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Home My WebLink AboutSUE TAWN ESTATE #2 BLK 1 LT 20 ./ MUNICIPALITY OF ANCHORAGE ~ ~ DEPARTI~ENT OF HEALTH & ENVIRONMENTAL PRO'i:'~:~TION ENVIRONIV]ENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAM,~ ~ O~'~ MAILING ADDR~ LOCATION DISTANCE TO: Manufacturer Liq. capa DISTANCE TO: Manufacturer DISTANCE TO: IF HOMEMADE: Inside length Well Dwelling No. of lines Length of ecr~i~e Top of tile to finish grade ~ / Length Width Foundation Total len~_~ I~es Material beneath tile Depth Dwelli r~_)~7- IWidth inches inches NO. OF BEDROOMS Liquid depth PERMIT NO, Liquid capacity in gallons / 005 Distance between lb]es Total effec/~ti(e~al so ' b rption area PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area Well ' Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTAI~LER REMARKS DATE LEGAL PERMIT NO. APPLICANT LEON & BONNIE ADAMS LOCATION LEGAL L20 Bl SUETANN TYPE OF SOIL ABSORPTION SYSTEM IS~ MAXIMUM NUMBER OF 8EDROOMS = 4 fqUf-~ :[ C: l,r"FI[_ I T"r" C,F Rf~lC:k' RFIGE DEF'ARTMENT ~,.~/ HEALTH AND ENVIRONMENTAL %,,-,~0TECTION " 825 'L' STREET., ANCHORAGE., AK. 9950± I--.IELL RI'4D L--,I"-.I--S I TE SEI-4EE,;~." F'EF:i'4 l- ( 824005 ) , SR2 4875 CHUGIRK 99567 LOT SIZE TRENCH "SOIL RATING (SQ FT?BR)= 688-~777/L{~ 99'9999 SQLIRRE FEET/ THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [)EPTH= 8 LENGTH= 6~::-" GRR%~EL E)EPTH= 4 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE E~CBVATION (IN FEET). sIZE= "~ 250 GRLLc"~'~S ~E~LIIREC~ sEpT~.IC TRf~i:: = PERMIT APPLICANT HAS THE RE-~.ONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INST~LLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. T[40 (2) I f-~SPECTI C~NS RRE ~:E6!LIIRE[:. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R NELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 108 FEET FOR R PRIVATE NELL OR t58 TO 208 FEET FROM R PUBLIC NELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM R PRIVATE NELL TO A PRIMATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICRTIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F-EF-:i'--i I T E~-~P I I~:ES DECEI'IBER _-~--~k.. ::i_982 I CERTIFY THAT ':L: I AM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED: ..... ' ~ - - ......... APPLICANT LEON"& BONNIE R[:,AMS ..... S, ~ :,: L.,~:: 725 OLD sEWARD ~& £N.GINEERS, INC. ANCHORAGE, ALASKA 9950:5; S ~ ' ' ' 54,9 -6561 ::: '; SOILS LOG - PERCOLAI Ov'c ?. 2 3 ,._~-~ {¢~,~vc-'-L 5/Cc, 7' 9- ~1-~-~ LC> 10- 11 ~ ~ WAS GROUND WATER ENCOUNTERED? 12 IF YES, AT WHAT DEPTH? 13 19~ 20 t__ PERCOLATION RATE TEST RUN BETWEEN Time Ne1 CERTIFIED BY DATE · ' ' ~. ; , ' ~,~.~J; . . D ~ s on of Environmental s~rvlces ~,,.~.~.,,.,, ..~l~ -~... -..': . · , . _ PO. Box 196650 Anchora e,A as a 9951~650 ' ;'" ...... ~:":~ :~':'~' "'" ' - -':APP~n~A/. __..__.._ FOR A SINGLE FAMILY'_____..._BW~LI' YNR ' - : ~.: :.!'.':'r_ }!;,:~GENE~L INFORMATION .... ;: ,~.,,~?';~.[[~' ~,r.-'~ ,-':::r.-:~}~-,: %: : ..... ~:.~,~2~ ..... ~¢,~}} ..... ' .. :::? ComPletel~a[descripti~n' ' . Lot 20: :~oek I; S~ T~n Es~ ~2 · - -- WASTEWATER STATEMENT OF INSPECTION BY, ENGINEER ~'=~ .' ..... .'~ AS certified by r~y ...... , seal affixedhereto and as of ~h.e. 