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HomeMy WebLinkAboutTUSTAMENA TERRACE LT 6Tustarnena Terrace Lot 6 #017-381-12 Municipality of Anchorage Page of V, DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: �I� �i201� PID Number: d t--1 30 f IZ— Name: Wastewater System: ❑ New pgrade Address: �Lo I � rJ AKc.1�tL- I_rJ . q9�� I (o ABSORPTION FIELD Phone: X22 - 2 No. of Bedrooms: eep Trench - Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: �/ LI :/_ �GPD/S . Ft. Total Depth from original grade / 1 G Lot: Block: Depth to pipe bottom from original grade( Gravel depth beneath pipe / �u��aubdivision: —7-a©' Ft. 0 Ft. Township: Township: Ra nge: Section: Fill added above original grade: , Ft. Gravel length: __ / // wZ'� Ft. WELL: ❑ New ❑ Upgrade GraveY depM+(Q71 f>(�i / Number of lines: Distance between lines: `�� FL I Ft. Classi ation (Private, A,B,C): Total Depth: Cased To: Total absorption area: m�ate�rial: eIO . \J vTJ Ft. Ft. tdCOSQ. Ft. `Pipe -r, ' T-7 Driller: Date Drilled: Static Water Level: Installer: - Date installed ^:- �/ p Ft. �iOlk: 7" Yield: Pump Set at: Casing Height Above Ground: II TANK GPM Ft. Ft. �/X I STi f�-i SEPARATION DISTANCES ><5eptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Well I�j,' / I' __ Z�1T Material: Number of Compartments: Watere toa'-'- ICY�`t — — — LIFT STATION Lot 3�r �r Size in gallons: Manufacturer: Line Foundation Id/L(F.y "Pump on" level at: ump off" level at: Th water alarm at: Curtain Pump Mak odel Electrical Inspections performed by: Drain Remarks: BENCH MARK IV 'C1GTB^'t� c�T � \ IfJ Location and De�scric�I JlJ1- C/i�l� Assumed Elevation: I� o ENG, RR SEAL OF 44 �y ` "491 ° S & S ENGINEERING Inspections performed by: 17034 Eagle River Loop Road, MIDW: 1 t—IALliln Eagle River, Alaska 995772nd I Oillt. °ROG J _R�HAFER Department of Health and Human Services approval 1 N0.9 15 ®4i 00 Reviewed and approved by: ��+�� Date: / i pR0FESSI011P\��®w� 72-013 (1/91) MOA 25 Permit No. Page Z of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: �ueTPcrl 0. , TC2� T l,pr (o PID No.: ot-"3a(IZ 17, _1 1 72-013 A (2/81) MOA 25 l o� NIL ER J�SHAFER No. 15 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920140 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:KING DAVID W OWNER ADDRESS:5615 NAKNEK LN ANCHORAGE, AK 99516 PARCEL ID:01738112 LEGAL DESCRIPTION: TUSTAMENA TERRACE LT 6 LOT SIZE: 14400 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 6/18/92 EXPIRATION DATE: 6/18/93 --IS-9a Ic:� 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: VERIFY SEPTIC TANK INTEGRITY. PUMP OLD TRENCH PRIOR TO EXCAVATION AS NEW TRENCH WILL BE CLOSER THAN 10'. RECEIVED B ISSUED BY: Y; DATE: DATE :���/z_ Municipality ®f Anchorage r,L*o) Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 June 19, 1992 Roger Shafer, P. E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 A Subject: Waiver Request for Lot 6 Tustamena Terrace Subdivision Waiver Request #WR920028, PID #017-381-12 Dear Mr. Shafer: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 5 foot to the southwest property line. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, `I - Daniel N. Bolles On-site Services ljm#7 Concur: '4 4 ohn Smi , P. E. Program Manager On-site Services I MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR#1,12c17 n0_aS PID# 017-381-12 HA# Permit # Date Received: June 15, 1992 Legal Description: Lot 6 Tustamena Terrace Subdivision Engineer: Roger Shafer, P. E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River 99577 Applicant: David Kinq Waiver Requested: Lot line waiver - 5 foot to southwest property line 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: �/k_*�_ Waiver is NOT Granted: List Conditions orpJjjeasons for above: Rec #: 23775 Amount: $ 70.00 Date Paid: June 15, 1992 It June 12, 1992 HEALTH AUTHORITY Municipality of Anchorage APPROVALS DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 SEWER & WATER MAIN EXTENSIONS REFERENCE: Tustamena Subdivision, Lot 6 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 SEWER&WATER Request you issue a permit to upgrade the septic system INSPECTION serving the referenced property. An adequacy test was performed on the existing system and the absorption capacity of the existing trench was found to be ENGINEERING STUDIES inadequate.AND REPORTS A test hole was excavated and a percolation test performed in the area of the proposed upgrade. The ground water monitoring tube within the test hole has been checked and found to be WELL INSPECTION & FLOW TEST drY • Attached is an upgrade design which shows the location of the proposed trench. SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN Due to the limited amount of room on the property for a septic upgrade outside of protective well radii and away from existing and abandoned septic systems, :we're requesting a 5 foot property line waiver to the Southwest property line. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic upgrade. If you have any questions or require additional information for your review, please contact us. Sincerely, ROGER J. SHA ER, P.E. RJS/LSU/lsu J� !16 �60 i����li lv�/G�y2 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 X' = 20' UPGRADE p SCALE 0 TRACT A-1 N r a r Oa cmi m z y v� °o Q) y P � y cn •a � n r �1 r 0 0 0o 2 DECK v C n LU O o to (� O I Cn 0)poro Z o I C Oma u � m Z m m DFGy �• 41 mk o • �� n y b r cn O A C x Ay r bx O O, n y O O �i (° y O a a i 60' rz �zo��rri o ti m ®m g. °�� m : NAl�9VEK LANE � ���v e Municipality of Anchorage DEPARTMENT OF HEALTH 8, HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: VISTA ILIAL CS7/-17E /L�U�N �/f%CUIL DATE PEI LEGAL DESCRIPTION: L—OT O.F I U S7AAtF" } S/yTownship, Range, Section: SLOPE SITE PLAN 10 WAS GROUND WATER ENCOUNTERED? 11 b I L IF YES, AT WHAT O ' DEPTH? P 12 I E Depth to Water After VV b 13 Monitoring? Date: 14 -I 0 15 I ( f 16- 17 617 61 IRWNE� 19 admg Date Gross er DEPTH Net Drop I -92 au S A: 06 )0 rij�I (FEET) 10 11 025 2,.55 1 �of &I 'os 1 n at5/s ?K I 2 J b• 3 4 o 5 0 6- 7- 8- 8 6 9 10 WAS GROUND WATER ENCOUNTERED? 11 b I L IF YES, AT WHAT O ' DEPTH? P 12 I E Depth to Water After VV b 13 Monitoring? Date: 14 -I 0 15 I ( f 16- 17 617 61 IRWNE� 19 admg Date Gross er Net Depth to Time MIN Water Net Drop I -92 au S A: 06 )0 rij�I �j 13S 10 11 025 2,.55 Io �• a &I 'os 1 n at5/s ?K 20 -{ I C / 6 r' cul PERCOLATION RATE J3 (minutes/inch) PERG HOLE DIAMETER q r TEST RUIN BETWEEN L FT AND g FT COMMENTS PERFORMED BY: S & S ENGINEERING I CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River Loop Road No. 204 �P^ ACCORDANCE WITH kTIkV PN� IgWyGUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 0*1 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME E'A N A (zo AJ S'RUG. TI o _Aj F,?i`LS -1aCQ -%-i-z, KNEW EJUPGRADE MAILING ADDRESS •36.05 YJ kcri� 66 c o .