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HomeMy WebLinkAboutHIGHLAND HILLS #1 BLK 1 LT 3Jan_11.2023 09:53 AM Anchorage Well & Pump Service Inc 9072430742 #5650 P 1/ 1 MUNICIPALITY OF ANCHORAGE Development Services Department womma~ Awe Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-3437997 Pump Installation Log Welt Drilling Permit Number: Date of Issue: -� Parcel Identification Number: 050 382 - 8 Legal Description Block Lot Property Owner Name & Address-, FLANAfaAN ERIN J 12110 BUSINESS BLVD STE 6 HIGHLAND HILLS #1 1 3 EAGLE RIVER, AK 99577-7798 11 Pump Installation Date: 01 - 10 - 202s Pump Intake Depth Below Top of Well Casing: 175 feet Pump Manufacturer's Name: BERKELEY Pump Model: B7P4JP07221-02 IPump Size- .75 hp IPltless Adapter Burial Depth: 12 II Piwtless Adapter !Manufacturer's Name: II Pitless Adapter Installer: feet MARTINON Well Disinfected Upon Completion? lyes 0 No Method of Disinfection: PELLETS Comments: Pump Installer Name: _ Company: Mailing Address: City: ANCHORAGE WELL, & PUMP SERVICE; 7540 ICING STREET ANCHORAGE, AK 99518 907-249-0740 State: zip: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE DE ITMENT OF HEALTH AND HUMAN SER' -S Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL. INSPECTION REPORT NameA� T� ^^ ®Ia)TAN4Swr1 TO FROM SEPTIC TANK ADSORPTION FIELD WELL Address yX IytS61 - e7-se4L-� `I� `ACUS, I Phonce) Per and No. No. of Betlrooms WELL \tea LOT LINE L LEGAL DESCRIPTION Lot Block Subdrvi ion FOUNDATION - - -� Township, Range. Section �� 'A ) " C� G TANKS AS -BUILT DIAGRAM (Show locauon of well, septic system. properly lines, foundation. driveway. water bodies. etc) SEPTIC ❑ HOLDING — - � — — — — Mauulacturcr �_- Mater—ial�1�/�' Capacity m gallons I No f C7ompahmenls - f 1 W01 TYPE OF SYSTEM t4'TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER -- Depth to pipe hottom frons _ original grade U FT_ Total depth from original grade ��-"� t� • - _ _ '�_ v - _ L _ Pol added above original grade 0-0 FT Graveilength "-- -- �2, D FT _ _ _FT Gravel depth Ueneath pipe _ 0 I0 FT Gravel width 2• • S FT _ — — Total absorption area -- �-L_ SOFTa Numofber hies Soil rating It.17\s0 SOFT i Drslance between lines )a FT I — --- - -` -- - Pipe material (J__ SVA- tnsfaller Dale Installed ,2 WELLS — — PRIVATE ❑ OTHER (Identifv) Classihcaton (A.B.G) t ST I IJ I— ----- Installei ed to total Depthr__ FTFT Dale Installed. — — REMARKS: - / Scale: ' \ Tb Inspections Pe formed by. 2 � � inspection was performed according to all D II lT I EE(\;SE Clr t, .stir• ..Pno,L•pt �,��� `� Of .44 • @ .• tom. 4r�6�h Poe •v. ee a+P•°v�� � - S & S ENGINEERING __s.__ i----- I 6A�7 (7] certify that [his I.' itlI��K�9)�7% Municipal and Slate guidelines in effect on this d e� Health Department Approval: ✓--`� 72-013 (3/851 '- K~��� ��� DEPARTMEN) OF HEALTH AND ENVIRONill' NT�� PROTECT[ON 825 L STREET, ANCHORAGE AK 9��0l 264^472O PERMIT ND: 860145 DATE ISSUED: 05/29/86 ~ �rw�~-�~� APPLICANT: ADDRESS: % S&S ENGINEERlNG EAGLE RIVER, AK 99577 CONTACT PHONE: 694~2979 LEGAL DESCRIP: SUBDIVISION: HIGHLAND HILLS LOT: 3 BLOCK: 1 SECTION: 28 T[}WNSHIP: 141", RANGE: 1W LOT SIZE: 96570 (SQ.FT. OR ACRES} MAX BEDROOMS: 3 Listed helow are the options available to you in des0.gniT.1g your septic system. Choose the option Lhat best~[its your~siLe"~ �1 11.1-:0 DEPTH TO PIPE BU[TOM GRAVEL DEPTH (FT.) 8.0 0"5 3.5 TOTAL DEPTH (FT") 12"O 4^5 7"5 GRAVEL WIDTH GRAVEL LENGTH (FT.) 29,0 36,0 49.0 GRAVEL VOLUME (CU.YDS^) 22"9 25.4 36.3 TANK SlZE (GALS) 1,000.0 ** 1�000"0 ** 1,000.0 ** SOIL RATING (SQ.FT,/BR) 150 150 150 ** TANK MUST HAVE AT LEAST TWO COMPARTMEN[S I certi[y Lhat: �ami'Ir iar with Lhe requirements �or on�site sewers and wells as set �orih by the Municipality o� Anchorage (MOA> and the State o� Alaska, 2, I will install the system in accordance with all MOA codes and regulations and in compliance with the design criLeria o[ this permit. 3" I will adhere to all MOA and State o{ A1aska requirements [or the set back distancerom any existing well� wastewater disposal system or public sewerage system on this or any adjacent or nearby lot" 4. I understand that Lhis perm�t is valid [or a maximum o� 3 bedrooms and any elrg naeIn 11 will require an additiona] permit^ IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, R IT AND INSPECTION MUST 8E OBTAINED; (2> AS~BUILTS - 01 1\1 EPORT; AND (3) THE APPLICANT ;�� 1SSUE1.) 8Y DAlE: '~-�~-'�� ~-�- --7----7------� OF ti co, V. t% a'_•�`4r°J `AQgw P u Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOO — PERCOLATION TEST PERFORMED FOR:'1 DATE PERFORMED: LEGAL DESCRIPTION: L.,2., P,9� A61kt,,oJa t IL4A Township, Range, Section: er 4" V. -\4j P TP7 SLOPE SITE PLAN I 17 18-- 19-- 20 819-20 COMMENTS u*r-TVw C#f Wut WAS GROUND WATER I ENCOUNTERED? IF YES, AT WHAT L " O DEPTH? P E Depth to Water Aller dg� Monitoring? -0-0— kajilfkale: ReadingI Date I Gross I Net I Depth to I Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER FT AND _ FT PERFORMED BY: �SRR(B� 19p6pip p pfd 'a CERTIFY THAT pTHIS r�TEST WAS PERFORMED IN ACCORDANCE Wil"1 9 RT4 h1DMI0i4Fl IFMA Gt�JIDELI N EFFECT ON THIS DATE. DATE: MAY 2 3 1986 72-008 (Rev. 4/85) J fi Cr Cs`�_-- rQ, �� ..