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 ~nves.tLgation and inspection, the on-site water supply and/or wastewater disposal system'!s.in compliance with all MunicJ pal and State cooes. ordinances, and regulations in effect on the date of this inspection. Name of Firm 17034 Eagle River Loop Road N 204 Address .... ..... ....................... -., A Anoroved .... . : · ~=: ~,~ Cond~t onal. approval for~, ,,, b~rooms,~w~th the follow ng. stipulations '?:Date':'~-~ The M~n[c pa ty of*~chorage Department of Health and Human Servmes (DHHS) ~ssues Health Authority ~ApproVaI~-. ertiflcat~s based only upon the yepreeentations giyer! in paragraph 5:above by an independent . .: prpfesa~onal flngtneer registered ~n the Stateof Alaska. The DHHS does this as a courtesy to purchasers of homes and t~elr, lend~ng restitutions ~n order to satisfy certain federal and state requirements, Employees of DHHS do not .: r~UCt i Sl~'~cti lyze date: b f,O te ! u. ip lit,/ co n ons or ana e re a certiflca s iss ed. The Munic a of Anchorage is not ; '~'~SPonsibie fo~ errors Or omis~iOhS ~ n. ' :' : ;:~ ~ ' ; ' : =': r . ........ ~[clpahty of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Sanitary seal ~N) ~ ~ ,.{ ~..~,~.-~,_r,._ FROM WELL LOG A. Well Data Well type ~~ If A, B, or C, attach ADEC letter. ADEC water system number Logpresent (~) ,.~ Date completed ~ ~ /¢';~2. Driller Total depth o,~ ~, Cased to ~ D ' Casing height [.z.)[ Jr ¥ Date of test Static water level Well flow Septic/holding tank on lot Absorption field on lot Public sewer main Pump level1 SEPARATION DISTANCES FROM WELLTO: ' Wires properly protected ~N) · ~AT INSPECTION q.p.m. Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank m WATER SAMPLE RESULTS: Coliform ~) Date of sample: ~, - / ~ <~ B. SEPTIC/HOLDING TANK DATA Nitrate /, 5'- Collected by: Other bacteria ~ & S ENGINEERING ~ ;3g~ ~agle River Loop Road NO. 204 +&?;!~. i~iver, Alaska 99577 Date installed Cleanouts {~N) / High water alarm (Y~.. Date of pumping '~ -~ ~- ~ ~' / Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Tank size ] ,z a"~ Compartments Foundation cleanout (~r~l) ~/' ~ Depression~(Y~). /"/ Alarm tested (Y/N) ? On adjacent lots Absorption field /~ol-~ Well(s) on lot i z-/c> /'~ To property line {,~ / r~ Sudace water/drainage Foundation Water main/service line 72-026 (3~3)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA elestdcal codes (Y/N) ~ SE~ STATION TO: W~II on lot On adjacent lots Manufacturer Manhole/Access (Y/N) Surface water D. ABSORPTION FIELD DATA Date installed ~0~.~ /,¢,~.~- Soil rating (GPD/Ft2) /2-5"'¢/~,¢ Systemtype Length "~Z- / Width __ ~" Gravel thickness ~-/ / Total depth ~ / Total absorption area --¢74. ~ ~--w~-, Cleanout present ~) ~/ Depression over field (Y/¢~) Date of adequacy test y¢ ~ ,2 c - q ~ Results~l;~[/fail) ._/~A-~ ~ for '7/ Water level in absorption field before test .f~ ~ '~ After test Peroxide treatment (past 12 months) (Y~ ~"~,/'E.-- /~,,~,J-J If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Bedn~ms Well on lot /5~¢ To building foundation On adjacent lots Surface water Curtain drain ~f/.q On adjacent lots ,/~ ~ Property line .¢'-'~ / + To existing or abandoned system on lot Cutbank "J/A- Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I ce~'fy that I have checked, verified, or conformed to all MOA and HAA guidel/nes in effect on the date of this inspection. Signature Engineer's Name HAA Fee $ '~). ~ Date of Payment ~'.///~'~/,¢2 ~'~ Receipt Number ¢>7 ~f?~.? %/ Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) I ~::'~- { -~ ~I,L~ '~,..~ ~'['~'. Property owner Mailing address Lending agency Mailing address Agent Address Day phone ~- tC~'~'~'~'~'~'~'~'~-' Day phone Day phone NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water Unless otherwise requested, HAA will be held for pickup. 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: 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. 