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HomeMy WebLinkAboutUS SURVEY 3042 LT 94 N 120' OF W2 T10N R2E SEC 19US Survey 3042 Lot 94 N120' of w2 #075-093-22 WELL LEG • Date Drilled: 12-6-89 Static Water level 68 feet Draw Down ti/A feet I pe Material Drilled: 0 feet to 2 ft. Overburden 2f t, to 15 ft. Silty Clay t-- _ to _aas,Eilt sand 6_Grave P. 02 Deb and John Reiser Hottentot.Rod. Girdwood . Alaska Gallons Per Minute '10+ Total Feet of Casing 160 • 28 ft.. to 150 ft. Clay w/ Streaks of Sand a Gravel 150 ft. to 160 ft. Gravel w/820 to to to to HEFTY DRILLING 3540 AKULA DRIVE ANCHORAGE. AK 99510 (907) 345.0593 204 996 uS- /-44e, 3o ya_ G',rdW6OS , �41C MUNICIPALITY OF ANCHORAGE Department of Health & Human Services 825 L Street, Anchorage, Alaska 99501 343-47220 O N- S I T E WELL PERMI T Permit Number: 890152 Date Issued: 00/03/89 Owner Name: JOHN HEISER Owner Address: BOX 703 OIRDWOOD, A'.: 99587 SLOS9OteS a Day Phone: 783-22222 Parcel Id: 075-093-22 Lot Legal: Subdivision: 'US SURVEY 3042 Lot: 94D Block: 00 Section: 19 Township: 10N Range: 2E W 1/2 N 1/3 OF LOT 94 Lot Size 11880 (sq.ft. or acres) Max Bedrooms: This Permit: 3 Total Capacity: 3 WELL: Log must be submitted to Municipality of Anchorage Department of Health and Human Services within 30 days of well completion. I CERTIFY THAT: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. .3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I 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 require an additional permit. Signed: (Owner) Issued By: DATE: DATE: • zho€w'S S h .1° fib +°1 w.. %a dr/ -A •fLtyY✓ % e/ -4 — %u 3N pos, /il,l ��.-i„I..-, /1 i'o,� yr---:- /.-• - /.�'UICt�Ci ,lr^.s O1 4a.0,3 sit c!/ --o v�` ^� ,110-,.., '�\ G%� tc491 — ��%'/C!/1� /1>tar/ /.1.40 rr4 h'� /45 f' / . c,0 v./ (..../f - z-4- - n v� J -i • / �S �Q e ref/if,/ 4'.e..... Y.v a /,- - .n,.. -,i£. 41 € �c. 1 ('' ^i 00 r t.� ear, 4. Cc,-%.-, �0.- .....„,-/74 ..,...0„.3._/.v,! / rine-71(0/ �' C'��:n8. f1 .'S2>' '—'C "-.,74, /4t,K^ "ce k,, i/ 6r ..r...-4..-,4 of O/%r/ 1 '" G'%''re Are enik (acicacn run7' oaf Peg on /m o /10 //.✓n.i /, e eYKrIS ri it Co•�t1i++c�ro� /off e out 6 de/.ce/' fie /re ` afi.9 is as / G.A. Ate / / 4 4,true,-. km . eir fr pv, ve) [ `,vc/vea /or/ trio/'` 7 / e / 1. -ed L.* / .3/4//e/f0,-71 e'° /ccf !re/, - Ae a rev/inti /Xs/ .4v /ne nGt /er /n -C/a./// o%; .C, ne'i- / ,rte o/ /o/ 4 c. /a//wa/o, !,G no-// .r,'' 7 4/d - ,t a it Ay/ a- /nP Al, /l/.' t'' '"�/ ^ 0]^ tosr BlI / W .// /cc- (fp //, we /Cenn+/t'4r- /0 7t. r r Approi. ci sionc a(bPr uu�e wel.\ tD See. er \A S 1 r . 3 &1br;n�` tuel Cr) Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL f'10V 066207i TA 4 tc Parcel I.D. 075-093-22 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent Expiration Date: .Qft° r u�iee r US SURVEY 3042 LOT 94 N120' OF W2 7/0/1 aaa SEGS 275 HOTTENTOT MINE ROAD *GIRDWOOD, AK 99587 SHANNON AND WARREN SOUTHER Day phone 275 HOTTENTOT MINE ROAD *GIRDWOOD, AK 99587 SAM DANIEL 2. TYPE OF DWELLING: • Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System WaiverAtariance request for: Received by: n/a • 3 719, TYPE OF WASTEWATZ'R DISPOSAL: Day phone 783-1910 Individual On-site Individual Holding tank Community On-site Public Sewer COSA to be released to the engineer, unless otherwise requested by the engineer. Date. • Distance: — COSA Fee $ 5a1 - Date of Payment /� Ot7�L/"_, / Receipt Number /I2( COSA# Osc 11157 X 111 I"1 i i Cnt.