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HomeMy WebLinkAboutSAMS LT Aary\s IV () , X,.., k /, S- L.L( MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221325 Work Type: Septic Upgrade Tax Code Number: 05115344000 Site Legal Address: SAMS LT A G:1256 Site Mailing Address: 19633 S BIRCHWOOD LOOP RD, Chugiak Owner: RITTER ROBERT R JR & CAROLYN E Design Engineer: EKLUTNA ENGINEERING, LLC" This permit is for the construction of: 17 Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date ��cnt Q, n )apartment Lot Size in Sq Ft: Total Bedrooms: 8/31/2022 8/31/2023 43035 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received B) Issued By: 3 �l 2o2Z Date: (3 Date: (Z Z MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-153-44 Property owner(s) ROBERT RITTER Mailing address PO BOX 671709 CHUGIAK, AK 99567 0701 Site address 19633 S BIRCHWOOD LOOP RD Chugiak Day phone Legal description (Sub'd., Block & Lot) SAMS LT A Legal description (Township, Range & Section) Lot Size 43,035 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) Q (w/wo ADU) Septic Tank El Upgrade Z (D) ❑ Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Cedes. z/1 (Signature of propertowner or authorized agent) Permit/Rush Fees: '0 X95 Waiver Fees: Date of Payment: g�s� -z Date of Payment: Receipt Number: OY2000 Receipt Number: Permit No. 05 P22 13 2 5 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\FormsUient FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221325, Deb Wockenfuss, 08/31/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221325, Deb Wockenfuss, 08/31/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221325, Deb Wockenfuss, 08/31/22 - L����•iS�/' licit/ ���� i ��e e • • :9UIL.T-NO CORNCRS SET THIS DATE. SEWARD & ASSOCIATES LAND SURVEYING 688--4566 iER ErT cF-R,rIFY THAT I HAVE SURVEY1=0 THE SOa'E'_ o+wr►�* DESCRIBED PROPERTY% /-, ra �� (�F AAr CS y l L bWiNG DESt; .. .•.O, S. ,• ,- 'v„ury er-'y-ten:'• n 14 �y fig, e • • :9UIL.T-NO CORNCRS SET THIS DATE. SEWARD & ASSOCIATES LAND SURVEYING 688--4566 iER ErT cF-R,rIFY THAT I HAVE SURVEY1=0 THE SOa'E'_ o+wr►�* DESCRIBED PROPERTY% /-, ra �� (�F AAr CS y l L bWiNG DESt; .. .•.O, S. �I r` /�. 55::' /__1, MUNICIPALITY OF ANCHORAGE TANKS DL .RTMENT OF HEALTH AND HUMAN SEF. ;ES Environmental Health Division a 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES 01019% G o� /! TYPE OF SYSTEM TO SEPTIC ABSORPTION i Address C FROM TANK FIELD WELL IC4 i Gravel depth beneath pipe 45_ FT Gravel length �I FT Phones Permit No. o- of Bedrooms WELL 1 oS Number of lines Soil rating 2IP45 SQ FT Pipe material N�%-170 ,. LOT LINE �%�� ( Date Installed LEGAL DESCRIPTION Z `� 1 _ Lot Block Subtlim on 1`;' `% FOUNDATION I (py Total Depth FTJ Township, Range, Section G L Installei AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, �I r` /�. 55::' driveway. water TANKS SEPTIC ❑ HOLDING Manufacturer ,�..,�// Capacity in gallons Material L No. of Compartments 2 /! TYPE OF SYSTEM TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER i C Depth to pipe bottom from original grade FT Total depth from original grade I FT IC4 i Fill added above original grade � FT Gravel depth beneath pipe 45_ FT Gravel length �I FT Gravel width "2 FT Total absorption area �� fl SO FT I Distance between lines pt FT Number of lines Soil rating 2IP45 SQ FT Pipe material N�%-170 ,. Installer 6�SL&• Date Installed WELLS _ PRIVATE ❑ OTHER (Identity) P` Classification (A,B,C) i,r-� A Total Depth FTJ Cased to FT G L Installei Date Installed: REMARKS: If S & S ENGINEERING I; - 41certify Mal [his 