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Home My WebLink AboutLODGEPOLE LT 4 _ Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ,..~/~) ~)~ It_'.'.~ PID Number: O1~- ~f~-" Name: ~ [[~ ~ ~ ~e~ Wastewater System: ~ New ~Upgrade Address: ~ t ~~ ~;~ ABSORPTION FIELD Phone: ~ No, of Bedrooms: ~eep Trench D Shallow Trench ~ Bed ~ Mound ~ Other Total ~opth from original LEGAL DESCRIPTION SoilRating: , ~ GPD/Sq. Ft. 1 Lot: Block: Subdivision: 3epth to pipe bottom from original grade: Gravel depth beneath pipe Township:,~ I Range~ [ SOction:[ > Fffl added above original grade:j__ ~ Ft. Gravel length: ~¢~ Ft. Upg u ' '--ra'e Grave~ ~: ~ ¢~ ~ Number of lines: Distance~between¢ lines: WELL: New ~ Ft. ~ Ft. Classification (Private. A.B,C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: StaticWater Level: Installer: Dat~installed: Yield: Pump Set at: Oasing Height Above Ground: TA~~ ~ GPM Ft. Ft. SEPARATION DISTANCES D Septic D Holding U S.T.E.P. To Septic Absorption Lift Holding Public/Privat~ Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Material: Number of Compartments: Well [ ~ ~ Su,f~ce LIFT STATION Water Lot Size in gallons: Manufacturer: Line Foundation ~ ~ "~ump on" I~vol at: "~ump off" Iovol at: High wa~er alarm at: Gu~ainDrain ~ ~ump Mako& Model Bectdcal Inspoctions pe~ormed by: Remarks: BENCH MARK Location and Description: ~ ~ Assumed Elevation: ~E~G!NEER'S SEAL Inspections performed by: ~ ~ Dates: let ~Y[~ ~ 2nd ~/~/9~ ~'~." ~ Department of Heal~ Hu~~~ices approval ~;~,%'~, ...... '. ,~,'..~ Reviewed and approved b - ~ Date' ~ ~.. ~-,,. 72-013 (1/91) MOA 25 N SCALE, 1' = 50 FT, TOBBEN SPURKLAND P,E. 203 W 15TH. AVENUE ANCH, AK, 99501 LOT 4 LO~GPOLE S/~ S~9C~1~ T!~N R3W DL YMPIA Cll~ SEPTIC SYSTEH ASBUILT ])ATE, SHEET~ 2/3 GRID, Y !C/de 6c°,5' Lan9 lO' Beep 5' Se~er rock 4' £over to new trea~h SPEE-B- VALVE 94 Nlra Fi 140 6 Ft oF Septic Rock Cleanout~ Nonltor --~ 4' Topsoil ~ 88 1250 ga/, septic tank TBN Porch a t Nam Boor th bottom 82 Assumed Elev, lOfl. O0 TI SPURKLAND P.E. W 15TH, AVENU: ~nchora9e Ak 99501 LOT 4 LI:7 dEPOLE SECTION I3, T12N R3lC 595I DL YMPIA CIR, SEPTIC SYSTEM AS3UILT DATE, i'~orch 31, 1993 SHEETm 3/3 GRID, 2438 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930018 DESIGN ENGINEER:TOBBEN SPURKLAND, OWNER NAME:BOLLING JOHN D ~ OWNER ADDRESS:5951 OLYMPIA CIR ANCHORAGE, AK 99516 DATE ISSUED: 2/23/93 P.E. EXPIRATION DATE: 2/23/94 PARCEL ID:01506138 LEGAL DESCRIPTION: LODGEPOLE LT 4 LOT SIZE: 29386 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 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 (iSAAC80). 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: A DIVERTER VALVE MUST BE INSTALLED TO ASSURE EQUAL DISTRIBUTION OF SER~C T~gJ~K EFFLEUNT T~ BOTH TRENCHES. iSSUED 203 ~ 15~h, AYenue~ Suite 208 (907) 279-~918 SEPTIC SYSTEM DESIGN LBT ~ LO}~) GEPBLE S/D JOHN BDLLINB i'~ILui]l:)c*r' (iff: Ele(:]t-'c~(:)rn~-~ 4 l...~;m(:;!t:l"~ (:~[: "['r'~z~rJcl"~ 4 :.: ?5) / 12 :=: &:~!; ~:i: SYSTEM CONF i GURI~T I ON T~D STANDARD TRENCHES TOTAL LENGTH 2 X 45 : TOTAL ~IDTH TOTAL DEPTH ROCK DEPTH COVER 90 FT. 5 FT. 10 FT. 6 FT. 4 FT. SEPTIC TANK 1250 GAL. EXISTINB DIVERTER VALVE EXISTIN6 SYSTEM NEED REPLACEMENT SITE thr'[~:,,,.;e J:::,(Lac:Jl,"[:)or/i~B. E,~.