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Home My WebLink AboutDOUBLE G LT 85ALEGAL DESCRIPTION MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~ ~ ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT !PHONE [] UPGRADE ~l0 z DISTANCE TO: 3 Manufacturer IF HOMEMADE: I Abs°rpti~are~' Dwe~go I' Inside length Width DISTANCE TO: Manufacturer Material Nearest~tSe /~~ ' Trenc h~d~ ,irnches V./2 ~//~nches Well ing DISTANCE TO: Wel/o~.~ ' ~ I F°undati°n~ ~ No. oflines / Length~o.~3~ne, Total ~1~ Ii ~es Top of tile to finis~ra(~e I Material beneath tile Length v Width I Depth Type of crib Crib diameter DISTANCE TO: Well DISTANCE TO: OTHER Depth Building foundation Crib dept~~' ~ Total effective absorption Building foundatlbn' J Nearest lot line Driller Distance to tot line Sewer ne Sept?~. ¢' PIPE MATERIALS SO L TEST /0o INSTALLER REMARKS NO. OF BEDROOMS~.~ PN~Rof~co ~nt~s~ Liquid dept h~._,__..~ PERMIT NO. Liquid capacity in gallons Distance ~e~es ' Total~e~i~a~s~io n area.'~ ~-2 ¢1// //'~. ~.- PERMIT NO. ~ irea Abs°rpti°Tm(~ ~ APPROVED DATE LEGAL 72-013 (Rev. 3/78) PE iRMIT NO: DA'TiE I3S!J~D: A~PLICANT: CONTACT ?HONE: L~SAL D£,~CRIP: LOT ,S Y ~'~ T'' ~ ~HAT .... ~:F,= CHOOSE THE ~E?T~ TO PIPE iBOTTO~ (FT.) ~RAV~L DEPTH 'TOTAL DEPTH (FT.) G~AVEL L~GTit GRAVEL VOLU~ TANK SIZE .(GALS) SOIL RATING ($;~.F'T.I~) TANK ~U',ST HAV£ '"~T Li~AZT 'T~O C::)~!~?~qT.~!LNT'? CERTIFY THAT: t. I Ai~ FA~ILI~ WITH 'TH~/ P.C~iiU:~RE?.~.~NTS r-~];i,< O~'~SITiF ST~'E~S ~,ND W~ELLS ,~S SET '2. I WILL iN~TALL THE SYS't';~:?~ :<~ ArCO-IDaC, CE ~,~'TH ~LL ~OA CODES ,~D REGUL~.'TIONS. AND IN CO~PL]ANCE HI'TH 'THT ~%tq~G~ FJ~.'.~'T!J~T~: '~F THTS PER~iT. '~,. I WILL ADHERE TO ALL MOA A'.~D STarTlE ~F AL,~SK~ ~'~gUTR~]NTS FO~ THE S(~T DA~K DISTANCES F;;.O~q ANY EX[STi{~G W~;LL. ~.STE~$~:T':E;~ T;'TSP:hS.~L SYST~?4 OR PUBLIC %EW~AGE SYST':~ ON THZS 0~ ANY ~DJ~C~T O~ ~'~,~Y LOT. LIFT S'TAT~ON ;IS ~NST~;LL~ED IN A~] ~i~.~ C~VE,~!;:D i=¥ ,",~, >~UIL~,TNG C. ODES. AP?LICANT: ROGC~ C!.,~:VSE~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] SOl LS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: LOT 6 7 8 SLOPE 10 11 13 14 15 16 17 18 19 20 No. 14.57-1i COMMENTS WAS GRO~ND WATER ~¢-----S SL ENCOUNTERED? O P IF YES, AT WHAT ¢ E DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop J ~,'oOe to ,, f5 z ,-,'PERCOLATION RATE TEST RUN BETWEEN CERTIFIED ~7 (minutes/inch) ~ FT 72-0O8 (6/79) o¥ Anchor-age POU ,,i 6-650 ANCHORAGE, AI_.ASKA 99502-0650 (907) 264-4111 IONY KNOWI[?, MA DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit #: 840667 January 31, 1985 TO: Permit Applicant SUBJECT: T15N R1W Section 8 Lot 85 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as-built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Keith E. Bandt, SupeYvisor Environmental Engineering Program KEB/ljw eric: Copy of Permit SWP/0 5 7 MUN I C I PAL I T'Y O~-- ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET., ANCHORAGE.~ AK 99501 264-4720 ON.