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HomeMy WebLinkAboutSCIMITAR #1 BLK 3 LT 1Scimitar #1 Block 3 Lot 1 #051-132-39 v Municipality of Anchorage Development Services Department A Building Safety Division a ^ * 4 * r On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW020469 PID Number: 051.132.39 Name: Wastewater System: ❑ New ® Upgrade MARY GAFFNEY Address: 2240 JENNISON CIRCLE, ANCHORAGE, AK 99508 ABSORPTION FIELD Phone: Number of Bedrooms: ❑ Deep Trench Shallow Trench ❑Bed ❑Mound ❑Other: 276-1984 3 LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: 1.2 GPD/Ft' 7.5 Ft. Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: 3 1 SCIMITAR #1 5.13 Ft. 2.37 Ft. Township: Range: Section: Fill added above original grace: Gravel Length: 1.3 Ft. 56 Ft. Gravel width: Number of lines: Distance between lines: Well: ❑ New 1:1Upgrad 5 Ft. 1 I NA Ft. Classification (Private, A, B, C): Tcla: Depth: Cased to: Total absorption area: Pipe Material: Private Ft. Ft. 424 Fly D3034 & F810 Driller: rig& Date Drilled: Static Water Level: Installer: Date Installed: r Ft. CALKINS CONST. 1211212002 Yield:I Ft. Pump Set al: I Casing Height Above Ground: TANK GPM Ft. SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity: From Tank Field Station Tank Sewer Line Anchorage Tank 1000 Gal, Well 100'+ 100'+ NA NA 25'+ Material: Number of Compartments: Steel 2 Surface Water 100'+ 100'+ NA NA LIFT STATION 5'+ 10'+ NA NA Size. i in. Manufacturer. Foundation 5+ 1 Or+ NA NA Lot Line Gal. Pump on level at: Pump off I High water alarm at: - in. Curtain Drain NA "50'+ NA NA Pump Make & Electrical Inspections performed by: Remarks: *none known EXISTING TANK ABANDONED - NEW TANK INSULATED BENCH MARK Location and Description: TOP OF SECOND SAUNA TUBE Inspections performed by: KND Engineering, INC. Dates: 1' 1211212002 2nd 12112102 Development Services Department Approval Reviewed and approved by: Date: (Rev. 12/00) Assumed Elevation: 100 Ft. Engineer s Stamp OF .A `e41or 49®� b me oe •we6eL •ee• • o o eese eee 1•••.•9,111 0Ker,nerh ,. ).. S.® co E7na .� a��Fo eAOF.•.51� 'Q����� KN. -D AS -BUILT SYSTEM SCIMITAR #1, SEPTIC A -C= 44,9' B -C= 27,4' A -D= 50.8' B -D= 31.2' A-E= 57.2' B-E= 36.2' A -F= 68.0' B -F= 75.2' A-13=116.0' B-6=104.0' MT DETAILS/SITE BLOCK 3, LOT 1 A ' B EXISTING 3 B EXISTING 3 BDRM HOUSE co 0 EXISTING SYSTEM 0 B 0 u G 5Z PLAN EXISTING 1000 GAL SEPTIC TANK co L EXISTING BULL RUN VALVE Permit SWO20469 PID#051-129-29 VACANT TAT 'D2-1 ------------------ 10' -----------------10' UTILITY ESMT, _------.-- �---SGALEI-L�-�\\ 101.83 02.8 VBG STAKING: CHECKED: KMD 0 DATE 12/18/02 DWC, FILE. CAD: NW1261 AGAR "LE' 02080. DWG Ix 02080 F4 ti 1250GAL SEPTIC FINAL GRADE, FMTM FAZHC\., TANK 7 :294._14�1_9199 �ft.%b7"kNk AdW OF 444 A 9 ITH* . ........... .... S. CE -7 AO' ........... -SEWER ROCK 9�1.94 1 56.01 PREPARED FORi MARY GAFFNEY 2240 JENNISON CIR ANCHORAGE, AK. 99508 (907) 337-0220 FIELD BOOKS COMPUTED' BOUNDARY: DRAW VBG STAKING: CHECKED: KMD AMUILT. DATE 12/18/02 DWC, FILE. CAD: NW1261 AGAR "LE' 02080. DWG 108 Na: 02080 SCALE, NTS 1 T ZHID ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 ................................... . ......... . :... ...................... ................ ............ . ....... .. .... (907)696-6111/FAX (907)696-8111 f MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Permit Number: SW020469 Legal Description: SCIMITAR #1 BLK 3 LT 1 Design Engineer: 0070 KND Engineering Owner Name: Mary Gaffney Owner Address: 2240 Jennison Cir Anchorage , AK 99508-0000 Upgrade j). -1L_0)_ @ Date Issued: Nov 26, 2002 Expiration Date: Nov 26, 2003 Parcel ID: 051-132-39 Site Address: 024444 WHALEY AVE Lot Size: 44928 SQ. FT. Total Bedrooms: Permit Bedrooms: X This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. 7R`C H L t -;T r L caG- /z q #15rX XOOM AAR&L ' Received B, —� Issued By: �� Date: 112 10/0 Z Date: II/ 2 6/6 � Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage,ak.us (907) 343-7904 ON-SITE SEWER)WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I. D. 051-132-39 Property owner(s) Mary Gaffney Mailing address (1) 2240 Jennison Cir., Anchorage, AK 99508 Mailing address (2) Legal description (Lot, Block & Sub'd.) Scimitar #1, Block 3, Lot 1 Permit Number SW D 20469 Day phone 276.1984 Zip Code Legal description (Section, Township & Range) Lot Size +5- z!t/ jol7 Acreq.Ft Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only Sewer and Well ❑ Water Storage Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi Swimming Pool ❑ Water Softening Unit Therapy Pool ❑ e I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. �i ure of property owner or authorized agent) Permit Fees: Xy00 Waiver Fees: Date of Payment: y Date of Payment: Receipt Number: 0201y,1,2— � kr Receipt Number: (Rev. 12100) MDENGINEERING, INC. The existing system on the subject lot has been identified as in failure, and the owner has requested that we proceed forward to obtain a septic permit to upgrade the septic system. On November 11, 2002 one testhole was excavated for the proposed system. The results of this test are attached. The general slope of this lot is from east to west at a grade of approximately 8-13%. We have designed our system utilizing the existing testhole that was excavated for the existing 3 -bedroom house. The lot is served by an individual well, located on the northern portion of the lot. We propose to install one 5' wide shallow trench. Water was not encountered during the excavation or during monitoring. There are no public or private wells within 200' of our proposed system location except as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111 /FAX 696-8111. Respectfully submitted, �Jll� Engineering, Inc. c enneth M. Duffus, P.E. Attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test WELL & WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN SCIMITAR #1, BLOCK 3, LOT 1 KND � 8 SEPTIC NO PUBLIC WELLS WITHIN 200' OF PROPOSED SYSTEM, NO PRIVATE WELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED, NO SEPTIC SYSTEMS WITHIN 200' OF PROPD= WELL EXCEPT AS NOTED. ��.OF 4 P.......N-dw -/ CE \t0FE3SI01Z=r OF DRAMN: VBG STA TNG: CHECKED: Valley Ave ASBUILL \ 11/21/02 Dwc. FILE GRID: NW1261 'SAD FILE: 02080.DWG o�ws«bn, 02080 n.wsE ' 20 �SE• �'mew VACANT Fn ni SM6 ORERM �n E - mmro v�mrc snse� / /EPIIC S2 %h / DESIGN DETAILS 3 BDRM X 150 GPD = 450 GPD 450 GPD/1.2 GPD PER SQ, FT. (2.32 MIN/IN.)