�GREI :R ANCHORAGE AREA BOR IGH (i 01, , Department of Environmental Quality %' 3330 C Street Anchorage, Alaska 99503 _ NAME kAy-cAT INSPECTION REPORT ONSITE SEWAGE „ ( c.4ctIchmA MAILING ADDRESS DISPOSAL SYSTEM PHONE LOCATION LEGAL f� � ++_ ��[fIjt�kdIUu:1l' SEPTIC TANK: 7 DISTANCE/ FROM WELL MANUFACTURER -6 ree, r"),MATERIAL �1 e_& 4- NUMBER OF _COMPARTMENTS_ I INSIDE LENGTH --INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY_Lvvv GALLONS. SEEPAGE PIT: %veer?e�rlir NUMBER OF PIT. DIAMETER, OR WIDTH M_ LENGTH S' DEPTH 7/ S 5rePc_ ,f/ LINING MATERIAL CRIB SIZE: DIAMETER�DF_PTH 6 DISTANCE FROM: WELL _. TOTAL EFFECTIVE /' BUILDING FOUNDATION EQ�f NEAREST LOT LINE ABSORPTION AREA (WALL AREA) / SQ. FT. ADDITIONAL ABSORPTION WELL: /t/0( j r4.<wle -e( 1irue 4t TYPE BUILDING FOUNDATION __CONSTRUCTION NEAREST LOT LINE_ CESSPOOL OTHER SOURCES NEAREST SEWER LINE APPROVED DISAPPROVED_ REMAR DEPTH SEPTIC TANK_ DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: a r Ca,, PAPE MATERIAL: 6S1 LOT SLOPE: RE -MARKS: DATE Form No. EQ -031 /10 61fr APPROV DISTANCE FROM: SEEPAGE SYSTEM _. G.A.A.B. GRE:ATI ANCHORAGE: AREA BORO ;I-1 \.� DEPAHTMENT OF ENVIRONMENTAL QUALITY PE.RM17 NO. 3330 "C" STREET ANCHORAGE, ALASKA 99503 V TELEPHONE 274-4561 SEWAGk: DISPOSAL SYSTEM ---a APP@.ICATiO V ANMD H.[:10/iIT NAME OF APPLICANT MAILING ADDRESS _ -_-'- ®�AV- ^. PHONE _.-_.-----.- INSTALLATION LOCATION C f-li�.• G!l'I �� �\ h- —'-- v LEGAL DESCRIPTION _ 1S i/.'y1C'r c k.(t: rt(-�:1 +-4•-' a�=--- - ' INgTAI I ATInN nF. SFPTIC TANK SEEPAGE PIT - DRAIN FIELD -. OTHER TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH 'TO BE INSTALLED BY ____.-- __—_------.-----.-.---- <>OIL TEST RESULTS —. �'- —, NOTE=: THIS f cF: R11T IS, NO VAL1D V1riTLROUT .aOI. CO`d PLETION DATE ANTICIPATED 'IT".:aT FINAL. INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ADIY SYSTF_M WITHOUT FINAL INSPECTION BY I HE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE ._ ---.- TYPE _. ` — .__ SEEPAGE AREA SIZE __ __._ .___... TYPE '1 - --- „ / ! .,;,�;IP.lUhS L�IvTANC.GS, REQUIREMENTS FOUNUAI'ION TO SEPTIC TANK I OiINDATION TO SEEPAGE PIT __ /Lr..' DRAIN FIELC SEPTIC TAN K'CO SEEPAGE PIT WALL SEPTIC 'fA.NK ___---. SEEPAGE PIT DRAIN FIELD TO NEARr sT LOT LINE. WELL I'C SCPI'IC TANK DNAIN FIELD _ ! SEEPAGE PIT — /VC ALSO CONSIDER AREA WELLS. V/ArFR MAIN '10 SEPTIC TANK DRAIN FIF_LID SEPTIC TANK, SEEPAGE PIT TO RIVER, LAKE, STREAC4. SEEPAGE PIT DRAIN FIELD 1b'I'S)..LNA 2U:C,.OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVA1101- b FEE]' IN -10 UNDISTURBED SOIL. 4 II-Cii DIA14- TFP CA T IRON SIPHON PIPES ON SFP'!IC TANK AND SEEPAGE PIT ...... FIIfEID WINE AIRTIGHT REMOVABLE CAPS. JONFOPM TO DOROUCH REGULATIONS REGARDIN':i INSTALLATION. jam) 1 � 1 I 1 / OR LIC@NSFD OUSIGNER DIAGRAM of :!YSTF:1-4 I C,6RTIFY THAT I AM FAMR-1AF. V, lyl THE REQUIREMENTS OF GREATER AN.^HORAGE AREA BOROUGH <:RI);NANCE NO. 2..6--6 I.'"'> IHA) -11 -DOW- IS IN ACCOPDANCE WITH SAID CODE. r i Dill IT APPLICANT'S SIGNATURE ._ _ 1 � 1 I 1 i , I i 1 i ! I c X 1 1 1 I F I i 1 1 1 I I li I 1 I _ II 1 1 I I ' I I- I I 1 i i i I C,6RTIFY THAT I AM FAMR-1AF. V, lyl THE REQUIREMENTS OF GREATER AN.^HORAGE AREA BOROUGH <:RI);NANCE NO. 2..6--6 I.'"'> IHA) -11 -DOW- IS IN ACCOPDANCE WITH SAID CODE. r i Dill IT APPLICANT'S SIGNATURE ._ _ M -W DRILLING, Inc. P. O. Box 4-1224 • 1310C International Airport Road (907) 274.4611 ANCHORAGE, ALASKA 99509 DRILLING LOG I."Onard -,17ulmy _Use of Well Dani Well Owner — Location (address of: Township, Range, Section, if known; or distance main road— IES, Blk 1; Highland Hilly Sum S. Fork Eagle River — Size of casing Depth of Hole L0) feet Cased to 26 feet Static water level 26 ft. (aw�d:,. _(below) land surface. Finish of well (check one) open end ( X ); Screen ( ); Perforated( Describe screen or perforation )` l None — Well pumping test at 10 gallon per (Hou`f) (minute) for l hours wits 100 ft of drawdown from static level:_ Date of completion 11 June! V; 4•. �l t f y WELL LOG Depth in feet from f ;i ground surface Give detail's of formations penetrated, size of material, color and hardness O—TO S .1t .. C3 4VQ I i tillaceQus 'je 7_(7() laitdroI k C71(sc?L)5 4.0;1^ a nood tiVE��:e ��eap in fracture _TO _TO TO — TO a TO _ — TO - — MUNICIPALITY -OF ANCHORAGE 1, UM rICAL111 ENVIRONMENTAL PROTECTION —TO - APR .2 :i 1986 ° E I V_,r D —TO — ---TO --- -—TO — — _TO 3—CONTRACTOR GREATER ANCHORAGE AREA f30R01' ' Department of Environmental Cl :ty E_;�. 3330 'ICI' Street: Anchorage, Alaska 99503 111 1974 AM SOILS LOG - PE OLATION TEST SkEAI Ek ANU10Rr'.GE ARtA BVP.OUGIi DEPT OF F^ F TAL UAHTY Performed for Bear Cat Construction Date Performed 7%'27 74 Legal Description:_Lot 3, .,Bloch_ 1Highland Hills _Subdivision This form reports: Soi Is log Yes Percolation on hest Depth Feet 1 - Black Organics 2 3 -- 4 -- 5 - Gray sandy gravel slightly damp with occasional boulders 6 - 150 S.F./B.R. Bottom of test hole 141 Was ground water encountered? No S/06, If yes, at what depth? ,eading Date Gross Time [let Time Depth to Water Net Drop �! 