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ALDER PARK LT 1
Aid r Park Lot I 011-131 -36 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division ?// /// 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT DISTANCES ;EPTIC ABSORPTION FIELD WELL INo of Beams Township Rar,ge, Section TANKS FOUNDATION ~) I ; O I p~(~O / AS-BUILT DIAGRAM ,,Snow Iocat,on of well, septic system, property hr, es, tourldatlorl Elrl~LWa¥ Wa;~r bodies, e~c) ~ SEPTIC [] HOLDING Marluracturer t Capacity in gallons Matenai .,~ ljff~o o~Com partmerhs TYPE OF SYSTEM TRENCH ~BED [] W. DRAIN ~} OTHER Depth to pipe botlom horn Total depth from original grade F~II added aL)ow. {:,rig hal grad~ G~avel depth benead~ p,pe Numbe~,; hms [~o,T~;,ng ---' Pipe ma:enal FT FT FT FT ~ PRIVATE ,~OTHER {Identify) ~l~[i~7i~iClass'f'cdt~°¢" (A.B (~ ~'"'~"~¢~¢'~----~"~tf ~-~ [ lota~ Depih FT Cased to FT REMARKS: Scale: Ir[spectlons Performed by/ ~ T'I..'~.~'. ¢_L ,~. ~¢x-~-l,..AU, N,,,,'N ced~y,tha, ,his inspecIion was ped0rmed acc0rding t0 all Municipal and State gu'de ' ~: : . / ~ , / ENGINEERS SEAL 72-013 (3/85) PERFORMEO FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O Municipality ol Anchor~age DEPARTMENT OF HEALTH & HUMAN 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DAT[ "~' ~ ? Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED; ,INEERSSEAL) ~ J. Coffin SITE PLAN ] I \ ,,, \ s IF YES, AT WHAT DEPTH7 p E i'leplh to Water 6iler . Gross Net Depth to Net Reading Date Time Time Water Orop PERCOLATION RA'fE __ (m~nutes/~nch PERC HOLE DIAMETER COMMENTS TEST RUN BETWEEN FT AND __ FT PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: / - 72-008 (Rev. 4/8,5) ' .' 0 ~: 'Ii ' , , ~A' '- ~/Z~3 C?,-'' / ~/,:.' k' '-: NOTE: Property corners could , ~ ~ ,,, .. not be located, reference~ ~ ~ ~,~, .f *~: ...... ./-~ ~ to property lines are assumed and ~ ~'-" ~' 7 -- i time of excavation by Contractor. SEWER SYSIEM LOCAl ION PLAN LOT ~ BLOCK ~U~DIVISlON ~ /.. ':, ..... % V ~ ~ - ~ -fj'~ T~ ACCUffA~ OF LOCATION OF EXI~TIN~ '~.' ~ ~ ~ PROPERTY CORNERS, WELL~, AND SEPTIC ,./'~ - DRAWN BY, SYSTEMS INDICATED IS NOT EXACT. :/' ............... . ~ NORTH ~ __'~ OINENSlONS INDICATED HAVE - ~ ..................... ¥ "'"~ .............. :' "':'"'""'" ".": ':: "::. ::'" ::" ~"'"':'~ '~":~':[:':':;:~ ? NOT 8 Y S U R V E Y I N e T E C H N I O U E :. :i....: ..... · .,;.. :::.::: .............. :~ ~'"--'"' "':':"':' · .... "::': - 2_0 FT. X 'd. 5FT. = 900 SQ. FT. --OT ~/_ 5.0 5.0 FROM 2i2.0' . i I ~ 1' t f I I t I I i I :l t I I I I ] I I I I I ! ! - ABSORPTION SYSTEM PLAN VIEW NATIVE BACKFILL O~IGtNAL 2 % 2 % III II 'x ,, / / / 4" PERFORATED PIPES 2~~ SECTION ' - ~ ~ RECEIVED NOTE: Property corners cou~o not be located, r'eference~ to property lines are assumed and must be located and verified at time of excavation by Contractor. NORTH LOT j BLOCK SUBDIVISION / J _ /$L D~P~ p/~ SECTION / TOWNSHIP/RANGE -I'-17_-- .,~/ ,I'Z- ~--d.J, : ~-C-- 77 10 SCALE, / NO"TE, ///2 ~0I "~/-- Ti'~: ACCU.ACY OF LOC^TIO. OF P.OPE.TY CO. NE.S. WELLS, AND DRAWN BY' I~YSTEM$ INDICATED IS NOT EXACT. ~ ..J ~' DIMENSIONS INDICATED HAVE BEEN DETF_.IRMINED BY USE OF CLOTH TAPE AMO NOT BY SURVEYING TECHNIQUES. FOR, PERFORMED FOR: LEGAL DESCRIPTION: ,DEPTH -(FEET) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 17 18 19 20 Municipality o! Anchor'age DEPARTMENT OF HEALTH & HUMA~, 825 "L" StreeL Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township. Range. Seclion: ~.¢-/0// ~ pC/~C~?_./~ SLOPE SITE PLAN Gross Net Dep',h to Reading Oate Time Time Water Drop I , PERCOLATION RATE (mmutes/~nchJ PERC HOLE DIAMETER TEST RUN 13ETWEEN FT ;~ND __ Fl ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIOELINES IN EFFECT ON THIS DATE. DATE: ?2-008 (Rev. 4/85) ,&AAB HD I G~.ATER ANCHORAGE AREA BORO'''''-H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ADDRESS LOCATION LEGAL OESCRIPT,ON PHONE SEPTIC TANK: DISTANCE FROM WELL C ~'g]/ LIQUID CAPACITY /~f')C~ ~ GALLONS. MAT E RI A L ~. ·/'7 (~:/~ INSIDE LENGTH NUMBER OF /' COMPARTMENTS INSIDE WIDTH 9' DEPTHLIQUID /(~' I SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER DISTANQE FRO~ WELL _ ~/ =~. , BUILDING FOUNDATION TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE ........................ .... TOTAL LENGTH FOUNDATIO'I~' " NEARE"~LOT LINE OF LINES DISTANCE BETWEEN LINES TREN~,~WIDTH ~......~.,..-ff~. ~UI'AL ~-~-r-ECTIVE SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: LOT LINE ~./~ (d DEPTH y..-." DISTANCE FROM ~-~---' WATER , BUILDING FOUNDATION.. SAMPLE NEAREST NEAREST ,c..-.-- SEPTIC c._- SEEPAGE ~ CESSPOOL ~ OTHER SEWER LINE .,TANK SYSTEM , , SOURCES c.. , DISTANCES: I i ~ · ('.:: 6 - Cz 30, DIAGRAM OF SYSTEM DATE APPROVED AUTHORI Municipality of Anchorage t On -Site Water and Wastewater Program (907) 34377304 s A f r CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel 1.D. 11-131-36 Expiration Date: Sep` CIO 1. GENERAL INFORMATION Complete legal description Alder Park Lot 1 Location (site address) 8336 Sundi Drive Anchorage, Ak Current Property owner(s) Jesse Fosfer Day phone Mailing address 8336 Sundt Drive, Anchorage Ak Real Estate Agent _ Day phone ' 2. TYPE OF DWELLiNQ'- _- © Single Family (wlwo ADU) Duplex': ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS' AK q TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual X❑ Individual Well ❑ Bolding Tank ❑ Individual Wafer Storage; M Community FI Cot nmunity Class— Well ❑ Public Sewer ❑ Public Water System [ Waiver/Variance request for: Distance - Received by: "-X,Date' ed _ CCSAto be releasto the engineer, onfess other t • , sted by the enginaer. CASA, Fee ll(J Waiver Fee $ Date of Payment 2- ("1, Dale of Payment Receipt Number Recelpt Number COSA# '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 in 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 ARCTERRA CONSULTING., INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD�,.EAGL'E_RIVEIZ,,AK 995'77.____ Engineer's Printed Name KENNETH M. DUFFUS Date —49— A�I1� Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen. .ate , OF 411 encroachments, deficiencies or discrepancies exist. yr `� 10, �! 6. DSD SIGNATURE System #1 Approved for bedrooms. -P KENNETH' i. `1, l: p4 System #2 Approved for bedrooms.s�`�:b+�" Disapproved. Conditional approval for bedrooms, with the following stipulations: Original Certificate D 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 X Septic System Advisory Well Flow Advisory COSA blue sheet_1G10.12.dec Nitrate Advisory Arsenic Advisory Other COSA Checklist Legal Description: Alder Park Lot I Parcel ID: 011-131-36 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA E] Well log is filed with Onsite (or attached) Date drilled Total depth Cased to ft F1 Sanitary seal is functioning correctly El Wires are properly protected Casing height (above ground) in. Date of flow test for CCA Static water level at beginning of test ft. I Age of tank(s) __�l years Tank type/material SIR Lic/Concrete Measured operating fluid level in septic tank 50 Standpipes/foundation cleanout per record drawl Date of pumpin 11/25/19 I 91WA *191 Z12 I [01Z NJ]# I � " 4jl7;-W,- Which system tested (date installed) 1012 8 IN ALL standpipes present per record drawing Total measured depth from grade 5.8 (max) Measured depth to pipe invert from grade 5.3 ft (min) M N/A - pressurized field 11 Monitor tubes gDA-it-r-lic-imn- Wwm-mi*-w- depth into effective Structure served by this system I Well production at time of test qpm Water storage tank volume gallons Well disinfected for coliform test? j Yes No El Coliform bacteria is Negative Nitrate mg/L E] Nitrate less than MRL (ND) Arsenic ug/L El Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION F] Required maintenance completed Age of lift station years Lift station material Adequacy test date 8/24/20 Results ZPass For 4 bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 0 in Elapsed time 10 min N Code -required soil cover over field Final fluid depth 0 in F1 System