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SOUTHFORK BLK 4 LT 2
HE w 40 7li-ba►-og r c-� a Inev. tlp i) mvA ca - Municipality of Anchorage Page of� DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: _�GU %303/x_ PID Number: D�gOZ %d b Name. I EP ✓/ M � /`/74R7-7/`/74R7-7/`/74R7-7W t St t asewaer sem: D New Y Upgrade Address:"15 A2_0/4 l� ABSORPTION FIELD Phone: No. of B?5Pms: !] El Deep Trench LJ Shallow Trench Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: D GPD/S . Ft. Total Depth from original grade , - 5 Lot: Block: Subdivision: Depth to pipe bottom from original grad Gravel depth beneath pipe - 5 Ft. Oi C Ft. Township: Range: Section: Fill added above original irade ��:/J Gravel length: /',.Q / � CJ Ft, WELL: D New ❑ Upgrade Gravel width: �I Numb of lines: Distance �etween lin A Cla_sJfi4 /atiop (Private, A,B,C): Total Depth. Cased To: Ft. Total absorption area: / Ft �m Ft. Pipe material: t ZYI 6 Ft. Ft. L _S0, Ft. '�3J Driller Date Drilled: Static Water Level: Installer Gi 33 Date installed Ft. d.�tl-r`•r e!2 7 -IS g 2ln �'/ J� Yield: Pump Set a Casing Height Above G•ound: TANK GPM FL Ft. SEPARATION DISTANCES / SepticCT_//l�_ Holding DS.TE.P. J To SeDoC Absorption Cdl —..,�,o,nq Pubi,r v...;a.., Man i(aa ,rerC��l� Cac>_cily in gallons: —� FfOnl Ta^k Field Station Tank Se,--,, Lines /vLJ�y Well / / �/� / ._.—.- `�•� Material: N ,_-^„ elf CommCpaarrtt/m—, 2✓-{" v Water e 167J — — �-- LIFT STATION Lot/ Line �� 2� r �J`v Size in c-- ons: Manufacturer. Foundation r / / �_ ' 'Pump clevel at: "Pump off' leve' a. High water aldr Curtain Drain I Pump Ma`- dAodel Electrical Inspections zerformed by. Remarks BENCH MARK Location and Description.- Assumed Elevation: list t ENGINEER'S SEAL •�� a INE Y14;3 :f 4 s..q ly C)v �5 fa,dtp y, S & S ENGINEERING Inspections performed by: 17034 Eagle River L0QP Reed Nobs: 1st Y V y4 e!! eG09l E3 Nily0W a91119 'J Eagle River, Alaska 99577 2nd y{Y�V X9v Y044c .n �m • Department of He111d Huma ervices aper va , �9aA. JflVuaMa`Y7 3n *a6ud �• 9C 'aee N0. 1437.E a46XReviewed `%'� and a roved b :� approved Y Date: �•. � �ftr;: r c-� a Inev. tlp i) mvA ca - SW930312 2 2 Permit No. Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report SOUTHFORK SUBDIVISION, BLOCK 4, LOT 2 07802108 Legal Description: PID No.: ♦ TH #2' I A B I EXIST. TRENCH DO ED FCO 11.1 43.2 SUCH THAT ,MAYI ED COI 12.5 43.8 19' I� IN THE FU. REA. . CO2 17. 45. zI ' DV 23.9 48.3 C04 I �~ a CO3 17.5 68.5 C04 63.0 81.0 MT1 28.5 87.0 I 1 N MT2 60.0 75.0 ' NERTER VALV TH #1 DBL 1000 GAL EPTIC TANK CQcoz TEG B ITY VER�FI 8/2/93 o 1 72-013 A (Rev. 9/91) MOA 25 - 3 C01 a- CO nit L \ GAR \\ 10' 1 JTIL. E A - \ \\ 3 BDRM p HOUSE < 1 C(- 7 \\\ ��1 100' WELL RADIUS SCALE 1" = 40' \WE L 86.1' MT2 C04 86' FIL R FABRIC EN_,G1fidE1tW&t§E,AL fir � yul� a�tre3���, 77.5' � V 2' LAKE OTIS GRAVEL 79.5' 80.0' SR a v tr ntrx as.x aoeo. x"x<o ne ads- e A : 69' WATER FOUND 8/13/93 .#o1 rl A. Sha6A N.T.S.A n•o IQ °�, No. 1457.5 e, T F `trr q,v c":1 it c O l`S Slay r 72-013 A (Rev. 9/91) MOA 25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE j p m DEPARTMENT OF HEALTH AND HUMAN SERVICES p, 14- 73 P.O. BOX 196650, 825 "L" STREET, ROOM 502 C7 T ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT L{_� C> PERMIT NUMBER:SW930312 DATE ISSUED: 8/20/93 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 8/20/94 OWNER NAME:MARTIN ERVIN P & OWNER ADDRESS:9373 HILAND ROAD EAGLE RIVER, AK 99577 PARCEL ID:07802108 LEGAL DESCRIPTION: SOUTHFORK BLK 4 LT 2 LOT SIZE: 84720 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: zI2-01�2j DATE: - h. �` August 12, 1993 Municipality of Anchorage HEALTHAUTHORITY DEPARTMENT OF HEALTH AND HUMAN SERVICES APPROVALS 825 L Street Anchorage, Alaska 99501 SEWER&WATER REFERENCE: Southfork Subdivision, Block 4, Lot 2 MAIN EXTENSIONS ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Request you issue a permit to upgrade the septic system serving the three bedroom house on the referenced property. SEWER & WATER INSPECTION An adequacy test performed on the existing system on July 28, 1993, for Health Authority Approval purposes found the absorption capacity of the existing system to be inadequate. ENGINEERING STUDIES ANDREPORTS A test hole was excavated and percolation test performed in the area of the proposed upgrade. Attached is the proposed upgrade design. WELLINSPECTION We do not anticipate any adverse effects on neighboring &FLOW TEST properties by the installation of the proposed septic upgrade. SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN If you have any questions or require additional information for yobreview, please contact us. A. Shafer, P.E. /LSU/lsu 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 !� U) w Q J Y 0 9 * F F � •�, ,,.. Ny `, �rJ Fa .