HomeMy WebLinkAboutSTONEHILL BLK 1 LT 4'0
tonehill
Block 1
Lot 4
#060-342-04
~.~.~ GREATER ANCHORAGE AREA BOROUGH
..... ~ Department of Environmental Quality
"~' 3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELL /ff2~)
MAN U FACTU R E IR (~/-/LZ~-'C-')--~$,4 A T E RIAL
NUMBER OF
' "~,~""/~ , COMPARTMENTS
LIQUID C APAC ' TY_ '/~ ~4--~A LLON S.
INSIDE LENGTH_ ,-~- INSIDE WIDTH LIQUID DEPTH
'-?-,Se roe.,/ -
~TJJ~-4_~'4A I N-:FlEE D :-
£ TOTAL LENGTH
DISTANCE FROM WELL __Z--)~ FOUNDATIONI _~~lc/p X _NEAREST LOT LINE z~e / '~-OF LINES .5'F /
NUMBER OF LINES DISTANCE BETWEEN LINES _ _TRENCH WIDTH:___IN.~¢ TOTAL EFFECTIVE
AJ~ORPTION AREA ~( ¢~0 5~l FT, LENGTH OF EACH LINE ~ /
--~ t DEPTH OF FILTER p / Z/'--/
DEPTH: TOP OF TILE TO FINISH GRADE _MATERIAL BENEATH TILE __IN. ABOVE TILE IN.
WELL:
BUILDING NEAREST
FOUNDATION____ LOT LINE ___
RUCTION DEPTH
NEAREST SEPT lC SEEPAGE
, SEWER LINE TANK__, SYSTEM__
DISTANCE FROM:
CESSPOOL
OTHER SOURCES
APPROVED . DISAPPROVE[)
DISTA,'CES:W
/,4 d_ ::
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE: ~
REMARKS: /¢%¢/
REMARKS
DIAGRAM OF SYSTEM ,.
/j/ &.A.A.B.
Form LQ-032
i i ii ,::! i i i!..~ i,i :, ~. ,i::h"'[',,J.'
i '-"i-:':!:: i i:: ::;{ ii' i:; ::::::.,i"d;i' :: i' i' ' ',i '::' "/':: f' :::' ; ':: 'i
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i [.,ii::-'{:,:'i:,: [ '::; [',,iii ':::;i:,: i h.i 'i: !::,i~ 'i i:: i:d;;: i l:;i:~:~:i',ff::i
¢::ii:',iJ':' ii'l!::: i~:~:;'i! j'!;;ii'i iL": ii"fi': ~:::':;i~:l:::l'v'i::i'i"l;!:!i',i ;i'i'.i
"On~ ~es~ t~ wort~ a ~hou~and o~ini~ns"
2204 Cleveland
Leoal ~escri~tion: Lot~Block__
This ~orm Renort$ Soils Loa //~$
Anchorage, Alaska 99503
Date Performed
Percolation Test
8
10
12
neoth
feet ~.-m.,,..~c- Soil Characteristics
Re~L_ .$2/~_ .......
16--
18--
20--
·
Was Ground Water Encountered?
I~ Yes, At what Denth?
' Readin~ Date Grnss Time Net Time Denth to H20 Net Dron
Percolation Rate Hinute
Prnoosed Installation: Seeoaee Pit Drain Field
Deoth of Inlet Deoth To Bottom Of Pit Or Trench
Date:~ ~? ~
by
A & L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588
OWNER OF LAND ,"" : , '>7/~: ,' ,?' DEPTH OF WELL / ~ -'
· ' ' · ...... '-; ~ ,'2', .... STATIC LEVEL OF WATER FT.
:,, , ~ ,v ,' "~.i ~5/3 DRAW DOWN FT. -% ~
LEGAL DESCRIPTION /~,/ _ o _~ : o.
DATE - Started //:". '¥', / '~, Ended ~/ ~ ,/'/ 9;. GALS. PER HR
PERMIT NUMBER / fi .'~'~'C~ KIND OF CASING ~:x o' ~-<(]
KIND OF FORMATION:
Frmn 7:' Ft. to '-') >'
From "· ' Ft. to ">'
From 'i Ft. to /
From ~ Ft. to ! o.
Ft. A//,c3Z; (i ,~[~i,,~,':(~?/~c,. o~ ~o'.~;,:'3' From Ft. to __Ft.
Ft. 1(/:'~,-,'v.'~ c.' ,,:" .... From Ft. to Ft
~ Ft ~,?~.~,.:;, ,,. /-:' ]~(?~i, ~¥.J,:::.O From ___Ft. to. Ft
Ft. d~/'~') .-.i' "~, ~:: From Ft. to .... Ft.
Ft. to } '; ~-Ft. / ~';?~ / ~"z? 3,'y From Ft. to __Ft~
From ; Ft. to ~ :L__Ft /.)/,~; ,?o<,=:: /:,~:L~,:<~/cJ':(j*:? From Ft. to_~Ft
From~Ft. to Ft From Ft. to Ft
From~F/. to_ Ft Froln 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 Ft. to Ft.
From Ft. to Ft. From Ft. to Ft.
From ~Ft. to Ft From Ft. to .__Ft.
MISCL. INFORMATION:
DRILLER'S NAME
Municipality of i�ricForage .•• ••.
'DevelooMofit Services Department .
Building Safety Division
Ori -Site Water S Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage. AK 99519.6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING f
Parcel I.D. 060-342-04 HAA# 05 10010 '-
1. GENERAL INFORMATION Expiration Date: ui~r
Complete legal description STONEHILL SUBDMSION• LOT
4.
BLOCK
1 -
Community Class Well
❑
Public Water System
Location (site address or directions) 7425 HILAND ROAD
•
EAGLE
RIVER. AiC 99577
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
JASON do PEARL PETERSON Day phone 622-2268
7425 HILAND ROAD • EAGLE RIVER AK 99577
Day phone
CAROL SCOLES w/GREATLAND MORTGAGE Day phone
694-9125
13135 OLD GLENN HWY. SUiTE 100 • EAGLE RIVER, AK. 99567
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's
work.
