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HomeMy WebLinkAboutCRAIG LT 3Cr'aig 015-$42 -13 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. SI~IT BY:STEW~T TITLE OF Al( ; §- 8-B6 ; 8:,57AM ; TITLE/AD~IN-, ............ "-' ......... ~ ~. · ,a, '&'.L,~-- 80784~4786;# 1/ 1 A$-BUA~ T MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ~,, ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES ~ IL..LIAIq ~ /~EM EI/A ('~_PAi,", SEPTIC ABSORPTION Address' ...... ~ WELL -.., TANK FIELD Phon , , o'Bedrooms WELL ~/C '~' ~*~ o~sc.,.~.o. LOT LINE Township, Range, Section AS-BUILT DIAGRAM ~Show Iocabon ot well, septic system, proper:y Imes, Ioundat~on, TANKS '~ "A" yo L -- ~ ~;' :'~ .... ~ SEPTIC ~ HOLDING ~f~ ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER[~, ,,,~< ~" ,~ ~,: ti° ~ bottom from~~ 7otto depth from or,gmal graOe ~ ,'~" Fdl added above otlglrqa~ grade Gravel depth beneath p*pe ~ ut Iirq I rahng . ~ _ ~)0 / SOFT ~S'~ I}~C~q ~' ['~',~' ~ J WELLS i,,i,,,,~ ~ PRIVATE , OTHER (Identify) ..'otal Depth I Cased to Classff*cat~on ~A.B.C) ., ,,I - REMARKS: L ' . :' ~ , Scale: ~T~ ~.-~ ~' ...... r' ~, . , -,~--,~ ~ :q -?-,r~ .... ,padmenl Approval: ~~ t' ~ Date. *¢ 72-013 (3/85) Owner' lqame:~ W I I....I... I AM .?:,: GENIEVA CF:A I(3 ((.:.:, r ~:.~::i,:::1 r ess ,", 1. 0040 CRI-~i]EI< f.; I RC!...E AIqCHOi::i'.AGtE, Al< 995 16 :545-..' I Zl 4 4 L.c.,t Legal: !':h..~bd:i.v:i. sic, r'~: CRAIG ~UBDIVI~ION Se,:::i:. :~. cn"i '..~ :1.4 'i",:::,~.nsh i p: ;I.;'21'..1 Range: 3W L....~ L :i3 i Z ,:e ;I. t)78 (~.:- q ,, I: ~' C:, r a c: r'. e s ) tfi.:,.:...~ .l:}c:;i r oc, ms :'~ 'H"i i s F:'e r. m i t. ~: :J!; l"ot a 1 Cap ac: :i. t y B I cic k, ..... Si~iI:::'T'I] [J "FANI<: Mi n ].mum 't. ot.a 1 sept :i. c tan k c:al::.',ac i-Ly: :1., ()0() gal 1 (::~ns, Each sep'L :i. c: · Lank niust have a'J: least 2 coml:]artmeri'k.~,, Depth 'f..c, top of' septic tank (s',, .::: i c~: e't'. t-. :-:.:, ,:::t u :i. r' e s ~. n s u 1 a t :i. o n o v e r t. a n !.:: (s) . ', .... '~ I .... IS'T ~ 2t"4D I NSI::'F.i:CT il: ONS BY' ENG I NI:I:':i:F;: :, r F' '"., ............ ~ "j '--, r-. ("'/" ......... .: c~ C'" ,'~ ~'" ' ' ~* H' t ~:, ~ "]!:::'1::: i CIE t"',L. LII-~o, ..... ...,I...I .... :54(:.:;'""468 1 (-~ND LI:.AV~::. A M~ ........ :~.,~..':~1: .... ~'-c',. ~ . r"'~ -',]~ ~ ........... ~. '~ ...... z~t".l ~:"r~ .... ;~.- . t. F'ER c.l~,:~ I I1:.I:1~;:~ ~-~[ I~i,.:'l ......... AI:::'PROVED DESIt.:,~. IHIS I:::'t:Fi'M]:T IEXI:::'IRES :..;". ":::' :I. /'89 AND JPl....ID F:'OFi A SiN[':~i....E Fi~I¥1It....Y HOME, :I .... I ~n't lam:i, il. Jar ~.,;:i.t.I-'~ the J"ecluir'emeni:s for orl-.-.s:Lte sewer's and welis as set. ',:'c:,rt.l"i by 'Lhe Mun:i.c:ipality of:' Anct'",or. age (MOA) and the State of Alaska,, ;J.t~ .[ w:ill instal]. 'Lhe i~iy~iit, i-:~)iTI J.i] acc:c)ndanc(.:~.~ wi'Lb ali MOA codes arid and :i.n ,::omp].:iance w].t.I-'~ the de.~:ign c:r:iter'ia o{ th:is per. m:i.t,, .:~;.. .[ w:i i.I. .a(:lher. c~ i;..c~ .a] 1 !'"!(::)(::t and SLate c:~i ~q.l.a~tt.::a r. equ:~rements i,:;:~'~ the set back 4,, '[ Lu'~cterst. and that this per'mii.. J.s valid for a max:i, mum ,:::,t: :]; bedr. oc, ms, a [[ i;~i,:::) LiF/CI~:,t'" ~;'!,.aricl 'lt.l"i4:dtL '[l"il-:.;~ C: a l:::, a c: :i. i'. v' ':; f t,l"ll((.) ~..O'!'.a [ !~iF?:;t.