presoaked Absorption rate 600+ ar-)d (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) If yes, enter date Gallons introduced gallons Cam ments/Deficienicies:." E. SEPARATION DISTANCES Septic Tank/Lift Station on Lot > 100' Yes if No Community Sewer Manhole/Cleanout > 100' Water Main > 10' Yes if No it F7 Yes if No ft Neighboring Tank > 100' Yes if No It Private Sewer/Septic Line > 25' El Yes if No ft Absorption Field on Lot > 100' F] Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' n Yes if No ft Yes if No ft ManurelAnimal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No it Surface Water > 100' Yes if No ft Property Line > 5' Yes if No it Wells on Adjacent Lots, Absorption Field > 5' Yes if No ft Private Wells > 100' Yes if'No ft Water Main > 10' Yes if No ft Community Wells > 200'I Yes if No ft Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No 2* ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Water Service Line > 10' Yes if No ft Community Wells > 200' Surface Water > 100' Yes if No ft F. ENGINEER'S COMMENTS *Waiver on file I cerW 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. 12 Yes if No, ft 10 Yes if No it Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program ,4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. o1~- ~- Expiration Date: GENERAL, INFORMATION Complete legal description Location (site address) i Day phone 7_ V 8 - lq f,, 5 Day phone CUrrent Property:°wn;r(s) d Mailing..addre'ss PO ~ox Lending agency Mailing address Real Esta~e'Agent ~o.a Floc;o .Mailing Address' ::!~.:i ~"!= :' Unless othbna~ise're~uest,~; COSA will be held by DSD for pickup. TYPE OF WATER sUPpLy: Individual Well' Individual Water Storage Community Class ~ Public Water System Day phone Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding Tank [] Community On-site ~ Public Sewer I The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for propedies served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I 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 .~pug~l~.~J Address ~.o3 w, 15''~' ~ve. ~. ZoZ /,A,,)~l,,o,,'?~/ ,4)( Engineer's Printed Name DSD SIGNATURE L~ Approved for Disapproved. bedrooms. Phone 2 7-?- 371~, Date, Conditional approval for bedrooms, with the following stipulations: By: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other ~)~riginal Certificate Date: (Rev, 11/05) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343:7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA F~I~ Well type" Date completed ~ Total depth --. ft. If A, B, or C provide PWSID # ~ Sanitary seal (Y/N) -- Cased to "" ft. Parcel ID: Oil- 131-3G FROM WELL LOG Well Log (Y/N) m Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION Date of test ~ --' Static water level ft. Well production ~ g.p.m. g.p.m. WATER SAMPLE RESULTS: "Coliform '" colonies/100 mL Nitrate -' mg/L Collected by: "'- Arsehic: ~ ug/L date of sample: B, SEPTIC/HOLDING TANK DATA Tank Type/Material Co~cre,~L¢. Tanksize [ZSO gal. ,,/Number of Compartments Foundation deanout (Y/N) ~' Depression over tank (Y/N) /V Date of pumping G/~/7..0,/~ Pumper ~<~v.~, ABSORPTION FIELD DATA Date installed t~)[z'l[~ Soil rating (g.p.d./ft2or~ I Length 5.~ ft. Width t'~ 7~ 12 ff. Total depth ~,~ ft. Eft. absorption area ~ ?.1 ft2 Monitoring tube Date of adequacy test (,'/~111 Results (Pass/Fail)' ~, Fluid depth in absorption field before test ~ in. Water added (~)0 gal Elapsed Time: .. ~ min. Final fluid depth _.~ in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) /~0 Date installed ¥?/6? Cleanouts (Y/N) '~ High water alarm (Y/N) /v' System type ~,O Gravel below pipe O. 5 ft. Depression over field A/ For ¥ bedrooms New depth ,~ in. ~,00 g.p.d. Absorption rate >= If yes, give date D. LIFT STATION Date installed f,,,~ize in gallons ,,~anhole/Access (Y/N) / "Pump on' level at ,,,~ln. "Pump off" level at ' .