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SCIMITAR #1 BLK 1 LT 5
1� OS\IMV \ 3a- Ott MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 2.64-4720 ON-SITE; SEWAGE: DISPOSAL SYSTEM AND/OR WELL INSPIECTION REPORT DISTANCES FROM�� TO SEPTIC, TANK_ ABSORPTION FIELD WELL Add,ess - — f_GF1��.1 j �(' • a�1sl°� Phonc(S Permit No. No of Bedrooms RI��— WELL _ ?7 LOT LINE- }-- LEGAL DESCRIPTION lotBlockSubd `� vision FOUNDATION - 'I ownshlp, Range, Section �r-- i-- AS -BUILT DIAGRAM (Show location of well. driveway, water bodies, etc.) -- septic system. properly Imes. foundation, - - - TANKS _ SEPTIC ❑ HOLDING - 1 -- — ✓4 - _— -� - -- Manuiac:urcr--- Capacity in gallons Malenal No. of Coll^ Amen is _ TYPE OF SYSTEM ----..--_�_ �I-RENCH F1LlBED I W. DRAIN OTHER n - Depth to pipe bottom Isom original grade PTI loml defelh from ongmal grade I I FT / — FII added above ongmal gratle O FT Gravel depth beneath pipe ^I FT Gravel lenq:h TOlal absorption area Jp� GI �ZSQ FT mber So Nuof lin-es Soil rating �ZZ SO FT. Gravel witlih 2 rr� F ( — T_ -- - , I •/ 'o -- 'stance between lines Di I, ri pipe mateal Installe r Dale Installed WELLS--- _ _ _ 4y PRIVATE ❑ OTHER (Identiiv) GaSSlhcail011 (Q,[$, L.) TOta DCPIII Cased to i FT FT Installer Date Installed a I-- - — - -� - — — REMARKS: ---- —�� - _ _ scale: t tl,>-/-�-0 Inspections Periormed by. Date- s �--2 .-. 8 � _ _-e�...--.__.__ ins was performed according to all action c— Elgc9tAErtS�^SFf4l - ' a 'p�., c+ .',S'. I Y �� 4P V + ",a•n �saem + l � a• �d .•a••v•M •a •.� """•" . $aibcnt A. 5tuffl1 a g• � F% •� Jam••1•k� 1.457-� �.•�� �` . pp�. • •• •, Z ;` —� �,°�•'9" y� _ !xP � -a=u��.��.i�-IX�J.'c1Y ��l�rr. ��._�-��Jl; . ,. p7..e- 17034 Eagle River Loop Road iV® 2,04 that this certify t 7S— Municipal and Stale guidelines in ellect on INS date: _�—�— I-leallh Department Approval: ..— � " `^ -�-� �---Dale.7�—'—'3�1� — iiUNlClPALl|Y OF ANC�)'��A�E beparL/oenL o{ Hea]th & Human Services 825 L Street; Anchorage� Alaska 99���| J43~4720 UN~Sl[E SEWER PERM\T Permit Nupber: 8801Y7 UpqrZvi e Date IssuedEnqineer was igned �~me: |//[S UALE Day Phone: 563�1069 CHUGlAK, AK 99567 ) a/c~! !d: �!'! ':�-04 Ln� |, Mid ivision: SC]MITAR #1 Lot: 5 Blocko 1 Sec1Dill : 10 lownship: 151\1 Range: 1W Lot S:ze 43524 (sq.[t. or acres) �/^^ drcions : This Permit: 3 Total Capacity: 4 Minimum total septic tank capacity: 1,250 gallons, Each septic at least 2 compartments" Depth to top o� septic tank(s) � 4.0 equires insulation over tank(s)" INFD|(M 0.H"H.S. PRIOR TO 1ST & 2ND INSPECTlONS DY ENGINEERv IF A| |B( 01 IOURS CALL 343-4681 AND LEAVE A MESSAGE. CONyilIUCT PER £NGINEERS ATTACHED APPROVED DESIGN" 1111 PERMIl EXP1RES 12/31/8B, !|�|� PEHMIT VAlU FOR A SINGLE FAll 1LY RESIDENCE ONLY" [HAl: �amiliar with ihe requirements for on-site sewers and wells as set the Municipality oAnchorage (MOA> and the State of A1aska. / will instal1 Lhe sys�em in accordance with a1l MOA codes and requlations, and in comuliance with Lhe design criteria ofthis permit. 3. 1 wil1 adhere Lo a]] MOA and State oor the seL back '!�s�ances from any aLer disposal system or pub1ic age sysLem on 11"Mor any adiacenL or nearb� lot, iL i �id for a maximum o[ 3 bedroums. l l s�stem is 4 bedrooms and my r: permit. ' . T AE Municipality of .Anchorage Department of Health and Human Services dhh5 825 "L" Street Torn Fink, Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 September 20, 1988 Robert A. Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Anchorage, Alaska 99577 Subject: Waiver Request for Lot 5 Block 1 Scimitar Subdivision #1 Waiver Request #WR88-057, Permit #880197 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 feet. 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, Daniel J. Roth Civil Engineer On-site Services DJR/ljw#7 Municipality of Anchorage %r ►'' °4x DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "U' Street, Anchorage, Alaska 99502-0650I ti .1 •^ ••^••••+•••e'10+p er SOILS LOG PERCOLATION TESTR"A •e °j.waes7+ G6! PERF=ORMED FOR: L e�� 1�/G'� i DATE PERFORMED' + -� LEGAL DESCRIPTION:, Township, Range, Section: - 1 )s pJ V-Au� O_ �—� SLOPE SITO PLAN 2 o 3 O � 4 c� 6 6) fj 7 O 8 O, 9 `�PJ 10 11 12 13 14 ) 15 — 16 17 18 19- 20- COMMENTS 920 COMMENTS `z( FA 22,CS, WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT 0 DEPTH? _ p E Depthto Wale Montt q Monitoring? Date:� 7'g� Reading Date Gross Time Net Time Depth to Water- Net Drop tZ- c�`• 1,0 Q II PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN --:L�-FT AND 16 FT PERFORMED BY: 17034 Eagle River Loop Road No. 2� —� CERTIFY THAT T IS -ST WAS PERFORMED IN Eagle River, Alaska 9Y577 dy ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELI EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) II 1 SCALE ®® n 0 N .. Or GREW Z ANCHORAGE AREA BOR H Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 f�INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM �f� NAME /` ,C�///y MAILING ADDRESS �,�� � pJc �i�L� ��/�/ PHONED'- �J ) LOCATIONiA%� (%�`-S�t��' -LEGAL DESCRIPTION SEPTIC TANK: DISTANCE / i _ - NUMBER OF FROM WELL "G� MANUFACTURER �`�w-�G� MATERIAL_��_��� .__ COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH _ LIQUID CAPACITY/,"2,-';y GALLONS. TILE DRAIN FI-EL—D _ TOTAL LENGTH f DISTANCE FROM WELL ��2� FOUNDATION NEAREST LOT LINE-_�_ .