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HomeMy WebLinkAboutCABIN BY THE CREEK #2 LT 1Cabin By The Creek #2 Lot i #015-521-42 v Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: 615 - 5 1- `I Z �L•-� S GE gyp' Development Services Department Building Safety Division o z Pump Intake Depth Below Top of Well Casing: 1c30 feet Pump Manufacturer's Name:�-��— On-Site Water & Wastewater Program — ! 4700 Elmore Road P.O. Box 196650 Mark Begich Anchorage, AK 99507 Mayor www.muni.org/onsite (907)343-7904 04 ANCHORAGE WELL & PUMP SERV. Pump Installer Name: 330 EAST 76TH AVENUE e. Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: 615 - 5 1- `I Z �L•-� S GE gyp' B V i o z Pump Intake Depth Below Top of Well Casing: 1c30 feet Pump Manufacturer's Name:�-��— Pump Model: -i�; S\'Z— Pump Size ��p Pitless Adapter Burial Depth: / -Ifeet ¢ c ZD ("A )q ) w f 1?,j -NF- CQl-i[4Z Legal Description C,O,bJ n by -I�, e Glee le Z L 1 Property -Owner Name & Address: �O 1 t ois21 cveo," t �6(v Pump Installation Date: Pump Intake Depth Below Top of Well Casing: 1c30 feet Pump Manufacturer's Name:�-��— Pump Model: -i�; S\'Z— Pump Size ��p Pitless Adapter Burial Depth: / -Ifeet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: �YesO Well Disinfected Upon Completion? No Method of Disinfection Comments: 04 ANCHORAGE WELL & PUMP SERV. Pump Installer Name: 330 EAST 76TH AVENUE e. -PANCHORAGE, AK 99518 PHONE: 907-243-0740 AWPS.COM Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Municipality of Anchorage Page of 3 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 Permit Number: cJ LJ 9501 3 Q PID Number: Name: Wastewater System: New ❑ Upgrade Address ®, gd 7-112—�M�TL A�L ABSORPTION FIELD Phone: No. of Bedrooms: Deep Trench 1:1 Shallow Trench 11 Bed El Mound 11 Other LEGAL DESCRIPTION Soil Rating: Total Depth from roriginalgrade: a I,o GPD/Sq. Ft. % Lot: Block: X Subdivisio Det pipe bottom from original grade: 'r}� Gravel depth beneath pipe Ft. Ft. Township: Range: Se ion: Fill added above original grade: Gravel length: Ft. I04P. Ft. WELL: ew ❑ Upgrade Gravel width: + Number of lines: Distance between lin es: ll�- 6.6 I. Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: t ,3e" j Ft. Ft. 13bk SQ. Ft. O Driller: Date Drilled: Static Water Level: Installer: ALASKA Dat installed: Ft. Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding /Private Ma ufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines O Well 144 > (OV- > 100 Material: S Number of Compartments: Z Surface ?� > 130`' = LIFT STATION k�- Water Lot��� Line (� 2' Size in gallons: Manufacturer: Foundation / "Pump on" level at: p off' level at: High water alarm at: Curtain Pump Make 8 Mod Electrical Inspections performed by: Drain F� Remarks: 11cf�n v 'r W BENCH MARK Location and Description:O . � 'J" SIG(L r L 605 Assumed Elevation: ENGINEER'S SEAL P( Jv Inspections performed by: Dates: 1st b 3' ®�� ®•.° c 9Q Fy� 2ndLIE 123�ma0w0 ..... .� o.. Department of Health and Human Services approval %eLP y Dater ��.�;,,► Reviewed and approved by: 72-013 (Rev. 9/91) MOA 25 Municipality of Anchorage Page 3 of 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 Permit Number: PID Number: Municipality of Anchorage Page of 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 Permit Number: PID Number: STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD i nre•riniu AC UM 1 eOROUGH iunowwoN LOT $LOCK swTtom WAS memo" Tovvwm P R"06 RIENDIAN ON 0 f C� ! ❑S ❑W LOCATION/SKETCH: WELL OWNER; RE"HS MEASURED FROM:❑casing top Oground surface WELL 00"' DATE OF COMPLETION Depth of hoie:,�—ft BOREHOLE DATA: Depth Depth of casino: 4Z!9 _ft 1 '� Material Type and Color From To DEPTH TO STATIC WAT LEVEL.: rr" ft below top of casing C3 ground surface Date: .