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HAMANN LT 2A
Hamann Lot 2A #050- 611 - y 1 72-(A3 (Pev. 3/78) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ,e NAME /^'! /% q /J \J C, i/ /^' L' �4 P,,��gyyN�E vfJ Z/-- EW ❑ UPGRADE/ MAILING ADDRESS ,,` �� -� A� �.r .- ii u ` W ` x LEGAL DESCRIP I N LOCATION /� ^` � % NO. OF BEDROOM /C lhlWell DISTANCE TO: „i,� �`/•[�d Absorptio�nlafea� 7' Dwelling, 2 (•, r 1,-r-) PERNO111,Y VY GV l _ !! Cr F- Z Manufacturer - Mat r No. of compartme co Li e dal Ions IF HOMEMADE: Inside length Width Liquid depth, ;:,.a., • i #"-"-" .,.• (� i DISTANCE TOj0Z: Well Dwelling PER T. ±` r - 2zF Manufacturer Material -` Liquid capacixyin gallons 0 DISTANCE TO: Well (!/ Q� Found ( NeaZ lot line( PER - - µl�U. w= _ Lj _G. ul E 2 J w No. of lines LRn�t f I e Total len of lines ` Trench idt1� Distance betty en li 74 - 2 F _ / _� (7 Ci inches .... Top f tilf toy de, Matgr beneath,t"eye Total effective absorption area O nish gr ,,Gt, J,-y "/ / Gs �/ 7/G inches Length Width D pth PERMIT NO. - w C7 a F Type of crib Crib diameter Crib depth Total effective absorption area LU w rn Well ' Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. ' J l LU � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER • PIPE MATERIALS t' V SOI L TEST RATI NG 2 INSTALLER r CZ REMARKS rl \ i• f7A}ih(}�!R A. Shoo-m I4J (- K. 1437-F : 4`.:' G 6 a • N 'n APPR ED DATE LEGAL 72-(A3 (Pev. 3/78) M U 04 X C.- :1 1 MV 13 F` FRI, F C? 1- 1 FIT 1=1 1:1 E=_- ' . DEPHRTMENT\,JHEHLTH AND ENVIR�NMENTHL\~.�OTECTION ^ 825 'L/ STREET/ HNCHORHGE, HK. 99501 � 264-4720 D- v XWEEs. "o" 1=7 1-1 FFEE: F� E -E jr--H 1W PERMIT NO. ( 811152 ) HPPLICHNT STEVEN L SKHGGS PO BOX D CHUGIHK 688~2831 1_8CHTI0N E. R. RD L.EGHL L2 HAIMMAr-4 S/D LOT SIZE 120000 SQUHRE FEET TYPE OF SOIL ABSORPTION SY5*TEM IS: DRAINFIELD MIA'X'IMUM INUMBER' OF BEDROOM -S' = -2: SOIL. ('_SQ FT/BR)= 2,10 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ������-g == �����, -r,��= MC -'-5 VW 1.. �F-_� _T K.-Iz � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCF4VHTI(.:iN (IN FEET). 7' 1_4 EE W FT W F -A 1.11-1 Wo :1107- 1-1 :1 yq W. STIVITU W F=7 1EW -17. THE GRAVEL. DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL. PIPE HND THE BOTTOM OF THE EXCHVHTION (IN FEET). ������E'_--E_,H I 1=1 144 As 17, 1 ��L__.��� PERMIT APPLICANT HAS THE TO INFORM THIS DEPHRTMENT DURING THE INSTHLLHTION INSPECTIONS OF HNY WELLS ADJACENT TQ THIS PROPERTY HND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE �W CH �.7. 1 N��A F_-' E=7 17 W 1 CH 1rA.,H-,, fow FTC FE- Fit GA 1U, I . E_ E'14 BACKFILLING OF Ar -4Y SYSTEM WITHOUT FINHL INSPECTION HND HPPROYHL BY THIS DEPARTMENT WILL BE SUBJECT TO PRi-*i,,.--';ECLJTION. MINIMUM DISTHNCE BETWEEN H WELL AND ANY ON-SITE SEWHGE DISPOSHL SYSTEM IS 100 FEET FOR H PR�VHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDIN.IG UPON THE TYPE QF PUBLIC WELL MINIMUM DISTHINCE FROM H PRIVATE WELL TO H PRIYHTE SEWER LINE IS 25 FEET HND TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY HPPL\! SPECIFICHTIONS AND CONSTRUCTION DIHGRHMS FIRE HYHILHBLE TO INSURE PROPER INSTHLLHTION. F=p Ezr����� ������� ��������� ��L^ ���� � I CERTIFY THAT � �: I HM FAMILIAR WITH THE REQUIREMENTS FOR 8N-ATITE SEWERS HND WELLS HS SET | FORTH BY THE MUNICIPHATY OF' ANCHORAGE / 2� � I WILL INSTALL. THE SYSTEM IN HCCORDHNCE WITH THE CODES | . / ]: I LINDEORYAND F SEWER SYSTEM MAY REQUIRE IF THE ! RESID DE MORE THAN ] BEDROOMS. SIGNED:.. SM WL. ICAN T� STE�EN/i� 'SKHGGS /_!� ISSUED B .DHTE�~ V40 PERFORMED FOR: LEGAL DESCRIPTION: DEPTH (FEET) 2 -"��-3 1 J) J Ip ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST DATE PERFORMED: /0 o c -7- P/ 6 1 7 8 9 10 11 12 13 14 a Date Gross Time .. Depth to Water r / a.h 5 15— .4.o r nr,1.e �- 2 vr.f 30 IV) 16 2 31. „ 3 4 `LS P , yLM 17� -.iia` n• f. ,vtMRA' R 18 <ss 20 COMMENTS SLOPE WAS GROUND WATER e S ENCOUNTERED? L O IF YES, AT WHAT E DEPTH? SITE PLAN Reading a Date Gross Time Net Time Depth to Water Net Drop / /a Q It �- 2 30 IV) / /2 2 31. „ 3 4 `LS P 10 ri PERCOLATION RATE T RUN BETW EN ` 2 r N e e v PERFORMED BY: �/V(I'�/y/��y CERTIFIED BY: 72-008 (6/79) 2-03 Ar '( FT (minutes/inch) f AND .r . � FT DATE: CONSTRUCTION TEST LZ1B "One Test is worth a Thousand Opinions" 2203 Cleveland Anchorage, Alaska 99503 277-0231 s rformed for Bob Hamann Date Performed 12/29/79 gal Description: Lot__2 r Blocky Subdivision Tract A Hamann Subd. is For.;i reports: SOILS TEST Yes PERCOLATION TEST epth Soil Characteristics eet _g Peat Brown Sandy Gravel (GP) 13' wdtQr Bottom of Test Hole s Ground 'Water Encountered yes YES, What depth?