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Home My WebLink AboutDONALD C SCHROEDER #2 TR 1-B-ADonald C 0 Schroeder #2 Tract I -B-A #050-341-14 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:-SV49202.�55 PID Number: 0Z50-:>ef l,0fj Name4L,._.�1' 1 ��t'1►TH' Wastewater System: ❑New pgrade ABSORPTION FIELD Phone: gIO� No. of Bedrooms. ❑ Deep Trench hallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: 0-(X`GPD/Sq Total Depth from original grad Ft Lot. Block: Subdivision: h to pipe bottom from original red f �fT Gravel depth beneath pipe ' G • �� l� FI Ft Township: Range: Section: Fill added above originde: gra/ Gravel length: FI D Ft WELL ❑New ❑Upgrade Gravel width: Number ollines: Dwtance weer ines: 0 FI • Ft fication (Private. A.e.C): Total Depth. Cased To: Total absorptionarea: Pipe material:'$ IQ Ft. FI O Ft Driller'. Date Drilled: Slant water Levet I tla ler: Date installed: n ✓I l� (: Ft. Yield:Pump Set at: Casing Heignl Above Ground: TANK GPM FI. Ft. SEPARATION DISTANCESapt+ ❑ Iding ❑S.T.E.P. To Septic Absorption Ldt Holding ubtiUPnvale Manufacturer: Capacity In gallons: From Tank Field SlaliOn Tank Sewer Linn 10050 Well 10'L I IODI Zs + Material: Number of Compartments: SurfacWater IOZ54- 14D4 — — LIFT STATION Lot/ I -;5 I f Size in gallons: Manufacturer: Line Foundation/i%t / () /'Pump 102 (0 b on" level at: Pump off' level at: High water alarm at: Curtain/ Pum .e d Model Electrical Inspections performed by: Drain Remarks: rtT IVJG4 l 1:1- BENCH MARK Location and Description: O -G rel.?. A . I T- i1K : /_-1/1-77A1Z vY'/-1 -ri !N Lfc% �-Ti T—:P-Li nn Assumed Elevation: E Alaw i�Q•o .ati/ S t S ENGINEERING Inspections by: �7934�-48 River Loop Road,!%pa ! 1s GI Z N aN•N•N .w ... performed �•�•� Eai Riverr, Alaska 2nd �e5 ROG R J SHAFER : W Department Health,and Human,Services sti No. 15 •J?�' ��'�y••.e1ej of approval �•.•f��S (1%FESS.� Reviewed and approved by: Dater/1131�-Z-. 77-013 (Rev. gigs ( MOA 25 Page --z— of -z-- 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 —Do1j P• L'o G 41-7, Legal Description: - 717Z_P / 1 flp PID No.: 4250� I l oaE 1�4An'GaAv'6 U, qlt wax -�u.,� elz�laz 4"-10 ' A 1 S Co! 16M n W r -r 14&01!2e + VV 72-013 A (Rev. "I) MOA 25 »• N• :R SHAPER J� No. 215 f �t OFESSI�N ��" '" "•. ROBERTA. SHAFER. P.E. &I1�j11PFrt11i� 694.2979 •%�' 17034 EAGLE RIVER LOOP ROAD, SUITE 204 FAX: 694-1211 EAGLE RIVER, ALASKA 99577 Subject: LOT 18: DONALD C. SCHROEDER SUBDIVISION, ill HEALTH AUTHORITY APPROVALS EXCAVATING (CIVIL ENGINEERING WORK ARRANGED I ADEOUACY TESTS ISOIL TESTS WATER & SEWER LINES ► MAIN EXT. ON SITE INSPECTIONS DATE OF MESSAGE ROUTINGSYMBOL To: Robbie Rob.in6on Muni.c.Lpatity o5 Anchoaage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Staeet P.O. Box 196650 vuvovyvv Anchorage, Ataska 99519-6650 The ex.i4ting tench =6 .te6t .in uee and the clean-out6 toca-ted on the new trench hae been marked with ae6Zeetoaa. From: REPLY RETAINED BY ADDRESSEE Eng-ineen. Technician RECEIVED NOV 9 1992 Municipality of Anchorae Dept. Health & Human Seryices DATE OF REPLY IROUTINGSYMBOL SIGNATURE OF REPLIER TITLE OF REPLIER PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE f)L'On DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920288 DESIGN ENGINEERS & S ENGINEERING OWNER NAME:SMITH GLENN N OWNER ADDRESS:PO BOX 771256 EAGLE RIVER, AK 99577 PARCEL ID:05034109 LEGAL DESCRIPTION: DONALD C SCHROEDER #2 TR 1B LOT SIZE: 65340 (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: DATE ISSUED: 9/16/92 EXPIRATION DATE: 9/16/93 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: VERIFY SOILS AT EASTERN END OF TRENCH, SOILS LOG TO BE SUBMITTED WITH AS -BUILT. RECEIVED I ISSUED BY DATE: r17116 DATE• August 12, 1992 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (9071694-2979 FAX 694 1211 HEALTH AUTHORITY APPROVALS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 SEWER& WATER MAIN EXTENSIONS REFERENCE: Remainder Tract 1-B; Donald C. Schroeder Subd. #2 SEWER&WATER INSPECTION Request you issue a permit to upgrade the septic system serving the referenced property. The existing system is completely saturated. ENGINEERING STUDIES AND REPORTS A test hole was excavated and a percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is depicted on the attached proposed upgrade design. W ELL INSPECTION &PLOW TEST We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic upgrade. If you have any questions or require additional information SITE PLANS for your review, please contact us. Sincerely, ROAD DESIGN ROGER J. SHA ER, P.E. SOILTEST RJS/LSU/lsu PERCOLATION TEST STRUCTURAL► MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DE! 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 UPGRADE ct: SCALE tl 0 t ' a / o r O U O W m i y / O r- p (n Rl W Cb (A am y n . r: to 0 4 Z r rri �rn r �°'cn C7 Z Z r 0 i � o � enc ` P O Z � n 1 r- � � o w in to M� a� j O x -4 rn �QQSul ro n rij r y o � 0 2 O 0 0 e rn ai 00 t Y op t �I�yFFRt : �� p e v Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: t-1 fj 'J I DAT Tl?lkG-1— LEGAL D (FEETI 1 � 0• ' •0 2 0 3 Oo 4- J` 5 s r 7 D..r 9- to - 11 1011 12- 13- 14- 15 213 14 15 d 16 17 18 19 .4041. e, Section: SLOPE WAS GROUNDWATER ENCOUNTERED? 17 - IF YES, AT WHAT DEPTH? _ Depth to Water Attu Monitoring? 