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HomeMy WebLinkAboutFISCHER BLK 1 LT 3A4Fischer
Block 1
Lot 3A4
#015-292-15
Municipality of Anchorage
Development Services Department
Building Safely Division
On-Site Water and Wastewater Program. 4700 S. Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650 Page of
www.cl.anchorage.ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: 5W010116g PIDNumber: O)S— aqa—I5
Nero" J;a�dr
Wastewater System: ❑ New ❑ Upgrade
AdkM,
Ol 15,eY0f7 Q, Z e j4nc t7 ai
S -U ABSORPTION FIELD
pn— / I 1 - 2_73 5 rwnaw a e.ao«m "j / �
U
Xoeep Venom O lvia w n«w « O tied O M� O an
LEGAL DESCRIPTION
Sal RH:q
�ioc
faM DM honepaprW rsde
Ia/S,
, ,p,,
Block.
to A/� SWDAMvm , see
S
DepBr pip aan&VkW Wwy
b p Ea5 FI.
mbenebeneath� S D.l d" beneath pla:
. FI.
Tuen,llip- Range seellar
Fa sdbdeeovsai gtele:
c,.,a Lagar
il.
Well: ❑ New ❑ Upgrade
Grsva wWnr
3
NurroaalMs'
d,lsna bN.eenlMs:
—•
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CM,a4eluon (Prl,n.. A B.
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TOM Dept:
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lar w. Peon «e. ��
P STM
5
i
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430 3 �'
Dean
Vale
SIACWna LevM
Mina
�1:6abel
Dale Mlsaed
Ia-l0'-0l
FI
YIeM nN:
mglNgla Apure Geur.l
TANK
GPM FI.
Ft
SEPARATION DISTANCES
D (Septic []Holding ❑ S.T.E.P. ❑ Other:
To
Septic
Absorption
Lift
Holding
puDllUPrlval
Meed "«'
k
cspaely
From
Tank
Field
Station
Tank
Sewertlne
L i
5 a.
wall
d I `
IODµ.nee.
GprrDsnmea,.
s.eleeewe«
100+
��1�-
LIFT STATION
La LM
la`
�y
`
e.,
'P.mp ai MM a 'Poop ar M
HVh rn« a«m a'
FaadMen
I /
In • In
h
Pump M.kea EI.ehMW Mpsaime pAamM aY
Gudeinaain
m
no
'—
R«n«kksan%Fc rA,..,r P✓�hPro
BENCH MARK
ct,Zv(noo A.%o AdA-oo:-114.
tofJlgn w pew�pba.
Ua„a e slab
Tlt.d.-C.N Cxc,rv.Jrj 3 4+1 rN REe4.a,*4A
"/nn Il A.su.rd Elevaw,
hear poi/J� P l OU' FI
Vrr07.2
Eggn'` pr /�a
�~ ............_ l e1l,it?
Eagle River Loop Road, No. 204
r ;,
Inspections performed by: Dates:
Dates: 1”Eagle River, A'�&'ra 5
nd
ZlaI
C. COA
Develop me pt Services Department Approval
R03E2T
E t/.
Reviewed and approved by: O Date: I -.27-I
1(1 '
raev
PERMIT N0. SW010468
PACE 2 OF 3
Municipalit of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.D. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 3A4, BLOCK 1, FISCHER S/D P.J.D. NO. 015-292-15
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SCALE: . 40•
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ROURT C. COWAN
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_______
lo' Uiil Esmt --
--- —-------
.�� �_�-'•''~~.�
PERMIT NO. SWOT 0468
PAGE 3 OF 3
Municipalityof Anchorage
DEPARTMENT OF HEATH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Ataska 99519-6650 • Telephone 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 3A4, BLOCK 1, FISCHER S/D P.I.D. NO. 015-292-15
ST1
ST2 100.4'
FINAL GRADE
95.5'
NEW 1250 95.3'
GALLON
SEPTIC
TANK
F --A- B
FCO 2.5 35.5
C01=101.0'
ST1 28.5 13.5
ST2 37.0 9.0
Cor
CO2=100.4'
DBL1 38.0 10.5
DBL2 39.0 11.5
COI 25.0 45.0
7"CO2
MT1 24.5 44.5
40.5 24.5
FINAL GRADE
MT2 40.5 2a.0
SR
CO2=94.8'
N. T. S.
61T1=87.1'
h1T2=87.2'
A
NO WATER
FOUND
Oil
83.1' B.O.H.
i �`.'^'....: ,......,..
20-"T C. COWAN ••fiC
Id`c s� CE • C801
Itt`
�1�•,,`4"
December 24, 2001
ROBERTC. COWAN. P.E.
ROBERTA. SHAFER, P.E.
CMLENGINEERS
(907) 6942979
FAX (907) 6941211
MUNICIPALITY OF ANCIIORAGE
HEALTHAITHORITY
Development Services Department
APPROVALS
Onsitc Nater and Wastewater Program
PO Box 196650
Anchorage, AK 99519
SEWER& WATER
IAAIN PXTENSIONS
REFERENCE: Lot 3A4, 13lock I, Fischer S/D
12equest you issue a 1lcalth Authority Approval on the referenced property
SEWER&WATER
INSPECTION
and grant a waiver for the separation distance between the east property line
and the new leaclifield at 0 feet and 5 feet to the property to file north. We
do not anticipate any adverse effects to the referenced property or to
adjacent properties.
ENGINEERINGSTUM
AND REPORTS
If you require additional information, please contact us.
Sincerely.
WELLNSRECTION
ePLavTEST
22
Robert C. Cowan, P.E.
SITE PLANS
RCC/skh
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MO MICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577
C.
Municipality of Anchorage
X, George A 1Vuerch, Mayor
Building Safety Division
P.O. Box 19Ck5O 94700 S. Bragatt• street
Anchorage, Alaska 99519.6050 a (907) 343.8301
h ttp://w�r�a•.cl.attchom�;c.akats
S & S Engineering
ATTN: Robert Cowan, PE
17034 Eagle River Loop Rd, #204
Eagle River, AK 99577 -
December 27, 2001
Subject: Waiver Request forFISCHER BLK 1 LT 3A4
Waiver # WR010103 Lot Line Request for Parcel ID 015-292-15
Dear Engineer:
Department of
Public Works
Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater
disposal system to the lot line has been approved. The approved separation distance is 0 feet.
This waiver approval applies to the current on-site wastewater disposal system and lot line
separation only. Any future upgrade to the on-site wastewater disposal system and lot line will
require all separation distances to be met or another waiver approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office at
3434744. .
Sincerely, V.P6L-�
Jeff Poe
Engineering Technician III
On -Site Water Quality Program
MUNICIPALITY OF ANCHORAGE
Department of Health 3 Human Services
On -Site Services
Waiver Review Worksheet
WR#: 010103 PID#: 015.292-15 HAM 010651 Permit#: 010468
Date Received: 12-24.01
Legal Description: Fisher Stock 1 Lot 3A4
Engineer. S & S Engineering
17034Eaule Rivei Loop Rd. #20 Eagle River. Alk. 99577
Applicant: Jim Scruggs
Waiver Requested: Absorption Field to Property Line of 0 feet
Criteria: 1. Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
2. Special Conditions:
3. Other.
Waiver is Granted: ✓ •••••••••• Waiver is not Granted:
List Conditions or Reasons for above:
Date: f 2 — 27-0/ By
of Rc
..N..N..
Rec#: 12-24.01 Amount: $11115.00 Date Paid: 12-24-01
//- 2'-ol
MUNICIPALITY OF ANCHORAGE h
Development Services Department r T %%4'u
Onsite Water & Wastewater Program
4700 South Bragaw Street /0 : 30 Q . M
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Nov 14, 2001
Expiration Date: Nov 14, 2002
Permit Number: SWO10468 Parcel ID: 015-292-15
Legal Description: FISCHER BLK 1 LT 3A4
Design Engineer: 0003 S & S Engineering Site Address: 005100 DEL CIR
Owner Name: Jim Scruggs Lot Size: 11578 SQ. FT.
Owner Address: 5101 SELDON CIR Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE. AK 99516-6623
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 (24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By
Issued By
Date:
Date: _1/-1E-0,1
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(907)343-7904
ON-SITE SEWERMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcell.D. 015' 2`i2'1S Permit Number SW 010468
Property
S
Mailing address (1) slot C-1rc-\f,
Mailing address
Legal description (Lot, Block & Sub'd.)