� W J bt9 O w wE z w wIL m IL LO U-0 El f2l 0 cn OU v� iL -< 6) C> Otn wco Jaz N�O� �L OQQ 20 OF o 0 tfaoO0�w J Awa H> a r i- �� J Z UI 0._ O Z ra o `) OZwa 0-1 x w N < V) F- 0 W0 w=N wa- w N_ W oa k O V)ZZ ~ t::� El NJ maw of0OwLriWU m 0FQ U00 a0 x �Z a z_ o. Vi a �_>aN Z Zaoaf J1 Q r Q 20 OHO N VI Q F= F- O U M FY OU On_� �. .-d a CY W C) ' W Z U L� S F— Z z / V)� o a F� V �0 w W 00 to �� r, W ;, _ D- LSF rn a NOo L O oz w I M I U) Q w F- d' ZE" D U] w z w c� II �� �x W 14W a' U ,ice �pW pJw ONO F� J ifs moo A W _ 0.',.a W x a.o N , Z d' a W MVI n wW w. rn V) (0 �mw �Nzo wz J i z�wWF i W�awo i xx¢wo �-WaZU 4 dfee4 6 fi ��v1 i ,� � w u� �M1 " 3ltlJS .09 = „L Municipality of Anchorage 0* DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: w DATE PERFOR E `F� ' �- ° +\• �-`� LEGAL DESCRIPTION:�1.�L�i &t�7(4 &r- �(D Township, Range, Section: SLOPE SITE PLAN ,D Pyki FEET„ 1 1. . �. f�� p�LGFI�S N 2 3 4-' I M LICL �(LT LSA y II I 5 l 6 II 7 I II I ' 8-M G� 9 10 WAS GROUND WATER ENCOUNTERED? IVC/ S 11 L IF YES, AT WHAT 0 DEPTH? P 12 E Depth to Water After 13 Monitoring? gate: 14 Reading Date Gross Net Depth to Net Time Time Water Drop 15- 16- 17- 18- 19- 20 51617181920 PERCOLATION RATE— (minutes/inch) PERC HOLE DIAMETER ,�^.' / TEST RUN BETWEEN �— T AND T COMMENTS �LJtt�—��AISCtL77SL dT Z C�p2�C S & 5 PERFORMED BY: IyO34 ga3lL Five" LO®P Road No.2041 T9 Ver Ale+gl�a 99577 ACCORDANCE WI-�A�9 T9 ATE AND MUNICIPAL GUIDELINq� 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: { y3r9 a, r;`�° °3n e ei�, •g yf Municipality of Anchorage Py 0jt.^ DEPARTMENT OF HEALTH & HUMAN SERVICES Tr @s , 825 "L" Street, Anchorage, Alaska 99502-0650 . 4s .atloo as SOILS LOG — PERCOLATION TEST ;toboil A, Sh,`rsx PERFORMED FOR: nh1 C/V-,)-jE r9^°ab°-8F/ DATE P RI rOs `af" / � LEGAL DESCRIPTION: L-aT CcYa71+ -agr Township Range Section: DEPTH SLOPE SITE PLAN (FEET) 2 �^���� F -z 3 4 5 6' 7 8 Get/ML — s � �zy sfw�y GsxnuE� WIAL SILT I-Fk -S� ;, THfiLo�f�-�uz. �Ar�P 10 WAS GROUND WATER Yes ENCOUNTERED? 11 f S 11'' IF YES, AT WHAT Cf L 12 [�.ci t t DEPTH? 00 P iJ E 13 Depth to Water After, Monitoring? Date: 14- 15- 16- 17 4151617 18 19 gn I I PERCOLATION RATE JC0 • (minutes/inch) PERC HOLE DIAMETER b L�_ll nn,, ,,TEST RUN BETWEEN, �rJ AND oS ' ' FT COMMENTS S` D JVyI-C 4 (E AI 12UN / C) S ��1CS (fSE cA'r +"01-i L-OWF--a- EL( - y Cr�>= , C to ` [JF P 6/--s �ecPPsL QlDg PERFORMED BY5 & S ENGINEERING ACCORDANCE v��r 3g4�EnS le giver Loop RoadNo. 204 �ygle FbiVE A ,i6� 1� ISJF�"YWMPAL GUIDE 72-008 (Rev. 4/85) (/// Lx ys' EjEa CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: �r .�s®■ems I I PERCOLATION RATE JC0 • (minutes/inch) PERC HOLE DIAMETER b L�_ll nn,, ,,TEST RUN BETWEEN, �rJ AND oS ' ' FT COMMENTS S` D JVyI-C 4 (E AI 12UN / C) S ��1CS (fSE cA'r +"01-i L-OWF--a- EL( - y Cr�>= , C to ` [JF P 6/--s �ecPPsL QlDg PERFORMED BY5 & S ENGINEERING ACCORDANCE v��r 3g4�EnS le giver Loop RoadNo. 204 �ygle FbiVE A ,i6� 1� ISJF�"YWMPAL GUIDE 72-008 (Rev. 4/85) (/// Lx ys' EjEa CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Southfork Subdivision, Block 4, Lot 2 GENERAL: 1. The scope of this project includes the installation of an absorption bed to serve the three bedroom residence located on the referenced property. The existing leachfield is to be abandoned such that it may be used in the future. 2. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page Two Southfork Subdivision, Block 4, Lot 2 August 12, 1993 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. LEACHFIELD BED INSTALLATION: 1. Excavate the proposed Bed Area to the depth shown on the design. The bottom of the excavation shall be within 2 inches of level. If the bottom of the excavation becomes smeared, it must be raked or scratched (ruffed -up) before gravel or sand placement. 2. If a sand layer is required, place sand over entire excavation to the required depth shown on the design. The top of the sand layer must be within 2 inches of level. 3. Sewer rock shall be placed uniformly throughout the entire bed. Perforated distribution pipe must be installed level with perforations down. Gravel depth below the perforated pipe shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a minimum of two (2) inches. The total gravel depth throughout the entire bed shall be a minimum of twelve (12) inches. 4. The perforated distribution pipes must be no more than six feet apart. The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet. 5. Silt barrier material must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Page Three Southfork Subdivision, Block 4, Lot 2 August 12, 1993 6. Monitor tubes shall be of four (4) inch diameter and installed at the locations shown on the design. The portion of the monitor tube extending through the gravel depth shall be perforated six (6) inches below the bottom of the horizontal distribution lines. 7. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finished grade over the bed must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Page Four Southfork Subdivision, Block 4, Lot 2 August 12, 1993 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, it's gradation specifications must conform to current M.O.A. or D.E.C. requirements. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. ✓ MLJNICIPALITY OF ANCHORAGE % L)E.PARTMF..NT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL- ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99509 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ffq4FW ❑ UPGRADE MAILING ADDRESS U . By S6 e � LEGAL DESCRIPTION La 8q 'S�Ocj& Fair -k LOCATION NO. OF BEDROOMS 3 v Y DISTANCE TO: ell D Absorptionarea / Dwelling PERMIT NO. 8 -:?N0 �'- F Z LU I.- Manufacturer/''e � . Materi I C_ No. of compartments y Liq. capacity in gallons o IF HOMEMADE: Inside length Width Liquid depth — O L' DISTANCE TO: Well Dwelling PERMIT NO. O z F Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: W I s Foundation !" Nearest lot line 'f -/U PERMIT NC) aLcJ,ra3" J LL z F Z W No. of lines oS Length of each line Total length of lines Trench wid_t�hr Distance between lines F. CC 0 Top of the to finish grade Ka ff2. Material beneath tile f--:,<- -__ inches Total effective absorption area � , Lu a Length Width Depth PERMIT NO. Q I- wa Type of crib Crib diameter Crib depth Total effective absorption area WWell W DISTANCE TO: Building foundation Nearest lot line J J CI r cs Depth Driller Distance to lot line PERMIT NO. W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER i PIPE MATERIALS A 30 3 SOIL TEST RATING M INSTALLER REMARKS &oy-_de_ MTV LG g th L'C s8` APPROVED DA�iTE LEGAL Z&2 Wo 72-013 (Rev. 3/78) 0 U MUNICIPALITY OF ANCHORAGE Department L� Health and Environmental ,-otection I�_� 3 825 L Street, Anchorage, AK. �15 �, 264-4720 # # # HANDWRITTEN PERMIT # # # Permit 0 WELL AND/OR ON SEWER PERMIT_< Applicant: �( �= Mailing Address: %-'6 130 6 56 % L/ES 2 Location: Phon�ej _Nu' Number: 9 S� Legal Description: Lc� �G� yI�C Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: X Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) / �$ The Required Size of the Soil Absorption System Is: DEPTH 5 LENGTH P- 0, __ GRAVEL DEPTH <::) r WIDTH / The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). # # REQUIRED SEPTIC(HOLDING) TANK SIZE _ 0 �� GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. # # TWO(2)..INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 2 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the.Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 be,r ms. Signed: Issued by: Applicant Date: 7Z SWP/024 (1/81) Type. of Soil AbSOrVtion System Ls; Trench: Grainfield: J'� Maximum Number of Gedre s: Phone Nuif ier. protw-tion 995a? I r / fl Lot Size; seepage nati.. Holdinq Tarek: Soil €ating(sq. ft/br) 91 The Required Size of the SoiX Ab- orptLoii System I-5: r Tit .LENGTH _ _� • GRAVELDEP� {� 'sor The len.-Ith dimension ig the "angth (i n Leet) of the trench or drain (elf: depth of a trench or pit is the distance between the surface of the gr<7undf the bottom of the excavation (in feet) . There is no set Width for tranche_da The gravel. depth W the minimim depth of gravel between the outtal �6Lqa a the bottom of the excavation (in feet) t REQUIRED EPUC(HOLDIs ) TANK SIZE _ _10 "'0 GALEONS Permit! applLcant has the responatbility ray ;inform ttai� t3epart at lar€ng tae= tastaLlat;ion Lrispa tions of <axny - , tc this property an tha numbL k of re*Ldenoes that tate well will serve. 7W MSPECriO s ARE REQUIRED Backf fling of any sy:5tef wLthaut final inspection and approval by this dapar will be subject; to prosecution. Lx : distance betweiin a well and any onsite aewage disposal system :is 10 for a. private well or LSO to 200 feet ECOM a PUblic wall ep.nding upon the Of public weal. Mi,nlmt= distance from a private waLL to a private %away le 25 feet and to a Community **kfer line is 75 feet, WaLl logs are requtrbl and mu6t be raturned to this department_ vithin 30 days of the well complete Other reF ui rimer t: may apply. Specifications and casnot:ru=«tion diagrams are available to Inagra proper inataLlatLois. € PERMIT EXPIRES DECEMBER 3L 1 9 92 X cer t i. Ey that; (3.) 1 familiar with the requirements for on-site sewers and welLa a: set Eorth by the 14unici_pality of Anchorage. (2) 1 will Lnstail the system in accordance with erodes - (3) 1 n stand that the on-site Gewer syst€m tray rewire enLa�tl � t e re ? dence is remodeled to tiles lk}ide more that 3 b r= pis, i Issued by. 7&4 pLi, t WV/024 (1/81) f MUNICIPALITY OF ANCHORAGE +.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 _ 264-4720 SOILS LOG — PERCOLATION TEST SOILS LOG Ley PERCOLATION TEST PERFORMED FOR: l�l RICA CJ DATE PERFORMED: I ' 2— LEGAL DESCRIPTION: Sol l.�"� 1 J(' l X31 L SLOPE SITE PLAN wilC�ei �- i)rYihlc 5� l� �O 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS 6m)`is',I+vIs-ancly, tri vel (Gm)—Ve-rv)64v c(rave'l i-lgtWy pac' e -Cd �a ec .A WAS GROUND WATER S ENCOUNTERED? Yr.