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HomeMy WebLinkAboutSCHROEDER EAST BLK 6 LT 21Schroeder East Lot 21 Block 6 #050-062-27 MUNICIPALITY OF ANCHORAGE WATER & WASTEWATER UTILITY 3000 ARCTIC BLVD. PHONE: (907)564-2762 BLOCK/LOT/TRACT BLK 6 LT 21 SUBDIVISION SCHROEDER EAST WATER CONNECT PERMIT :97 - 5019 DATE OF APPLICATION -06/11/97 SCHEDULED COMPLETION DATE 12/31/97 TAX CODE 5006227 GRID NW0352 AS -BUILT, STREET ADDRESS 12403 E PRINCE OF PEACE DR OWNER DITLEVSON EDWARD J & CONNIE L MAIL ADDRESS 12403 E PRINCE OF PEACE DR EAGLE RIVER, AK 99577 SINGLE FAMILY MULTI -DWELLING No. APTS COMMERCIAL - –`— PHONE CONTRACTOR *UNKNOWN ASSESSMENTS [� Repair Existing Service ® Main Line Extension On Property Only ❑ City Tap Have Seen Levied Hydrant Only ❑ Main Tap - To Property Line Only [] Main Tap & On property Connect ❑ Row No. 50' or Longer To Be Levied omments: ��q /' (� �`0` Disconnect [] R & R - Main Tap Only caner Staff CONNECT SIZE 1" ISSUED gkrotke INSPECTION FEE $ 103.00 PAID ❑ CASH PERMIT FEE $ 45.20 F] CHECK # $ 0.00 _9L OTHER DEPOSIT $ 0.00 INSPECTED BY REIMBURSABLE TOTAL $ 148.20 19 NUMBER DATE 6 REMARKS PERMITTEE (Please Print)�� W a \ '� �rQ �/ $ O�(�� PHONE MAIL ADDRESS 6- - c SIGNATURE POST IN A CONSPICUOUS PLACE AT THE JOB SITE AWWU INSPECTOR 'tlllMOo.e� - -27SP Original DATE SCHEDULED SUBDIVISION SCHROEDER EAST INDICATE NORTH TIME INSPECTOR BLOCK/LOTrrRACTBLK 6 L 21 D'p C, � Cm iJ �,5 � A 90 I .I SIZE CONN 1" CORP. STOP CURB STOP C TO C FT. COPPER PIPE 1 1/4" OR 2" KEY BOX FT, THAW -WIRE _ THAW-PLATEINUT KEARNY CONNECTOR OTHER ❑ DOMESTIC ONLY ❑ BOTH FIRE & DOMESTIC ❑ FIRE LINE ONLY ❑ FIRE HYDRANT ONLY DATE OF TAPE / / BY SIZE MAIN ❑ ALLEY ❑ STREET ❑ EASEMENT TYPE MAIN EXCAVATOR DISCONNECTS ❑ YES ❑ NO SIZE OF DISCONNECT COMMENTS,TUS AR,c1) 69 - KEY �i rnt___Qltltz2L_ KEY BOX LOCATION 3L_S OF __LlJh[ JDV .�u.__ STnsc% INSPECTION REPORT V LINE BLOWN OUT 6, /72 17.7 ❑ INSULATED INSPECTOR_] DATE 6 IZZie77 COMMENTS ;iq K.B. & T.W. - OK AFTER BACK -FILL ❑ OPEN DORE FLUSH ❑ 200 LB. TEST ❑ MAIN CHLORINATED ❑ CHLORINE FLUSHED ! / OK TO TURN -ON ❑ DO NOT TURN -ON INSPECTOR_] DATE 6 IZZie77 COMMENTS DATESCHEDULED q7 TIME INSPECTOR "UNKNOWN �j/rf �0 SUBDIVISION SCHROEDER EAST BLOCK/LOT/TRACT BLK 6 LT 21 t INDICATE NORTH , . ..-.. - I / I I � so 'to P V, �y 600 —:Zo N M 6110 I 4?- &'VMS 32. I lf I I 310 36 /0: enlf i SIZE CONN 1" DOMESTIC ONLY ❑ BOTH FIRE & DOMESTIC ✓ CORP. STOP ❑ FIRE LINE ONLY ❑ FIRE HYDRANT ONLY CURB STOP C TO C DATE OF TAPE /ly / 9' BY 04 j FT. COPPER PIPE SIZE MAIN ALLEY P-tTREET ❑ EASEMENT ✓ 1 1/ ' OR 2" KEY BOX TYPE MAIN EXCAVATOR OA/6H/ALG_,gAIT. _ �5 FT. THAW -WIRE DISCONNECTS ❑ YES [jNO SIZE OF DISCONNECT `^ THAW-PLATE/NUT COMMENTS �- KEARNY CONNECTOR KEY BOX LOCATION ,321I�nQe'[� (JF 1n JF�L T PAo _ Q OTHER INSPECTION REPORT [P,-�INE BLOWN OUT P / �// q7 []INSULATED V<❑ K.B. &_T.W. - OK AFTER BACK -FILL OPEN FLUSH V, i TEST [,1/4AIN CHLORINATED / VCCHLORINE FLUSHED / [j�/OK TO TURN -ON ❑ DO NOT TURN -ON INSPECTOR] DATE {i / / -7 COMMENTS MUNICIPALITY OF ANCHORAGE WATER & WASTEWATER UTILITY 3000 ARCTIC BLVD. PHONE: (907)664-2762 BLOCK/LOT/TRACT BLK 6 LT 21 WATER CONNECT PERMIT 96 - 3596 DATE OF APPLICATION SCHEDULED COMPLETION DATE SUBDIVISION SCHROEDER EAST SCHROEDER, EAST WID #329 TAX CODE 5006227 GRID