HomeMy WebLinkAboutTHOMAS LT 2Thomas
Lot 2
#018-262-27
Municipality of Anchorage -
Development Services Department I'4
Building Safety Division
On -Site Water and Wastewater Program, 4700 S. Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
*%vw.d.andlorage.ak.us (907) 343.7904 Page / of Z
FON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: Stn. t'9/ po
Wme; PID Number:
f•K1 Wastewater System: ❑ New 10 Upgrade
Aeaeb:
Ph : wnearaeeaoona ABSORPTION FIELD
Oeep DTwm PK$hallow T,.n h O ee4 Cl MI V 0 Oftr.
LEGAL DESCRIPTION $ae mong: Tom Dew wan La: mpw p,ea:
etre: Z
,L swmNYe : D"M b PPe ii x "Man y r p.as: . /` •' Ft.
h m a �� Eeaet tlanNN pa:
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Well: Fl.
CMNew � UG
p taw.am: wmo«aun.a: wwnc.
$ O o.n sen firm.
at.M,esn (Porte. A e. CR Taal Depot' Care W. FI' _F 1.
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Dom nFI. FL yVo Fr 3v3'F
ole.r. lallo: Stauc w,tr [.w: Ytel«la;
J,/ Dalt lnfMNee:
n«a: Pump s«,LFL
Caalnp Netpnl Moe rxaap:
GPM FI. FL TANK
SEPARATION DISTANCES ❑septic ❑Holds
To Se Oc n9 ❑ S.T.E.P. ❑ Other.
P Absorption Lift Holding uGirlPmate acuasr.
Fes+ Tank Field Station Tank g pJ61Y
Sere LNe
wa /00 + /Ove rl/ rpoN� mat";N~a l,:
Satacewat« mo 14 /00,;
V � '' '. LIFT STATION
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N �L�.Yh ��Maae6Moa« ElearlaotiDxoata0erlameeDy
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r / I C / L Laaum ana DeemPom:
l 7 T `% G C r Q�G t°iner lUd r
�.0 � Y LTJ �' n wmsu arauon:
/ R
o (,✓ a d �.-
Engineer's Stamp
r 1P�E OF At l`(
Inspections performed by: _Mrht, 1"fl ev ea/1 Dates: 1" / -2L3 0 ow *? 49*H •••�' *//
/. e........
z^° 3: 3 D �........
Developme t Services Department Approval % VO MIC AEL N. ANDERSON;
Reviewed and approved by: I %CE
tty�nn
IRrt 1_WI ate: •+��`.00,N . .Ilk % I offs it
0 «
Permit No. SW010018
Page 2 of 2
• Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744
On—Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: LOT 2, THOMAS SUBDIVISION PID No.: 018-262-27
A
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SWO10018
Legal Description , —.2
Design Engineer: 0088 Anderson Construction & Eng'g
Owner Name: JOE MILLER
Owner Address: 3551 TWILIGHT LANE
ANCHORAGE, AK 99516-4022
Date Issued: Feb 08, 2001
Expiration Date: Feb 08, 2002
Parcel ID: 018-262-27
Site Address: 003551 TWILIGHT LN
Lot Size: 50191 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
Disposal Field [�] Septic Tank ❑ Holding Tank F] Privy
All construction must be in accordance with:
1. The attached approved design.
Private Well 7 Water Storage
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: Z
Date: 2 —t"1 0/
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWERIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. Q 18 -
2 6 ?. `-' 2 7
Permit Number SWO100 /8
Property owner(s)
� �tac'f YI �e���a✓I
MJ I �� r
Day phone `31 -os-- 33�?'-
Mailing address (1) 3551 TWIL/6HT
Mailing address (2) 5'AM.F Zip Code %`%Slro - 4022 2 -
Legal description (Lot, Block & Sub'd.) 1' r, 2 T k ", a i
Legal description (Section, Township & Range)
Lot Size Acres/q.F . Number of Bedrooms 3
3-0,191
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade I`-'
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: 3 Z a, oo
Waiver Fees:
Date of Payment: IA-ZU ( Date of Payment:
Receipt Number: Receipt Number:
(Rev. 12/00)
Michael N. Anderson, P.E.
Civil/Structural Engineering
4640 Shoshoni Avenue
Anchorage, Alaska 99516
Phone 345-3377
Fax 345-1391
February 2, 2001
Department of Health and Human Services
P.O. Box 6650
Anchorage, Alaska 99519-6650
Re: Lot 2 Thomas Subd.
To Whom it may concern:
This is a request for a permit to upgrade the existing three bedroom system which was tested and
failed. The house has been sold and will require a `Blue Slip" after the upgrade. The original
system was installed in the 80's and has water at the top of the lateral. Even excavating down to
the lateral showed the owner the field was full and in failure. A new test hole was excavated on
the east side of the existing leach field showing silty gravel, GM, the full depth of the test hole.
The perc was 4 minutes per inch which was similar to the original system. No water was
observed at the time of excavation or after the 7 day monitoring period. A 5 wide trench by 38
feet long, will be installed to keep the system as high as possible due to bowl area where it will be
constructed. The tank will be inspected for leaks and replaced if any holes are found. Also a
diverter valve will be installed to the old trench for future use.
This new system will not affect the future development of the neighboring properties due the large
lots and locations of the wells and septic systems. The general drainage is to the west and south
beyond the road/driveway.
If you have any question please call me at 345-3377
SincerW.Anderson,
W&7'
ichaP.E.
MOUND OVER
a GRADE
-1' ORo
FILTER FABRIC
N
O
O
GM
V
DRAIN ROCK
-15
EAST 24.60'
WELL
t �
s. EXISTING
r
i
ern, HODS
L
EXISTING WELL
100' RADIUS
9�
- - �. EXISTING
3
SYSTEM
o
r
r �
o
'00� C
� o !
