Loading...
HomeMy WebLinkAboutPETERS GATE TR 1BPeter's Gate Tract 1 B #051-551-10 Municipality of Anchorage Page 1 of 2 �pN 2 2004 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION 3y3:7WH T�Popf ao�tltgR0 •Anchorage, Alaska 99519-6650 • Telephone:3433-ff" l • ewater Disposal System and/or Well Inspection Report NVIRUN�•SF SO 03o3I(Ah OS,-951- 10 Permit Number: PID Number: "°m° System: T76w Upgrade ru, ve-o„�.,Wastewater Aedrnesa: ABSORPTION FIELD Phone: Z -0 No. of Bedrooms: 3 p Deep Trench tTShallow Trench 0 Bed D Mound O Other LEGAL DESCRIPTION Soil Rating: Total Depth from rlginal grade: GPD/Sq0.0 FI Lot:_ Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe ��--.. t EAr—T 1J P _qts (,A _. Ff. Ft. Township: Range: Section: Fill added above Original grade: Ft Gravel length: q �y 1 D FI WELL: ❑ New ❑ Upgrad Gravel width: s Number of lines: Ddtanu beNreen lin es: FI. FI. Classification (Private, A.B.C): Total Cased To: Total absorption are T Pipe materiel: Fl. Ft. J SG. Ft. 3 — $ I Driller;yL� Date Drilled: Slatic Water Level: Imfallec FTvFt i7 OwNtrC Dale Installed: Ft. T rIiA /0 Yield: Pump Set at: Casing Height Above Ground: - TANK GPM Ft. FL SEPARATION DISTANCES septic 0Holding ❑S.T.E.P. To Septic Absorption un HoWinq PubficrPrivale Manufacturer: Capacity In gallons: From Tank Field Station Tank Sero Lines Ap (ft 'm_ )%m)K 11000 Well /02 r Material: Number of Com anments: TEL Surface Water /vv + 1D ,+ _ _ 100'f LIFT STATION A/ Lot .f $ fi 1p — r * l0 Size In gallons: Manufacturer: Line Foundation 1O4 — _ • "Pump on” level at: >Mp level at: High water alarm at: 0..t 1 Curtain Sot SO/ { 1C rI J Pump Make .Moat Electrical Inspections performed by: Drain Remarks: BENCH MARK Location and Description: NAI TRuI R Wr,s &ejb oF I- ACH til ap Assumed Elevation: i t%0. 175 Ft E EAL e ..As.. *• I Inspections performed by: GNRTSToPH E2 kkyb Dates: is —.._ . 1C'oA� FLODF/J 2nd lok-Yk I:NRisT PHER R WOOD .r Department of Health and Human Services approval0� .............•• .> Reviewed and approved by: Date: *Cq — dont & �5 Tx-013(A..MI) MOA 25 v f Permit No. SW0303862 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: PETERS GATE SUBDIVISION, TRACT 1—B PID No.: 051-551-10 SWING TIES C 1 58.2' 96.3' D 1 71.8' 90.5' N90'00'00"E 1290.53' w C O c Oo N90'00'00'E b (0 226.93' �r N V1 SCALE 0 I* -6w O O O O N f WAN 99 '1 \ C \ A M u \ ® D D o 0 A O U) N90'00'00"L 1221.93' DATE n NBA IN HIRCN TREE UMED ELEV ASS • 100.00' ENGINEER'S SEAL ELEVATIONS OF At�4p� (NOT TO SCALE) o�P�k..••....... 5,400 106.3• 90.Y WLE0 ; .'' 4 oOp 4 5' �J OPNER R. vM • Q Q4 CE -10387 aQ TANK \ � ' 10L8 01.6' 84.9' 94.YO NDGVT 0o4 o•'•..... '•�� 3.9 77.9' 4p��� E�VI"oo DATE: April 7, 2004 MUNICIPALITY OF ANCHORAGE Building Safety Division MEMORANDUM TO: On - Site Services Program FRs ss, P.E. qJ1 ger, On -Site Water Wastewater Program SUBJ: Slope setbacks from >25% In situations where slope conditions will not allow a wastewater disposal field to be located 50 feet horizontally up gradient from a change in slope to greater than 25%, as required in AMC 15.65.060.A.1.b the following requirements apply: (As allowed by AMC 15.65.030.G) 1. A point shall be determined two and one half feet above the invert of the distribution piping of the septic field at the field's closest point to the slope greater than 25%. 2. A line shall be drawn from this point and perpendicular to the distribution piping at a down slope of 25% in the direction towards the slope greater than 25%. 3. The intersection of this hypothetical line and the actual slope shall be a minimum of 35 feet horizontally from the point established in #1. 4. This 35 foot horizontal separation shall be the minimum allowed between a disposal field and a slope of greater than 25%. If a property has a wastewater disposal system that was constructed prior to 1986 and the absorption field encroaches a change in slope greater than 25%, an upgrade of the failed system may be approved in the same location if the following applies: 1. No other location exists on the property to construct an upgrade drain field with proper separations. 2. The engineer field verifies that no effluent ever surfaced on the slope surface. 3. The engineer maximizes the separation from the field to the slope as much as possible. s MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Sep 18, 2003 Expiration Date: Sep 17, 2004 Permit Number: SW030386 Parcel ID: 051-551-10 Legal Description:[PETERS GATE_TR -i B.' Design Engineer: 0848 Eagle River Engineering Services Site Address: 025124 KOLLANDER DR Owner Name: Bill Fordham & Jeff Fondy Lot Size: 1157389 SQ. FT. Owner Address: P.O. Box 220215 Total Bedrooms: 3 Permit Bedrooms: 3 Anchorage , AK 99522-0215 This permit is for the construction of: 0 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, seated, and heated to prevent freezing. Received By: Issued By: 4A .4-1 Date: 2 F��4 Date: g 0.3 09/03/03 11:27 FAX 9073438437 HOA -L& . USE ENFORCEMENT Municipality of Anchorage Development Services. Department Building Safety Diviion On -Site Water and wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchoragmak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING 121001 Parcel I.D. OS I - � 5 I - O Permit Number W 0386 Propertyowner(sg1l I_ FORbHAjfl +TCFF 'F64&'/'_ Dayphone '22-3-0717 Mailing address (1) 70 I-syX 2207-1 >- .4ficNoPA6,C, AIC 19522-02/5 Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) I� A Legal description (Section, Township & Range) 1 � 1 l ."-t i (-;I I (1 VX t li 4 _ t Lot Size 3 Acre q.FL Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only, ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑, Water Softening Unit ❑ Therapy Pool ❑ I certify that the above inf rmation is correct I further certify that this application is being made for a Single Family Dwelling a , d Is in accordance with applicable Municipal Codes. (Signature of p owner or authorized agent) Permit Fees: Date of Payment Receipt Number: (Rev. tyoa) Waiver Fees: l�J D�13 Date of Payment 1 Receipt Number: Eagle River Engineering ,Services Louis Butera, P.E. Christopher R. Wood, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax September 18, 2003 Jim Cross, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Peters Gate Tract 1B Additional Information for re -submittal Dear Mr. Cross: We have attached a new site plan, incorporating the review comments from Dan Roth on 9/16/03. Additionally, we have modified the stamped design talcs and specs to show a total excavation depth of 6 feet. We have measured the slope below the leachfield, and have indicated the slopes on the site plan. Slopes exceed 25% in some areas and