1"Dme: 20 1_ y PERCOLATION RATEL /�- (mmutesnnRRcn) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND 1 FT COMMENT S'Lj" S�"�V-45n:> PERFORMED BY: S & S ENGINEERING I CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River LooRoa�J A7 ACCORDANCE WITIE h 7t9��,9ti9 �1`�5� EM?LM IN EFFECT A THIS DATE. DATE: 72-008 (Rev. 4,85) • MUNICIPALITY OF ANCHORAGE r j \` DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 99501 Telephone 264-4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE 7�3tl NEW Tom Luchterhand 344-7638 ❑ UPGRADE MAILING ADDRESS P.O. Box 10462 Anchorage, AK 99511 LEGAL DESCRIPTION Tract 1B Schroeder Subdivision 7 �� LOCATION NO.OF BEDROOMS Ea le River Well Absorption area Dwelling PERMIT NO. DISTANCE TO: 110' 5' 60' 780846 U Y 1-2 Manufacturer Material No, of Compartments W< Anchors a Tank Steel Wi Liq. capacity In gallons Inside length Width Liquid depth 1 000 IF HOMEMADE: d Y DISTANCE TO: Well Dwelling PERMIT NO. J2 Oz F Manufacturer Material Liquid capacity in gallons G Well Foundation Nearest lot line PERMIT NO. W = DISTANCE TO: 123' 73' 20' 780846 J LL Z No. of lines Length of each line Total length of lines Trench width Distance between lines F 2 w 1 inches Top of the to finish grade Material beneath tile Total effective absorption area 0 4' 48 Inches 480 Length Width Depth PERMIT NO. W Q t— Type of crib Crib diameter Crib depth Total effective absorption area W� yj Well Building foundation Nearest lot line DISTANCE TO: .j Class Depth Driller Distance to lot line PERMIT NO. J W Building foundation Sewer line Septic tank Absorption steals) DISTANCE TO: OTHER PIPE MATERIALS Cast iron b plastic SOIL TEST RATING 150 Sq./ft. per bedroom INSTALLER Robert Hamann Excavatin � REMARKS A. tV I C• e APP DDATE LEGAL /O—Z—?,? 724K3 (Rev. 31781 W r MUNICIPALITY OF ANCHORAGE t� — DEPARTMENT OF HEALTH 84 ENVIRONMENTAL PROTECTION I� ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 09501 Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW Tom Luchterhandlj 344-7638 1 O UPGRADE MAILING ADDRESS P.O. Box 10462 Anchorage, AK 99511 LEGAL DESCRIPTION dd..of.( C Tract 1B Schroeder SubdivisionZ� LOCATION NO. OF BEDROOMS EaPle River DISTANCE TO: Well 110, Absorption area r 5 Dwelling PERMIT NO. �Y . 60' 780846 r 2 Manufacturer Material No, of compartments a< Anchora e' Tank Steel Liq- capacity in gallons 1000 IF HOMEMADE: 1 Insitle length Width Liquid depth date DISTANCE TO: Well Dwelling PERMIT NO. _? H Manufacturer Material Liquid capacity in gallons W = DISTANCE To: Weu 123' Foundation 73' Nearest lot line 20' PERMIT NO. 7$0846 w Z No, of lines Length of each line Total length of lines Trench width Distance between lines f'?C60 24 Inches F• Top of file to finish grade Material beneath We Total effective absorption area 0 41 48 Inches 480 Length yy.dth Depth PERMIT NO. W l7 n F W0 Type of crib Crib diameter Cribdepth Total effective absorption area a DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area (a) OTHER f PIPE MATERIALS Cast iron & plastic SOI L TEST RATING 150 Sq./ft. per bedroom INSTALLER Robert Hamann Excavating REMARKS G, • ti a a G 0. V C all. ... .. IF �i APP D DATE LEGAL /Lana vsev. er.m • � ' M L_I t,.! I �� I P• F=i L I T ^,+ �_� F= 1=1 rJ r. H �� P=: R G F DEPARTMENT OF HEALTH AND ENI+IRONMENTAL PROTECTION 825 'L"STREET, ANCHORAGE, AK. 49501 254-4720 IJF=1_L_ RrJc� �iFJ—� I TE EtiEI•dF_F=: f�ERIy I T PERMIT NO. C 780846 ) APPLICANT TOM LUCHTERHAND PO BOX 10452 99511 144 763 LOCATION EAGLE RIVER: RD LEGAL TRACT 1B SCHRODER S/D LOT SIZE 57000 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SG! FT/EF:)= 150 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: L'-•EF~l-H= L: ILEr-JC3-r" !�5 r GF;?f=f -'El_ L}EF•TtAt - ---1 THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OF: DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN 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 CIN FEET). 1=: t= rl-! ISI I K"F_= LI `_ t= F_ -I- I C T R t -J K _, I 2: E = 1. c=I c__v ►_l 13 H t- L Q r -J PERMIT AP'P'LICANT 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. --- TIJCi < 2 7 I rJ�7,F•FEE f --T I QrJ FIF:F_ F:Es_!U I FREC• --- BACKFILLING OF ANY SYSTEM WITHOUT FILIAL INSPECTION AND APPROVAL BY THIS DEPARTMENT IJILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE E:ETIJEEt-I A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL: OR 15.1 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE RE!UIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. t= F_=F,m I T EBF-• I 2::1-, 2S4 r : 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 IJILL INSTALL THE SYSTEM III ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELEDTn�d�'IL�E--MORE THAN 3 BEDROOMS. S I G14ED ICANT Tilts LUCHTERHAND 1 FerfGrr'.cd Fnr_�I�I^� c.�.� Lo KS4�—C/'`e Ferforr..ed Ci — j eraI r+escrintion: 'L t — ifttcV 5vbdivis1ri1, This rorm Fenorts oils Lon yS—Percolation Test T'rtic nen t h `ry Feet __pil f ,racTeristics 4 — e -- i_g— I 10 � 12 14 16— is- 20- Was r•rounl Water Encountered?Ve� If Yes, At what Depth? 16Z ><eadina 1 Cate Gross Tire f:et Time Depth to N20 Net Cr 'I T , 1 I� ><eadina 1 Cate Gross Tire f:et Time Depth to N20 Net Cr , Fercolatinn Rate iiinute Frnrosed Installation: Secr.aoe Pit.--- _ Crain Field Ceeth of Inlet Centh To oottcm Of Pit Or Trench r r v r%E f� T S: ec r sc..-- rG ' H —/1 t i �Y._�--- Test Perfora.ed B Data Cert>>>ed Y _-_=�� _ Ey: Cate: �_L=! f:ucRon I�<<L Z(2� 2204 Clevelan Rnrcho.