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Home My WebLink AboutNETTLETON ACRES #2 LT 10Municipality of Anchorage Development Services Department • -- Building Safety Division On -Site Water & Wastewater Program, 4700 South Bragaw St. t; A_ P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SWO050152 PID Number: 015-062-14 Name: DUANE AND JULIE MAYER Wastewater System: ❑ New ■ Upgrade Address: 6711 PAULA PL. * ANCHORAGE, AK. 99516 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 346-8559 4 ■ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: 0.8 Total Depth from original grade: 10 MAX GPD/Sq. Ft. rL Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: — 10 NETTELTON ACRES #2 SEE DWG. Ft. 6+ FL Township: Range: Section: Fill added above original grade: Grovel length: — — — SEE DWG. FL 65 Ft. WELL: ❑ New ❑ Upgrade Gravel width: 2.5 Number of linea: 1 Distance between linea: — Ft. FL Classification (Private, A B,C): Total Dep Cased To:(BEDROCK) Total absorption area: Pipe material: D 3034/ F-810 Ft. FL 780+ so. FL Static Water Level: Installer. GEG, Ltd. Date installed: 7/8-12/2005 Driller. �X� Date Drilled: FL Yield:Pump Set At: Caetng Height Above Ground: TANK GPM FL FL SEPARATION DISTANCES ■ Septic ❑ Holding ❑ S.T.E.P. ❑ Other To Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Lines Manufacturer. ANCHORAGE TANK Capacity In gallons: 1250 From Well 100'+ 100'+ - - 25'+ Material: STEEL Number of compartments: 2 Surface water 100'+ 100'+ — — — LIFT STATION Lot Line 5'+ 10'+ — — — Size in gallons: Manufacturer. Foundation 5'+ 10'+ — — — 'Pump on' level at: ump at High water alarm at Curtain Drain NONE KNOWN Pump Make eI: Sectrical Inspections performed by: Remarks: BENCH MARK Location and Description: OLD SEPTIC TANK WAS COMPLETELY ABANDONED BOTTOM OF SIDING AT FCO. PER UPC. Assumed Elevation: 100.00 Ft. ENGINEEIRS SEAL Op 4,; GEG Ltd. Inspections performed by: Dates: 1 st 7/8/2005 2nd 7/11/2005 D :' 1 0....... ?..�...... �...:...........0 f 3rd 7/12/20050 QO .Jeft r A. arness.: X . Development Services Department Approval Ohm CE- 953 oQ 4�s ,. .�°o p @�a /«f�� 7 Reviewed and approved by: / !� Date: (Rev. 12/01) ��Aoo �O�dP �ofessla�000 QOO4p0�4 IPERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: I SW050152 015-062-14 0 m m r. m T4 A B FCO 14.94 47.05 ST1 34.50 37.17 ST2 40.50 39.47 DBL1 44.20 41.27 DBL2 45.40 42.09 C01 107.77 74.98 MT1 98.41 87.70 CO2 98.84 105.78 MT2 98.30 106.12 r / / / / NEW 1250 / GALLON SEPTIC/ TANK I A. 9� go M No, I GPgpG6 \\ DBL1 \\ DBL2 \ ALTERNATE SITE /\ / / . r'. �•`.ttf'� •` / EXISTING / / WELL I / / NOTE: TEST HOLE LOCATION FROM DESIGN WAS APPROXIMATE, ACTUAL LOCATION IS AS SHOWN. GARNESS ENGINEERING GROUP, Ltd. ----_---- - CONSULTANTS & GENERAL CONTRACTORS 3701 F_ MOOR ROAD, SURE 101 • ANCHORAGE, AK 99507 • PHONE (907)337-8178 • FAX (907)338-3248 N'EMM* wmgomfwf»ngG rtrq.c PREPARED FOR: PHONE NUMBER: PAGE NUMBER: DUANE AND JULIE MAYER (907) 346-2559 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: NETTELTON ACRES SUBIDIVISION #2; LOT 10, R.A.L. TYPE OF WORK: DATE: AS -BUILT FOR NEW SEPTIC SYSTEM 7/14/2005 (Rev. Ulm) 'O 3 jJ ff e .2�. Garness.: ` CE -79,53 •' ,`c°G �4�O�professio�ao�/ PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: - SW050152 015-062-14 TOP OF TANK AT INLET = 95.13 - INVERT OF BUNG AT INLET = 94.55 — FINAL GRADE = 