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HomeMy WebLinkAboutSCIMITAR #3 BLK 1 LT 2Rc4t, .A, C3\"& 00 cis . k (01 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 ��9 ��' ��J�f✓: PHONE �j� NEW ❑UPGRADE MAILINC 11ADKFESS LEG DESCRIPTION _ Z_ 2 LOCATION _ % 43 1,0. OF BEDROOMS Uy DISTANCE TO: Well, j �� Absorptionarea ! Dwellingo� / ! PER�,4jVT0 _ 1 l% a Q LU F_ Manufactuyef"'-e (J—/ Ma P j / No. of comp$rtments G to Liq. coity�,C�in g�Ilons l� IF HOMEMADE:— Inside length Width Liquid depth_ L' DISTANCE TO: Well D elfin PERMIT NO. J t�Z 02 F Manufacturer Material Liquid capacity in gallons 0 W DISTANCE TO: WeII Foundation? j Z Nearest lot lige / P J 0 � J LL No. of lines Length of eag liry6 Total len h o links Trench w' h Ir Distan bet en n Z F _ inches Q Top f' isFlgrade NNja eri?lt bene t11eC� (� Total ffective orption of rile to `?� ares t/ 0 2 Uc42 inches 'Scj Length Width - epth PERMIT NO. Lu 0 Q l,- Type of crib Crib diameter C i pth Total effective absorption area aFL w LU rn Well Obilding foundation Nearest lot line DISTANCE TO: J Clas�..., ,/' Depth Driller Distance to lot line PERMIT NO. J Lu � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS U l i if C' SOI L TEST RATI INSTALLER ex zi REMARKS r �•r 0 Ji %}\� .:ffr� F1• �'fi•7il+J "W v F ' Y V APPROVED -�'' " H DATEWMEA _I I )�Vrer iV l�Lj4-4 72-013 (Rev. 3/78) .----- --. (_�/ — ` �i 1Rj 10 1: ED 'R� F:I11 H ]o'_ -Y "w' oil Fo- ��A m-_*."..'.,: 1 iCA, IF�7' F—H 91'� E�­ DEPH�TM�NT OF IHEHLTFI AVID PIR.GTEC:T10V1 825 L STREET/ HNCHORHGE/ HK 99501 264-4720 m1AP~53 IE MEE: W KEE': K 14 W IL,_� � / `�'vw' MIA PERMIT NO: 840081 DHTE ISSUED� 0]/27/84 HPPLICHNT: ENG'G. MYERS CONSTRUCTION ADDRESS: SRB 1964-'. EHGLE RIYER� HK 99577 CONTHCT PHO�F� 694�2979 ' LEGAL SUBDIVISION: SCIMITHR 41 L8T� 2 BLOCK� 1 SECTION� 10 TOWNSHIP: 15N RHNGE� 1W LOT SIZE FT. OR HCRES) MH�/ BEDROOMS� ] LIST�D BELOW HRE THE OPTIONS HVHILHBLE TO YOU IN DESIGNINQ YOUR SEPTIC 7SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE, ` .... ���� ���������� ' DEPTH TO PIPE BOTTOM (FT. ) 4.0 4i0 4.0 GRHVEL DEPTH (FT ) W0 5 .� ]�5 TOTAL DEPTH (FT. ) 8.0 4. 7.5 6RHYEL WIDTH (FT. ) 2.5 1 4%0 5.0 / GRHVEL LENGTH (FT ) ]20 28.0 280 / GRHVEL VOLUME (CU. A. 14�5 �` 20.7 THNK SIZE (GHLS) 0 ** 000 0 ** / SOIL RFIT IN6 (SQ � FT /BR) � 85 85 \ 85 / ' ** THNK MUST HAVE _..... AT Lill ST ..... _..... �~��~��—��_���~~_�~_��___��~ TWO COMPHRTMENTS ` �� I CERTIFY 1 I HM FHMILIHR WITH THE REQUIREMENTS FOR ON~SITE SEWERS HND WELLS AS SET FORTH BY THE MUNICIPHLITY DF HNCHORHGE (MOH) HND THE STATE OF HLHSKH. 2. I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH FILL. MOH CODES HND REGULATIONS, AND IN COMPLIHNCE WITH THE DESIGN CRITERIA OF THIS PERMIT. ] I WILL HDHERE TO HLL MOH HND STHTE OF HLHSKH REQUIREMENTS FOR THE SET BACK DISTHNCE� FROM HNY EXISTING WELL, WASTEWATER DISPOSAL. SYSTEM OR PUBLIC SEWERHGE SYSTEM ON THIS OR HNY HDJHCENT OR NEHRBY LOT. 4I UNDERSTFND THHT THIS PERMIT IS VHLID FOR H MAXIMUM OF ] BBDROOMS HND HNY ENLHRGEMENT WILL REQUIRE HN HDDITIONHL PERMIT. IF H LIFT STA TION IS INSTHLLEl) IN HNHREH COVERED BY MOH BUILDING CODES, THEN (1) HN ELECTRICHL PERMIT HND BE OBTAINED/ (2) AS—BUIL-TS WILL 1101- EE HPpRMED WITHOUT HN ELECTRICAL INSPECTION REPORT/ HND THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIHN. SIGNED DHTE A -1 f--~~ HPPLICHNTC/O S 1�S ENGLf my MYERS CONSTRUCTr�m � ISSUED BY MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST ❑ SOILS LOG dui b S// a J ❑ PERCOLATION TEST G%�7) PERFORMED: 1 1 PERFORMED FOR: L�'V«✓J _ DATE –,?— 7w l LEGAL DESCRIPTION: SLOPE SITE P N DEPTH 4EEET) �O 1 2 j 3 b 4- 5 5 a/ 6 l G 7 /0 le 9 �. 10 6 11 n WAS GROUND WATER S l L ENCOUNTERED? O 12 � `f P E IF YES, AT WHAT DEPTH? 