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BOREALIS LT 5
Borealis Lot 5 #015-203-09 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES jU A crt Soil TO SEPTIC ABSORPTION Address FROM TANK FIELD Phone(s) fPeit No. No. of Bedrooms WELL 3�s~�4Z8C� U010-1 LEGAL DESCRIPTION LOT LINE 3Q'I 1 ©1 Lot '5—Block - Township, Range, Section 1-12 Al R3 W WELL irvision SIE -1C -(S FOUNDATION 6' ! - - 2 2. AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, driveway, water bodies, etc.) TANKSA, ., TF X SEPTIC>\s�� LlHOLDING Manufacturer Capacity in gallons / coo Material No. of Compartments TYPE OF SYSTEM ❑ TRENCH1 BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from Total depth from original grade original grade P J( � FT Z Fill added above original grade Gravel depth beneath pipe 1 I J 1 FT Gravel length Gravel width l width _ 4O FT / �— Total absorption area Distance between lines !z0 SO FT 6 t Numbero!lines Soil rating Pipe material J /SO SQ FT A3TMDb3¢ plr_(riz Installer " j� tn z Date Installed X-7 Lzo &L SWELLS [IPRIVATE 0,>�-f OTHER (ldentifv) Classihcallon (A,B,G) �yAY>`UnI, Total Depth Cased to FT Installer Date Installed: REMARKS: (1 � Sok _ _'2L \ -." -t-cc n k GJCc. S +L, / h S'u /a +ed_ i 6y AcG. f ,f t %G�D13G1L> Ki��t�=L Municipal and State guidelines in effect on this date: . Health Department Approval: 72-013 (3/85) J SIN W=R .FEMME x+ In pections'P/erforn eV by: ,�C.t� Date. 7/ZO that this inspection was performed according to all Date. L _'?_98 8 up MEMBER MEN ENGI'�i aa®' CIO R2 ,bert E. Knl No. 4149- ?�t•c MUNICIPALITY OF ANCHORAGE Department of Health & Human Services 825 L Street, Anchorage, Alaska 99501 343-4720 ON - SITE SEWER PERMIT Permit Number: 880107 Upgrade Date Issued: 07/05/88 Engineer Designed Owner Name: HARRY BORST Owner Address: 4830 ALPHA CIRCLE ANCHORAGE, AK 99516 Parcel Id: 015-203-09 Lot Legal: Subdivision: Section: 22 Lot Size .5A (sq.[t. Max Bedrooms: This Permit: .BOREALIS.Lots ���''�Block: 1 Township: 12N Range: 3W or acres) 3 Total Capacity: 3 Day Phone,- 345-4286 hone:345-4286 SEPTIC TANK: Minimum total septic tank capacity: 1°000 gallons. Each septic tank must have at least 2 compartments. Depth to top of septic tank(s) < 4.0 feet requires insulation over tank(s). INFORM D.H.H.S. PRIOR TO IST & 2ND INSPECTIONS BY ENGINEER, IF AFTER OFFICE HOURS, CALL 343-4681 AND LEAVE A MESSAGE. INSTALL PER ENGINEERS ATTACHED APPROVED DESIGN. MAXIMUM DEPTH SYSTEM TO BE INSTALLED IS THREE(3> FEET THIS PERMIT EXPIRES 12/31/88 THIS PERMIT VALID FOR A SINGLE FAMILY RESIDENCE I CERTIFY THAT: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I und t that thip permit is valid for a maximum of 3 bedrooms. I also d al system is 3 bedrooms and any enlarty t wil quire an additional permit. Signed: DATE: -------- (Owner)/ RRY v Issued By: DATE: ---------r-~��-----�----�-�---------- �-------------- � CORWIN & ASSOCIATES, INC. 4790 Business Park Blvd. Building E Suite 1 ANCHORAGE, ALASKA 99503 Phone 561.6151 JOB L. a-tt Se- K _1&#." L 1S S (./a, 0 SHEET NO. 1 CALCULATED BY CHECKED BY— OF— DATE Y OF_DATE MOV DATE PRODUCT 204-1 [/V—) Inc.. Gdw Mass- 01471. •� � �/ I I I l v�N � i it A_ I 1 ( 1 '�f 1, • • ' • (j' ; BILL SHEFFIELD, GOVERNOR OF ANCHORAGE DEPT. F HEALTH & DEPT. OF ENV/RON"ENTAL CONTAL PROTECTION ANCHORAGE/WESTERN DISTRICT OFFICE JUL 2 1 1988 ANCHORAGE, A►ASKA 1995003 RECEIVED 214-2533 April 18, 1985 Alaska Environmental Contrul Services 1200 West 33rd Avenue Suite 8 Anchorage, Alaska 99503 SUBJECT: Waiver Horizontal Sevaration between Well and Septic System Lot 5, Block 1, Borealis Subdivision, Anchorage, Alaska 8521 -WA -136 Dear Sirs: The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the well and septic system to 150 feet on the subject property for a 3 bedroom single family residence only. Sincerely, C"' &ILC Steve Eng, P.E. District Engineer SE/dd Municipality of Anchorage e � � �.c :t ./ a a -a.�a�ccs, •eoo.. DEPARTMENT OF HEALTH & HUMAN SERVICES tr c 825 "L" Street, Anchorage, Alaska 99502-0650 '� .- SOILS LOG — PERCOLATION TEST';, e UC J�Convin si e N . CE -5283 v cr* I. �# ` r�OFESS��; PERFORMED FOR: GV P. e S C 'iNl� G _ DATE PERFORMED: Township, Range, Section: —'5,-c, 22 T3W /�3 LEGAL DESCRIPTION: �N/ EPTH JCI' �Z�(� ��'('✓?ti�lllz SLOPE SITE PLAN (FEET)__ [� 4 3 4 5 i 6 , 7 9 10 11 t 12 13 14 15 16 17 18 19 z s WAS GROUND WATER ENCOUNTERED? S L p IF YES, AT WHAT ( O 3 DEPTH?