4. 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, based on procedures outlined In the Health A uthority Appro val Guidelines for this application,
shows that the onsite water supply and/or wastewater disposal system /s(ara) 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 ofAnchorage files and from my investigation and inspection, the
onsite watersupply and/or wastewater disposal system Is(are) In compliance with all applicable Municipal
and State codes, ordinances, and regulations In effect at the time of Installation.
Name of Firm GARNESS ENGINEERING GROUP. Ltd. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 " ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. allompted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines d Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwaterlevels that may
fluctuate during the year, and the water usage of the temily being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate of how long the system will continue to meet Me
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
otherperson or party Is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
V/1" Approved for _� bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following
337-6179
ON-SITE
Attachments: ✓
HAA Checklist . Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory
Other
By Original Certificate Date: fih— or
CR... rl
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Stte Water 6 Wastewater Program
47W South SM98W SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.d.anchorageak.ut
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: S70NEHILL SUBDIVISION: LOT: 4. BLOCK 1. Parcel ID: 060-342-04
A. WELL DATA
Well type PRIVATE If 0. S. or C provide PWSIDN N/A
Date completed 7/13/77 Sanitary seal (YM) YES
Total depth 180 fL Cased to 180 ft,
FROM WELL LOG
Date of test 7/13/77
Static water level 90 ft.
Well production 4.0 g,p,m,
WATER SAMPLE RESULTS:
ColifOm► 0 c0lonies/100 ml. Nitrate Z,S mgA.
Well Log (YM) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
12/27/04
94 ft.
6.0 —
9 -p.m -
Other bacteria _J_colonies/100 ml.
Arsenic: N/A mgA. Date of sample: 12/27/04 Collected by: GEG. LtD.
lis os
B. SEPTICIHOLDING TANK DATA
Tank Type/Material STEEL Date installed 7/11/77
Tank size 1250 gal. Number of Compartments 2 Cieanouts (YM) YES
Foundation deand�ut (Y/N) YES Depression over tank (YM) NO High water alarm (YM) N/A
Date of pumping 5/28/04 Pumper JRS'S PUMPING
Date Installed 7/11/77 Sop rating (g.pAJftVJ� 150 System type TRENCH
Length 39 ft. Width 3 ft. Gravel below pipe 8 ft.
Total depth –.=0-2--& Eft. absorption area 450 fe Monitoring tube YES Depression over field NO
Date of adequacy test 12/27/04 Results (Pass/Fall) PAW For 3 bedrooms
Fluid depth in absorption field before test 15.5 in. Water added 621 gal. New depth 23.5 in.
Elapsed Time: 990 min. Final fluid depth 14.5 in. Absorption rate :on 450+
p.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date –
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at _in.
E. SEPARATION DISTANCES
High water alarm level at
Cycles tested Meets alar & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankA(ft station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
On adjacent lots 100'+
On adjacent lots 1000+
Public sewer rnanhole/deenout N/A
Sewer /septic service line 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 101+ Surface water 1001+
Wells on adjacent lots 1001+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property fine 10'+ Building foundation 10'+ Water main N/A
Water service line 100+ Surface water 100'+ Driveway. parkinglvehide storage 50'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
0. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and * 4
review of Mun/cipal recwds that Me above systems are in """ "'
conformance with MOA HAA guidelines in effect on this date. i
Engineer's Printed Name JEFFREY A. GARNESS
Date
HAA Fee S `1- Waiver Fee $
Date of Payment / / Date of Payment
Receipt Number (-)6X- )D �IgN Receipt Number
(Rw. 12101)
IPES IN THE FIELD.
12/28/2004 16:36 FAX 9076943093
12/22/2004 16:56 9076222268
JR1 Pu Mping
PO Box 773415
Eagle River, AX 99577
(907)694-6454,
CREAT LAND REALTY
P PETERSON :W
()002/002
PAGE 02
rk no f ce Ayp •eemenl
4t.e'ber: 011 06
&-11ak;— 11trfrZM
Is Ile 11014: 2441 or^2004 -1
j�luinplMormdien....---_����.. -ntdan Tc
Pead a Jason Peterson r Job DeaeAp6an: 10000
74" HAI' nd Road _7�
z
P O. NunlW
Eag4sAlwir,AK 40577
Terme:
Net 00
(K7') 622-2246
Sdeerop:
NIKols
: 11 Rep4n
Map Book:
M 14rd: 152..
.•_..•...—•—.
r Site Information
; CrossSusaN:
Mand Road
._ .—.....
je4p,i
JobCommenY;
:LQ 3orN4x.ldl6ro3 11
1126 M110nd Rd
iCAeCN00 and pumpY. 4r
4M .Ramal
L01 4 Berl Storbhnl
'
Eapie Kw. AK 49577
W) 622.2256
Tax Percent
0 __
ier.lae Type ply P41a EmIn x 27rlert TO;
----
GoInk Somas Under 2k 4 5126.00 No No
Addltlonal Loostlon Comtlentx:
2 story brown house. locks Ilk& 1 level. 2 dope
eontalned
Piles aro nett to 4eperetad venal. upra
pump. not Day scow
Dlagnm:
I
Tarn
41 bank
� Nouse
Gro
I
f"
2°1? It
• • .. • • exw441en /kill .d .•
i1Tl a
1
i
1
"i Plennoo 1000
.INNACNii• „„ �.
Mow 1. Yoh: 2
Dout1: Tank:',l
Puma I •tem:
Bartel Inlet i" r
6xrnen M6et'.:. , �...� «.
