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Home My WebLink AboutSPRING HILLS ESTATES #1 BLK 1 LT 13 "~ MUNICIPALITY OF ANCHORAGE ~O · 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 PHON~' ~ NEW MA~UNG~bRESS LOCATION NO. OF SEDROOMS DISTANCE TO: IWell J,r~' IAbs°rpti~ng' Dwelling PER~ 'TNO. ~ Z Manufacturer Material No. of compartments , ~ Well Dwelling PERMIT NO. O ~ ~ Manufacturer Material Liquid capacity in gallons ~ Z DISTANCE TO: 1~3 ~-- NO. of lines ~ Length of ea~ Total lengt ~ .. ~esh~J~j Trench wi~¢ ~ ~ Top of tile to finish grade ~ I ~ Material beneath ,tile ,~¢ ~t~ Total effusive abso~)ion area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot llne ¢ DISTANCE TO: ~ Cl~ Depth Driller Distance to lot line PERMIT NO. OTHER SOIL TEST RATING = ~ ,APPROVe) DATE LEGAL ,LOCK. I TOTAL Cf.;~.T]:FY THAT: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, A(aska 99501 264-4720 SOILS LOG - PERCOLATION TEST ~-~"'~SOI &S LOG [] PERCOLATION TEST 3 4 7 8 9- 10- 11 33 3~ 14 - 15- 16 17 19 20 72-O08 (6/79) DATE PERFORMED: c?* .-~- ~ ~'f SLOPE ~ ~ SITE P ~N ,> / / / / ? WAS GROUND WATER S ENCOUNTERED? ~ 0 L ~ P E IF YES, A7 wHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE .... (minutes/inch) TE T UN BE'rWEEN . FT AND . FT CERTIFIED BY: M-W DRILLING, Inc. 84-2,53 .. P.O. Box 10-378 ,, 10300 Old Seward Highway ~.0~.~.~ (907) 349-8535 ANCHORAGE, ALASKA 99511 Well Owner R.P. C~SI0 N DRILLING LOG Use of Well Do~sgic Location (address of: Toumship, Range, Section, if known; or distance main road Lot 13 Block 1 Snrtn~ Ibtlls Addition ~i~1 - Anchorage Size of casing 6" Depth of Hole Static water level 153 ft. Screen ( ); Perforated ( ). Describe screen or perforation I~one Well pumping test at 5 gallons per of drawdown from static level, Date of completion Septet,bar 1~ 1984 182 feet Cased to 181.20 Ceet (below) land surface. Finish of well (cheek one) open end ( x ); (minute) for 1 hours with 100% WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness S 0 _TO. 2 TO 3 .TO $0 _TO. 120 .TO. lf5 .TO 170 .TO. TO. .TQ ____TO .TO. .TO. .TO. .TO. .TO 170 182 Overburden '1 Brim silty Kravel MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTIO~ .RECEIVED BrcWn si.ltv ~Czavel - khterbea~inr ~-~_avel - %~-.~-~e~d i~IWWA Cert~Ue~l Certificate No's. 814 & ~ 3--CONTRACTOR 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 1, GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner fP~6~¢--~O,.~.~.~.~.~.~.~.~.~-~ ~ "~'~-.,¢L~gA~ ,.~.~V.~-~,--) Dayphone ,¢4-,~-?-R~'~ Mailing address SA-~i ¢--- Lending agency Mailing address Agent "~¢'~--- '~'J*'~ ~-'~'/ Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 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. 72q)25 (Rev. 1/9~) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Alaska Water & ~Estewater Address Engineer's signature 6. DHHS SIGNATURE v/ Approved for bedrooms. Phone Date Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Depar[ment 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. MUNICIPALITY 0W ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage MAR 2, 1998 DEPARTMENT OF HEALTH & HUMAN SERVICES~EpEj%~--- Environmental Services Division il[.t.~LIl~,~ ~1~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Health Authority Approval Checklist I~j I~ 5~-~,~g f~L(.~ ParcelI.D.: · system number IfA, B, or C, attach ADEC letter. ADEC water ',-/,~.5 Date completed ~/I z'/ Cased to I~l/ Casing height (above ground) ~- /'~ 'V~--.~ Wires properly protected (Y/N) Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed /O/~ Tank size Foundation cleanout (Y/N) Date of FumpMg '~/l~/'/® AT INSPECTION . FROM WELL LOG Nitrate [~'O Number of Compartments ~ Cleanouts (Y/N) . Depression (Y/N) A/O '~ High water alarm (Y/N) ,,,J//3, Pumper /~' +' C. ABSORPTION FIELD DATA Date installed /0/ / Length ~- Width Soil rating {g,C-~:t-J1~or ff~/bdrm) / / Gravel thickness below pipe Effective absorption area ~' Z.