HomeMy WebLinkAboutBROADWATER HEIGHTS BLK 3 LT 5AP44 24.�A *\ 0 60 - ()%R1�LAO Development Services Department Building Safety Division �P GL 8Li On -Site Water & Wastewater Program 4,14 4700 Elmore Road z�_o U r01 P.O. Box 196650 " Mark Begich Anchorage, AK 99507 s a ` E r Mayor www.muni.org/onsit1.7 (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Parcel Identification Number: (%;-v, Oel • 1( () Date of Issue: Legal Description Property Owner Name & Address: °7 rtl_ j TOM HENRY ilL\: aLt yy�� 12008 W SKYLINE 3 L ,�j iC EAGLE RIVER, AK 99577 Pump Installation Date: MARCH 23. 2016 Pump Intake Depth Below Top of Well Casing: 249 Pump Manufacturer's Name: RED JACKET Pump Model: CN8S16 Pump Size 314 hp Pitless Adapter Burial Depth: 12 feet Pitless Adapter Manufacturer's Name: MARTINSON Pitless Adapter Installer: N/A Well Disinfected Upon Completion? F/I Yes ❑ No Method of Disinfection: PELLETS Comments: feet Pump Installer Name: ANCHORAGE WELL & PUMP SERVICE, INC. 330 E 76TH AVENUE ANCHORAGE, AK 99518 Attention: The pump installer shall provide a pump installation lag to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE DE► ITMENT OF HEALTH AND HUMAN SER% ES Environmental Health Division ( /� 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES 1A/0,e TO FROM SEPTIC TANK ABSORPTION FIELD WELL e ss Phone(s) Permit No. No. of Bedrooms WELL ��Q f, 90 Q 12 9 D2-7� LOT LINE /Q _ L LEGAL DESCRIPTION Lot Block Block Su wsion FOUNDATION !` r ,b Q ,�, Range, Section Township, AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, /VA) , " / i / !�' / driveway, water bodies, etc.) �--- TANKS /�•/it/ �' 0r JL tM X SEPTIC ❑ HOLDING Manulacturer Capacity in gallons _ �o0 Ir Material No. of ompartments e! /L ► `� TYPE OF SYSTEM ATe '1 ❑ TRENCH BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom Iro� Total depth from original grade / 5 original grade FT 21 FT Fill added above original grade _ Gravel depth beneath pipe eli Z FT FT Q , Gravellength 39 Gravel width / FT `8 FT 2 qhu q� Total absorption area Distance between lines t�5 SQ FT 6 FT L__4j Number of lines Soil rating Pipe material D SOFT G _80J �Z I Installer Date Installed GI,A /3 S. R -- Z /`-- 8 ii WELLS c V PRIVATE ❑ OTHER (Iden l Classification (A, B, C) Total Depth [Cased to Installer Date Installed: FT FT REMARKS: .irk /,-V,r7d9 L L 150 TIT Scale: /V. F .-P• Inspections Performed by: "�� O : A Date. ••�v 14//a, �41 , is INILPIVI /V K. / G — LS<< ri/L �! J.. /LrjGitl a• • 'we•r�^ ING arc ISR B 196Xcertify that this inspection was Municipal anfAGE 11ffV9kc/ A :597 -/Zi IHealth Department Approval: 79_ni'i r`i/RFt Date: ormed according to all $6 .... .... c. —n .. a�,n S a.. b.rt A. sher{vir ' •• No. 1457-F AW 011������������ ' DEPARTMENT HEALTH AND ENVIRONMENTAL ROTECT3ON ' 825 L STREET, ANCHORAGE, AK 99501 ~ ^ 264-4720 " APPLICANT: LORRAINE MINOR /S&S ENG. ADDRESS: GR BOX 196X EAGLE RIVER, AK 99577 CONTACT PHONE: 694-2979 LEGAL DESCRIP: SUBDIVISION: BROADWATER HTS. LOT: 5A BLOCK: 3 SECTION: 1 TOWNSHIP: 14N RANGE: 2W LOT SIZE: 31 (SQ.FT. OR ACRES) I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN., SIGNED DATE: -..~-- - --.��r ---�-�—�------- APPLICANT: LORRAI ISSUED BY DATEx _-_______________________________ ' PERMIT NO: 860276 UPGRADE ` DATE ISSUED: 08/08/86 APPLICANT: LORRAINE MINOR /S&S ENG. ADDRESS: GR BOX 196X EAGLE RIVER, AK 99577 CONTACT PHONE: 694-2979 LEGAL DESCRIP: SUBDIVISION: BROADWATER HTS. LOT: 5A BLOCK: 3 SECTION: 1 TOWNSHIP: 14N RANGE: 2W LOT SIZE: 31 (SQ.FT. OR ACRES) I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN., SIGNED DATE: -..