NEW SYSTEM
ED
0
r
i' WEST --1-4$..62'
i
' 7'T W I L I G H T L A NSE -
i
DESIGN CRITERIA:
3',BDRM X 150 = 450 GPD
S?ILS = 450/1.2 = 375 SQ FT REQ'D
315/10 = 38'
TRENCH:
'6' DEEP
4EFFECTIVE
5.0 WIDE
38' LONG
SEPTIC DESIGN PREPARED FOR
JOE MILLER
�8 . A�°e�®
° �s
LOT 2
.��'`��
ow
THOMAS SUBDIVISION
r° * e 49TH e d
0
PREPARED BY
MICHAEL N. ANDERSON, P. E.
� ° MICHAELN. AiV D'cR50N : � 60
P� �',,
14250 N. GOLDENVIEW DRIVE
CE 9459 •
(907) 345-3377 / FAX (907) 345-1391
��°�°�� 7%�,r •°(•4,e��
ed
��� ¢:�° r�r�4 ,sem
SCALE: 1 "=100' JANUARY 31, 2001
10' UTILITY EASEMENT
-----------1------------------
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EXISTING HOUSE
�
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w
\
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F
/
EXISTING C.O. --'-j
EXISTING 1,000 GALLONG TANK
TO BE INSPECTED AND REPLACED
EXISTING WELL
% 100' RADIUS
IF FOUND TO HAVE HOLES p
O
DIVERTER VALVE
EXISTING SEPTIC
\\ TO REMAIN
C.
NEW TRENCH
� I
\\
! 1
1
1
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TH#1
MONITORIN TUBE
\
3-5% C.O.
� �,,
SEPTIC DESIGN PREPARED FOR
JOE MILLER
2
���••^4'����
Ga°° id
LOT
v •°
THOMAS SUBDIVISION/
°°4�ST t�
;10.10 .•• • • • • • • • m�/
PREPARED BY
%g"K,
° I
as hGiY
MICHAEL N. ANDERSON, P. E.
• a
MICHAEr_ N. ANDERSON ; 43�: O
14250 N. GOLDENVIEW DRIVE
6 v . CE 9 69
��
(907) 345-3377 / FAX (907) 345-1391
;A•?� ( m•m•'N\sc;��
��'
SCALE: 1"=30' JANUARY 31,
2001
_.; .:.
V
e ..� Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
� tea.° '���;,'�'ae°•'g+ P�
see ° a aae®a.sa.A
• MI CHAEI. P.I. ,4'c IERSG,y
Y I,_ CE - `r'GC,
PERFORMED FOR: �bG elf `'e l/ DATE PERFORMED: I
LEGAL DESCRIPTION: �� T �GYY�GY i S/JD Township, Range, Section:
DEPTH SLOPE SITE PLAN
(FEET) J` (��j GYM ti � Ir1 177
1.
2-
3-
4-
5.
-3•4•5.
6-
7
8
9
10
11
12
13
14
15
16'
17
18
19
20
stl � G
C Aq
0�(ry� tl
WAS GROUND WATER
ENCOUNTERED? �V
S
IF YES. AT WHAT L
O
DEPTH? P
E
0epM to
Mweawng? o h Date: 2 C o
Reeding Date Gross Net
Time Time
Depth to Net
Water Drop
6 v e?cope c y
/Ci in
Zi
v� f
/'O n
7 �?
I m rn
2,S r
PERCOLATION RATE - (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN � FT AND 'a- FT
COMMENTS
to t C1 C- TV -,C h r4 .
PERFORMED BY: Iii (c-hee ( A f, 1 t't '; .•r t CERTIFY TH T THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE r9/af
72-008 (Rev. 4/851
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES 2-27
Environmental Health Division (1
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
—
Name
OjIC.Cy 13/ZzJ'1')/GS c�>,
-
DISTANCES
\�—
TO
F110M
SEPTIC
TANK
ABSORPTION
FIELD
--
WELL
nddress
Z S Z' 13&,116!3F/Z/z
WELL
--
_
/Z/
/,3Y
Phone(s')
G -7 Z. Y, f
----
Permit No.
8S- O/ LZ
o. of Bed
Nrooms
LOT LINE
--
/7
--
2/
—_
7/
LEGAL DESCRIPTION
_
Lot
Black
Z
Subdrvm
iSn
FOUNDATION
--
/O6
—
Township, Range. Section
_
AS -BUILT DIAGRAM IShow III van i of well. sepJis sysrem,_ property lines, foundation,
dnvewa water bodms,
TANKS
PIQ SEPTIC ❑ HOLDING
Manulaclwer
4A-)614-1 %//f/ lC
Capacity in gallons
/000
–
�Y
Malerlal -
Material
No. of Compmraoms
--- TYPE: OF SYSTEM
--
td TRENCH ❑ BED ❑ W. DRAIN [] OTHER
Depth to pipe bottom from
original grade ,Z I _ L/ I
'T fT
Total depth from oriental grade
/o r -- �i'r FT
—
I
-
—
14
.0
{Ry
----
—
—
—
--
—
-
/.to
it
--
Z' {
(
—
—
��
3's"1
—
�O
E
FII added above o,,glnal grade
O 1 -- Z. f FT
Gravel depth beneath pipe
FT
Gravel mrcyth-- ---
3 FT_
Gravel width -
17-1S FT
Total absorptionarea
SO FT
Number of lines Sad rating -- --
_
Olstance between lines
�ff FT
pipe material
Installer
pcvAiG`/Z
----
Date Installed
AUC7--
WELLS --
PRIVATE ❑ OTHER (Identifv)
Classification (A,B,C)
-- --
1 olal Depth TI� Cased to
�J —f't—esY3FT
InslPlleli
/C i'Ci�
Date installed- p '`'
/ L
REMARKS:
//104 ?ff-UL3
-
-
-
--
G� 66 O .�
Scale:
Inspections Performed by:
�.yw.- ccL r,vc.
v,-".