� P E Depth to Water After i & it ? 8 Monitoring? Oate: Reading Date Gross Time Net Time Depth to Water Net Drop C) lew 5 fL7 20�PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN _ FT AND 2. FT _ COMMENTS �/ l .. 1-56 // ( ? �(_� : 7 f� l l �l ` •.: ,.� "7" { PERFORMED 8Y: %�/� u ' ( I RT IFY THAT T S TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN S N EFFECT THIS GATE. DATE: 72-008 (Rev. 4/85) ER SYST .�/ NORTH Crute Co. ��l•.4 t?� °� 0,�E-5153 ,.;�:� } C /vo le reel ��,•, � � i EM LOCATION PLAN LOT aIOCK sUaDIVISION SECTION/TOWN HIP/RANO£ �3 Pc � 22 NOTE • SCAI.E��— / � � THE ACCURACY OF LOCATION OF EXISTING (GCJ PROPERTY CORNERS, WEIRS, ANO SEPTIC DRAWN BY- SYSTEMS INO(CATED IS NOT EXACT, /1 JG DIMENSIONS INDICATEO HAVE 8EEN DETERM(NEO BY USE OF CLOTH TAPE AHD NOT BY SURVEYING TECHNIOUES. 49' PREPARED FOR. > d ,i J 1 iii �E� �iaeris•:�: 3r•9 ` s.x a� DATES / ( SHEET OF I 10 2� CO zo7, S uj UT Nf D3 'j rn of N(D < co o w LL PT ET NJ z Q Q u C 1. u i�2 ITI Z ui CO Lu N, ^I LL u. d d -to C: c —.— 9 c LI) 0 e- ft z o Q z F- < 0 :;7-: a. @ 4075 (n Cl) tf C(5 co u) N le Lo u7 N -a w< fn w . . . . . . . . . . . . . . . . R LL LL Ld U) CL Z (1) < uj Cl) OMW /L -U73 tHev.3/78) 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 PHONE ❑NEW Tum VJe-LiN1a✓N 134s 52, j IPGRADE MAILING ADDRESS H & 38 Cr'rJe— LEGAL DESCRIPTION gz,recit s L�' 5 l3iock l S'c iz T- 3W P,3"j LOCATION NO. OF BEDROOMS N l P ko- C,"Ic_ 3 Well Absorption area Dwelling PERMIT NO. UY DISTANCE TO: . I- Q Manufacturer i <' J 1 atrial No. of compartments LU ti Liq. capacity in gallons IF HOMEMADE: ide length Width Liquid depth Y DISTANCE TO: Well Dwelling PERMIT NO. JOZ 2 z �� Manufacturer Material Liquid capacity in gallons w = DISTANCE TO: WellFoundation (S Nearest lot line c PERMIT NO. j LL Z No. of lines Length of each line 3� Total length of Janes , Trench width Distance between lines j=ZW 70 '-3G' inches N H Top of tile to finish grade If Material beneath tile Total effective absorption area 1 3 inches 6 6 Ca Length Width Depth PERMIT NO. w O CL N W Type of crib Crib diameter Crib depth Total effective absorption area W DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER AI PIPE MATERIALS 'VV SOIL TEST RATING / INSTALLER int c.re a E r REMARKS VJa; ver w&s gm-n+k ky S-4eve gw� W e R- -ice - S -c p' S y Siri'1 6`s i -•,LL c e • 6 h, �n r y I•i e u ISO' ceks+C4 o•+ 2-0c)( e, vrMunr I.vtfl I ivsP•��t�d 6�� �o•�y ��� sr r 3 neW O ®N d T. r y Old y jtin APPROVED DATE LEGAL -2y - Ss5 -sUre_tilg Ri"lr4:_ i L'�ts pec -.z 7-3LuO J /L -U73 tHev.3/78) 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 N PHONE EW ❑ UPGRADE MAILING R SS 60 36G4V(_k0e_CtQe" I<% LEGA�DESCRIPTION LOCATIOA � LeZ 0' NO. OF BEDROOMS UY DISTANCE TO: We11 Absorption aea Dwelling�� PERI �O� / C.� n~. ZQ W I.. ManufacturerIg Material No. of compar ents ti Liq. capacity in gallons IF HOMEMADE: Inside length Widt;7-eE L.1 .... Liquid depth Y JCz DISTANCE TO: Well Dwelling PERMIT NO. O Z F Manufacturer/ Material Liquid capacity in gallons O W = DISTANCE TO: Well6 ISO/ Foundation„ pj, Nearest lot lin PERMIT NO. ! J LL Z Z W No. of lines Y Le of ea Ij�e / / Total n h o ines Tre h idth inches Distance between lines HTop p of tile to finish grade Material beneath tiled inches Total effecti a absorption area s FT W a Length Width Depth PERMIT NO. Q F c. a W Type of crib Crib diameter Crib depth Total effective absorption area WWell DISTANCE TO: Building foundation Nearest lot line J J Clas Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MA ERIALS 5T o3 SOIL TEST RATING � r INSTALLER 1 j j6 r Ld 44, -C - REMARKS b c�AW41121 f Aj d,A TA . L• Q�s &D Z DATE LEGAL 72M3 (Rev. 3/78) a � ' 1-1 Li 1%J 1: 1:1 1: 1=4 121 I1__ I _T - "W" 1:1 F= 021 P4 ED F-1 1:1151 WTI 13 IEH: DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 13 T%JI--- $3 1: -- EF E3 EZ VJ EE FR FA EE FT P1 3E-1 PERMIT NO: 850109 DATE ISSUED: 04/22/85 APPL 1CANTN TOM WELLMAN ADDRESS: 4830 ALPHA CIRCLE ` ANCHORAGE, AK 99516 ' JONTACT PHONE: 345-5278 LEGAL DESCRIP: SUBDIVISION: BOREALIS LOT: 5 BLOCK: 1 SECTION: 22 TOWNSHIP: T3W RANGE: IN LOT SIZE: 20000 (SQ.FT. OR ACRES) ' MAX BEDROOMS: 3 Listed below are the options available to you in , designing your septic system. Choose the option that best fits your site. _..... ..... ... ..... .... ______________________ 0 -Fol IEIT V"A oil 10-41 ..... ___________ TET EZ it Vi~ 13 FT f%][0J DEPTH TO PIPE BOTTOM (FT.) 4.0 4.O 4.0 GRAVEL DEPTH (FT.) 11-0 0.5 3.5 TOTAL DEPTH (FT.) 15.0 4.57.5 GRAVEL WIDTH (FT.) 