~ High water alarm level at Jim Datum Cycles tested . Meets alarm & circui s?' E. SEPARATION DISTANCES ?ul, li . tlzO SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot --- On adjacent lots Absorption field on lot ~ Public sewer main ----, On adjacent.lots "-' .. Public sewer manhole/cleanout Sewer/septic service line Holding tank F, Animal containment areas Manure/animal excrete storage areas ------ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5' ~' Property line 5 ' + Absorption field I Water main 10 ~- Water service line lO' 4, Surface water Wells on adjacent lots Ioo' -/-. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation I0 ~ Surface water !0~)' -~ Wells on adjacent lots ioof4· Property line '2. W ater Service line IO Curtain drain COMMENTS G. ENGINEER'S CERTIFICATION '1 certify that I have determined through tfeld 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 Water main 10 ~ ~- Driveway, parking/vehicle storage COSA Fee $. Date of Payment Receipt Number (Rev. 4/10) ctOtO- Waiver Fee $ Date of Payment Receipt Number Z.~ M O0 06' 'W 141.~7 Z / / MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 011-131'36 HAA # ~ ~ 1. GENERAL INFORMATION Complete legal description Lot 1, Alder Park Subdivision Location (site address or directions) 8336 Sundi Dirve, Anchorage, Property owner Mailing address Lending agency Mailing address Agent Address ~.] ~ ~ah~h .~hn Day phone 8336 Sundi Drive, Anchorage, AK 99502 243-8259 Alaska USA/Kathy Steinborne 4000 Credit Union Dr., Suite 550, Day phone Anchorage, 786-2800 AK 99503 Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water xxx 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 ti21 5. STATEMENT OF INSPECTION BY ENGINEER As cer[ified 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. S & S ENGINEERING C~ q - ,~- q 7 ~ Name of Firm 170:4 ~.~.~ ~c...": ..... _. ---~' --- -*~.._...~'-... ~_~ Phone Address Eagle River, Alaska 99577 EngineeYs signature .... ~~ Date ~ I/~ / ** DHHS SIGNATURE ,/~ Approved for 3 Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 ,< CEIVI:u Municipality of Anchorage APR 1 5 1999/~ DEPARTMENT OF HEALTH & HUMAN SERVlCE~uN~¢iPAUT¥ oF ANCH( Environmental Services Division ENVIRONMENTAL,SERVICES 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: Lo 7- I Health Authority Approval Checklist /J L,i)~ ~ t0~,'~.~. ~-/z) Parcel I.D.: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well.~n C ~ ~q s ~ C2 If A, B, or C, attach ADEC letter. ADEC water system number Date completed /.-.~-~' Cased to .,/~asing height (above ground) ~ Wires properly protected (Y/N) g.p.m. WATER SAMPLE RESULTS: Coliform 6 Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ~ / ~ / ~ ~j Tank size Collected by: AT INSPECTION Other bacteria ENGINEERING River, AlasEa ~9577 g.p.m. Number of Compartments ) Cleanouta~'Jv/N) ~ ~ J Foundation cleanout (Y/~) /v c Depression (Y~I~ Date of Pumping ~, / ~ ~' Pumper ~.~ ~'~ C. ABSORPTION FIELD DATA Date installed ;C ? ;) ~ / '~,/ Length '-~ ! ~;- L, Width Effective absorption area c~ ,~ ! Soil rating (g.p.d./ft2 or~~ / ~' U System type Gravel thickness below pipe ,- , ~ Total depth Monitoring Tube present (~/N) ¥¢ ) Date of adequacy test H. ¢ ~, 'q '') Result~s~.s~/Fail) Fluid depth in absorption field before test (in.); Fluid depth ~) ?~'¥ (ins) Minutes later: __ Depression over field (Y~ /" ~; For -~ bedrooms Immediately afterz/ff~ gal. water added (in.): R' ''~'' Absorption rate = z_/.t'-~ -f g.p.d. Peroxide treatment (past 12 months) (Y/N) N ~ ~' '~ ~: ~ ~' ''/ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* "P~ High water alarm level at* *Dat?~ Cycles tested ~ SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: ! / Foundation '-~' + Property line ~- ~ Absorption field Water main/service line /0 -~ Sur[ace water/drainage /c c ¢- Wells on adjacent lots r~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ! o Water main/se~ice line Prope~y line Sudace water ) o 0 + Driveway, parking/vehicle storage area Cu~ain drain N ~ ~ ~.- ~ H ~ w ~J Wells on adjacent lots r,, ,~.-',,,'~}~ / ~-~, ~,z. 4.