11 1� I1 If yes, at what depth? ,eading Date Gross Time [let Time Depth to Water Net Drop Percolation rate rrnnui<e. Proposed installation: Seepage Pit Yes Drain Field ;)epth of Inlet Depth to bottom of pit or trench C01111E11TS: _----------- Certified I3 Performed Dy: Nva y Constru�i ion___ 7/27/ -7 -4 - EQ -040 (6/74) Test Lab N bltpw lv�-, B • Municipality ®f Anchorage ° f� a On -Site Water and Wastewater Program .. (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcell.D. 050-382-28 1. GENERAL INFORMATION Expiration Date: 10 - P 4-e Complete legal description HIGHLAND HILLS #1 BLOCK 1, LOT 3 Location (site address) 5414 HILAND ROAD, EAGLE RIVER AK 99577 Current Property owner(s) STEVEN WILLIAMS Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: 5414 HILAN DR. EAGLE RIVER AK 99577 ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class _ Well Public Water System WaiverNariance request for: Received by: COSA to be released to the engineer, unless 3 Day phone TYPE OF WASTEWATER DISPOSAL: ® Individual ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ by the engineer. Date: COSA Fee_ $ ke CeA C 5-2- G �_ Waiver Fee $ Date of Payment `7/I I B �- Date of Payment Receipt Number 0 � Q 7-10 Receipt Number COSA# GSC IS -13 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER , As certified by my seal atbtsed hsrato and.as ofthe vabdation data shown below, I vor that my inveift based on procedures oWlned to the Ceriiflcate of OhZtte Sjrsfbms Appruval Guidefitsas. for this arppllo stows that the on-site water supply arKtror waetewker d>si l system is (are) safe, ffancslonal and: ads for the number of ttadroama and type 4i*uclure (ndicat�d herein. I further veriry that basad on the p[f4m obtained from the MunMpality of Anchorage tiles and from my Invsatlgatlop and inspection, the an-artrf% supply andlor wastewater dispdaal system is(are) In, compliance with all sppticahle Municipal and Sfat[+C '4rdlrWPEts, and regulat ma In effect 0t #)a Iime bflnstallation, :Name of Firm AftCf ft A CO(V�tii Tft+rG, IA] ` Phone �6B37S1 A4dress gom PTARbftGAN BLVD? 1ut4glEliLyf€ A KIL4R c Engineer's PrintedName .YEIITirPlrS _._. Date �mX1111 EnpktneVet3S7nneras: The invealiaaeart web acmpleted d Eafl1Waa aWi;n A= rd MOA tewlailuno. The wtassntant ef:thect {. . 'of Me wtxl Ana septi- applaa only to the oohdigans 3e atfhs day tatted. The fore end abeorpgoe rotas m37 chanaa dos to rutq t;. cmdhianalhotmay not be observed fmm/hovatfk*, 0010grtp gilanense.le'oI er�graaler sdes, �aurn aln kveis shot rn¢ tai g. c during Its year and the wl& usage of the f&My being %[sued By he att+t;:an. The gmmlianal lifeofeg well and septic systu scbjact t7lhasa ax ass and dyneatic 0l+rart94s0sa aM aro outsWe the oWfol of the d r irra4elnf Miha Weil anrt iw�,tie a.P'dlein. TYwtafaa, ArtTerra can not,dha any etuam a of hvw tarp • wstam vNl funatfor+ tatafactoty for aurrewl" rubxv �`i.'r►,_ o90 para or an ArcTxra guarantee MA no una!w ,r IlkOFIk, enoree rdnunty. dt fitiancke nr disaepancl-s afat. Ar i , 4EA� j !m ... - $.:- DSD SIGNATURE System #i Approved far 3— bedroom@, teen k f a. f rr I System 02 Approved for bWrtwms..rr ;� fiE9 IpNT?' -W Oisapproved_ �l•e ,� ..r _ Gondtkianal approval far b�raattts, with the foltowirog stipulations: 5 C1F A'' . 6N -SITE" — JAT-ER-AN0_._._ _ �STEWATER PROGRAM__.. d LA P&A OAQIna I CertttiCate Ctata: 2k Tits MX10 *alty ar A 0mrago 00u11411-ent SONION lbsidd tDW) itaue* Cor0est4s of 0"Ite Spstantb Appravill I009,4} bas+ Wtort the ropretanlatiats piaett in ttMVaph 4 by An indepsndsMprQisssFmel CVl,eagtneerregisieratt in the ataie crAohn. Thommi oFMchauago is nae raspanshtrk rarRrrwL of alc�ttaaaa M Alib frruvaaatdn� ae.'Ih6ars work ATTACHMENTS: COSAChecidist — .. NstrateAdvisory Septic System Advisory _..,. n., Anstertie AdAsary _ Well flaw A dvisoty CtitBr IGca[a. n..t_roio.fsms . If more than 1 septic system is on the lot: COSA Checklist # of _ Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: HIGHLAND HILLS#1 BLOCK 1, LOT 3 Parcel ID: 050.382.28 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # _ Date completed 6/11/1975 Sanitary seal (Y/N) y Total depth 100 ft. Cased to 26 (INTO BEDROCK) ft. FROM WELL LOG Date of test 611185 Static water level 26 ft. Well production 10 g.p.m. WATER SAMPLE RESULTS: Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 24+ in. AT INSPECTION 6130115 Il# Coliform Nea colonies/100 mL Nitrate 1.20 mg/L Arsenic: ND ug/L Date of sample: 6121116 Collected by: ARCTERRA B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC I STEEL Date installed 612186 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 7.2-15 Pumper JRs C. ABSORPTION FIELD DATA Date installed 61286 Soil rating (g.p.d./ft2 or ft2/bdrm) 150 System type DEEP TRENCH Length 32ft. Width 2.5 ft. Gravel below pipe 8 ft. Total depth' ti_1* ft. (Measured SW15) Eff. absorption area 572 ft2 Monitoring tube Y Depression over field Date of adequacy test 6/30115 Results (Pass/Fail) PASS For 3 bedroom's Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 28 in.. Elapsed Time: 30 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date *�e Municipality of Anchorage On -Site Water and Wastewater Program(907)343-7904 n CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcell.D. 050-382-28 1. GENERAL INFORMATION Expiration Date: /(1 ` / 4' /,5� Complete legal description HIGHLAND HILLS #1 BLOCK 1, LOT 3 Location (site address) 5414 HILAND ROAD, EAGLE RIVER AK 99577 Current Property owner(s) NICHOLAS T. WIRTH Day phone Mailing address Real Estate Agent 4477 CRESCENT RD. APT 3 FITCHBURG, WI 53711 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual 19 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Received by: Date: COSA to be released to the engineer, unless oth r uested by the engineer. COSA Fee $ 62--i Date of Payment -711115- Receipt /f %5Receipt Number 0bok2-'l COSA# 05C16 I �>�3 Waiver Fee $ Date of Payment Receipt Number Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 6/30115 Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseeni OF .4Z� X encroachments, deficiencies or discrepancies exist. Ar 4,, y , 4O`r1t 6. DSD SIGNATURE _ _? g / J/� System #1 Approved for � bedrooms. KESETH Vit. DUFFU , �� �r System #2 Approved for bedrooms. ', �Poo-s•sslo;;h� .