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HomeMy WebLinkAboutSPERSTAD #2 BLK 4 LT 4perstad #2 Block 4 Lot 4 #018-072-20 1UNICIPALITY 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 l:�G0 rNEW RADE MAILIN ADDRESS Ob LEGAL DESCRIPTION L 41 6 L{ -44->Z LOCATION _ NO. OF BEDROOMS DISTANCE TO: Well r 100 '+" Absorpti+8r7ea Dwelling,,,+ PERMIT NO. iL Q w Manufacturer C J.�(/✓t.Cl Material No. ofcompartments �L N Liq, capacitx in gallons U IF HOMEMADE: Inside length Wi th Liquid depth OUz DISTANCE TO: Well Dwelling PERMIT NO. Sz Manufacturer Material Liquid capacity in gallons 0 w y DISTANCE TO: Well / vo `F Foundatio i � � Nearest I t line fi! PER IT NO. r% 80,501 I Z Z w No. of lines Length feac� line Total length 9f lines TrencJ,i� ifl�h ;�� Distance between lines Fa- o Top of tile to finish gradeMaterial `4 beneath the 3 / _inches -inches Total effective absorption area p F3 W Length Width Depth PERMIT NO. a Q I— w° Type of crib Crib diameter Crib depth Total effective absorption area w `n DISTANCE TO: Well _ Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PER //MI�..fVQ',o 50 / W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER LEGAL PIPE MATERIALS r. SOI L TEST RATING I � Jr— INSTALLER J � 4,1 REMARKS 10 r � K APPROVED DATE 72-013 (Rev. 3/78) P-11 U t,-.0 1: -t- A ii— X .._p.... "-trj' C-1 A: --u P-4 I .-I C:R rrx�,:! h--,1 fl' -31 DEPAk:' 1, HENT Of" 1.1E F-1 L.Tll ANCE:Pd'v'Ir:ClYdrlE_PI"ffil_. F*Rc-rrl.'-"cT I otl -'L-TV.': E E T, FIhICI-101" .AGE.- I'l 1,':. S-49 r; I'DI, 0-4 UE: A__... 9 VA !ON (1) P11 --- "E., 1 -p-.. E,--' FF.-, A 1 T T F:11:1:1.rlil,f 11,40. < j.::jfq:q - , "0 l UINT 42CI8 LOCIrr I ON S pa LEGAL L'I. F:4 e, 1 0 T 1: F'- F; F-'. F -T OF .-'-'OlL i7iW1--.ORB'1-T0N TR.ENGH NUMBEF'., Of-' l"AEr)fN,'.iOH'S' SOIL FZFITING (SO F'T,,-'BR)= -1 Tlilr'-' CIE 'mr,-- SoH ABSORPTION IS: R-'-8 11'-"...0 - I --I L.- Q 104A_ �! -9- 1.- 1 -, =-. C�4 t'i' F-# L U. =" F� " J 9- -1 THE I EhIGTH DIHEN!*-ION 1:-'5 THE LENLYR-1 FEET',, OF' "rHE TRENCIA OF! DRAMOTEL. D. THE OF' 11 TRI'MI-1 OR f"IT HS THE DISTANC:E TFIE SL1F-`.FAC-,E I' -']F- THE 1"ROMID ANC', ITIF: DOTTOVI OF' THE EXCTNATION r.,it-i THER'E 1 t-.10 -SET WIDTH For;! TRENC:l-1F*-:C.-'-. T1,1E Cik.FIVEI DF-J"TH IS, 1HE M11`4111UM DEPTH OFC-'iRF11,Ji:l.- I,3E'Tl4EEN THE. OUTFi-ILL PIPE AND .I'I' IE f.H.'OTT(Drel OF' THE E:x-,C:A1VATION FEET'.1. .11" T (:V -V f"s 1-1 K Q X r--,: ---=- -.1 PE['411T A1=#FT.1C:AN'T HAS THE TO INFORM THIS DEPARTMENT LAJR'1111.'ii 'I"HE lNSF'F.:C:TTOr-j1-,.; OF, Ar.4'j, inswEva rO THIS PRCIPERTIr' F -M) TFIF.: NUMBER OF kT-.'.SlDENC:ES,.-- THFIT THE WELL HILL —H— t-4 C-1 < -- I I'A I evF=p F!--: I—_—_ —0— 1 rA F7-1 Fr" FTM" W. 1C.; -'p 110 T ff F -DI C'11- Al -4Y cPVS"FErq E41TIIOIIT' 17161FL 1NC;PL-:C:*T'l1=It--1 AND APPRO%JAL F:Ir' THf.".; WILL To PROS-EGUTION. MINIMUM DIS-TANGE [3ETWEEN A 1-41"Ll- FIN[`., ANY SF -WAGE :[S 100 F.T.J.-T fl FRIVATF-. HELL.; OF., 150 TC) 21'.10 FEE ­r FROM A PUBLIC WELL. UPON THF.'..' TYPE OF' PUBLIC, t.-IELA.