7034 M918 Municipal aiu��� O�IfdQlhe�i� or��rte Health Department Approval. )ia utas) i Scale: t" —.CLQ (>' Inspections Performed by: Date: pecection was performed according to.all d Date:—'Liea���r-•—=�.. WIRM /�UNIClPALITY OF AN Departme:t of Health & Human 5^ �25 L Street, (Anchorage, Alaska 99l ON�SITE SEWER & SEPTIC 'ermit Number: 880O43 EnlargemenL Date Issued: 05/1O/88 Owner Name: ASSOCIATED 8ROKERS S&S 1- A c:i Ad640 W, 36TH AVE" ANC�ORAGE, AK 99503 / �\ �m�/-� ^_��� =�� �-)�_���� }�ORAID) E es / 343~472O �NK PERM J �/ ���`� Day Phone: 563-3333 Parce1 Id: 1~153-44 ( Lot Legal: Subdivision: \9AM/S ABlocks._ Section: 8 Township: 15N Range: 1� LoL Size �|�14 (sq,ii. or acres) Max Bedrooms: This Permit, 3 Total Capacity: A �EWER SYSTEMS: Listed below are the options avai1abi An you in designing your ewer system. Chuove the option That best fitoo you ite. TRENCH Dep, h to Pipe 8ottop (ft�: 4"0 Gravel Gravel 1;rave1 Widith t): Length (It>: 2.5 Gravel Volume (cubic yds): Soil Rating Used (sq ;L/brm)a 260f ** Gravel length > 50 1eet requires multiple soils +sts, ** Gravel l"Nngth > multiple runs ot exceeding 75 f't each). IFT STATION: Ii a 1iit station is installed:j a higt /ter alarm must be onnected Lo the resiJence. /EPTIC TANK: Minimum total septic tank capacity: 1,0 gallons, Each septic ank must have at least 2 compartments. Depth to h of septic tank(s) < 4"0 rust. rmquirF's Wsulaiitoy, over taok(s). 15310 PER E1 iGINEER3 DESISN : TRENCH B1/ X 5MA� �M DEPTH )OT TO EXCEED 9', NDTIFY DHHS PRIOR TO iST to 2ND IN� �CTIONS. IS FORM ^XP`RE` 1- 31 88 MUNIClFALlTY OF AN: iORAGE DeyarNam i of Health As Human L vices 825 L Stree|." Anchorage� Alaska 9Y5` 343~4720 ON~SITE SEWER & SEPTlNK PERMIT "ermii Number: 88004� Page 2 C�R[IFY Tf A1: 1" I am �ami]iar wi�h d�e req�i�ements {or on~site forLh by the MunUipaliLy n[ An�ho�age (MOA) an�' 2. I wi!l insW1l the si accordance with ali and in comp1iance with the design criteria 3. A wiI A adhere tn a]1 Mn and State o[ Alaska rea, distances from any exisiing well, wastemavan di� sewerage system mn LAI WA or anv adjacent or noarh 4. I understand that this pero,it is valid for a mm also understand thaL the czPacity kit the total s any enlargement will require an add i|iona1 Yoerm1 �ers and wells as set �e State o� Alaska" jA codes and regulations� permit` ements 14-.)r the set back sal system or public ot, um o� 3 bedrooms" I em is 3 bedrooms and Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 .. b"m A. Ahv#v SOILS LOG — PERCOLATION TEST t tem 14187.9 �YO PERFORMED FOR: 4 �Cf/ � � ; rC 61-� DATE PERFORMEE LEGAL DESCRIPTION: �/ ! /// Township, Range, Section: 16-11 �� 7 DEPTH SLOPE SI PLAN (f-EEF) 2 3 1 4- C i — 5 </ 6 � 14 n 7 8 1�e2 9 a� 10 C r 7 11 12 „ f 13 14 15 16 17 18 19 WAS GROUND WATER ENCOUNTERED? ,1O S IF YES, AT WHAT L O DEPTH? P E /� r r Depth to Water Ager (/ M&O �7 h, 6 r il',�, o/ Monitaring7 gate: 20 PERCOLATION RATE ;2. 1 " (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN _S,L— FT AND FT COMMENTS _ / PERFORMED BY: 17034 Eagle River LqW Road No 2a4 /` —� CERTIFY THAT THI TES3, WAS PERFORMED IN Eagle River, Alaska 99577 r di ACCORDANCE WITH ALLSTATE AND MUNICIPAL GIjInFI INt&4KIEFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) INEWA s"�mv�� 20 PERCOLATION RATE ;2. 1 " (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN _S,L— FT AND FT COMMENTS _ / PERFORMED BY: 17034 Eagle River LqW Road No 2a4 /` —� CERTIFY THAT THI TES3, WAS PERFORMED IN Eagle River, Alaska 99577 r di ACCORDANCE WITH ALLSTATE AND MUNICIPAL GIjInFI INt&4KIEFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) N E 11 9 LOG OF ®RV-lJ NG by A & L ®R! LLI' G COMPANY OWNER OF LAND ------ o4 ra' -'._ DEPTH OF WELL ...... s �� .......... - - ADDRESS 1---------- 4jqqP--.