are noted. We feel that the chance of potential daylighting of effluent is negligible due to the fact that the soil layer immediately above the accepting layer is very clayey. The existing system, located entirely on the slope in question, has been in a nearly full surcharged state for more than 10 years, without any evidence of daylighting at, or down slope of the leachfield. The landowners are cutting the slope above the leachfield to make working room, and in doing so, are placing fill material below the leachfield location, lessening the slope immediately below the leachfield. In light of these facts, we are requesting a variance of the 25% maximum slope requirement. If you have any questions please call our office at 694-5195. Sincerely, EAGLE RIV 'ENG EEE G SE ICES �/ 1 7 Christopher R. Wood, P.E. \2003\03-040SEmcNARRArtvE2.Doc Eagle River Engineering ,Services Louis Butcra, P.E. Christophcr R. Wood, P.m P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax September 3, 2003 Jim Cross, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Peters Cate Tract 1B Narrative & Permit Application Dear Mr. Cross: The proposed septic system upgrade for this 3 bedroom single family dwelling will have very limited impact on adjacent properties for the following reasons: 1. This lot is very large and the surrounding lots are fairly large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Neighboring wells are all 100'+ from the proposed septic system. 4. Drainage will not be affected and is not a major consideration in our design. This septic system replacement will not affect the development of any other lots surrounding this unit. The slope of the terrain 'immediately below the western portion of the proposed leachfield trench is in excess of 25%. The steep nature of the terrain elsewhere on the lot limits the locations available for the replacement system. We feel that the chance of potential daylighting of effluent is negligible due to the fact that the soil layer immediately above the accepting layer is very clayey. The existing system, located entirely on the slope in question, has been in a nearly full surcharged state for more than 10 years, without any evidence of daylighting at, or down slope of the leachfield. In light of these facts, we are requesting a variance of the 25% maximum slope requirement. If you have any questions please call our office at 694-5195. Sincerely, Wood, P.E. 12003%03.040SerncNnrtrtnnve.00c 0 0o N90'00'00"E 226.93' MEl! 1200' �acrnc +30 } WELL .200' .30' 1290.53' AA � o rli LOG MOUSE N90 -00'00"E N THIS SEPTIC SITE PLAN PREPARED FROM OWNER PROVIDED ASBUILT SURVEY BY R.C. JOHNSON DATED JUNE 11. 1991 WE HAVE NOT SURVEYED THIS LOT OR VERIFIED THE ACCURACY OF ASBUILT SURVEY FOR SEPTIC SYSTEM LOCATIONS. NOTES 1. NO SURFACE WATER WITHIN 100 FT. 1. NO NEIGHBORING WELLS OR SEPTICS WITHIN 200 FT. SEPTIC SITE PLAN LEGAL:TRACT I—B PETERS GATE SUBDIVISION DWNER: JEFF FONDY & BILL FORDHAM CONTRACTOR: N A JOB 03-04OWS DATE: 9/03/03 SCALE 1 " = 50' AEACLE RIVER ENGINEERING SERVICES P.O. Box 773294 EACLE RIVER, AK. 99577 (907) 694-5195 FAX.(907) 694-3291 1221.93 ® — TEST HOLE • — MONITOR TUBE C — SEWER CLEAN OUT — WELL — — — EASEMENT — — — PROPOSED LEACH FIELD ©— DRIVEWAY Eagle River Engineering ,Services Louie Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM UPGRADE LEGAL: Peters Cate Tract 1 B, T15N RI W Sec. 14 September 18, 2003 A. GENERAL 1. The septic system upgrade plan is for a 3 bedroom single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. 1t is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. Any remaining open test hole excavations shall be filled and monitor tube removed. B. SEPTIC TANK I. Septic Tank shall be a minimum of 1,000 gallon tank of MOA approved construction, insulated, or place with 4' of soil cover, min. C. DRAINFIELD 1. The drainfield is to follow the natural land contour to maintain uniform total depth of the drainfield bottom. 2. The bottom of the drainfield shall be level, plus or minus 1.5", and shall be located at 6' below top of ground surface as measured on the downhill edge of excavation. 3. The existing drainfield shall be abandoned in place. 4. The drainfield gravel shall be covered with typar fabric material. 5. A minimum of 3' of fill, or a combination of soil and 2" extruded board insulation to an equivalent soil depth of 2', is to be placed over the leachfield. 6. The area over the drainfield is to be finish graded to prevent ponding of surface water runoff. Care shall be taken to ensure that 3' min. of native fill is placed over the entire drainfield. 7. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACIIFIELD DIMENSIONS: TOTAL DEPTH = 6' GRAVEL DEPTH = 1' under pipe, 2" over pipe DRAINFIELD LENGTH = 98' DRAINFIELD WIDTII = 5' SOIL RATING= 0.8 GPD/R2 BEDROOM CAPACITY = 3 total SEPTIC TANK = 1000 gallons min. Twenty-four (24) hours notice required for all Inspections. \\Gres\D0CS\WPD0CS\2003\03-040 drainfield- spec.doc EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 6945195 ERES Project No.: 03-040 Calculated By: CW Date: 09/18/2003 Legal: Peters Gate Tract 1B TEST HOLE 1 & 2 Single Family 3 Bedroom Dwelling Shallow Trench Subsurface Wastewater Disposal Field Percolation Rate Averaged between TH-1 and TH-2 Water use at 150 gallons per bedroom = Percolation rate = Wastewater application rate = Required absorption area = Trench width (W) = Gravel depth (D) = 450 gallons 6 minutes per Inch 0.8 gallons per day per square foot 563 square feet 5 feet 1 feet Required length = Shallow trench factor • Required absorption area / W Shallow trench factor = (W + 2) / (W + 1 +2 D) Shallow trench factor= 0.88 C. {I JJ I V?8CR R . CE;f01S7 03-040 drainfieldCaic.xis Total Excavation Depth = 6.0 feet Required length = 98 feet z .......................... lig'. f�..•�`:��j '�r�• 2:21 PM09/18/2003 • ..r Municipality of Anchorage DEPARTMENT OF HEALTH d HUMAN SERVICES 825'L' Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: _/ 4- PROPER ITES DATE LEGAL DESCRIPTION: I'E.TFRI 13 14 1 15 16 17 18 19 COMMENTS cLgY bonom of TI} Township, Range, Section: WAS GROUND WATER ENCOUNTERED? J . S IF YES. AT WHAT L DEPTH? O P Depth to Water Atter Monitoring? I-)AP1t• Dew eit�,L2,9 /03 Reading DEPTH (FEET) ORl hG epth to Water Net Drop F1Li('(4 LLVVY GRAJGL 2- If 3- 34 2 .,'i o 4 4 �`2o W IJ 7oPso1 L 6 pt Rs SM . G(ZhY SITT`/ SANK I 7 13 14 1 15 16 17 18 19 COMMENTS cLgY bonom of TI} Township, Range, Section: WAS GROUND WATER ENCOUNTERED? J . S IF YES. AT WHAT L DEPTH? O P Depth to Water Atter Monitoring? I-)AP1t• Dew eit�,L2,9 /03 Reading Date Grose Time epth to Water Net Drop sbI23 03 ;ctiPMq If 2 .,'i o r. l/Y/. 