECHNICAL SRV UA WORK Order 82565 Printed Date 09/30/94 ~ 15:16 hrs. CollectedDate 09/27/94 ~ 12:00 hrs. Received Date 09/27/94 ~ 14:00 hrs. Teclmical Director STEPHEN C. EDE Smnple Remarks: Parameter ROLryINE SAMPLECOLLECTED BY: T.F. MOORE. QC Results Qual Units Method Alloxvable Ext, Anal Lhnits Date Date hilt Nitrate-N 3.10 mg/L EPA 353.2/300.0 10 09128/94 CMP. * See Special Instructions Above ** See Sample Remarks Above U = Under ected, Reported value is the practical quantification limit. D = Secondary c~lution. UA = Unavailable NA = Not Analyzed LT= Less Than GT= Greater Than 5633 B Street, Anchorage, AK 99518-1600 ~ Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA 10/0Gx94 ¢ CT&E ENVIRONMEHTAL LAB SERVICES ~ 90?5451555 COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LAmORATORy SERVICES Drinking Water Analysis Report for 'Total Coliform Bacteria READ INSTRUCTIOP[$ ON REk'ERSE SIDE BEFORE COLLECTING SAMPLE MUST BE COlvIPLETED BY WATER SUPPLIER El PIJBLICWATERSYSTEMI. D.# L I I I [ II fl $gndRe~ulls El ,¢;end.rnualce Month Day Year SAIv~PLE TYPE: I~ Routine cl Treated Water I~ Repeat Sample (for routine sample 0 Untreated Water with lab ref. no. ) · 0 SpeclalPurpose LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to Satisfactory Umadffacior/ Sample over 30 hours old, results may be unreliable O Sainple too long in 'aa.n$it; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via special delivery fin',iL a,e ReeeiYed /o-.s F /haalytleal Method: I~embrane F/her 0 MMO-MUG * Number ofcolonie,/I00 ml. Lab Rcf. No. Result* Ana!yst .%ne to A.D.E,C. ~ Fbks Jun Faxcd Client notified of unsatisfactory results: l~honcd SpOke with Faxed BACTERIOLOGICAL WATER ANALYSIS RECORD N[MO.MUGResult: Total Collie*tm ~,, E. CMl Membrane Filter: Direct Count Verification: LTB ..... BGB ~- COLIFIKM Fecal Coliform Conllmation Final Membrane Filter l~esul/~ , . ColiforrMlO0 Colonies/l 0~3 all MUNICIPALITY Of ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services section P.O. Box 196650 AnchoragelAlaska 99519-6650 343-4744 Parcel I.D, # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site add'tess or directions) 57OZ. E Property owner E~-[ J Mailing.address . P.o. Lehdihg agency' Mailid'g ~ " Day phone Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: d '~ TYPE OF WATER SUPPLY: Individual well -Y' Community well Public water NOTE: 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 Public sewer NOTE: 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 verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply ~nd/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm A.$.C,G,£,~. Address .'3ol ~H-,,~.~i~,; P~lo~t,_/~l~e.~g~,,/~l~S/~ EngineeCs signature (~/~¢4~/['%- Phone $'[ ¢f- ~/'¢~ q55~,5- ,3o,3.S DHHS SIGNATURE Disapproved. Conditional approval for 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 DH HS 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~)25 (Rev, 1/91) Bsck MOA#21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type Log present (Y~) Totaldepth ~ Sanitary seal (~N) If A, B, or C, attach ADEC letter. ADEC water system number -- Date completed ~,~ ~.~,>-~.~ Driller u~ )~,~ Cased to '~ Casing height ! Wires properly protected ~,./~) ~c~ Date of test Static water level Well flow pump level FROM WELL LOG AT INSPECTION SEPARATION DISTANCES FROM WELL TO: / Septic/holding tank on lot ) ~ c~ Absorption field on lot j ?~o Public sewer main I°°'¢ Sewer service line Ir-poe ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ~ o o P WATER SAMPLE RESULTS: Coliform 4'2 K Date of sample: Nitrate Other bacteria Collected by: Tank size Foundation cleanout Y~) B. SEPTIC/HOLDING TANK DATA Date installed r~/Z ~z/ 7.c3 Cleanouts ~)'N) Y¢-~ High w~te.r.,alarm (Y~[.