-age, Alaska 99503 Performed Fnr Ab+�e�s.�� KST. Date Ferforr..ed_ eral nescrintion: Lot mmcv Subdivision c-C—o .— Q�7his corm F.enorts�z oils Lon _Percolation Test__ s7 r* -c-4" Feeth p nil Characteristics 2— 11 -4— 6 -- -8— 10- 14 0- 14 — 16- 18- 20— Bre tom. s'a,w oqr'130ec Was (round Water Encountered? Y�5 If Yes, At what De!+th? %d 0 Feidina Date Gross Tire tet Tinc Depth to X20 t:et Dri � I1 0 Feidina Date Gross Tire tet Tinc Depth to X20 t:et Dri Percolation Pate _—rrnnuce Frnnosed Installation: Seer.ace Pit _ Drain Field.— Deeth of Inlet Depth To B_ottom Of Pit Or Trench rnmvEhTS:_ Test Ferfor-ed 6 �Q—i Vata Certified .y:_._�_ _ - Y--- Date: ��MCTC�-ALT;! toN by A & L DRILLING COMPANY jAN a 1TO BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 6942588 RECUVED 3e OWNER OF LAND 70,-M CLie_kJ 7'EQ fGd�O DEPTH OF WELL G0 ADDRESS -P o !SOK IO 4 1" of A^' Ict rSTATIC LEVEL OF WATER FT LEGAL DESCRIPTION 2 91'k r / /3 SCiq X0 e4< DRAW DOWN FT. DATE • Started 9L/3Z72 Ended cl/,3,7 ,r GALS. PER IIR -?S PERMIT NUMBER 78 O r4 6 KIND OF CASING 6 5: O /) KIND OF FORMATION: From O Ft. to -4 --Ft. 4E< Ft. to Ft. From 4 Ft. to2 7 Ft. JJOu P� e{% P/9nJ a �From Bay��C" Frmn Ft. to Ft. From127 Ft. to–ILL Ft. AeFWZD c /C From Ft. to Ft. From_/ / Ft. to ,Ft. 13C DK c>c-/< 'FX 4<.T"QFrom Fl. to Ft From Ft. to Ft.�z 4 u'! -c 7– Z From Ft. to Ft FromI :? Ft. to a37Ft. Reese c & From Ft. to Ft. From Z27 Ft. to 21sFt. /SEO,fot/G From Ft. to Ft. 3 S 6 P From Ft. to Ft. From2_lt.toj2?60 Ft. I51E,04OC-C 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. From Ft. to Ft. From Ft. to Ft. From t Ft. to Ft. From Ft. to Ft. From Ft. to Ft MISCL.INFORMATION: ToS..,i 6, c(� DRILLERS NAVE IS�" QQr C_ ' Municipality of Anchorage .. Development Services Department Building Safety Division � � •• � ; On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage. AK 99507 www.muni.orglonsite (907) 343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL 2� FOR A SINGLE FAMILY DWELLING Parcell.D. 0-61-3q I- L COSA# 09 030`1 Expiration Date: I a — /0 — D 1. GENERAL INFORMATION I -J .-A G. Complete legal description • TRACLt,BL-0CK , DONALD SCHOEDER s/D 92 Location (site address) 8420 RUTH DRIVE. EAGLE RIVER. AK 99577 Current Property owner(s) TIM COON Day phone 694-6231 Mailing address SAME Lending agency Day phone Mailing address Real Estate Agent KATHY OLMSTEAD Day phone 244-8020 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well ❑� Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site IZI Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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. (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 Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S 8 S ENGINEERING Address 15861 S. BIRCHWOOD IP. RD.,CHUGIAK, AK. 99567 Engineer's Printed Name ROBERTA. SHAFER 5. DSD SIGNATURE Approved for Disapproved. 3 bedrooms. Conditional approval for Phone 694-2979 bedrooms, with the following stipulations: lI Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: c4 Original Certificate Date: d — 01 (RM IIMS) Municipality of Anchorage- Development Services Department Building Safety Division - *01 On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF0 ITE 1 Z,,S SYSTEMS APPROVAL CHECKLIST Legal Description: Parcel: ID: A WELL DATA Well typeQ11/,#T&- If A, B, or provide PWSID# Date completed _47�/3/76 Sanitary seal 04) \AS I Total depth C?60 4.. Cased to -3ft. Date of test I Static water level /NV josrbezz FROM WELL LOG 45, ft. Well production 0.58 g.p.m. WATER SAMPLE RESULTS: Coliform coloniesJ100 mL NitrateJ mg/L Arsenic: ug[L date of sample: OUT Well Log:V)N) 4--53 Wires property protected aN).'/E-:'Z " Casing height (above ground) 11:2In. AT INSPECTION gg it. 9 P.M. Other bacteria colonies/100 mL Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Ma ; terial Date installed LOA& Tank size JM0 gal. Number of Compartments 0? Cleanout!)Foundation cleanouON) Depression over tank (Y6P L High water alar , m (y4)_h1L0_ Date of pumping Pumper r -P C. ABSORPTION FI LD DATA Date installed i Y[A9 Soil ratinPS11t or ft2lbdrm) 19 1 - 651 System type 51qn 1'emco Length %) ft. Width -ft. Gravel below pipe 5 r ft. Total depth ft. Elf. absorption area 1JSft' Monitoring tube J_C�n, Depression over field -LI-0 Date of adequacy test Result scg;DlFaiE�5 For 3 bedrooms d before test (0 is In. Water added_#Oh23 it In. Fluid depth in absorption field gal. New dept z Elapsed Time: 19D min. Final fluid depth 17' in. Absorption rate >J/!Z f = g.p.d. Any rejuvenation treatment (past 12 mo.) (YO type) If yes, give date D. LIFT STATION d R Date installed 'Pump on' level at Datum In. E. SEPARATION DISTANCES Size in gallons Cycles tested =in. High water alarm level at SEPARATION DISTANCES FROM WELL ON LOT TO: I Septic tank/lift station on tot Ito + I Absorption field on lot !OD 4 Public sewer main R /F/ Sewer /septic service line 0 r� Animal containment areas go Meets alarm 8 circuit requirements? I On adjacent lots 1604 r On adjacent lots /Gb -f Public sewer manhole/cleanout Holding tank 'N /a 1 Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation r� Property line S !