- WKI-L 1 -CGS' ARE REQUIRED AND MUST BE RERMED TO 'l"HF-.: DEPARIVENT 1,11741IN :30 CiF' THt,.'.-: HEJA C 0 t-1 P L. F."T 1: 0 N. C'YRIEF.' k!ECIUMEMENTS NFlY AF11-1-Y. ANI.) Aly'F1lLi1BLE TC -t PR*OFER, 1.r•4s,f-FILLATION. 1p-, F�: F,? 1 1 1 - V LEE F-` 1 F"A EE lcK (11 Ent M lot K Fit -T fl- I K ED, I CEF;!TIV,le TVIAT 1: f AM F"AMILIFIR WITH THE REQUIREMENTS. F. CIF: 13N-----1TE-- SENEF."'S AND IdEt F'CiRTH B,`r' rm MUNICUPALITY Of- ANCHORAGE, 2: 1 WILT THL SYSTEM IN AC:C:ORE.jAt.JCE WITH 1"E E I I 'EF YF THE' SEVIL3,"! MAY FREQUIR.F. IF 'ITIE JND THF FRESIDEPATE IS FREMODEL.ED 'ro iNCLUDE MORE' TIAM-1 l.-..*EDROOl-1S. AP L I CANT TOAN SOILS LOG MUNICIPALITY OF ANCHORAGE ®11 DEPARTMENT OF HEALTH AND ENV1 RONMENTAL PROTECTION PERCOLATION 5 990TEST --1� {'ouch 6-650, Anchorage, Alaska 02 276-2221 SOILS LOG - PERCOLATION TEST PERFORMED FORJOan Burleson. 4208 Harrison, A1iC11S?rapc9ATE PERFORMED: 2(1 ,7iinr-± I'g7S_ LEGAL DESCRIPTION: LOt4, Block 4, Sperstadt Subdivision #29 Anchorage SLOPE SITE PLAN DEPT (FEET) Soil Description 1 1 Bro%,rn sand, SP -- �- 1.5 2 Fine grey sand, SP 2.5 --------------_.__--_---- -- 3 Grey gravelly sand SW C Grey brown gravelly sand SP 9 10 10. ------------------------- Grey clean fine sand SP 11. - __1aAS_RDUNI1WATER 11 Bottom ofpit11EI`JCVUNTERED? no 12 IF YES, AT WHAT 13 DEPTH? 14 15 16 17 18 19 P -- - - - - _ Reading Date Gross Time Net Time Depth to Water Net Drop i lk"lei, P -- - - - - _ Reading Date Gross Time Net Time Depth to Water Net Drop 20 L� PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS_ 4 ft 1101@ excavated shOWi-nom east sands_ame graVc'l�v Approxivate absorption area 125 sq ft per bedroom 7� J PERFORMED BY: �- --'y"� �"`"''Y Qw CERTIFIED BY Y DATE:!/° ✓t'' / n s �p� �� �� 0 72-008(7/76) Poo 65., da 00010 ,�Aao!`/©/aa�. coneoo•- �� aoaso oaebeon a"eu ((e�ee"eeI ecooc COVOY S' Byer Lova tion: Client's Name: BESSE, EPPS & POTTS 2220 FAST 88 AVENUE AiNafoRAGE, AK 99507 (907) 349-6451 WATER WELL TEST Date: Subdivision: ill �_ iil 14/ Lot: Block: .I;- Address: S Address: ///_: Tester: Initial Reading on Meter: X,_3' TIME GPM GALL,CNS VOLUME GAL LUgS TOTAL VOLUME �Fic %-Z/ hI > v NOTES: Prrx-bwtion Rite: x;1'; GPM 24 -Hour Capacity C,allonn til/f^,t I I vi CQ -gag- -n. -a I 1. W. Li i P F-4 E+ Pt P p P o o p 1w E-4 E-4 [.4 r j C3 d o b (14 ft. C?, f4 C4 �el r4 9 M N I to 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, Location (address__or._di1rec Application Date subdivision,•section, unship, range) (b) Applicants Name _`G�, s Telephone - Home Businesszz_z_sli,-�; Applicants Address (c) Applicant is (check one) Lending Institution ; Owner/builder Buyer E::l ; Other 1::� (explain); (d) Lending Institution C���%✓1d�NGfi�a%!j L,/f,422j,•, 12elephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: L•.! I C C P14 k& h c rq� C JL SI &- Uig _S- 2. Type of Residence Single -Family Number of Bedrooms 3. Water Supply - Multi -Family Other (describe) Individual Well Z_ 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 xf Public E=1 E-1 � 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] 