~ ENGINEER'S CERTIFICATION determined thru field inspections and review of Mun,c~pal records~.J~. ~:~t~_?bov~ ~.rns are I certify that I have in conformance with MOA, H,~A g~idelines in effect on this date. ~'~. .............. ~',~-~.~..~-~,..,,,~.,:,..,,.', ~ ~nglneer s Name .... · Date ~/I ~ / tic) ~ .~X ~ -~:c'~ ,.~... HAA Fee $. ,'~0--~ · ~'~ Date of Payment z///~, ~ Receipt Number ,/-TL "7--.~*//~ Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* ^PR-i;-Bg 0~:4~ FROU-CTE ENVIRONMENTAL $$15301 T-lO3 P.02/03 F-$BO ,~l~tK CI'&E Environmental Services Inc. CT&£ Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID Sample Remarks: 991553001 S & s Engineering Lot 1 Alder Park Lo: 1 Alder Park Drinking Water Client PO~ Printed DatelTl~e 04/19t99 07:31 Collected Date/Time 04/14/99 09:40 Receiv~l Date/Time 04/14/99 09:50 Technical Director: Slephen C. Ede Parar~eter Prep Rllaty$i3 To:at CoLiform 0 coL/100mL SM18 92ZZB 0~11~/99 ICAp aitrate-n 0.500 U 0.500 m01L EPA 300.0 lO max 0~11~199 04y14/99 Parcel I.D. # 1. 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 -131 GENERAL INFORMATION Complete legal description Lot 1; Alder Park Subdivision Location (site address or directions) 8336 Sundi Drive Anchorage, AK Property owner Mailing address Lending agency Mailing address Agent Address Harry Marsh 825 N.E. Multnomah ~1570 Sharon Glenn/Century 21/Crawford Day phone (503) 464-5234 Portland, OR 97232-2144 Day phone Day phone 562-5592 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 ~, TYPE OF WATER SUPPLY: Individual well Community well ×xx 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: xxx 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 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. $ & S ENGINEERING Name of Firm 17034 Eagle River Loop Road No. 204 Phone o~ c( fl/_ ;~ ~ 7 ~7 Eagle River, Alaska 99577 Address Engineer's signature ~-~//~./C"'~.. ~'~ -- Date /°//~°/'~'(" DHHS SIGNATURE ~ Approved for~'-~f/'-~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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. 72-4325(Rev. 1/91) Back MOA~Z1 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 34~-4744 Health Authority Approval Checklist Parcel I.D.' A. WELL DATA Well type c. ,.,~ ~ ~ (L If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water Well,p~"~tion Date completed Cased t%..~ F.ROM WELL LOG Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION g.p.m, g.p.m. WATER SAMPLE RESULTS: Coliform c Nitrate Date of sample: t O ? ,~- ~- / ~) B.~HOLDING TANK DATA Date installed ~t / ~/ Col Tank size Foundation cleanout (Y~'~) /..' c Date of Pumping C~ / ~ / ~i (o Pumper (.~. i Other bacteria $ & $ ENGINEERING Collected by: ~_7074 E=_9~e ~!~er Loop R~:--..~!--.. 204 Eagle River, Alaska ] C~ c ~,~ Number of Compartments i Cleanouts ((~)N) Depression (Y/~ '~' '" High water alarm (Y~_..~ ABSORPTION FIELD DATA Date installed ic,/.~// % ~ Length '~ ! =5'G Width Effective absorption area q ~ t ~', Date of adequacy test lC; /)-q / ~ (~ Fluid depth in absorption field before test (in.); Fluid depth ~'/R (ins) Minutes later: Soil rating (g.p.d./fF or~t~]b~r_~ ; 3' c' System type / Gravel thickness below pipe C, ~- Total depth ZMonitoring Tube present ~N). '~ ~ ~ Depression over field Results ~S/Fail) l~ ~ ~' For O ~ y Immediately after~ zu gal. water added (in,): ~/4 Absorption rate = H ~'C ~ .g.p.d. bedrooms Peroxide treatment (past 12 months) (Y/N) .~' ~.'~ ~','~,~,~ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles.~ Size in gallons ~'---- "Pump off" level at* *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ./v / ~. - c' c: t., ,~, .... r y ~--4 r ¢ .~ ~ ~ ~ ri' .-~ ~olding tank on lot Absorption field on lot Public sewer main Sewer/sepfl~c.~sP~ hne On adjacent lots O~OJ3-adja~e n t lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM~HOLDING TANK ON LOT TO: Foundation .