4 3 I Y16, c .1 _$! ft7 °� -i�Soh C 2 ATE PERCOLATIO RATE '� (minutes/inch) PPERC HOLE DIAMETER TEST RUN BETWEEN 51 S FTAND _..LS FT PERFORMED BY: OOD 1 /.'„ C RTIFY TH T THI TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: �� 3�O 3 72-M (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 `L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMEDFOR: I ±F PROPER11ts DATE PERFORMED:*f�/0:5 LEGAL DESCRIPTION: 16R< 6 A7 -r:,1 2Ar�I F� l 7-N DH n (FEEEPTT) 1 6Qow�/oRMJc,E OR(„gN1C5 3-I'Wb ITAli rc a G 6 S SP GI -WJE`/ C -RAVEL 9 I 9OUL or IE�T tf�l E' Section: SITE PLAN 10 WAS GROUND WATER vet,�r.��■v�r�s� ENCOUNTERED? NCS 11 S IF YES, AT WHAT L 12 DEPTH? P E 13 Depth to Water AftterA. Monitwlnp? mrMy_ Bate: 14 16 17 18 19 20 COMMENTS PERCOLATION RATE (mmutes/incn)'PERC HOLE DIAMETER TEST RUN BETWEEN FTANO FT PERFORMED BY: —�F R -re) Ln-3N ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE 72-008 (Rev. 4/85) TEST WAS PERFORMED IN vet,�r.��■v�r�s� PERCOLATION RATE (mmutes/incn)'PERC HOLE DIAMETER TEST RUN BETWEEN FTANO FT PERFORMED BY: —�F R -re) Ln-3N ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE 72-008 (Rev. 4/85) TEST WAS PERFORMED IN \ MUNICIPALITY OF ANCHORAGE _ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION 625 L Street • Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE gNEW L E. kj0LLt?1Uj)r1Z Z 4,010 ❑UPGRADE MAILING ADDRESS 0 lu, porH C on!iM -995002— LEGAL DESCRIPTION /-6 PE E 5 -/)7-F7 .<UAt)l 15/0 AJ LOCATION NO. OF BEDROOMS 25 02r_Eh- 3 DISTANCE TO: Well o / Absorption area Dwelling PERMIT NO. U y C�57 d Q Manufacturer Material No, of compartments w t-. 2 F 2 y Liq. capacity in gallonsIF O HOMEMADE: i h ,q d y DISTANCE TO: Well Dwelling PERMIT NO. JDZ _? F Manufacturer Material Liquid capacity in gallons O DISTANCE TO: Well / Foundation / ! Nearest lot line �t PERMIT NO. W T w f ? No. of lines Length of each line Q Total len Ih of lines 0 Trench width y Inches DistanceDistance between lines Top of ile to finish grade Material beneath the Total effective absorption area a; o (Ouj 17AIA q inches S / 12 Length Width Depth PERMIT NO. W C7 d F- wd Type of crib Crib diameter Crib depth Total effective absorption area a DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J w DISTANCE T0: Buildingfoundation Sewer line Septic tank Absorption area(s) D OTHER PIPE MATERIALS SOIL TEST RATING 150 CJ CSI) ..! INSTALLER 67-EVEAI I- S REMARKS Gp AI ST2UGT/ (7W r- ST94 PC 7 - A 141 zfivrmsr- .p AR A l E 1. O�,`v . s . r. �f•� V� c' I vf_f:. ��� ._ rt. APP;V/ DATE LEGAL/1 ' AC r / ,/LS &,4 72-013 May. 3176) / t t ^iK by DOC Co. abs . SULLIVAN WATER WELLS P•.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 6884759 OWNER OF LAND Cl/J ti' `' 4 ILIIt c DEPTH OF WELL V �� i ADDRESS i. f 16 "Je—t 25�-)elTATIC LEVEL OF WATER FT. 7t1 LEGALD I ESCRivrm 7R'`t<71 / /3 In<'icCT l rrTL DRAW DOWN FT. DATE -Started ,04 Ended % '�� GALS. PER HR PERMIT NUMBER ` KIND OF CASING 'KIND OF FORMATION: From I_Ft tck_ Ft `sR'J Q From Ft. to Ft. . From ) Ft. to ' ; 3_Ft. S2 From Ft. to Ft. From 17 Ft to"51" Ft. /'x.9'1' a l 'P`Y✓C G From Ft. to Ft.' r From,<�8 Ft. to LL/ Ft. ac Of„ _ %G ijlH From - Ft. to Ft From Ft:104f Ft. ;=x:14c lrjKc'Prom Ft. to Ft From Ft to Froni Ft. to Ft. Fromj l t Ft. tolc'_t Ft From Ft. to Ft. t From Ft to Ft: /(2 I R Q , Z SF�� fFrom FL to Ft. :From�Ft toL�Ft tYf_O!0</c ttrP<>vCrrutti Ft. to Ft. D,_*?tit�RFOE From " Ft to Ft. ` r� 7 From Ft. t1Ot2I ri°t+TFP.F HEALTH &ION • Epry1RONI+�E ' Fro m_Ft toJ Ft.^i�f °� L From Ft to ► 1A FromFt to Ft. From - - Ft. to t77— . [ From Ft to - FI From.. Ft. to___a `-'Y From Ft to Ft. From Ft. to Ft. j: From Ft. to Ft. - From Ft. to Ft. I From Ft. to FL From FCto Ft. From Ft. to Ft. From Ft. to Ft I MISCL. INFORMATION: 7-o T -i �- DRILLERS NAME MUM I C I F�AL I TY OF ANCHOFZA(3E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825.L STREET, ANCHORAGE, AK 99501 264-4720 ON—SITE SEWEF� �.c WELL P'F��M I T PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: 840547 ' ENGINEERED DESIGN 05/07/84 DARYL E. KOLLANDER 2910 W. 80TH ANCHORAGE, AK 99502 243-6610 SUBDIVISION: PETER'S GATE LOT: TRACT ID BLOCK: N/A SECTION: 14 TOWNSHIP: 15N RANGE: 1W 26.56A (SO.FT. OR ACRES) I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with.the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUSTi BE DONE BY.A LICENSED ELECTRICIAN. SIGNED APPLICANT:(( v . , iARYLfEE.. ISSUED BY ~ ~o/~/~ ~ SOIL LOG TRENCH DETAIL (TYP) SEC. B-8 PUMP STATION ~"~ ~*~: CORWIN &ASSOCIATES ....... KOLLANDER SEPTIC INC. -7: : : SYSTEM DESIGN PLANS, SECTIONS & DETAILS co...m.. Engine*ring (} ~L ? T.AC~ ~-~ o¢ 1 SOILS LOG MUNICIPALITY OF ANCHORAGE v„ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATIONTEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: S ,(EVEN L - %-LYGC>S GV A4<7t7• DATE PERFORMED: y /Z f LEGAL DESCRIPTION:_ %RPG% 1-8 / E7E/LS rrl77F- _SUL'i SLOPE SITE PLAN 1 18 VN: 19 -- b Net Time Depth to Water Net Drop 2j Grvl/GF 3- F�90-* .. e_m.. a.= a rVa 1r4nr�.-%n 5- 20 A ar 6- 67 77 8� 9 IL 10 11 •• 12- 2 13 13.-. t 14 1' . s 15 ` PERFORMED 72008 (6/79) WAS GROUND WATER ' I0 ENCOUNTERED? IF YES, AT WHAT DEPTH? 11 Reading Date b Net Time Depth to Water Net Drop rs o1f .. e_m.. a.= rVa 1r4nr�.-%n �.e E,3" ', 20 A ar PERFORMED 72008 (6/79) WAS GROUND WATER ' I0 ENCOUNTERED? IF YES, AT WHAT DEPTH? 11 Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN CERTIFIED (minut"Anch) AND FT SOILS LOG MUNICIPALITY OF ANCHORAGE ar DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION . O PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 2644720 L ` SOILS LOG — PERCOLATION TEST PERFORMED FOR: 64eye .�i n,— nS DATE PERFORMED: � 1 T� LEGAL DESCRIPTION: ^YCJe Y5 �iO.TC SUb A. VtOION TCC, 1 2 3 4 5 6 7 8 8 10 11 12 13 14 15 16 17 18 19 20 PERFORMED 72-008 (8/79) WASGROUND WATER ENCOUNTERED? IF YES, AT WHAT CI DEPTH? •J Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN CERTIFIED (minutes/inch) FT AND FT I r. SOILS LOG MUNICIPALITY OF ANCHORAGE ® I� v� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION 1 825 L. Stan, Anchorage, Alaska 99501 2644720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: S7'Eyo= J ( 5Kf1C+C� S CONST DATE PERFORMED: LEGAL DESCRIPTION: � solLs Loc MUNICIPALITY OF ANCHORAGE �\ ❑ PERCOLATION DEPARTMENTOF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: STEVEN L, SKF)C C -S CONST, DATE PERFORMED: FIIA LEGAL DESCRIPTION: SLOPE SITE PLAN 1 2 3 C 'J J. Corwin l{j, t8 �% • a -r.E .e y 5 19 ROFESS10�4m �F1L) 20 L.T, br.N, /Gs 4J b r,'j,' v.' ,�. END 8 9- 1011 10- 11 12 13 : OF 15 - A•.4il 16` .Y. '� T •t .......... � I i WAS GROUND WATER ENCOUNTERED? YF_ S IF YES, AT WHAT —7 DEPTH? .11 Reading C 'J J. Corwin l{j, t8 �% • a. CE -s283 0 'r P`��''• .e Q�i4 19 ROFESS10�4m 20 i WAS GROUND WATER ENCOUNTERED? YF_ S IF YES, AT WHAT —7 DEPTH? .11 Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN AND I Frru/,FFIV o� A V w PERFORMEDBY: 7-01) S1/E/Zi,4d A.) CERTIFIED (minutes/inch) FT cv'. 