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 inspection. jam_ > Name of Firm _ �-�;_�,� `/�; i �� _Telephone '5-15r; cL G Address Date Le7C� �. �'•0°n°an ecan°rti i k'h �p _ JYj -7 (ENGIR—°°',�a oo°n+oa, y' 6. DHEP Approval_ Q g Car Y S. Meyo� •: r 3f3/��• Approved for bedrooms By c°•°�°°%° °n�''� Date 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. Aj ej/D18 'age 2 of 2) ir: (DHEP SEAL) 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) 44UNIcip CHECKLIST - FEBRUARY 1984 DEpGTy OFA 264-4720 T ENVIRoNMENTA�F�oEeORLegal Description: ,JOIN 0 A. WELL DATA (y ) �; roved =" � �< � If A, B, C, D.E.C. A — Well Classification- PP (Y/N) Well Log Preser_J) 7 Date Completed �G �� �� Yield Total Depth�`. / Cased to %Da Depth of Grouting Static Water Level' Pump Set At Casing Height Above Ground - 5 Sanitary Seal on Casingl) Electrical Wiring in Condu6_N y-�— Depression Around Wellhead (Y® Separation Distances from Well: To Septic/Holding Tank on Lot<< f On Adjoining Lots i To Nearest Edge of Absorption Field op Lot �� /" ; On Adjoining Lots tel` To Nearest Public Sewer Line 4X,'! To Nearest Public Sewer / Cleanout/Manhole !� To Nearest Sewer Service Line on Lot ' Water Sample Collected by< '- ',tom ;Date ``��. Water Sample Test Results W /4�4 t7! iso -t 0K, Comments B. SEPTIC/HOLDING TANK DATA Date Installed�- i' ' _;If Size�'-7 U No. of Compartments Standpipgdd N) yE5 Air -tight Cape Foundation Cleanout (Y/N) 1 �� Depression over Tank (Ya NO Date Last Pumped Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) for Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well ='�� j -7� To Building Foundation To Property Line To Water Main/Service Course To Disposal Field r To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata / ' S -F -Z�iz' Type of System Design Date Installed_ — �� s Length of Field C� / Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes PresentfN) y�`a Depression over Field Y �S p (�1 � Date of Last Adequacy Test Results of Last Adequacy Test /-'Y Separation Distance from Absorption Field: To Water -Supply Well To Property Line ��� E' To Building Foundation h To Existing or Abandoned System on Lot zLI 41L-"' f r s .- i - On Adjoining Lots _:t / 74 To Water Main/Service Line To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course Z�-vr s To Driveway, Parking Area, or Vehicle Storage Area Comments -¢ f/i 4' fes 2!,,v -- r ,-i,�_ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments AR -6A MMVIA%v� AOJAawr ro FIEU0. -THO StTUPMQW 1-165 20AtGD 51rJCC TRIC lW OF THE FIFO. NO P906t.EMS q M>r SEN rxPaIk�wCt 0WNc:fz- REeolnm�N0 Afflzov, Selo vvorr y4:414om. ,s s- e- • D 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 certifythat I ave checl d, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. SignedDate Compan�1 5�'s r >%i7nnOA No. Receipt No. Date of Payment 4;" gTtl p p o IN Amount: $ /� U� °•°°neor, hdr•o"e- A [p e••° ° ... 