\r Fee (Mt C� 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, 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. 1 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 System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for Phone 337-6179 Date i t J l�t if 00rness; Q CE—a793 •' vp� •dl:/i`d',<c V 'Oro f e ssloh°oo appp oa ,Llltttl VTY �t(flirrrr t. g ON-SITE zio WATER AND m= bedrooms, with the following stipujt{ isoSTEWATER ck��i'/�� r r<'GRAMi� �-, mo X1 J , SERVrCt )))))11)10' LO bi �!' l /ALA Original Certificate Date:.' The r uniclpality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for ermrs or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory iaa„ wns\ Nitrate Advisory Arsenic Advisory Other 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: US SURVEY 3042 LOT 94 N120' OF W2 Parcel ID: 075-093-22 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 12/6/1989 Total depth 160 Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform - colonies/100 ml. Arsenic: iso ug /L B. SEPTIC/HOLDING TANK DATA Tank Type/Material ft. Sanitary seal (Y/N) YES Cased to 160 ft. Wires properly protected (Y/N) Casing height (above ground) FROM WELL LOG AT INSPECTION 12/6/1989 10/23/2014 68 ft 10+ g.p.m. Tank size 58 ft 5.5+ g p m Nitrate O' 11 mg./L. Collected by: GEG. Ltd. Date of sample: 10/23/2014 AWWU SEWER EXTENDED SERVICE LINE gal Number of Compartments Date installed C YES 12+ in. Foundation cleanout (Y/N) Depres ank (Y/N) High water alarm (Y/N) Date of •u ••'•= Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2or ft2/bdrm) System type ft Gravel below 't. Monitoring tube Depression over field Length ft Width Total depth ft. Eff. absorption area Date of adequacy test Results P- ail) Fluid depth in absorption field before t- in. Water added gal. New depth in Elapsed Time: Final fluid depth in. Absorption rate >= g p d. A ' venation treatment (past 12 mo.) (Y/N & type) If yes, give date ft2 For bedrooms D. LIFT STATION INSIDE HOUSE Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off" level : High water alarm level at in. Datu Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots 100'+ Absorption field on lot N/A On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer /septic service line *UNK 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 Property line Water main Water service line Wells on ad' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field Property line Water service line Curtain drain Wells on adjacent lots F. COMMENTS *SEWER EXTENSION LOCATION UNKNOWN. THE LIFT STATION IS LOCATED INSIDE THE HOUSE Building foundation Surface water ce water Water main nveway, parking/vehicle storage G. ENGINEER'S CERTIFICATION _'c„.....,r �p off... ...... 4 Qh I certify that I have determined through field inspections and p . ' 9 U / •.. fie Op review of Municipal records that the above systems are in ... VA conformance with MOA COSH guidelines in effect on this date. B. .., / V ess: 4 Engineer's Printed Name JEFFREY A. GARNESS vQ P CE— 953 ...• • gm Dete1 Le aProfessio�6 �D0000��o (Rev. 11/05) Ii TENTOT MINE ROAD NB? 1'00" '�... 