� Disapproved. Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: -""f "( — /,�_ Thd- unif;ipit o Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other . COSA blw sheet_ia1a12.dw If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: HIGHLAND HILLS #1 BLOCK 1, LOT 3 Parcel ID: 050.382.28 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # _ Date completed 611111975 Sanitary seal (Y/N) Y Total depth 100 ft. Cased to 26 (INTO BEDROCK) ft. FROM WELL LOG Date of test 6111175 Static water level 26 ft. Well production 10 9 - p.m - WATER SAMPLE RESULTS: o Coliform / * colonies/100 mL Nitrate Ab?,5 mg/L Arsenic: _ &Aug/L Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (YM) N Date of pumping / `�" %5 Pumper JRs Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 24+ in. AT INSPECTION ft. 9 - p.m - Collected by: ARCTERRA Date installed 6/2186 Cleanouts (Y/N) Y High water alarm (Y/N) N C. ABSORPTION FIELD DATA Date installed 6/2186 Soil rating (g.p.d./ft2 or ft2/bdrm) 150 System type DEEP TRENCH Length 32 ft. Width 2.5 ft. Gravel below pipe 8 ft. Total depth 9.1* ft. (Measured 6/30115) Eff. absorption area 512 ft2 Monitoring tube Y Depression over field N Date of adequacy test 6130115 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 28 in. Elapsed Time: 30 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum Size in gallons "Pump off' level at _ in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 1004 Public sewer main 751+ Sewer /septic service line 25'+ Animal containment areas 504 SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 5'+ Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manurelanimal excrete storage areas 100'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10'+ Water main 10'+ Water Service line 101+ Surface water 100'+ Driveway, parking/vehicle storage 104 Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS *New MT installed TV into 8' effective depth. Field is insulated with 2' minimum cover. Vacant system presoaked prior to testing. G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date COSA canary sheet 2-6-15.doc OF Al, AV tQTH m N oa °a7 ao "Lri z'9v, a cJ sE,oric �is°E r 0 0 o e zo %x600. Uc.� Cr F.00cE* iPEcc�rr/�ics2T/o.,/ 7�//s AC12I111 T_un nnc�•re c• crr �....+ ...�.. I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE - FOLLOWING DESCRIBED PROPERTY '� yc i : G� fl/GGS C/�// OF q��e R /✓rJ mor �i�/ AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT DATE:Ar. 6�z8/yam .. ....... wr A^� •' Sf 6� S _i: IS THE RESPONSIBILITY OF THE "*.OWNER TO DETERMINE THE EXISTENCE OF ANY GRID 0..... • ••..... EASEMENTS, COVENANTS, OR RESTRICTIONSWHICH &6'ks-�.fd DO NOT APPEAR ON THE RECORDED SUBDI- o�ene tl �d� VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB` LS- I =�ga ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- Ls„" DRAWN. ARY LINES. MUNICIPALITY OF ANCHORAGE DEPARI-MENT OF FIEALI-F-I & HUMAN SERVICES i` Division of Environmental Services "' € h C �„, � � f.:L�@ ei On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 JUN 02 1998 343-4744 MUNICIPALITY OF ANCHORAGE CERTIFICATE OF HEALTH AUTHORITY ENVIRONMENTAL SERVICES DIVISION APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 050-382-28 HAA #-J���-L�d_�j 1. GENERAL INFORMATION Complete legal description Lot 3; Block 1; Highland Hills #1 Location (site address or directions) Mile 4.8 Hiland Rd Eagle River, AK 99577 Property owner _ Pat & Debbie Morrow Day phone 279-4506 Mailing address 9871 Hiland Rd. Eagle River, AK 99577 Lending agency Mailing address Day phone Agent Gloria Hoflich/Prudentia_l Vista pay phone 242-5810 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 xxx 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. 72-025 (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 S & S ENGINEERING R y — A 7 7 cl Phone Eagle River Loop Road No. 204 Address Eagle River, Alasl 957T Engineer's signature 6. DHHS SIGNATURE Approved for Eb bbedrooms. M Disapproved. Conditional approval for Additional Comments Date S-1 3 0 � 61. S' CMZ Z7✓'n r ROPMT C. COWAN r �C cE - 8801 < n bedrooms, with the following stipulations: Date & `5 L The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 KtUIVLU • � Municipality of AnchorageJUN 0 2 1998 DEPARTMENT OF HEALTH & HUMAN SER�'Ii��:``I'ITY OF ANCHORAGE Environmental Services Division ENVIRONMENTAL SERVICES DIVISI 1 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: L3 B/ %ii6aLAvp /1tu.5 *1 Parcel I.D.:_ 05-0 ^ 301- "M A. WELL DATA Well type k IVB '� If A, B, or C, attach ADEC letter. ADEC water system number Log presentY(@N) Date completed 611117-57- Total depth /OG Sanitary seal Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Cased to -26 Tot-OR&Y.,k Casing height (above ground) FROM WELL LOG t '161 Ia Wires properly protectedC(YjN)' V65 AT INSPECTION f-Z�.l`If3 73z g.p.m•_�_ g. P.M. A¢s3R,c 7 ren ISY p4) $ P�Um Ott 6 - Nitrate O. `( 3 Date of sample: l a/ 1 66 Collected by B. SEPTIC/HOLDING TANK DATA Other bacteria b 5 & 5 ENGINEERING ✓� S r�1ii? 2703q_Eagle RIy,r 100P p I -----T-.--ad-No. 204 Eagle River, Alaska 99577 Date installed/hGH Tank size Number of Compartments -01-- _ Cleanouts(Y)N)_ Foundation cleanout Y/ ) _ ��� _ Depression (YO) _ 0 _ High water alarm (Y/N) Date of Pumping ,J - ` �/ Pumper Is C. ABSORPTION FIELD DATA Date installed o (o Soil rating (g,p.d./ft2r ftz/bdr ) i A/W --System BR_System type r � Length Width Gravel thickness below pipe Total depth �f7 17- ` Effective absorption area I Monitoring Tube present!) 