99.22 ST1 ST2 1 n I -----------I-I-----� i u I NEW 1250 GALLON SEPTIC TANK FINAL GRADE MT CO97.24-97.86 ORIGINAL GRADE = 97.38 ,FILTER FABRIC INVERT OF PIPE = 93.38 `BOTTOM OF TRENCH RELATIVE ELEVATION OF BOTTOM = 87.38 OF TEST HOLE ® 81.38 (TEST HOLE DRY) W GARNESS ENGINEERING GROUP, Ltd. c -- CONSULTANTS & GENERAL CONTRACTORS •-------------- 1 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507 • PHONE (907)337-8179 • FAX (907)338-3248 • WEBSRE r .gam ngiro rinq.wm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: DUANE AND JULIE MAYER (907) 346-2559 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: NETTELTON ACRES SUBIDIVISION #2; LOT 10, R.A.L. TYPE OF WORK: DATE: PROFILE AS -BUILT FOR NEW SEPTIC SYSTEM 7/14/2005 (Rev. 01/05) TOP OF TANKAT OUTLET = 95.12 INVERT OF BUNG AT OUTLET = 94.27 i..a......1........... J flr y A� rness. CE -7953 m� 's �• .� .••• •moo°O ` Pro f 11 si0�1\o0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDREZ~ / (~ l LEGAL DESCRIPTION - Well ,. - I Absorption area t [ Dwelling PERM T NO. m ~ I M~nu~acturer ~_ IM~teriall ~ No. ot~ompartl~ents ~' ILiql ~al)a~ity in~allons I IF HOMEMADE I Inside length [Width Liquid depth ~ ~ / DISTANCE TO /Well I ~welling PERMIT NO. ~ [ IWell _ Foundation INe~rest ot ina ~ PE~MITNO.. ~ ~ DISTANCE TO: I ¢~o~ /q ~o I /~ ~oo~m ~ ~ N /No. of lines I Length of each line Total length of~n~ I Trench width Distance b~t~..~ $,,,,s ~ ~ /To~ ot ~il~ :o ti.i:h ~ - w-~ Material beneath dl~ Total effectiv~a~sa~pJ{on area - m /L~"gth Width Depth PERMIT NO. -- ~ m ~ b /Type of crib~ Crib diarne~-~ Crib deptll~ -I Total effectiv¢~ion area , / DiSTANCE TO: Bui dblg foundatio Sewer line I ~ptic tank OTHER PIPE MATERIALS ~o~ ~ SOIL TEST RATING INSTALLER REMARKS _xn _ LEGAL APPROVED DATE PERMIT NO. RPF'L. I CRNT LC)CRT I ON LEGRL [:,EPRRTMENT m ...... FIEFI, L. TH RN[:, EN',,,',IRONME:NTFI~:., '"'"OTECTION ~l ~ PFt _ L. FI RN[:, HIZ, ME~TERE:, ~ b~ 5.8 NETTLETON ACRES S,,'D<~7''~' L.OT SIZE :1.:~.fl.68,4. S~;C~IJFIRE FEET 'TYF'E OF SOIL RBSORPTION SYSTEM IS: TRENCH I'qRXtMUM NUMBER OF BEDROOMS E;OIL RRTIHG ,::SQ FT,."BR:: .... THE REtT~UIRE[:, SIZE OF THE SOIl.. FIBSORPTION SYSTEM IS: THE LENGTH DIMENSION IS TNE LENGTH (IN FEET) OF' '['HE TRENCH OR DRFIINFtEL.[:,. THE [:,EPTH OF R TRENCH OR PIT IS THE [:,ISTFINCE 8ETI4EEN THE SURFRCE OF THE:: GROt.IN[:, FIN[:, THE BOTTOM OF THE ENCR',,,'FI'TION ,::Ir.,I FEET). THERE IS NO E;ET HIDTH FOR TRENCHES. THE GRR',,,'Et._ [:,EPTH IS THE MINIMUM DEPTH OF GRR',,,'EL BETI.,.IEEN THE OUTFFILL PIPE RND THE BOTTOM OF THE ENCR',,,'RTION <IN FEET). F'ERMIT FIPPLICRNT HRS THE RE2;PONSIBILITY TO INFORM THIS [.',EPI::IRTMENT [:,LIRING THE; INS]"RI._I._FITION INSPECTIONS OF FINY b. IELLS FI[:,JFiCENT TO THIS PREIF'ERTY FIND THE I'.,ILIME,'ER OF RESIDENCES THRT THE NELL P.IILL SERVE. BFICI<.'F]:Li..IN6 OF RNY SYSTEM NI]"HOLIT FINRL INSPECTION fiND I'-]PPROVRL. BY T'rlIS DEPFIRTMENT P.IIL..L BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN A NELL RN[.', RNY ON-..SITE SE!.,.IRGE DISPOSAL SYSTEM IS :.I..PiE~ FEET FOR R PRIVR]"E [4ELL OR ::LSE~ TO ;288 FEE]' FROM FI PUE~L. IC 14ELL. DEPENDINC'i LIPON THE T'¢F'E OF: PI. JBL. I C P.IEL.L. I"IINIMUI'4 -P.'ISTRNCE FROM R F'RIVFITE I.,.IELL TO R PRIVRTE SE!4ER LINE IS 25 FEET AN[) 'TO FI COMMUNITY SE:IqER LINE :IS 75 FEET. b. IEL. L LOGS 8RE REC~UIRED FIND MLIS';T BE RETURNED I'O TNE DEPFIRTMENT P.IITHIN Z.':E~ DRYS OF THE NELL COMPLETION. OTHER REQIJIREi"FENTS MFIY FIPPLY. SPECIFICFITIONS RND CONSTR. UCTION DIFIGRFIMS FIRE FIYFIILFIBL. E TO INSURE PROPER INSTFILLFITION. I CERTIFY THRT :L: I RM FRMILIFIF.: P]I]"H 'FHE REQUIREMENTS FOR ON-SITE SEI.4ERS ¢~]N[) P.IELi. S FIS :SET FORTH BY THE MUNICIPFILITY OF FINCHORFIGE. 