72~25 (Rev. 1191) 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 Engineer's signature bedrooms. DHHS SIGNATURE ~'~'-" Approved for Phone Date Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: 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 profe§sional 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. (Rev. 1/91) Bsck MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /---?~/~,/ Cu-~--/T~u,,),% ~'~.Y~"'2_ Parcel I.D. A. Well Data Well type pr [d m-(-~---. If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) /"-J. Date completed ~-.~t/.J~_ Driller r'J//Ic Total depth -~7--'-~ '~'+- Cased to *~-~-'('-' ~ Casing height '~- ~-~''~ Sanitary seal (Y/N) Y wires properly protected (Y/N) "'// FROM WELL LOG Date of test Static water level Well flow Pump level1 g.p.m. SEPARATION DISTANCES FROM WELL TO: AT INSPECTION G,'~-- g.p.m. Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ~'~ WATER SAMPLE RESULTS: Co,form Date of sample: / Nitrate Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) ~ High water alarm (Y/N) Date of pumping Other bacteria /'-'/~' ~.~---. ~-- Tank size [Z-'~ % Compartments Foundation cleanout (Y/N) V Depression (Y/N) .~/,~ Alarm tested (Y/N) o~,~-- Pumper ~ '~-'"~'~ ~:::~U/Lo~...~ Foundation '~--E) 1~ Water main/service line '~Yz::p Jr _ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~4C:)'J-'t'~- On adjacent lots /,L-O0"~'I~"{- TO property line LC'+ "~ir-- Absorption field Surface water/drainage /~(Dco Jr- 72-026 {3/93)° Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at High water alarm level Meets MOA electrical codes (Y/N) Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: /,~/,.~ Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~C"~-.- Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) \ cf ~ ~ Soil rating (GPD/FF) Width ,~d~ ~.¢-_,~ Gravel thickness ~'~_oc.o ~'~'~- Cleanout present (Y/N) (~/~.4./~-- Results (pass/fail) ~'~'-/ System type Total depth ~'~ Depression over field (Y/N) for After test If yes, give date h'~/ Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / ~.~ d-'.~ On adjacent lots ~.O~--'t-z~ Property line To building foundation ~ "/-1~ To existi~g,,~ or abandoned system on lot On adjacent lots ~-'~ '/-'~ Cutbank / ~ ~-~ Water main/service line Sudace water /~-~ 'p~ Curtain drain /~/.~c- Driveway, parking/vehicle storage area '~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on Signature Engineer's Name HAA Fee $ Date of Payment Receipt Number 72-026 (3/9~)* Back Waiver Fee $ Date of Payment Receipt Number ARCHIE GIDDINGS, P.E. P.0. Box 872024 Wasilla./~ 99687 (O0?) Location: ~ELL FLOW TEST Well Depth: Static Water Level: ~ (ft.) (measured fro~ top of casing) ~asing Above ~round: (ft.) · /)ate Inspector Froject ~ Meter Cum, Water Time Reading Volume Volume Level Flow Comments C~l/.g~a_~} (gal.) (gal.) (ft.) (gpm) TOT~ VOL~ OF F~OW: l~-$~ (gal.) TOTAL TIMEOF FLOW:_ ~z~ (min.) ~ r~ ~T~: ~'~ ,(gpm) Reviewed by: _~ ARCHIE GIDDINGS, P.E. P.O. Box 8720~4 ~/asilla, ~ 99687 s~'.P:rXc S~S~E~ A~,~UAC'Z TEST ~umber of Bedrooms: Septic Tank Size: [Z~O (gal.) ~oil 6bsorption System: (absorption) Date Inspector Project ~ Cum. Tank Change SAS Change Time Flow Vol. Vol. Level Tank Level SAS Comments (gpm) (gal.) (gal.) (ft.) (ft.) (ft.) {ft.) ~CO~RY TEST RESULTS L~Pas's~d Failed Reviewed By: ~~ 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 GENERAL INFORMATION Complete legal description Location (site address or directions) .'/~ ~/q :~-:-:-:-:-:-:-:-:-~.J ~ '~-/-,~J ,x/ Property owner /~z-b~L_ ~-~f>~-X--E~ Day phone Mailing address Lending agency Mailin. g address Agent Address Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 4 NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- lng 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. 