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Home My WebLink AboutSHENANDOAH HILLS LT 3 HEALTHAUTHORIT'¢ APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECT~ON ENGINEERING STUDIES AND REPORTS WELL INSPECT[ON & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER, P.E. October 11, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Rick and Linda Gattis 4305 West Shoreline Drive Wasilla, Alaska 99654 REFERENCE: Lot 3, Shenandoah Hills S/D 12015 Shenandoah Place Mr. and Mrs. Gattis, At your request, we have been working toward obtaining a Health Authority Approval (HAA) from the Municipality of Anchorage (MOA) on the referenced property. A well flow test was performed on the well serving the referenced property on August 23, 1993. The static water level was 35 ft below the top of the well casing. A meter was connected to an outside water faucet and the flow was turned on full. From this test we conclude the well currently produces a minimum of 6.4 GPM with a 10 ft drawdown. This flow rate is not guaranteed to remain constant. Subsequent variations can occur. Water samples were taken on August 21, 1993 and submitted to Alaska Chemical and Geological Laboratory for analysis. No coliform or other bacteria were present and the nitrate level was at 0.45 mg/1 (the Municipality allows 10 mg/1). An adequacy test was performed on the septic system serving the referenced property on August 23, 1993. Water was added to the system while water levels in the system were measured through the monitoring tube in the upgrade trench as it was the only monitoring tube evident at the time. This test was inconclusive due to the blockage of the pipe, absence of a monitoring tube in the old trench and conflicting inspection reports for the old and upgrade trenches. A second adequacy test was performed on August 25, 1993 when a monitoring tube in the old trench was located. During this test water was added to both the old and new trenches. From this test we have concluded the system absorbed enough water to meet Municipal absorption requirements contingent upon resolution of the conflicting inspection reports for the trenches dated 8/14/78 and 12/5/88. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two ~ bctober 11, 1993 Lot 3, Shenandoah Hills S/D The 8/14/78 inspection report for the original (old) trench shows 8 ft of cover over a trench with a 4 ft effective depth. The 12/5/88 inspection report for the upgrade trench shows 4 ft of cover over a trench with an 8 ft effective depth. Portions of the system were excavated on September 1, 1991 for investigation and repairs. Two cleanouts and one monitoring tube were repaired. The cleanout on the septic tank was found to be attached to the first compartment of the tank. It was decided at the time of excavation not to install a cleanout on the second compartment in order to preserve the tank's integrity. Four observations were made during excavation concerning the conflicting inspection reports. 1) Approximately 8 ft of perforated leachpipe at the base of the cleanout in the southeast end of the upgrade trench was crushed (flattened, not shattered or cracked). The leachpipe was constructed of a very thin plastic. 2) A break in the base of the cleanout pipe allowed sewage restricted by the crushed pipe to slowly leach into the soil immediately surrounding the break. Heavy sludge in the pipe between the tank and cleanout and sewage-stained soil surrounding the break suggest the break has been present for some time. 3) The upgrade trench has 8 ft of cover above the leachpipe. 2) The upgrade trench has only 6 to 12 inches of sewer rock below it. 5) The old trench has 8 ft of cover. 6) No more than 4" of gravel cover the leachpipe in the excavated areas of either trench. Our observations of the trenches are limited to the excavated areas at the first 8 ft of each trench, the area after the tank and at the inlet of the septic tank. On September 1, 1993, after repairs, water was again added to the system. Each time water was added to the septic system, the liquid level never exceeded 34 inches in the 12 ft deep monitoring tube in the upgrade trench. Water levels fluctuated between 4 ft and 5 ft in the 12 ft deep monitoring tube in the old trench. Page Two ~ ~October 11, 1993 Lot 3, Shenandoah Hills S/D It is our understanding you are having another engineer look at your property. Please have your engineer contact us if any further information from our investigation may be helpful in his assessment or if you wish for us to proceed with procuring a Health Authority Approval from the Municipality. Environmental Health Division - 2 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT '~4-s-~ ~t-74 I ~t~<)z4~] ~ 4 TANKS ~ SEPT}~~ ~ HOLDING ~ Capacity m gallons ] Mat~' ~ Nos;Compad met ts L. -"t*~,-/ j¢ .~., & TYPE OF SYSTEM ~TRENCH ~ BED ~ W. DRAIN ~ OTHER _~ ~ SQ FT ...... WELL~ ~ PRIVATE~(~/U0x ~ OTHER (Identify) C~&~',~at,on (A,B.C) '~ ~ oral Depth 78sed to REMARKS: WELL LOT LINE FOUNDATION DISTANCES WELL SEPTIC TANK 2ZO' I ABSORPTION FIELD /SO: AS-BUILT DIAGRAM (Show location of wellr septm system, property lines, foundation. driveway, walor bodies, otc} Insl)ections Period/m/ed by: FT FT Date:/2 --.~-~ E:(~ FT FT FT .... i; '%~-1..L.(':-(~_~ ~,j. (~2~,j~ . .cerlily that this inspection was pedormed according lo Fleallh Depadment Approval:~~ ~ ~V--L~ ~2-013 (3185) .X {! NORTH SECTION/TOWNSHIP/ 5 C7T. )RAWN BY' NOTE' Tt~ ACCURACY OF LOCATION OF EXISTINO P~OPERI'Y CORNERS, WELLS, ANO SEPTIC SYSTEMS INOICATED 13 NOT EXACT. OIMEN$1ON$ INDIOATEO NAVE BEEN OETEff~INEO BY USE OF CLOTH TAPE AND NOT §Y SURYEYINQ TECHNIOUE$. Co~4n :,,? ~' PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: TEsT RuN BETwEEN 2...~ FTAND,/ffr~FTg: FT PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON IHISDATE. DATE: 72-008 (Rev. ~,851 PERCOLATION RATE ¢~'~ 2~' tm,nules/inchI PERC HOLE DIAMETER */ Gross Net Depth to Net Reading Date Time Time Water Drop ,3()m/H, ~, 4-7 SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? //'~/~"~ S L IF YES, AT WHAT ~--- 0 DEPTH? p E Depth to Water Aller Monitoring? Date: __ · 0 / /'~ A 11~)(~"(~'~ ~'~9('"~ ~ ~o~p I SEWE9 SYSTEM LOCATION PLAN LOT ~LOCK J iUBDIVISlON r/~:~27~ ',, -~ sc~, [~.~?~, ~" ' ' /~ ~j,, :~} DRAWN BY' I SYSTEMS INDICATED IS NOT EXACT. r~ 2"~/.~),';. ' 1':/ ~" , NORTH ~J~ I OI"[HglOHS IflDIOATEO HAY~ BEEN ~ .,./?~/// ~ .) -~:~.x;.,~..~.>:,~.~.,~-.~.> .,~,.,'-;;.:r:. .... ~ '"""~'?~'""':'"'T':".~:~ ~.':' .p-,........;..~4:::.¢.?,:?~x:;::~.:~],~. ~ ~.~ ~?~ : ~ HOT BY 5URVEYINO TECHNIQUES. ..,> '~ % 7, /..