6S Depression over field (Yo 140 Date of adequacy test _ 5 X� ' 1np � Resul Pass ail) _j?j6 Z2__ For — bedrooms it Fluid depth in absorption field before test (in.); AL2 Immediately after gal. water added (in.): �I Fluid depth7— (ins) Minutes later: -2 �� 1 Absorption rate = _-J�5a_ _g,p,d, Peroxide treatment (past 12 months) (Y/N) _ N L cv�r�_ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION \ Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons " Pumly a 'level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: i Septic/holding tank on lot Absorption field on lot _ Public sewer main Sewer /septic service line /c0 "Pump off" level at* On adjacent lots loo r On adjacent lots )06 Public sewer manhole/cleanout ^/ LA 1014- Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 10 +. Property line IO .b Absorption field too f Water main/service line 10 1+ Surface water/drainage lad 14 Wells on adjacent lots 100 14, SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I6 + Building foundation )0 Water main/service line �a Surface water l0() Driveway, parking/vehicle storage area 14 0/ Curtain drain rA of Kdo i 0 Wells on adjacent lots top F. ENGINEER'S CERTIFICATION _ p1Zrs�N a s OF 7)?t� �1 t36lnw r»L �2cvbw'Jt�t, TUE i'r?&"Glt IS Z:IVSuLAY6J (5&[c 546-0.,V"ef 1 certify that f have determined thru field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. .OF ����"� n Signaturefir', Engineer's Name iIb >a:,: .,:< <, .,:•,', Date ROBERT C. COWAN CE -8801 de HAA Fee $ Date of Payment' Receipt Number�� �l f 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number JUN --02-1998 10:05 CT&E ESI ANCHORAGE CT&E Environmental Services Inc. .9161L, W�AWAr�"AW4WAF"AVArAV"A-AWAr.*rl" 9075615301 P.04/OG CT&E Rei.# 982494002 Client PO# Client Name S & S Engineering Printed Date/Time 06/02/98 08:27 Project Name/H N/A Collected Date/Time 05/27/98 11:30 Client Sample ID L3 161 Highland Hills N1 Received Date/Time 05/27/98 11:00 Matrix Drinking Watetr Technical Director: Stephen C. Ede Ordered By PWSID 0 Released By Sample Remarks: Al19ueble Prep Analysis Parameter Results POL Units Method Limits Date Date Init Total C9Liform 0 col/100m1 smia 92228 05/27/98 TRW Nitrote•N 0.930 0.100 mg/L EPA 300.0 10 max 05/27/98 05/27/98 RMV MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAU 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 l.D.# �%-�`�-cnl�h .=HAA#. 1,. _ GENERAL INFORMATION -Complete legal description _ Loi 3 Stock 1;' H tgh Pccnd H i 2 Y 5 #1 _ Location -(site address or directions) Mite 4.8 Hita.nd Road k,. Eagte Ri.veA, AK Property owner Rnbeat C. Eddy Day phone, 696-5808 Ma(ling.address' ' P U Box 202192 Anchorage AK 99520 } Lending agency ' Day phone —� Marling address:',` Agent _`I Mang. e Me iengeAd/'Don McKenzie. Rea.E; Eatate Day,phon.e Address x13135 U.Cd Gtenn INN- ' SMite ` 100 . Eacite' Riveh� AK 99577 S UnCess,otherwise'lequested, HAA wfll be held for pickup ;rro ? NUMBER. OF BEDROOMS. ,, ° Z > S TYPE OF;WATER SUPPLY*Z XXX Individual_well ... .. _ - ;.Communitywell � O m �z � i Publ(c water -- c`n c��n 0 NOTE: - ,, If community well system,. provide written confirmation from State ADEC att o tc- ing to the legality and status of system. ; 1)� "z A. - TYPE.OF WASTEWATER DISPOSAL: XXX Individual on-site Holding tank:,,.: .__' Community on-site �. hubl(c sewer NOTE. { If community' wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. _ 72A25(Rev.1/91) Front MOAM21 _ , Additional Comments 8Y' Fly , Date -21 CAUTION The .-i nicipality of A4 chorage Department of Health and Human Services (DHHS) issues Health Authority Approval 'Certificabased only upon the representations given in paragraph 5. above by an independent professional enc vreerr' istered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and thei�lending')nsiltutions 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. 1/81) Beck MOA e21 - Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST AV Legal Description: LT 3, C� j� �7/Gff[1�n/r� /7i sParcel I.D. A. Well Data Well type ?ZIL)( rF \ / If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) 7F_r, Date completed 6' -//JAS Driller Alf Total depth Cased to 26 r 10 6FP k�uc Casing height /a _ Sanitary seal (Y/N) Y Wires properly protected (Y/N). Date of test Static water level Well flaw Pump levelt FROM WELL LOG U RX I AT INSPECTION On adjacent lots r'b r Foundation /6 10 field U RX I AT INSPECTION On adjacent lots / 3 ,:i5 Foundation /6 r To property line __Absorption field �b , r`io't 3g `-I- l-1 MrT'£( t3 n�,,p 4 PLvj4Av(- Ill SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ((70 �l- ; On adjacent lots Absorption field on lot _ //0 f ; On adjacent lots Public sewer main ti A Public sewer manhole/cleanout n Sewer service line /C) Petroleum tank / VCr)r ��yowov WATER SAMPLE RESULTS: m ,X Coliformg f Nitrate Other bacteria S� Date of sample: �7 �l Collected by: aIN��t�Ljqjv, River Ne,_ B. SEPTIC/HOLDING TANK DATA F acgle River, Alaska 99577 Date installed 6 6 % Tank size Z606 6L Compartments_ .2 Cleanouts (Y/N) -Foundation cleanout (9/N) _ ES Depression (Y/Np AJo _ High water alarm (Y/N) _/J/A _Alarm tested (Y/N) ^ /`SIA _ Date of pumping _ % �h lP/ Pumper : r�' s /IGt/-�7���z r SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 106 r+ On adjacent lots Foundation /6 r To property line __Absorption field r r Water main/service line. �a Surface water/drainage_ I 6 q- 72-026(3M)•Front CONTINUED ON BACK PAGE C. LIFT STATION 01A Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANg5-F-140M LIFT STATION TO: Well on D. ABSORPTION FIELD DATA On adjacent lots Manufacturer off" Level at Surface water Date installedI h Soil rating (Glitz) �6 S~� System type Length Width a i Gravel thickness g Total depth Total absorption area 51a SF Cleanout present ON) LES Depression over field (YLEI) Al Date of adequacy test 7� 1 13 l ILS Results (pass/fall) PASS for 3 Bedrooms Water level in absorption field before test S �- After test Peroxide treatment (past 12 months) (Y/8) --LLT- NCA- N If yes, give date 10 �A pFK Tn>y.R;;Poe SEPARATION DISTANCE FROM ABSORPTION FIELD TO: —I=, ,, Rao MFts,, ?f�3fg5 Well on lot /06 On adjacent lots 4 Property line /U� To building foundation /6 ( I To existing or abandoned system on lot ad On adjacent lots o� S � Cutbank n O Water main/service line Surface water (W'4 Driveway, parking/vehicle storage area or Curtain drain Sd �o7rroti Or 12 'T Fflz�sp-S E. ENGINEER'S CERTIFICATION 5YS(F M 96 I certify that f have checked, verified, or conformed to all MOA and HAA guidelines in effect on thele of this inspection. :r OF Aa Asa n r !'� t Sig atu e Engineer's Name l�\�olktCoa,'q Date 5� /7 S' HAA Fee $ 110 Date of Payment Q l al J Receipt Number � Waiver Fee $ Date of Payment Receipt Number 1�. H i.rSric•n�u+rnw:•`Cril r � i• Y•. • e r+ � W ROBERT C. COWAN �`.ti CE -8801 fI N. 07i11i95 13:37 COMMERCIAL TESTING 4 9076941211 ALCT&E Environmental 5ervioes Inc. cr&E set -it 95.2611-1 Matrix WATER Client Sample ID L3 HLK1 HIOHLANIM HILLS Client Name a & S ENCINERRING Ordered By R. COWAN project Name Project# P'45ID UA sample Romarke: SAMPLE COLLECTED 8X: s & S ENGINEERING. NO.844 D02 WORK Order 16073 Printed Date 07/11/95 0 11:41 112:9. Collected Date 07/06/95 a 13:00 hre. Received Date 07/07/95 (p 11:30 hre. Technical Direct0r STEPHEN C. EDE Released Sy^'-"'.""`.'"'."" QC Allowable Ext, Anal Parameter Results Qual Unite Method Limits Date Date Init ------------------------------------ '-.--............... Nitrate-N 0.75 .,....----------------------------------------.__....----_— mg/L EPA 353.2 10. 07/10/95 CMR ..-�wswwna[..... ..I........wwwwwwCnZOCwwwrpwww.wwwwwwww.wwwccuwwmwwawww..... .wwwwwwwuvww.......... W...' wVweww......ww See Special Instructions Above UA w Unavailable * See sample Remarks Above NA o Not Analyzed -U w Undetected, Reported value is the practical quantification limit. LT w Lose Than -D - v Secondary dilution. UT � greater Than 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. # _ � " '_1 - _11?� 1. GENERAL INFORMATION HAA # Q C -Y'1 `� Qi 31 a(n Complete legal description L 3 84 1... 1- k land a1jiS Location (site address or directions) NA -1 141) ztn�_ R d _ Property owner L .1 00u-,% n� 12 -1_a_s Day phone Mailing address C)� -I 1 qn, 1� Lending agency Day phone Mailing address Agent l aw �awe�C b�° ✓• °" ie�!~ DaYP hone 69`h 9035 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well X 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 X 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 M21 5. 6. 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. v G-9 I S Name of Firm9 60\ RQ < ew r�)>,Phone 94-905,6 Pty k 97_ R AddressG 7_�,_ � X951 C-aBIQ_ _Lwoe A�� 99 Engineer's signature DHHS SIGNATURE KApproved for bedrooms. Disapproved. Conditional approval for Additional Comments Date I_l_g3 M y�J r is 1 as;�e' ill-uRt ••� 0.1!.')11 i111'R1lF��J ll.i:�nb Ji �>!.Y'S kg bedrooms, with the following stipulations: By: �-4�� — Date %-`r—`i 3- ItlTlC 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. Legal Description: Municipality of Anchorage - Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST L3,61 I �� )2md ��,1)S _ Parcel I.D. U So - 3' ti — �k P A. WELL DATA Well type ��I2'�112;' If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ON ➢}4v4�_ Date completed � � �� �9�5 — Drillers Total depth I OU —Cased to w Casing height Sanitary seal (Y/N) — Y Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG �-t\-15 Z to SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I o r 5 Absorption field on lot 115 a Public sewer main — -r I oo, p Sewer service line 4. to AT INSPECTION 6-Z�--53 31' 6.o ; On adjacent lots On adjacent lots — Public sewer manhole/cleanout Petroleum tank Y g.p.m. 4t7 +k (Do -11 CDC) r h -t 00, WATER SAMPLE RESULTS: Coliform g Nitrate �'D x'18 Other bacteria Date of sample: 6` 7-193 Collected by: Clx�sAvue-�1 "5 � S'nQjz^ s B. SEPTIC/HOLDING TANK DATA Date installed�- 86 Tank size I Uoo Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) _ Y Depression (Y/N) High water alarm (Y/N) pi A- __ Alarm tested (Y/N) Date of pumping 5'Z -9Z_ Pumper -Ti?'S Iwrr a SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ty \ ' 5 On adjacent lots +I 0c), To property line k 2`; Absorption field fiS r Surface water/drainage 4100, Foundation Water main/service line Z IJ -r 7 S' J. I ooI 72-026 (Rev. 7/91)Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) — Manufacturer Manhole/Access(Y/N) mp off" level at Cvcles tested SEPARATION DISTAN-C-E-F-ROM LIFT STATION TO: Well on D. ABSORPTION FIELD DATA Date installed — Length ZI Width On adjacent lots Z V7', Surface water Soil rating ),;,-u s���d�m System type �Y �Y Ck — Gravel thickness Total depth I Z Total absorption area <51 -Z 5 Cleanouts present (Y/N) Y Depression over field (Y/N) Date of adequacy test C�' Z - 93 Results (pass/fail) f�P s 5 for 3 bedrooms Peroxide treatment (past 12 months) (Y/N) rJ If yes, give date `- SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot a- )UU On adjacent lots Property line 10 To building foundation ` q0 To existing or abandoned system on lot +Zy On adjacent lots �CD Cutbank 26 Water main/service line a loo Surface water 'I 104 Driveway, parking/vehicle storage area "')N 'DKi\jaw,�rt i SU 5\45Th'm cv��v INsvL-P-Tla2 p� 45—ti3v\x.T &l' Curtain drain 5 � 5 LNG 25 6-Z- $(, E. ENGINEER'S CERTIFICATION certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on thp4atg. of this inspection. Signature �G Engineer's Name Go�S �, �NCj/2.. S Date 14X HAA Fee $ r Waiver Fee: $ Date of Payment ` -1 - �-) 7 Date of Payment Receipt Number .