�.S' L 0 P E IF YES, AT WHAT i DEPTH? PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND/fiFT n- /� 7 ". !/ _,i // w ill % � A/ ! i 11 t\I- (_7 ) O PERFORMED BY: I ' LCiGi�a'(�ICYiP �.JQI'le'1S(JI'\ CERTIFIED BY: 72-008 (6/79) DATE:Z Reading Date Gross Time Net Time Depth to Water Net Drop H2C7 q 1 0S `. �3 N I +-H7 tO 4110L?'. I cf too - .. Lc I p 10 14415- 5S + H2,0 q: Iq W:Z7 N77sLo ►y5 (, Wt, t rtZ© q:3 .&IS � 'f; 111 10 .5-1r� PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND/fiFT n- /� 7 ". !/ _,i // w ill % � A/ ! i 11 t\I- (_7 ) O PERFORMED BY: I ' LCiGi�a'(�ICYiP �.JQI'le'1S(JI'\ CERTIFIED BY: 72-008 (6/79) DATE:Z -7,_ -.i r.. �... -; ��w.T:-sirnua--.x-: m.. --�-,^ -_-. ='2z". scJJ. '�.:�.:, t __ .-c•--sr�-.�-�.-..��. - -.� +.,- -..w by - - - DOC Co. dba SULLMN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 r OWNER OF LAND /?/GL 5 7*0 DEPTH OF WELL - 7 ADDRESS ? /`" STATIC LEVEL OF WATER FT. LEGAL DESCRIPTION /S ��` � 6 ,J tx OW4AW DOWN FT. DATE - Started_Tl j5� Ended GALS. PER HR o PERMIT NUMBER KIND OF CASING KIND OF FORMATION: Ft. to Ft. From Ft. to Ft. From _Ft. to -2—f' Ft. %"rAk'4 .Z From Ft. to Ft. b 3 J< lr t"w- r From_�� �r--��_Ft. to *7 _f Ft. Ft. to Ft From -'Ft. to- Ft. _--,5 Ft. to Ft. FromFt. to Ft. W'St From Ft. to Ft Kjext r< From Ft. to Ft. CF K E�, APIrwoRAGF From Ft. to - - - Ft CFPT C z; From Ft. to Ft. _ FLivpR, b' iIf1N From Ft. to - - Ft. Ft. to Ft. From Ft. to—Ft. Ft. to Ft. From Ft. to Ft. Ft. V E D From Ft. to Ft. tREUI From Ft. to Ft.' Ft. to Ft. From Ft. to Ft. Ft. to - Ft. From—Ft. to Ft. Ft. to Ft. MISCL. INFORMATION: From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to - Ft From Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From CF K E�, APIrwoRAGF CFPT C z; From _ FLivpR, b' iIf1N From - Ft. to Ft. From Ft. to Ft. From Ft. V E D tREUI From Ft. to Ft. From Ft. to - Ft. 4tom Ft. to Ft. From—Ft. to Ft MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES QRML 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. # 078-021-08 HAA # 1. GENERAL INFORMATION Complete legal description Lot 2, Block 41 South Fork S/D Location (site address or directions) NHN South River Drive Property owner David & Linda Pepe Day phone Mailing address Lending agency Day phone Mailing address Agent Prudential Vista/F.vn i.okPn Day phone 689-6476 Address 16635 Centerfield Dr., Eagle River, AK 99577 - Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 - 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA X21 5. 6. M 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 verifythat 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. 5& 5 ENGINEERING G j�cf 7 cj Name of Firm RiverEngle oop Oa o, Phone Address Eagle River, Alaska 99577 , Engineer's signature DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments It ]TIC Date / 0 /.)_ 3 Iq OF lf'+ �S ROBERT C. COWAN F Q CE -8801 bedrooms, with the following stipulations: Date /0-27- J 8 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-M5 (RW. 1/911 Back MOA x21 A-1VH) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES OCT ".y Environmental Services Division 4auNIUVALIIY (.,itH':'- 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907-Y349W" 4T4kL SERVICES DIVISION Health Authority Approval Checklist Legal Description: 1'0� Q'-orke Y SaJrit F -"ti s40 Parcel I.D.: 07 5' 0 Xt —0 A. WELL DATA Welltype PR"V4-14z Log present &N) Total depth Sanitary seal &N) Date of test Static water level Well production If A, B, or C, attach ADEC letter. ADEC water system number Date completed 8-/' 3 /g, L r Cased to )7 'A- Casing height (above ground) FROM WELL LOG S-rl3lg�2- WATER SAMPLE RESULTS: ,X 'P i Lta Wires properly protected 6/N) AT INSPECTION y/>,/ y 7 Y�f 9— p.m- Coliform n Nitrate 0--7 X -)- Other bacteria 5 & 5 ENGINEERING / Date of sample: Io r I al �01 Collected by: 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date installed i G $ Z Tank size /060 Number of Compartments 2 Cleanouts O/N) Y4-1 Foundation cleanout (6/N) 74--3 Depression (Y,9 I"O High water alarm (YA19) wy Date of Pumping ) 0! 2 g Pumper '4� s C. ABSORPTION FIELD DATA Date installed i �� �A 3 Soil rating g.p. or ft2/bdrm) 0.5 System type Length SS r Width Gravel thickness below pipe ©r Total depth - 2 Effective absorption area i z Monitoring Tube present 6/N) y46�-fDepression over field (Y/Q /" a Date of adequacy test y 7 Results(E!oFail) Fluid depth in absorption field before test (in.); c Immediately after 6 �a gal. water added (in.): _ Fluid depth 0 L' (ins) Minutes later: Absorption rate = Y'{0 -1 c.p.d. i'Ass For bedrooms Peroxide treatment (past 12 months) (Y/N) Y- Mr1 G44-crck..d /O /ti/�Ir{ 72-026 (Rev. 3/96)` k"fow'd If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) _ High water alarm level at* E. SEPARATION DISTANCES "Pump on" lev *Datum Size in gallons "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot % t) o On adjacent lots r Absorption field on lot I o a On adjacent lots Public sewer main IJ Public sewer manhole/cleanout Sewer /septic service line asv Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line S Absorption field Water main/service line /0 Surface water/drainage 0 d " Wells on adjacent lots ° SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 Building foundation I a Water main/service line lD ' Surface water /06 r i'/ / A /A Cu rtai n d rai n _?J a>✓"-�' tif VO4,J AJ F. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area 71 Wells on adjacent lots I 0 d. �J ..,�..' .... , ,. N. I certify that I have determined thru field inspections and review of in conformance with OAh�AAin effect on this date. Signature Z� Engineer's Namee6 tX r C` Date /o/ 4- -5 / q S- HAA Fee $ 0-V P ZD Waiver Fee $ Date of Payment %0 Zia l / Date of Payment Receipt Number '2.:, (� ���E S' Receipt Number 72-026 (Rev. 3/96)* 5drds tha rMfoGrerltems are �. ,( QBER7 C gOWAN r`w CE 8801 •\: ..Ili OCT -23-98 13:34 FROM -CTE ENVIRONMENTAL J! T-162 P.04/05 F-262 Ci&E Environmental wvic . ' Laboratory Division 200 W. Potter Orive drinking Water Analysis Report for Total. Cc,": : , r ` a y aria A® chSoorage, zS9518-1606 READ INSTRUCTIONS ON FEYERSE SIDS' BEFORE Caf �'_ Fax- (907) 561-5301 MUST -69-COMPLETED BY WATER STJPPLIER� 0 Br --COMPLETED BY LABORATORY C3 PUBLIC WATER SYSTEM I.D. si nws this Water SAMPLE to be: O' FR$VATE WATER SYSTEM �__ . Urrs�rsfactory x Sen4 Resuirs Send Involver ;a:;axle over 30 hours old, results may v> u:r.teliabic � _ S mete Too 1on� in rransrr sample should 17034 Eagle la River Loo ar u =;- wx, be over 49 hours old at exammarton 1'5°"` " to River, Alaska "577 i io trtdacair teliabla results. Please send -...___ n.d,r sm-Iple via special del v ry mail. ,.-141D 10 O Send Resrrks D Send Ipverce <; =rat % C70 SAMPLE DATE- UE , I 01 1 Meath Day IU Year SAMPLE TYPE- X RBntine q 0 Repeat Sample (for routine sample, 19 ,with lab ref: no. [3 Special Purpose Time SAMPLE LOCATION CollcCud >> Loi -a- fit -.c r4 s2.24 Fa24 0%'—QZ w Camml;= r, ;a` mf:'Zhqd: tx, Merllbrane Filter a MMO-MUG PCofcolaries/1QOm1. ResulTQ Analyst A Fbks Jun l J Fazeo -:,- --- Tune- t , eta+ facz3 of unslitisfactory results: Spoke vnTb Fazed Z3 Tam: BACTERIOLOGICAL @ AT ER 3'wK: ,mmo-Mi1G Hosult: Total Collform Membrane Filter; Direct Count Verification; LTS BC n —v -- I _ I_ Fecal Coliform CunfirmaTIQu �} 106 til Final Membrane Filter Results Reported By Dare TNTC - Toe N..,max To Co..nr o@ a (knsr 8acr3ns ENVIRONMENTAL FACIµTIES IN ALASKA, CALIFORNIA Ft-oRIOR. It-r.INfliS, i! .. -- _ .,�<;.� ';-..::jSS 3URI. NEW JERSEY. Owl©. WEST VIRGINIA A OST -23-98 13:34 FROM -CTE ENVIRONMENTAL 4 L GT&E Environmental Services Inc r;:1F1-01 T-162 P-02/05 F-262 CT&F Rtf.# 986104001 21enMff Client Name S & S Engineering DaoeMme 10/23/98 11:12 Project Name/# N/A �'aUac�ed Date/Time 10/19198 14:00 Client Sample ED U 2 BIK 4 South Fork eceiy,4 �IWWTimv 10/20/98 15:10 Matrix Drinking Water Pirecor; Stephen C. Ede Ordered By 1?WSU) 0 Sample Remarks: Parameter Results Torn( Coliform 0 Nirrard-N 0.722 Allowable Prep Analysis Limits Date Date lnit 10/20/98 KAP 10 max 10/20/98 10/20/94 QCP +-, attesting to the legality and status of system." 72-025 (Rev. 1/91) Front MOA %21 . 1 5. STATEMENT OF INSPECTION BY t;F`GUR-tI.I. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this i-loalth Autrior ity Approval application shows that the on-site water supply and/or wastewater disposal systern is rMk, functional and adequate for the number of bedrooms %;ndt\/^,.. '::I (fir. Ilf' i �.1�. ,1i:. ' ..,;i '''sn. ' ' ntheirii( JOn obL-.hied from the (v' r ;<.:;ity of A rn my ' r _:.iior.:,nd insp�:: , ri, the on-site water supply and/or wastewater disposal systom is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm _� 5 5 ENGINECRIfi1G G y a q —� t� trl�er->Z,�rp wed Pty, Phone Addre,;s le River, Alaska 99573' Engineer's signature !''o:#`tl`UR ' A.. Approved for -2L )bedrooms. Dil'app'r'oved. Conditional approval for Additional Comments By: Date Fr. S ,;AY. 7h 1..,. ., �^ g ROBERT C: C&h/AtJ <;° k CE • 8301 bedrooms, with the following stipulations: 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 acourtesy to purchasers of homes and their lendinc; institutions in order to satisfy certain f -dc:, al and state requirements. Employees of DHHS do not conduct inspections or analyze data belom a rer ific -a is issued. The Municipality of Anchorage is not responsible for errors or omissior in )11 3iof .' ; ,r;.