—OF LINES % NUMBER OF LINES DISTANCE BETWEEN LINES - TRENCH WIDTH_— IN. TOTAL EFFECTIVE ABSORPTION AREA ��'h (� _ SQ. FT. LENGTH OF EACH LINE e. DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADEMATERIALBENEATH TILE_ ---IN. ABOVE "TILE ---IN. WELL: TYPEA41' L � e— -- CONSTRUCTION ���� �/ ---DEPTH ���= / DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC i SEEPAGE i FOUNDATION 'I J/ ' , LOT LINE SEWER LINE TANK ��, SYSTEM .//U CESSPOOL ///M, OTHER SOURCES APPROVED_.__ DISAPPROVED DISTANCES: �_ % ` INSTALLED BY:! PIPE MATERIAL — - __—REMARKS-i/S%/N�Gd�G.G DIAGRAM OF SYSTEM F 121Pc, C c i> LOT SLOPE: — u 4 iTrt c5 v f { t a lion r5 REMARKS:�, r DATE / J:�'APPROVED G. A. A. B. Form EQ -032 sat G`. GRR� 2 ANCHORAGE ARRA BOF aH j �'<•rk� 0 DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. C _ _ In(` 3330 "C" STREET ANCHORAGE, ALASKA 99503 - TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT✓� NAME OF APPLICANT T MAILING ADDRESS PHONE i-- INSTALLATION LOCATIO/-a 7�''--``I��Lr' �� ��}�`�f'' LEGAL DESCRIPTION ���]]_/�Sz! 1////f6 ��- IMSTALI_ATION OF: SEPTIC TANK —- SEEPAGE PIT DRAI FIEL _, OTHER —, TYPE AND SIZE OF FACILITY TO BE SERVED��'r•^"'�(��''�d;' �_��� • 1 �"L�� — FINANCED THROUGH � - TO BE INSTALLED BY e SOIL TEST RESULTS f o I � NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED _ FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF' ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. o So (V o . cwt SIiPTIC TANK SIZE TYPE-- ° -- SEEPAGE AREA SIZE — TYP MINIMUM DISTANCES. REQUIREMENTS FOUNDATION TO SEPTIC TANK •-' 1 -— FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK �s SEEPAGE PIT DRAIN FIELD`-�/�.) / TO NEAREST LOT LINE. WELL TO SEPTIC TANK 4"'" SEEPAGE PIT e�w DRAIN FIELD — ' 1 ' ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD e..a SEEPAGE PIT 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 SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. ' GRAVEL BACKFILL 5�nmtro A. — z �Z_ !/ CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. DIAGRAM OF SYSTEM , IL ct G.A,A.B. OR i a Q LICEN Q' DESIGNER fl ll AW, 1�;� 3 (2 X •�f - Et 1�a. �� �P� `YA C1 l,1 5 I CER TI F'Y AAT/II AM FA-' I R WITH THE E UI EM N S OF GREATER ANCHORAGE ARE BOROUGH R INANCE NP. 28.68 AND THAT HE AOVE DE:SCRIE7EDl5Y3'f`EM IS 1,IQ�iVCE WI�AID'F/�_ �0I V' ,. DATE 0 - a APPLICANT'S SIGNATURE FORM NO. EGI-016 Alt ?. CONStJL'rA:N-rS, INC. 249 EAST 51ST AVENUE P•O. BOX 6007 . ANCHORAGE. ALASKA 99503 August 5, 1975 Mr. Albert Melvin P. O. Box 400 Chugiak, Alaska 99567 ANCHORAGE: PAIRRANKS JUNEAU TELEPHONE 907-279-0403 TELEX 090-35419 RE: Test Hole and Soil Log Report for Sanitary System Lot 5 Block 1, Scimitar Subdivision Dear Mr. Melvin: R & M No. 562081 We are submitting herewith the test boring results and our comments regard- ing soil conditions encountered at the subject site. This investigation was performed in accordance with your request of July 1975, and those procedures outlined in a letter dated July 15, 1975, by Mr. Rolf Strickland of the Grea- ter Anchorage Area Borough Department of Environmental Quality. A single test hole was put down within Lot 5 for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with an auger type drilling rig and the test hole was extended to a total depth of 19.0 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M CONSULTANTS, INC. James W. Rooney/.c� Vice President JWR/ja xc: GAAB 1 SILTY GRAVELLY SAND w/OCCASIONAL COBBLE (SM) SANDY GRAVEL w/SOME SILT AND MANY COBBLES (Gid) 9.5' 12,0' SILTY SANDY GRAVEL WITH MA1,11' COBBLES (GM) NO WATER TABLE Log represents Lot 5 Block 1 Scimitar Subdivision RC� Consultants Ino. G_ ANCHORAGE FAIRBANKS- ALASKA JUNEAU 19.0' T. D. Albert Melvin Property Log of Test Hole Chugiak, Alaska 99567 DATE 7-31-/5 (SCALE 1"=31 1 OWN 6Y IVA/• A \ JCHKO BY DAS IPROJ. NO. 56320,91 IDWCt NO A- M "W DRILLING, P• n, Box 4.1224 • 1310C Internati ANCHORAGE?A AS1KA DRILLING LOG Well Owner. _—_Mr -- k A 7 tiiel�ci «:20 P.01 P081 -It" brand fax Irarsrni!tal rnerno 7671 "olpl- To -' n%G jC7FJ�!'(_ !_L�✓ From. Phone s az J�✓{C' Location --------Use of WelL--LXU{,- (address of: Township, Range, Section, if known; or distance main road"_ - --._-5-►--5�I?1 tr f - Size of casing_ c) of Hole___~" - -lQ2__feel Cased to_._,L7_-�-feet Static water level t 54 ft. (abo (below) land surface. Finish of �ti ell (check one) ( ) . Screen ( ); Perforated ( open end x), Describe screen or perforation ti NnnP Well-��_`_`.""__- _._•.___� pumping test at 2 ._gallons per (hour) --`__ of drawdown from static level, (minute) for__? _-____hours Date of completion- 7.5 ct`�oo_ v „74 Depth in feet from - -`- ` WELL `OG _ 4 --- _s._. _ __.._ ground surface__ �� `� -- - ----- Give details of for_rnati•.>r.s penetrate. -J, size of material, color and hardness Sand t wet ---TO.----'-- silty Gr`3vnl. c oc r•csonal cobbles 5075T0 r - 1{Aran t _ cc;lr�hly_`�r - -- r Boulders - 5 --TO--_ C:rave.l saalnaec; ueuanH *& 41IeeH .1cta0 - ---- -..vr..-.__._-__..._t>�e•,rat�vt>``#e'+ti±i�t#wtaft�itl__-. 102_TO__1.07 _ Gra"'eI_z� Hardpant eobbly _. 107 ._TO_-_ 11 �__.__,._._....._ir�..�.�.�•��------_�_____.__.. --UQ—TO--I 2L) -Gz-avellti, _I�Trril>^�n, cabt-�lti�_-._.__. .._.�/l•��'� C7 'W _QL y _._ -_1.25-TO. _-.12.7 t'oril .ler --- - - I� ---127-TO_-_ 12 Ft (.ouadez _-_-_ �.