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Home My WebLink AboutHENKINS BLK 1 LT 15Henki'Ons Block 1 Lot 15 #051-292-27 �i MUNICIPALITY OF ANCHORAGE _7^ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street. Anchorage, Alaska 99501 Telephone 264-0720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPE NAME UION REPORT Com•lr s PHONE NEW MAILING ADDRESS ❑ UPGRADE LEGAL DESCRIPTION L,C 51,6LOCATION .ia. C/NS NO. NO. OF BEDROOMS Well O DISTANCE TO: Y area Dwelling PERMIT NO.r 1-z Manufxturer C� r W I- Liq. x Material No, of compartment c acity in allons IF HOMEMADE: th Inside len '+1� Width Liquid depth 6aZ DISTANCE TO: Well Dwelling PERMIT NO. I?f Manufacturer Liquid capacity in gallons Material w W u Well DISTANCE TO: N p Foundation Nearest lot I 5 PERMIT NO. �• z ~ z_ w No. of lines Length r fine Total lengt n Trench wi Distance between lines ¢ F• Top of the to finish grade Material beneath tile Inches o Total effxli a r i ea w Length 9 Width Depth inches f7 PERMIT NO. < t- w d Type of crib Crib diameter Crib depth Total effxtw absorption area W N DISTANCE TO: Well Building foundation Nearest lot line _1 Class Depth 11 r Distance to lot line PERM17 NO. w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS YC, SOIL TEST RATING INSTALLER CC REMARKS Out 6t. I 6 f• s ............. _ . � Robert A. Shafer • F9 ••••,, Cis APPHO Al LEGAL SRCSE=I "ER(FIG [3 1E�X r+c:.OLE- RIVER. ALASKA 72-01 IR .3/78) £:77 f fl. Vv'!-LvfJ by DOC Co. dna SULLIVAN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 6882759 OWNER OF LAND 'H Ljc K ADDRESS 2 /) , , , LEGAL DESCRIPTION L�' �''�' 1 hi'•�.'�C DATE - Started '7"/) . �; ? Ended PERMIT NUMBER DEPTH OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR KIND OF CASING 4-�- KIND OF FORMATION: From Ft. to —2 Ft. e) From Ft. to Ft. From Ft. to o Ft. _ SH D t �%: �r From Ft. to Ft. From Ft. to ? L Ft. _ <+C,4 /' From Ft. to Ft. From Ft. to Ft. From Ft. to Ft From '' Ft. to `0�' Ft. `f ^ �� <' ��'� v - From Ft. to Ft From Ft. tot .a FL _ 0<rt 7' £ / "'I'll ./ e-[ From Ft. to Ft. From :� Ft. to - Ft. . �p -� e) From Ft. to Ft. From Ft. to Ft. `'-'r T From Ft. to Ft. From 1 Ft. to 7 6 Ft_ ,4 .0 n w c J From Ft. to Ft. From -72 Ft. to / Ft.. '-'4'4 i = /, F2i ...irC From Ft. to—Ft.- oFt.From From—Ft. 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 MISCL. INFORMATION: %— DRILLER'S NAME MUNICIPALITY OF ANCHORAGE Department Health and Environmenta�rotection 825 L Street, Anchorage, AK. yg501 20 Permit #-;5 i �• * * * HANDWRITTEN PERMIT * * * WELL AND/OR ON-SITE SEWER PERMIT Applicant: CCC Ce_) liT Mailing Address: Location: Phone Number: 7 � tit• �£ E v Legal Description: /- br20 Rr_-Nle/A15 Lot Size: Type of Soilsorption System Is: Trench: - Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: .3 Soil Rating(sq.ft/br) AVf-/67/gZ_ The Required Size of the Soil Absorption System Is:'Id . JT` DEPTH LENGTH -GRAVEL DEPTH WIDTH The length dimension is th�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(HGa NG) 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 departmer 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 3 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 enlar a ent if the residence is7rode'ed to include more tha 3 rooms. Signed: Issued by: Applican Date: SWP/024(1/81) UNICIPA : Department(' HealthLand Environmental"'rotection -- 825 Street, Anchorage, AK. .j501 264-4720 Permit 9 le * * * HANDWRITTEN PERMIT WELL SEWER PERMIT nn Applicant: ` C �' � Mailing Address: 1- d e0X V% �f Location: / /� (12s�(�� n Phone Number: (a (0 F--5' 2, 2- Legal Legal Description: L/ up h K N S Lot Size: Type of Soil Absorption System Is: Trench Maximum