9 .00 10'ICEA EASEMENT Bk 1119 Pg 64 » ✓1 \SHED\ c a. 7.7 SB7°5_1301—F 99.00' • j*:49TH QF• ? j,},k1 Micha J, Horne .'Q No. LS -53 8 (O/yoy'J�� � 1�'°AOFF55NMkt P��p NOTE: 1) Bearings and distances are as per Deed Description Book 03833 Page 0437. 2) Monuments found on west side of LT94PTN mis-marked. s ASI3UILT SURVEY OF: ;SURVEY CERTIFICATION: FARPOINT has conducted a physical A. Portion of Lot 94, U.S. Survey No. 3042,1survey of the subject property, the improvements situated c-Cia Per Deed Description ithereon are within the property lines as shown. • 'EXCLUSION NOTES: It is the owners responsiaility to determine ( ml WORK ORDER No. DATE SCAtE- — the existence of any easements, covenants, or restrictions which l Oct 20, 2013 1"--401 :do not appear on the Flat used for this survey. NOTE. Under no Farpoint Land Services, LLC SURVEYING, MAPPING, LAND PLANNING, GIS 1 131 E. 7Gth Ave., Suite 101 Anchorage, Alaska 99518 FarpointAK.com (907) 522-7770 = survey@farpointak.com LEGEND END. BRASS CAP MONUMENT WELL ELECTRIC PEDESTAL PCWER POLE Girdwood, Alaska 14180 DRAWN !CHECKED GRID No; IFA NOOrQPAGL !d rCUm stances should any data hereon oe used for construction JLA - ME 1. SE 4912 1 119/8 f :or for the establishing of property lines. END. 5%8" REBA MEASURED S. tit GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS November 18, 2014 Municipality of Anchorage PO Box 196550 4700 Elmore Road Anchorage, Alaska 99519-6650 Planning and Development Services Department On -Site Water and Wastewater Program Attn: Jay Crewdson, P.E. Ref: US Survey 3042, L94, N120 of W2 — Separation Distance from Well to Sewer Service Line Mr. Crewdson, The facts regarding the subject well and sewer service line are as follows: 1. The well was drilled on 12/6/1989 2. The extended AWWU sewer service line was installed in October of 1990. It is reasonable to assume that the well was visible and efforts were made to insure separation between the new service line and the well; however, there is no documentation indicating such. 3. The separation distance between the well and the service line is unknown 4. The extended service line is 2 inch pressure line (assumed to be HDPE or copper) and it was inspected prior to burial by AWWU 5. The well water was recently tested and the nitrate level was 0.11 mg/L and there was no Coliform bacteria. In short, if there is an encroachment, it has not caused an adverse impact on the water quality. If you have any gzestions, please call or email. Besf ligatds Jeffrey,/A. Ga Presd1fnt. 's, P.E, M.S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com Q=OICO1 -31y0 .A8 03103dSNI 91943p YUWh 0.921:007 �r� —tbr7( O -gcrn unif �—,4- _ r�' syam s,, '01 aF Sr'N C'- I 'S +5-'7 }AN 3 �. 0? N , ! SC .� n :S1N3WW00 99 kItu (sOW '.. 'a.`e`a ,a/\C "0MM °+ 19'srry'°O 's-& -'tl'W 04. NeHA).s 4.1 \M y -Ptv 2fynS-SaUd 'P, '7} ,Y) :N 011VOOl 103NNO0 GUI dOld LV H1d30103NNO0 S'Qi NIVW 1V H1d301O3NNO0 J-rt:NIVW 3dA1 & NIVW 3ZIS S10ONV31O/S31OHNVW IOHJNOO dO NOUV001 MORS CV HOl3)IS 9N11 9OIAH3S II3MBS A311V P6 :Jo, > Z Ww3atu \ 0 d W LU J 17. .4 Z 2 1- Z J ¢ m E 0 z�(❑ D O a 0 0 W J_ W 0r 0 -Ja 0 0 22 W'0 JLa N 00 (0 CO 00 W m' W ¢a Z ao0 i3O. 0 O m 0 CC0 1N0019 H.LHON 31VOION1 0 01 m z 4 tag 0 z m 0 O Zi boG`^ b+'arrns. s'fl INOISIAI090S kJ SUBDIVISION /./SS 0 a Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 075-093-2a 1. GENERAL INFORMATION