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HomeMy WebLinkAboutCRAIG LT 1'0 Craig Lot 1 #015-342-11 72-013 (Rev. 3178) ,/ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 0* ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAM(E�r t �/t. �j �r � _ _ ON/E��// ;/ PLI 7 (GfD7 NEW E] UPGRADE MAILING AD RE,SS �h y� C1 LEGAL DESCRIPTION LOCATION L NO. OF BEDROOMS v Y DISTANCE TO:IF Well Absorption area 1 Dwelling �/ -f PERMIT NO. wQ N Manufacturer Material No. of comp ments &Cn Liq. cay ty„iUn gallons Otf V IF HOMEMADE: Inside length.._- Width Liquid depth 0 0 Z DISTAN Well Dwelling1 PERMIT NO. O Z Qcturer = H Mat iquid capacity in W J LL Z H Z w °C DISTANCE TO: No. of lines Wel - Length of each lin�_� Foundatio i 7 Total length of li s.7 / Nearest lot line (10 Trench width nches PERMIT NO. 7-7 Distance be�t�/ve Ines /'J — 0 To of tile to finish rade p 9 �s Material beneath the i s Total effecti a absorption area 41n 7 LU C7 Length Width Depth PERMIT NO. a H wa W Type of cr- Crib diameter Crib depth Votfaleffective abso n area w DISTANCE TO: B ' ing foundationof line w C Depth Driller Distance to lot line PERMIT NO. Building foundation DISTANCE TO: Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS 0� SOIL TEST RATING INSTALLER G t' 7 REMARKS APPR VED DATE LEGAL Irl �/' Ll 72-013 (Rev. 3178) ,/ MU" I C: I F>"L- I -T"-ra CIF:- DEPHRTMENT ' HEALTH AND ENVIRONMENTAL OTECTION 825 'L STREET, ANCHORAGE, HK. 99wa1 264-4720 �__��1-FF= ��F=U4���� F�F�F�r�I -� V PERMIT NO. �( 810277 ) ( / / APPLICANT PAUL LETHENSTROM P.O. BOX 10-367 34'-"�' LOCATION GRHIG CIR LEGAL LOT LOT 1 SUB LOT SIZE 54168 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C7- REEF` _T A 121 L_ E: r-41:3 -F 1:3 F;-:.* " *v* FE I C-- E: F="���= , ~ ' THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H 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). �F= C_! U I ���I #::- �F::l lr-4 I-;:-- �1 7-f 1== A- C21 C-1 �n L_ L_ f--'�� 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. ___ _1F U-4 Cl < -=` --A I r -4!E; F=* FE C:7 _F I Cl r-4 �-. " F__" FE �;E: C_! 11 1 F;;? F= U_- BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ���M I -IF �X F=" I F;-> r=- ����M E.* F="F;;? 3-:1L, ���A- I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY 2: 1 WILL INSTALL THE OF Hit !QRRGE. 3 ^ ". ENLARGEMENT IF THE AN 3 BEDROOMS. ----_- BY ��-��___un/��=�- -���_ Y4.0 \ r� v` �� E) SOI LS LOG MUNICIPALITY OF ANCHORAGE 7• a „ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: i t e x,y I`I P - i" `� � �r7�[ hCT/� r /k �''i?DATE PERFORMED:__ 4Z11 LEGAL DESCRIPTION:, FFEEPT—H-1 SLOPE SITE PLAN 1 2 3 .— —` 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: 72-008 (6/79) WAS GROUND WATER S ENCOUNTERED? N G L O P IF YES, AT WHAT E DEPTH? MIS Reading / Date Gross Time Net Time Depth to Water Net Drop zad / •;�It% .... .................� PERCOLATION RATE (minut$/inch` TEST RUN BETWEEN FT AND ; No. 2100 - E • j C' C - C, I • -1 � : 4, low Aw %X WIVAL CERTIFIED BY: KEN'S COMPANY WATER WELL DRILLING PUMP SALES & SERVICE (907) 243-7893 KEN JOHNSON pAUL L THEI`dS 2ROV, r.0. BOX 10-367 ,inc_norage, Jilaska )9511 RE: Lot 1 Craig Subdivision 3163 LINDEN DRIVE ANCHORAGE, ALASKA 99502 June 15, 1981 I 'R ;ELL LOG FT. TO 8 T. Or;�7-nic silt 8 ft. to 23 _: t. course 7rLvel 23 J. to 28 ft. isied gravel trace of bro 1n clay 28 ft. -to 32ft. Cementr,,vel 32 ft. to 36 ft. Lr-:�;e boulder.. Bent casing;.. pulled back rotated 180 D .. JRove to stc=4i hten.. . Pull back 3 ft. shot boulder 8& redrill 36 ft. to 45 ft. Course -ravel & cobbles ( dry creek bottom ) 45 ft. to 46 it. 