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MARIE ESTATES LT 1
Marie Estates Lot 1 #051-111-34 — MUNICIPALITY OF ANCHORAGE DE ITMENT OF HEALTH AND HUMAN SER ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name A% deL_S DISTANCES TO FROMWELL SEPTIC TANK ABSORPTION FIELD Address `P Or {W4/hnL2 WELL J I �' r gtj Phone(ss)Q) Qa r S L-056— LI agW Permit No. No. of Bed11ro�o�ms LOT LINE LEGAL DESCRIPTION Lot Block SubtlivlslR n FOUNDATION—T, �V1 Township, Range, Section t �� n 1 \� S �G_` I IL— AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, driveway, water bodies, etc.) TANKS SEPTIC ❑ HOLDING Manufacturer Capacity In gallons Material No. of Compartments TYPE OF SYSTEM 'TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER % Depth to pipe bottom from original grade FT Total depth from original grade `D FT ` FIII added above original rade 9 9 1, O FT Gravel depth beneath pipe q b FT Gti G 1L ^ — Gravel length rJZ,o FT Gravel width 3,0 FT Total absorption area -5 16 80 FT Distance between lines � PFT Number of lines Soil rating q5 SQ FT Pipe material T73 a3 `i Installer M 6ais-r Date Installed l0 22- S WELLS lvt PRIVATE ❑ OTHER (Identifv) Classification (A,B,C) Total Depth FT Cased to FT Installei Date Installed: REMARKS: Scale: Pt'T+NGIt+IEE Inspections Performed by: Vb,,$;vAL ka: ter,+•� �j2, f� a .,.11 .s4 9H3g6'E o'i n E a , Pdo, i657•k �' �c,. _:,., �n'•. ��'� �- Date: v inspection was performed according to all / I cerlily that this Y 7 Municipal ariti`Sla)e guidelifies in elfec on tfiis ale: � �./arty-�, <t� U% -t c. Health Department Approval: �"/ Date: 7 72-013 (3/85) MUNICIPALITY OF ANCHORAGE „ Department `. Health and Environmenta' ?rotection 825 ,y Street, Anchorage, AK. ::501 W 264-4720 # # # HANDWRITTEN PERMIT # # # Permit # es, 4 ..,--- .... - i ON-SITE SEWER PERMIT Applicant: &J,/-fYA16 Mailing Address: �. �bk % (p �• Location: Phone Number: Z 14- Legal Description: / .r �L /Z,e/, Lot Size: Type of Soil Absorption System Is: Trench:_ Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) 7he Required Size of the Soil Absorption System Is: t ! DEPTH -- LENGTH 77, GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ �f� GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. I . * # * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 u 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage.' (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the sidence iremodeled to include more tha 3 bedro Signed: Issued by: Applic aA t C - g Z Date: SWP/024(1/81) TO R n M SUBJECT �v% ,(. ... a_✓ �_ ��� I` � DATE (Z /2(. b5 ;MESSAGErJ2 { ✓n �GI 1 DE�aa�- U.. _A js s• �� i ✓7 4/i r n i A rcc..+ c�--✓zl+.. PIG o- i j Y'� -u�, r ✓'ACU C S i'b /' ��i. / h S`�r- (C ci, f i E:l S4 .. .• /� L, m, i �t .tea f eL-/ (-. ,dG a .Ca-•��L �t v C ec,cJ I 47y G't-7.i S � FX �-f � �l -✓ �r ®a/'L 1 -+tet -t �P � �-� c� t d r.�c d! �Ia.. � t � 41 I. SIGNED " -27 f REPLY I i 121 SIGNED DATE - - REDIFORM 04S472 SEND PARTS I AND 3 INTACT - - POLY PAK (50 SETS) 4P472 PART 3 WILL BE RETURNED WITH REPLY. l�CT A!`Ll AAlll C11 C CIIO Cl11111\1/ Illi - - a 10 /� /JJJr 11 y� �jWWAS GROUND WATER L i-��T (� ENCOUNTERED? O R -OL -e e 12 IF YES, AT WHAT 13 DEPTH? 14 (FEET) L7 0e,6A—e be-, SOILS LOG ' MUNICIPALITY OF ANCHORAGE 15- +.r DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION ° D67 3 '� 6°° �oa3ee 4 TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 17 - e as oa nm o 00 aeusVs �o SOILS LOG — PERCOLATION TEST l �taFrt��f k'.. xira�ar e,� r v� 5- i C6f�SIN ell �� DATE PERFORMED: J,°a, R',«. ➢moi- a sem' , Z��' � PERFORMED FOR: q 7n ;;y,uae aea� �Ki��`as' 19 6- 'nom LEGAL DESCRIPTION: DEPTH U SLOPE SITE PLAN a 10 /� /JJJr 11 y� �jWWAS GROUND WATER L i-��T (� ENCOUNTERED? O R -OL -e e 12 IF YES, AT WHAT 13 DEPTH? 14 (FEET) L7 0e,6A—e be-, Net Time Depth to Water OF 4C t% 15- 1 3a®Q 4 16s9 7- �� y J e ",fr,p�� Y V S`. i c .y. a Alk a �.y w;�, a ° D67 3 '� 6°° �oa3ee 4 17 - e as oa nm o 00 aeusVs �o l �taFrt��f k'.. xira�ar e,� r v� 5- J,°a, R',«. ➢moi- a sem' q 7n ;;y,uae aea� �Ki��`as' 19 6- 7 $ CLF}YeY �,2xrv�L 9 a 10 /� /JJJr 11 y� �jWWAS GROUND WATER L i-��T (� ENCOUNTERED? O R -OL -e e 12 IF YES, AT WHAT 13 DEPTH? 14 Date � s � Net Time Depth to Water OF 4C t% 15- p o °yeaoa c°ce$ y, e :A � �• 16s9 � J e ",fr,p�� Y V S`. i c .y. a Alk a �.y w;�, a ° D67 3 '� 6°° �oa3ee 4 17 - e as oa nm o 00 aeusVs �o l �taFrt��f k'.. xira�ar e,� r v� 18- J,°a, R',«. ➢moi- a sem' q 7n ;;y,uae aea� �Ki��`as' 19 Reading Date Gross Time Net Time Depth to Water Net Drop 20LJPERCOLATION RATE /I (minutes/inch) TEST RUN BETWEEN FT,AND COMMENTS SRE1 y561€ w r'ty PERFORMED BY:111V�9,,��jkk`tS'Q�if CERTIFIED ��/: DA .E: 72-008 (6/79) SOILS LOG MUNICIPALITY F ANCHORAGE • +.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Y'V A--WIV Ce ( _Zp[a /l\/C—,q- ( DATE PERFORMED: S--2t2--(53 LEGAL DESCRIPTION: � SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS L,494e, >=uL 0AZA SL_, T3� tea �t cv N_0L- �� ....-,.....ems bs�1 A. Shuimr � naa. 1457-E c N U� PERFORMED BY,: 72-008 (6/79) NOME ■■E■ NMEN EEM■ NMIEN EE NE ■M®■ ■NME NEIRM ■■IMM MINEE WAS GROUND WATERS S ENCOUNTERED? O L O P IF YES, AT WHAT E .f DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE • (minutes/inch) TEST RUN BETWEEN FT AND FT CERTIFIED DATE: $tOni.