72-008 (6/79) V - DATE: CORWIN & ASSOCIATES, INC. CONSULTING ENGINEERS 4321 GRAPE PLACE SUITE 204 ANCHORAGE. ALASKA 99504 (907) 561.6151 SUPPLtMENTAL SOILS INPOMMATION T.H.J)J T. 11. (P t) Pt Pt t I •, 1 1 /,.. GP i i OL 1; • J) 3 i• .� 3 3 GP 4 SM 4 Sof 4-0 �'• S�1 5 H10 5 Hz0 5 G 6 6- 7 7 7 9 s 9 10 - lo - 12 0 12 12 r 4� 12- 14 14 fou / ., ua.,+.,«.. i14. 1 15 151 L �14� J. Ccr 'n .15 r is t6 i, '•. `1 y' 17 t7 `: �' %' 17 18 18 18 19 19 19 20 20 20 LEGAL DESCRIPTIOV �r P t rf i (-AP ? -r ." T.H.#(O Pt t 7II�1 'IIi! OL 2 .�• SP 4 ' 5- 6 6 ' 7 '•' • 8 H2� 9 10- 11 21314 12- 13- 14 15 16 17 18 19 20 CORWIN & ASSOCIATES, INC. CONSULTING ENGINEERS 4321 GRAPE PLACE SUITE 204 ANCHORAGE, ALASKA 99504 (907) 561.6151 SUPPLEMENTAL SOILS I:IFOWEATION T.H.9 7 T.11.9 T.H.1 T.A. DEPTH DEY1++ OEv1N E r IFEETI I{EET1 1f EETJ 1 ML I I I 2 2 2 2 J 3 3 3- 4 4 4 4- 5 5 5 5 .. 6 ... SP 6 6 6- 7 ML 7 7 7 E Nz0. 8 8 8 9 9- 10. 10• 10 10 10 OF 11 i l � �1.LC� 11 11 At !%I 12 - 112% 4tp 131�� '�1, it 13 13 14p l cn �•✓ is is Is 17 17 17 17 18 18 18 16 19 19 19 19 20 20 20 20 LEGAL DESCRIPTIO. eE ,eG5 077Z+r c. ' �� CORWIN & ASSOCIATES, INC. CONSULTING ENGINEERS 1549 E. TUDOR RD., SUITE 204 ANCHORAGE. ALASKA 99507 September 4, 1984 (907)561-6151 MUNICIPALITY OF ANCHORAGE C:PT. CF HEALTH & Mr. Keith Bandt ENVIRONMENTAL PROTECTION Anchorage Department of Health & Environmental Protection SEP`_! 1984 Division of Environment Health Pouch 6-6 Anchorage50Alaska 99502 RECEIVER Dear Mr. Bandt: Enclosed is a synopsis of the construction of the on-site wastewater disposal system for Tract 1-B Petersgate Subdivision. Due to the complexity of the system, I felt that the standard inspection form did not reflect enough information for your approval. Consequently, this memorandum was written to accompany the inspection report inconjunction with sheets 1 and 2. When I arrived on site the pad for the proposed house had been excavated and stakes had been placed at the house corners. A test hole had been dug the previous day and left open for my inspection. Please refer to the soils log on sheet 2 of 2. The overall slope at the site was approximately 178. I had the contractor dig an extra 4 feet below where the bottom of the system was to be placed in the SP sand layer to check ground water. No ground water was observed. Referring back to the previous soils logs performed this spring, you will note that high ground water levels were observed. It is obvious that these holes did not extend into the SP layer in the locations near the house. Due to the fact that there was seasonal runoff (break up), water flowing through the upper gravel layer, these holes filled up with water due to the impervious nature of the intervening ML layer. Since there was no ground water present, there was no reason that the system could not be placed in the SP layer. However, I felt that there was a great potential for the upper gravel layer to become saturated during spring break up periods. Consequently, I had the contractor construct a gravel drain above the system on the north side of the driveway from the septic tank to 10 feet past the end of the drainfield. This drain was then constructed under the road and daylighted to the south; twenty-five (25) feet away from the system (refer to Figure 1). This drain was constructed from ground level to a depth of 4 feet extending into the impervious ML layer. This will cut off any seasonal flow of water through the upper gravel layer and also divert any surface runoff away from the system. 0,6 0 W Mr. Keith Bandt Page Two September 4, 1984 r The rest of the system was constructed according to the plans and specifications submitted by Corwin & Associates previously, and with accordance with the Municipality of Anchorage, Department of Health & Environmental Protection regulations. If you have any questions, please do not hesistate to call. Very truly yours, CORWIN SSOCIATES INC. Tod Sherman TS:kjh Attachments INC. `.^" Grape.~.~ _~_~_4 ANCHORAGE, ALASKA 99504 JOB SHEET NO. OF CALCULATED BY 71-S, CHECKED BY DATE |--^--'---^--^------�-- --��—�---` -'—'---�--�--| —[--r----'' — —�—Y��—��|��i��^ pip IA |--^--'---^--^------�-- --��—�---` -'—'---�--�--| —[--r----'' — —�—Y��—��|��i��^ 00ftK, CORWIN & ASSOCIA S, INC. . Consulting Engineers 4321 Grape Place Suite 204 ANCHORAGE, ALASKA 99504 JOB P6 SHEET NO. OF CALCULATED BY LAS DATE v 24 - CHECKED BY DATE 1CP1 wl CNFWPY4 0 mm I�� r !� f i11._. ..� ;_ i I .. ..... . . ............... 1CP1 wl CNFWPY4 0 mm 1.0 General r SPECIFICATIONS FOR TIERED 5 -WIDE TRENCH WASTEWATER TREATMENT SYSTEM PETERS GATE TRACT 1B 1.1 The drawing, Sheet 1 of 11 shall be a part of this specification. 1.2 All materials and workmanship shall meet the requirements of Anchorage Department of Health and Environmental Protection Permit. 1.3 All excavations and depths are advisory and are to be verified or modified in the field by the Engineer. 1.4 It is the responsibility of the Owner to obtain all necessary permits or easements. 2.0 The Pump Station 2.1 The stock material for the Pump Station shall be corregated metal pipe (CMP), either steel conforming to the requirements of AASHTO M-36 or aluminum conforming to the requirements of AASHTO M-196. 2.2 The 36" pipe for the Pump Station shall have a welded water tight bottom as indicated on drawings. 2.3 There shall be 2" polyurethane foam insulation covering the outside of the culvert with 2 layers of visqueen around the insulation as indicated on the drawings. 2.4 All penetrations of the Pump Station shall be welded and water tight. All welds shall be cleaned of slag. Welds on galvanized steel will be sprayed with zinc rich paint or coated with bitumastic. 2.5 The manhole cover shall be rain tight and securely fastened with screws. 2.6 There shall be 2" polystyrene insulation on the manhole cover as indicated on drawings. 2.7 All electrical fittings and connections in the Pump Station shall meet the requirements for a water tight service. 2.8 There shall be a high level alarm set at the level of the soil pipe from the septic tank. The buzzer shall be located near•the electrical control panel or in a locations designated by the Owner. n n 2.9 The sump pump shall be located as indicated on the drawings with a chain attached to the discharge pipe. 3.0 5 -Wide Trenches 3.1 The gravel for the trenches shall be screened to the sizes indicated. 