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HomeMy WebLinkAboutPREUSS #3 BLK 6 LT 10\© Hea].~.~ and Environmental Protec.~)n Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: ~ ~'P' NUMBER OF DISTANCEFRoMWELL~~___MANUFACTURER S~A'~'[j~''j' -MATERIAL ~,.m'~l~,:.~ COMPARTMENTS ~ INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY ~J:)~ GALLONS. DISTANCE FROM WELL 1~1' FOUNDATION '# of Lines t DISTANCE BETWEEN LINES ABSORPTION AREA '~"~¢'~"'_ SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER ~ OEPTih TOP OF TILE TO FINISH GRADE _ "~.,-~ MATERIAL BENEATH TILE__7 IN. ABOVE TILE LINE~_j~) ~/~J~ TRENCH WIDTH"'~' IN. TOTAL EFFECTIVE SEEPAGE PIT: Log Crib __ Rings BUILDING FOLINDATION _ DIAMETER __ OR WIDTH ____, EENGTH DEPTH Crib Size: DIAMETER___DEPTH_ DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE ___ ABSORPTION AREA (WALL AREA) SQ. FT. Well Class:~._~. Depth: Well Distance To: Lot Line Bldg: Sewer ~ine: Pipe Materials: ~ of Bedrooms: Installer~~._~..~.~.~l~_~. Remarks: DATE 10/~17'3_ APPROVED DEF:'FIRTME]'-~T OF HE;FII_]'H RND EN,, '¢RO[~&~T'F:IL PRO]'ECTI()N 825 "L." STREET., FINCHORFK:4E., RK. 995Oi. 77898 ::, i::iJ:' P L I CFt N T I_OCF:IT 1 ON ' LEGFIL BOX 5410 EFIGL. E RIVER LOT S :[ ;.:ZS520 SQl. IF:IRE F'EET TVF'E OF' E;OiL FIBE;OI:;;:BTION '_::;'-/ST'EM IS: TRENC:H I'"iRXIMUM NUI"IE:fiER OF BE[:,F-:~OOM:E; = SB:[L. RFtTIiqG (SQ FT,-"BR)= :1.:I.O 'THE RE(.:.!U :[ F.:EC, 5; I ZE OF THE 5.:.;01L RBSORF:'T :[ ON E;'.?5.:.TEM I S: THE [...ENG'TH [.':, I i-"IEN5 ]: ON I 5; THE L_lENGTH ,:: I N FEE]' ) OF Tt-4E: TRIEt'.,tCH OR [:,[;..'FI i NI:: t EI_D. THE DEPTH OF' FI TF~:ENCH OR P:[]" Z:E; THE D:[S"f'FINC:E BETHEEN THE: :E;UF.'.F'I:::ICE OF:' THE GF.:OUNC, RNE:, THE BOTTOM O1::' THE E:e,E:RVFI]" :[ ON ,:.' IN F:'EET). ]"HERE :IS NO SET' 1.4ID]"H FOR TRENCHES. T'HE GRFt'v'IEL. [:,EF'TH :[:5 'THIE M:[NIMLtM .DE:P]"H OF GRF:IVEEL. BE]"I.,.IEEN THE OUTF:'F::t[..L. F':[F:'E: RN[:, THE i.~iK:YT'i"EIM OF' ]"I-IE E',:.:',C:FIVFIT :[ ON ,:: IN FEET). ........................................ IF-- Itq L..IF--.~-It ...:fl[:. F' ii_.. Fl f..4i -F" C:,F:"-f' Z C~ii%~ ............................. FI F'F~CI<t'-'IGI::-:' Pt....FtNT Ml:::l"r' BE XNSTfqLLED FIT I-HE F'ERMXT'TE~'"S OPTXON '.~;U~:JECT TO THE FOLL. Okt I NG CONI} :[ T t ONS: i. E:[THER F:t CI_FISi~E; :[ OR :[I NSF FtPPRCCv'EE:, F't._I::~NT MFI'¢ BE INtE;]"f:tL.L.E[). 