--S I TE. SEWER & WELL F'ERM. I T PERMIT NO: DATE ISGUEI): 840667 08/06/84 APPL I CANT: ADDRESS: CONTACT PHONE: GILBERT RANDELL ,BOX 775467 EAGLE RIVER~ AK 688-40:311 99577 LEGAL DESCRIP: LOT SIZE:' MAX BEDROOMS: SUBDIVISION: NA SECTiON:~ 8 TOWNSHIP:' 15N 108900 (SQ.FT. OR ACRES) 5 LOT: 85 RANGE: 1W BLOCK: NA' Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. 'I-RE~4CH BED W . :BRA I N DEPTH TO PIPE BOTTOM (FT.) 4.0 GRAVEL. DEPTH (FT.) 4.0 TOTAL DEPTH (FT.) 8.0 GRAVEL WIDTH (FT.) 2.5 GRAVEL LENGTH (FT.') 52.0 GRAVEL VOLUME (CU.YD8.) 15.5 TANK SIZE (GALS) 1,000.0 ** SOIL RATING (SQ.FT./BR) 85 5.0 4.0 0.5 5.5 5.5 7.5 14.0 5.0 28.0 28.0 14.5 20.7 1., 000.0 ** 1,000.0 85 85 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS 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. 5. I will adhere to ali 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 mny adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 5 bedrooms and any enlargement will require an additional pe.~:mit. IF A LIFT STATION IS:'tNSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL'PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILl_ ~OT BE AF'PROVE~ WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (5) THE ELECTRICAL WORK] M~T B~' ~NE By/A L~C~SED ELECTRICIAN. ' APPLICANT: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: ~'~U,J -,.-~ ! L..t~_ ~'~ · E~A, DESCR,PT,ON: LOT 8'~ / ,S ~ 2 3 4 7 8 9 SLOPE I ~o 11 WAS GROUND WATER ENCOUNTERED? 12 13 14 15 16 17 18 19 2O COMMENTS PERFORMED BY: 72-008 (6/79) Ne, IF YES, At WHAT DEPTH? O P E Reading Date Gross Net Depth to Net Time 'rime Water Drop PERCOLATION RATE ~ I~ (minutes/inch) / TEST RUN BETWEEN FT AND ~ FT CERTIFIED B~ PARCEL: 051-091-50-000-97 CARD: 01 OF 01 RESIDENTIAL SINGLE FAMILY STATUS: RENUMBERED TO/FROM: .... CLAUSON ROGER D & JULIE A PO BOX 670764 CHUGIAK AK 99567 0764 DOUBLE G LT 85A SITE 20435 MCGOWEN ST LOT SIZE: 55,609 ZONE : R6 TAX DIST: 022 GRID : 0 NOTES : REF 051-091-26 FINAL VALUE 1994: FINAL VALUE 1995: FINAL VALUE 1996: EXEMPT VALUE 1996: STATE EXEMPT 1996: FINAL VALUE 1996: ---LAND-- 33,600 25,800 23,900 0 ---DATE CHANGED--- OWNER : 06/06/96 ADDRESS: / / HRA # : 000000 .... DEED CHANGED .... BOOK : 2931 PAGE: 0851 DATE : 05/30/96 PLAT : 840344 · ASSESSMENT HISTORY. --BUILDING .... TOTAL--- 78,300 111,900 91,700 117,500 87,300 111,200 0 0 --EXEMPTION--- ..... TYPE ..... 0 -CON, VI COUNCIL- 111,200 BIRCHWOOD BIG DIPPER DRILLING MUNICII~ALITY OF ANCHORAI~i~ DEPT. OF HEALTH & ENVIRONMENTAL P ROTE[: ,~,~J~ RECEIVED' 7529 E. 6th Avenue · Anchorage, Alaska 99504 October 31, 1984 Mr. Roger Clauson P. O. Box 770688 Eagle River, Alaska 99755 (907) 333-6435 The following information is your copy of the ,well log for the property located at Lot 85A, Sec 8, T 15N, Range 1 W. This should be retained as your permanent record of improvements to your property. WELL LOG 0 To 4 Feet 4 25 25 27 27 28 28 34 34 41 41 43 43 50 50 73 73 80 80 82 82 83 83 86 86 90 90 92 92 t00 100 104 Peat, soil Sandy silt, gravel Gravel