3.2 The bottom of the excavation shall be raked with the backhoe blade to insure that the bottom has not been compacted during excavation. The bottom elevation shall be level plus or minus 2". 3.3 The insulation shall be polystyrene of the thickness shown on the drawings. 3.4 The septic tank or trench must not be closer than 100 feet from the well. CORWIN & ASSOCIAI'04; INC. JOB Consulting Engineers SHEET NO.- OF 4321 Grape Place Suite 204 CALCULATED BY DATE ANCHORAGE, ALASKA 99504 CHECKED BY DATE SCALE ce v- la _ C 5c 5. sFc eb j — --- --� — —�— - .e C 6& x� I IL I J_ L—t— I I _A L - VML.. T- _17 7 --T-I f 7 •ai _ ' •1 W -v •: L •- y • M N C •� PC V Q M MAI 2 O O. � s .. DATE: TO: FROM: SU0.)ECT: M,nicipa►fity of Anc&, age MEMORANDUM July 23, 1984 Laura Crow Environmental Health Division Request for Refunds - Account # 2460 Please make arrangements for the following refunds. Two(2) were MOA inspections and changed to engineer inspection. One(1) the well permit was paid for twice. One(1) the permit was revoked. Daryl E. Kollander 2910 West 80th Avenue Anchorage, Alaska 99502 Receipt # 278742 Amount $15.00 Account # 2460 Tract 1-B Peter Gate Subdivision Permit # 840035 - Well Permit (Purchased Sewer and Well Permit on Permit #840547) Bernie Willis 10008 Marmot Circle Anchorage, Alaska 99502 Receipt # 279032 Amount $145.00 Account # 2460 Lot 1 High Hopes Subdivision Permit # 840156 - Sewer/Well Permit (Purchased MOA inspection changed to engineer inspection.) Premiere Construction 4155 Tudor Road #206 Anchorage, Alaska 99503 Receipt # 279608 Amount $145.00 Account # 2460 Lot 9 Block 2 Spring Hills Estates Subdivision Permit #840521 (Purchased MOA inspection changed to engineer inspection.) R.D. Neilson Star Route A Box 738OW Anchorage, Alaska 99516 Receipt # 288398 Amount $20.00 Account #2460 Lot 8 Block 2 Spendlove View Heights Subdivision Permit #840514 (Permit has been revoked by this Division) Laura J. Ward Office Associate cc: File attachements 91 010 (4/76) t- r'tura Fl r-4 ID FRFiGE DEPARTMENT OF HEALTH iAND ENVIRONMENTAL PROTECTION 025 L STREET, ANCHORAGE, Fit" 99501 264-4720 Ota—=ITE LJELLLL PERMIT NO: 0400=5 DATE ISSUED: 03/02!04 APPLICRPJT: DARYL E KOLLANDER ADDRESS: 2910 JJ 00TH ANCHORAGE, 'AK 99502 CONTACT PHONE: 243-66.10 LEGAL DESCF.IP: SUEDIVIc,t�it�J' PETERS GATE LOT. R 1-E BLOCK: NA SECTION: N�14 TOIdNSH I P : 15N Rt J 1FJ LOT SIZE: 26.5A (SCE. FT. OR ACRES) I CERTIFY THAT: 1. I AM FAMILIAR WITH THE REQUIREMENTS F SITE WERS AND WELLS AS SET FORTH BY THE JU ICIPALIT OF ANCHORAG CM A) THE STATE OF ALASKA. 2. I WILL INSTR L T E SYSTEM IPJ RCCOF,U FJC IT LL MOR CODES RPJD REGULATIONS, AND IN COMP IRFJCE WITH TH DESIGN C 'IT RI F THIS PEF.MIT. s. I WILL RDHE E TO L JtOR R D STATE R �I;R REQUIREMENTS FOP. THE SET BRC{: DISTANCES F Ott AN EXISTING J• L 4 ST DATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SV- TH r OF.' CENT OR NEARBY LOT. SIGFJEDDATE: -------------- APPLICANT: D .TL E JAL AP DEF: ISSiIED 64' - - ---- ----------- DATE: - 3��Ap�----- Gam- t�aA 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.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0S1^557I ' to HAA# 05'0 11 3 ., ' 4'. Expiration Date: l /a4/ %j 1. GENERAL INFORMATION Complete legal description PCTG(ZS 4ATL T 2 213 r Location (site address or directions) 25124 KoD2, Current Property owner(sj 13TLL beak 6&14 l T &MP 54ay phone 430 - 2 319 Mailing address 21911 (31HULAY DR. ER AIC 995.77 Lending agency Day phone Mailing address Real Estate Agent Mco,r S7TL7A YZ Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: .3 3. TYPE OF WATER SUPPLY: � TYPE OF WASTEWATER DISPOSAL - Individual Well Lr Individual On-site L� Individual Water Storage ❑ Individual Holding tank •❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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. l 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 Eagle River Engineering Services Phone : 6 4 H' 5V? f 10421 VFW Rd., Safte 201 Address Fagle River. AK 995n Engineer's Printed Name 6491n2p EQ 17_ I,.icv> 5. SIGNATURE ` DSO7 Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory_ Other By:, . 0.. _ . lJ Original Certificate Date: Municipality of Anchorage i • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST 1 Legal Description: JR5 ,64TC Tit 113 Parcel IC: 0!;-A- sr /-10 A. WELL DATA Well type -}&I'v'A F Date completed ]ley Total depth 21212 ft. If A, B, or C provide PWSID ff Sanitary seal QN) _W Cased to eft. FROM WELL LOG Date of test 7/4 Static water level 70 ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate 2.07 mg.11. Well Log &N) WCS Wires properly protected ®/N) YCS Casing height (above ground) ILI_in. AT INSPECTION 3 /tD ID5'_ -73 ft. 0.5- g.p.m. Other bacteria _4 colonies/100 ml. Arsenic: — mg./l. Date of sample: 3,�,s�ps Collected by: 1Dli>1J H 4Y]5 Al B. SEPTIC/11668111G TANK DATA Taak-4pelMaterial i TF -Z L Date installed /O /0d IO 3 Tank size I ODO gal. Number of Compartments ,2 Cleanouts &N) VCS Foundation cleanout &1) -Y,96 Depression over tank (Y© /1% High water alarm (Y& AJ D Date of pumping' iUe.ut_ Pumpers Jtl/4 GES 4OMA11 S C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 ortt=lbdrSystem type 'DIZ+;WFt Length 9 ft. Width S ft. Gravel below pipe �_ ft. Total depth (v ft. Eff. absorption area _AJL CLft2 Monitoring tube �,,� Depression over field kJ D Date of adequacy test 410tJ :e t2ElR'tN Results (PasslFeitr• 5 For 3 bedrooms Fluid depth in absorption field before test - in. Water added_ gal. New depth= in. Elapsed Time: =min. Final fluid depth =1n. Absorption rate >= I g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) — If yes, give date D. LIFT STATION Date installed Size in gallons `Pump on' level at _ in. 'Pump off" leloo I.#ff Da Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lifletetien on lot -hty0 r Absorption field on lot 'h /yn I Public sewer main t 71q 1 Sewer /septic service line 'f' 25- r Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? r On adjacent lots 1,100. On adjacent lots I-100 r Public sewer manhole/cleanout +iJO Holding tank 'f" 100.11 SEPARATION DISTANCES FROM SEPTIC/! 19LBIN6 TANK ON LOT TO: Building foundation "I- $� Propertyline 't'/O r Absorption field i Water main 'h'10 1 Water service line 1-/0 Surface water 1-100 Wells on adjacent lots 1100 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r Property line +10 fBuilding foundation '' Irk Water main t /00 � t Water Service line t 25' Surface water or 100 � Driveway, parking/vehicle storage,�� Curtain drain' 'r' SO r Wells on adjacent lots 1-(00 r F. COMMENTS t 6ATA . 