~' :i. ![~i: :i. I"~(.~J i:,'..'[~r~J.:: ['~(~¢~4~ I:)(~(.;m vl.:.:?r J. ',~: :i. (;(?(:l ~'is i:~t :J..,c.,..¢... .... Lt....~-,...I. 'l:'.~ank, Use area along south lot ].ine au:. area ,~or upgrade. L.oc:ate lot .... c:~:)rn~a~rs 'b::) pi. ac(~ 'b'"~.~:,r"~ch~:,s 1() .~ ~.:~:,et c:r[: 1 ot ]. i ne, 'l"esthol (.:~.~ and f3WM I::'el:)~ ?,~ 1993. · ~.:rom b~? ir~?:~tal ].~:ad (:~n the ac]jacent :l. ots. are nc:, [J Ja v e::, ]. c,j::)ecJ c::,r' i")atLira]. ,.]~t.)r';c ,'!:'~ce / st.~b ,.:!~.lr.~ ac::~):e c:Jrai []ag(.-:a c:(:)urs(-:~?; (::rl'] 'l:hi s or th(.:e a(:J j a(::ent I ors. "i'l"'~:~, I::)rol::)os~:~,d ~,l:)tic:: sys'[:~,m will.:: r-~ot chang~z.~ tt'~x~ g~:~.~r~er'al slope o~ '[:h(~ area. F:'c~r~(:Jing and/or concentra'l:.ion o'f sur~;ac~, runo~'f wi].l not resu].'[.: ~rom this in~.tal]atJon~ Th(~? e;.(:i, stin(~l ':lank was e::-(f:)o.sed and e,xam:Lrlecl on :::'el::). 9~ :t. 993. No A div(~rt:er valve w:i. ll be im:.~talled to prc)v:Lch~.~ 4:l..d:ure acc:ess tl")~,? (.la;..' i-.:.-st i ng 'b"'~.~n(::h. new absorp'~.:i, on system wi l:J. c£:)n!~-~i st (::,~: two trench[.z~,s. A di- w:.~rt,:~:~rva].v,~ will. l:)e instal, led to provid(.~ [hca ~:].cgxibi].it:y to L.~S~.~ ~.:~,ith~zer (::)n~ ~:)r both c:~q: thee n~w tr'(~nc::hes. Siai:)tic System DesJ. gn Lot 4 I...odolai:)o:l.l~.:.) S/D LOT 10 LD LBT I1 v'A ~.,~ ~'r' I I I I I ~ III I V.~C~N'r- /.I I I LDT/'///l I1,~ LOT ~ I:- N LgT 5 NOT SU~DIVIJ2EJ~ I J I I I I I I I I I 3£ALE; I' = 100 FT, £00 ~50 300 LL~T 13 LOT 15 L~T 1~ LLTF 17 TBBBEN SPURKLANB P.E. 203 ~ ]STH. AVENUE ANCH. AK. 99501 LOT 4 LO. DGPDLE S/2 SEC, 14, TI~N R3W 5951 DL YMPIA CIN SEPTIC SYSTEM DESIGN DATE, FEB g, 1993 SHEET, 1/3 GRID, £438 J L_ Ext'/-, Trench 25 5t1 75 SCALE; 1" -- 50 FT, I ~ro~osee rr}nci]es 1~ 125 150 TOBBEN SPURKLAND P,E. 203 ~ 15TH. AVENUE ANCH, AK. 99501 LOt 4 LD~6POLE S/~ SEC. I~, T1~N ~3~/ 5951 Ot YI. tPIA CIR SEPTIC SYSTEH DESIGN DATE, ~bS~t~ SHEET~ r Monitor 4S Cleon S fondord ?renchem 3' Wide 45 lO'Deep 6'Sewer rock 4' Cover Cleon l£ Septic tonk Monitor Cleon DIVERTER VALVE SPEE-D- VALVE ND SCALE 3 Miro Pi 140 6 £~c o£ Sept;it RocR 4' Topsoil ~ _ N~ SCALE Exist, 5round 4' Min Cover '"~over ?onk 1~50 gal, sept:lc ~onk TOBBEN SPURKLAND P,E. ~03 ~lSth Ave Anchorcge Ak 99501 LZJT 4 LLTJgOEP~LE S/~ SECTIDN I~i~ TI2N R3W S9S! DL YMP]A CIR, SEPTIC SYSTEM DESIGN DATE, FEB, I~, i9~3 SHEET, ,3'/3 GRID, 2438 PERFORMED FOR: LEGAL DESCRIPTION: L."'~ q 3 '9 '~10 11 12 13 14 15 16 17 18 19 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 20 Township, Range, Section: SLOPE WAS GROUND WATER k ~ ENCOUNTERED? t~q- L~ S L IF YES, AT WHAT O DEPTH? p E SITE PLAN Depth to Water AI~ . Monitoring? ~_%~ Date: *~/7/'~% Gross Net Depth to Net Reading Date Time Time Water Drop / / : PERCOLATION RATE ~--{~) (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~' Y'Z- FT AND 7 FT COMMENTS PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: .'~'~ ~:1/. / ¢ ¢.