-------------------------------- ... STATIC LEVEL OF WATER FT. ...� ---`..------------------ j-� WELL SITE. --G-I'?.- .R� - � -4- / JLC F DRAW DOWN FT. ------ 7-1 DATE—STARTED q1:7_-"------------ rz��vi-/ --------------------------------- �O GALS. PER HR. ----------......------.... --- q y DATE—ENDED------ 'I_131I--3------------------------------------------------------ if KIND OF CASING -------------------------------------=-------------------- KIND OF FORMATION: FROM-0--4........ FT. TO------ FT..e��%Y - Jit! c'L ,( FROM..qj.... --------FT. TO--47.6 ............. FT.CL­------------­------- � i 4 ®- FROM-!TTO.0a--------------FT .64ve Q r FROM---- ------------- FT. TO----I ------------------FT -.QRf1jiO4 ----......---FT. t--`(-----------------FT. A'i0 44.(tG�e� FROM 1 '----------FT. TOW------------ FROM TO--------------FT J-- FT. TO - FROM-)4&f FT. TO-..I FROM. -ty -----------40- -FT.- g' FROM ..............FT. TO ------------ FRMPe�e W/T..�jgltJ�- �------- �eIALITr OFF ; a //aa FROM-F �------- --------- FT. TO-.%3_-----------FT.-_,_e- - - DEPT. OF HEALTH & FRO 6jii�ENTAL.ipTo 10N....----.1-..... FTG cv RTP ¢ FROM-- 7�-------------.FT. TO53.............FT. /L z/r�. S�_..®....-C � A [� p� FT. ----_------------------------ FROM H� Gv I( ... ;�-------- FROMe!- FT. TO ..[- FT.LU �_G 4� FROM -- ---,---FT. d C f i� i� i MISCL. INFORMATION: ivi„ 4) F Q f Y/j p y� 6-40 A z 614o E _ WG4c •Ta tic ! fi i A D Y L v P,�� h� 5 �cyolo p�! L. 4, DRILLER'S NAME --- / /4---- ....................... ------------ GREATER ANCF40RAGE AREA [BOROUGH DEPARTPAE•NT OF ENVIRONMENTAL, QUALITY PERMIT NO. -_._-- 3330 "C'• STREET ANCHORAGE, ALASKA 99503 LLL III TELEPHONE 274-4561 SEWAGE DISPOSAL S Y S`E'EM .taw= �aPKIC `� ION � � 3 P �.�?P�117 NAME OF APPLICANT _._-".-----e-. INSTALLATION LOCATION LEGAL DESCRIPTION _.. INSTALLATION OF: SEPTIC TA14K T"YPE AND SIZE OF FACILITY T'O DE SERVED FINANCED THROUGH .----.,_-. SOIL TEST RESULTS COMPLETION DATE ANTICIPATED _ .. MAILING ADDRESS PHONE ----- SEEPAGE PIT'..___. _----. DRAIN FIELD OTHER .._ TO BE INSTALLED DY DOTE; THIS 13 NOT VALID WITHOUT SOIL.- TEST PINIAL INSPECTION! 24 HOUR NOTICE REQUIRED. SACKFILLING OF ANY SYSTEM Wil't•1OUT rINAL INSPECTION BY THE DEPAR TI•At NT OF FNVIRONMEI`JTAL, QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE _ �--".- SEEPAGE AREA SIZE ---------- TYPE -----.---.--- T'!PF' ..___.._a_..�-�---- -._v._- _. Iv1r4fi IUM D IETCAI`;CCS, RE�QUIREDAENTS FOUNDATION '1"0 SEPTIC; TANK FOUNDAT"ION TO SEEPAGE P11 DRAIN FIELD _ --"-• SEPTIC TANK TO SEEPAGE PIT WALL _.-_-.-- -- --"' SEPTIC TANK SEEPAGE PIT DRAW FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK SEEPAGE PIT ___�- ..-----• DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK .-_ __-.-. SEEPAGE PIT DRAIN SEPTIC TANK, --- SEEPAGE PIT -_ DRAIN FIELD TO RIVER, LAKE, STREAM - CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPT"IC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GR'p4vEL. BACK ILL. CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER DIAGRAFA OF SYSTE94 I CERTIFY -THAT I AM FAMILIAR WITH THE REQUIRFMF.N7'S OF GREATER ANCHORAGE AREA BOROIJGII ORDINANCE NO. 211-63 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE __� - -�- APPLICANT'S SIGNATURE i 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. # I - 4)2) - it LA HAA# 0�i1q)c):21L1- 1. GENERAL INFORMATION Complete legal description Lot