" ANG jFlS'
.A o"+F�w rrenJ-0.)rVeiMp
t
�r� ort✓.
y -''ala' j` r IS'Gt1 a�T r -r
f z Aa
--
Dale- -I-�r
—
r!i/��_�i7O%�G�sV}'- �N fJ cerlily [hat this
/----
Municipal and State guidelines in ellect o hl dam,f[9�7: YO
Health Department Approval: O/%�_
inspection was performed according to all
Date:l �L_lfL
72-013(3/85)
Municipality of Anchorage d
\ Department of Health and Human Services. 115
Ton, Fink, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
January 9, 1989
Wiley Brooks
2525 Blueberry Road #105
Anchorage, Alaska 99503
Subject: Lot 2 Thomas Subdivision
Permit #880122, PID #018-262-27
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1986.
Permits are issued on a calendar_ year basis by authority of
Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system
not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this Department for documentation of the installation and to
close the permit.
If a private engineer inspected the installation of: the
on-site sewer system, the original as -built inspection report
(three-part form) must be sent to this office for review and
approval, and for documentation.
When applying for a new permit, the fees are: $90.00 for
an on-site sewer permit; $50.00 for a well permit; $140.00
for a combined sewer and well permit.
If there are any further questions, please call this office
at 343-4744.
S' cerely, n
p IC617 '
Daniel J. Roth
Acting Program Manager
On --site Services Section
DJR/ljw
enc: Copy of Permit
WELL: Log must he submitted to Municipality of Anchorage Department of Health
and Human Services within 30 days of well completion"
INSTALi PER ENGlNEERS DESIGN, A TRENCH TYPE ABSORPTION SYSTEM.
LENGTH = 60's GRAVEL DEPTH = 4', MAXIMUM DEPTH - 8'"
THIS PERMIT IS ISSUED FOR A SINGLE FAMILY RESIDENCE ONLY AND
EXPIRES 12/31/88"
I CERTIFY THAT:
1" I am familiar with the requirements for on-siLe sewers and wells as set
lorth by the Municipality of Anchorage (MDA) and the State of Alaska"
2. I will install the system in accordance with all MOA codes and regulaLions,
and in compliance with the design criteria of this permit"
3. I will adhere Lo 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 understand that this permit is valid for a maximum of 3 bedrooms. I
also understand that the capacity of the total system is 3 bedrooms and
any enlargement will requirm an additional permit�
Signed: DATE:
" 8 ---^--�---'=---
(Owner) WIL�Y BRODnS
Issued By: DATE:
�
v K
MUN1ClPAiITY OF ANCHnRMGE
. `
Department of Health & Human Services
825 L Street, Anchorage, Alaska
99501
343-4720
'
ON-SITE SEWER & SEPTIC TANK &
WELL
PERMIT
Permit Number:
880122
Date Issued:
07/13/80 Engineer Designed
Owner Name:
_
uIiEY BROOKS
Day
Phone:
Owner Address:
2525 BLUEBERRY RD. #105
277-2484
ANCHORAGE, AK 9950.�',
Parcel IQ
010-262-27
Lot Leqal:
3uhdivision: THOMAS Lot: 2 Block:
~
Section: 33 Township: 12N Range:
3@
Lot Size
50191 (sq.[t, or acres)
Max Bedrooms:
This PermiL: 3 Total Capacity:
3
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"O
feet requires
insulation over tank(s).
WELL: Log must he submitted to Municipality of Anchorage Department of Health
and Human Services within 30 days of well completion"
INSTALi PER ENGlNEERS DESIGN, A TRENCH TYPE ABSORPTION SYSTEM.
LENGTH = 60's GRAVEL DEPTH = 4', MAXIMUM DEPTH - 8'"
THIS PERMIT IS ISSUED FOR A SINGLE FAMILY RESIDENCE ONLY AND
EXPIRES 12/31/88"
I CERTIFY THAT:
1" I am familiar with the requirements for on-siLe sewers and wells as set
lorth by the Municipality of Anchorage (MDA) and the State of Alaska"
2. I will install the system in accordance with all MOA codes and regulaLions,
and in compliance with the design criteria of this permit"
3. I will adhere Lo 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 understand that this permit is valid for a maximum of 3 bedrooms. I
also understand that the capacity of the total system is 3 bedrooms and
any enlargement will requirm an additional permit�
Signed: DATE:
" 8 ---^--�---'=---
(Owner) WIL�Y BRODnS
Issued By: DATE:
�
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`iUl IC 31 S1 EM PC 1! tl FOR:
UC 33, 112l la, SM
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CONSTRUCTMIG 1/NPIN IRS, INC.
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.luno 2 ' 1968
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A1NF:11O'c•'tM, At 99616
IMunicipality of Mchoiago
o DI PAM MEN I OF HEALTH & HUMAN SEHVICE,,-;
Q
825 1" Stfoot, Anchorage, ANiska 919502-0650
S)OILS L0(3 --- PfL.'FICOVATIOAN TEST '0. NO. 1732-E 4"0".
Juno 22, 1966
6K
P'I(FOHMFD FOR eir? DAP IT131:03' 0
--- — -------- 4 . e - p
LFGAIF. DFSCRIPI ION: L. '04twl),> VISfi I owwsl It[), viaFige, Section: 33 T I ? 1v Te. -:S v,.l 5. M.
SLOPIF F11 F PI_ANI
I I
(FEET)
3
4
b
(3
7
8
9
10
it
13
14
16
1G
17
18
19
20
s
VAIAS GROUND VVA_1 rt
ILLICOUNrEIII-W 1,16
S
IF YUS, .4f WHAT L
DEPTH?
