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Home My WebLink AboutSCIMITAR #3 BLK 1 LT 7imit r lock I Lot 7 051 - 132 -74 .~ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: OSP 111183 PID Number: 051 -- 132--74 Nome: MARY WILLIAMS WastewaterSystem: [] New · Upgrade Address: 19712 BELDQUE COURT *CHUGIAK, AK 99567 ABSORPTION FIELD No. of Bedrooms: i_lOt~,,,~ Ph°ne:(907) 632--3310 3 · Deep Trench 0 Shallow Trench 0 Bed OMound LEGALDESCRIPTION ~i, Rotlng= Tote, Depth, .... rlginol GPO/Sq. Ft. J Ft. Block: Lot: Subdivision: Depth to pipe bottom from original grade: Grovel depth ~;~efeC'~eeth pipe: 1 7 SCIMITAR #3 Ft.~. Ft. Township: _ Range: _ Section: Fill added above orlginol grade: , ~G ~ length: - Ft. Grovel width: -.~~ Number of lines: Distance between lines: WELL: [] New [] Upgrade ~~--~ ~t. Ft. Clossificotlon (Prlvote. A,B,C):~'~ Cased TO:(BEDROCK)Ft. Total obeorp~ Pipe moterlol: illl]n Dote Drilled: Static Water Level: Dote installed: 8/10/11 Ft. EEN GENERAL Pump Set At: Casing Height Above Ground: Ft. ~t. TANK GPM SEPARATION DISTANCES=Sept c .o d,ng []Other* T~To Septic Absorption l Lift Holding 3ublic/Private Manufacturer: Capoclty in gallons: Tank Field Station monk S,,~r U,~ ANCHORAGE TANK 1000 Moterlol: Number of comportments: Well 100'+ (._9 - - 25'+ STEEL 2 Su~oce Water ~00'+ ~ - - - LIFT STATION Lot Line 5'4- .... (~ Size in gallons: Manufacturer: Foundation 5'+ ELI _ -- -- "Pump on" level at: "Pump off' leve~r alarm at: Curtain Drain ' NONE KNOWN _~ Pump Ma~cal Inspections perfon'ned by: I I Remarks: OLD TANK WAS PUMPED AND COMPLETELY BENCH MARK Location and Description: REMOVED BOTTOM OF TANK Assumed Elevation: 91.1 7 Ft. ENGINEER'S SEAL Inspections performed by: GEG, Ltd. Dates: 1st 8/10/11 3rd /~--~ '"-..-F, ~), Development Services Department Approval Conditional approval: Date: Reviewed and approved b · ~/~d ~' /'~/ ~') ''~ J:)ERMIT NLIMBER: AS BUILT DRAWING PARCELID NUMBER: OSP111185 - 051 -152-74 A B ST1 12.81 59.61 ST2 18.20 65.27 DBL1 20.05 64.25 DBL2 1g.79 65.37 SCIMITAR #3; BLOCK 1, ~ LOT 6 SCIMITAR #3; ~ BLOCK 1. LOT 7/ ~ zo. / / 30' GARN.ESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS E. 3UDOR ROAD, SUITE 101 * ANCHOI~E, AK 99507 * PHONE (907)337-6179 * FAX (907)338-3246 * WEBSI~ vre~.gerne~enginee~ng.com PREPARED FOR: I PHONE NUMBER: I PAGE NUMBER: MARY WILLIAMS 652-5510 2 OF 5 LEGAL DESCRIPTION: DRAWN BY: SCIMITAR #5; BLOCK 1, LOT 7 PNB TYPE OF WORK: DATE: ASBUILT DRAWING 8/18/1 1 ~"~""~": AS BUILT DRAWING "^"'= "~"": OSP111185 - 051-132-74 INVERT OF BUNG AT INLET = 95.42 NEW 1000 GALLON SEPTIC TANK INVERT OF BUNG AT OUTLET = 95.21 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTOi~S F-. TUDOR ROag, SUITE 101 * ANCHORAGE, AK 99507 * PHONE (DO7)557-6179 * FAX (g07)338-3246 * ~ ~.g~me~ineering.c~n PREPARED FOR: I PHONE NUMBER: I MARY WILLIAMS 652-5510 LEGAL DESCRIPTION: SCIMITAR #3; BLOCK 1, LOT 7 PaGE NUMBER: 30F5 DATE:8/1 8/11 TYPE OF WORK: PROFILE DRAWING orness,o Permit Number: Tax Code Number: Work Type: On-Site Wastewater Disposal System Permit OSPl11183 05113274000 Septic MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade Permit Effective Dates: August 05, 2011 to August 04, 2012 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: SCIMITAR #3 Site Legal Address: SCIMITAR #3 BLK 1 LT 7 G:1261 Owner/Address: WILLIAMS MARY N D PO BOX 774396 EAGLE RIVER AK 995774396 Site Mailing Address: 19712 BELDUQUE CT, Chugiak Lot Size in Sq Ft: 40262 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must 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 must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. ~ia{:~ roviSions: The Inspection Report will not be approved until letters of non-objection are provided for the well in the easement. ,~ Provisions: The proposed tank must be 5 feet away from all sonotubes or piles used to support the deck. Received By' ~"'~¢'~ '; Date: ,~/" ~/// Issued By: ~'-- //~~~/~c.