~-- - --.��r ---�-�—�------- APPLICANT: LORRAI ISSUED BY DATEx _-_______________________________ ' a Municipality of Anchorage � r w X ....••► DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 ♦ �» SOILS LOG --PERCOLATION TEST Its �a •. Orr ,tw, PERFORMED FOR: � �Z�.�1�► f �1�� t I-) a-- DATE PERFORMED: LEGAL DESCRIPTION: SIa. S�j Cr, �y Township, Range, Se, 10 11 12 13 14 R! WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? ;tion: -T-1 +,-i 1 S— ITE P AN � Depth to water After llA�„� Monitoring? Nia Sti1eTW- Date: / �N F' 16 Seb.rt A. Shafer 1404 .01 4 17 -4y •Ir 18�► 19 Ka] COMMENTS S & S ENGINEERING S L O P E -i ading Date Gross Time Net Depth to Time Water Net Drop SLOPE (`F E EZ) 1 � ••r i-` 2 dam. 4 C- �4 5 0 7 9 10 11 12 13 14 R! WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? ;tion: -T-1 +,-i 1 S— ITE P AN � Depth to water After llA�„� Monitoring? Nia Sti1eTW- Date: / �N F' 16 Seb.rt A. Shafer 1404 .01 4 17 -4y •Ir 18�► 19 Ka] COMMENTS S & S ENGINEERING S L O P E -i ading Date Gross Time Net Depth to Time Water Net Drop PERCOLATION RATE —'f A (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN —_ FTAND FT PERFORMED BY:MLE i AK 995 — CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL �UIDELI EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) S & S ENGINEERING SR B 196X EAGLE RIVER, AK 99577 DESIGN CRITERIA Lot 5A; Mock 3; Broadwater Heights 3 Bedroom house. tx.%Atng 1500 Gatton Septic Tank SoM = 150 4quare beet per bedroom Use a Bed: 1) 2 gees deep 2) IS deed: X 38 AM 3) 6 inch gravot aver and !.finder per6orated pipe 4) 2 .inch DOW - A - In4utati.on 5) 2 beet minimum 6.itt hauled in aver top o4 4y4tem - side 4tope at 3:1 -.fop 4 inches to be top 4o.i.L. NOTE: A lift station wift be �tegiw%ed. Use a 500 gallon Anchorage Tank Qt 4ry4tem or equ,ivatent. 9 If %'Af, —ki 01 _ w yf� �5���t�`7 �O 5 0 z hr�ry�v�b rya y N''�� r( y 40440 y " /q 0 3ldOS / // 4 Ci i !Opp qT 0:to AV 9 If %'Af, —ki 01 _ w yf� �5���t�`7 �O 5 0 z hr�ry�v�b rya y N''�� r( y 40440 y " /q 0 3ldOS / // 4 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES} T 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. # CILL - CIL - QAC) HAA # IAEA 1 aD �--1L-1 I 1. GENERAL INFORMATION_ Complete legal description 6z,., Location (site address or directions) IZ C)C9 Se_YL, tj a De - Property owner-T-rAo+uA—s Fjzr_, r- Day phone Z(o C/ ` Z./ Z c-';' Mailing address 11005 10 SP{uNa; 9n C -it-& Lz � Air- 99 S77 Lending agency �� �f%� Day phone Mailing address Agent i;y e .max, / �-ti� /�!/cv`AKc Day phone % SfZav 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 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 DL 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. 