0
F,
Depth In Wall;[ Alter
pilonilaing? 0?10
Read .g Dile
me Time
----- - - - - - - - -
qw0c,r.Ife"Wv- ?,-hN(7
Dcoth toNct
VVioa, I Drop
PHICOLATION PAIL PERQ'HOLE DlAhirrfm
TES? RUN BP VVEEN I I AND _.__.__._.-FT
(30MMEWS h"Irl" Us_-
v
PERFORMED BY.
CH-111IFY THAT 1111S rEST WA., PFFIFORMUDIN
I_
ACCC)RI)ANCI-.WllllALL STATE AMD MUNICIPAL GUIDELINES INPHEC1 UNIHISDAIL. DAME:DAME:71
72-008 (Rev. 4,851
MUNICIZZ'2 E� /,� ul7'T `� UM4111UP(D T\ f(D )MZ
ENVIRONM G/iw�a\IiI�T�.w, I��1/1'1 I`in\�h J' 1_i/ \V%VY I`fi��I,
`SEP - 2 1.988
RECEIVED
ANCUORAGEg ALASIKA
'344-7714
SIX INCH WATER WELL DRILLED OUT TO THE DEPTH OF
83 feet:.
DRILLED AT THE RATE OF
"1 00
S.teet
— PER FOOT.
cc4.uzsi out ,to 83 feet.
(,,) Q2 Arco Ips 'Lo.
PROPEkTY OWNER _.l'JI�3C C.Lw�t accottn is ;�7 (ldoltic wLdeted b(k�-cL& SChaPAIA J_
�-'ttks
SwG• 7150rm
MUNICIPAUTV OF ANCHORAGE_S
DEPT OF HFAITH-&—.
LOCATION OF WELL SITE_
_
ENVIRONMENTAL. PROTECTION
DRILLER Bvmte CtauiJ
of- P.amp]JL-L`
5Ef' 1988
WELL LOG:
0---•-26 i S.ilttk (JJLavet.
35% crag b.uzdvL. Seve tat jnja.0 bo,_I.t � pg� ! I V E D
26----52' T,iae gAave,t. 20% c tmj,.
52---79' Comue qAa-ve" 403' CI . DJet 6 td tV sand at 79 leet.
79---b'3' rood watm, .Uetuutng. coauwe gzavet 4.ta&t-,u0 (t 80 -eet. The bottom Of
,the tnatezt Gea)L q fommatton .ij at 83 dee-t. The 2uaJttV o� Iauttet i4 ve�uymood, ---
uri.th etgJit CjP(A 4teabj, gtetd. Tarentls .deet of water tecouvlui, ,in «-n.ry. Subae,)r,6tbte
ptu ip 4hou td be bt4 tatted Vase :to f atuL Feet o -f bo tl am. (Doton to 80 deet)
UOJLLOUA ,--bam., off' ,the -thiA Idett mat),ihoity a yteatez nit iej,.)wt f tour Mate. The
a,i.iwtance off' AmpaU P&i.V-,itza Idotko t,6 that ,t1aA IJeU. i4 a good (paUtty. & quont.Uy.
!Jell (..
Cort o� d�U,? q: ,27.00 IZet foot X 83 fleet: 371,743.00
Paid 4n Pi U bls dim Schq-vL-j. 6Rttclu4 t 3, 1988)
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF -'"._.__----_------
THANK YOU VERY MUCH.
BERNIE CL S OF RAMPART D ILLING WORKS
DATE Ratkuw 15th, 1988
SERVICE CHARGE 0 F' 1%' P R, ONTH I I_ E ASSF_SS O PAST DUE ACCO�u ryTS.
Thank tyou, Y,im. 7t ti'j not ,� _U ouvi I ta, da vou. ze eAt �'ob pw'" ute.
Municipality of Anchorage
On -Site Water & Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I. D, 018-262-27 Expiration Date: `.
1. GENERAL INFORMATION
Complete legal description THOMAS; LOT 2
Location (site address) 3551 TWILIGHT LANE *ANCHORAGE, AK 99516
Current Property owner(s)
Mailing address
Real Estate Agent
TOM & TAMMY LETTS Day phone
3551 TWILIGHT LANE *ANCHORAGE AK 99516
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
3
Day phone
JUN 19 2014
764-7610
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
0
Individual Water Storage
❑
Individual Holdinq tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
WaiverNanance request for, 4d,a
Distance:
Received by:
COSA to be released to the engineer,
the engineer.
i i.
I Z
!i Lm_ 7
Date:
COSA Fee $ p� Waiver Fee $
Date of Payment �o 6 I I -I f Y� Date of Payment
Receipt Number61 23�0/� Receipt Number
COSA # 056r� v� � Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 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. t 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 _ GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 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.
6. DSD SIGNATURE
_11_� System #1 Approved for bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone
337-6179
Date J10
bedrooms, with the following stipulations:
������iuuurrrrrfr
OF A&6y((,
ON-SITE
=� WATER AND
c3 WASTEWATER Q^
=PROGRAM
Original Certificate Date: C, 2._�,- I LL
The Adudlcipa% rA rage Develop, amt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the repre enata ons 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. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
iaa„ +vns
L.Nitrate Advisory
Arsenic Advisory
Other
4 .
e .
W x=cN mi 2;d'
Z 5 Y• "
4z se
F-/
RAMP
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i..I hereby. egrtliyShai I hajre performed e!Mori
SITof t{�a followfog deaa�lbed property:
ho Inc .Sub'..
:... ... a• eor
... .. .. ... _. .. `°_. -=p. -.- chorRg�ading-Predngh�fiieeka�and thREitho
' sl i ) ..a x pry :menta ue d thereon' ere wlthln the property bni
a.a a" nM 'mA r eaMOMIL on I prop lylneladjaa
A t0 that no i amspto on 1preperty lying someone
enorone on a premises Ini¢neetlon and tbpt the
c` Fm. Y�alan&a reay¢, tganemission lhual or other. vWblo ease
f +• ' : r said prop9erty except asindieetad hereon.
C ;ti, N .Ei iS Dated[ at Any`]mease, Alaska , .
tail.ARyor3�
-EASEMENTS OFAEDORD, OTHERITHAN
.. THOSE SHOWNON THE RECORDED �' ""''""�4 FDllllWALATIG4 & pE3
;FLAT ARE NOT SHOWN HEREONIH, WillanEn9Weers and Survgyors
In,
urn
If more than 1 septic system is on the lot:
COSA Checklist # _of_
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: THOMAS; LOT 2
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N A
Date completed 8/15/88 Sanitary seal (Y/N) YES
Total depth 83 ft. Cased to 83 ft.
FROM WELL LOG
Date of test 8/15/88
Static water level 63 ft.
Well production 8 g.p.m.
WATER SAMPLE RESULTS
Coliform 0 colonies/100 ml.
Arsenic: A)l0ug./L.
B. SEPTIC/HOLDING TANK DATA
Nitrate t'tO mg./L.
Date of sample: 5/15/14
Parcel ID: 018-262-27
Well Log (YIN) YES
Wires properly protected (YIN) YES
Casing height (above ground) 12+ in.
AT INSPECTION
5/15/14
48 ft.
5.1 g.p.m.
Collected by: GEG. Ltd.
Tank Type/Material SEPTIC/STEEL Date installed 8/1-10/7/88
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (YIN)) YE�S� Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping to I 1 Y! 1 7 Pumper /�A)f4h1C. -7,/ Pry
C. ABSORPTION FIELD DATA *BELOW EXISTING GRAD
8/1-10/7/88 150 TRENCH
Date installed 2/4/01 Soil rating.p.d./ft r(2(!2/ bdrm 1.2 System type SHALLOW TRENCH
63 . 4
Length 40 ft. Width 5 ft. Gravel below pipe 4 ft.
*9.16+ 504 YES
Total depth *9.58+ ft. Eff. absorption area 400 ft Monitoring tube **YES Depression over field NO
Date of adequacy test ***5/15/14 Results (Pass/Fail) PASS For 3 bedrooms
4 +,t ,t*
Fluid depth in absorption field before test 42 in. Water added 460 gal. New depth 51 in.
Elapsed Time: 130 min. Final fluid depth 48 in. Absorption rate >= 450+ g,p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date
**MONITORING TUBE GOES 3 INCHES PAST EFFECTIVE.
***TESTED 2001 DRAINFIELD.
1988 DRAINFIELD HAD 28 INCHES OF LIQUID IN IT AT TIME OF INSPECTION.
4W* OT THE 1,,lv(r�r—DF .14arc a2o�r PrR
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN
"Pump on" level at in. "Pump off" level ' . High water alarm level at
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'
Public sewer main N/A
Sewer /septic service line
25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Properly line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 5'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 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 JEFFREY A. GARNESS
Date 6/r 8z/Y
(Rev. 11/05)
a.144.µ
Municipality of Anchorage
j • '� Development Services Department y `
Building Safety Division
On -Site Water and Wastewater Program ;
4700 South Bragaw St ',• CTV
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904'
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FORA SINGLE•FAMILY DWELLING
Parcell.D. 01 — (,2-27 HAA -4
1. GENERAL INFORMATION Expiration Date:
Complete legal description /. o Z -rh o m a.5
Location (site address or directions)5 T,�; �,•� �, N o Q� is
Current Property owner(s),7'e}ryw/Y(a,t, e f diensc6lan Day phone .3yy"8o76
Mailing address 36'6'1 Tw, ,ltch&y xr
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER"OF BEDROOMS: i7
3. TYPE OF WATER SUPPLY: '
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
Individual Water Storage❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional 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 verity that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm
Address
Engineer's Printed Name
S. DSD SIGNATURE
Approved for _3 . bedrooms.
Disapproved.
ri
Phone _.272 - 9 33G
Date !oS
Conditional approval for bedrooms, with the following stipulations:
. . -
. .,.o rrrt!!!
WATER AND m=
Additinnal Comments wik TFHffER�
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: (�(� e �— Original Certificate Date: 1 - 3-0-157
ma o,Axr
Municipality of Anchorage
' Development Services Department
Building Safety Division
On-site Water & Wastewater Program •
4700 South Bragaw St
rt P.O. Box 150850 Anchorage, AK 99519.8650
www.d.anchorage.akus
(907) 5437904
/ HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Le4 1 TA0,^4C ParcelID:0
A. WELL DATA
Well type It A, B, or C provide PWSID # _ Well Log (YM)
Date completedg' 1 S'1M . Sanitary seal -(YIN) Wires PmPe►N Protected (Y/N) Y_
Total depth _tL1L Cased to S.3-_fL Casing height (above ground) 2 in.
FROM WELL LOG AT INSPECTION
Data of test . . g ' I5 •Sty ? • 2 V • e S
Static water level b r It 4(. 6 _ ft
Well production iS g.p.m, $.o
g.p.m.
WATER SAMPLE RESULTS:
Cotifor lonies/100 ml. Nitrate -49 rngJl. Other bacteria 0olonies/100 ml.
Amenic:N�A. Date ofsample:7 te.S Collected by: S l5 FneJe rine
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Date Installed �7
Tankatte e 0 , OaL Number of Compartments ; Cleanouts (Y/N) i
FoundatidOdbarlmd (M-Depression over tank (YIN) .V High water alar (Y/N)f%SDate of pymping. PumperN*z44ALRJ
?t Aye a Sarto,,-
C. ABSORPTION FIELD DATA Or
Date installed If soil rating (g.p.d./R' o/bdr j11;9
System type �1"CYfGh
Length &3ft Width 76.5 R Gravel below pipe �_ it
Total depth R Eft. absorption area S°± ft= Monitoring tube ,2 Depression over field Al
Date of adequacy test I' Z fr• o S Results (Pass/Fail) PS 55 For g bedrooms
Fluid depth in absorption field before test 3 %% in. Water added Sia
gal. New depth in.
Elapsed Time: i/O min. Final fluid depth ii1 in. Absorption rate >= 600 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N/eG 'k+OWN If yes, give date
4 %287 ev"tpr//a z ,n ori iw/ sraiew. LWA44 We. 4r* '4j
q��ewMw{• Lritt rr!/•H ft,�'Itq IN, .teOJ �p oI'i Bi Na/.iy3T�r( iM /j)to,.i to,,;/ Zoos
D. LIFT STATION
Data installedN N� Size in gallons
`Pump on' level at
Datum
E. SEPARATION DISTANCES
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/liR station on lot (2 l
Absorption field on lot 13t'
Public sewer main
Sewer /septic service line
ManholelAceess(Y/N)
water alarm level at in.
Meets alar b cir*A
On adjacent kds'•
On adjacent lots
'> Loos
Public sewer manhole/cleanout
i
Holding tank let I
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r
Building foundation q Property line Absorption field 7 S
Water main S Water service line % Surface water (oa
Wells on adjacent lots 7 /0*
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Properly line 7'Z Building foundation 4.r Water main >;r✓
Water Service line "YS" t Surface water 7 `0y.r Driveway, parkinglvehide storage rZ1
Curtain drain Wells on adjacent lots odr
F. COMMENTS
e9]lhf G. ENGINEER'S CERTIFICATION
I ceRlfy that 1 have determined Mrough Beld Inspectlons andreview of Municipal records that the above systems are in.
conformance with MOA HAA guidelines In en this date.//�EngineeraPrintedName l.c.r+-�//"pate
HAA Fee $ - �b� u5h
Date of Payment Q C6
Receipt Number
(Rev. 12/01) = C .:
Waiver Fee $
Date of Payment
Receipt Number
NORTHLAND PUMPING SERVICE, INC.
Your Professional Septic Pumping Service Company
7501 E. 140th Avenue
ANCHORAGE, ALASKA 99516 16207
(907) 344-7146 FAX (907) 868-6770
TO are
PO•
1
JohP. Aierschmn
• 3551 T�tiIibht Lane
.Aa,chorage, AE 99516
Septic
First thing
Evcrythina in rmu ino`S1Ow
- 1iun:r ,e1d ifneed (ort �t a CIO-)
11/03100gallons; Z Kang a
dp pes, 1 hose • ' r . "
JLt right
drivev
THANK YOU
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• MUNICIPALITY OF ANCHORAGE ���
DEPARTMENT OF HEALTH & HUMAN SERVICES *}I
CDivision of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE: FAMILY DWELLING
Parcel I.D.It L\ (�- q1 -- -q-)
HAA4 VJagQ(`. LL I
1. GENERAL_ INFORMATION
Complete legal description LOT 2 THOMAS SID
Location (site address or directions) 3551 TVIL16HT LANE
Property owner LEaANNA �_ KE 11TH PORTER Day phone 345-2111
Mailing address 3SSI %u), hyh/ Gan A-nc� Aa 995'6
Lending agency
Mailing ad
Day phone
Agent S1 of Oe 91Mang -
Re /Hax
Pr-oerrH-&
_ Day phone 276 -2761
Address 2600 (arae -t%
A-ACAara a
A6- 99S'o3
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
3
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OFWASTEWATER 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.
72-025 (RCV. v91) Front MOA 421
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.
Name of Firm FLATTOP TECH SVCS Phone 345-1355
Address 14530 6'CNo S -T' AmCN AK 99516
Engineer's signature �ta* � fin — Date NOv 199Z
6. DHHS SIGNATURE
Approved for
Disapproved.
mgr OF At g41
m"... b
' :T 14 nf>
.e. ...........•r !•T
iHEOJO.'.E E MOGRE ; }1
P Cc- 3329 S, R
�"+ynf�u • ° .... • : aY
� 4 P'Cle��-.s, i;'_�
1 bedrooms.
Conditional approval for
Additional Comments
M
ICITIC
bedrooms, with the following stipulations:
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1,91) Back MOA 021
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L,OT 2 'T HD MAS _ Parcell.D.