� METHOD OF DRILLING: .fr air rotary ❑ cable tool ❑ other USE OF WELL: E3 domestic ❑ irrigation ❑ monitor 7 ❑ public supply ❑ other tAJdAj C.)Casing CASINGSTM-UP: it. Diem: in. to-/�t type in. to Wp L INTAKE OPENING TYPE: (&open end ❑ screened ❑ perforated ❑ open hole Depths of openings: to — ft SCREEN TYPE; 1 — Diam; in. } riJ /t1 Length: ft Slot/Mesh Size;ov GRAVEL PACK TYPE; Volume used: Depth to tap: GROUT TYPE; Volume: from ft to ft Depth: —'N - _ - DEVELOPMENT METHOD; _arr:t. Duration: PUMPING LEVEL AND YNXD: r- /[/ S� ft after . -- hrs pumping..Al)m PUMP INTAKE DEPTH: It Horsepower. WELL DISINFECTED UPON COMPLETION? &YES ❑ NO CONTRACTOR INF TION; REMARKS: RegisterediusiroM Name ��; • / PLEASE MAIL WHITE COPY OF LOQ TO: ! — �� j DNRIDIVISION OF WATER ;9r;ature ofuuthoonzecU asp sentkive Date PO BOX 772116 EAGLE RIVER AK 69577.2116 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930130 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:FENSKE JOHN E OWNER ADDRESS:P.O. BOX 2112 HOMER, AK 99603-2112 PARCEL ID:01552118 LEGAL DESCRIPTION: CABIN BY THE CREEK LT LOT SIZE: 44194 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 1 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 5/28/93 EXPIRATION DATE: 5/28/94 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: IF, DURING CONSTRUCTION OF THE TRENCH, THE TEST HOLE IS DEEPENED TO 16 FEET, THE TOTAL DEPTH OF THE TRENCH CAN BE 10 FEET. RECEIVED BY: ISSUED BY: DATE: DATE: Z ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 May 21, 1993 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 1, Cabin By The Creek Subdivision Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: Lot 1, Cabin By The Creek Subdivision is traversed by Little Campbell Creek. The septic system, therefore, must be located a minimum 100' away. The ground at the location of the proposed system slopes gradually at a rate of 3% to 5% toward the creek. Surface runoff will not accumulate at or near the new system. If the system is constructed as designed the following conclusions may be drawn: 1. The system, if constructed as designed, will have no adverse impact on the wells currently in use or to be placed in the future on lots in the area. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. Sincerely, Michael E. Anderson, P.E. A :' � �c^oeo eaa m 0. ,r � frt;c�ae E. Anderson o .eVs tia 4::81 -E JOB L0 -r / Ca t�� 8x SHEET NO. OF CALCULATED BY 14 CA DATES CHECKED BY SCALE a nil A «y PA -0A D DATE Yrwp(.f>4-u f ,l I VAGPrNT LOT PROCuCT 204.1(&npM Shoo) 20&1(PaM)41 mInt.,Gro AMan. 01/71. To OAA PHNE TOIL FREE 14pO225M /" = G0' Or A44j� '�' d m000aoa� jw Q e •m®u�amcmo cello JOS mS Some m ee m 006000.0 •eo..•e•e• • ° �6 n ;Michael E. Anderson a :;�i �•e 4381 - E e JOB Go -r 1, C,a�„� g y Ti' a" -m SHEET NO. OF CALCULATED BY ' DATE s CHECKED BY DATE ��•O�t�R�t�yi �� ..�nrf r•' t MOF 4 C1 • o , . �f Municipality of Anchorage, � y DEPARTMENT OF HEALTH & HUMAN SERVICESr. 825 -L" StreeL Anchorage. Alaska 99502-0650io e Qa ado �osao •as��� •e+eaea. 1,11 0— n• ......+e.....