---' Date: ~,~.~//~/ MUNICIPALITY OF ANCHORAGE Community Development Department Development Services On-Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907- 343-7997 Mayor Dan Sullivan On-Site Sewer/VVell Permit Application For A Single Family Dwelling Parcel I.D. 051-132-74 Property owner(s)MARY WILLIAMS (C/O DAN GREEN) Day phone 696-1805 Mailing address 19712 BELDUQUE COURT *EAGLE RIVER AK 99577 Site address 19712 BELDUQUE COURT *EAGLE RIVER, AK 99577 Legal description (Sub'd, Block & Lot) SCHIMATAR #5; BLOCK 1, LOT 7 Legal description (Township, Section & Range) Lot Size Sq. Ft. Number of Bedrooms 5 THIS APPLICATION IS FOR: ( [] all that apply) Absorption Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage ['-] THIS APPLICATION IS AN: Initial [] Upgrade [] Renewal [] THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: N/A I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) g 0" -~-~'~'~ ¢-¢:,¢~c(L~ Waiver Fees: /Rush Fees: ,..r ,~ of Payment: ~*-! i ] t I Date of Payment: Receipt Number: ~: ~' '?~-di ~' ~ Receipt Number: Permit No. C'~ ',;~{~ i~\\ ~'~ Waiver No. (Rev. 01/11) GARNESS ENGINEERING GROUE Ltd. CONSULTANTS & GENERAL CONTRACTORS ~~',~,,~ July 28, 2011 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Proposed Septic Tank Upgrade for Scimitar #3; Block 1, Lot 7 To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The septic system consists of a 1000 gallon septic tank and a trench type drainfield. The homeowner is planning on adding an addition to his deck and due to the age of his septic tank would like to replace the tank at the same time. We are proposing to pump and remove the existing tank and replace it with a new 1000 gallon steel septic tank to be placed in the same location as the existing septic tank. We are requesting an expedited permit for this installation. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Presi( septic system. P.E., M.S. , is a site plan drawing and a design drawing, which are all part of the design package for this (Contact G.E.G. Ltd. for 7page construction specification letter.) 3701 E. Tudor Road, Suite I01 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com //.~"---.~/ / / ~ / ~ SCIMITAR i~3; BLOCK /// t~/// / / X XX 1. LOT 15 .- "iT~ .. cio 9~N ~REE~ I 696-~05 ~ or 2 t'~. ~l~x~~ss..' PROPOSED SEPTIC TANK MUST MEET ALL REQUIRED SEPARATION DISTANCES (100' FROM EXISTING WELL, 5' FROM FOUNDATION, &: 5' FROM EXISTING DRAINFIELD.) NOTE: THE CONTRACTOR ~ SHALL HAVE ALL WELL RADII ~ FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. NOTE: PROPOSED SEPTIC TANK MUST BE 5 FEET AWAY FROM ALL SONOTUBES USED TO SUPPORT DECK. PUMP AND COMPLETELY REMOVE EXISTING TANK AND REPLACE WITH A NEW 1000 GALLON SEPTIC TANK, ~ INSTALL DOUBLE C/O'S%~ EXISTING DRAINFIELD --~.