Day phone 4 4 1 - 2-7,35
Zip Code r)950 - -
Legal description (Section, Township & Range)
Lot Size t 01 U ( -Aires/Sq.Ft. Number of Bedrooms f
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade Im
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
2 S 8 S ENGINEERING
(Signature of property owner or authorized agent) 17034 Eagle River Loop R;
Eagle River, Alaska 99577
Permit Fees:
3 -1,O. eo
Waiver Fees:
Date of Payment: It//3/0 / Date of Payment:
Receipt Number: O 1 5' 6 C Receipt Number:
(Rev. 12100)
S&
11G ROOM C. COWAN, P.E.
wAw CML ENG W EEnS
(907)694-2979
FAX(907)694-1211
November 13, 2001
rEAtnlATnrgnry
Ar•rTMItS
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
5M- IISWAIE11
Anchorage, AK. 99519
MAxr E%IEW,KM
REFERENCE: Lot 3A4, Block 1, Fischer S/D
smnAwnTEn
WP"°bN
It is requested that you issue a permit to upgrade h septic system to serve the existing
four bedroom dwelling on the referenced property.
EP"WEnINOSTIAIES
A test hole was excavated and a percolation test was performed. The approximate location
A ntmnls
m
of the test hole is located on the attached site plan. At the time of excavation on 10/30/01
no water was found. After seven days of ground water monitoring the test hole was still
found to be dry. An additional test hole will be percolated at the time of excavation.
MR WSPECT"
6i1ON1P51
The existing trench was excavated on 10/30/01. No sewer rock was found under or around
the distribution pipe. The upgrade as proposed will be installed partially where the existing
trench is located.
SITE RNA
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
POAOOERMVT
construction of this system will not prevent any future development on any of the adjacent
properties. ,
If you require additional information, please contact us.
SOIL TEST
Sincerely,
EAIIDN
TEST
PERIST
Robert C. Cowan, P.E.
RCC/jhm
MEDWOM
RSPECnCNS
Enclosure
ON91E
WASIEWATEn
DSPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99977
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Municipality of Anchorage r- C.)fENGINEE�k§EAL'►' - rdr
Development Services Department i� re
Building Safety Division 1
y� On -Site Water and Wastewater Program �y.�,.•.,•.
4700 South Bragaw SL �•' ......
P.O. Box 196650 Anchorage, AK 995196650f) . �j� ROBERT C. COWAN ;1�
00
w+vw.d.anchormak.us 1 cy CE -8u01
(907)343-7904 ,+1=rel'•w.. •;�4',•�
Soils Log Percolation Test 11tko"'i�--�`�~
Performed For. 73-1 e" 1 S C 1:'.' 6 6 5 Date Performed: )0/.30/01
Legal Description: LOT 3 A I BLoeK I F I S CAI r& 2 Township, Range, Section:
Slope Site Plan
Depth 1 6" fJ? SJ.I-
u
5-
6-
7-
8-
9-
10-
V
-7-B_10-
4
11- ^ V,
12-
13-
14-
15-
2-13-14-15- 11.00
•'+
16-
17-
6 -17-
18-
18-
19-
19 -
M L
ML SoL-T
G'%' 5 P
WAS GROUND WATER
N O
PERC HOLE DIAMETER 6 -"
ENCOUNTERED?
S
Lvv,lu G.?AAt,d
G FT
IS
_ L
GnAJ4L IOTA
IF VES, AT WHAT DEPTH?
Depth to Water After
O
PadRLy (.AAOGO
Monitoring?
V%.lJ E
SAN 0
Date:
11 A/0I
B. 0. d.
111
PERCOLATION RATE
C 1
(Mwevtnch)
PERC HOLE DIAMETER 6 -"
TESTRUNBETWEEN
S
FT AND
G FT
COMMENTS ,1100 L.WOv" PA J) TNk
HG`- V
To, V4
a
---�'
-
PERCOLATION RATE
C 1
(Mwevtnch)
PERC HOLE DIAMETER 6 -"
TESTRUNBETWEEN
S
FT AND
G FT
COMMENTS ,1100 L.WOv" PA J) TNk
HG`- V
To, V4
a
PERFORMED BY: 1 CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUID LINES IN EFFECT ON THIS DATE. DATE:
MUNICIPALITY OF ANCHORAGE
Hear and Environmental Proteceom"bn
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
279-2511, x 224, 225
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME 1v0 - MAILING ADDRESS �_l1� ,�Vg%i%i.�M�—,, (PHONE
LOCATION Cto"E=�L _ LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE NUMBER OF .l
FROM WELL Lb Sr MANUFACTURER V •'r MATERIAL j COMPARTMENTS _
INSIDE LENGT
INSIDE WIDTH
LIQUID DEPTH —� LIQUID CAPACITYIZS('GALLONS.
TILE DRAIN FIELD: �Ds�'Q"�
( � TOTAL LENGTH � (
1 OI `)
DISTANCE FRO!.* YELL —FOUNDATION 3 P�— _NCARCST LOT LINO I � OF LINE �.---
# of Lines DISTANCE BETWEEN LINES °1—TRENCH WIDTH�(r IN. TOTAL EFFECTIVE
ABSORPTION AREA _—1 --:i-1A—SQ. FT. LENGTH OF EACH LINE
DEPTII OF FILTER I
DEPTH: TOP OF TILE TO FINISI4 GRADE � MATERIAL BENEATH TILE IN. ABOVE TILE �" IN.
SEEPAGE PIT*
DIAMETER OR WIDTH—. LENGTH_, DEPTH
Log Crib _Rings_ Crib Size: DIAMETER _DEPTH_DISTANCE FROM: WELL .
- --' - --- - --- -- - TOTAL EFFECTIVE
BUILDING FOUNDATION— . NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT.
Well / \\ .� 5' - �. _ pt/• �._.
Class: �'^d Depth:
We Distance To: Lot Line L
Bldt: a U i- Sewer 'Line: H
Pipe Materi ls:
# of Bedrooms:
Installer: 14V,r j- a5 I P
Remarks: So* l 1014
it
I -T
DATE ?/W/—L APPROVED
U
I
I
_
DATE ?/W/—L APPROVED
U
-MIJN T C TAL I TV 01= Fq"1="i 7RAC3E l .S p-
825
DEPARTMENT HEALTH AND ENVIRONMENTALi.OTECTIONS 'L' STREET. RNCHORRGE, AK. 99.,d1 J ,
279-2511 9 -0 -?1 07ol
WELL AIV[? ON-SITE SEWER PERM T
PERMIT NO. < 77402 )�'t� % pm.
APPLICANT NO LOTS CONSTRUCTION 3419 NEWCOMB3l7 333-5436
LOCATION DEL IRCLE
LEGAL L3A4 B1 FISCHER SUBD LOT SIZE 11500 SQUARE FEET
TYPE OF SOIL RBSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS 4 SOIL RATING CSO FT/BR)= 101
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
OEPTHm 1 �d LENC3THa S1 CCRAvE:t- E>EPTH- 4
THE LE14GTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF.A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE I5 NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION CIN FEET).
IREGIIJ I REl7 SEPT T C TANK S I ZE- 12� J C3ALLOt�S
TWO < 2 7 I NSPEC►T I C3Nn3 ARE REAM J I REO
BACKFILLI140 OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT I -JILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHI14 30 DRYS
OF THE WELL COMPLETION.
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTALLATION.
PERM I T 4jpAIL I I? FOR ONE YEAR FROM I SStJE
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED ----- --------
APPLICANT NO LOTS_PMSTRUCTION
ISSUED BY
1)
n n
GRE.,, ER ANCHORAGE. AREA BOROUGH
•'' DEPART14ENT OF ENVIRONMENTAL QUALM
3330 "C" Street
ANCHORAGE, ALASKA 99503
E
Case P
Performed For 0anl4M.l L (444-S 100)5TRAXTtC-3 Dated Performed S n ?
Legal Description: Lot3 .Block o+j_SubdivisiontoTti 3A «r I Fisemm5u6.
This Form Reports Soils Log YG5 Percolatio Test nIA2!.
- Soil Test Must Be Logged To 4' Below Proposed Seepage System -
Depth
Feet Soil Characteristics
Was Ground Water Encountered? Alo
If Yes, At What Depth?
GrINaMlI 3,, MON, R� �
r pO r A `a
Reading
Date
Gross Time Net Time
Depth to Li-a� ,ette6•... I
ho I
96.
F'ry! Sal&1, tom.,da-A
F!e,cell
—,
yra�.d
YMN P. WMrIACI
,y
=a'
6W 8S sopr�BaeM
t•;/4
RED
Ery, Se .ilfw,Pawp�
L
fi''3 Cry, $2/FII, Pwanc,Gla.y
�,
lMieriY•111�I( Sand 60.cl
<Sa�•
i.¢II elraded 6W _ 8S$o Ft
Was Ground Water Encountered? Alo
If Yes, At What Depth?