~ I~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME--- J~HONE / ~.gEW LEG~AL DESCRIPT~ION LOCATIQN ] I NO. O F~DROQMS Absorption area DwelHn~ ~ Manufacture~Gb~ ~ MaterJaJT~t No, gmpartments ~ ~ Liq'i~J,~gall°ns IF HOME.DE: Inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. :~ ~ ~ DISTANCE TO: We,~ .o. of li~ L~ 7~ch IiZ ~ Total length of line~ Trench Distan ~' ~--' w~ inches Total~e~=orp,'o area ~ ~ ~ Top of tile to finish grade J J Material ben~at~ tile ~ ' Widt h~ ~¢ inches Length Depth PERMIT NQ. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NQ. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOl L TEST RATING I NSTA L L~~ REMARKS I AP~ DATE LEGAL , ,::[(i)!.j~lE:iEi :B(;:¢,,.iFiF;:E F:EE:T UF'ON THE: T"r'F'E ER' Pi.F....Y": HELL. i[ E:E!;:T i F%" :I.: :f !~?...- F:F:lh!:!:L. IF:if4: i.!:['!'F-¢ 'T'FffE REX;:¢JIFi:E?IENT'.~; F:'OF;: ON--:~;:[Tr:~L' SE:!4E:F;::ii; F!ND HE:t,,.L,:i!:; F:~:i~ :BET FORTH EW 'T'HE r'?UN :,': C :~: i:::'F&~ i!i 'T'? OF F!NC:HORFY,-3E. 2: Z :.'-,!~:LL ii:N:~;TFE_L. THE z~;'¢?!"Et,! ~:h! F:iCE:Eff~:L':,Fff.,!C:E NZTH THE CODEE;. [~:: :[ UNDE.:J:~::.:3TF:ff.,E:, THFiT '¥HE ON-..E;7¢TE :~i;EHER E;?:!ii:TE~i'"i .b!F!'¥' RE(;:!L!][F~:E ENL. F~F~:GEFEi~;NT JIF:' THE MUNICIPALITY OF ANCHORAGE DEPARTMENT 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: 9 10' 13- 15'-- 16- 17 18 19 20 COMMENTS Gi71 SLOPE O. Tolbot 4069 - E SITE PLAN WAS GROUND WATER NO ~_ ENCOUNTERED? O IF YES, ATWRAT ,.~ E DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop I i(~nt(>~ 5 '.4zO 0 I.~ ~-- 0 PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section p.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 015-061-38 HAA# HA930030 1. GENERAL INFORMATION Complete legal description Lot 4 Lodgepole Subdivision Location (site address or directions) 5951 Olympia Circle Property owner John/Bonnie Bolling Mailing address Day phone 214-754-6898 Lending agency Mailing address. Day phone Agent Whitney Jones/Niel Tysver Address Exsell Relaty Dayphone 276-3333 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Three(3) Individual well Community well Public water XXXXX If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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. XXXXXX ~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. NameofFirm Tobben Spurkland, P.E. Phone 279-3916 Address 203 West 15th Avenue ~206, Anchorage, Alaska 99501 Engineer's signature Date Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: .... _ ~ 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. 72~125 (Rev. 1/91) Back MOA #21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING (~ - /~°c~ NAA# GENERAL INFORMATION Complete legal description Location (site address or directions) Mailing address Day phone Lending agency Mailing address Agent t~'~t ~'-~ ~.~.~ Address ~"~'~. <~,~ Unless otherwise recluesto~, HAA will De held for pickup. NUMBER OF BEDROOMS: Day phone Day phone,~--'7~ -~:"~' TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER By: As certified by my seal affixed hereto and as of the validation date shown be, low, 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. Phone ~'"~ ~ ~,~ '/ Name of Firm Address Engineer's signature / DHHS SIGNATURE Approved for bedrooms. Disapproved. ,/~ Conditional approval for ~' bedrooms, with the following stipulations: Additional Comments~~¢,¢~ ~ ~'/ ~ t. : The M~i¢ipalib/of ~¢hem~ ~par~e~t of Health ~d Hum~ $~/i¢e~ (DHH$) i$$~s He~l~i~ ~uthority re~pon$ibl~ fo~ ~r~r$ o~ ~mi$$i~$ in th~ p~of~$si~n~l ~in~r's wod~. 