(-~nt :[ s 3 bed r. ~'~1']~?' E~I] ]..6i, f' (~:jE~?ili~.:Fl"it !/~t ;i. 11, r" equ i r' eari add i. ~'. i. Cil-i~'l ]. pen m i i:. PERFORMED FOR:('"_ F~J~ 'T(~_ !EY' Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SEI~I~ 825 "L" Street, Anchorage, Alaska 99502-~'5'/~'"~'~ ~ SOILS LOG -- PERCOLATION TI~, * LEGAL DESCRIPTION: LoT ~ 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 No ~ND NATEF.. Sug'D WAS GROUND WATER ENCOUNTER ED? Township, Range, Section: 'TIZ ~ ~_~L) ~ 14 SLOPE SITE PLAN S L IF YES, AT WHAT O DEPTH? p E Depth lo Water After/ .~ ~)E.V' Monitoring? '-7/'~/~c) ~J~:. / Reading Date Gross Net Depth to Net Time Time Water Drop ,, it.. /~ I~ ,~,~ . ~' . I0 " i'l:/~ . " //' .~ · ~0 ' PERFORMED .Y: ACCOROANCE WITH ALL STATE AND MUNICIPAL GUIDEEiNES iN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85J PERCOLATION RATE / 7. 7/ (mmules/inch¢ PERC HOLE DIAMETER TEST RUN BETWEEN ~1 FTAND ~ ' FT THAT T.IflIS TE.~T WAS PERFORMED IN N unicipality of Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 July 28, 1989 Bruce Corwin, P.E. Corwin & Associates 1000 East Dimong Boulevard Suite 205 Anchorage, Alaska 99515 Subject: Waiver Request for Lot 3:.Craig Subdivision Waiver Request ~WR890037, PERMIT ~SW890123 PID ~ 015-343-13 Dear Mr. Corwin: Your request for waiver of the required 100 foot separation of a septic system to a private well has been approved. The approved separation distance is 90 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this deparqment.~ D~iel J. ~oth ~g ~ivil Engineer On-site Services DJR/ljw#6 Pt~oP~$E D BED ~ E)<' I~-F. SYSTEM ~.,,,. ~ TklSTALL I000:~._1 STEEL - TEST LL i TE .... . -- ~ ~OM ITOE , SEWER SYSTEM 'LOCATION PLAN /~ - .~,~ ,,,,, ,,,,, ,,,,, ,,o,,, " ~ '~'~"~' ~ -_1" = I~0 ~/~?~> ......... ..~ DRAW. aY, I SYSTEMS INDICATED IS NOT EXACT. ~:: ' , NORTH d ...................................... ' ..... ]. ~.~.......] ....................... ~ DETERMINED BY USE OF CLOTH TAPE AND ~/~,./~ :F':.("~',!t.:~'iX':,:,*L:7~:.¥:-..:2 .:.:..: ........... ,....;...::::-.~.-;S.;:;~.~-.>;,.:.:..L~:d:~:;~ NOT BY SURVEYING TECHNIQUES. MUNICIPALITY OF ANCHORAGE ENVIRONMEN1AL SERViC~.S DIVISION & associates,inc. Consulting Engineers 1000 E. Dimond Blvd. · Suite 205 · Anchorage, Alaska 99515 · (907) 522-1311 July 26, 1988 Mr. Dan Roth Municipality of Anchorage Department of Health & Human Services 825 L. Street, Fifth Floor Anchorage, Alaska 99501 f){., 2 6 ]989 RECEIVED SUBJECT: REQUEST FOR WAIVER OF WELL TO SEPTIC AND FIELD ON LOT 3~ CRAIG SUBDIVISION Dear Mr. Roth: We request a waiver from the 100 ft. to a 90 ft. separation distance from the sewer system proposed to be installed on Lot 3, Craig Subdivision to the existing well on the same lot. The drainage from the septic system on Lot 3 cannot flow directly to the well on the subject lot as the well is located some 10 ft. higher in ground elevation than the proposed septic system. The well log for Lot 3 indicates 67 ft. of sands and gravels to a 4 ft. clay layer with the total well depth being 90 ft. Since there is more than adequate treatment capability to the 90 ft, level and a clay layer at 67 ft., there is virtually no way for contamination from the proposed septic system to reach the total depth of the water strata at 80 ft. The static level of the well is 61 ft. The well on Lot 4 is