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Home My WebLink AboutNAVROT LT 4I avr'o ' Lo1- 4 #015-271-61 MUNICIPALITY OF ANCHORAGE DE, ITMENT OF HEALTH AND HUMAN SER~ ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name Address LEGAL DESCRIPTION TANKS ~ SEPTIC [] HOLDING TYPE OF SYSTEM TRENCH ~) BED ~ W, DRAIN ~ OTHER orrgmn., grade ~_ Fr / '~ FT WELLS [] PRIVATE [] OTHER (Identifv) Classlhcauon (A.B.CI t Iota,Iota! Depll~ Cased to I.slalle, _j DateJns~a led: ~ .~. L REMARKS: DISTANCES '-"~OM~ SEPTIC ABSORPTION FROM -'-----...., TANK FIELD WELL WELL -~ ~ LOT LINE 'q~ 8 d ~ ~'-~' FOUNDATION z ~ 3 ~-- -- AS-BUILT DIAGRAM (Show location of well. sephc system, property hnes, Ioundabon, drweway, wator bodies, e[c.) Municipal and StaLe Du'~"~nes in effect oo this date: __ codily that this inspection was perlornled according Io all Health r)epartmenl Approval: Date:. ENGINEER'S SEAL 72-013 (3/85) DI~i]x:'I!-q:;:TTMEi]".FT (]:) ~ r FlE]j.tg_]'l'l GI"-ID E{NVII:;:('3I'",II"IIZNT'rr.i!_ I::'F;'.IW'I"I!ii:E',TIOI".I ~ 2 &,zl--.x!· 720 CEIN'I"r~'iCT F:'I"I(}N!E: 349-2.407 ,'SE:CT I ON: 2. 1 T'OWI'q~iH I I'-": I..OT: 4 BI...[)Cd<: I".1(:~ 1 ,~';:'. N IR i.t BI [")l!i( i: :]11,9 ./~..i,'.. "l~qlxll< MLJDT HAVE A'I" I....lii:.'A~iH" "l'WO CEIMI::'AFR'I'Iqliii:Iq"I'S tcm't'.h by l:.he.~ i""l~.~'i:[l:::i.l:;)~::l:l.:i.'l:.y of' (:~nc:l'ior'ag~.~, (1'"1i::)~-"~) ,:arid t. he~ Eit. i:'~t.~.~:, of' (.~,la.~,l.::~a,, ;~?,, I u,.~:i.].l ir'i~rl..all t.l'ue ?~y~il'.l.~:,lii :i.r'i ac:ccmclarlc:[.~, i,~:i.t.l"i all I~1l::}~I {:::(::)<:l(.~:.~i and ;:~.l]i::l J.[] c;Oml:i].:i, aric:t'.,., w~:i.t.i"l 'l:.,l"i(~.:;, ch,(,!~iigl'l c:Pit, e.,r'ia (:;ti' 'l'..l':i:i,~!; per'mit.,, :],:, I u,~:i, ll ~:'~cllie,:~r'e t.l::i all t~1i:,1~ Ltl"td fiH'.,a'l:.,(.:.~ el{ (.~:l.a~:il.::a i"eH:tLt:i.r'i;.Hii[,:?rlt,~i t'i::ll" 'I',,HD ~iii~,'i',, bac:l.:; ~i0})WE;)I' ~';/g('}'~ ~)i~i'~B't'..(.:)lll C?I"i t.h i !~B IBP ~:/l"ly ?~d..'j i:':'d:::t)}iFit, C)I' I"lti')i;:'ll" J.:iy ]. C)'['., z~,, ]: t.u'lcll~Td".e~t.~:irld It. hat '('.l-ii~s i:)e~r'mi'l'.. :i. si~ v~:/l:i.d Fc)r' ~;t mg~ximum e]i' 4. I::~ex::lr'ooms~i ~'u'ly ~.s~rl:l.~::xr'gorrx.:~n'~t. will r'~:S:cluir, e.~ ,':'~n ,'~¢~dcti'i'..iclnal !::)(er'mit.,, Municipality ol Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 2 5 6 8 9 lO ~o .~ ~vel -~ ~[t s ~ e ROU~D WATER ENCOUNT~D~ 11 (ENGINE ~/~S~L) DATE PERFORMED: ~,, t ~j ~ ~, ~ Township, Range, Section: ~_..~. -~ ~ T/z/V ,~z~ ~ SLOPE SITE PLAN 13 14 15 16 17 18 19 20 s IF YES, AT WHAT DEPTH? p E Depth to Water Alter $'~'II Monitoring? 'h> J Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch] PERC HOLE DIAMETER __ TEST RUN BETWEEN FT AND __ FT COMMENTS So," PERFORMED BY: ~ '- ~°"-~ ~ C//~/¢/ ~~CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFE NTHISDATE. DATE: 72-008 (Rev, 4/85) SOILS LOG PERP. OI.ATION TEST 1 2 3 4 5 6 7 8 9 11 -J ° ' ~7 2O SLOPE IF YES, ATWHAT DEPTH' / Gross Read ng Date Time ,'"< ~- '".',, P/-.4 % ,~,~..." .....