NenTaxebls yowl Is. • T el Tu Tut. I grand' 44 4
Es rnand Charges: 4175.00 110 30.00 11121.:11
Actual Charges: - - -- •... .... .,.. �..« ........
cuslo a 4prou toe* IWAS and cdnddone pined on fie beck. THIS IS A BIN01N0 AI : ;5 41.31
Signature end Title of C%is m r IiepromMIA11" Dole
ACZ@PW by JRs I•ymping Date :: 41
For your added wnronlenoe we accept Amevtrun Egrrowr Djo i,7Mw and Muter Cmi ::4 VA • u4 dM pnoht
AfteSopays 1.611 wit" charged orTHERE WLLBEADELIV6RY$3.00For N:•I. On •utAll
to]
■N? 01-11-05 04:39PN FROM-CTIE ESI. SGS ENV SERVICES 9075615301
■f
SGS/CT&E ENVIRONMENTAL SERVICES
SIG
Drinking Water Analyis Report for Total Coliform Bacteria
READ MSTMUCT"s DN REVERSE SIDE D"o CDLLECTWD SAMVL[ .
MUST 13E COMPLETED BY WATER SUPPLIER '
Q PUBLIC WATER sYSTEM 9*
rn4r ATE WAM SYSTEM
T-526 P.01/01 F-915
200 W. POTTER DRNF,
ANCHORAGE, ALASKA 99518
Tet 907562-2343
Fac 907-581-5301
SAMPLE COLLECTION.
Dry: 5 ,
coa.clnr +�
. TnewPawd :...... :,.
to Lab OF Bas coserdcr � Othef:�i 7. ir--
- SAMPLE TYPE:
t7Routlrw. Q Treated water
L7 Raput SaraPte 13 Una.atedWater
(rrrtartotiu.no t
❑ spaces Purpo"
TO ISE COMPLE="LABORATORY
SamaleRecelvlaa: s.naw>oa�. ❑ RUSH SAMPLE
Dar.,: l-�-v5 ' ❑ MruS�eWaa.ar+. "
Time• 12�� __
Term a . l
❑ a rww.I..r
WoSaeA
phonoa'
far
Fax
Delivery MMhod: cam
Received Dr.
N.w�..N�U�(O.YN.NY.NO I.
..YNM..
...................NNN.......MAH..PN..1...............M.........Nu..O..........
T.. /. Y
nolo,ir+lWaterAnaM M "'
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etxt.
seelrarne
PMrrd Cl % O
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MOWRAIIETILTT]t pL7tILTa:
Andytka Mfdmt ..
OM�eI Ca'<ec • �.
CaloeekJlOanA.
p�rfTNw•,,;_����
tear
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waa. .1
®
Satisfactory
MMO MUG (PIA)
ww=•--_—
..
((L
0
Unsatisfactory
Ec
Tellc. iM Mrrw.. r e«ra
t3-6
oe •ef.ew.r.rr.
/� QaterTlma: .
Reported Qy: -
so +.•
... Form S FW -0057 12117107
21 05 05:44p 91 Corp
6949210 P.
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AS -BUILT
I hereby certify that I have surveyed the following described
property: � -}
SrJS C7. ti S%ni - -
Anchorage Recording Precinct. Alaska, and that the Improve-
ments situated thereon are within the property lines and do
acent there-
toioverlaor thatt no Improvemats on prop lying ach on the property adjacent thereto
en.croach on the premises in question and that there are no
roadways, transmission lines or other visible easements on
said property except as indicated hereon.
Dated at Eagle River, Alaska
7.Y/: f..11C LGO�
this %�..r —day of
ROBERT C. JOHNSON �' r
SCALE: r Registered Land Surveyor No. 880 -IS
I" o fJ-C' Box 456, Eagle River, Alaska
Phone (007) 694-2543
01-04-05 09:37AM FROM-CTIE ESI, SCS ENV SERVICES
SCS ReLq
1048255001
Client Name
Gayness Engineering Group, Ltd.
Project Namelit
Various
Client Sample ID
Stonchill SID Lot 4 Elk 1
Metrix
Drinking Water
Sample Remarks:
9075615301 T-431 P.02/08 F -T97
All Dates/rimes are Alaska Standard Time
Printed Date/time 01/032005 15:17
Collected Date/rime 12/272004 16:30
Received Date/time 12/282004 15:54
Technical Director / Se C. Ede
Released �
Aauwable Prop Analysis
Parmneta Results PQL Units Method Container ID Limits Date p'te Imt
Waters Department
Nitrate -N 2.50 0.100 mg/L EPA 300.0 B (<=10) 1229/04 B1A
Microbiology Laboratory
Total Coliform 30OB,NoColi col/100ml- SM -109222D A (r -I) 1228/04 DKC
01-04-05 09:38AM FROM-CT&E ESI, SCS ENV SERVICES 9075615301
SGS/CTBE ENVIRONMENTAL SERVICES
Drinking Water Analysis Report for Total Coliform Bacteria
READ INSTRLICTI011S ON REVERSE 710E FEFORE COLLECTING SAMPLE
MUST BE COMPLETED BY WATER SUPPLIER
PUBI.rc WATER SYSTEM ma — — —
VL7!VA7 WATER SYSTEM
T-431 P.04/08 F -T97
200 W. POTTER DRIVE.
ANCHORAGE, ALASKA 99518
TN: WT -562-2343
Fan: 907561-5301
1'04B255 yq
11111111
—•--
SAMPLE COLLECTION: r
I(- i--11 •y ZtaO�
pate: y rw
r,a. e•r
La
ea
SAMPLE TYPE:
Routine 13 Treated Water —
Repeat Sample Q Untreated Water
(refer to lab no t
❑ Special Purpose
Tn"PoMU
to Lab av: ❑ Same a6 collector
TO BE COMPLETED BY LABORATORY
;ample Receivin0:
Date:
Time: S`
Tamp:
Delivery Mett
Received
I
❑smp•m«30lx "04 ❑ RUSH SAMPLE
Ruuln maY W
CI
se Phone
Fa tataeana Fax •:
O" Arm
Cammwft:
..............................................................................................................
••••••.........................sasnAllEc:
B1C1erlolOol01 Water Analvah Reeo� tatAO*W (PIA) RESULTS- ANC FBK NN
n.rrt.na-
Anayal•B•aan• t�2A'�0*/ l7 flD Tor CbNomr.