4A vn e Carey Byer L J °® 3 3 sr Page 2 of 2 �Q��A °•e° °,•' 72-026 (11/84) `4 OrcSSO 21 NORTHERN TESTING LABORATORIES, INC. 600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASKA 99709 907.479-3115 6957 OLD SEWARD HIGHWAY, SUITE 101 ANCHORAGE, ALASKA 99518 907-349-8623 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIENT ❑ PUBLIC WATER SYSTEM I.D. # ❑ PRIVATE WATER SYSTEM City State Zip Code SAMPLE DATE: Z &. Phone Mo. Day Year Purchase Order No. SAMPLE TYPE: " ` ,Routine ❑Special Purpose ❑ Check Sample (for original contaminated sample with lab reference no. ❑ Treated Water YUntreated Water sample Time No. LLocation Collected II ed by boratory Ref. No. 2 3 4 5 6 7 8 9 10 Signature of Representative FOR LABORATORY USE ONLY CASH CHARGE PREPAID IDANSMITTAIL SPECIAL INSTRUCTIONS MAIL HOLD FOR PICKUP TO BE COMPLETED BY LABORATORY Received at: ❑l Anch. 14 Fbks. Date Received Time Received Next Sample Due COMMENTS: SATISFACTORY /S 1 UNSATISFACTORY U RESAMPLE R OTHER BACTERIA OB TOO NUMEROUS TNTC TO COUNT Direct Verification Final count O wu Ilu" nesun- O K:ummenn o. of Tota"Colif`Colonies per 100 mis C -w" _ l,Lt,l_ �—cv-1—• 'Report gd b Date � �_ l m m Lb z CS LA l� w A z i 0 m MI m N d G m Cl) m (A 1 W 0 ' m APPLI NT FILLS OUT UPPER HA ONLY Time Property Owner ' s-^ h� ` , �1 n r Phone Lj Mailing Address L Zip Code 99s�2 l / Buyer � Date fin._ CL-�5� lA7Zc��` Inspector Address -- C, Zip Code Inspector Lending Institution f ,v t4 �c Phone Address Zip Code 1 1 Realty Co. & Agent Phone t'j Lal I Address Zip Code ( ) DISAPPROVED Legal Description ,�._ �"j / �� �C pe'r >; r A, 0 706 A Street Location DATE Type of Residence " Ingle Family �� Date Installed Well To Absorption Area Multiple Family No. of Bedrooms_ lSewer ❑ Other Septic Tank Size _ 1 ;--•� Water Supply ;W�'-ndividual ATTACH WELL LOG. Awell log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal �} ;<' Individual � q Year Individual Installed: 1 9 72 ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date fin._ CL-�5� lA7Zc��` Inspector Inspector Inspector Inspector 1 1 Field Notes: t'j Lal I APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: Soils Rating Date Installed Well To Absorption Area Well Log Received i(_n lSewer Well to Tank Septic Tank Size _ 1 ;--•� 72 023 CHEMICAL & —LOGICAL LOGICAL LABORATORIES i,_ 2 ALASKA, INC. TELEPHONE (907)-279.4014 ANCHORAGE INDUSTRIAL CENTER 274.3364 5633 B Street 4¢ LpeORAMRIES Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY WATER SYSTEM: SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. t ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 2 I I 7 4 I READ INSTRUCTIONS BEFORE Analysis shows this Water SAMPLE to be: ❑ Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Recelved Time Received Analytical Method: ❑ Fermentation Tube Or Membrane Filter Lab Ref. No. Result' Analyst I.D. NO. I�--1 fzl I I EE Water System Name - Phone No. .No. of colonies/ 100 ml. or No. of Positive portions. Mailing Address - City State Zip Code SAMPLE DATE: Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. t ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 2 I I 7 4 I READ INSTRUCTIONS BEFORE Analysis shows this Water SAMPLE to be: ❑ Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Recelved Time Received Analytical Method: ❑ Fermentation Tube Or Membrane Filter Lab Ref. No. Result' Analyst I�--1 fzl I I EE .No. of colonies/ 100 ml. or No. of Positive portions. 