~- 4- Property line S- ~ Absorption field rt , Water main/service line / C Surface water/drainage /u ¢ '+ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line -3. '¢- ' __ Building foundation /c Water main/service line Surface water / e c ,-/ Driveway, parking/vehicle storage area , / Curtain drain ~"" ¢ "¢~ lc: ,,~ c ~, ~ Wells on adjacent lots /' 4'.~.~ r Z F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records are in conformance with MO~ H~idelin~ in effect on this date. ~¥- .............. L/ ;Z X., ' ..... Signature D ~'~ "~ / Engineer's Name Pg ~ '5 ~?~F: ~__ ~ ~'~ ~~'7 d <~i~ ,' Date / C i ' ' ~ '~.~,~ C~-8801 Z HAA Fee $ '~- ~ Date of Payment.J//"~/--~//~- . . Receipt Number c:~~ (~ ~ 72-026 (Rev. 3/96)* rT'~ O i--,-i r-,a Wa~ve~ Fee $ ~ ;L~ Da~e ~f Payment ~ R~t Number Ric~ ,~:lystrom. Mayor Mtmic pality of Anchorag'¢ Department of Health and Human Services 825 "L' Street P.O. Box 196650 Anchorage. Alaska 99519-6650 December 9, 1996 Robert C. Cowan, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 1 Alder Park Subdivision Waiver Request #WR960068, P1D #011-131-36, HA960481 Dear Mr. Cowan: Your request for a waiver of the required 10 foot separation between an on-site wastewater disposal system and a lot line has been approved. The waived distance is 2 feet from the leachfield to the northeast property line. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. If there are any further questions or concerns regarding this waiver, please call our office at 343-4744. /Sincerely~'3 James P. Williams · / Civil Engineer On-site Services JPW/ljm:Marsh MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR~ WR960068 PID~ 011-131-36 Date Received: NOvember 27~ 1996 HA# HA960481 Permit # Legal Description: Lot 1 Alder Park Subdivision Engineer: Robert C. Cowan, P.E., S & S Engineerin~ 17034 Eagle River Loop Road, Suite 204, Easle River. Alaska Applicant: Harry Marsh 99577 Waiver Requested: ~--l~to northeast property line of 2 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Date: By: Name of Reviewer Rec #: 02511/3549 Amount: $ 115.00 Date Paid: Nov 27. 1996 ROBERT C. COWAN, P.E. ROBERT A. SHAFER, P.E. CIVIL ENGINEERS November 27, 1996 (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Hum~ Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 1; Alder Park 8336 Sundi Drive Request you grant a waiver for the horizontal separation distance between the leachfield and the northeast property line at 2 feet. The property is flat. We do not anticipate any adverse effect on adjacent properties. The property line is adjacent to the Sundi Drive righ~-way. A cleanout was installed in the northeast corner of the bed on November 26, 1996. This corner of the bed is more than 100 feet from the well on Lot 5. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 10/29796 ll:~ CT&E ESI RNCMORRGE ~ 90769~1211 N0.1S3 ~02 CT&E Environmental Services Inc. I.~boratory Diviaion .__.._-___J~_:_ L'_~:::"-";---%---~-~"-'% ....... Laboratory Analysis Report CT&E Ref.# 965766001 Client Name S & S Eagiaecrlag Project Name/# L1 Alder Park Client Sample ID Lot I Alder Park Matrix Drifting Water Ordered By PWS1D Sample Remarks: Client PO# Printed Date/Time 10/28/96 18:27 Collected Date/Time 10/25/96 13:00 Received Date/Time 10/25/96 i3:20 Technleal Director: Stephen C. Ede Parameter Results PQL Unita Nftrate-N 0,100 lJ 0.100 mg/L Total Coliform 0 0 col/100mL Alto~ab[e Prep Analysis Method Limits Date Date Init $M18 4500-NO3F 10 max t0/28/96 SM18 9222B 10/25/96 TAV 200 W. Potter Drive, Anchorage, AK 99518.1605 -- Tel: (907) 562-2343 Fax: {907) 561-530~ 3180 Peger Road, Fairbanks, AK 99709-5471 -' Tel: {907) 474-8656 F~x; (907) 474-9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN. MISSOURI, NEW JERSEY. ONTO. WEST VIRGINIA MUNICIPALITY OF ANCHORAGE ~ Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ~)// I~I ~¢ HAA# ~_\~O~_ ~t_~OiL,a 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner Mailing Address (c) Lending Institution Telephone ' (home) Telephone Business ¢~ ~/ Mailing Address (d) Real Estate Company and Agent Address Telephone ~' ¢'/--------~ ' '~ / (e) Mail the HAA to the following address: (or check here~i![ if hold for pick up.) List contact person and day phone_ number below: 2. TYPE OF RESIDENCE Singie-Family~ Number of bedrooms 3. WATER SUPPLY Individual Well [] Community~, Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site'l~ 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. Page 1 of 2 72-025 (Rev 7/88) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm /4~ ~ Telephone Z- ? ~'- 5"5"..