~-~ ~ ~ Z ~ ~ PERCOLATION RATE TEST RUN BETWEEN SITE PLAN Net / Dep[h to Time / Water Net Drop FT AND FT DATE:__ jl Proposed Well and Septic System for: Lot 4 Navrot Subdivision Scale: 1" = 40' Notes: 1) Property to South is a gravel pit. 2) Lot to the west has well and septic more than 100 feet from this lot. 3) Protective well radios for adjacent wells are shown. All septic systems are beyond the wells and more than 100 feet from this lot. N unicipahtYo¥ Anchorage P.O. B, , 196650 ANCHORAGF, ALASKA 99519-.6650 (907) 264-4111. TONY KNOWLES, MA YO~ DEPARTMENT OF HEALTH & HUMAN SERVICES June 23, 1986 Donald Saur 12640 Atherton Anchorage, Alaska 99516 Subject: Lot 4 Navrot Subdivision On-site Sewer & Well Permit #860108 - Issued May 1, 1986 On May 20, 1986, The Anchorage Assembly al)proved a new ordinance regulating on-site wastewater disposal systems (septic systems). Ail septic systems constructed after the effective date of this ordinance are subject to the provisions of this ordinance. Our records show that you currently hold a permit for the installation of a septic system. We strongly urge that you coutact this office prior to constructing your system. Any changes in the code that could impact the construction requirements of your septic system will be identified and brought to your attention. Please contact the Environmental Services Division at 264-4720. Thank you for your cooperation. Sincerely, Susan E. Oswalt Program Manager On-site Services SEO/SSM/ljw SiX INCH WATER WELL DRILLED ........... OUT TO THE DEPTH OF. DRILLED AT THE RATE OF ._~21.00 _ PER FoOt, $,te~eJ.. co.~ ~o 2~0 PROPERVY OWNER gO~ 01~ ~ ~; ~ ~(SO~)~ ~[~ ~C.) LOCATION OF WELL SIT~ 4 ~OAO~ S~~o~. (~ DRILLER ~L ~ 0~ ~ ~~ WELL LOG: 0 .... 19' 5g--135' /I ce~e,n,Ze~2 qy~ei. R~'z. gpO~o 135-192' Cocut~e~ g,,u~ei ~a,M.k 157o 792'~227~ 45% e.L~j. ~i. fJ~ ~.a. crei & ~e..u'~ .,/.a~e.4 221-249' ,;~ cemea.t.e.d Crave. g ~ag.f.A ~z ~ 0scvf. e.~ p~.odu, c.~ort .~*.ot~ 236 .6o 239 fiee~f.. 249-270' 270-286' L~a2.e.r b~a. ga.q. 9,,~. FeW. ~,bL,f~. ?oor ~zie.,b/. Coo,f. o~ d,zLgl. O~: $21.00 pe~ ,g.f., X 290 f.t.: S6,090,00 Co.~ o~ ~~9 i,~: e¢4'20,00 ¢ 510.00 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPL~ION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM O~ THANK YOU VERY MUCH, BERNIE CLAUS OF"RAMPART DRILLING WORKS DATE~ 30~% '19~ ~~ ~ SERVICE CHARGE OF 1V,% PER MONTH WILL BE A~SE~ED ON LOG OF SOIL TEST SH T. ..... OF.___ [..)ATE: ,,c-,,%~ ".7, TYPE BORING: .1, ~ ~ ~ SOIL DESORIPTIO~ I0-- -20- ~5- BARNARD--IC, ARTH 81 ASSOCIATES--20:5 WEST 15TH AVE.--ANCHORAGE Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 015-271-61 HAAfl H/z~) 1. GENERAL INFORMATION Expiration Date: O Complete legal description NAVROT SUBDIVISION; LOT 4 Location (site address or directions) 11111 NAVROT * ANCHORAGE, AK Current Properly owner(s) LARRY SHELVER Mailing address Lending agency Mailing address Real Estate Agent Mailing address Day phone 349-3962 Day phone MICHAEL PIKE w/ PRUDENTIAL VISTA Day phone 4241 "B" STREET * ANCHORAGE, AK 99503 529 -2400 Unless othen~ise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ~ Individual Water Storage Community Class Well [--~ Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ~ Individual Holding tank Community On-site [~] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system.. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a pedod of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ to dosing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER at, or pdor I 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 t'#es and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. CARNESS. P.E. Phone 337-6179 Engineer's Comments: In conducting this evaluation. AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reposed results described the performance of the system under the conditions encountered at the time of the lest. and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year. and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC. Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meel the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ~" Approved for ~" bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisor,/ Well Flow Advisory bedrooms, with the fllowing stipulations: ~. ON-SiTE .~: WATERAND ~ ;. WASTEWATER Manitenance Agreements :,'7,,',,-,,, o ,,~ Supplemental Engineer's Reort Other (Rev. Original Certificate Date: Municipality of Anchorage Development Services Department BulMing Safety Dlvtsion O~ Wa~r & W~r P~ 47~ ~ 8~ ~ P.O. ~ 1~ ~, ~ ~51~ ~.~a~ge~ (~ ~7~ HEALTH UTHORITY PPROVAL HECKLIST Legal Description: A. WELL DATA NAVROT S/D; LOT 4 Parcel ID: 015-271-61 Well type .P~VAT[ If A, B, or C provide PWSID# Date c~mpleted 6/30/1986 Sanlter/seal (Y/N).YES Total depth 290 fl. Cased to 290 It. Date of test Static water level 180 Well preductJon 20 WATER SAMPLE RESULTS: Coliform (~ colonies/100 nd. Arsenic: N/A mg.lL. SEPTIC/HOLDING TANK DATA Tank Type/Mate~ml ~,'rtL FROM WELL LOG 6/30/1986 ft. g.p.m. Well Log (Y/N) Wires property protected (Y/N) Casing height (above ground) AT INSPECTION 11/5/2002 163 ft. 5.4 g.p.m. Nllrate ..(~p._ mg JL. Date of sample: 11/5/2002 Collected by: YES YES 12+ Other bacteria ~._colonies/100 mi. Length 33 ft. Width 2,5 fl. fl. Total depth o!4.5 fl. Eft. absorption area 528 fl= Monitoring tube 'fl[S Depmsaion over field. NO Date of adequacy test 11/5/2002 Results (PassiFall) PASS For 4 bedrooms Fluid depth in absorption field before test 55 in. Water added 552 gal. New depth 68 in. ElapsadTime: 1315min. Flnalftuiddepth 50 in. Absorption mte >- 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - ~'3 ~]EDR00M HOUSE. SYSTEM SIZED FOR 4. System type DEEP TRENCH Gravel below pipe 8 Tank size 1250 gal. Number of Compartments 2. Foundation deanout (Y/N) YES DepreSsion over tank (Y/N) NO Date of pumping 11/5/2002 Pumper ABSORPTION FIELD DATA PI~Lq. OW ;X~S'nNO r..,'~oO Date installed 5/21/1988 Soil rating (g.p.dJff~o~ 125 Date installed 5/21/lg86 Cleanouts (Y/N) YES High water alarm (Y/N) N/A CHUGACH in. AKWWC, INC. Size in gallons "Pump ~ I~vgl ct Cycles tested D. LIFT STATION Date installed "Pump on' level at __in. Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ in. Manhole/Acc--s (Y/N) High water alarm level at Meets alarm & clmuit requirements? On adjacent lots 100'+ On adjacent lets 100'+ Public sewer manhole/cleanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Absorption field 5'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN Building foundation 10'+ Surface water 100'+ Wells on adjacent lots 100'+ Water main N/A Driveway, parking/vehicle storage 10'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date l, /<~/0o~' NAA Fee $ 3"/5 Date of Payment Receipt Number (Rev. 12~01) Waiver Fee $ Date of Payment Receipt Number I ! I~reby ~ertify ~hat ! bare surveyed the follc~lql described property, I-~T ~ end that no en:roacl~ents exist except ~ indicated. Ilated al: Anclnraile, Alaska, thta I~ day of .I~JQ. I~) flx~ (0X)7)~9-2607 ;go7 5815301 ~ 2/ 3 CT&E Ref.