Niniker of B DEPTH Seepag Bed: Holding Tank: of Rating(sq.ft/br) of t Soil oi Absorption System Is: 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 = - LAJ 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 departmer 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 8 3 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 . Arhedence is remodeled to include more that 3 bedrooms. Signed:Issued by:t ` Date: SWP/024(1/81) �t SOILS LOG MUNICIPALITY OF ANCHORAGE i DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION 825 L. Street, Anchorage, Alaska 99501 2644720 TEST SOILS LOG - PERCOLATION TEST PERFORMED FOR: C.C.C. GON ST. LEGAL DESCRIPTION: LOT IS RI -d.4 bt Llr O R.(o.41q l c S!t-TS 5 � CJS SA-nt?>Y GaR✓aL 9s'�/aa ccra-y tc.ISe SwN�Y b�,rvat B �7T b sem— Q� 1�01.G ,��vt<qqY 72-008 (6/79) WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? DATE PERFORMED: %— 7-5--8; ?KiNS 5/d n SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop It "rt M , PERCOLATION RATE TEST RUN BETWEEN 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 Parcell.D. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051-292-27 1. GENERAL INFORMATION HAA #_r Ogg Expiration Date: . 9- 9 � U .5 Complete legal description Lot 15- Rlnrk 1 Nrnkina Snhdiviainn Location (site address or directions) 1 6i i 6 nivi ci on qt Chugiak Current Property owner(s) Margaret Baker Day phone 622-1702 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Cindy Stearns Day phone 6a9 -1H15 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site U Individual Water Storage ❑ Individual Holding tank .❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 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 Address Engineer's Printed Name 5. DSD SIGNATURE 694-2979 Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Well Flow Advisory Supplemental Engineer's Report Other By: [ /j//Z„/ we / � Original Certificate Date: rD 05 - (Rev OUOI) 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: 1-21' 15" Bu,cic 1 � WEP- K 2051 g ! Parcel ID: OS 1 - 2y2 - a. ? A. WELL DA� Well type 21 V W7t- Date completed q?O/03 Total depth _fL( �ft. If A. B, or C provide PWSID # = Sanitary seal 42N) `LS r Cased to qo + ft. FROM WELL LOG Date of test 2p e 5 1 Static water level �`�j ft, Well production /b 9.p,m, WATER SAMPLE RESULTS: Coliform ! colonies/100 ml. Arsenic: — mg./I. Nitrate 40 mg./I. Date of sample:5 (7105 B. SEPTIC/HOLDING TANK DATA TankType/Material St -FT -le- / S'Ty-&(_ Well Log()N) yE S Wires properly protected 01) YES Casing height (above ground) Mit-li- in. AT INSPECTION 5 1C710 'r U9r ft. Su I g.p.m. Other bacteria I colonies/100 ml. Collected by: $4-S Ex�6r�1K7G Date installed g to 1,Q) 3 Tank size _01 0 gal. Number of Compartments ti CleanoutsON) �-16% Foundation cleanout 67-5;AAepression over tank (YAID> L O High water alarm (Y/to Date of pumping 101LOLVq Pumper �1 g `w Owl P106 C. ABSORPTION FIELD DATA Date installed 93L211B3 Soil rating (g.p.d./ft= o(ftz/bdrm )LOJ?� 46 System type Tar_-&cH 1 /}S5 V IY1 LC U Length t E ) ft. Width Vv� " �• S ft. Gravel below pipe S r ft. 1 Total depth ft. ft. Eff. absorption area uf�tZ Monitoring tube VES Depression over field 6J0 Date of adequacy test 5/17&5 Results as il) 1�r4+4� For edrooms It Fluid depth in absorption rn field before test in. Water added %3gal. ` New depth in. rr Elapsed Time:ID min. Final fluid depth 0 in. Absorption ratee5>0=_g.p.d. Any rejuvenation treatment (past 12 mo.) (W(P14 type) NU If yes, give date D. LIFT STATION Date installed Size in gallons 'Pump o�Ievel�in. "Pum�tested _ in. Datum Cycles E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot IM �L Absorption