~'~ Address / ¢/~ /,4). ;~ ~/-"'~ /~¢/~. ~ ¢' ¢ ¢',,5 Date 6. DHHS APPROVAL Approved for -~ bedrooms by Approved --~ Disapproved Terms of Conditional Approval Conditional Date //~ ¢-(~ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) ~ Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: /-O7' / ~.~ ,,~/~ If A, B, C, D.E.C. Approved~) __ ~L~og Present (Y/N) Date Completed Yield 'i'otal D~____ Cased to ___ Depth of Grouting __ ,Static Water L~,~ .... Pump Set At __ Casing Height Above"~,~d ____ Sanitary Seal on Casing (Y/N) Electrical VViring in Conduit"~____ Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot "--..... ; On Adjoining Lots _ __ To Nearest Edge of Absorption Field on Lot --.~.... ; On Adjoining Lots To Neare~lic Sewer Cleanout/Manhole To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~"'~'~'~ Size Stand pipes ~.,h~N) Depression over Tank (Y/~) Pumping/Maintenance Contact on File (Y/N) ,'d/F1 Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well / 5'0 -/" To Property Line Z. To Water Main/Service Line /O /~-5"0 No. of Compartments Air-tight CapsCN) / Foundation Cleanout (Yg Date Last Pumped /O -/~-,f'J' /$/1~_$ · for ~//~ Temporary Holding Tank Permit (Y/N) ~//'~ To Building Foundation To Disposal Field To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /d - ~..~/-~'~ Width of Field Square Feet of Absortion Area Depression over Field (Y,~___) Results of Last Adequacy Test / 5'0 Type of System Design Length of Field Depth of Field Gravel Bed Thickness O, .5' · Statndpipes PresentCN) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ? 5'0 · .~ To Building Foundation · Lot ! /0 ~- To Water Main/Service Line To Property Line /O To Existing or Abandoned System on ; On Adjoining Lots To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Cutback (if present) / /~o ~ ! Comments D. LIFT STATION Date in Gallons ~ Size "Pump On" Level at -'""'""'--~~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) -"'"'"'"~.~.~.....~ Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** · . i" I certify that I have checked, verified, or conformed to all MOA and HAA gu~del~ q~f~tgo~t~,e date of th~s inspection. ~_-/~.~¢ ~ Signed _ ~ ~ ;, ~O~H~~ ~ ~ Company ~C~ 5~: ~.~*~,~' ~ Receipt No. ¢ O ¢00 L~ ~%~ / Receipt No. Date of Payment // - ~ ~ ~ Waiver Fee: $ Amount: $ /.~¢ ~ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 STEVE COWPER, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 563-6775 DATE: PWSID: TO Whom It May Concern: 10-11-88 Class C Well According to the records on file in this office, the ALDER PARK~ Lot 1 Water System is in compliance with the State of Alaska Drinking Water Regulations. MPL:pkk Sincerely, Michael P. Lewis, PE Environmental Engineer LAB INSTRUCTIONS for Work Order ~ 10349 Date Report Printed: NOV 9 88 @ 11:01 Client Sample ID:LI, ALDER PK PWSID :UA Collected NOV 8 88 ~ 12:15 Received NOV 8 85 @ 12=40 hrs. Preseryed with ~4 DEG. C Client Name :AECS Client Acct : AKECSRP P.O.~ NONE REC'D Req ~ Ordered By : ' ChemLab gel. ~ :3377 Analysis Completed Laboratory Supervlso~ :STEPHEN C. Released By : EDE Send Reports to: ~AECS 2) Special Instruct: Chemlab C1 ient Par amet er Sample ~ Sample Description Matrix To Test Method Units ~ Result 1 L1, ALDER PK i 201S3-NITRATE-N MUNICIPALITY OF ANCHORAGE ~/ ~ ~-,~--~ . DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ( ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing, 1. PROPERTY OWNER ~ PHQNE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE PHONE MAILING ADDRESS I PHONE 4. REALTOR/AGENT MAILING ADDRESS ,_ 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four ~ SINGLE FAMILY [] Two F--] Five [] MULTIPLE FAMILY ~ Three [] Six [] Other 7. WATER SUPPLY [] INDIVIDUAL* ~ COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date._.