# Client Name Project Name~ Client Sample ID Matrix PWSID 0 Sample Remarks:. I027548001 AK Water & Wastewater Consultants Inc. Nawot S/D; Lot 4 Navrot S/D; Lot 4 Dtinklng Water Units Merci All DateOTlmes are Alask~ Standard Time Printed Date/Time 11111/2002 11:39 Collected Date/Time 11/05/2002 15:10 Received Date/Time 11106/2002 15:00 Technical Director £da Released By ~~ Allow~blc l~.ep Analysis Limits Date Date Init W& kez's Depaz*t~nent: Nitratc-N 0.600 U 0.600 mg/L EPA 300.0 f<-101 11/07/02 JS l~:l. crobJ, olo97' Laboz'at:or¥ Total Coliform 0 ¢ol/100mL $M18 9222B 11/Off02 KAP Parcel I.D. MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services ITY OF ANCHORAGE On-Site Services Section EN',,~I~G~,~,J~I~TAL SERVICES DIViSiON P.O. Box 196650 Anchorage, Alaska · 99519-6650 343-4744 JUL 2 9 1997 CERTIFIOATE OF HEALTH AUTHORITY RECEIVED APPROVAL FOR A SINGLE FAMILY DWELLING - Z7/ -6'"/ HAA# 1. GENERAL INFORMATION Complete legal description Location (site address or directions) / I t ~ I N¢zu ~'~,~' Ctr¢/¢... Property owner D,o,~ ~(~Z- Mailing address Lending agency N,~/t~,~¢/ ~a,~ ~ ,~? ,A-/wA-,,. Day phone Address 76'00 l<,~vq, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer Day phone 995' NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system, 72-025 (Re'/. 1/91] Front MOA #21 o 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/orwastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, lfurtherverifythat 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 FI~/'~F 7-~ c/, ~ ~ ¢~, I .5~ ,-~,'~.~,. Phone Address I Y~-ZO /.Ec4c, ,¢/.,, /¢~,~ 4o/c,,,,¢~ /d-~. 9q,¢'/¢/ Engineer's signature ,~'~ ~ ~ __ Date :~-'-~/,y DHHS SIGNATURE Approved for Disapproved. Co'nditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of'Anchorage Department of Health and Human Services (DHHS) issues Health Autho'-'~y Approval Certificates based only upon the representations given in paragraph 5 above by an independe~t professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICE8 DIVISION Municipality of Anchorage JUL, 2 9 1B97 DEPARTMENT OF HEALTH & klUIVIAN SERVICES Environmental Services Division I~, ~ C E I VE D 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4-/"44 Legal Description: A. WELL DATA Well type ? Log present (Y/N) Total depth Sanitary seal (Y/N) Health Authority Approval Checklist Lc, h 5[,, ~\lQ c/ ro f & K'b Parcel I.D.: 7' IfA, B, or C, attach ADEC letter. ADEC water system number Date completed ~' ~' .7 o/ ,96" Cased to '~ Po ' Casing height (above ground) Y' Wires properly protected (Y/N) Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~ Co / Date of sample: '7 / '& $ / ? 7 B, SEPTIC/HOLDING TANK DATA Date installed Ct' Z 7 / gS" Tank size Foundation cleanout (Y/N) Date of Pumping '7 / ~'/ /? 7 C. ABSORPTION FIELD DATA Date installed d'/ Length 3~-7' Width ~'- ¥' Effective absorption area Date of adequacy test. '7 / Z,~ / ~ '7 FROM WELL LOG 170 ' AT INSPECTION 71 ?-3 77 7 g.p.m, g.p.m. J71' 5', c., Nitrate O, Zc;~2 ,,~u¢ /.~_ Other bacteria Collected by: ~ 8.