�jr by DOC Co. dba SULLIVAN WATER `YELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND (,kl 017'R�✓42,g) cJ < /!1 t= 44-1 DEPTH OF WELL ADDRESS f' C1 00 Y 17 (1 3 !i STATIC LEVEL OF WATER FT. _70 LEGAL DESCRIPTION Z / /71'9A' I r f I= DATE • Started � 11-, 3 — Ended �;2 / e PERMIT NUMBER KIND OF FORMATION: DRAW DOWN FT. GALS. PER HR — G� 0 ( J/ KIND OF CASING From ��! Ft. to-.d—Ft. 0 (2 C R 1(3 V P G tr � From Ft. to Ft. From r Ft. to—!—Ft. s C K '7 `•� 4 Froin—Ft. to Ft. From Ft. to 4 P Ft. H/+iT46-Y`k) J! ICUu-:qg ,0rmn Ft. to Ft. From 4 f Ft. to Ft. � °� C.� °/t c"f `� r�oU�49 From Ft. to Ft, From '10 Ft. to Ft. From Ft. to Ft. From e ' Ft. to 35 Ft. W h<fi /64--J ;•` ^ J �' From Ft. to Ft. From_t Ft. to 1 O Ft. ,fw,v0 f 64.:4.✓ c"G From Ft. to Ft. From 71U Ft. to_tNi) Ft. -Ve'- e From Ft. to Ft. From Ft. to Ft 3 4)c t�®r .S From Ft. to Ft. From f7 o Ft. to c242 ? Ft. YlvUJ GevJt%L From Ft. to Ft. From Ft. to Ft. r ® From Ft. to Ft. From,-) , .3 Ft. to2a �- Ft. 3�`'�" I� -'�`=` From Ft. to Ft. From Ft. to Ft. ��'=F From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft._ From _Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to ' Ft. Froin—Ft. to Ft_ MISCL. INFORMATION: r) DRILLER'S NAME Received STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION APPLICATION FOR ON-SITE WATER AND SEWER SYSTEM APPROVAL I. GENERAL INFORMATION Source of Water and Containment (Check all that Apply) Type of Water Supply System Legal Description of the Location ❑ Well (Drilled or Driven) ❑ Surface (Identify) El Private E] None ❑Chlorination ❑ Roof Catchment ❑Other (identify) Public (Serves more than one Applicant N me �`/��� El Holding Holding Tank Applicant is: (Check one) ❑ Bank ❑Certified Installer No. j Well Data Owner/Builder Address (Street or P. O. Box) Is drainage directed away from or around the casing within a radius of 10 feet of the well casing? ❑ Yes ❑ No Type of Residencer� Totel No. of Bedrooms r • �•- �JC 3S Yield (If Available) - ❑5�Single Family Multi -Family City, State and Zip Code Gal/Min Gal/Min Telephone �P -vim G�WG,�.d-tL amiss Sewer Lines on Lot Absorption Area on Lot Closest Septic/Holding Tank. on Adjacent Lot Send Approval to: Closest Edge of an AbsorptiomArea on Adjacent Lot If toxic materials are stored on the property, including fuel tanks, paints, lubricants and other petroleum ❑ Applicant Other: (Give Name & Address) On Adjacent Lot G, L":r-- ILI V6A__ I /enc- - Qt G sj -7 11. WATER SUPPLY SYSTEM Source of Water and Containment (Check all that Apply) Type of Water Supply System Treatment of Water (Check all that Apply) ❑ Well (Drilled or Driven) ❑ Surface (Identify) El Private E] None ❑Chlorination ❑ Roof Catchment ❑Other (identify) Public (Serves more than one E] Filtration ❑Mineral Removal El Holding Holding Tank ❑Other: Well Data Is the Height of the Well Casing more than 12" above the Ground? ❑ Yes ❑ No Is a sanitary seal installed on the well casing? ❑ Yes ❑ No Is drainage directed away from or around the casing within a radius of 10 feet of the well casing? ❑ Yes ❑ No Date Drilled Depth of Well (Feet) Static Water Level (Feet) Yield (If Available) Pump Rate (If Available) Gal/Min Gal/Min Separation Distances from the Well Casing to each of the Following Sources of Contamination: Septic/Holding Tank on Lot Sewer Lines on Lot Absorption Area on Lot Closest Septic/Holding Tank. on Adjacent Lot Closest Sewer Lines on Adjacent Lot Closest Edge of an AbsorptiomArea on Adjacent Lot If toxic materials are stored on the property, including fuel tanks, paints, lubricants and other petroleum On Lot On Adjacent Lot based materials, pesticides, fungicides or herbicides, indicate distance from contaminants to well casing: Water Sample Taken by: Name Sampler Is: ❑ Buyer ❑ Engineer Address ❑ Banker ❑ Government Official Water Sample Results: ElAttach Copy Satisfactory - Date: ❑ Unsatisfactory - Date: Comments/Recommendations: 1 certify that the above information is correct: Signature Typed/Printed Name Title Date NOTE: Must be signed by aCertified Installer, Professional Engineer, Department of Environmental Conservation or the Owner/Builder III. WASTEWATER DISPOSAL Package Treatment: Septic Tank/Absorption System ❑ (Specify Brand Name or Process) Holding Tank -Capacity of Tank Where Waste is Disposed Frequency of Pumping ElSpecify: Septic Tank Outfall - Other (Specify): 10 Discharged To: �6,iQj�1i'(l...i�p-•C,�i ❑ (Outhouse, Incinerator, etc.) Name of Installer Date Installed C t Lam— 2'ti — OG El Certified Installer ❑ Other: Owner/Builder Type/Manufacturer � � {� fa-� /� No. x//11 Septic Tank Size (Gallons) Number of Compartments Soil Type or Rating 1 - Type Soil Absorption 11S 5System Dit�mfe siioonys/SSiizzee Soi /A�gsorptt,o�n System /tit / Utbt!"'1r {�J Type/Quantity Backfill Material used for Soil AbsorP ipnr5t3rry,s ,�. Tl.+�....>�sf� d Is�iU" "f _/ /��rrl'"r % r 3J �•- Percolation Test Results Percolat'on Test by: (Name) Minimum Ground Cover over Absorp- Minimum Ground Cover over Septic Tank Cleanout Pi es/Caps Installed on Septic Tank Cleanout Pipes/Caps Installed on Absorption System tion area/[� _f Feet /I, "� Feet Yes ❑ No 1 59 liir Yes ❑ .No SeparationLot Water Supply Source on Lot N earest Water Supply Source on ffacent �^ Nearest Body of Water 11-- Water Table/Bedrock ( f I Lot Line )L Distance to: `fp' Feet �� Feet ,,..