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HomeMy WebLinkAboutSUNDI LAKE BLK 1 LT 111 - MUNICIPALITY OF ANCHORAGE ~,.., DE,.~/1TMENT OF HEALTH AND HUMAN SER~..~..--S Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~"~,~/Z'/z~ ,,~,~'~-,~,,Y ~'~./p/~' ~/ DISTANCES Add,ess ~ SEPTIC ABSORPTION TANK FIELD WELL ,Phone{st~_ ~ ~ Permit~g ~N°' NO. of ~rooms WELL ~ LEGAL DESCflIPTION LOT LINE .~ // J ~/v~/ ~ FOUNDATION Township. Range, Secdon ~.~ AS-BUILT DIAGRAM Show oca on o[ well, sep c system, property hnes foundahor ~SEPTIC ~ HOLDING rj Material No o, Compa.ments .TRENCH ~ED . W. DRAIN 'OTHER / . . = ~.~.. Fdl added above original grade Gr~vel depth beneath p~pe ~ '~ ~ ~ ~ Gravelleng~h Gravel width ~ ~ ~ ~ ~ ~ ET ~ FT~ ~'~ ~ ~R~' ~,n,~ Number of hnes Soil rating Pipe material ~ ~ ~ ~. ~ ~ /~.~ SOFT /gg~/~ ~VC 4 ~ ~ :~,~., WELLS ~RIVATE ~ OTHER (Identify) / -- -- ~ ~'/~ Classification (A,B,C] Total Depth Cased to ~ t~l ~ ,~ i. ~ Inst~lte, Dine Inst~rled: ~/~Jjll ~ ~ '~ff~ ~j. /~/~ ~¢~ ~ Inspections Pedormed by: ~ { ' I~ ~ ~/~ cedify thai Ibis inspection was pcflor~ed according io all Municipal and State guidelines in effect on this date: /~ ~ ,Add i" l.:ess '~ Day F'hone ~ Max !,l,c ..... i:~C-:~'C::'(Li!::ii"~,~ ].0 "J"oi~i"lSh:j,!::,:~ ]2N l-L'.anCle~: 41.4 ~. J. on :~. Each sept i c sa, ptic tank(s) < 4.C) NI!=ER' S D!!:F~:I:GK! AF'PFd:)ViFO, BLI'i AF:',L':>EARS ]'0 BE OVER D i:i,k~i'i'AL.L }:;~[:F~ t:iqGII~.I[::E:F:~S DESIGN- :.i',IG]JN[::E~I:~ P'IUSF VE:FRTFry 'll'l~l' Ai:L NANHOI...E COV!Li'RS~ INLE'T' f' : ~]UTL. E'T' SEF:"I:[C 'iAIqK/LiI;:'i STATION I':'ACKA~L?;E~ PL. AN'! HAS WA'fE:R"~ i AND CCiLJF:i IFIGS ~.,r.s and wells as set: '.:.:~ S'kate of Alaska. -q c:odei:] aFld Pegulations~ :~ePmit,, ~:~t:~r]t:,!~ f(:)p t. he ~;et, back ':'~.1 sys'Lem or' public: uniCYp lity of AnchOrage Department of Health and Human Services Torn Fink, 625 "L" Street Mayor P.O. BOX 196650 Anchorage, Alaska 99519-6650 May 10, 1988 Robert Schilling, P.E. Area Engineering P.O. Box 112207 Anchorage, Alaska 99511 Subject: Waiver Request For Lot 11 Block 1 Sundi Lake Subd. Waiver Request Number WR88r018 ' ' ' Dear Mr. Schilling: Your request for waiver of the required 100 foot separation of a septic tank/lift station package plant from surface water has been approved. The approved waived distance is 55 feet. This separation was approved because at the time of installation you will verify the tank and lift station plant are installed with no damage to the protective coating on the tank and all connections including the manhole covers are watertight. This approval is for the existing septic tank/lift station package plant only. Any future upgrade will require all separations be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-Site Services co: Gus Andress, P.E., Manager On-Site Services/Water Quality Programs PO SOX 11220? ANCHORAOE~ ALASKA gg~11 (gO?) 34g-5552 April 20, 1988 SUBJECT: Sundi Lake Subdivision Lot 11 Block 1, Reque. t Iot Variance for Septic Tank to Surface