¢¢~,¢/ Number of Compartments ,~ Cleanouts (y/N)___ Depression (Y/N). High water alarm (Y/N) ~'. Pumper Fluid depth in absorption field before test (in.); 5'.5- Fluid depth '-/~ '¢/~¢ (ins) Minutes later: ~ '7 Peroxide treatment (past 12 months) (Y/N) No~¢ 72-026 (Rev. 3/96)* Soil rating (g.p.d./fF or fF/bdrm) __/~~System type Gravel thickness below pipe Monitoring Tube present (WN) Y Results (Pass/Fail) Immediately after75'7gal, water added (in.): __ Absorption rate = ~> o~o¢_,2 g.p.d, /,c~,,,__ If yes, give date A/. ,4, ~ ' Total depth / __ Depression over field (Y/N) For _ ¢/ bedrooms' D. LIFT STATION /v. Date installed Manhole/Access (Y/N) "Pump on" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot I Absorption field on lot ! Public sewer main Sewer/septic service line Size in gallons SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ?~ 8 ' Property line ~ ' Water main/service line ;> ~o' Surface wateddrainage '~ fcc, ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: :~' Building foundation 3' 7 ' "Pump off" level at* On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station 72-026 (Rev. 3/96)* HAA Fee $ Date of Payment Receipt Number ~,.~' ;./0 ENGINEER'S CERTIFICATION ........ ~.~.'~.. .¢,~?.- ~ /: ;,.~ I certify that I have determined thru field inspections and review of Munmlpal record~..~.jt~.the,~be¢~~ S~ste~ns are in conformance with MOA H~ guidelines in effect on this date. Engineer's Name ~ ~a ~o ~ ~. ~oo ~C ~- ~¢ .:,,,'.,.,.,-.:,,, · Waiver Fee $ Date of Payment Receipt Number Property line Surface water Curtain drain Water main/service line Driveway, parking/vehicle storage area 5' Wells on adjacent lots ~ ~o-o, Absorption field z,- Wells on adjacent lots SUL-25-&99? ~5=~ CT&E ESI RHCHORRGE 9075615301 P.02/03 ZfK. CT&E Environmental Services Inc. CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PW$ID 974017001 Flattop TechnJcld Lot 4, Navrot Lot 4, Navmt $/D Drjnklng Wate~ Pa~remeter Nitrate-N rote( Cotfform 0.209 ~ ol~ w/o cOLi Client PO// Printed Date/Time 07/25/97 10:36 Call.ed Date/Time 07/23/97 13:00 Received Date/Time 07/23/97 ]4:05 Technical Director: Stephen C. l~de PqL Units Method Al (oweb(e Prep Ana{y~is ~ '-~ Limits Date Onto Init 0.100 rng/L ~,H8 4.~O0-NO3F 10 max 07/Z&/97 jgj sM18 92~2B 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 GENERAl. INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) I'V~.,v~o/-" L~.~.d Bt¢,'/- ~ 6'~ ',-~ r/~/v~.'~'~ Locatio~ ,(ad'dress or (b) (c) Appii~nt N~m~"/~o;, ,S'.~ ~.:~- Telephone: Home Business ~.~¢/~c~.~ AppliC~i,'Address' // .L~'~" ~ '~/ /'z/ ~ /~ ~0/~o,~,~? ¢ /~ /~,~'1~ ¢~ ¢'~' ¢ J~/d~? · / Applicant is (check one): L(~nding Institution []; Owner/builder~; Buyer El; Other [] (explain); (d) Lending Instituiion Telephone Address (e) Real Estate Company and Agent i ~'"¢' Address .~" Telephone (f) Mail the HAA to the following address: .//~/,~' TYPE OF RESIDENCE Number el BeOrooms ._L_/___/ Other WATER SUPPLY Individual We~/~' Community [] Public~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. .. SEWAGE DISPOSAL Onsite"~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/04} ENGINEERING FIRM PROVIDINu INSPECTIONS, TESTS, FILE SEARCH, DA=A 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 ~ ~'C~ Telephone D HEP APPROVAL.