~ SEPTIC SCIMITAR #3; ~ BLOCK 1, LOT 7 ~ / / / SCIMITAR #,:3; BLOCK 1, LOT 8 SCALE: I I 1' = 30' TANK UPGRADE SCIMITAR #,3; BLOCK 1, LOT 6 / / / GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS E. TUDOR ROAD, SUITE 101 * ANCHORN~E, N( 99507 * PHON[ (907)337-6179 ' FAX (907)338--3246 * WE~SI~.: ~l~.g~rnessen~ineering.com PREPARED FOR: PHONE NUMBER: C/O DAN GREEN 696-1805 LEGAL DESCRIPTION: SCIMITAR #5; BLOCK 1, LOT 7 PAGE NUMBER: 20F2 IDRAWN BY: DATE: P N El 7/28/11 TYPE OF WORK: SEPTIC TANK UPGRADE 3000 Sper~d Road P,O, 8ox ~90288 Anc~ho~a~,~, Alas~ 995 ~§.0288 September 26, 1991 Ms. Rae Hall Greatland Realty '11411 Old Glenn Highway Eagle River, AK 99577 Dear Ms. Hall: ENSTAR Natural-Gas company has no objection to the well that encroaches into the utility easement on Lot 7 Block 1 scimitar Subdivision, unit No-3. If you have any questions please call me'at 264-3743. Very truly yours, ENSTAR Natural Gas Company Dan Westervelt Right-of-Way Agent DW/sr '91NOU 7 8R 8 30 STATEMENT OF NON-OBJECTION FOR ENCROACHMENT WITH UTILITY EASEMENT :Electric ~atmn, Inc. (MEAl Rs no obiection with the location · cas[ ~. bOUndary of the following property~ Lot 7, Block 3, Scimitar Subdivi~sion. that MEA wil! :be held that my resUlt from the by: Matanuska Electric Associ June 23, I994 Date-T MEA ACKNO~/LEDGEMENT OF ALASKA ) ) SS. JUDICIAL DISTRICT The foregoing agreement was acknowie:dged before this June , 19 94 by David E.~ ~n~alls me Rotary My commiSsiOn expireS: Matanuska Telephone Association, Thoma~ R. Minn~ch P~denUC.l~O. NON-O~ON TO ]Lx.~KMElWT ENcROA~qF. aNT D~ EP.' ~ domzme~t. Matanuska Telephone t~ on pm~ d~ ~ ~ Scimica:~ ~lrd J~ D~ ~cho~a~e ..... ~g D~ ~: a.~W~ ~ Un~ W~'Sy~ b.__ ~ UM~ or ~ve Gm~d ~c S5~ c ...... F~ ~ .C~lar Drive ................. ~c~~t ~ a.~lt of d~t d~ not au~o~ a~(s~ PLF..ASE NOTE: This docamcat is, in no way, an agremae~t to ~te ~y ~on of ~c pla~ ufili~ m~s). ~d ~d mot ~ ~t~ ~ ~ by buye~ ~ ~.~m~ SPECLKL CoNDn'IoNs: ~eco.%~i~,e,.,d are :hose located RLS o~ _.i~...b.e responsible fac.~li~ies ~ick ~y be {n the ..... ~. L~,. near tke we~t, as it hoc aooear t~ a cable ~c~ra ,~ called for iD a_~e$~ to East ~ ~ p~d~ to ~c ~om~. b'~a ~e ~ of ~e od~:l d~em ~om ~e R~s 0~ a r~g ~. ~,n,~ ~pi~ ~v ~ ~i~ ~m ~ ~ ~ ~fl ~ $~r. for M~m~l~ Tclep~ ~on. b~¢~ ~ I [ ch of July ~ ~S ~ OF. I have hcre._i=m ~ ~ ~.and and aEuxed :my. ~ ~ the day. and 3~ in this ~ca[e first ~ve ~xiaem ORANTOR(S) Jei~e=v O. a~d ~rv N. D. Williams P. 0. SOx 774396 ~.Z%e River, ~ ~9577-43~6 ~ ZLmm~ · ~anuska Td~hofie ~on~ Post ~:t~x 3550 Palmer. ~ 99645-3550 June 14, 1994 Je~y D. and Mae), N. D. Williams P. O. Box 774396 Dear Mt.and Mrs. Williams: Subject to your agrement to inde~fy the company asset fog below, Prime Cable of ~ ~ no ObjectiOn to the ~veway encroaching aeroas the Platted utility ea_semem on Lot 7, BlockI, 8c~ # 3 Subdivision, City ~d NW 1261. This Ietter of non-objection in no way preclud~ Prime Cable fi'om full use and enjoyment of any fights it may' have within any portion of the fight-of-my, including u~imited access for servicing its facilities. By si~ng below, you agree to in&nmi_fy and hold Prime Cable harmless, now and forever, :for any damage, rests, expense Cmcluding reasonable attorney's fees), liabilities and injury to any person or property occurring as a result of th~ encroachment. Please indicate your acceptance by si~ing and returning this letter to myself at the address below. /jr xc:: Greg Schmid, ATU 5151 FAIRBANIqS ~REET · ANCHORAGE, ALASKA 99503 ~, (907) 562-2400 DEPT. OF ENVIRONMENTAL CONSERVATION TONY KNOWLE$, GOVERNOR DIVISION OF ENVIRONMENTAL HEALTH DRINKING WATER AND WASTEWATER PROGRAM 555 CORDOVA STREET ANCHORAGE, AK 99501 http://www.state.ak.us/dec/home/htm Telephone: (907)269-7696 Fax: (907) 269-7650 April 29, 1998 Mr. Jeffrey D. Williams J & M Rentals P.O. Box 774396 Eagle River, Alaska 9957 Subject: Lot 7, Block 1, Scimitar Subdivision #3, Eagle River, Alaska, Class C Public Water and Wastewater Disposal Systems, ADEC Project Number 200, Review Dear Mr. Williams: I have reviewed your April 14, 1998 submittal regarding the upgrade Of your single family home into a Bed and Breakfast. Based on this review, I have the following comments. From the submitted information, it appears that the existing water system met all regulations and guidelines when it was installed. Based on this information and the fact that the demand on the existing water system will not be increased, it appears that the water system will be able to meet the demand without modifications. Therefore, the existing Class C Public Water System serving an one bedroom Bed and Breakfast and a two room single family residence located on the above-referenced property is approved for the concerns of this Department. A final Operation Certificate, constituting this approval, is enclosed. By opening a Bed and Breakfast in your home, the existing water system classification changes from private to public. The Department is assigning Public Water System Identification (PWISD) Numbers to all public water systems. The PWSID Number assigned to your public water systems is 218569. This number will need to be placed on all forms requesting analytical results. I recommend that you monitor for total coliform bacteria and nitrates (as nitrogen) once a year. Since the existing wastewater disposal system has not been operating at full capacity, it should be able to accept the volume of wastewater from an one bedroom Bed and Breakfast and a two bedroom single family residence. Thus, in accordance with the provisions of 18 AAC 72, Wastewater Disposal Regulations and the Department's guidelines, the wastewater disposal system serving the facility on the above-referenced property is approved for operation. A final + ~,_ ..~ MUNICIPALITY OF ANCHORAGE i ~ 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 PHONE ~'NEW ~ ~ NO. OF BEDROOMS LOCATION ~] } Wall Absorption area Dwel]in9 ~ PEaMIT NO. ~S~AaC~ ~o: I~r ~/ ~r g ~ '~' Manufacturer ~~ Material ~rr~/_ No. of compart~ts ~ ~ Liq. capacity in gallons Inside length Width Liquid depth ~ ~ DISTANCE TO: Well ~j~ Dwelling PERMIT NO. O Z ~ Manufacturer Material Liquid capacity in gallons ~' ~'STANC~TO: w~cr~N Y2: "°'"'"'°n~/ 'Z "earestl°tlin°,~ 'ERMITNO.a ~ N°'°flines / Length of each I~ ~_ T°tal length °~li~zj ~ Trench wi~ inchesDistance bet~e~O~ ~ ~ Top of tile to finish grade~ /~ Material beneath tile ~ inches Total effective~zz~bs~tion~ area Length Width Depth PERMIT NO. ~ ~ Tgpe of crib Crib diamet Crib depth Total effective absorption area m Well * / / Building foundation Nearest lot line ~ DISTANCE TO: ~ Class~ ~/ ~ Depth Driller Distance to lot line PERMIT NO. ~ Building foundation ' Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS ',~ SOIL TEST RATING ~/B ~ INSTALLER REMARES ~ APP DATE LEGAL ~ .~ ~,: v. 3/TB} PERMIT DEPBRTMENT OF HEBLTH BND ENVIRONMENTBL PROTECTION 825 'L~ STREET~ ANCHORBGE~ BK. 99501 264-4?20 ~4EL~ Rr-~[:, C,~-~---SITE SE~-~EF: F"EF:r4 IT ( 82t107 ) BPPLICANT LOCRTION LEGAL MYERS CONST L?Bi SCIMITAR PO BOB ~5t CHUGIBK 995~7 694-44t4 LOT SIZE 999999 SQUARE FEET TYPE OF SOIL BBSORPTION SYSTEM IS: TRENCH MBXIMUM NUMBER OF BEDROOMS SOIL RRTING (SQ FT?BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [)EF'TH= 10 LEt'-~ST H = 19 ~.3 F-: Ft %." E L [)EPTH= 7' THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRBINFtELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTBNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVBTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVRTION (IN FEET). PERMIT RPPLICBNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. T~,] (:-~') I ~5F°EE:TI,]~-~'--=;~ R~:E F~Ea~!gJ I BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTBNCE BETWEEN R WELL RND RNY ON-SITE SENBGE DISPOSRL SYSTEM IS 100 FEET FOR 8 PRIVATE WELL OR t50 TO 200 FEET FROM ~ PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.. MINIMUM DISTRNCE FROM R PRIVRTE HELL TO R PRIVBTE SEWER LINE IS 25 FEET BND TO R COMMUNITY SEWER LINE IS ?5 FEET. HELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRAMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. PE~:~." ~-11 T E~-(F' I E~'ES [:,EC:Ef'IE:ER _?~-1.. tL~. E:.'s-- I CERTIFY THRT 1: I AM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH 8'T' THE MUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. 3:: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF' THE RESIDENCE IS, REMODELE[:-~O I~CLUDE MORE THRN ~ E:EDR. OOMS. SIGN ...... '_ R~PLIE:RN~ MYERS CC~- PERFORMED FOR: LEGAL DESCRIPTION: 1 2 4 7 8 12 13 ~4 17 18 10- 20- COMMENTS PERFORMED BY: 72-008 (6/79) ~, ~ ; i[~ SOILS LOG MUNICIPALITY OF ANCHORAGE [] PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 8;25 L. Street, Anchorage, Alaska 99501 ;264-4720 SOILS LOG - PERCOLATION TEST SLQPE DATE PERFORMED: SITE PLAN i ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN CERTIFIED FI/~,ND ~ ET ?? · (minutes/inch) DATE: yslcal Surveys 277-6615) T E ~, WELL R E C O R D ' .~ U,Si~,S. L'o~al Iio. Dr 111 Ing Perml t No.' la.-.Bor~ugfi;[;~.: :Subdlvlsloh''~: :,:Lot: Block lb. Fract(on Section No. Township ' Range · . ~erldlan Ic,(~;O I stance and'_ ~ I ~cc ion Road .. ~ --~;. .~-.-~, ..... "~ ' . ' [ ' -: ". ~C6 l'~'lo~ '.?~"T~s~l~<~,~;drL~:~ed:.under my ~urlsdlc~on and th~s repor~ 15 ~rue ~o ~he best o~ my know]edge and be~ 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 7; Block I; S~imitar Subdivision #3 Location (site address or directions) 19712 Bc.~duque Court Property owner Mailing address Lending agency Mailing address M~',:b~ & Mary 19712 Belduque Court, Day phone Chugiak, Alaska 99567 Day phone 688-1338 Agent Rae H~Z1 GREATLAND REALTY Address 11,411 r~?rl ~?,~ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well NOTE: Day phone 694-9125 z~a~_ ~ 99577 Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Address ! 7n:~4 F~ngle Ri,vet Loop Road Eagle River, Alaska Engineer's signature Approved for Disapproved. Conditional approval for bedrooms. DHHS SIGNATURE Phone bedrooms, with the following stipulations: Additional Comments The Municipality ef Anchorage Department of Health and Human ~e~vices (OHHS/ 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 #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-.~-t' '1 ~v.¢- I ~'C, ~"I,TA'~- ~;[~'~5 Parcel I.D. A. WELL DATA Well type ¢¢,~V>"rc~- Log present ~N) y Total depth ~ 0~' Sanitary seal ~N) *¢ Date of test If A, B, or C, attach ADEC letter. ADEC water system number Date completed 1 \ - "~.~ ~'Z~ Driller r-'t Cased to -'J ~ ~ Casing height Wires properly protected (~N) FROM WELL LOG AT INSPECTION iCUNICIP^LtTY ~l ' ~ ' c~'b' ~¢~ ' ']_1,..~ ~t ~ ~t,,~/[?,oNMENTAL SERVICES DIVISION Static waterlevel Well flow ~'~ c> g.p.m. Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ C)O t~ Absorption field on Public sewer main Sewer service line t, JOV 2 6 1991 g~.E.C ~ IV ~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: B, SEPTIC/HOLDING TANK DATA Date installed ti3, ~ '2.'5 ,-- '~ '1.- Tank size Nitrate O, ! 