~ Monitoring Tube present (Y/N) ~/ Date of adequacy test ~//c)'/'~ (5 Results (Pass/Fail) t0~'~ ~ Fluid depth in absorption field before test (in.); Depression over field (Y/N) For Immediately after-7 ~gal. water added (in.): System type _/-'"P-.~O~ Total depth bedrooms Fluid depth I'"/'"/--~ ~ (ins) Minutes later: 1'~¢~oO Absorption rate = Peroxide treatment (past 12 months) (Y/N) ,'oo,,~- ~4,,)c~,,J If yes, give date 72-026 (Rev. 3/96)* ,~ ~,,,~o,.~J c~J ~fzoo~'0' ~) + g.p.d. D. LIFT STATION Date installed Siz ons~E~ Manhole/Access (Y/N) ~vel at* "Pump off" level at* High water *Datum Cycloid E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot I O~I+ Public sewer main Sewer/septic service line On adjacent lots / On adjacent lots / O(~ '~ Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation -~' !'f- Property line -~/~' Absorption field ~' ~' Water main/service line ~Ol~ Surface water/drainage I OO/~" Wells on adjacent lots I~::~O/~- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: ! Property line /0 + Building foundation '~'-5'/ Water main/service line Surface water /60/'+' Driveway, parking/vehicle storage area I Curtain drain ¢o~J~ ~,~c>~O Wells on adjacent lots JO0 ~' F. ENGINEER'S CERTIFICATION I certify that I havo~eter~ .d t~,~o//~fd~ ~spectiona and review of Municipal in conformanc~withlM¢~/~, 4~g~loline in effect on this date. Signature HAA Fee $ ~ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number ~J ~' ~'~.' u~4 ~-~ 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,d / 8'"'~ ~,~'/- ~ '~ HAA# GENERAL INFORMATION Complete legal description Location (site address or directions) Pro~ertyowner ~ _ . Mailing address Lending agency Mailing address Day phone Agent Address Day phone # .,~c,.~ Unless otherwise requested, HAA Will be held for pickup. NUMBER OF BEDROOMS: Y %` TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legaiity and status of system. 4. TYPE OF WASTEWATER DISPOSAL: /- Individual on-site Holding tank Community on-site Public sewer NOTE: /f 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 structu re indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies 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 ~4 ~]) u'c~-J_~ "~. ~ Phone ~ ~- ~ ~ ~ ~ Address ~ ~ ~ I~ ~ Engineer's signature ~ ~~ Date ~. Z~ ~ I ' DHHS SIGNATURE '~ Approved for ,~m~/'~("-//~) Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By:. /~~ ~"'~%- Date /D - Z - ¢ ,7- 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-O25 {Rev, 1/91) Back MOA ~1 (~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LI-~/~K.I---"~'~"~'~/'[$~'~LtJl Parcel I.D. 015- A. WELL DATA Well type ~ If A, B, or C, attach ADEC letter. Log present (Y/N) Total depth ~ ~--~ Cased to Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level I~'~ Well flow .-~ g.p.m. Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main I~'~'/~. Sewer service line ~' ,.~.~' /'ID ADEC water system number Date completed ~*/IZ./~°~q Driller Casing height Wires properly protected (Y/N) ~ AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform .~/ ~ Date of sample: "//~ ~/,~7..- Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~)~-~ Cleanouts (Y/N) ~.* High water alarm (Y/N) Date of pumping Tank size I)-6~ Compartments Foundation cleanout (Y/N) ~/ Depression (Y/N) Alarm tested (Y/N) /¥//~ r,./ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line > ~ Surface water/d rainage 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 NoNE Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed loll Length ~,~ Width /'~ Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating I*~-~'-'-'-'~ System type T'r.~-~ Gravel thickness ~ Total depth Cleanouts present (Y/N) Date of adequacy test _ for If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: To building foundation On adjacent lots Surface water Curtain drain On adjacent lots ~ /~.