+..... r SOILS LOG — PERCOLATION TEST it 1 of `hiichael E. Anderson se � PERFORMED FOR: R1<5 GATE PERFd . Vim �y LEGAL DESCRIPTION: Gf,!FtA/ dV THE Township. Range. Section: 5 ZZ ,'� /7/_/ /? IBJ SLOPE SITE PLAN DEPTH' (FEETI TMJ - 1 N 2S M p' L E 3 4 5 6 7 a- 9 10,_ 11- 12- 13- 14- 15� i6 17 18 19 20 S/lr-y 5.4,4/D s/Z ry- PooA--Zy 6 WADED 5A Na 5 ECEIVED EP 9 1991 WAS GROUND WATER ENCOUNTERED? A/O S L IF YES. AT WHAT 0 DEPTH? P E Mun{c party of ,Anchorage Be" aWNW Mw Dept. Health & Human Services, Mee.w"? No WATER 5/YJ ,'M■ 7- Asn■ 5.4 410 IM11 wmp ej." `' *i e BMW- � II�IIP..1OMEN ..n9.0e'..G.m O.. ... • m.+ ficel E. Anderson v '�hoea S L IF YES. AT WHAT 0 DEPTH? P E Mun{c party of ,Anchorage Be" aWNW Mw Dept. Health & Human Services, Mee.w"? No WATER PERCOLATION RATE . I = lmrnuwn^c^I PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS HOLE �2F SOA.E�E�, TEST h/oG6 �MT) 3 DlZ �/ 5/hGH S -29-91 PERFORMED BY: 1 �� C TIFY THAT HI TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE q/ 5/YJ 7- 5.4 410 9110"L/ ej." `' *i e 7 r ..n9.0e'..G.m O.. ... • m.+ ficel E. Anderson v '�hoea 431$1 -E .z - ti 60 PERCOLATION RATE . I = lmrnuwn^c^I PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS HOLE �2F SOA.E�E�, TEST h/oG6 �MT) 3 DlZ �/ 5/hGH S -29-91 PERFORMED BY: 1 �� C TIFY THAT HI TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE q/ Q 4 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN.SERVICES 825 'L" Street. Anchorage. Alaska 99502-0650 SOILS LOG — PERCOLATION TEST 4 q ` o••t•avatee•••• (alYc es o•e•� 1 v,6" Michael E. Anderson a° ",I Or PERFORMED FOR: DATE PERFO CAB/✓H - I 1 -.1 LEGALDCRIPTONCOrZ Va SLOPE SITE PLAN DEPTH IFEETI I 1 2- 3- 4 3 4 5 6 7 8- 9- 1010- 11 - 9- - 11- 12- 13- 14 213•14 15 1s 17 18 19 S 1 LTy SAWS TH 3 WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? at" to waw Ahs gyp? m D to ATB.R o3tt 7C S L _. O P E 130 H I Raedin9 I Date Gem Time r -'1z ]viol � em CCe� ®ossa u�o�3•a+a •9^3•• m ®OP4 Cato".•°•••e•eo• •• e•t .'� s Michael E. Anderson 4�� 6, ®e 4381 - E }}t.oes m Not to Net IDeath Water Drop so .z 17 20 Lj PERCOLATION RATE :50 tmuwtewwcnI PERC HOLE DIAMETER TEST RUN BETWEEN _ 3 FT AND Y_FT COMMENTS -E 5 T 14 b L 1= PRE -.SOAK—EN PERFORMED BY: v�' �� I A,1,G'�AI�' Dtw `'EpTIFY THAT THI TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIOELINES IN EFFECT ON THIS DATE. OATS 72-000 IRs+. u051 IPT. Municipality of Anchorage Development Services Department Building Safety Division �i On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-521.42 1. GENERAL INFORMATION COSA # n1a)g 4 Expiration Date: 7-13-07 Complete legal description Cabin by the Creek #2 Lot 1 Location (site address) 10821 Baronik St, Anchorage, AK Current Property owner(s) Kenneth Jelinek Day phone Mailing address PO. BOX 244523, Anchorage, AK 99524 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA wX be held by DSD for pickup 2. NUMBER OF BEDROOMS: 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 Onsite Systems Approval (COSA) based only upon the representations given In paragraph 4 by an Independent professional civil engineer registered In the State of Alaska. Certificates of OnSRe Systems 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 COSAs upon request to homeowners. Certificates of Onsite Systems 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 engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Watkins Engineering, Inc. Phone 907-349-1851 Address P.O. Box 110443, Anchorage, AK 99511.0443 Engineer's Printed Name Cindy W. Ellis, P.E. Date 4'7-07 < 49T 6. DSD SIGNATURE I ft �, Cin y W. Ellis Approved for bedrooms. CE -to Disapproved.y�t� Conditional approval for bedrooms, with the following stipulatio Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date:—q —13—o-7 (Rw