A. WELL DATA
Well type PR 1VAr5 If A, B, or C, attach ADEC letter. ADEC water system number _ N.A•
Log present (Y/N) y
Date completed BIIS188 Driller RAm_�A_RT
DRIVING
Total depth 23
-Cased to. A3— Casing height a2 1
Sanitary seal (Y/N) — i
__ Wires properly protected (Y/N) Y
FROM
WELL LOG AT INSPECTION
Date of test
Static water level 63
C
z_
z
Well flow
_ g.p.m. _ > Y S — g•p•
n
_,
Pump level
> 5-5, _ ""
'' m
I"ii
z < x'
n
T
SEPARATION DISTANCES FROM WELL TO:
f'A� N
op
Septic/holding tank on lot 1 21
; On adjacent lots > foo
R
Absorption field on lot 13 9
; On adjacent lots > /oo
z
Public sewer main y /O0 /
—Public sewer manhole/cleanout?/'0
Sewer service line 35�
Petroleum tank NoNE o85E:RVEi)
WATER SAMPLE RESULTS:
Coliform eo f //Game Nitrate _2.2y m _ Other bacteria _92 r°! / taam ,(_
Date of sample: - 11 2172Collected by: FLATTOP T'tGN Svcs
B. SEPTIC/HOLDING TANK DATAt
Date installed °I�88 4&U _Tank sire 1000 GA'- _Compartments
2
Cleanouts (Y/N) _ Y Foundation cleanout (Y/N) T Depression (Y/N) K
High water alarm (Y/N) N,A• _Alarm tested (Y/N) N.A
Date of pumping 10 I 12 2 _ Pumper_ _r - S�
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s)onlot 121' On adjacent lots >f°O _Foundation_ 8`)
To property line_. 20' _Absorption field Water main/service line So'
Surface water/drainage 7/001
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
D. ABSORPTION FIELD DATA
"Pump off" level at
Cycles tested
Surface water _
Date installed cjA8
S(/l '&
Signature
Soil rating ISO a'/gpRM
System type TRENCH
Length (a 3 �
Width
2 • S r
Gravel thickness Lf
71
Total depth
Total absorption area
Depression over field (Y/N)
Results (pass/fail)
Cleanouts present (Y/N)
Date of adequacy test U/2/q2
for
Peroxide treatment (past 12 months) (Y/N) No NE KNowN If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 139 On adjacent lots '>100' Propertyline >20
To building foundation 97 ( To existing or abandoned system on lot N•A
On adjacent lots > 20( Cutbank NIA , Water main/service line > 50
bedrooms
Surface water > 100
Driveway, parking/vehicle storage area I2 /
Curtain drain NA,
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
HAA Fee $ 170 a C0
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
Signature
� v, .", � �;''�i
`400
eV eOly 1-100,V—
Engineer's Name TA r• �
..>.•.e•e"°"°""'• +r•
Date Nov 13, 19 9 2
Date
f0 . , ^ THEOJO;)E F. JAOORE ^
CL - 358,9
C
HAA Fee $ 170 a C0
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
r'r (I , 17
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
��eon�ronv 5633 t3 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301
s— AIIALYSIS RESULTS for 1HVOICE 4 6D276
Chorrl,b Rof.`i, 92.6097 Somplo 1. Ifitox: I90TU
C.11ont Sample ID L2 TIIO1dihS S/D BACK HOSE RIR
PWSID Uh
Co:LAocted 110V 2 92 0. 14:00 h,:s.
Reoeived 110V 2 92. 0 17:00 hrs.
Prosorvorl with AS REQUIRED
Arinlysis Cmnpl.otod : HOV 5 92
Lrahoratory Saye ytoor STJIPIICIi C EDE
Rel.onsod By
P,xamotoi Results
NITRATE -N 2.24
Cl?-ont 9.ame :FLATTOP TEC111TWAL SRV
Cliont Acct :ALATTOT
RPO;' P0ll :1I011E RECEIVED
Rego
Orclorod By
Send P,oports to:
J)NLAT'%OP 'PECHNICAI. SRV
,.`e. ,,
UTA11", ,,...o^nl:othod ^` Allovablo L1mits
m0/1 EPA 3.53.2/300.0 10
Somplo ROUTIHP, ShIMLE COLLECTED BY: CBRTS.
Remarks:
1 u, Toots Porfori;iod=Snc Spoc.ial Instructions Above, llh•Unnvailrblo
11D. Hone Doteetod See Sample Remarks Above,
IIA" Hot Analyzed LTAoss '}'hon, CT^Orontor. 'Thmt
��„�ErlGS Member of the SGS Group (Societ6 GAnArale de Surveillance)
ueoe� nvnv
COMM RCIAL TESTING & ENGINEERING CO. AK DIV
CHEMICAL t& GEOLOGICAL LABORATORY
TELEPHONE (907) 562-2343
5633 B Street
Anchorage. Alaska 99518.
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETEDIBY WATER SUPPLIER TO BE COMPLETED BY LABORATORY
El PUBLIC WATER SYSTEM I.D. N ���
f£� PRIVATE WATER SYSTEM Analysis shows this Water SAMPLE to be:
FI-AI^TOPFF3457- I35S
Name Phone No.
Ig530 ECHO Sr.
Malling Address
95
ChYF}NcN ae 9ZJp/�6
SAMPLE DATE: =
Mo.
SAMPLE TYPE:
FoT2] F97-2-1
Day Year
XRoutine
❑ Check Sample (for routine sample
with lab ret. no._ —> ❑ Treated Water
❑ Special Purpose % Untreated Water
SAMPLE Time Collected
No.
II LOCATION Collected By
`
1 IoT 2 THDMf} S _SIP I 200 CMIS-
2 ( BACK HOSE B ]B
3 i--
4
5
C.
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
I,, Satisfactory
/❑ 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 mall.
Date,Reoelved _ �I/) IZ _
'rime Received
Analytical Method: Membrane Filter
No. of colonies/100 ml.
Lab Ret. No. Result* Analpt
92.6097 L.
FT -1
I m
—J m
m
BACTERIOLOGICAL WATER ANALYSIS RECORD
Membrane Filter: Direct Count C�) Collform/100 in]
Verification: LBB
Fecal Collform Confirmation
BGB
Final Membrane Filter Re It Collform/100 ml
s Pb
Reported By rL `� ' "� Date
TNTC = 70o Numerot�ls To Count Time;/ 6 °�- _ a.m.
OB = Other Bacteriap n
PART ONE OF TWO
re�lQ0 ",� . Memberotthe REMAINDER TO FOLLOW
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
• _ DIVISION OF ENVIRONMENTAL SERVICES -
343-4744
2)n
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF.
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # HAA #
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
l o� Z % Flami / F_S T i t A-) 2 3 w 51"1
Location (address or directions)
(b) Property owner LIN_iL CWL
Mailing Address 17 -Dy "T , J 11 71n/
6
Telephone: (home) -79' IC07 Business,))7-.. IKLI
61
(c) Lending Institution
Sccj& in
Telephone _
5Ld SCo C
Mailing Address
6L.o E� a 11Ar
VV c�j
q ��k `JSiC S
(d) Real Estate Company and Agent ���s CIO '
Address
Telephone
7_
-1-? ^ L484F
,,e_ brxrljlid
(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,J 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 th legality and status.