_ 111 an lmmoomm MIN®IMENIM N'1E ading �' Date Gross Time Net Time ..� Depth to H2O Net Drainage 1 rcolation tate Minute Proposed Installation: SEEPAGE PIT Depth of Inlet IDe-Dth to Bottom o 1'•IENTS: -19S aniiarp fit drainage—area rPaui rad3 i DRAIN P I ELI? Pit or Trench st Performed by^ \ 1w-" Data Certified Bv: Const. _ Test Lab Ind . Paul Date 1/4/80 Ti -n -n -n -n r+ r+ r+ r+ -n -n -n -n r+ r+ r+ r+ -n -n r+ r+ > 0 > m M m r- > M r -n -n n -n -n -n -n -n -Ti -n -n -n x X M X Do DO X X x M x 0 0 0 0 0 0 0 0 0 0 0 "n n -n n -n -n -n n n 0 0 0 0 0 0 0 0 0 0 0 Ti -n -n -n -n r+ r+ r+ r+ -n -n -n -n r+ r+ r+ r+ -n -n r+ r+ > 0 > m M m r- > M r 70 M I m x 0 0 0 0 0 0 0 -n -n -n -n -n -n -n f+ r+ r+ r+ r+ r+ r+ m rm- -n -n -n -n -n 'll -n -n -n -n -n x X x x x x x m x DO x 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -n -n -n -n !-+ 1+ e-+ 1+ 0 W o > 0 > m M m r- > M r 70 M I m x 0 0 0 0 0 0 0 -n -n -n -n -n -n -n f+ r+ r+ r+ r+ r+ r+ 0 0 0 0 -n -n -n -n !-+ 1+ e-+ 1+ M 0 W o > 0 > m M m r- > M r 70 M I m x cn n 0 r 0 > m m < M 0 W 0 j� > ---i M m r- > 0 n 0 r 0 > m M < m rm- OF MUNICIPALITY OF ANCHORAGE Department o{ Health & Human Services 825 L Street, Anchorage, Alaska 99501 343 Permit Number: 890096 Enlargement Date Issued: 06/21/S9 Owner Name: A"H.F,C. Owner Address: PO BOX 101020 ANCHORAGE� AK 99510 WELL PERMIT Day Phone: 694-42O0 Parcel Id: 05O~611~02 Lot Legal: Subdivision: HAMANN Lot: 2 Block: � Section: 15 Township: 14N Range: 1W Lot Size 12000O (sq,{t, or acr(.-!s) , MaxBedrooms: This Permit: 0 Total Capacity: 3 WELL: Log must be submitted to Municipality of Anchorage Department oH Health and Human Services within 30 days o[ well completion" INSTALL PER ATTACHED SITE PLAN. THIS PERMIT IS ISSUED FOR THE EXISTING SlNGLE FAMILY DWELLING ONLY AND EXPIRES ON 12/31/89^ I CERTIFY THAT: 1" I am familiar with the requirements {or on~site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of A1aska" 2. I will install the system in accordance with all MOA codes and regu1ations� 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 distanany existing well, wastewater disposal system or public sewerage sysLem on this or any adjacent or nearby lot. 4" I understand that this permit is valid �or a maximum of 0 bedrooms" I also understand that the capacity of the total system is 3 bedrooms and any enlargement will require an additional permit` Signed: DATE: ��~2_1_{��� �'^~~ ~_�_�~ (Owner) A.H F C lssued By: i DATE: 44 ;vl11 N V C�rrfifieil +drilling +ungby DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION—/—L-2— 1164 DATE - Started ` Ended PERMIT NUMBER KIND OF FORMATION: DEPTH OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT GALS. PER HR KIND OF CASING From —,'Ft. to ' `= Ft. �' ``� � � ��� �` J � From Ft. to Ft. From Ft. to Ft. {C �J iE �f v '' iry 4'W -i? From, FMOFd From Ft. to Ft. �t'' '�� From DEPT. OF HEALTH & FE.�pIRGNMfAl From •' Ft. t&7Ft. Edi i<: From Ft. to F -': From- rom Ft. to a Ft. X/471 1 '`t`�O "° From_ UR zt,.1989 Ft. to Ft Froml r�: ' Ft. to. Ft. %J.✓)R 3 c, K !nC -., ' From Ft. to BEC IVSD From ._Ft. to-16—Ft. iZ oLrQ.'i t -'G From Ft. to Ft. From 7(o Ft. to Ft. 1 z!F40,4' OC./,e 116,f a, L-gw`j From Ft. to Ft. From /F, -S Ft. to:' .y Ft. a _1,rC �.SJf% From Ft. to Ft. From Ft. to Ft. J x,.i '�! d �' A From Ft. to Ft. From A �' Ft. to - f -'j Ft. 1US12le DK } �- From Ft. to Ft. From Ft. to (22, - Ft. -}C Q �� '= "j From Ft. to Ft. From Ft. to Ft. °�R�<=�`�'a �� ��," From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to : ,3 -Ft. r r � z From Ft. to Ft. _ From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft MISCL. INFORMATION': DRILLER'S NAME _Development Services -Department ( __ Rho ne:_90-7--343-79D4------ ____ _ _On-Site_Water_& Wastewater Section _ ___ __ __ __ _ Fax: 907 -343 -7997 - Certificate of On -Site Systems Approval Parcel I.D. 050-611-41-000 Expiration Date: Legal description HAMAN N LT 2A Site address 24200 HAMANN RD Eagle River AK 99577 Current property owner(s) SHEPHERD JEFFREY G 11/4/2023 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Septic Tank is 41 years old. a Original Certificate Date: $/4/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE Development_ Services_Department__ _ hone:_9.0.7_-34.3-79.04—____ _ _ On -Site Water &_Wastewater Section Fax: _907 -343 -7997 - Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-611- . 