~. ....... ..:~,~ ........... ~ ':' ~ " ~]~'~'" ~" "~-"~": ~: or MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAl.TH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~AME ~ ~ / .... ~PFIONE [] UPGRADE MAILING A~D 'ESS ~ /~;~ ~'~ [ '~( ~EW LOCATION Well/~ f Abso~ti~ area DweJling ~ DISTANCE ~O: ~ ~ Liq. ca~y~xallo,'; i; H-;MEMADE: Inside length Width Liquid depth ~ Well Dwelling PERMIT NO. ~ ~ DISTANCE TO: ~ M.nu'acturer ~- M"t"rial kiquid ca..ciW 'n .allons ~oundation , Nearest I ~l~e~ Total len~h ~f I~es Troncll,,~i~ll// Distance between lines ¢O ~--~-- ~ O~ inches ~?,~ absorption area ~ NO. of lines/ Length of each li.e Top of tile to finish grade ~ f'- Material beneath tile Total ~ inches Length Width Depth PERMIT NO. ~ N Type of crib Crib diameter Crib depth Total effective absorption area ~u Well Building foundation Nearest lot line ~ DISTANCE TO: ~/ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER ~IPE MATERIALS iNSTALLER REMARKS APPROVED DATE LEGA~ 72-013 (Rev. 3/78) SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF DRILLED AT THE RATE OF $19000 PER FOOT. PROPERTY OWNer II~o ~oq.~ £~ny~ 2240 ?axoo~ ~. 99504 100 333-1781 LOCATION OF WELL SITE DRILLER WELL LOG: 0---27' 8,LL~.~ c.6a~ ta, Od~ 10% q..za~red.. 27--69! ~. ~ ~. 8e~ ~ ~o~. Puf~p ~hauid t~e~ d.r~¢d ~iv~e~ fe~e.~ of~f ,Oo.¢Aatr~. COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION SAID WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF ]~'~'~00,,00 THANK YOU VERY MUCH. DATE__ BERNIE CLAUS OF RAMPART DRILLING WORKS SERVICE CHARGEOF IVy% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS, I:;iHi~I G El:;?. :?~;I-] E N f::l l',l [)0 I:::1H PI THE: L..E:NGTH [::' :1: i'"IE:N:!~; :t: ON :1: ~.; THE: I...Ei'.,IGTH ,:: .T. t",1 I:'I?E:'t" ::, C)t:::' "lq'..IE 'rI:;i:E3.,ICH Cil:;;'. I:::,I:;;:F:I ]!: I',IF:' I E:L[::,. THE: DE:PTH Ol::' F:i TI;tEF,ICH OI:R I:::'Z'I" :[:E; 'THE: I;)I:E;TI:;:INE:I!!:". 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L..OEiti:.:; F:IRI'E I;:[E(;!IJIF;%D FII"4E:' hll...l:i::';T E',E R'.ETLII:d",IE[::' TO THE: OF 'T'I"IE I.,IE:L.L.. COMi:::'L. ET I ON. [:YTTIE:I;.~'. [.~'.E(;:!IJ I RI:i:ME:NT':ii; HF:I"r' I::tF'I~:'L"r'. E;PEC :f. F I CI:':IT I ON':':'!; FIN[::' C:ON'.~i;'I I;;;:UI::::~I' f::I',,,'FIiI..I::IE:I..J!E TO '[I",t'~SIJ~C;?.E: F'I';i:OF'EF;: ::1..: :1:I::11'"1 F:'F:If'I:[I...~I::IF?. P.It"FH THE: RE:QI...III:;?.E:ME:I",I'f'E; FOE'. ON-"~ii;I"f'E 'i'i;l::i:HE:F'~::i:i; I:::IN[::' kII!!!:L..I...E!; R:E; :~;ET' I::'(:)I;i:'TH E',"r' THE: MIJI'.,IIE:IPr'::II..IT"r' OF 2: :1: P.IILJ... IN:.:'2;Tf::II....I.~. THE: E;"r'%'I'E:H :Il",! FICCOF:':E:'I"::fi",ICE I.,.I:I:TH THE:: ;':!:: :1: Ui",IE:'I~;ER'.~!;'T'I::II",It:::' 'T'FIFIT THE: ON" ':E; '.I: TE: :i!;E.kE!:F~: ~i;"¢E;TE:H MFI"r' RE:(::!I..I:I:I:;itE ENI...FII:;i:EiE:HE:I"4'T' :[1::' THE: [:;?.EE; :[ E:'E:I",ICE ~OE:'IEL..ED TO ! NE:I...UI::'E;' i-"lCd-;i:E: 11"'11:::11",f .E: E~E:[::'I:;.'.OOM'.~i;. // . ............. .?' 4040 '°B" STREET ANCHORAGE, ALASKA 99503 (907) 278-1551 May 11, 1978 W.O. #A18435 Grid'#2736 Perry Eaton 3501 Hooper Way Anchorage, Alaska -99502 Subject: Subsurface Investigation for Suitability of On-Site Sewer, Lot 3, Shenandoah Hills Subdivision Dear Mrs. Eaton: Transmitted herein.in accordance with your instructions are the results of the above referenced investigation. The in- vestigation was originally performed by us on May 3, 1977. The results of that investigation are presented here. The scope of this project is the investigation for suitability of an on-site sewerage system. Included in this transmittal are: Test Hole Location Sketch Test Hol~ Log Explanatory Information Figure 1 Table A Sheets 1-3 The exploration was conducted using a continuous 'flight solid stem auger. The rig is owned and operated by Denali Drilling, Inc. Drilling Was sdpervised, the test hole logged and percolation test performWd by Mr. O. M. Hatch, geologist for Alaska Testlab. Th~ log of the tes~ hole is included as Table A of this report. In interpreting the log, it would be helpful to utilize the explanatory information contained in Sheets 1-3 of the report. When drilling was completed a 3/4" slotted PVC pipe was inserted in the hole to aid in determining the free water level. For the percolation test, the test hole was filled with water and. left overnight to saturate. On returning the next day, the hole was refilled with water and the drop in the water level carefully monitored over the next 60 minutes. This procedure is not a standardized percolation test, .howver, we understand that the Municipality of Anchorage, Department of Public Health and Environmental Protection prefers tests performed in this manner to evaluate a site for a proposed on-site sewerage system. Mrs. Perry Eaton May 11, 1978 Page 2 Using the above test, the observed minimum percolation rate for test hole 4 was 3.0 minutes/inch. The percolation rate obtained is higher than would normally be expected for the soil types encountered. These fine grain soils, though they may percolate, have a tendency to plug. It may therefore be prudent to use a more conserva- tive design value of about 5.0 minutes/inch. No water table was observed during drilling. It should be noted though, that the free water level normally fluctuates seasonally and with precipitation. We hope this report'meets your present needs. If we can be of further service, please feel free to contact us. Very sincerely, ALASKA TE S TI~..~ Robert C. Stinnett RCS:bjc enclosures' APPROVED Melvin R. Nichols, P.E. Laboratory Manager Test Hole #4 Table A Date: Logged by: 5/3/78 O. M. Hatch WO #A18306' Depth in' Feet From To 0.0' 1.0' 1.0' 8.0' 8.0' 11.0' 11.0' 16.0' Soil Description Brown Peat, Pt., damp, soft. F-4, brown Gravelly Sandy Silt., ML, damp, stiff, nonplastic. F-2, Brown Gravelly Silty Sand, SM, poorly graded, fine sand sizes only, damp to wet, medium dense. F-2, olive Silty Sand, SM, poorly graded, fine to medium sand particles, damp, medium dense. Bottom of Test Hole: Frost Line: Free Water Level: 16.0' Trace None Observed • PG E jec c Municipality of Anchorage / On-Site Water and Wastewater Program 4 `j j j (907) 343-7904 s AFETY Certificate of On-Site Systems Approval Parcel I.D. 015-212-40 Expiration Date: 11 1 i 1. GENERAL INFORMATION: Complete legal description SHENANDOAH HILLS; LOT 3 Location (site address) 12015 Shenandoah Rd. `Anchorage 99516 Current Property owner(s) David &Susan Hardenbergh Day phone 242-0186 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 ' 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: Distance: r f Received b _ Date: (-.;-./ ( , . / COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 6P Waiver Fee $ Date of Payment 11 DSP l.(1 Date of Payment Receipt Number 6lo l-1 Receipt Number COSA# O i\ 19,6 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road,Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: �QQoopp4 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o OF A 4�Q� in accordance with the guidelines and regulations established by the Municipality of Anchorage andd �.