Percolation nate w)nuv�
Proposed Installation: Seepage Pit Drain Field X
Depth of Inlet. --AL--- Depth to Bottom of—Pit or Trenc�[�'—J
C014MEPITS:_EX�tv,t etewj Saga-tselcEsc_A!QW % I
Test Performed /F. Date Certified BY:
_E Date:
��7
r pO r A `a
Reading
Date
Gross Time Net Time
Depth to Li-a� ,ette6•... I
ho I
.l
YMN P. WMrIACI
,y
t•;/4
RED
Percolation nate w)nuv�
Proposed Installation: Seepage Pit Drain Field X
Depth of Inlet. --AL--- Depth to Bottom of—Pit or Trenc�[�'—J
C014MEPITS:_EX�tv,t etewj Saga-tselcEsc_A!QW % I
Test Performed /F. Date Certified BY:
_E Date:
��7
0*F Municipality of Ancho gOn-Site Water and Wastewater Pro m ��L L I i miro (907) 343-7904 �6 �6 �� �
CERTIFICATE OF ON-SITE SYSTEM PR VA AI -
01 —6R E95
Parcel I.D. 015-292-15 _.., Expiration Dgte ("
1. GENERAL INFORMATION
Complete legal description FiSCHER,BLOCK 1; LOT 3A4
Location (site address) 5101 SHELDON CIRCLE, ANCHORAGE 99507
Current Property owner(s) Warren CII & Kimberly S Metzger . Day phone
Mailing address 5101 SHELDON CIRCLE, ANCHORAGE 99,507
Real Estate Agent Day phone
2. TYPE OF DWELLING:
M Single Family (w/wo ADU)
❑ Duplex
Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4
1
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:
Received by:nee Date: 2 9—��5
COSA to be released to the engiss o1 equesfed by the angneer.
COSA Fee $1� 3!J - z,� Waiver Fee $
Date of Payment ?/2_0416 Date of Payment
Receipt Numble�rG/� �OOQq l Receipt Number
COSA # v �n CJ 1 f-} 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.
Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791
Address 20441 PTARMIGAN_ BLVD.,. EAGLE RIVER, AK 99577_-_-...
Engineer's Printed Name KENN 'Tf t M. DUFFUS _ Date 7121;2615.....
Engineer's Comments: This Investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. 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 the well and septic system. Therefore.
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future ,' \
occupants or can ArcTerna guarantee that no unseen
encroachments, deficiencies or discrepancies exist
rep
6. DSD SIGNATURE
System #1 Approved for V bedrooms.
System #2 Approved for bedrooms. 'AV
Disapproved.
Conditional approval for
bedrooms, with the following I
tlttir
OF,t
ON-SITE
WATER AND
PROGRAM
By _ .. Original Certificate Date:..-
Theid ity Anc ge Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 9 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
rrcn nnx an,.o, ,n.n:.,>n,v
If more than I septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description FISCHER SUED. BLOCK 1, LOT 3A4
A. WELL DATA
Well type PRV.r If A, 8, or C provide PWSID #
Date completed UNK* Sanitary sea] (YIN) Y
Total depth >25V. ft. Cased to >255* ft.
FROM WELL LOG
Date of test UNK' 1123/93 COSA
Static water level 242*
. . ... ... .......
Well production
9 -p.m.
WATER SAMPLE RESULTS:
Coliform NP—'. colonie$1100 mL
Arsenic:. NO ug/L Date of sample: 6J2412015
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material . SEPTIC I STEEL...
Tank size 1250 gal. Number of Compartments 2
Foundation cleanout (YIN) Y Depression over tank (Y/N) N
Date of pumping 9117/2014 _ . - Pumper ONE STOP.
Parcel ID: 015-292-15
Well Log (Y/N19 /V
Wires properly protected (YIN) Y
Casing height (above ground) 18 in,
AT INSPECTION
9117114
247 ft.
Nitrate _---4.._1-1 — --- ------- mg/L
Collected by: ARCTERRA
Date installed 12110/01
Cleanouts (YIN) Y
High water alarm (YIN) N
C. ABSORPTION FIELD DATA
Date installed I2110120.01 Soil rating (g.p,d./ft2 or ft/bdrm) 1,2 System type DEEPTRENCH
Length 35 ft. Width 3.__.. Gravel below pipe .7.5. ft,
Total depth 14.1 ft. (Meas. 9117/14) Eff. absorption area 626 fe Monitoring tube Y Depression over field N
Date of adequacy test 91.17/14. Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in- Water added 6.1.0 gal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= Boo+
__. g.pA.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N . . . . ........... . .. If yes, give date
D. LIFT STATION
Date installed _
Size in gallons
Manhole/Access (Y/N)
"Pump on" level at _,.._ in.
"Pump ofr level at in,
High water alarm level at in.
Datum
Cycles tested
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station 6n' lot 100+
On adjacent lots 100'+
Absorption field on lot _100+
On adjacent lots 104'±....__
Public sewer main 75'+.
Public sewer manholetcieanout
Sewer /septic service line 25'+
Holding tank 100'+ -
Animal containment areas 50'fi._._
. _..._....
Manurelanimal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+_____.
PropertyIlne 5'+
Absorption field 5`+
Water main 10'+
Water service line
10'+ Surface water 100'+
Wells on adjacent lots, 1004
ABSORPTION FIELD ON LOT TO.
Property line `01+ _
Building foundation 5'+
Water main ._10'±
Water Service line t01+
Surface water 100'_+..,,
_ Driveway, parking/vehicle storage - 0'
Curtain drain 50'+ (w t( WFFJ
Wells on adjacent lots
100'+
F. COMMENTS
MOA waiver to lot line dated 12/2712001._,.
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 MOR COSA guidelines in effect on this date.
Engineer's Printed Name _KENNETH M. DUFFUS
Date 712 712 01 5
COSA canary sheet_2.6-15.doc
I�
iLOT 3A5
Ss9283o
I
F
I
�2`�A3.
SHED rust
I �tiR�
j
LOT 4A2 ( I
M
w 26.2 26 4
Z Z
O I w
O
LOT 3A4 EXISTING
HOUSE SELDON CIRCLE
- I ® (DEL CIRCLE)
v �"` o
5.2
o I 1.0 o
i 0
N O
N ...
i2O.o
LOT 4B-2
iSHED St000
�Rl
/ LOT 3A3 00000DOppp
0
of AC�41
�.
49TH**
Ip... 9TH
.......
0..••. • 0
Q�.•.Anthbny•an::
N�
00O 5-9020 �Qp�
NOTE:
THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT �4p °fessiono\ o�
n
PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LANTECH. pppp
Legal Description: AS-BUILT
ordered By. Warren Metzger
Legend:
Asphalt
septic Standpipe OOConcrete
Lot 3A4, Block 1,
Fischer Subdivision
Water Well
Fence—X—X—Overhang
Woo eek
SURVEY CERTIFICATION: has conducted a physical survey of the
property as shown on thishis drawing and certifies that the improvements
Lmrl=EXCLUSIONARY
situated thereon are within the property linea and no encroachments exist
other than noted.
LAND & CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS
NOTE It is the owners' responsibility to determine the
existence of any easements, covenants, restrictions or right—of—way
440 West Benson Boulevard, Suite 200 Phone: 562-5291
Anchorage, Alaska 99503
takings which do not appear on the recorded subdivision plat Under
no circumstances should any data hereon be used for construction,
Fax: 561-6626
for establishing property lines, or for plot—plan purposes.
Plat: 70-170 Grid: 2537
Date: May 6 2009Drawn By. CB
Work order. 2009—L-37 Ref: 2001—L-709
Scole:1"=20' Checked By. JMZ
MUNICIPALITY T ANCHORAGE
• -• DEPARTMENT OF HEALTH & HUMAN SERVICES t
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 l.D. # CWl) - gS2A- \-'-) nHAA# I ry)
1. GENERAL INFORMATION
I L � AFt/�
Complete legal description
�� EL SMF
Location (site address or directions)
Property owner I VAA S 1h, Day phone 4142- 9191—
Mailingaddress
,, �5110 C'` -
/7 It IIA74"
Lending agency °� wcu Day phone S(o 2 S1o2
Mailing address
Agent
Address'
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. 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(72.0.1/01) Fwl MOA/21
S. 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.
Name of Firm / o //a aH SD r�C �aK.sQ I�� phone — 3 11 b
Address
Engineer's signature
6. DHHS SIGNATURE
X Approved for T bedrooms.
Disapproved.
Conditional approval for
Additional Comments
By:
Date r'J' 1 Y3
bedrooms, with the following stipulations:
Date 2 - / 7 - y3
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.
non aw. iA» e.a r OA M
Municipality of Anchorage ARL
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: It el- 344 Ft,6CLA-e-• Parcell.D.
A. WELL DATA
Well type 9, If A, B, or C, attach ADEC letter. ADEC water system number N�ti
Log present (Y/N) t A Date completed 147 g Driller
Total depth 7.2';5 Cased to 72q c; Casing height 9
Sanitary seal (Y/N) Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
O•
AT INSPECTION?
z
t�2.FY'43
rn
^
7
g.p.m.
g'p' 1T1
w
>,aq -
D
SEPARATION DISTANCES FROM MLL T .
Septic/holding tank on lot ! 6 e it i;:"'r Jrjak�n adjacent lots ) t a3
Absorption field on lot 10 ! ; On adjacent lots % io3
Public sewer main N�A Public sewer manhole/cleanout 1 f'//A
Sewer service line%
C. LIFT STATION
Date Installed .