72-025 (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 X. 4aw"Z") Phone 694 -as7�-1y Address 7�0 2-1 Engineer's signature 6. DHHS SIGNATURE /K Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments Date -Alli11. bedrooms, with the following stipulations: By: -� c f r� 'SM n -W Date `1L23/1Z 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 821 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lr�;A- P"x 3 Parcel I.D. Fb,e0"c0AgW0_ A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number /J Date completed UN 4�u0w� Driller I'iLr- MWaw Log present(Y�N Total depth Cased to Casing height Sanitary seal 6A) Date of test Static water level Well flow Pump level Wires properly protected�fY V) FROM WELL LOG g.p.m. 6, SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /,5/0 ; On adjacent lots /�Dt Absorption field on lot /3f ; On adjacent lots Public sewer'imain A4 Public sewer manhole/cleanout / ale, T AX"', Public sewer service line A1.0 Petroleum tank "' 14a1 -1.y o WATER SAMPLE RESULTS: Coliform '- 2�� 12-- Nitrate Other bacteria Date of sample: ,L-- Collected by: (7-)X 9=e4t:1_= CA4 B. SEPTIC H41011 "lift TANK DATA Date installed UK Tank size lSE-0 Compartments Z Cleanouts jt�y.'/N) Foundation cleanout (Ya Depression (yg j High water alar ly;#- Date of pumping `/ZZ Alarm tested(- ' � SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot %790 On adjacent lots « Foundation To property line® Absorption field 58 Water main/service line Surface water/drainage°¢ /o/ Al"k7- 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE ra AT INSPECTION o z 7217 z rn /�4 �rt I {�I tl�il rn N �AY _y G) O rn Z Septic/holding tank on lot /,5/0 ; On adjacent lots /�Dt Absorption field on lot /3f ; On adjacent lots Public sewer'imain A4 Public sewer manhole/cleanout / ale, T AX"', Public sewer service line A1.0 Petroleum tank "' 14a1 -1.y o WATER SAMPLE RESULTS: Coliform '- 2�� 12-- Nitrate Other bacteria Date of sample: ,L-- Collected by: (7-)X 9=e4t:1_= CA4 B. SEPTIC H41011 "lift TANK DATA Date installed UK Tank size lSE-0 Compartments Z Cleanouts jt�y.'/N) Foundation cleanout (Ya Depression (yg j High water alar ly;#- Date of pumping `/ZZ Alarm tested(- ' � SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot %790 On adjacent lots « Foundation To property line® Absorption field 58 Water main/service line Surface water/drainage°¢ /o/ Al"k7- 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed -- 2?/�c Manufacturer Lt,•�. Size in gallons Manhole/AccessO/N) Vent A "Pump on" level at -74-3 �c "Pump off" level at 5g High water alarm level ,-/& Cycles tested Meets MOA electrical code&N) 402M r` 0 1-- IVZe;;L- SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot /12-1— On adjacent lots A00MSurface water A10AA5 D. ABSORPTION FIELD DATA Date installed _6 �ZZ/ (o Soil rating �� '�' System type 15672�) Length '20 ( Width lg Gravel thickness y Total depth � Total absorption area (""[ Cleanouts presentd'N) Depression over field (Yo Date of adequacy test Z_ Results (pass/fail) for Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: bedrooms Well on lot % On adjacent lots Property line To building foundation To exie*n"r abandoned system on lot coco On adjacent lots IV, UAf 6- Cutbank 10(4' Water main/service line 0 Surface water '62ti's'- Driveway, parking/vehicle storage area Curtain drain AIT,-- &�A! E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature �` • ,,�* �: 44 Of Engineer's Name ff �a • Date �% /2e� / �l 2f M; David R. Daytm S gi �•• 010. 