-2 �t-f-(©U � � 7 / � Receipt Number ® THERN TESTING LABORUORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 • FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 • FAX 274-9645 Constructing Engineers HC83 Box 192A Myrtle Drive Eagle River AK 99577 Attn: C. Landers Our Lab #: Location/Project: Your Sample ID: Sample Matrix: Comments: A124408 Highland Hills L3, B1 Water Report Date: 06/30/93 Date Arrived: 06/29/93 Date Sampled: 06/27/93 Time Sampled: 1500 Collected By: CAL * Definitions * B = Below Regulatory Min. H = Above Regulatory Max. E = Estimated Value M = Matrix Interference D = Lost to Dilution MDL = Method Detection Limit Lab Date Date Number Method Parameter Units Result _* MDL Prepared Analyzed -------------------------------------------------- g�------------/-------- -------- A124408 EPA 353.3 Nitrate -N m 1 0.8 0.5 06/29/93 r' Reported By: Susan C. eifental Microbiology Supervisor NO THERN TESTING LABORAT ORI E , INC. h o 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 • FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 • FAX 274-9645 DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA Constructing Engineers Public Water System I.D.# 9601 Buddy Werner Drive Anchorage AK 99516 Date Received: 06/29/93 Time Received: 08:20 Date Analyzed: 06/29/93 Time Analyzed: 11:00 Date Reported: 06/30/93 Time Reported: 16:35 Next Sample Due: Collected by: CL Sample Type: Routine Untreated Method of Analysis: Membrane Filtration Comments: Comments: S = Satisfactory U = Unsatisfactory POS = Positive Test Result ND = None Detected TNTC = Too Numerous To Count (>200 Colonies) CG = Confluent Growth HSM = Heavy Sediment Masking, Results May Not Be Reliable SA = Sample Age >30 Hours But <48 Hours, Results May Not Be Reliable Old = Sample Age >48 Hours, Too Old For Analysis R = Resample Required NT = No Test * # Colonies/100 ml ** # Colonies/ml Sample Sample Total* Fecal* Other* HPC** Location Date Time Lab# Coliform Coliform Bacteria Result Comments ----------•---------------------------------------------------------------------------------------- 1 L3 B1 Highland Hills, 06/27/93 15:00 AA14928 0 NT 0 NT S Hose Bib Susan C.Ti_fental Microbiology Supervisor MUNICIPALITY OF: ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIR014MENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date I. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 3 Block 1 Highland Hills Subdivision Location (address or directions) (b) Applicant Name Leonard Dubay_ Telephone: Home 694-9844 _ Business 278-3757 Applicant Address SRB 9125 Eagle River, Alaska 99577 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ®$ Buyer ❑ ; Other ❑ (explain); Lending Institution Address Real Estate Company and Agent Address Telephone Mail the HAA to the following address: S & S Engineering 2. TYPE OF RESIDENCE Single -Family Q<xMulti-Family ❑ Other Number of Bedrooms three(3) Telephone 3. WATER SUPPLY Individual Well ®x 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 [Kx 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. Pagel of 2 72-025 (1 1,811) 5. ENGINEERING FIRM PROVIDING JPECTIONS, TESTS, FILE SEARCH, DATt. _,ND 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 -cite 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 Telephone Address Date Engineer's Seal This department has received written confirmation from the engineer regarding the Conditional Approval of April 24, 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 forThree 3 bedrooms by Approved XXXXXXXXXX Disapproved Terms of Conditional Approval Conditional CAUTION June ib, 1986 The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/e4) MUNICIPALITY OF ANCHORAGE ` r 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 /'V/s G 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Namecn�a� — Telephone: Home Business 7 Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution �� //���,� Telephone 3 % — Address/! -- (e) Real Estate Company and Agent — Address Telephone Mail the HAA to the following address: SRS 1966 E:affle ?iver, Afaska "977 2. "TYPE OF RESIDENCE Single-Farnily � Multi -Family ❑ Other Number of Bedrooms 3 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. Page 1 of 2 72-025 (11/64) a 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 rny'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 _ _.STelephone— Address SRB 196x Eanle River, Alask-a 995 APR 2 U 1985 Date .lgineo a al % r. A Shh,r 1467 � ey 6. DHEP APPROV h Approved for �" " bedrooms by Approved Disapproved Conditional Terms of Conditional Approval �r--���GE p N ter'/ TC=lcJHl ?FL[J�iT�r� �/1 USC Sy.sT�(F Jkl. �Z_.A).