'Later bearing course 7ra.vel ( 4 t. head ) 4.6 ft. to 50 ft. dater be _r_i_ng ,`:ed. `-ra.vel ( reaves ) 5o ft. to 62 ft. Brown silt 1,iith clay texture 62. to 70 ft. `later bearing iaied. s�,.nd O; :gravel ( heaves ) 70 't. to 71 ft. Clean Pied. sand & 7ravel ..Water bearing Test bailed one hour at 15 GPIVI Static 4.6 ft. 15 Gpm 1 ft. Drawdown Death 71 ft. Bottom stable Set pump at 64 ft. +- Municipality of Anchorage On -Site Water &Wastewater Program — (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I. D. 015-342-11 Expiration Date: 1. GENERAL INFORMATION Complete legal description CRAIG; LOT 1 Location (site address) 10160 CRAIG CREEK CIRCLE *ANCHORAGE AK Current Property owner(s) Mailing address Real Estate Agent DONI THOMPSON Day phone 227-2131 10160 CRAIG CREEK CIRCLE *ANCHORAGE AK 2. TYPE OF DWELLING: E Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Day phone JUN 10 2014 TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding_ tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for. n I a Distance: — Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer COSA Fee $/�tTlk7 —Waiver Fee $ _ Date of Payment b r / Date of Payment D Receipt Number ©�'J 1l N Receipt Number COSA# 0SLI` [ 2 5-3 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. /further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, UD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE tl System #1 Approved for _3 _ bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. Phone 337-6179 Date 010/11, bedrooms, with the following stipulations: tllllOF (tlUt((r(f ON-SITE Nk WATER AND WASTEWATER p^ �jJJlh By. l Original Certificate Date: Thenici( ality r A6chorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: COSA Checklist. Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other ra> 111W If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: CRAIG; LOT 1 Parcel ID: 015-342-11 A. WELL DATA *PER SURROUNDING WELL LOGS Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 6/15/81 Sanitary seal (YIN) YES Total depth 71 ft. Cased to *40+ ft. FROM WELL LOG Date of test 6/15/81 Static water level 46 ft. Well production 15 g.p.m. WATER SAMPLE RESULTS: Coliform Q colonies/100 ml. Arsenic: J�,2Dug./L. B. SEPTIC/HOLDING TANK DATA Nitrates - 3 l mg./L. Date of sample: 6/3/14 Well Log (YIN) YES Wires properly protected (YIN) G -S Casing height (above ground) 12+ in. AT INSPECTION 6/3/14 41 4.24 g.p.m. Collected by: GEE Ltd. Tank Type/Material SEPTIC/STEEL Date installed 6/9/81 Tank size 1000 gal. Number of Compartments 3 Cleanouts (YIN) YES Foundation cleanout (YIN)) YESDepression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping _ I -, Pumper o i,, I I " C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 6/9/81 Soil rating (g.p.d./ft2or /bdrm) 125 System type TRENCH Length 37 ft. Width 3 ft. Gravel below pipe 5.5 ft. Total depth *8.83 ft. Eff. absorption area 407 ft2 Monitoring tube *YES Depression over field NO Date of adequacy test 6/3/14 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 1655 gal. New depth 0 in. Elapsed Time: E min. Final fluid depth E in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date — *MT ONLY EXTENDS 3.58 FEET INTO EFFECTIVE D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankA'rft station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots Public sewer main Public sewer manholetcleanout N/A Sewer /septic service line 25'+ Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Atsorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkingIvehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date & 110lirf (Rev. 11/05) --M-W DRILLING, INC. DRILLING LOG Well Owner a Location (address of: Township, Range, Section, if known; or distance main road Size of casing Depth of Hole ' ` feet Cased to Sa'• r feet of Well Static water level ft. (abb ) (below) land surface. Finish of well (check one) open end ( ); Screen ( ); Perforated ( ). Describe screen or perforation i'1A Well pumping test at gallons per i< ld6i) (minute) for hours with ft. of drawdown from static level. Date of completion Depth in feet from ground surface —TO - -T TO - TO - TO TO TO TO TO TO TO TO TO TO TO WELL LOG Give details of formations penetrated, size of material, color and hardness "asir , .;tickt1: Organic.,, 'iandv Brave' —Silty 'gryei „ster :.:vel NWWA 'e-lMod Coattr:ob>r 3—CONTRACTOR DATA SHEET l� „-��E l,� PROJECT: LOT �LK,eplG Dd7E OF TEST: � LOCATIOa OF WELL (Legal Description): WELL DEPTH: �(,+ FT. _/ CASING: �Q FT SCREEN: DATE ORILLRIG COMPLETED: y( /zcj164 DULLER: STATIC WATER LEVEL (Top of Casing):. (� / FT CAS1.06 /{ z` tibove Grw �7 dpsed Time Sincel Clock pumping Started/ Depth to Drawdown/ Punping f Renarks Tine Stopped, Hirt. 1 Water, ft. I Recovery Race, rp, f 0 RECOVERY 0 /,7.47 Municipality of Anchorage Development Services Department • +e Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING�1� n Parcell.D. 015-342-11 HAA# dk2,Qr59 1. GENERAL INFORMATION Expiration Date: —7' �Z 3"0 z1 - Complete legal description CRAIG SUBDIVISION; LOT 1. Location (site address or directions) 10160 CRAIG CREEK COURT * ANCHORAGE. AK 99507 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address RICHARD CRISCI Day phone 346-3883 10160 CRAIG CREEK COURT * ANCHORAGE, AK 99507 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well lilt Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. /further verify that based on the information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD. SUITE 2B ' ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date �- Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefif of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the flowing stipulations: Manitenance Agreements Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other By: LZ�. Original Certificate Date: / -•2- 3 - 1 (Rev. 17101) Municipality of Anchorage • Development Services Department Building Safety Division OnSke Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 995196850 www.d.enchorage.ak.us (907)343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: CRAIG SUBDIVISION; LOT 1. Parcel ID: 015-342-11 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 6/15/81 Sanitary seal (YIN) YES Total depth 71 ft. Cased to 40'+ ft. FROM WELL LOG Data of test 6/15/81 Static water level 46 ft. Well production 15 — g -p.m - WATER SAMPLE RESULTS Well Log (YIN) YES Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 4/8/02 45 ft. 4.25 g.p.m. Coliform 0 colonies/100 ml. Nitrate 1.65 mg./L. Other bacteria 0 oolonies/100 mi. Arsenic: •002 mg./L. Date of sample: 4/8/2002 Collected by: AWWC. INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 6/9/81 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cieanoul (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 4/17/02 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed 6/9/81 Soil rating (g.p.dJft=o10!5jE0125 System type TRENCH Length 37 ft. Width 3 ft. Gravel below pipe 5.5 ft. Total depth 10.2 ft. Eff. absorption area 407 ft' Monitoring tube YES Depression over field NO Date of adequacy test 4/8/2002 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 3 in. Water added 628 gal. New