A; Sams S.ubdivi6ion Chug.iak, AK 99567 Location (site address or directions) 19633 B.itchwood Chug.ialz AK 99567 Property owner KeLth and Cynthia BakeA Day phone 688-2062 Mailing address 19633 B.ikchwood Chugiak, AK 99567 Lending agency Mailing add Day phone Agent Dan2ene/ REMAX oA EAGLE RIVER Day phone 694-4200 Address 16600 Cen-tenA,.ietd D i.ve, Suite 201 EAGLE RIVER, AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 I 3. TYPE OF WATER SUPPLY: Individual well XXX 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 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. S&SENGI Name of Firm 9 5_ Address Engineer's signature Eagle Road No. 204 6. DHHHS SIGNATURE 1� Approved for�0 bedrooms. Phone 6 a-,9 7�7 Date Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ,�..._. Date 1- & r� 11 Mir, 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 fo'r errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ��DT �V✓lS 5,9 Parcel I.D. 1 `� A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present O/N) _Date completed �'�' Driller p` `• `- �F-«-� y Total depth 1St, Cased to �'D t k Casing height �24� Sanitary seal(�' ) 4 Wires properly protected O/N) Sewer service line Z� 1 4— WATER SAMPLE RESULTS: Petroleum tank Coliform a Nitrate D , / D Other bacteria Date of sample: (o -1 7-9/ 3 B. SEPTIC/HOLDING TANK DATA U Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Date installed 5'--2\ -` E> Tank size 1 06a Compartments Cleanouts (Y N) Foundation cleanout Y t) Depression (NCNNN High water alarm (Ya N Alarm tested (Y/N) Date of pumping 5--19'(73 Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \':> �5- On adjacent lots k o � %A- Foundation I t To property line '2'c> Absorption field Surface water/drainage 1 b r5 72-026 (3/93)' Front S Water main/service line k -e, -W- 4�,, A-a,,te.- ;T / ---* -:,3 . '9 , 0 Z -t' CONTINUED ON BACK PAGE FROM WELL LOG AT INSPECTION 44 -T-D IGJM0 Date of test �1 �'� -13 l� '22 s13 L)a1-wl2)U')AS Def--rD S l ( LrK c,rp� u Static water level l?J o Well flow g.p.m. E..! ^, E 9•p� -. - J AZ- J rn z Pump levell N t SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ii D'5- t ; On adjacent lots 1Dmmi w o A C D Absorption field on lot 1 03 ; On adjacent lots Cn 1? I Public sewer main '� `A� Public sewer manhole/cleanout Sewer service line Z� 1 4— WATER SAMPLE RESULTS: Petroleum tank Coliform a Nitrate D , / D Other bacteria Date of sample: (o -1 7-9/ 3 B. SEPTIC/HOLDING TANK DATA U Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Date installed 5'--2\ -` E> Tank size 1 06a Compartments Cleanouts (Y N) Foundation cleanout Y t) Depression (NCNNN High water alarm (Ya N Alarm tested (Y/N) Date of pumping 5--19'(73 Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \':> �5- On adjacent lots k o � %A- Foundation I t To property line '2'c> Absorption field Surface water/drainage 1 b r5 72-026 (3/93)' Front S Water main/service line k -e, -W- 4�,, A-a,,te.- ;T / ---* -:,3 . '9 , 0 Z -t' CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) tested SEPARATION DISTANCE FROM LIFT STATION TO: D. ABSORPTION FIELD DATA Date installed 5 - 66 Length C t Width On adjacent lots off" Level at Surface water Soil rating (GPD/Ftz) ZCr a ` �� System type Tk"C14 1 Gravel thickness Total absorption area ?) t b � Cleanout present�DN) -5- Total depth 9 Depression over field (YQ r1 Date of adequacy test (-a- 22 --�i3 Results ass il) PAS.s for 5 Bedrooms N 1, Water level in absorption field before test After test I S Peroxide treatment (past 12 months) (lQ) µ``o � 6- If yes, give date ,� P SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot � a 12-;, On adjacent lots \ o N Property line k S t To building foundation 1 To existing or abandoned system on lot 1 c� 1 On adjacent lots 3 n 1 Cutbank 4P_ Water main/service line t a Surface water n t Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION l certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in r' Signature WEAWMERMEWA of this inspection. Engineer's Nam4 b' „ A ; 034 Eagle River Loop Road No. 2 1 ' Date Z �� t HAA Fee $ r ?L0, - 0C Waiver Fee $ Date of Payment 4� - 2 _ 3 Date of Payment Receipt Number Receipt Number 72-026 72-026 (3/93)' Back AL COMMERCIAL TESTING & ENGINEERING CO. A,6� ENVIRONMENTAL LABORATORY SERVICES SINCE 1908 Chemlab Ref.# :93.2880-7 Client Sample ID :LA SAMS S/D Matrix :WATER Client Name :S & S ENGII Ordered By :RAY SHAFER Project Name Project# PWSID :UA REPORT of ANALYSIS Sample Remarks: SAMPLE COLLECTED BY: RAY. QC Parameter Results Qual Units --------------------------------------------- Nitrate-N 0.10 U mg/L 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 WORK Order :67364 Report Completed :06/22/93 Collected :06/17/93 @ 13:00 hrs. Received :06/18/93 @ 15:00 hrs. Technical Director:STEPC. EDE /-7/ Released By : .Jr� Allowable Ext. Anal Method Limits Date Date Init EPA 353.2/300.0 10 06/21 LLH M * 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 D = Secondary dilution. GT = Greater Than %"SGS Member of the SGS Group (Societe Gen6rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA MUNICIPALITY OF ANCHORAGE 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 `: _ 2A web 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) L"moi ,Ds '�> ics, Location (address or directions) (b) :Property Owner �• J t V Telephone: Home Business Mailing Address (c) Lending Institution Mailing Address (d) Real Estate Company and Telephone Address Telephone (e) Mail the HAA to the following address: or: Check here;2'�if hold for pick up. List contact person and day phone number below. 17034 Eagle River Loop Road No 204 - Lagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Familyw- Number of Bedrooms 3. WATER SUPPLY Individual Well 0- 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. S & S ENGINEERING�r�L�2 y7 i Name of Firm elves r, een Road Ne- 2Dd Telephone Address eagle River, Alaska 99577 Date i 6. DHHS APPROVAL Approved for T bedrooms by Date L s Approved Disapproved Conditional Terms of Conditional Approval CAUTION Z ,%%{ ............f� ..� ■b, i A. ffih&*r 1 '1p 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 rRev 8/861 Back A. WELL DATA ;�l 1N� OF ANCHORAGE (MOA) 66 1`Y�PMUNICIPALI�1 JJt6jaTKWITY APPROVAL (HAA) EN0,0NMENTY TACHECKLIST - FEBRUARY 1984 MAY 2 3 1988 264-4744 Legal Description: RECEIVE® Well Classification IMD►✓rD�o� If A. B, C, D.E.C. Approved (Y/N) Well Log Present (Y(5Date Completed ov_ Yield I Total Depth I )(�— Cased to i Depth of Grouting Static Water Level 'a2 Pump Set At N Casing Height Above Ground — Electrical Wiring in Conduit (PN) Se aration Distances from Well Sanitary Seal on. Casing PN) — Depression Around Wellhead (Y/® P I To Septic/Hek" Tank on Lot ; On Adjoining Lots I� To Nearest Edge of Absorption Field on L t dpi t ; On Adjoining Lots To Nearest Public Sewer Line a t, To Nearest Public Sewer Cleanout/Manhole NLP To Nearest Sewer Service Line on Lot Water Sample Collected by /+� ; Date o Water Sample Test Results `2R!7CV'5 ' � � - W V -'L t 1= Comments Lit_ F�:LOv� -J "T Z N C) B. SEPTIC/P"X-DIN6 TANK DATA Date Installed 5-21'88 Size , 900 No. of Compartments Z Standpipes/N) — — Air -tight CapsdDN) Foundation CleanoutQVN) Depression over Tank (Y/CQ C� Date Last Pumped Pumping/Maintenance Contract on File (Y/N) � Q ; for N Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/He id g Tank: To Water -Supply Well 1 0 To Building Foundation SOI 1 dti5 i To Property Line 7� i To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage 1� `Course QXD Comments Page 1 of 2 72-026 (Rev. 8/86) Front - C. ABSORPTION FIELD DATA .dam Soils Rating in Absorption Strata 2 -AP 13 Fri Type of System Design Date Installed S I -A — �0 Length of Field �}t Width of Field J Depth of Field Gravel Bed Thickness 5 Square Feet of Absorption Area `�\ Standpipes PresentCDN) Depression over Field (Y/a Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well \ L'"-1'2 t To Property Line \S To Building Foundation' To Existing or Abandoned System on Lot \ t� ; On Adjoining Lots �� I To Water Main/Service Line To Cutbank (if present) , To Stream/Pond/Lake/or Major Drainage Course i -=�o A - To Driveway, Parking Area, or Vehicle Storage Area &nota 1ijvS!2 Comments D. LIFT STATION J� Datn Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) — "Pump Off' Level at " Check Permitted Bedroom Rating Against HAA Request "' Vent (Y/N) Pumping 6yc1es during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA an HAA guidelines in effect on the date of this inspection. S & S ENGINEERING 2'L Yd Signe 0J)ate Come River, Alaska 99577 MOA No. Com-- --0 Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (Rev 8/861 Back 6g Q 3V,6 r. CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 \ FEDERAL TAX ID # 92-0040440 Client Sample ID:LA, SAMS PWSID :UA Collected MAY 6 88 @ 10:15 Received MAY 6 88 @ 14:45 Preserved With :NONE ANALYSIS REPORT BY SAMPLE for Work Order # 6519 Date Report Printed: MAY 10 88 @ 12:32 Client Name S & S ENGINEERING Client Acct SNSENGP hrs. P.O.# NONE REC D hrs. Req # Ordered By : R. SHAFER Analysis Completed :MAY 9 88 Laboratory Supervisor :DANIEL J. BACON Released By Special Instruct: Chemlab Ref #: 9951 Lab Smpl ID: 1 Matrix: Water Parameter Tested Result/Units ---------------------------------------------------------------- NITRATE-N ND(0.10) mg/1 Send Reports to: 1)S & S ENGINEERING 2) Allowable Method Limits -------------------------------- EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY R.P. 1 Tests Performed'' See Special Instructions Above UA=Unavailable ND= None Detected See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than MUNICIPALITY OF ANCHORAGE + > DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Lal Description (include lot, block, subdivision, eg 2 Z.-0 / A S9- ----- 7_1_S- �)J rte' / &(-� Location addre$ or irections) CD , 0 1 r('� (A) 00 0 (b) Applicants Name �/f Applicants Address -0 Y.g 0 tsl_ (c) Applicant is (check one) Lending Institution Buyer E= ; Other [-:�j (explain); (d) Lending Institution Ads s Z�14A_) /) ff/0l �n tov's ip, range) Home Business ; Owner/builder , ; (e) Real Estate Co. & Agentyy A1j r Address Telephone l"?�Llo (f) 41a*l� the HAA to the following address: :;� as c. 819B 1916X z 2 Type of Residence Single -Family Multi -Family Number of Bedrooms 2 3'., Water Supply Other (describe) 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 OnsiteP6 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] 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 ow -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 Firm Telephone �i�ytiv�s„ro�h'. i ��Ra'e'®��� Address �e ;�;i 9��3a -- ------ 6. DHEP Approval Approved for bedrooms Approved Disapproved Terms