HAA# Hi 0 10 20 o Expiration Date: g "1/— 0 J Complete legal description US SURVEY 3042 LOT 94 W2N3 Location (site address or directions) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address USS 3042 HOT N TOT MINE RD. WARREN AND SHANNON SOUTHERS P.O. BOX 1135 GIRDWOOD 99587 Day phone 783-1297 Day phone SARAH FALKNER — MATTINGLY Day phone 356-6133 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Water Storage Community Class Well Public Water System El Individual On-site Individual Holding tank Community On-site 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 5 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 less than 30 days old. (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 or13 wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $800.00 at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION SY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, i verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AWWC, inc. 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. AWWC, inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Date f 000�oo© vrrsF!- of t Y Galva s: o° C� 7953 cpc. 7, 4000ey Pio fess 0006 IZ Approved for 3 bedrooms. d .. 0 a ON-SITE 0. e 01" p -moi WATER AND : ri'-= Disapproved. `; WASTEWATER PROGRAM Conditional approval for bedrooms, with the filowing stipulation•-•-:--. Q� ,�`` Jjr, NfiM)T a\1\ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: Manitenance Agreements Supplemental Engineer's Reort Other (Rev. 1900) Original Certificate Date: 6 - I i" 0 / Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: US SURVEY 3042 LOT 94 W2N3 Parcel ID: 075-093-22 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (WN) YES Date completed 12/6/89 Total depth 160 ft. Sanitary seal (Y/N) YES Cased to 160 ft. Wires properly protected (YIN) Casing height (above ground) FROM WELL LOG AT INSPECTION Date of test 12/6/89 4/22/01 Static water level 68 ft. 61 ft Well production 10+ g p.m. 6.6 g.p.m. WATER SAMPLE RESULTS: Coliform 0 Date of sample: colonies/100 ml. Nitrate .500 mg /L 4/22/01 B. SEPTIC/HOLDING TANK DATA Collected by: Other bacteria 0 AWWC, INC. YES 12+ in, colonies/100 ml. Tank Type/Material Date in Tank size gal. Foundation cleanout (Y pumping Number of Compri Cleanouts (Y/N) epression over tank (Y/N) High water alarm (Y/N) Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2or ft2/bdrm) System ty Length ft Width ft ravel below pipe ft Total depth ft Eff. absorption area ft2 I oring tube Depression over field Date of adequacy test esults (Pass/Fail) For bedrooms Fluid depth in absorption fi- • •e ore test in. Water added gal. New depth in. Elapsed Ti min. Final fluid depth in. Absorption rate >= g p.d. y rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Ac "Pump on" level at in "Pump off' - _ in. High water alarm level at in. Datu Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A Absorption field on lot N/A Public sewer main 75'+ Sewer /septic service line UNKNOWN On adjacent lots 100'+ On adjacent lots N/A Public sewer manhole/cleanout 100'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water service line Absorption field Surface water Property line Water service line C am F. COMMENTS Building foundati urface water Wells on adjacent lots Water main Driveway, parking/vehicle storage 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 HAA guidelines in effect on this date. Engineer's Print d Name Date S to/ r JEFFREY A. GARNESS Gorness: 953 j •......