13 14 ":'?';= .i : - Reading Date Gross Time Net Depth to Net Time Water Drop s- 6 16- 17 17 1 8 18- 19- 19 20- 20PERCOLATION PERCOLATIONRATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS I - PERFORMED BY: '�°" a)`?2:i CERTIFIED BY: 72-008 (6/79) DATE V J� WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological 4 Geophysicol Surveys Drilling Permit No. OCATION OF WELL (Pleose complete either lo, Ib or Ic.) A.D.L. NO. la. Borough Anch Subdivision char 3 Lot 2 Block Ib. 1/4qI re. eef—of—°f� Section No. Township NO sQ Range E❑ WC] Meridian lo. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS Street Address and Area of Well Location 3. OWNER OF WELLMr. Paul Myers Address: P.O. Box 351 Chugiakg Ak. 99567 - - Feet Below 2. WELL LOG Surface Material Type - Top Bottom 4. WFLLdEPTH (final) iplJ ff• S. OATE OF CO PLET104, '-- 3 & . a e_ g, Q Coble tool Olary Q Driven a Dug _ [] Auger Q Jolted Q Bored Q Other t ` 9 / Gravels boulders 20 30 T.Usax Domosfle Q publla Supply ❑ Industry ' Q Irrtgotlon" Q Raaearo Q Co' ®rl act 0 Test Well Q Other. Gravel silt some boulders 30 92 Greenstone 92 365 Greenstone / crevices water 365 3 0 8. CASING: ® Threaded XgWeidod ' Mass. li�_In. to_,q2_ It. Deptb Wolghf_ lbs./ If. dlam. In. to ft. Depth Stickup 1t. Greenstone with layers of 380 530 Gre ns one 9 water 530 5 S, FINISH OF WELL: Typo: Diameter: Slo1lMoeh Size: Length: - Set between ft. and ft. Backlilllnq Gravel pack - NO 1E)RAG119 RAUNICIPA HEALTH & ENVIRONMENTAL PROTECTION 10. STATIC WATER LEVEL: ft. Above or O Below land surface OOto Equipment used: ` II.PUMPING LEVEL below land surface and YIELD It. after Ara. pumping O.P.M. ft. offer Aro. pumping O.P.M. 12.GROUTING Wali Grouted: O Yes ONO Material: ❑ Neat Cement O Other: ' 13, PUMP: (If available) HP Length of Drop Pipe fl. capacity Q Subm. Q Jet ® Centrlfieal O Other 14. REMARKS: Production of 20 GPH 18. WATER WELL CONTRACTOR'S CERTIFICATION: IS. Water Temperature �° O F Q C This well was drilled under m )urlsdlellon and this report Is true to the beet of mr Akno� 612 and belief; Magnuson Drilling A 7 Registered Business Name Contract License Number - AddressP.0. Box 770504 Eagl® Rivers Ak; 99577 ' Signed: Date: March 249 9984 -I Authorized Representative Form 02-WWR (11/81) Copy Distribution: WHITE -State DOGS, PINK-Drlllsr, CANARY•Customsr ' MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES] 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 5 ��Z f G HAA # #14 (J YOS11 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Scimitar #3, Lot 2, Block 1 T15N, R1W, Sec.10 Location (address or directions) NHN Seika Drive Eagle River AK 99577 (b) Property owner H.U.D. Telephone: (home) Business 271-4342 Mailing Address 222 W 8th Ave. (Box N-64) Anchorage, AK 99813 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Associated Brokers Address 640 W 36th Ave Suite #1 Anchorage. AK 99503 Telephone 5 1= (e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family 3. WATER SUPPLY Individual Well M Number of bedrooms 3 __� 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 0 Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the 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 Eagle River Engineering ServTelephone 694-5195 Address P.O.B. 773294 Eagle River, AK 99577 Date 6. DHHS APPROVAL Approved for bodrooms by .61 Date 1 Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in 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. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) I�rr �' • � Health Authority Approval (HAA) ��i CHECKLIST - FEBRUARY 1984 ti 343-4744 Legal Description: 1_ A. WELL�AIrA Well Classification Pr/ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N)Date Completed 3I at1l 14-1 Yield -eQ-bd 6n 10/7) '71 �y Total Depth 07 Cased to Depth of Grouting /1//9 Static Water Level /31' .6e/6uJ a*V C1�� Pump Set At lt� Casing Height Above Ground q.66/ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) N Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot /.�(P I ; On Adjoining Lots ; On Adjoining Lots 't'/00 To Nearest Edge of Absorption Field on Lot /101 t/QO 7 To Nearest Public Sewer Line n 11q To Nearest Public Sewer Cleanout/Manhole A To Nearest Sewer Service Line on Lot 1�0 Water Sample Collected by �^;s'^ �� r ; Date Water Sample Test Results Comments �/ C F ��GC/fi�GG 7�7na Glc A' /SSh �aC OA/Af B. SEPTIC/HOLDING T N DATA Date Installed Size/ 06—No. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) Y Foundation Cleanout (Y//N) Depression over Tank (Y/N) N . / Date Last Pumped �) %-IC Pumping/Maintenance Contact on File (Y/N) for P- 1,4 Holding Tank High -Water Alarm (Y/N) YL Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well /��� To Building Foundation /L9 To Property Line t I To Disposal Field 0 To Water Main/Service Line 1 0 To Stream, Pond, Lake or Major Drainage Course n 1.4 Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design L"Cz�h Date Installed o�-Z yc i Length of Field -� $ Width of Field Depth of Field Gravel Bed Thickness 3-S Square Feet of Absortion Area 11COStatndpipes Present (Y/N) - y Depression over Field (Y/N) V) Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FI To Water -Supply Well _ To Building Foundation Lot _ M14 To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Property Line / I / To Existing or Abandoned System on On Adjoining Lots 33G I To Cutback (if present) hlR 5 C001 L -A-40 To Driveway, Parking Area, or Vehicle Storage Area * / 6 7 Comments Jbac-h. �i &lcl f,n.cb Loc -u -`i-66 a- �tp 60+ rl 6&:L C -L), -r C-0 E V11� &V I cL£,rl co n .02 h m L 0 4- i r> 5✓ /- n e n D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. p �s1 Signed Eagle River Engineering Services i Company C (Ake{ Date I '7 � '1 e) � G `i Eagle River, AK 99577 Engtreef Seal MOA No. 5 T— Louis A. 2uierci i,� z•-u,3Oo..o ooe°ohm\�4 Receipt No. Receipt No. Date of Payment Amount: $ Z D C� 72-026 (Rev. 7/88) Back Waiver Fee: $ Date of Payment Page 2 of 2 e CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B Sl HEET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID 4 92-0040440 1,141YSIE. REPORT BY S)WLE iji Fbrk Order f 18538 Dbte Rerort Printed: DEC 4 89 E 10:24 ' Client Srr.,ie Iu.L2 L, __..:T]P, L'!i;T 3 Client Name E1.GLE RI�'!R EF•:a F;i�IC 'UA Ciicnt 1_ct EAG"Ur. ^ElL=^ted i4"6 30 'c.i @ :us P.O.# N(!:I hE"F"';EC EOP 3'_' ac a 19-n0 his. Req i F:e-er:ed W h :A9 R.EMRED 0*dered By : LOU EUTE: MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES] 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel 1. D. # 0 )\ - 1 L'.- 1 C9 HAA # G Q�S'�\ Ll '7� G 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Scimitar #3, Lot 2, Block 1 T15N, R1W, Sec.10 Location (address or directions) NISI Seika Drive Eaqle River, AK 995 (b) .Property owner Lomas Mortgage U.S.A. Telephone: (home) Business Mailing Address 1525 Viceroy Drive Dallas TX 75235 n /;, (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Maintnence Management Address 4101 Arctic Blvd Room 104 Anchorage AK 99503 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: Pick -M by Engineer 2. TYPE OF RESIDENCE Single-FamilyX7 ( Number of bedrooms 3. WATER SUPPLY Individual Well ® 1/ 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-sitek7 r� Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the 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 Eagle River Engineering Serv. Telephone Address Date P.O.S. 773294 Eaale River, AK 99577 6. DHHS APPROVAL j Approved for bedrooms by Approved —_C Disapproved Terms of Conditional Approval — Conditional CAUTION 694-5195 illy k _; Engneer's Seal �� .a000�c�v oi.occ�o oo aoc� .. Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in 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. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) of F �\��s` o Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744h'' ��"`, Legal Description: € -) -- �1 '� T ire t2 /w s<<.ib A. WELL D} Well Classification If A, B, C, D.E.C. Approved (Y/N)�A Well Log Present (Y/N), y Date Completed Yield 0,6Z GPS/�s ��/ � / IA Total Depth 'r�� Cased to 9� Depth of Grouting ^� Static Water Level /3/ ' ee/ow %p GQ, ­;j / Pump Set At 570 i Casing Height Above Ground o7 r Sanitary Seal on Casing (Y/N1 zV Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot -/-U ; On Adjoining Lots I To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line A�1� - To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results /I/, 9"4 e Comments All On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole //a ' Date 7z --z%9 9 B. SEPTIC/HOLDING F� > l J�ATA 3 �f Date Installed `/ Size /000 5 No. of Compartments Standpipes (Y/N) y Air -tight Caps (Y/N) /V Foundation Cleanout (Y/N) y Depression over Tank (Y/N) ^) Date Last Pumped Vee C.Trra«.) Pumping/Maintenance Contact on File (Y/N) /111'•; ; for "V�s' Holding Tank High -Water Alarm (Y/N) "v14' Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well To Building Foundation To Property Line ¢/O To Water Main/Service Line 7r'/o / To Stream, Pond, Lake or Major Drainage Course Comments To Disposal Field /o / 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 8S ��� Type of System Design Date Installed �S�`9 Length of Field Width of Field�S / Depth of Field 7 / Square Feet of Absortion Area 2s•5 Gravel Bed Thickness s, s Statndpipes Present(Y/N) Y Depression over Field (Y/N) N Date of Last Adequacy Test 7/- f -/J -s Results of Last Adequacy Test r< l ,i 11gG:y;2 4'4J --d, o;l/C4 fc �» 3 .err tires SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well tI" v To Building Foundation 3a / Lot 104 To Water Main/Service Line Y_/0 To Stream, Pond, Lake, or Major Drainage Course / To Property Line To Existing or Abandoned System on On Adjoining Lots 3v To Cutback (if present) /✓ter roc ro.>..,e� To Driveway, Parking Area, or Vehicle Storage Area le" Comments Ze4<-4 �'e/� a /eca k 7' i v S,vdoc , &ve, nidi' reef 4.rr &,A' Goole Nd D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) — Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed -�� �-- �,• � � "9 <.,r Company Eagle River Engineering Services sr��/�j Eagle River, AK 99577 Date 'Engineer's Seal i33 MOA No. ST --"6r Receipt No. a S � co I --� l.P Date of Payment (6--Sc1 Amount: $ t -ID, 00 f', rc:.=uauao�oo©00000 eo eoo Via:+ `''� 'p `L Z CL -6726 O C(� p t �\`f Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 EAGLE RIVER ENGINEERING SERVICES Lou Butera, P.E. P.O. Box 773294 Eagle River, Alaska 99577 Telephone (907) 694-5195 August 7, 1989 Mr. Robbie Robinson M.O.A. 825 L. Street Anchorage, AK 99501 RE: Scimitar #3, Lot 2, Block 1 Dear Mr. Robinson, We have checked our records and Municipal Grid Maps regarding the correct legal description of the lot for which we have submitted a Health Approval. The physical location of the home matches the legal as we submitted it (Scimitar #3). Also the physical location of the well and septic, well depth, and septic layout, as per 1984 inspection Report by S & S, matches the home located at Scimitar #3. There is no well and septic located on Scimitar #1, Lot 2, Block 1. The lot is undeveloped. Therefore, I would assume that the inspection report dated 5/5/84 should have the legal description Scimitar #3, Lot 2, Block 1. As this is simply a matter of correcting the legal on existing paperwork, I