06.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collected Source a. M. Date Received Time Received p.m. Lab. No. Presumotive loml I loml I loml I loml I loml I 1.0m1 I 0.1ml 24 Hours Hours EMB Broth 24 hours: Broth 48 hours: COLLECTING SAMPLE Multiple Tube Report: 10ml Tubes Positive/Total 10ml Portions Membrane Filter: Direct Count Coliform/100m1 Verification: LTB BGS Final Membrane Filter Results Collform/100m1 Reported By Date Time: p.m. 5. LEGAL DESCRIPTION DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME 6. TYPE OFRESIDENCE TIME DATE DATE DATE/� tW Two ❑ Five ❑ MULTIPLE FAMILY — \q _ (SCS �1"" INSPECTOR INSPEC OR INSPECTO. MUNICIPALITY OF ANCHORAGE MUNICIP TY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTiq%VIRONMENTAL PROTECTION 625 L Street - Anchorage, Alaska 99501 • ENVIRONMENTAL SANITATION DIVISION SEP 16 1980 Telephone 264.4720 rr 11(� // REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWEA'C�IT1Eh °' DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER — J0Ki'- � � f- { %jJ n C—�t�u� Ae;D �P-) NE���0 C /22 �� MAILING ADDRESS Loi PROPERTY RESIDENT (if different from above) PHONE 2. BUYER PHONE MAI LING ADDRESS 3. LENDING INSTITUTION - - PHONE MAILING ADDRESS (o zk(o �l' � - U � • - r� 4. REALTOR/AGENT - PHONE K) MAILING ADDRESS - 5. LEGAL DESCRIPTION STREET LOCATION lso'-:30 6. TYPE OFRESIDENCE NUMBER OF,BEDROOMS D One ❑ Four ❑ Other C/SINGLE FAMILY tW Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SU PLY INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM' C2r' INDIVIDUAL/ON-SITE-' G YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) - - F\�)� r} 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: I If Tank is homemade give dimensions: SOILS RATING + cl- TYPE OF TANK MANUFACTURER �• _ ,, TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS L&-�APPROVED FOR Z BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE q ` r173—eo BY 72-010 (Rev. 6/79) CHEMICAL & GERiLOGICAL LABORATORIES uF ALASKA, INC. TELEPHONE (907)-279.4014 ANCHORAGE INDUSTRIAL CENTER 4A.M.. 274.3364 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER I' TO BE COMPLETED BY LABORATORY WATER SYSTEM: FETT I.D. NO. water System Name Phone No. Mailing Address City state -.-Zip Code -- SAMPLE DATE: W CJ_J C Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. 1 ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 3 4 1 I 5 1 1 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Analysis shows this Water SAMPLE to be: EJ Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received Time Received Analytical Method: ❑ Fermentation Tube ❑ Membrane Filter Lab Ref. No. Result' Analyst I i m L i CZl I � m L- -_J m I I CTJ *No. of colonies/100 ml. or No. of Positive portions. 06.