depth 11 in. Elapsed Time: 15 min. Final fluid depth 6 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — NOTE: MT ONLY EXTENDS 44 INCHES BELOW INVERT. D. LIFT STATION Date installed 'Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 50+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I oer* that I have determined through field Inspections and �* review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. '• f e A. ..... ss:• Engineer's Printed Na a JEFFREY A. GARNESS Qo4 7953 `a: ' Lp2 ,d' •...... Date• '��o 'i�'`'7 Qt�rpro renin^d HAA Fee $ 43`/5-' Date of Payment q -17-e.? Receipt Number o / F W7 (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number �i In /70 m m 0 .—. N 0'04' 46' W 163.97 10' UTILITY EASEMENT I� A: • N�: :p s �n a2' i a �i In /70 m m 0 .—. N 0'04' 46' W 163.97 S U'lU'U4"W lb5.3y' CRAIG CREEK CIRCLE m Iq LA N r rq w N 0 Ill �0 10' UTILITY EASEMENT VEL VUVEVA a g^ \ C' s / N N O S U'lU'U4"W lb5.3y' CRAIG CREEK CIRCLE m Iq LA N r rq w N 0 Ill �0 . 4-15-02: 4:03PM: LCT&E Environmental Services Inc. • �riirrriirrrrrisir� CT&E Rein 1021803001 Client Name AK Water & Wastewater Consultants Inc. Project Name/n Craig SID Client Sample ID Lot 1 Outside Hose Bib Mfatrlx Drinking Water Ordered By PWSID 0 Sample Remarks: 0.00210 :907 661 6301 0 A- 2 w : i � I All Dates rimes are Alaska Standard Time Printed Datdrirse 04/15/2002 12:04 Collected DateMme 04/08/2002 15:00 ! j Received Date/time 04/09/2002 11:20 Technical Director Stephe��de - Released By ' Parameter Results PQL Units Method Allowable Limits Prep Analysis Date Date Init Metals Department Arsenic 0.00210 0.00200 mg/L EPA 200.9 (<0.05) 04/11/02 IMP Waters Department ' Nitrate -N 1.65 0.200 mg/L EPA 300.0 (<10) 04/10/02 IDT ..i Microbiology Laboratory Total Coliform 0 col/100ml. SM199222D (<1) 04/09/02 SBH n P 4 ' --MUNICIPALITY 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) z Location (address or directions) //Q L A f:` Applicant Name���--S: <'�<-<"�'��/ Telep)hone: Home Applicant Address /o / er v Business (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder'; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution p/os-,v2 S'/Q'4f 'E0 tic Telephone .2 Address s/U 4. /✓oelhe,,'' N L-iqlds (e) Real Estate Company and Agent F }��y f �` {"`5 �.<'� `��triN�e ����,✓ Address% ~ Suc /off Telephone 76 c S (f) Mail the HAA to the following address: V 'Aro kj 2. TYPE OF RESIDENCE Single -Family //) Multi -Family 13Other Number of Bedrooms -3 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 a 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of ection. Name of Firm 5c` L/'o�S f % j i� -Teleph ne Address z� Date l� Al (s * ...i . r ye$er'�s� i . .#6353 4 , PROFESSO 6. DHEP APPROVA .. ' Approved for bedrooms b `-tL 2'�'L�t ate PP Y Approved _ _ Disapprov Conditional Terms of Conditio al Approval 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 72-025 j11/84) MUNICIPALITY OF A DEPT. OF HEALTH & :NVIRONMENTAL PROTECTION — MUNICIPALITY OF ANCHORAGE (MOANam HEALTH AUTHORITY APPROVAL (HAA) MAR 27 Ia CHECKLIST - FEBRUARY 1984 r D 264-4720 R E C Y�-t Leg Description: —�" A. WELL DATA Well Classification % !''