Size In gallons
Vent(Y/N) _
High water alarm level
/4
"Pump on" level at
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
. \ ,
SEPARATION DISTANCE FROM LIFT STATION TO:
1
Well on lot
On adjacent lots
t
"Pump off" level at
Cycles tested
Surface water
D. ABSORPTION FIELD DATA
Date installed � g/ 7� Soil rating System type 4XI.4 LA
-.length 3 Width 35_Gravel thickness—_�4_Totaldepth
- 10
Total absorption area 14,2
Cleanouts present (Y/N)
Depression over field (Y/N) �, Date of adequacy test I 1 7.2413
y- Results (pass/fail)' � for bedrooms
Peroxide treatment (Pas( tz months) (Y/N) N If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot- /07 On adjacent lots> 17-0 PrPropertyline-
To building foundation 5To existing or abandoned system on lot N�.4
On adjacent lots Ia2 — Cutbank- oN Water main/serviceline I > D
Surface water N o H t Driveway, parking/vehicle storage area �(
Curtain drain O 1 .)(: piLe 14" E A•B -4014 10 ' 7
: o .u. OAA t t %',�r'a,Q,O �,. Qs, ei, . L.A 3 A q
E. ENGINEER'S CERTIFICATION L,1, 3/}3% I UA to o_ r•
ktiaeA4 ,
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect onV.date of this inspection.
Or
Signature dl 1 u X� �( (i'x .. ,;: , }'•.
Engineer's Name �
Date �t l9
CE
HAA Fee $ n Waiver Fee: $ ' •, O,yJ
Date of Payment 2 —�� �%T 3 Date of Payment .2-11A3
Receipt Number �� Receipt Number
72-M(Aw. 9/91)11 ck MOA 21 ®S 'Xi LLL C /
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 B STREET ANCHORAGE. ALASKA 99518 TELEPHONE (907) 562.2343 FAX: (907) 561.5301
Chenlab Aft. :93.0385-1 REPORI of ANILISIS
Client Sample ID :L3 14 IISCHER S/D
Matti: : MATER
Client Name :IOBBEN SPURILAND, P.L.
Ordered By ' :TOBBEN SPCRELIND
Project Name
Project$
PWSID :UA
Sample ROUTINE 31MPLE COLLECTED IT: STUART.
Remarks:
QC
Parameter Results Qual. Units
NITRITE -N 1.26 mq/l
9
Collected :01/28/93 1 16:00 hn .
Received :01/28/93 1 16:00 hrs.
WORK Order :62709
Report Completed :01/29/93
Technical Director E C. EDEGG�
Released By :�
lllovable
Method Limits
----------------------------------
EPA 353.2/300.0 SO
Extract Analysis
Data Date Init
-------------------------
01/29/93 01/29/93 LLB
.......................................................................................................................................
See Spacial Instructions Above OA - Unavailable
'• See Sample Remarks kbove NA - Not lnalyred
0 . Undetected, Reported value is the practical quantification limit. LI - Lase Ihan
D . Secondary dilution.��±±��-+- OI - Greater Than
(ONC13S Member of the SGS Group (SocI60 GdnArale de Surveillance)
COMMERCIAL TESTING & ENGIN
CHEMICAL & GEOLOGICAL
TELEPHONE (907) 562-2343
EEI>NG CO. AK DIV
LABORATORY
Drinking Water Analysis Report for Total Coliform
TO BE COMPLETED BY WATER SUPPLIER
❑ PUBLIC WATER SYSTEM I.D. 0
pFA,pRIVATE WATER SYST
1.nn i
Malnp Aftm
Cry sw. Zo Coo.
SAMPLE DATE:
Mo. Day Year
SAMPLE TYPE:
Routine
❑ Check Sample (for routine sample
with lab ref. no. 1 ❑ Treated Water
❑ Special Purpose tQ jntreated Water
SAMPLE TimeCoftoed
No. LOCATION � Collected
I I .�19C1
` I
21
31
41 I
51
=.C.-/--9-v1C�
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Street
Alaska 99518
TO BE COMPLETED BY LABORATORY
Analysis sho j this Water SAMPLE to be:
XSatisfactory
❑ Unsatisfactory
❑ Sample t(;6'longIn transit; sample should
not be over 30 hours old at examination
to Indicate liable results. Please send
new sampi1 via special delivery mail.
Date Received Za
Time Received �CO�
Analytical Mejhod: Membrane Filter
i
I
No. of coloniesl100 mi.
I
Lab Ref. No. Result* Analyst
Ea5 Q9
Z
93.0385 m
BACTERIOLOGICAL WATER ANALYSIS RECORD
Membrane Filter: Direct Count
Verification: LSB BGS
v Coliform/loo ml
Fecal Coliform Confirmation
Final Membrane Filter Results p, Coolliform1100 ml
Reported By � Date /, 2 / r / 7
6C
TNTC c Too Numerous To Count Time: l a.m.
p.m.
OB = Other Bacteria
PART ONE OF TWO
���rJGS Member of the REMAINDER TO FOLLOW
.� Muni7ipality of Anc2orage
Department of Health and Human Services
625 "L" Street
Tom Fink,
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
February 17, 1993
Tobben Spurkland, P. E.
203 West 15th Avenue #206
Anchorage, Alaska 99501 3i:4
l
Subject: Waiver Request for Lot _aBA,Block 1 Fischer Subdivision
Waiver Request #WR930005, PID 1015-292-15, HA930055
Dear Mr. Spurkland:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved. The
waived distance is 7 feet from the absorption field to the property
line.
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sincerely,
Daniel J. Roth
Civil Engineer
On-site Services
DJR/ljm
MUNICIPALITY OF ANCHORAG
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR# WR930005 PID# 015-292-15 HA# HA930055 Permit #
Date Received: February 17
Legal Description: Lot ;3 Block 1
Engineer: Tobben S urkland, P E.
ivision
203 West 15th Avenue #206 Anchorage, Alaska 99501
Applicant: Jim Scruggs
Waiver Requested: Lot line waiver -leachfield to property line 7'
Criteria: 1. Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Points:
Waiver is Granted: Waiver is NOT Granted:
List Conditions or Reasons for above: S,Ef ENG/A.tiERl 1 ii A-CKFD
LF_I-F_/Q
Date: 2-17-93 By:
ame of Re'
Rec #: 24457/6490 Amount: $ 70.00 Date Paid: 7-17-q3
T _ E3FrURKLLAND F="-FE-
L751
'_E_L751 M. DIM04D BLVD.
ANCHORAGE, ALASKA 99502-3904
(907) 248-5095
Municipality of Anchorage 'February 15, 1993
Division of Environmental Health
Department of Health and Social Services
E72O I Street
Anchorage, Alaska 99501 Q,O
Subject: Lot 3A Fischer S/D j
Lot Line Waiver
Gentlemen;
During an 14AA inspection of subject property it was observed that
the clean out at the end of the absorption trench serving this
property was located 7 feet from a small retaining wall that
probably defines the lot line between Lot 3A4 and Lot 3A3.
The absorption trench for Lot 3A3 was measured to be 12 feet away
from this clean out. The trench on Lot 3A3 was installed 5 feet
from the lotline, and parallel to it.
We request a lot line waiver of three feet. Since a trench
already exist 5 feet from the lot line , the granting of this
waiver will not affect any future upgrade on lot 3A3.
Yours
V•
Tobb n Spurkland E.
/ MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services ati
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel l.D.# r)\{-Aqn-\'6 HAA# 4ACNSS tl^Q\
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
FZ) SC.H 9 R S/D LOT 3A4 25LOCK I
Location (address or directions)
5/ I Sc /c%n ale - li ncJ A k_ ':�?-j-l E
(b) Property owner �� c Yo l Ls, „G Telephone: (home) Business`ICIO
Mailing Address SzU c 5 �zA
(c) Lending Institution N �� Telephone
Mailing Address —Nin
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here if hold for pickup.)
List contact person and day phone number below:
SZZ-l3il
2. TYPE OF RESIDENCE
Single -Family e Number of bedrooms ¢
3. WATER SUPPLY
Individual Well C2( Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site V Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
n-025(Rw.7/U) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, 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 COP' W / AJ ge 65WC. Telephone
Address _ 1000 E ,D IMOnI D 84V& SU1 TC 2_O5-
Date
OSDate JUNE.P)9 1989
Seal
6. DHHS APPROVAL
Approved for _bedrooms by ! Datelen-LI-
Approved
Approved4—Disapproved Conditional
Terms of Conditional Approval
I . - - I I CAUTION .