/- Absorption field 13 r Water main 14R Water service line /� Surface water /00 Wells on adjacent lots /Co f in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /O r4— Building foundation AO -'OL' Water main N r r Water Service line /0 Surface water Z&t!n 4- Driveway, parking/vehicle storage t!::) •f - Curtain drain M04 Kd UUWells on adjacent lots 1010(•,, NOT t)c1'C>a<C. DQ we F. COMMENTS G. ENGINEER'S CERTIFICATION J P �w � i r._ p/ I certify that I have determine r gh field inspection and r % review of Municipal record that ab conformance with MOA COg ' rues Engineer's Printed N •me _ ............./ D ra Date �' r COSA Fee $ 49 Waiver Fee $ Date of Payment C/ ' - Date of Payment Receipt Number O 3S b C Receipt Number (Rev. 11/05) 09/10/2009 13:53 9076941211 SNSENGINEERING PAGE 02/02 SGS Rdx 1094624001 CtientNansc S & S Engineering ' Project Name/# T1,BA Donald Sehoeder SID #2 Client Sample 1D T1 BA Donald Sehoeder SID #2 NEOAX Drinking Nater Sample Remarks: Printed Datefrime Collected DatdTime Received DateIrtme Technical Director 09/092009 8:10 09/022009 9:15 09/02/2009 12:15 Stephen C. Ede Allowable Pmp Analysis Puweter Results PQL VlIiO lfcdwd Corrta w ID Limits Date Date but Mierobiology Laboratory Colony Count 0 coV100mL SM20 922213 A (000) 09/02/09 DLC Total Coliform 0 coV100mL S%120 9222B A (<l) 09/02/09 DLC Fecal Coliform 0 eoV100mL SM09222131 A (<1) 09/02/09 ALC SOS Ret# 1094147001 Client Name S & S Engineering Project Name/# Tract I;BA Donald Schrader #2 Client Sample ID Tract I;BA Donald Schroder #2 Matrix Drinking Water Sample Remarks: Parameter Results POL (<10) 08/17/09 08/17/09 NRB Metals by ICP/MS SM20450ONO3-F 13 Arsenic ND 5.00 Waters Department Total Nitrate/Nitrite-N ND 0.100 Microbiology Laboratory Colony Count 1 Total Coliform Positive Fecal Coliform Negative Printed Date/Time Collected Daterrime Received DalJrime Technical Director 08/18/2009 14:07 08/12/2009 14:30 08/12/2009 15:50 Stephen C. Ede Allowable Prep Analysis Units Method Container ID Limits Date Date Mit ug/L EP200.8 C (<10) 08/17/09 08/17/09 NRB mg/L SM20450ONO3-F 13 (40) 08/13/09 LCC col/IOOmL SM209222B col/IOOmL SM209222B col/IOOmL SM209222B A (<200) A (<1) A (<I) 08/12/09 DLC 08/12/09 DLC 08/12/09 DLC Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. 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 Parcel I.D. 1. GENILRAL INFORMATION Complete leg aCdescription ' b C OA —n C HAA # D`l o 519 Expiration Date:�lhnC .. ) ,�� RUTH DRI�t Location (site address ordirgections Current Property owners) Mailing address ; Lending agency 4') . T2 Day phone Day phone Maifingaddress / Real Estate Agent SUZ4r/A(e C o CL Day phone b Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well '� Individual On-site 19 Individual Water Storage ❑ Individual Holding tank .❑ Community Class Well ❑ Community On-site' ❑ Public Water System ❑ Public Sewer ❑ 7 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 sample results. (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 Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm -C//,/ G Phone 6,W- 7GQf Address/ /ocJ ! ,>r=fri'(_ /,F/W Engineer's Printed Name S! /5 15 ) 6 Date 5. DSD SIGNATURE Approved for Disapproved. 7 bedrooms. Conditional approval for bedrooms, with the following stipulations: nN-SITE Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: In S 0 (R.v. 0M) Municipality of Anchorage \• '" Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: C. "$045499A %;L?fCT 164 Parcel 0:6SO-341-N A. WELL DATA Well type T If A, B, or C provide PWSID # _ Well Log (Y/N) Date completed �317so' Sanitary seal (Y/N) Wires properly protected (Y/N) T Total depth 20 ft. Cased to _:IQ ft. 6A9LVCd - Casing height (above ground) in. FROM WELL LOG Date of test 5(3 7& Static water level '!13 ft. Well production 3s g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate Oi mg./l. Arsenic: = mg.11. Date of sample: V/ oq B. SEPTIC/HOLDING TANK DATA AT INSPECTION /o/e/4 y 7 ft. J g.p.m. Other bacteria Q colonies/100 ml. Collected by: Y' Ql*ft Tank Type/Material AxicWa 4015 il( L -e Z,rr9541 Date installed /012I7P Tank size /006 gal. ' Number of Compartments Z Cleanouts (YIN) Foundation cleanout (YIN ) yy Depression over tank (Y/N) _� High water alarm (Y/N) A!A T = Date'ofpumping.?S O Pumper S4W17-0/41Z✓ R&+"e-1" C. ABSORPTION FIELD DATA' Date installed 2420a Soil'rating (g.p.d./ft2orft'/bdrm)V.o System type epic -14 Length qo ft.- Width ft. Gravel below pipe Total depth ft. f Eff. absorption area _7 _ft2 Monitoring tube 4 Depression over field x% Date of adequacy test30 o Results (Pass/Fail) 4S-1' For _.L bedrooms Fluid depth in absorption field before test -2 in. Water added Ogal.t New depth in. Elapsed Time: 6 min. Final fluid depth Z in. Absorption rate >= 5-0 g.p.d.+ Any rejuvenation treatment (past 12 mo.) (Y/N & type) UAfk If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) 'Pump on' level at in. 'Pump off' level at m. High water alarm level a in. Datum Cycles tested Meets alarm & circuit r uirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /OG 'f6 Absorption field on lot Public sewer main A f% Sewer /septic service line 2.7 rt On adjacent lots /OQ of On adjacent lots X00 r r Public sewer manholelcleanout Holding lank /,1/4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation /o •* Property line Absorption field /V r14 Water main IJ114 Water service line /� �f Surface water /00 •' Wells on adjacent lotso/ d ,+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /d r " Building foundation SCI' r'- Water main NI -4 Water Service line 16 1- Surface water /Oo �f Driveway, parking/vehicle storage S-rr Curtain drain /,hlY Wells on adjacent lots /QO ,* F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and i review of Municipal records that the above systems are in �.» 