the only other adjacent well and it is more than 200 ft. away from the proposed system and uphill from the site as well. Further, we cannot easily locate the septic system in any other location than it is at. We respectfully request approval of this waiver request. A copy of the well log and other information is enclosed for your review. As we are under permit and ready to build the system, we request your early review of the submitted data. Should you have any questions, please let us know. Very'"~ruly y/uts, Pres i~'e n,t / / I x, I Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SEI~.,,I~C 825 "L" Street. Anchorage, Alaska 99502-~ SOILS LOG -- PERCOLATION T~ ~'ERFORMED FOR:C E~'TI/- RY' LEGAL DESCRIPTION: LOT "~ DEPTH 1- 2- s,/~-y 3- 5- 7- 8 12- 3 ~D ~o ~ND NATEE 4- 15- 16- 17- 18- 9- 0- COMMENTS '-~ 21 Sug'D SLOPE Township, Range, Section: -T'/~_ SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Depth to Water Monitoring? Gross Net Depth to Net Reading Date Time Time Water Drop -- ~lz%h,? ~ / :o8 . .~o' "~ / " 1/:18 I~,-,~;. . ~' . I0 ,, //.:/~ - ~Z '. //:2¢ I~,~ .~2~ " II :Z~ , ~ ~ " 1i.'~ I0~,. .dZ' " i/' 5e · .ER.ORMED .~: ' r F_e. V I~' FFC~' , $1-k~' e ',1. (¢rt~-,tt.-- CERT,.. T.AT T~,S TE.T WAS ...... , I F 'f NTH, DATE DATE ?/& ACCORDANCE WITH ALL STATE AND MUNICIPALGUID6LNES NE FEC O S . : ~' 72-O08 (Rev. 4/85I PERCOLATION RATE / 7. 7 ! (m,nutes/inch.~ PERC HOLE DIAMETER ~" TEST RUN BETWEEN ~ ~t FT AND ~ t FT IN Drilling Co. Driller Well o~ner Location road '~ATEH WELL DRi~LLERS LOt~ (address of; Township, ~ang , 5t~tic water level one) Open en~-( ); USGS No. Area Use of well section, if known; or distance from main Depth of hole ~ feet Cased to feet feet (abovo) (belo~) land surface. Screen (); Perforated (). Finish ~f ~ell (check Describe screen or perforations Well pumping test at _gallons per (hour)(minute) for feet of drawdown from static level hours with Remarks Depth in feet from _~_.-~ ~ground surface Well :~'~$ Give details of formations penetrated, size of material, color, and hardness. to to to to to to to to to OAT~ SH2~T ~× -LOCATIO;I OF ~IEL[ (Legal Description)- Y/ELL DEPTH' ~;~ FT. CASING' / · -STATIC NATER LEVEL (Top of Casing): DATE OF TEST- - / / , 70' FT DRILLER' 6/ ' FT SCREE;I- Elapse~ Time Sincel J Clock Pumping 'Started/ J Depth to Drawdown/ Pumping J Remarks Tine Stopped, Hin. ,Nat.er, ft. Recovery Rate, GPH I I //'OS 0 ~/' (s~l) 0 0 J Start I/'~'~ ~o J ~' ~., I .120 (Z hours)l 150 180 (3 hours)l I 240 (4 hours) . RECOVERY 12 :~ 1o I ~ / ' 35 I : I 4o I 4S I 50 ~ ' 55 : Uu~fl (l hour) J ' Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-342-13 GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: ~u~ -- / ~ '- /// Craig S/D, Lot 3 6201 Craig Creek Court, Anchorage, AK Current Property owner(s) Jon Thomas/Ann Lyon Day phone (907)346-1486 Mailing address Lending agency Day phone Mailing address Real Estate Agent Mailing Address Starr Marsett Day phone (907)240-1310 Prudential Vista Real Estate, 3801 Centerpoint Dr., Anchorage Un/ess otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ ' Public Water System Well 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 On-Site 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 On-Site 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 On-Site 