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 ~' ~' ~' ~ ~-/'7',/~-~- S & S ENGINEERING Address . * 17~4 ~nDle River L~o~ Engineeds signature Phone Date DHHS SIGNATURE ~ Approved for Disapproved. F~) L'//~ bedrooms. Conditional approval for ............ 4g'h ~. ~, ~.~ ~z ....~ -, r- ~-. ~ ..... t bedrooms, with thb 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 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 ,]L~ I ~ 1~9~ ~.~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ~_~c.~.=~,~, 825 L Street, Room 502 · Anchorage, Alaska 99501 ~ ~~ ........ Health Authority Approval Checklist A. WELL DATA Well type ,~/~-/,~'7-g Log present (Y/N) Total depth ~ / If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to ~ 0 + Casing height (above ground) Sanitary seal (Y/N) Wires properly protected (Y/N) Date of test Static water level Well production FROM WELL LOG 0c7- AT INSPECTION C' I/4 g.p.m. 4~ ~- g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: ~, //(-~ /~¢ B. SEPTIC/HOLDING TANK DATA Date installed / ~/(~- Tank size Foundation ~leanoUt(~N) Date of Pumping /~/~'/~.,~.. C. ABSORPTION FIELD DATA ' ' Date installed Depression (Y~ /~ 0 High water alarm (Y/N) Pumper ~ ~'7-'/:¥~.~ ~/'~?~/...~ Other bacteria Collected by: /~ ~- S & $ ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River,,~laaka 99577 Number of Compartments ~- Cleanouts {~/N) Soilrating (g.p.d./fF~ 1~-5 ~,~ Systemtype i'~"~-~---'-~J~_~ffl~ Length ~-~_ / Width -~ / / Gravel thickness below pipe 4 Total depth ~' / Effective absorption area ~ ~7--F~-~ CMonitoring Tube present (Y/N) ~'~ Depression over field (Y/N) h..~ O Date of adequacy tes, (a//(a[c~q Results(Pass/Fail) /;~,4-$5' For 4 Immediaiely afte~'~O gal. water added (in.): /. Absorption rate = F'~' ~ ~-- g.p.d. K'~6~f yes, give date ~ · Fluid depth in absorption field before test (in.); -~ Fluid depth ~) (ins) Minutes later: ,..~ ~ Peroxide treatment (past 12 months) (Y/N) /~/'(~) N ~'L bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed _ ¢/~ /,/~' Size in gallons Manhole/Access (Y/N) .... Pump.~le*~T'at * __ High water alarm level at* _ ~ *Datum Cycles teste¢~ E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: /~)f.,) / ~ On adjacent lots __ /~)~ /?/-'- On adjacent lots __ Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line "Pump off" level at* /t///-} Public sewer manhole/cieanout /V'//~- ~_~- /~L.. Lift station SEPARATION DISTANCES FROM SEPTiC/HOLDING TANK ON LOT TO: Foundation 3- /'Tz'' Property line -'¢~-/'/- Absorption field '~- Water main/service line ,/O/"/' Surface water/drainage /_/~.?~)/'vL Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line _ ¢,,'~/../z- Building foundation /(~/~L Water main/service line /~) /"~- Surface water ,/("~¢/'~ /'J- Driveway, parking/vehicle storage area Z,~-/?'- Curtain drain ,,~/O/v/~- /~/U/~/.'tJ/'kJ Wells on adjacent lots //~)(~ / F. ENG,NEER S CERT,F,C^T,ON ..'--~ O.~ ,~ '~, ~;,5.'.:..: ............ I certify that l have determined thru field inspections and review of Municipal recor¢~'.?¢ the abcz~ in conformance with MOA HA,~,guidelines in effect on this date. ~. '~ ; . _. / //? ¢' ~ ...... :..,~2;~1:...¢...,;~....,......¢. Signature "")("¢"//'~ ~"'- [/'¢~--' ~. D~.~,....(¢'~'~--- Engineer's Name I~,~.,A. 7'- ~-. L-O~'~¢,,.) ~?~-~'., CE-880t Date 6 / / ~ / ~l ¢1 t', ,~,' ........... ,%' .-.., ~,u F¢.,~..; ..... Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number JUN-il-git 11):31 FROM'CTE ENVIRONMENTAL ~!