'r.5 22.0 5.0 GRAVEL LFNGTH, (FT.) 30. 43.0 72.0 GRAVEL VOLUME (CU.YDS.) 32.0 35.1 53.4 TANK SIZE (GALS) 1,000.0 ** 1,000.0 ** 1,000.0 ** SOIL RATING (SQ.FT./BR) 220 209 220 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS �..... ..... ..... ... �������..... ..... ��������... ..... ... ..... ����..... �..... ����� I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State o{ Alaska. 2. I will install the system in accordance with all MOA codes and regulations, ' and in compliance with the design criteria of this permit � 3. I will adhere to all MOA and State of Alaska requirements {or the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum.o{ 3 bedrooms and ` any enlargement will require an additional per/nit. � IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDIPG CODES, ` THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN,, SIGNED DATE: ____..... ..... .... ______... ..... ..... _..... .... ..... ..... ..... ..... __..... ..... ..... ..... ..... .......... _.... ... ..... _ __..... ..... ..... ..... ..... ..... ..... ..... ..... ____ APPLICANT: ISSUEh 5Y DATE: __ __________ ��________�__ No pum rop 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 PHONE XNEW LNUN o5—(a ❑ UPGRADE MAILING ADDRESS J61 V_14 LEGAL DESCRIPTION LOCATION V NO. OF BEDROOMS DISTANCE TO: Well ` 5 Absorption ares "r Dwelling r PERMIT NO.'I'aO � v Y W wManufacturer < QL�£� Material �E:.. No, of compartments h N Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth 6 Y DISTANCE TO:II Dwelling PERMIT NO. JCDZ Oz FQ- Manufacturer 14 Material Liquid capacity in gallons Well DISTANCE TO: %.So Foundation IL Nearest lot line PERMIT NO. '� LU + 0"1 J u. Z No. of lines .t� Length of each line '1 Total length of lines Trench w`dth 5j Distance between lines N Z w F --M h I .S 1 –� inches Top of tile to finish grade , �� Material beneath tile s� Total effective absorption area p "t © inches Length Width Depth PERMIT NO. W Q F Type of crib Cr diameter Crib depth Total effective absorption area as w w rn WIbill Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. Jmm W r. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS 3034- L 36 4 SOIL TEST RATING X25 C INSTALLER A'TQ s REMARKS 33 r_ S - 6 ESE,Iu�Q. ow r, � K c5' a O PROVED DATE hh � s\ 72-013 (Rev. 3/78) ��J �A ���������� �� ���I ����� DEPHRTMENT �r vEHLTH HND ENYIRONMENTHL PnnTECTION 825 'L TREET, HNCHORHGE, 264-4720 ' PERMIT NO ( 780720 ) HPPLICHNT DENNIS CONLEOBX]60 HNCH LOCHTION HLPHR CIRCLE LEGHL LT.5 BLK.i BOREHLIS S/D LOT SIZE TYPE OF SOIL HBSORBTION SYSTEM IS� DRHINFIELD MHXIMUM NUMBER C F BEDROOMS = ] SOIL RRTING (SQ FT/BR)= 225 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS� ......... .... ��= CA 9 p 0 E 0 IF' H 11= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE QROUN[ HND THE BOTTOM OF THE EXCHYHTION (IN FEET) 0 1 OF -,-l"' ���Ir--4 FA J. I� THE GRHYEL DEPTH IS THE MINIMUM DEPTH OF GRHYEL BETWEEN THE 8UTFHLL PIPE HND THE BOTTOM OF THE EXCHVHTION (IN FEET) H. 11, �R,._ ..0 . ...... .. ...� PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE INSTHLLHTION INSPECTIONS OF HNY WELLS HDJHCENT TO THIS PROPERT9 HND THE NUMBER OF RESIDENCES THHT THE WELL WILL SERYE. ___������ BHCKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTION HND HPPROVHL BY "TT-1IS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION� MINIMUM DISTHNCE BETWEEN H WELL HND HNY ON-SITE SEWHGE DISPOSHL SYSTEM IS 100 FEET FOR H FIR. IVHTE WELL/ OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL OTHER REQUIREMENTS MHY HPPLY� SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS H�E HYHILHBLE TO INSURE PROPER INSTHLLHTION �R.' E f F P1 E* �� �� �� I CERTIFY THHT FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE 2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES ]� I UNDERSTHND THHT THE ON-SITE SEWER SYSTEM MHY RFQUIRE EWLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THHN ] BEDROOMS SIGNED�_ __ _________ HPPLICHNT DENNIS CONLE\�� � pv ISSUED BY_ ____DHTE�YI2 A SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 1:1 PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: TDY�1 W �' I MA �') DATE PERFORMED:/ 2 6 b LEGAL DESCRIPTION: �o: eaS Q T (A I �-, SLOPE SITE PLAN FEE t OL 1f vrwi4e a�:�anic Sc 2 I J I 3- 4--t 4 S; (} iA. C[>dhf,- � • � �t sem,- p;�Q � �h ., �,, rn, 5 0� 6 7 8 9 10 11 Date WAS GROUND WATER Net Time Depth to Water ENCOUNTERED? A0 12 r(�•1 M■■■..