Sand, gravel Silty sand, gravel Sand, gravel Gravel Sand, gravel Silty sand, gravel Sand, gravel (wet) Gravel, water (4 GPM) Sand, gravel Sand Silty sand Silty sand, gravel Silt Sandy silt, gravel, water (2 GPM) - Perforations from 78 feet to 81 feet to obtain totaY' 6 GPM Static water level 76 feet ..... · STATEMENT 104 Feet drilled and cased @ $20.00 per foot 3 Feet perforated @ $20.00 per foot = $2,800.00 = 60.00 Total $2,860.00 Thank you for specifying BIG DIPPER DRILLING :for your water well needs. Please call when you are ready for your pump to be installed. Sincerely, C. R. Kron Owner Licensed · Bonded · Insured Parcel I.D. [~,". Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street 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 GENERAL INFORMATION Compl,.ete legal description Lot 85A Double G SID Lo~ation (~ite add.,mss or directions) 20435 Scenic Rd., Chu.qach, AK 99567 · Current Property owner(s). Monty & Paula Benson Day phone 561-44'10 Mailing address Lending agency Mailing address HAA# O L/-OC Z+I 'Expiration Date:...,C"- / '7 - O 20435 Scenic Rd., Chu.qach, AK 99567 Day phone Real Estate Agent . Judy ~ J & J Properties Day phone 227-7335 Mailing Address 545 E. Northern Li.qhts Blvd., Anchoraqe, AK Unless othe/wise requested, HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: ~3 e TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class. PUblic Water System. Well r-1 TYPE OF WASTEWATER DISPOSAL: Individual On-site ~] Individual Holding tank I-'1 Community On-site. [-1 'Public Sewer J--I 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to home owners. 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 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. · (Rev. 11/~3) Municipality of Anchorage Development SerVices Department Building Safety Divisl6n On-Sit~ Water and Wastewater program 4700South BragawStreet i ~ P.O. Box 196650 Ancho~age,:AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 85A Double G SID A. WELL DATA Well tYPe P : If A,' B, or C provide PWSID # ~ Date completed 1013111984 Sanitary seal _Y Total depth 104 ft ~ Cased to .104 ft FROM WELL LOG Date of test 1013111984 Static water level 76 Well production WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi Date of sample: 21812004 B. SEPTIC/HOLDING TANK DATA ft 6 . g,p,m ·Nitrate Collected by: AT INSPECTION 2/712004 Parcel'l.D.: · Well Log Y Wires properly protec~,ed Y Casing height (above ground) ;, ~: 12"+ in. 79 ~ mg/I Other bacteria ,Laura Pannone Tank Type!Material Greer Steel ' · Date installed 1111011984 Tank size 1250 Cleanouts Y_ Foundation cleanoUt Y Date of pumping 21712004 .' - . Pumper Chuflach Pumping' C. ABSORPTION FIELD DATA Date installed 11110/1'984 . Soil rating (g,p,d./ft2 or ft2/bdrm) '100 L:ength .53 ft Width Total depth 5.._~5 ft Effective absorPtion area 305 ft2, Date of adequacy test 21712004 Results (Pass/Fail) Fluid depth in absorption field befor~ test Dry in Elapsed Time: 40 min Final fluid dep[h Dry in Any rejuvenation treatment (past 12 mo.) (y/N & tYPe) N (Rev. 11/99) g.p.m ' :' · ~ colohies/10o mi Depression over tank N gal Number of Compartments 2 High water hlarm. NIA System type ;Shallow Trench Gravel below pipe 1.0' It Monitoring tube Y Depression over field N pass .. 