72-025 (Rev, 1/91 ) Back MOA ,~21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services Qn-Site Services Section P.O. Box 196650 Anchorage, Alaska 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHOF APPROVAL FOR A SINGLE FAMILY ~A # 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Unless otherwise rec NUMBER OF BEDRO~ TYPE OF WATER S Indi C~ NOTE: If c in TYPE OF NOTE: Day phone ,~,lc//- 7ff~-~,z~'~/~ Day phone Day phone well 'nunity well )lic water HAA will be held for pickup. well system, provide written confirmation from State ADEC attest- ,gality and status of system. ~,STEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system, i 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown be, low, 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 fo~ne number of bedrooms and type of structure indicated herein. I further verify that based on th~rnformation obtained from the Municipality of Anchorage files and from my investigation and~spection, the on-site water supply and/or wastewater disposal system is in compliance with ¢ Municipal and State codes, ordinances, and regulations in effect on the date of this inspecti~. be4 By: Additional Cc bedrooms, with the following 'stipulations: The Municipality of Anchorage )artment of Health and Human Services (DHHS) issues Health Authority Approval Certificates based 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 courtesyto 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 JFIR-lO-O~ FKI 1E;1E E~:~ELL KEflLI'~K Pfl~ RU, ~U(E(U~I~ F, OE LOOATION: DWNE~i John / Bonni~ ~lling 8ingl~ F~mi ly, WELL: TANK: 8,'e~r ~eet 12~0 8al. Two Oompa?~. DAT~ OF LAST PU~PIN~: ABSORP?ION SYSTEM: Trench ·QIL RATtNB: 2~ ~N~TALLATION DAT~ 7/20/8~ A~ch. C~s~ P~ol Jan. 14, 17, 1~2 ~und wi~h ~.~ ~=m~ of c~va~ mhd Wi~h a liquid level of w~t~. T~ench monitor' tube W,~i"g.5 ~me~ deep wi~h ~0 in~hm~ of, 5~0 gallons Of ~l~an w~t~? wa~ added ~o ~h~ ~?~nch ~hi~ Anchora0e, The my~tem ~as ~lo~ded mt first test and bu% ~ystem wa~ not ~lmoded. Enzymes have been used, causing mlud~e Eo be di~h~'ged from %he s~ptic tank. This practice iS n~t NOTE Th~ ~perati~nal li;e o~ all septic ~y~t~m~ d~ends ~n the estimate m~ h~w long this system will function sati~oko~Y Legal Description: A. WELL DATA Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST If A, B. or C, attach ADEC letter. y Date completed I ~ Cased to ADEC water system number f~,~-~Z- Driller I ~ Casing height Wires properly protected (Y/N) AT INSPECTION g.p.m. FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ¢ Nitrate Date of sample: ~_-q ~' Other bacteria /'~ ~-~ Collected by: ,.~ ~..~.o..r- ~ B. SEPTIC/HOLDING TANK DATA Date installed Y~-O/~' F_. Tank size /¢,~.~ L~ Compartments Cleanouts (Y/N) X// Foundation cieanout (Y/N) ~/' Depression (Y/N) High water alarm (Y/N) I"//A Alarm tested (Y/N) W~'/~ Date of pumping ~.~.