2: I 1.4ILL INSTRLL THE SYSTEM IN RCCORDFINCE L4I]"H THE CODE'_:;. ~: I UNDERSTFIi'.,ID THRT THE ON-SITE SE!.,.IER '-2.,Y~TEM i',IFIY REC..!UIRE ENLFIRGEMENT IF' THE RES I[:,ENIZ:E I S..~::EMO[:,ELE[:, TO INCL. U[:,E MORE THFIN ]: BE[:,ROOM[-.]. CONSTt',dCTION TEST LAB PERFORMED FOR, WESTERN ENTERPRISES LEGAL DESCRIPTION: Lot 10 Block THIS FORM REPORTS: ~Visual Soils Examination 180L W. 48TH AVE. STE. 'C' ANCHORAGE, ALASKA 9950;5 248-1;533 DATE PERFORMED:9 / 1 7 / 80 Subdivision Nettleton Ac r e s <~I~::?_ O Percolation 'rest DEPTH S al L F'EET DESCRIPTION NOTES 6" TOPSOIL N/A _~ 10" BROWN SILT 480 TAN GRAVEL 100 SF/B! 2' w/ Coal Chunks GW-GP - TAN FINE SAND 150SF/BR SP 7' TAN GRAVEL w/ cobbles & 100 SF/B boulders GW-GP 16 ' BOTTOM OF HOLE WAS GROUND WATER ENCOUNTERED NO IF YES, WHAT DEPTH LEGEND ® - Perc zone l(hme¥ R. o,~ ® S - Sample token 3~5~: ~ BI -- Frozen zone GENERAL SITE SLOPE ~'- Water table ,~ READING DATE GROSS TIME NET TIME DEPTH TO I.t20 NET DRAINA61-' PERCOLATION RATE: PROPOSED INSTALLATION COMMENTS: DRAINAGE REQUIREMENTS'. O SEEPAGE PIT X~3(DRAIN FIELD O OTHER TEST PERFORMED BY:B · P · DATA CERTIFIED BY:Kinney R. Baxter, P.E. DATE: 9/17/80 ~ 0 0 0 0 0 0 0 0 0 0 0 0 0 : :LO ~ : : : 0 0 0 0 0 0 0 0 : : : 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. Ct CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1, GENERAL INFORMATION Complete legal description Lot 10; Net~bC. eton Acres Location (site address or directions) Dr. Jc~es Scw~ly 4120 Laurel Street, 6700 Paula Anchorage, AK Property owner Mailing address Lending agency Mailing address Agent George McCoy/ Jack White Co. Address 5201 "C" Street S~.te 200 Day phone 562-6764 Suite 203 AnChorage, AK 99508 Day phone Day phone 563-5500 Anchoraqe~ AK 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 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. 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. 1/91) Fronl 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 ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm s & $ ENGINEERING Phone ~ E/ z/' _ ~ ,~ 7 ~] 17034 Eagle River Loop Road No. 204 Address Ea~l/e River, Alaska 99577 Engineer's signature '-~¢'~i-¢ E'~ '~"?"--- Date 5//'~'/ / ¢/6', DHHS SIGNATURE \ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date // 'The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificr~tes 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) Bsck MOA ~21 IviUNiCJPAL. ¥ 'or Ai~t~it~)r.~.~c- ENVIRONMENTAL SERVICES DIVISION unicipa{{ty of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICI l! C I!!V ~ D Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4'?'44 Health Authority Approval Checklist LegalDescription: LO T lo tv~r rt~ro~ t~c/~ 5 Parcel I.D. : O~ S- ~' Oro,~ -- ))t A. WELL DATA Well type Log present Total depth IfA, B, or C, attach ADEC letter. ADEC water system number Date completed / o / ;~ ~ / ~' O Cased to ~'/0 ¢- Casing height (above ground) Sanitary seal (~q) ~/~- J Wires properly protected ¢i;)/N) V t' y Date of test Static water level Well production WATER SAMPLE RESULTS: FROM WELL LOG AT INSPECTION g.p.m. (a .