The Municipalityof Anchorage Departmentof Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-WS)Rw. 7/88) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
*ICI'PALrrY
Health Authority Approval (HAA)
143-4744UARY 1984
ENVIRONMENTAL SERVICES DIVISION
Legal Description: / o+ __?!#4 &_L_I
JUN 21 1909 Fi f, Ne Cup h
A. WELL DATA . RECEIVED
Well Classification 1-' R 1 V f) i If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) N Date Completed BEEOR E 1978 Yield S:P ^I
Total Depth-2,Z7_5'tased to 40 4- Depth of Grouting h�a'
Static Water Level 2 49 r Pump Set Aty NK AIOW N
Casing Height Above Ground 2-0
Sanitary Seal on Casing (Y/N) y
Electrical Wiring in Conduit (Y/N) V Depression Around Wellhead (Y/N) N
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot r ; On Adjoining Lots I 0 -
To
-To Nearest Edge of Absorption Field on Lot 11)7, ; On Adjoining Lots /00,+
To Nearest Public Sewer Line n �� To Nearest Public Sewer Cleanout/Manhole n /eL,
To Nearest Sewer Service Line on Lot 10 '+
Water Sample Collected by K • �- /'� (` a n Date 9 S 9
Water Sample Test Results Q 17 APP ZO V EID
Comments WAIVE(' tJf-3T'A1Ah=D `l/2-5-/85
B. SEPTIC/HOLDING TANK DATA
Date Installed '3/7-1 Size 1250 No. of Compartments 2
Standpipes (Y/N) N1 Air -tight Caps (Y/N) Foundation Cleanout (Y/N) V—
Depression over Tank (Y/N) N Date Last Pumped
Pumping/Maintenance Contact on File (Y/N) n�� ;for n IA_
Holding Tank High -Water Alarm (YIN) h Temporary Holding Tank Permit (Y/N) n 0 -
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Weil 9 6 To Building Foundation
1 !o
To Property Line 10 ' To Disposal Field 1 2
To Water Main/Service Line 10'+
To Stream, Pond, Lake or Major Drainage Course n la"
Comments
72-M )Rw. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 1 O 1 Type of System Design -%R ENG;A4
Date Installed 8 / 7 7 Length of Field
Width of Field �» Depth of Field 9
Gravel Bed Thickness
Square Feet of Absortion Area 4-2-4- S!� ft Statndpipes Present (Y/N) Y
Depression over Field (Y/N) N Date of Last Adequacy Test 6 el 189
Results of Last Adequacy Test - LATISEACTo&Y
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well 10-7 To Property Line 1 O )
To Building Foundation To Existing or Abandoned System on
Lot ; On Adjoining Lots /2-1
To Water Main/Service Line. 10 +' To Cutback (if present) �a-
To Stream, Pond, Lake, or Major Drainage Course - h/C_
To Driveway, Parking Area, or Vehicle Storage Area .D R 1 V Ef,t) i4y O V Ems' 77REAJC H
Comments
D. LIFT STATION n lo.
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)
Meets MOA Electrical Codes (Y/N)
Comments
"Check Permit)'eb Bedroom
I certify that
inspection.
Signed _)
Company Cie
Date
MOA No.
Against HAA Request"
or conformed to all MOA and
Receipt No. 70
Date of Payment /— p 9
Amount: $ O'
Receipt No. _
Waiver Fee: $
Date of Payment
72-M (Rev. 7/88) Back a/a/3 Page 2 of 2
Pumping Cycles during Adequacy Test.
effect on the date of this
k- .
Engineer's Seal
HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 5622343
FEDERAL TAX ID N 920040440
Client Sample ID:EISCUER SID
PWSID :CA
Collected JUN 16 89 4 14:45 hrs.
Received JUN 16 89 1 16:00 hrs.
Preserved with :NONE
AN.ALISIS REPORT 8I SA)fi'LE for Work Order t 14107
Date Report Printed: JUN 19 89 1 14:10
Client Name : CORWIN r ASSOC
Client Ace% : CORWIN?
P.0.1 NONE REC D
Req
Ordered Ey
Analysis Completed :JUN 16 89 Send Reports to:
Laboratory Supervvilor :STEPREN C EDE 1)CCRWIN 6 ASSOC
Released Ey : J((s✓C. 2)
....................................................................................................................................
Special
Insttuct:
Chemlab Ref t: 5790 Lab Smpl ID: 1
Parameter Tested
NITRATE -N
Y
Sample ROUTINE SAME
Remarks: SAME COLLECTED EI E.L.
Mattlr: NATLA
lt/On1t/ it / Method
1.6 sig/l / EPA 353.2
Allowable
Limits
10
..............................................................................................................
1 Teats Performed See Special Instructions Above DA -Unavailable
ND- None Detected See Sample Remarks Above
NA. Not Analyzed LT -Len Than, OT-C:eat•t Than
PI Cr -0P
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
'r TELEPHONE (907) 562-2343 5633 B Street
Anchorage. Alaska 99518
^-•• Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIERII TO BE COMPLETED BY LABORATORY
❑ PUBLIC WATER SYSTEM I.D.M � I I A I Is shows this Water SAMPLE to be:
C✓PRIVATE WATER SYSTEM
S2Z- /
Name ' Phone No.
/GOO Z)111GND CLVa 2(-);
Mailing Address
City State Zip Code
SAMPLE DATE:
Mo. Day Year
SAMPLE TYPE:
ca"'Routine
❑ Check Sample (for routine sample
with lab ref. no. ) ❑ Treated Water
❑ Special Purpose ❑ Untreated Water
SAMPLE Time Collected
NO. LOCATION Collected By
1 1 Tlscr-( e sU;',Qi. I 2:6- 4.h.;
..
2 I I
3 1 1
na
Satisfactory
Unsatisfactory
❑ Sample too long in transit; sample should
not be over 30 hours old at examination
to Indicate reliable results. Please send
new sample via special delivery mail.
Date Received (P — l("—g?
Time Received Ma C10
Analytical Method: Membrane Filter
No. of colonies/100 ml.
Lab Ref. No. Result' Analyst
s7I ?o1 ®-
U m
U m
U m
U m
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS Membrane Filter. Direct Count
N
V��Ir�%11
i, i 111r
ti +
Collforml100ml
BEFORE Verification: LTB -BQ5
COLLECTING SAMPLE Final Membrane Filter Resu
ltsCoilforml1100ml
Reported Bye --fir a Date
Time: a.m.
p.m.
TNTC = Too Numberous To Count y'
OB = Other Bacteriaa&, l yr,
V
ISAACS PUMPING SERVICE
(Norm Tibbetts. Owner)
6218 Quinhagak Street
ANCHORAGE, ALASKA 99507
Phone St3-32nn .
— //'— 19
-4;
;A
_..._e .:.. — .; .;. :- -m:. :. 6:ml�;. -
Y veoTAX
TOTAL
All
O�pa"4d by thi* bj,jg-�s MUST b.
-6552 acc
�0 ... I 7hank
Ip ATO � cYou
W
n
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH 09,L-- 1 ru t
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date 9/1, Ig(,
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
"-I- 3A Y T31C j 69h ev- SEC- 15, TIAN.11231ez
Location (address or directions)
510 s4--lZ064 Cec/e
(b) Applicant Name r 1 kyUd G11 Telephone: Home Business
Applicant Address qo
(c) Applicant is (check one): Lending Institution O ; Owner/builder 0 ; Buyer O ; OtherX (explain);
iz //
(d) Lending Institution
Address
(e) Real Estate Company and Agent
Telephone A-26 -/33 1
(f) Mail the HAA to the following address:
2. TYPE OF RESIDENCE,
Single -Family Multi-Family0 Other
mber
Nuof Brooms 4/
3. WATER SUPPLY
Individual Well ko Community 0 Public ❑
Telephone
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
I1'', Irl.,,
Onsite Public [3 Community ❑ Holding Tank 0 1 1
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
3
73-025 251,841
rmi
n,
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 this inspection. -I
Name of Firm 7.-.S . Telephone a7cf - S91
Addre
Date
r*• f(.Ttl �*r.
0•• gineer's Seal
r2N 225-E
RIME 2S, 1971
6. DHEP APPROVALtO
Approved for )5'6LW- bedrooms by e �—j_ ��
T—z
Approved l,== Disappn Conditional
Terms of Conditional Approval
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based wkly 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 engineers work.