1/4 9W ,..« J... conformance with MOA HAA guidelines in effect on this date. �D+... Engineer's Printed Name FKI s.:." W. E:' �2 J� 1� 'F Ut" Date _ /a/ %/af/ �1i 9F • '••.......•'f F�� HAA Fee Date of Payment Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number Test Date: Legal: Location: Class: Water Well & Septic System Inspection River View Estates, Lot 5, Block 7 NorthRim Engineering Steve Eng, PE, PH (907)694-7028 830-4186 (cell) 6/3NuuaumE 922 r V �-Donald • Shroeder#2,Tract lB 8420 Ruth 9,F A f'1 3 Bedroom, Single Family, Private Water Well WAte—moi Static Water Level: Well Casing: Well Depth: Storage: Flow: Results: 50' below top of well casing (TOC) 12" above ground level 260' Pressure Tank Water flows @ 5 gpm+from faucets; Water well produces 2.5 gpm measured recharge rate Meets Municipality of Anchorage requirements. Sent_.._ Septic Tank: Absorption Field: Monitor Tube: Test: Results: 1000 gallon, 2 compartment, steel tank (MOA records) 1 Deep Trenches, 90' long x 5'wide x 9' deep (MOA records & measured) Monitor Tube 450+ goons of water added -system passed System accepted the flow; Meets tested. Municipality of Anchorage requirements for the day - iPEY�.fi"�F/c9Tloy 'ASBUILT-NO CORNERS SET THIS DATE. I HEREBY CERTIFY THAT 1 HAVE SURVEYED THE SCALE' FOLLOWING DESCRIBED PROPERTY3 Q�.�O� s�y,�uss,Aso�e,va,r� r.Pxr/-8� DATEt AND THAT NO ENCROACHMENTS EXIST EXCEPT AS zea•/J� INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB+ �� 7 ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWNt ARY LINES. COTES •� /941E T; I .� . tk ......... Wane Mark Sward LS -6918 ZI ••......•• dalbfq�r�.,1�,:^�;o SCS Ref.N 1045621001 All Dates/rimes are Alaska Standard Time Client Name NorthRim Engineering Printed Date/Time 09/08/2004 7:28 Project Name/N Donald C Schroeder #2 Tract I Dh Collected Date/Time 09/01/2004 9:00 Client Sample ID Donald C Schroeder #2 Tract l B Received Date/rime 09/01/2004 10:15 Matrix Drinking Water Technical Director Step/he . Ede Release/r PWSID 0 Sample Remarks: Allowable Prep Analysis Paramdtt Rmlts L PQ Units Method Container ID I imi 4 Data Date [nit Waters Department Nitrate -N 1.09 0.100 mg/L EPA 300.0 D (<=10) 09/02/04 JIB Microbiology Laboratory Total Coliform 0 coU100ml, SM209222B A (<=1) 09101/04 DKC \ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES y1r Division of Environmental Services Onsite Services Section P.O. Box 196650 Anchorage, Alaska 99519-&650 (907) 343.4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel I.D. # 050-341-09 HAA # O O 0 4 7:7 1. GENERAL INFORMATION Complete legal description DONAL n C. SCHROEDER #2' TRACT 1 R Location (site address or directions) B420 RUTH DRIVE EAGLE RIV R. AK 99577 Property•. , : :.E TANK Day k7•Y7I:�IIIiTL'• Mailing address • RUTH DRIVE EAGI F RIVER. Lending agency Mailing address Day phone Agent SI I7ANNF COOL w/PR ID NTIAi VISTA Day phone (907) 699-6464 Address 16635 r FNTEREIEI n DRIVE 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 ing to the legality and status of system. 72-025 (Rev. 1191) Front MOA #21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1012.72 at, or prior to, closing for the engineering services provided. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. l 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 Phone (907) 337-6179 Engineer's Signature v Date in conducting this evaluation, AWWC, Inxf affemoted to provide a thorough, conscientious engineerinj analysis of the system In accordance with ADEC and MOA DHHS Guidelines & 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, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of o O A 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. �r AMVC, Inc. can therefore not provide any warranty for future estimate of how long the p� r v system will continue to meet the operational requirements of the ADEC or MOA DHHS. 0 ..:.... -. .r ...........: The content of this report Is for the sole benefit of the owner listed above. Any 0 reliance upon or use of this report by any other person or party Is not authorized, O. ... ...... nor will itconfer any legal right whatsoever. On �, J tfr y A G rness.: 6. DHHS SIGNATURE _L� Approved for 3 bedrooms Disapproved Conditional approval for Additional Comments bedrooms, with the following stipulations: Date 9-;P,7'0o 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 order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Computer Version RECEIVED Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES SEP 2 6ja Environmental Services Division 825 V Sheet, Rm 602 Anchorage, Alaska 89501 (907) 3434744 MUNICIPALITY OF EMARONMENTAL SERVICES DIVISION Health Authority Approval Checklist Legal Description: DONALD C. SCHROEDER N2: TRACT 18 Parcel I.D.: 050-341-09 A. WELL DATA �POSRNE DRAINAGE AROUND WELL HEAD. Wen Type PRIVATE H A. B. or C, attach ADEC letter. ADEC water system number N/A Log pint (YM) YES Date completed 9/13/78 Total depth 260' Cased fo 30.75' Casing height (above ground) • 10" Son" seal (YM) YES Wires properly protected (Y/N) YES FROM WELL LOG Data of test 9/13/78 Static water level 43' Wen production 0.58 9— p.m- WATER SAMPLE