= 375 SQ, FT (375/5'(W)) X .5(RF) (4,0' GRAVEL) = 38.0 FT, TRENCH USE 1 TRENCH - 50 (L) X 5' (W) X 4.0'(D) Total depth of system Is 7.0' from orlginaL grade. Total depth of gravel below distribution pipe is 4.0' , N❑TESI 1. CONTRACTOR & ENGINEER TO VERIFY INTEGRITY OF SEPTIC TANK AND REPLACE AS REQUIRED. INSULATE TANK IF <4' COVER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM, 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK, 4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE MIN, 3' COVER IF REQUIRED, 5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS, LOT LINES, FOUNDATIONS AND ALL OTHER SETBACKS, MARY GAFFNEY 2240 JENNISON CIR ANCHORAGE, AK. 99508 (907). 337-0220 FIELD BOOKS COMPUTED: BOUNDARY. DRAMN: VBG STA TNG: CHECKED: KMD ASBUILL DATE' 11/21/02 Dwc. FILE GRID: NW1261 'SAD FILE: 02080.DWG " N°•• 02080 Scalel 1'= 100' PAGE 1 OF 2 M UJ ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 E WASTEWATER DISPOSAL SYSTEM DETAILS SCIMITAR #1, BLOCK 3, LOT 1 50' EXISTING 3 • RIIRM "r)lICF 22, - :OPOSED 1000 L SEPTIC TANK BEL Z200—D DIRECTOR CONNECT TO EXISTING SYSTEM TH# 02-1 law Ar TH KENNETH M. D `+c Af PREPARED FOR: MARY GAFFNEY 2240 JENNISON CIR ANCHORAGE, AK. 99508 (907) 337-0220 FIELD BOOKS coMPuTm. B"DARY. DRAWN: VBG STAMM CHE" KMD ASBUILT: DATE 11/21/02 DWG. FILE GRO. NW1261 ACAD FILE. 02080.DWG 'OB Na. 02080 Scatel 1'= 20' PAGE 2 OF 2 ZHID ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)896-6111/FAX (907)696-8111 P, SOILS PERCOLATION TEST t49Fop �1►i Performed for: Mary Gaffney Date Performed: 11/11 Project: Scimitar #1, Block 3, Lot 1 TEST HOLE # 02-1 Depth (Feet)SEE ATTACHED SITE PLAN — ORG/OL — silty overburden FOR HOLE LOCATION 16- 17- 18- 19- 20 - Was Ground water encountered? NO What depth? NA Depth to water after monitoring? NO Date? 11/18/02 OF �-��j-•%V Gross D .Ak°Q'S'�,1 �' Net ENGINEERING, INC. y* ;'' 20441 PTARMIGAN BLVD.►°;..; EAGLE RIVER, AK 99577-8736 ...: N.....,.«. e Water Kenneth M. Duffus W ,� S'�• CE 7116 ?� SOILS PERCOLATION TEST t49Fop �1►i Performed for: Mary Gaffney Date Performed: 11/11 Project: Scimitar #1, Block 3, Lot 1 TEST HOLE # 02-1 Depth (Feet)SEE ATTACHED SITE PLAN — ORG/OL — silty overburden FOR HOLE LOCATION 16- 17- 18- 19- 20 - Was Ground water encountered? NO What depth? NA Depth to water after monitoring? NO Date? 11/18/02 I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. Reading Date Gross Net Depth to Net Time Time Water Drop GP/SP — Med dense, w/ trace of silt & cobbles to 2', 1 11/11/02 1:00 6" - moisture increasing W/ depth 2 1:10 10 min 15/16" 411/16" 3 * 1:11 - 6" - 4 1:21 10 min 18/16" 48/16" 5 1:22 - 6" - 6 1:32 10 min 110/16" 4 6/16" 7 * 1:33 6" - 8 1:43 10 min 110/16" 4 6/16" 9 1:44 - 6" - B.O.H. 10 1:54 10 min 111/16" 45/16" 11 1:55 6" - 12 2:05 10 min 111/16" 45/16" * Water Added Percolation Rate 2.32 (min/ in) Perc Hole Diameter 6" HOLE PRESOAKED PRIOR TO TEST Test Run Between 3.5 feet and 4.5 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. MUNICIPALITY OF ANCHORAGE Dr ]TMENT OF HEALTH AND HUMAN SEF Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name Address ~-.j Phone(sI Permit NO ~¢ NO el Bedrooms I.er LEGAL DESCRIPTION A'e¢. /0 TANKS ~,~ SEPTIC ~j HOLDING TYPE OF SYSTEM ~3TRENCH ~ BED ~ W.[)RAIN ~ OTHER added above original grade ~ FT /J~ so FT WEbLS Gravel lengd~ FT FT ~ PRIVATE [] OTHER fldentifv'l -~7~as';,i',&t,%% tA.U.O,4..~ -- j ~ot.~ Ooptb~ $,-~ FTI] Ca,ed/¢.),¢/t° REMARKS: FT DISTANCES WELL LOT LINE FOUNDATION SEPTIC TANK ABSOHPTION FIELB WELL AS-BUILT DIAGRAM (Show Ideal,oH ol well sepbc syslem property hnes, Ioundabon. Inspc~ ~qn,%~edo. rmed by: ~f~agl~.