'Z~ '"'~r/J~. Other bacteria Collected by: 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Compartments 'z.. Cleanouts Y~N) '¢ Foundation cleanout4~/N) y High water alarm (Y/~ /~ Date of pumping ~ I ~7./ ~ / PumPer SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \ Dc> ~'~' On adjacent lots ~ I:>c~ ~ ~ Alarm tested (Y/N) To property line Surface water/drainage Depression (Y~ Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) Manufacturer Manhole/Access (Y/N) "Pump on" level at ~' level at High water alarm level ~ Cycles tested Meets MOA electrical codes (Y/N~~ SEPARATI~ANCE FROM LIFT STATION TO: Weql on lot Surface water On adjacent lots D. ABSORPTION FIELD DATA Date installed \b, .- "/..'5 ~ ~ "~ Length ?--'~ Width ~ ~ Total absorption area "~"/.-'L-~¢ Depression over field (Y~_.) ~ Results ~fail) ~'A'~-~ Peroxide treatment (past 12 months) (Y~ Soil rating Gravel thickness Cleanouts present I~/N) Date of adequacy test for (..~"~ Iz.,,/~J ~ If yes, give date System type Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot Loo I'P On adjacentlots too 14- Propertyline ~ r~ [''~ To building foundation I c, ~ *' To existing or abandoned system on lot On adjacent lots "z~c~ ~'~ Cutbank ~31~ Water main/service line Surface water I o, ~:~ ~ ~¢ Driveway, parking/vehicle storage area Curtain drain /,J E. ENGINEER!S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S 8, $ ENGINEERING Signature 17034 Eaqle River Loop Roaa Eagle River, Alaska Engineer's Name Date [ ~/~ ~ HAA Fee $ / Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-028 (Rev, 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA99518 TELEPHONE (907) 562-2343 ANALYSIS RE~ORT E¥ SABLE for WOR~order~ ~0408 Date Report Printed: NOV 20 91 @ 15:19 FAX: (907) 561-5301 Client Sample ID:L7 BI SCIMITAR S/D PWSID :UA Collected NOV 18 91 @ 12:40 h~s. Received NOV 19 91 @ 13:45 hrs. Presezved with :AS REQUIRED Client Name :S & S ENGINEERING Client Acct :$NSENGP BPO ~ PO # NONE RECEIVED Req ~ Ordered By :R. SHAFER Analysis Completed :NOV 20 91 Send Reports to: Laboratory Supervisor/~TEPNEN C. EDE 1)S & S ENGINEERING Released E y: //~ /~//~. 2) .... Chemlab Ref ~: 916233 Lab Smpl ID: 1 Matzix: WATER Allewable Parameter Tested Result Units Method Limits ............................................................................................................... NITRATE-N 0.12 mE/1 EPA 353.2 Sample ROUTINE SAMPLE COLLECTED BY: RAY, Ramarke: I Tests Perfozmed ' See Special Instructions Above UA-Unavailable ND~ None Detected "See Sample Remarks Above NA- Not Analyzed LT=Less Than, GT=Greater Than SQ-~ Member of the SGS Group (Soci~t(~ G6n~rale de Surveillance) · . APPLK./NT FILLS OUT UPPER HAI .... ONLY Pr~o~erty O~ner Phone MailingAddre~ ....... 1~O BOX 1596. 'eog]~ Buyer Address Nflv ~ / Zip Code Lending Institution Phone t,'i:p~ Pedera! Ss. vin~;s &Los. n Address 813 ~1, Northern Bealty Go. & A~nt Phofie To%em geal-bT~ Inc. (3lm Hon'bg.~uo) Address P0 BOX 911~ .Eg, rr!e River, AK ZipC°de99577 694-9494 Legal Descript~n Lo'b~% Block l, SciNi'b~.r Street Locatim ?,r'*~,, 1!~3 ~,,~,,~ Type of Resi~nce ~ Single Family ~ Multiple Family No. of Bedroo~ ~ Other Water Supply Individual A~ACH WELL LOG. A wall Icg is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach Icg if available). ~ Public Utility Sewer Disposal ~ Individual Year Individual Installed: ~' Public Utility When Connected to Pubhc ~hty: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Timk~-q c'*~'~'J Date Date Date Date Inspector Insp~tor Insp~tor Insp~tor ~U~ ICIPALII Y Ur Field Notes: ~- DFPT C~ ','~'LT t o, / ~ ENVIRD;~;,.~, A. ' .O 5~TION RECEIVED (~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* Soils Rating Date ~wer Installed Well 1o Absorption Area /~ ~ v Well Log Received , 72.023 (3/82)