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HomeMy WebLinkAboutQUIET WOODS LT 6AQuiet Woods Lot 6A #050-281-47 NELL G^NSI4UGIIOK LOG �r } Ol i m"s Co.�.�lft/D �t_M_ CA�L✓a%��. _.._—_.__— USGS no. oriner�lct���fi.1��Ss// ._Tvpe of tlg_71.iT�t __..__.Datr mall Completed_`O&Z' Will owner— 110 .11 est tenmunilg—`A�/� �i ✓s2 tell location: (address & local ansci ipl ion) at pih al Ie 11—L —II. Gaging: depth ._I t, tli,n•—,(.-_rn, Static Islet rweol-7-0- It. .abare, beluwl land surface. Date-?rr1-(pe'y finish of well: (open -•cad, scfeen, Gleloraled, open -Dole, Des-tribn Intsivels and sIce: '•e.vt-1'wr!!^_.C6�✓..Q�....—.— . Will tlnld festal by (Pumping, bagging. air) at /O —_g,l/min. lord— haus wilt, —_.ft. of drawdown from static level. I, DRILLER'$ MATERIAL LOG Location sketch or remarks noysE /stjs(v �m%c•/a, T/yN Ra&)A Sm Nay-0611,PA 1 wag- /yq3.25o-A Depth be log land _ Give description of sttate penslialed gullies In lost (sire of 0`11141101, e•)lal, hardness of drilllnL, and water Content) TY /l AXWAAAI %!' Al IA, SrS_ DEPT. OF t4elT�oAGE lo /1 8�� �'VPENT a, /Wor XJ — - — '_-- A1. PROTECTION _e£� _lo–sr �{- w�e�p�,r�'_•_��sJ.ds.�s------ � :.4,41',---- ,o L� _MAR /f�.redt�r OtwreL—'-------�-------- RE� • X11 1_L_la °D C,*A.Cre rA,v_J' ,� cRw�<<�H:r>:.�rs,� .►_r s�,� -4— 111 /'-I- -/i of to (tiw.t JC Sq A/i ♦ �ifAri( /k/ATe --- Y . _ l a—. �, -. y...`..�... a H• - ML1FV I C I F=1 L_ I TY EDF F=l r-JCI^PRFiGFEE DEPARTMENT•UF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, RK. 99501 264-4720 hJE=L.IL FERN 3E 'r PERMIT NO. C 810891 ) APPLICANT HARRY A. MACKEY SR BOX 6365 PIONEER. STREET 99 688-2813 LOCATION LEE STREET LEGAL L 6R 8 8 QUIET WOODS LOT SIZE 40000 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER. LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. FOEFOPl I T EXP' I RES DECEMBER TALY 1f551 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. SIGNED APPLICANT HARPY R. MACKEY ISSUED BY ------------------------------ DATE_ _-aCv-2�j---- V4.0 ITY Department7'fUHealthLand Environmente Protection 825 L Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT WELL ANDA0REGftnS+_4tE SEWER PERMIT 5? �r G1,X #636S�PioneerSf Applicant: OrArrq A CVP4Mailing Address: CLL 'u% AK- ggc_O Location: LeeA_. ��P �.JP/ Phone Number: (IgK -o)$IZ Legal Description:4 4 S� noje. (��Cnc�S _ Lot Size: Type of Soil Absorption System Is 1114 Trench: Drainfield: —, Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: /C/)/ DEPTH LENGTH GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * *.* TWO(2) INSPECTIONS ARE REQUIRED Backfilling of.any system without final inspection and approval by this departmen� will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 1 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if t sidence o eled to include more that 3/b)edrooms. Signed• �l -^AG/ '� % Issued by: �1la G�/�� Applicant ✓ l . Date: ;26 ri 1 SWP/024(1/81) n em�, September 17, 1981 Harry A. Mackey Star Route #2, Box # 6365 Chugiak, Alaska 99567 MUNICIPALITY OF ANCHORAGE LE?T. OF 1:°-:1!