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collected Source a.m. Time M.'si, nt! - - _. -in m. I ah. Nn. EMB Broth 24 hours: Broth 48 hours: Multiple Tube Report: 10ml Tubes Positive/Total 10ml Portions Membrane Filter: Direct Count Collform/looml Verification: LTB BGB Final Membrane Filter Results - - Collform/100ml Reported By Date - a.m. p.m. A ,j v k TV Yb allf; a Inv TOM, WAV aly 'mangul. If", 9-'(�& c" iUf `�Wellvkltw q93 If 11011 UsAwbun A, Tdr urate r onplynk +: :_.i. out! 1"a3Mq! van',, !w"OVap Whow mm'don Wl hi;;vq; win) lahmAiny im quickly na possibla Wthim 443 hoursaHormUnction. 1, Alim �'- h(Hug" HN2 T"i" �mi Pilo j Aflu; holutovkTogical M101YA 1S 131113USId kid rommupling will bi, new now, Nwi Aj 1 ad'5 w0bry ASK,& -t 4v: (Q. Oaycial dolivaq, mak) lot wMayukhall Offlug e I Ai s: wV1, ij yevemmad :411 flAorm: 0) 11046 vew my nevidors 03v plwim Itin"od Wo 011dow. h) 'Amelloqhly fhwh Y's Ov U&MAy Ima-ioi, tip vum 'iwoly VAJI a 4111v opumod oudutfor Wrow W 11010, ;A051100. it) I loci ow I I myy TO d 01 was"m ImMu Wom walurby; SAVA. 151h, NoWn Ill unit; hakid vuhik, "i'vilovibq q ('ap vviidl flui 4:7ahoi. Avoki 101010int! MG OCQ A Go, WIMU ;md dhl, hil'ido 1148 (,ap. M W! AM% ill it; 91KHMOV W11 110 Qkyvajhin� I lki) avoid. gplashit, lnnrlocua-k-'A�r mp1va-!O q-�tqp' ho'hiq MrO W! it 13'Q3e@T, WIT lMt Ugili: il=;J�o ';pfi* dw, q'ap. TO provkhAl (11 silo lah form which it; inamod nu mi m-livivirmij BY SUPPLUM." MI ill ad! himlin; tvaraftilly, hicludiql your joidAic wntav systemm idmitificatim riumber. (M lot).). WwWwo Uio 1 (4 rkivimilmental Gotloolva-doil K You (10 1101, khOW POUF @1' amthm. (Old4k; mum Oqlpuorn My) 11) SO i"'a-umily ill lywailhq! hdx: with €!.svomi. 8% "yqWummits ytw sladyedo W lWAM watur wyNtams fur total (101iform bw'-wFia am delitic"d fil tho -w -1vivomwv"Irkal Yi vihtvwv w1gdaMMIS swuni"MMOO by ur of "'i MUNICIPALITY . - . - OF XNi2HORAGE 11 Y OF loli'[%(;L DEPT. C, H-ALTH & DEPARTMENT 01 HEA. UW_ [>�iUWFWAL PROTERMONMEN&L pi_ iECTION 1-Niv i I 101flirllo Al !A L 1_P1iik� i- 4_Ii)l V I '-'! 0!'.1 -DEC 7 1918 To- ompme MOM RECEIVED 11 nOU up, f 120 r! AFT I UAIA I. o F .IL.. I a 1 MA i . WyAl 1 AN D AWN 1 FAM UP 2S G J50 3__O_ Cine,;,,,. L1 L 1 1 P L I- FAN; 11 _Y hreu �Ih!Ljl ""I ww\1- 1 OciA _i:,l lug is (Of.11 drilli"'! Cot,A�.!UNI i Y (it k d pito' 3 l,L 'UtAlc U 111 1 1I' 10 WARM is Ulk I 'tj'[: :IC; Ul ILI I y MIS SIU:: HAi 01:! 1 C! A L USL ON[ r. N 0 M13 I- f "' 0 1: 111 0 110 0&1 S 01 IN- S 11) E'N C L' SI.NGLE FMAILY ONF THREL f-IVE Fj OTHER iJULTIPLF FAMILY 7v,10 FOUR six UPPLY PFoml-f NUMBEA, S 1NDIVIOUALOEPI H OF l%TLI I Y —D A I F. —DRII LFI —3 M[flj(, Lj 1-1 t.1 -1-Y L �` R I-- C F -I VE D P F-- l,1 r f%I Llm LCL I 1)18110JDAL SYsTI-M .1)11� IDUAIJON -SI-iT -7e L c, oil Vill fird — ------- NS I Al.LER amk is hol n.—Illad, SO I LS R AT I N G ION A11 FA Fail EHIM- 0 ptlof I A I ca Sc POM 101(4111�1 in eat.c 1j"; Lig r, VV E L 10: W ,tri I Milealv,.j Lw Line N I S li APPROVI-D FOI; Bt DROMIS CC, N D I'l -IONAL APPHOVAL Outte: lflusi: accompany cerl;ifiCal2j -L,,IDISAP;)R0Vl`-D Bly i o -I! AIt C & GEOLOGICAL LAEORAT'ORIES OF ALASKA, INC& TELEPHONE E P.O. BOX 4.1276 ANCHORAGE, ALASKA 99509 4849 BUSINESS PARK BLVD. Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY PUBLIC WATER SYSTEM: LABORATORY: I.D. NO. Public at f Systam, 10my 9 50 IO "' r ADDRESS SAMPLE DATE: 1/ 1 n Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE NO. LOCATION 2 3. L 4 5; - Time Collected Collected By Date Received 2 / Time Received j Analytical Method: ❑ Fermentation Tube Membrane Filter Lab Ref. No. Result" Analyst i No. of colonies 1100 ml. or No. of Positive Portions. 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collette( READ INSTRUCTIONS Date Recelved BEFORE COLLECTING SAMPLE Form No. 18.310 (3-78) Hours 24 Hours Multiple Tube Report: Membrane Filter: Direct Count Verification: LT Final Membranb FII ♦<}_��5lult� Y Reported 13yT_ � Source _ a. M. _Time Received p.m. Lab. No. — lOmi loml ioml lOml lOml 1.0ml I 0.1m Broth 24 hours: Broth 48 hours: lOml Tubes Positive/Total 10ml Portions Collform/100ml BGB f/ Collfgrin/100ml —Date i' Time: a.m. p.m. Parcel I.D. 018-072-20 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: 2 '�?_ a / q Complete legal description SPERSTAD #2 BLOCK 4 LOT 4 Location (site address) 13030 BACK ROAD ANCHORAGE AK 99515 Current Property owner(s) NANCY WAINWRIGHT Day phone Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) MAY 1 9 2014 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] Individual M Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water Svstem ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: Z --- A' Date COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 52-% — Date of Payment _-ho' /I g/+� Receipt Number 0545-1 C COSA # 07 p( -1t'[r I `V Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm SPURKLAND ENGINEERING Address 203 W. 15TH AVE., STE. 202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Phone 279-3916 Date 4/28/914 ; � 1 Or. ES ,!Oj " Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: Thenic�n ltyA rage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory _,_ Well Flow Advisory Other COSA blue sheet f , u If more than 1 septic system is on the lot: COSA Checklist # Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: SPERSTAD #2 BLK 4 LT 4 A. WELL DATA Well type PRIVATE If A. B, or C provide PWSID #_ Date completed 6/1978 Sanitary seal (Y/N) Y Total depth 100 ft. Cased to 100 ft FROM WELL LOG Date of test 6/22/1978 Static water level 49 ft. Well production 15 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate ND mg/L Arsenic 55.3 ug/L Date of sample: 4/22/14 B. SEPTICIHOLDING TANK DATA Parcel ID: 018-072-20 Well Log (Y/N) Y Wires properly protected (YIN) Y Casing height (above ground) 24+ in. AT INSPECTION 10/29/13 34 3.2 ft. t!xauZ Collected by: ANSON MOXNESS Tank Type/Material SEPTIC/PLASTIC Date installed 6/23/78 Tank size 1250 gal. Number of Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A Date of pumping 8/2013 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed 6/23/78 Soil rating (g.p.d./f:2 or