RESULTS: AT INSPECTION 7/27/2000 24' 2.5+ g.p.m. Coltiorm D Nitrate .5 ma/L (U) Other bacteria 0 Data of sample: 9/12/00 Collected by: A.W.W.C.. INC. B. SEPTIClHOLDING TANK DATA Date installed 10/2/78 Tank size 1000 Number of Compartments 2 Cieanouts (YM) YES Foundation deanout (YIN) YES Depression (YIN) NO High water alarm (Y/N) N/A Date of Pumping 7/27/2000 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date Installed 9/22/92 Sop rating (g.p.dAM or If2Mdrm) 0.6 System type TRENCH Length 90' Width 5' Gravel thickness below pipe 3' Total depth 8.4' O MT Effective absorption area 775 SO FT Monitoring Tube present (YIN) YES Depression over field (YIN) NO Date of adequacy test 7/27/2000 Results (PasafFail) PASS For ?S • • 4 Fluid depth in absorption Held before test (in.); DRY Immediately atter 523 gal. water added (in.): 18 Fluid depth DRY (Ins) Minutes later. 1144 Absorption rate - 450+ Perwdde treatment (past 12 months) (YIN) NONE KNOWN if yes, give data ----- 72-M (RW.9loer Co MUW VWWW a .. D. UFT STATION Date installed Sbm High water alarm level at" "Pump ofr level at* 'Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septldholding tenk on lot 100'+ On adjacent lob 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main Public sewer manhole/deenout N/A Sewer/septlo service line 25'+ LIR station SEPARATION DISTANCES FROM SEPTIC(HOLDING TANK ON LOT TO: Foundation 5'+ Property One 5'+ Absorption Heid 5'+ Water main/service line 10'+ Surface wateddrainage 100'+ Wells on adjacent lob 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water maldservice One 10'+ Surface water 100'+ Driveway, parldngivehide storage area 0' Curtain drain NONE KNOWN Wells on adjacent k1b 100'+ F. ENGINEER'S I certify that J ofMunidpal tv with MOA HJU Engineers 7714C0.00 HAA Fee S 1/efd Inspections and review aystems are /n codbimance to nils date. A. Date of Payment 57,-,;Z 6 - 00 Receipt Number b621-1 72-M (RW. &W CcmpWr VwWm Waterer Fee Date of Payment Receipt Number 09-19-400 09:09 FROM -CTE ENVIRONMENTAL CT&E Environmental Services Inc. id ow. . . ------�� Cr&ERef.# 1005506001 Client Name AK Water & Wastewater Consultants Inc. Project Nsmel# Donald C Schroeder SD Tract I Client Sample ID Outside Hose Bib Matrix Drinking Water Ordered By PWSID 0 Sample Rertmrks: 5615301 T-338 P.01/03 F-829 Client PO# Printed Date/rime Collected Date/rime Received Date rime Technical Director Released BY AA 09/18/2000 15:33 09/12/2000 14:57 09/13/2000 10:45 Stephen C. Ede Allowable Prep Anslysts Patametv Results PQL Units Method Limits Date Date Init Waters Department Nitrate -N Microbiology Laboratory Total Coliform 0.500 U 0 0.500 mg/L EPA 300.0 coVlOthnL SM189222B 10 max 09/13/00 SCL 09/13/00 KAP MUNICIPALITY OF ANCHORAGE O DEPARTMENT OF HEALTH 8 HUMAN SERVICES of Division of Environmental Services �tiM 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.# fly,4(',-ZLI%-C:) 1. GENERAL INFORMATION HAA It Complete legal description ReniaindeA Tnaat 1-15; Dona.Cd C. SchAoedeA Subdivision No. 2 Location (site address or directions) 5.8 Eagke RiveA Road ' Property owner Glenn N. Smith Day phone 694-4867 Mailing address F. 0. Box 771256 Eaate Rive, Ai'.aska 99577 Lending agency Mailing address. Agent Address Hat: Jackson HERITAGE REAL ESTATE 18850 Eagte R.LveA Road Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 N 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water Day phone Day phone 694-4994 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 XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-0251Rm. V911 hot MOA.21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S 3 5 ENGINEERING Phone 17034 Eagle River Loop Road No. 204 Address Eaple River. Alaska 99577 Engineer's signature 6. DHHS SIGNATURE K Approved for bedrooms. Disapproved. Date 9 -21v -`t2. Conditional approval for bedrooms, with the following stipulations: Additional Comments I°� -7 Date // /3 /'7 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 theirlending 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. nozs (A" 1191) exk Mon m V Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST " I�rJPn-•n C• `'moi' -3`,Z Legal Description: Et2 Parcel I.O. L� A. WELL DATA Well typt If A, B, or C, attach ADEC letter. ADEC water system number N " Log presen(Y N) Date completed -C1 t3"�� Driller Q f7�- Lam.{q 7Cl Total depth ZLoO / Cased to *-50' CIO Casing height 12 Sanitary sea (Y ) Wires properly protectedd9N) WATER SAMPLE RESULTS: Coliform �- Nitrate Other bacteria d5p- Date of sample: 9 9 Z Collected by: B. SEPTIC/HOLDING TANK DATA Date installed I n - 2' 8 Tank size lognn 4P—L— Compartments Z Cleanouts (Y N) T Foundation cleanout ON) _ Depression (Y® 'y ` High water alarm (Y N)� Alarm tested (Y/N) Date of pumping -/�/�P-q Z Pumper Mpi t SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot �b2 f —On adjacent lots { bd �+ Foundation 15 % � � r To property line Absorptionfield ' '" " Wafermain/service line Surface water/drainage �� 41- 72-026 (Rev. 7191) From CONTINUED ON BACK PAGE FROM WELL LOG AT INSPECTION Date of test Cn Static water level rn rn w Well flow -5* G.P. 44, -Iz . t Pump level Ur--I M 0 01 SEPARATION DISTANCES FROM WELL TO: g m Septic/holding tank on lot On adjacent lots 10".5 4' Absorption field on lot On adjacent lots 100`1 Public sewer main U Q • Public sewer manhole/cleanout i A Sewer service line '?