field on lot 106 t+ - Public sewer main N K 5owerfseptic service line 2S 14 - High water alarm level at Meets alarm & circuit requirements? On adjacent lots (OO 14. On adjacent lots 1 0 1 - Public sewer manhole/cleanout N i4 Holding tank N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 Property line Absorption field t Water main N Water service line I O 1 t' Surface water 1 b 1 Wells on adjacent lots b(7 1 Tal SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1 b f� Building foundation 10 14— Water main Iy 14f I Water Service line Surface water �� Driveway, parking/vehicle storage 10 •F- I Curtain drain NOA3E- eklowQmis on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined review of Municipal records the conformance with MOA HAA,g Engineer's Printed Name Date field inspections and )ve systems are in HAA Fee $ 430'a Date of Payment U ya�� Receipt Number 0O rg t.fNJo_ (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number _ +4 r •. 30 , . AS -BUILT ;. ' •.:: I hereby certify that 1 have surveyed the following described -- property:%./S� IF 10 Anchorage Recording Precinct, Alaska, and that the Improve- .' •'.�' ::�.a ments situated thereon are within'the property lines and do • -,•'.� not overlap or encroach on the property lying adjacent there- _ to, that no improvements on property lying adjacent thereto encroach on the premises in Question and that there .are no •� 4 roadways, transmission linesorother visible easements on �.N said property except as Indicated hereon. Dated at Eagle River, Alaska - tht. L$ day of 1�-�' <f ROS>ERT C. JOHNSON WFq, SCALE: Registered Land Surveyor No. X60 -LS Box 456, Eagle River, Alaska Phone (907) 694-2543 Municipality of Anchorage Development Services Department Building Safety Division OnSlts Water and Wastewater Program 47W South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.8650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWERIWELL SUBMITTAL COMMENT SHEET To: Bob Shafer Legal description: Henkins Block 1 Lot 15 The attached paperwork has been reviewed and is being returned for the following reasons: Original signature or stamp missing on Calculation error in design. _ Additional soils information needed. _ Water monitoring results inadequate. Discrepancy in information submitted. Topographic information missing or inadequate. Incomplete; missing Need foundation cleanout I Incomplete; missing Additional adequacy test information needed. Water sample unacceptable. _ Measured/proposed distances/dimensions missing. Locations of all soils, percolation and water monitoring tests not shown. Proposed system too deep for soils information submitted. Well log required. _ Omission in narrative. Insufficient fill over tank or field. %� Other. V A -s 3 6 C,�l r'^ �o,cvs Name of reviewer: Jeff Date: 6/7/2005 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK \ Municipality of Anchorage 1 Development Services bepaittment Building Safely Division On -Site Water and Wastewater Program ` 4700 South Bragaw St. P.O. Box 196650 Anchorage, Ak 99519-6650 www.ci.enchorage.ek.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING y Parcel I.D. 1051 ' U 7 Z Z HAA # �& 0'�-o /oZ Expiration Date: 0.2- 1. GENERAL INFORMATION Compietetegaldescription' Lot 15; Block 1; Henkins S/D Location(sifeaddr6ssordirections) _16116 Division St., Chupiak, AK di�rrentProperfyowner(s)Pan Reynolds Dayphone 357-3997 Mailing address 3360 Anaheim Drive, Wasilla, AK 99654 Lending a'`eii'' Lending g cY " Day phone Mailing address Real Estate Agent Mailing Address tack White -Prudential :harles Lawrence Dayphone762-5801 Unless otherwise requested, HAA will be held by DSD for