~,~ ~L/I I~'~ Pumper ~' (~d,~-/L¢~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~7 To property line ~' --~ Surface water/drainage On adjacent lots Absorption field Foundation Water main/service line 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 Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent iot~ Surface water D. ABSORPTION FIELD DATA Date installed ,~ ,C-- Length 'Z'~ Width Total absorption area ~(.2~') Depression over field (Y/N) ~ Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating r'~/~'~-- System type ~/~.~,,//rr:- ~/ ! / to Gravel thickness 1~ Total depth Cleanouts present (Y/N) ~ Date of adequacy test I Z~ '~/~ ~' for ~ bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I¢¢'~''7 To building foundation On adjacent lots Surface water Curtain drain ~ On adjacent lots ? /.%O Property line /~) To existing or abandoned system on lot 1"///~ Cutbank No F/'¢,L- Water main/service line Driveway, parking/vehicle storage area /~-~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature t ~ Engineer's Name HAA Fee $ DateofPayment ' /- //~/ -¢~5 Receipt Number ~/--f/.~ 9~ ( --~-'~7~///] Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Oivision 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 ParcelI.D.# 01~- o[o - I"~ HAA# Complete legal description L~¢J~ ~ L¢cO~ ~ F,,I ~ -'-~'~ Location (site address or directions) Property owner Mailing address Day phone Lending agency Mailing address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: Day phone ~'7~0-- ~ ~ Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, ] verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/orwastewaterdisposalsystem 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 / o/2~e~'/ u~ ¢- ~/~ L¢~¢-- 7/? Phone Address ¢¢_(p~ ~ /.~/_~. /~Z ~ ~ Engineer's signature Date DHHS SIGNATURE ../k~ Approved for '~ Disapproved. Conditional approval for bedrooms, bedrooms, with the following stipulations: Additional Comments 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~)25 (Rev. 1/91) 8ack MOA ~21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site ServiCes Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 'ICATE OF HEALTH AUTHORITY FOR A SINGLE FAMILY DWELLING Parcel I.D. # 01~ HAA# 1. GENERAL INFO[ Complete legal )tion Location (sit, or Property, Mailing ~s Day phone ~2/q- 7~/-~,$9&, Lendin tgency Day phone Maili~,.ddress Agent I,l~Jr~'.¢ Day phone Address '~,~X ~ Unless otherwise rC~,%ested, ' for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well * ~,~unitywell PU bi i:~ate r __ C°m m u'~i~.r.0~-site Public sewe'¢ ,~ %.. NOTE; =. ADEC attest- If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 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. NameofFirm "'~o~,~-'/ -.--~]~¢¢'kLc~¢'~ Phone Address ¢¢--6:)_-_-_-_-_-_-_-_-_?~ ~ ~-/-~. '~¢ ~ ~ Engineer's signature _ Date I DHHS SIGNATURE ~pproved 'f.,o,.r ~bedrooms. Disapproved".:~ ¢" Conditional apl~(oval for , bedroq~s, w~h the f~ilowing stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~25(Rev. 1/91) Back MOA~21 Drinki TO BE [] PUBLIC WATER SYSTEM I.D. ~-.P. RIVATE WATER SYSTEM Me,ling Address ~ ~ Water Analysis Report for Total Coil /ER Phone No. c~ SAMPLE DATE: MJ~o. ~ . ~Da SAMPLE TYPE: ~utlne [] Check &ample (for routine sem~:~ with lab ref. no. ¥ ) [] Special Purpose SAMPLE No. LOCATION Slate Z~p Code ~[~_, Year [] Treated Water ,,::~--~m~cea[eu Water .: Time Collected Collected 1 Bacteda '~ IE COMPLETED BY LABORATORY Analys~s shows this Water SAMPLE to be: / [] Uilatisfactory [] ~r~ple too long in ffansit~sample shOuld no!lb~,' over 30 hours old at examination to indicate reliable results, Please send neW sample via special delivery mail, Date I~eceived Time Received Membran® Filter * N°. of colonies/100 mi. Lab Ref. No. Result* Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TNTC = TOO Numerous 1/o Count OB = Other Bacteria BACTERIOLOGICAL WATER ANALYSIS RECORD ~) Collfor~v'lO0 mi 8GB Membrane Filter: Direct Count Verlfi~tion: LSB Fec~! Coliform ~onflrmMIon Final Membrane Filter Results Reported By ~ ~f ~ Date ~ r Time: PART ONE OF TWO REHAINDER TO FOLLOW Coliform/100 mi a.m. p.m. CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANA[,YSIS RESULTS for INVOICE ~ 61773 Chel~l~b Ref,~ 92.6898 Sample ~ 5 Matrix: WATER Client Sample ID PMStD Collected Received Preserved with L4 LODGE POLE UA 12/17/92 8 i?:O0 hrs. 12/18/92 @ 12:30 hxs. Analysis Completed : ]2/2i/92 Laboratory Supervisor .!.S~EPHEN C. EDE Released By :z / ~,~ ' ,,~C.~' ....... Client Name :TOBBEN SPURMLAND, P,E. Client Acer: :TOBEENS BPO$ : POS :NONE RECEIVED Req~ : Ordered By :TOBBEN Send Reports to: 1)TOBBEN SPURKLAND, P,E. Para~netor Results Units l{ethod Allowable LJroits NITEATE-q~ 3.96 mS/1 EPA 353.2/300.0 10 Sample ROUTINE SAMPLE COLLECTED BY: STUART. 1 Tests Performed * See Special Instructions Above UA=,Unavallable ND~ None Detected "Sea Sample Remarks Above NA: Not Analyzed I,T~I, oss Than. GT,,Groatsr Than ~Sr~-~ Member of the SGS Group (Soci~t~ G~n6rale de Surveillance) Pit. (907) 276-3333 · FAX 276-3515 3333 Den.dIst.,sIc. II0' Anchorage, Ak 99~03 TO; Beth Oli~npic Circle NUI~ER OF PAGES TO INCLUDE CO%t~R: Followi}lg is the se~T~tic rer~,rh. The s,/st:"~tl~ wl'lt:l retested passed. YOLk' ~ple :;~,~,~'.,d;~u.v a~R..'adv hlc?:.' as Tobin says ~at ---~i%V have ~en ~wh-%j what he has ~e2~ do~ The spstem has [~sscd i:,-:F a 3 h~-e';m home-flor 4 ' ' ~9o2 it TOJulI~ says ~rr~] the t~,-:~:'~[l~:~ ~ ~ was set uS as a 3. The t~< 12~0 is for 4 but ~e field is desi<~!od for 3 It ~soros at $~2 ~ .:, .~cJ=~zll~ only re<Nires 450 ~'~d a 4 would rc~luire 600. S~v . t h~ even a~st,_o~ ~laP. ~ stra!gnt 3 grim still F~'~'~ ~,~t i, uLewa~rt had i~ ~%~:~ h:ow he was -~l- 7.~--[~t'o or.tgiP[hl t~sl: tt would have N:ass~i all t~he way MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lo(~ation (address or directions) ~?~/ ~Y,~,~/,,~. ~_/~. Property Owner (/---¢./.~,~/--c~/' (' (b) Maillng Address (c) '- Lending Institution ~'~'~27/~ ~ ~7~'~:~/~ ~z~C~LTelephone Mailing Address .~//~-/~ / (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or: Check here ' ,[~if hold for pick up. List contact ~rson-and, day phon.e n.umber ~eloW. TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms 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. 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 (Rev 8/86~ Front 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 Address 1700 Date ,"~//fi DHHS APPROVAL Approved for 'tt"~'*'~'~edrooms~ by ~ ~' "~e~.