___ ✓' --22}z._TO 170_ C -.___-_____ .�m�rs�>•__��FS_n�a�h,.xn��-- __-_ELaY - 1 ILL-'-'.;_' I17UTO_ 160 (;c,ul.ie c;r,-�vr 1 a `wtitPYh�<�Y1 i;� t -,FGRE' ':R ANCHORAGE AREA BO' IGH l Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 L),-- 1 - i )_ U -1 JJJJ II/NSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME MAILING ADDRESS—PHONE PHONE ( { _ LOCATION SK# K004 r) LEGAL DESCRIPTION /OTS S G Kw( -k 5���/lrf9/? d 6(p. SEPTIC TANK: DISTANCE ►� . NUMBER OF FROM WELL MANUFACTURER5MNSe-T PCASrm% MATERIAL&ci� _wj1SS _COMPARTMENTS _ INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY Zj0 GALLONS. SEEPAGE PIT: NUMBER OF PITS I. DIAMETER W OR WIDTHC LENGTHS,. DEPTH _ LINING MATERIAL CRIB SIZE: DIAMETER IZ DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION—, NEAREST LOT LINE 2I ABSORPTION AREA (WALL AREA) �f�0 SQ. FT. ADDITIONAL ABSORPTION WELL: kJvr 1#5kil qt- TI+Kr✓ o( Itfi yet 11o), - TYPE _ CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION—,LOT LINE—,SEWER LINE CESSPOOL OTHERSOURCES APPROVED DISAPPROVED DISTANCES: INSTALLED BY: lar PIPE MATERIAL: I,n{HS(� r 6%1- Taw LOT SLOPE: REMARKS: ij p � ov�u Y �tvo rr� Form No. EQ -031 REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK—_SYSTEM . DIAGRAM OF SYSTEM -LI, DATE /V/////T APPROV G. A. A. B. T AA „o a GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 "C” STREET ANCHORAGE, ALASKA 99503 1\1\V51�1 IIIIIIIIIII//////)///, TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT I f7U& I.'_./t- MAILING ADDRESS PHONE INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED SEEPAGE PIT , DRAIN FIELD _ OTHER , TO BE INSTALLED BY _ _ c. NOTE I THIS PE EMIT IS NOT VALID-WITHOUTSOILTEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE /^` ' () TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK iC 9 K, � SEEPAGE AREA SIZE FOUNDATION TO SEEPAGE PIT '.` ) , DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL ' -,� SEPTIC TANK -j , SEEPAGE PIT `� - (Z DRAIN FIELD _ TO NEAREST LOT LINE. WELL TO SEPTIC TANK ( % / SEEPAGE PIT /ro / DRAIN FIELD ALSO CONSIDER AREA WELLS WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD SEPTIC TANK,/(."0/ 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 SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER TYPE DIAGRAM OF SYSTEM I CERTIFY THAI' I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE: ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE Ma icipahty of Anchorage A Department of Health and Human Services RickMystrom' 825 "L" Street 9 Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 Notice of Violation September 19, 1994 Pameula S Sloan P.O.Box 671998 Anchorage Alaska 99567-1998 Subject: Proper located at 20236 Chugach Park Dr . Anchorag_e AlasLa sitar #I Subdivision • Lot 6 • Bloc cel Dear Sir and Madam: During a recent on-site investigation of lot 5 block 1 Scimitar #1 Subdivision, It was verified that the septic tank on your property is located less than the required minimum separation distance (100 Feet) from your neighbors well. The well on lot 5 was operational on November 24, 1974. The septic system on your property was installed on September 22, 198A The encroachment of your septic tank on the adjoining well is in violation of Municipal Ordinance AMC 15.65.050.A.4. While the Municipality has no desire to restrict or inhibit your rights in property, we must require that you adhere to applicable municipal code requirements established to protect the rights of your neighbors. Accordingly, it will be necessary for you to correct the violations. Please do the following: ♦ A Health Authority Approval (HAA) certification is usually a requirement of financial institutions at the time of sale of the property or refinance. In order for you to obtain a certification, you must apply for and pay the appropriate fees for a well to field waiver. A All violations or violations referred to herin are to be corrected at the time of the next septic system upgrade. Please feel free to contact my office, telephone (907)343-4744, between the hours of 8:00am to 4:30 pm if you have any questions regarding this matter. Your ly, Robert W. Robinson Civil Engineer On-site Services. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES- Division ERVICE$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. # ��� ? o`/ HAA # f L 7 1. GENERAL INFORMATION Complete legal description �^ 6 / Sc, wAt mr *1 Location (site address or directions) �3CN 04t-«nC4 I� O2, Property owner Cn a -A: -:-A?- Day phone (W-66 1 Mailing address 110, -Som (2 u6ui y- -J9,'z7 Lending agency Day phone Mailing address Agent 61) 0__ e�vz/ IC Lr14c �� Day phone G 9y- 9o3s` Address -- Unless otherwise requested, HAA will /be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well 5C _ 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 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 David R. Dayton P.E. — Phone Address _ ChuAak, Alys�a 99567 Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Date 8� 377 'J dot Y 4'::"H 1/yS� ...iii• CGB 4oO t • agt li Creiz' ? Daytnn 1W'0 ge Cz�. 