111-/ Complete legal description Hamann Lot 2A Location (site address) Current property owner(s) 24200 Hamann Jeffrey Shepherd 2. ON-SITE SYSTEMS SIZED FOR _BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: V Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 41 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench © Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $_ Date of Payment eAA 2 s COSA # 0/0C1,7 > / z Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 Legal Description: Hamann Lot 2A Parcel ID: 050-611-41 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA J❑ Well log is filed with Onsite (or attached) Date drilled 6/1989 Total depth 300 ft Cased to 5414.5" ft 0 Sanitary seal is functioning correctly ❑✓ Wires are properly protected Casing height (above ground) 20 in. Date of flow test for COSA 7/18/23 Static water level at beginning of test 107 ft, Comments B. TANK DATA Measured operating fluid level in septic tank 12/9/81 Date of pumping 10/10/22 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 12/9/81 Fv] ALL standpipes present per record drawing Total measured depth from grade 3 ft (max) Measured depth to pipe invert from grade 2 ft (min) ❑ N/A — pressurized field. ❑✓ Per record drawings, field is insulated. n Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 4 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes PI Nc © Coliform bacteria is Negative Nitrate 0.489 mg/L ElNitrate less than MRL (ND) Arsenic ug/L P] Arsenic less than MRL (ND) Collected by Arcterra Consulting Date 7/13/23 STATION ❑ Require Age of lift station Lift station material Comments: ce completed Adequacy test date 7/18/23 Results v Pass Fluid depth prior to test 0 in Water added 450 gal New fluid depth 8 in Elapsed time 60 min Final fluid depth 0 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 12 in Effective depth used 0 in Effective depth remaining 12 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' ./❑ Yes if No Community Sewer Manhole/Cleanout > 100' Yes if No ft 0 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No It Absorption Field on Lot > 100' ❑Z Yes if No ft Holding Tank > 100'✓❑ Yes if No It Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑✓ Yes if No ft ❑✓ Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ✓❑ Yes if No ft ✓❑ Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ./❑ Yes if No ft Surface Water > 100'✓❑ Yes if No ft Tank to Property Line > 5' ❑./ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑✓ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' © Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10'❑ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Arcterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date Engineer's Comments: This investigation was completed in compliance with ADEC and *VIOA 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 4 i 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 aMr 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 unseen 0-20. encroachments, deficiencies or discrepancies exist. 0 tir COSA Checklist June 2022 NA UFRCWAUTV OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section - www.muni.org/onsite -- Septic Tank Advisory Certificate of On -Site Systems Approval # OSC231278 Subdivision: Hamann Block: , Lot: 2A 907-343-7904 Fax: 343-7997 The septic tank for this property is 41 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. Municipality of Anchorage Development Services Department 4 / Building Safety Division On -Site Water and Wastewater Program s << 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 050- 6//-02 HAA# OS DS �6 Expiration Date: 7- - / 67--c!)6 1. GENERAL INFORMATION Complete legal description / r)7- 7 /4 Location (site addressor directions) 24/2.c -b ff.*Aj jv v 121>, Current Property owner(s) _Poh<rT SjJfkl5a.y Day phone G % 6- Mailing address Lending agency Mailing address Real Estate Agent Mailing Address _Zlf7cxj 14"64'444✓ RL E'4-41EEIPTdt2 41C 990.77 Day phone /L/47"L r')L-M Day phone r; ?y— c, 2 mo Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a piivate or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm 6- 441,C Prof Env[• SJct. Phone Address 101121 VtFW 2h e�411- P.T✓t•�l_ alt 99577 Engineer's Printed Name GHRTS e>P& P 5. DSD SIGNATURE _� Approved for __ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: 0 V • • Additional Comments ` J� : • ON-SITE •:��,s < • VVAILRANU urecTGWATFR e Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Rev 01003) Municipality of Anchorage e. ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St, P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: t4 / i✓ LOT' a- Parcel ID: A. WELL DATA Well type PLl Y7;r If A. B, or C provide PWSID # _ Well Log ON) f ES Date completed _� Sanitary seal &N).