pickup. �G, f Civ,,y 1r, /o Z 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Individual On-site ID 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 Slate 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.) Cerfifid'ates 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 dale 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 tyslenl 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 Slate codes, ordinances, and regulations In effect at the time of Installation. NameofFirm S&S Engineering Phone694-2979 Address 17034 N.Eagle River Loop, Ste. 204, Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan. P.E. Date :-02 5. DSD SIGNATURE �pf *\ ROBERT G COWAN cf CE.8801 Approved for f bedrooms. tt1�>>tiiw_� Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date:�- ,Rei. 12=1 Municipality of Anchorage ' Development Services Department Building Safety Division ` On -Site Water 8 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: 8f f)C > L' I X13 SID Parcel ID:bW1-%AZ'7T A. WELL DATA Wen type f ✓Q4 /fir ��_ Date completed9*18.3 Total depth eft. If A, B, or C provide PYVSID # = Well Log (YIN) �J Sanitary seal (Y/N) Wires properly protected (YIN) _A-/ Cased to Aft. Casing height (above ground) is 4-- in. FROM WELL LOG AT INSPECTION Date of test q 1W JA3.1 415 Ozi Static water level 49 ft. 5 .k— ft. Well production to g.p.m. '57, 77 9 -p.m. WATER SAMPLE RESULTS: Coliform 0 colon' s/1 ml. Nitrate g5XIA. Other bacteria 0 colonies/100 ml. Date of sample: S O Collected by: ("-TG) 5 taJG t,.i c�c-�/•J G--� B. SEPTIC/HOLDING TANK DATA Tank Type/Material 7p1`e' Date installed �3 Tank size 1 gal. Number of Compartments Cleanouts (YM) Foundation Geanout�(Y�/NN)(� – Depression over tank (YIN) High water alarm (Y/N) Date of pumping Pumper J is C. A@SORPTION FIELD DATA Date;hatatled Soil rating (g.p.d./f ? . fP/bd [l1Gt � System type %� <+.l L H aL Length —�� ft. Width Lb4 4 ^Z• ftA!06u Gravel below pipe S ft. Total depth `7•5ft. Eff. absorption area 4foft= I Monitoring tube _`� Depression over field A-1 Date of adequacy test S Z Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test In. Water added4jobal. New depth in. " Elapsed Timer min. Final fluid depth —ZIn. Absorption rate >= 45?) g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) A10A14 44 rt � AJ If yes, give date ea"P, /W I'WU'f t t ' YLhx'I G— fit,( 21 f.1 r, T7--57'. D. UFT STATION Date installedA/ !� Size in gallons "Pump on" level a _ in. 'Pump oti level at in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankASAWroon on lot 100 r Absorption field on lot /00 r 4+' Public sewer main ev I r /septic service line Manhole/Access (Y/N) High water alarm level at Masts alarm & circuit requirements? On adjacent lots f 90 ! �— On adjacent lots Dt7 r'Y Public sewer manhole/dearwut Q Holding tank Z.1— SEPARATION rSEPARATION DISTANCES FROM SEPTIC/ NK ON LOT TO: i Building foundation Property line -r r Absorption field S r Water main %N Ar Water service line / i Surface water I Ofl I ^t- Wells on adjacent lots _LQ_ in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line O rt- Building foundation (Q t Water main I Water Service line / O r + rface water. O O } - Driveway, parkirplvetdde storage 1 d f I Curtain drain h' / Gl ells on adjacent lots !U' +- F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspecflons and review of Municipal records that the above systems are In conformance with MOA HAAguidelines in effect on this date. Engineer's Printed Name '/` a E Q ' �• Cc Data 4z ! 