-E K -c�3 LEGAL DESCRIPTION L t rk s Ti /tu N 7-E c L -7-1 z til R 3 w sEc, 2 7. LOCATION N - A) I -5 f NO. OF BEDROOMS 3 LJ Y DISTANCE Well Absorption area Dwelling i a PERMIT NO. (- .7 1- 2 N< Manufacturer c 6-6 Material srEc� No, of compartments i Liq. capacity in gal ons (� 0 IF HOMEMADE: Inside length Width Liquid depth C7 z DISTANCE TO: Well Dwelling - PERMIT NO. O E < Manufacturer Material Liquid capacity in gallons 0 wy DISTANCE TO: Well ( Foundation / Z6 Nearest lot lin f �� PEM NO. © 74 � Z m F_� No. of lines Len th of each line Total length of inep 1 Trench w'idjh f Distance betwe n lines �k ® Top of file to finish grade ( s Material beneath file ( S Total effective a sorption area �66 w Length Width Depth PERMIT NO. I F- as w Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J J Clas Depth Driller Distance to lot line PERMIT NO. ' w � DISTANCE TO: Building foundation Sewer lin ` Septic tank .,f `` Absorption meals) OTHER PIPE MATERIALS C -Sr --k- 03403 SOIL TEST RATING , Iqo , 2 L INSTALLER t L) AJ C x 41-- ► c> Re R��E��t�tAR KS �.��/ ��� OL4, -� R Z1LA-PciL i :/5 8 1N�UL1�'tiOnf tfoeR 'TA&) ri� D c Ecl'C� ' � iso 6A'T ' Mo < 4 -oz 3 3c> c N 6 1 S APPROVED DATE LEGAL 3 (vim /O/231g� L� �itN�47usat� P'vATE/iR. 7r2rug31*JSCc2 i Pwl LJ PJ 1` .����� �� ��//����� `-' " �° � DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION , 825 L STREET, ANCHORAGE, AK 99501 4720 264 - - / PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: C35�4_L�3 I -FE= E3E=&1E=1FT go ���L- F"EnFAPI 3E I- CONTACT PHONE: 840741 HAND WRITTEN 0O/31/84 EA NA CONST" CO. 3605 ARCTIC #466 ANCHORAGE, AK 99503 333-2232 LEGAL DESCRIP: SUBDIVISION: TUSTAMENA TERRACE SECTION: 27 TOWNSHIP: 12N LOT SIZE: 14400 (SQ"FT^ OR ACRES) , |OT: 6 BLOCK: NA RANGE: 3W I certify that- ! I. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and.the State of Alash^ 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit" 3^ I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot" � IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING.CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS^BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL.WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED APPLICANT: " CO" ISSUED BY DATE: ___ 7--h_--^---- DATE. -`-~-~~~~^----- ` �� � `^ /�,°^',-.�,,/ -/ �/-' ' / SOILS LOG MUNICIPALITY OF ANCHORAGE +.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 /� �j 7(/ /� SOILS LOG - PERCOLATION TEST PERFORMED FOR:/ /7 1'✓/4 ` p%�,S �.P(���Tl C�l7 DATE PERFORMED: LEGAL DESCRIPTION: LOf (o T_u SfA M Ftp A 'TE r_r_AC_F__ TO N e` 0 Sec -'�`J SLOPE SITE PLAN 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Gm" Si li.o Ed 060 3eou.)n, dfzjL>, d4. F_ SII'I QRLWF.1 WAS GROUND WATER S Q2Ou7ln ENCOUNTERED? A)U OL P E IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN COMMENTS SnJI_log PERFORMED BY:. -S-0" CERTIFIED BY: 72-008 (6/79) (minutes/inch) FT AND FT DATE: 02,&-L PERFORMED FOR: LEGAL DESCRIPTI 1 2 3 ':4 5 6 7 PERF RMED 72-008 (6/79) /--. X SOILS LOG' MUNICIPALITY OF ANCHORAGE PEC t4T1ON DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 7ESTS7 \� 825 L. Street, Anchorage, Alaska 99501 264.4720 r �/ SOILS LOG — PERCOLATION TEST ((l DATE PERFORMED: _O�_/% r_ -e_ SLOPE WAS GROUND WATER No ENCOUNTERED? IF YES, AT WHAT DEPTH? 69 PLAN y„ Reading Date Gross Time Net Time Depth to Water Net Drop 0/ 3:20 "- 3 7Z -' PERCOLATION .. :i•1. CERTIFIED SY'}�� ALASKA 6I01ROWnTAL COnTROL RUNS, InC. Engineering & enuironmenlal Studies February 27, 1985 Department of Health and Environmental Protecction 825 L Street Anchorage, Alaska 99501 Subject: Lot 6 Tustamena Terrace In October 1984 AECS inspected the on-site septic installation on the subject property. During the first inspection, a second test hole was excavated to 17 feet (attached). The purpose of this test hole was to verify 4 foot separation from ground water. The system was installed in the strata (8-13') reflected in the 5/31/84 soils log and perc. Hopefully this clarifies the as -built on the subject property, and the modification of permit. The depth of the installation was 13 feet, with 5 feet of gravel below the perforated pipe. If this office can be of further assistance, please contact us at 561-5040. Sincerely, L. D. Montgomery Approved by: 1200 West 33rd Auenue, Suite B • Anchorage, Alaska 99503 • (907) 561-5040 s WELL LOG m� t�Cv void Lot 6 Date Drilledt a-an-tarBlk. TU$C-Amena Terrace. Static hater Level mg feet Gallons Per Minute -Draw Down N/A feet Total Feet of L%sin& 240 Type Material Drilleds` 0 feet to 16 Gravel w/clay 16 feet' tO' 48 Sand M�A7C 148 feet to 69 t S nd gravel ' FAV iq -OP,�M 69 feet t0 Sand � P 1�PY0, R.T� 86 feet to 120 Sand w/gravel 120 feet to 135 cemented rock 135 feet to 137 Sand, gravel 137 feet to 150 Damp clay 150 feet t2158 Clay,'. g�ravei Sand 1158 feet to 360 Boulders ( 160 ft.' to 164 _ ft. water 1 gpm.) _`.164 feet to *190 Cement6d rocks Hefty Drilling _ 190, feet to 495, Rocks, clay _ S.R.A. Box 1553 H 195 feet to'220 water,'at;2 gpm. Anchorage 220 feet"to 240 Tight gravel 99507 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 l.D.it Q/7•-3�'��l Z HAA# 1+R q�Loogz 1. GENERAL INFORMATION Complete legal description Lot 6; Tubtamena.Teanace Subdivision Location (site address or directions) 5615 Nahnek Property owner Dave King C/0 Vi6ta REak Estate Day phone 562-6464 Mailing address 4247 "B" StAeet Anehoqaap, AK 99503 Lending agency Mailing add Day phone Agent Kevin Taypon/VIeTA RFAI FSTATF Day phone 562-6464 Address 4241 "B" S.tAeet Anchonagg AK 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XXX NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC 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 furtherverify 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 17034 Eagle 6. DHHS SIGNATURE Approved for 2 bedrooms. 0 Disapproved. Conditional approval for Additional Comments 204 Phone Zy s� „ . annro.+o s�rr s bedrooms, with the following stipulations: 111717 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 orderto 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-M(Rv."1) Back MOAN21 HEALTHAUTHORITY APPROVALS SEWER& WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANOREPORTS WELL INSPECTION & FLOW TEST SITEPLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTE WATER DISPOSALSYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 August 10, 1994 FAX 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage Ak 99519-6650 REFERENCE: Lot 6, Tustamena Terrace S/D Conditional requirements have been met for the referenced property. Please issue a permanent Health Authority Approval at this time. Contact us if you require further information. S A—SHAFER, P.E. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577. Lending agency J, Lending agency 6211�ayphone Mailing address Agent Kevin Taylor/ VISTA REAL ESTATE „' bay !phone. 562-6464 Address 3000 "C" Street Suite 101 •Anchorage; ,r> AK `99503••= Unless otherwise requested, HAA will be held for pickup: 2. NUMBER OF BEDROOMS: ` J 3. TYPE -OF WATER'SUPPLY: Individual well X'= 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) Front MOA #21 e 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 S'R s'Entr,rti —Phone 17034 f;iigle R Address Loop old No. 2ad k�a1 as � Engineer's signature Date A. �8 fl'f i11t11 V ,oni. •:W411 (' 1t - _ _.' Y ♦a of A(/ (ry A � REQUEST A CONDITIONAL HEALTH AUTHORITY APPROVAL UNDE� THE STIPULA THAT THE DEPRESSION OVER THE LEACHFIELD BE FILLED IN' AND FINE..G[tADD BY SPRING 194 6. ` 'DHHS SIGNATURE Approved" >for bedrooms, Disapproved. 'Conditional approval for 3 bedrooms, with the following stipulations: �' � ' l�K�ur' Accc�vntr IMUS'[' f36 L�'nAUSHt�t7 "R� Cot.�R CST Oi fl�cl�G�t�e3srovl at�2 C�t�. IUokK wtus� 40 P oaMav� B�� DI-f74S co)L7FreD Gotm4cmQ_ lay. �l N4 - Additional Comments By; 3O t 12`F c7l 1— Date '3 h o q ¢ 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 andiheir lending institutions in orderto 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. . .� Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: / UT I(ASTAMA Parcell.D. Di��g(lo2 A. Well Data Well type �� I I1 FATE If A, B, or C, attach ADEC letter. ADEC water system numb�er// fQZq Log present N) �� Date completed R>' 0-8y Driller rYEcTY /J 121 LC IJU� Total depth 2L46, Cased to x1-16 Casing height f 8 r Sanitary seal (YIN) EF -5 Wires properly protected (IDN) //55 FROM WELL LOG Date of test Static water level Well flow g.p.m Pump levelt ��o SEPARATION DISTANCES FROM WELL TO: Septic/he" tank on lot Absorption field on lot AT INSPECTION �f-102 �0 2 138 g•p• baa m boa t f� On adjacent lots On adjacent lots Public sewer main PJYA Public sewer manhole/cleanout 014 Sewer service line 9,S:4 -/I Petroleum tank m)E >` uoWN WATER SAMPLE RESULTS: m Coliform (D Nitrate 1,- " Other bacteria Date of sample: I 10 ' 9 `-1 Collected by: S � 5 CYU&INFE; IfJG B. SEPTIC/FtCUMM TANK DATA Date installed 10 -a_6: -BH Tank size J.bcc� (SAC_ Compartments a Cleanouts ((}'N) YF -5 Foundation cleanout (YEN) Depression (Y/10 () High water alarm (YO 6J A- Alarm tested (Y/N) l J�-f Date of pumping 0111/ 94 Pumper A N6i/ E SElwtci=S SEPARATION DISTANCES FROM SEPTIC/FlGMMG TANK TO: Weil(s) on lot IO0 On adjacent lots Foundation /D, To property line T3f Absorption field r Water main/service line AS f Surface water/drainage 100 r4- 72-026 (3193)' Front - CONTINUED ON BACK PAGE C. LIFT STATION �t4 Date installed Size in Vent(Y/N) High water alarm level Meets MOA electrical codes "Pump on" level at SEPARATION DJSTANCE FROM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA On adjacent lots Manhole/Access tested off' Level at Surface water Date installed (-� �i-� 2 Soil rating (GPD/Ft') D. cls `�P°�s(f System type Length 6x.51 Width 3 Gravel thickness Y Total depth �a Total absorption area OW': -r Cleanout present (Y'N) Depression over field (DN) Date of adequacy test A11A - Ove/ Svs • Results / (pass/fail) for Bedrooms Water level in absorption field before test N�%� /,�I/IEAfter test ` r Peroxide treatment (past 12 months) (Y(Ii}ij 6 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot [ On adjacent lots ( (Y.) V Property line S To building foundation To existing or abandoned system on lot 3 On adjacent lots Cutbank N 1 Water main/service line o25 Surface water `r�c5 k Driveway, parking/vehicle storage area n / Curtain drain I o"O E_ KNC(oo �uESz F)- eoNpIWONAr- Sccctr TRA -7( 7-#-F— -PcRkESSrWr3 ovFn 7fE E. ENGINEER'S CERTIFICATION Tp:,-( gF R(_(_ED .LN r 1 e G2Roev v/17H Cc,EA" HC.C. WORt f�6 Co np er by SPRuw(r 151x( I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature &5 Date Eagle River, Alas a 99577 HAA Fee $ �&O rUL7 Date of Payment z a Receipt Number L4 72 _ 72-026 (3193)` Back Waiver Fee $ Date of Payment Receipt Number 02/15/94 12:19 CT&F ENVIRONMENTAL LRB SERVICES p; S89 D02 SINCE �9GP CT&f Ref . # Client Sample Matrix Client Name Ordered Oy Project Name Project# PWSID Commercial Testing & Engineering Co. Environmental Laboratory Services 94.0664-i REPORT of ANALYSIS ID :L6 TL15TAMENA TERRACE S/D :WATM :S & 5 ENGINEERING :R. SHAFER :UA Sample Remarkst ROUTINE' Parameter Nitrate -N 5633 B Street Anchorage; AK 99518.1600 Tel: (907) 562-2343 Fax: (907)661.5301 WORK Order Printed Date Collected Date Received Crate Technical Director Released ny :75779 t02/15/94 @ 10:48 hrs. :02/10/94 @ 17:10 bra. :02,11/94 @ 11:45 hrs. S EI' C EDE Z COLLECTED BY- S.5.�`— QC Allowable Ext. Anal Results Qua.1 Units Method Limits Date Date Init 1.70 mg/L EPA 353.2/300.0 10 02/14 LLH * See Special Instructions Above - UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical, quantification limit. LT = Less Than t' D = Secondary dilution.! GT =Greater Than MamGer of the SGS Group (Soci4td (38n&ate de surveillance) ENViRpNMENTAL FACILITIS-S tN i,LASKA, COLORADO, FLOW'DA, A, i_ i.:(:) -hRY1.AND, NEVJJF.RSEY, ONIC. UTAH, WEST L'--•%.INIA 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. # 1. GENERAL INFORMATION Complete legal description U 2 HAA If Wfl�%gQ0-ALA Lot 6; T"tamena Te trace Subdivision; Location (site address or directions) 5615 Naknek Lane Property owner David King Day phone Mailing address 5615 Naknek Lane Anchoaage, A aska 99516 Lending agency Day phone Mailing address Agent Kevin rayzrn VISTA REAL ESTATE Day phone 562-6464 3000 C Stkeet #101 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 N 3. TYPE OF WATER SUPPLY: XX 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: Individual on-site xx Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 95 ENGINEER+NG Phone 17034 Eagle River Loop Road No. 204 Address �,,, —;� _- Engineer's signature 6. DHHS SIGNATURE XApproved for Disapproved. 0 Conditional approval for Additional Comments edrooms. HITIC Date 0' 3-9Z bedrooms, with the following stipulations: Date F/— _ - �Y 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 orderto 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. 7M25(ROV. 1/91) Back MOA 021 Municipality of Anchorage - Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LT (z,f TLtSr.4/V)E/y4 TF7 nAca Parcel I.D. ® / 1 3 �7 / / -,7— A. A. WELL DATA Well type WA -75. If A, B, or C, attach ADEC letter. ADEC water system numbe��ryyJ/A Log present6N) YES Date completed -�� Driller HFFT(/ DoLt-im, Total depth a�lC� r Cased to o2YU Casing height Sanitary seal &N) YE S, Wires properly protected &N) Yes FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/1g tank on lot loo Absorption field on lot Public Public sewer main ��/� Public sewer manhole/cleanout 7 Sewer service line Petroleum tank /UU/ui_ hNOwn� WATER SAMPLE RESULTS: m AT INSPECTION t�/� Other bacteria Date of sample: -A - CO- Collected by: S4- S Evr,/Nr�,z 6r 3 > z 138 , t;> D ~< h"rd C. > n o g.p.m. g.p.m.`�, < n co T r Z., On adjacent lots too/- ooAOn Onadjacent lots 1001 /- Public Public sewer main ��/� Public sewer manhole/cleanout 7 Sewer service line Petroleum tank /UU/ui_ hNOwn� WATER SAMPLE RESULTS: B. SEPTIC/HaMM TANK DATA Date installed /0 gy Tank size /000 GAc- Compartments 2 Cleanouts &N) TW(' Foundation cleanout 6b(N) V65 Depression (Y/© No High water alarm (Y/(I 01pr Alarm tested (Y/6NA Date of pumping 2 Pumper At- Howls '�—aUIcos SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 16o On adjacent lots a Q t! Foundation /0 r To property line b3` Absorption field 3 / Water main/service line as 'I- Surface fi Surface water/drainage J()() 72-026 (Rev. 7/91) Front CONTINUEDONBACK PAGE Coliform U Nitrate t�/� Other bacteria Date of sample: -A - CO- Collected by: S4- S Evr,/Nr�,z 6r B. SEPTIC/HaMM TANK DATA Date installed /0 gy Tank size /000 GAc- Compartments 2 Cleanouts &N) TW(' Foundation cleanout 6b(N) V65 Depression (Y/© No High water alarm (Y/(I 01pr Alarm tested (Y/6NA Date of pumping 2 Pumper At- Howls '�—aUIcos SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 16o On adjacent lots a Q t! Foundation /0 r To property line b3` Absorption field 3 / Water main/service line as 'I- Surface fi Surface water/drainage J()() 72-026 (Rev. 7/91) Front CONTINUEDONBACK PAGE C. LIFT STATION � I Date installed 14 Manufacturer Size in gallon Vent(Y/N) ��p� High water alarm level Meets MOA electrical codes (Y on" level at Manhole/Access (Y, SEPARATION DISTANCE FROM LIFT STATION TO: On adjacent lots C). ABSORPTION FIELD DATA "Pump off" level at Cycles tested Surface Date installed ?`/c/-92 Soil rating o/N5 GP[MSY System type7kmH Length 6x15 Width 3 Gravel thickness 6 / Total depth Total absorption area 16100 SF Cleanouts present &N) Y -E-7 S— Depression over field (Y& jyo Date of adequacy test L F(Gy Sys. Results (pass/fail) L/6 r &F -W Sys7F/v for _ bedrooms Peroxide treatment (past 12 months) (Y/6 Nl� SEPARATION DISTANCE FROM ABSORPTION FIELD TO: If yes, give date N Well on lot On adjacent lots X06 /� —Property line To building foundation 4-� To existing or abandoned system on lot _ 3-- tv Onadjacentlots as a- Cutbank )UTA Watermain/service line �5 ' Surface water I ( (YJ Driveway, parking/vehicle storage area Y Curtain drain ONCi KrvawN E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effectgrbtpe data of this inspection. Signature s 1C S CNGINEr-KING 1 0.611184 9 / ; CaUlo River, Alaska 99577 09.0099 �� a; a r Engineer's Name at 666.� 66 a a6 60. �J - �J� �� mRS RO(3 ., J. „RAFEfi /� Date ®„;P,e6 No. 15 .•°-6a`us ' U U HAA Fee $ 7�� r, Waiver Fee: $ Date of Payment v -7 Date of Payment Receipt Number C 3 i / )- 3 J Yb Receipt Number 72-026 (Rev. 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABOPMTORY A DIVISION OF COMMERCIAL. TESTING & ENGINEERING CO. 5d'33 N 55 ^nEET AN-W)RAGE; ALASKA 9951!3 TEI-EPHONE (207) 562-2.3,13 FAX: (:107) 501-OUVI AXALI315 RESULTS fot INVOICE 4 56964 Cho, -,lab W A 92.3979 Sample I Matrix! WATER Client Sample ID L6 TU5TANENI TTRRACR Client Name :S & s ENGTNEERINU PNBID : UA Client Acct :9NSENGP Collected JUL 20 92 1 1':30 hre. BPot PDI :NONE RECRIVID Received ' JUL 29 97, 1 14:15 hza. Reqt PtesaiTed with : AS REQUIRED Otdotad By ;R. SWIR Analysis Completed . JUL 31 92 Sand Reports to: Labozetory Supero 0r._@T;P IN C. HE QS & s ENGINEERING Released By :��.! Y ................. ••`............_........ ...=RY,... ... .. `..... Method ..,............•••.•..... amter ........Limits ------------------ ----- ------------ . .... NITRATE -N 1.3 mD/l EPA 353.2 10 sample Reteatke : ....................................................................__......................... ,.................. I .................. 1 Tests Performed Sao Special Inttrucf1cre Abeva 111-Unavaila.ble MD. None Detected `" See Sanple Remarks Abova NA- Net Analyzad LT•Loss Than. GT.Greatat Than ROt!"11N3 BAMP'.B COLLECTED BY; J.W. r.W)8GBNIeriNt.r of the SGS C;rcup (SQ,416 G6R9r51e ee 5urvelllenre) _ 4 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH f DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ARFLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE M. a= .,fora tion Application Date `�� S t r a 'Z 9i" �s ription (include lot, block, subdivision, section, township, range) T 72 Z2 iL240 jgc� -2 7 L . 'R, _.kation (address or directions) _ 'II 35 7z -4L - Applicants Name j of It�_� 2�JAJ Telephone - Home Business : Applicants Address 3 607tz& Applicant 'kc� 9 ,ti..pp is (check one) Lending Institution Owner/builder Buyer E::l ; Other [:�] (explain); %�� (d) Lending Institution EIL PES! -Y -i._ l�PWJ1< Telephone Ad ss 4 (e) Real Estate Co. Agent Address a Telephone (f) Mail the HAA to the follox-ring address: LcaRau 1,.Cox I (PkO.Je W I*E4-) Z. ype of Residence Single -Family rz Multi --Family Other (describe) Number of Bedrooms 3. Water Supply Individual Well 1z 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. oil [Page 1 of 2] /_& T�sA 1�eC_za 6-F i 5. Engineering Firm Providing Inspections, Tests, File Search, Data and T,Zforma 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'`c, 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 regula- tions in effect on the date of this inspection. Name of FirML2 ��j/�%/�jy j� L � � �j l/%FC Telophone S��S�yd Date O. `-r Lv� 6. DHEP Approval Approved for/./-..- bedrooms Approved Disapproved Terms of Conditional Approval(/ n 77 E/_ Or A ,.CPO... ®d0.pg0P0�P0PP `°y C. a_ iZ_4 _ Bye y _(l; Conditional CAUTION It THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 HOMESAND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. 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 014ISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 (Page 2 of 2] 7-19-84 A. WELL DATA MUNICIPALITY OF ANCHOMAC - DEPT. OF HEI\LTI $ MUNICIPALITY OF ANCHORAGE (MOA) CNMONMENTAL PP-- f TION HEALTH AUTHORITY APPROVAL (HAA) 111;18 2.21985 CHECKLIST - FEBRUARY 1984 j Legal Description: r AFC�-J:V) Well Classification If A, B, or C, D.E.C. Approved(Y/N) AJ/4 Well Log Present Date Completed 813VIS-51 Yield Total Depth 2517 Cased to d2�y Depth of Grouting Abl do Static Water Level i/ S' Pump Set At A)0 f Orr W F// P Casing Height Above Ground Sanitary Seal on Casingkom- epression Electrical Wiring in Conduit Y )Z DAround Wellhead d ` ) Separation Distances frau Well: To Septic/Holding Tank on Lot ; On Adjoining Lots4 /06 / To Nearest Edge of Absorption Field on Lot 1 ao / ; On Adjoining Lots44py To Nearest Public Sewer Lire 104 To Nearest Public Sewer Cleancut/Manhole %A To Nearest Sewer Service Line on Lot IIIA Water Sample Collected By /_ hM Date Water Sample Test Results�� Comments 4,142vna ��fmyvaFyV. IeC. B. SEPTIC/HOLDING TANK DATA Date Installe �'12-3le q Size /000 No. of Compartments 2 ti Standpipes Y ) Air -tight CapsY ) Foundation Cleanout 42 ) Depression over Tank (Y Date Last Pumped qA Pumping/Maintenance Contract on File (Y//N) �J(A- ; for `J A' Hol ing Tank High -Water Alarm (YIN) 0/h- Temporary Holding Tank Permit (YIN)% Separation Distances from Septic/Holding Tank: To Water -Supply well 10�r To Building Foundationo61 To Property Line jo To Disposal Field /p To Water Main/ervice Lire ��V+ To Stream, Pond, Lake, or Major Drainage J tPage 1 of 21 Receipt # 33 c�g Date Paid: 3-aD.-FS Amount: 2-15-84