Page 2 of 2
72-025 (iii(
MUNIgpAL"Y OF ANCFgy4ol
DE". OF WALTH
00"' E LL Pito ancnw
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA) SEP 1 1
CHECKLIST - FEBRUARY 1980' I
264 4720
A. WELL DATA
Well Classification 9 If A. B. C. D.E.C. Approved (Y/N)
Well Log Present (Y/N)— Date Completed . 1�8 YieldGQN�
Total Depth Cased to � 0 Depth of Grouting IA-
Static
��
Static Water Level Z - Pump Set At / y ">W
Casing Height Above Ground ,n Sanitary Seal on Casing (Y/N) —
Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N)
Separation Distances from Well:
I a
To Septic/Holding Tank on Lot — el � ) : On Adjoining Lots
,,/s
To Nearest Edge of Absorption Field/on Lot .07 On Adjoining Lots
To Nearest Public Sewer Line /V To Nearest Public Sewer
Cleanout/Manhole AN
/To Nearest Sewer Service Line
on
Lot
/�
Water Sample Collected by �,�j�F of 45 A/ : Date �/� V
Water Sample Test Results W6
Comments Zio
B. SEPTIC/HOLDING TANK DATA
Date Installed Size Size �Q— No. of ompartments .09
Standpipes (Y/N) Air -tight Caps (Y/NFoundation Cle u (Y/N
Depression over Tank (Y/N) 41 Date Last Pumped 9
Pumping/Maintenance Contract on File (YIN) Al ; for
Holding Tank High -Water Alarm (Y/N) N#0 Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well 9CTo Building Found
To Property Line tL61 —T— To Disposal Field
To Water Main/Service Lie �� To Stream, Pond, Lake, or Major Drainage
S iA
ation / Z7 /
�n/
Course
Comments
Page 1 of 2
72-026111841
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ��2/ Type of System Design
Date Installed ZZ Length of Field
Width of Field 36 Depth of Field C)
To Driveway, Parking Area, or Vehicle Storage
Comments
D. LIFT STATION /� //,{
Date Installed / V �1/
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
Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Check Permitted Bedroom Rating Against HAA Request •'
I certify that I have checked, verified, or cont ormed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed Date
Company
Receipt No. `i b O ll — w poi
DateofPayment
i
Am(Ont: $ L
Page 2 of 2
72-026 (11,04)
INMZ"
1P�E OF. AI�. JI
h: •rte` • - '.-7
_ !"i
2225-E
'� • JU::: 2S, t7�J
Engineer's Seal
r
s
Gravel Bed Thickness
Square Feet of Absorption Area
Standpipes Present(Y/N)
Depression over Field (Y/N) N
Date of Last Adequacy Test
Results of Last Adequacy Test — / Jif �,✓
le
Separation Distance from Absorption Fiyld:
To Water -Supply Well ZI-0:27
i
To Property Line h-7
To Building Foundation de
/ To Existing or Abandoned System on
LotjR
; On Adjoining Lots
�/ I
To Water Main/Service Line/r% To Cutbank (if present)—/�%/'1
To Stream/Pond/Lake/or Major Drainage Course
&44
To Driveway, Parking Area, or Vehicle Storage
Comments
D. LIFT STATION /� //,{
Date Installed / V �1/
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
Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Check Permitted Bedroom Rating Against HAA Request •'
I certify that I have checked, verified, or cont ormed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed Date
Company
Receipt No. `i b O ll — w poi
DateofPayment
i
Am(Ont: $ L
Page 2 of 2
72-026 (11,04)
INMZ"
1P�E OF. AI�. JI
h: •rte` • - '.-7
_ !"i
2225-E
'� • JU::: 2S, t7�J
Engineer's Seal
r
s
` n
CHEMICAL & GE 6 TORIES OF ALASKA, INC.
— TELEPHONE (907) 5622343 5633 B Street
1 Anchorage, Alaska 99518
Y
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER TO r BE COMPLETED BY LABORATORY
�
❑ PUBLIC WATER SYSTEM I.D.I. Analysis shows this Water SAMPLE to be:
1 PRIVATE WATER SYSTEM tl
�^A �7 ,-Satisfactory
� z e R"k- /-rA ❑ Unsatisfactory
Name i Phone o.
❑Sample too long In transit; sample should
not be over 30 hours old at examination
Mailing Address I to Indicate reliable results. Please send
new sample via special delivery mail.
City
State
SAMPLE DATE: Emo{ I Ekit Eal
Mo. Day Year
Zip code
SAMPLE TYPE:
,bl Routine
/ ❑ Check Sample (for routine sample
with lab ref. no. 1 Treated Water
❑ Special Purpose Untreated Water
SAMPLE
Time Collected
NO. LOCATION
Collected ,r_8y�
-
21
I
3I
4I `
5I
I
READ INSTRUCTIONS I
BEFORE
COLLECTING SAMPLE
Date Received JO
Time Received (9 9 -
Analytical Method: Membrane Fitter
No. of colonies/100 ml.
Lab Ref. No. Result* Analyst
® D�
U m
U m
U m
U m
BACTERIOLOGICAL WATER ANALYSIS RECORD
Membrane Filter. Direct Count
Verification: LTB
Final Membrane Filte As Its
Reported By
Time:
TNTC = Too Numberous To Count
OB = Other Bacteria
C
w
Coitfonn/looml
a.m.
p.m.
I
f^ r'1
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
I 1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, se
,..
Location (address or
Application Date— w &�
township, range)
I" (b) Applicant Name e• VIC—ILu lr Telephone: Home Business
Applicant Address
(c) Applicant is (check one): Lending Institution ❑ ; OwnerP_-4Udar9; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the NAA to the following address:
2. TYPE OF RESIDENCE
Single -Family Multi -Family❑ Other
Number of Bedrooms
3. WATER SUPPLY
Telephone
Individual Well V Community ❑ Public ❑
Note: Rcommunity 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 Slate Department of Environmental Conservation
attesting to the legality and status.
72-025 n ve41
Page 1 of 2
5.' ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, 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
s 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'nspection.
�e,279 -T 9/.b
Name of Firm o.t Telephone
Addre
" Date
6. DHEP APPROVAL
`'.
Approved for b2ca P bedrooms byL
Approved _— Disapproved
Terms of Conditional Approval
h
OF A
*•49T-�►
CAUTION
o. 2225-E ",tp ineer'sSeal
IN: 25.1971 � 4„i
OVAL
1
Date 21'=^!OAS`
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 engineers work.
Page 2 of 2
.._
72-M 91140 ..._ _...--. -
J
f
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (NAA)
of {O"CKLIST - FEBRUARY 1984
DEPT Of I ECiION 2fi4 4720
I�NNENTAI Legal Description: LOT 3AN, '13LOr Y, I
SEP Z O *S F i ss=kJF R-> s a c I , R-5 W
A. WELL DATA ED
Well Classification ����� If A. B. C, D.E.C. Approved (YIN) N/A
Well Log Present (YIN) tel— Date Completed '.P -C- 1978 Yield S+
Total Depth i 26-61 Cased to 7 40 Depth of Grouting t` �
Static Water Level ;4!5_25 Pump Set At —? 26t.
Casing Height Above Ground r� Sanitary Seal on Casing (YIN)
Electrical Wiring in Conduit (YIN) y Depression Around Wellhead (YIN) N
Separation Distances from Well: p
To Septic/Holding Tank on Lot 7 r ; On Adjoining Lots O
To Nearest Edge of Absorption Field on Lot obi ; On Adjoining Lots 7�L70
To Nearest Public Sewer Line _NDIJ G To Nearest Public Sewer
Cleanout/Manhole N 0 N 1 = To Nearest Sewer Service Line on Lot
Water Sample Collected by TS• / : Date 9/17/ 5
Water Sample Test Results S eL};s �SC4. V_�,
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed Q' Size 1450 No. of Compartments -- TWO I
Standpipes (Y/N) O N C Air -tight Caps (YIN) %� Foundation Cleanout (YIN)
Depression over Tank (YIN) N Date Last Pumped Q�i6ZS5
Pumping/Maintenance Contract on File (YIN) KLA ; for NSA
Holding Tank High -Water Alarm (YIN) H/A Temporary Holding Tank Permit (YIN)
Separation Distances from Septic/Holding Tank
To Water -Supply Well 96 To Building Foundation J/
To Property Line �O* To Disposal Field �2
To Water Main/Service Line 1> mgrs To Stream, Pond, Lake, or Major Drainage
Course TION t✓
Comments 4i % sTan�O ac -
Page 1 of 2
72-026111,841
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata lot Type of System Design i f2 EN GH
Date Installed R/77 Length of Field 53
Width of Field 36 Depth of Field 9
,/ Gravel Bed Thickness 174,
Square Feet of Absorption Area H Standpipes Present (Y/N) aN�
Depression over Field (Y/N) t/ Date of Last Adequacy Test
Results of Last Adequacy Test
C
Separation Distance from Absorption Field:
To Water -Supply Well /O 7 Y- To Property Line /D
To Building Foundation Za To Existing or Abandoned System on
Lot r4n ; On Adjoining Lots /.a
To Water Main/Service Line 7 10 To Cutbank (if present) N D NE
To Stream/Pond/Lake/or Major Drainage Course NONr'
To Driveway, Parking Area, or Vehicle Storage Area Di oye- t.11TW 04
Comments r2" 4ln
D. LIFT STATION I T O J( t
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at 'Pump Off' Level at
High Water Alarm Level at Vent(Y/N)
Tested for
Electrical Codes (Y/N)
Comments
'• Check Permitted Bedroom Rating Against HAA Request ••
I certify that I have checked, verified,
Signed _
Date
Pumping Cycles during Adequacy Test. Meets MOA
HAA guidelines in effect on the date of this inspection.