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 pedod of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation,~ based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Arcterra Consulting, Inc. Address 20441 Ptarmigan Blvd., ER Engineer's Printed Name Kenneth M Duffus Phone (907)696-6111 Date 3//~'/11 DSD SIGNATURE L./ Approved for --~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: By: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ~-~ --/~ "// (Rev. 11/05) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Craig S/D, Lot 3 A. WELL DATA We~ ~pe Ind Date comPieted 8/64 Total depth 90 ft. If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to 90 ft. FROM VVELL LOG 8/29/64 Unk Unk Nitrate 1.95 mg/L Number of Compartments 2 Depression over tank (Y/N) ~ Pumper A+ N Parcel ID: 015-342-13 Date installed 8/7/89 Soil rating (g.p.d./~ or~ 201 System type Bed Length 46 ft. Width 21 ft. Gravel below pipe 0.5 Total depth 8 ft. Eft. absorption area 966 ~ Monitoring tube Y Depression over field, N Collected by: Arcterra/kmd Date installed 8/7/89 Cleanouts (Y/N) Y High water alarm (Y/N) N/A Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL 'Arsenic: ND ug/L date of sample: 3/11 B.'-SEPTIClHOLDING,TANK DATA Tank Type/Material Septic/Steel Tank size 1000 gal. 'Foundation cleanout (Y/N) Y Date of pumping 3/9/11 C. ABSORPTION FIELD DATA Date of adequacy test 3/9/11 Results (Pass/Fail) Pass Fluid depth in absorption field before test 0 in. Water added452 gal. Elapsed Time: 6 min. Final fluid depth 0 in., Absorption rate >= 450 ^ny~w~ation'treatment~past 12"mo:) (Y/N&type~-No_~ ........ ~f V~s For 3 bedrooms New depth 0_~__ in. g.p.d. Well Log (Y/N) Y Wires properly protected (Y/N) Y · Casing height (above ground) 16 .in. AT INSPECTION 3/9/11 61 ft. 5 g.p.m. D. LIFT STATION Date installed "Pump on" level at~ Datum Size in gallons in. "Pump off" level at ~ in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 97 * On ac Absorption field on lot. 91' ~ Public sewer main N/A Public Sewer/septic service line ~~,.~ ")'~,~P... Holdil Animal containment areas 50'+ Man~ Water Service line 10'+ Curtain drain None Known SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK O Building foundation 10'+ Property line 10'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LO' Property line 10'+ Building foundation 10'+ Surface water 100'+ Wells on adjacent lots .....100'-I- Manhole/Access (Y/N) High water alarm level at Meets alarm & cimuit requirements? ........ in. F. COMMENTS acent lots 100'+ acent lots 100'+ sewer manhole/cleanout N/^ g tank N/A e/animal excrete storage areas 100'+ * Waiver on file. Well capable of higher production. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Enginee~s~~ K~.neth M. Duffus Date ~~.... _~...,~/~ ~.///{ COSA Fee $ Date of Payment Receipt Number (Rev. 4/10) LOT TO: Absorption field 5'+ Surface water 100'+ ' TO: Water main N/A Driveway, parking/vehicle storage..10r-I- .'overed within 1' of pre-test-6 min Waiver lee $ Date of ~ayment ReceiptNumber SGS Ref.