�' d ' If A, B, C, D.E.C. Approved (Y/N Well Log Present�l) Date C pleted - h� Total Depth r Cased to tDepth of Grouting — Static Water Level ­2LZ Pump Set At Casing Height Above Ground — Electrical Wiring in Conduig '< I) Separation Distances from Well: To Septic/Holding Tank on Lot i Yield Sanitary Seal on Casin) Depression Around Wellhead () On Adjoining Lots To Nearest Edge of Absorption Field on.Lot �' �- ; On Adjoining Lots %C To Nearest Public Sewer Line To Nearest Public Sewer / Cleanout/Manhole -�� �� To Nearest Sewer Service Line on Lot `7�G Water Sample Collected by "- �'"`�� ; Date Water Sample Test Results Comments 1`TA'Me GY ELL "I'i U�'V IZ i, :e L (a'i'l'- 7U2-"� PkFSU T5 B. SEPTIC/HOLDING TANK DATA Date Installed- �`---/ Size Standpipe/ 1) Air -tight Caps (&) ) Depression over Tank (W Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Holding Tank. To Water -Supply Well�- i To Property Line No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped - - - ;for Temporary Holding Tank Permit (Y/N) i To Building Foundation To Disposal Field i To Water Main/Service Line G �— To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata,/ Type of System Design i Date Installed — �Length of Field Width of Field �� Depth of Field Gravel Bed Thickness Square Feet of Absorption Area/c % S- Standpipes Present&54) Depression over Field (Y Date of Last Adequacy Test Results of Last Adequacy Test _�? — 1�1 ` —If lG Separation Distance from Absorption Fieli : / To Water -Supply Well IC To Property Line _-/d i To Building Foundation To Existing jr Abandoned System on Lot On Adjoining Lots To Water Main/Service Line To Cutb_ank (if present)' To Stream/Pond/Lake/or Major Drainage Course �(' �� To Driveway, Parking Area, or Vehicle Storage Area Comments "'Tif+✓Y� tNtC�lvlti ('—���i D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify thatave checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date 6 Company ��� MOA No. Receipt No. ���% dd � z" �� P 1P`�6+p••SAs®i ��'� Date of Payment 3'C `� or CO _-- •R�s' .a S 49T M r Et; c n is Seal Amount: $ �.o•oNu.a• �e.�•.•�.•.r, a �t Cg Car . Meyoc 53 Page 2 of 2 see, •�''"��� \ti ROFESS10N�i 72-026 (1184) OF A 9-r" r e � •• • 1N4.111N 1; Co .Meyer �I �•1• 353 'y��I aw Loca tion: BESSE, EPPS & POTTS 2220 FAST 88 AVLNUE ANCHORAGE, AK 99507 (907) 349-6451 WATER WELL TEST %o 0,�. C�c► F� foto 0+ Da to : -:13' — �z Subdivision: A � Lot: Block: de - Client's Name: Address: Tester: Initial Reading on Meter: ['rte ;i ick ion R: -i kr.: s� GPm 21 -;lour Cor.-1ci tY_(X11 cn:3 5. LEGAL DESCRIPTION DATE RECEIVED INSPECTION APPOINTMENTS STREET LOCATION i"IME 6. TYPE OF RESIDENCE TIME(} TIME ❑ One ❑ Four ❑ Other —a t� ❑ MULTIPLE FAMILY DATE 7. WATER SUPPLY DATE// DATE * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** INSPECTOR ❑ PUBLIC UTILITY INSPECTOR INSPECTOR ``•'��. MUNIC�a�.11i11__ p.Qf\4&CHORAGE DEPT. OF H"ALTH MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL i :OT[CTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION RECEIVED Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE ! Lid f4 - (a (,4 MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE 2-7c( 1471 4 -4 . MAI LIN ADDRESS tZ 1 (0 8 Q) 29I 3. LENDING INSTITUTION PHONE 11 (j MAILING ADDRESS 4. REALTOR/AGENT PHONE r, UA - N1� -7r3-7 1 MAI LIKIG ADDRESS .3 I -S b 1 W- I t. L, c- -r _ y 5 b 5. LEGAL DESCRIPTION 1 1 STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY r• NOTE: THE INSPECTION FEE MUST ACCOrPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) $ U THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE [J' -"THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY C!T' INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON -SITE ED PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER E315eptic Tank or ❑ Holding Tank Size: 10610 If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK 1% MANUFACTURER TOTAL ABSORPTION AREA MATERIAL s 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE,% (l B� 72-010 (Rev. 6/79)