~t~CT~EEnv;ronmelntalServiceslnc. $61530{ T-g56 P.02/03 F-Z95 CT&E ReL~ 992843001 Client Name S & S Engineering Project Name/// N/A Client Sample ID Lot 20 Blk 1 Sqe Tawn Matrix DriRkirig Waler Ordered By PWSID Sample Remarks: Client PO~ Printed Dale/Time 06/19/99 17.52 Collected Dale/Time 06116/99 21.05 Received Date/Time 06/17/99 13;30 Teuhnlcal Direclor: Stephen C~ Ede JUN'I~'D9 lg:31 FROM-CTE EiWIRONMENTAL 5615301 T-g56 P.03/03 F-2g5 CT&E Environmen~a~ ~ervices Inc. L~bme~ry Division ~~ _~ I~ 200 W. Po'~er Drive Drinking Water Analysis Report for Total Coliform Bacteria A.c.or,0., aK ~5~n-~eo8 Tel {flOT) ~62-2343 READ INSTRUCTION."; ON R~VER,.~E SIDE BEJCO~E COLLECTING $~MP.~E Fa~ ~907l 861-S301 PUBLIC WATER SYSTEM I.D. PRIVAT£ WATER Seaa Run,It* ~ $vnd tn~ce MOS? BE C0lqPLETE'D BY' W^'D~R~u??LI~ SAMPLE DATI~. Month SAMPLE TYPIC: ~ Routine ~ Repeat Sample (t~r routine sample wi~h lab ref, au, . ) ~ Special Purpose Day Year Treaged Water [] Ua{reasecl Water Time Collected SAMPL£ LOCATION Collected By TO Be COMPLI~TED BY LABORATORY AnalySiS sho~s this Waler ~AM~LE Safisfacto~ Sample over 30 hours old. res~Rs may be unreliable O Sample too long in ~nSlt; sample should not be over 48 hours old at examina:ion w indicate relrable results Please send new sample via s~ec~l del~eU mad. 't ~ ' Time ~ceiv.d / ~ . A0a~ysi~ g~an ana, ly~teal Method: .~ Membrane Filter [] MMO. MUG N~,mb~r of colomea/100 ~1. Result* Analyst Client notified of unsatisfactory results: BAC'rERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result; Total Coliform E. Coli Membrau~ Filter: Dir~ Coun~ ~ ..... Coloni~100 mi verilkaIion; LTB BGB COLIFIRM Fecal Coliform Confirmation I~inal Membrane Filter Results '~ Collforlml00 ml [;NViRQNMENTAL FACILITIES JN ALASRA. CALiFOrNIA. FLORIOA. ILLINOIS. MARYLAND, MI£IIIGAN. MISSOURI. N~ JERSEY. OHIO. wEST V~RGINIA GENERAL INFORMATION (a) ('~'/ MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date Legal Description (include lot, block, subdivision, section, township, range) Lot 20, Block 1, Sue Tawn Est.'. #2 Sec. 15, T15N, R1W Locatiof~ (address or directions) Sue Tawn Dr. (b) Applicant Name Red Carpet Realty Telephone: Home n/a Business 694-3503 Applicant Address P.O. Box 633 Eagle River, AK 99577 (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); ~8~tor (d) Lending Institution Citjy Mortgage COrp. Telephone 694-8505 Address 405 W. 36th Suite 100 Anchorage. AK 99503_ (e) Real Estate Company and Agent Applicant Aq~nt - Kathy D. Geraci Address as above ~ .-~:,¢-~*~? ~-?eJephone~as ~bove 7 ': 7:'3 i ....... ~'77~ =7"'7 (t) Mail the HAA to the following address: Pick up by enqineer "" 2. TYPEOFRESIDENCE " / ~ i Single-Family [] Multi-Family [] Other Number of Bedrooms 4 WATER SUPPLY Individual Well I'~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 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 (11/84) ENGINEERING FIRM PROVIDINg- .4SPECTIONS, TESTS, FILE SEARCH, DA. AND INFORMATION As certified by my seal affixed hereto end 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 end State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Eagle River Engineerinq Services Telephone 907/694-5195 Address P.O. Box 773294 Eaqle River, AK 99577 Date Approved for t'~--(~ bedrooms by Approved u-~._ Disapproved Terms of Conditional Approval Conditional Date 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 72.025 (1 [/84) ~ J,,ALJNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION wAY 4 1988 A. 3,F ; JV E D MUNICIPALITY OF ANCHORAGE (MO~')' HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Lega~ Description: Well Classification Well Log Present (Y/N) Y Date Completed 1~'.'~' Yield Total Depth ,~ / Cased to ~"~ ' e f~'. Depth of Grouting Static Water Level _ ?A · ,5'~_/e-.