ECdl:
i
am%b Caa
t
MEMBRANE LTER RE611LTa: Ptwed
0. F
axe
d Q
Anaykal Mrbod: o"d Court Cd A4110MAL D.MYa: .
.'
Membrane Fitw Verr"a0A.
MMO-MUG (PIA) WALi®Satisfactory
I ❑ � Unsatisfactory
r...+•w EC
7MC.YwNo..�•w �•t•"�
a •ow..ww•
y patemma: 1 3 6�i
Reported BY;
s,Qn.r.
Farm / FW- 8053 121T103
. r.r.T.M..d.nn...V'NI FM111121703.xl6
f—aa,Jan.18. 2005: 2:56PM KiGarness Enaineerine Group, Ltd. 9076943094 Ne•3320 P- 2/21
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• • , • I hereby certify that I have twveyed tha tollowinf described
'.,.. •. rreDerty; L,o)-rx sz� �.lt•l� s•4..:� t ;'L '
191 7W ' Au - 1--
• s+• A � •�., AnehOrMaRecordinSpt'ecinct.Alaska.andgAl theimDrove-
+v`i r �' .^ menta P1uated Xhaeon are v;Wh;tne. Pr frt7', ce and e-
a%!� .•••� e " �� •� not oviciapno Or encroach ser the propert,
adjacant these-
: • s.,.� . ,; ; �,• ., to; Lpat to zopremise on proper n 1 ng adlaeant tam Do
.•'eeac• 1 _ . ;• i 1 r engwth nh the Drt�e? 1n Cuestlon and that'thrtt ar0. Do.
r' ' e h::i:'r ,.. r, •t'r �i roadways, trarinalssion lines.Other vfsIDlIF-ewe mcnfs on'
•c+p.•..w., ...•.-•e •••;x,.:..•,.• "Ed Wop�ty exeCPtu lldlgtad hareob .
' f'�, r, �.���`"�'+fvk �!}-• Dated' at Eagle �UVM Alaska .
' �. j ,".'a}t•: K. :iv.: 'that144- day �'{✓•{�.�.I1 may'"
Ron10Cf 10FiNSON N MOSS
SCALE: !ReCbteeed l.Aod S4cveY r V.
..Q�!: y`•'• K ir' I" _ Q-0 Boir4Se. Fernier. R!ver•.AISy!th
t`y.�:r�%yr� ,I'horie-(9bY)fi94.2343 •,:
u5
Municipality of Anchorage ,
• Development Services Department
/ Building Safety Division .. .
Onsite Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.enchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 060-342-04 HAA# I/aO/t7 3 o %
1. GENERAL INFORMATION Expiration Date: L7 -oZ q' O
Complete legal description STONEHILL SUBDMSION: LOT
4,
BLOCK
1,
Community Class Well
❑
Public Water System
Location (site address or directions) 7425 HILAND ROAD
"
EAGLE
RNER. AK 99577
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
LINDA KOOLEY Day phone 552-9583
7425 HILAND ROAD • EAGLE RNER, _AK 99577
Day phone
KATHY OLMSTEAD w/ REMAX Day phone 694-4200
16600 CENTERnELD DRIVE • EAGLE RNER, AK 99577
Unless otherwise requested. HAA will be held by DSD for pickup.
2. • NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may
be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of
up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B
wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat affixed hereto and as of the validation date shown below, I verify that my
Investigation, based on procedures outlined In the Health AuthorityApproval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system Isiare) safe, functional and adequate
for the number of bedrooms and type of structure Indicated herein. l further verify that based on the
information obtained from the Municipality of Anchorage riles and from my investigation and Inspection, the
on-site water supply and/or wastewater disposal system isiare) In compliance with all applicable Municipal
and State codes, ordinances, and regulations In effect at the time of installation.
Name of Firm ALASKA WATER & VIASTEWATER CONSULTANTS, INC.
Address 6901 DEBARR ROAD, SUITE 28 • ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting fila evaluation, AWWC, inc. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines & Regulations. The reportod results described the performance of the
system under the conditions encountered at the time of the test and separation
distances measured to readily Idenuriable features. The operational Ab of all wells and
septic systems depend on the beat soils condition, groundwater levels fiat may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory lest
results do not guarantee future performance of the system, nor do theyguarantoe that
there are no hidden defects or encroachments. AINWC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or partyIs not aurhorized, nor will R confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for _3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the filowing
Phone 337-6179
Date [C, o/
Attachments:
HAA Checklist Manitenance Agreements
Septic System Advisory Supplemental Engineer's Reort
Well Flow Advisory Other
��Q� �•' " 0
• • ON-SITE
WATER AND .:
WASTEWATER
PROGRAM
By: 461 J — Original Certificate Date: _ G
IRw. 1zml
Municipality of Anchorage
a, Development Services Department
\ JJ
Building Solely DMean
on -sits Water & Wastewater Program
4700 South BMWM SL
P.O. Box 198650 Anchorage. AK 995158850
www.d andhaage ak us
(90n 343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Dearxiptl= STONEHILL S/D• LOT 4. BLOCK 1. Parcel ID: 060-342-04
A. WELL DATA
Wen t" PATE R A. B. or C provide PWSID# N/A
Date completed 7/13/77 Sanitaryseal (YIN)3S
Total depth 180 R. Cased tD 180 fL
FROM WELL LOG
Data of test 7/13/77
Static water level 90 it.
Wen production 4 —
g -p.m -WATER SAMPLE RESULTS:
Conform 0 colordes/1o0 ml. Nitrate 2.91 mgA-
Well Lop (YIN) YES
Wires property protected (YIN) YES
Casing height (above ground) 12+ tn.
AT INSPECTION
5/29/01
99 R
5.0+ g.p.m.
Other bacteria 0 cotonies/100 ml.
Date Of sample:
5/30/01 Collected by. AWWC. INC.