# 1110765001 Client Name ArcTerra Engineering and Surveying Printed Date/Time 03/14/2011 16:53 Project Name/# Craig Lot 3 Collected Date/Time 03/03/2011 15:15 Client Sample ID Craig Lot 3 Received Date/Time 03/03/2011 15:45 Matrix Drinking Water Technical Director Stel~hen C. Ede PWSID 0 Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 03/04/I1 03/07/11 NRB Waters Department Total Nitrate/Nitrite-N 1.95 0.100 mg/L SM20 4500NO3-F B (<10) 03/03/11 LCE Microbiology Laborator~ E. C01i Total Coliform Negative 1 100mL SM20 9223B A 03/03/11 DLC Negative 1 100mL SM20 9223B A 03/03/11 DLC 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone ._~ ,~.-_~ Day phone Agent Address Day phone: ~'-~:~ '-' Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: Individual well ~, Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer 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 #21 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 in oompliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature David R. Dayton P.E. 20210 Donalar St. Phone ~"~-c:~,~/7 Date DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: .._1C:, bCrq ~-~/u¢ t'~--4- 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 DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. , 72-025(Rev. 1/91) Back MOA#21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ,,~.~ C,~¢--~7'/~---~ ,,~,z:~ Parcel I.D. A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~/'z-~/4,¢~ Driller ~'-'")cz..~:~0-5 ~ ~/ Cased to ~'~ Casing height /(,=," Wires properly protected (Y/N) )/ Date of test Static water level Well flow Pump level1 FROM WEEE=EtS~ Gl' AT INSPECTION g.p.m. ~- g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ 7 ' ''~ ; On adjacent lots ,-~ Absorption field on lot ~/' /,'~'~,~ ~ ; On adjacent lots Public sewer main Sewer service line /×~-- -/- '~//',~- Public sewer manhole/cleanout /v'//t- Petroleum tank WATER SAMPLE RESULTS: Coliform ¢~ "'/,"/~ 3 Nitrate Date of sample: ' ~//~ ~ Other bacteria Collected by: ~',~'. B. SEPTIC/HOLDING TANK DATA Date installed ¢7;/~°' '~ Cleanouts (Y/N) y High water alarm (Y/N) Date of pumping Z._. Tank size j ~o~:b Compartments Foundation cleanout (Y/N) ~/ ,,~.,,~,,~. Depression (WN) ~/~ Alarm tested (Y/N) /(/~ ~/?~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ 7 To property line J~-~ Surface water/drainage On adjacent lots /.3-z.o -,,- Foundation Absorption field /,~-~ Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date installed ~/7/~' ~ Length ~ Width Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) Z.~ / System type /~,r'~ 7--~! Gravel thickness ~," Total depth ,~,5' ' ~ ~. J- ' Cleanout present (Y/N) ¥ Depression over field (Y/N) ~ Results (pass/fail) ,~,~-~ for _.E, Bedrooms ~:~ After test /~ '~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~'/ To building foundation On adjacent lots Surface water Curtain drain On adjacent lots /~'z~ ~- Property line Y~5'- To existing or abandoned system on lot Cutbank ,~-~//,,~ Water main/service line x~'~ ~/~-- Driveway, parking/vehicle storage area 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. David P.. Dayton P,~ ~0210 DonaZar St. ~.~ugiak, Alaska ~567 Signature Engineer's Name Date /'~/'Z-7,/~ .