&_5 Wires properly protected (Y)N) Y S Total depth 00 ft. Cased to __(o�ft. Casing height (above ground) so in. FROM WELL LOG AT INSPECTION Date of test 4/99 -71131c.5- Static /l3/osStatic water level //;1- ft. I 15, ft. Well production 4 g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform ,d colonies/100 mi. Nitrate . 4SZ- mg.A. Other bacteria ecolonies/100 ml. Arsenic: n a mg.A. Date of sample: 7 /3 vs Collected by: CAZ /,., B. SEPTICS DATA Tank Type/Material 90!E!�'`� Date installed Tank size I na0 gal. Number of Compartments. L Cleanouts (9N) Foundation cleanout O/N) ( , " Depression over tank (Ya ` Y,& High water alarm (YIN) n�ti Date of pumping 7 /f97.OS Pumper T& 's -f L-� C. ABSORPTION FIELD DATA Date installed 01.q Length `75 13(o ft, Total depth 3 L ft. Soil rating W4853e or feftrm) z/ 00 Width S Eff. absorption area JE30 ft' Date of adequacy test 310.g System type tv/d-c drzr,:,-/;gd ft. Gravel below pipe / ft. Monitoring tube .(dfj, Depression over field Results ( as Fait) �aa2 For 3 bedrooms Fluid depth in absorption field before test Er in. Water addedyfQ gal. New depth 1(L in. Elapsed Time: 5 min. Final fluid depth Z in. Absorption rate >= _ 4 So g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) .ter., , 4..�ti If yes, give date n ja. D. LIFT STATION Date installed Size in gallons "Pump on" level at_ in. 'Pump off' level at Datum ycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAitl-station on lot + I00 Absorption field on lot * 100' Public sewer main +?S Sewer /septic service line + a S Manhole/Access water alarm level at in. Meets alarm 8 circuit requirements? On adjacent lots * 100' On adjacent lots +100 1 Public sewer manhole/cleanout + 100 ' Holding tank t-100' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation *S' Property line -' 5-` Absorption field +S' Water main *to' Water service line t /O ' Surface water -t 100' Wells on adjacent lots -r 100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line +(0, Building foundation +10 ' Water main +10' Water Service line + 10' Surface water t 100 Driveway, parkinglvehicle storage Curtain drain +5-0 ' Wells on adjacent lots * ro0 , F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name /'E+,CfS-ZVtA59= L. WOOD Date� O y127 5— HAA Fee $ ?i O Waiver Fee $ _ Date of Payment 49 0 Date of Payment Receipt Number % 7 Receipt Number (Rev. 12101) Mil 07-28-05 07:57AM FROM-CTAE ESI. SGS ENV SERVICES woi 9075615301 T-585 P.02/04 F-386 SGS RtfA 1054283001 All Data rimes are Alaska Standard Time Client Name Eagle River Engineering Printed Date rime 0712MOO5 9:27 Project Narne/N Tlamum Lot 2 Collected Datefflme 07/132005 14:55 Client Sample ID flamann Lot 2 Received Dstefrime 07/14/2005 12:40 Matrlt prinking Wakr Tecbaical Director Stephen C. fide Sample Renutks: Microbiology Laboratory Total Colifona 0 coVI00mL SM20 9222D A (<-1) 07/14/05 TLF Allowable Prop Analysis Paramew itnatu P0l. Units Method Container lD t4mits Dau Date fall Nikate-N 0.652 0.100 mg/L EPA 353.2 D (<-101 07/14/05 PLW Microbiology Laboratory Total Colifona 0 coVI00mL SM20 9222D A (<-1) 07/14/05 TLF 07/22/2005 14:13 9073449821 JRS SEPTIC PAGE 02 JRs Pumping PO Boz 773415 Eagle River, AK 99577 (907) 694-6454, BIINng Mdornladon ... r ,_. Eagle Rater Engineering 10421 VFW Rd Ste 201 Job Description: 12000 P.O. Number: Service Agreement Number. 017320 Opfer Date. 13 -Jul -2005 SeMosOate: 19Ju13005 12:00 om Technician: Tony Eagla River, AK 99577 Teems: Net 30 (907) 694-6195 Salesrep: 1,111c01e Job Type Repent Map Book: Map Grid: 122- - ob 8Ne In/orrndl0n •.� Crcee Stneta: WO 5.3 E291e River Road . �_..— _......._ .. Chris Job Comments: Leet oonlce 061=3 1200g 24200 Hamann Road Eagle River, AK 99577 (907) 694.6195 Tax Percent 0 Service Type Gy Price 4ah x 2 Men Tax Extension Actual Septic Service 15K 1 5140.00 No No $140.00 Due to difficulty of pump Additional Location Comments: Diogram: Gallons Planned: 1000 13t dw on right an Hartmann - Brown stele Gallons Actual: home, no lige, bug dw. Pipes M front 8 Volbte - out of house,• • Hose Length: 3 downhill off side of dw. Uphill pull, tank Is 25R below buck. '_' n H Double Tank: Pump System: [�!J �,////// //WlZ f//ff Battles Inlet ❑ ChE Baffles Outlet: ❑ NonTaabM Total Taxable ToW Tu Total Grand Total Estimated Charges: 5140.00 50.00 $0.00 $140.00 Actual Charges: Cusbmer agrees to IN terms and conditions printed an the back. THIS IS A BINDING AGREEMENT. Signature and Title of Customer Repreeentalhre Date Accepted by JR4 Pur" Date Accepted For your added convergence we accept, American Express. Doom. Visa and Mosler Card payments over the phone. After 30 Days socamts wle be turned Our to odiectbns. 