'For3 bedrooms ::i Water added475 gal. " Ne~vdepth2 in. · AbsorPtion rate >='450+ g.p.d. If yes, give date 14. 5' 89 4:9 "/,~ £ O! · · ':,.~--~770. ' '~~ · --~ I -' /FI c--K I N /- E ."E-.. =, . Lot _(~-[A, Block -' '-.'Double ¢' Anchorage Recording Districtt Alaska .......... A E. .- Ea,emente of record at,er th=. those ,hown on the plat of reoor~ are not eho~n hereon unle~ LOT SURVEY CERTIFICATION I hereby certify Ihat I hove lurveyld the property shown and delcrlbed hereon, and that tm Improv'ementl lltuoted thereon are within the prop- erly lines and do not overlap or encroach on adjacent property and that no Improvements on od|acent property overlap or encroach on the premllel · In question and that there are no r~adwoyl, utility lense, o~ other vlllbll sa,anent, o~ laid property except as Indicated hereon. ofhlrwlle noted. LEGEND Brass or Aluminum capped monument recovered 0 Iron pipe and/or rebar recovered. ra 2 x2 hub ~ tack recovered · §/8"x~:)" rebar est this survey Scole/? ~/ Ref. NW /$57 Date cD O7-OD- EB. No. Prepared by: · (.907)£79-6200 t7, L. BUTTON t~eg/stered ~ond Surveyor 519 Vt, Eighth Ave. Anchorage Alaska 99501 0Z-11-04 OZ:43PI/ FR~:t/~-CT&E ESI, SG$ ENV SE~ICES 90i'5615301 T-360 P.03/03 F-448 /~ SGS/CT&E ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria MUST EE COMPLETED BY WATER SUPPLIER [] PUBLIC WATER ;YSTEN', ID# ...... ~1~ PRIVATE ~ATER SYSTEM r 200 W. PO"FI'ER DRIVE ANCHORAGE, ALASKA 9g518 Tel: 907.562-2343 Fax: 907-561-5301 1040672;[ [] ~,end RaiMa, I"'lSmna l~m,,oice C~ I$11I I SAMPLE COLLECTION: SAMPLE TYPE: ~ [] Treated Water TO BE COMPLE~D BY ~BO~T~Y Time: ~ Temp: ~ ~ ~ur ~- Phone Elac~erloloQical Wator Analvlll Record: An.lyric.! M. ith~ ,~ Membrane Filter MMO-MUG Reported By:_ ~ ~-,~--~) I Sent tn ADEC: MMO.MUG {P/A) RESULTS: I ANC Total Colifixm: I Date/Time: Date/Time: FBK JUN Faxedr-"i From ~ FW- C053 121171D3 ~tr~ub'ic'~OCUMENT~FORMS'~MIc~/Coi Form 1217D3.xls 0Z-11-04 O2:~2PY FROt/-CT&E ESI, SGS ENV SEI~/ICES 9075615301 T-360 P.02/03 F-&48 ........ SGS SGS Ref.# Client Name Project N~lmz'# Client Sample ID ~trix 1040672001 Pay. none Eng. Srv. Lot 85A Double G, Chu~iak Lot 85A Double O, Chugiak Drinking Water I'WSID 0 All Dates/Times are Alaska Standard Time Printed Date/'fime 0~11/2004 13:46 Culletied Date/Time 02/08/2004 13:00 Received Datcrl'lm~... 02/09/2004 9;15 Technical Dit~et~ Stephen C. Ede Sampte Re~mrks: Re~lu PQL Uuiu M~,cd Allowubl~ Pr~p 7u~lysis Container ID ].