~ I + Coliform O Nitrate Date of sample; 3 / ~- ~/o/~ B. ~OLDING TANK DATA Date installed lO/)o /~o Tanksize /o0 o (2, I Collected by: g.p.m. Other bacteria O S & S ENGINEERING 17034 EagJe River Loop Road No, 204 Eagle River, Alaska 99577 Number of Compartments ~- Cleanouts (5}/N) ye ?' Foundation cleanout ~/N) x/,~ 5 Depression (Y~ /,/O High water alarm (Y/~ /,/ o Date ofPmnping,5'/,~ ,~-/~6 Pumper ~' 3- //o,,,~ 4_ 5'~ v/c:r; .1%'4 C. ABSORPTION FIELD DATA Date installed /~/-:~ o £ Length 3 0 Width Effective absorption area ~/ ¢ Date of adequacy test Soil rating (g.p.d./ft2 or~.-1 3 Gravel thickness below pipe Syste~n type Total depth Monitoring Tube present(~/N) V~ ~r Depression over field (Y/I~ ~v c, Results (Pass/Fail) f6 ,if For -~ bedrooms 6 i Fluid depth in absorption field before test (in.); I q Immediately after6 *'-] gal. water added (in.): Fluid depth ~ t 8'" (ins.) Minutes later: ,:1 3 ~¢~ ¢ Absorption rate = t4 5' o q- g.p.d. Peroxide treatment (past 12 months) (Y/N) t~,./~ tc,,u,~ ~ If yes, give date ~ Do LIFt STATION Date installed Manhole/Access (Y/N) Hidh water~ E. SEPARATION DISTANCES Size in~ level at* "Pump off" level at* *Datum Fo SEPARATION DISTANCES FROM WELL ON LOT TO: ~T~holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line ( ; On adjacent lots / o 0 ~- / .; On adjacent lots ! 0 o --/- Public sewer manhole/cleanout A//~ Lift station /~/,~ SEPARATION DISTANCES FRoMisEPTIC}HOLDING TANK ON LOT TO: Building foundation l ~- / ~- Property line ~' 0 r4- Absorption field Water main/service line 30/4- Surface water/drainage./0o /'P Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Curtain drain Property Line ~'o -p Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots / 0 0 ~ wt. ENGINEER'S CERTIFICATION I certify that I have determined thrufield inspections and review of Municipal rec~. Signamreinc°nf°rman~:"'OAH'/~guideliq'exineffect°nthisdate' Engineer's Name Date ~/?/ Date of Payment eceipt umbcr /'7 / ¥ (?o 7 Waiver Fee $ Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc 03/29/95 16:49 CT&E ESI ANCHORAGE * 90?6941211 N0.814 CT&E Environmental Services Inc. Laboratory Division ,~',~',e~r,~',e,~'ara~a~,~,,v-j,~e~aer~r~a Laboratory Analysis Report CT&F, Ref.// Client Sample ID Matrix 961015.7947 L[O NI3TTI,ETON S/DJ 10[$.01 Drinking WRier Pwsm o Sample Remarks: '" Collecled Date 03/25/96 Technical Director R~leased B y.~., --T,~_.,__ .,...,.- ...... NitrateQI 0.100 U ' 6',~ ~g/'"~=~ EPA 353.2 Attowab[e Prep Analysis Init 03/~6/96 EM8 200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tel: (907) 562-2343 Fax: (907) 561-5301 3180 Poger Ro~O, Fairb~!rik$, AK .99709-5471 -- Tel: (907} 474-~650 Fax: (907) 474-9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS. MARYLAND, MICHIGAN. MISSOURI. NEW JERSEY, OHIO, WEST VIRGINIA 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. # bO ! ''~-- 0 b,~g- --/ 1. GENERAL INFORMATION Complete legal description Location (site address or directions) 6711 Pau~a Place Property owner Curt Dawleq Mailing address 6711 Pau~a Place Anchorage, Day phone Alaska 995~6 346-2448 Lending agency Mailing address Day phone Agen~2amelia Buschman FORTUNE PROPERTIES, INC, Day phone_ $46-1685 Address 3000 A street #101 Anchoraqe, Alaska 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: XX 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. XX 72-025 (Rev, 1/91) Front MOA ~2t 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature S & $ ENGINEERING 17034 Eagle R[¥er Loop Road No. ~ Eagle River, AJasl(a 9~527 Phone DHHS SIGNATURE ~ Approved for f~'.,¢¢¢~.) 