�/-3 Petroleum tank V'100 "OIL) tJ I WATER SAMPLE RESULTS: Coliform �- Nitrate Other bacteria d5p- Date of sample: 9 9 Z Collected by: B. SEPTIC/HOLDING TANK DATA Date installed I n - 2' 8 Tank size lognn 4P—L— Compartments Z Cleanouts (Y N) T Foundation cleanout ON) _ Depression (Y® 'y ` High water alarm (Y N)� Alarm tested (Y/N) Date of pumping -/�/�P-q Z Pumper Mpi t SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot �b2 f —On adjacent lots { bd �+ Foundation 15 % � � r To property line Absorptionfield ' '" " Wafermain/service line Surface water/drainage �� 41- 72-026 (Rev. 7191) From CONTINUED ON BACK PAGE C. LIFT STATION Date Installed Size In gallons _ Vent (Y/N) "Pump on- leyel at High water alarm level Meets MOA electrical codes (Y/ SEPARATION DISTA E FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Manufacturer hole ess(Y/N) 'Pump off' level at — Cycles tested Surface water Date Installed; Soil rating b y�Z System e �� tyP.�-�� Length 1LZ_Width r I Gravel thickness �! Totaldeepth- (2 - Total absorption area �� 1� �. Cleanouts present QN) Depression over field Date of adequacy test Results (pass/fall) 1Jts4„ i �`�� ►i'y"'1 for bedrooms Peroxide treatment (past 12 months) ( /N If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot Q1 On adjacent lots I ( Property line To building foundation 140To existing or abandoned system on lot On adjacent lots 3o'4- Cutbank �/ Water main/service line Surface water IDD ( •(— Driveway, parking/vehicle storage area 0/ n/+ StCE Curtain drain Q00-61 DJz.Vcv4y E. ENGINEER'S CERTIFICATION I certify that t have checked, verified, or conformed to all MOA and HAA guidelines In effect on the date of this Inspection. 5 & S ENGINEERING Signature 17J33 Eagle River Loop Road No. 2o4 GV,10 klwd-,Alaska Engineer's Name Date �1-21p-9Z- HAA Fee $ ZD ` aV Waiver Fee: $ Date of Payment Date of Payment Receipt Number !OW10 5� 411 5 Receipt Number 72-M (A". spa/) 8�k MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTINGS ENGINEERING CO. 6833 0 STREET ANCHORAGE, ALASKA 99318 TELEPHONE (907) 562-2343 FAX' (907) 881.3301 IIALISI3 1130LIS for IIVCICI 1 56027 Chenleb laf.1 92.S262 Sample 1 1 11atri:: M1111 Client Semple ID TRAGI 16 NVALD C SCPIOID13 12 Client Its.. :3 & 3 110IISORIIG rNSID : 111 Client Leet :813111CP Collsoted : SIP 2e 92 f 15:30 bts. IPOs : Raeeieed SIP 25 92 1 WOO tar. 1s91 Pteureed with : AS UQOIRID Ordered 17 :R. SRAM Aralytis Completed : SIP 21 92 taborstoty Supe to r : 3,111^11 C. IDI 111sated By Sera Reports to: 1)3 a S 1MCIIISRIRG 2) POt :11011 RICIIPIO .................. .............. ....... ..... ........... ................... .... .... ............................... ... ................ Parameter I.tultI unite method Allowable Units ................................__.......__..__.__....._...._------_........._______._._...---...------..........._........4...... RIIIAT6.1 ID(0.10) a)/l In 351.21100.0 10 Sample ROLRLIS Swu C1vlalti II: I.J.3. lauke: .................................................................................................................................... I Seita Pasfat"d . Sea special Instructions Above CA•V:uvelleble No- lona Dateoted " Su sample Aematke Above It. Not 1u1720d 11144tt Than. CT -Creates Than Mmmbe: of the SGS Group (SdCldtd G60ralo do Survelllamee) E08 910 00000000000000000000 00000000000000000000 ZZ:11 6Z-60-2661 C imuriI �e1�l�J7I�Ze�y�7j7► : i i A DIVISION OF COMMERCIAL TESTING S ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561.5301 ANALYSIS RESULTS for INVOICE E 55453 Chamlab Ref.t 92.3213 Sample I 3 Matrix: MATER Client Sample ID : REMAINDER TRACT 11 DONALD L. SCHROEDER' Client Nana :S i S ENGINEERING PMSID : DA Client let :SNSENGP Collected JUL 2 92 l 11:30 hrs. IPOI : POI :NONE RECEIVED Received JUL 2 92 4 14:30 hrs. Raga : Preserved with : 13 REQUIRED Ordered By :R. SHAPER Analysis Completed : JUL 6 92 Sand Reports to: Laboratory Supervisor : STIPHIN C. EDE 1)3 6 S ENGINEERING Released By : 2) .................................................................................................................................... Parameter Results Units Method Allowable Limits NITRITE -N ND(o.10) mg/l EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED II: RAY. ' S/D 12. Remarks: .............................................................................................. 1 Torts Performed See Special Instructions Above OA -Unavailable ND- None Detected " Sae Sample Remarks Above NA- Not Analyzed LT -Lm Than, GT -Greater Than r8 S'MS Member of the SGS Group (Socidld Gdn9rale de Surveillance) 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 10/30/85 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Tract 1B Donald C Schroeder #2 T14N R1W Sec.14 Location (address or directions) Easrl e River Road (b) Applicant Name Virginia Kohfield Telephone:Home N/A Business 694-4200 Applicant Address P.0 Box 772849, Eagle River 99577 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Others (explain); Realtor (d) Lending Institution Pirst Guaranty Mortgage Telephone 276-3949 Address 307 E N Ltc Blvd Anchorage, AK. 99501 (e) Real Estate Company and Agent RE/Max Eagle River— Virginia Kohfield Address P ^ Rox 772849, Ragle River Ak 99577 TelephonE69 4 —4 2 00 (f) Mail the HAA to the following address: pickup 2. TYPE OF RESIDENCE Single -Family M hlulti-Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well EX Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. ,1 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. 