2105-E do HAA Fee $ / Z-0 Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number D. R. DAYTON, P.E., R.L.S. Chugiak, Alaska 99567 20210 Donalar St. July 20, 1992 ADEQUACY TEST Legal Description: Lot 5A, Block 3, Broadwater Heights Date of Test: July 18, 1992 (907) gx,l 696-2417 Septic System: 1500 gallon, 2 compartment septic tank (DHHS Records) and 500 gallon lift station Absorbtion System: 18' x 38' bed (DHHS Records) Soils Rating: 150 sq. ft. per bedroom (DHHS Records) Design Flow: 3 BR x 150 qal/day/BR = 450 gallons per day Test: 695 gallons of water were injected into the absorbtion bed in a 3 hour period. Results: The absorbtion bed accepted more than 1500 of the daily design flow with no rise in the liquid level in the monitor tube. Conclusion: The absorbtion system is currently functioning adequately. OA- A4 &°° ee �* David R. Dayton NO. 2205-E '✓ --•°•s•°°,•' % ;OP OfESS�©� CT D. R. DAYTON, P.E., R.L.S. MUMMM1026 Chugiak, Alaska 99567 (907) UMO&I 20210 Donalar St. 696-2417 July 20, 1992 WELL FLOW TEST Legal Description: Lot 5A, Block 3, Broadwater Heights Date Performed: July 18, 1992 Depth of Well: 254 feet (DHHS Records) Static Water Level:14.2 feet below top of casing Test: The well was pumped for 2k hours at 3.5 gallons per minute. The valve was then opened full and pumped for 30 minutes at 5.7 gallons per minute. Results: The well produced 524 gallons in 2h hours at 3.5 gallons per minute with a drawdown of 33.8 feet. The last 30 minutes of pumping with the valves fully opened produced 5.7 gallons per minute with a drawdown of 39.2 feet. Conclusion: The well is currently producing adequately for a 3 bedroom house. ' 6F Ali '�����me odg9u}�o � ygu��► 9T •S. WwM•�•►w •••ate+ • •• .g David R. ©ayfon NO. 2205-EAw • ; �% pROFMO' ''w CHEMICAL & GEOLOGICAL LABORATORY ka — A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. L�fOw.7ow• 563313 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (BOT) 5024343 FAX: (607) 581.5301 ANALYSIS IEMOLTS fez INVOICA 1 55911. Che>,lab Ref.1 92,3515 Saw* i 1 IlatsiY: WITe1t Clleht Semple ID : L5A 13 UOAD1lATIR 008. Client Nate :DAViO DAYTON, !,>l. Clie� Acct �DAYIDDA 40# .NOMI R[CIIVID Reg1 Ordered By :DAVID UITON MID : CA Collected JOL 15 92 ! 14:00 Imre. Received in 16.92 1 12:30 hz/. Pceeezved with AS 190MIED Anelpsis Cmpleted M 20 92 Labolatory SuperN DE Released If _ , _. Send Report/ to: 1)DAVID DAYTON, P.E. 2) .. __ _ _uu..............aa....r...a...r.................................0 ■.r....a.paxamater......... • • ... .t.......e... uemm�.'.a........uv.. Results Unit/ IbthOd Allotreble Liedt/ " -------"------=-------.---------------------------d.A s9/1 IPA 353.2 ----KITRATE-N 10 SaMpie RORINE SALE COLLICTED W D.I. DAYTON. Rsssttks :...... .rr.. r.rv....ay...a.........a...........au............................ eeMenem............r..r..r..uua.u..wa.re.. M..r.a I Test/ Potfoerd Bob Special Io/tsuctions Above DA-umnilable IDM Now Detected " See Sample Kmmr o Abort U. Not Analysed LT -Lees Than, 0-01e6te: Ih/n Member of the (ams Group (Soc16t6 Un6rele de Surveillance) EOd tbo 00000000000000000000 00000000000000000000 95:t[ Oa—LO-266 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 5A Block 3 Broadwater Heights Subdivision Location (address or directions) Skyline Drive (b) Applicant Name Lorraine Minor Telephone: Home 694-4804 Business 694-4200 Applicant Address Re/Max of Eagle River (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other EK (explain); Real Estate Agenet (d) Lending Institution Alaska Pacific Mortgage Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Ek Multi -Family ❑ Other Number of Bedrooms three (3) 3. WATER SUPPLY Individual Well Mx 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 DISPOSAL Onsite Px 