•. "• industry practices. The reported results describe the condition of the system/s on the date/s of the Qe��,•' evaluation. Separation distances were measured to readily identifiable features. Hidden defects or V1� encroachments may exist that were not identified during the evaluation. The operational life of all wells / * t 9 H f' •3 V� and septic systems depend upon a variety of variables, including but not limited to, soil conditions, !•.•..... "' groundwater levels (that may fluctuate during the year), quality of construction (materials and it workmanship), and the water usage of the family utilizing the system/s. These conditions can vary,and / .... ... . . ....... .........Q are outside the control of GEG. Satisfactory test results do not guarantee future performance of the 0 .J- fr-> A. orness system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of QO _ •795 ' c; the well or septic system. GEG makes no representation whether an alternative well or septic system 9 •. l can be installed on the property in the event either of the current systems fail to perform adequately in Opp,. .(Z '1cc+°',==7 the future. The content of this report is for the sole benefit of the person/party that retained GEG to 04 Pro f ess on°4c7 perform the evaluation. Reliance upon the information provided in this report by any other person or ��ppOgoo party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Ci—Y 0:- ��, i`rJ Disapproved �` O Conditional approval for bedrooms, with the followi g sti itif Tyras �C i✓yNS� AND EWAT Ti- n nh� vi 14— � B Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist ?6" Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc 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: SHENENDOAH HILLS; LOT 3 Parcel ID: 015-212-40 A. WELL DATA Well type Private If A, B, or C provide PWSID# N/A Well Log (YIN) Yes t1. Date completed 8/7/1978 Sanitary seal (YIN) Yes Wires properly protected (Y/N) Yes p Total depth 100 ft. Cased to 100 ft. Casing height (above ground) 12+ in. 3 1 FROM WELL LOG AT INSPECTION Date of test 8/7/1978 6/29/2017 i. Static water level 40 ft 35.1 ft. N Well production 10 g.p.m. 5.9+ g.p.m. WATER SAMPLE RESULTS: O Coliform '~ colonies/100 ml. Nitrate I . (o ‘ mg./L. Collected by: GEG. Ltd. - t� L-:- 11 LL . Arsenic: KD ug./L. Date of sample 6/30/17 B. SEPTIC/HOLDING TANK DATA 39 YEAR OLD STEEL SEPTIC TANK IS REACHING 1 THE END OF ITS USEFUL LIFE Tank Type/Material SEPTIC/STEEL Date installed 8/14/1978 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Yes Y Foundation cleanout (YIN) T Depression over tank(YIN) No High water alarm (YIN) N/A Date of pumping '?-)21i-114 Pumper A HT. SF�Z.0 cam.[ C. ABSORPTION FIELD DATA I*Below Existing Grade Date installed 1988/1978 Soil rating (g.p.d./ft`orn /bdrm 368/125 System type TRENCH Length 71+52 ft. Width 2.5+ ft. Gravel below pipe 8/4 ft. Total depth *11 .6+ ft. Eff. absorption areal 136+416 ft` Monitoring tube***Yes Depression over field No Date of adequacy test **6/30/17 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 37 in Water added 496 gal. New depth 53 in. Elapsed Time: 120 min. Final fluid depth 43 in. Absorption rate >= 600+ g.p.d Any rejuvenation treatment(past 12 mo.) (Y/N & type) None Known If yes, give date — **PRE—SOAKED 1988 ON 6/29/17 — 2060 GALLONS OF WATER WAS INTRODUCED INTO THE DRAINFIELD. TESTED 1988 TRENCH ONLY, 1978 TRENCH APPEARED TO BE DRY DURING INSPECTION. ***MT IN 1988 TRENCH ONLY EXTENDS 6.66 FEET INTO EFFECTIVE. VIABILITY OF 1978 TRENCH WAS NOT VERIFIED BY GEG. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off level at '. ' a er alarm level at in. Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75 ±- Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 1OO'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ _ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots *85. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *10'(?) Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain None Known Wells on adjacent lots 100'-I- F. COMMENTS *SEE 1997 LETTER BY ALASKA WATER AND WASTEWATER IN MOA RECORDS 40400� G. ENGINEER'S CERTIFICATION o4OF A ��N ��.. . -.9•954-,k,i- 0 ,,,v6,. .• I certify that I have determined through field inspections and :. 4••- 7 a0a review of Municipal records that the above systems are in ! vA conformance with MOA COSA guidelines in effect on this ! 0 date. r -,IVA. Gorn-ss.,' 0 Engineers PrintedeNa e JEFFREY A. GARNESS O�Oq�s.. , �Ef-' 95 �•A`�-0 Date t1 Z� 1' % \\'' 1/2P�f'2 • d, `a ro(essioo o \O0000a� #AECC884 (Rev. 11105) st i !i 1 L=64.35' l R-50.00' Lot 4 � �_ 1 Ni6. s�5s0>' 3Sa•f , Lot 15 / aSEPTIC PIPES �' 5,0' x 16.0' ROOF OVERHANG 1 T——— 2.0' CANTIIIIIIINIMIIIIIFIP 100' PROTECTIVE WELL RADIUS 1 '0 i2V4, 5.0' COVERED DECK I yQ)q4Ip'VO 1.8' CANT 8.0' x 11.5' GREENHOUSE S Lot 14 O y ?` - 11.6' x 18.0' DECK Lot 2 �� / Lot 3 4N �0 / 65,340 s.f. •O� $--- / 14 - i m P / e 0 r, i 73 u Lot 13 r o I 12: 1 ,s' x) tn OI r N 89'58•00-W 160.91' -- - O = I I I I I Lot 7 Lot 6 Lot 7 I I I I PLOT PLAN — AS BUILT X SCALE 1- - 40' GRID SW 2736 Project No. _ 17-236/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone (907) 522-4625 Fax �� Professional Land Surveyors kenOlongsurvey.com 0 -A(,� jonathanOlangsurvey.com • 0 I hereby certify that I have surveyed the following described property: 49TH Y: LOT 3, SHENANDOAH HILLS (Plot No. 77-157) Anchorage Recording District, Alaska, and that the Improvements situated thereon ore a t / t j4 within Me property lines and do not encroach onto the property adjacent thereto, that 4j ( 1�- no improvements on the property lying adjacent thereto encroach on the surveyed i�/„ KENN - �, premises and that there ors no roadways, transmission lines or other visible fl 1 ' easements on said property except as Indicated hereon. n� -.4,-1-, ..1 V -ib -.4.S-5202.-•• Dated this the K'' Day of --r-.)'-' • -'-'�M.L_, at Anchorage. Alaska moa 0 It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS SEPTIC ADEQUACY TEST DATA LEGAL DESCRIPTION: SP), v- d a s tali- 3 STREET ADDRESS: CLIENT: //�� PHONE NUMBER: NUMBER OF BEDROOM: `1 GALLONS PER DAY NEEDED: ‘Q SEPTIC: *SEE C.O.S.A. SITE VISIT CHECKLIST* DATE OF TEST: */2 Q/ 17 FIELD MEASURMENTS: MT1 MT2 MT3 MT4 TOP OF MT TO BOTTOM: TOP OF MT TO L.L.: Qv? STICK-UP OF MT: 1 I •• TOP OF MT TO DIST. LINE: *DRAW DIAGRAM OF SYSTEM ON BACK OF FORM* TIME METER GALLONS MT1 MT2 MT3 MT4 MT1 ♦ MT2A MT3A MT4A 12 :z°' 9 91- l DRQ( 1 : 'IS 4' 344 , ;23 0 "'' 36 Gam. 1o01 _ q) 9 I1 q' 5&? 