1XSs' T/fhnl 2 -AS &Lb. SYbT AI 0*6 0N1.y 046ti) tol-AtrN 1=02 6 MD. G. ENGINEER'S CERTIFICATION 1 certify that l have determined through field inspections and CK review of Municipal records that the above systems are inconformance with MOA HAA'guidelines in effect on this date.Engineer's Printed Name GH - 2a570?d t�. WC*t> Date 3/2Z/0� , 1R HAA Fee $ Ll 50 + 1 %S� RV.S � Waiver Fee $ _ Date of Pavment 3 2,4 - O S- Date of Payment Receipt Number 6,6-2-6-,3 (Rev. 12/01) Receipt Number Municipality of Anchorage :. • Development Services Department Building Safety Division s• •• On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Health Authority Approval # 050113 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block , Lot of Peters Gate Tract 1B subdivision, the well's productivity was determined to be 0.5 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute. Although the . subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. 3-14-05t e:55AM: :807 5615301 0 2/ 4 SGS ReLR Client Name Project NameM' Client Sample ID Matrix Sample Remarks: 1051214001 Eagle River Engineering Eagle River Engineering Peters Gate Tract IB Drinking Water All Dates/ Imes are Alaska Standard Time Printed DateMme 03/11/2005 14:39 CollectedDste/fime 03/06/2005 15:16 Received DateMme 03/07/2 O5 9:20 Tecbnical Dlrecto� SStep C Ede Released PQL Units Method Container ID Allowable Prep Analyse Parameter Results limits Date Date Init Naters Department Nitrate -N 2.07 0.100 Microbiology Laboratory Total Coliform 0 mgfL EPA 300.0 B (<=10) 03/07/05 CAM col/100mL SM209222D A (<-1) 03/07/05 DKC �i �.✓B9's/ay'rY zzs9� .vey "-r7'oe'w /z9o.r� ,Yefl'syya�w /i: i vl ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829 1 HEREBY CERTIFY .THAT I HAVE SURVEYED THE SCALE, FOLLOWING DESCRIBED PROPERTY- /:*00 .+�����,� �f At AND THAT NO ENCRdACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY DATEi `PSE ..... �P�6 OF THE rn`� OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS GRIDS.00 .Ywi/6z ••• ••••- veve" WHICH DO NOT APPEAR ON THE RECORDED SUBDFB: PLAT. UNDER NO CIRCUMSTANCES SHOULD o,•.,• Me,k s•..•,e AVISION •'•,ANY im; DATA HEREON BE USED FOR CONSTRUCTION /�-�� t ''''•. OFFENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. DRAWN:4,t,Fy`�=l. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Sl. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ek.us ge.ak.Us (907)343-790A CERTIFICATE OF HEALTH AUTHORITY APPROVA FOR A SINGLE FAMILY DWELLING Parcel I.D. n91 -951-1n 1. GENERAL INFORMATION HAA # gWC-)f5�3 Expiration Date: 3 Complete legal description Tract 18: Peter's Gate Suhrfivisinn Location (site address or directions) 75174 Knllander chngialr Current Propertyowner(s) Tom & Susan Yeager Day phone 688-5041 Mailing address Lending agency Mailing address PO Box 672026 Chugaik, AK 99567 Day phone Real Estate Agent Judy Lamb Day phone 345-3600 Mailing Address 7 Unless otherwise requested, NAA wi7/ be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ©{ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) 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 sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certifid'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 engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows Ihal,lhe 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 furtlier 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,.,,s. and regulations In effect at the time of Installation. ti• Name of Firm S 6 S Engineering Phone 6942979 Address17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Dale •)O/ -a3/0 Z F OF ly p 4 ROBERT C. COWAN 5. DSD SIGNATURE �' pp 3 bedrooms��+f°'rc ..,CE -8801 „` 1 Approved for . ,.. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments WATFR AND m . WASTEWATER . Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: W o Original Certificate Date: (r" 12m) Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water 3 Wastewater Program : • "' 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6850 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY/APPROVAL CHECKLIST Legal Description: ZPA'GT /(` C3'r� E S�� Parcel to: 4r!07/ A. WELL DATA Well type -2E Date completed:184 Total depth YkfL If A. B, or C provide PWSID # Well Log (YIN) y Sanitary seal (YIN) Wires properly protected (YIN) Cased to6-L�ft. Casing height (above ground)n. FROM WELL LOG Date of test Static water level ft. Well production 7i�7/ 9— p.m- WATER SAMPLE RESULTS: Couform —0—colonies/100 ml. Arsenic: = mg.A. B. SEPTICIHOLDING TANK DATA AT INSPECTION /3 DZ 7/ ft. Sr D g.p.m. Nitrate /• /9 mg.A. Other bac!eria _� colonies/100 ml. Date of sample: 0190-1- Collected by: 5 S Tank Type/M6teriel �CY7 rL I �b[i Date installed B4 Tank size hn gal.' Number of Compartments Cleanouts (YIN) _ )/ Foundation cleanout �(YIN) y Depression over tank (Y/N) High water alarm (Y/N) 'J Date of pumping f O 7i Pumper S'474 r ri79-,rU`� C. ABSORPTION FIE DATA i Date installed Soil rating (g.p.d./fir otf/bdrr;j� 167 System type Length 00 Irl, fL Width ft. Gravel below pipe Z ft. Total depth 9 R Eff. absowtion area ft= Monitoring be � Depression over field ^/ Date of adequacy test yZ l7li Results (Pass/Fail) S5 For 3 bedrooms Fluid depth in absorption field before test _ in. Water added S33gal. New depth --- V in. Elapsed Time:I/*)min. Final fluid depth 0 in. Absorption rate >= - 40 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed* Size in gallons 'Pump on" level at in. 'Pump off' level at in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: i Septic tank/II� on lot Absorption Heid on lot /029 �+ Public sewer main /} Semi CrIseptic service line Manhole/Access (YIN) High water alarm level at Meets alarm 3 draft requirements? On adjacent lots 0 "` On adjacent lots _ lty ',?- Public sewer manhole/cleanout ^� Holding tank SEPARATION DISTANCES FROM SEPTIC/H9le1 RG TANK ON LOT TO: Building foundation Property lineAbsorption field Water main to 14 - Wells on adjacent lots Water service fine _ d r Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / Building foundation Z, 2 F Water main Water Service line /Q f Surface water Driveway, parkinghrenlde stornpe 2 Curtain drain Z0 ,? Wells on adjacent lots Aid--L-D i sF. 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 HAAguidelinesin effect on this date. 'y's .., Engineers Printed Name /PJ-dt 4T- C. CDwd.