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 Oertificates 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. ~/91) Back MOAt21 Municipality of Anchorage Department of Health & Human Services HEALTHCUTHORITY CPPROVAL CHECKLIS'r A. WELL DATA Well t y pe/'<"~'1~ Log present(¢~4) Total depth Sanitary seal If A, B, or ~, attach ADEC letter. ADEG water system number Date completed ~ c:~- ~.'~ ~ ~,o Driller "(,, , '~"~' Cased to ~ Casing height_ '"'( Wires properly protected(CC)fN) y Date of test Static water level Well flow Pump level \~' SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main ~ Sewer service line FROM WELL LOG g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~5;> ~::~/~ Nitrate Date of sample: //'- /g¢'-':~ 1 13. SEPTIC/HOLDING TANK DATA Date installed [ET~~:~ Tank size . . Cleanouts~N) / High water alarm (Y/N) Date of pumping I'~ .'~, Collected by: Ot~er bacteria \ ~__.,~_,~d:~ Compartments % F u dation cleanoutd~N) _ V Depression (Y~ ~ Alarm tested~Y~.~) , / '---'-' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots Absorption field Foundation ~ ~ Water main/service line ~,Of ~"' 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date ins~ta te.~ Manufacturer Size in gallons % Manhole/Access (Y/N) Vent (Y/N) "P~I at "Pump off" level at High water alarm level ~ ~....~tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Meets MOA electrical codes (Y/N) ~ Surface water D. ABSORPTION FIELD DATA Date installed ~¢- ~<::~ ~'~::::~ Soil rating Length '"'~ ~::~ Width L.~ Total absorption area ~ Depression over field (Y~) Results (pass/fail) ~~ Peroxide treatment (past 12 months)(V~ Gravel thickness '~ Cleanouts present4~) Date of adequacy test for ~ /~'~\'~t.'D'J If yes, give date ~4-- Total depth ~,'~.~ -- bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot ~, C?~.¢~-I~'~ On adjacent lots / ~ ''~ Propertyline To building foundation ..~_/I~ To existing or abandoned system on lot On adjacent lots '~ -~r'- Cutbank I"~ L*") ,-J ~..~ Water main/service line Surface water ~1 ~f mt-- Driveway, parking/vehicle storage area Curtain drain ~--~c:~ I-~ ~--1~ ~-~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on; of this ' S & $ ENGINEERING Signature 17034 Eafjle River Loop Road No, 204 Eaule River, Alaska 995~t~, Engineer's Name Date \~,,~_.~ ~ ,c::~ [ ¢i~ HAA Fee $ //'70, Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMM["RCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALYSIS REPORT BY SAMPLE for WORKordar~ 40275 Date Report Printed: NOV 15 91 ~ 16:11 FAX: (907) 561-5301 Client Sample ID:NETTLETON ACRES #2 LIO PWSID :UA Collected NOV 14 91 @ 14:00 hrs. Received NOV l~ 91 @ 16:02 hrs. Preserved with :AS REQUIRED Analysis Completed :NOV 15 91 Laboratory Supezvis~EPNEN C. EDE Client Name Client Acct BPO $ Req t Ozda:ed By :S & S ENGINEERING :SNSENGP PO ~ NONE RECEIVED :R. SHAFER Send Reports to: I)S & S ENGINEERING 2) Chemlab Ref #: 916166 Lab Smpl ID: I Matrix: WATER Allowable Parameter Tastad Result U~lts Method Limits NITRATE-N ND(O.IO) mE/1 EPA 353.2 Sample ROUTINE SAMPLE COLLECTED BY: LYNDA, Remarks: Tests Performed ' See Special Instructions Above UA-Unavailable None Detected '" See Sample Remarks Above Not Analyzed LT-Less Than, GT-Greater Than Member of the SGS Group (Soci~t~ G~n~rale de Surveillance) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-472O Application Date_ '. - GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~..