will leave that up to your office to resolve. If there are any questions regarding this matter, please contact me at 694-5195. Sincerely, Louis A. Butera, P.E. MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH Mt1NICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTEUNOF HEALTH AL pLOTECII JN APPLICATION FOR HEALTH AUTHORITY APPROVAL CAYff?6� 1. General Information (a) Legal Descriptio Application Datp 2 6 19V (inclu�e..,lot, block, subdivision, sectio p%bab\j Lange) Location (address or directions) (b) Applicants Name Applicants Address d Af'r hone - Home Business (c) Applicant is (check one) Lending Institution ; Owner/builder p ; Buyer 1::1 ; Other 1-1 (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the .following address: 2. Type of Residende Single -Family 114:"�, Number of Bedrooms 3. Water Supply - Multi -Family ,_ 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 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. F [Page 1 of 21 �i �J 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 regula- tions in effect on the date of this inspection. Name of Firm s rrll S R D 1 Address I .'i'ki, 094 - Date 0 6. DHEP Approval Approved for bedrooms By Approved 'k— Disapproved Terms of Conditional Approval CAUTION Telephone to Conditional v 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 7-19-84 [Page 2 of 2] ,.... _. s g•<'tf�;-;k.-zth","Ff2�*'_'::�-s:r'ks`!:$.�.'�"'�x ..s'?3-=' - -"- MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & CHECKLIST -FEBRUARY 1984 ENVIRONMENTAL PROTECTION fjUL 2 61984 A. WELL DATA RECEIVED Well Classification; If A, B, or C, D.E.C. Approved(Y/N) Well Log, Present Date Completed Yield-2_6tP_6b- Total Depth _� f Cased to Depth of Grouting r1- Static Water Level /0 1 Pump Set At Casing Height ''Above Ground a Sanitary Seal on Casing Y ) Electrical Wiring in"Conduit!(S1'/N) Depression Around Wellhead Separation Distances fran Wells > To Septic/Hjlg Tank on Lot f On Adjoining Lots epZ� / l To Nearest Edge of Absorption Field on Lot( ; On Adjoining Lots /0,6� To Nearest Publ1c Sewer Lir. ` To Nearest Public Sewer Cleancut/Manhole_ � To Nearest Sewer Serv•ce Li. on Lot J 40 / Water Sample Collected By �_ Water Sample Test Results _ Comments B. SEPTIC TANK DATA Date 71 Date Installed Size %00-J. No. of Compartments Standpipes M) Air -tight Caps Foundation Cleanout i) Depression over Tank (Y ) Date Last Pu / Y d c \10114 Pumping/Maintenance Contract on File (Y/N) A ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Wall / z S / To Building Foundation To Property Line �T i To Disposal Field / D If To Water Main/Service LineIV1To Stream, Pond, Lake, or Major Drainage Course Comments Ell [Page 1 of 21 2-15=84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata r_3�� `/z3g2- Type of System Design Date Installed �� �jj �_ Length of Field _ 'Z-�3 Width of Field jQ Depth of Field _ 7 //z � Gravel Bed Thickness Square Feet of Absorption Area -S' Standpipes Present <CDN) Depression over Field (Y te of Last Adequacy Test A/L_7\ell Results of Last Adequacy Test /lu4 Separation Distance from Absorption Field: I To Water -Supply ;%b ll To Property Line i To Building F undation 3 To Existing or Abandoned System on Lot VIA On Ad'oining Lots tab % f_ To Water Main/Service Line A /J To Cutbank ifresznt�� To Stream/Pond/Lake/or Major Drainage Course A,A To Driveway, Parking Area, or Vehicle Storage Area (p(� Continents D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes Pumping Dimensions g/Access (YIN) Off" Level at Vent (YIN) during Adequacy Test. Meets MOA ** 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. I Signed Date Z > e' `7l Company MOAN . KB1/d5/s (Page 2 of 21 14 t*, + G Ott •r� R RIOT A. a; M ti •tido w.. 1437-i ft1�E '40FES$\(�,*�� 84