~.it~ I~{c Date lull 1.7g 0.100 B (<=lO) O2/O9/04 Total Coliform coV100mL SMIi} 9222B A (<=1) 02/09/O4 KC MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description (Lot 85; Sec. 8~ T15Ni RIWi S.M~I Location (site address or directions) NHN Scenic Drive Property owner Mailing address Lending agency Mailing address Rover Clauson Chuqiak, AK P.O. BOx 670764 CI%ugiak. AK Day phone Day phone 786-0225 Agent Ad dress Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 ~ TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community well system, provide written confirmation from state ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 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 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 flies and from my inves.ti_gation 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. S & s ENGINEERING Name of Firm Addr, ess Engineer's signature Eagle River, Alaska 99577 Phone ~ q'7-'~'? 7'~' DHHS SIGNATURE ~:: Approved for --~ Date bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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. 72-025 (Rev, 1/91) Bacx MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well type Log present (~TN) Total depth Sanitary seal~)N) y, Health Authority Approval Checklist ~[~. B1 ~15~ I ~t~ Parcell. D.: O~l If A, B, or C, attach ADEC letter. ADEC water system number Date completed I o -_~ I - 8 ~ Cased to I o'1 Casing height (above ground). Wires properly protected (~N) Y' FROM WELL LOG AT INSPECTION Date of test Oc.~. Static water level Well production g.p.m. WATER SAMPLE RESULTS: Coliform O Date of sample: ~'- B. SEPTIC/HOLDING TANK DATA Nitrate I. 5Hr Other bacteria O Collected by: ~ ~-- .~ Date installed t I - I~- ~ui Tank size Iz$o Foundation cleanout (~N) Y' Date of Pumping -~-'ZS~ q~ C. ABSORPTION FIELD DATA Length' .~3' Width Depression (Y~) ~ Pumper ~ ¢. ~°u~fl~1 ¢. Number of Compartments' 'Z. Cleanouts (~)'N) '/~ High water alarm (YJI~ Soil rating (g.p.d./fF or fF/bdrm) tool~/Sg. System type ,-r'K~d~ ! Gravel thickness below pipe I Z Total depth Effective absorption area ~ t Monitoring Tube present,N) Y Depression over field (Y/~ Date of adequacy test ~, - '7- 't C Results (t~/Fail) I='~ For .~ Fluid depth in absorption field before test (in.); t't Fluid depth =1 ~' (ins) Minutes later: ~ '70 Immediately after 5'oo gal. water added (in.): Absorption rate = t/S; o + g.p.d. .bedrooms Peroxide treatment (past 12 months) (Y/N) NeN. I~.,=,,~ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed ' Manhole/Access: (Y/NI High ~vater on" level at* *Datum "Pump off" level at* iSTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~holding tank on lot I0 3 Absorption field on lot Public sewer main 7.6 Sewer/septic service line 'Z,~ lO0 ~ 4. On adjacent lots / o o I -.l-- On adjacent lots JOO -I. Public sewer manhole/cleanout Lift station I o o' Surface water/drainage Wells on adjacent lots SEPARATION DISTANCES FROM~HOLDING TANK ON LOT TO: Foundation /o I Property line I o i 4- Absorption field. Water main/service line SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water I oo' 4, Curtain drain Building foundation }o~-P Water.main/service line ~-S ~ ~ Driveway, parking/vehicle storage area ~°~ -'+ ~ ,,~u,~ Wells on adjacent lots Ioo ~ ~- F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records in conformance with~21in~on this date. ~ Signature ?Jii Engineer's Name /'~ox~,~ '~'~- Co~,4~, ~ Date (; / ~' e// ~ ~, HAA Fee $ ~T~, ~ Date of Payment /-,'/P-//~ ~ Receipt Number ,/~-'~ L/'~''~::~ Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 06×03×96 14:07 CT&E ESI ANCHORAGE ~ 9076941211 CT&E Environmental,Services Inc. ~.