523.00 For NSF Checks Relumed. 4 Jim Sullivan 688-2510 or 258-2510 745-2510 Fax 688-2543 COMPETE WATER SYSli-MS SALES! SERVICE PUMP & WELL No 9520 Alaska Distributor P.O. v�=133i > NWWA CERTIFIED PUMP INSTALLER P.O. Box 770197 Eagle River, Alaska 99577 • •----- r"y -y 11IVVIce. An account Past Due will be charged 1to%. $25 second billing charge THANKYOU �P 1 A! ti Oc A4 •!z� t•'d � o .r T. t _ 7 s %` 1 .✓OTF.'RifY+.t-eY'N ��if'oFerA`Tj' C.!vsr 'A- A v.... ^� 1&.. Duane Mark Seward M •., LS • 6918 ;Ar r� .•� c zArO s_ RECERTIF ED-Z-26-89, RECERTITIED 10-3-89 . AS-BUILT Neeormern set this date :ASENENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE HORDED PLAT ARE NOT SHOWN HEREON. The information hereon is for the use of lending institutions showing the relationship of existing structures and platted easements and lot lines. It isnot to be used for positioning additional' structures or fencelines. -orf I hereby certify that I have performed a Mortagee•i in. spection of the following described property: Hamann Subd. Lot 2 Anchorage Recording Precinct, Alaska, and that theImprove• ments situated thereon are within the property lines and do 'noroverlop orvneroach on the property lying adjacent there to, that no Improvements on property lying adjacent thereto encroach on the premises in question and that there are ne roadways, transmission lines or other visible *►+omenta or said property except as Indicated hereon. Dated at Anchorage. Alaska thin 18 day or Oct. IY 88 688-4566 SEWARD 8 ASSU(:IATES LAND SURVEYING 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. # e azo__ 414/ (-'Z - HAA # .&—IZ 7�)K' 1. GENERAL INFORMATION Complete legal description Lot 2; Hamann Subdivision Location (site address or directions) 5.3 Eagle River Road, Eagle River Property owner Carter and Kathy Andersen Day phone 6961-2335 I/ Mailing address p n Box 770721, Eagle River Alaska 99577 Lending agency City Mortgage / Mark Truskett Day phone Mailing add Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: Individual well XX 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 XX 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. 6. 0 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 Firmc s E. mINFEMING Phone 17034 F.acjle River Loop Road No. 204 Address i„ Al, ka 94577 Engineer's signature DHHS SIGNATURE Approved for C Disapproved. Conditional approval for Additional Comments bedrooms. IIIITIC n Date 1\ -2---'lI— A ^3 9AO3191 OFES9\ 14 bedrooms, with the following stipulations: %/ Date ;14-7 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 U21 Municipality of Anchorage Department of Health & Human Services _ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �--'r Z V�PNAhLA "tfl Parcel I.D. A. WELL DATA Well type Ff-W NT - If A, B, or C, attach ADEC letter. ADEC water system number 6 _z t �y /N) y Date completed Driller Log present Total depth 30 0 Cased to S4 �% Casing height Z F - Sanitary seal ON) Wires properly protected a/N) . FROM WELL LOG AT INSPECTION Date of test ' S M Static water level 11 L' /�}3' rn oz y o 4 Well flow g.p.m. gam. Pump level vK vK ®".. 1t m o z co Mry n ti i SEPARATION DISTANCES FROM WELL TO: 00 Septic/holding tank on lot On adjacent lots 1 0 C ti "M' Absorption field on lot �o `} ; On adjacent lots tco k4 - Public sewer main 1'"` Public sewer manhole/cleanout '31'� ?f �r Sewer service line ofLlum, I ACL, \.� 6-L-4, WATER SAMPLE RESULTS: Petroleum tank ZS r+ aa�s P� �E� �a-1PD�� �y,},5 � � „1 c,,.a •t i Z•, k �cfsoJ. tE- c„wP.a� +4c. LAS �,J.�1��P �•i TDP or �-,.rs r.Jln � .(�tP aJ r�•A Stere �,..il.. G,uta� Coliform O Do Pa. Nitratey 73 H�/� Other bacteria IJo46 Date of sample: /p- Z 2- ' S 2- Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date installed /2' $ Tank size /O0 Compartments Cleanouts &N) — High water alarm (Y& Date of pumping 2 Foundation cleanout O/N)T Depression (Y& IJ ^( Alarm tested (Y/N) "/`4 2 L -i2- — Pumper Gf Sse6eL SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /aa ` On adjacent lots 1Qd Foundation 17 i i y To property line /0 ) Absorption field 7 Watermain/service line Surface water/drainage /oo / H 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 Manufacturer Manhole/Access (Y/N) " p off" level at Cycles tested Cycles FROM LIFT STATION TO: on lot On adjacent lots D. ABSORPTION FIELD DATA Surface water Date installed �2—et Soil rating -2--10 +16f- System type Length I t 1 ' _ Width S ( Gravel thickness / t Total depth -30 area �nri- Total absorption L030 G, , p Cleanouts presentON) Depression over field (YQ) Date of adequacy test Results ail) PSS forL3� — bedrooms Peroxide treatment (past 12 months) (Y(pY) t,14A'f- I-nloul AJ If yes, give date 04L, -q AC Z a Q. A P a c Arty SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1 u a t r " On adjacent lots loo (* Property line /0 1 To building foundation On adjacent lots3 e 1 To existing or abandoned system on lot _Cutbank v` /Ar Water main/service line. Surface water job Driveway, parking/vehicle storage area fo Curtain drain �J/A ri E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature giver Loop Road No. 204 saver, Alaska 9957' Engineer's Name — Date -2 le 1?, HAA Fee $ 7,0 ` s Waiver Fee: $ — Date of Payment i l 17 Date of Payment Receipt Number ZNZ-Ltl �� ?