IM) Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196850 Anchorage, AK 99519 -WW www.muni.org/onsits (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Cabin by Me Creek ff2, Lot 1 Parcel Io- 015.521-42 A. WELL DATA Well type Private If A, B, or C provide PWSID p = Well Log (YIN) Y Date complsted 5.20-93 Sanitary seal (YIN) Y Wires properly protected (YIN) Y Total depth 149 ft. Cased to 149 ft. Casing height (above ground) 24+ in. FROM WELL LOG AT INSPECTION Date of test 6-20.93 2-14-07 Static water level 70 ft. 52 ft. Well production 15 9P.m. 7.1 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate < 0. 1 rngIL Other bacteria 0 coionies/100 mL Arsenic: 40_005 mgA Date of sample: 3/5/2007 Collected by: Rocky Trainor B. SEPTICIHOLDING TANK DATA Tank TypalMatarial steel septic tank Date installed 63-93 Tank size 1500 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping February 14, 2007 Pumper Northland Pumping, Inc. C. ABSORPTION FIELD DATA Date installed 6.7-93 Soil rating (g.p.d./fte or ft2/bdrm)0.45 System type deep trench Length 106.5 ft. Width 1.3 ft. Gravel below pipe 6.5 ft. Total depth 11 ft. Eff. absorption area 1384 fe Monitoring tube Y Depression over field N Data of adeWacy pest 2-14-07 Results (Pa Pass For 4 bedrooms Fluid depth in absorption field before test E 55 / W 21 inEaaagWlext 1 gal. New depth75159 in. Elapsed Time: 941120 min. Final fluid depth 71/52 in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) no If yes, give date D. UFT STATION Date Installed NA Size in gallons Manhole/Access (Y/N) 'Pump on" level at _ in. pump off" level at _ in. High water alarm level at in. Datum Cycles tested Meeh alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/tiB station on lot 140+ On adjacent lots 100'+ Absorption field on lot 107'+ On adjacent lots 100'+ Public sewer main 100'+ Public sewer manhole/deanout 100'+ Sewer /septic service line 100'+ Holding tank 100'+ Animal containment areas 100'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 2G+ Absorption field 15+ Water main 100'+ Water service line 50+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 20+ Building foundation 10+ Water main 100'+ Water Service line 50+ Surface water 100'+ Driveway, parwnglw"cje storage 25 Cumin drain none Wells on adjacent lots 130+ F. COMMENTS: G. ENGINEER'S CERTIFICATION I car* that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Cindy W. Ellis, P.E. Date 4-10 -o COSA Fee $ `f Date of Payment l 1 D Receipt Number 51 B (Rw 11/05) Waiver Fee $ _ Date of Payment Receipt Number my W. Ellis CE. toes 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.muni.org/onsite (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-521-42 HAA # 0s0,� _�3� Expiration Date: q=8 " © S 1. GENERAL INFORMATION Complete legal description Cabin by the Creek #2, Lot 1 Location (site address or directions) 10821 Baronik St., anchorage Current Property owner(s) John & Kay Fountain Day phone Mailing address Lending agency Mailing address 10821 Baronik St., Anchorage Real Estate Agent Ken Jelinek Mailing Address REMAX Properties Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 21 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 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 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 verity 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 Watkins Engineering, Inc. Phone 349-1851 Address P.O. Box 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis Date 6-3-2005 6. DSD SIGNATURE Approved for L bedrooms. �+ Disapproved. Conditional