1-,•( h fr J a h t, i c,�v-F,--111 ) 31" 3 q 6 4 Gv.o Js a� f 711 )1/1/ / V f -9- RES TS: PASSED ABSORBED GALLONS IN MINUTES ( GPO) : FAILED -SEE ATTACHED LETTER Comments: Signature:"..4 ,__ �� Date: elf 3701 E.Tudor Road,Suite 101 *Anchorage,AK 99507*Ph:(907)337-6179*Fax:(907)338-3246*gamessengineering.com MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAl_TH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING (~/~C- ~,~/~- - ~"0 ' NAA# /~'~'~5"''') (~/---)~ ,,GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address ,~' Lending agency Mailing address Day phone Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: z~'"v TYPE OF WATER SUPPLY: Individual well ~ Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 ; STATEMENT 'OF INSPECTION'BY ENGINEER.I ! ........... .," As certified by. my seal affixed hereto ahd a,s', of the validation date shown' below, I verify that my investigation of this He, a. Ith'Author. ity 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 furth(~r 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 s~stern iS in. i~0mpliance wi~h'all Municipal and State codes, ordinances, and regulations in ~ffe~t on the date Of this inSPection.,' Name of Firm L'-- Phone. '. .... · Approved for ~¢~ bedrooms. Disapproved. Conditional approval for bedrooms, with the.following stipulations: Additional Comments ,.' By: '/-~'-~~~:'": ' ' .... ' Date '/Z' / ::~Z. ~ ..* ...~ .;.~''~..~'" ,..- . .....: ~, .~.'":'. ' .~ ' ..... :; ' .. '~ _,; .:'. . ;.'~ .' , ' .' - . ....... -;.-~ . . ,. ~:: ~ .j ,, , ~..- -,. : ;, ~ ., · .... :~,'-',~,~,-.¥~', .... t-.~ , . .' ,:~ . ~,. . ~3. : . , ~; '.. ,, , '. ~ : ...., , , ,,. ; ,. : .' ,..¢: ;.~.'.,. ', i , ; ~ . , ' . . The Municipali~ of Ahch0~ge Depa~ent of Health and Human Se~ice~ {DHHS} i~uos Health ~pproval Gedifimt~ ~a~ only upon th~ mpr~ntabon~ ~wen in paragraph 5 a~ovo ~y an independent prof~ional engin~ ~ogismred in me stA{e of Al~ka. Th.e DHHS do~ thiS.~iA'~uae~ t6 pu'rch~m of hom~ · and ~eir lending institutions in order to ~s~ ce~ain f~eml and s~te ~uiremen~, ~ploy~s of DHHS do not conduct inspections or anal~e data before.a~fimte ~ ~ued, :~e.Munm~pah~ of Anchorage ~s not responsible fo?'e~om or omi~ion~ in th~'~m~iOh&l eh~in~'~. ~.:'.,¢~...'*.-~} ~.' ;' :'. ..... ~'-. ~(R~.1~1) ~ MOA~ Municipality of Anchorage OEC ]~ 1997 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ~ E C [ ~ V [ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: /-o'r' '~/' ~SF-CJ/Irc[~CrH Parcel I.D.: A. WELL DATA V~elt type r~tL~Pc-f If A, B, or C, attach ADEC letter. ADEC water system number Log present (~)/N) Total depth. Sanitary seal~)/N) /O6 t Date completed Cased to [o0 r Casing height (above ground) Wires properly protected ~N) FROM WELL LOG AT INSPECTION Date of test O~/0 :~-[ :~ II Ilc] Icl Static water level /..1/O ¢ L~I Well production ]0 g.p.m. 5, g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed (~-/~-:~ Tank size I~-~-~-~-~-~-~-~-~O 6~u.. Number of Compartments r~ Cleanouts ~N). Foundationcle~n0~('~N). Y~S Depression (V/~ ~o High water alarm (Y/~ 'piti '} Iff. Pumper Date o¢~0`m g )1 ~ C. ABSORPTION FIELDDA~A',. Date.j,inst,alled(~/I-~1-8 8' "? ;- ; ~?1 rating (g.p.d./ff2 o~) ¢ ~68 System type Length~¢ ~1' _Width ¢ %o" Gravelthickness belowpipeCg~" " Total depth Effective ab~orPtion, area~ I1~. sF Monitoring Tube present ~N~ Depression over field (Y/~ Date of adequacy test II/lff/~ Results (~s/Fail) ~fiS% For ~ bedrooms ¢ ~ gal Water added (in.)~ depth in absorption field before test (.~);¢~- 5~" Immediately a~er . 5~" GOO + .g.p.d. Fluid depth (ins) Minutes later: ~o Absorption rate = Peroxide treatment (past 12 months) (Y/~ ~o% ~l~6W ~ If yes, give date LIFT Date installed Manhole/Access (Y/N) H!gh water alarm level at* ~ Cycles tested I atum .I DISTANCES ,, SEPARATION SEPARATION DISTANCES' FROM WELL ON LOT TO: Renti~-JhoIdinn tank on lot ' Absorption field on lot Public sewer main ' Sewer/septic service line ~ HAA Fee $ ~ O~ · ~,, "Pump Off? level at* Lift station :i, SEPARATION DISTANCeS'FRee'SEPTIC/HOLDING TAN~ .,ON ~OT,,'I'O: Foundation {ot.I- :~ ProPertyline:' I I! Water main/service line io ~- ~ Surface water/drainage SEPARATION DISTANCE FROM ABSORPTION FIELDI ON LOTTO: , I0 ~' i Euildingfoundation i,., I i,.~. ; .::: .watelr;main/~e:r~iCel lihe Property line ' , ' :,,~ ~,' :', .- ' ' ', , i ~ t .............. : .' '. ,~,.,,-, ~-!: ~Ulq~l.C~ Wi~L~[ ' ' · I~,''-~ ~ ' ~.rf~in Hr.in ~/0~E J/-~u,~v: ENGINEER'S CERTIFICATION I cerfify that I have det"b~nino_dtgJu,ield inspections, and re,view of M~n,c,pal roco~.~.,ttf~"~_~ - ,; ~ ,., ' ' ~ I° ; '' ', , ., ; ,I 'e,, :,, in conforma~¥h ~JA H~A~Tb[d~hnes ~n effect on th~s date. Signature . .^'. ....... L ~' :i ,"' r.) F:::FpfLm----~, ~nglneers~ame ,,, ,,j ..... I .... ,, ' 'j "~~.,'~-~...'~,a'~: Date of Payment R, eceipt Numbe,r . Date of Payment '¢~. Receipt Number. /' : , 72-026 (Rev. 96 * '~, · laska Water & Wastewater December 11, 1997 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 7320 East Chester Heights Circle - Anchorage ~ Alaska 99504 Phone (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers Subject: HAA for Private Well & Septic System. Lot 3, Shenandoah S/D. To whom it may concern: The subject lot has a 4 bedroom house on it which is served by a private well and septic system. The results of the field investigation and adequacy tests are summarized as follows: A. WELL: The static water level on 11/19/97 was 41feet below the top of the casing (BTC). Water was pumped from the well at a rate of 5.24 gpm for a total of 315 minutes (1651 gallons). Within the first 7 minutes the level in the easing dropped 5 feet, to 46 feet BTC, and fluctuated between 40 feet and 48 feet throughout the rest of the test. Based upon this data it was determined that the capacity of the well exceeds the Municipal requirements for a 4 bedroom house (.42 gallons per minute). B. SEPTIC SYSTEM ADEQUACY TEST: The trench installed in 1978 was completely surcharged, and the trench installed in 1988 only had 32 inches of liquid in it; therefore, an adequacy test was only performed on the 1988 trench. The piping was damaged between the septic tank and the 1988 trench so that flow was restricted. A+ Home Services (Mike Blakeslee, 345-1890) replaced the piping between the septic tank and both trenches. A tee was installed after the septic tank so that flow favored towards the 1988 trench. Flow won't go to the 1978 trench until the 1988 trench has completely failed and spills over. Double clean-outs were installed between the tee and both trenches (two sets of double dean-outs). The 1988 trench 2.5 foot wide, 71 feet long, and has an effective depth of 8 feet. Prior to starting the adequacy test, the M.T. had 32 inches of liquid in it. The first 866 gallons of water introduced rose the liquid level to 59 inches. The next 785 gallons resulted in an addition rise of 17 inches, to a total depth of 76 inches (6.33 feet). Twenty-three hours later the level had dropped 19 inches, indicating that greater.than 785 gallons had been absorbed. Based upon this data, it was determined that the absorption rate of the trench exceeds 600 gallons per day, as required for a 4 bedroom house. NOTE: The adequacy of a septic system is in. fluenced by numerous factors, inchtding, but not limited to, seasonal surface water in. filtration, groundwater variations, septic system maintenance (frequency of