(~ ~/~-'~-- c .~/~ 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 PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONL. DATE RECEIVED iNSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE NSPECTOR INSPECTOR INSPECTOR DIRECTIONS: NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE E3 PUBLIC UTILITY Connection Verified []Septic Tank or E] Holding Tank Size: If Tank is homemade give dimensions: [] ONE [] THREE [] FIVE [] TWO EZ] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line [] OTHER Septic/Holding Tank IAbsorption Area Sewer Line INearest Lot Line 5. COMMENTS [] APPROVED FOR~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accuracy certificate) [] DISAPPROVED DATE '"/"' LEGAL DESCRIPTION 72-010 (Rev. 3/78) June 21, 1978 R&M No. 851542 Alaska State Bank 310 E. Northern Lights Blvd. Anchorage, Alaska 99503 Attention: Mary Hiller Subject: Adequacy Test on Existing Sanitary Sewer System; Alder Subdivision, Anchorage, Alaska Lot 1, Dear Ms. Hiller: At your request of June 19, 1978, we conducted a test of the septic system on the above described property. During this test the liquid level in the septic tank was monitored as water was added to the system. The measurements are summarized in the following table: Liquid Level Below Top Total Gallons Time of Standpipe Added 10:10 7.8 0 10:17 7.8 25 10:25 7.7 75 10:35 7.7 125 10:42 7.6 150 11:00 7.7 150 11:10 7.75 150 The meter used during the test was a Rockwell 5/8" standard water meter which had previously been calibrated by R&M Consultants, Inc. If the 3 bedroom residence on the property is to house 6 people, the average load on the system can be expected to be 450 gallons per day .31 gallons per minute. During the test, the system accepted 150 gallons in 60 minutes. This indicates an average effluent acceptance rate of approximately 2.5 gallons per minute at the time of the test. June 21, 1978 Alaska State Bank Page 2 Because the house on the lot is occupied, we assume that the leach field was at its normal degree of saturation. We can therefore conclude that the system is disposing of effluent at an adequate rate for a 3 bedroom residence. We appreciate this opportunity to be of service to you. Please contact us if you have any questions concerning this test or if we can be of additional service. Very truly yours,- R&M CONSULTANTS, INC. Lynne Kosikowski Staff Geologist Gary#Smith ProJ/ect Manager JMB lkky FHA Form 2573 Form Approved ~'e~ ~,~y 1958 FEDERAL HOUSING ADMINISTRATION Budget Bureau No 63-R296.8 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INsLiRIblG OFFICE I MORTC, AGEE ......... !SERIAL NO. Anchor_age VA C _a s e _ ~.1_9__4~ _1_9 _ ~_ Fir_st N~a?iona ~1 Ban~ o~f Anghoragq MOIRTGAC, OR OR SPONSOR J PROPERTY ADDRESS LiEN~R'F~ Wayne ~nd Janice ~ 8336 Sundi Drive~ Anch.~ Alaska_ $UBO~VJS~OJ~ NA~ BLOCK NO. LOT N0 - Ald~r Park Subdivision TOTAL NUMBER: ....... , - - ~ BASEMENT r~J New installation ] ;~ 4 2 , Yes No 1 Can attic or other area be made into additional bedrooms? Ill Yes ho'.,., mony~) SUPPLY BY: SYSTEM DESIGNED FOR :'urqi, s,=teln ~ ~mmunity system ~ Individual ~ Yes ~ No PART II.~TO BE COMPLETED BY HEALTH DEPARTMENT DEPARTMENT iNSPECTOR'S SKETCH It is the opinion of the J---} State J--J County J~ Local Department of Health that this individual water-supply system j~] is J-"l is not satisfactory as a domestic water supply for the subject property. It is the opinion of the J---J State J'--] County J~ Local Department of Health that this individual sewage-disp(:s~] ~',s- tern with proper maintenance: {~._~, Can be expected to function satisfactorily, and is not likely to create an insanitary condition : ~/9/72 J S e ~ t, [ c 'Fa n 1.': :.; ~, ? e I.~ S-O ::. / Request fox Approval of T [(age Two 9. Co~men%s: · ....:_:::...: