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HomeMy WebLinkAboutFIRE LAKE BLK 1 LT 6AFi re La kd Lot 6 Block •1IM051 361 32 iz-tris Ihev. silts) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME f1h PHONE NEW 4 Q�._ `ZIAq(� El UPGRADE MAILING ADDRESS LEGAL DESCRIPTION p li'._ "' 1 'c b,Vgtf.� LOCATION ` NO. OF BEDROOMS V _Y DISTANCE TO: Well '� Absorption area Dwelling PERMIT NO. 1 F- Z Manufacturer ��� Material No. of compartments 17, Liq.capacittyingallons IF HOMEMADE: Inside;e�gth Widtl� �� �q Liquid 'e h DISTANCE TO: Well Dwelling PERjMMIT NO. = z Manufacturer Material Liquid capacity in gallons = T DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. J LL z No. of lines Length of each line Total length of lines Trench width Distance between lines �Zw � inches H Top of tile to finish grade Material beneath tile Total effective absorption area O inches W Length I=T Width ip-T Depth c PERMIT NO. C7 Q I- R T e of crib Crib diameter Crib depth Total effective absorption area WR DISTANCE TO: Well Build fooundation Nearest lot line Class Depth Driller Distance to tIi e PERMIT NO. J W DISTANCE TO: Building foundation Sewer line Septic tank to Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER • r " r REMARKS l pI— bl � —✓� 0 14 11 q � SrD CM E �_ ILI ` •W'OL _SANK L%= iC !� > . 4. TOVED DATE LEGAL Ar V ( Av �Tz) �� -1 cx M i 1) A\ -, \ P� iz-tris Ihev. silts) E-4 E-4 E4 P E-( P E-4 &4 E4 E� 14 1-4 PK4 Pr4 114 rX4 P64 E-A: F4 P P E-4 E-4 E-4 E E-4 E4 E4 E4 E4 E4 E4 E4 E� E4 �T4 IX4 �T4 V.4 P4 fX4 rT4 rX4 �k rTW fZ4 rAl z m 04 • r4 iz 0 0 0 0 0 0 0 0 JO 9 9 9 9 9 9 9 9 9 9 9 9 fps1 " rjr4 rE4 W rZ4 [;4 W [Z4 f&4 04 w z MA ommm M V4 t 4p >= t:0i es :-- : • N 0 C) (D C) p E4 p E-4 E4 E4 D PI r-I C's :,Dr) E4 F--j Fra �T4 E-4 Z" rA4 rZI � [;4 rM4 FZ4 F34 rM4 5. 54 fr4 Q E-4 E4 z rn to !1-11 U-3 P-.�! 'l 1 ���­ "-.ry 9-D! 1=7 1=0 141 cl 00 f -AFT: 1=1 owl [EP.- DEPARTMENT(---WEALTH EP.-DEPHRTMENT qEHLTH AND ENVIRONMENTAJ TECTION 825 STREET, ANCHORAGE, AK. 95 --- 264-4720 -T �� m4 cj ^ CD rA__<3��� ���������� ������ �-� ~/8 ��� PERMIT NO. ( 780144 ) \ OLARS HPF" LICHNT DHRRELLCH��nN 8721 MIDLAND PL ------� 349 2446 ��- LOCATION EAGLE RIVER LEGAL L68 B1 FIRE LAKE S/D LOT SIZE 54000 SQUARE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MHXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: �PF-7 FI,:" -F 11-4= -11.120 L.. E=L p4l IC -31 *-F H-1 F=r.��� THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD` THE DEPTH OF H 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). ������F.-- E> I!.-- L,=, -I- 1 10 ���� :E :Z E:-7. HE -_=u IL7-j 101 02i M=l J_���:-E_._- PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPAR ENT DURING THi INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROFiff-ITY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION iTA, F-1 UVAL il THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. 1,,lIl%lIrlUN DISTANCE BETWEEN A WELL AND ANY ON—SITE ;ZdAGE "IS OZFL SYSTIf 100 FEET FOR A PRIVATE WELL, OR 150 TO 200 FEET FROM A PUBLIC WELL DEPEN)INC W310 V E lY­ OF/pil OTHER REQUIREMENTS MAY APPLY. SPECIFICA_-Of I AND' EQ2' AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT 1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS ANC :LLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ' ]: I UNDERSTAND THAT THE ON—SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. ' SIGNED.- ` APPLICANT DHRRELL CARSON . - /'� ��-� / THE.. REQUIRED SIZE OF T1 -1'i--..• SOIL ABSORPTION _ Y;..}.EM 15: 1=0..:_ a n00 ­ :1.41% wool's 6...:u FA_ 1•-.1 =n•,=' F=7.. b _ 01 EEL �'=` s j—j = q=.0 THE LENGTH _ a -._a a m _f_ c _S, a E 9 a—_ _E.. r = '—n v F r E 0 =.—: E a=—? & -_r -- 9 c_.p F._. �'}-E!_: THE LENGTH (IN FEET) DEPARTMENT t,_t±—1"}L`i i"} }"'}`pit.! >_`'�'[[ .i !'�:t_tl'•;i'L=..•�..! r"iL i 10 '[f A TRENCH H 3-25 L_(l rREET, nNCHORAGE, RK. 99C BETWEEN THE SURFACE t–!CE OF THE GFs:t_t%iN_D AND D i HE BOTTOM OS= ` — n—i_— AL R„i_J17- 6 2_qiili:;it�, PERMIT NO. —Wit'_- 770985 ` TRENCHES. �:e �4..I-1 EES. _ !!`±E_L CARSON 8721 MIDLAND PL. Ai -*ICH :t _ !«''44 LOCATION E. R. L BE i•°• EEE THE OUTFALL !`1` AL._I_ i•`[Ih'`E LEGAL [ i.... t _ 1 , -• {'-; '7 ', . ...: FIRE LAKE =+r L: I LOT SIZE 54000 SQUARE FEET T`r`PE OF SOIL i=i':. S iRB T I. +_ N SYSTEM 15: `I'F:L",Nt:. H MAXIMUM 14}_( '7EiER OF i.-iEDI';t_tOMS = _ SOIL RATING ( SQ T/I;:R) = 100 0 THE.. REQUIRED SIZE OF T1 -1'i--..• SOIL ABSORPTION _ Y;..}.EM 15: 1=0..:_ a n00 ­ :1.41% wool's 6...:u FA_ 1•-.1 =n•,=' F=7.. b _ 01 EEL �'=` s j—j = q=.0 THE LENGTH D:t:M NSit_ N IS THE LENGTH (IN FEET) OF THE TFZE14CH OR = RA 1 i`•iF I E.LD. THE DEPTH OF A TRENCH H t_tR i-' i T 15 THE DISTANCE BETWEEN THE SURFACE t–!CE OF THE GFs:t_t%iN_D AND D i HE BOTTOM OS= THE EXCAVATION (IN ). FEET). THERE IS 1'[tt_t SET WIDTH FO ` TRENCHES. �:e �4..I-1 EES. THE GRAVEL DEPTH I S THE MINIMUM }'I I N I M M DEPTH H {_!}- GRAVEL L BE i•°• EEE THE OUTFALL !`1` AL._I_ i•`[Ih'`E AND THE BOTTOM OF THE EXCAVATION (I N FEET). §''_=_ :� r_.s e._3 �.. a -.. r•..._... !�__-� _—= L— n N �. g.= a p_. 04 laz 15 1 20t?,�=� _ ._- C_ r — �.. - a r. __ ti.._u i_ 4" _ 6 i G_,Er _ ca r/ q j 9 }-t PACKAGE }",[_.f' NT =' }�}; INSTALLED r��! . ! HE 'ESR ! it ' } N -t. fB _�E1._ ? 7 t_r THE FOLLOWING ..: t_iltl` OR --I! APPROVED � �. S�l 1.. E 3. T I-ItllR • } CLASS 1 t_if ; I ! Y�yS }i!='r[i�::t..t`:� ED !='L i('d T d'lt 1`:' _tE �NS T .LLEED. -. _ _ .�. i-A t_i L 11' t•-. ["- T:' C t-+- - a I' -"REQUIRED. 71-` s N ra '1`•,SiV.'' , . �• C•d 1. r•�1 _ . _ -ii I .ti rM,7 I-! _,-. _ a. t'.. 1.L i 1=.�'ti. P"{t._lf :EEI`I!_j ,i1'•41_1Ti�:(_ii� G` ` . _ !. L:L- t ' '1 !� �' V } }—It~i_�t_t('• P f It_e =•`'r_�t� .i't Pi'•IL�r''i_iR YOU MAY BE SUBJECT Lt T Tit r'r —' 'i. j".... r •S� 1 . _. BACKFILLING t_tl- A,—'_— ['•iNY SYSTEM WITHOUT FINAL It' SP -'E . I 1t_tS'":I AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. }_€TION. MINIMUM DI Tf`IN E BETWEEN A WELL AND flffli s I ir.4..-S I T L SEWAGE DISPOSAL ==Ir,_[T1= M 100 FEET FOR R A PRIVATE WELL OR LF_ 0 B=EET FOR R A PUBLIC WELL. I•a:.LL I_.iiGS t-fRi.� REQUIRED AND MUST BE RETURNED (E, _E}_: , i_t THE DEPARTMENT W.L : iIN 30 DAYS OF F THE WELL (_ i,:i_!f'1i=`I._} T I t,.tN. OTHER rE-tRL;EiF 1=rAPPLY. PEC I F t _HT I _jS AND CONSTRUCTION SIi —AARE AVAILP"IL_LE. TO It'd',►_}t''•:E f=`i::OPER INSTALLATION. @—" E�_ K-==`_ G -""T 1. n K=j ,; -C E I az=" i-= .`.. _• F-. iii':_: n. �. j-1 E=, !_._ FQ =1 ::._ _ =E... " _ 1 CERTIFY THAI .1. _ 1, . .. WITH ! ,_[ ON—SITE r _ r- - AND t �., - �"• .L t..1F1 s-f'i `iIL.I.Hi'='. :•'•(I T H `I'I-E REQUIREMENTS FO i_N i , _•r_WEh:S !I'•4D ;-°sr LL f=f_: SET F70FZTIA BY THE: tiU141I FIRL I "i-'•!! OF ANCHORAGE. HOi;;AGE. I WILL.. INSTALL THE SYSTEM IN ACCORDANCE WITH THE Ct_ii:::sES. .: •UNDERSTAND1 THAT_ ON—SITE _: SYSTEM M.r REQUIRE =d_:G,ET ,- TI••Ic.. RESIDENCE I'_.� REMODELED ELED Tt i INCLUDE Mt_tP::E i yi N _ `EL:)Rt_ _ t`I=. r3' tom, i H'SIGNEED: POW? K, A `F= L I t=:AINT E:'f-(Rt' ELL iw Ail%-'_[._tl',; CHNICAL & DEVEL M O ' Et E G E C ENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Soils Et Foundations Earl Ellis 688-2280 Land Development Performed for: Name: ---, '\-Z Tel. No. C'? - Mai I in g Address: Legal Description: e' - Depth (feet) Soil Characteristics 0- I 3- 4 5- -D 6- 7 8- 9,- 10- 11- 15 16 77" Ground Water Encountered: Yes No If yes, what depth Proposed Installation: Seepage Pit Drain Field <S Comments: 'Z -<> Performed by: Date: :Z7 Municipality of Anchorage • Development Services Department Building Safety Division - Y On -Site Water and Wastewater Program S A FE T Y 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 1. D. d,T ~ 3 6 3 HAA �-A 00. Expiration Date: 5 = O �- 1. GENERAL INFORMATION Complete legal description i— O j G,- 6i L a C X ( r,,V e 2- 4,k- E_ `x/10 Location'(site address or directions) 3 g k nco !3 �/ i �� ORi v� ►�,� �- +r P. icl�f� Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Day phone 13 31JL KN013 /1«L_ D4ivr ,�GL/� f2iy r�2� 4K C9 -t!-77 Day phone Day phone Mailing Address 7 Unless otherwise requested, HAA will beheld by DSD for pickup. - C ` C /q/ `f 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 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 4 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. (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, 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 � & 5 ENGINEERING 17034 Eagle. RWe* Loop Road No- 2G.,j, Address `.axle River, Alaska 99577 Engineer's Printed Name I? o � k� C - C0 (fA e 5. DSD SIGNATURE 1/ Approved for 3 bedrooms. Disapproved. Phone GR 11 71 Date a /X/o y ROBERT C. COWAN } CE -8801 4 Conditional approval for bedrooms, with the following stipulations: Additional Comments Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that periodic testing be pe orm. to insure the weHs continued sui a Current nitrate concentration is 5.06 m maximum concentration is 10.0 m information on nitrates is avaflable from the n- 343-7904. Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: c2-" S_ (Rev. 01102) \ Municipality of Anchora e 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.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �C f (dLCaC-►� , l 1!—� I��� S/� Parcel ID: O� r — 36PH 2- A. A. WELL DATA Well type l� r If A, B, or C provide PWSID # Dare completed 421 Sanitary seal (YIN) Total depth 1. 10 ft. Cased to Tft. FROM WELL LOG Date of test Static water level ft. Wel! producrion . C) RIM WATER SAMPLE RESULTS: Coliform © colonies/100 ml. Nitrate S_ 06 mg./l. Arsenic: mg./l. Date of sample: !13 7`O`f B. SEPTICIFIOLDING TANK DATA Tank Type/Material Tank size 11lv. gal. Number of Compartments 71 VV ell Log (YIN) _.YCS Wires properly protected (YIN) y Casing height (above ground) 0't—in. AT INSPECTION /C4jft. 9.13 -m - Other bacteria 0 colonies/100 ml Collected by: S ! -16- l N Cr, /N1,— Date installed -7-6 Cleanouts (YIN) Foundation cleanot (YIN) _ l Depression over tank (YIN) /J High water alarm (YIN) Cu��scoc,) - � Date of pumping Pumper �) S C. ABSORPTION FIELD DATA Gate installed Soil rating (g.p.d./ftz o ftZ/bdr ) OQT System type�� Length i ?J' ft. Width ft. Gravel below pipe to ft. Total depth f (v ft. Eff. ab orption area `Zftz Monitoring tube Depression over field Al Date of adequacy test! J Results (Pass/Fail) 1 For _a bedrooms Fluid depth in absorption field before test G, in. Water added�y D gal New depth ) in. Elapsed Time: VO min. Final fluid depth/,,4 in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) A©/I%EASWWW — If yes, give date '—' D. LIFT STATION Date installed IV "Pump on" level a in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off"level at in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? Septic tank i tin on lot / CC) i •t- On adjacent lots / C�© f r - Absorption field on lot f f�f- On adjacent lots+r- Public sewer main '� Public sewer manhole/cleanout /J StweeT /septic service line �i� f' Holding tank SEPARATION DISTANCES FROM SEPTIC/Uet6"G TANK ON LOT TO: I 6- (� Building foundation Property line �:;7 4- Absorption field_ Water main /U Water service line lot - Surface water /00 rr- Wells on adjacent lots I Or? SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main t Water Service line 1 O + Surface water10 V I ' ,( / 1 4- Driveway, parking/vehicle storage ! ©f-- Curtain drain ,VC/JC�1�%lh�N Wells on adjacent lots l� / w ,+t Ve F. COMMENTS Wk 37--og G. ENGINEER'S CERTIFICATION f , .-� ! certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. �+ . V� ` ^� ROBCRT C. COWAN r i4; Engineer's Printed Name IQ � �'� �1l�a% dti c- •. CE - 8801 , ti Date Z x w HAA Fee $ �7 �' Waiver Fee $ Date of Payment _ C' Date of Payment Receipt Number _ % 7 Receipt Number (Rev. 12/01) SGS Ref.# Client Name Project Name/It Client Sample ID Matrix Sample Remarks: 1040498001 S & S Engineering Lot 6A, Block 1, Firelake S/D Lot 6A, Block 1; Firelake S/D Drinking Water All Dates/Times are Alaska Standard Time Printed Date/Time 02/02/2004 12:27 Collected Date/Time 01/27/2004 15:10 Received Date/Time 01/28/2004 11:40 Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Waters Department Nitrate-N 5.06 0.100 mg/L EPA 300.0 B (<=10) 01/28/04 JJB Microbiology Laboratory Total Coliform col/100mL SMI8 9222B A (<=1) 01/28/04 DKC - P.RELIMINARY - Municipality of Anchorage Recertification Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 Ok P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel aD: 051-361-32 1. GENERAL INFORMATION Complete legal description. HAA# HA000178 Expiration Date: Lot 6A, Block 1, Fire Lake Alaska S/D Location (site addressor directions) 13812 Knob Hill Current Propertyowner(s) Janet Garner Mailing address 13812 Knob Hill, Lending agency Mailing address Day phone Eagle River, AK 99577 Day phone Real Estate Agent Frank Irwin/Remax Anchorage Day phone Mailing Address 2600 Cordova Street Anchorage, AK 99503 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 249-1338 257-0154 C1 /)J -/O TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ❑ Individual Holding Tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. 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 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. 72-025 (Rev. 07!00)' 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S & S ENGINEERING Name of Firm 17034 Eagle River Loot, Road No. 204 Phone iGgt '7 Address Eagle River, Alaska 99577 It i Engineer's Printed Name Robert C. Cowan 6. DHHS SIGNATURE L—� Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments Date -11/'//00 ��1ROBERT C. COWAN ti CE - 8801 r �t bedrooms, with the following stipulations. Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: Expiration Date: / 2 / 5f— O 10 Reissue Date: 72-025 (Rev. 01/00)' 98? 694 1211 P.03/03 I-I~U ~,UI/U~ CT&E Her,# 100~4g6001 Client Name S & $ F-~gineerJng Pr~}eet Named# L6AB] F~Lk CUeflrSample~ LGABI ~eLk Matrix Drinking Wa[~ O~ered By P~JD Sample Remarks: Nilr~e-N ToToI Coliform Client PO# Prfltted Date/Time 09/1412000 13:08 Collected Date/Time 09/I2L2000 i 1:35 l'ieeeived Date/Time 09/1Z/2000 12:30 Techn~al Director 8~phen C. ~a~ Released B~~ M~hocl Limi;s .Dam Date lxlit 4.97 0,500 mg/L ]~PA 300.0 I 0 max 09112/00 SCL 2 OB, No Coli ceYlOOmI.. 5M18 9222B 09/12/00 TOTAL P. 83 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY- DWELLING Parcel I.D.(ZS) _ 5(JD 1 - 3 oZ 1. GENERAL INFORMATION HAA# YfOMFlf, Expiration Date: Complete legal description Lot 6A, Block 1, Fire LakeR=#=Z/D Location (site address or directions) 13812 Knob Hill Current Property owner(s) Janet Garner Mailing address 13812 Knob Hill, Eagle River, Ak Lending agency Mailing address Day phone 99577 Day phone 249-1338 Real Estate Agent Frank Irwin/Remax Anchorage Dayphone 257-0154 Mailing Address 2600 Cordova, Anchorage, Ak 99503 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site KI Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer _ . ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. 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 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. 72-025 (Rev. 01/00)' 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S & S ENGINEERING Name of Firm 77044 F291le R',ver Loop Read No. 2G4 Phone Address Eagle River, Alaska 99577 Engineer's Printed Name R 66 6, 7- Co Date 6. DHHS SIGNATURE li' Approved for �_ bedrooms. Disapproved. GqI — a-/ 75 01 IkEER �F RCBURT 'C.. 'Cis"VVA-K CE 77�C ala............ Conditional approval for bedrooms, with the following stipulations. Note* The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration is 6.52 mg/l. EPA maximum concentration is 10.0 mg/1. More information on nitrates is available from theOn-site Services Program, DHHS,`343-4744. Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: - / 5-- 0 0 Expiration Date: ---1S =A A Reissue Date: 75-025 (Rev. 01/00)' 2%L.%_L_i V 6.-V MAY 0 4 2000 Municipality of Anchora%@NICIPALITY or DEPARTMENT OF HEALTH & HUMWSEh�(l0E-S'IC-FQ �i Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: LJ/ 61 .' / C� /. �12L' G�K�,garcel I.D.: A. WELL DATA 51-0 Well type IJ /1`14 7-6- If A, B, or C, attach ADEC letter. ADEC water system number Log presentyN) �L S Date completed /0/ / 7� Total depth ID Cased to / Zd Casing height (above ground) Sanitary seal ON) FROM WELL LOG �I Date of test /0 /7 / � T Static water level Zv i Well production WATER SAMPLE RESULTS: Wires properly protected"/N) C-5 AT INSPECTION g.p.m. g.p.m. Coliform 0 Nitrate ("• S- A Other bacteria 0 Date of sample: / / Collected by: S & S ENGINEERING B. SEPTIC/HOLDING TANK DATA Eavde River, " `` sfzz Date installed4 = 92 Tank size 1�!5� Number of Compartments Z Cleanouts�)N) Foundation cleanou (Y ) `6-5 Depression (Y/N) High water alarm (Y/N) Date of Pumping Zipumper 'S C. ABSORPTION FIELD DATA j Date installed Soil rating (g.p.d./ft2 or ftz/bdrm) X00 �I System type 0/2-%5) Length ! Width �1��/ Gravel thickness below pipe Total depth /0 Effective absorption area �/ Monitoring Tube present ®/N) ES Depression over field (Y,)) A/0 Date of adequacy test Results (Pass/Fail) //il S's For t4 6-1(_-- bedrooms / el Fluid depth in absorption field before test (in.); `-t Immediately after4IS:?gal. water added (in.): il Fluid depth !VZ (ins) Minutes later: Absorption rate = 45V g.p.d. Peroxide treatment (past 12 months) (Y/N) MQWJ 4d'tIAef yes, give date 72-026 (Rev. 3/96)'` D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* .; Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off" level at* Septic/holding tank on lot Ad� r On adjacent lots Absorption field on lot r j On adjacent lots /Go t Public sewer main N/A Public sewer manhole/cleanout Sewer /septic service line Lift station /V A SEPARATION DISTANCES FROM SEPTIC/H �ON LOTTO FoundationProperty line Absorption field Water main/service line f Q Surface water/drainage 4077 Wells on adjacent lots SEPARAT ION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line �� / f Building foundation %� �� Water main/service line % r /- Surface water 0 0 Driveway, parking/vehicle storage area 6) ! t /�/0 n/&- %�r'VCya'/V Curtain drain Wells on adjacent lots F. ENGINEER'S CERTIFICATION l certify that l have determined thru field inspections and review of Municipal in conformance with MOAHAA guidelines in effect on this date. Signature Engineer's Name r `� �'e'T �� w� ✓ Date HAA Fee $ Date of Payment �T Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number .m '� i `'sem•` ROPERT C. COVVAN are MUNICIPALITY OF ANCHORAGE 0< DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date. :2/11,7h-7 1. _GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner �/"'_' - Telephone: Home (2%4� - c2022 Business _:�; 7Q - (,/ z y (c) Mailing Address Lending Institution ��P 0_'�_ lephone Mailing A,�A,. (d) Real Estal Address Telephone (e) Mail the HAA to the following address: or: Check here ❑, if hold for pick up. List contact person and day phone number below. S ENGINEERING 17034 92gle River Loep 110e d No. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family X 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. Page 1 of 2 72-025 (Rev 8/861 Front 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 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��'�/ 17034 Eagle River Loop Road No. 204 Address Laala Rlusu! Alaska 99577 Date 6. DHHS APPROVAL Approved for Approved fAeleat 69 bedrooms by �^ Disapproved Conditional _ Terms of Conditional Approval CAUTION OF 4 AV • ° ° :'' .r T_- yDn/I mo '174 XOFc`SS140 Date S— !o — a The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 Rev 8/86) Back C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �Cb�f� Type of System Design Date Installed Length of Field 13 Nnre[iT.1Nalm- [` Square Feet of Absorption Area Depression over Field (Y, V) Results of Last Adequacy Test 312 `, Depth of Field I ! Gravel Bed Thickness k�a — Standpipes Present d)N) Date of Last Adequacy Test Z2 8 7 Separation Distance from Absorption Field: , To Water -Supply � 1 S pp Y Well To Property Line � To Building Foundation �� To Existing or Abandoned System on Lot P ; On Adjoining Lots I To Water Main/Service Line To Cutbank (if present) F� er-- To Stream/Pond/Lake/or Major Drainage Course 00N*, To Driveway, Parking Area, or Vehicle Storage Area 2a Comments , P14- 10C--0ftX lh Ilse-e— wa..'v�r., D. LIFT STATION 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 that I have checked, verified, or conformed to all MOA and H A guidelines in effect on the date of this inspection. Signed& S ENGINEERING Date 2 % 17034 Eagle River ooP oa o. 204 ComEagib River-, Alaska 99577 MOA No. Receipt No. _ OO — Olj6 Date of Payment H -A- o e o Amount: $ R-) o -3 4 Page 2 of 2 72-026 (11/84) 426 ,I 9 d 0. � P'ewca ,a.n„�� ooe�eo A. ahcfw a s 1457 E -F August 10, 1987 P.O. L X 196650 ANCHORAGE, AL-ASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES Robert A. Shafer, P.E. S&S Engineering 17034 Eagle River Loop Road #204 Eagle River, Alaska 99577 Subject: Lot 6A Block 1 Fire Lake Alaska Subdivision Waiver Request WR87-044 Dear Mr. Shafer: Your request for a waiver of the 100 foot separation required between the seepage pit on the subject lot and a private well located on the neighboring lot (Lot 12A Block 1 Fire Lake Alaska S/D) has been granted. The required distance has been waived to 96 feet. A letter of non -objection from the owner of the well on Lot 12A was written in 1978 at the time of the seepage pit installation. You have submitted a risk analysis to this department that indicates that there is no possibility of bacteriological contamination of the well from the encroaching seepage pit. You have shown that there are elevated background levels of nitrate levels in the area. It is unlikely that these elevated levels are the result of this single well -to -seepage pit encroachment. This waiver is valid for the existing seepage pit only. Should the pit require upgrade, the upgrade will be required to meet applicable setback standards. Sincerely, Stephen S. Morris Civil Engineer On-site Services cc Gus Andress, P.E. Manager, On-site and Water Quality Programs HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT A. SHAFER CIVIL ENGINEER 694-2979 August 5, 1987 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION AUG c) 1987 Municipality of Anchorage Department of Health and Human Services RECEIVED 825 L Street Anchorage, Alaska 99501 ATTENTION: Steve Morris REFERENCE: Lot 6A; Block 1; Firelake Alaska Subdivision This letter supplements information provided in our letter of July 25, 1987 request for waiver on the referenced property. Based upon our conversation concerning the high nitrate levels for the well on the referenced property and the adjoining property additional samples were taken within the immediate area. Copies of these analysis reports are provided for your information. As you can see by these reports the nitrate level in other wells in this area is also high. It is our opinion that these nitrate levels adequately establish background for the aquifer in this area and that granting a waiver as requested in our previous letter will not in any way contribute to these nitrate levels. If addi # information is required, please contact us. ss . SHAFER, P.E. SRB 196X EAGLE RIVER, ALASKA 99577 page two Lot 6A; Block 1; Fire Lake Alaska Subdivision July 25, 1987 It is our opinion that the horizontal separation distances prescribed by 18AAC72.021 are not required in this case. If you require additional information, please contact us. Sincerely, A. SHAFER, P.E. ss HEALTH AUTHORITY APPROVALS 2 July 25, 1987 ROBERT A. SHAFER IVIL ENGINEER 694.2979 Municipality of Anchorage Department of Health and Human Services 825 L Street SEWER &WATER Anchorage, Alaska 99501 MAIN EXTENSIONS REFERENCE: Lot 6A; Block 1; Firelake Alaska Subdivision Request you issue the attached Health Authority Approval and grant a SEWER WATER INSPECTION waiver for the horizontal separation distance between the see a e P it P seepage located on this property and a private well located on Lot 12A at a distance of 96 feet. Prior to the on-site wastewater disposal system being installed on Lot ENGINEERING STUDIES AND REPORTS 6A a waiver was granted by the Municipality of Anchorage for a horizontal separation distance of 96 feet. At that time the owner of the property on Lot 12A provided a letter of non -objection. WELL INSPECTION A risk analysis has been performed and it appears that no bacterialogical &FLOWTEST pollution is possible from this source. Attached for your review are the following documents: A. On-site wastewater disposal system inspection report for Lot SITE PLANS 12A showing a horizontal separation distance between his septic tank and his well of 78 feet (installed in 1970). B. A copy of the letter dated April 18, 1978 from the owner of Lot 12A stating his non -objection to the septic system on Lot ROAD DESIGN 6A. C. Copies of on-site wastewater disposal inspection reports, permits, well log and soil test for Lot 6A. These documents support SOIL TEST the existance of a previous waiver. D. Risk analysis waiver review work sheet. PERCOLATION E. Coliform and nitrate analysis of water taken from both wells TEST on Lots 6A and 12A. F. Flow test and well information for Lot 6A. STRUCTURAL& G. A plot plan showing relative distances between on-site wastewater MECHANICAL INSPECTIONS disposal systems and wells. ON SITE WASTE WATER DISPOSALSYSTEM DESIGN SRB 196X EAGLE RIVER, ALASKA 99577 D sn \ � Qq s X11 31VOS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES WAIVER REVIEW WORKSHEET DATE RECEIVED: LEGAL: to tu. � Av"l-SIVA ENGINEER: S & S ENGINEERING 17034.Eagle River Leap Road No. 204 Eagle River, Alaska 99577 APPLICANT: 2nnL' WAIVER REQUESTED: CRITERIA: 1) Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation 2) Special Conditions: 3) Other: Points: TOTAL: Pwbvil A. Shfx 1457.2 ih n t)oi, WAIVER IS: granted, with conditions listed below: not granted for reasons listed below: A 00- DATE: BY: NAME \ ?-r- S & S ENGINEERING 17034 Zagle River Loop Road No. 204 Eagle River, Alaska 99577 VIE \ ?-r- S & S ENGINEERING 17034 Zagle River Loop Road No. 204 Eagle River, Alaska 99577 ~ CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 3 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ~ ...... ~.',,~;'~ FEDERAL TAX ID # 92-0040440 _CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. V ~o.^,o,,~;~'~ FEDERAL TAX ID # 92-0040440 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 PROJECT: 17034 Eagle River Loop Road ROBERTA. SHAFER Eagle River, Alaska 99577 CIVIL ENGINEER 694-2979 DATE OF TEST: ~"~-'~.,t--~'"7 LOCATIONOFWELL(LegaIDescdption):~L.-c:>~ ~;,/~ ,~ ~ _~'\~_.~ ~ WELL DEPTH: i,,~.,~ / FT. CASING: ~'~ I -- - FT. SCREEN: STATIC WATER LEVEL (Top of Casing): __ \ 4~::',,~ I ~ FT. DATE: ~ - ~ CLOCK ELAPSED TIME SINCE TIME PUMPING STARTED/ DEPTH TO DRAWDOWN PUMPING STOPPED, MIN. WATER, FT. RECOVERY RATE, GPM REMARKS ~ 0 I u (swl) 0 0 Start ~ ac 3,5 __ 40 45 50 ~ ' 90 -- 120 (2 hours) 180 (3 hours) :~0~' 240 (4 hours) RECOVERY ~ ~ o 10 15 20 25 30 35 11/19/03 15:40 FAX 907 273 8440 ct PRUDENTIAL VISTA REAL ES Z001/001 X 94 Ile A -SUILT S I haiv surveyed the t NOY 'x dew1bed I ALpki - and tlk,;- the frnpmvt-. Mrs ed d-feim am wiliftin the propen y lines and do ncg ibev*to, encloach, per"',,. - Y on *am 77- X 94 Ile A -SUILT S I haiv surveyed the t NOY 'x dew1bed I ALpki - and tlk,;- the frnpmvt-. Mrs ed d-feim am wiliftin the propen y lines and do ncg ibev*to, encloach, per"',,. - Y on *am