~'0 Property line ~"----~ To existing or abandoned system on lot Cutbank /"~ ov/L~' Watermain/serviceline. ~'Y"~-~ 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,?9, t~ed¢te of this inspection. Engineer's Name 'T"o~[~-~vl ~p~k~ ?~.- HAA Fee $ /7(~ 0......~ Dste of P yment / ¢ - . oeipt.um r Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3191) B~ck MOA 21 Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) LcJ~ I.~; B?cJ~k I; S?x'ng Hx'£1S E~a~¢.~ AddZ~cm. #I Subdivx'.s~'c~n; Location (address or directions) 4720 Silver Sprin~ Circ~ (b) Property owner Mailing Address MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 ..,.... Horan Telephone: (home) . Business (c) Lending Institution Mailing Address Telephone (d) RealEstate Company and Agent JACK WHITE COMPA~Y ATTN: Ka~ Enqland Address 3201 C Street, Suite 100, Anchorage, Alaska 99503 Telephone 563-5500 (e) Mail the HAA to the following address: (or check here~ if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING '~7n-~4 E=~le Ri,vet' Loop Road Eagle River, Alaska 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms - '¢ 3. WATER SUPPLY Individual Well [2~ Community [] Public [] Note: If community well system, mUSt have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ Public [] Community [] Holding Tank [] Note; If community weJ] system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) 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 flies 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 ~ ,~ ~ E?,~f¢,~,~R!NG Telephone ~" - ., p., ,~ Loop ~a~ Address 7a~:l,~ Rivet, &l;~ska 99577 Date 6. DHHS APPROVAL Approved for Z/ bedrooms by Approved ~_ Disapproved Terms of Conditioqal Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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¢325 {Rev 7/88) Back Page 2 of 2 A. WE~.~'ATA Well ClasSification ..~.~,'"'~ I~' ~'~,,~t;/~ Well Log Present (Y/N) ~ . Date C,ompleted ~.. - Total Depth [ [~2. Cased to / L~/, ~Depth of Grouting Static Water Level / .-~/-/ ? Casing Height Above Ground 2 ~ / Electrical Wiring in Conduit (Y/N) h / SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot / ~ ~ / To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line "~5- -¢ MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST-'FEBRUARY 1984 343-4744 Legal Description: ~/,,~PI~ If A, B, C, D.E.C. Approved (Y/N) --' {;:;;~ Yield Pump Set At (2/N/'' Sanitary Seal on Casing (Y/N) ~L~ Depression Around Wellhead (Y/N) ; On Adjoining Lots ,/ ~:~-~ ' ; On Adjoining ~ots / To Nearest Public Sewer Cleanout/Manhole ( To Nearest Sewer Service Line on Lot 2 ~'* H- Water Sample Collected by Water Sample Test Results Comments ;Date B. SEPTIC/HOLDING TANK DATA Date Installed / {~-~- ~/"/Size Standpipes (Y/N) ~ ~' Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) ~ ;~. 5--0~1 No. of Compartments 2- Air-tight Caps (Y/N) c/ --' Foundation Cleanout (Y/N) ~ - /',,) ~ Date Last Pumped ,/2. ~ ~ - ~_ 0 ; for A2///"A Holding Tank High-Water Alarm (Y/N) ~//A' Temporary Holding Tank Permit (Y/N) /~/~t SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Building Foundation To Disposal Field ( OO TO Water-Supply Well / To Property Line To Water Main/Service Line To Stream, Pond, Lake dr Major Drainage Course Comments _,~ ~ '~' C ,,/3 0 ~,~ ~-d 72-028 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata [ ,~---~- Date Installed ~ O -- ( -- ~:P2/~ ~-~/1~,~ Type of System Design Length of Field (~ ~- Width of Field ~ ' Depth of Field Gravel Bed Thickness '/¢ Square Feet of Absortion Area /'~.~ O ~ Statndpipes Present (Y/N) Depression over Field (Y/N) f%J ~'~ ~ Date of Last Adequacy Test Results of Last Adequacy Test .~¢t-/"~'.~ ,~.'~'o¢'~ -- ~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well / ~,-,...~ / To Property Line ~ To Building Founrdation -)("- ..~:~ ' ~ To Existing or Abandoned System on Lot /~/¢~ ;On Adjoining Lots ~:.