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Home My WebLink AboutSTOCKHAUSEN LT 26GAAB-HD- I GR'~-'~r, TER ANCHORAGE AREA BOROL~"~ D~-rAFITMEI~T OF ENVIRONMENTAL 0. UALI,. 3500 TUDOR ROAD ANCHOF~AGE, ALASKA ggs07 279-8685 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: LEGAL DESCRIPTION DISTANCE FROM WELt LIQUID CAPACITY NUMBER OF /' MATERIAL ~"~ ;~'~-' COMPARTMENTS LIQUID GALLONS. INSIDE LENGTH ~ INSIDE WIDTH ~ DEPTH_ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETE~R OR WIDTH , LENGTH , DEPTH DISTANCE FROM WELL ,./~ / , BUILDING FOUNDATION NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ,./-/g'2 ~~-'''~ SQ. FT. TILE DRAIN FIELD: ,/v//,~ ABSORPTI~ SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH OF LINES ,.~/'~'TO T A L ~E IN. ABOVE TILE -- WELL: T y p E .-~..,.~D"/~-~:' DEPTH ~"~::~/'-~,'~z~''~----'?~' N E A R E ST LOT LINE /~/~'~'"~ , SEWER LINE //.2 DISTANCE FROM , BUILDING FOUNDATION. SEPTIC / SEEPAGE · TANK '~"';'~'/ , SYSTEM WATER SAMPLE ..·.-./~//_.~/r;.~ NEAREST / OTHER , CESSPOOIr,'4/,~-''~/~ , SOURC,~S~. DISTANCES: DIAGRAM OF SYSTEM ~' G.A.A.B. DATE ~ '~ '/'"~-'-" ~'::~'~'~'~ APPROVED FEB 19 ~9£ 09:33 DHR-DIV.OF_I~JATER EAGLE RIVER ...................................... ............................................................ ......... ~ ........... ~,;~v..~&/~2 ~. ..... ~~~ ......... FILE · 1)~4ILL£R SAM O0~I'EN COMP 8880 SINGLE DWFJ,.L~NG CONS ~':i~:~' WAT[:'R WELL INVENTORY C;HANGE ''' r ' , ',~ , '," P~JL R LAT N~6 LON W4~ W ALT ' MIETH ~,~ HETI4 ~ROUTING { £ATER ANCHORAGE AREA BOROL~ / DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 CASE # Performed For ,fl:~,,! Legal Bescription: Lot This Porm Reports Soils Log Date Performed ~ __Subdivision ~m~Na.~. Percolation Test 2 3 Depth Feet Soil Characteristics Ground Water Encountered?~ ~?o^ If Yes, At what Depth? Reading Date Gross Time Net Time Depth to H20 Net Drop Percolation Rate Minute Proposed Installation: S.eeoage Pit Depth of Inlet Depth To Drain Field Bottom Of Pit Or Trench Data Certified By: Date: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division.of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, AJaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # O~'i'O~2~_.-'~-- HAA# GENERAL INFORMATION Complete legal description Lot 26, Stockhausen S/D Location (site address or directions) 21423 Ginqer Lee Drive PrgPerty' oWner Mailing address James & Peggy Fowler Day phone 552-2570 21423 Ginger Lee Drive, Chugiak, AK 99567 L~nding agency Mailing address Agent Address Norwest Mortgage/Jamie Godfrey Day ~hone 694-1144 10928 Eaqle River Rd.f Suite 100, Eaqle River, AK 99577 Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 3 NOTE: Individual well x×x Community well Public w~ter If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: NOTE: Individual on-site xxx Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~ {Rev. f/91) Front MOA~t21 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 Firm s & s ENGINEERING ....... ,,,~,~ Phone ~ c4 ~ - ;~q 7 ¢/ Address Eagle River, Alaska 99577 EngineeCs signature Date / 0 DHHS SIGNATURE ,~ I/" Approved for ~ ~-~ f~ E E' bedrooms. , '- ...... -~-, Disapproved. Conditional approval for bedrooms, with th-e following stipulations: Additional Comments 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 D HHS 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. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744 Legal Description: [,~oT' '~, Health Authority Approval Checklist Parcel I.D.: '~'"ONMENTAL SERVICFg ~!V!_~fO~ A. WELL DATA Well type ~I~,U'~'T'-/,- Log present ~)N) Total depth C]I ) Sanitary seal ~) If A, B, or C, attach ADEC letter. ADEC water system number Cased to FROM WELL LOG Date completed Casing height (above ground) Wires properly protected~N) AT INSPECTION Date of test Static water level Well production [O, 'O g.p.m. ~, ~ -F g.p.m. WATER SAMPLE RESULTS: Coliform ~ Nitrate [. ~ 7 ~' Date of sample: ~ .~.f/_ c~ ~, Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed b - ~. S-- ~/2~ Tank size I'~:>c:, Number of compadments ! Cleanouts~)'N)~/__ Foundation Cl~anout (~/N) ,,/ Depression (Y/{~ ~ High water alarm (Y/N) /'3IA;' j Date6fPu~nping o~,,~;~.,~,, Pumper C. ABSORPTION FIELD DATA Soil rating (g.p.d./fF or ft2/bdrm) Lengt'h /(~' Width ~ 7~/~7~' Gravel thickness below pipe Effective absorption area '/~ Z~-'~ Monitoring Tube presentl~N) y' Date of adequacy test ~-~ 2 - ~ ~ Result~ail) Fluid depth in absorption field before test (in.); ~ ~ ~ Immediately after~/ gal. water added (in.):, Fluid depth ~. ~ (ins) Minutes later: / ~ Absorption rate = g.p.d. Peroxide treatment (past 12 months) ~)~N~/~o ~ If yes, give date sYstem type ~'-~----, ~ ~ s Total depth /~ / Depression over field ("~ ,~ For ~ bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump on" level at* ~* *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ~'~ ~ /"~F-,¢~ ~ ¢-~r-Cr~')On adjacent lots t Absorption field on lot Public sewer main Sewer/septic service line ~' ~ '~' On adjacent lots t. ~ ~''~ Public sewer manhole/cleanout Lift station /"~1 ,~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation \ b ~4- Property line { o IA' Absorption field ~ '[ Water main/service line (-¢ ~- Surface water/drainage ¥o,p ~k- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ~ t Building foundation lo ~' ~' Water main/service line Surface water ~¢ o ~ cc Driveway, parking/vehicle storage area Cudain drain ~ ~ - ~o~ ~ ~ Wells on adjacent lots F, ENGINEER'S CERTIFICATION ~-~ OF ' cedify that lhave determined thru field inspections and review of Municipal recor~ ~{he ab~ in conformance with MOA HA uidelincs in effect on this date. ~ ~/- 4~. Signature - ~ ~ : HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number OCT-D2-g8 15:09 FROki'CTE ENVIRONMENTAL · ~t~ C T&E EnvimnmentalServic.,,.c. T-6gg P.O~/03 F-777 CT&Ig ReL# Clieut Name Project Name/// Client Sample lg} Maw~x Ordered By PWS~ 985598001 S & $ L 26 ~rc'l~ Haxtsen DriVing Water 0 SampleR=marks: Client Printed Date/Time 10/02/98 09:59 CollcctedDate/Time 09/27/98 13:30 Received Date/Time 09/28198 10:30 Technical Director: ~ephcn C. Ed~ 0 cot/lOOmk $~18 9~22B 09/2~/98 1.75 0.100 mS/L [?A 300.0 10 qmn Og/lB/9B 0912B/95 GCP MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~\-~¢'J~¢)--~---~ HAA# ~'l~c~ :~~;~,'~ GENERAL INFORMATION Complete legal description Lot 26; Stoakhau~en Location (site add'ress or directions 21423 Ginger Lee Lane Property owner Mailing address Paul Curtis ~II~ ~ Day phone 3542 A16xander Anchorage, Alaska 99508 Lending agency Mailing address Day phone Agent Virgi~a Kohfield RE/MAX OF EAGLE RIVER 'DaY phone Address 16600 CCnt~rfield Drive, Ea¢le River. Ak 99577 Unless otherwise requested, HAA w/l/be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 3 XX 694-4200 