��) Receipt Number 72-026 (Rev. 3/91) Back MOA 21 i.1. JA?AF i °o i "ID. i1; 15 (P ma®. aid uee oa®�ap0 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 59987 Chemlab Ref.# 92.5946 Sample # 5 Matrix: WATER Client Sample ID : L2 HAMANN S/D Client Name :S & S ENGINEERING PWSID : UA Client Acct :SNSENGP Collected : OCT 22 92 4 13:10 hrs. BPO# : PO# :NONE RECEIVED Received : OCT 23 92 4 14:30 hrs. Req# : Preserved with : AS REQUIRED Ordered By :R. SHAFER Analysis Completed OCT 26 92 Send Reports to: Laboratory Supervisor ST N�C. EDGE 1)S & S ENGINEERING Released By : � c " " J 2) .................................... _....-__•-•__-._..-...._. Parameter Results Units Method Allowable Limits ---------------------------------------------------------------------------------------- NITRATE-N 0.73 mg/1 EPA 353.2/300.0 10 Sample ROUTINE SAMPLE COLLECTED BY: S.S. Remarks: 1 Tests Performed See Special Instructions Above UA -Unavailable ND. None Detected " See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than 10% SGSMember of the SGS Group (Societe Generale de Surveillance) I MUNICIPALITY OF ANCHORAGE • t Department of Health & Human Services 4 r DIVISION OF ENVIRONMENTAL SERVICESi 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # C {(O—tD O -0 7 HAA # 011`7,S -A9 7-L 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) r5 -f (b) Property owner �T" �� # � � �y Telephone: (home) Business Mailing Addres `T 7 (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agentt>� Address Telephone (e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.) List contact person and day phone number below: s & 5 ENGINEERING 17034 Eagle River Loop Road No 204 Eagle River, Alaaka 99577 2. TYPE OF RESIDENCE Single -Family] 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 th legality and status. 4. SEWAG�ISPOSAL On-site Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 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 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 Telephone `2 /Z 5 �� S & S ENGINEERING Address 17034 Eagle River Loop Road No. 204 Eagle River, Alaska Date 4 '11h 41, 4 Ir 14" •.4 S.� 'FN "'LLL✓ a ' 1.57-11 \ � �%' aa• a°• 4 a1R a a9F�pRF.S7��* 0Fagr'® 6. DHHS APPROVAL / Approved for _bedrooms by�� Date `lig Approved Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88)Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES MUNICIPALITY OF ANCHORAGE (MOA) a • Health Authority Approval (HAA)I � [ 2 5 egg CHECKLIST - FEBRUARY 1984 343-4744 RECEIVED Legal Description: Z� 0 A1q /n,4A1Af -<119 A. WELL DATA Well Classification 2l�lf3 If A, B, C, D.E.C. Approved (Y/N) Well Log Presen (Y/ ) ��((D��ate Completed L Yield ��64'1 Liq Total Depth 79 Cased tdS Depth of Grouting Static Water Level Pump Set At e2 L t Casing Height Above Ground Sanitary Seal on Casing((Y)N) Electrical Wiring in Condui (Y/ ) Depression Around Wellhead (YN)' SEPARATION DISTANCES FROM WELL: r f To Septic/Hetdirrg Tank on Lot On Adjoining Lots `01) P � To Nearest Edge of Absorption Field on Lot ��//'� ; On Adjoining Lots To Nearest Public Sewer Line 111 To Nearest Public Sewer Cleanout/Manhole 4 To Nearest Sewer Service Line on Lot leo f Water Sample Collected by <" —5- ;Date 7 Water Sample Test Results Comments 621—,t) & r � � A &j-, %dyOL b5 B. SEPTIC/HSG TANK DATA Date Installed &oC / Sizl2re No. of Compartments Standpipe(YvN) Air -tight Cap �(Y/ N) Foundation Cleanou(Y N) Depression over Tank (Y(N)) Date Last Pumped 2, i Pumping/Maintenance Contact on File (Y/N) , fes' ;for Holding Tank High -Water Alarm (Y/N) `� Temporary Holding Tank Permit (Y/N) 6 SEPARATION DISTANCES FROM SEPTIC/FTANK: To Water -Supply Well � � l To Buildin Foundation 1- / To Property Line f 5 r To Water Main/Service Line�� to l To Disposal Field To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 0 Ai C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ��� Type of System Design j !