B. SEPTICIHOLDING TANK DATA
Tank TypelMatedel STEEL Date I staned 7/11/77
Tank size 1250 gal. Number of Compar MIMIS 2 Clearouts (YIN) YES
Foundation dednout (Y/N) YES Depression over tank (Y/N) NO High water alarm (YIN) N/A
'Daterof pumping 5/26/01 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA
Data Installed 7/11/77 Son ruling (9.p. A%1% )150 System type TRENCH
Length
39 fL Width 3 R Gravel below pipe 8 fL
Total depth —2—.211. Elf. absorption area 450 Re Monito" tube YES Depression Over fleid NO
Date of adequacy test 5/29/01 Results (Pass/Fop PASS For 3 bedrooms
Fluid depth In absorption field before test 8_5 In. Water added 1217gal. New depth 29-5 In.
Elapsed Tyne: 923 rain. Final fluid depth 14.5 in. Absorption rats >= 450+ g.p d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN M yes. give date -
D. LIFT STATION
Data Installed
'Pump on• level at _in.
E. SEPARATION DISTANCES
Size In gallons
High water alarm level at In.
Cycles Meets alarm 6 circuit requirements? -
SEPARATION DISTANCES FROM WELL ON LOT TO.
Septic tankAiR station on lot 100'+
Absorption field on lot too'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPT10HOLDING TANK ON LOT TO.
Building foundation 5'+ Property One 5'+ Absorption Held 5'+
Water main N/A Water service One 1 O'+ Surface water 100'+
Weill on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
10'+
Building foundation
10'+
Water main N/A
Water service One
10'+
Surface water
100'+
Driveway, parldngfvehide storage 50'+
Curtain drain NONE KNOWN Wage on adjacent bis 100'+
F. COMMENTS PIPES SHOWN ON AS—BUILT SURVEY DO NOT MATCH
ACTUAL LOCATION OF PIPES IN THE FIELD.
G. ENGINEER'S CERTIFICATION
I car* that I have determined through field inspections and
review of Municipal records that the above systems are /n
cwdbnnance with MOA HAA guide0nes In effect on this date.
Engineer's Pdn ed Nlpme JEFFREY A. GARNESS
Dais _1 glbl
HAA Fee saleino.61:1
Date of Payment 4o/ lot 11D 1
Receipt Number &01 cG1 I
OW. 12M)
Walver Fee S
Date of Payment
Receipt Number
Garnsa;•
53
... . �r
JJ
,+ X
76
'1 e�K
9'
✓j� J .. n
00
//�.
of
MtT1SJOEC 10-7 x/7 -Pi"
AS -BUILT
�••.s ••. L'OC,C,.QF •t.ItCt_ •Ti Cttn.tof'1 '
,4 .k.• -
?F • SCP.lIe �.�iMsK, I hereby cerlity that I have a , eyed the toltowinj described',
property' 'L•.'e'7` �",• '� To/t..t � i �1
.-• ... O> roti; 19 7'l+t•'til�:(•w� ��-1.
Alaska: and that the, improve+
•.or iso ✓�' �-0;Ajehoage Itecording Precinct,
, , .. menta; titgated'theseon are within'thw.properb+ lines and do
« 'F ,.• J.:' + . 1 c not.ff er)ip or eherosch on thd,'properly, 1 "adiaeent there
v Y} .i g•adjaeeht thereto
" •. a+I:j,,r+• .•CS.• t%� �l, ••�' �: •• •'.. •. t0,.that n0 TOVCmerlt6 Olt;proper)n'
,+ "n�, .: k•d� :: t.� encfoech'om .the premixes Jn.4ueeHon,and that there are no
( kn t,1? �• , } ,4 roadways, transmlrslon, ISnn or other visible easements an'
saldproperty except as lndlcated hereop.
bated•it Eagle ltiver, Alaska
'
,y ✓Jxs+,' ROB$RT'. C JOHNSON
�.. j.: i•11• t '
neRlstered,Land Surveyor NO -980 -LS
,�a•�"C;ii2..•N,rtitil''..', 1»�+ Box X
��66; Eegte Rivlr, Alaska:
*y'; .ts'��iS .AY• ! r Phone (907) 694-250
JUN -01-01 16:51 FROM -
CUE Environmental Services Inc.
�rirrirrrrr�rrrrrrrrr
LT&E Ref.0
1012966001
Client Name
AK Water & Wastewater Consultants Inc.
Project Name/N
Stone Hill SID Lot 4 Block 1
Client Sample ID
Stone Hill S/D Lot 4 Block 1
Matrix
Drinking Water
Ordered By
PWSID
0
aampte tc=Tka:
T-319 P.02/03 F-874
Client PON
Printed Date/17me
Collected Datefrime
Received Date rime
Technkal Director
Released BY A/0
06/02/2001 14:28
05/30/2001 8:30
05/30/2001 15:55
Stephen C. Ede
iq-Id�
Pmmettt Aaowable p
R=ilts PQL Units Method Lnnits Date Dare
Imt
Waters Department
Nitrate -N 2.91
Microbiology Laboratory
Total Coliform 0
0.500 mg/L EPA 300.0
0 eoV100mL SM1992220
(<10) 05/30/01 SCL
05/30/01 KAP
MUNICIPALITY OF ANCHORAGE
r DEPARTMENT OF HEALTH & HUMAN SERVICEAEM
S
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. # n CO- Sum - -- HAA # 4\ 215"1 rn'"
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) /1%�t 2 7 / r' /aitp 21•
Property owner
Mailing address _
Lending agency
Day phone
Day phone
Mailing address n,/ a
Agent l ' 64-1.0-m t i4a4I 7 - Day phone fag r–J 1Zs—
Address '
Unless otherwise requested, HAA will b�ehel for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest -
Ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL: .
individual on-site
Holding tank
Community on-site –
Public sewer '
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
rean1mw.1/911 From MOA811
S. 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.
Name of Firmi ND Engifleedng
—26k1-Ptar� Phone _
Address ... ogle River, AK 2M7.RM "--
Engineer's signature ��s �L Date v
6. DHVHS SIGNATURE
�4 Approved for
Disapproved.