■.■■ PERCOLATION IF YES, AT WHAT _ &ZyT l C2C DEPTH? 13- 't 14 15 16 17 18 19 A■■■■®■■■■ Date Gross Time Net Time Depth to Water Net Drop r(�•1 M■■■..■.■■ PERCOLATION RATE (minutes/inch) &ZyT l C2C ALAT %E 6C (Z6r"4 't ■■■■.■MMME■ ■■■■■■'.■.'■ MIMSEE..ICE310 EMEMENIENNIN ■■■■■■REN■ Va i 'C�� loc-(AlOoj or -1-4 e- csep"�l'� S�I5+C$I-- Xr"A , II�I1 �1I �41e sP�.P� , �e /S1wE,- rock w L1 l aZk C'LCC,t+ Com'( , n T•(I wuJ o[.-cq J PERFORMED BY: eD aj V+10p `3-r 95 Celt{ CERTIFIED BY: DATE: ENNNEMEMEE efF i ,-,* - � `R4 suj 4&fT 1 �— ■■■■■MEM■■ ■■■■■■EW■■ M■■■■■■■■■ EME■■■■■■ Rea Date Gross Time Net Time Depth to Water Net Drop r(�•1 PERCOLATION RATE (minutes/inch) &ZyT l C2C ALAT %E 6C (Z6r"4 't ww guile Va i 'C�� loc-(AlOoj or -1-4 e- csep"�l'� S�I5+C$I-- Xr"A , II�I1 �1I �41e sP�.P� , �e /S1wE,- rock w L1 l aZk C'LCC,t+ Com'( , n T•(I wuJ o[.-cq J PERFORMED BY: eD aj V+10p `3-r 95 Celt{ CERTIFIED BY: DATE: APQ.,-�n-Ky efF i ,-,* - � `R4 suj 20 r(�•1 PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS Tk�'S 't ww guile Va i 'C�� loc-(AlOoj or -1-4 e- csep"�l'� S�I5+C$I-- Xr"A , II�I1 �1I �41e sP�.P� , �e /S1wE,- rock w L1 l aZk C'LCC,t+ Com'( , n T•(I wuJ o[.-cq J PERFORMED BY: eD aj V+10p `3-r 95 Celt{ CERTIFIED BY: DATE: APQ.,-�n-Ky efF i ,-,* - � `R4 suj 4&fT 1 �— j 72-008 (6/79) SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 1 ,,m Wekk`14 I DATE PERFORMED: _ 1 Z6 I P� LEGAL DESCRIPTION: Safes Q ( L S 'jt12 FF T SLOPE SITE PLAN 1 pF I E ) 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS i cA- 0 WAS GROUND WATER 5 ENCOUNTERED? no L O P IF YES, AT WHAT E DEPTH? G Reading Date Gross Net Depth to Net Time Time Water Drop 3126 1zo6 60 - IZIG Io .13 J21b _ 6D 2 12"16 to ifs- 15 'SD 3 123b in 6 U i U 1236 _ 50 `( ]2q6 0 to f 2y b 5' IZ�t to - PERCOLATION RATE W'Z i0b to (minutes/inch) dH TEST RUN BETWEEN FT AND Z FT 1 tv lC( Is r,+CJ (& ZOS t7'/6 i PERFORMED BY: !?u.— y N2 a.�i s"r 85- 02-1/ CERTIFIED BY: 72.008 (6/79) DATE: S -C T %VF;k MUNICIPALITY OF ANCHORAGE Depart of Health and Environmental Lection SOILS LOG PERCOLATION TEST Perfornmed for Tom Wellman Date Performed May 5, 1978 Legal Description Lot 5, Block 1, Borealis Subdivision TEST '� hs : X41' h1 � ''�S' r o� So��-rltwG-ST coRNG-tZ of I.OT o 2 _4 F-1 L 12 lei IEd 0.0'- 0.5' - -- J 1 us Mk e.g Net Drop 0.5'- 1.5' - Red sandy soil - SP. -0- 120 min. 150 Sq. ft./bdrm. -5.25 in. 1.5'- 7.0' - Grey, sandy silt with silty sand stx SP -SM 200 sq. ft./bdrm. (some seasonal water perched on silty 7.0'-15.0' - Very tight grey silt - ML 275 sq. ft./bdrm. e A, TD = 15 feet Average visual square feet per bedroom = 238 Date Net Time Depth Net Drop 5-5 -0- - .5 in. -0- 120 min. -5.75 in. -5.25 in. Percolation Pate 22.9 Pcr_`ormed By v ingers minute s/inch = �,5�1 — CHAMPION DRILLING COMPANY, INC. Vir Municipality of Anchorage g Development Services Department Building Safety Division On-Site Water & Wastewater'Program 4700 South Bragaw St. P.O. Box 196550 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. t?1Z'y"c�j HAA# n,(4in l 1. GENERAL INFORMATION Expiration Date: - 10 -J6- ' S Complete legal description Location (site address or direct Current Property owner(s) RICHARD MAKI Day phone 345-2370 Mailing address 4830 ALPHA CIRCLE • ANCHORAGE AK. 99516 Lending agency Day phone Mailing address Real Estate Agent RANNA FEKRAT W/ PRUDENTIAL JACK WHITE Day phone 762-5802 Mailing address 3201 "C" STREET SUITE 200 f ANCHORAGE, AK. 99503 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 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class A Well 0 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 samples. (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 engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I 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. 