--..,,I (��"TFeet / +Feet )Feet Comments/ Recommendations 9, �r7't ✓�-lN�� � c. -s7) /`•-y�A.. �— /' ^ ` I�-- I� 1 �i I certify that the above information is correct: Signature - Typed/Printed Name Title, Reg, /Cert. No., Inst. No. Date NOTE: Must be signed by a certified installer, professional engineer or DEC Staff. ❑ Existina Svstem Name of Installer- Date Installed ❑Certified Installer ❑ Other: ❑ Owner/Builder Type/Manufacturer Septic Tank Size (Gallons) Number of Compartments Soil Type or Rating Type Soil Absorption System - Dimensions/Size Soil Absorption System _ Type/Quantity Backfill Material used for Soil Absorption System Adequacy Test Results: ❑ Pass ❑ Fail Adequacy'r erformed B y:(Attach Copy of Report) Date Septic Tank Pumped (Attach Copy of Receipt) Minimum Ground Cover over Absorp- tion Area - Feet Minimum Ground Cover over Septic Tank Feet nout Pipes/Caps Installed on Sept Tank ❑ Ye No Cleanout Pipes/Caps Installed on Absorption System El Yes ❑ No Separation Distance to: Water Supply Source on Lot Feet Nearest Water Supply Source on Adjacent Lot Feet Nearest Body of Water Feat Water Table/Bedrock Feet Lot Line .Feet Comments/ Recommendations I certify that the above information is correct: Signature - Typed/Printed Name Title, Reg./Cert. No., Inst. No. Date NOTE: Must be signed by a professional engineer. SEAL Registered Professional Engineer CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION . PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of l t t�3�� Q � t Jtaa ��� public water system located ri in 2,2LA_!% Alaska, submitted in accordance with 18 AAC 80.100 by S �QV0.�nLA 09 _Q LLQ have been reviewed and are Aapproved. ❑ conditionally approved (see attached conditions). 6V TITLE DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contract order no. Approved by Date or descriptive reference) The "APPROVAL TO OPERATE" section must be completed before any water is made available to• the public. APPROVAL TO OPERATE The construction of the public water system was completed on (date). The system is hereby granted interim approval to operate for 90 days following the cpmpletion date. TITLE DATE As -built plans submitted during the interim approval period, or an inspection by the Department has -confirmed the system was constructed according to the approved plans. The system is hereby granted T inal approval to operate. BY TITLE DATE _ fM'•_ Municipality of Anchorage On -Site Water & Wastewater Program = (907) 343-7904 e CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-111-34 Expiration Date 1. GENERAL INFORMATION Complete legal description MARIE ESTATES S/D LOT 1 Location (site address) 24224 TEMPLE DRIVE CHUGIAK AK Current Property owners) THOMAS SCOTT Day phone 240-4211 Mailing address Real Estate Agent DAR WALDEN Day phone 865-6404 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex URMI ❑ Multiple Dwellings (Single Family and/or Duplex) TTAL 3. NUMBER OF BEDROOMS: g Al JG 1 € 2014. 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well i Individual On-site 0 individual Water Storage ❑ individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: — s Received by: Date:> COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ G" Date of Payment T1 d q -� r Receipt Number 0/�RZ4 COSA# OSLjglgz_o Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my sea] affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system 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. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reposed results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE r System #1 Approved for bedrooms System #2 Approved for Disapproved. Conditional approval for M bedrooms bedrooms, 337-6179 Date S/s�1°f Original Certificate Date: g -2 /- / q The Mdniclpglifj✓oLAfichorage Develop, emt 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. ATTCHMENTS: / COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev. 11105) OF'v VCrjri V�\'I y' ON-SITE with the following stipulations) WATER AND WASTEWATER o� ;,RnrzAlv1 Original Certificate Date: g -2 /- / q The Mdniclpglifj✓oLAfichorage Develop, emt 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. ATTCHMENTS: / COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev. 11105) 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: MARIE ESTATES S/D: LOT 1 Parcel ID: 051-111-34 A. WELL DATA *BASED ON SURROUNDING WELL LOGS Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) Date completed FEB 1983 Sanitary seal (Y/N) YES Total depth 225.25 ft. Cased to *40'+ ft. FROM WELL LOG Date of test 2/83 Static water level 170 ft. Well production 15 g.p.m. WATER SAMPLE RESULTS Coliform _ colonies/100 ml. Arsenic: N fl ug./L. B. SEPTIC/HOLDING TANK DATA Nitrate -7'(3 ( mg./L. Date of sample: 7/23/14 YES Wires properly protected (Y/N) YES Casing height (above ground) t2+ in. AT INSPECTION 7/23/14 173 ft. 6.39 g.p.m. Collected by: GFG I td. Tank Type/Material SEPTIC/STEEL Date installed 10/22/85 Tank size 1750 