NW252 AS -BUILT STREET ADDRESS 12403 E PRINCE OF PEACE DR OWNER DITLEVSON EDWARD J & CONNIE L MAIL ADDRESS 12403E PRINCE OF PEACE DRIVE EAGLE RIVE, AK 09/27/96 12/31/96 U SINGLE FAMILY n MULTI -DWELLING No. APTS COMMERCIAL PHONE 7544 CONTRACTOR ASSESSMENTS [� Repair Existing Service Main Line Extension I� On Property Only U City Tap � Have Been Levied Hydrant only Y ❑ 50' or Longer [ J To Be Levied IX] Main Tap - To Property Line Only Comments: Main Tap & On Property Connect Row No. L� Disconnect - — -- --- -- R & R - Main Tap Only caner Staff _ _ l CONNECT SIZE 1" ISSUED SAP INSPECTION FEE $ 0_00 PAID ❑ CASH PERMIT FEE $ - 0.00 CHECK # $ — 0.00 OTHER DEPOSIT $ 0.00 INSPECTED BY REIMBURSABLE TOTAL $ 0.00 -UNKNOWN�r7(�u NUMBER 8896-4160-0016 - - — ---- DATE IiAl - 2 ----- REMARKS PERMITTEE (Please Print) *UNKNOWN _ PHONE MAIL ADDRESS , SIGNATURE - --..- - - - - - POST IN A CONSPICUOUS PLACE AT THE JOB SITE AWWU INSPECTOR Copy 2 Municipality of Anchorage DEPARTMENT OF HEAL Thi AND HUMAN SERVICES page _L_ of Jr ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 S Anchorage, Alaska 99519-6650 ® Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection ort Permit Number:��1gL�j� l Report PID Number- Wastewater �- Number: Wastewater System: em: .. %�NJeew/�`1 ❑ U- p�grad�®e ABSORPTION FIELDNoof ems Booms '® -- d: -- -® o LEGAL, DESCRIPTION Lot: _ — Subdivision. Township: '—�---� Range: _ Section: WELL: ❑New -���® EJ Upgrade i6a��s rtfication (Private, A,B,C�_ 1J17`k/n �,� rTotal Depth Tr,,n From Well Surface Water Lot Line Foundation Curtain Remarks: ueep Trench — and ❑ Shallow Trench ❑ped ❑ Mound ❑ Other fnpl,j, Ratin- g: �-�"'�� Total Depth from original grade f 6 GPD/Sq. Ft. c:=!h j o pipe bottom from original �irade: Fill added `-above grade: Gravel �p:�f - �r To: Total abso rptlpn afed. Ft. 3telLevF�:� Installer: Pump Set at: i °G'7171 f -PI Casing Heig t Above roun GPM _ Ft. Sl�AldAail0M DISTANCES FL p�aSepilC e)Sorption Ll til Holdin Tank a nublic/Pn Fivale Manufacturer: Field Station Tank Sewer Lines 1 bD r ICO'4- Gravel depth beneath Pipe_- ----------- ipe_— Gravel length: _L_9 F'� Numberoflines: pislancebefwee��st Pipe material: Ft. _ �I� Date installed: TANK CI Holding O S.7.E.P. Capacity in gall N ' Capacity of�,,,o_; LIFT STATI Size in gallons: Manufacturer —'�_:�;p "Pump on" level al�-- �>p^ P off' level at: High water alarm at: Pump Make &Mfg �"�a �o`ns —elm electrical Inspections performed by: �­ BENCH MARK Location and Description: Inspections performed byl.�' �I>�_ Dates: 1stlU ?_ 2nd_�Q �- Departrnent of Health �+ n S rvi approval Reviewed and approved by: -44k- ___ Date: - 72-073 (1/91) MOA 2���-� Assumed Elevation: rni i 4 'se1'F'ar)c x� o a a IX Permit No. kALaAA— Page _ of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. BOX 196650 • Anchorage, Alaska 99519-6650 • Telephone: 3 On -Site Wastewater Disposal System and/or Well I spection Rep ort Legal Description: �CNkt.r� p C)0 -!5GAU: I" =10' COZ I Z w4 w5 Iqs is 54_ IT 55°' (01 �1 z W3 COZ KkEtJ C� IL Q; �� — � 10, UTIL_ 12-013 A (2/91) MOA 25 Coo P�1 �.r_�7_ J;?ay 1}-2(0 -aj1 11 —8S? MUNICIPALITY OF' ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O, BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE JmMMogW WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW9103 