~ Date Approved Disapproved Conditional T~rms of Conditional Approval CAUTION 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 ALASKA i~IIUIROnMI1TAL CONTROL SE2UICeS, ~n§ineerin9 $ [[nuironmenlol Studies INC. MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION ~Y~tJ6 9 4 1987 RECEIVED The qsT~arr~ ~o Tn~,;{-O~ ]~',ri ~'rl Et SJ ) Lp o ...... ~lDd ' ' ' and one i0 i"ee'h 'hhick. Se{~ ;zhe at?ached well los. There is no o[:her sysh~m There shouJrl_, be no i;ea] ~:b hazards :--~o:,i ~¢-~..,~_. ~ ~no°- from g;. ...... an u 2z:::~-" '~he waiwer ..... of Lhe aank ' c.~ ant ..... ,(,0 to fee( .... App?ovP. d by: ¢~x/?zo-CfC,~-~q~ ~'~' HEALTH AUTHORITY APPROVAL (HAA) , r', ~.~ ~"/ CHECKLIST- FEBRUARY 1984 ~_~ '~ 264-4720 L..-xT f WELL DATA Well Classification ?? ~V~ ~ Well Log Present Total Depth /00/ Cased to Static Water Level ~ Casing Height Above Ground / Electrical Wiring in Conduit ~/)N) Separation Distances from Well: To Septic/Holding Tank on Lot (~'7 / To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole /'¢¢~-~ Water Sample Collected by Water Sample Test Results If A, B, C, D.E.C. Approved (Y/N) Date Completed ~'~,~'- ,~ Yield Depth of Grouting Pump Set At Sanitary Seal on Casing~N) Depression Around Wellhead (Y/~ ; On Adjoining Lots ./5)~/'~' ; On Adjoining Lots /¢~ "-/- To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~' ~/~( ; Date ~-- 7'-- ~-- Comments B. SEPTIC/HOLDING TANK DATA Date Installed7h¢/F¢ Size /~ aa ~4£¢'~No. of Compartments Standpipe (~1) Air-tight Capsc-~*¢4) Foundation Cleanou¢~N) Depression over Tank (Y/~} Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ,/U'/-///4 ;for Holding Tank High-Water Alarm (Y/N) ./'~//./-/- Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well TO Property Line /bO /"~' To Water: Main/Servicp Line C(~urse ' /¢cO~ ¢- .. Corn ments To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed "~/,~62 ,/ Width of Field ' '/"~' Square Feet of Absorption Area Depression over Field (Y/¢/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation '~67 /'-/- Lot /1/// To Water Main/Service Line _ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Gravel Bed Thickness ¢ i ~.~ ~ ~ Standpipes Presentot~N) Date of Last Adequacy Test Type of System Design ~"'-/~ ~'/L/'C/7/ Length of Field -7 ~" / Depth of Field t~ t~¢~I~' ~II.E /~r$~[Ctct/.7 To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N~./-'"--'~'~ Vent (Y/N) ~ycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed X/./~2c-_ ~ ~'/ Date Page 2 of 2 72-026 (11/84) unicipakW ANCHORAGE, ALASKA 99519-6650 ' O~ (907) 264--4111 Anchorage MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES August 27, 1987 Leroy C. Reid, P.E. Alaska Environmental Control Services 1200 West 33rd Avenue, suite B Anchorage, Alaska 99503 Subject: Waiver Request for Lot 4 Lodge Pole Subdivision Waiver Request Number WR87-049 Dear Mr. Reid: Your Waiver Request for the above mentioned lot has been approved. The required 100 foot separation from a residential septic tank to a private well has been waived to 87 feet. The approval was based upon the two layers of dry clay with gravel, 