of Conditional Approval sa`t _.2 aaEa. Rbel A. Shahs ',.: ; •' ,.) �� S By % "t cam? Date 1 i Conditional CAUTION 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 HOMES AND 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 OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Descr 71 Z 31) MLINICIPALITY OF ANCHORAOF DEPT. OF HEALTH -& ENVIRONMENTAL PROTECTION J MAR 2 01985 RECEIVED tion: Gam' a/ Well Classificati W74 If A, B. or C. D.E.C. Approved(Y/N) �— Well Log Presen (Y ) Date Completed / 9 7 3 Yield, < 0?,A r �y Total Depth Cased to `JIJI_D Depth of Grouting Static Water Level 7 1 Pump Set At l i4y eP Casing Height Above Ground Sanitary Seal on Casing ti. Electrical Wiring in Conduit (Y Depression Around Mllhead (Y Separation Distances from Well: To Septic/ 'Tank on Lot AV f ; on Adjoining Lots l� To Nearest Edge of Absorption Field on LotOn Adjoining Lots./VD To Nearest Public Sewer Lig /) To Nearest Public Sewer C Cleanout/Marhole ! // To Nearest Saw; Service Line on Lot 2 Water Sample Collected By -V �Y —Iple ; Date Water Sample Test Results ':�) �✓ 77eS' iia C B. SEPTIC/HOLDING TANK DATA Date Installed / M Size A900 No. of Ccmpartu ents Standpipes (Y Air -tight Caps (Y ) Foundation Cleanout 0 ) over Tank (73 ) Date Last Pumped 9 —��&5- Depression Pumping/Maintenance Contract on File (YJtQ''f /1A-- for Holding Tank High -Water Alarm Temporary Holding Tank Permit (Y Separation Distances from Septic/UeldiWTank: To Water -Supply Pb ll /6)0 ( To Building Foundation 2 2 To Property Lire /0 To Disposal Field /7z6 P To Water Main/Service Line '- To Stream, Pond, Lake, or Major Drainage �0YJE Course Convents A11-0 4/ Receipt # Date Paid: Amount: [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata k Type of System Desigr.`'���Jf.� Date Installed z9 7.3 Length of Field 41< Width of Field e,< (ems Depth of Field /Z Gravel Bed Thickness o Square Feet of Absorption Area Standpipes Present 42LO Depression over Field M _ Date of Last Adequacy Test 73-17-&,3_ Results of Last Adequacy Teste ?! S14r9c 7:5,i-e77>.i jS'/ tS' Separation Distance from Absorption Field: r To Water -Supply Well /,CO � To Property Line /O To Building Foundation �'�f To Existing or Abandoned System ai Lot �,� ; On Adjoining Lots 1.�J / To Water Main/Service Line /62 '/_ To Cutbank(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 Dive ns ions Manhole/Access (Y/N) �i_,"Pump Off" Level at High Water Alarm Level at IT -1 Vent (Y/N) Tested for ing Cycles during Adequacy Test, Meets MOA Electrical Codes(YM) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. 4ii...'i'Sif 1YLT.i �'Sit��a ucAep On^ �� Signed F31�' Date Co an -IVEF, ALAS(S, MOA No. S'�UiJ j mP Y 0� X979 y a'L1 E KB1/d5/s (Page 2 of 21 5 a-Jq> q5100 1�,gs 7, a Hasan A. Shafer n Na, 1437-E 2-15-84 I _ - T/s /1/ w DATE RECEIVED —I i INSPECTION APPOINTMENTS NUMBER OF,BEDROOMS TIME - - TIME TIME f� DATE ❑ Three ❑ Six DATE DATE INSPECTOR *ATTACH WELL LOG. A well log is required for all wells drilled INSPECTOR INSPECTOR Ff�/r• , ❑ PUBLIC UTILITY MUNICIPALITY OF ANCHORAGE 8. SEWAGE DISPOSAL SYSTEM MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & [$C INDIVIDUAL/ON-SITE** DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT lf IRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 • ENVIRONMENTAL SANITATION DIVISION NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Telephone 264-47 20 ��J V FD REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW A DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER C AS%� PHONE ilo✓� G$? 