~ (~ /7~~--~-~L~'~~q,t ~'~-~ ~'/~f¢~'"~ Approved for ~E~,~ bedrooms by e Approved /~-¢~"~ Disapprov6~d __ Conditional Terms of Conditional Approval ',, CAUTION 'The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska, The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to Saris'fy certain federal and state requirements. Employees of DFIFP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work, Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHOR,,-~r- DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: RECEIVED WELL DATA Well Classification ? Well Log Present ~)N) Total Depth ~ ¢O Cased to Static Water Level /,9 Casing Height Above Ground Electrical Wiring in Conduit ~/~) Separation Distances from Well: if A, B, C, D.E.C. Approved (Y/N) Date Completed ~ '- ~0 ~o~ Yield 2~ ¢'o Depth of Grouting '~' Pump Set At '~' Sanitary Seal on Casing Depression Around Wellhead (Y/[¢~ To Septic/Holding Tank on Lot / To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ,'~"~ Cleanout/Manhole Water Sample Collected by ~--~"-'~') Water Sample Test Results Comments s,,.I, ~"~'5 ' ; On Adjoining Lots /3-O .~-~,~1¢ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on ;Date ~ ' B. SEPTIC/HOLDING TANK DATA Date Installed ,z/ /~,,~' ~¢~' . Size Standpipes ~) Air-tight Caps~N) Depression over Tank (Y/I~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /~ .,f~ To Property Line ~' To Water Main/Service Line / 7_ S~O No. of Compartments 'z., Foundation Cleanout ~:~N) Date Last Pumped ; for ,,vr~ Temporary Holding Tank Permit (Y/N) Course To Building Foundation ~ 2- To Disposal Field ,5~ To Stream Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 2 / "¢1,~ ~' Width of Field ~- ¢ ~//.~-/o.~f.4- Square Feet of Absorption Area Depression over Field (y/~v" Results of Last Adequacy Test Type of System Design Length of Field /'Z. Depth of Field Gravel Bed Thickness Standpipes Present ~N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot /v'~ To Water Main/Service Line 15'-0 d"l- -z T To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line /--/~ To Existing or Abandoned System on ; On Adjoining Lots Ge'Z- -a~O To Cutbank (if present) /v-/¢ /0(2 LIFT STATION "~ Date Installed '% Dimensions Size in Gallons ~. Manhole/Acc~s (Y/N) _ "Pump On" Level at ~ "Pu.,~Off" Level at High Water Alarm Level at %.. ./ Vent (Y/N) _ Tested for '"",,~4J Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Co m men ts ~/ ~.....~.~ ** Check Permitted Bedroom Rati g~Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signed Company- MOA No. ,.CT ,P4¢0 7.-/ Receipt No..._~¢~4~/ ~d¢~¢ 7 Date of Payment Amount: $ ~,~""', Page 2 of 2 72-026 (11/84) ALASKA ENVIRONI~,,'NTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO. CALCULATED BY ~ ¢~ 7 CHECKEO BY SCALE OF DATE "AS-BUlL?' hereby certify tha~ I have surveyed the following described property: ~' ~ and that no eacroadmmnts exist except as indicated. Exc lu~sion Note: It is the responsibility of die owner to detennine the existence, of any easements, covenants, or restrictions whid~ do not appear on the recorded subdivision plat. Under no circtlnstances sheuld any data hereon be used for construction or for establishin~ boundary or fence lines, Dated at Anti.rage, Alaska, this I~ day of ~O¢~, I~],~p OONT~CTING ENCINEERS & ASSOCIA'U&S ASBUI[_T Anchorage, Alaska 99502 Phone (907)349-2407