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 9/9/13 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 10/22/85 Soil rating (g.p.d./ft'or � 95 System type TRENCH Length 72 ft. Width 3 ft. Gravel below pipe 4 ft. Total depth *7.48 ft. Eff. absorption area 576 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 7/23/14 Results (Pass/Fail) PASS For 6 bedrooms Fluid depth in absorption field before test DRY in. Water added 915 gal. New depth DRY in. Elapsed Time: 0 min. Final fluid depth DRY in. Absorption rate >= 900+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off" level At'i . High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanknift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ Public sewer manhole/cleanout N/A Holding tank Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation *10'+ Water main N/A Water service line 12'±— Surface water 100'+ Driveway parking/vehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS DISTANCE OF SHOP WATER LINE TO SHOP SEWER LINE UNKOWN *DRAINFIELD MAY BE LOCATED UNDER STABLE G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date $Islr�1 (Rev. 11/05) Municipality of Anchorage Community Development Department ° Development Services Division S�FLTY � On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 141420 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 1 of Marie Estates subdivision. This inspection revealed a nitrate concentration of 7.81 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage • Development Services Department Building Safety Division < 1 e On -Site Water and Wastewater Program , T; 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING RE IsSU E Parcel I.D. 251-111-34 HAA # O 3 o O S� 3 Expiration Date: I O — q - 0,:3 - 1. GENERAL INFORMATION Complete legal description J.crJ. Made-EState-,,-vulAvieton Location (site address or directions) .24224Semple_Drive Current Property owner(s) _Keggie_Ball Day phone 2524.54.5 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 24224 Tern ple__Pri.Ye_Chugiak, AK_9956Z Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System -42jx_ 6) - Day phone Day phone TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A 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, 1 verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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 An anion Enainaadm3 Phone--Ez2-7T-Z.3---. Address X,Q Box 240773 Anchara0e..,6KR024 Engineer's Printed Name-lxtiohael_E. AndaEwnn. per- — Date .-7/8(2003 — '- 49th _ j�.MML&M E. RaERSDN w 5. DSD SIGNATURE {� Approved for -- G bedrooms. •••�'+i� ss� .rte•` Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: ��"" " Original Certificate Date: 7- -03 ANDERSON,SENGINEERING' - P.O BOX 240773 ' , c n ANCHORAGE; AK 99524 522-7773 a 522-6779 FAX March 10, 2003 Mr. Reggie Ball 24224 Temple Drive Chugiak, AK 99567 Subject: Lot 1, Marie Estates Subdivision Well and Septic System Inspection, Testing and Certification Certificate of Health Authority Approval Dear Reggie: On February 22, 2003, we completed the inspection and testing of the well and septic system on your property. A prior review of the records on file with the City indicated the septic system was constructed in 1985 and is composed of a 1,750 gallon septic tank and an absorption trench approximately 72' long with 4' of gravel beneath the distribution pipe. The trench was constructed in soils rated at 95 square feet per bedroom at the time of construction. This type soil is considered very good for the treatment and disposal of septic effluent. Our initial probe of the absorption trench indicated no standing water indicating all septic effluent had been absorbed into the underlying strata. We then pumped 974 gallons of water into the septic tank and monitored the rise in the absorption trench. No water was ever noted in the trench indicating it is capable C of absorbin at least 900 gallons of water in a 24-hour period as required for certificatio We did note, however, a minor blockage in the outlet piping of the septic tank, which caused water to back up. This blockage did not fully restrict water from flowing to the trench and all water pumped into the tank eventually reached the trench. The blockage may be attributable to an ice buildup. More likely, however, is that the pipe exiting the tank is beginning to plug with a thick layer of biological matter. The plugging is not critical at this time, but may eventually completely plug the line exiting the tank. This process could take many years. Simultaneously with the adequacy test we performed a flow test on the well and water system on the property. The log for the well states it was completed in July of 1983. It has a total depth of 226' with casing the entire depth. The log further states the well produces in excess of 15 gallons of water per minute. The well was run constantly for a total of 4 hours at an average rate of slightly more than 4.1 gallons per minute. During that time the water level in the well receded to a depth of 178.9' below the top of the casing. The static water level in the well was Lot 1, Marie Estates March 10, 2003 Page 2 o[2 initially measured at 175.3' Based on our test we conclude the well is producing