<.;er's work. 72-025(Rev.1/91) Back MOA421 MUNICIPALITY OF ANCHO.ltAGE ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERUdf>�90 4 1997 Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 •WHI4f3M Health Authority Approval Checklist Legal Description: �T Z�S�-L�— `'t F ��L Parcel I.D.: 612 4'0 -2 /y A. WELL DATA 1 Well type If �S �S'� If A, B, or C, attach ADEC letter. ADEC water system number ` Log present,@N) V) Date completed -2- Total Total depth 77, b ` Cased to 7 7, S Casing height (above ground) /Z u Sanitary seal ON) S./ Wires properly protected &N) FROM WELL LOG AT INSPECTION Date of test P' 13 -,q2- 77 Static water level Z `/ Well production 7 ° , O g.p.m. 7 9 - p.m -WATER SAMPLE RESULTS: Coliform Nitrate O� °� 6 Other bacteria O Date of sample: 3 7 - 5 7 Collected by: S S B. SEPTIC/HOLDING TANK DATA Date installed % ' ///5 ' �Z Tank size /000 Number of Compartments Z a'�- Cleanouts ( N) Foundation cleanotyGN). Depression (Yt�jl High water alarm (Y/N) d14 01 ' Date of Plffn�ing �o" Pumper d) vib"t,r< vri- vf- rlp4- 5--// /61 1 C. ABSORPTION FIELD DATA Date installed �' a t- 4 3 Soil rating (g.p.d./ft2 or ftVbdrm) 6 System type jeX'-C> Length 7 Width :° a%% Gravel thickness below pipe 151 Total depth •S� Effective absorption area �(yg� Monitoring Tube present )9N) Depression over field (Y/1�_ Date of adequacy test 77 Results Fail) 64�S For 3 bedrooms Fluid depth in absorption field before test (in.); Immediately after(( ° gal. water added (in.): , Fluid depth v (ins) Minutes later: Absorption rate = �`�' g.p.d. Peroxide treatment (past 12 months) (Y®) yes, give date J� ,lo S a X P5,4--1, J y 7-0 ° rc `moi �� is „-, �, 7,E s 7-- 72-026 (Rev. 3/96)" D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjacent lots Absorption field on lot On adjacent lots "Pump off" level at* /On r F v ) 141 - Public sewer main 'J //) Public sewer manhole/cleanout A. Sewer /septic service line 2S 14 Lift station 14 - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation b Property line /o 1 Absorption field !Z Water main/service line / d 1�Surface water/drainage /00 14- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Building foundation /2-/ Water main/service line /C) Surface water / ° I Driveway, parking/vehicle storage area / Curtain drain Wells on adjacent lots /00 F. ENGINEER'S CERTIFICATION l certify that I have determined thru field inspections and review of Municipal in conformance with M A A gl delinees in effect on this date. Signature�� Engineer's Name C. C a Date `] / 3 / 7 HAA Fee $ `)U�� Waiver Fee $ Date of Payment (✓ / L{ / ` 7 Date of Payment Receipt Number Receipt Number 72-026 (Rev. 3/96)* y w ROBERT C. COWAN.:- CE - 8801 t are APR -02-1997 17:42 CT&E ESI ANCHORAGE CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By YWSiD CT&E Environmental Services Inc. 971495001 S & S Enlgineezirw N/A L2, BTC 4, South Fork S/D Drinlang Water Sample collected by: Ray Parameter Nitrate -N Total Cotiform G 907 561 5301 P.03iO4 Client 1'0# Printed Date/Time 04/02/97 16:59 Collected Date/Time 03/27/97 11:15 Received Date/Time 03/28/97 12:10 Technical Director: Stephen C. Ede Released By C Allowable Prep Analysis Results PQL Units Method Limits Date Date Init 0.26 0.100 mg/L EPA 300.0 03/28/97 SPM 0 col/100m1 SM16 92226 03/29/97 RAM CT&E Environmental_ Services Inc. Laboratory Division roil/////////ii////s/ills//isiiid►iis/rsisiii�a Drinking Water Analysis Report for Total Coliform Bacteria A 0 of get r Drive 99518.1605 READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAHPLE Tel: (907) 562-2343 Fax: (907) 561-5301 MUST BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D. # y, PRIVATE WATER SYSTEM ❑ Send Results ❑ Send Invoice Winer Svsm. Name Company Name Consul name S & S ENGINEERING o. e N um In e 17094 EaEle River LOOP KWI • _ . ax • umer . 1adlny Address g4ep pAva , Alaska 22M Gry - swt Zip C'odc ❑ Send Results ❑ Send Invoice Company Name a Fe S ENGIM11=0 com.w name 17034 Eagle River Loop Road, No. 204 Nlmlm, Address jle River, Alaska "577 ply Sime Zip C,de SAMPLE DATE: O 3 Month SAMPLE TYPE: Routine ❑ Repeat Sample (for routine sample with lab ref. no. ) O Special Purpose SAMPLE LOCATION 2 -t FWEE Day Year ❑ Treated Water �T Untreated Water Time Collected 11-1 Collected ooBy Fi4-4 Please Print TO tat CQMFLh I EL) BY LABUKA I U K Y Analysis shows this Water SAMPLE to be: Satisfactory ❑ Unsatisfactory ❑ Sample over 30 hours old, results may be unreliable C3 Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received -3)2,s Time Received Analysis Began Q / J6) Analytical Method: X Membrane Filter ❑ M11,10-11AUG * Number of colonies/ 100 mi. Lab Ret. No. Result* Analyst O1. ) I Vvi— 97145 Sent to.A.D.r..u. :finch Fbks Jun ❑ Faxed Date: Time: Client notified of unsatisfactory results: El Phoned Date: BACTERIOLOGICAL WATER ANALYSIS RECORD iVILNIO-MUG Result: Total Coliform Membrane Filter: Direct Count D E. Coll Colonie3/100 ml Spoke with Time: El Faxed Verification: LTB BGB COLIFIRi'vI rvrc'- n,r, ,vumerv.ut To C,,unr oil -Other Bacteria Fecal Coliform Confirmation Final Membrane Filter Results Q �/ C ol `iform/100 ml Reported B p y Date -3 3� t Time 14—/ _ Irrs Comments: PART ONE OF tfOl SESS Member of the SGS Group (Soci6td Gi&n6rale de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA. FLORIDA, ILLINOIS. MARYLAND, MICHIGAN. MISSOURI, NEW JERSEY, OHIO. WEST VIRGINIA 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 Parcell.D.