septic tank pump#tg, usage of biological additives), condition of dra#t pipe attd pipe jo#tts (which can be damaged by seismic activity and deteriorate with age}, type of sttbstances deposited #t septic system (cigarette butts, sanitary napldns, misc. objects}, and the amount of water being introduced on a con#nual basis. Consequently, the results of this adequacy test are only valid for the specific day of the test. Furthermore, because of the limited nature of this #tvestigation, it is possible that there are hidden defects which may not have been detected. No warrantee is made regarding the fitture performance of this well or septic system C. SEPTIC TANK: The existing septic tank was installed on 8/14/78 (almost 19.5 years old). According to the M.O.A records, it is 1250 gallons, has two compartments and is made of steel. Most tanks of this type have a structural life of approximately 20-25 years. No warrantee is made regarding the future life of the tank. D. SEPTIC TANK IS TOO CLOSE TO WELL ON LOT 2, SHENANDOAH S/D: The septic system on the subject propertY (Lot 3) was installed on or before 8/14/78. The well on Lot 2, Shenandoah was drilled on 8/18/78. In short, the septic system on Lot 3 existed prior to the well on Lot 2. Based upon our field measurements (site plan attached), the well on Lot 2 is only about 88 feet from the septic tank on Lot 3. According to the past HAA's issued for these lots, the subject separation distance is greater than 100 feet. There is no well log on microfiche at DHHS for Lot 2. The well log for Lot 3 is attached. According to the log the geological profile is as follows: 0-27 feet the soil is primarily silty clay; 27-69 feet is gravel containing 20% clay; 69-98 feet is silty wet sand and clay; 98-100 feet is water bearing gravel. Per the 1988 septic system design, the soil rating was 368 ft2/bedroom, which is a very tight soil. Undoubtedly, this tight soil strata has served to protect the groundwater aquifer. This encroachment has existed for almost 19.5 years with no effect on the well water quality for Lot 2. According to the 1/10/94 HAg_ for Lot 2, the nitrate level was .98 rog/1 and no bacteria was present. The topography is such that any overflowing sewage from the septic on Lot 3 cannot flow to the well on Lot 2. In short, there is minimal potential for contamination associated with the subject encroachment. It is my recommendation that the subject separation distance be waived from 100 feet, to 85 feet. Since the septic system existed on Lot 3, prior to the well on Lot 2, it is reasonable to assume that the owners ofLot 3 are responsible for payment of the waiver fee, the next time an HAA is issued for their property. Consequently, we did not submit the $625.00 waiver fee with this package. E. SEPARATION DISTANCE FROM 1988 TRENCH TO THE LOT LINE: According to the 1988 inspection report (Corwin & Associates) the separation distance from the trench to the lot line is 10 feet. The most recent as-built survey (Fred Walatka & Associates) shows the clean-outs for the 1988 trench being about 9-10 feet from the lot line. If the trench width is 2.5 feet, then it is possible that the trench could be as close as 7 feet from the lot line. It is possible that the survey, which appears to be of limited accuracy (1" = 50'), does not show the precise location of the trench clean-outs. The only way to be absolutely certain of the subject separation distance would be have the lot line flagged, the trench exposed, and physically measure the distance. Please provide direction from your department. F. CLOSING: Ifyou have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. Sincerely, 12/11/97 T}tU 13:34 FAX / YIS'¥A REAL ESTATE INC 2h-6 ¢=' 't--- ~/(~ 4- C/~°°i W E_ LI_ i · ,'~ ,,.: ,~ c~., E~SEM~NTS OF RECORD, ~HER THAN THOSE SHOWN ON THE RECORDED =~T A~B N~ SHOWN H~EON, ~%'& 3~- ~ AS-BUILT NO CORNER8 SET THIS DATE I hereby certify thai 1 have Performed a Modgagee's Inspaction of tho following described property: LO 7"' ,~ , Anchorage Recording Precinct. Alaska, and lhat the Improvements situated thereon are within the property !ines ancl do not overlap or encroach on tile property lying adjacent ~ereto, Ihat nn Improvements on properly lying adjacent lhotelo encroach on tho promises in question and that there ~re no · roadways, trsnsmisslon lines or other vi,~ible easements on said prooer~y except as Indlcaled hereon. Oared at Anchorage, Alas~ FRED WA~T~ & ASSOCIATES DEC:-09-!99~ 08:53 CT&E ESI ANCHORAGE ~tl~ CT&~, Environmental 8ervioea Ino. CT&E Ref.# Client Name P~,ojeet Name/# Client Sample ID Matrix Ordered By PWSID 977344001 Al(, Water & Lo[ 3, Shen~clo~ Hilts S/D Lot 3, Shen~:~lo~ l-Iill~ $/D Drinking Water Client PO~ Printed Date/Time 12/09/97 0B:43 Collected Date/Time 12/09/97 12:15 Received Date/Time 12/0~/g? 13 T~hni~l Director: Stephen C, Edt 0 Released By Sample Remarks: ~itrate-N 0,100 mg/L Date Oo:e (nit EPA 300,0 10 O.O0 ¢oUlOomk $M18 9~2B ~210~197 M4V 12105157 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # GENERAL INFORMATION Complete legal description /~",-~ ¢---~/~~Z~)~/~/z// //-///'/-~ Location (site address or directions) /~O/~ ~~~ ~' Property owner ~¢~A~¢~ ¢~ ¢~/~ Day phone ~- Mailing address ~ ~ ~¢¢/~/ ~/~/, ~ Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: individual well Community well NOTE: Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1t91) Front MOA,~21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date sl~own 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/~/c/'/ ~_~/'V/..3"~/...7~/V' -~ ~t/'~-~/,A/~'~'/~.~ Phone Address ~0, ~/~/~ ~~~/ ~/~ ~//- /~ ' t re//~ ~ ~~ Date ~ Engineers signa u /~v~/ DHHS SIGNATURE Approved for ~ ~z~4.~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ,~~ ~ 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 #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:~¢~ A, Well Data Parcel I.D. Well type /¢~:'/k','¢ 7-ZC- Log present (Y/N) y Total depth /~2~ ~' 7' Sanitary seal (Y/N) Y If A, B, or C, attach ADEC letter. ADEC water system number ~ Date completed ~'/~'~' (~ Driller,,~,,4/P/P/¢/,~'7' (~ Casedto 100~'7" ~ Casing height (~ Wires properly protected (Y/N) FROM WELL LOGo Date of test . Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /'¢O ~z ('~7-,4/:::~¢ .) (~); On adjacent lots Absorp, onf e don ot/50' ¢;O. adiacent ots Public sewer main /'~//~r (2~) Public sewer manhole/cleanout Sewer service line /~/,,~ (~ Petroleum tank WATER SAMPLE RESULTS: Coliform ~ (/~,¢~ ~7~4o¢~/>~) Nitrate Date of sample: r_~--~,/::27;', /,4~? / ~¢],2:~ /-/-'/-/-/]~J///~- Other bacteria Collected by: ~:)/_./~7"//',/ /-//~/7/ B, SEPTIC/HOLDING TANK DATA Date installed ~:~ / Cleanouts (Y/N) Y High water alarm (Y/N) (~ Tank size // 2.~(:~ (~)Compartments ~ Foundation cleanout (Y/N) : (~ Depression (Y/N) Alarm tested (Y/N) /V',~ Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) onlot /~ ~T?