••.• oPialr ro f ess\0{'oo HAA Fee $ 300.00 Date of Payment Receipt Number (Rev. 12/00) 5/7/01 3970 Waiver Fee $ Date of Payment Receipt Number MAY -03-2001 01:56 PM FAULKNER REAL ESTATE IeUI'10-21 42u 14.10 CM U 111UW' JgGGO UA NU, 907 783 1298 71 UJ 7714 9l^Y'dl^) 14.11 ~#1,14 Pr7) U yl 7411191.1/1111420100411,41414011.4 Pita*Wind P. 01 PORTION OF LOT 94 • • • e If0so 02 gasp.... -4. 00"r....-•• ,r LEGAL DESCRI BEGINNING �' THE SIXINDA Y UNE WHICH N A MC MOST N LOT 941 iM CC SOUTH 47' NORTHERLY CORNER MO 111 LOT 141 MANGE SOUTH NORTH 20.0 FEET HMORE OR ERS ION: LAO CORNER OF toot 40.0 FUT MONO DS OCTAieN SMe MOOT MOST EASTERLY CORNER Or SAID TWEPCWEST 110.0 !E[T n1Ere4 1N aNT Of CEGINNINO T v • 6* mnelh 4 Oreyv,`' �`•4 ,LS -5202 n.a.nP °°- REMAINDER OF LOT 94 1/4At1 n4 elMwnoM p 11112 Rip x11!11..01.11 R Y.1..w1n4 MMR111rs «hIMN1 e m ( JOHN H� SSR IIi411n1411a :n anted airm•'.Ad�11� �.eM lar �St)oaHH�@��NS�"�0, epe 1,1. b.* 24.1004 94 L-595A�51",p°wn ,'�""eFLa' "5012 .. n w anM,MIR 14 I, 1 YneM IN OYN'ro1MaM M saw - aalw_Qn..a •nn Fu 4M ••144 1 Winne M n w xb41MJ1. IN.4 iN0lNiilli atm Sea•'Sa01, (fu) 541-6121 211/41 J, 44i1 "y rnl'.teNiA Y Md M Mw4411- mSiw"1ii, 1 AS—BUIL OI•1 iSa1t025eW1 irks wart yr re 0 14e• .&9O .G Whinny?4, WI n AOC n.eu- 11049 RPS. µ14.. MIA�� MIPMC •kIDFMLI• A PUTS] 8r LOT 9S U.S. SURVEY NO. 3042 SEC ABOVE FOR LEGAL OESdiPnON 40M.Suv1 sawn Sill °r eS—C T�AL71' 500 Scale MOA Grid N Wastewate C 62 Municipality Water & Wa Notes: I 4 0 C- 0 0 0 IG U 0 N _ rL nl m n z z _. 0} b z o 11/4,T. o z w W.5, 50. L ItnT 1-1 IFI 9-' C) 0 "Uz co Z 0 • -1 6- u E n I Ill _ 1 Y i C1 3' x, It S. 3tir C "� I - p dl't e rn C� w5 0 c .J. pr.; Z. y r d 12. 1„rs it— cc r Ir QV1 SEWER $NSO!CTION REPORT 00 • -4 3' —1 rr4 0 0 d n o am 0 ail 0 m 0 ;n z i7 O rl r r e rn z ul "1' PF, o !� In S r7 r (11 2 0 r1 i Cs) Eif1/2-5 716_ E0 'd L2179Z99L06 'ON Xdd r_ CD rn 0 z Cr GJ 0 r r 0 0 .+_•r.'.. e•, ^-'ftr it; . ..'.Y.:Sr,:'Y'. n. :,:r u'.h vim' rf"g n - AP iAaK , C.CM f1MMd 051 AH1 10-8 -AVM 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 CERTIFICATEOF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I D k r%r 0`13 ZZ 1. GENERAL INFORMATION HAA # �11�rt1i`1S Lit Complete legal description Ll S 56kt Nie ../ tvo, 3c4 t Lei -'i y u i •. 1 (1 Location (site address or directions) Lime c (o_e yk 0415 e on }4H.4* W\:ne_ (Zce..ck At. G:rk ,..,„„X Ak Property owner 1 `•^ `' ^ - F . Day phone Mailing address Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: Individual well Community well Public water x NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site . Holding tank Community on-site Public sewer X NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA I21 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 5, '3 ecn m• v4c_4,I C nne�. v. eaf , Ictc. Address ?CC E. F. re w«J to . (-e to \ Phone 272-9336 Engineer's signature 6. DHHS SIGNATURE _X.— Approved for 2 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By: Date V26/941 !<r_..0 5�I' RRYjA1. _ CESOY14411, tiSJ4,A ie yi,,-3.tNon-9698: z" Additional Comments ViV Date 4 -29-99 CAUTION The MuniciPaiity 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. 