~ HAA Fee $ ~;~ , ¢¢7~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back D. R. DAYTON, PIE., R.L.S. ~ Chugiak,.Alaska 99567 20210 Donalar (907) ~ 696-2417 December 24, 1993 ADEQUACY TEST Legal Description: Lot 3, Craig Subdivision Date of Test: December 10, 193 Septic Tank: 1000 gallon, 2 compartment, steel, tank Absorption System: 21' x 46% bed Soils Rating': 201 sq. ft. per bedroom Requirements: 3 BR - 450 gallons per day (DHHS Records ) (DHHS Records) (DHHS Records) Test: Water was pumped into the bed while measuring volume, time and water level rise. After pumping was stopped, the water level drop was measured at timed intervals for 2 hrs and again at 24 hrs. Results: The seepage bed accepted 509 gallons in 24 hrs and is currently functioning adequately for a 3 BRhome D. R. DAYTON, P E., R.L.S. ~ Chugiak,~Alaska 99567 20210 Donalar December 24, 1993 (907) ~ '696-2417 Legal Description: Lot 3 Craig Subdivision. Date of test: December 10, 1993 Well Depth: 90 ft. Static Water Level: 60.8 ft. Requirements: 3 BR - 450 gallons per day Test: The well was pumped with'the existing 'pump through an outside hose bib. The well produced 760 gallons in 2 hr. 34 minutes with a total drawdown of 6.6 ft. The drawdownwas fully recovered within 40 minutes after pumping was stopped. '- Results: The well is currently producing adequately for a 3 bedroomhome. COMMERCIAL TESTING ENVIRONMENTAL LABORATORY SERVICES & ENGINEERING CO. Chemlab Ref.~ :93.6631-1 Client Sample ID :10040 CRAIG CIRCLE Matrix :WATER REPORT of ANALYSIS E~ KITCH ~}- FAUCE~ HO * 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Clier~t Name :DAVID DAYTON, Ordered By :DICK DAYTON Project Name : Project# : PWSID :UA Sample Remarks: ROUTINE SAMPLE COLLECTED BY: WORR Order :'14041 Report Completed :12/14/93 Collected :12/10/93 @ 14:05 h~'s. Received :12/10/93 @ 15:35 hrs. Technical Director:ST]fPHE. N C. EDE Released By---~-=~--~~: STUART GILBERT. * SCREEN - R~2 'MIN. Qc Allowab!~e Ext. Anal Parameter . ~esults Qual Units Method Limits Date Date Init Nitrate-N 1.3 mg/L EPA 353.2/300.0 10 12/13 CMR * See Special Instructions Abow'~ UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification ].].mit. LT = Less Than D = Secondary dilution. GT = Greater Than ~.~,~SGS Member of the SGS Group (Soci~t~ Gen~rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, {ownship, range) Location (address or directions) ./C~O 4-~ ~ ~A I F-~ (b) Property owner M~% Mailing Address !4'_?(_%4-O (c) Lending Institution ~_/A Mailing Address ~ //J, (d)'Real Estate Company and Agent Address j~ ///~ Telephone ' (home) .'-~5"-/'~H~Business - ..,:.',. ,, AN. CH Telephone Telephone (e) Mail the HAA to the following address: (or check here~, if hold for pick up.) List contact person and day phone number below: ~-ZT_- /~il 2. TYPE OF RESIDENCE Single-Family', Number of bedrooms ,"~' 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 th legality and status. 4. SEWAGE DISPOSAL ,~ Public [] Community [] Holding Tank [] On-site Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm ~._~2C_~.',~/L~' ~ ~.'.~'~¥ Telephone Date Engineer's Seal 6. D~HS APPROVAL r--,,.- Approved for ', - bedrooms by Approved '~' Disapproved Conditional Terms of Conditional Approval Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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. 7/88) Back Page 2 of 2 ~ IVI_IJ N[C,(jr ~Do~I[Y OF ANCHORAGE (MOA) L ~;;'TALY['¥t:~,-~e~'t~ ~,,,~r~l[~)rity Approval (HAA)  ENTAL S ~v~I~ECKLiST . FEBRUARY 1984 343-4744 M~G- 7 1989 Legal Description: ~ RECEIVED A. WELL DATA Well Classification P ~.t l/,,~ Well Log Present (Y/N) \//' Date Completed Total Depth c../(~ , Cased to Static Water Level ~ ! Casing Height Above Ground ~ ' Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ~ ~C'" [dcc// _ __ Depth of Grouting /,J.