0 HAA Fee $ 3 7 S , 00 Waiver Fee $ _ Date of Payment Y / y / 0 Z Data of Payment Receipt Number O) S' 0 0 S Receipt Number (Rev. 72100) a Mar -26-01 12:(Isom From -PRUDENTIAL JACK 49077623189 T-213 P 002/002 F-242 0 1G/,y it -� I I i 6-c,�j 1 IF a v V ' w r N i � O % rr \rf-, V-4 AS -BUILT I hereby certify that I hnve surveyed the following dcseribm Mehonge Recording Zlreeinct. Alaska. and that the improve mento altoattd thereon tae within the prvp#M lines and d not overlap or tmeoaeh on the property lying adjacent tbere to. that ao lmprevements an prepvrty tying adjacent therm anatnch on the premise in question and that there are tr roadwam transmission lines or other visible easements o acid property except as indicated hereon Dated at Eagle River, Alaska eh;. zs �. ,.y or T.t•r�, 19h.•-- ROBfnT C. JOHNSON Z. SCALE: • Registered Land Surveyor No. 60 -LS 1" .3 G Box 456. Eagle Rivtr. Alaska rhone (907) 694-2513 Parcel I.D. # MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH 8 HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING O S— I - acq z. - a 7 GENERAL INFORMATION HAA # F1EOD Cl -100 Complete legal description Lot 15; Block 1; Henkins Subdivision Location (site address or directions) 16116 Division Street Chugiak, AK ti Property owner Temmie Roberts Day phone 696-3018 C Q HFS Mobility Services Attn: Nuala McKenna Mailing address 40 Apple Ridge Rd. Dansburv, CT 06810 Lending agency Day phone ',Mailing address Agent Lynn Swanson/ Jack White Real EstatqDayphone Address 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 694-5500 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-M JR.. 1A 'F, t MOA 621 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& S ENGINEERING Phone 6 01 Y -'>-Cl 7 y 17034 Eagle iverSop oa No. 404 Address Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments M ItlTir Date `j A /9 7 ;k ROBERT C CowAN %, CE -8801 bedrooms, with the following stipulations: Date l Y 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. r2425(p .1191) 8. WAND f."rJNlar^RNnA.L sE ,��,`Es•ctvlsic�l.. . ChJIRot� e Municipality of Anchorage SEP C-) 1997 DEPARTMENT OF HEALTH & HUMAN SERVICES RECEIVE Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: L-ar IS Ri 14ftiK,w, 41) Parcel I.D.: Oa7 A. WELL DATA Well type PeIVATF- If A, R or C, attach ADEC letter. ADEC water system number Log present i�i 1) 1 IPA Date completed Total depth / �/! Cased to 7 Casing height (above ground) 12,1 + Sanitary seal &I Wires properly protected Y�1) FROM WELL LOG n Date of test Static water level '`fi Well production fin, D g.p.m. WATER SAMPLE RESULTS: AT INSPECTION 5---7 9 - p.m - Coliform -4- Nitrate 'Z A2 Other bacteria Z Date of sample: /gt Collected by: / B. SEPTIC4HOLDIN�G, /TANK DATA Data installed Tank size - AW Number of, Compartments a Cleanouts N)� Foundation dean/out (Y® - t40_ Depression (V/® High water alarm (Y6I /_ Date of Pumping , Q-�- 9 Pumper _ .-rp, t5 C. ABSORPTION FIELD DATA. .. Date ipstalied 'Soil rating (g.p.d./ft' or ftYbdrm) System type 're& e- i Length �` —Width OK Gravel thickness below pipe 5� Total depth Effective absorption area Monitoring Tube present Y�/ q� Depression over field (YA1 Date of adequacy test Results '1) P > ; For Mde-&�e- bgdrooms tiJ S Fluid depth in absorption field before test (in.); " Immediately after gal. water added (in.): " 5 N SM T Fluid depth (ins) Minutes later: 4/ rn �'e Absorption rate = 4 -�Sl� g.p.d. 49 , .4744 4440 ra S.) 040�j1 Permdde trea ent (past 12 months) (YM��i{) /lf If yes, give date ` 72-026 (Rev. 9/913)• :S 5---7 9 - p.m - Coliform -4- Nitrate 'Z A2 Other bacteria Z Date of sample: /gt Collected by: / B. SEPTIC4HOLDIN�G, /TANK DATA Data installed Tank size - AW Number of, Compartments a Cleanouts N)� Foundation dean/out (Y® - t40_ Depression (V/® High water alarm (Y6I /_ Date of Pumping , Q-�- 9 Pumper _ .