Water Municipality of Anchorage Division of Environmental Health Department of Health and Environmental Protection 9th & L Street Anchorage, Alaska Gentle m an: On behalf of our client, Frontier Alaska Credit Union, we are requesting a waiver, when an upgrade is accomplished, for the separation of the septic tank from surface water (Sundi Lake). You will find attached an asbuilt, site plan for the proposed upgrade layout, a soils logg for the proposed new bed system and a desi§n for the new septic drainfield. The well on lot 10 makes it very difficult to meet any of the protective radius requirements. I believe this site plan layout will provide the best solution for protective radius requirements. However the protective radius requirement for the septic tank will have to be waived. A lift station will be employed and all connection will be water tight to avoid leekage. Please find attached the require submittal fees for waiver, well permit, and septic permit. Should there be further questions or information required please contact myself or Roger Goodman at 349-5552. Sincerely, -.L,. ~U88 TAOK IHT) I O~OUND ~T IRON ~IPE (IP) ~POUND ~ET B~ASS OAP (80) ~FOUND SPIKE or PK (S~.K] ~FOUND XSET IRON REBAR (IR) OF~ND ~SET ALUMINUM CAP(AC) ~FOUND WOOD FENCE ..... . DRAINAGE ~ ~'MSL CHAIN LINK FENCE ~ ~ ~ : ~ PAVING ~ ELEVATION =~ASSUMED DATE SC~E LEGAL DE~RIPTION SU. iVEY TYPE "' C ' I4APR88 l"=50' LOT II 8L~K l PO BOX 112207 GRID ZONING SUBDIVISION ~ ' ANCHORAGEs' ALASKA 99518 2224 SUND1 LAKE DRA~ BY CHECK BY PROJECT ~ (907) 349-5552 RD BS ~%~.'% ~S-3426 /, ~ It is ~ res~ibility of t~ o~r or ~il~r~ ~ior ~o' comt~ction~ to ~i'~;~% ....... '"/~'%~ tio~ a~ to' deie~i~ t~ existe~e oF any e~s) .co~nts or Li$ie~ tista~es preveil o~r stalin, Re~od~tion'~y c~e di~ioriioh,. ' FORM ~7 PLOT PLAN/ASSUIkT Li . ~UB8 TACK [HI) flFOUND I~T IRON PIPE (IP) · FOUND ~SET BRASS CAP (BC) ~FOUND SPIKE or PK (S~K) ~FOUND XSET RON REBAR (IR) 0 F~ND ISET ALUMINUM CAP ~AC~ ~ FOUND ;H~IN LINK FENCE ~ ~ ~ : : PAVING ~ ELEVATION =~A~SUM~p DATE SC~E LEGAL DE~RIPTION SURVEY TYPE P ~ C , .I4APR88 l"=50' LOT II BL.K. PO BOX 112207 GRID ZONING ~BDiVlSION ' 2224 ANCHORAGE~ ALASKA 99~18 DRA~ 8Y CHECK BY SUNDI LAKE (907) 349-5552 RD 8S PROJECT ~ . ~,... ~ .,p~,. t~ probity li~ a~ ~ mt o~rlep or a~ro=h on ~ pro~riy lyi~ ~,,,,,.,,,,...,,,,.., ...... ~ Fo~rty I~i~ 'adjacent t~reto omroach on t~ pre~ises in question a~ . ~..~.~ ~t t~ra ~e'~ ro~ tra~i~ion li~s or.ot~r e~e~nt~ on aaid . v~% CE ~ , .~ I[ is t~ res~mibili~y o~ t~ o~r or ~il~r~ prior to'co~iructio% 4~'.. ...~ ~ri~y Fo~sed ~ildi~ gre~e re.leti~ [o [inish Fe~e' e~. atility con~c- · t~&O~'..."~[~ tiom~ a~ to' dete~im t~ exisieme oF any en~S; .co~mnts or ~ restrictiom .hich do mt ap~ on ~ recorded s~i~sion plat. · Listed dlstames prevail o~r scali~. ~eFod~tion'my c~se d[stortior,.. ' FOEM 27 PLOT PLAN/ASBUILT L~ · ' 'LOT I0 ~"a ~$/'1~c. TACK FOUND MSET SPIKEorPK ~FOUND XSE1 WOOD FENCE : c ~ - ~ = PACE PO SOX ll220T ANCHORAGE~ ALASKA 99518 (907) $49- 5552 Robert D. Schilling '.% ..... ..-' ~k~ ~OFESSX~'~~ FORM 27 PLOT PLAN/ASBUIL.T L PIPE (IP) (~ FOUND IRON REBAR FOUND DRAINAGE - -- PAVING DATE SCALE LEGAL I" 50' I4APR88 = · GRID ZONING 2224 RD BS LOT II SUBDIVI SION SUNDI LAKE ~)$E'[ BRASS CAP (BC) ALUMINUM CAP ELEVATION DESCRIPTION SURVEY BLOCK I PROJECT .{ ~)FOUND :' MSL TYPE I ~erb~ certify that the property deeorihad .hereon has been ~ervel~d by or ut ~ direotion~ eM that .tbe'i~provencnt~ situated thereon e~'e .ithin tbs property lima aM ~ not overlap or encroach on tbs property lying adjscaM thereto unless other.isa .shasta. · That re iaprove~ents 0n the property I¥ing 'adjacent thereto encroach on the proais~s in question and · that there era.no road~al~ trues!cajun lime or.other eueMnts on said propertp except aa abe#n, It is the raspemibilit¥ of the o~mer or b~ildar~ prior to'con~truotion~ to veri~ proposed Ixiil~ing 9rads relative to finish g~ade' eM. utilitp conr*o- tions~ and to' dete~im the existence o~ any eaamn~a~ .covgnsnta or restrictions Mhich do not appear on the rocorded subdiv, taion plat. · Listed distcnses prevail over scaling, Rsproduotion'~a¥ cause distortior.. ' Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~ ~ ~ ~obor~ D. Schiftln~ ~ ~ ~:% C~ 1411 .~ DATE PERFORMED: ~:~- ~ LEGAL DESCRIPTION: ~"~.;7"// ~"/ ,.~-~'///g2/~ Township, Range, Section: 7~/~./,/-,~'~4,j -.~'~ 5 6 7 8 10- 11 13 14 15 16 17 18, 19- 20- SLOPE WAS GROUND WATER ENCOUNTERED? ~ IF YES, AT WHAT DEPTH? Deplh to Water After Date: SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN FT AND FT PERFORMED BY: , , _ ~t'0, CERTIFY THAT THiS TE~T',,AS PERFORMED IN ACCORDANCEWITHALLSTATEANDMUNICIPALGUIDELINESINEFFEOTONTHISDATE. DATE: ~ ~/ '- ~ ~ T~ ~I~P'YIC 24' ~HOP~T FORHUI,AO Number of Bedroem~ H 8otl Rating N 1 ,~i = Total Area Required $ X 12~ X 1.5 ~-' ~,2~UAREFEET Length 24' ~4 Feet Designed Width -~ ~ Total Area Eequtred Designed ? f& ~UA~I~ F;GT HOUND OR BACKFILL WITH NATIVE HATERIAL HINIHUMOF 4 FEET FROM TOP OF ROCK TO FINISH GRADE Clean ~ravel ~eptto ANCHORAGE ' - MUNICIPALITY OF DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION ON-SITE WASTEWATER DISPOSAL SYSTEM INSPECTION ENGINEER FIELD AUDIT LEGAL DESCRIPTION: ENGINEER: EXCAVATOR: AUDITOR: AUDITOR '~'~/ WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geolo(]icol a GeophysicoJ Surveys Drilling Permit No. LOCATION OF WELL (Please complete either la, lb or lc.) A.D.L. NO. ~lSorough Subdivision Lot Block ~ I/4qtr$- Section No. TownshipN[~ Range E[~ Merldion Sundl Lak( 11 I --of--of--of__ S['-I W[~ ISTANCE AND DIRECTION FROM ROAO iNTERSECTIONS 5. OWNER OF WELL: Sundi Lake D~ Address: ~O~e~ C~ed~ U~o~ Street Address and Area of Well Location 2. WELL LOG Feet Below Surfoce 4. WELL DEPTH: (tirol) 5. DATE OF COMPLETION g+,~ ~k--~]n 0 2 6. ~ Cable tool ~ Rotary ~ Driven ~Dug ~g~nic 2 4 ~ A~ ~ detted ~ Bored ~ Other: Sandy g~velly silt 4 10 7. USE: ~ Domestic ~ Public Supply ~ industry Sandy silt 10 7~ ~ Irrigation ~ Recharge ~ Commerical Silty G~vel - ~11 ~mt ~0 191 270 Ty..: open end O~om.,e,: 6" Silty sandy gravel seams with ~0 270 452 s., be,ween ft. Ond ft. ~ackfilling Grovel pack -. Water s~nd & Cr~vel 452 459 ~o. s~ar,c W*T~, ~w~: 83 .. 