✓ �.l `CE OI mµ Date /0 / 'A.3 %o Z I+fff2 HAAFee $ Tr •� +fts0 J- cte'rH) Date of Payment 10 /3 Y /u'z Receipt Number C9 a7 3 J 7 (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number In. JA ,. . ME Environmental Services Inc. All Datesff Imes are Alaska Standard Time Printed Daterrime 09/1612002 14:14 Collected Date/rime 09/1212002 14:00 Received Date)Time 09/122002 17:40 Technical Director Ste 7de Released By Sample Remarks: 1. CME Re1.N 1026037001 Client Name S & S Engineering Project Name/a Peter's Gate S/D Tract I B Client Sample ID Peter's Gate S/D Tract 1 B Matrix Drinking Water Ordered By Limits PWSID 0 All Datesff Imes are Alaska Standard Time Printed Daterrime 09/1612002 14:14 Collected Date/rime 09/1212002 14:00 Received Date)Time 09/122002 17:40 Technical Director Ste 7de Released By Sample Remarks: Allowable Prep Analysis Para meter Results PQL Units Method Limits Date Date Init Waters Department Nitrate -N 1.19 0.200 mg/L EPA 300.0 (<=10) 09/13/02 JDT Hicrobiolocv Laboratory Total Coliform IOB, NoColi coU100mL SM189222B (<_I) 09/12/02 KAP 3 C / t i .14tit G^rG�NL-G-e.k..rG o/GL/`OL 1 Cx:T4k,., ••A r•wc`. AS -BUILT 1 hereto' certify that 1 have surveyed lite following described property:`LCnLT' C.ArF 5�3 NW t;t, CTrn l —i4 - Tr5N�_RIW1.--- Anchorage Resorting Precinct, Alaska, and that the improve- ments situated thereon are within the pniperty lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property (viiif; adiacent thereto encroach on the premises in question and that there are no roadways, transmwsmn lines or other visible easements on said properly except as Indicated hereon. Dated at Eagle River, Alaska thio LA day bV ( FE1BT-UtnlLi9.� ;• Tw ROBERT C.JOIINSON h SCALE: Registered Land Surveyor No. 880-LS't ,1" . 200' Box 77-0456, Eagle River, Alaska 99577; j. •:1 ` Phone (907) 6942543 tr 4. ALG -06-2003 11:37 S&S ENGINEERING Mmill N111nn17 N71bnN t "Milaaaltn stlanlw.un 5Q 0111111 tl"a"Mtllawl MMO! MIt pill In"Cllnl Ifltwntl till"No aleMaft.>I id lest ftaf•.11A1KW1 Its! Ntxaul.f 1 CI W WA IOMel"m dlsllt MU11••alln 1 n1 '10,nnl flowl 907 694 1211 P.02i02 IY)Ilpilt C.V0VyNi.s'1:. �ltArrt>_�- 1 --- _ --- vivo mmiliCF111 n[lrQtfAQY 7 :EiT roRM iAXIMI P111211 cl i or hrhhooMs: T. —est 1'llc 1nI11ViICI11 srt•I!Ilnllfllt Ift V11:1 _ /� ►- IYI'COr- nnsnhrl1011SYSICM:CC!1 _ SI'Plt`%TnIIIfs1zF- atmotlttk_)llrILLLPMA. 11cplessingovalIleldIYtlll: , sr1-nl1n110110151nNrt:1`110140(�1130111'11011 rtla It lo: , bllvoway. patMngrvelllcla /tntapo 1114a: _ Cullaln......�..o _ taClc114LA1A: 11.laol1a1,11d11q; ronlldallon elangoul nil: V_ (/clllaNlnn (Ytlll: �f . LIC1.$1Atlf)t1; 1'11b1pt111-I Val RI: i "publrct(,, Invetet: _.......___- Illpll wnler 21anN IaVal: 2X %f �. — fdElE1I an►..olis ......w .�.....,�.- LlQntl) .Fvr_I_ .�.�..........�e. LIME IlCnnitld aMMI, 1110TAI-I ,Z at/ S.T. M. Z_ff COMMMIls _.. Av 35_ _ .... 99 -- — - '-9 ... _.... — Itg$lll.j�: I'ASS)rAll.: ss _ txl'I.nllnil0tl• -` _� �SZ�_ (rp_ . ..._..—__ 1111S sy$ItM Is Not u1JAIlntJlVkh A.001SY Sllnst:gU11-Pll I'Alt IIIII: 110.11 l M NIM rnt:1 r lyvrll l IX1r • rt Mr ?0 t - rAl y r I OW K At ASK A 7e111 `r➢f NEXIN MUNICIPALANCHORAGE • ^' DEPARTMENT OF HEALTH 8 HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 051-551-10 1. GENERAL INFORMATION "Iffi- no .'a' &_' Complete legal description peters Gate, 'tract 1B Location (site address or directions) 25124 Kollander Drite, Eagle River Propertyowner nAryl r. .TPAs KnllAndPr Dayphone 688-3636 Mailingaddress P.O. Box 671462, Chugiak, AK 99567 Lending agency Northland Mortgage Day phone 694-7872 Mailing address 11421 Old Glenn Hwy., Eagle River, AK 99577 Agent William deSchweinitz/Vista Dayphone 562-6464 Address 3000 C Street, Anchorage, AK 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 1 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water 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 X 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 (R«.1/911 From MOA Y21 IU YOn i" (LGII *i H) SMU •1!Jom saaau16ua Ieuo!ssaloJd ayl w suo!ss!wo Jo sJoJJa Jol apsuodsaJ IOU si a6eJo4ouy jo JIl!jedfo!un!N ay1 •panssf s, aleo!j!lJao a aJojaq elep az(feue Jo suogoodsuf lonpuoo Sou opSHHOjosaaAo!dw3 sluawaiinbaialelspueleJapajufeuao(lsflesofJapJou!suopnl!lsu!6u!puafJfayipue sawoy jo sioseyand of Aselinoo a se s!yl saop SHHO ay1'e>fse!y jo alelS ayl of paJals!6aJ Jaau!6ua Ieuofssajad luapuadapuf ue Aq anoge 9 ydeJ6eJed ul uan16 suo!lewasaJdaJ ayl uodn A!uo paseq saleo!jyJaO Ienaddy ,(l!JoylnV yl!eaH sanss! (SHH(3) sao!niaS uewnH pue yl!eaH jo luawlJeda6 a6eJoyouy joitl!fedfofun!nl ay1 e( -8/ _S alfa sluawwo0 Ieuo!l!ppy muo!le!nd!ls 6u!mopoj ayl qpm 'swooJpaq Joj IenoJdde Ieuo!j!puo0 w 41le0 LLS66 oinleu6!s s Jaau!6u3 XV 'sanig OT6eg '66Z£LL XOg •O'd ssaJppy S615-669 auoyd wJ!d jo OWLN 'uo!loadsut s!yj jo alep ayj uo joalla u1 suo!le!n6aJ pue 'saoueu!pJo 'sopoo alelS pue Iedfo!uny4 lie yl!m eoue!Idwoo ut s! walsAs Iesods!p Jalemalsem Jo/pue Ajddns Jolem al!s-uo ayl'uo!loadsui pue uo!je6!ls9nu! Aw woJj pue sa!!j 06eJoyouy jo /ged!o!unVy ayj wall pau!elgo uo!jewJolui ayj uo paseq jeyjApJanJayjJnj I •u!aJay pajeo!pui aJnjoruls jo adl4 pue swooJpaq jo Jagwnu ayl Joj alenbape pue Ieuo!iounj'ales s! wags (s Iesods!p Jajemalsem Jo/pue J(Iddns Jalem al!s-uo ayl mil smogs uo!jeof!dde IenoJddy J(luoylnV 411eaH s!yl jo uo!le61lsanu1 Aw leyl ApJan I 'mo!aq UM04S alep uo!lep!Ien ayl jo se pue olaJay pax!jje pas Aw J(q pa!j!lJao sy kl33NION3 AS N01103dSNl d0 LN3W3.LV1S 'S •panoJddes!0 �A�,a-aoc.ZE� •swocupaq Joj panoJddy 3un.LVNOIS SHHO '9 �s! n L wom w s(nol °.4.b....4 ' r a LN X1 `iy 41le0 LLS66 oinleu6!s s Jaau!6u3 XV 'sanig OT6eg '66Z£LL XOg •O'd ssaJppy S615-669 auoyd wJ!d jo OWLN 'uo!loadsut s!yj jo alep ayj uo joalla u1 suo!le!n6aJ pue 'saoueu!pJo 'sopoo alelS pue Iedfo!uny4 lie yl!m eoue!Idwoo ut s! walsAs Iesods!p Jalemalsem Jo/pue Ajddns Jolem al!s-uo ayl'uo!loadsui pue uo!je6!ls9nu! Aw woJj pue sa!!j 06eJoyouy jo /ged!o!unVy ayj wall pau!elgo uo!jewJolui ayj uo paseq jeyjApJanJayjJnj I •u!aJay pajeo!pui aJnjoruls jo adl4 pue swooJpaq jo Jagwnu ayl Joj alenbape pue Ieuo!iounj'ales s! wags (s Iesods!p Jajemalsem Jo/pue J(Iddns Jalem al!s-uo ayl mil smogs uo!jeof!dde IenoJddy J(luoylnV 411eaH s!yl jo uo!le61lsanu1 Aw leyl ApJan I 'mo!aq UM04S alep uo!lep!Ien ayl jo se pue olaJay pax!jje pas Aw J(q pa!j!lJao sy kl33NION3 AS N01103dSNl d0 LN3W3.LV1S 'S Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: pE>Ge5 4,02K 24C I' / Parcel I.D. 7_/51V 440 A. WELL DATA Well type AR/ygfK If A, B, or C, attach ADEC letter. ADEC water system number W14 Log present (Y/N) YE S Date completed 0 9���I Driller 5 /l1-L/L4,kI Total depth 7,00 Cased to /� a/ Casing height- Sanitary eight Sanitary seal (Y/N) YE5 Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow g.p.m. Pump level /IN/tNOIJN SEPARATION DISTANCES FROM WELL TO: Septic/hekhrrg tank on lot �O�r AT INSPECTION D5�05/9Z � GL' o D 47 g.p.rrm /93o ro O rn N On adjacent lots 4-/00 4 ` � '= m 2 Absorption field on lot 4 //V ; On adjacent lots 'A /bo Public sewer main M/,4 Public sewer manhole/cleanout NSA Sewer service line t ter' Petroleum tank �✓�^� QPr+s�+� WATER SAMPLE RESULTS: . Coliform Nitrate 3 11 A Other bacteria Date of sample: D 5J05 /9 Z Collected by: B. SEPTIC/HOL MG TANK DATA Date installed 09f Py Tank size AM Compartments Z Cleanouts (Y/N) YE 5 Foundation cleanout (Y/N) %' Depression (Y/N) ND High water alarm (Y/N) AIIA Alarm tested (Y/N) 141.4 Date of pumping Pumper SEPARATION DISTANCES FROM SEPTIC/Id61z0ff46 TANK TO: Well (a) on lot lob On adjacent lots —Foundation r2ceDp-Q) To property line //19 Absorption Iield( [leen) 9 rmaterre-eis/sePA4;eline P''/0 Surface water/drainage V/4 72-026 (Rev. 7M) Fwt CONTINUED ON BACK PAGE C. LIFT STATION Date Installed Manufacturer Size In gallons Manhole/Access I Vent(Y/N) High water alarm level "Pump on" U Meets MOA electrical codes SEPARATIONNCE FROM LIFT STATION TO: On adjacent lots D. ABSORPTION FIELD DATA "Pump off" level at Cycles tested Surface water Date Installed Soil rating , System type 09A/NF/ELD 'Length go Width r] Gravel thickness Z r Total depth 6 Total absorption area-1,V6BOrr)) 591 Cleanouts present (Y/N) Y6 1� Depression over field (Y/N) ^/a Date of adequacy test n5 Q51.92_ i Results (pass/fail) f ASS for bedrooms Peroxide treatment (past 12 months) (Y/N) LVO If yes, give date .4 .,.'SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots A90 Property line f To building foundation CO0ep %y To existing or abandoned system on lot NIA On adjacent lots 74 Cutbank NIA Watermain/service line Y'10 • Surface water f /4A) r Driveway, parking/vehicle storage area �� r Curtain drain -2 ' je&6,7/ lr,A" •ree 1'•1!1 E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ,b Signature // g/ Lam" � � �. . ' ' y . ee-7 Engineer's Name , ,r DateZ. CE -6736 r f/i fait dd c t to"), n. eoforo I $ j HAA Fee S /70 -OD Waiver Fee: $ Date of Payment 2 Date of Payment Receipt NumberZ St�� D�� Receipt Number 72-M (Rev. 3N1) Back MOA 21 MAY 03 '92 10:23 NORTHERN TESTING. ANCHORAGE P.314 NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 06-3116 • FAX 456-3128 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277.8378 • FAX 2749645 Eagle River Engineering P.O. Box 773294 Eagle River AR 99577 Attn: Louie Butera Our Lab It A117132 Location/Projects Peters Gate Your Sample IDI TR 10 sample Matrix? Water Commentet Method Parameter EPA 353.3 Nitrate -11 A:::�' C144) at"' Reported Bys Susan C. kifental Microbiology Supervisor Report Datet 05/08/92 Date Arrived: 05/05/92 Date Sampledt 05/04/92 Time Sampleds 1500 Collected Byt LB MDL a Method Detection Limit Flag Definitions B e Below Regulatory Min. It - Above Regulatory Max. E a Below Detection Limit Estimated Value Date Units Result rlag MDL Analyzed I g/1 1.3 ) 0.1 05/07/92 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRO&%MNTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONXENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) LFA>G3f- (b) Applicants Name hat -:c/ n/ ,7dzt— Telephone - Home Business Applicants Address tx 67/q6Z- C /,c nu;�k 99.E <-7 (c) Applicant is (check one) Lending Institution ; Owner/builder L�11 ; Buyer [:::I ; Other Q (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. S Agent Address Telephone (f) Mail the FL%A to the following address: 2. Type of Residence , Single—Family" Multi—Family Other (describe) Number of Bedrooms 3 3. Water Supply Individual Well Community Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public Community Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 21 (1' 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 regula- tions in effect on the date of this inspection. Name of Firm Cert. n Telephone(/- Address 15-4Q F 4C% Date /- _ c! o��p�%' g••;r'a1i • Tse�: <�� =�0 . ....:t.......... • e t 6. DHEP Approval Approved for bedrooms Approved - Disapproved Terms of Conditional Approval 1. Corwin . CE•5287 CAUTION Conditional Date 1 THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. DIPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR kIALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS 0 THE PROFESSIONAL ENGINEER'S WORK. 1(AIJEF7 SEAL) i RR4/ej/D18 [Page 2 of 21 1 1 ,s�: 7-19-84 CCJT. CF Hi,::. VUNICIPAU7f OF MUNICIPALITY OF ANCHORAGE (MOPS) HEALTH Xn1iORITY APPRovAL (HAAT JAli 2 `' 191}5 CHE(RI.M - FEBRUARY 1964 RECEIVED. Legal Description: i'ckrs r: -A& -SAKI;v,'s,n. A. WELL DATA Tra of /- 8 Well ClaSsification P.-;vnA- If A, B, or C, D.E.C. Approved(Y/N) Well Log Present (Y/N) Y Date Completed 7W ' Yield/.54n Total Depth 200' Cased to /o Depth of Grouting Static Water Level 7r) * Pump Set At Casing Height Above Ground 2' Sanitary Seal on Casing (Y/NP( Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) Separation Distances from Wall: To Septic/Holding Tank on Lot 'toe' ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot 13z' ; On Adjoining Lots To Nearest Public Sewer Line — To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot - Water Sample Collected By A1, n hie 6 ; Date Water Sample Test Results sact;s,Cn iaa Comments 41 Z a Rts c el( �nw B. SEMC/HOIDING TAN& D= Date Installed 9-'f- ei Size 1000 nc_ No, of Compartments 0- Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped Pumping/Maintenance Contract on File (Y/N) - for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply mil 1cg' To Building Foundation 5 3' To Property Lina >10, _ To Disposal Field '9' To Water Main/Service Line - To Stream, Pond, Lake, or Major Drainage Course > Camlents Receipt i Date Paid: Amount: z 50.E [Page 1 of 21 2-15-84 Soils Rating in Absorption Strata (50 s-F/6r Type of System Design T;vn, _ Date Installed `t - N - a g Length of Field -rw, f D a cAcs < Sty Width of Field 6-1 Depth of Field ant o fluor 1I Gravel Bed Thickness 3 ' Square Feet of Absorption Area 5-7r Standpipes Present (YM) Y Depression over Field (YM) N Dets of Last Adequacy Hest Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -supply Well 125' To Property Line > I o' To Building Foundation '70' To Existing or Abandoned System cn Lot — s On Adjoining Eats To Water Main/Service Line — To Cutbank(if present) To Strew/`PaxVLake%r Major Drainage Carse > too, To Driveway, Parking Area, cr Vehicle Stcrage Area Camzents D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Rmp On" Level at "Pump Off' Level at High Water Alarm Level at Vent (YM) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) Caments ** Check Pe I I certify t I ha on the da this Signed ' KBl/d5/s (Page 2 of 21 Bedroan Rating Against HAA Request ** e/checked, verified, or confcrued to all NIDA HAA Guidelines in effect Date 1-2,$—FJ MOA No. '2Zf' 2-15-84