approval for bedrooms, with the following 49TH 111y W. Ellis CE-los» Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: �O-e,71 Original Certificate Date: iD — mw ouo2t Municipality of Anchorage • Development Services Department Building Safety Division OnSfte Water & Wastewater Program 4700 South Bregaw St. P.O. Box 196550 Anchorage, AK 99519-6650 www.munl.org/onsfte (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Cabin by the Creek 02, Lot 1 Parcel ID: 015-521-42 A. WELL DATA Wen we Pri If A, B, or C provide PWSID # Date completed $4Pft Sanitary seat (YIN) Y Total depth 149 ft. Cased to 149 ft. FROM WELL LOG Date of test 6.20.93 Static water level 70 ft. Well production 15 g.p.m. WATER SAMPLE RESULTS: Conform 0 colonies/100 mi. Nitrate 40.1 mg.A. Arsenic: NA mg.A. Date of sample: 62666 B. SEPTICIHOLDING TANK DATA Tank Type/Material steel septic tank Tank size 1500 gal. Number of Compartments Y Well Log (Y/N).! Wtres property protected (Y/N) Y Casing height (above ground) 24+ in. AT INSPECTION 616.03• 57 9.1 ft. g.p.m. Other bacteria 0 colonies/100 ml. Collected by: Cindy Ellis Date installed 63-93 Cleanouts (Y/N) Y Foundation cleanout (Y/M Y Depression over tank (YIN) N High water alarm (Y/N) NA Date of pumping 10'6'04 Pumper A Plus Home Services C. ABSORPTION FIELD DATA Date installed 6-793 Soil rating (g.p.dAe or ft /bdm) 0.45 System type deep trench Length 106.5 ft, WkKh 1.3 ft. Gravel below pipe 6.5 R. Total depth 11 ft. Eff. absorption area 1384 fl? Monitodng tube Y Depression over field N Date of adequacy test 6 -16"03'6 -vi 7 Results (Pass/FaIQ PASS For 4 MS Fluid depth In absorption Reld before test 16-6E In4er1 V1 Water added _� gal. New depthhW_Ll EEin. Elapsed Time: 94 min. Final fluid depth 75_1E kr. Absorption rate >- 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed NA 'Pump on' level at _ in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump ofr level at _ In. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankllift station on lot 140* Absorption field on lot 107+ Public sewer main 100' Sewer /septic service line 100+ Manhole/Aooess (YM) High water alarm level at Meats alarm 8 circuit requirements? On adjacent lots 150+ On adjacent lots 150+ Public sewer manhole/cleanout 100+ Holding tank NA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 20+ Absorption field 15+ Water main 100* Welts on adjacent lots 110+ Water service line 50+ Surface water 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 20+ Water Service line 50+ Curtain drain none F. COMMENTS *Test Conducted by Ted G. ENGINEER'S CERTIFICATION Building foundation 10* Surface water 100+ Wells on adjacent kits 130+ P.E. I certify that I have determined through field inspections and review of Municipal records that the above systems are in conftmance wiM MOA HAA guidelines in effect on this date. Engineer's Printed Name Cindy W. Ellis Date 63-2005 Water main too+ Driveway, parkingNehide storage 25 HAA Fee $ y U • Waiver Fee $ Date of Payment q*01=6 Date of Payment Receipt Number is= Receipt Number (Rev. 12/M) JdY W. Ellis 711 N i U o �H Tmg U HU A 7A. CW y o_ a T •�09 M •1 icy F F> _, .L33ZI1S NINOHVE3 S 0003'27°E 275.62' / 'fu -3-13-13 fu-3•mv s •mna ,o � m � m � i m A ^ x, C= 6 0°03'36%V 5.B3' O 0. r r m E� 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. O IS- S Z/ - Y Z� ttAA fl. r Expiration Date: —? - - 'co"I 3 1. GENERAL INFORMATION Complete legal description L.o t 1, 6u 6 in - 4.X .. 