~ Lv~ T~ UCTIOY3 0,v ~ v~( J/DE ~FO~ COL LECTI.~'O ~.4.~I~L ~ ~ ~:- (~o7~ ~ ~ :, :; :Month Day Y~ar S.-kXf?LE Routine 0 Treated 'Water with I~b ret'. ~to_ ) Special Purpose Time S,~,3'[P L]~ LOCATION Collected Repeat Sample {for roqdne )ample /l~ L:nzreaied Wazer Col)ec~ed By Time Received ,~ma (ysi5 Began BACTERIOLOG[CAJ.~ WATER .-MN'ALYSIS R~CORJ) M.MO-,',fL'(~ R~5~mt: Total Coliform E. Col~ M~mbeaneFil[¢r: DireclCount ,,_, verificason: LTB BGB COLIFIR3I Coliform Confirmation ..... Colifi}rm/~O0 mi 05×03×96 13:53 CT&E ESI ANCHORAGE ~ 90?6941211 CT&E Environmental Servioes Inc. Laboratory Division, - .... --__~-- _ .... _-_:::__-_- :7:~~,~.~;~: Laboratory Analysis Report CT&E Ref.# Client Sample ID Matrix PWSID 0 Saalple Remark,s:.. 962073,962073001 L85 $8 T15N R1W Outside Fau¢ Driuldag Water Collected Date 05/28/96 Technical Director: Stephen C. Released By ~.:,-,----~_...~_~ ,. Nilrite-N Nitrete~N Totat Col(form Results QC Pal Units Method Quat 0,100 U 0.100 I~g/L 1.54 0,100 mcj/l 0 0 col/100mL EPA EPA ~53.Z S#18 922~ Allowable Prep Limits Dote U - urtdetg~' LT - Less L~ ..... 200 WI Potter Drive, Anchorage, AK 99618-1605 -- Tel: (907) 562-2343 Fax: (907) 561-530~ 3180 Pager Road, Fairbanks, AK 99709-5~t71 -- Tel: (cJO7) 474-8656 Fax: (907) a74-9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIgORNIA, FLORIDA. ILLINOIS, MARYLAND, MICHIGAN, MISSOURi, NEW JERSEY. ~' ° MUNICIPALITY OF AN~HORAGE % DIVISION OF ENVIRONMENTAL ~r~.ALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date .~/~ ~.~/~' -~ (a) Legal jDescrip~io.n (inclu~ lot?; block, subdivision, section, ^township, range) ' T15N R1W Section 8 Lot 85A Locatio, n (a4dress or directions) ,. (b) Applicants Name (~,])~:~////~zj~-/~?.t,.~.~,v,.~ Telephon.e -,Home . Business (c) Applicant ~is (check one) Lending Institution ~-~ ; Owner/builder ~; s=yer ~; Ocher ! ! (~xplain); Add~sa · (f) Telephone M~I the HAA to the following address: 2. Type of Residence Single-Pamily[_'~ Number of Bedrooms Multi-Family~-~ Other (describe) 3. Water Supply Individual Well ~ Community ~-~ Public ~--~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite ~ Public ~--~ Community ~-~ Holding Tank~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, [Page 1 of 2] En~ineerin~ Firm Providing, Inp, pections~ Tests~ File Search~ Dat, a and !nf0rmat,i0n 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 amd/or wast,water 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. Telephone Name of Firm ~p ~ ~prov-~ / Approved ~ Disapproved Terms of Conditional Approval CAUTION 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. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/DI8 [Page 2 of 2] 7-19-84 C, ABSORPTION FIELD DATA Soils Rating in Absc=ption St=ata /O0 Type of System Design Widths.of Field / ~" ' Depth of Field , , /~' , ' ~essi~ ~= Field (~ ' -m~ o[ ~st ~~' ~st , ~'~ , ---- ~p=ation Dist~ ~ ~ti~ Field: TO Buildt~ F~n~tion ZO ,,~ To Existing =' ~ndo~d%~m Lot ~ $ ~ ; ~ ~jotntN.~ ,. ~, [~ ...... To ~te~ Mai~vi~ Li~ . /~,'.(~. To ~t~(if ~nt) ~ o~ ... To St=e~ond~ke/= ~jo= ~ai~ ~~ , .... ~ ~ ~ , ,, TO ~i~y, P~ki~ ~ea, ~ Vehicle St~a~ ~ ,-3 . ~m F Date Installed . Dimsnsions .. Size in Gallons. . Tested fO= ........ PumPing~c~~ng' ~ (Adequacy Test,,' Meets MOA Elect=leal Codes(.Y./N) , , , , [ ,, . , Cc~m~nts . , .......... ** ** Check Permitted Bedrocm Rating Against HAA Request I ce=tify that I have. checked, verified, c= confc=med to all MOA HAA Guidelines in effect on the date of this inspection. . [Page 2 of 2] 2-15-84 Total Depth ~z. ~., Cased to Static Water Level 76 ' Casing Height Above Ground j o Electzical Wiring in Conduit~,Y.~ Sepa=ation Distances f~cm Well: MUNICIPALITY OF ANCHORAGE (MOA) H~LT~ mmO~TY m~ (~A) CHECKLIST - FEBRUARY 1984 Legal Description: TO Septic/Holding Tank on Lot /~ , I On Adjoining LOtS TO Nearest EdGe of AbscFption Field on Lot /'~ ~ ; On Adjoining Lots /O0 ./ TO Nearest Public Sewsr Line /~/~ To Nearest Public Se~r Cleanout/Manhole ~/~3~ To Nearest Se~r Service Line on Lot Water Sample Collected By~¢sC/~r~/4r , Date wa~r S~le Test ~,ults ~ ~/~,~,~'u ~,g ..... Cc~msnts ................// StandDi~es'~ Ai, tight Cap~~ Foundation Cleanou~,(~ De~essionq/ver Tank (~h~'. ,z ~te ~V~d '~ .' .~ ~inG~inte~nm ~n~a~ m File (Y~)P/~ ; f~ . ~ . . Separation Distances f~cm Septic/Holding Tank: To Wate=-Supply Well /O ~ TO PTcperty Line /O ' ~- To Water Main/Se=vice Line ~6; ~-- Course To Building Foundation To Disposal Field To St=earn, Pond, Lake, Receipt % Date Paid: Amount: c= Majo~ D=ainaGs [PaGe 1 of 2] 2-15-84 HEMICAL& GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I,O, NO, Water System Name Mailing Address Ciwr Stat~ · Day Year (*) See h on back Phone No. Zip Code SAMPLE TYPE: ~_Boutine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose ) [] Treated Water .~t::3Jnt reated Water SAMPLE NO. 1 2 3 4 LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY ,/Analysis shows this Water SAMPLE to be: ~,._Satisf actory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Pleas~ send new sample via special delivery mail. Date Received Analytical Method: Fermentation Tube [~Membrane Filter Lab Ref. No. Result* Analyst I I-I-] I .CT-] I m eno of colonies/lO0 mi or NO of Positive Dolt,OhS 06.1220 (b) Rev. 1983 BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE Membrane Filter. Direct Count Verification: LTB BGB Final Membrane Filter Results ~ Reported B y _~/"~,~?~/~') _~?-~d, Date Time: Coilformll00ml Collformll00ml /'~-s-~ e.m. COLLECTING SAMPLE TNTC-- Too Numerous To Count