-rp, t5 C. ABSORPTION FIELD DATA. .. Date ipstalied 'Soil rating (g.p.d./ft' or ftYbdrm) System type 're& e- i Length �` —Width OK Gravel thickness below pipe 5� Total depth Effective absorption area Monitoring Tube present Y�/ q� Depression over field (YA1 Date of adequacy test Results '1) P > ; For Mde-&�e- bgdrooms tiJ S Fluid depth in absorption field before test (in.); " Immediately after gal. water added (in.): " 5 N SM T Fluid depth (ins) Minutes later: 4/ rn �'e Absorption rate = 4 -�Sl� g.p.d. 49 , .4744 4440 ra S.) 040�j1 Permdde trea ent (past 12 months) (YM��i{) /lf If yes, give date ` 72-026 (Rev. 9/913)• D. LIFT STATION Manhole/Access High water alarm level at' Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at' SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off" level at' Septic/holding tank on lot 4Z/ On adjacent tots Absorption field on kri My On adjacent lots Public sewer main UFi Public sewer manhole/cleanout Sewer /septic service line a,51 5 l Nt station y SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 6' Y Property line /©14 Absorption field 5 f Water maintservice line �0, j Surface wateddrainage lQQ '4 Wells on adjacent lots 100 r f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /Dry Building foundation (p r+ Water main/service line �10 14 Surface water /M M Driveway, parkingNehicle storage area 5 Curtain drain ,JnrJf K.inwn% Wells on adjacent lots F. ENGINEER'S I certify that I have determined thru field inspections and review o/ Municipal in conlorrnarrce w►M`/?��delJpes in effect on this date. Signature_ Engineers Name C- /�e ✓ �^� Dateg ` 3 /9 7 HAA Fees 6C ' G7J Date of Payment3 % Receipt Number 10L (2-7 72-026 (Rev. 3/90)" Waiver Fee $ Date of Payment Receipt Number the t, WseVT c. COWAN CE -9801 ift are a MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH B HUMAN SERVICES �) Division of Environmental Services' Services Section ' •'.. :. r i P.O. Box 198850'Anchorage, Alaska .99519-6650 ,• : z. , r', .._( -.,�i i.t r� �.ai _.. . r 343-4744 .,CERTIFICATE OF HEALTH AUTHORITY : :APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 01-1 — L9 2 — •a 7-11 n ', .HAA # 1. GENERAL INFORMATION,.- _ Completteelegal description -Lot 15 Etoch 1; N¢nki•na Su6di%;tiion J~ Location -(site address or directions) 16116 Divialon - - - • zti�� •,-z Eagte R.ive4. AK 1 '.'• a ., \r.Z 762-2130 .. Pro partyownei,y ` Manfz Foal Day phone __-. •._.' address " P.O. Box 241803 Ancho e, AK 99524 - • Mallin address '" '� `. Lending agency ti �� Day phone • 'Mailing address ty .t)Qdo RIAVO / RomeY n F Po Ridnn 694-4200 Agent• F 6—ag Day phone - - Address 16600 Centeii6ield'D2iv2 Eagle Riven, AK ... V !Ac Y' • , .• / . S.F., - ", t _ Unless otherwise naquesfed, HAA will be held for pickup fir` 4. NUMBER OF BEDROOMS. T 4 3. _TYPE OF WATER SUPPLY 1 Individual well ''XXX T: Community well : r lL- - - .•.Publicwater -- _ NOTE. if community well system, provide written confirmation from State ADEC attest-' \ Ing to the legality and status of system. _ 1 4. TYPE OF WASTEWATER DISPOSAL. n 1 r T Individual oh -site" , XXX Holding tank -7-7' n' n t ii'sd.t'%tYrt:Jl.-�rt•J Ac,,n r.., ,. T{ } 'r y i..' i'�•, tT :� Uf•�,�I •f..1,1 '� ti, ;.. Community on=site , ply- i',, .•e- 1 r ' >."��' r .••Cr O .•...x- - ••Public sewer....c,� �. , L ,.).,. .I., : ! m r^ v'rttL ,cs.. x,17'_ 1 r l � ` t-�" a ., z , 7-. .wa'.L..+w aT,.,.raL, :; 3,t, o! v'J + -, Ji•..�� ioJ uGs a-i..:f 'r'•h'. t � ; .. NOTE If community wastewater system, provlde written confirmation from State ADEC _ _.•hr-.�... -. .-c . _ s -....-..._..i iii2 �.-i tri iCi.-'CNt--.•t..+..