~O , / To Water Main/Service Line ! O p To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course ___~2. ~' ! To Driveway, Parking Area, or Vehicle Storage Area /-I/ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at '~, High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **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 Company Date MOA No. Date of Payment Amount: $ ~/~(~ 72-026 (Rev 7/88) Back Receipt No Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS NEPORT BY SAMPLE for Work Order $ 30700 Pate Report Piinted: DEC 13 90 @ 09:58 Client Sample ID:LiE B1 SPRING NILL ESTATES ADD #1 PWSID :UA Collected DSC 7 90 @ 15:30 hrs. Received DEC 7 90 @ 16:30 hrs. Preserved with :AS REQUIREP Client Name : S & S ENGINEERING Client Acct: $NSENG? P.O.$ NONE RECEIVED Req # Ordered By : R. SR~FER Analysis Completed :DEC 10 90 Send Reports to: EDE 1)S & S ENGINEERING Laboratory Supe~2~so~ :~EN C. Released By : .J~~.~ 2) Epecial Instruct: Chemlab kef $; 905151 Lab Smpl ID: 1 Matrix: WA~ER Allowable Parameter Tested Result Units Method Limits NITRATZ-N 0.75 mg/1 EFA 353.2 Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY SDJ. 1 Tests Performed See Special Instructions Above UA=Unavailable ND= None Detected '* See Sample Remarks Above NA= Not Analyzed LT:Less Than, GT:Greatez Than CHEMIC~4L & GEOLOGIC~IL L~4BORATORIES O~ ALASKA, INC. TELEPHONE (907) 562.2343 56,33 B Street : · Anchorage, Alaska .,99518 ~ ~ Drinkin~ Water Analysis Report for Total Coliferrn"Bacteri/ TO BE cOMPLETED BY WATER SUPPLIER [3 PUBLIC WATER SYSTEM "D~ ~,, PRIVATE WATER SYSTEM Name Mailing Address I Phone No. S & S ENGINI~RING 17034 Eagle R!ver Loop Road J~ ~ Eagle River~ Alaska 99577 City i State Mo. Day Year Zip Code SAMPLE TYPE: ' ~., Routine Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. LOCATION Time Collected Collected~ TO BE COMP~ED By LASO~RATORY ~ :yws this Water SAMPLE;t0 be: Satis ctory' [] Un~tisfactory [] S~nple too long in transit; sample should n~tbe over 30 hours old at examination tc~indicate reliable results. Please send n~w sample via special delivery mail. Date ?,ceived /~-~/"~'/~'~ TimelReceived ///~ Analytical Method: Membrane Filter * No; of coioniesll00 mi. Lab Ref. No. 9o.5t5t .A.D.E.{ Result* Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD':' ~:~; READ INSTRUCTIONS BEFORE- ': COLLECTING SAMPLE Membrane Filter. Direct Count Verification: LTB Final Membrane Filter Results Co form/lO0 mi '~ .BGB ' ~ : ' ColifOrm/100 mi C.te Time: a.m. TNTC = Too Numberous To Count OB = Other Bacteria ' REHAI-NDER:T0 .FOLLC Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) ' 13 ' Location (address or directions) (b) Property Owner L'~,P/.7~Z/~/ ,,~,~4,./-~..///~ Telep~o/ne: Home Mailing Address ~ -%~ / ~ -~ (c) Lending institution ' Telephone 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 person and day phone number below. ' Business 2. TYPE OF RESIDENCE Single-Familytl~' ~,~/ Number of Bedrooms ' WATER SUPPLY Individual Well'~.. Community [] Public [] Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsitet~. Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. Page 1 of 2 72-025 iRev 8/861 Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal aifi×ed 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 Telephon~ Address Date DHHS APPROVAL Approved _ ~ Disapproved ~ Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approvai 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 th is 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 Muoicipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 IRev 8/86) Back MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVI$1ONMUNIClPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) RECEIVED CHECKLIST - FEBRUARY 1984 264-4744 Legal Description: /.~7"/~ ~z~' / ~'/¢,('~,~/~ ,/~z~, WELL DATA Well Classification We, Log Present, N! Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in ConduitON) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole ,~/~' Water Sample Collected by Water Sample Test Results '~/~///''~'z;~' /'"/4 If A, B, C, D.,E,..C. Ap/proved (Y/N) Date Completed ~-'/~ ~'~/ Yield Cased to /ff'/',;5-~ Depth of Grouting /5~Z / Pump Set At ~//~' Sanitary Seal on Casing(~/N) Depression Around Wellhead (Y~N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer .- To Nearest Sewer Service Line on Lot ~ ~dig~'/ ; Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed /~" Size /~.:~o No. of Compartments Standpipes/~N) Air-tight Caps~_~)N) Foundation Cleanou~C(~N) Depression over Tank (YL/N~ Date Last Pumped .2"'%/"~/ , Pumping/Maintenance Contract on File (Y/N) /~/F ;for /-):¢~ /' Holding Tank High-Water Alarm (Y/N) /.J>-l- Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holdin/g Tank: TO Water-Suppl~4 W§II /~o To P;o,_e.._yr n d L~nel , ,:',', ~ ' ' · .... /o To Water MaiD/Service Line (2omments To Building Foundation /¢ /' To Disposal Field /'-~: To Stream, Pond, Lake, or Major Drainage Pagelof2', · 8~i,J' 72~026 IRev 8/86) Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date installed Width of Field Type of System Design.. Length of Field Depth of Field Gravel Bed Thickness Standpipes Present(-~>) Date of Last Adequacy Test Square Feet of Absorption Area Depression over Field (Y~/~ Results of Last Adequacy Test ,.~ Separation Distance from Absorption Field: / To Water-Supply Well /~-'¢f--. To Property Line / ''~ To Building Foundation i~-~.~ ' To Existing or Abandoned System on Lot ; On Adjoining Lots /'~ To Water Main/Service Line /~-' ¢~ To Cutbank (if present) , To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~'~¢_~',~z.¢..~..-//;'¢/~,.'~ /.~?/z /?~'~/ LIFT STATION Date InstalleO Size in Gallons "Pump On" Level at "'"'--~ '"'--~. ..... High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ......... Vent (Y/N) ..... Purqp.~i~g Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I h a,¥.~/~eck~d, veri~ed, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed c Date Company '/¢¢~'~- MOA NO. ~- :X~ ¢ Z."'/ Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 fRev 8/861 Back · MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR REALTH AUTHORITY APPROVAL CERTIFICATE 1o General Information Application Date (a) Legal Description (include lot, blocky subdiviston~ section, township, range) *¢/ Location (address or directions) (b) Applicants Name ~,'~ Applicants ~dress (c) Applicant is (check one) Lending Institution Buyer ~--~ ; Other ~ (=plain); (d) Lending Institution ~"~'~.""/~ Telephone - Home3¥ Telephone Address (e) Real Estate Co. & Agent Address ~' ~/'1 Telephone (f) Mail the HAA to the following address: ~ of Residence Single-Family~ Number of Bedrooms Water Supply Individual Well['~ Multi-Family~ Other (describe) 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~ Comm~nity~ 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] Q /. E_~_~ineering Firm Providing Inspect~.~ Tests, File Search~ Data and ~nfo~ation As certified by my seal affixed hereto and as of the validation date sho~a 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 ~ter supply and/or wastewater disposal system is in compliance v~th all PS~nicipal and State codes, ordinances, and regula- tions in effect on the date of this inspection° Name of Firm Address DHEPA~p~rova3~ ~ Approved for bedrooms By Approved ~/ Disappro~~ Terms of Conditional Approval Telephone Conditional 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 PA~GRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN Tile 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° (DHEP SEAL) RR4Iej/Di8 [Page Z of 2] 7 -19-84 .- MUNIClPALhW' OF ANCHORAQF, ' [,~ ,'""~ DEPT. OF HEALflj & ~ H~CIP~I~ OF ~C~GE (MOA) Well Classification ~omc5'p''c If A, B, ~ C, D.E.C. ~omd(Y~). ~11 ~ ~esent ~) ~ / ~te ~leted /c~/z/~ Yzeld Total ~D~ I ~% /~d to / ~/' ~ /~pth of ~outing Static ~ter ~1. ~ ~ ~ ~ ~t At Po $~ Casing ~ight ~ G~nd ~ / / Sanit~ ~al on Casing ~) Elec~ical Wi~ing in ~nduit ~) y / ~ession ~ound ~l~ead (Y~ ~p~ation Dicings ~ ~11: To ~ptic~olding Ta~ ~ ~t /~-~ ~ / ; ~ ~joining ~ts To ~a~st ~ of ~s~tion Field on ~t /~-.