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 72-025 (11/84) 5. ENGINEERING FIRM PROVIDIN%i INSPECTIONS, TESTS, FILE SEARCH, DA i'A AND INFORMATION As certified by my seal affixed hereto and as oft he 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 S & S Engineering, Robert A Shaf lephone Address Date Engineer's Seal This department has received written confirmation from the engineer regarding the Conditional Approval of November 15, 1986. The corrections have been accomplished and an inspection has been completed by the engineer. The subject property meets with Municipal standards and is now approved. 6. DHEP APPROVAL Approved for three(3) bedrooms by to August 27. 1986 Approved XXXXXXXXXXXX Disapproved Conditional Terms of Conditional Approval 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 2of2 72-025 (11/84) - k1 MUNICIPALITY OF ANCHORAGE (MOA)�V `LTJ / HEALTH AUTHORITY APPROVAL (HAA) I.CE_C' CHECKLIST — FEBRUARY 1984 264-4720 At �� ''` ✓ Legal Description: L 47A 8 3�✓ A. WELL DATA °f Well Classification 42,a 74 If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y N) Date Completed �U/ r1 !v _ Yield Or Sow - Total Depth 2S Cased to Depth of Grouting Static Water Level 2 / / Pump Set At 1.4 L -r Casing Height Above GroundZ' 7 Sanitary Seal on Casing (Y N) Electrical Wiring in Condui (Y N) Depression Around Wellhead (Y6 Separation Distances from Well: To Septic/Hofdtrg-Tank on Lot /00 4 ; On Adjoining Lots To Nearest Edge of Absorption Field on LotD �� ; On Adjoining Lots /, t To Nearest Public Sewer Line ".-f To Nearest Public Sewer Cleanout/Manhole ^f M To Nearest Sewer Service Line on Lot Water Sample Collected by -� �S.S' ��rlwe �i`01�+..., ; Date Z° �/6 AS— /UO Water Sample Test Results Comments C L/ C Cty^ /",, B. SEPTIC/HOLDING TANK DATA I/ Date Installed Size /SUy No. of Compartments Z Standpipe (Y N) Air -tight Caps&N) Foundation Cleanout (Y/ Depression over Tank (Y(9 Date Last Pumped /2 a Pumping/Maintenance Contract on File (Y/N) ; for N,�h Holding Tank High -Water Alarm (Y/N) % /4 Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/H&dit1TTank: To Water -Supply Well �� (� To Building Foundation To Property Line �a To Disposal Field �2 To Water.AReWService Line Z- 71 To Stream, Pond, Lake, or Major Drainage Course ^J 0' Comments 9:!FY6 ggeoTiC Ti9`✓/? lnJr-X-AO'GL_x"q Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption: Strata l_,eV /41 Type of System Design JZ ,BEQ Date Installed 2- Z ` Length of Field Width of Field / Depth of Field Z r Gravel Bed Thickness G Square Feet of Absorption Area Standpipes Present QN) Depression over Field (Y/O Date of Last Adequacy Test ti e- �J Results of Last Adequacy Test NZ e4 - Separation Distance from Absorption Field: To Water -Supply Well fav (f To Property Line LO f +� t To Building Foundation Or f To Existing or Abandoned System on r Lot 3a ; On Adjoining Lots 4. r To WaternfService Line To Cutbank (if present) A11,001 To Stream/Pond/Lake/or Major Drainage Course /y C "` r I -- To To Driveway, Parking Area, or Vehicle Storage Area 0 -- Comments AZ4Eo-1 Bodo / A_J r'u e- 0" -70-o `✓c c 61 Ci Lr- I-fi9"G,� D. LIFT STATION Date Installed 2r LZ 2- l' Dimensions �l%0 t /01 /D/4 Size in Gallons Manhole/Acces (Y N) AG /e zz N "Pump On" Level at a "Pump Off" Level at 34 N it High Water Alarm Level at / G Vent efe Tested for V Pumping Cycles during Adequacy Test. Meets MOA Electrical Code(Y N) �L S .