Company arty MOA No. ST— d (lf
Receipt No. OF / Xl
Dateof Payment �j'a0'�s y1P•.• /� .�1�+
Amount:$ _ 4�c *:.49T" I -
Page 2 of 2
). 2225-E
N; 1S• 1911
72-026 (11,64) 11.1 1.%
Engineer's Seal
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907) 562.2343 ANCHORAGE INDUSTRIAL CENTER w
.e.. e... 5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM: I I I I 1 11 Sea h on bad*
I.D. NO.
t,XT 3Ay BLar-VC 1 :FISc1ar^R
Waren symem Nerve Phone No.
'510 1 s i~s 1 pp, czr4
Mailing Addrea
0
Stab - — - — "29 cab
SAMPLE DATE: © EFF-1
Mo. Day Yew
SAMPLE TYPE:
Routine
Check Sample (for routine sample
with lab ref. no- t O Treated Water
O Special PurposeUntreated Water
SAME
LOCATION
I Q()r%7-rnM rAP
CollectedTimeCols
tad
z I
I
3
4
5
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
Satisfactory
❑ Unsatisfactory
❑ Sample too long in transit; sample should
not be over 30 hours old at examination to
Indicate reliable results. Please send new
sample via special delivery mail.
Date Received
Time Received
Analytical Method:
O Fermentation Tube
''Membrane Filter
Lab Ref. No. Result* Analyst
L 1 CM
uu m (/
I I �
I I m
•w Mwww.✓roue V140 aMm..e«eo•.
darriORl BACTER 10 LOGICAL WATER ANALYSIS RECORD
Pe.. 111°7
READ INSTRUCTIONS Membrana Finer. Direct Count Coliformr100ml
Verification: LTB BGB
Final Membrane Filter Re Its Collformflooml
BEFOREg F-"
Reported By Dale
Time:/5—ON-0 a.m.
COLLECTING SAMPLEp.m.
TNTC= Too Numerous To Count
Municipality
of
P.O. BOX 6650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
Anchorage10
�.. 11 t
� - TONYKNOWLES.
�`- MAYOR
DEPARTMENT
OF HEALTH & HUMAN SERVICES
September 25, 1985
Tobben Spurkland, P.E.
203 West 15th Avenue
Anchorage, Alaska 99501
Subject: Waiver Request WR85-033, Lot 3A4 Fischer Subdivision
Dear Mr. Spurkland,
This department has approved your request for a waiver to 96 feet
for the minimum horizontal separation distance requirement between
the septic tank and well on the subject lot. This waiver is valid
for the existing well and septic tank only. Future upgrades must
conform with separation distance requirements.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
SSM/ljw
X10 Ga gP�G3G3dQGJD9 pv�o OANCHORAGE, ALAI
CONSULTING ENGINEER TELEPHONE: (907
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF ENVIRONMENTAL HEALTH
REQUEST FOR WAIVER
LOT 3A4, BLOCK 1, FISCHER SUBDIVISION
GENTLEMEN;
6
SEPTEMBER 24, 1985
IN THE PROCESS OF PERFORMING AN HEALTH AUTHORITY APPLICATION
INSPECTION ON THE ABOVE MENTIONED PROPERTY IS WAS DISCOVERED THAT
THE DISTANCE BETWEEN THE ON PROPERTY WELL AND THE STAND PIPE FROM
THE SEPTIC TANK WAS 96 FEET, FOUR FEET SHORT OF THE REQUIRED 100
FEET SEPARATION DISTANCE. THE WELL IS MORE THAN 255 FEET DEEP. NO
WELL LOG IS ON FILE.
WE HEREBY REQUEST A WAIVER FROM THE 100 FEET
DISTANCE.
YOURS
TOB EN SPUR ND P.E.
SEPARATION
�• 1
. 40 � � Ga �l?�G3G3dQaD� poCv
CONSULTING ENGINEER
?203 W. 16th AVE "C" SUITE 203
ANCHORAGE. ALASKA 98601
TELEPHONE: 180712793816
R E S I D E N T I A L W E L L I N S P E C T I O N
— — — — — — — — — — — — — — — — — — — — — — — — —
LEGAL:
LOCATION:
OWNER:
TYPE OF WELL:
WELL LOG AVAILABLE:
LOT 3A4, BLOCK 1, FISCHER
5101 SELDON CIRCLE
CLARENCE VICKUHR
SINGLE FAMILY
NO
INSTALLATION REQUIREMENTS MET: YES
WELL YIELD FROM WELL LOG: NOT AVAILABLE
PUMP YIELD:
DATE OF INSPECTION:
5 GALLONS PER MINUTE
SEPTEMBER 19, 1985
TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 6
GALLONS PER MINUTE WHILE THE DRAWDOWN WAS
MONITORED. THE STATIC LEVEL WAS FOUND TO BE
255 FEET BELOW TOP OF CASING. WATER LEVEL DID
NOT CHANGE DURING TWO HOURS OF PUMPING.
TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON
SEPTEMBER 17, 1985. TEST WAS NEGATIVE.
TEST RESULT:
THIS WELL MEETS THE REQUIREMENTS OF THE
MUNICIPALITY OF ANCHORAGE.
The Municipal requirement for well flow is
SE OF•/1(il
150 gallons of water per bedroom per 24
i
`p,.• ,_1
hours.This well surpasses this requirement.
The assessment of the condition of this well
applies only to the conditions as of this
�}► '•"'
date. The flow rate of the well may change
due
.�G.•. •�
/,
to subsurface conditions that may not be
e• N. 2225-L :'
observed from the surface, and changes in
1 N- 2S, 1971
;�^^•
land use and other factors that may impact
••';���
the conditions of the aquifer feeding the
well.
4©M e IED T)pJA idGQMD9 PA.
CONSULTING ENGINEER
203 W. 15th AVE "C" SUITE 203
ANCHORAGE. ALASKA 99501
TELEPHONE: (9071279-3919
S E P T I C S Y S T E M A D E Q U A C Y T E S T
LEGAL: LOT 3A4, BLOCK 1, FISCHER
LOCATION: 5101 SELDON CIRCLE
OWNER: CLARENCE VICKUHR
RESIDENCE: SINGLE FAMLIY, FOUR BEDROOMS
WATER SYSTEM: ON SITE WELL
SEPTIC SYSTEM: FROM MUNICIPAL RECORDS:
TANK: GREER STEEL, TWO COMP.
1250 GAL
ABSORPTION SYSTEM: TRENCH
ABSORPTION AREA: 424 SQ. FT.
SOIL RATING: 101
INSTALLATION DATE: AUGUST 1977
DATE OF PUMPING: SEPTEMEBR 18, 1985, ANCHORAGE CESSPOOL
DATE OF TEST: SEPTEMBER 19, 1985
TEST PROCEDURE: WATER WAS ADDED TO THE SUMP AT A CONSTANT
RATE OF 5 GALLONS PER MINUTE. THE WATER
LEVELS IN THE SUMP AND IN THE TANK WERE MONITORED. AT THE
BEGINNING OF THE TEST THE WATER LEVEL IN THE SUMP WAS 31 INCHES.
AFERT ADDING 50 GALLONS THE WATER DEPTH WAS 48 INCHES AND RE-
MAINED AT THIS DEPTH DURING THE REMAINER OF THE TEST. THE WATER
LEVEL IN THE TANK DID NOT CHANGE. A TOTAL OF 600 GALLONS OF WATER
WAS ADDED. AFTER 15 HOURS THE SYSTEM WAS CHECKED AGAIN. AT THIS
TIME THE WATER DEPTH IN THE SUMP WAS 21 INCHES. MORE THAN THE 600
GALLONS HAD BEEN ABSORBED BY THE SYSTEM.
TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE
MUNICIPALITY OF ANCHORAGE.
The operational life of all septic systems depends on the local
soil conditions, 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 this septic system. We can therefore not give any estimate of
how long the system will continue to meet the operational requi-
rements of the Municipality and State.
'Alunicipality of Anchorage
--1 Development Services Department
Building Safely Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
r arcei I.D. 01 S- a'f L -1S
1. GENERAL INFORMATION
HAA # y /9' 10 4 �o
Expiration Date: 3 - -.9- 7- 6 :2 -
Complete legal description `LO r 3 A q 64-0c. K I F( S G /a E•2 S Ap
Location (site address or directions) S) a I S6 r_ 0o 0J Grkc. f , Al C J4.
Current r'roperty owners) _T/M S Cie', G-lr 1 Day phone 4 `/ / — a 7 3s
Mailing address S-101 Sic.0o.,1 CiPC.r..¢- .4,<,cy. RK gciS-1G -66a3
Lending agency
Mailing address
Real Eslnle Agent
Mailing Address
Day phone
AV 0 g H L — 0 Y r 9N+r C P100. Day phone
Unless otherwise requested, NAA will be held by DSD for pickup. �1� Z e zy/o r
7.. NUMBER OF BEDROOMS: y J
3. TYPE Or WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual Water Storage ❑
Community Class Well ❑
Public 'Plater System ❑
Individual On-site NJ
Individual Holding lank ❑
Community On-site ❑
Public Sewer ❑
'riie Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (I IAA) 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 bo-tween spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSO also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 flays 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 may be reissued for a period of up to one year with
valid water samples.) Cerlifid"ates 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
Pngineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the
Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of Installation.