more than 4.1 gallons per minute or more than 900 gallons per day which is required for certification. A water sample was taken from the system and tested for coliform, nitrates and other bacteria. No coliform or bacteria was detected and the nitrate content was well below the maximum allowable of 10 milligrams per liter. The water is therefore well within acceptable parameters and suitable for human consumption. Sincerely, Michael E. Anderson, P.E. Attachments 07/01/2003 MON 13:06 FAX 9012182013 ADN PRODUCTION' JLL-03-2003 11: 58 S&S ENGINEERING N3/003 907 694 1211 P.03/04 .SCS Re" 1033630001 All DatesMmes are Alaska Standard Time Ciimr Name S & S F -*&"ring pa to DaterrIme 07101=3 11:12 PrejrdPiamCIN Lot 1 Marie Estatss Cnnaeted 1?atdrUnG 06tlSY2003 ISAS tear Sample JD Lot 11%we Estates Received Daterrime 06!20!2003 10:40 btatris Drinlen Water Technical Director StephC* C. Bae Relraud By Sample Rem k= Cor:eeted Report Sample ID 1& Marie Estate&. Attow.ble we.t, Pmmerer Qstalifia& Results PQL Units Moa CmminerlD �� �� Bane 'nit Pause Department Nitr:i" 4.75 0.100 >`A.eu:obiology Zabomtcm7 Total Coliform 0 9 n g& EPA 300.0 D (<-10) 0&7=3 1$ cuV10Dml.5MIS=B A (<:,l) MMM3 KAP sR „r• ✓ u . Ci,V \. v: ' 'a t' � ..I � ••,, .:Sr. ..IA^ \:.t4 ;Cllr i i]� .Z1� .. �... �V.)_ Yc...• _ ,,{--:�';Y ����r 1 -� `Y! n'r� Y 4.j4 ,l je � r ,l"� VEL : +r....•.-•++ +/ ..'rte"- J, r _. f r N Yrs r 4 � r 1 a '�.+ �1 t �• �. r ( ��_ it t,� -.'l� t r� �.�d ,�-, y . a i ty r rc �'�r ��{� ,S tr . • .:.vy 1 V �' KM/ �. YJ'/�y.�+ � �T„\ ...P , r1r � Y, .v, r .•_! 'w'i.nA ✓ � �+v + �f Y 5 r .� 5} �� / j'S �l♦ a t cCj f �/ ' r)ii41 d„� _ri44 wy V v.a ,w �,.� ` r.ir ly �. 4 '"':�i .•t+ r '� . r.. i j .r i`t } i ,y, i '. a r+, r ' v1 �. a�ir•«i. • jy� '�G! :. C R 2w"x^ r' 1. 4t t �` ti i� t,. A. -r .!•�-.-Jl �__ ��.� tirii. �pk. .,l�ll _ ,I^ -....i... _ t Y. Mti V1,}� VE -TECH Engineering Technical Services Telephone: 907-357-6304 PO 873141, Wasilla, AK 99687 Date: February 22, 2003 Legal: Lot 1, Marie Estates Subd. Well Depth: 225.25 Ft. Static Level: 175.3 Ft. Type of System Tested: E Single -Family ❑ Multi -Family Type of Test Performed: r-1 Well Flow Onlv n Sentic Adenuacv Onlv Fa s cim ile: 907-357-6305 Project#: M0306 Inspector: T.L. Kimbrough # Bdrms. 6 ❑ Commercial = Both Time Flow Rate (gpm) Volume (gals) Cum. Volume (gals) Well Static Level (ft) ST Liquid Level (in) MT#1 Liquid Level (In) MT# 1 Delta (in) MT#2 Liquid MT#2 Level Delta (In) (In) Meter Comments Reading 10:05 175.3 47.5 0 NA 49859 StartTest :15 3.8 38 38 179.2 49.5 0 0 49897 :25 4.2 42 80 179.9 51 0 049939 :35 3.7 37 117 179.4 53 0 0 49976 :45 4.4 44 161 178.9 56 0 0 50020 :55 4.6 46 207 179.2 61 0 0 50066 11:05 3.3 33 240 178.4 63 0 0 50099 :35 3.9 117 357 178.9 63 0 0 50216 12:051 3.9 1 117 474 178.9 63 0 0 50333 1105 3.9 234 708 178.9 63 0 0 50567 14:051 4.4 1 266 1 974 1 178.9 1 63 1 0 0 50833 End Test I 4.1 I Average Gals/Min Well Flow Sentic Peak Load Test Calculations: (# bedrooms x 150 gaVbdrm + 10% _ # of gallons required for test) 6 x 150 = 900 + 90 = Rnrnvnnr 990 Gallons ADEC Code Compliance: Does septic tank need pumping? ❑ Yes a No ❑ NA Is well wire in conduit? 0 Yes ❑ No ❑ NA Is wells sanitary cap installed? 0 Yes ❑ No ❑ NA Elevation of well casing above ground level: 1 FL PWS ID # Is this system currently in compliance? If PublIC Water Supply ❑ Yes ❑ No Test Results: JJ,, ^^N Passed [3 Failed fir' Reviewed By: r/1 Date: NO Test results are Indicative of conditions at time of testing. Ve-Tech nor Michael E. Anderson make any representation to the future life of the systems nor any or the mechanical components of the systems. Time ST MT#1 MT#2 Static I Comments 14:05 63 NA NA 178.9 Start Recovery 14:35 51 176.1 End Recovery ADEC Code Compliance: Does septic tank need pumping? ❑ Yes a No ❑ NA Is well wire in conduit? 0 Yes ❑ No ❑ NA Is wells sanitary cap installed? 0 Yes ❑ No ❑ NA Elevation of well casing above ground level: 1 FL PWS ID # Is this system currently in compliance? If PublIC Water Supply ❑ Yes ❑ No Test Results: JJ,, ^^N Passed [3 Failed fir' Reviewed By: r/1 Date: NO Test results are Indicative of conditions at time of testing. Ve-Tech nor Michael E. Anderson make any representation to the future life of the systems nor any or the mechanical components of the systems. -M 60L Municipality of Anchorage 17- Development Services Department "' Building Safety Division _ On -Site Water and Wastewater Program 51111'TY 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051.111.34 HAA Expiration Date: co 1. GENERAL INFORMATION Complete legal description Lot 1, Marie Estates Subdivision Location (site address or directions) 24224 Temple Drive Current Property owner(s) Reg-gie Ball Day phone 257.4545 Mailing address Lending agency Mailing address 24224 Temple Drive Chuaiak, AK 99567 Day phone Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Six (6) 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A 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 affxed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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 Anderson Engineering Phone 522.7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 3/10/2003 .C) y 49th MICHAEL E. ANDERSON j 5. DSD SIGNATURE #�4'/ j,ND. 1E -43e+ r' N. •. Approved for _) bedrooms. I,0P�;�S�.