~t¢-'~ ~")~-.""( Telephone: Home [-~-6 '-~<¢r~'~ Business ;'-~(-¢¢- Applicant Address ~, ~, '~'~X' Ii '~--~ % ~' / fl~,-~(',~-~¢.,.~' RE.. ~:7 ~'~/~ (c) Applicant is (check one): Lending Institution [],; Owner/builder/J~Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address (f) Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family,~ Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual We!lc.J~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4, SEWAGE DISPOSAL Onsite~.,~~ 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 (11,,84) Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seai a:ifixed hereto and as of the validation date shown below, I verify that.my investigation of this Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequ~, for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtainet~ from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposat system is in compliance with all ~unicipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm (~ '~'~ ~F~ ~F~ ~[~elephone ~ ~ 7 ~ Date ... 7 DHEP APPROVAL Approved for ,2~/,-'.~_ ~?~'}b e d ro o m s b y Approved ~ Disapproved Terms of Conditional Approval Conditional _ CAUTION Tile IVluncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP 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 responsible for errors or omissions in the professional engineer's work. MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: WELL DATA Well Classification ~""'~--I ~J ..¢¢T~'~ If A, B, C, D.E.C. Approved (Y/N) ~"~ Well Log Present (Y/N) ~'¢~, Date Completed ~/~ /"~O yed~. Total Depth ~'~:~'~- ' Cased to Z.,~.~ ~' 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 Pump Set At ~'~%~4 ~6 Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) N~:~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot __[ ~ t ~._; On Adjoining Lot,,; ( ~(~.~i To Nearest Public Sewer Line ~ ~' ~ To Nearest Public Sewer Cleanout/Manhole ~""'~ I ~Or To Nearest Sewer Service Line on Lot Water Sample Collected by ""'T'~'~¥',~ .1~, .r~: r...c4¢,.~; Date '?/J ~/ Water Sample Test Results B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) "(_~:'~ Air-tight Caps (Y/N) Depression over Tank (Y/N) .~,,~:~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~ ~ ~''''~ To Property Line '7'~" TO Water Ma~'/~ice'~i~e _ Course ~/'~ I ~b/'~-~f'~:)_ Size ~,~::;5'.-..'~.~ C¢'¢/'L. No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) Comments To Building Foundation _ "~.%~ To Disposal Field _ ;~'~- f To Stream, Pond, Lake. or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field I~ Square Feet of Absorption Area Depression over Field (Y/N) Last Adequacy Test "~ '~~ Results of Separation Distance from Absorption Field: To Water-Supply Well j.~ t ..~,~_ To Building Foundation ~ r...