72-4:C5 (Rev. 1NI) Back MOA CI RECEIVEv Municipality of Anchorage APR 28 199 DEPARTMENT OF HEALTH & HUMAN SERVICES AN Environmental Services Division VIRONME TA SE VI 825 L Street, Room 502 • Anchorage, Alaska 99501 • (90ENVIRONMENTAL 343-4744 �seavlce Health Authority Approval Checklist Legal Description: U5 5t.trve.y Nv. A. WELL DATA Well type VeNeAr• 3oyz Parcel I.D.:6'r5 d93 LZ If A B or C, attach ADEC letter. ADEC water system number Log present (WN) Y Date completed Iz1L%81 Total depth 1G O 4. Cased to IG U S +, Casing height (above ground) Z Z. rr4 , Sanitary seal (Y/N) Y Wires properly protected (YM) Y FROM WELL LOG AT INSPECTION Date of test Izl4 %89 y/z i �9i Static water level / F 44- 5-1.c-4, Well production 1 O + g.p.m. 9' g.p.m. WATER SAMPLE RESULTS: Coliform 0 c c (loo Nitrate • 6Z9 rev Q le. bacteria 0 c o1/, c., ,_ Date of sample: VAI /99 Collected by: CL- r� ,$ 4. cso rx 8. SEPTIC/HOLDING TANK DATA /I/% Date Installed Tank sizesNumber of Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) Date of Pumping Pumper C. ABSORPTION FIELD DATA,. ,ii//A Date installed Soil rating (g.p.dJft2 or ft2/bdrm) System type Length Width Gravel thickness below pipe Total depth Effective absorption area Monitoring Tube present (YM) Depression over field (YIN) Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test (In.); Immediately after gal. water added (in.): Fluid depth (ins) Minutes later. Absorption rate = g.p d ' Peroxide treatment (past 12 months) (YM) If yes, give date 72-026 (Rev. 3/96)' D. LIFT STATION NSA Date installed Size in gallons Manhole/Access (Y/N) `Pump on" level at 'Pump off" level at' High water alar level at' 'Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Moyle OVse r + a On adjacent lots I I 0 4-1-. Absorption field on lot 'VA On adjacent lots MMA Public sewer main 1 So f 44. Public sewer manhole/cleanout 1 5 o + 1-, Sewer /septic service line 3 T . I-. Lift station Newi • O\'s• • \re A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: mil Foundation Property line Water main/service line Surface water/drainage Absorption field Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 0 A Property line Building foundation Surface water Driveway, parking/vehicle storage area Curtain drain F. ENGINEER'S CERTIFICATION Water main/service line Wells on adjacent lots 1 certify that 1 have determined thru field inspections and review of Municipal records a dtove,� ms am in conformance with MOI HAA guideeVn effect on this date. .A, ,`P ' s� ��1 Signatuf . ::e>-"d'/Ci *��i9� _ r `ri`a fa !1�=GL —�.Otti r � c`ria Engineer's Name }� La YA HEtf�sott "'e * Date V2 PA? V°P%;- No. CE -9698 -.c.f., ,v. _cp._ HAA Fee $ `5I400.� Waiver Fee $ Date of Payment 7 — Y 7 9 Date of Payment Receipt Number C)54/-74- ( 3.- 3 1 Receipt Number 72.026 (Rev. 3/96)' APR -2T-01 16:07 s CTSE Refs Client Name Project Namely Client Sample 1D Matrix Ordered By PWSID &ammple Remarks: FROM -CTE ENV IROl8EWTA1 CTBE Environmental Services Inc 991669001 Environmental Mgmi Inc (EMI) US 3042 Lot 94B US 3042 Lot 94B Drinking Water 0 5615301 1-336 P.02/03 F-116 Client NW Printed Datefflme 04/27/99 16 09 Collected Date/17me 04/21/99 13 15 Received Date/Time 04/21/99 14.25 Technleal Director. Stephen C. Edi: Released By Parameter a i trate-a Tout Cotitore