�/n/ /L' L10 Date Installed %����- Length of Field r %,� 3 Width of Field Depth of Field / Gravel Bed Thickness Square Feet of Absortion Area ( Statndpipes Presen Depression over Field ()CN1 Date of Last Adequacy Test f� \ Results of Last Adequacy Test -�� T/� /4C 7o I `-v Fe -/C -Z_ 2 s, SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well rG'U To Property Line To Building Foundation 27 To Exi ting or Abandoned System on Lot /V/ 14 ; On Adjoining Lots �� /� To Water Main/Service Line To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course /,' C ,1u 1= To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATiOAI` Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) _�7_.u.Lnp Off" Level at Vent Pumping Cycles "Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect inspection. Signed S & S SNGINEERING X� Company »034 Eagle River LOOP oa o, 204 AO* Unska 00577 do OajPJ o. Date 9 � Alfe� MOA No. 6 Receipt No.r� c� / _ c/ Date of Payment % " Z,S �/ Amount: $ 17o . 67) Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 equacy Test. of this •..,..•.1,,e ' 6 \ yy, Q �a 7, �ddi 0 s 6 9 s•..•„•, yso yet N% 1457-Y y0' r� a ono? Fssio`'��Z� cL wt CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 \ FEDERAL TAX ID # 92-0040440 Client Sample ID:L2, HAMANN PWSID :UA Collected OCT 21 88 @ 16:00 Received OCT 21 88 @ 16:30 Preserved with :4 DEG. C ANALYSIS REPORT BY SAMPLE for Work Order # 9990 Date Report Printed: OCT 25 88 @ 09:46 Client Name S & S ENGINEERING Client Acct SNSENGP irrs. P.O.# NONE REC D his. Req # Ordered By Analysis Completed :OCT 24 88 Laboratory Super i ox :STEPHEN C. /EDE Released By Send Reports to 1)S & S ENGINEERING 2) Special Instruct: Chemlab Ref #: 3143 Lab Smpl ID: 5 Matrix: WATER Allowable Parameter Tested Result/Units Method Limits -------------------------------------------------------------------------------------- NITRATE-N ND(0.10) mq/l EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY RJS. 1 Tests Performed See Special Instructions Above UA=Unavailable ND= None Detected See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Gxeatei Than &�,�oCHEMIC5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 LPBORPTO RIES ANALYSIS REPORT BY SAMPLE for Work Order # 15141 Date Report Printed: JUL 25 89 @ 14:22 Client Sample ID:L2 HAMANN Client Name S & S ENGR PWSID :UA Client Acct SNSENGP Collected JUL 23 89 @ 16:00 hrs. P.O.# NONE REC"D Received JUL 24 89 @ 16:30 his. Req # Preserved with :AS REQUIRED Ordered By Analysis Completed :JUL 25 89 Send Reports to: Laboratory Sups i STEPHEN CC EDEE 1)S & S ENGR Released By : r6. L 2) Special Instruct: Chemlab Ref #: 6535 Lab Smpl ID: 1 Parameter Tested -------------------------- NITRATE-N Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY RJS. Matrix: WATER Result/Units ------------------------- 0.77 mg/l Allowable Method Limits EPA 353.2 10 ............a-=-=»a=---_mese»'-e 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 Client Sample ID:L2 HAMANN PWSID :UA Collected JUL 23 89 @ 16:00 Received JUL 24 89 @ 16:30 Preserved With :AS REQUIRED ANALYSIS REPORT BY SAMPLE fox Work Order # 15141 Date Report Printed: JUL 25 89 @ 14:22 Client Name : S & S ENGR Client Acct : SNSENGP hrs. P.O.# NONE REC"D hrs. Req # Ordered By Analysis Completed : Laboratory Supervisor :STEPHEN C. EDE Released By : Special Instruct: Chemlab Ref #: 6535 Lab Smpl ID: 2 Matrix: WATER Parameter Tested Result/Units -------------------------------------------------------------- TOTAL COLIFORM col/100ml Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY RJS. Send Reports to: 1)S & S ENGR 2) Allowable Method Limits ---------------------------- =33===cal Tests cPerformed See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT=Less Than, GT -Greater Than MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information (a) Legal Descriptign, (include lot, lc G 2 /-/ d? e Location (address or directions) S /.S' I /471- .cl (b) Applicants Name '-'h0 /�P Applicants Address G/" 10 Application Date A'e' / c-� q , subdivision, section, township, range) c hone — Home Business J/ APC- h (c) Applicant is (check one) Lending Institution Buyer ; Other 1::� (explain); (d) Lending Institution Akz rkG, Owner/bu+14ex- 1 ; Z2-- 6/ay v � Address zo �2/ L7�/�<S0 /J (e) Real Estate Co. & Agent To If/t7 Address 74e-z--�`''. r<�—r7,-�� '7211,F/f y/—C/ � C?Ion Telephone 2;7 Z -"0,5- (f) Mail the HAA to the following address: 2. Type of Residence Single -Family Number of Bedrooms 3. Water SuLy Multi --Family Other (describe 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 F-7— 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] M 