22C5 -E f? w Conditional approval for �_ bedrooms, with the following) stipulations: Ve /C- � 7O We Additional Comments 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 (Rev.1/91) Beck MOA #21 Municipality of Anchorage Ack ARM Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: It �- �-= 1 3�4m'rAR d`) Parcel I.D. V15' 1 e 132 A. Well Data Well type P9J U +- _If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) A/ _Date completed e / 9;T Driller. 6 Totaldepth 1"71. eco eitLylo.ts"A4 Casedto ±e..- Casing height r " Sanitary seal (Y/N) Wires properly protected (Y/N) rI FROM WELL LOG AT INSPECTION Date of test 1986 /-�-AA- Ay -e, t o� A/,W M y c> n _ Static water level Well flow_yJ 6�2,- g.p.m. (0 _g.p.m. n rn Pump levels V; ° SEPARATION DISTANCES FROM WELL TO:�� Septic/holding tank on lot t Z) --s ;On adjacent lots <>Z -rnuw -SL) %Vy$ 7 -A -,,JA - Absorption field on lot �-LQ ;On adjacent lots / c7�� Public sewer main Public sewer manhole/cleanout �-`- Sewer service line 2--5-4- -- Petroleum tank - ^-- WATER SAMPLE RESULTS: Col'rform (D S s & Nitrate 6, z4r,lr Other bacteria c) Date of sample: rs d Collected by: B. SEPTIC/HOLDING TANK DATA Date installed i 9 5 � _Tank size Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) l33 Depression (Y/N) AJ High water alarm (Y/N) T— Alarm tested (Y/N)_1%� Date of pumping � _ Pumper <",-°. 9%ovl, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot l03 On adjacent lots 'To property line 10-1— Absorption field Surface water/drainage t' Foundation % Zs .4-- Water main/service line L--sv- 72-026(3/s3)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed A//�_ Manufacturer Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on D. ABSORPTION FIELD DATA On adjacent lots Manhole/Access (Y/N) "Pump off" Level at Cycles tested Surface water l9 , Date installed - Soil rating (GPD/Ft2) Z Z<! ` –System type .v /31 LengtW3,5` Gravel thicknessf%� Total depth � /L—�— 7n, nom!— Total absorption area -;Y41'&?,- +ouc rs Cleanout present (Y/N) Y _Depression over field (Y/N) _ Al Date of adequacy test_14– jolt ?Af Results (pass/fail) hh �-f� for <_73 Bedrooms Water level in absorption field before test !�9 it After test F✓9 Peroxide treatment (past 12 months) (Y/N) Al _If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots iii —_� 1 _Property line To building foundation To existing or abandoned system on lot On adjacent lots __I,-_ __Cutbank /V titer Water main/service line ' Surface water /62o'�' _ Driveway, parking/vehicle storage area Curtain drain N::,vr 14N1-xWAJ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect orkthe date of this inspection. r' David R. Dayton P.E. Signature 20210 St. --t:hogiak, kt Engineer's Name Date HAA Fee $ V�00 Waiver Fee $ _ Date of Payment j Date of Payment _ Receipt Number Receipt Number 72-926 (3/93)• Back MUNICIPALITY OF ANCHORAGE M E M O R A N D U M WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO.HA940434 During a recent Health Authority Approval on-site inspection and test of tlje potable water supply well on Lot 5 Block 1 of SCIMITAR #1 Subdivision, the well's productivity was determined to be 0.6 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 bedroom residence is 0.4 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such Es washing cars and watering lawns and gardens may be required. This advisory mutt be attached to all copies of the subject Health Authority Approval. Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that a periodic testing be performed to insure the wells continued suitability. Nitrate concentration is 6.8 mg/1. EPA maximum concentration is 10.0. mg/1. i6--(� D. R. DAYTON, P.E., R.L.S. 20210 Donalar Chugiak, Alaska 99567 (907) 696-2417 August 30, 1994 Municipality of Anchorage Dept of Health & Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Re: LOt 51 Blk 1, Scimitar Subd. #1 Attn: Mr. Jim Cross Dear Mr. Cross, While performing an adequacy test on the septic system on the subject lot we have found the distance from the lot 5 well to the lot 6 septic tank standpipe to be 95 .ft. The tank edge would then be 92'-+. The distance to the lot 6 trench has not been precisely determined but is probably 100 ft. assuming the trench is 5 ft from the trench as shown on the inspection report. Both of these properties have previously been issued HAA Approvals with the distance in question being noted as 11'+. We request you review the submitted HAA data and issue a Conditional Approval pending resolution of the matter as referenced in paragraph b of DHHS letter, July 14, 1987, from Mr, Lee Browning to Assemblyman Fred Dyson. The situation as it exixts is creating a financial hardship on the owner as he is unable to close a sale. If there are any questions please contact me at 696-2417. Sin rely, David R.Dayton 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 1. D, # 1�1�I -- I ')� ')-(-, I HAA it 1. GENERAL INFORMATION Complete legal description Lot 5; 8tock 1; Scimitat Subdi,vi,5ion #1, Location (site address or directions) 20236 Chugach Pakk D,cc:ve Property owner Do4o-thy Sotick 9 Logia Date Day phone 688-9744 Mailing address P.O. Box 670769 Chu yah Ak. 99567 Lending agency Mailing add Day phone Agent Vtitginia Koh4iUd RE/MAX OF EAGLE RIVER Day phone 694-4200 Address 16600 Cente46iad D,,ive #201 Eaqte Raven, Ak. 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. n. 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 Address 5 & S ENGINEERING - Phone — iVeK-Loop-Remit A n_„v r�._ Engineer's signature Eagle River, Alaska 99577 Date 6. DHHS SIGNATURE X— Approved for Disapproved. bedrooms. .7e U. MM ,.