~. Lot / ¢r To Water Main/Service Line ~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~'~¢ $~ Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line "Z~- / '"[''- To Existing or Abandoned System on ; On Adjoining Lots r~ ( ~ TO Cutbank (if present) ~,,5/¢2~F D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at THiegsledW~;~r Alarm Level at//'~'~.,/ Electrical Codes(Y// Comments / Dimensions Manhole/Access (Y/N) "Pump Off" Level at /.~g Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checke(~, verified,'~r conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~'"~--l~,~,-,. (J~-,'-N~xOf,,~~ Date ~/~ Company g~~ ~ ~o. ReceiptNo. ~O~' O~ J~ Date of Payment ~ ' ~-~ Amount: $ ~ ~ ~ Seal Page 2 of 2 72-026 (11/84) ./ A+Hot,,~ Se~ices 15900 Francesca Drive Anchorage, Alaska 99516 345ot890 * 345.2444 DATE L DESCRIPTION PREVIOUS BALANCE CREDITS i cHARGES BALANCE DUE [~ BALANCE If this statement does not agree with your records please notify us at once, $ TA TEMEN T -,' DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE ~NSP~C~O~ ~NSP~CqOR MUNICIPALITY OF ANCHORAGE DEPARTMENT OF H~ALTH & ENVIRONMENTAL PROT~C~ICIPALI~ OF ANCHORAGE B2~ L Street - Anchorage, Alaska 99501 DEPT. OF HEALTH & ENVIRONMENTAL p;~OTECTION ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 JUL 1 0 1981 ..ou s A...OVAL O. DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing, 1. PROPERTY OWNER I PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from abovel ' ' PHONE 2. BUYER PHON~ MAILING ADDRESS 3, L~NDIN6 INSTITUTION MAILIN~ADDRESS 4. REALTOR/AGENT / PHONE M~I El ~ G ADD~ riSS 5. LEGAL DESCRIPTION STREET LOCATIQN -. /.~. . 6. TYPE OF RESIDENCE NUMBER OF.,BEDROOM~,~ [~"'~SI N G L E FAMILY [] One I~1~ I~ o~[l~r [~,/Two [] Five ~ MULTIPLE FAMILY Three ~ Six [] Other 7, WATEr. PLY INDIVIDUAL* [] COMMUNITY [] PUBLIC U"FI LITY * ATTACH WELL I_OG. A well Icg is required for all wells drilled since June 1975, For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM I~"-~NDIVIDUAL/ON-SI'['E** ./~"'~) YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FFE MUST ACCOMPANY EACH REQUEST BEFORE PROCE881NG CAN BE INITIATED, 72-010(Rev. 6/79) ~ / THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVl DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY I~ Connection Verified _ INSTALLER []Septic Tank or []Holding Tank Size: JO(~ ~) If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER ~ TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line I Nearest Lot Line WELLTO: I I Absorption Area to nearest Lot Line 5, COMMENTS [~"~APP ROV ED FOR -~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev. 6/79) July 17, ].98i Wes'tern Enterprisest :Inc. 4101 Arctic~_~r,)u~ ].evard, h(.,o,,)--m 203 Anchorage, Alaska 99503 Subject: Lot 10 Nekt].eton Ac:es Subd. iv:i_sJer~ The sewer system on tb.e subject property wz-:s desigrtcd and installed has a three(3) bedroom single i-amJ_].y The request fo': approval for bank financing four (4) bedroom sincle family Therefo:e, before approval may he granted, a 500 9'ali_ohs septic tank will need -to be instal]ed and an additional ten(l) feet of trench with eight({;,) feet of gravel backffJ.ll will be needed. _ ~/'/ , The water analysis report needs u~ be sttbm:J_tt, ed to ~- '~' ~,&(~of'fice from tho Cl',em Lab, 5633 B ..... ,~- = ~ ol.r(_:[.~ ~O/2 ,)tlr .Fevic'w, If -there are any further ques'tions, please, ca]l this ozV"'.~:zce at 264~-4720. Sincerely Robert C. Pra'tt, R.S. Associate Specialist RCP/ljw cc: Alaska Pat'[fit Bank i01 Benson Beulevard 99503