6 /20/88 ~ Above or ~ Below land surface Date II. PUMPING LEVEL below ian~ surface and YIELD Ortgio~l weZl a~ndondd 6-22-88 3~ ft. after 1~ hrs. pumping ~ g.p.m. ~ ft. after hrs. pumping g.p.m. DEPT. OF HEALTH & Material: ~ Neet Cement ~ Ot~er: :NV~g~N~hHfAL PROTECTIOJ ~S. PUMP: {if available) HP Length of Dr~pe ~ft. capacily- 7 g.p.m. ~ IIIM 0 0 16, WATER WELL CONTRACTOR'S CERTIFICATION: 15. Water Temperature o ~ F ~ C This well was drilled under my jurisdiction ond this report is true to the best of my knowledge end belief; Registered ~usJ~ess Nome Conlrect License Number Form OZ-WWR (11/81) Copy Distribution: WHITE-Stale DGGS~ P~NK-DriIleG CANARY-Customer hose PVC p~pe Typ --Adjus-'t~b~e Fto~t Surtch ~semb!.y -- vended '1 1/4' s~ee~ cou~l~c3 1/4' dl~' drain beck hoIe 1 3/8' ho~es 6' OC 1/8' r~sh potye+~hytet~e screen 15' d~, x ~ I9 ~notes --1/3 hp e??tuen~ pu~p, v&rlous M~nu'F~c~urss · 1250 ~00 ~.OOO I I.~esorye C~p~c!{y :.. ' ~ .'9~ GAL 857 GAL ~d]°~!'C~~ ~0;-'" 161' GAL ___ ~ R..s- 5 p yL:?..'L..- ..:' '. ),.f~ .' -' '- '"'"": "-" ':-"" ~60'..GAL 3I~'. GAL 415 GAL ~bove pu~p' on-:-:'::- C~p¢c~y De,ween · ": : ; ' "" ' " Punp on ~ Pump" oF~' ~09' GAL 131 GAL 175 GAL At~r~ 48 I18' 48 118' 48 1/~' Fto~ Lever On' ~- 44 1/8' 44 1/~'1 44 Se~In9~ D~P 40 1/~' 40 1/~' 40 1/~ LIFT STATION DATA 84 80 18 16 14 c~ 6 Go, tton$ per Minute TYPICAL PUMP PERFORMANCE CUR~ 35 4ELL A B C 1850 18 GAUGE 181 1/8' 81' 40 1/8' (3 BEDROOM) 1500 18 GAUGE 145 I/8'97" 48 1/8' (4 8000 10 GAUGE 194' 129 3/8' 64 5/8' (5 SIZE CHART GAAB-HO-I G[~_.~..~R ANCHORAGE AREA BORO~ ~/ DE?~FITMENT OF ENVIFIONI~IENTAL 0.UALIT~~' 3§00 TUDOFI ROAD ArYOHOF~AGE, ALASKA gg§07 27g-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY MATERIAl '~'~Z;-"Z~/ NUMBER OF / .COMPARTMENTS. )~/'/C~'~ c~;~"'~?~'- LIQUID GALLONS. INSIDE LENGTH_ INSIDE WIDTH ~DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER ~ OR WIDTH /~'- L,N,NG MATER,AL D,STANCE FROM WEU NEAREST LOT LINE ~'~) ' 7~ ~" TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) LENGTH /~- DEPTH . BUILDING FOUNDATION~-'~ .SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA / DEPTH: TOP OF TILE TO FINISH GRADE ,/'""'/~DISTANCE BETWEEN LINES , NEAREST LOT LINE SQ. FT. LENGTH OF EACH LINE WELL: TYPE~) ~,~ ii C.:b NEAREST SEPTIC LOT LINE , SEWER LINE TANK TOTAL LENGTH . OF LINES .IN. TOTA~ DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE DISTANCE FROM WATER , BUILDING FOUNDATION.__SAMPLE I,~O}~ , NEAREST ! OTHER -~ .