(�1';.•� Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Wo ON-SITECM AND rn • •:" WASTEWa O • r-, OGRAM -715 J1J1111)F Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report X Well Flow Advisory Other By: Original Certificate Date: 3'" /R C) 3 (Rev. 12100) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 1. Marie Estates Subdivision Parcel ID: 051.11134 A. WELL DATA Well type E&M If A. B, or C provide PWSID # Date completed 21111983 Sanitary seal (YIN) Y Total depth,.,n¢,_fL Cased to j28 fL FROM WELL LOG Date of test 21111983 Static water level 170 fL Well production 15 G.P.M. WATER SAMPLE RESULTS: Coliform _,Q_colonies/100 mi. Nitrate 4.3 mgA. Well Log (YM) Y Wires properly protected (Y/N) Y_ Casing height (above ground) 24 n. AT INSPECTION 212212003 175.3 IL 4.1 9— p.m- Other bacteria —L colonies/100 ml. Date of sample: 212712003 Collected by. TLK B. SEPTIC/HOLDING TANK DATA Tank Type/Material SepticlSteel Date installed 1012211985 Tank size 1.750 gat. Number of Compartments j Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) jq High water alarm (Y/N) N Date of pumping 1011812002 Pumper JITs Pumnina C. ABSORPTION FIELD DATA Date Installed 10122/1985 Soil rating (g.p.d./ftz or f'e/bdrm) 95 SHBDRM System type Deep Trench Length 72 R Width 3 ft. Gravel below pipe 4 ft. Total depth Z IL Eft. absorption area ¢,Litz Monitoring tube Y Depression over field jY Date of adequacy test 212212003 Results (Pass/Fail) Pass For ¢ bedrooms Fluid depth in absorption field before test Q in. Water addedj 7A gal. New depth2 in. Elapsed Time: Q min. Final fluid depth Q in. Absorption rate; >= 900 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum Size in gallons "Pump ofr level at ! in. Cycles tested Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankllift station on lot , 100' On adjacent lots >100' Absorption field on lot >10T On adjacent lots >100' Public sewer main NIA Public sewer manhole/cleanout NIA Sewer /septic service line >25' Holding tank _NIA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >S Property line >T Absorption field >5' Water main NIA Water service line >10' Surface water >100' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line MV Building foundation >10' Water main >10' Water Service line >10' Surfacewater >100' Driveway, parking/vehide storage >25' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and Ja h review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. i•� _ • I K4• MICHA77 AHDfRSOu Engineer's Printed Name Michael E. Anderson. P.E. No. ce-.�e'. Date 311012003 •♦��i� PRricr�S�dJPi�'• HAA Fee $ 3 5 Date of Payment Receipt Number 3 zJ b;2:: (Rev. 12=) Waiver Fee $ _ Date of Payment Receipt Number in. March 10, 2003 Mr. Reggie Ball 24224 Temple Drive Chugiak, AK 99567 Subject: Lot 1, Marie Estates Subdivision Well and Septic System Inspection, Testing and Certification Certificate of Health Authority Approval Dear Reggie: On February 22, 2003, we completed the inspection and testing of the well and septic system on your property. A prior review of the records on file with the City indicated the septic system was constructed in 1985 and is composed of a 1,750 gallon septic tank and an absorption trench approximately 72' long with 4' of gravel beneath the distribution pipe. The trench was constructed in soils rated at 95 square feet per bedroom at the time of construction. This type soil is considered very good for the treatment and disposal of septic effluent. Our initial probe of the absorption trench indicated no standing water indicating all septic effluent had been absorbed into the underlying strata. We then pumped 974 gallons of water into the septic tank and monitored the rise in the absorption trench. No water was ever noted in the trench indicating it is capable of absorbing at least 900 gallons of water in a 24-hour period as required for certification. We did note, however, a minor blockage in the outlet piping of the septic tank, which caused water to back up. This blockage did not fully restrict water from flowing to the trench and all water pumped into the tank eventually reached the trench. The blockage may be attributable to an ice buildup. More likely, however, is that the pipe exiting the tank is beginning to plug with a thick layer of biological matter. The plugging is not critical at this time, but may eventually completely plug the line exiting the tank. This process could take many years. Simultaneously with the adequacy test we performed a flow test on the well and water system on the property. The log for the well states it was completed in July of 1983. It has a total depth of 226' with casing the entire depth. The log further states the well produces in excess of 15 gallons of water per minute. The well was run constantly for a total of 4 hours at an average rate of slightly more than 4.1 gallons per minute. During that time the water level in the well receded to a depth of 178.9' below the top of the casing. The static water level in the well was Lot 1, Made Estates March 10, 2003 Page 2 of 2 initially measured at 175.3' Based on our test we conclude the well is producing more than 4.1 gallons per minute or more than 900 gallons per day which is required for certification. A water sample was taken from the system and tested for coliform, nitrates and other bacteria. No coliform or bacteria was detected and the nitrate content was well below the maximum allowable of 10 milligrams per liter. The water is therefore well within acceptable parameters and suitable for human consumption. Sincerely, �4I Michael E. Anderson, P.E. Attachments J- J -U3; 3:31PM; CUE Environmental Services Inc. CT&E Ref.