bedrooms.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
By. = Date /-
.53
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
rofessional en r
P 9ineeregisteredfntheStateofAlaska.TheDHHSdoesthisasacourtesytopurchasersofhomes
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 Vol) BKk MOAM
MUNrurnLtrr Or ar.�ORA*
t.W1R0t M80,kLSERVICESDIVISION
Municipality of Anchorage JAN 2 / 1007
DEPARTMENT OF HEALTH & HUMAN SERVICEEk
Environmental Services Division E C E I V E D
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
/ Health Authority Approval Checklist
�n
Legal Description: L 5' St/�rN/� ��5� l7 Parcel I.D.: DSO r (p Z 07
A. WELL DATA
Well type 112d1 If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) F Date completed %
/71
i01
Total depth /80 Cased to ;:�l9 Casing height (above ground) /2
Sanitary seal (Y/N)
Date of test
Static water level
Well production
FROM WELL LOG
90'
WATER SAMPLE RESULTS:
Wires properly protected (Y/N) Y_
AT INSPECTION
18A?7
/03 '
g.p.m. 7 g.p.m.
Coliform D Nitrate �!� ^_ Other bacteria a
Data of sample: I I o I9 ? Collected by: N r
B. SEPTIGHOLDINO TANK DATA
Date installed j�% 7 Tank size 12.50 Number of Compartments z Clsanouts (Y/N)
Foundation deanout (Y/N) I— Depression (Y/N) High water alarm (Y/N) I—
Date of Pumping I g Pumper J R IS
C. ABSORPTION FIELD DATA
Data installed 7h 7 Soil rating (tlp'or(tt° drr9) /TD System type !a►`o f
LengthWldth 3 Gravel thickness below pipe t Total depth /.2'
Effective absorption area SUo z r Monitoring Tube present (Y/N)—�L- Depression over field (YM)
Date of adequacy test I& Results (PasslFail) �_ For
bedrooms
Fluid depth In absorption field before test (in.):. Immediately after_&gal. water added (in.):
Fluid depth _ (ins) Minutes later: Absorption rate = �ed `f' a.p.d.
Peroxide treatment (past 12 months) (Y/N) Al If yes, give date
72.026 (Rev. 3196)•
D. LIFT STATION
Date installed
Size
Manhole/Access (Y/N) `Pump on" leve t' "P p off" level at' _
High water alarm level at' •Da
Cycles tested
E. SEPARATION DISTANCES -4( I
W 'Separa!"A1,", w ,r 6ufieb 0.1 surue.FS as -6,:W AW 531457 witic n:S aijaci�+1 .
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot /DO r f On adjacent lots /nr0 -f
Absorption field on lot / O L) 1 `f On adjacent lots / o io r -f
Public sewer main /t/A Public sewer manhole/deanout /V4
r
Sewer /septic service line t Litt station NA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation — A0 r4' Property line /O r Absorption field / Q r F
r
Water main/service line .z'S i Surface water/drainage /DU -F Wells on adjacent lots / 0lam' r f
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
r
Property line Building foundation /O rf Water maintservice line
Surface water /UO r --f. Driveway, parking/vehicle storage area 1 S +
Curtain drain L✓o+?C /I/Oc V Wells on adjacent lots /LSD
F. ENGINEER'S CERTIFICATION
I cerMy that 1 have determined thru field inspectlorrs and review, of Municipal records
rw
In conformance with MOA HAA guidelines in effect on this date. � - ; f1. are
Signature .Y - � � Or Co 0 �9+)
Engineers Name
Date
t/I KennFh M. Q'
CE7116 Jg�!
HAA Fee $ c3 LSD r
Date of Payment / 2
Receipt Number a
72-026 (Rev. 3/96)•
Waiver Fee $
Date of Payment
Receipt Number
V
•f' ecK
e6o- All
N
1 4 r ✓f
AS-BUMT
I hereby certify that I have surveyed the /follo/wine described
37
<–ZT7
—
�� �. ; ,�: � * Anchorage Recording precinct,within
-theska, ro that lineshe and
do
. ;��.:.>�t•. ,,.:.,, � n -. •�� , • .. < menL suuated encroahereonch
RM we property
property j lines and do :
'..,u gip• M.;��.. o not ovalaD or encroach on the.PzoP' adjacent there-
"sn,y 4._ ,-�{ r;.. V. ^T to, that no Improvements ori property. l g•adlaccnt thereto
i', ;+ , �,l . 'L h encroach on the premises in question and that there are no
.� .a� t �. y Y,l !• roadways, transmission lines or other visible easements as
.+o M»....• .....:....... �..,..:.,e said property except as indicated hereon.'
Dated'at Eagle River, Alaska
Gp � . v
-." Y t:oL••'t`_,9•: zv-..r',...' ; .. thbleny * ThiY. .a 19.L2
ffi 'il'• :` ROBVRT C.- JOHNSON %CAST
SCALE:, Registered Land Surveyor No. 880•LS
.� •• '��' 3 • rH. e • "' _ C Box 456, Eagle River, Alaska .