~ SEEPAGE '~o '~- ".,CESSPOOL SOURCES , SYSTEM ., DISTANCES: DIAGRAM OF SYSTEM /G~A.A.B. }'~,F~" GRE:~A'T~2R ANCHORAGE AREA SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SO~L TEST RESULTS LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PiT ~ , DRAIN FIELD OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINA~LJN~SPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH D~~JECT TO PROSECUTION. SEPTIC TANK SIZE GE AREA SIZE TYPE MINIMUM DIS~FANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ~ FOUNDATION TO SEEPAGE PIT ., DRAIN FIELD SEPTIC TANK TO SEEPAGE PiT WALL -- /~-- SEEPAGE PIT , DRAIN FIELD. / / 5- ~> SEEPAGE PIT ? ~ ALSO CONSIDER AREA WELLS, SEPTIC TANK TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD DIAGRAM OF SYSTEM WATER MAIN TO SEPTIC TANK ~EEPAGE PIT 7c CAST IRON INTO AND OUT Of SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGU ATIONS REGARDING INSTALLATION. _ HEALTH AUTHORITY Or L}OENSED DESIGNER CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS F NCHORAGE AR.E_A {:)ROUGH ORDINANCE NO. 28-6/3 AND THAT THE ABOVE EATER ANCHORAGE AREA BOROUGH~ k.,~..~7 HEALTH DE~ARTM~NT~ 32? EAGLE STREET ANCHORAGe, ALASKA CASg fl Performed For C~'J~}~ f~lF_i'~"/}~_ J~L~g_ ..... DElhi' Date Performed J(~ -- , Thzs Form Reports a: ~ozls ~og , ~..rercolatzon rest Depth Soil Cha.=~te~stlco Location S~elch ~ : ~LL,~ ~ -J.':.. ~ LLL~I /0 . ~o (~) Reading Net Drop Proposed Instal~Seepage Pit /~' . Drain Field ~,z, ,,,,-~~~'c~,,, , 0 © DICKINSON OSWA LD & PARTNERS ENGINEERS AND SURVEYORS 800 CORDOVA STREET January 20, 1972 Mr. Rolf Strickland Greater Anchorage Area Borough Department of Environmental Quality 3500 Tudor Road Anchorage, Alaska 99502 Re: Lot 11~ Block 1, Sundi Lake Subdivision HOuse under construction by Supreme Builders Dear Rolf: On or about December 1st, Jim Hanson of Supreme Builders con- tacted us regarding a review of the well location on subject property. In the course of construction, the driller spudded in the well at the wrong location and as a result, the well is approximately 62 feet from the septic tank. I have reviewed this location in the field and have reviewed the well logs. The upper well casing is approximately 25 feet above the location of the septic tank. The southerly lot has a house constructed on it and the septic tank is installed on the lot. Subject tank is on the southerly side of the lot and is in excess of 130 feet from this subject well and is in a downhill location from this subject well. Taking into consideration the clay dike located between the 2 foot depth and the 24 foot depth, and the clay dike between the 70 foot depth and the 112 foot depth, and the favorable surface condition, we feel there is no sanitation problem relating to the well's location. ' If you have any questions regarding this review, I would appreciate a call this afternoon or tomorrow insomuch as I will be out of town for a few weeks after Saturday. Very truly yours, 0N-OSW & RTNERS Lewis E. Dickinson, Partner LED:jp cc: Jim Hanson direct ons). , MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alasl(a 99519-6650 _343-4744 '" ' '~' CERTIFICATE OF HEALTH AUTHOR 'rY': APPROVAL FOR A SINGLE FAMILY DWELLING pa';cel'.l'D.# O!,/_ /~].~ ~1-:-:~' ::!:" "' .:-":i:?l~t~i;'"",~,~'~("~t,~(~- ''~- Completelegaldescription' /-~ Il( ~ $O~,~) L~-)~:.I=- :~, Day phone "' ~ ~' ' ' ~ ,' ;: , - Y.' t:-~ ~,~ - ' "~Y~-';~,'-" "-;' .