~ ~,"~ ~'<.r,D~- Pump Set At ,~'~, Casing Height Above Ground ,='~,P" Sanitary Seal on Casing (Y/N) If A, B. C, D.E.C. Approved (Y/N) Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot 2' Depression Around Wellhead (Y/N) To Nearest ~d§e of A~$orption Pie~d on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results ~'~" ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot /~'~ ; Date -~./"~/~'~' Comments B. SEPTIC/HOLDING TANK DATA Date Installed /?~' ~ Standpipes (Y/N) _,Y Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ,"~'i/'~ Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line ,5"~ To Water Main/Service Line '~/,~" Course Size J~"¢"°..1~,/ No. of Compartments Air-tight Caps (Y/N) __)/ _ Foundation Cleanout (Y/N) Date Last Pumped __/~,~.~ ; for ,'~'..~ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /'~ ~ c- Width of Field -2 ~ * Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /4 ,~ / To Building Foundation Lot To Water Main/Service Line Y'/~' / To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ?~ · L./ Depth of Field g' / Gravel Bed Thickness 4.' / M' Standpipes Present (Y/N) ,,J/ Date of Last Adequacy Test ¢~,/a To Property Line ,.2 3 / To Existing or Abandoned System on ; On Adjoining Lots ~",~¢' / To Cutbank (if present) Comments LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Bequest I certify that I have checked, verified, or conformed to all MOA and HAA g uideli nes in effect on the date of this inspection. Signed ~- Date Company Eao~e Rivnr F~.ntr~es~o¢ee/tee~ MOA No, P. O. ,ox 773294 / ..~ Receip! No, Eagle River, Al( §9,~77 Date of Payment . .Amount: $ ? ~;~) ¢ ~¢ ,...;r qgineer's Seal Page 2 of 2 72-026 (11/84) AP LI( >NT FILLS OUT UPPER HAl, ) ONLY PropertyOv~-ner,, ~.,-~ (~(~";; :: ~-:~'~?/'~/~ /'~-/'/~1":: Phone Buyer Address Zip Code Lendinglnstitution '~l/ ~,? /=~'~//~/ ~c. ~- : Address LLJ, .;1 r/~ [?,. : ~ [ ~ / . (:il .~ :;' ZipCode Legal Description 2~ ~ (- -} ~ / /~' / ~ ~'~ : T:- t~ ,~ ~ % ~ . Street Cocati~ ~( , I x i" :) -~ ~ ~4 ~' ' oJ t ~ ~k ~ ~:. ' :/ / ; . Type of Resi~nce ~ Multiple Family No. of Bedroo~ ~ g Other ~ Community For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility "~' ' / Sewer Disposal ~ Individual Year Individual Installed:. / ' ' E' /~ ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Date Inspector Inspector Field Notes: Time MUNICIPALITY ANCHORAGE ENVIRONM ii', ~ A,. L,O~ ECTION RECEIVED ) APPROVED BEDROOMS ) DISAPPROVED CONDITIONAL APPROVAL* 'CONDITIONS OF APPROVAL Soils Rating Date Sewer Installed Well Log Received Septic Ta~k Size ?/ ,~ _~ CHEMICAL & G~.~OGICAL LABORATORIES L_/ ALASKA, INC. TELEPHONE {907)-279-4014 ANCHORAGE INDUSTRIAL CENTER 274-3364 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER I.D. NO. Water System Name Phone No. Mailing Address City State Zip Code Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. r-I Special Purpose - Treated Water - Untreated Water SAMPLE NO, t I 2 I I LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to De: ~1 Satisfactory [] Unsatisfactory [] Sample too long in transit, samole should not be over 48 hours o~o at examination [o indicate rehable results Please send new sarr Date~Received , Time Received Analytical Method: [] Fermentation Tube r~Membrane Filter Lab Ref. No. Result* Analyst READ INSTRUCTIONS BEFORE COLLECTING SAM PLE 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date C ollecte~l Sour:ce P~esumptlve 1Omi 1Omi lOml 1Omi 10mi 1,0mi O,lml 24 Hours 48 Hours Confirmatory 24 Hours o° ~ z ( f o4( F_,91- t;,Z )(6~-9Z ) '- '~ Og8 LOOI.LO (Y~O~ 3NIRSVP (eul,ooe ~, m ~ LLI