~lver I:ngineerm9 Services Date Eagle River, AK 99577 h ate~ ~'~' Heallh Depadment Approval' by DOC Co. dba SULLIVAN, WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 * TELEPHONE 688.2750 OWNER OF LAND LEGAL DESCRI~ION DATE- Started ~1 PERMIT NUMBER DEl'TH OF WELL STATI(' LEVEL OF WATER ?7 DRAW I}O;VN FT, GALS. PER HR ~ ~ 0'0 KINI) OF ('aSINC {~ .~ ~ 0 KIND OF FORMATION: From~K. Ft. to-~ Ft, ~ ~ ~~ From. From~ F,, ~0 ~r 'Ft. ~0 ? ff~~ From__ From ', - Ft. t~ , Ft. ' ~ ~ OLOg~ From Ft. to From_ ' Ft. to Ft, From__ From ', ./ 'Ft, to · Ft, From__ From~ Ft. to "Ft, From From-- ,Ft. to Ft. From From Ft. to Ft From From Ft. io Fl From From ,. Ft, to Ft, From From · · _Ft. to Ft. From From . Ft. to _ FI From Ft. to __Ft. Ft. to ._~FI, · Ft. to . .__ Ft. ~FI,. ~Ft, ~. Ft._ . Ft. to. Ft Ft. to.__Ft Ft. to Ft Ft. to Ft. Ft. to. __Ft,__ Ft. to. _FI DRILLER's name __/~.0' ~,~_.e~ ' .. :' MUNICIPALITY OF ANCHORAGE DI=PARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST /.~ SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19, 2o- COMMENTS SLOPE DATE PERFORMED: ~ITE PLAN' ENCOUNTERED? ~ O P IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop INE R C(~-Aq:tE}N~RAT E J ,¢~) r .~..._ (.mirtute,C~ncb} TEST RUN BETWEEN FT AND --. FT 72-008 (6/79) Municipality of Anchorage. Development Services Department. Building. Safety Division On -Site Water and Wastewater Program 4700 South Bragaw-St. - *'` :f MT' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us - (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-132-39 HAA # t-� A©_-� 0 Expiration Date: -2 3 - 1. GENERAL INFORMATION Complete legal description SCIMITAR #1 BLOCK 3, LOT 1 Location (site address or directions) 24444 WHALEY AVE., CHUGIAK, AK 99567 Current Property owner(s) MARY GAFFNEY Day phone 276-1984 Mailing address 2240 JENNISON CIRCLE, ANCHORAGE, AK 99508 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3- 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and 'type of structure indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm KND ENGINEERING, INC. Phone (907) 696.6111 Address 20441 Ptarmigan Blvd., Eagle River, AK 99577 Engineers Printed Name Kenneth M. Duffus Date 12/19/02 J00 Y y i •oaea• e.e n.nn.e � 5. DSD SIGNATURE� r� .° raC7 ` 1.. a ; Approved for 3 bedrooms..F�F n=°» Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments` 4.' ,.N-,�kTF MATER AND v YY r 55 , G PROGRANI l Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineers Report Well Flow Advisory Other � f By. Original Certificate Date: (Rev. 01102) Unable to remove well seal to monitor static water level well pump intermittently running throug-oit�,,%; ..G. . ENGINEERS CERTIFICATION + E:QF c�S � �•••«...�� 1 certify that.1 have determined through field inspections and Q� �* j�••'�q��� review of Municipal records that the above,systems. are rn conformance with, MOA HAA guidelines in effect on this date. ��•� �'•"• "'• "! Engineers Printed. Name Kenneth. M. Duffus Date 12119102 / ATF .•s..CE 2716 . ••. HAA Fee $375.00 :. Waiver. Feel. Date of Payment 12/19/02 Uate..oi Payment • • .. . Receipt Number Receipt Number (Rev. 12/01) 12-10-02; 3:41PM; CT&E Environmental Services Inc. CT&E Ref.