72025 01 V I Page 1 of 2 P& n 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system is In compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm cdnLE4WER-ENGINEERIWGZERVIGES—Telephone Address EAGLE RIVER, AK 99577 /o/sem/`C' P. 0.80X 773294 Date 694 519 6. DHEP F3 Approved for/"' - — t _ 6d Approved Terms of Conditional Approval Engineer's Seal Loi: A. Burera C:-6736 �Ifl. Date Conditional ' is Loi: A. Burera C:-6736 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 �Ifl. Date Conditional 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 µtlhilCIPAUTY Of ANCHOR IGZ , 4 �- MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH yIi 1c' HEALTH AUTHORITY APPROVAL (HAA) ENVIIONW&WK PROTEaION 1 CHECKLIST 2 "720FEBRUARY 1984 nCT 3 I.c C. Legal Description: -,-qcT A. WELL DATA Well Classification pF' r v^ TE If A, B, C. D.E.C. Approved (Y/N) /V /q Well Log Present (Y/N) Y_ Date Completed ;>.9Yield 3 G ``" (�7-e:L c 4h Total Depth 26 0 Cased to 30 '6�Z1-12116pth of Grouting N 1't Static Water Level ^ 5-7 �T"r • Pump Set At G 77—• Casing Height Above Ground Sanitary Seal on Casing (Y/N) Z—' - Electrical Wiring in Conduit (Y/N)- y- Depression Around Wellhead (Y/N) /Ll Separation Distances from Well: To Septic/Holding Tank on Lot y 00 ; On Adjoining Lots /,,;,o y To Nearest Edge of Absorption Field on Lot On Adjoining Lots /00 Y To Nearest Public Sewer Line 'Y "'L To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by . ^ec" ; Date /O�2y�Ss Water Sample Test Results S< Comments B. SEPTIC/HOLDINd TANK DATA Date Installed 10/7 k Size 1440 G. /• No. of Compartments -2 - Standpipes (Y/N) i Air -tight Caps (Y/N) i Foundation Cleanout (Y/N) y - Depression over Tank (Y/N) /t--" Date Last Pumped /y/3./F (- Pumping/Maintenance Contract on File (Y/N) ; for R11A Holding Tank High -Water Alarm (Y/N) fi Temporary Holding Tank Permit (Y/N) '*Y4 Separation Distances from Septic/Holding Tank: To Water -Supply Well {/O0 - To Building Foundation To Property Line z a0 I To Disposal Field To Water Main/Service Line To Stream. Pond. Lake, or Major Drainage Course / jO1 Comments Page 1 of 2 72.026111;841 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /_570 Type of System Design __ 7 "tee, e A Date Installed Length of Field �Q Width of Field a r Depth of Field _ Gravel Bed Thickness Square Feet of Absorption Area �l80 �' ! Standpipes Present(Y/N) Y Depression over Field (Y/N) Date of Last Adequacy Test to A3011,r s— Resultsof Last Adequacy Test E f''t `}"s 7f- 3 Separation Distance from Absorption Field: To Water -Supply Well / 3 d To Building Foundation 7J- Lot 3 Lot /VI - 114 - To Water Main/Service Line ie' 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 a ; On Adjoining Lots To Existing or Abandoned System on 7- r To Cutbank (if present) N"C e 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 HAAguidelines in effect on the date of this inspection. Signed �r Date /a� 3ift-S— Company � i 2 E, t r MOA No. rT �� ! I— Receipt No. !:_tn Date of Payment 16-311-k5 Amount: $�� Page 2 of 2 72-026 (11,64) �r CJ PrP+, ? T f4, Louis A. Butma 4�4 (1G:: �'• C&6736 ' Engineer's Seal APPLI""NT FILLS OUT UPPER HA ONLY Owaei. G6/ /(/ C//TF/ 11NAJ,6 Phone joperty Tima Mallinp`Address /,'_ i s G e % , Buyer !Address /) [– v Zip Code Lending Institution rR�r &4Z4AI llee%e�G� V r�+nC�, 1 nG. �/ Phone I r Address ! r/f , ,(pAllid7 ! /: Zip Code salty co. a age;i (/ t� //r y _ / /t/ rbPoU!/J� — 6Qej111.< t. , I r , Phone Address :0• r J Zip Code q2 c 7 7 Legal riptbn %%Gr //J Jeww v C. u:5, Aa2 Street Location ' Type of Residence Single Family Multiple Family hh No. of Bedrooms�.y� ❑ Other Water Supply �D Individual ATTACH WELL LOG. A well lop Is required for all wells drilled since June 1975. /❑- Community For walls drilled prior to that date, give well depth (attach lop 11 available). ❑ Public Utility Soils Ratlnp Sewer Disposal —7 '7 -Z nQ,.W55rvldual Year Individual Installed: el LJ Public UtiIIIY O Holding Tank When Connected to Public Utility: l 5 S /) '�+l.,a,dJ_.p. ra., 1 ! Well to Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time(Op TIS Tima Time — /5� , 7 /3 L�(�CC'o Date Date Date Date Inspector Inspector Inspector Inspector Field Notas: Field (3) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' - DATE `I BY: Soils Ratlnp Date Sewer Installed Well To Absorption Area Well Lop Received Y•d, Septic Tank Size,10 ._� Well to Tank 7M3 Mn June 1£t, 1982 Ton Luchterhand c/o Charlaine Skeel Century 21, !dctropolitnn P.O. Cox 677 Eagle River, A?: 99577 Subject: Tract lII Doald C. Schroeder Subdivision 02 Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: • Exposed electrical wires to the well head are in violation of the Municipality of Anchorage codes and nust be encased in conduit. • The water analysis report needs to be submitted to this office from the Chem Lab, 5633 G Street, for our review. • A four (4) inch cast iron cleanout needs to be installed to the septic tank and/or leaching area. Please notify this Department for a reinspection when the noted discrepancies have been corrected. if there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt Associate Environmental Specialist P.P137/p/Ell