//c~C,C,,)O(~nnadjacentlots ./~/'~/~'P/)(~oundation To prope~y line ~'AS~d/ur Absorption field Sudace water/drainage CONTINUED ON BACK PAGE Date installed Size in gallons. Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION. TO:' ·. On adjacent lots Well on lot. Manufacturer Manhole/Access (Y/N) "Pump off? Level at ..Cycles t~ ,...~--~'. · , ~"~ D. ABSORPTION FIELD DATA Date installed ~,,/'},¢:~.~,'¢~F~4 ~,~'/4Y'~.z~il rating (GPO/R=) ~ ~ ~ _System ~ ~ ' ~ / ~ ~//~.,:~. ~, ~/ ~ Gravel thickness ~Total depth _/~ ~ Le~h~ ~// ~w,u~._ ~ · "Id YiN ~78~ ~g~.. X.~~ .... , ...... ,,vi ~ ~ ~Depress~n over he ( ) Total ab~tion area~gSF///~ uleauuu~ u,~o~,,- ~,, N, __ Dateotadequa~test_~//~/~~ ~ ReSu,s(pas~lail) p~ ~ for ~ _Bedr~ms Waterlevelinab~tiontieldbeforetest - ~'~//~/~ ~/i. ~ Ntertest_..~,~//~ O// Peroxide treatment (past 12 months) (WN)_ ~ ~w~) If yes, g~e date SEPARATION DISTANCE FROM ABSORPTION FIELD ~O: To bui~ing foundation ~I ' ~ .To existing or abandon~ system on !ot ~ On ad[ace~ lots /~//~gD~bank ~'~~ ~ Water mal~seMce line ~ - Sudace water ~~ ~ D6veway, ~Ain~ehicle storage area ~ ~/~ . . . Cu~ain drain ~ "' " ~ 1~/~ E. ENGINEER'S CER~FICATION /~7~ ~C~ ~ /~ of ~s inspecb~n. I ce~'~ ~atl have checked, verified, or ~nfo~ed to ~! MOA ~d H~ guidelines in ~~~¢ ot ~ · ..:...:.:.~ ....~:-. .~}~ . . .... .. Signature Date ~~ '" ~ '~'~" ~' ' ,; H~ Fee $" ~ ~ ~ . . Waiver Fee $" ' Oate of Payme~ ~- ~- ~ Date °t Payme~ Recei~ Numar ¢ ~--{ ~ ~ J ¢~ ~ Receipt Num~r, 72-026 (~)' .,Fl .....=.; h, l, ...... , ¢oDLOF4AIUi. UTAII. II LINOIS, Oili£.i, i'¢AR'¢ ~ q ) , , ,,,.. . , - r.-: . MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner J~f¢-./, ~,~,4+f Mailing Address /~O/-¢ (c) Lending institution ~ Mailing Address Telephone: (home)--'~4t's"%0~74 Business Telephone (d) Real Estate Company and Agent //~r,/,,~__ Address ~,~t Telephone (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 ~ Number of bedrooms 3. WATER SUPPLY Individual Wellx Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site J;¥ 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(Re¥.7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, Iverifythat my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional end 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. NameofFirm L-~,~d;,/~/ F/~5'%OC- Telephone ?~'~Z - /7// Date 6. DHHS APPROVAL Approved for - /bedrooms Approved x,~ Disapproved Conditional Date /,~ - 2 - ~'% Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHSdonotconductinspections or analyze data before a certificate is issued. TheMunicipalityofAnchorageis not responsibleforerrorsoromissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 WELL DATA Well Classification ~'~/~/ C/c~ Well Log Present (Y/N) Y' Date Completed Total Depth /_~O ' Cased to /C-dF' Depth of Grouting Static Water Level Casing Height Above Ground ~...~ ' Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot //~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line f{,[ ///~ To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results MUNICIPALITY OF ANCHORAGE (MOA) ~ Health Authorily Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: ~o¢ .¥ If A, B, C, D.E.C. Approved (Y/N) Yield Pump Set At _(~,"t Sanitary Seal on Casing (Y/N)' '~"' Depression Around Wellhead (Y/N) ; On Adjoining Lots /~?C~ t ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole , ; Date // Comments SEPTIC/HOLDING TANK DATA Date Installed (~/,"/7~ Size ¢ ~' Standpipes (Y/N) ~ _Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) /~ Holding Tank High-Water Alarm (Y/N) /t~/- No. of Compartments Foundation C~leanout-(¥/N) D at e Last p u m p d~i/~.~/r~,~_~' ;for' Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well / /-~, ' To Property Line ~' ' -f- To Water Main/Service Line ~'~ ' '+ To Stream, Pond, Lake or Major Drainage Course To Building Foundation To Disposal Field / Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA .' /..------ .... . Soils Rating in Absorpti~'n Strata ~.~,~.~.~C~ -/~,,~j //'e,/c/.xTyPe'of system Design Date Installed / ~','~ ~/ /?7,6 (_~,r~ r-o~_.;~ Length of Field .:-~ "f're'~,le-c Width of Field . ' ~ , ~ t Depth of Field /o~ ~ ~ Gravel Bed Thickness ~ ~ '~'~ ': ,*J"-"-J --/-r,.,o/-.. Square Feet of Absortion Area-¢/(-,?¢~- ¢' /.,/.~6 ~/- Statndpipes Present (Y/N) Depression over Field (Y/N) ~l .Date of Last Adequacy Test .~/v['-fi',,, 'ResultsofLa~tAdequacy Test -~'¢~ ~Jlp~ r~¢.~ /c/~Y A_.~O~,,~¢,~ .. SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well //~ ' 'To Property Line /0' To Building Foundation1 ~"(2 .~ · · To Existing or Abandoned System on Lot ](~ ~ ~'''' : : ; On Adjoining Lots '~ ~C;fl To Water Main/Service Line ~::~"~ '-f- To Cutback (if present) / To Stream, Pond, Lake, or Major Drainage Course .,-, To Driveway, Parking Area,~or Vehicle Storage Area Comments- ~..~_..,t -'l~r~,~'c'.]~ "]~ ~.~ ]/~c/ /(~]od,. 1 _,8 D. LIFT STATION , ,S 'pZuen~; ~',', °LneSv e, a t High Water Alarm Level at'x,` Tested for.. Meets MOA Electrical Codes (Y~.) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **' ° . ~'-" l, · * .; ' . ' ** Check Perrrti~ed Bedroor~/Rabng Against HAA Request tha*/~/~e/cl']' '/'P ;ck~~fied'-- -'-"2-''7'; or conformed to all MOA and' HAA ~,,~"b~ ,~f, ffect on the date of this I certify Signed ///~//~L~ '/ f ~ - , ' ~, ~/.-"/~ "~J;~=~' -'.?l;*~, " ~/~ ' ' · . ' -~"~'~j~'~ ..... ~ Engineer's Seal Date I ~ ~ ~.J~~~.~.- ...... .,,. MOA NO. ~ ~[ ~ ' ~ ~ ~ ~'~. .... ~.',~ ~ " Receipt No. ~0 ?~/ ~/ Receipt No. Date of Payment ./~ --~ -- ~ Waiver Fee: $ Am0unt:$ .. / ~ ~ ~ ~ ~ Date of Payment 72~26 (Rev. 7/") Back P~ge 2 of 2 · "Ci/:IEIOICAL.& GEOLOGICAL 'IiABO RIES OF'AI. ASKA, INC. / ~,~",'?:.'?~?~ *' ' 5633 B STREET ANCHORAGE, ALASKu~ 99518 TELEPHONE.(907) 562-2343 ~,~~.,,~ · FEDERAL TAX ID # 92-0040440 ANAL[SIS REPORT BI S~J(PLE fo= Wo=k O~er S 10629 Date l~epo:t ?zinted: NOV 30 88 ~ 15:i9 Client Sample ID:SheNANDOAH HILLS L3 PWSlD :UA' Collectbd NO? 25 B8 t' 11:00 · .Received NOV 28 88 ~ 12:00 Pzeserved with Client Name : CO[WIN & ASSOC Client Acct : COE~kT E.O.I NONE · Che~ab kef t: 3560 Lab Smpl ID: I Eatzt~i WA2IE Allowable ..':...;'.-. ~a~an~te~ Te~te~ ~e~ult/]~ts Method LlnnLts .~._~. ........................ ~ .......................................................................... ~.. NI~E-N 0.30 ~g/l ~[ 353.2 lO Sample I[O~IHE SA!~L£ l~e~rks: SDiPLE COLLECTED !~! I~[UCE COI~WlN, ! ~ests'Pezfozmed ' See Special Instructions Above UALUna?allable. 'ND- None Detected "See Sample Eemazks Above HA- Not Analy~ed ' LT-Less Than, GI-$:eate: ?hah ... MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION L)IVISION OF ENVIRONMENTAL HEALTH CERTIFICA~fE OF INSPECTION FOIR HEALTN AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date .......................... GENERAl- INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name _~0b~ ~77 Telephone: Home _~-- ~¢2~ Business Applicant Address .