1 further verify that based on the information obtained from the Municipality of An 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SURE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Attachments: / HAA Checklist L/ Septic System Advisory Well Flow Advisory Phone 337-6179 Date - 1q, I -u 4 bedrooms, with the fllowing stipulations: ttttt(tl((t A kl OF Manitenance Agreements Supplemental Engineer's Reort Other WATER AND : r PR-7VA �� ' ,... By: / �� Original Certificate Date: (Rev. IWI) unicipa i y o nc orage o� a� Development Services Department Building Safety Division' On -Site Water &,WastewaterP'ro ram �" °'r 9 F ,.. 4x�ou ragaw ti.. ox 196 Anciorage AK 995 fg 866 is vaac4 w u �amny uoiyuo �avuvo y+vunu� ui _ —9-P.M. Date installed. o/zo/ I wo 011 ni.::: .c,'rvrnn YCC Results (Pass/Fail„) rnbo For .5 bedrooms "`sl?' s..S' ggg ft sy(i -c 1v: v, xB .,.,ErF'3zy'"a. ;'G Lx' /s2�.'�,C" .:v.. Wateradiled 0 nal New rleofh 0 in gallons Gri6ms C Mahh6lb/Ac WWI High water alarm level at in. Cycles tested- Meets alarm & circuit requirements? line — that the yesystems are in in effect on this d. water e4W A. 61 Miss., Fee $ Receipt Number 0 Ell On adjacent lots _ Public sewer manhole/cleanout ;. Holding tank yesystems are in in effect on this d. water e4W A. 61 Miss., Fee $ Receipt Number 0 Ell 09/28/04 TOE 11:09 FAX 1 907 762 9189 Jack White Estate U002 .Sante AMf� Amll ncv. vs.m) /►d* FDIOMF RIMGi AL,-PjJA Cie, a Rami >tiMfi P Is.A waao fBFAa Q O I N .p tJ •� V � 1 1 b� I k ys r Y Lp� tr n 9 Q1,lYlr� 9S�' q4 F, P, CAivl 3 c;, rf� d UNDER NO CIRCUMSTANCES SHOULD AN ASI-KALT BESUSE FOR Cd151RlICTld1 OR I= EVIA9J9WNC BOUNDARY OR FENCE GNM THE SURVEYOR TAKES REVONSIOLM FOR 7HE INIRAL 7RMSACDON ONLY AND ASSUMES FINANCIAL UABIUT' ONLY FOR 7HE OOST OF THE SURVEY. LISTED OISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. Uff SURWY SURVEY TYPE SYMBOLS FUMDAWON ASI -M&7 ❑ NAL 7 1111 0 7 1111E A& a ••••••••• SET ::::::::.. ASPHALT DRADHA� ...... 3 -BMT ❑ UN ... A>f.11W,r , .. LOI SUNaY ... MAS-R1Y PIAT mm.* k. Imm la P o FOUND REBAR 9-0. a WOOD FENCE '••+0 CONCRETEAa-SAT ® ASSUMED C".-K—K--K- METAL FENCE ® WOOD DEC( PLOT PLANS do LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE SURDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRACIE RELATIK SHOWN. FINCI . MEL43. $ffJMC�CLEANCUTS SiarmxS• DRIVEWAYS. TO FINISHED AND U71UTY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN 7HETR APPROXIMATE LOCATION. ONLY. SNOW THE EXISTENCE OF ANY EAsFMEN= COVENANTS OR RESTRICTIONS MAY PREVENT SOME MPROViMENTS FROM BEING SWEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORDVNL=3 D7 IERWISE NOTED. SURVEY CERTIFICATION F '`�y Prepared Ty— Robert .Johns, Jr. &Assoc. yF„TF,M PWT PLM ..wr ,...1Y aw �.. p,...7..•..1 .........� Som!0 ^I -1P1.• Professional Land Surveyors 11 AVE :."'.ww + v w M r • .r_............... ,r' AY IE 1 S ORAE Al.w AN•iCA 92601 WORAOE. � Rmc. W S.F. R. Plot FE. Na 49th . FouNonnaR AS -WILT y•• •• i 1" = 30' D 9-24-04 Grow bX RES Chocked by.••••• FEJ L b.,n C AMa J. MwF �.) M I .Yru« '+i.�1s� wrM. Nww«.,4�.w.www«-ww�sMw.—i ••• •• •••• /i P1�•{ D°'�°'' 9-24-04 ra 2736 w 248140 .lww � •'`'� FINAL SNONRE AS -ORT L..L A..i,. 4121— ...t A,♦♦'I� 01 DwcFbdttac Mrw..rrw w,1Mwr. u1In,•.WsrN.�..,LI«•g«M.MM_•wv•w• 'y A..., Lot 5, Borealis Subdivision Yw.a.�nu.�.M 1.1ti.. ll I. W �• Y �( r.� �OI�rr11NAd V'•� MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information (a) Legal Description (include lot, b Application Date d SSS , subdivision, section, township, range) Location (address or directions) 146312 i4/.off C i 2C lF ,.315- 6.7 17 V (b) Applicants Name %Is? ajgll,&lclw&i Telephone - Home Bus iness,.�lo3-V30y Applicants Address AIR) AZ/,ha;delt AnClizeaa £F,A5K.4 gqS/�o (c) Applicant is (check one) Lending Institution =3 ; Owner/btA4Ae-r � ; Buyer = ; Other � (explain); (d) Lending Institution b1�A 2s Telephone pno k -L `10 2_5 Address /7rtc �cti-� � 4k 9iJ /0 c (e) Real Estate Co. & Agent i Address Telephone (f) Mail the HAA to the following address: ,)�6 � a co 2. Type of Residence Single -Family � Multi -Family Number of Bedrooms ,3 Other (describe) 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 M Public [::� Community [:::I Holding Tank M 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] L„ S 6 / 404Fov2lS S/6 A . 