3A. - Ceve k S1 :;* Z Location (site address or directions) 1 O& -Z/ f3aron r k S/-. Current Propertyowner(s) Ty^7 ireeAGn Dayphone & 2Yz-2??A/ Mailing address Lending agency Mailing address Real Estate Agent Mailing Address I.o62/ feLeziorIrSr�t A�^ctio�ii Uv _-1c 9S/ ���.an�ccy� ttvv L/ � Day phone Day phone 2'-/ 2 -Z7 7 y W 7z(C&A- Re/.. 1M c/i Gr a q!, A -4c 9 9.5 G Unless otherwise requested, HAA will be held by DSD for pickup. P /.-m/e_ Call �? Aa /%ALO 24Y'2 -Z2 -7,y r- 'h�ffN ✓oady 2. NUMBER OF BEDROOMS: Pcl-r sutiin 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑X 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 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 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 that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Fta f 6p T.-eehogIeA SerI'(cor Phone Address I,YS 30 Echo S/ .AmeAorexee. A -1-C 99S-4411 Engineer's Printed Name-Theotlyo-le F. Maas Date .Tcc-,).e Z°/ ,• rt:� ."` 1 n >i • lj.9TH , THEODORE F. A40ORF S. DSD SIGNATURE ;•. CE -3589 = a V Approved for Y: bedrooms. `% '••••• �,�°; ? Disapproved. %Y;; ; ct Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (c7 (Rev. 01102) Municipality of Anchorage *A6 Development Services Department Building Safety Division .444 Onsite 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 Legal Description: 1,ot' %, CGt fn - by- H+e- Cie Parcel ID: O rS- 52l - Y2 A. WELL DATA Well type _ r wa itt Date completed C I W19J Total depth 1 N9 ft. If A, B, or C provide PWSID # V. A. Sanitary seal (YM) Y Cased to ! H 2—ft. FROM WELL LOG Date of test 6/ 2 o/ 91 Static water level ?G ft Well production /s- g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mi. Arsenic: - mg.A. B. SEPTICIHOLDING TANK DATA Nitrate 40.1 mg./l. Well Log (Y/N) Y Wires property protected (Y/N) _r_ Casing height (above ground) ,''min. . AT INSPECTION 6 /l6 /03 g.p.m. Other bacteria O colonies/100 ml. Date of sample: X6/03 Collected by: Ftuh4:;ee TcA S,c Tank Type/Material -,�{� Iqc l SI -w e / Date installed 6 - Tank size /500 gal. Number of Compartments Cleanouts (Y/N) _ i' Foundation cleanout (Y/N) Y_ Depression over tank (YIN) N High water alarm (Y/N) N• A Date of pumping is f /U3 Pumper IV or M lanCAO- P&f.n/7/ ;!g C. ABSORPTION FIELD DATA Date Installed g3 Soil rating (g.p.d./ft' or ft /bdrm) O• `+ISW System type Tren Ch Length 1 d 6. ft. Width 1.3 ft Gravel below pipe 6•,�^ ft. Total depth _JL_ ft. Eft. absorption area jIfi(ft Monitoring tube Y' Depression over field A_ Date of adequacy test -.j'� Resyy�� (Pass/Fail) Pew For 4/ bedrooms r s..s "Cc) 8/0 0 Fluid depth in absorption field before test 0 in(w) Water added�%gai. New depths in. Cuff �s•/ Elapsed Time: � min. Final fluid depth . f in. C� Absorption rate >= GGn g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) No.4je kn ou..� If yes, give date N• 14 D. LIFT STATION N• .4. Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at _ in. "Pump off level at _ in. High water alarm level at in. Datum Cycles tested Meets alarm d circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100 ' On adjacent lots 7 t &0 Absorption field on lot t ©'t On adjacent lots > t&0 Public sewer main N Public sewer manholelcleanout N• A�. Sewer /septic service line > 25 Holding tank 1y • 14• SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation to Property line 2 7 Absorption field —� 20 Water main N. Water service line 71 D Surfacewater > too Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1 `t' r Building foundation 10' Water main N • A. Water Service line > 10' Surface water 12 S Driveway, parkinglvehide storage '20 ' Curtain drain No o S vP� Wells on adjacent lots 7 1 u0 ' F. COMMENTSow.A�ra.