~7~l r~_~lAd p~Ald~[O~/~.~__ ¢~ (c) Applicant is (check one): Lending Institution ~; Owner/builder ~ Buyer ~; Other ~ (explain); (e) Real Estate Company and Agent Address ¢) Mail the HAA to the following address: " ' ' "' TYPE OF RESIDENCE Single-Family [~ Multi-.Family [~ Other Number of Bedrooms ....... -~ WATER SUPPLY Individual Well [~' Community 1~ Public Note. If community well system, must have written confirmation from the State Department ~i En¥i'rdnmental attesting to the legality and status. 4. SEWAGE DISPOSAL ' ' Onsite [~ Public ~ Community BI Holding Tank L~ Note: If community well system, must have written confirmation from the State Deoartment of Environmenl¢l Oor;s,~,%-,.:¢ioa attesting to tho legality and status. Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORIVlA'rlON As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Heatth Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the informatio~ obtained from the Municipality of Anchorage files and from my investigation and inspection, the o~-site wa~er supply and/or wastewater disposal system is in compliance with aH Municipal and Sta~e codes, ordinances, and regulations i~ effect on the date of this~/~ ~ ,n~ect,on., ~ ?~'~ "'Y~ ~.--~"~~ ~ _ ~elephone __~-~ - ¢~J4~J Name of Firm ~~t~ Address ._¢?~ ~[~. ~J~/ ?~~F~ ~/~ ¢~ ~ Approved .... ~_~e~ ~%;~%~ ;; ~' Terms of Conditional Approval ~ 't~ '~' CAUTION i., ~nchorage Department of Health and Environmental Protection (DHEP) issues Health Authority The Munc~paMy' 0i ' I i Approval certificates~ based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DFIEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not rosponsible for errors or omissions in the professional engineer's work. Page 2 of 2 99502 R~C~IVED ~ot/.t ~/sss Ln~ a mo~nd~ ~~ and o~a~ ~bd~u;~ton~ bo ;~nc~dod ;~n ~ ~Cu, d.t) ar~.a o~- ~-I:~ P~z6]~- ~-or~o. Sltonandoal~ / MUNICIPALITY OF ANCHORAGE DEP¥, OF HEALTH & ENVIRONMENTAL PROTECTION RE6EIVED MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~::2/" 3, WELL DATA Well Classification P~/~ Well Log Present (Y/N) Y / Total Depth /O~ .?~..t.. Cased to Static Water Level · ,.~,¢..~,~, i Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: If A, B, C, D.E;C. Approved (Y/N) Date Completed ~'/7,~_~ '~' Yield t/~_ ~"~' Depth of Grouting ~ '~'" Pump Set At q~~'/~'~,~5¢/9'/~'g~ ':~ Sanitary Seal on Casing (Y/N) Y Depression Around Wellhead (Y/N) ~ ; On Adjoining Lots J~"7/ ; On Adjoining Lots ql.- To Nearest Public Sewer To Nearest Sewer Service Line on Lot ;Date '~/~,~/~¢~ .r~ , I To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest PubJic Sewer Line _ Cleanout/Manhole Water Sample Collected by Lt~i~. Water Sample Test ,Results _ ~--¢z'~'.~'~¢'~.. B. SEPTIC/HOLDING TANK DATA Date Installed ~'"/4'-'7~ ':~ize Standpipes (Y/N) y_ ____ Air-tight Caps (Y/N) Depression over Tank (Y/N) · /k~ Pumping/Maintenance Contract on File (Y/N) /k//./~ Holding Tank High-Water Alarm (Y/N) /k~ JJgli Separation Distances from Septic/Holding Tank: To Water-Supply Well __~ t' To Property Line .4~,~2 t To Water Main/Service Line _ 'J¢'I~O *' Course ~/~ /~..~ '~;: No. of Compartments Z ~ Foundation Cleanout (Y/~) Date Last Pumped ~ ~/~ ~ '~'¢ ; for Jk/// Temporary Holding Tank Permit (Y/N) To Building Foundation fi' ~ ! To Disposal Field __~ ~ '~)(" To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11t84) Soils Rating in Absorption Strat! /~_~/3 '/~/~y.) .~' Type of system Design "J"'~~'/ "~ Date. Installed ~.-Jz~o 7~ '~ Length of Field ~..~, i ..~ ,.....~' Square Feet of Absorption Area Depression over Field (Y/N) Results c~f Last Adequacy Test Separation Distance from Abso~'ption Field: To Water-Supply Well To Building Foundation ~ ! Lot /V'/~ To Water Main/Service Line '/"~) ! Depth of Field Gravel Bed Thickness Standpipes Pres. ent (Y/N) Date of Last Adequacy Test . :i To Stream/Pond/Lake/or Major"Drainage Course To Driveway Parking Area, or Vehicle Storage.Area ° Comments ~ [~/~~()r)~ ~ /~_..~/.~ F To Property Line ~ / !i To Existing or Abandoned System on ; On Adjoining Lots u (~'~- ! To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes.(Y/N) comments Dimensions Manhole/Access (y/N). "Pump Off" Level at Vent (Y/N) ' Pumping Cyc!es during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** . I certify tha~l have check, ed,_.veri, lied, or confo, r%ned~to all MOA ~nd HAA guidelines, in effect on the date Date of Payment ~-~'~ : Page 2 of 2 72-026 (11/84) of this inspection. FIELD PU:tPING TEST DATA SHEET · LocATIQ;I OF bIELC (legal Description}: ilELL DEPTH:..IOz~ 'FT.' CASING: · DATE...DRILLING CONPLETED:_~-7-7~ ''STATiC,WATER LEVEL (Top of Casing): ~.~-' DATE OF TEST: lis lO(P FT SCREE:I: F? "- ElaPsen Time Since ~ClJck Pumptng"Started/ Depth to Drawdown/ Pumping Remarks - Tine'I Stop. peal, Hin. ,l~ater, ft. Recovery Rate, C,P:4 " '"'1{9:00' ':" 0 ~,~.5" (swl) 0 0 J Sta?. 16):o, ! J jo~lo lO ~ , I : to: zo ~O q'~.~" ~,~ I · ".'_,o: ~o 30 ,~_. io~;6o · 50 4~.S' S,7 - ! · Il:oD 60 (! hour} j 47 %,~ I ~.:~o .120 (2 hours} _ I"Z,~ ~0 150 42. 1.45 :' ' ~ RECOVERY 5 I · - 10 I 15 I 20 50 ~ 60 I hour) ,OCorwin & associates,inc. Consulting Engineers 4790 Business Park Blvd. · Bldg. D · Suite One · Anchorage, Alaska 99503 · (907) 561-6151 LEGAL DESCRIPTION: NUMBER OF BEDROOMS: ADEQUACY TEST LOG 4 DATE TIME SEPTIC TANK READINGS REMARKS LEVEL PERFOPJUIED BY: ]~,,O/'-b(, .~, ~ ~late~ Absorbed (Gallons) ---'.-., ..... ........ .............. ................ t ..... ................ ........... t ....... ..' ...... ~- ..i ............................................................ : ........... I ......... ........ t .... ~:"":1:~ ........ ! ............ 'X ............ ! ........ -: ........ I ...... : ....... , .... ........ , .......... ~...~ · · .~...i ................ ~ ........ t .................. i .... I---~ ....... : ' .". ~ ....... I -..: .... :::;:'~.":1.:::! 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[-- ¢ _~.~-.--.----. ~ ::=.-_., ........ ½ ' t---I ........._-7-' L-- ,--- ] . ~.-- .k'::;:::: ::::;::.':. _-'..n ~.= ::": .-:.-. t:.-z e, ~ --==---~- :=q:"":J:::':::-" =: ............ ~ -': .... t'2=- ......................... , .... ,'-' ....... ~- ...... , ................................... I I- ~ ~__.~]~...~_ ~ ......... "':'~' '" .................. .-"---' ;:':':~l-" ~ ........... J ........... '. ...... ~_. __, .... i __[ .............. ! _ . L_ ..... :. ...... ~ .......... ~ .... ............. ; .......... ! ..................... . ,- ..... :.: ..... ~-~ ................. ........ ~ ............... ~ ...... ~::':::/ ..................... ~ ................. , ...... ,..-.~ ............... ............................ ~ ................. 4 ........................ ~----, .-'~ ................. ......... t~ ........... ~ ....... ~ .... I'"':-' '/~ ............................. t-- ......... t ....... -,'-:: --', ..... \,' .......... .