# 1031043001 Client Name Anderson Engineering Project Name/# Lot 1 Marine Est Bath Vanity Client Sample ID Lot 1 Marine Est Bath Vanity Matrix Drinking Water ;907 S515301 0 2/ 3 All DatesMmes are Alaska Standard Time Printed Date/Time 03/03/2003 14:19 Collected Date/Time 02/27/2003 9:40 Received DatefPime 02/27/2003 10:35 Technical Director Stephen C. e Released 13�Z11X Sample Remarks: Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Waters Department Nitrate -N 4.46 0.200 mg/L EPA 300.0 (<=10) Microbiology Laboratory Total Coliform 0 cal/100m1, SM18 922213 0 02/27/03 is 02/27/03 SKW C 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. # �! j / / / 3 4 HAA # 1K 9 0 / Sa 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Marie Estates Sub. Lot 1 T15N, R1W, Sec.10 Location (address or directions) ►I`V"O (b) Property owner H.U.D. Telephone: (home) Business 271-2792 Mailing Address 605 W. 4th Ave. suite -on -Anchorage, AK 99501 (c) Lending Institution Mailing Address (d) Real Estate Company and Agent The Realty Store Telephone Address 8040 ••. - Anchorage. •K 99502 Telephone 243-1022 (e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.) List contact person and day phone number below: Pick -yin by Fngi nP(-r 2. TYPE OF RESIDENCE Single -Family N Number of bedrooms 4 r 3. WATER SUPPLY Individual Well 12 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 R. Public ❑ Community ❑ Holding Tank ❑ Note: If community, well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 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, I verify that my investigation of this Health Authority Approval shows that the 6n -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 Eagle River Engineering Servs. Telephone Address P.O.B. 773294 Date 6. DHHS APPROVAL River, AK 99577 694-5195 eel y7 4'� �i '] oen •-:� �i 3 t 0 0 •u u 0000C o°eeu u. ° al eeeo oy°oop°.°v amo•o° •°••e °•e<+ Louis A. Butes am o G, ©�°e° CE -6736 08,3o Engita8 ®414`9oo°•eoao �. sv �b,z. ROfESS1'J,,�� Approvedouc for �`� bedrooms by r �"�" " ��` r0`� C Date Approved Disapproved Conditional Terms of Conditional Approval 1IITIC ef—YF_8 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 orderto satisfy certain federal and state requirements. Employees of DHHS do notconduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors oromissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 k N A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) VMUNICIPALIWOF Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 ANCHOR JJ -4744 ENVIRONMENTAL SERVICES DIVISION Legal Description: if't2 271989 T/s'.✓ R w !c /o ECFIVED Well Classification Pry �e- If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) % Date Completed 21e3Yield > , `/ Goy, Total Depth 3a.6 Cased to f Depth of Grouting Static Water Level /S'/ Pump Set At pN yN Casing Height Above Ground 4. 7 Sanitary Seal on Casing (Y/N) ,'� Electrical Wiring in Conduit (Y/N) % Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 11_/40tv ; On Adjoining Lots t/sy To Nearest Edge of Absorption Field on Lot j/av ; On Adjoining Lots 20/0 v To Nearest Public Sewer Line A11.4 To Nearest Public Sewer Cleanout/Manhole ^'�a To Nearest Sewer Service Line on Lot Water Sample Collected by 45 -r o -e— t ; Date y�y3�/85 Water Sample Test Results L Comments B. SEPTIC/HOLDING TANK DATA Date Installed i�;Fr Size 17r4 No. of Compartments -a Standpipes (Y/N) i Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) ek / Depression over Tank (Y/N) A.1 Date Last Pumped `//'Ry Pumping/Maintenance Contact on File (Y/N), for 10/-" Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) N/9 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well �'�oQ To Building Foundation io To Property Line do To Disposal Field 10 To Water Main/Service Line ;'`/o To Stream, Pond, Lake or Major Drainage Course y1� Comments 72-026 (Rev. 7/88) Front Page 1 of 2: C. RESORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed Length of Field %a Width of Field � � Depth of Field 7� Square Feet of Absortion Area 7 Gravel Bed Thickness ' / 40 d ' P t Y/N y Depression over Field (Y/N) Results of Last Adequacy Test J SEPARATION DISTANCE FROM ABSORPTION FIELD: yl-, — r To Water -Supply Well _ To Building Foundation Lot 411.4 To Water Main/Service Line ao Bio " ^e, A _ Statn pipes resen ( ) / Date of Last Adequacy Test %X4 !E& 5 r / J4 09a�, 6 .. H b AV ra t eG: To Property Line JO To Existing or Abandoned System on On Adjoining Lots ASO To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "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 certify that I have checked, verified, or conformed to all MOA and HAA gu!del irnes§J'h,effe:eton