9 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 regula- tions in effect on the date of this ninspection. Nami of Telephone(p/-5 O 116 Address IZV)h u%]� 3.3 )Q4nc_ iZ XO -a, 0L. 41,4S k'A 52s7s %3 Date0 C2 Of �tt f�yt8 a l�de�-pti4.v�- epic �,�t •.a d (ENGINEER SEAL) i o..y .. °e•. •° u ya R V •• ,,q ,y 6. DHEP Approval Leroy C. Reid, Jr. d® ° No. 251-E \ i® / ,� Approved for C��c(�F�bedrooms By "rte /=i/t Da� ®®� Approved_ Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. 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. RR4/ej/D18 [Page 2 of 2] (DHEP SEAL) 7-19-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY Of ANCHORAGE VEpT. of HEALTH & ENVIRONMENTAL PROTECTION Legal Description: Lbf S' /S/o nk / APR FCEIVED 22 Well Classification! If@ B; or C, D.E.C. Approved(Y/N) Well Log Present (Y/N) N(A VDate Completed W (A, Yield A -'1A Total Depth Cased to 0 j 14 Depth of Grouting N�_ Static Water Level w( Pump Set At Casing Height Above Ground AJJA Sanitary Seal on Casing (Y/N Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N)fV1A Separation Distances from Well: To Septic/Holding Tank on Lot/00 On Adjoining Lots �i� To Nearest Edge of Absorption Field on LotiS`o On Adjoining Lots A-1 To Nearest Public Sewer Line AJJA To Nearest Public Sewer / Cleanout/Manhole t4A. To Nearest Sewer Service Line on Lot N1A Water Sample Collected By #J 1,4- ; Date NJA Water Sample Test Results fj(4 Comments DrnQ&A"ALL 3/�9is B. SEPTIC/HOLDING TANK DATA Date Installed 8/25-17re Size [©fin No. of Compartments -z- Standpipes )a Air -tight Caps �N) Foundation Cleanout Depression over Tank (Y4 Date Last Pumped Pumping/Maintenance Contract on File (Y/N) A4 ; for ►aJ IA - Holding Tank High -Water Alarm (Y/N) �1- Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: Z To Water Supply Well /yo To Building Foundation Ia . To Property Line 30 To Disposal Field G'j � To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Commentsdm,o 3/10M ©4/aCA, a bF 08 Receipt #"9q3'3�4G Date Paid: Amount: A(15 - (Page 1 of 21 2-15-84 C. LS al i3st;¢.a11-�.c ABSORPTION FIELD DATA w Ado - Soils a(¢.Soils Rating in Absorption Strata °2.2 Type of System Design 7Z&*tcA Date Installed 11 /a, /?8' Length of Field ? 2 e Width of Field S"' Depth of Field 4,..5 - Gravel Bed Thickness .?.S-' Square Feet of Absorption Area 3iO Standpipes Present �) Depression over Field (YIAO Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply i\bll To Property Line /.2' To Building Foundation 23.5 To Existing or Abandoned System on Lot ►Uf ,¢ On Adjoining Lots >30 To Water Main/Service Line To Cutbank(if present) KJ1.4 To Stream/Pond/Lake/or Major Drainage Course >/0,60* To Driveway, Parking Area, or Vehicle Storage Area e02" Comments© %c A. 319�d S ; v►t AA&d J- �?w ak D. LIFT STATION Date Installed PIA, Dimensions N 12f Size in Gallons A4,4, Manhole/Access (YM) N "Pump On" Level at o 11,4- "Pump Off" Level at V 4 - High Water Alarm Level at A) Vent (YIN) W171 Tested for W?A- Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(YM) N(&- Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or, conformed to all MOA HAA Guidelines in effect on the date of this inspection. .401 � — Signed Date° see 66 �'v �e Company 4e;cs MOA No. 5-02 L 4 RS 0%-V a It goes �Va R'9, ; Le C. Reid, Jr..' w No. 2251-E [Page 2 of 21 2-15-84 ALASKA 6nuIROnrf STAL COnTROL RHOS, InC. 6ngineerinq & 6ironmental Studies APRIL 1 1985 TOM WELLMAN SELLER— WILL PICK UP FROM OFFICE 4830 ALPHA CIRCLE ANCHORAGE AK 50047 LEGAL:BOREALIS SUBDIVISION BLOCK 1 LOT 5 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE -3/19/85 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 734 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 125 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 676 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS NOT ACCEPTABLE FOR A HOME OF 3 BEDROOMS. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 7/24/85 . OF AL �'®1 soh�• �� • " _ °•'���,p S .49 [i �.