ReaulTS PDL units Method Allowable Prep LiMiTS Date Analysis Cate Init 0.629 0.500 nyi. EPA 300.0 0 10 ma 04/21/99 04/21/99 Het. rol/100nL Sm18 92220 04/21/99 RMV w w V w R-99% 5615301 04-27-99 03:58PM P002 864 •tr.ti��+vr;r 1CJa't' r r"? Yid• 4C,' c ;., rIo:.:, < 1 C 1Y Nla. 1t J rt ,r , �':{l !I r! i:-'.' ..y. :r MUNICIPALITY OF ANCHORAGE y 'r' r1 t.t DEPARTMENT.OF.HEALTH & HUMAN SERVICESi Division of Environmental Services . y '• "On -Site SIG -Ades- Sean ,C . i° f `i• U'I P.C.OBox 196650r,'Anctiorage Alaka s;99519.6650 a < ° X• 343-4744` "rats I•.t ;. r, ; r_rTo-,„C'iff CERTIFICATE OF HEALTH ALITHORITY�r;- APPROVAL FOR A SINGLE FAMILY DWELLING ✓/2/ —47 art r }•,•r(,•': :J i1 i', rli •, I rl t•I P8f• cea„r. - Or; 015-093-22 (44g1.10 9a -..t:;. 11 D. N C 41sT: HAA tI P 0r;r;r t..i,; 4,02 31t67,T—._... 1 Z-,•. 1 ` GENERAL INFORMATION _ _ 4v Carr tt C' . Lot 945;',1miv 1.S. Sey 93P42 _;• r' ' Complete legal description ` ';''-:Location (site address oVdirections) tI ' -NNW ' Hn fion#ot'Miriv Reid''= 1 «%•. ..t Z•c,.. - _-••. Gucdwood.' AK • •... • "1.1 •.. ,.Property'owner='°John HadeA Day phone • Box 241687 Anchortage, AK 99524 Mailing address . 'P.O. ;• \,:_,Lending agency r Mailing address't }'Agent `'Address; . 1'. �• , r �,. 4'4.;i A � ; ' ; • 1 i i t �Y til ;' -. nless'otherw se requested, HAA will be held for pickup NUMBER OF BEDROOMS r^ r .,• -4 Day phone`. OFWATER SUPPLY* Individual well XXX V ..< Community well rr '.c : �y ,ti, ... „E: ,,._ _.... `Public water• I-/14 .:.?' ing to the legality and status' of Systemr'«' t �} < y\ tlr � nq',t” .,>. .. r -1 i11r^:- : -' r< -r-• w^4 nna y0.y. - Y�y' ^Se'�```�• 1T1� iri���'{rJtl TYPE OFWASTEWATER DISPOSAL. h � � 3'��1 } 4 Mdividuaijbn HOidiIng1. tank O 'Communityon-ssrte4 "�u of =x ; jar t' \1tl2err4 :3 .int Public sews •• �� %•xxx• NOTE: { If common iP/ wastewater system,. provide written confirmation attesting to thelegalityand status of system ati ` tea' 5. STATEMENT OF INSPECTION BY ENGINEER . n'As certified by my seal attixed hereto and as of the validation date shown below,' I verify that my•;,t ; • inveitigatiOn-of this Health Authority taxon( application shows' that the on-site water supply .• and/or wastewater disposal system is safe, functional and adequate for the nurther of bedrocims and type of structure indicated herein. I furtherverifythat 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, • 'bixiinances, and reguiationiiii effect Onethe'date of this inaPection. 1, '15 i EN GINERRING ; I Phone 7 fl , A . Name -of Firm 17034 Ent* Rhyr Loop Road No. 204 Address .14 Eaglo RI Date 1- " Ergin.eers signature , t • „ . . . . ' . • L.. ..-". 1 I.., '''''''' -. 6.fr...• 'IL', -;...1 '',.. ... .1 .• ..*1.4') :2; i :h.b.....'Ll4 ..,... V... ... ....- .; r ' 'C.': I ....b...“.....f‘ 4021121ClaNW:4.:: : , . ei " • • 1 .e.' . . . - • I. ' - - 1. ; > i C ;...."f.‘—• .. .......i.Cv%It., .0. .t -... " ., tt.• 4 —...cc,k7- 4I„ t/ C •pE Yi ,-,-.00 • • ',14 4 „ „. ttt t 7,1 •,stipulations: -4;, .6. 1'4. 4111:i 9 : . • , • ' " t. Additional Comments .1 .'_'.ti ; 7:•.7 '; "t3 ATteln.1.1.-19.•?"4," ' Date ef 4,111Art7 • 'Ivo • e.);:"' „Iiii,W. :::;t: tr:Ci:4; :':.'Y , t ...... • 1 ..", .. ., 1."..... 