the date of this inspection. Signed �/� 177 coo ,7 n Eagle River Engineering Services Company F. ex ^ ::Eng".peer's Seal _?Date o o ^UU4�bl 95 MOA No. Receipt No. �S �/zz Date of Payment Amount: $ Z 7D `Q:n) Receipt No Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 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 264-4720 Application Date Z619 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 1 MAle',� fs ? S'/Q ®' (c) Location (address or directions) Applicant Name 1&4e -Ir �j7 Telephone: Home W68—'iSbB Business big 3��is Applicant AddresspoX Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) 4Aaii-the HAA to the following address: S & S ENGINEERING Telephone U0GLE1UVERr-A"9577-- 2. TYPE OF RESIDENCE Single -Family Multi-Familil/y ❑ Other 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 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 5. ENGINEERING FIRM PROVIDIN, INSPECTIONS, TESTS, FILE SEARCH, D:.. A AND INFORMATION 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 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 S & S ENGINEERING Telephone SR B 196X Address EAGLE RIVER, AK 99577 JUIN 2 4 1930 Date 6. DHEP APPROVAL ��'�-a.Lt" Date Approved for �'u'` bedrooms by Approved Disapproved Conditional Terms of Conditional Approval cJhep CAUTION /7A'(, The Muncipality 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. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA). HEALTH AUTHORITY APPROVAL (HAA) N 2 j 19W CHECKLIST - FEBRUARY 1984 284-4720 R E CJ. 1 y E D Legal Description: L,2'I r'its �� A. WELL DATA Well Classification 5•i'. If A, B, C, D.E.C. Approved (Y/N) f Well Log Present &N) Date Completed zzes Yield S 41ep'1 Total Depth 22 5 13 Is Cased to t3 N Depth of Grouting Static Water Level?o Pump Set At J'�^ Casing Height Above Ground 130 # Sanitary Seal on Casing P/N) — Electrical Wiring in Conduit ON) Separation Distances from Well Depression Around Wellhead (Y/rte To Septic/ mg Tank on Lot 1(0 1 { ; On Adjoining Lots 1 To Nearest Edge of Absorption Field on Lot — On Adjoining Lots To Nearest Public Sewer Line r3 p To Nearest Public Sewer Cleanout/Manhole P To Nearest Sewer Service Line on Lot Water Sample Collected by S• ; Date Water Sample Test Results 5ArZt Comments B. SEPTICA40EDNG TANK DATA Date Installed 12- 2'L -Bs Size 1-1SD No. of Compartments 7 - Standpipes Standpipes ON) Air -tight CapsOPN) Foundation Cleanout (VN) Depression over Tank (YAQ Date Last Pumped kke_'� Pumping/Maintenance Contract on File (Y/N) ; for tS Holding Tank High -Water Alarm (Y/N) Temporary; Holding Tank Permit (Y/N) Separation Distances from Septic/Hofd#Tg-Tank: zt To Water -Supply Well I b I 1 To Building Foundation To Property Line /O It To Disposal Field !0 J To Water Main/Service Line /D t Course Comments Page 1 of 2 72-026(11/84) To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata cis Type of System Design Tt�ta Date Installed 1 c> Length of Field 7 2 / r Width of Field 3 Depth of Field I Gravel Bed Thickness 1+ Square Feet of Absorption Area ��(o Standpipes Present (ON) ` Depression over Field (Y/0 Date of 4a§t Adequacy Test fJ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well b5 ' To Building Foundation Lot Z A To Water Main/Service Line n �� To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION To Property Line 101+ To Existing or Abandoned System on On Adjoining Lots 3n �-" To�Cyutbank (if present) A Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify t� e� or conformed to all MQ�,ancH(i guidelines in effect on the date of this inspection. Signed SR n Sow Date JJ IIVV QQ C3 86 CompanFAG E RIVER, AK9957 MOA No. �S—Gtr 3 Receipt No. : Of A`$�i � �Q� ii iiiBiii�.ia Date of Payment ' � � __ � :. Q }M '� rytsA, 6 eer'�,. Amount: �� r �� % g Page 2 of 2 72-026 (1 1184) I Tb -r r E bu F L S N p DEPT. OF ENVIRONMEr4TAL EONSEBVATION Telephone: (907) Address: Anchorage Western District Office 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 Robert A. Shafer S & S Engineering SRB 196X Eagle River, AK 99577 Dear Mr. Shafer: 274-2.533 July 31, 1984 MUNICIPALITY OF ANCHORAG DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Subject: Lot 1, Marie Estates S/D, Wastewater Approval (8521 -DA -018) AUG 6 19R RECENE® We have reviewed the plans and specifications for the subject project. The plans are approved, conditioned on adherence to the following items: 1. screened rock back fill in deep and wide trenches (3/4" - 311 ). 2. screened rock back fill in absorption bed (3/4" - 1 1/2"). 3. sufficient area plotted on as -built for repiacemert system. This letter constitutes the permit required by A.S. 46.03.720(a) for plan approval of sewerage systems. It should be remembered that final approval will necessitate the submission of Engineer As Built Plans to include photographs as indicated on page 13 of enclosure. This will consequently mandate that a professional engineer conduct basic inspection of this project so as to be able to sign off on as built plans. Arrangement for this inspection work is the responsibility of the developer. JFH/dd Enclosure cc: Robbie Robinson (MOA) As Built Plans submitted by Sincerely, James F. Hayden Environmental Field Officer Date Approved by Date