# 1028293001 Client Name KND Engineering Project Name/# Scimitar #1 B3: Lot 1 Client Sample ID Scimitar #1 B3; Lot i Matrix Drinking Water PWSID 0 Sample Remarks: 907 5615301 All Dates/Times are Alaska Standard Time Printed Date/Time 12/09/2002 16:44 Collected Date/Time 12/06/2002 15:45 ReceivedDate/Time 12/06/2002 16:05 Technical Director '�'y'•��Stephe Ede reor Released By i L Units Method Towable Prep Analysis Parameter Results P Q Limits Date Date Init Waters Department Nitrate -N 2.20 0.200 mg/L EPA 300.0 (<=10) 12/06/02 is microbiology Laboratory Total Coliform 0 col/100rnL SM18 9222B (<=1) 12/06/02 KAP 12-10-02; 6:41PM; ;907 5615301 # 2/ 3 JL CT&E Environmental Services Inc. ZtL Laboratory Division Mailing Address Cay State SAMPLE DATE: FTM G I ©&P I v Tel Month Day Year Analytical Method: Membrane Filter MMO-MUG ziocoae * Number of colonies/100 ml. Lab Ref. No. Result* Analyst SAMPLE TYPE: Routine ❑ Treated Water ❑ Repeat Sample (for routine sample �. Untreated Water with lab ref. no: ) ❑ Special Purpose SAMPLE LOCATION som i&. -4-t a3/ t o -H Comments: no._. Time 200 W. Potter Drive Drinking Water Analysis Report for Total Coliform Bacteria Anchorage. AK 99518.16o5 REVERSESIDEBEFORECOLLECTINGSAMPLE *(907)562-2343 TelREADINSTRUCTION.SONFax Fax: (907)561-5301 MUST BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEMI.D. # I # I A alysis shows this Water SAMPLE to be: PRIVATE WATER SYSTEM Satisfactory Send Results ❑ Send.Invoice + ❑ Unsatisfactory �.0 z /1�G/y 'lNlr0"1we, lel- Gr/.r{�irt j . ❑ Sample over 30 hours old, results may be ' WaesSyste�mN/ZRaOCompanyName err�+Contactnane JJ) Civ - 3%C%/ lltr+(A '3'x'3 unreliable . Sanat let o iong in transit; sainple z,aouid Phone Number Fax Number . 2,PV l IOWW140V 36,&W- not be over3i tours old at examination to indicate reliable results. Please send Mailing Address�--7 � at �9 new sample via special delivery mail. City zip co a7 Date Received Time Received L LAA ❑ Send Results ❑ Send Invoice ' - Analysis Began Comuanv tJamc Comact mate Mailing Address Cay State SAMPLE DATE: FTM G I ©&P I v Tel Month Day Year Analytical Method: Membrane Filter MMO-MUG ziocoae * Number of colonies/100 ml. Lab Ref. No. Result* Analyst SAMPLE TYPE: Routine ❑ Treated Water ❑ Repeat Sample (for routine sample �. Untreated Water with lab ref. no: ) ❑ Special Purpose SAMPLE LOCATION som i&. -4-t a3/ t o -H Comments: no._. Time Collected Coollle�c�tteed� By ' Please Punt j, p2S 2�3 Ar [ZE'l - d Sent to A.D.E.C. Anch Fbks Jun ❑ Faxed Date: Time: Client notified of unsatisfactory results: Phoned Spoke with Faxed Date: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total Coliform E. Coli Membrane Filter: Direct Count 0 Colonies/Io0 ml Verification: LTB 1;GB Fecal Coliform Confirmation Final Membrane. Filter Results �A Reported By )(—� ��-- – ate COLIFIRM Coliform/100 ml Time , ZA \/hrs AIN 13GS Member of the SGS Group [Societe Generale de Surveillance) TNTC® Too Nunwous To Cal u,t OB -other Bacfzria ro 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 Application Date 1. GENERAl_ INFORMATION lo/21/85 (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1 Block 3 Scimitar #1 q~15N R1W Se~;IO Location (address or directions) SR2 Box 6734 Chugiak, AK 99567 (b) Applicant NameTM W. Proffittrelephone: Home 688-.5019 Applicant Address SR2 Box 6734 Chugiak~ AK 99567_ (c) Applicant is (check one): Lending Institution []; Owner/builder~; Buyer []; Other [] (expla~'in); __ Business 694-3527 (d) (e) Lending Institution Home Savin.g~ & Loan Telephone Address }2otlch 7008, Anchorage ,_~Ala~sk_~ ~9~.