� 8 ENVIRCI:;A:\iAL i,::•tCCTION SrP 17 1981 RECEIVED Mr. Rolf Strickland Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 Re: Waiver for Lot 6a, Blk 8, Quiet Woods Subdivision Dear Mr. Strickland: The following is a request that we be granted a waiver allowing the private well on Lot 6a,';Blk. 89 Quiet Woods, Subdivision, Eagle River to be lo- cated 74 feet from the manhole. Respectfully 7 ,�Mii ted, Harry /[. Mackey L �= MUNICIPALITY ANCHORAGE • '� DEPARTMENT OF HEALTH 8 HUMAN SERVICES Aifil Division of Environmental Services MW 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. # 050 — 215/ ^ Y7\ - HAA# 1. GENERAL INFORMATION Complete legal description L� �Oqrail{ G✓o°�S Location (site address or directions) 10037 Lee SVied- Earle 4m, Property owner Ken Henna Day phone 96 — 7y05 Mailing address /Oo3-7 Le-sle .P✓e.- , " 99577 Lending agency Mailing address Agent Address _ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3-.1 3. TYPE OF WATER SUPPLY: Individual well �— Community well Public water Day phone Day phone 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. 72.M (Fw 1/91) Front MOA921 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of FirmKN� tnnc rnter,Hc Phone (056-61" Address AK 995'77 Engineers signature Date / S vyF,.r; - H;ice cc 6. DHH/S-SIGNATURE �1D�G i Approved for _�11^L+— bedrooms. a Disapproved. M. Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. performed to insure the wells continued suitability. Current nitrate t +s�5.04—mg/l ro, ..j. p, r-t4on is IQ A mg%1 More information on nitrates is available from the On-site Services Program, Additional Comments / /��110— L, I I �' Mu Date 12-30-99 ItlTir 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. nass(RW.W) 6. MOAM Municipality of Anchorage RECEIVE DEPARTMENT OF HEALTH & HUMAN SERVICES DEC 17 199 Environmental Services Division am 825 L Street, Room 502 • Anchorage, Alaska 99501 • (9Q'AgfT40FANO*� Health Authority Approval Checklist Legal option: Lett GA R69gr 6P e1 44J0 1f Parcel I.D.: OSO - 201-- Y7 A. WELL DATA r'o Y` Well type J2 -;"'de- if A. B, or C, attach ADEC letter. ADEC water system number N A Log present (Y/N) 1 Date completed /,*- d /- 0/ Total depth /O v" Cased to /O r/ Casing height (above ground) 2/ Sanitary seal (Y/N) 7 Wires property protected (Y/N) FROM WELL LOG Date of test Static water level W Well production /O g.p.m. WATER SAMPLE RESULTS: AT INSPECTION /2-4:1-.9e 73' Z/ I- g.p.m. Coliform Nitrate :5-11( Other bacteria Date of sample: 12--10-90 Collected by: ,CA/ D Eo,7 iti «i:' :f 13. SEPTIC/HOLDING TANK DATA Date Installed Foundation cleanout (Y/N) — Date of Pumping C. ABSORPTION FIELD DATA Date installed Length Width Effective absorption area _ Date of adequacy test Tank size I Number of Comte C40anouts (Y/N) (YM) High water alarm (Y/N) Soil rating (g.pdJft' or ft'/)dnn) Gravel thickness below pipe Monitoring Tube present _ System type Total d 6 s on over field (YM) For bedrooms Fluid depth In absorption Rel tam (In.); immediately after gel. water added On.): _ Fluid depth line) Minutes later. Absorption rate Perwdde treatment (past 12 months) (YIN) it yes, give date 72-028 (Rev. "Br D. LIFT STATION Date Installed Manhols/Access (YM) High water alar level at' _ Cycles tested E. SEPARATION DISTANCES "Pump on" 'Datum SEPARATION DISTANCES FROM WELL ON LOT TO: SeptMJholding tank on lot Size in gallons "Pump off' level at' On adjacent lots /00 �-t- Absorption field on lot A/16 On adjacent lots 0.0 Public sewer main SD /.k Public sewer manhole/cleanout %y Sewer /septic service line / '+' Lift station � UAt� Wrlsii� c�d� a� fiw,c SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: er" i s�hr Na6�^ Foundation Property line Water main/service line Surface water/drainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Curtain drain F. ENGINEER'S CERTIFICATION Building foundation Wells on adjacent krts Water Wells on adjacent lots I certify that I have determined Mm fled inspections and review of Municipal in con/ormance *cite MOA HAAouidelines in eflact on ddb date. Data no HAA Fee $ Q3t9O - 9 b Date of Payment //2 / —/ 7 x — / o Receipt Number O D �0 LU ,13D 72-028 (Rev. 3198)' storage area Waterer Fee $ _ Date of Payment Receipt Number ' CE 71161 E GEC 16 '98 09:51AM NTL kICHOFAGE P.1/Z NORTHERN TESTING LABORATORIES, INC. 33301NDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 190714563116• FAX 4S6-3125 8005 SCHOON STREET ANCHORAGE. ALASKA 99518 19071349.1000 • FAX 349.1016 POUC4 340043 PRUDHOE BAY. ALASKA 99734 190716595145 • FAX 659-2146 KND Engineering 20441 Ptarmigan Blvd. Eagle River. AK 99577-3736 Attn: Client 1D: B81.6A Client Project M: Source: Quiet Woods NTL Lab#: A159399 Sample Matrix: Water Comments: Report Date: 12/14/98 Date Arrived: 12/10/98 Sample Date: 12/9/98 Sample Time: 14:30 Collected By. Kelly 44 Legend •• Mn - Method Report Lrvel MCL - Max Cowmimm Level a - Present In Method Stank E - Exan" ed Wive M - Matrix Inttifnenoe H - Above MGC D - last To D"m Date Date Method Parameter Units Result MRL Prepared Analyzed SM 4500 NO3 E Nitram-N mgt 5.94 1.25 RECEIVED DEC 17 1999 12!11/98 MUnlc:pal.ly of ,k,A;no1a9e Oept. Health 8. Human Services MUNICIPALITY ANCHORAGE • -� DEPARTMENT OF HEALTH 8 HUMAN SERVICES AEML 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 HAA# 1\i.CLQ10 .0_'l �!/_y'% Parcel I.D. # n3 1. GENERAL INFORMATIONLo f �A Complete legal description Location (site address or directions) �dCr tier G Day phone4 S6 � 0(�4_o Property owner DG"iG U //'. A v 40479 Mailing address Lending agency Day phone Mailing address Day phone Agent Tci/rc PSS Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 X 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 X . NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025rR".1/9l1 F0111 MOA421 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 Iurtherverify 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 KND Fng neg�ng Phone 20441 Ptarmigan Blvd. Address gagle Air 99577L---- Engineer's signature � '1 ,�/%� Date '� �a' k 6. DHHS SIGNATURE Approved for 3 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional C�mments Note: The well for this property meets existing State an Municipal Codes. There are nitrates present. It is suagested that a periodic testing be performed to insure the well continped suitap}lity. Nitrate concentration is 5.8 mg/1. EPA r MMa w1miurWNW a — • The Municipaflty 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. +amsm..