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If.community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~025 (Rev, 1/91) Front MOA #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 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 Address Engineer's signature 17034 Eagle River Loop Roa(J No. 2(~ Eagle River, Alaska 995?7 Phone Date DHHS SIGNATURE r~ Ap'proved Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date "~" ~' - ¢' >- 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. (~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: '~-"~'¢ '~' ~' S'Cc~-~--'t~/~.-.¥-'~,~ Parcel I.D. (.) ~-~- A. WELL DATA Well type ~'~ Log present (~/N) Total depth Sanitary seal ~N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~- ~/--t-??--- Driller ~-->,~v~ Cased to '~r c:~ ~ Casing height I .Z_,i 4- Wires properly protected ~/N) ' ~ FROM WELL LOG Date of test (-~ Static water level ~"~'~ Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform (~ c'" ~'~/tc<~ ~-- Nitrate Date of sample: g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/¢leanout Petroleum tank Collected by: B. SEPTIC/HOLDING TANK DATA On adjacent lots Absorption field Other bacteria /~ ~ ~ F~. S & $ ENGINEERING 17034 Eagle River Leop ~oad No. 204 Eagle River, Alaska 99577 Compartments \ ' Depression (Y,~ ~ Date installed L~ .- ~,~'.'"7'/~ Tank size '~¢,~,o ~ ~ Cleanouts ~N) ~ Fogndation cleanout ~N) V High wat~¢;alarm (Y~ · ~, Alarm tested (Y/N) Date 0f p~mping , ~ T. ~; Pumper SEPARATION 'DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~. :; ~¢ To propertyline ~ ~ ~%~ Surface water/drainage Foundation \o ~' Water main/service line ~, o ~.~ :' ". : !~. CONTINUED ON BACK PAGE C, LII"T STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level ~ Meets MOA elect~ ~STANCE FROM LI FoT~lc~t 7o~; Manufacturer Manhole/Access (Y/N) ~evel at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed L~ - ~,~' -"J ?.-.- Soil rating Gravel thickness Lc~ Cleanouts present(i~/N) Date of adequacy test for '~ F-~¢.~.~ L'~ /"¢~/'~ ~ ~ ~/~ If yes, give date. Length ¢-¢¢ ;, ~5,' Width Total absorption area Depression over field (Y~,~ Results (;~/fail) Peroxide treatment (past 12 months) System type Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: On adjacent lots Surface water Curtain drain Wellon lot To building foundation E, ENGINEER'S CERTIFICATION: On adjacent lots ~,~:'o '' '~'' Property line To existing or abandoned system on lot Cutbank ~,,-~- l ~ Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date ENGINEERING ~7e~4 ~le R vet Loop Roar~ NO, 2(~ HAA Fee $ / '~ 0 ¢ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number H^FER .¢ No, ~ CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS ioz INVOICE ~ 51288 Chemlab Ref.$ 92.0683 Sample $ 3 Matrix: WATER Client Sample ID PWSID Collected Received Preserved with L26 STOCKHAUSEN SD. Client Name :S & S ENGINEERING UA Client Acct :SNSENGP FEB 19 92 @ 13:00 h~s. EPO~ : FEE 20 92 @ 16:00 hrs. Req~ : AS REQUIRED Ordered By ;NAY PO# :NONE RECEIVED Analysis Completed : FEB 24 92 Laboratory Supe%vl~z__t~_~_~..~EPHEN C. EDE ReleasedBy :~ ~....~ Send Reports to: I)S & S ENGINEERING 2) Sample ROUTINE SAMPLE COLLECTED BY: RAY. Remarks= I Tests Performed See Special Instructions Above UA=Unavailable ND- None Detected "See Sample Remarks Above NA= Not Analyzed LT-Less Than, GT-Greater Than ~SF~S Member of the SGS Group (Soci6t6 G6n6rale de Surveillance)