*_, ;• ;QP` � ;i'. � .!" 1• . Phone (907) OW2543
KN D ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-8111
January 22, 1997
Municipality of Anchorage
Dept. of Health & Human Services
On -Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
Subject: Lot 4, Stonehill SID - Adequacy Test
Gentlemen:
On January 18, 1997, we conducted an adequacy test on the subject lot. The as -built
drawing that was completed in May 7, 1986, indicated the location of the field stand
pipes, tank and the foundation clean out. Further investigation of the previous
health authority indicates that the FCO question was left blank with separation
distances based on the previous surveyor's as -built. Due to the difficulty in locating
the stand pipes in the snow during our field investigation we recommended that all
the standpipes be raised from the existing 3" above grade to 2' plus. Without swing
ties we chose to have a contractor excavate in search of the field. During the
excavation we noted that the field did not have any separation material between the
ground cover and the sewer rock. In addition, concerns over the proximity of the
field to the lot line, which was unknown, prompted a request for verification of the
previous as -built survey. We received verification that the system was outside the
easement based on an as -built survey dated January 9, 1997, that the separation
distances were consistent with the previous system and I have enclosed a copy of the
survey for your records. For the record, it should be noted that the swing ties we
took in the field after the pipes were located, although approximate, do not match
the locations as identified on the survey as -built, and we noted the overhead power
line seems to be directly over one of the clean -outs.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
END
Kenneth M. Duffus, P.E.
attachments: HAA Certificate
HAA Checklist
As -Built Survey
JAN 24 '97 02:36PM NTL RNCHORAGE
PA
NORTHERN TESTING LABORATORIES, INC,
SM INDUSTRIAL AVENUE FAIRBANKS, ALASKA 03701 (907) 45&3118 • FAX 458-3125
( 8005 SCHOON STREET ANCHORAGE, ALASKA 99515 (907) 5491000 - FAX 347.1010
DRINKING NATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA
KND Engineering Public Nater System I.D.#
20441 Ptarmigan Blvd.
Eagle River, AK 99577-3736 Date Received: 01/20/97 Time Received: 09:30
Date Analyzed: 01/20/97 Time Analyzed: 09:30
Date Reported: 01/22/97 Time Reported: 10;49
Next Sample Due:
Phone No.
Purchase Order No.
Collected by: KND
Sample Type:
Routine Untreated
Method of Analysis:
Membrane Filtration
Comments:
Comments:
S - Satisfactory
U ■ Unsatisfactory
POS - Positive Test Result
ND - None Detected
TNTC - Too Numerous To Count (>200 Colonies)
CG - Confluent Growth
HSN - Heavy Sediment Masking, Results May
Not Be Reliable
$A - Sample Age >30 Hours But 48 Hours,
Results May Not Be Reliable
Old - Sample Age >48 Hours, Too Old For
Analysis
R - Resample Required
NT - No Test
* / Colonies/100 ml ** i Colonies/ml
Sample Sample Total* Fecal* Other* NPC**
Date Time Coliform Coliform Bacteria Result Labf Location Comments
--'-----------------------'-----^------------•---------------'-------- --
1 01/18/97 09:49 0 NO 0 NT AC3866 L4 Stonehill Satisfactory
JM 24 '97 02:36PM NTL A10I0MM
P.5
NORTHERN TESTING LABORATORIES, INC.
•
=0 INDUSTRIAL AVENUE FAIRBANKS. ALASKA 89701 (907) 458J718 • FAX 458.3125
8003 SCHOON STREET ANCHORAGE. ALASKA 99518 (907) 349.1= • FAX 349.1016
I
END Engineering
20441 Ptarmigan Blvd.
Yagle River, AA 99577-3736
Attns Ren Duffus
Report Dates 01/24/97
Date Arrived: 01/20/97
Date Sampleds 01/18/97
Time Sampleds 0949
Collected Eye R. Duffus
** Definitions **
8 a Preaent in Blank
B ■ Above Regulatory Max
Our Lab fs A148646 E a Eatimated Value
Location/Projects N a Matrix Interference
Your Sample ID: L4 Stonehill D D Lout to Dilution
Sample Matrixs Water MDL a Method Detection Limit
Lab Comments: Date Date
Number Method Parameter 0nit■ Result + MDL Prepared Analysed
�-- -r - - -M w ----- -M-r-r--
A348646 Sri 46008 Nitrate -N mg/L 1.94 1.00 02/22/97
Reported Pys Ant ony J. Lange
Chemistry Supervisor
n
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION �,1��r t Q3�
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date.�
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
HILL
Location (address or directions)
(b) Applicant Name LIA PA Hi (Z, Home h?q—W�0 Business !9d —F-1941
Applicant Address r • 0' `0I 7LZ y8
(c) Applicant is (check one): Lending Institution 0 ; Owner/builder la ; Buyer O ; Other ❑ (explain);
(d) Lending Institution _AIL IN^� � 4>09105� Telephone /C'4r HdZ1)j 57,2- SZZ�
Address _ g2 0 W G l_h filo/ a , /.SGC
(e) Real Estate Company and Agent
Address
Telephone
(f) fi�the HAA to the following address:
S & S ENGINEERING
SR B 196X
EAGLE RIVER, AK 99577
2. TYPE OF RESIDENCE
Single -Family 10% Multi -Family ❑ Other
Number of Bedrooms 3
3, WATER SUPPLY
Individual Well C1 Community[3 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 f t T i
Onsite 9k Public[3 Community[3 Holding Tank O
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2
l
72-025 111 U84)
5.
P
ENGINEERING FIRM PROVIDI G INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION r r
As certified by my seal affixed heretoand as of thevalidation 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 o1 this inspection.
Name of Firm S & S ENGINEERING Telephone 6 yfe 2979
SR B 196X
Address
Date
DHEP APPROVAL C�
Approved for bedroomsb Date
Approved _ i-- Disappr d Conditional
Terms of Conditional Approval
?/Z/:c/�6
�,
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 engineers work.