+A+i •.ow Mwm Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division NN� 825"L" Street, Room 502 • Anchorage, Alaska 99501• (907) 3434744 V, 4 Health Authority Approval Checklist o / / Parcel I.D.: Legal Description: LofGA �/i%B li%iZ k�ciOO.S A. WELL DATA Q Well type �_ If A. B. or C. attach ADEC letter. ADEC water system number Log present (YM) i Date completed /D —/ 8/ Total depth /a •S� Cased to /©S/ Casing height (abo%c ground) Sanitary seal (YM) Y Wires properly protected (YIN) FROM WELL LOG AT INSPECTION Date of test /O - / -8/ .2 - 16 - 96 Static water level 70 Well production WATER SAMPLE RESULTS: 75-33 g P.m. 3 .: f g.p.m. Coliform Nitrate Other bacteria Date of sample: 1 .? T V, Collected by: B. SEPTICMOLDING TANK DATA Date installed Tank size Number of Com Foundation deanoot (YM) Depresst n (YM) Date of Pumping Pumper C. ABSORPTION FLEW DATA Length idth Effearve absorption area Date of adequacy test Fluid depth in absorption field Fluid depth (ins.) h Soil rating (g.p.d.lft Gravel thic Monitoring Tube ft'Podrm) panmemu Clamouts (Y High water (YIN) below pipe System type Total depth Depression over field (Y" Results (Pass/Fail) \ For test (in.): Absorption Peroxide treatment (pest 12 months) (YAC If yes, give gal. water added (in.): D. LIFT STATION Date installed Manhole/Access (YIN) _ "Pump ori' level High water alarm level at' \ *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: in gallons "Pump oft' level at* Septic/holding tank on lot .V 4 ; On adjacent lots /00,+ Absorption field on lot .VSA ; On adjacent lots IOD I + Public sewer main J50- ' Public sever manholetcleanout Sewer /septic service line 1 0'4 Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: o�,nsia><drBr1 Building foundation Property line Absorption field Water main/service line Surface water/drainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPI1ON FIELD ON LOT TO: Building foundation Water service line Surface water Driveway,ing/vehicle storage area Curtain drain Wells on adjacent lots Property line F. ENGBYEER'S CERTIFICATION I certify that I have determined thru field mWerions and review of Wunicipal tecordc _ ,� fre in conjormonce with MOA IL -.1 guidelines in effect on this date. i �p ; •'• •�� •.,� ,�. i AVyr • 9�1 Signature f'49�y Engineer's Name 1 rn ; w /yG i Dated CE 7116(, $`"• HAA Fees Dn Date of Payment ReceiptNumber` $j0, Rev. 8/95 OSS: haa.wk.doc Waiver Fee S Date of Payment Receipt Number NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS. ALASKA 99701 190714563116• FAX 4563125 2505 FAIRBANKS STREET ANCHORAGE. ALASKA 99503 19071277-8378 • FAX 2749645 KND Engineering 20441 Ptarmigan Blvd. Eagle River, AK 99577 Attn: Ken or Dee Our Lab f: Location/Project: Your Sample ID: Sample Matrix: Comments: A143285 Lot 6A Quietwoods Water Lab Number Method Parameter A143285 EPA 353.3 Nitrate -N 2Z, � Reported By: Anthony J. t -qe Chemistry Supervisor Report Date: 02/27/96 Date Arrived: 02/23/96 Date Sampled: 02/23/96 Time Sampled: 1000 Collected By: Definitions " B Present in Blank H Above Regulatory Max. E•- Estimated Value M - Matrix Interference D - Lost to Dilution MDL - Method Detection Limit Unite Result ' HDL mg/L 5.81 1.00 Date Date Prepared Analyzed 02/26/96 MAR -0546 TUE 10:13 JACK WHITE REAL ESTATE FAX N0. 9077623189 P.02 AS BUILT SURVEY 1-7?LA ,r."A F Zor fnv� �J ,,., h v Z � �F n w A% /7✓I. S/ maz dews! /a/.17 r'u. t ,wA 19- ./tfAA H M w A% /7✓I. S/ maz dews! /a/.17 r'u. t ,wA 19- ./tfAA I, Richard P. Hankins, hereby certify that t hove surveyed the following described property: <07- cn, oursr 1106AS 5U84WI-114W Anchorage Recording District, Alaska, and that no encroachments exist ��..•.c•LyL except as indicated hereon. tr�•pf aqS b It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on .