9 G.s 9 -MAILING ADDRESS IV .2IL/C PROPERTY RESIDENT (If different from above) PHONE 2. BUYER Atzr PHONE MAILING ADDRESS .�5A G-4 —e iL / /C -TJS- 7 7 3. LENDING INSTITUTIONS p 70 f �9 S%4 AL1-)S/(1i e y/T 0'V PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS - 5. LEGAL DESCRIPTION ,L ©7 a o) - T/s /1/ w STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other J5< Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY % X' INDIVIDUAL- '.�� *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [$C INDIVIDUAL/ON-SITE** J %73 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY — - NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. _ - 72-010 (Rev. 6/79) ,JCy11/.¢at.e 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE EJ PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING - TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS l./`� sem. s't-*.. .� A.�,�'t.-,�.,t,4. •''z fs .. //I 1 1.-%.=t 11�-APPROVED FOR Z— BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE / ! t9 BY 72-010 (Rev. 6/79) r 825 , -L„ STREET 110-11,9- Wn Arlt HO- AGE, ALASKA 99501 (007) 264-4111 Gc,011cc; M, GUL LIVAN, N41AYOF1 0',PAT 1'. MEN T OF IIFA L_T>1 AND ENVIRONMENTAL_ PAO-TCUM octobor 3, 1980 Sam Nestor Box 837 Eagle River, Alaska 99577 Subject: T151,1 RIW Section 8 Lot 201 Approval for your i.ndividual sewer and water facilities cannot be grant --d until the following items have been completed: '(1) The water analysis :report be delivered to this �n Ufa' del art tent from Chem Lab, 5633 B Street, for �Ys our review. (2) Locate andexpose the well for oui-J-n-?:pect. of to C c- det�:1 r trzp ,operty r_ canstuci.aon, also to insure the min unum distance requirements are met between your. e well and sewer system, (3) ']'h septics -yank pumped with a receipt submitted to / (4) An adequacy test be performed on the existing leaching < area. This test will determine if the system .is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this department for. our review. If there are any further questions, please call this department at 264-4720. th�.s c3r•part.:nrnt. The total ruml�er oL. a�11Qns pumped nee�to be on the receipt to verify the size or the tank. '\This will need to be v�ri f_�ed �,��,g.��.t.e�:ed encaineer prior to submittal. Robert C. Pratt, R.S. Associate Specialist Sincerely, RCP/ljw MECHANICAL ENGINEERS CIVIL ENGINEERS NAME: ADDRESS: r_ -l0 STATEME. o s -i SRB 196X EAGLE RIVER, AK 99577 4�-;J-7> DESCRIPTION AMOUNT Ave,, `r TOTAL BALANCE DUE 30 DAYS FROM DATE OF BILLING. 1'/z% INTEREST PER MONTH ON ACCOUNTS OVER 30 DAYS, DAVID A. SLENKAMP MECHANICAL ENGINEER 694-9055 October 92 1980 ROBERT A. SHAFER CIVIL ENGINEER 694-2979 MUNICIPALITY OF ANCHORAGE - DEPT. OF HEALTH & ENVIRONMENTAL POTECTION OCT 13 1900 Sam Nestor Box 837 RECEIVED Eagle River,, Alaska 99577 Dear 1✓1r. Nestor, Reference: Lot 201A; Section b';° T15N; RIW An adequacy test was performed on the seepage pit located on the referenced property, per your request. The seepage pit was dry at the beginning of the test; then the crib was charged with 2000 gallons of water. A'24 hour period was provided for saturation of the soil surrounding the crib and after another 24 hour period, percolation of 364 gallons of water had occurred. It can be concluded from this test that the seepage pit is currently functioning adequately for your new two bedroom home. If we may be of further assistance, please do not hesitate to call. Sincerely, s BLTA. 1(tkS/ss cc: Municipality of Anchorage Department of Health and Envio-rnmental Protection U.S.A. Alaska Federal Credit Union SRB 196X EAGLE RIVER, ALASKA