27 feet and 10 feet thick respectively. The well casing penetrating through the these clay layers should assure no surface contamination entering the aquafer feeding the well at the depth of 100 feet. This waiver is good for the existing system only. Any future upgrades of this septic system will require approval from D.H.H.S. Sincerely, Daniel J. Roth civil Engineer On-Site Services cc: Gus Andress, P.E., Manager, On-Site Services/Water Quality Programs ~r~l':~:~ ~ ' ' ' SYREN BROS. DRILLING. George Cleans . DATE.~'~tTED::=8.5-82 ' ' STATIC LEVEL OF WATER GALS. PER HR/~N._...g...g..a...],.,...P..~.~...~J...rL.:H::~ FROM ............... FT. TO ........... FROM .................. FT. TO ........... FROM._2_6 ri'. TO_:.3._~ .... ,~T.s,.a..n...d....a..n.d...~.o..m..e grave 1 FROM .................. FT. TO : FROIL_3.2 .........FT. TO...~..~ ..... Jri'.~.V..~rAf}.F..~ve! drY/~ FROM ................ Fl'. TO ........ ~T ...... -::- ..... . ....... F~OM ~L..FT. TO..~.8 ..... J~T~..~.g~. 1---,~et FROM .................... FT. TO FI~O~ 96 .~T. TO._9.8_ ....... j~t.s.!.l_t_~.a..t..e.,,r..._a_nd ~;ravelFROM ............... FT. TO ........ j~vu u ~ FWOM:=9.8. .... _FT. TO_1...0.9_ ........ a~..~...~.e_L..~.O.d...~r~ ye ! FROM .................. FT. TO ............. FT ....... F.O. ................... ..,o ............. FROM .................... FT. T~ ............... ~T ............... FROM ...................... FT. TO .................. ~T ...................... DRILLER'S NAME..,..~q.L e ~ n...[l-.,~q~.~ DATE CHARGES AND CREDITS 8-5-82 'One ~ille~ and cased water well, per ft. Well depth 100'. Well site, lot 4 Lodge Pole Sub. @ $23 BALANCE '~2300.00 Thank You SYREN BROS. DRILLING, INC. SYREN BR. OS. DRILLING, INC. 2701 EAGLE STREET ANCHORAGE, ALASKA 99503 274-6437 STATEMENT DATE ' 8-6-82 IN ACCOUNT WITH George Clemmens L PLEASE DETACH & RETURN WITH YOUR REMITTANCE. AMOUNT REMITTED CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~"'[,~.'o~*~.',[~'% FEDERAL TAX ID # 92-0040440 Repoct~ ¢,ddcess ALASKA EnuIR0nmdlTAL CONTROL SI~RUICt~S, InC. ~nc~ine~rin§ ~ ~nuironm~nlal Slu~ies MUNICIPALITY OF ANC, HORAGB DEPT. OF HEALTH & ENVIRoNMENI'AL pROTEC[ION RECEIVED i, od2_fe Pole S,'.t})(it?isJo~, Lot ~ APPLIC~ .IT FILLS OUT UPPER HAL~ ONLY Prop~Aj) Owner Mailing Address Buyer .- Address z,p Code Zip Code Phone Realty CO. & Agent Address Zip Code Zip Code Phone Phone Legal Description d:-~ ,~'/~,/~ ~-..~ I ~ "(~ ~ ~',C'L. Type of Residence '~ Single Family Multiple Family No. of Bedrooms [] Other Water Supply '~i Individual [] Community [] Public Utility Sew_,er D?~pesal L(~"in d ivid ual [] Public Utility ~_.gLd in g Tank ATTACH WELL LOG, A we~l log is required for all wells drilled since June 1975, For wells drilled prior to that date, give well depth (attach log if available). · Year Individual Installed: ~ When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: ~.. ~ ~.4J4 C. -(,~ ~' ~J~'/, ~ MUNICIPALI~ OF ANCHORAGE PF2T , RECEIVED ( ~ROVED BEDROOM~ *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' Soils ~atino Dato ~w~r Insta~lod WolI 1o ~bsorption ~roa ~ ~ t.~ Well Lo~ ~--~0'~ ~, Well toTank /0~ t Septic T~k Size BAI~FtY AVE