-7n.::^� attesting to the legalityand status of system. 72-M(Nw. rn1) lim u0Am - - _. _,;>„'„•M, .. 5. STATEMENT OF INSPECTION BY, ENGINEER N 7 As certified by my seal affixed hereto and as of the validation date shown below, I verity that Investigation of this Health Authority Approval application' shows that the on-site water supply;;�',�t and/or wastewater disposal system is safe, functiona I I I and I adequate for I"he'numbe . r of be*drooms-' and type of structure Indicated herein. I further verity that based on the information obtained from the Municipality of Anchorage files and from my Invest!qation 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.. S & S ENGINEERING 00 Name of Firm V War Road No. 20+— Phone q y - >-9 7 .agle River, Alaska "577 Address 9 --Eri6ineees'signiture Date' a/ :L A OF ROBE RT C- COWAN 4e DHHS SIGNATURE"" FC -T .z Approved for,� 3bed r-O'om,� -S-.' `Z-- Disapprovedr A % �L.. Conditional approval for harimnnr�q with-thA ffillni4ing stipulations L: A dditional Cornments" A ------------- ---- CAUTION nLejpal d- Aii-in-an.' Services -.(D-H.H...S.),I.a'ities'Health-A-utho'rit'y I ifill upon the representations given In paragraph 5 -above"by." an. independent a[ in in the Statiof Alaska: The DHHS does this as a courtesy to purchasers of homes ............ their ;g institutions In order to satisfy certain federal and state requii;i�r4nb: Employees *ofDHHSdonot .7., conduct,tnspectIons or,analyie data before a certificate Is ls3ued.,The Municipality of Anchorage Is not, responsible for errors or omissions in the professional engineeeswork .';,;7-, 111 t 1610A M Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Envimnmerttal Services Division 825*V Street, Room 502 • Anchorage, Alaska 99501 • (907) 3434744 h Health Authority Approval Checklist 11 � 1 Legal Description: _ 1 �r W &-ji, 1 K�,JY.4t\ s 5� Parcel 1. D.: OS-/ 072- 0 7 _ A. WELL DATA n o Well type _2jr�fL If A. B. or C. attach ADEC letter. ADEC water system number Log present&/N) J Date completed 4-.7 i) - 03 r M tM [� ur f Total depth Bb '? ` Cased to80 fEt%S,e;' Casing height (above ground) /2. Y1 Sanitary seal ON) Wires properly protected&N) a "•. FROM WELL LOG ATINSPECIION i a Date of test i Static water level 7'b So j Well production /0.0 g.p.ro. G,.z g.P.ro. WATER SAMPLE RESULTS: I Coliform C7 Nitrate 3,2 Other bacteria O Date of sample: g d S"- 9S Collected by: S i S ENGINEERING 11934 • yr LOOP R*ad j B. SEMC/I1OLD1NG TANK DATA Eagle Rlwr, Ala*a 99577 Date installed B - 6 i Tank size /000 Number of Compartments 2- Cleanoutso/N) _ jFou pdatim eteanout &4) Depression (YO_,J High water alarm (Y.W I Date *f 7 -2r -?S Pumper .1/ . A)AIP.,Z4_ + C. • ABSORPTION FIELD DATA i Date installed b-83 Soil rating (g p.d./tY or tl'/bdrm) 106 4 System type Length 5/®r Witlth Li- Gravel thickness below pipe tr Total depth Effwuve absorption area JA0 Monitoring Tube presen&M__)( Depression over field (Y® ; Date of adequacy test i-,2 9 -fS- ResultalIDFail) eAgs For bedrooms i Fluid depth in absorption field before tea (in.): >�. D • Immediately aRerS/O gal. water added (in.): a7 r I' a Fluid depth 0 (ins.) Mimnes later: s Absorption rate = V'170fi tt.p.d. Peroxide treatment (past 12 months) (Y® PI OA- VC . j •) If yes, give date y� 20�p ►-1e.1=r,A-.,45 7-oerz ttJ sysr F�r�r,Acj-�- •V,f �ilw x«�o�r— rr+zr D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump on" level *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: off' level at* Septic/holding tank on lot Ino t} : On adjacent lots %tats tr Absorption field on lot Ino t+ : On adjacent lots 1 O Q r Public sewer main Y Public sewer manhole/cleanout riI, Sewer /septic service line ZS 1 Lift station r� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Budding foundation S t F Property line Io i Absorption field 5- ' Water main/service line 10 t Surface watu/drainage l ob t + Wells on ffi 8=1 lots % k SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Budding foundation 10 t r Water main/service line 1 C,%4- Surface f}Surface water 1Qo %A- Driveway, parking/vchicle storage area ZS t k Curtain drain k-+ rJ� vL, o%A,. Wells on adjacent lots toa t'r Property line 10 t F. ENGINEER'S CERTIFICATION I cerlifv that I have determined thra field inspections and review ofUnnicipal in conformance wi h f)AAYA rklines in eJfecl on this date. Signature Engineer's Name r. C. Ce Date 10 /A Iq I— HAA Fee S 300 • e'YV Daze of Pa-. mew , Receipt Number /3J 33$ Rev. 8/95 OSS: haa.wk.doc Waiver Fee S Date of Payment Receipt Number CE -6801 Time APPLIC-IT FILLS OUT UPPER HAhONLY Time Property Owner r - r • CCC Construction Phone 6L)e (� Date P.O. BOX 647 Eagle (River, Alaska Zip Code 9957? 688-3273 Mailing Address Date Beyer tdark Ford Inspector Address 5724 Lucas Ave. Eagle River Ak. Zip Code 99577 Inspector Lending InstitutionAlaska Bank of Commerce Phone LJ11 Eagle River, Branch 99577 694-20-21 Address Zip Cede c�(1 Really Co. 6 Agent Dynamic Realty, Inc. .s Liz-6q� -33�A Phone Eagle River, Alaska 99577 694-3626' Address Zip ode ( 0 -APPROVED BEDROOMS •CONDITIONS ( ) DISAPPROVED Legal Description Lot 15 Block 1 Eenkins Subdivision A Street Location Type of Residence �✓�� /w _ _ W GLC''/ ./"'�'wc.! �l'�T�W ieFamily MuttlDie Family 0 Multiple No. of Bedroom ms �� 3 bedroom system) ❑ Other Water Supply Solis Rating6 D Date Sewer Installed Well To Absorption Area JE Individual ATTACH WELL LOG. A well log Is required for all welts drilled since June 1975. ❑ Community Septic Tank Size / ry-g For wells trilled prior to that date, give well depth (attach log If available). O Public Utlllty Sewer Disposal 2 Individual _ Year Individual Installed:.Tnl 3, 1983 ❑ Pubilc Lit"" -- When Connected to Public Utility: 11 Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: 0-D MUNICIPALITY OF ANCHORAGE r. LJ11 ,,II'' DEPT. OF Y.` -ALR' PROTECTION �n1'rr °3 hrt'✓ ENVIROti+LNTAL c�(1 ^ _ �� OCT 9 � 663 RECEIVED ( 0 -APPROVED BEDROOMS •CONDITIONS ( ) DISAPPROVED OF APPROVAL Z ( )CONDITIONAL APPROVAL' �y c` C i3O 3 A DATE BY: �✓�� /w _ _ W GLC''/ ./"'�'wc.! �l'�T�W Solis Rating6 D Date Sewer Installed Well To Absorption Area Well Log Received /46 ��• 1 Well to Tank I ..., Septic Tank Size / ry-g n ADEOUACY7EST WATER AND SEWER INSPECTION WELL INSPECTIONS AND FLOW TEST SITE PIANS ROAD DESIGN SOILTEST ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN EXCAVATION WORK CCC Construction P.O. Box 647 Eagle River, Alaska 99577 Dear Sir: Reference: Lot 15; Henkins Subdivision ROBERTA.SHAFER CIVILENGINEER 694-2979 October 19, 1983 MUNICIPALITY OF ANCHORAGE DEPT. OF H`EALTFI t. ENVIRC\ti.t:NfAL PROTECTION OCT RECEIVED. A well inspection was performed on the referenced property, as you requested. The well casing was examined and found to be adequately equipped with a sanitary seal and all wires are in conduit as required. The ground surrounding the well casing is adequately sloped away from the well. A water sample was taken from the hose bib on the side of the house and submitted to Chemical and Geological Laboratories of Alaska for an analysis for coliform bacteria. The results of this water sample were satisfactory. If we may be of further service, please do not hesitate to contact us. Silncere ? t/vV/ Ac-'-j//� /ez )'z /7 /Ss , P.E.`CL y cc: Municipality of Anchorage Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA 99577