�e..i�- D� Comments /`-TG l-/ si Q Q 0 y` -_J - T/?"nJl� +� L l T 5-7-04, ** Check Permitted Bedroom Rating Against HAA Request ** I certify th$k &6vE""gam f, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed CQ R 1O/GY Date 'R/Z Z/8' S Compan;EAGLE RIVER. OK 99577 MOA No. G- ad 3 Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN U August 21, 1986 i I�yN1C1PAUv OF WCHORPGE pEPT. OF HEALTH & ENviRONMENTAI PROTECTIOI`i Muvu.cipa2.i.�y ab Anchanage Department ob Heatth and Human Servicez AbG Z 2 825 L Street ,^ Anchorage, Ataska 99501 ATTENTION: Steve Morr.iz REFERENCE: Lot 5A; Btock 3; Bnaaduaten Heights Dear Steve, ROBERT A. SHAFER CIVIL ENGINEER 694-2979 In November, 1985, you issued a cond.iti-onat Health Authon.ity Appravat. The conditions ob this approva.- requited engineering word, nepai'ts to the weU, and ib necesaany, upgnad.ing ob .the septic system. Engineering wadi was completed and it was determined that an upgrade ob the septic system would be nequtired. Attached is an on -6 ite sewage d%3posat system inspection nepant ne4teet.ing the aa-bu.itt conditions ban the upgrade ab the aseptic system under your penm.it #860276. The weft casing has been extended and weft wires have been ptaeed in conduit. Request you .issue a b.inat HAA ban this property. 14 you nequ i.ne additional inbarmation, ptease contact us. S.ineenet y� ROT A. SHAFER, P. E. 'RAS/ss SRB 196X EAGLE RIVER, ALASKA 99577 Y 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 l) e`er --- 1. GENERAL INFORMATION (a) Legal escription (include lot, block, subdivision, section, township, range) Location (address or directions) % (b) Applicant Name Telephone: Home QZ� ��6 LL_ Business Applicant Address (c) Applicant is (check one): Lending Inst ion ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other / I q (explain); .lrci — (d) Lending Institution 4QArl elephone - - Address -- (e) Real Estate Company and Agent Address - Telephone _ — (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other--__�-- Number of Bedrooms - 3. WATER SUPPLY Individual Well 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 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. 72-025 (11i64) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION t 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. w..v w r� b� .;: Name of Firm g.4--,"' Telephone ' 'st}'l. R, AW�11 ll Address An or Date s sz�,r� V �-. �S ela 7-,lc y �? d /u s 7-WL(-,v / `ate 70 l �7'.96 /9 76 G-.- '.v `►V �(/ V / n y/G MI / j /J J 4;t v asci t� r u� Fsrg a y 1 2: y kaabiDa A Shofar Vol' No. 1467.[' 6. DHEP APPROVAL Approved for bedrooms by ' ate Approved ___ _ Disapproved _ Conditional x Terms of Conditional Approval eFgAj.0 S ✓ �� C 5 C� O �✓ ,97 D 7 fiG4 © 1-✓ CU MK GT/o.0 f' �} N d "J S1 'T /� Gc11� cS ? rr r c1 �- �>- /e T 1)e? ,er!;, sf10 AJ o GJ l l2�_cf' 20/3 10c. 14 G ✓J ! Aj 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 ornissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) Aftc AlttMY GF MUNICIPALITY OF ANCHORAGE (MOA) mN HEALTH AUTHORITY APPROVAL (HAA) NOV 0, 8 �. CHECKLIST - FEBRUARY 1984 284-4720 Le I DescriptJ'on: G -,AECEIVED c� S A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield Cased to V — Depth of Grouting Total Depth 2 Static Water Level 2— Pump Set At `-- Casing Height Above Gr6undNe=X ?'