4. SEWAGE DISPOSAL
On-sitejK 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.
72-025 (F1ev. 7/88)
Page 1 of 2
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MUNICIPAU 1Y OF ANCHORAGE
ENVIRONMENTALSERVICESDIVISIOMUNICIPALITY OFANCHORAGE (MOA) a
• Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
j A N ). 0 19�� 343-4744
RrCEIVED
A. WELL DATA
Well Classification
P
Well Log Present (Y/N) Date Completed M3
Legal Description: L0T' Z / /FC>MPrs
i �ZtJ rZ3C'u s'VJ
Total Dep83th Cased to 0 _ Depth of Grouting
Static Water Level — 03 _
)
Casing Height Above Ground -F j
Electrical Wiring in Conduit (Y/N) _—
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot / 2
To Nearest Edge of Absorption Field on Lot 13
To Nearest Public Sewer Line 4 1 0-D
If A, B, C, D.E.C. Approved (Y/N)
Yield ? ` POI
Pump Set At
Sanitary Seal on Casing (Y/N) —
Depression Around Wellhead (Y/N)
On Adjoining Lots
4 /oa
MA
; On Adjoining Lots t f 0-t3
To Nearest Public Sewer Cleanout/Manhole 410-0
To Nearest Sewer Service Line on Lot _ 2 O
Water Sample Collected bytivt^� s) c— ; Date I ^ S- 90
Water Sample Test Results repot 4,a�
Comments
B. SEPTIC/MOLDING TANK DATA
Date Installed g� Size / crtro No. of Compartments — �
Standpipes (Y/N) Air -tight Caps (Y/N) r Foundation Cleanout (Y/N)
Depression over Tank fY/N) KJ _ Date Last Pumped iV 6 -Lo
a
Pumping/Maintenance Contact on File (Y/N) A-)
Holding Tank High -Water Alarm (Y/N) _'y i'`
for
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well// Zr To Building Foundation
To Property Line / To Disposal Field
To Water Main/Service Line '(__l1S
To Stream, Pond, Lake or Major Drainage Course
Comments )2'V'Vf F $ - 0 f Z''L—
72-026 (Rev. 7/86) Front Page 1 of 2
M
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed _ g
Width of Field Z+ S
/S O
Type of System Design
Length of Field 3
Depth of Field
Gravel Bed Thickness
Square Feet of Absortion Area 5 D
Depression over Field (Y/N) A/'
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well / 3 %
To Building Foundation /
n� = w
_ Statndpipes Present(Y/N)
Date of Last Adequacy Test
EN cO
To Property Line 2 -/To Existing or Abandoned System on
Lot No /<No ; On Adjoining Lots 4 /O_�
To Water Main/Service Line + r o To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course _ /
To Driveway, Parking Area, or Vehicle Storage Area "I' �O
Comments All/ / Fff J o/Z-�,
D. LIFT STATION — Nv % Il5 rs5-D
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
t / &-'b
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
nspectionA4 ,,, � °
�/N K/_ l.i:c4
Signed"
h=,
00:5 i �N�j/CS 72;U Ci
of
Company
Date
MOA No.
Receipt No. G " 0 Receipt No.
Date of Payment - /(� ' Waiver Fee: $
Amount: $ 170,0o Date of Payment
72-026 (Rm ]/88) Back Page 2 of 2
PIC). U32•C
Juno 22, 1989
this
w
NAME
FOR LABORATORY USE ONLY `' 1 ':^
DNAflDE PREPAID T N IIIAI -� 9PECU41Nil—mor DNS M— DLD PDR
� PIEKU�
Mol hS dd�.'e �! /
/�.•,� ��1� /j
City Stale
ZIp Cade
SAMPLE DATE: Id o.Y LO Phone
Mo. Doy Year
Purchase
Order No. ,
SAMPLE TYPE:
�</Routine
%' ❑ Treated Water,
❑ Special Purpose
Z� Untreated Water
❑ Check Sample (for original contaminated
sample with lab reference no. ,
Semple Time
No. Lee on ,Collect�ry
j� �s� �iiy •� N
Collecjad by - Laboratory Pet. Np,
el
• TO HE COMPLETED.
BY, LABORATORY
Received at:"" QyAnch.❑ Fbks.
9-0
Date Received — 5
Time Received
Next Sample Due r --
COMMENTS:
SATISFACTORY �S
UNSATISFACTORY U
RESAMPLE R '
-OTHER BACTERIA OB
TOO NUMEROUS TNTC
TO COUNT
Direct vernication Final
•'count LSD - BDB r, Result- Comments -
-Z - _ S
[_—CARI
FOR LABORATORY USE ONLY `' 1 ':^
DNAflDE PREPAID T N IIIAI -� 9PECU41Nil—mor DNS M— DLD PDR
� PIEKU�
NOIITHERN TESTING
L8BORAITOI1IES,
INC.
600 UNIVERSITY PLAZA WEST, SUITE A
FAIRBANKS, ALASKA 99709
9074793115
2505 FAIRBANKS STREET
ANCHORAGE. ALASKA 99503
90727 owB
Constructing Engineers
9601 Duddy Werner Drive
Anchorage, AK. 99516
Attn: Ed Israel
Source: 12 Thomas Sub.
Sample IDN: A010590-5
Parameter
Unit
Date Arrived: 01/05/90
Time
Arrived:
1230
Date
Sampled:
01/05/90
Time
sampled:
1200
Date
Completed:
01/05/90
A010590-5
Nitrate -N mfg/1 1.2
Reported 1Sy: 4�, �. �,, �.� Date: 01/08/90
Francois Rod'igari, Anchorage Operations Manager