•.••ii'�Ta�o o a•0oo• reab� •• f• _ ....... ...... ¢. as ,r� Gt..w � Ler C. Reid, Jr. ��J'J•c o.2251 -E an <. 1200 West 33rd Auenue, Suite B • Anchoroge, Alaska 99503 9 (907) 276-1361 6--' [W I r BILL SHEFFIELD, GOVERNOR IV — 1 1 1 Lh DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (907) Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 274-2533 ANCHORAGE, ALASKA 99501 DATE: ) '�/o za PWS I.D.# , To Whom it May Concern: g Accordi to records on file in this office the %��p D \ l�d�,�',Q: � Water System is in compliance with the State Drinking Water Regulations Sincerely, DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 April 18, 1985 BILL SHEFFIELD, GOVERNOR 274-2533 Alaska Environmental Control Services 1200 West 33rd Avenue Suite B Anchorage, Alaska 99503 SUBJECT: Waiver Horizontal Separation between Well and Septic System Lot 5, Block 1, Borealis Subdivision, Anchorage, Alaska 8521 -WA -136 Dear Sirs: The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the well and septic system to 150 feet on the subject property for a 3 bedroom single family residence only. Sincerely, Steve Eng, P.E. District Engineer SE/dd 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 AUt IS S'7 ��- Mf8e, 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) 1) TT S 9 ef_ K 1 p Ac l S S'v r3 r� Location (address or directions) 403c' AL Pt -1A Gr e'C (b) Property Owner PA If F -V &eo' T- Telephone: Home 34 ' 4286 Business Mailing Address 4 pC- P N 14 I ec& ^,c.1� (c) Lending Institution- Telephone Mailing Address �t - (d) Real Estate Company and Agent f Address Telephone (e) Mail the HAA to the following address: or: Check here if hold for pick up. List contact person and day phone number below. 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 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 8/861 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 G';r t')J,0 ACCs -t , Telephone _= -ZZ - i31 I Address >(000 E• 7%Ati7r^ tz f/ n S*Gu le 00:5— An Date __Z b W 77 Poo .ry Br c J. Corwin c� •• o cr_z283 .' ® ` Fili AMP 1i11 ��r�11��rC9�®� 6. DHHS APPROVAL Approved for bedrooms by Approved — Disapprovec Terms of Conditional Approval Conditional CAUTION Date 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 8i86) Back CJ MU ICIPALITY OF ANCHORAGE (MOA) 61 GN I" AUTHORITY APPROVAL (HAA) o,( OFPv crWO� CHECKLIST - FEBRUARY 1984 MSN\G\y P SR 264-4744 \RpN E� �, 0 of Legal Description: 1-0 -F �'`� A. WELL DATA Well Classification rn't, CA,6, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed f%Kna�"' Yield Total Depth Static Water Level Cased to Depth of Grouting Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) 1 To Septic/Holding Tank on Lot I !x 4—; On Adjoining Lots t To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots — To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Water Sample Test Results Comments (fomr,tjil) 4,/ 6L)e l l PtyS•.r1) B. SEPTIC/HOLDING TANK DATA Date Installed Size /A LA � IG No. of Compartments Z Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped Ah /Pr r7S'qACS &40.� Z709 Pumping/Maintenance Contract on File (Y/N) for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well /.5?} To Building Foundation To Property Line To Disposal Field _�L_ To Water Main/Service Line * 4C2 + To Stream, Pond, Lake, or Major Drainage Course Comments rA Page 1 of 2 72-026 (Rev 8/86) Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata S'-� Type of System Design Date Installed S� Length of Field 4o 1 Width of Field f1f,ti� Depth of Field c Gravel Bed Thickness �/ Square Feet of Absorption Area 7-Z 55,��* Standpipes Present (Y/N) / n Depression over Field (Y/N) �j Date of Last Adequacy Test Alk, Results of Last Adequacy Test z{ e") 4- - Separation Distance from Absorption Field: � t To Water -Supply Well To Property Line �0 To Building Foundation -7 To Existing or Abandoned System on Lot 10, ;On Adjoining Lots 7 Zo , To Water Main/Service Line 40' + To Cutbank (if present) N 1A To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments A Seeng, Ski S y�_,� Sys 1' 1 D. LIFT STATION Date Insta d Size in Gallon "Pump On" Level _'11\ High Water Alarm Lev Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company MOA