•�at.. r - Al � A r. •....A •...� � . G. ENGINEER'S CERTIFICATION v �,��•49TH ••'.j,r � I certify that I have determined through field inspections and aI � review of Municipal records that the above systems are in • TI$ODCRp r, Ai00RE .AT conformance with MOA HAA guidelines in effect on this date.1b t 35ap AP @r Engineers Printed Name TAeIS "cic`C a•••••••••�`C . .� n Zy 20O1.4i�,.._ Date HAA Fee Waiver Fee $ Date of Payment 6 2 y / 03 Date of Payment Receipt Number _3 7 S'Y I Receipt Number (Rev. 12/01) 06/11/2003 12:33 348-0141 M CUBLRJ 9• ?.-T.V! i t s 1 0 F' 02 ---------- ';AA MI � \ fit►.. • �` � '-� •''•' i : '•�= • ' •; %J ALI 44 Pb 4 U y A.. :' ♦sk r• , i -ASaBUIT Ai t' '*' podsibtlity of t6 oreer to•deter.ine d �`ue►aa ue ax(st " of An) sacenentst coianants, dr re. y sLricNaiAlich do aot app�mjr• on'the "Orded sub- of diviitongpl4t. Under 114eio VAstmia should alar t" data hereon -be used for sa> butt oa or fdr, estab. � c °ied � i7i 1tsAtny b vh4* or tae* ]tries. Us scuurrvgror takes a aweolrr' r4I nM1 ,llcr..tn. *►......n . mase on only. e. :r ��� �� � �WMtY IaHgM '• LCiii.-LLMt�&�� \ IqI Wi andgi so -Otto lfs •bOls /'-Ids :J 1 MUNICIPALITY OF ANCHORAGE AL • '� DEPARTMENT OF HEALTH 8t 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. # 0/ 552. M9 Lj Q_ HAA # I �� �i11 �°► `l 1. GENERAL INFORMATION Complete legal description LOT %� (��-�/'J l.� y _71H C 2C Location (site address or directions) Property owner 7Cm_,,j C • Fps iz- Day phone Mailing address PC) • 6Ox 011 2- A)rnC_:R 4 'y_ qqz 003-- ZI/Z 11 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: q 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(Rev.1/91) Front MOA821 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 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 141-ij) c- -/I-,5o /J ie;j Girl 0r--72_1n16Phone Address 77 s Vq-- -/SS/ car+. A /c 99 SzY Engineer's signature (f Date // 9 6. DHHS SIGNATURE _ Approved for bedrooms. Disapproved. Conditional approval for Additional Comments By: ESP °C �P� c„ .i.. Ga (C/„/�•�� 9fI®AA O� P•.. �G 90 e0D ,>q i. �t c r\:'Y ica v, Michael c. Anderson � `r f 4^e J, •° 4381 - E bedrooms, with the following stipulations: Date 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 engineers work. 72.025 (Rev. 1/91) Back MOA e21 Municipality of Anchorage AL Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: I -Or j CAffW 9 y7, -C CtVC0L•- Parcel I.D. p/5-' ZJ/ � A. Well Data Well type P2iV.4ri If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 4, Z0 93 Driller Au��,�E Total depth 1 Cased to 149 i Casing height Z Y Sanitary seal (Y/N) I Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION &Ao 9.3 Date of test 7p _ rn a � z Static water level Well flow _ �5 g•p•rn• �-1 9 VQ cn C ,1 m y Pump levell N © LJrl V� w �' C N SEPARATION DISTANCES FROM WELL TO: G% p Septic/holding tank on lot I �� r ; On adjacent lots > 150 Z Absorption field on lot D 7 ; On adjacent lots i > LOIa Public sewer main 7 /✓1i &4e Public sewer manhole/cleanout Sewer service line > /Uflr Petroleum tank / WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed (-13/93 Tank size /5700 64,L Compartments -7—w0 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Depression (Y/N)) A N High water alarm (Y/N) 1A Alarm tested (Y/N) A/ A Date of pumping AJ C --I j Pumper /4//4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line 2-7 Absorption field Surface water/drainage 7 141,9 /45' On adjacent lots 7 ZDO f Foundation f c1 l Water main/service line f �laa 72-026 (M3)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed Length "Pump off" Level at Cycles tested G/� 5/9 .