Page 2 of 2
72.075 p t )
n
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1884
2114-4720
pt "WALITY of AN01ORAGE
DEPT. OF HEALTH S
gMRpNMENTAL PROTECTION
Legal Description: V I M
S%bN� /
Well Classification l ' r r� If A, B. C, D.E.C. Approved (Y/N)
Well Log PresentCY�l) Date Completed % 1/ 3/ 71 Yield n'< GPN +
Total Depth / ao Cased to 5_5 Depth of Grouting
Static Water Level 90r Pump Set At tA lL
Casing Height Above Ground Sanitary Seal on Casing &N)
Electrical Wiring in Conduit &)N) Depression Around Wellhead (Y&
Separation Distances from Well:
To Septic/Holding Tank on Lot / Lo ; On Adjoining Lots �� +
To Nearest Edge of Absorption Field on Lot Ilia" ;On Adjoining Lots
To Nearest Public Sewer Line NIA To Nearest Public Sewer
Cleanout/Manhole NSA To Nearest Sewer Service Line on Lot
Water Sample Collected by 5 S G -n1 LArN1Nb ; Date
Water Sample Test Results lin SPAu Y
Comments WcLA.. Ylcx-6 TaST SNoWcr"> WJU- Pepbue'60 Ir -1
YCc'S F ;, &,,4v -
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (%N)
Depression over Tank (Y,9
Size 12-TO&Lf- No. of Compartments
Air -tight Caps (9N)
2 -
Foundation
Foundation Cleanout (Y/N)
Date Last Pumped
N//A- Pumping/Maintenance Contract on File (Y/N) ; for "—
N
`, A Temporary Holding Tank Permit (Y/N) A
Holding Tank High -Water Alarm (Y/N) �/
Separation Distances from Septic/Holding Tank: ,
To Water -Supply Well 12A / To Building Foundation �y
To Property Line 1 f To Disposal Field d
i
To Water Main/Service Line (0-f To Stream, Pond, Lake, or Major Drainage
Course
N/A
Comments
Page 1 of 2
72-026(11/64)
1113
C. ABSORPTION FIELD DATA
t �'
Soils Rating in Absorption Strata_ • ype of System Design f %=IJC.H
Date Installed / —
Length of Field
Width of Field .
Square Feet of Absorption Area
Depression over Field (YIQ
Results of Last Adequacy Test
3 Depth of Field /Z
Gravel Bed Thickness G
Standpipes p'pes Present(oN)
Date of Last Adequacy Test
15&77,5 Fiir_r KY y=ob
Separation Distance from Absorption Field:
To Water -Supply Well ),kD r
To Property Line
To Building Foundation 1/cr
i4-
�/� To Existing or Abandoned System on
Lot ; On Adjoining Lots • +
To Water Main/Service Line To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course N /A
To Driveway, Parking Area, or Vehicle Storage Area Sar
Comments __F/moi A i1Jr�Ii�r w� A L &i�_L isPi40cIrJA4M-W
/tdG11Wf944 V 7f2
LIFT STATION
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at "Pump Off' Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
'• Check Permitted Bedroom Rating Against HAA Request ••
Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
I certify that I have checked• verified• or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed S & S ENGINEERING Date
CompanySR B 196X MOA No. g6 T2o�
Receipt No. 900 1 • 6e l 1 OF qL
Date of Payment _Q -CI Sic. c
�x
Amount: $ 6ri4Q
Page 2 of 2
72-026 f11,e41
ewy A. &%.1r
Nw 1,167.E
rN
MAILING ADDRESS
/72010 (Rev. 6/79)
O. ♦RECEIVED
INSPECTION APPOINTMENTS
FINSPECTOR
TIME ,r.
TIME
DATEDA
E
INSPECTOR
INSPECTOR
c1
MUNICIPALITY OF ANCHORAGEDEPT. OF HEALTH 8
✓IRONM.ENTAL FLOTECTION
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO
E9801
= L Street - Astdtorage, Alake
• SEP 1 0 1981
ENVIRONMENTAL SANITATION DIVISION
Telephone 26"'120 RECEIVED
APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
REQUEST FOR
. IneontplNe r o."as r.td trot Ise proawed. Please allow ten (10) days for processing.
DIRECTIONS: Compl!dMe2ene)
PHONE
/. PROPERTY OWNER
c :-11�a.MAI
LING/JADDRESS
PHONE
FMiOPERTY RESIDE above)
PHONE2. BUYERcT
MAILINGA D SSPHONE
LENDING NSTI
MAILING ADDRESS
1, REALTOR/AGENT
KP
MAILING ADDRESS
/72010 (Rev. 6/79)
's
72010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
OF BEDROOMS
— /NUMBER
❑ ONE Q THREE ❑ FIVE ❑ OTHER
❑SINGLE FAMILY
❑ MULTIPLE FAMILY
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
PERMIT NUMBER
❑- INDIVIDUAL
DEPTH OF WELL
❑ COMMUNITY
❑ PUBLIC UTILITY
DATE DRILLED
Connection Verified
LOG RECEIVED
SEWAGE DISPOSAL SYSTEM
PERMIT NUMBER
,3..,,
C;+NDIVIDUAL/ON-SITE
❑PUBLIC UTILITY
Connection Verified/
❑SepticTapkor ❑Holding Tank
DATEINSTALLED
INSTALLER
Sizery If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCE$
WELLTO:
Absorption Area to nearest Lot Line
Septic/Holding Tank Absorption Area Sewer Line career Lot Line
/ d-o So
5. COMMENTS
APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE BY
/^� p
's
72010 (Rev. 6/79)
n
a
EXCAVATION
Peter Miller
SR 2 Box 9375
Fogle River, Alaska 99577
Dear Mr. Miller,
WORK
n
September 16, 1981
ROBERT A. SHAFER
Reference:' Lot 4; Block 1; Stonehill Subdivision:- Old Tract A;
R & R Subdivision
6942979
A sewer system adequacy test was performed on the system located
on the referenced property, as you requested. Theseptic tnnab orption
k was
pumped and verified to have a capacity of 1250 gallons.
The water over
trench was tested by a continuous flow of 857 Cn lons
a period of 24 hours without any measurable rise in the water level
in the sump at the end of the trench.
It can be concluded from this test that the waste water disposal
system serving the three bedroom residence located on this property
is currently functioning
aquent adefaiquately.
However the system cannot be
guaranteed against
If we may be of further assistance, please do not hesitate to call.
lincer ly,
/i �,�-�/
�.l
ERT- A. , P.E.
RAS as
cc:. Home Federal ESavingsSas and Loan
ATTENTION: Judy
Municipality of Anchorage
Department of Health and Environmental Protection
SRO 196X EAGLE RIVER, ALASKA