` c,S' 99 Sanitary Seal on Casin (Y/ ) Electrical Wiring in Conduit (Y N) Depression Around Wellhea (Y ) Separation Distances from Well: To Septic/Hctdttg•Tank on Lot On Adjoining Lots 4 To Nearest Edge of Absorption Field on Lot to f ; On Adjoining Lots ,4 To Nearest Public Sewer Linea" To Nearest Public Sewer 1 Cleanout/Manhole To Nearest Sewer Service Line on Lot '~ Water Sample Collected by �� �ii?G �h�•�/—T— ; Date Water Sample Test Results Fa— Comments W L0" .0 !n B. SEPTIC/HOLDING TANK DATA v�6 %� �%Tid c��l� -r� TC /y/ (� LA) AS .. G zJ oV 7 Date In Iled Size No. of Compartments Standpipes (Y Depression over Tank (Y/N) Air -tight Caps (Y/N) Pumping/Maintenance Contract on File ( Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line To Water Main/Se ' e Line Cour Comments Page 1 of 2 72-026(11/84) Foundation Cleanout (Y/N) Date Last Pumped Holding Tank Permit (Y/N) To Building Foun To Disposal Field /9 G1 To Stream, Pond, Lake, or Ma—JoF�tZrainage C. ABSORPTION FIELD DATA Soil Rating in Absorption Strata Date Insta Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation Lot To Water Main/Serviee'Line To StreaTAPd-nd/Lake/or Major Drainage Course Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequ est To Prope tVq ine ; On Adjoining Lots To Cutbank (if present) ng or Abandoned System on T.e-Driveway, Parking Area, or Vehicle Storage Area Comments efAA D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) _ Comments — Dimensions Manhole/Access (Y/N) ff" Level at Vent (Y/ ping Cycles during ** Check Permitted Bedroom Rating Against HAA Request ** est. Meets MOA I certify that I have checked, verified, or conformed to all M A and HAA guidelines in effect on the date of this inspection. Signed Q s 9con Jornz a Date �110ER► ALASKA '20577 Comp'AV — i 694•+247 MOA No.41 ��w Receipt No. „Aw •••+�°• °Qme® ° y Date of Payment Amount: $ to `� •"" Page 2 of 2 72-026 (11/84) Robed A. Shafer , �? • No. 1.A57 -E40 �� '.o+a P+.•w••''":®•fir Aw in% CESSPOOL PUMPING BOX 56 MERCY DR. EAGLE RIVER, ALASKA W" lon7) 69 .4-6464 \\A MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH 8, ENVIRONMENTAL PROTECTION NOV 15 19P�, RECEIVED WPUMPING ROY DR. EAGLE (RIVIK A94LASKA SOW' 907) 6-6454 i 3 TER AINCHORAGE AREA BOROUGH I-'EALTYi DEPARDIENT 327 EAGLE STREET PO'ORAGB, ALASKA 99501 279-2511 DATE RECEIVED INSPECT: REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES FOR ee 1. Approval Reque ted By Address JAI ��X �D O, /�/�/C,G`/� Phone 7 2 . Property (vier !/ dr, ,p p Y Phone_ ?Z • yr3� 3. Legal Description T y- = 4. Type of Facility to be Inspected ,�j&4@!jjrs0 STREET: Number of Bedrooms S. Well Data: A. Type B. Depth C. Size D. Construction E. Bacterial Analysis b. Sewage Disposal System: A. Septic Tank (If homemade, show diagram on back) 2. Age // .,e&>l, 3. Manufacturer 4. Installer Approval Request for Sewa Nater Facilities Page Two B. Seepage Pit 1. Size 2. Lining__D�/� C....Disposal Field 1. Number of Lines 2. Total Length A//j0 7. Required Measurements A. Well to Septic Tank Z/2, B. Well to Seepage Pit //tom 1 C. Well to Sewer Line Ae D. Well to Property Line E. Well to Other Possible Contamination F. Foundation to Septic Tank $ G. Foundation to Seepage Pit ,? % / H. Seepage Pit to Property Line ZD" 8. COMMENTS: P APPROVED: DISAPPROVED: DATE :1, j I DATE : --r APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED. GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT ED1170