~F ~ ~ Adjoining To ~est ~blie ~ Line ~ To ~est ~blic Clean~t~ole /V~ To ~est ~ ~vi~ Li~ on ~t Wate~ S~le Colle~ed. By ~ 6tf-~ ? ~., ~te ~ Wate~ S~le Test ~sults ,~r~~ / SEPTIC/HOLDING TANK DATA Date Installed io~1 - ~ ~Stze 1 2,~'-O ~"~N~. of Co,%~a~tments Depression o~ Tank /~ Date Last Pumped Pum~ing/Maintenan~ Contract on File (Y/N) A/4- ; for Holding Tank High-Water Ala~ (Y/N) /~/~ Temporary Holding Tank Permit Separation Distances f~cm sePti~c/Ho!d~ng~: To Wate~-S~pply Well /~ ~ ~ __ To Building Foundation To P~ope~ty Line 3/! ~ To Disposal Field To ~ter Main/Service Line /~ ~ /To Stream, Pond, Lake, Receipt 9 Date Paid: Amount: q~ [Page 1 of 2] 2-15-84 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed /o -I - Width of Field ~! / L~' ~////~- TyDe of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present ~/N) Square Feet of Absorption Amea Depression over Field (Y~ /X/ Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absc~ptio~ Field: To Water-Supply Well / 5' 3 ~ TO PrOperty Line / ~ TO Building Foundation ~ ~. 5-- ~/ To Existing or' Abandoned System on Lot ~A/+ ; On Adjoining Lots / To Wate~ Main/Service Line /D ' /~ To Cutbank(if present) To Stream/Pond/Lake/or ~ajor Drainage Course /D&) / { TO Drivaway, Parking A~ea, or Vehicle Storage A~ea ~% 5- / ~ ~'~.f 4 D. LIFT STATION Date Installed /~A Size in Gallons /~ "Pu~p On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) /v~ "Pump Off" Level at . Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Co~w~nts ** Check Permitted Bedrccm Rating Against HAA Request certify that I hav~ checked, verified, or confu=,,~d to all MOA HAA Guidelines in effect on the date of this inspectic~. Ccmpany x~/-='~'x~..S- /m = MOA No. [Page 2 of 2] roy C. Reid No. 2251.~ 2-15-84 ALASKA Er dlRORmeI1TAL CO[1TROL $ RuiCeS, II1C. ~nclineerincI ~ ~nuironmealal $1udies February 22, 1985 Keith Bandt Department of Environmental Protection 825 L. Street Anchorage, Ak. 99501 Dear Keith: This is in regards to Spring Hills Estates Addition #1, Block 1s Lot 13. On February 22, 1985, I was taking measurements for a HAA on this lot. The septic system was built properly in October 1984, but at that time there was no house on the lot. Since then, the house has been built, and one end of the septic system is only 3.5 feet from the garage. I am enclosing a drawing of the situation to help clarify matters. The garage is built on a cement slab. The drainfield is over 15 feet away from the house; it is only close near the garage. On behalf of the owner, Rick Gaston, I am requesting a waiver of th~--~-~ distance required between absorption area and foundation to be onli3.5j~-~ feet, in this case, since it is only the garage that is involved Sincerely, Approved by: Reid Jr. ~PhD, Darcy~Bevens Engineering Geologist 1200 UJcsl 33rd ~uenue, ~uile ~*/~nchoraq¢, /~laska 99503 , /907) 561-50z]0 ALASKA ENVIRON~[,ENTAL CONTROL SERVI(:, i, INC. ]200 West 33rd Avenue Suite B ANCHORAGE, ALASKA-99503 Phone 561-5040 JOB SCALE- DATE CHEMICAL & GEOLOGICAL LABORATOR F ALASKA, INC. TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria ': TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I.D. NO, Water System Name Phone No. 5--3 / - s-~)~/O Mailing A~dress (*) See h on back CiW State Mo. Day Year Zip C~de SAMPLE TYPE: i'-r Routine ID Check Sample (for routine sample with lab ref. no. [] Special Purpose ; [] Treated Water [] Untreated Water SAMPLE NO, ~ I 2 I LOCATION J,:/- /.:) fS/": I J Time Collected Collected By lO'"/& ~*-~.~ TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: /~tisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results, Please send new sample via special delivery mail. Date Received Time Received Analytical Method: [] Fermentation Tube /~ Membrane Filter Lab Ref. No. Result* Analyst I CCI I I FT-] I CF] BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter:. Direct Count Verification: LTB " Final Membrane Filter Results ~-.~ BGB Collformll00ml TNTC = Too Numerous To Count