~- ~ ~ ....... , · - Day phone . - '~,:; Malhng address' . ~- "'"~ :';-: Day phone Agent .... Address ' ':' ':'~ - ' '"' pckupl unless ~therwise requested, H/LA will be held for i NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: / Individual on-site Holding tank Community on-site Public sewer NOTE: 7~-02~(R~v,l/91) FrOnt MOA~'~I if community wastewater system, provide written confirmation from State ADEC :~ ' ,' attesting to the legality and status of system. ~ 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 wastewamr disposal system is safe, functional and adec uate for the number of bedrooms and type of structure indicated herein. I furtherverifythat 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. ~ Address ~L~) Engineer's signature "& 6. ~ DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: (~Ciitional Comments ('t~ ~ ~' '/'h' t , 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. Em ployees 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. LegalDescription: ~ 0 '7- IlI ~l_l/,4D~ . DEPARTMENT OF HEALTH & HUMAN SERVICES · Environmental Services Oivimon 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907~343-47~'4,~ Health Authority Approval Checklist Parcel ~.D.: DI/-ISI-- A. WELL DATA Well type ~ If A, B, or C, attach ADEC letter. ADEC Water system number Date completed Cased to Z/5- ~ I Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Log present (Y/N) Total depth / I Sanitary seal (Y/N) / FROM WELL LOG Date oftest Static water level Well production ~.~ Co WATER SAMPLE RESULTS: Coliform ¢ . Nitrate Date of sample: t t~'/[ l qJ'~'- SEPTIC/HOLDING TANK DATA Date installed ~/f/~/~/~ Tank size ¢'~1 P Other bacteria ~ r Collected by: '%~, -~ Number of Compartments ~ Cleanouts (Y/N) Foundation cleanout (Y/N) ~ Depression (Y/N) ~'~ High water alarm (Y/N) Date of Pumping ] ~ 7/~'"" Pumper ABSORPTION FIELD DATA Date installed ¢~'/~'~ Soilrating (g.p.d./~2orft%dm0 ]~.-~ Systemtype Length ,% t-/I Width e~ ¢ / Gravel thickness below pipe ~// Total depth z~, Effective absorption area t~ 1~ Monitoring Tube present(YfN) 7 Depression over field (Y/N) Date of adequacy test Vr~'/~] ~ Results (Pass/Fail) ~-~ For ~ bedrooms Fluid depth iii absorption field before test (in.); immediately after Ig q~gal, water added (in.): Fluid depth ~Z~(ins.) Minutes later: ]~.O Absorptio? rate =/~ .4/~{~) g.p.d. Peroxide treatment (past 12 months) (Y/N) ]k~ If yes, give date Dale iostalled ~ Manhole/Access (Y/N) 7 Iligh water alarm level at* Cycles tested ~/ Size ill gallons ti "Pomp on" level tit* ~-7~ "Pomp ofF' level ,/ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank Oll lot Absorption field oil lot Poblic sewer main Sewer/septic so.ice liae ; On adjacent lots ; On adjacent lots Pablic sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: / Building foundation /t ,~ Property line ~, / ~) Absorption field Water main/service line ~.ff_.~- Surface water/drainage ~. ~ ~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building fonndation Surfaco water Water main/service line ~ ,.ff-. 5 Driveway, parking/vehicle storage area ~/g9 / Curtain dram /%] Wells on adjacent lots ~> /O-'e..~ Propertyline lO / F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal reco?~l~(ffl, ld}"tl~q~fi;b~vei',~M, qms are in conJbmnance with MOA lt~ g deline~' in ef~t on th ~ date HAA Fee $ ~ · ~ Waiver Fee $ Date of Payment /~/~/~: Date of Payment Receipt Number /~7~ ~4) >>.) Receipt Number Rev. 8/95 OSS: haa,wk.doc CT&E Ref.~ Matrix Client Sample ID CT&E Environmental Services Inc. Laboratory Division ~j~.~,~.j~.~.~rj~-~.~j~,~'j~-~. 9s.9299-1 Laboratory Analysis Report WATER PETER STA~MEN, SL~NDI LJ~KE Client Name TOBBEN SPURKLAND, P.E. WORK Order 19944 Printed Date 12/07/95 ~ 17:50 hrs. Ordered By Collected Date 12/01/95 ~ 13:30 hrs. Project Name Received Date 12/01/95 ~ 16:40 hrs. Sample Remarks: SAMPLE COLLECTED BY: T.S. Allowable Ext. Anal QC Results Qual Units Method Limits Date Date Init .... ....................................................................................... ............... Nitrate-N 0.10 U m~/L EPA 3~0.0 ION 10 12/05/95 MCE ..................................................... UA = Unavailable See Special Instructions Above NA = Not Analyzed ** See Sample Remarks Above U = Undetected, Reported value is the practical quantification limit. LT = Less Than GT = Greater Than D. = Secondary dilution. 200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tel: {907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA. CALIFORNIA, FLORIDA, ~LUNOIS, MARYLANO, MICHIGAN. MISSOURI, NEW JERSEY, OHIO, WEST VtRG~NtA ~J MUNICIPALITY OF ANCHORAGE ~"/ -~)[ \ -\~,~\ - ~ ~, DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~- [~~1~1 OF ON-SITE SEWER AND WATER FACILITY 264-4728 Application :)ate 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ' (b) Applicant Name-~¢-~4/~',E¢-~'' ~-'~/ Telephone: Home ,¢.¢~¢'-~"~'Z Business ~-¢ . (c) Applicant is (check one): Lending Institution E ; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution Address (e} Real Estate Company and Agent . Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family 1~ Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well E~ Community [] Public [] Note: If community weJl 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. 72~325 (11/84} Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND !~FORMA'TION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site Water' ~L~l~ly 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 ,~.~z~,~ ~,."~-////'.e.~"~'~/~'/-~ Telephone Address ,~-,7.:~'.:~ ~//t~'...-/.~.y C"/~,..,~- .,~.,,~¢,/~.,~.-~,~.z~ ,.~.~'~,,(:~.~ Date -.~"¢'--'"-~.~ ,~,'~ 6. DHEP APPROVAL Approved for ~ Approved -'~ Engineer's Seal ..... ~) , ~, Robert D. Schilling beOro°mlb; ~~~ ~Dato Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. 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. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHOP~AOE ENVIRONMENTAL SERVICES DIVISION 1988 RECEIVED A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~,,~t'// ,~,:~'~ -/ ,~'"~-/,/'O.,' ~',,'.~,~'~ Well Classification Well Log Present (Y/N) Total Depth '¢ ,'~'9 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 ~-- If~ A, B, C, D.E.C. Approved (Y/N) ? Date Completed ~' ~ -'T-b"~" ;~'¢i~ Yield -~:~' Depth of Grouting Pump Set At .~,~'~ .~ Sanitary Seal on Casing (Y/N) ~' Depression Around Wellhead (Y/N) ; On Adjoining Lots ¢' '~'-~' '¢ ; On Adjoining Lots ~ /~'~' / To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/~ Tank: To Water-Supply Well To Property Line ¢- .~0' To Water Main/Service Line Course ~ ~ Size /~5~ ~..¢'/ No. of Compartments Air-tight Caps (Y/N) ~¢/ Foundation Cleanout (Y/N) Date Last Pumped ,X/ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation --~ ' To Disposal Field -~" To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72~026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area ~8/~., Depression over Field (Y/N) // Results of Last Adequacy Test Type of System Design Length of Field Depth of Field ~'~', Gravel Bed Thickness / ' Standpipes Present (Y/N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well '/"/,,Z~9¢ To Building Foundation /~ ~ Lot ~ '~' / To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line /'g2 z To Existing or Abandoned System on ; On Adjoining Lots '~'~-/~)~ ' To Cutbank (if present) ¢- /.~9~ LIFT STATION Date Installed Size in Gallons Dimensions Manhole/Access (Y/N) "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments "Pump Off" Level at Vent (Y/N) )/' Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request **. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company MOA No"~ Receipt No. ¢~O/¢"¢ (~"~ ¢')'~) /'"/5/~_, Date of Payment ~ %::~ '~' ~¢l¢'¢j~ Amount: $ 4/70, ~ Page 2 of 2 72-026 (11/84) ~¢ , ~*;" Robort D. Schilling ~('~ ,% CE.1411 Seal CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. /"j~,.,,~. ~.%~ 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ~.~.,,,~ FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BE SAMPLE fez Wozk Ordez $ 7466 Date Repo~t Printed; 3UN 28 S8 ~ 09:14 Client Sample ID:Lll, E1 SUNDI LAKE PWSID :UA Collected JUN 27 88 8 11:00 ?~. Kecelved JUH 27 88 ~ 11:30 h~s, ?seserYed with :4 OEO, C Client Dame : GDOD~,~N, ~OGE~ Client Aoct : 6OODRC P.O.$ NONE REC'D Req ~ O~dezed By : Analysis Completed :JUN 27 88 Laboratory Supervisor :STEPHEN C. EDE Released By : Send Repozts to: i)GOOD~91I, ROGER Special: HoLD~O~ PiCK NP, CALL UPON CONPLETION 349-5552, Instruct: Chemlab Ref ~: 1542 Lab Smpl ID: 1 Matrix: Wat~= Allowable Paramete~ Tested Result/Units Method Li~ts NITR~TE-N ND(O.iO) m~/l EPA 353.2 10 MUNICIPALITY OF ANCRORAGW DEPT. OF HEALTH & ENVIRONMENTAL PROTECT ON ~JUN 3 0 i988 RECEIVED Sample t~OIlTINE SAMPLE Re~m~ks: SA~4PLB COLLECTED BY NOLY Tests Pez£ozmed See Special Instzuctions Above UA~Unavallab].e None Detected ** See Sample Remarks Above Net Analyzed LT-Less Ehan, OT-Greater Than