(,LJ cer•z/iza"Aj-r G0G�s eF a �h•st,�,e. (UO,e � TD e(.F Cv�cr���iCc ti L.T. /S Jug✓ (98� dh�p CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 77-025 n 1184) nivl�i.rn�ll l yr M1N%' IVt(AUr_ DEPT', OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) AP R % 11986 CHECKLIST - FEBRUARY 1984 264-4720; r C� VED Legal Description: 4 3 dl�� A. WELL DATA Well Classification _f Z�el 0a If A, B, C, D.E.C. Approved (Y/N) / Well Log Present (Y N)— Date Completed fu C1 YieldX����f°�1^ lam?• Total Depth _/DD r Cased to Z 6 'OF, Depth of Grouting w / Static Water Level 2 6 — Pump Set At Casing Height Above Ground Z Sanitary Seal on Casing(Y N) Electrical Wiring in Conduit 6y1 ) Depression Around Wellhead (Y& Separation Distances from Well: To Septic/Holding Tank on Lot rig ; On Adjoining Lots /'03 To Nearest Edge of Absorption Field on Lot 40V ; On Adjoining Lots _��O / F To Nearest Public Sewer Line To Nearest Public Sewer P Cleanout/Manhole To Nearest Sewer Service Line on Lot _ /23 F Water Sample Collected by '� �✓�G�FI�e�%G y ; Date���/ Water Sample Test Results / /� /7 Tis /tc zu� Comments ��IJf�C 7`ad/r B. SEPTIC/HOLDING TANK DATA Date Installed Size `D' cP No. of Compartments Standpipes ((1�yN) — Air -tight Cap (Y/N) — Foundation Cleanout (Y/g N Depression over Tank (Y/) Date Last Pumped _�/ _ Pumping/Maintenance Contract on File (Y/N) h ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) N Separation Distances from Septic/Mu" Tank: To Water -Supply Well 7fr To Building Foundation f ,f To Property Line f0 To Disposal Field Tn Wetar Main/iarVICP. I ina Tn Rtreem Pnnri I aka nr Mainr nrainana Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 4/1- a'O Type of System Design�a�Q 1� Date Installed u f 7 Length of Field 16 7 i Width of Field Depth of Field /7 - Square Feet of Absorption Area Depression over Field (YA9 _ Results of Last Adequacy Test 356 Gravel Bed Thickness % i — Standpipes Present 0N) Date of Last Adequacy /Test />D//✓/!✓IP- dam( Ct�J�JaJ/:�at � 13/1 Separation Distance from Absorption Field: To Water -Supply Well GO (� To Property Line To Building Foundation Lot A,) o To Water Main/Service Line to "A To Stream/Pond/Lake/or Major Drainage Course r o ,c To Existing or Abandoned System on - r , On Adjoining Lots To Cutbank (if present) /1-b I.r F nl0 0,-/F To Driveway, Parking Area, or Vehicle Storage Area /L✓//9 Comments Sy��t �e / faZ5:? c e 6( S(GDTcC O N 6-7e000J,6, 74F Cu SGC ;F, -J0 u C- .1,f /�A- 7 -M -F Cu2re�=�✓'' o CCu�ccvr zJ C-� T vy D. LIFT STATION Date Installed Dimensions Size in Gallons 4Nan ole/Access (Y/N) "Pump On" Level at ' Pu p 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 ** I certify that I have checked, verified, or conformed to all A and HAA guidelines in effect on the date of this inspection. Signed S & S Engineering Date ZOle C SRS 196x CompanyS%gle{iver, Mask -9 537 MOA No. Receipt No. 3% ? K9n Date of Payment " 1___) 1 78 Amount: $ Page 2 of 2 72-026 (11/84) k A Fy CCE RI V, R, PIPS�P HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS C ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN June 3, 1986 Municipa2.ity og Anchonage Depan.tmen-t ob Health and Human Senv,iees 825 L S-tnee.t Anchorage, Alaska 99501 REFERENCE: Lot 3; 82ock 1; H,igh2and H,i22s Subdivision ROBERT A. SHAFER CIVIL ENGINEER 694-2979 MU;vrclp'lury a'cnrOh 4N rNVIRp'VMEZT R� A ~ C> O l VFj) A eonditi.ona2 Health Authonity App4ova2 was ,issued by youk obbice in Apkit, 1986 {yon the nebenenced pnopenty. A condition o{ this app4ova2 nequined a eomp2ete nep2aeement ob the on-site wastewa.ten disposal system. The conditions o{y ,this app4ova2 have been met and attached is a copy o4 the as -built on -bite sewage dtisposa2 system .inspection nepont which was upgraded unden your penm.it #860145. Request you .issue the 4.ina2 HAA. 16 we may be ob {yun-then 5ekvice, please contact us. /ss l . CHAFER, P. E. SRB 196X EAGLE RIVER, ALASKA 99577 IM A-)( '�& 1 Roo awcyFR . C3.. 7 -- Time Time APPLI` DINT FILLS OUT UPPER HA` " ONLY Property Owner Phone ..Mailing Time Address ..�� r/ � ///� ii...i�t` 4 %IJs'i - �� c,_. Zip Code (;rf:-`' �� Yu/ 6"-/ Buyer Address -`iM4Ca•Q -� Zip Code Lending Institution i _ — Phone Address Zip Code Inspector Realty Co. & Agent Phone Address Zip Code U �, 1 Q_Us Legal Description � 1 f�/CJC Ak;rC>/ c�T/S , <i41il l f/i5i a;,--- Street Location Type of Residence .. t. tv` 3� ® Single Family _ A ENVIROViv1LNTAL PROTECTION ❑ Multiple Family No. of Bedrooms ❑ Other V V- Water Supply X Individual( ofiv CEN ED ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. El Community \ i1 For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility ( ) APPROVED BEDROOMS Sewer Disposal 'CONDITIONS OF APPROVAL 19 Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding 'rank DATE_Y— ® 3 NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. IM A-)( '�& 1 Roo awcyFR . C3.. 7 -- Time Time Time Time Time Dale Date Date Date Inspector Inspector Inspector Inspector U �, 1 Q_Us Field Notes: Ga -E �.1 ' rwf vim. h.t ,-°..r .,,y .s-' LIZ�I; C C�a�?v. `�-(` '`t{e - ti�JUNICIP.4LITY OF ANCHORAGE C: DEPT. OF H9ALTI-I .. t. tv` 3� _ A ENVIROViv1LNTAL PROTECTION CTS, AA. Clo 1) L—• �:._. V V- ofiv CEN ED 7 cis AJLA-- ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( �) CONDITIONAL. APPROVAL* DATE_Y— ® 3 P BY: —�s��� Soils Rating Date Sewer Installed qq C !'1-11.r l t q Well To Absorption Area Well to Tank 76 Well Log Received Septic Tank Size (0 C) 72023 131821