4, Si? 4. I E 6;.44. e. • ' ''''• ; f 1.,} • 1.1,-1./;:in.t'411.1:(-• ' !.PJ ' r • Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:/ar 9VA LIS. stove/ 364,2- Parcel I.D. 0 7 S 09 3 A. Well Data Well type PRIOA-Tr. . If A B or C, attach ADEC letter. ADEC water system number Log present (Y6) Total depth Sanitary sea a -a. Date completed Driller Cased to Casing height /8"'+ - Date of test Static water level Well flow Pump levell Wires properly protected ey N) FROM WELL LOG AT INSPECTION 1nT At l4/MAL1 /,1-/9- 9K g.p.m. SA' m rn ni �.m.r rn G Rt-5i41cuu0 Ay Pail SEPARATION DISTANCES FROM WELL TO: IVA Septic/holding tank on lot • On adjacent lots A/ / A Absorption field on lot ti/ /A ; On adjacent Tots u /A Public sewer main T S ' + Public sewer manhole/cleanout / 0 0 ' -F-- PLvn44.v(. N O c 6" Z Sewer service line a r f WATER SAMPLE RESULTS: Coliform O Date of sample: /2- / f B. SEPTIC/HOLDING TANK DATA Petroleum tank Na N G K,.! o w n/ Nitrate 0.10 Other bacteria 0 Collected by: /Gull ltilL,A.s.S S £ S i^rGrrEt.Rini G - Date installed Tank size Compartments Cleanouts (WN) Foundation cleanout (Y/N) High water alarm (Y/N) Ala Date of pumping SEPARATION DISTANCES FROM SEPT Well(s) on lot To property line Surface wa : .rainage Pumper OLDING TANK TO: pression (Y/N) sted (Y/N) ^1�A On adjacent lots Foundation Absorption field Water main/service line 7/99)• Front CONTINUED ON BACK PAGE C. LIFT STATION N/a Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (WN) mp otr Level at Cycles tested SEPARATION DISTAN ' OM LIFT STATION TO: Well on 1• On adjacent lots Surface water D. ABSORPTION FIELD DATA /WA Date Installed Soil rating (GPD/Ft2) Sys Length Width Gravel thickness To . depth Total absorption area Cleanout present (Y/N) Depression over field (YM) Date of adequacy test Results (pa -11) for Bedrooms Water level in absorption field before test After test ty Peroxide treatment (past 12 months) (Y/N If yes, give date SEPARATION DISTANCE FROM SORPTION FIELD TO: Well on lot On adjacent lots Property line To building foundation To existing or abandoned system on lot On adjacent lots Cutbank Water main/service line Surface wat Driveway, parkingNehicle storage area Cu - drain E. ENGINEERS CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in el QV1 tMFditiof ttPs/nspection. C9 _11 Signature Engineers Name Date /[B9Eti'7- C. f o1119 i �R y l;t • 4.1 : 11.s4 'SOS 0741 A.f.t Client Savmla matrix Client Una Ordered ay trojeet Una Pro) sate PsetD Commercial Testing & Engineering Co. Envlronrttaftbt Laboratory 8.Mc+s - - LABORATORY ANALYSIS REPORT 64.4104.1 ID Leta De fl,vly 1042 VATS, S 4 f t2:211rWr it COLLI R DA v0ar Order Pr!mead Data Cotleted Data Resolved tat. 11114 32/22/41 12/14/44 l2/2D/14 • 00:S2 • 1.4100 • 12.04 Technical Director STOW: C. CDS taloned Dy..�-�� bre. Ace. bre. Sample Samara.: RODS= •AMPLS CO2=IDDT. COLtZR. Parameter Secrete -11 oc t.evlt• Dual Unite Netacd Allo.ebl• tat. Limit* Date Anal Dau Inst 0.10 D aq/L t24. i47 1 10. 12/21/04 CM2 • 2.a Special Inateu0tirna Abase •• s,. Se•Zacepla Pew4rl. Aber* :U. Undetected. Reported value se the practical q antlficatien limit. ID - Secondary antitheft. 5633 B Street. Ancients. AK 99514.1600 — Tel (907) 662.2341 rax: (907) 661.5301 411 • Unavailable WA . Not Analysed LT • Lu Tbsn C• . [treater Than £MNROMMENTAL FAWNS 04 ALASKA. COLORADO. FLORIDA. ILLINOIS, MAR,LAMO. MEW JERSEY. ONTO, UTAH. MST VIROtNIA WMA «sr •n..