~0 Real Estate Company and Agent ~/A Address 276-1_~_~ 5 ! Telephone (f) Mail the HAA to the following address: Pick-up TYPI= OF RESIDENCE Si n gle-Far'nily:,l~ MultFFamily Number of Bedrooms Other 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:E~ Public I~] Community [] Holding Tank I'~ 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 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of tile 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 _ Telephone EAGLE RIV[,R Address ~1~ Date ~rz/g~- t~~94 694-5195 Engineer's Seal Approved foiC'_~C'EZbZ~¢..~ bedrooms by Approved ~k, Disappr°vec~/ C ° n ditic~'~l~'- Terms of Conditional Approval Date __/ CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representalions given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a coudesy 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 MUNICIPALITY OF ANCHORAGE (MO,-,~ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: __.7- / ~- ,,,~ ,.~ ~ ~,~ J~,dUNICI?/~LITY OF ANCIJORA2:i DEPT, OF HE/NLI'I.I ~ ,EJxlvI ROFIM~ N'I'/;L PRCTEC rfc)? I 1985 WELL DATA Well Classification ~ ~ ) c,',,4 ;r Z.: If A, B, C, D.E.C. Approved (Y/N) //,')J,4 Well Log Present (Y/N) )'/ Date Completed _ ~/~ 5- Yield "'~,¢'o (~¢/-'/ Total Depth ~ $-'° Cased to Static Water Level ~' ? / Casing Height Abeve Ground c~ / Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Depth o! G~outing _ ¢~¢t./ Pump Set At ~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot ,/~ ''/-' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /b)c,-'~z. Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ; On Adjoining Lots /o,o' ¢- ,,/~ ~ w- ; On Adjoining Lots /~ ¢' To Nearest Public Sewer To Nearest Sewer Service Line on Lot -.-~- ~ ¢- ~',~ 5 ~.e/e_~¢-~.~ ;Date /O./'¢'~'J~ B. SEPTIC/HOLDING TANK DATA Date Installed / ¢£-~'- Size /¢0¢ ¢,,2'~/, No. of Compartments Standpipes (Y/N) ~ Air-tight Caps (Y/N) / Foundation Cleanout (Y/N) Depression over Tank (Y/N) A~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) //'/'/~ ; for Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well '¢~ ) To Property Line /¢2 To Water Main/Service Line /~/- Course Temporary Holding Tank Permit (Y/N) To Building Foundation /'-~ / To Disposal Field _ /~" To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata [)ate Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test . Separation Distance from Absorption Field: To Water-Supply Well ~ 'Fo Building Foundation J/';/~ /' Lot To Water Main/Service Line /'¢ +' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area 'z¢' '¢'~ Type of System Design Length of Field Depth of Field ~ / Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line /o '" To Existing or Abandoned System on ; On Adjoining Lots ~'~ -/ To Cutbank (if present) * Comments Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at "rested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** 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 r_.~.-~-- ~--:~-~.~-~,.-;¢~----~- Date /0 Company ,'~/'~ ~, ~ ¢ MOA No. Receipt No. ~[~ ~ ~ O ~/ : ' Date of Payment / O ~ [~ ~ Amount: $ Engineer's Seal