-------' ':.-.--T-----.":::. 7_-"~'.-::: :.:':[:::I::::L-::;.. '.-.':':::: ::.':-':: :.-.---.----':'": :j.':-..":'.: .'::.-':': iT.':'.' ::::i::':: :~::! ::'; · ' ~.': :::. ':" ::: 'C) 0 APPLIC"-~NT FILLS ouT:UpPER HAl. ~ONLY Pr°pert~Owner ~"~C,.)q< ~ ~-O'Y",,Cj ' ~ ' Phone ,Mailing Addre~ ~ ~ ~ Zip Code Address /~OJ~ ~A~(/r)¢ ~l ~/ ~C'~ ~ ~ 'ZipCodeq9~O7 Lending Instltutio~()'J IU ~1o / ~O ~. O ~ ~J~ ~ .... Phone Address ~ ~ y ~ e~ Zip Code Realty ~. & A~nt ~ Phone Address Zip Code LegaIDescrlpt~n ~ ~0~:: :'~ Type of Resi~nce .~Single Family ~ Multiple Family No. of Bedroo~ ~ Other Water Supply ~ Individual A~ACH ~LL LOG. A w~l log Is required for all wells drilled since June 1975. ~ Community For wells ~illed prior to that date, give well depth (attach log If available). ~ Public Utility Sewer Disposal ~ Individ~l ~ Year Indiv~ual Installed: ~ Public ~ility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION ~E MUST'ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED. Time Time Time Time Date Date Date Date ~-~- Inspector Inspector Inspector Inspector Field Notes: ~ MUNICIPALITY OF ANCHORAGE ~ ~ DEPT. OF HE/',LTH ~ ~ ~ [~0 ENVIRONMENTAL PROTECTION ~y.,,.... c.o:-t APR 1 RECEIVED ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) CO_.D,T,ONALAPPROVAL' SOilS Rating Date Sewer Installed Well To Absorption Area ,,,~/ 0 a Well Log Received (~'"" "~ (~ Well to Tank '~ / ~ ~ Septic Tank Size 72-023 April 13, 1983 Roger Long Douzlas, Ak 99824 Subject: Lot 3, Shenandoah Itills Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: The top of the well casing should be sealed so that it is water tight. Exposed electrical wires to the well head are in violation of the Municipality of Anchorage codes and must be encased in conduit. ?The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. The septic tank pumped with a receipt submitted to this department. An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. Tile standpipe to the sewer system need caps on them. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, Enclosure RP16/eJ/E1 Robert C. Pratt Associate Environmental Specialist . . ::iNSPECTiON'APPOiNTMENTS / TIME . TIME TIME DATE ,: DATE DATE INSPECTOR : :. INSPECTOR . INSPECTOR } ' MUNICIPALITY OF ANCHORAGE ;. ~ MUNICIPALITY OF ANCHORAGE' DEPT. OF HEALTH & .~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~ONMENTAL PfiOTE~ION ~ ~ 825 L Street - Anchora~, Alaska 99501 ' ~ ~.ENvIRON~ENTAL SANITATION DIVISION 00T 2 3 lg81 Telephone 2644720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AN E I DIRECTIONS: Complete all parts on page ],.?ncomplete feques~ will not be proce~ed. Please allow ten (10) days Jot processing. 3. PROPERT~OWNER ~, ; J PHONE MAI L~G ADDRESS ~; PROPERTY RESIDENT (If different from above) ~ PHONE 2. BUYER ~ ~ i PHONE ~ .... 3. LENDI.gI.STITUT,O. - ~~ ~AILING ADD~ESS ~ ~ 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE E FAMILY [] MULTIPLE FAMILY 7. WATER SUP, I~LY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY NUMBER OF~BEDROOMS [] One [] Four [] Two [] Five [][;J';'~'Three [] Six [] Other ATTACH WELL LOG. A well log!is required for all wells drilled s~nce June 1975, For wells drilled prior to that date, give well depth (attach log if available,) 8. SEWAGE DISPOSAL SYSTEM ~ i' [~ INDIVI DUAL/ON-SITE'** [] PUBLIC UTILITY ! [ YEAR ON-SITE SYSTEM WAS INSTALLED, J NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH'REQUEST BEFORE PROCESSING CAN BE INITIATED. ,2-0,0 (.ev. 6.9, i' THIS SIDE FOR OFFiCiAL USE ONLY 1. TYPE OF RESIDENCE [~ SINGLE FAMILY I--I MULTIPLE FAMILY WATER SUPPLY [~ INDIVIDUAL [:::] , COMMUNITY [] PUBLIC UTILITY Connection Verified NUMBER OF BEDROOMS [] ONE [~]~/'TH R E E [] FIVE [] OTHER [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL , , . DATE DRILLED · LOG RECEIVED :: ! ' 3. SEWAGE DISPOSAL SYSTEM [:~'~ DlVl DUAL/ON -SITE []PUBLIC UTILITY Connection Verified [~]~'eptic Tank or [] Holding Tank Size:' ~::Z? If Tank is homemade give dimensions: PERMIT NUMBER ~)ATE INSTALLED NSTALLER SOILS RATING . TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA - -, ' · MATERIAL- Septic/Holding Tank IAbsorption Area ISewer .Line .,:.' I Nearest Lot Line 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS ' [[~A'~P R OV E D FOR '~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) []' DISAPPROVED 72-010 (Rev. 6/79) 825 '~' L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEO[:IGI' M. SULLIVAN, MAYOI{ DEPARTMENT OF HEALTH AND ENVIHONMENTAL PROTECTION October 29, 1981 Roger/Norma Lang Post Office Box 10-1509 Anchorage, Alaska 99511 Subject: Lot 3 Shenandoah Hills Subdivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. (2) The septic tank needs to be pumped with a receipt submitted to this office. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. ASsociate Specialist RCP/ljw cc: National Bank of Alaska Pouch 7-025 99510 ION , ~:~ 825 L Street -'Anchorage, Alaska 99501 , ';; OCT 9 1980 ~ ENVIRONMENTAL ENGINEERING DIVISION}r :.~Tolephone264 720 RECEIVED ~ ~EOUEST FO~ APPROVAL OF I~DIVIDUAL WATE~ AND 8EWE~ FAOlLITIE8 DI BECTIONS: Complete ~II parts on page 1; Incomplete requ~ts will not be proc~sed. Please ~llow ten (10) ~aVs for process[ng. PRO~RTY~ESIDENT (If different from abpv~ ' / PHONE z. aUVER ~; ~HONE MAILING ADDRESS ~: 4. REALTOR/AGENT ' ~i' / ' ~ ' ' ' PHONE .5..LEGA L p ESCR I PTII~N~/_ - I;~ ~, /' ~.. t¥1~E O~= RESIDENCE l~i [~SINGLE FAMILY " [] 'MULTIPLE FAMILY ~ii NUMBER OF BEDROOMS [] One [] Four llwo [] Five hree [] Six [] Other ~ INDIVIDUAL' [] COMMUNITY [] ' PUBLIC UTILITY ~'~TTACH WELL LOG. A W611 10g is reqbired fo'f all wells drilled since June 1975. For wells drilled Prior to that date, give well depth (attach'log if available,)" .: 8. SEWAGE D~OSAL SYSTEM :il ~ I NDIVI DUAL/ON-SITEi[i* [] PUBLIC UTILITY 'ii '*If individual/on-site, give installatidn date 1C~'3 ~. . If system is over two (2) years old an adequacy test is required by this Department. ' ~' NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PR'0CESSING CAN:BE INITIATED. 724310(3~78) -- ~ THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS TIME TIME DATE DATE ~ INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM 'ED I NDIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified 'l~]Septic Tank or [] Holding Tank Size: I ~ ~ If Tank is homemade give dimensions: TYPE OF TANK 4. DISTANCES WELLTO: Absorption Area to nearest Lot Line ;)ATE RECEIVED TIME 3ATE INSPECTOR NUMBER OF ~DROOMS ' [] ON'E "~ THREE !i,[~ FIVE [] OTHER [] _.. TWO~ [] FOUR [] SiX PERMIT NUMBER ' ': DEPTH OF WELL DATE DRILLED PERMIT NUMBER DATE INSTALLED %- INSTALLER SOILS RATING MANUFACTURER MATERIAL Septic/Holding Tank ~Absorption Area I ISewer Line I Nearest Lot Line 5. COMMENTS [~APPRoVED FO~ 3 BEDROOMS ; [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED (Title) DATE 72-010 (Rev. 3/78)