# "A# 1. GENERAL INFORMATION Complete legal description Lot 2; Block 4; South Fonk. Subd-ivi6-i.on Location (site address or directions) NHN South R.ive). Dni.ve Property owner FHv1w and 7nt7,ivy. Martin Day phone 694-9035 Mailing address 9373 Hita.nd Road Eagle Riven, AK 99577 Lending agency Day phone Mailing address Agent Don McKenzie/DUN MCKENZIE REAL ESTATE Day phone 694-9035 Address 13135 Otd G.tenn Hwy. Eagte Riven, AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 N 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer G 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 MOAN21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. A. Well Data WATER SAMPLE RESULTS: Coliform 10 Nitrate ���� �ng�� Other bacteria O Date of sample: z�%/ _Collected by: s � S B. SEPTIC/#99WN&TANK DATA Date installed 7 Tank size SAL%D Compartments CleanoutY/) Foundation cleano ( /N) Depression (Y/b �G High water alarm (YO p� Alarm tested (Y//N) � AA Date of pumping �f Z Tll'I Pumper cam/. k,�� lei tel' SEPARATION DISTANCES FROM SEPTICfJ�tf G TANK TO: Well(s) on lot � On adjacent lots �� ✓ Foundation To property line _Absorption field Water main/service line Surface water/drainage O -D ,+_ 72-026 (3/93)' Front CONTINUED ON BACK PAGE /),L- t✓1 If A, B, or C, attach ADEC letter. ADEC water system number Well type Y Date completed / 2 Driller �ULL i I/ LC ;� Log present ) r Total depth `� Cased to ��" ,� Casing height -i - Sanitary sea N) Wires properly protected 6N) FROM WELL LOG AT INSPECTION m Date of test (� 2� q o z en 2 z�j rn K m D Static water level / Well flow g.p.m.g.p.m. m m p Pump levell _� z m n ir► w o 0 SEPARATION DISTANCES FROM WELL TO: ® , SepticAmel bg tank on lot zo)q ; On adjacent lots Z m Absorption field on lot ��L� ; On adjacent lots /� Public sewer main / 4 � —Public sewer manhole/cleanout Sewer service line 'Petroleum tank u� WATER SAMPLE RESULTS: Coliform 10 Nitrate ���� �ng�� Other bacteria O Date of sample: z�%/ _Collected by: s � S B. SEPTIC/#99WN&TANK DATA Date installed 7 Tank size SAL%D Compartments CleanoutY/) Foundation cleano ( /N) Depression (Y/b �G High water alarm (YO p� Alarm tested (Y//N) � AA Date of pumping �f Z Tll'I Pumper cam/. k,�� lei tel' SEPARATION DISTANCES FROM SEPTICfJ�tf G TANK TO: Well(s) on lot � On adjacent lots �� ✓ Foundation To property line _Absorption field Water main/service line Surface water/drainage O -D ,+_ 72-026 (3/93)' Front CONTINUED ON BACK PAGE /),L- t✓1 COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES SINCE 908 Chemlab Ref.# -93.3601-1 Client Sample ID :L2 B4 SO FORK S/D Matrix :WATER Client Name :S & S ENGINEERING Ordered By :RAY Project Name Project# PWSID :UA REPORT of ANALYSIS Sample Remarks: ROUTINE SAMPLE COLLECTED BY: RAY. QC Parameter Results Qual Units --------------------------------------------- Nitrate-N 0.94 mg/L 5633 t3 STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 WORK Order :68706 Report Completed :07/27/93 Collected :07/23/93 @ 11:30 hrs. Received :07/23/93 @ 15:00 hrs. Technical Director:STEPHEN C. EDE Released By : / /JZ - Method --------------- EPA 353.2/300.0 Allowable Ext. Anal Limits Date Date Init ---------------------------- 10 07/26 LLH ------------- * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than 10% Sc3sMember of the SGS Group (Societe Generale de Surveillance) ftift ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA f COMMERCIAL TESTING & ENGINEERING CO. AK DIV CHEMICAL & GEOLOGICAL LABORATORY °ueonwmnr TELEPHONE (907) 562-2343 1 5683 BStreet Anchor e, Alaska 99518 Drinking Water Analysis Report for Total Coliform B eria TO BE COMPLETED BY WATER SUPPLIER TO BE MPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM I.D. # PRIVATE WATER SYSTEM Analysis shcovs this Water SAMPLE to be: I Satisfact ry Name 1 Phone No. ❑ Unsatisf cry Mailing Address ❑ Sample tbo long in transit; sample should not be over 30 hours old at examination CRY Sladeto indicate reliable results. Please send Zip Codenew saled pie via special delivery mail. SAMPLE DATE: J �7i3 Mo. Day Year Date Rece SAMPLE TYPE: Time Rece ed 17M jRoutine Analytical thod: Membrane Filter ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water *,,No. of col Hies/100 ml. SAMPLE Time Collected No. LOCATION Collected By Lab Ref. No. Result` �Analyst 1 I Z L T7p 93. UOI ! � — 2 FT -1 3 I IL� 1 m 4 m 51 1 �J m A. 0, C BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count Collform/100 ml BEFORE Verification: LSB BGS Fecal Coliform Confirmation COLLECTING SAMPLE Final Membrane Filter Results Coliform/100 ml Reported By t n �7fr��� Date 1-53 TNTC = Too Numerous To Count nom• l (� c6 a.m. OB = Other Bacteria PART ONE OF TWO061%SG E3 Member of the SGS Group (S REMAINDER TO FOLLOW MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date n � a r 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2, Block 4, Southfork T13N R1W Sec. Location (address or directions) South River Drive (b) Applicant Name Janus Brown —Marti nTelephone: Home 694-9208 Business 694-9511 Applicant Address SR Box 9373, Eagle River Alaska 9957.7 (c) Applicant is (check one): Lending Institution ❑ ; Owner/buildern ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution National First Mortgage Telephone 563-5011 Address 4300 B St #204 Anchorage, Alaska 99503 (e) Real Estate Company and Agent N/A (f) Address Telephone Mail the HAA to the followi 2. TYPE OF RESIDENCE Single-Familyb Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well M 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. 