PAGE I OF Ili ffn Is Los �c� L- DESIGN ENGINEER:S & SIENGINEERS OWNER NAME:DITLEVSON EDWARD i DATE ISION DA0/:10/2 OWNER ADDRESS:6909 E, EXPIRATION DATE:10/24/92 8TH AVENUEMENNOMW ANCHORAGE, ALASKA 99504 PARCEL ID:05006227 LEGAL DESCRIPTION: SCHROEDER .EAST BLK 6 LT 21 LOT SIZE: 21229 (SQ. FT,) NUMBER OF BEDROOMS: 2 THIS PERMIT: 2 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: I. THE ATTACHED APPROVED DESIGN, 2• ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAI, 3. REGUFOLLOWINGLATIONS PROVIISIONS8AAC72) AND NG WATER REGULATIONS (1IIAAC80) SPECIAL PROVISIONS: 1' COPY OF RECORDED EASEMENT FOR USE OF WELL IS ON FILE WITH SW910340, 2• ENGINEER MUST VERT \ INSTALLATIO Y ,y NO B�RO \K TO 15.0 FEET DURING RECEIVED BY: \ _ DATE: ISSUED BY: DATE: HEALTHAUTHORITY I September APPROVALS 30, 19 91 ROBERTSHAFER, P.E ROGER SHAFER, P.E. E-EERCIVIL ENGINEERS S (907) 694-2979 FAX 694-1211 Municipality of Anchorage SEWER &WATER DEPARTMENT OF HEALTH AND HUMAN MAIN EXTENSIONS 825 L Street SERVICES Anchorage, AK 99519-6650 REFERENCE: Schroeder Subdivision SEWER &WATER Lot 21 , East Addition, Block 6 INSPECTION We request you serve the proposissue a permit to install a se ed 2 bedroom house on the referenced system to ptic ENGINEERING STUDIES AND REPORTS A test hole was property. 1991- performed on the property on September 19, The was location Of the test hole the attached site plan. The monitoriis located on ng tube within the hole WELL INSPECTION has been checked and found to be dry. &FLOW TEST Thelots `' in this area are relatively large with sufficient room for future se attached site septic upgrades which can be on neighboring plan. we do not anticipate an seen on the SITE PLANS septic hboring properties by the installation Ofthe effects proposed This-proge-r Sim I _lye" l.G C �Irrr�n.�-.. wel,_ L'��. SID, East Addition, Block 6.-ith__Lo 2 _of Schroeder ROAD DESIGN is served by a pr'' The lot to the North, Block 3 S rin p well and the lot to the South Lot 20'A, p g Brook Vista is served b Lot 1, If You y Community Water. for have any questions, or require additional information SOIL TEST Your review, please contact us. Sincerely, PERCOLATION TEST Roger J. Sh fer P.E. STRUCTURAL& I RJ S/ 1 s u MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA QQR79 all m OCZ k �j- 10' Ffat�T' Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST aF. (EtJEi1Nf tii;t3A,V4) — t cne "QaS� u ° � c < " 1• ji V t • � 47 t,.:'..� p Sid � � i/�•)e P2, 0 0? anoa .SIle �n PERFORMED FOR: DATE PERFORI LEGAL DESCRIPTION: UTownship Range Section: KEET) 01 2 b v_ 3 (,U 4 t, 5 a_ is �b 13.zii� 14 15- 16 17 18 19 20 COMMENTS — �'v'c e , )n�I�•eee.i'al SITE PLAN WAS GROUND WATER ENCOUNTERED?. -------�. nnie (minutes/inch) PERC HOLE DIAMETER ---UL_ TEST RUN BETWEEN FT AND _� FT PERFORMED BY: 17034 Engle River Loop Road No, "TA is a CERTIFY T ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON HIS DATE. DATE: TEST WAS PERFORMED IN 72-008 (Rev. 4/85) 3b> '41F E E 1 LAE y y m F IL w 9 { o y^(t y t up ® Municipality of Anchor� SEP 2 9 2015 On -Site Water and Wastewater Progra � 132-1f (907)343-7904 a i Certificate of On -Site Systems Approval Parcel I.D. ©fes - 00 _ �-7 Expiration Date: cilil7, 1. GENERAL INFORMATION Complete legal description �Ch�t PEIZ Z477- (,pT