•.l °ova 9J. Conditional approval for bedrooms, with the following stipulations: Additional Comments —Note • ThA Well for this nron State and Municipal Codes. There are nitrates present. It is suggested that a periodic testing be performed to Insure t e we. co inued suit i it Nitrate concentration is 7.8 m UM co c tion is 10.0. mg/l. /1• EPA By:---�-__ Date _,�? Zi The Municipality of Anchorage Department of Health and Hu an Se (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. 72-025 (Rev. 1/91) BaCk MOA 921 is ® Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LC�f5 �a s� Ir r S Parcel I.D. A. WELL DATA Well type 9LN a e= If A, B, or C, attach ADEC letter. ADEC water system number p. Log present (Yo Date completed ^' Iii Driller_ 0V Total depth \1 �" �i k Cased to Casing height_ 1'V"_ Sanitary seal YON) -- Wires properly protected (!7N) FROM WELL LOG AT iNSPEOTIot4UNICIPALITY OF ANCHORAGE Date Of test ENVIRONMENTAL SERVICES DIVISION Static water level 1992 Well flow f� `� ( C D y g.p.m. _ F I V Pump level — 11-71 SEPARATION DISTANCES FROM WELL TO: 6A -L' Septic/holding tank on lot _ 1 Dc�> \ hwYG ; On adjacent lots ___lbc> Absorption field on lot Public sewer main 1` On adjacent lots la' Public sewer manhole/cleanout A Sewer service line -_ t� Petroleum � tank ZS � �4 WATER SAMPLE RESULTSn ' v I Coliform _�_Nitrate _ �" `} I Q . \\ Other bacteria Date of sample: Collected by: S 5 ENGINEERING —�— --- 1X3_4 EaU eTRiver LnoP Roa No. B. SEPTIC/MOLDING TANK DATA Eagle River, Alaska 99577 Date installed Sg Tank size _ 1 ov o Compartments _? Cleanouts &N) _ Foundation clean outY r� ( �% ------ . Depression (Yfi�) _�— High water alarm (Y6 _ r� _ Alarm tested (Y/N) Date of pumping _ q7_ L n Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wells) on lot � bo' On adjacent lots 1b'o �� t — Foundation_ To property line Io 11 Absorption field � _Water main/service line l0\-4" Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) _ High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N SEPARATIO ANCE FROM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA On adjacent lots Date installed Length SIS, �3'_ Width �•� 1 Manufacturer Manhole/Access (Y/N) p off" level at Cycles tested Surface water Soil rating �2�' !�[ _ System type y —Gravel thickness I o1 _Total depth Total absorption area L`1_LnZA�� Cleanouts present &N) Depression over field (Y& Date of adequacy test -;> - -,�Z- Results,��fail) P45 for bedrooms Peroxide treatment (past 12 months) (Y. % ��F{Lr1D�L A1 If yes, give date.— SEPARATION ate. SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot � \3' On adjacent lots— �1 do' A- Property line To building foundation ``1 o To existing or abandoned system on lot _ J� On adjacent lots `�, r-;,\--t—Cutbank i�'!cr __Water main/service line—_ 1 t+ Surface water �Qa Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & S ENGINEERING i Signature 11034 Fatale River Loop Read No. 204 JL fir+ Engineer's Name r Date HAA Fee $ / r U a I 4' Waiver Fee: It Date of Payment - 3 6 - %- Receipt Number �44_`�_ l �/ 72-026 (Rev. 3/91) Back MOA 91 Date of Payment Receipt Number stn\ /�" 17034 Eagle River Loop Road • Eagle River, Alaska 99577 k ROBERT A. SHAFE ## WELL FLOW TEST DATA SHEET f q�(E � *# CIVIL ENGINIEE 694297 R/VEP P'V0 PROJECT: ` � 1 ` (� cc) ✓A t LOCATION OF WELL (Legal Description): �-- -r �5 DATE OF TEST: 3 �� -�Z �u '+ r•� t-r�,(� sly � 1 WELL DEPTH: � -7 •Z FT. CASING: o --_ DATE DRILLING COMPLETED: FT. SCREEN: DRILLER: V V-- STATIC WATER LEVEL. (Top Of Casing): (p(� r -----.__FT. DATE: CLOCK ELAPSED TIME SINCE - TIME PUMPING STARTED/ STOPPED, MIN. DEPTH TO WATER, FT. DRAWDOWN!—� PUMPING RECOVERY RATE,GPM REMARKS 0-------- LPL-.' (swl) Start r tel. ----------- 15�- 20 - - - 25 lo'.SS 30 -- _— �_—.- -- 35 ` 1- -- 40 45 50_-- 55 -�-2� 60 (1 hour)) 120 (2 hours) - 150 180 (3 hours) ---- - �' • 2� 240(4 hours) -- �-- I - RECOVERY -- — t 0 5 --- 0 10 --- 15 20- -__ 25 --- 30 -----_ _ 35 Comments:�J �w R _ ` O 1, u ---- Flow is not Guaranteed Subsequent Variations MUNICIPALITY OF ANCHORAGE ' Department of Health & Human Services R DIVISION OF ENVIRONMENTAL. SERVICESr, 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. #="�Cq- u- HAA #. LI CIC( 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot:. 5' R1 nnh- i. e _ Location (address or directions) Poniard Road (b) Property owner lois Dale Telephone: (home) 6B8=9244__ 5h_ jn6g Mailing Address. P.O. Box 670769, rh„n4 ,L J„ _ _, ___ (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent _ Address Telephone (e) Mail the HAA to the following address: (or check here iX if hold for pick up.) List contact person and day phone number below: —_--5__&_SENGTNEERING- 17034 Eagle River Loop Road No. 204 age (ver, as a 2. TYPE OF RESIDENCE Single -Family cX Number of bedrooms wee_ 3. WATER SUPPLY Individual WeIIZ Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Q Public O Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the 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 _ Tele phone -f-2-12 Address 17034 Eagle River Lu ,,. ... mag—TTe Tfwer,as a i. . Date f114ow 04 ` ...a. .. Q9r •4 .o��'py6� S ry 4 a 1s°,p"►0FF�sio�i� 6. DHHS APPROVAL Approved forbedrooms byy�/L ate ApprovedDisapproved Conditional Terms of Conditional Approval The Municipalityof Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do notconduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) ' Authority Health t y A pproval (MAA) ��� CHECKLIST - FEBRUARY 1984 A 343-4744 u t; Legal Description: Lc r A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present Dat1 e Completed '� tGl —j S t -.�, --Yield ��.L�Z- ��t`'1 r" Total Depth_I-%t' Cased to A0! Depth of%Grouting _ Static Water Level_ Pump Set At Casing Height Above Ground 1 n _Sanitary Seal on CasingLVN) Electrical Wiring in ConduitC(MV)7— yDepression Around Wellhead (Y/ I --- SEPARATION DISTANCES FROM WELL: To Septic/H,9 d n Tank on Lot _ N On Adjoining Lots l Do I Fr To Nearest Edge of Absorption Field on Lot On Adjoining Lots � To Nearest Public Sewer Line _/A ; To Nearest Public Sewer Cleanout/Manhole A To Nearest Sewer Service Line on Lot I k -- Water Sample Collected b `�� S\r Y ' I rSit�-jL"i � ;Date Water Sample Test Results �7A (-t c t-���zs�_� `X,_ — A, Comments B. SEPTIC/HOLDING TANK DATA �:r> - V�" - Date Installed 'q -ZZ 8�3 SizeC7;'2c;) ZJ --�--- No. of Compartments _ Standpipes (-?/N) _ V -Air-tight Foundation Cleanout (Y Depression over Tank (Y/Q r_ - Date Last Pumped N Pumping/Maintenance Contact on File (Y/N)/A �/ ;for Holding Tank High -Water Alarm (Y/N) , Temporary Holding Tank Permit (Y/N) — rJ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:, To Water -Supply Well oo ) To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front To Building Foundation To Disposal Field Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 2 ✓ �rL _ Type of System Design Date Installeda=(--IC _,I _22–`f38 _ Length of Field Width of Field _ 2 Depth of Field Gravel Bed Thickness Square Feet of Absortion Area 6_Z_91 - )�Statndpipes Present((DN) `// Depression over Field (YQ r__� _ Date of Last Adequacy Test 8–?Li --8O c.– Results of Last Adequacy Test � � F�2– 1 iL ��.)-�JPG�(La���] �v �, pa(2 SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well I 1 -?-�> ) — To Property Line To Building Foundation Lot 0 To Water Main/Service Line I --k,5-- To Existing or Abandoned System on On Adjoining Lots To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments-* 1 JI�p D. LIFT STATION (� J Date, Installed I Size in G "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request*" "Pump Off" Level at Vent(Y/N) ping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on thne�d e of this inspection. Signed q g, s EN INEERINC Company 17034 Eagle River Loop Road No. 204 Eag a rve , 72--77- Date MOA No. _ c� 3 Receipt No. 2 Date of Payment _"�o� 2 _d� Amount: $ / % O Q 72-026 (Rev. 7/88) Back Receipt No, Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OFALASKA, -INC. TELEPHONE (90/) 562.2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria %r TO BE COMPLETED BY WATER SUPPLIER TO BE"COMPLETED f( ❑ PUBLIC WATER SYSTEM I.D.k— BY LABORATORY p PRIVATE WATER SYSTEM Analysis shows this Water SAMPLE to be: XSarlsfactory Name S & S ENGINEERING Phone No. 17034 Eagle River Loop Road ElUrl atisfactory NO Molllnp g ver, 20❑ as a 99577 S ple too long in transit; sample should no+be over 30 hours old at examination to Indicate reliable results. Please send city State Zip Code new sample via special delivery mail. SAMPLE DATE: M—J WE © Date Received — Mo. Day Year Time peceived SAMPLE TYPE: Routine Analytical Method: Membrane Filter ❑ Check Sample (for routine sample with lab ref. no. ) IJ Treated Water FJ Special Purpose ❑ Untreated Water No, of colonies/100 ml. SAMPLE NO. LOCATION Time Collected Collected By Lab Ref. No. Result* Analyst ' 11 EE2 EE 3 I I��I --J 4 I mmm ED 5 m BACTERIOLOGICAL WATER ANALYSIS RECORD Il f READ INSTRUCTIONS Membrane Filter: Direct Count BEFORE verification: LTB -- Coilform1100m1 — COLLECTING SAMPLE Final Membrane Filt st s BG8— - Reported By - Collier /100m1 Time: ----� s7h— - TNTC = Too Numberous To Count a.m. p.m. OB = Other Bacteria OF.HVt PE fHf C HEMICAL & GEOLOGICAL LABORATORIES' OF ALASKA, INC. o 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343FEDERAL TAX ID k 92-0040440 8 4� ANAU-01S Date Aepolf Ftznted SIF 16 82 .3 09:09 - Client 3anple TD:i;S, E1 M111TAP, 3,t PPISID :a Cn2a2cted SEP h 37 0 15:45 hea. k,relyon SEP 9 Gr3 E• 15:00 hxs. Pzoser.yed with :? Dh0. Cfiotit }lame 3 l" ,; EtlGTt7EER1:1:G Cliont Acci S1LR11GP P.0.� 1:1011}; RFC U Rcn =I Or.ne,--«,a sy DJ, hnn.lydic comp,letLe, :SEP 12 fl8 ;hrtid Repmtr, i.' Lohor.atoty upot 'aor :STEpI}E11 C. EpE i}g n, S EiICTtdf,ER.IBC T11�7 t1: urt: Chemlab Aof n4G Lab SrnrA 10: 3 Matfix: "'"AUR AL1o:rablo, Par.emots. Toet3d 1ez.lt/Unit. tllTrr'i'r. ]I 3 0 ir,Ij/1 EPA 365. S„-mple ROUTINE UNPl. Remiss : 3AMPLI, COLLECTED BY R,i I Toats Pei fnr.mr;r,', :gee rpaciul 1n tz!ut,o.�, Abovo t_lh Ilnnlei�;,nle NU- Pone D tc-ton :03 ;ion11>le t;emaxko hboyu UA- lint Anolyzeil 1.T -Le,,.• Thar,, GT-Groatex 'Phan DIVISION OF ENVIRONMENTAL HEAL.T" CERTIFIC OF INSPECTION FOR HEALTH AUTHC Y APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date z4h (�7 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Locatio�(address or directions) (b) Applicant Name/U�Telephone: Home Business'/,�� Applicant Address e (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution a� Telephone Address (e) Real Estate Company and Agent 3 Address _� f Telephone (f) Mail the HAA to the following address INsat, Alaska 99577,' ' 2. TYPE `OF RESIDENCE F, 4 Single Family. Multi -Family -El Other.. -Numberof 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 OnsiteA 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 (11;84 5. ENGINEERING FIRM PROVIDING 1r1SPECTIONS, 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 Telephone Address SPt3196x - Date Eagle'?fiver, Alaska 99573" 5t�src� r',aicEd ,goc-quac. y 7-- r7 ,tj-DJ�✓/ fv ✓ 2, ere Gcr 6L-Ae s -a o c_ T� 3 &1e iv �- 7 ij UAII< 7/ C 7-y,vy iz� BE' EXCAU�yz�J/ ° 14 AJ G� O!s�OGN GvELC jSOu.v4?nr/E .s s OF or'S• '.�.•a (1 •.,y. S T> °�.e ae ee ae• .a°aua• .•. gi ° ea d 1 S e o +• +e••°aaro •+'� rn Robert A. Shr 4 <C11•° `� AA (C s as ea+« 6. DHEP APPROVA Wfll Approved for /bedrooms by DateQ CJ Approved Disapproved Conditionals _ Terms of Conditional Approval`��1L� O •t_���i2, d457 -A 4) A�c.c i�.� e G1%ctsT-s, "P—xb�5d1 of xs:� uuifu CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) A. WELL DATA MUNICIPALITY OF ANCHORAGE (Mok , HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 MUNICIPALITY OF ANCFIORAGE DEPT, OF FIEALTFI & ENVIRONMENTAL PROTECTION Legal Description:�!' ft- ,1 F Well Classification �t21\1/ If A, B, C, D.E.C. Approved (Y/N) All Well Log Present Datet mpleted lyf7 S Yield Total Depth Z�C71 Cased to _ /< V1 Depth of Grouting _ uK Static Water Level ! 2 7 Pump Set At "oe Casing Height Above Ground _ IZt/ r _ Sanitary Seal on Casing &H) Electrical Wiring in Conduit &K Separation Distances from Well: Depression Around Wellhead 4-Y/0 To Septic/Holding Tank on Lot — q113 ; On Adjoining Lots /LP0 / To Nearest Edge of Absorption Field on Lot /I(2 7 ; On Adjoining Lots /oD To Nearest Public Sewer Line Al N To Nearest Public Sewer Cleanout/Manhole ! To Nearest Sewer Service Line on Lot a U Water Sample Collected by iNC5 geJNl� ; Date Water Sample Test Results _� �ar1,51::�-,gdrbe, Comments B. SEPTIC/HOLDING TANK DATA Date Installed /� )r _ Size zo5-) No. of Compartments _ Standpipes -_ Ju© Air -tight Caps (WM /V49 Foundation CleanoutO Depression over Tank KA Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ni ;for Holding Tank High -Water Alarm (Y/N) �� Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-ST upply Well —__ y8! Zo 4 To Building Foundation To Property Line To Water 44m/Service Line Course — rr To Disposal Field — /D ! ¢ 5- To Stream, Pond, Lake, or Major Drainage N Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Q e Soils Rating in Absorption Strata Type of System Design �rZE�ucN _ Date Installed -I ` I Width of Field 5 6 V Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area �b�C7 _ Standpipes Present 40"r Depression over Field (X4 Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well I ( b I To Building Foundation 3c) 1 4 - Lot A/ Date of Last Adequacy Test _ /~� To Property Line — 161 ; On Adjoining Lots To Existing or Abandoned System on To Water Main/Service tine 62N '- To Cutbank (if present) _ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Z�O !f Comments ._�SSIZ-_�=dam Z 3R N t' s lAP RA.pF�D - /HLsa Ss.4T 1�1��PS 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 M Y A and HAA guidelines in effect on the date of this inspection. Signed 5_ onearhv_____ Date 4 0 L _ Company5RR ti96x' MOA No. E.a ;Go ';fiver, Afaska 99577 K, Receipt No. 37 U 1 , 01 -4/ %f X'$ f Q"% d 3'?E7 Date of Payment _ Amount: $ Page 2 of 2 c i 72-026 (11/84) .. INSPECTION APPOINTMENTS 1`lME TTMe MUNICIPALITY OF ANCHORAGE MUNICIPALITY OP ANCHORAGE DEPARTMENT OF HEALTH &-ENVIRONMENTAL PROTECTIO PPT. C' HENT:'? "• UVII, I J _11215 L Street - Anchorage, Alaska 913501 - , Ir:'.-? A . ' i0 E" II \1 �� ENVIRONMENTAL SANITATION DIVISION ® Mu" 17 11192 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWERR�CfL�IE� � L� DIRECTIONS: Complete all parts on page 1. 11 tCOMPlett: reryeests will not he processed. Please allow ten (10) -- days for processing. 1 PROotfl?TYOVJNER -----.. - --- ----------- ,T __ .. Y. MAI I TNG AnOH ESS '--� - --- - ---- -- - _- PHOI'[RTY RESIDENT Ilf different Ironm a6ove-l "-------------------------------- - 2 BOYER�_� ��vofy `Jtf��ck Lays PHONE Al22cn N1AIi.lrvc uuHf — -- �_- 1 3, LCNDI/N�GINS71TUP10 f4lrill TNG ADDRrSS P a V>1� -;c 9 4. RrALTOR/AGENT—_._._.—._ra._._..- �1 ADHESS MAII I ' L - �N� t d' - Vii,- r :r 1 J -raine :•'.inor .?.`. 3X _Zealt`./ _ PoX 343 <i vPr, Alaska EXCAVATION ROBERT A. SHAFER WORK CIVIL ENGINEER 694-2979 September, UNICIPq 17Y OE ANCHORAGE F,ca y Ca k J !7 .•� Sewer system adequa^v test '--as Lnrf-"Drmed on the syst:: located on the referenced pro--=_"ty as you requested. -he septic `anK was pumped a.nd Vert led = .'id`:? d capacity In excess Of rO i1S. 7 e a;Jsor ion __- h waS test 2d by d continuous _`low of water over a Leriod of =8 hours without any adverse effect on the system. =t can be concluded from this test that the waste water disposal system serving the three bedroom residence 'Located on this property is currently functioning g q y in.