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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: —• Fl. FI CM,a4eluon (Prl,n.. A B. a TOM Dept: C.sed W lar w. Peon «e. �� P STM 5 i R 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 I I 1 I oo, oo. I 1 < < I I 3A6 3A5 �' s' 9o�G vo�G 3A7 I I I � � I I 1 1 I o I I � I I 1 r A FCO MTI C 1 I � NCO= -NEW TRENCH W v = ST SELDON ---_—_---- Cir I TBM T2 MT 02 8 DBL1 & DBL2 1 PA (h. N NEW 1250 GALLON NI SEPTIC TANK c00, I ?1 s 3A3 3A1 I N OI SCALE: . 40• J� I � S_1 I rn C;' U1 ROURT C. COWAN CE -0301 I I L +1 ' . n �1�2; _______ 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 _ _ __SITE_ PLAN I DESIGN I 1" = 40 II r i � COO :ems- G ca 113 I N o r I _ > µ 002–�- e 20' Drug smtN'PC Z D..m ►.a �✓�O� Zo^ Ev C . � 5 O 5m��� !•txo ['t] 10' Drug smt i m d ri 7 — — — Oa�m yti lL' _ — — —M. IZ 2 0vL 'OYO r..yy m>ri 7 L r R07 ono C7 r -r =2 =R07 Z OC I OOn z Non— ;,:• !� pO00 _ moo- "zti nn _ 0, i, m�n s�A i w r d� LA N o z q� Z Gi I ? 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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, 01 lux 0311112130 2101 1d130321 ...-1Is. O ,,1,O O (.pr ,.Y„ .0s)"YR1YN011YN831N1 801 lON Cory Willis, R.S. —0301A08d 33Y83AO3 nNY8nsNl ON OOSO 1161 .i3Y Sanitarian _ d sd ,,, __....................... ........._�•qM.+../.,p.) 103,11130 1Y103d5 ►fir .....07. . A1N0 33S23M00� Ol M3A1730 • !SE' ppgpp µN pn1.p'W . 11 p 0PM 17711,Yr.l c CS'T/l j h uws 1 077 `— lluo ps.up0. 01 4.,II.p 1311330 P" YIIM �sf " pp,lUp q.v p.. .l.yr p u.Ys •. Nanllt '� alb IvrpwaaY gip, i73ue7s trNou�n — N v 3003 31Z ONY 31Y1S "0'1 .A CD 'ON ONY iaax.< 01 lux 0311112130 2101 1d130321