No. Receipt No d 1p %s -l. Date of Payment Amount: $ a d Page 2 of 2 72-026 (Rev 8/86) Back Engineer's Seal r SCMrA 1, F N2 M 'M V DEPT. OF ENVIRONMENTAL ATION ` ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STRE:T, SUITE 303 k` ANCHORAGE, AP.ASKA 99501 April 18, 1985 Alaska Environmental Control Services 1200 West 33rd Avenue Suite 8 Anchorage, Alaska 99503 Alli SHEFFIELD, GOVERNOR 274-2533 SUBJECT: Waiver Horizontal Separation between Well and Septic System Lot 5, Block 1, Borealis Subdivision, Anchorage, Alaska 8521 -WA -136 Dear Sirs: The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the well and septic system to 150 feet on the subject property for a 3 bedroom single__family_residence only. Sincerely, Steve Eng, P.E. District Engineer SE/dd STEVE COWPER, GOVERNOR a or o d o DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 1334 ANCHORAGE. ALASKA 99503 DATE: August 10, 1988 PWSID: 211708 To Whom It May Concern: According to the records on file in this office, the BOREALIS ALPHA CIRCLE Water System is in compliance with the State of Alaska Drinking Water Regulations. Please note that departmental records indicate that the public water system was installed prior to the 1978 implementation of the Alaska Drinking Water Plan Review regulations. No as—built plans have been reviewed or approved by the department, nor are any necessary. Since the system has submitted acceptable water samples on a regular basis and received a satisfactory sanitary survey evaluation by the department, the system is acceptable under the standards in effect at the time of installation. An official "Certificate to Operate" may be issued upon receiving a complete set of as—built plans. Any expansion of the water system after 1978 will require plan review and the issuance of a "Certificate of Operation" permit. Sincerely, Steven W. PE District gineer SWE:pkk c� CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 LABORATORIES ANALYSIS REPORT BY SAMPLE for Work Order # 8261 Date Report Printed: AUG 9 88 @ 11:34 Client Sample ID:ALPHA CIRCLE PWSID 1211708 PWSID :UA Collected AUG 2 88 @ 13:15 hrs. Received AUG 2 88 @ 14:00 hrs. Preserved With :4 DEG. C Analysis Completed :AUG 9 88 Laboratory Superyiso STEPHEN EDE Released By : G - Client Name COLDWELL BANKER Client Acct COLDWETB P.O.# NONE REC'D Req # Ordered By : ROBERT D. MARTIN Send Reports to: 1)COLDWELL BANKER 2) .................................................................................................................................. Special CA. LL FO.R PICK-UP BY 8-9-88. Instruct: Chemlab Ref #: 2045 Lab Smpl ID: 1 Matrix: Water Allowable Parameter Tested Result/Units Method Limits --------------------------------------------------------------------------------------------------------------- INORGANIC CHEMICALS/TITLE 18 n/a n/a ARSENIC ND(0.001) mg/1 ASTM D2972 0.05 maximu BARIUM ND(0.05) mg/1 EPA 208.2 1.0 maximum CADMIUM ND(0.002) mg/1 EPA 213.2 0.010 maxim CHROMIUM ND(0.01) mg/1 EPA 218.2 0.05 maximu FLUORIDE 0.17 mg/1 SK14 414C 2.4 maximum LEAD ND(0.01) mg/1 EPA 239.2 0.05 maximu MERCURY ND(0.0002) mg/1 SM14 301AVI 0.002 maxim NITRATE -N 0.27 mg/l EPA 353.2 10 SELENIUM ND(0.001) mg/1 ASTM D3859 0.01 maximu SILVER ND(0.01) mg/1 EPA 272.2 0.05 maximu TURBIDITY 0.65 NTU EPA 180.1 1.0 maximum Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY R.D. MARTIN. .............................................................................................................. 12 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than -- =7 � --(Rev x"(76-) MATE = _ = 1TA?7=€ YlV P ^Qa ~— 7RQSRETT R _ 1RlSi�ECTf T T�P�+�l�iG�t�EN�� _ i�iC7MB�R �F aEDRL�i�1�!! _=S1NtLE FAMILY LO IME THREE I� NfUl�l�I-PLS-P Mt1.Y' -ED TWO 0 _ FOUR _ m SI' �41A'Il3JPGY PERJVl1T NU1U[BER _ ❑ t6i�7Cbimxl= DEPTH ELL MMU7�3at7Y=- _ .1�. TILITY bhet�Q7LVE17iEs% 16C%RECEIVED _ PERMI i NUN1BEPt TNt31J�3L1N SITE ' DATIIV ����t�� iz �r CFL•[atdmg Tank t - --SOILS - ize'� ank is hai�ernad� RA-riMG -PE$ A(tfK N1AlVUFACIURER - ������._ S�Rtc] bldii�g "nk -Absorption Area - Suver 1„in =Abaorp��rt Axes t��ear_Lot Gird - _- -_ ARPVE� FSR BEI]Ra�M ` l� ii1� ----' AL-APPR��/A:L (hetterrn t ticor p c$rttf cats) =, _ - =Y Tula) 'G1=SAL RIPTION =7 � --(Rev x"(76-)