ftz/bdrm) 135 System type TRENCH Length 68 ft. Width 3 ft. Gravel below pipe 3 ft. Total depth 7 ft. Eff. absorption area 408 fe Monitoring tube Y Depression over field N Date of adequacy test 10/29/13 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off" level at _ Datum — Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1004 Absorption field on lot 11004 Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50+ Manhole/Access (Y/N) in. High water alarm level at - Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 1001+ Public sewer manhole/cleanout N/A Holding tank 100+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 10+ Water main 50+ Water service line 25'+ Wells on adjacent lots100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 50+ Surface water 100'+ Curtain drain N.O. Wells on adjacent lots 1004 Absorption field 5.+ Surface water 1001+ Water main 50+ Driveway, parking/vehicle storage 1 F. COMMENTS DRIVEWAY NEXT TO TRENCH HAS EXISTED SINCE INSTALLATION, NO PROBLEMS HAVE BEEN REPORTED AND NO EVIDENCE OF PARKING OVER FIELD G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name LARS SPURKLAND Date 4/28/14 COSA brown sheet 10-10-12.doo in. Municipality of Anchorage s , Community Development Department Development Services Division 5 E, On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 141201 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 4, Lot 4 of Sperstad #2 Subdivision. This inspection revealed an arsenic concentration of 55.3 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsitc or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. RECERTIFIED COT" 5 C07_3 Lot —4— , Block 4 S,oersfcxa' Subc2' /Vo. 2 Anchorage Recording Precinct, Alaska I E LOT SURVEY CERTIFICATION LEGEND I hereby certify that I have surveyed the property shown and described -15;I=Pr/C hereon,and that the Improvements situated thereon are wtthln the prop- erty lines and do not overlap orencroach on adjacent property and that no s.a�s improvements on adjacent property overlap or encroach on the premises • _ �/B',x 3d'rebor set this survey 0 easements on said property except as indicated hereon. 235.33' C07_3 Lot —4— , Block 4 S,oersfcxa' Subc2' /Vo. 2 Anchorage Recording Precinct, Alaska I E LOT SURVEY CERTIFICATION LEGEND I hereby certify that I have surveyed the property shown and described Z = Brass capped monument recovered hereon,and that the Improvements situated thereon are wtthln the prop- erty lines and do not overlap orencroach on adjacent property and that no 0 = Iron pipe and/or rebar recovered o = 2x2 hub a tack recovered improvements on adjacent property overlap or encroach on the premises • _ �/B',x 3d'rebor set this survey in question and that there are no roadways, utility lines a other vlslble easements on said property except as indicated hereon. amu. • .30` TL L Bulton 15-3792 i'�FE5SIDN Al �Aasaw� Scale 40 Date Prepared by: ,ge9ReN ed4andrOSurveyor (907)279-6200 519 W. Eighth Ave. Anchgroge, A/osko 9950/ Ref. F. B. No. Property of: JEFF JESSEE ZB3Z �8— 1 NANCY WAINWRIGHT