-? Soil rating (GPD/Ft2) 5rJ`- r /D r Ai Width 1.3 Gravel thickness Surface water System type G VZ r Total depth Total absorption area I .3.. 0IV Pi' "Cleanout present (Y/N) i Depression over field (Y/N) Date of adeauacv test N,�;- (,J Results (pass/fail) A/A for Water level in absorption field before test /` 0 ".JAfter test _ Peroxide treatment (past 12 months) (Y/N) nO If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1&4 7 / To building foundation On adjacent lots >200/ On adjacent lots 7 r zoo Property line ,Qi7JJcc �7 012-1 To existing or abandoned system on lot d14 Cutbank // d^/e* Water main/service line Surface water '> 130Driveway, parking/vehicle storage area Curtain drain A/ LA E. ENGINEER'S CERTIFICATION Bedrooms I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. En dS> ri Q 61 '[ Signature g omaEngineer's /►'/ 1 GfA CL vsea �Dd2s0J A 0.0 Name a"d 9 �9 3 h`66 ael E i nJ_-son 43L-1 e Date �,®g;R,, - @"o` Oa �� HAA Fee $ Waiver Fee $ Date of Payment / d ! Date of Payment Receipt Number ZQtL4 — /d Receipt Number_ 72-026 (3/93)' Back 11/16/93 09:41 CT&E ENVIRONMENTAL LAB SERVICES 4 907 344 2130 "S§ NO. COMMERCIAL TESTING & ENGINEERING CO• AIS DIV CHEMICAL & GEOLOGICAL LABORATORY TELEPHONE (907) 562-2343 3633 B Street Anchorage, Alaska %5 IS Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ❑PUBLIC WATER SYSTEM I.D. # F -F---[= ❑ PRIVATE WATER SYSTEM - Name Pp 23 z$�o77-? — Maaing Addreea Ati c.44 Slaw city SAMPLE DATE: i Mo. Day pay Year SAMPLE TYPE: Routine -.0 Check Sample (for routine sample ❑ Treated Water with tab ref. no.,_— ❑ Special Purpose Q Untreated Water SAMPLE No. LOCATION 2�� 3 4 –� TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory 0 Unsatisfactory 0 Sample too long in transit; sample should not be over So hours old at examination to indicate reliable results. Please send new sample Via special delivery mail. Date Received_ Time Received — Analytical Method: Membrane Filter " No. of colonies/100 mi. Time Collected Lab Ref, No. Result' Analys Collected By �1it}73 I I J L 13ACTERIOLOG}CAL WATER ANALYSIS RECORD A •C •E.C. E) Coliform/100 ml READ INSTRUCTIONS Y Membrane Filter: Direct Count BEFORE Verifioation: LS3 606 Focal Coliforat Confirmation COLLECTING SAMPLEColiformll00mI Final IAetnbrane I'll Results VNI 4? �. Reported By nate Time: s.m. TNTC = Too NumerOUS To Count p.m. QB = Other Bacteria M%SGr= Member of the SGS Group (Socj6t9 G6n6rale de Surveillance) COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES SINCE 1908 REPORT of ANALYSIS Chemlab Ref.# :93.5989-1 Client Sample ID :L1 CABIN BY THE CREEK SUED. Matrix :WATER Client Name :ANDERSON ENGINEERING Ordered By :ALAN Project Name Project# PWSID :UA 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 WORK Order :72957 Report Completed :11/10/93 Collected :11/05/93 @ 14:16 hrs. Received :11/05/93 @ 15:30 hrs. Technical Director;STEPHEti C. PE Released By Sample Remarks: ROUTINE SAMPLE COLLECTED BY: A.H., WITNESSED BY RUSS OLIN. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init ------------------------------------------------------------------------------------------------ Nitrate-N 0.10 U mg/L EPA 353.2/300.0 10 11/09 CMR * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than ANNSE3S Member of the SGS Group (Societe Generale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA