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HomeMy WebLinkAboutSTREET-SHERMAN LT 2Onsite Rk (Rev 05/02/18) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: 017-101-50 PID Number: OSP 191353 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ■❑ Upgrade Name RHONDA STREET ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 5660 EAST 142 ND ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot STREET-SHERMAN LOT 2 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 100'+ 50'+ TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity GREER 1250 Gal. Surface Water 100,+ Material PLASTIC Number of compartments 2 Lot Line 10'+ NA Foundation10'+ LIFT STATION Manufacturer Capacity Remarks NEW PLASTIC TANK Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034Tank to 3034 drainfield Installer MIKE N ANDERSON, P.E. Drainfield CO/MT 3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 100 ft Inspection 15' 8/15/19 Location and description nd dates:2 CORNER OF BLDG SIDING 3`d 4'h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date ��°F°,' ,ow `i.•� ' '�'¢w'9' :49TH •,,f� � . o ..... a . e s e. o e e o .. s• -+ V • MICHAEL N. ANDERSON :,�_ A0 Septic System Approve - Date ^�� �••• CE- 4 • �����,,•, .•��'�� y l Note: this approval does not include well permit requirements. t,® RQ6t$510"�� (Rev 05/02/18) Permit No. OSP191353 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: STREET—SHERMAN LOT 2 PID No.: 017-101-50 MARK A B C01 13 22 4:991 15 20 TCO2 20 20 CO2 21 23 CO3 21 21 C04 22 20 0 OF IDING\ —TCCool, I � �CO2 CV > WELL 1 1 L / ASBUILT SCALE: 1"=50' LOT 1 1250 GALLON PLASTIC TANK LOT 2A LOT 2 i I I I i rCoi �TCo1rCoz �CO3 �C04 *'670k k YA F ;Caz q I �� , . AV AV ® 49,H \ ®® g 1.15010 T11 1 00 ......... ....................... s P250 GALLON ........................... p 8 pV® •:,MICHAEL N. ANDERSON.-, d NO. C:- 9,169 ; AW SEPTICS CTION.TN ®® ® E%\ , Municipality of Anchorage Page of Z 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 O/5Z 6/--7/0/2-¢ Permit Number: oSUJ9 PID Number: Name: T Dmta5 C, W .� l3�2�jf� re.4^. $u l�� T Wastewater System: ❑ New Upgrade Address: 5&�o E, ��-z,�a� A -✓G GI95/Cv ABSORPTION FIELD Phone: ooms: No. V42 cap Trench O Shallow Trench 1:1 Bed ❑Mound 1-1 Other LEGAL DESCRIPTION Soil Rating: C2//�� Total Depth from original grade:� Y�GPD/S . Ft. Block: nn / Subdivision :�C / LI T M7�sd STC-�K�- Depth to pipe bottom from original grade: J. 5Ft. Gravel depth beneath pipe Fl. Township: Range: Section: Fill added above original grade: ! Gravel length: 5' Y O - 0.5 Ft. Ft. WELL: El New El Upgrade Gravel width: �/ Number1of lines: / Distance /ween/nes: 0 Ft. Ft. Classification (Private, A.B,C): Total Depth: Cased To: Total absorption area: Pipe material: 7-610 ��tC %�l�' �L)kl �. Ft. Ft. y,5 Zl: SQ. FI. AS 7-7—/ V 5 54— '0 Driller: Date Drilled: Static Water Level: Installer: /� G�Nl7r&'i_5 Date installed: ` v/OZI173 Ft. -ce)JS77z Yield: Pump Set at Casing Height Above Ground: TANK GPM FL Ft. SEPARATION DISTANCES opticC,5,Xl' 5 -r> Holding ❑S.T.E.P. To Septic Absorption Lill Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer lines /z5a Well �O I � ID�'r 1-- ZS -t- Material: c�!�E� Number of CErlpartments: Surfac I� I6-2�14- — — ' LIFT STATION Watere Lot/ ,t / r. Size in gallons: Manufacturer: Line -to r Foundation 10 ..Pump on" level at: P off' level at: High water alarm at: 1 Curtain1/ '-- �o^)t 1 ak el Pump Mod I Electrical Inspections performed by: Drain BENCH MARK Remarks: Location and Description: Assumed Elevation: O ENGINEER'S SEAL S 8, S ENGINEERING 17034 Eagle River Loop Road, 93 t if Inspections performed by:tza s e KlVert Alaska 99577 2nd Department of Health an' Hum n e, ces approval Reviewed and approved by: 72-013 (Rev. 9/91) MOA 25 v E� E N d' r Permit No. SW930152 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: I LIAMNA ACRES SUBDIVISION, TRACT 2B PID No 01710124 72-013 A (Rev. 9/91) MVA 25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930152 DESIGN ENGINEERS & S ENGINEERING OWNER NAME:SWEAT THOMAS C JR & BARBARA C OWNER ADDRESS:5660 E 142ND AVE ANCHORAGE, ALASKA 99516 PARCEL ID:01710124 LEGAL DESCRIPTION: ILIAMNA ACRES TR 2B LOT SIZE: 49601 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 1 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 6/11/93 EXPIRATION DATE: 6/11/94 r7 6� l 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: RECEIVED BY: C Gt DATE: CQ I 0 [ 9 3 ISSUED BY: Q.'at DATE: 6 -- // - '�; HE ROBERT SHAFER, P.E. ROGER SHAFER, P.E. y� J CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 S/LSU/lsu STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Municipality of Anchorage HEALTHAUTHORITY DEPARTMENT OF HEALTH AND HUMAN SERVICES APPROVALS 825 L Street Anchorage, Alaska 99501 SEWER & WATER MAIN EXTENSIONS REFERENCE: Iliamna Acres Subdivision, Tract 2B SEWER &WATER Request you issue a permit to upgrade the septic system INSPECTION serving the four bedroom house on the referenced property. The existing septic system was designed for a three bedroom capacity. The property Owner's have requested the existing ENGINEERING STUDIES AND REPORTS stem be upgraded to four bedrooms. The one bedroom system Pg upgrade will increase the septic system capacity to four bedrooms. Therefore an alternate site has been depicted on the attached site plan. WELLINSPECTION &FLOW TEST Two test holes were excavated and percolation tests were performed in the area of the proposed upgrade. Attached is the proposed upgrade design. SITE PLANS We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic upgrade. ROAD DESIGN If you have any questions or require additional information for your review, please contact us. Sinc rely, SOIL TEST o t A. Shafer, P.E. PERCOLATION TEST S/LSU/lsu STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1,. = 5Q' UPGRADE [}p. SCALE m a P 9 Ctt V DO m > D z r r OA I � r 7 I � 1-3 n a � ► o � P a� 7 tom] CD -- �.o C m y z I Z, ------------------- �--- z F, ----- — I \ W r x zo I \ i ppsi a W r 9CIA 111 V Ti �n ua- OOC) Cn�Of rrl N rO� \moo Z rri m rn II D rO m a II o II ri On II o it `i'ur, �2 poo m u q -7Q 0 V (ZI C7 D O 0 p r� m m ,p o � 9 , Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES, , 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOC — PERCOLATION TEST PERFORMED FOR:DATE PERFMED:•/'- LEGAL DESCRIPTION:" T/iil a-I'I 1' -]Township, � Township, Range, Section: DEPTH �Gk-6:'r ?r'{/ SLOPE SITE PLAN ,(EE T) N 2 3 a� �,rl 4 5 f( 6 7 8 L" 9- V /YI 10 WAS GROUND WATER ` ENCOUNTERED? I` -D f S 11 L IF YES, AT WHAT O 12 / DEPTH? E ' E geplit to Water �tle{� 13 Monitoring? J./1�Date: 14- 15 j 16 -??.D.4 17 18- 19- 20- COMMENTS 81920 COMMENTS PERFORMED BY: S & S ENGINEERING 703�h*iver Loop R< ACCORDANCE WITI-&WjjrAKpa1Pft 72-008 (Rev. 4/85) mmmmm�- a 011 PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND e5 FT CERTIFY THAT THIS TEST WAS PERFORMED IN ECT ON THIS DATE. DATE: ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Iliamna Acres Subdivision, Tract 2B GENERAL: 1. The scope of this project includes the installation of a leachfield trench to serve the four bedroom residence located on the referenced property. The existing septic tank is to be excavated to verify integrity. If of poor integrity, the tank is to be abandoned and a new tank installed. 2. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page Two Iliamna Acres Subdivision, Tract 2B June 4, 1993 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed - up) before gravel (sewer rock) placement. 2. once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page Three Iliamna Acres Subdivision, Tract 2B June 4, 1993 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, it's gradation specifications must conform to AMC 15.65.060D. Page Four Iliamna Acres subdivision, Tract 2B June 4, 1993 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. 72-013 (1/91) MOA 25 Municipality of Anchorage Page —�_Of Z DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 i Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SlxJ 9 2 Z PID Number: eb l I 1 © 1 2,q Name: Wastewater System: ❑ New �/19Upgrade Address: th ABSORPTION FIELD 20 o Phone: 35 Sg I No. of Bedrooms: peep Trench ❑Shallow Trench ❑Bed 11 Mound O Other LEGAL DESCRIPTION Soil Rating: Total Depth from originalgrad: l GPD/Sq. FL �c� 2 Ac. Block: —r^Subdivision: Depth to pipe bottom from orig/i�naI grade: Gravel depth beneath pipe '�J yAcres/ ' Ft. r Ft. Township: Range: Section: Fill added abovepriginal gryde: I Gravel length: ./ n-2, Ft. S� Ft. WELL: 11 New ❑ Upgrade Gravel deptrl k t Number of lines: Distancebetweenlines: I VJIt Ft. l t) Ft. Clas ' tion (private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: e5to Ft. Ft. SO. Ft. y, r Driller: Date Drilled: Static Water Level: _ In alley_ T Date in talied, I Ft. J Yield:Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Litt Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines 2j45�-0 Well f I � � I I T Mate ial: Number of Compartments: Surface rfa e / LIFT STATION WatLott 001k pork Size in gallons. ufacturer: Line bI� � Foundation 4,7,t "Pump on" level at: 'Pump off' level at: i h water alarm at: Curtain Pump Make & Model Electrical Inspections performed by: Drain Remarks: BENCH MARK Location and Description: Assumed Elevation: b ENGINK. > FAL . `" ` Inspections performed by, S & S ENGINEERING Dates: 1st 17034 Eagle River loop Road No. 2A42nd ° Eagle River, Alaska 99577 p C. r Department of Health d m n Serv' s approval Reviewed and approved by: Date: 72-013 (1/91) MOA 25 SU •411 n v ti u Permit No. Page 2- of � Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 9 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: IWAMWA ACggf;) -r!Z 26 MAR I "-10{ M N PH) Kin - � 1 .7-4 4ekV6 00 W E�YJA!rrIQ6i 12*0 4A(" SeXlrl C" -rm � l� PiD ve� I // = 56' 01 00 C06 G� Mr A 40) 6:0 er);� 14e 121 -34° 4V �! 42,± W E�YJA!rrIQ6i 12*0 4A(" SeXlrl C" -rm � l� PiD ve� I // = 56' PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910227 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:CREED JOHN H & OWNER ADDRESS:200 WEST 34TH AVENUE #1100 ANCHORAGE, ALASKA 99503 PARCEL ID:01710124 LEGAL DESCRIPTION: ILIAMNA ACRES TR 2B &L)b-n �: no DATE ISSUED: 8/02/91 EXPIRATION DATE: 8/02/92 LOT SIZE: 49601 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PRr"'raTnnic• RECEIVED B' ISSUED BY: DATE: o I DATE: w _ / H A HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS m M JuZy 24, 1991 A`P5F P Mun.icipaPity o{y Anchon.age DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Stn.eet P.U. Box 196650 Anchamage, A2a61za 99519-6650 REFERENCE: Tn,ac,t 28; Ttiamna Acnes Subdivision; PERMIT REQUEST NARRATIVE ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Request you t66ue a pen.m.it {yon. the upga.ade o6 .the on -,site wa6.iewa-te+c di6po6a2 system located on the n.e{enenced pnopenty. The upgnade o6 -tki6 6y6 -tem wilt co"i,s-t p& ma&ity o6 adding an addi.tiona2 -tAench panattet to .the existing -tAench. This additional ab6omption area .i6 nece-66any since the existing abs mption an.ea 6aited an adequacy tut. A condition o6 .the permit w.i2t atso Lequ,i&e an existing 1250 gatton septic tanlz .instaX2ed in 1982 to be excavated to vet i6y .its i tegn ity. Thi -6 i.5 a tan.ge tot (ove)L an acne) with gen-t2e Stopes. The upgrading o6 this sy6-tem wilt not have a n.e6tlLictive e64ect on the miLounding pn,o pentie6 . IU you n.equ,in.e additi.onat in6owation, ptean contact u6. S,incen.ety, ROAD DESIGN L ROGER J. SHAFER, P.E. SOILTEST RJS/gm PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 5, a. 1 ^(ENCiIKIEER'SISEA, /,+ cA y l: Municipality of Anchorage r DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 , ' °' ° ° ' ' • ` SOILS LOG — PERCOLATION TEST �J,•. a'x,c ,t�; `;' ^ Q PERFORMED FOR: v/t%,Opi Qn ,Q / DATE PERFORMED. �• +� LEGAL DESCRIPTION:/[ C 7_Z - '//9/44/19 Township, ange Section: R�P� 1:.14 e (LG 2 '�•� 5M CQRoG�.v) 3 4 r r 5 6 � t• 7 8 t, 10 �t 11 C < t/ 12 13 14 15 16 _. 17 18 19- 20 COMMENTS Sn4 60/y, IVO e, 2 TV SLOPE V WAS GROUND WATER r� ENCOUNTERED? et rop S IF YES, AT WHAT L DEPTFI? _ P E Deplhto Walcr At MonitorinA7 � Montt Dale:7 !3 j SITE PLAN Reading ate Gross Time Net Time et rop 5 o q ✓� f� t.. r= 1 (0 0 o �j HaZ„EaJ Z 412 °�� y„ #?/ orpPERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT PERFORMED 817034 EagleRiverLoop Road NO, Za4 C r I — CERTIFY THAT THIS TESS.TT WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON IS DATE. DATE: 72 -DOB (Rev.4/B5) '• (Et3�iINEER'S SEAL) y Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES y^ Y• l U L (1 1 1 t. C 1 , i 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:6`L'`'p,��'^t�.?@,;•'�`"�,� DATE PERFORMED: , /Qn %� _/^/ Nnn/ 4G(Z LEGAL DESCRIPTION: %/t /'� 7-G � TZ4 b9,�'/'✓ � Township,�ange, Section: MEPT44 /� b 2 SLOPE SITE PLAN 3- 4- 6 4 6 � << 7 8 � t w F � 10 ( 11 12 / 13- 14-, 3 14 _ 15- 16 5 16 17 18 19 S+J1 8-0-P, FOR M , l30/-/, lvo . 2 T—o E". 10erAN NOISE ■W■■ ■■I■. ■■I■■ OMEN WAS GROUND WATER /10 ENCOUNTERED? S L O P E ?j3�jl IF YES, AT WHAT DEPTH? Depth to Water At Monilorii Date: Reading ate Gross Time Net Time Depth to Water Net Drop Z-'/0 Z " 3 2' 3Q 7 0 ! 2" vo !o 8 " ! Z n S Zi 12/0 7 7 7 �'r g ., 20 I� // PERCOLATION RATE Z/7 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND `� FT COMMENTS 17024 Eagle River Loop Road No, 204 1 PERFORMED % r Alaska 99577 A4 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON IS DATE. DATE: 7" 72-008 (Rev. 4/85) ALASKA ENVIRONVcNTAL CONTROL SERVIC. , INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561.5040 JOB SHEET NO OF CALCULATED BY DATE CHECKED BY DATE / SCALE y/S PROXV2'41'kcus m: G,01� Veu 01471 MUMeiaq , DePT j1' OF ANCHO �NVIRpN NTgl F R9T a or RECE'VED MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION v ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME -T T—_- PHONE ❑ NEW I/1 Vl Q {�'. C YVI��-� r r -A C--(t(� ��1"( _���, EJ UPGRADE MAILING ADDRESS pc) LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS DISTANCE T0: WellAbsorptioi re Dwelling 6 PERMIT NO. w Q Manufacturer M� No. of compartments to ~ Liq. carar,.j _woallons IF HOMEMADE: Inside length Width Liquid depth J C7 Z DISTANCE TO: Well Dwelling PERMIT NO. O Z Q T H Manufacturer Material Liquid capacity in gallons 9 J S w - DISTANCE TO: We C UO �- Foundation Nearest lot ii e(' , �CJ PERMIT NO.C- O c� (� SJ LU ' Z w No. of lines Length o each line .z Total length f lines _ _ Trench 'dth („� inches Distance between lines FTop O of the to finish grade Material beneath tile inches Total effective -I)ssso'rRtion area U L? Length Width Depth — — PERMIT NO. C7 Q 1- LU— Type of crib Crib diameter Crib depth Total effective absorption area w `n DISTANCE TO: Well Building foundation — Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHERPIPE LEGAL MATERIALS T-TF SOIL TEST RATING NSTALLS VILA 4 REMARKS T r Ir r AP ROVED DATE 72 -OM (Rev. 3178) �� I �U,i �1-9 1 2: - W - No ITA 1�" I A N c; W A Film My 0� DEll Fat TMENT HEHLTH HND ENVIRONMENTHL 101E2TION STREET, HNCHORHGE/ HC 99591 J 264~4720 K\L> !!^���� .. , M Q Kit py8--- 57 1 71- K--.�� E�::K^1 11::4�;�: F::::�, 11 1!, 8 V PERMiT NI ( 820554 ) HPPLICAN- DHNNHR CONST INC 9]81 POKEY CIRCLE ]49�2]86 LOCHTION LEGHL TR 2B ILLIHM�H ACRES LOT SIZE 99999� SQUHRE ���T TYPE OF SOIL HBSORPTION SYSTEM IS� TRENCH MHX�MUM NUMBER OF 5OW RATING (SQ 1:1/BRW" 14k) THE REQUIRED SIZE OF THE SOIL HBSORPTION 5YSTEM IS: �M Q - V, 1-1= in, �M 01 (3 -1- 1-1 — ITT .20 �Fit VON "N' IE��.: A THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H MENCH OR PIT IS THt OF THE GROUND OND THE B8TTOM (AF THE EXCHV�TI0N (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GHHVEL �ETWEEN THE OUTFHI-L PIPE HND TiE: BOTTOM OF THE 1 1,)N (IN FEET). V:-�!! 11 p__11 J: ��-1 - :1 o117 W 501 N l< ��... �cy 6414:: PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEP1,:1RTMENT D' THE INSTHLLHTION INSPECTIONS OF RNY WELLS RDJHCENT TO THIS PROPERTY FRAC- THE NUMBER OF RESIDENCES THHT THE WELL WILL SERVE ���� ��� ����������� ���� �������� ~�� LA IMA OF MAY SYSTEM WITHOUT FINHL INSPECTION HND HPPROVAL BY THIS DEPHRTMENT WILL BE �UBJECT TO PROSECUTION MINIMUM DISTHNCE BETWEEN H WELL HND HNY 0*0I1E SENHGE TEM IS 100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PU8LIC NELL MINIMUM DISTHNCE FROM H PRIVHTE WELL TO H PRIVHTE SEWER LINE IS 23 FEET HND TO H COMMUNITY SENER LINE IS 75 FEET NELL LOGS HRE R�QUIRED �ND MUST BE RETURNED TO THE DEPHRTMENT HITHIN ]0 DHYS OF, THE NE -11. COMPLETION OTHER SPECIFICATIONS HND CONSTRUCTION DIHGRHMS HRE HVHILF1BLE TO INSURE PROPER INSTHLLHTICIN. 5000014 1: W 12 X A"! 1� EE�:� AD; Q Q M 11 Ely AIR: FA': 12: I CERT��Y THHT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS HND NELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHOR��E 2� I WILL I 1 ,".11 1 THE SYSTEM IN HCCORDHNCE WITH THE CODES. ]� I UNDERSTHND TH ' TW UN~SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESID�NCE IS RE�ODEiED TO INCLUDE MORE THrIN ] 8EDROOMS SIGNED�... ..... ._..... .... ~.~~^~~~^_~�~��-~~~~~_-~~~~-~�-~�~ APPLICHNT DHNMHR CONST 11!C V4� 0 / •1 t��,`r'Fn;417';i"".•1r lj=" g-iri'#I_!"tf :iPl�i YFJ'+tf>�r;d•(!•1<<t•fg'#=3f_ �`RFeaf'>�ly('EJj(d ' � ,-� � _ .� g"}S:`...:: i s f�#'11�:-}i_I�i'tJ]•—. • i't}+ ''S''{�,���5 3 - rir�- -`x _ f J:f 1t•f t' t.�r�ftdtiFt 3.. 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Ct r7C� _:i'Ftt 7r;�T 1HE Jltti _:t,,_ 3:t,-..? ,�1r:fI T'ttir ,:•_J:Y_FIR1 ttJ.ti. �.-ig•--.iF £, f'!i•._ r __fl):�,t'1!�`• f'� i -:±.M lJ_s�%'.#:.r IF fJ.l It#1 :i ,I 11 '�+.--'- 1'IJ1ii1� T!•li�!'�i � !_ ii;?r 7t-)#'#' 1tdf_?;t� i' A A �y SOILS LOG MUNICIPALITY OF ANCHORAGE PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION �v\;�1}yr� II TEST 7/'J 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: A/1 C-0 DATE PERFORMED: ' - r't 7 , SLO LEGAL DESCRIPTION: ���''�/�/c7iJ c ll/ � �F.n.-� � SLOPE SITE PLAN OStidy C.-1 2 3• 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 ���f`� S•l(1,r eSnJJCI COMMENTS C_= iC PERFORMED BY: �1T ✓`t ��= 72-008 (6/79) WAS GROUND WATER S ENCOUNTERED? ct L O P E IF YES, AT WHAT r`/o DEPTH? PERCOLATION RATE ✓ (minutes/inch) TEST RUN BETWEEN /Z-- FT AND FT � r CERTIFIED BY: DATE: i� Reading Date Depth to WaterDrop�l7 NetTime WGrossNet r`/o I-0 ' i . � 0 -t 0 .2. - 1 33 3.3 3 r PERCOLATION RATE ✓ (minutes/inch) TEST RUN BETWEEN /Z-- FT AND FT � r CERTIFIED BY: DATE: i� Reading Date RETURN TO: Division of Geological and G yslcal Surveys (DGGS) 3001 Porcupine Drive (Tele, 277-6615) Anchorage, Alaska 99501 W A T E R W E L L R E C O R D Vern' s 1)rilling Drilling Company Name pi.— either la, ib, or Ic. U.S.G.S. Local No. Drilling Permit No. A.O.L. No. STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES LVUAI torr yr nu.l Ia. BoroughIubdivision Lot Block Ib. Fraction Section No. Township Range Meridian .�1 a111na �.ra j. 2 / / N/S E/W Ic. Distance and Direction from Road Intersections 3. OWNER OF WELL. Address: Danmar, buihld.er Golden View Area Street Address and Area of Well Location 2. WELL LOG� Material Type Feet Below Surface 4. WELL DEPTH: (completed) 1 46Comple�t^�ifon Ft. Surface Elevation Date of T Top Bottom ro wn Silt till � 0 5. ❑ Cable tool ® Rotary Q Driven El Dug ® Auger I_J Jetted ❑ Bored ❑ Other: s o ppy Sl _ �~ sl y -grave - seepage L - - 6. USE: ElOomestic Public Supply Industry ❑Irrigation ❑Recharge ❑Comcerc Ia1 []TeSt Well ❑Other: r-� 6 si. y grave.- - seepage _ 5 11.0 cemen ec. grave._ - _w enses 140 1 -- 7, CASING: — Threaded UAIded 6 in. to 1 4 5 1f t.119d}h Weight lbs/ft. in, to ft. Depth — ---� ^A - 8. FINISH OF WELL: Type: _ Diameter: Slot/Mesh Size: _ Length: Set between ft. and ft. Fittings: ve - — - 9, STATIC WATER LEVEL: L)1 ft. [] Above Below land surface Type of Measurement: 10. PUMPING LEVEL below land surface r7 ft. after hrs. pumping r _ 9•p•m• ft. after hrs. pumping 9 -P.m. �e..�. 11. WELL HEAD COMPLETION: In Approved Pit ® Pl Lless Adapter inches above grade --- 111, TTY OF AN - 12. GROUTING: Well Grouted: ❑ Yes No Material: []Neat Cement ❑ Other: •{y {cn:=GPS-- ,:_ n" CFnT Cr =r ON -- 13. PUMP: (if available) HP — 2 Length of Drop Pipe ft. capacity 9.p• Type: ❑ Submersible []Reciprocating 11 Jet ❑ Other: 14. REMARKS: Water Temperature: ENVIR'M;. ''r �� - - 15. WATER WELL CONTRACTOR'S CERTIFICATION: This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief: Vern's Drilling & Ent AA 3327 Registered Business Name Contract License Number- um erAddress: 1//224.1 Aviom Street, SRA Box 1560 Anchorage Alaska Address: Signed: Date: Authorized Kepres ntative Form 02-WWR Copy Distribution: WHITE - State DOGS, PINK - Driller, CA14ARY - Customer Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax.- 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-101-50 Expiration Date: 1. GENERAL INFORMATION Complete legal description STREET-SHERMAN LT 2 Location (site address) 5660 E 142ND AVE, ANCH AK Current property owner(s) RHONDA STREET Mailing address SAME Day phone Real estate agent Day phone f.. 2. TYPE OF DWELLING:' y r=te a Al 0 Single Family (w/wo ADU) L6 - ❑ Duplex) '> ❑ Multiple Dwellings (Single Family and/or Duplex) �_ J 3. NUMBER OF BEDROOMS: 4 �gi01�1� 4. TYPE OF WATER SUPPLY: TYPE OF W T OSAL: Private Well ❑ Private Water Storage ❑ Holding�`'�J Community Well ❑ Commu ❑ w Public Water System ❑ Public S e� ❑ �Q> Z� OL 6/ Waiver request for: Distance: Received by: zAmv/t, Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ _N6 Date of Payment Z) IQ l (9 Receipt Number 2u I (01(o COSA # 46CM 13t2q Waiver Fee $ Date of Payment Receipt Number Waiver # 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, 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 8-18-19 0 Fa 6. DSD SIGNATURE '-' ' 49gH e' + �� `...... . e.• e e e e o •.• e o. e• r{ System #1 Approved for 4 bedrooms /....................... MICHAEL N. ANDERSON e System #2 Approved for bedrooms � �, CE-949ZP .e\ Disapproved F4� °�.y�+�'i\� PROFFSSt�t� Conditional approval for bedrooms, with the following stipul����° 1� �� y: � tom+--�C— Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other 61> n� JO�Y��T"Jjr� //l oxo 1� �� y: � tom+--�C— Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other COSA Checklist Legal Description: STREET-SHERMAN LT 2 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ■❑ Well log is filed with Onsite (or attached) Date drilled 811982 Total depth 146 ft Cased to 145 ft 0 Sanitary seal is functioning correctly ❑E Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 7/25/19 Static water level at beginning of test 65 ft. Comments B. TANK DATA Age of tank(s) 0 years Tank type/material PLASTIC Measured operating fluid level in septic tank NEW ❑■ Standpipes/foundation cleanout per record drawing Date of pumping NEW TANK INSTALLATION Parcel ID: 017-101-50 of Structure served by this system D. ABSORPTION FIELD DATA 1991 SYSTEM TESTED Which system tested (date installed) 9 -t 2,,-q W ALL standpipes present per record drawing Total measured depth from grade 10.5 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field OF Monitor tubes go to bottom of effective. If not, state depth into effective ■❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 4+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes No ■❑ Coliform bacteria is Negative Nitrate 6.46 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑t Arsenic less than MRL (ND) Collected by MNA Date of Sample 7/25/16 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 7/25/19 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 25 in Water added 600 gal New depth 48 in Elapsed time 1440 min Final fluid depth 24 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date UN E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' F71 Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft Q Yes if No Neighboring Tank > 100' El Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' 0 Yes if No [Z] Yes if No ft if No ft If septic tank is under driveway ft ft ft ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' M Yes if No ft r,/1 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' F71 Yes if No ft Surface Water > 100' a Yes if No. Property Line > 5' El Yes if No ft Wells on Adjacent Lots: El Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ✓� Yes if No. Water Main > 10' F-71 Yes if No ft Community Wells > 200'✓0 Yes if No. Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' U Yes if No ft If absorption field is under driveway comment below Property Line > 10' 7 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' El Yes if No ft Community Wells > 200' ❑✓ Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS All / 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. COSA Checklist yellow sheet 0-1 a•�� ,} P •eo ems �.�.♦. oe.s..aem.¢,j v% MICHAEL N. ANDERSON ;4`= �< CE -94¢4 A (J SFMk��� ft ft ft ft ft V1 T Nitrate Advisory Certificate of On -Site Systems Approval # OSC191384 Subdivision: Street Sherman lot 2 -i..:. t •�I. A water sample revealed a nitrate concentration of 6.46 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. h a4�tfa�>[nb►ddre�sOBo3,19�0 * gn�hc�ragmetlaska9566iiuv�m'x -R, ' W1111iM, a d . a� r rzor T 142nd AVENUE � o S 89'56'36"E 247.53' — — - • - RETAINING WALL 42.7' ,�.. •ASPHALT• ..:.•.. .2 •5 s PAD' . ELL :3z. a -PN / �• �"•. 258 Q��N SEPTIC PIPE O�G� z 00 :•''265 2.0' CANT— °' SEPTIC PIPES o y LOT 1 CANVAS o QUONSET HUT O ! 10.5'x12.3' SHED 5��i Ci �— ;``, MANHOLE SEPTIC PIPE--- CHAIN—LINK FENCE LOT 2 74,406 s.f. UTILITY, T&E EASEMENTS N 89'57'38"W 247.42' TRACT 3-1 LOT 1 DEN WALKWAY —2.0'x8.2' CANT izz \ LOT 2A `—I 3.0'x12.2' � (n GREENHOUSE o U% 0 0 Lni a M w 0 0 W LOT 2B PLOT PLAN AS BUILT 2 SCALE 1" = 50' GRID SW 3037 Project No. 19-372/R2 q, 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 La n & A s s o C i a f e s inc. (907) 522-6476 Phone (907) 522-4625 Fax Professional Land Surveyors kenOlongsurvey.com d 0 F q Op Jonathan 0tongsurvey.com 00'`� '' I hereby certify that I have surveyed the following described property: LOT 2, STREET—SHERMAN SUBDIVISION (PLAT No. 2005-18) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the k0l' Da of /,-Gr ST Z -off Day S , at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. '* 49TH y*� KENNETH LAN Z,ocr LS— 20�.-' S OG 4 • yQ�R�FFSSI0NA1- � Q� AECC963 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section -P.O. Box 196650 Anchorage, Alaska 99519-6650 - 843-4744 Location (site address or directions) ­­k�'.­— .4"Mailin ss bLe lain cy Mailing add`reis­sL' Agent Address s Sweat 5660 E. 142nd Avenue Day phone 345-0960 East 142nd Avenue, Anchorage, AK 99516 Day phone Day phone Individual well - AAA 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 WASTIEWATER-DISPOSAL: Individual on-site XXX 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-M (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 system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING Name of Firm ii0i4Ea0laRiVf-r1nn0 oad-NOW204 Phone roolq )-c179 Eagle River, Alaska "577 Address Engineer's signature 'Date A OF - 'Ar _6 SE ROBERT C. COWAN JAP 6. DHHS SIGNATURE CE -8801 ile 7. Approved for bedrooms. Disapproved.' Conditional approval for' bedrooms, with the following stipulations: Additional Comments 0 Date --- _3 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 donot 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-MS(Rev.1/91) Back MOA #21 RECEIVED Municipality of Anchorage AUG 17 1 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUNICIPALITY OF AN 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907)E39,qTALSER`rIC q� Health Authority Approval Checklist Legal Description: _T s', /1 �_ 13 i Ll q,,, �j 4 A! C� 2 r S Parcel I.D.: G / ? A. WELL DATA Well type PP, 1,414 T E_ If A, B, or C, attach ADEC letter. ADEC water system number Log present Y)N) Y , Date completed S % S Total depth 1 H Q Cased to i - S Casing height (above ground) Sanitary seal &/N) Date of test Static water level v dL f FROM WELL LOG Well production WATER SAMPLE RESULTS: Coliform U 7 Wires properly protected C/N) AT INSPECTION i/713/"j Nitrate a , /;, "l s J (, S_ S! g.p.m. Other bacteria C) Date of sample: 7 / -Q1 / 9 `f Collected by: S & S ENGINEERING 17034 Eagle River Loots Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed 7 I `5 Tank size 5-0 Number of Compartments Z Cleanouts &N) Yf J Foundation cleanoutY,/N) Y 4- J Depression (Y/@ nj V High water alarm (Y/16) ^' Date of Pumping 7 b''(- /'� `) Pumper 4 t 1- ,a r, L s h, t %',P 4 s C. ABSORPTION FIELD DATA Date installed . �/ i t C3 Soil rating g. /dp ft or ftz/bdrm) System type J Length 1 cl 'i>_ Width 3 Gravel thickness below pipe C ��- Total depth -) s y Effective absorption area F3 `12- / �4 Monitoring Tube present( /N) /10 Depression over field (Y/@ Date of adequacy test 7 -3 / 9 Result (Pas�Fail) A For V bedrooms Fluid depth in absorption field before test (in.); 0 /Zy Immediately after('G gal. water added (in.): 6 1 Fluid depth 1 3 3/ti (ins) Minutes later: 1:R Absorption rate = 6 0 u -) g.p.d. Peroxide treatment (past 12 months) (Y/N)�" C rz- 1t ` 1� -I- If yes, give date 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* "Pump on" *Datum Size in gallons "Pump off" level at* Cycles tested' E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot I ©0 On adjacent lots '4 Absorption field on lot �' r On adjacent lots D J # Public sewer main N �� Public sewer manhole/cleanout Sewer /septic service line a 't Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation o Property line S Absorption field S� 1 Water main/service line %0 Surface water/drainage Wells on adjacent lots C '� SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / o 4- Building foundation / 0 Water main/service line ) 0 Surface water / C 0 / f Driveway, parking/vehicle storage area Curtain drain 1y a a /L K Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal in conformance with OA HAA uidelin s in effect on this date. Signature _•� Engineer's Name d l; k 2T C� w,g✓ Date S, l I s, ) ei � HAA Fee $ ' Waiver Fee $ _ Date of Payment AMP,. Date of Payment Receipt Number `r./ Receipt Number 72-026 (Rev. 3/96)* p ROBERT C. COWAN r CE -8801 are MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES T Division of Environmental Services} j 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. # CA 1 , �G11 -,Q4 NAA # IAI6�\ q 2 C-) I, �1 1. GENERAL INFORMATION Complete legal description Tnact 2B; ILUamna Acne6 Subdivi6ion Location (site address or directions) 5660 E"t 142nd StAeet Thoma3 Sweat y p rz. A Propertyowner Da ho �� 0 Mailing address. 5660 Ea,6.t 142nd AnchoAage, Ata,61za 99516 Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water Day phone Day phone 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 XX 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 MOA N21 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 furtherverify 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. S & S ENGINEERING Name of Firm Phone ��11 Address Eagle River, Alasica 99577 Engineer's signature 6. 7.DHS SIGNATURE Approved for bedrooms M Disapproved. Conditional approval for Additional Comments Date 1 C�1— \ — `�?l bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 7Ak� w��'�r--1A Parcel 1. D. Pe_, A. WELL DATA Well type'L-LljLqtr� If A, B, or C, attach ADEC letter. ADEC water system number Log presentON) \1/ Date complete/1d� �L Driller ` eR Total depth �� IG't Cased to , `� J I Casing height \,ll -A— Sanitary seal(LD 1) Date of test Static water level Well flow Pump level FROM WELL LOG � t�2 SEPARATION DISTANCES FROM WELL TO: Wires properly protected RN) Septic/holding tank on lot On adjacent lots 14 - Absorption field on lot ; On adjacent lots' t Public sewer main Public sewer manhole/cleanout A 1 Sewer service line 2S Petroleum tank C> WATER SAMPLE RESULTS: Coliform Date of sample m Nitrate Z.c� g R Other bacteria Collected by: A S B. SEPTIC/HOLDING TANK DATA Date installed 8�4'_ Tank size -Compartments�2—'D Cleanouts CON) Foundation cleanoutd�Y7N) T Depression (Y/RQp High water alarm (Y/N) Alarm tested (Y/N)®� Date of pumping I _ 6 Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well (s)onlot ���I On adjacent lots � calk Foundation �, t I To property line Absorption field a- Watermain/service line o) y Surface water/drainage (oo )+. 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE Z AT INSPECTION o ('e-,.� f z N m �' g.p.m. ¢ 1� L.0 C3 Z o 0/ �o Septic/holding tank on lot On adjacent lots 14 - Absorption field on lot ; On adjacent lots' t Public sewer main Public sewer manhole/cleanout A 1 Sewer service line 2S Petroleum tank C> WATER SAMPLE RESULTS: Coliform Date of sample m Nitrate Z.c� g R Other bacteria Collected by: A S B. SEPTIC/HOLDING TANK DATA Date installed 8�4'_ Tank size -Compartments�2—'D Cleanouts CON) Foundation cleanoutd�Y7N) T Depression (Y/RQp High water alarm (Y/N) Alarm tested (Y/N)®� Date of pumping I _ 6 Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well (s)onlot ���I On adjacent lots � calk Foundation �, t I To property line Absorption field a- Watermain/service line o) y Surface water/drainage (oo )+. 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water _ _T Date installed �"���� Soil rating r�,w !�t`I—System type::J�C 4 Length �`� Width Gravel thickness (-- 'E�1 Total depth dol Total absorption area �� Cleanouts present(jY N) Depression over field (Ye5p ' ') Date of adequacy Results (pass/fail) L165� "2-1(2-S for Peroxide treatment (past 12 months) (Y dP (-A If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1 � -4- On adjacent lots \ Property line bedrooms l o I �,— To building foundation To 0 ting or abandoned system on lot On adjacent lots �( `� —Cut bank A Water main/service line t Surface water Driveway, parking/vehicle storage area Curtain drain � Ut. & lav kllf E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA gu 5 & S ENGINEERING Signature 17034 kale River Loop Road No. 204 Eagle Rivew, Alaska 99577 Engineer's Name Date ``::)— ` —X12_ HAA Fee $ 7 -�-� Date of Payment (rir ,J/ r Receipt Number (7�dJ `� 00) 72-026 (Rev. 3/91) Back MOA 21 8 'k 5 Waiver Fee: $ Date of Payment Receipt Number -ction. MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES}i 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. # (t]l-i - lam) - _QL' HAA # 1. GENERAL INFORMATION Complete legal description Titact 213; Iti.amna Acnes Location (site address or directions) 5660 East 142nd Avenue Property owner John 9 Lynda Cneed Day phone 3 45-4881 Mailing address 200 glut 34th Avenue #1100 Ancho;tage Ak. 99503 Lending agency Day phone Mailing address Agent Kim Mc Kean RE/MAX PROPERTIES Day phone 2762761 Address 2600 Co4deva St #100 Anchokage.,-A. 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 'N' 3. TYPE OF WATER SUPPLY: Individual well XX 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 XX 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 MOA P21 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 5 & S ENGINEERING Phone Address 17034 Eagle River Loop Road No. 2e4 Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments 0 bedrooms. Date—- �� 4 7H °> ,e •>ea e o sena ror,3 �•�e> ° ;Y •'7A \n e R "GRJ �Rl RE. e t� a Cy is • d ' 15 . a p�Illkk P OFaFe' bedrooms, with the following stipulations: Date ad,411?1 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA N21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 7R 2" " j -rl' QtiA Ac Pew Parcel I.D. O 1:1 t O I Zg A. WELL DATA Well type _6 tJQ la M4 If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) 1, Date completed i3 2 Driller l eirtJ,S L r)111� Total depth _Cased to / J `� t Casing height / .2 h Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Z Date of test Z (p - .20 - C( r / v Static water level (o'� 1 �, W N Well flow g,p,m, "7 • g.p.m¢ z � � Pump level U K U !tr U Rtes z 2 a' SEPARATION DISTANCES FROM WELL TO: f Septic/holding tank on lot (DO ; On adjacent lots ( Oa Absorption field on lot 1 D 0 ; On adjacent lots / 0L) /f Public sewer main /a1lA Public sewer manhole/cleanout Sewer service line / n f Petroleum tank til 0AJ6� t( rJOW WATER SAMPLE RESULTS: Coliform Nitrate�A�i_<fAc-fio�ulcz >_l Other bacteria Z C r 0 Date of sample: Collected by: '5 -I' E � iti ePd,IIli B. SEPTIC/HOLDING TANK DATA Date installed :J -Z O- e z Tank size 12-1S-0 Compartments �- Cleanouts (Y/N) U _ Foundation cleanout (Y/N) L+ Depression (Y/N) A) High water alarm (Y/N) A) f Alarm tested (Y/N) AJI Y) Date of pumping to- 16-91 Pumper t /40AA C,*5 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot (00 i On adjacent lots l �d /I Foundation / O 'I - To property line ( D f Absorption field /O f Water main/service line / C) / t Surface water/drainage f oo t 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed _ Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water Date installed ' 9 I Soil rating (a-6;,) System type Length e Width 3 - Gravel thickness (p • `J Total depth h Total absorption area 46 Cleanouts present (Y/N) y Z Depression over field (Y/N) /J Date of adequacy test n 1/14 Results (pass/fail) NIW for Peroxide treatment (past 12 months) (Y/N) Nllcl If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ( DC �t On adjacent lots Cc �� Property line / D rt r , To building foundation O To existing or abandoned system on lot (D f � r On adjacent lots 3 D Cutbank Water main/service line ( D 'f r , Surface water 1 00 j Driveway, parking/vehicle storage area 30 Curtain drain f1i E. ENGINEER'S CERTIFICATION bedrooms 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. l� .r S & S ENGINEERING Signature 17034 Gayle River -Leet: Ito-.,; No.204— ¢� Eagle River, Alaska 99577 °"<s Engineer's Name t ° s a (i (' Date HAA Fee $ 170 ` Waiver Fee: $ Date of Payment �' J� `er 1 Date of Payment Receipt Number 7 C �'a / �3 / Receipt Number 72-026 (Rev. 3/91) Back MOA 21 J MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES In CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date�/�� 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) TRACT ZB /G1,4Mt11 4C/rE5 SCOrs�l %/Z Al 23[Al Location (address or directions) S/a/e0 J�. ly2ub (b) Property Owner _t Mailing Address d._ ephone: Home (c) Lending Institution Telephone Mailing Address Business 3y5- 789.5 (d) Real Estate Company and Agent 1=2A IfEAL`ry C EIJT>=7r % Fg0Z /t!(L Sanl Address 9 ` 00 IMOT-ZEL. 2w 9riCN02AlE �4 995-0% Telephone 3 `-14 O SO! (e) Mail the HAA to the followina address: or: Check here>rif hold for pick up. List contact person and day phone number below. OCEASE CALL- PiqV1, LJIlso>,( 344-05-01 F6Z Pr«uP 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 the legality and status. 4. SEWAGE DISPOSAL Onsiteo Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-026 (Rev 8186) Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm l�4&)_DL_nS0d CVb rA) t'(Z7LtA1G Telephone 3 7— h_?G % Address Pli, fox ZVO 77S � L-i�t.'Llfi. Ale- Date Ki AL4,c� It *p •�O e • 4 i �®,1 • fp C® doom Sao 0a0• .y I • (t✓A ,°, ..• F. Anderson • w�,� 9 S Micheel i • A361 • E ; •,��' j 6 41 PROFC.SSUy,�v`°� a DHHS APPROVAL Approved for 3 bedrooms by Date Approved —2 Disapproved Conditional Terms of Conditional Approval c�hhs CAUTION Engineer's Seal The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (Rev 8 86) Back ,G�peNGICIPALITY OF ANCHORAGE (MOA) 0 P� \`ASO HEALTH AUTHORITY APPROVAL (HAA) ��v�t 4ScQ t CHECKLIST - FEBRUARY 1984 J���c>`v 1°�� 264-4720 _11) Legal Description: .9C.e4!FS o c;[ .Sear- 3y TlZN A. WELL DATA Q "� Well Classificationge/VAt'F— If A, B, C, D.E.C. Approved (Y/N) _ Well Log Present (Y/N) __ Date Completed f��, Total Depth /4/(0 ' Cased to IVY" Depth of Grouting A10"VE ��� Static Water Level 651 31, Pump Set At A/oT D6T� erniyeD Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) j' Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots To Nearest Edge of Absorption Field on Lot On Adjoining Lots To Nearest Public Sewer Line ,SEVERAL m, (ES To Nearest Public Sewer Cleanout/Manhole SAme_ To Nearest Sewer Service Line on Lot 81' Water Sample Collected by W M4;:"ADD EM Date "So a Water Sample Test Results SAr,54TAc70 Comments 191E B. SEPTIC/HOLDING TANK DATA Date Installed 7`90`8Z Size /Z 50 No. of Compartments Z Standpipes (Y/N) y Air -tight Caps (Y/N) tet/ Foundation Cleanout (Y/N) V Depression over Tank (Y/N) Al Date Last Pumped 9-/` Pumping/Maintenance Contract on File (Y/N) y ; for Olfs Holding Tank High -Water Alarm (Y/N) Al _ Temporary Holding Tank Permit (Y/N) AlyA Separation Distances from Septic/Holding Tank To Water -Supply Well zoos To Building Foundation 06 To Property Line �d 74 To Disposal Field /6 To Water Main/Service Line Course 1, DOO' To Stream, Pond, Lake, or Major Drainage Comments 59P IC TAtlkL 1.5 40eQ0A7'r_ Fn,- 3 HabRGem 5;7, (Je7-ure Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /yo Type of System Design reEr/ef/ Date Installed 7 ZO-Length of Field 62, Width of Field Depth of Field 77 Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present (Y/N) y Depression over Field (Y/N) Al Date of Last Adequacy Test 830 -88 Results of Last Adequacy Test /oA%/frAe7-0/? y i9f 9 b" 9i A, /%eF1YPj7FN J 12 -ffff Separation Distance from Absorption Field: To Water -Supply Well To Property Line /O t i To Building Foundation i�4 To Existing or Abandoned System on Lot A1.C£ ; On Adjoining Lots SO To Water Main/Service Line '>'% To Cutbank (if present) Voye -�N 4W,!E To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments W. Dimensions Manhole/Access (Y/N) "Pump Off' Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) mping Cycles during Adequacy Test. Meets MOA I certify that II have Jc)h�ec�kk)ed, verified, or conformed to allI JMOA and HAA guidelines in effect on the date of this inspection. Signed 7 6CfLGzw �liGLlCu�cv�-Date B/j0%b Company 4NAG7LJ0'2CNGlLG. MOA No. Receipt No. �p`� o20 / Date of Payment / `/ J�/ Of /��a� Amount: $ �/ / (1 �����°•��neer'S Seal .Q�9 .oa ve• asanp..Y�o •ao• o '. Page 2 of 2.s ...o....(«'�(.�«Su.ee..«..... ;Michael E. Andorson + W4 4381-E 72-026 X11/84) ,� �kk PROFESSI "'I � CIIEIVICAL & GEOLOGICAL LABORATORIES OF ALASK4 INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID N 92-0040440 I AO DRATO n,ES ANALYSIS REPORT BY SKMFLT for Work Ordet'# 8869 Date Report Printed: SEP 1 88 8 13:36 Client Sample ID:S660 E 142ND TAP WATER Client Name HC£ADDEN, WAYNE PWSID :UA Client Acct MC£AWC Collected AUG 30 88 @ 14:30 hrs. P.O.t NONE REC D Received AUG 30 88 @ 12:00 his. Req 3 Preserved with :NONE Ordered By Analysie Completed :AUG 31 88 Send Reports to: Laboratory Superviscr :STEPHEN C. EDE 1)NC£ADDEN, WAYNE Released By : G. le 2) ......,.................................................---........................................................................... Special Instruct: Chemlab Ref 4: 2418 Lab Smpl ID: 1 Matrix: WATER Parameter Tested Result/Unite ---------------------------------------------------------------------- NITRATE-N 1.1 my/l Sample ROUTINE SAMPLE Remarks Allowable Method Limits -------------------------------- EPA 353.2 10 .................................................................................. ........... .....,,.......... 1 ;esti Per_orned See Special Instructions Above UA -Unavailable ND- Nona Detacted See Sample Remarks Above NA->:,: `::._'_-e? LT -Less Than; GT-Greator Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 r� Application Date / 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 7_ Zzl Location (address or dire tions) (b) Applicant Name �K i 0��(? Telephone: Ho -�,,1�,,��� Business Applicant Address ��'�� ''C� tme ���// �Y�' /iJl%C7T• /el (c) Applicant is (check one): Landing Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other 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 the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 -of 2 72-025 (11/84) %te zl) /76163 5. ENGINEERING FIRM PROVIDIN, INSPECTIONS, TESTS, FILE SEARCH, DA.A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm AW, -_ Telephone Address I�'y /V -5 — 5,kl7a� 2_3 Date~� 6. DHEP APPROVAL Approved for Approved bedrooms by .� � �"' �' • /,, ' Date Disapproved Conditional Terms of Conditional Approval dhep CAUTION y zy y .• rtoy C. a0,141 Jr..� 4, :a //o1860 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 Ilending 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 72-025 111/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAR 0 61986 RECEIVED Legal Description: 7'?4e7- Iz-,5 /44//iY.r/% 1*'X0e5 'TiZ,A% 43Pd seV- _3� A. WELL DATA Well Classification ��'�✓� If A, B, C, D.E.C. Approved (Y/N) Well Log Presen (Y N) Date Completed Yield // ) r Total Depth Cased to Depth of Grouting Static Water Level Pump Set At /9 Casing Height Above Ground Z ' Sanitary Seal on Casing6N) Electrical Wiring in Conduit (ON) Depression Around Wellhead (Y/N) Separation Distances from Well: s To Septic/Holding Tank on Lot ; On Adjoining Lots /e To Nearest Edge of Absorption Field on Lot On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer r Cleanout/Manhole /J To Nearest Sewer Service Line on Loth Water Sample Collected by A&85/r / ; Date 3-3-94 Water Sample Test Results SSlTof'� Comments (2)W6u 1---4z4J B. SEPTIC/HOLDING TANK DATA Date Installed "�L Size No. of Compartments y Standpipe(Y/ ) Air -tight Cap (Y/ ) Foundation Cleanout (Y N) Depression over Tank (Y(9 Date Last Pumped -3-&Zo Pumping/Maintenance Contract on File (Y/N)�/4 ; for Holding Tank High -Water Alarm (Y/N) ex Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line To Water Main/Service Line Course �✓�p Comments Page 1 of 2 72-026(11/84) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /k f ���H Date Installed Type of System Design — Length of Field Width of Field -j Depth of Field Gravel Bed Thickness Square Feet of Absorption Areay� Standpipes Presen (Y/ ) Depression over Field (Y� Date of Last Adequacy Test Results of Last Adequacy Test -7;YLs2-lev Separation Distance from Absorption Field: To Water -Supply Well Ids To Property Line To Building Foundation �ry To Existing or Abandoned System on Lot // On Adjoining Lots To Water Main/Service Line 6✓1,4 To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course -l14 To Driveway, Parking Area, or Vehicle Storage Area 5'0 f 'f Comments D. LIFT STATION / Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping s during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I h / he ed, ve ified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed G� /J Date ,,,�''®�`� Company MOA No. �� " u2-� ��LL (� OF A4�bt Receipt No. 3'7 S ;1-, C2 r0+2 1, Date of Payment cam'"�� *� 49 o..a..: Amount: $ (c 7 �• i .Fs r. a .. gyp [sro C. Reid, Jr.:% i tJ".. 0.2257-E 01 �a��pROFf5S14N�� `�"` Page 2 of 2 72-026 (11/84) ALASKA mU1R011fY nTAL COnTROL %idlUS, IN. Cngineerinq & 6nuironmentol Studies MI KE TOMCO 5660 E 142ND ANCHORAGE AK 99516 Mardh! t5 , 1986 SELLER—MIKE TOMCO MIKE TOMCO 5660 E 142ND ANCHORAGE AK 99516 LEGAL:ILLIAMNA ACRES TRACT 2B ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE -2/28/86 4f&HiC�p IkkIT ��ry °�Y 0. °F 'L1<c�Tqicy 4 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 496 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 665 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 3/3/86 . THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. FLOW TEST ON WELL WELL FLOW DATE -2/28/86 A FLOW TEST WAS PERFORMED ON THE WELL. 665 GALLONS OF WATER WAS PUMPED AT A RATE OF 4.2 GPM OVER A DURATION OF 2.5 HOURS. THE DRAWDOWN WAS 56.9 ' WITH A RECOVERY TIME OF 120 MINUTES AND THE STATIC WATER LEVEL WAS 64.3 FEET. THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME. gpyconnpp �, ry'i;! t. + 1 yQi i� No. 2251-h C a 1200 blest 33rd Auenue, Suite B • Anchorage. Alaska 99503 • (907) 561-5040 Time APPLIk NT FILLS OUT UPPER HAL ONLY Properly Owner Time CSl} � C L �ACz Date Phone Mailing Address + ` / _ �`� Zip Code3,j, c' Buyer Inspector Inspector Address A .V,- _- - Zip Code -- Lending Institution _ yam\ Phone Address / 3 982 Zip Code RECEIVED Realty Co. & Agent 'CONDITIONS OF APPROVAL ( ) DISAPPROVED Phone Address �L /%-_-� ` Zip Code Legal Description 777/) .- �_,- 1 /,L_ Soils Rating Street Location ell To Absorption Area Well Log Received Type of Residence `/ -�� ]:Well to Tank 11 Side Family _ ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply GYf-rdividual��a 0� ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community-� For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility �l) .�-.. Sewer Djsposal E7-11idividual Year Individual Installed: (i` s=-- ❑ Public Utility LL�S�) -� _�U_ �� When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time CSl} � C L �ACz Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: (� � %)� j DFnT C� ;'' Cf l P. yam\ ENVIRc); It, :tr, A.U. [[ -TION / 3 982 RECEIVED ( 2) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: Soils Rating Date Sewer Installed ell To Absorption Area Well Log Received `/ -�� ]:Well to Tank Septic Tank Size I o