�49L/,Lj' •j,�'•� the data hereon be used plot. Under ishould for for establishing IL ....•. boundary or fence lines. Mcherd P. Hankin rte•._ NO. 3142S a ¢1'eopq••......•••�.o �»;,-.6 Date: Drawn by: R� Prepared by RICHARD P. HANKINS REGISTERED PROFESSIONAL LAND SURVEYOR Scale: Plot filing no: 1 P.O. BOX 1105 -EAGLE RIVER,ALASKA /' • so' 8/-C4 PH. 694.2371 99577 I MUNICIPALITY OF ANCHORAGE D J DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL 1 d OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) LoT 6-A 3�� 87 CJL r tt, Sa Location (address or directions) / oo z':;L L e c - (b) Property Owner :7rte•/ 841"—c Telephone: Home Business Mailing Address so Lo ),JtL trwJ AVt'r /•/t- «tifA Ngo .l TA JA (c) Lending Institution MAL- Telephone Mailing Address (d) Real Estate Company and Agent i� Ae-K w H tD Cd� I I I ,ti0A ,3�AN,v -A_ Address 0 3olC �-} /Gjq G A—e 945i:7 Telephone Los �l - S S Dc (e) Mail the HAA to the following address: or, Check here MrIf hold for pick up. List contact person and day phone number below. t NG'NEERINr' - 17034 Eagle River Loop Road No. 2064 Tzagle KIVOr, AI&9ka 9V311 2. TTPt Uh riCD1UC1Yl.0 ,� , ,_ Single -Family G1� Number of Bedrooms 3. WATER SUPPLY Individual Well Cb—Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE .DISPOSAAM Q l!r 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. Page 1 of 2 72.075 tFw e'e61 Root 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 c at 5 ENGINEERING Telephone G Address 17034 Eagle Rlvw Loop Rad No. 204 Date ,11 I; 1j 6. DHHSAPPROVAL/ / Approved for rl! � bedrooms by Date Q/X1r� .— Za. /9A7 Approved' Disapproved Conditional Terms of Conditional Approval 4 &ot, View CAUTION 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. Page 2 of 2 , rams (R" 9461 Beck MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4744 a3 RDH test f z AON NOISIAKI SDIAnS 1V1N3WN041AN3 30W0l4:)NV 40 A111YdOINf1W Legal Description: / '^ I -A 7--m-1. 8 A. WELL DATA S. F. If A. B, C, D.E.C. Approved Well Classification PP ( Y/N I 1 -JQ Well Log Present(Y'N) Date Completed 10-1-31 Yield S . Z (oPM + Total Depth /Cpq r Cased to /O`/� Depth of Grouting Static Water Level (+ S r - Pump Set At N• k Casing Height Above Ground Z,43 " Sanitary Seal on Casing (�IN) Electrical Wiring in Conduit Um) Depression Around Wellhead (W6) Separation Distances from Well: � To Septic/Holding Tank on Lot 7� ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line 2t iy To Nearest Public Sewer Cleanout/Manhole �wr To Nearest Sewer Service Line on Lot. 2S�f Water Sample Collected by S 1 S L'/c,11G-?;MlA/c. ; Date Water Sample Test Results _Sam sop- AJ jxk A`S cF 3A.5-7 Comments 3V t- F'z-car ?13] D /Q2 e/ -/o -b-4- /s2 g1yA.S; rn/S7A1ce;Y) TO CODE /?T 1 / f -t c pP• 145:7+UA-1aJ B. SEPTIC/HOLDING TANK DATA Date Installed _ Size No. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line To Water Main/Service Line Foundation Cleanout (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Course v C D&1h.LaC_?Lu> %0 7uC3 t/ L SG Wim- /D -2 5 9 Z / FGIJGVN Comments :X. '7C' Page 1 of 2 72-M FA -v 8 PSI From C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed Length of Field Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present(Y/N) Depression over Field (Y/N) Date of Last Adequacy Test . Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation To Property Line 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 To Driveway, Parking Area, or Vehicle Storage Area Comments -1; �Y- nI.,cr„8�7-0 7 c Sh 'itYt' /D L9 9i .ei[f D. 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 Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments •• Check Permitted Bedroom Rating Against HAA Request •• Icertify that Ihave checked, verified. orconformedtoall M AandHAAguidelinesineffectonthedateofthisinspection. Signed B3ENGI aIttN6 Date Compigp34E4*RULar Loop Road No. 2WA No. —c7o 3 EIa River, Alaska 99577 ay Receipt No. t{oot - oeo4 pF�1% Date o1 Payment t l - ,,,C.;4 P�.•••• '• •:FSS i Amount: $ 1yO� .'7 V7 4 Page 2 of 2 77.076 (Rev 6'961 aM• R.eM A. S!1.fiir ry No. 1157.6 ci A. CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 5622343 FEDERAL TAX ID M 92-0040440 Fi1nLiJlj FUJRT B'L' S;4:FLE is lEnt Fi.: 10 Dr F29 r: Lt.; ol'IEl •JI�W J V (E tP:. C ibis 4 C: w :r.trG[[t Gwi t J:i rt: x LW;r rS., $4j4 k;ne-120 ret is b�l0 Lia Srpi IJ: l Hitrl:i: Miter Fitir,eter 'fwel imitlunits --------------------------- t;li ATE h 4.e 4orN &cer G:,. . d:.. Cl lent nC".,)Lnt a4ijn:iJ? MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION NOV 131987 RECEIVED �r;oie f+WTit.E s-•r.FLi vc:5; •5: A11nL'i9:S G:"u'LET:U: 11-6-b' L5ur,i:uF', S;FEr':i.xF: STE=vii„ C. ECi .V /o-.-.. C. l Tes Fertormec • see 6,Pec131 Instructions Above LG= Is—& i.rteetee •• see Sa.:ple Femirt.s Abo:e hA- 6,t en31izec LT -Less Tsin. eT=oreiter Tnin hEtnJ3 Limits -------------------------- lu _I I DA..—R EIVED INSPECTION APPOINTMENTS STREET LOCATION • -' TIME TIME NUMBER OF BEDROOMS DATE DATE DATE ❑ Two ❑ Five ❑ MULTIPLE FAMILY QO Three ❑ Six 7. WATER SUPPLY X7 INDIVIDUAL' C INSPECTOR INSPECTOR INSPECT7NIC ALITY OF Pt. OF HEALTH 8 MUNICIPALITY OF ANCHORAGE PROTECTION NOV 17 1981 DEPARTMENT OF HEALTH & ENVIRONMENTAL ❑ INDIVIDUAL/ON-SITE" /825 L Street • Anchora9a, Alaska 98501 �3 PUBLIC UTILITY • RECEIVED ENVIRONMENTAL SANITATION DIVISION Telephone 2844720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts On page 1. Incwrdats requests; will not be prPlease allow ten (101 days for Processing. 1. PROPERTY OWNER 1688-2813 PHONE Harry A. and Madeline M. Macke MAI(JM:AWtEss# 2, Box # 6365, Pioneer St., Chugiak, Alaska 99567 PROPERTY RESIDENT If different from above) PHONE 2. BUYER Engler, Terry and Donna PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE I WILL PICK UP AND TAKE TO BANK MAILING ADDRESS 4. REALTORIAGENT Target Realtors, Agent: Dick Brown 277-055 MAILING ADDRESS S. LEGAL DESCRIPTION Lot 6A, Blk 8, Quiet Woods STREET LOCATION Lee Street, Eagle River S. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ One ❑ Four ❑ Other K] SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY QO Three ❑ Six 7. WATER SUPPLY X7 INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON-SITE" YEAR ON-SITE SYSTEM WAS INSTALLED. �3 PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. . 72010 (A—. 6/79) /1 THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OR BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ' SOILS RATING' ❑Septic Tank or ❑Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ®--'APPROVED FOR _� BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE //-�-V gy 72010