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, 1 Y 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 regula- tions in effect on the date of this inspection. Name of Firm Address Date' (ENGINEER SEAL) DHEP Approval Approved for bedrooms By Approved Disapproved Terms of Conditional Approval CAUTION Telephone - - Fa"i A. Shobcr l �• a• •® No. 1457 Conditional THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS VOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/DLII [Page 2 of 21 7-19-84 A. WELL DATA � t M MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description:Lot 2, Hamann Subdiv. Sec 15 T 14N R1W (apprx. Mile 5.6 Eagle River RQ da ) Well Classificatio /V07 If A, B. or C. D.E.C. Approved(YM) O•dL/ "r _ Well Log Present (YA) Yes Date Completed 10-15-81 Yields Total Depth 305 Feet Cased to ¢0' -/ Depth of Grouting �e7 - 2 n I49 Static Water Level 126 1 0? Pump Set At C,e Casing Height Above Ground 30 Sanitary Seal on Casing (Y ) Electrical Wiring in.Coridu (Y ) Depression Around Wellhead (- ) Separation Distances from Well: To Sept ic%B .gig Tank on Lot A?o 4 On Adjoining Lots i To Nearest Edge of Absorption Field on Lot_z_!22; On Adjoining Lots / 0 � To Nearest Public Sewer Line ALI P4- To Nearest Public Sewer Cleanout/Manhole AJ To Nearest Sewer Service Line on Lot Water Sample Collected Bye Date r Water Sample Test Results 70 e- Coments Home was completed and occupied January 12, 1982. �s B.. SEpTICA36L-5R497 TANK DATA Date Installed ClPeC F/ Size / t9 No. of Compartments _ Air -tight Caps (Y// Foundation Cleanout Standpipes gp(Y/ Depression over Tank WN7 Date Last Pumped ey ZZ Pumping/Maintenance Contract on File (Y/N) P/4--; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) E� Separation Distances from Septics Tank: / To Water -Supply T\Je11 To Building Foundation To Property Line C� To Disposal Field To Water Main/Service Line 6 c' 1L -, = To Stream, Pond, Lake, cr Major Drainage Course Comments [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA AUG 3 0 V841 1 Soils Rating in Absorption Strata Type of System Design Date Installed �% I)eC rl ngth of Field Width of Field © Depth of Field c Gravel Bed Thickness _% Z Square Feet of Absorption Area �y } �7 /10 Standpipes Present Depression over Field (e4 Date of Last Adequacy Test 2 6 g Results of Last Adequacy Test 2;z Separation Distance from Absorption Field: To Water -Supply Trill A-1 / ` To Property Line /L To Building Foundation 2 -7 To Existing or Abandoned System on Lot / On Adjoining Lots /e�cD 71 / To Water Main/Service Line el -0 7( To Cutbank(ifpresent) ` 75" To Stream/Pond/Lake/or Major Drainage Course AJ / /,I- iW To Driveway, Parking Area, or Vehicle Storage Area / Comments D. LIFT STATION Date Installed Dimensions J Size in Gallons Manhole/Access (Y/N) "Pump On" Level at Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. p Signed • IW��RIMC Date X'1Z y Company SBD I�4AS�',�,a7t MOA No. KB1/d5/s (Page 2 of 21 � (.,/✓ 041 .. "► 71 h • .& o barT A. shnfa c`e 1� • •,• E.,. ww 2-15-84 5. LEGAL DESCRIPTION DATE R - INSPECTION APPOINTMENTS STREET LOCATION — 0 fl ME TIME TIME NUMBER OF,BEDROOMS ED One El Four El Other L SINGLE FAMILY ❑ Two ❑ Five DATE DATE DATE ® INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE 1981 YEAR ON-SITE SYSTEM WAS INSTALLED. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 • ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER PHONE THOMAS KLEIN CONSTRUCTION 745-2731 MAI LING ADDRESS Box 2524, Palmer, AK 99645 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE William & Nora Shore 333-2197 MAILING ADDRESS 234 South Hoyt Street, Anchorage, AK 3. LENDING INSTITUTION PHONE Alaska Pacific Bank ATTN: D.J. WEBB MAILING ADDRESS Benson Blvd., Anchorage, AK 4. REALTOR/AGENT PHONE Totem Realty, Inc./William J. Schlegel 272-0571 MAI LING ADDRESS 724 E. 15th Avenue, Anchorage, AK 99501 5. LEGAL DESCRIPTION Lot 2 Hamann Subdivision STREET LOCATION Hamann Road Eagle River Alaska 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ED One El Four El Other L SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY LN Three ❑ Six 7. WATER SUPPLY ® INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ® INDIVIDUAL/ON-SITE** 1981 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) 1 THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED LAI INSTALLER ❑Septic Tank or ❑ Holding Tank Size: 1000 If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Ll,he Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS EZJ—' APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE . O/�) 1 ? "�-- BY 1, : C 1i 72-010 (Rev. 6/79)