72-025 (11184) Page 1 of 2 5. ENGINEERING FIRM PROVIDING— INSPECTIONS, TESTS, FILE SEARCH, DAI-1�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 Y _-- Telephone EAGLE RIVER EtdGINEE ti( Address BkG E WE41—, n Date 1a%z kE� p, 0. BOX 773294 694-5195 r; ' c o � Louis A. 3u°cra o CE -6736 Cramp, 6. DHEP APPROVAL(3D �__E Approved for bedrooms by Approved Disapproved _ Conditional Terms of Conditiona Approval 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) MUNICIPALITY OF ANCHORAMUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 DEC 2 61985 264-4720 Legal Description: RECEIVED 7' 3 fv ie 1W sec 7 A. WELL DATA Well Classification f'n' VA rx-r If A, B, C, D.E.C. Approved (Y/N) 71 Well Log Present (Y/N) Date Completed ^`'VZ Yield 7. G min Total Depth '7� 7 Cased to 78 Depth of Grouting �f19 Static Water Level _QO ` Pump Set At 'fid" Casing Height Above Ground la Sanitary Seal on Casing (Y/N) y Electrical Wiring in Conduit (Y/N) %� Depression Around Wellhead (Y/N) N Separation Distances from Well: To Septic/Holding Tank on Lot /05'' ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line /V/A To Nearest Public Sewer Cleanout/Manhole N ) A To Nearest Sewer Service Line on Lot 4-a S ' Water Sample Collected by 4412 21&1y:A 6h51nee_,f, ; Date 3'As- Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed ` Size No. of Compartments a Standpipes (Y/N) Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) 'N Depression over Tank (Y/N) ^J Date Last Pumped Jw/5 /583". Pumping/Maintenance Contract on File (Y/N) L� ; for r Holding Tank High -Water Alarm (Y/N) od// n Temporary Holding Tank Permit (Y/N) A114 Separation Distances from Septic/Holding Tank: To Water -Supply Well /6s / To Building Foundation 6 To Property Line FU%B , To Disposal Field f To Water Main/Service Line /y To Stream, Pond, Lake, or Major Drainage Course %GD Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �iS Art, T p Type of System Design Date Installed �/`9�2 Length of Field &3/ Width of Field Depth of Field �a i Gravel Bed Thickness a y� Square Feet of Absorption Area Standpipes Present (Y/N) Depression over Field (Y/N) /V Date of Last Adequacy Test Ar - Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well X65 + To Building Foundation % Lot /1J4-,?- _ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments To Property Line To Existing or Abandoned System on On Adjoining Lots + 3° To Cutbank (if present) r- + //J Dimensions Manhole/Access (Y/N) — "Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test, Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection Signed % Date Company (a_s MOA No. f Receipt No. 17�U�0� Date of Payment i c) Amount: $ ( bU y�`ti"8 Engineer's Seal o _�JOO�CGLpuu00 eao°e -, / 9 „ Louis A. 3uier4t Pa e2of2 Page 0 CF -6736 72-026 (11/84) APPLI, ANT FILLS OUT UPPER FIA.-,,: ONLY Ower€2JirJ 1? f rf)hllUt Vii. /7�/5'/`/�/ N�nc Phone C, � y-7Zog /(� /� Mailing Address/` Z �O>( 73/3 X 6 0Le: '' "JE"� �� Zip Code �c 7 �ti' 2GG `jos 3 Buyer Address Zip Code JiJ�rS tOl. �i 4d!) Lv4d Lending Institution Nf��7C �Fc'%%Z /Y5Soc Phone_ - Date Address S �_. ,� _^,.� ..Tt�C {-I J77t� (,-L_ Zip Code r so/ TN'- &let Z21 - Realty Co. & Agent Phone Address_ - Zip Code - Legal Description L-Ol Z B//L- oC.IG `' So I: For K, - S414' 14' (l�'S1,0j, (if (()) Street Location S ,,, F' -F- Cr R,)c1A !! We '✓ Type of Residence � - A Single Family % T� ❑ Multiple Family No. of Bedrooms'- ❑ Other Water Supply '4 Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility - ( ) CONDITIONAL APPROVAL - Sewer Disposal 1 `A Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: Well To Absorption Area ❑ Holding Tank - -^F 'L, Well to Tank - NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date - Date Date ,} . I Inspector Inspector Inspector �J \ 1 - Inspeptor Field Notes: MUNICIPALITY OF ANCHORAGE T� ENVIR-)A,% 3,.A. , .V -,fION 1982 RE I V h ( APPROVED BEDROOMS - - 'CONDITIONS OF APPROVAL ( ) DISAPPROVED - ( ) CONDITIONAL APPROVAL - DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size -^F 'L, Well to Tank 72023 (3182) CHEMICAL & GkOLOGICAL LABORATORIES'&E ALASKA, INC. oF.NOEOENOEHr TELEPHONE (907)-279.4014 ANCHORAGE INDUSTRIAL CENTER90 II' g 274-3364 5633 B- Street y _ ;