Location (site address) (� �U f7ar ✓l `y�- >��/tC C Current Property owner(s) LA FPa Y Day phone Mallingaddress L.Z"fo�i E'✓Cct i'/jCy Rea4, Estate,Qgent NONE Day phone — 2. TYPE OKbWELLING`L [�J- Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) [ 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System Public Sewer ❑ WaiverNariance request for: "'OV69 - - - Distance: 0 5. STATEMENT OF INSPECTION BY ENGINEER As certifed by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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 ls(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm E!✓GLNGcj2T,_/� Phone g5q-_55-5 Address 6i;22 `fo (FR-PHOE a y AV-1- Engineer's Printed Name CH•F} ?,l ?2/f41j4-9 X"2 Date �* 45TH 6. DSD SIGNATURE " " / �.s�t�arini ✓ System#1 Approved for —I bedrooms�ps� bedrooms-or System #2 Approved for _ bedrooms Disapproved X14 F SS1 Conditional approval for bedrooms, with the following stipptt s: liii�li�if(rf� V� OF ANC '(1, z ON' Np fig, EwP� 5 ip PROG 6, By* il Original Certificate Date:Q r -The nicipality of Anchorage Development Services Division (DSD) Issues Certificates of On Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered In the State of Alaska. The Municipality - - of Anchorage Is-not responsible for errors or omisslons In the professional eng!nears work. 7.- ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Wall Flow Advisory Other COSA blue sheeLr 1, c i If more than 1 septic system is on the lot• COSA Checklist # —Lof 7 Structure served by this system _I Certificate of On -Site Systems Approval Checklist Legal Description: �GH�Cr%� JF,"T 36, Parcel ID: 0 50 r 60 -..77 A. WELL DATA Well type P(47 X WgV1'f7A_, B, or C provide PWSID # z Well Log (Y/N) Date completed _� Sanitary seal (YIN) / Wires properly protected (YIN) Total depth _,/ ft. Cased to % ft. Casing height (above ground) in. FROM WELL LOG Date of test Static water level ft: Well production g.p.m. WATER SAMPLE RESULTS: Plit�7�iL ✓i4TEi� Coliform0 olonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material AT INSPECTION ft.. g.p.m. Collected by: / - Date installed to/ " Tank size (6o0 gal. Number of Compartments Cleanoutse/N) G C Foundation cleanout_M Depression over tank (YIN) _ High water alarm (Y/N) Date of pumping 1419410 Pumper C. ABSORPTION FIELD DATA Date install" *0< Length ft. Total �p'{tt_:_t� ~tE? rating (g.p.d./ft2dPnl) � dO 2�/ System type Width J ft: Gravel below pipe 6 ft. i\ Rion area ggft2 Monitoring tube Yr35 Depression over field AIQ �R... Date C i eq lf�Tt3 Results Fail) For a bedrooms \1N i , irtJ �, Fluid deldh id•pbg8r dodaeld.tie test in. Water added gal. NewdepthJ_ in. Elapsed Ti;v�kop Ornin� =Final fluid depth 50 in. Absorption rate >= , AO g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) AAW 9 If yes, give date e!YA D. LIFT STATION AA9 LT - Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons ( Manhole/Access (Y/N) "Pump off"level at in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? WELL ON LOT TO: 17d34-� Septic tank/lift station on lot t Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas / SEPTIC/HOLDING TANK ON LOT TO On adjacent lots On adjacent lots W Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas Building foundation h S / Property line 't f / Absorption field 1'S / r , ' Water main f l v Water service line Surface water 4lmo Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line + lO Building foundation t 10 Water main �' 1 0� 1aX Water Service line f to Surface water 41 � i Driveway, parking/vehicle storage Curtain drain :� cio Wells on adjacent lots f 1&�> F. COMMENTS v vg t z -Ep-ow�T- Dom. / ear37 �i 1` R LQ rte ski iytl-Rw T y6U cca A -r Ti7t,,e_ o c i7iZs'✓&1AY Pitt? G. ENGINEER'S CERTIFICATION I certify that i have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name QAO�a7� T3'�� � Date COSA yellow sheet_2-6-15.doc 4910* - - �tllitNit71 CE • 13% t!yfl. >. Ilk %V16 W LO N 00 39Zb8 T N I 0 i S03°47'00"E 120.00 J 10, Utility Easement ------------------ I I 0 I I I 8 10.0m d a 2 4.0 8.0i4 + o 22. o y J I 9 1 I I o JD o g ° ° 0 I N 3 0 1 I J M9 \ I E \ I m 8 w \1 I z .� \\ \ I � � I 8-255.00=62.42 F- ru Ix W z Of 0 0 z m w_ F J 7 0 m 0 T m 0 01 J O. ,CZCmg>�OWyN, �o�3 ._ a ' �.❑�xcU -«bco3daNOC ' .O �:RLQ>w `VN yc_oda�tcJ0yoPCN .c�:iodOO KW>>3Qw zO O4i Q acvWcE2 MQ N F f A EN.00TZMI5O tH5 - z0> moL -e,aM w C 0 M D om3 0 "0 W W 0 Q EOZEE N O O 0 N 0 « C O Q E N N M- N L L W .. Cq N W W i00 �' :o N ' j CD 000. LO Ivy d AW m n/ 00 O M YJ ZD ofP eace Drive N Eprince z f� z 0 M I I W J U U) ~ w Wz 000 w dMM W ox z w~0 Co 0 Z �0Z W N X 2W¢ Co 0 n=a 40 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICESi Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907)343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel I.D. # 050-062-27 HAA #I 1. GENERAL INFORMATION Complete legal description SC 'RSR S/n• I OT 21 RI oCK 6 Location (site address or directions) 12403 E PRINCE OF PEACE CR EAGLE RIVER AK 99577 Property owner ED DITLEVSON Day phone Mailing address 12403 E PRINCE OF PEACE CIR EAGLE RIVER AK 99577 Lending agency Mailing address Day phone Agent CAROLINE 5TREANO w/ COUNTRY REALTY Day phone (907) 655-8500 Address P.O. BOX 671923 CHUGIAK AK 99567 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 2 XXX 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 XXX Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC Ing to the legality and status of system. 72-025 (Rev. 1191) Front MOA #21 Computer version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $850.00 at, or prior to, closing for the engineering services provided. 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 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 inspecton, the on-site water supply and/or wastewater disposal system is in compliance with all Municipa�fgl State codes, ordinances, and regulations in effect on the date of this inspection. ,z / Name of Firm Phone (907) 337-6179 Engineers Signatur)encountered / Date Vinga /a In conducting this evaluation, AWWC, In .ateted to provld a thorough, conscientious engineering analysis of the system in accordance with AE and OA DlS Guidelines & Regulations. The reported results described the performance of the system under the condition 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, ground water levels that may fluctuate during the year, and the water 06000 usage of the family being served by the system. These conditions are outside the control of o�OF the evaluator of the system. Satisfactory test results do not guarantee future performance o 40 of the