~'~ ,u'r~,:~'4. Z Pump Set At I/A~ tr_,,,d~c~/, t Sanitary Seal on Casing (Y/N) Y V Depression Around Wellhead (Y/N) If A, B, C, D.E.C. Approved (Y/N) Yield ,~- d~ 7~ ~ ; On Adjoining Lots ~ /~C~ ' ; On Adjoining Lots ~/OO ' To Nearest Public Sewer Cleanout/Manhole /~//dr B. SEPTIC/HOLDING TANK DATA Date Installed ~/~'~ Size Standpipes (Y/N) ~/' Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) N Holding Tank High-Water Alarm (Y/N) /~ //~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well [~,.~© ~ To Property Line ~<,~ ~-'~ To Water Main/Service Line I~/.~ To Stream, Pond, Lake or Major Drainage Course Comments l~,l d.,~J -7'-~ ,~ K ,~ / ~/ ./,. OdO.~i NO. of Compartments ~ )¢/ Foundation Cleanout (Y/N) / Date Last Pumped ~1~,.~ ~/~.c/ ;for /Ii/~t Temporary Holding Tank Permit (Y/N) /I,,I/~ To Building Foundation ,~- 5" ' '+ To Disposal Field -~ ' + 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absor. ption Strata / Date Installed Width of Field ,--~ Square Feet of Absortion Area c~'~.~ Depression over Field (Y/N) /~ Results of Last Adequacy Test ~_~,~ -¢(' ~- Type of System Design Length of Field ,~E ~_ f Depth of Field '~' -fo ~] Gravel Bed Thickness ~" Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well c~(,~ ' --~ To Building Foundation ~ Lot ;~ / ¢-''' ~ To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Stora~ge Area Comments -~ ~_/~' / 0'¢/ V To Property Line ~/~ ~ To Existing or Abandoned System on ; On Adjoining Lots ::~--~ ~" ~ To Cutback (if present) /s, + / Size in Gallons%,,% "Pump On" Level ,% High Water Alarm Levt~Ixat Tested for od es~/ Meets MOA Electrical C N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permi,~t~ Bedroom/~ating Against HAA Request** I certify that I,/'~)~, ,c~hecke.~, v~ified, or conformed to all MOA and H; ' ran effeCt on the date of this inspection. ////~ ~/L / - ~i~e~a ny/~/~ Date Engineer's Seal MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 Tom Fink, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 July 28, 1989 Bruce Corwin, P.E. Corwin & Associates 1000 East Dimong Boulevard Suite 205 Anchorage, Alaska 99515 Subject: Waiver Request for Lot 3 Craig Subdivision Waiver Request #WR890037, PERMIT #SW890123 PID # 015-343-13 Dear Mr. Corwin: Your request for waiver of the required 100 foot separation of a septic system to a private well has been approved. The approved separation distance is 90 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. ~ D~hiel J. froth ~ Civil Engineer On-site Services DJR/ljw#6 ~ CHEMICAL ~'"~~ & GEOLOGICAL LABORATORIES OF ALASKA, INC. ,~o/, ~ FEDERAL TAX ID # 92-0040440 o. KNAL'fSIS P, EPORT BY Sk~PLE for Woxk Order { 15681 Dote Repo~t P~inted' AUG 10 89 ~ 19:4~ PWS!D :UA Cllent Acct : CO,WIN? Ccll,cted AUG 8 g9 ~ 16:00 hrs. P.O.$ NONE R.c~iv~d AUG B 89 ~ 16:i5 ?~es~rved with =A~ REQUIRED Ord~zed By Send R~po;ts -o: I)CORWiN & AggOC 2) ChenAab Ref {: 658~ Lab ~mpt ID: 2 ~t:lx: WATEE Aliowabl, ?aram~te~ Te~t~d Result/Um;$ ~ethod Llmlt~ NITRA~E-N 3.1 mg/1 E?h 353 Z 10 Teeta [ezformed * See Speci~l instructzons Above None 9etecte~ "See Samp!~ Remarku Above