S & 5 ENGINEERING
Name of Firm Phone 691 -al `7
Address Eagle River, Alaska 99577
Engineer's Printed Name�0 G e -r: T C . �o w�l Date
5. DSD SIGNATURE '1 "•', L--2.-; C. ccw.°7
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
\Q�v ,......;I.Ae
ON-SITE
u,.. •u.,+TVVh I cr\ mi"Cd•
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: �ei1 Original Certificate Dale:
(pM 12 M1
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bmgaw St.
P.O. Box 196650 Anchorage, AK 995196650
www.clanchorage.ek.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lo i 3 4 y BSO G K: I f= r S C -we 2 '/v Parcel ID: O 1 S-- d 9 ]. -/S
A. WELL DATA
Well type LA, gar L -
Date completed PR 4 _ ).17 8
0 A B, or C provide PWSID # —
Sanitary seal ©N) YE J
Total depth0 �tft. Cased to 40 t ft.
FROM WELL LOG
Data of test
Static water level ft.
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform --Q--colonies/100 mi.
Date of sample: ) 1 / o I
B. SEPTICIHOLDING TANK DATA
Nitrate 3 • ° 7 mg./I.
Wed Log (Y49 ^' D
Wires property protected6IN) Y"-"
Casing height (above ground) 11+ In.
AT INSPECTION
'd46) ft.
1.0 9—
p.m-
Other bacteria O colonies/100 ml.
Collected by: S i S ENGINEERING
17024 EspN It wr LftP Rad U& 204
E4* River, Ala .a 99377
Tank Type/Matarial .S E.". r / S T4 4 L
Tank size I a SO gal. Number of Compartments
Date installed ) a /i o / a I
Cleanouts&N) Y r I
Foundation deanout®/N) J!L-f Depression over tank (Y/& -L-0 High water alar (Y®
Date of pumping N /A - N i w Pumper
C. ABSORPTION FIELD DATA
Date installed li r4 • /
Length -35-
• - ft.
Soil rating g.p.d.lft2 or ft2/bdr) l• 1 System type
3
NJ
T-1 f � L N
ft. Gravel below pipe
i. S' ft.
Total depth 13 'S, ft. Eft. absorption area 3'>1" fe Monitoring tube Yil Depression over field N V
Date of adequacy test P/A - N E"' Results (Pass/Fail)For -Y—bedrooms
Fluid depth in absorption field before test _ in. maple r adt� ded_ gal. New depth_ in.
Elapsed Time: _ min. Final pth _ in. Absorption rate >= g.p.d.
Any rejuvenation treatleat((fast 12 mo.) (YIN & type) If yes, give date
D. UFT STATION
Date installed
"Pump on" level at _ in.
Datum
E. SEPARATION DISTANCES
Size in gallons Manhole/Access (YM)
"Pump air level at water alar level at
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot 100
Public sewer main
N /.4
Meets alarm & circuit requirements?
On adjacent lots / 00
On adjacent lots / 0 0
Public sewer manhole/deanout N1.I
r
Sewer /se tic service line a S" + / Holding tank N A
F
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 6 Property line II J r Absorption field S
r
Water main // A Water service line /0+ Surface water ) 0 0 4 -
Wefts
Wells on adjacent lots O 0 f
SEPARATION DISTANCE FROM ABSOR71ON FIELD ON LOT TO:
r
Property line 0 r(wA'v41 �tOJBuilding foundation 17 Water main /J �%
� r
Water Service line ) O f Surface water /00 -I- Driveway, parkingtvefdde storage
Curtain drain Nz -'t tc 00" Wilft un adjacent lots 100 t
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify 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.
Engineer's Printed Name C. c0wA,''
Date I a/
HAA Fee $ 3 o p .
Date of Payment I x/ > Y /a /
Receipt Number 013-7
$ U
(Rev. 12/00)
C:
ACUOTL: COWAN
,i'.�•.z CC • EC01
Waiver Fee S j I S•
Date of Payment
Receipt Number
Ix/IV/0/
0/3"YO
DEC -14-01 09:37AM FROM-CT&E ENVIRONIENTAL SRV 9075615301 T-050 P.03/03 F-046
/11 ME Environmental Services Inc.
fi Laboratory Division raa�wiivi �Is - "yy,210VAPERVAPWWAM
200 W. Potter Drive
pinking Water Analysis Report for Total Coliform Bacteria Anchorage. AR 99610-1605
Tel: )9071552.230.1
READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Fax: (907) 561-5301
MUST BE COMPLETED BY WATER SUPPLIER
O PUBLIC WATER SYSTEM I.D.0
tf' PRIVATE WATER SYSTEM
pt Sexf Rerafrr It Seal Invoice
warm �nwiemp.nr nerve
4—" Pa. S. r
w
r •. ZIP
13 SexiResufa O Serwinvoice
..•veer n.•r w:a nm.
NrIuV Aiaru
W r
LW
SAMPLE DATE: EM [az D
Mouth Day Year
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
XSatisfactory
O Unsatisfactory
O Sample over 30 hours old, results may
be unreliable
O Sample too long in transit; sample should
not be over3lVhours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received I 7
Time Received r'Lto
Analysis Began I G
Analytical Method: JC Membrane Filter
a MMO-MUG
e Number of colonies/ 100 ml.
- •` ` Rnult- Analyst
11018362
SAMPLE TYPE:
,i Routine
O Treated Water
O Repeat Sample (for routine sample
)if Untreated Water
with lab ter. no. )
0 Special Purpose
Time Collected
SAMPLE LOCATION
Collected By
s.rjny ALK r,scrl�a Jj�
)I'3uq., 6x3 c.
tu•. F
Comments:
ch Fbka Jun ❑
Faxed
Date. Time:
Client notified of unsatisfactory results:
❑ ❑
?boned Spoke with Faxed
Date: Time:
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO-MUG Result: TotalCollform
E coa
Membrane Filter. Direct Count h Colonles/100 ml
Verification: LTB BOB COLIFIRM
Fecal Collform Confirmuttoo
Final Membrane Filter Results
Celllorm/I00 ml
Time 22e) D bn
TNTC- rw N� To Cmw
'w' 9211mi'MO Member of the 106 Group IS96614 GdnMele do Surveillance)
ENVIRrINUFNTAL FACILITIES IN ALASKA CALIFORNIA. FLORIDA, ILLINOIS, MARYLAND. MICHIGAN, MISSOURI. NEW JERSEY. OHIO. WEST VIRGINIA
DEC -I4-01 08:37AM FROM-CTIE ENVIROMENTAL SRV
CUE Environmental Services Inc.
9075615301 T-050 P.01/03 F-046
CT&E WE#
1018362001
Client PON
Clleat Name
S & S Engineering
Printed Datefrlme
12/13/2001 22:37
Project Nsme/N
Lot 3A4 Blk 1 Fischer 1 SID
Collected Doterrlme
12/072001 11:30
Client Sample 3D
Lot 3A4 Blk 1 Fisher 1 SID
Received Vote/Time
12/072001 12:10
Matrix
Drinking Water
Technical Director
Stephen C. Ede
Ordered By
Released B
PWSM
0
Sample Remarks
Allowable Prep Analysis
Parameter Results PQL units Method Limits Date Date Init
Watars DanStmant
Nitmic-N 3.07 0.200 mg/l. EPA 300.0 (<10) 12107/01 SCL
filernhinlagy Labnrlt=
Total Coliform 0 col/100mL SM18922211 (<1) 12107/01 SBIL
August 9, 1977
Northern Lights Construction
4 Bryce Howlet
3419 llewcor..b Drive
Anchorage, Alaska 99504
Subjects On-site Sewer Installations in Fischer Subdivision
This letter is to inform you that all on-site sewage
installations must be performed by a licensed excavator as
stated in the Municipality of Anchorage Ordinance 15.65.040
paragraph A. This department made an inspection of Lots
3A4, 3A5 and 3A6 Block 1 Fischer Subdivision and fourn three
(3) on-site sewer systems being installed by your company.
In forder for this department to approve the proper
installation of these systems, your company must obtain and
excavator's permit from this department.
It was also noted that the trench on Lot 3A5 was approximately
ninet}c-two(92) feet frma the well on Lot 3A4. This is in
violation of Municipality of.Anchorage Ordinance 15.65.060,
paragraph C.
The above mentioned itmas must be corrected immediately or
legal action may occur.
If there are any further questions, please contact this office
at 279-2511, extension 224 or 225.
Sincerely,
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