system, nor do they guarantee that there are no hidden defects or encroachments. oP S O� AWWC, Inc. can therefore not provide any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. .... , ,, , 1 ......... „ *, The content of this report is for the sole benefit of the owner listed above. Any � i' reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever.O /J fr A. Gor ess,- ° 6. DHHS SIGNATURE 0( E-7953 •., •' ;o`O _ zf Approved for '�_- bedrooms Disapproved Conditional approval for Additional Comments 0 bedrooms, with the following stipulations: Date y- 2 7- D O 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 #21 Computer Version Ktc.tivtu APR 25 2000 Municipality of Anchorage MUNICIPALITY OF ANI:HUMGe DEPARTMENT OF HEALTH & HUMAN SEFMO L SHVIUC ('IN" Environmental Services Division 825 "U Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 Health Authority Approval Checklist Legal Description: SCHROEDER EAST; LOT 21, BLOCK 6 Parcel I.D.: 050-062-27 A. WELL DATA Well Type PUBLIC If A, B, or C, attach ADEC letter. ADEC water system Log present(Y/N) Total depth Date FROM WELL LOG Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Date of test Static water level Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform Date of Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 10/25/91 Tank size 1000 Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression (Y/N) NO High water alarm (Y/N) N/A Date of Pumping 4/19/2000 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date installed 10/25/91 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 System type TRENCH Length 32' Width 3' Gravel thickness below pipe 6' Total depth 9' Effective absorption area 384 SQ FT Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO Date of adequacy test 4/19/2000 Results (Pass/Fail) PASS For Bedrooms Fluid depth in absorption field before test (in.); 50.5" Immediately after 365 gal, water added (in.): 57.75 Fluid depth 54.25 (ins) Minutes later: ' 30 Absorption rate = 300+ Peroxide treatment (past 12 months) (Y/N) NONE KNOWN If yes, give date ----- 72-026 (Rev. 3/96)' Computer Version - D. LIFT STATION Date installed in Manhole/Access (Y/N) "Pump on" Is "Pump off" level at" High water alarm level at" "Datum Cycles to E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjacent to Absorption Feld on lot n adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/se Ice line Lift station N/A **EXACT LOCATION OF WATER SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: SERVICE LINE UNKNOWN. SEE ATTACHED CONNECT CARD. Foundation 5'+ Property line 5'+ Absorption field 5'+ Water main/service line **UNKNOWN Surface water/drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: *DRAINFIELD PARTIALLY UNDER DRIVEWAY Property line 10'+ Building foundation 10'+ Water main/service line**UNKNOWN Surface water 100'+ Driveway, parking/vehicle storage area *01 Curtain drain NONE KNOWN F. ENGINEER'S CERTIF C TI / certify that l h e h field inspections and review of Municipal r cor s t e o systems are in conformance with MOA H gu li s. e on this date. Signature Engineer's Na e JEFFREY A. GARNESS Date f� �0 HAA Fee S � ' 41 Date of Payment 5 D� Receipt Number S56 3' �lt J}v 72-026 (Rev. 3/86)' Computer Version Wells on a Waiver Fee Date of Payment Receipt Number