~ /~J~ . , .: ,¥/ / Date of~ um lng' 3 ,~.- ...... Pumper SEPAR,~TION DisT~ANCES FROM,~EPTIC/HOLDING TANK TO: · " On adjacent lots I (~ o~' Well(s) on lot ,l.o 5 f Topropertyline''''': ;~o-~''''*~ Absorptionfield / (' ' Surface water/drainage ~g>o~' Compartments Depression (Y~) Alarm tested (Y/N) Foundation Water main/service line 72-026 (Rev. 7/91) Front coNTINUED ON BACK PAGE C. LIFT STATION iX.J, Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed t~,~'A~lol~ Length .G ~ / Width Total absorption area ?£~- Depression over field (Y/~.~ Results (pass/fail) Soil rating /Z-5 ~'~ /'~¢~ System type Gravel thickness (.' Total depth Cleanouts present ~N) Date of adequacy test ¢'/-,5//¢' for ~'( Peroxide treatment (past 12 months) (Y/~ ,L)¢ bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ 'Z o To building foundation On adjacent lots Zo' Surface water / ~o ~' Curtain drain ~P0 ¢- On adjacent lots ~od'4, Property line To existing or abandoned system on lot Cutbank / ~o'~' Water main/service line Driveway, parking/vehicle storage area 5 E. ENGINEER'S CERTIFICATION I certify that I have checked, vedfied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. HAA Fee $ ~/70'¢'~ Date of Payment L~.~/p ~c~-~.... Receipt Number ~"~ ~'c/.z¢ Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 907-456-3116 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907-277-8378 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIENT ~/PRIVATE WATER SYSTEM NAME SAMPLE DATE: SAMPLE TYPE: ~'Routine [] Special Purpose '3 .2.:~ ¢i~ Phone '~d~-% ~/~' Mo. Day Year Purchase Order No. [] Treated Water J~x Untreated Water [] Check Sample (for original contaminated ~ample with lab reference no. Sample ~me No. Location Collected 2 3 4 5 6 7 8 9 10 Signature of Representative Collected by Laboratory Ref, No. FOR LABORATORY USE ONLY CASH CHARGE PREPAID TRANSMITIAL SPECIAL INSTRUCTIONS MAIL 1 HOLD FOR PICKUP / TO BE COMPLETED BY LABORATORY Received at: ~Anch. [] Fbks. Date Received Time Received Next Sample Due '- COMMENTS: SATISFACTORY (~ UNSATISFACTORY U RESAMPLE R OTHER BACTERIA OB TOO NUMEROUS TNTC TO COUNT 'E ~D TIME A~ALZYED 3/26/92 16:30 }iE-~ P~E FILTER Direct Verification Final Count LSB BGB Result* f Total Colifor~,Co~nies per jO0 mis. R e~o rt~a ~y Date Time NORTHI R T ST NG LABORATOtRt $, 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 · FAX 274-9645 Arctic Slope Consulting Group 301 Danner Avenue, Suite 200 Anchorage AK 99518 Attn: Report Date: 03/30/92 Date Arrived: 03/26/92 Date sampled: '03/26/92 Time Sampled: Collected By: Our Lab ~: Al16691 Location/Project: Your Sample ID: A Sample Matrix: Water Comments: MDL = Method Detection Limit Flag Definitions B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Date Method Parameter Units Result Flag MDL Analyzed EPA 353.3 Nitrate-N mg/1 1.8 0.1 03/27/92 RECV'D Reported By: William E. Buchan Organic Chemistry Supervisor WELL LOG LOCATION: Lot: Block: Client's Name: e,~,..l Address: TESTER: Initial Reading on Meier: DRAW TIME GPM GALLONS GALLONS FIELD MONITOR METER DOWN VOLUME TOTAL LEVEL READING 7" I ',q~' Z,O 73/ 31 ;! */' /o ~ 3& 7~ 1'~"' 2_;lo 2.~q -(ed ~/ Z~,' {_,,~ 37 NOTES: 5'oZ. ~'/~o0 Production Rate: ~ GPM 24-Hour Capacity ~ Gallons HOME SEBUICES, INC. 1B9 POE INVOICE # 6236 DATE I DEBCRIPTION AMOUNT ~,-o E. 9?th $ 90 00 04-03-92 Pump Septic: At .,/.. I ...... Fil~ ~acor,:t~: Non~ .... I .... T~AL 3~9-5~48 ' ' "' REMARKS I ~ PROSL~ AREA--OALL FOR~ORE INFOH~ATION ~ NEED~ ~ B~ DON~ AGAIN IN ~ ~ON~H~ i ~ Good Shape ~Sludge buildup on Bottom ~ Floater on top Jim cap missing or ~Cut standpipe to 1' Above ground D Needs Septlctrlne ~ needs replacing