- ade uatel However, t::^.e system cannot-be--gs-A--r-antee agains£`suD-sequ-c-nt failures. if we may be of further service, please do not hesitate to call. SinceJly / ? J/ss /// cc: municipality of Anchorage department of Health and Environmental Protection SRS 196X EAGLE RIVER, ALASKA EAGLE RIVER AREA MUNICIPALITY OF ANCHORAC DEPARTMEN OF HEALTH AND ENVIRONMEN,. PROTECTION 825 L Street, Anchorage, Alaska 99501 279-2511, ext. 224 or 225 #1: Time l Date It 2: Time Date Date Received: August 31, 1977 #3: Time Date Insp l_�� .ls Insp Insp REOUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Spokane Mortgage Company Mailing Address 2. Property Owner Mailing Address: 3201 C Street Albert E./Sylvia J. Melvin 3. Legal description: f`►r1w, Phone: 277-0543 Phone: 688-2980 Lot 5 Block 1 Scimitar Subdivision #1 4: Single Family Residence: ( 4 Multiple Family Residence: ( ) 5. Well System Permit # Number of Bedrooms: Four. ot Number of Bedrooms: Individual Well (x) Community/Public System ( ) Depth of Well :1 Well Log on File Construction gr�si�v Bacterial Analysis 6. Sewage Disposal System: On-site S stem (X& Public Utility ( ) Permit It _ Installed? f Installer rA 1975 Septic Tank Size Manufacturer Absorption Area Soils Rate' ?Sf Material 7. Distances: Well to Septic Tank %0 to Absorption Area to Sewer Line _ N Nearest Lot line _ �0 S Absorption Area to Nearest Lot Line — -� '— IUN I C I PAL.I I Y OF ANCHORAGi 4. Realtor/Agent: Mailing Address: z f� /� Phone: 5. Legal Description: :t:ceet Location: 6. Single Family Residence: Number. of Bedrooms- Multiple Family Residence: ( ) Number of Bedroo;ns: 7. Water Supply: Individual_ ?Jell_ ( Public/Conrmun_l:y Sysem (//) If Individual- Well, well depth()--- jG¢Z�C� �f9l If Communit-y System, name of s;vstem 8. Sewage Disposal System: On-site System (K Public: System If Department of Health and Environmental pr.otecti_on System, 825 L St.reei-, Anchorage, Alaska 99501 E 279--2511., ext. 224, 225 Request for Approval of Indivi�iva:l. Sewer anr� ?ester 1'acili.ties ]_. Property Owner:—_..___cil�/__✓_f_J___.__.__!�(..11/1.Ci......____-_._ Mailing Address; on ALI, wells d.rill.ed 2. Name of Buyer; Mailing �! Address: ;� phone ° -,. 7 ' 3. Lending Institution: � 1 mailing Address:Fhone-. 277,oe�- 2 __----------._.___✓-.til J 4. Realtor/Agent: Mailing Address: z f� /� Phone: 5. Legal Description: :t:ceet Location: 6. Single Family Residence: Number. of Bedrooms- Multiple Family Residence: ( ) Number of Bedroo;ns: 7. Water Supply: Individual_ ?Jell_ ( Public/Conrmun_l:y Sysem (//) If Individual- Well, well depth()--- jG¢Z�C� �f9l If Communit-y System, name of s;vstem 8. Sewage Disposal System: On-site System (K Public: System If On-site System, date of installation: *NO'T'E,: A well log is required on ALI, wells d.rill.ed S.1I1Ce 6/7J. 3/77 Fage Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 5 Block 1 Scimitar Subdivision Comments: Affadavit Attached: ( ) Letter Attached: ( ) Approved: — S�QDate: 5 % Disapproved: Date: Department Worksheet; F ^LE RIVER AREA Af o � 405 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality �4{�APf°lA�UA�y�96` 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received August 30, 1976 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. Approval requested by: First National Bank of Anchorage o Mailing Address: Post Office Box 720 99510 p 279-448 EQ -034 (1/74) Page 1 of two pages hone. _ x 572 2. Property Owner: _Albert E. & Sylvia J. Melvin Phone: 688-2980 Mailing Address: -Post Office Box 400, Chugiak 99567 s 3. Legal Description: Lot 5 Block 1 Scimitar Subdivision 4. Location: NHN Poniard Drive, Chugiak 5. Type of facility to be inspected Single Family No. of bedrooms 2 6. Well Data: A. Type Individual B. Depth C. Construction D. Bacterial Analysis _ 7. Sewage Disposal System: On --site system A. Installed _ B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material _ E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank Absorption area Sewer Lines Nearest lot line _ Other contamination B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages hNJ^9CIPAI-ItY OF ANCIIOfL.GFi MUNICIPALITY OF ANCHORAGE I,EPT. OF HF./o.Tw DEPARTMENT OF ENVIRONMENTAL QUALITY 1-NVInUNMENTAL PROTECTION 3330 "C" Sweet, Anchorige, Alaska 99503 -- 2744561 AUG 3 01976 REQUEST FOR APPROVAL OF RECEIVED' INDIVIDUAL SEWER and NATER FACILITIES 1. Type of Inspection: CMRO — VA FHA _ CONV X _ 2. Property Owner: MELVIN, Albert E. and Sylvia J Mailing Address: P. 0. Box 400 Chugiak, Ak. 99567 Day Phone 6R8-2Apn 3. Name of Guyer: None Mailing Address: _ Day Phone _ 4. Name of Lending institution: The Pirst National Bank of Anchorage Mailing Address: __P• 0. Box 720 Anchorage, Ah. Phone 279=4481 x572 5. IN!ame of Realtor or Agent: Mailing Address: Phone 6. Legal Description: _ Lot 5, Blk 1 Scimitar S/D Location: NIIN Poniard Drive Chugi.ak, Ak 7. Type of Facility to be inspected: SPR S. (Nater Supply Type of Supply: Public Utility _ If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility If Inclividual, date of installation t0-037 rI ;a) No. Gdrms. .2__ Individual Individual (on-site) X 8/2.6/76 A. Dodge Pagn 2 of two pages - Rec t for Approval'of Individual c Legal Description Lot 5 Block 1 Scimitar Subdivision Comments Approved Disapproved r & Water Facilities Date � �/ 2E Approval .,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 1 1.;ertin-y Lnat the inrormation contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date