2. R CON'T'INIJOUS MR :[ N'F'E:NflNCE RGREEME]'qT' I5; REQUIRED. IF FI P'IFIINTENFINCE RGREE}'IIENT IS NOT KEPT CLIRRENT '¢OU FIFt"r' E:E REQUIRED TO ENL.RRGE THE 55OIL RBSORPTION 5'¢5]"E]"'1 Rt'q[:,/OR '¢OU MFI'¢ BE SUBJECT TO PROSECUTION. ......... -'ii- !b-ii ,::]} ,< ;;?.' 2, r~: P'qt 55 F' iii.-=..] C: 'T :'il: C~ IF'4 .57.'S F" F;--:: .E: ~5:: E; E.;:." iL.." :rii:: ii:E4.". ~Z ii:::::" .............. BFICKF :[ L.I.... :[ NG OF Ftiq"r' 5'r'STEM t.4 I-f'HOUT F':[ NFIL I NSPEE:TI ON FIN[:' FIPF:'F::OVFIL B"r' TH I ':2, DEPFII'~:]]"IENT 14:[L.L E',E 'E, UE,'JECT TO PF;.:OSECLrT:[OIq. M I N :[ MI.jM [) I STFINCE BE'TI.,IIEEN R NELL laN[.'-" Fllq'-r' ON-S ]: TE 5EklRGE i. OO FEET FOR FI PRIVFrTE: klE'I_L. OR 200 FEET FOR la PUBLIC t.,iELL_ i4iELL LOGS f.:ff;.:E: REQL.IIREE:, FINE:, MUST BE RETUFdqE[:, TO THE [.',EF'F.~RTMENT H ITHIt'.,I AF THE !.4EL. L COMF'LET:[ON. OTHER RE(;!U I REMENTS MF:I"r' FIF'PL..'¥'. :F:;F:'EC I F I (::la"[' :[ ON:'5 FIN[) CONS'TRUE:'T 1 ON [)I FIGRFIi"IS I::tRE Ff,/B I L. FhE',L.E TO :[ NE;UI;."E PI:;.".OPEI:;.: :[ I'..ISTRLLFIT l ON. I CERTIF'¢ 'f'HlaT' i.: :[ FIM F:'I:~M :[ L :[ FIR NI"I-H THE RE(;:fl_IIREMENT'_E, FOR ON-SITE %Ei4ERS FINI?, I.,.IE!....I_:5 FIS SET FORT'H BV THE MUN I (::.' i F:-"F:tL :[ 'T"r' OF F:INCHORFIGE. 2: :[ bJiL. L. :[NE;TFtLL. ]'HIE 5;VSTEM IN FICE:OI;.'.[:,RNCE i4:[TH THE CODES. 2-':: :[ UN[)ERS.:;]"FtND 'T'HFIT THE ON-SITE SEt.,.IEi:;~ S'T'STEM t'"tF::I'¢ REQLIIRE ENLRRGEMENT IF' THE RE.'.=.,IDENCE :IS REMO[:,EL.E[:, 'TO INCL. t. JDE MORE TFIFIN ::¢ E:E[:,RCIOME;. ~[::,Pl z~'~'¢XlpFl" TF4I','It.L-'::: I-f -" l-4gl[~.'¢:l 2204 Cleveland Anchorage, Alaska 99503 Lena10escrtntton: Lot /~ Block ~ This ~orm Re,orts So~ls Lo~ Percolation Test .neath Feet Sol1 Characteristics 10-- 12' 14-- 20 ,. , Was ~round Water Encountered?//~ I~ Yes, At what Depth? Readinq Date Grnss Time Net T!me Depth to H20 Net Dron Percolation Rate Ufnute Prn~osed Installation: Seenaoe Pft Orafn Fteld ~eot~ of Zn,etOeoth Z~ ~ottom Test Performed By _ Data Certified ~ Date: / / / :'.';"'~ '~"'/ Li':)'T' '::') / ,t ~ I I I''' ~' /7'""~. ':""' I?-~l' .·.. t-~'."' . ........ ',~---'" - .I ! ' ~ ~,....,_,,~.~ ..I,.., I ,.. ,,~:~., - .. ..-- ~ ~ d -'1 \ ·~.?~*... · ' .-~'~} I \· - .. ~, "%% F I' o ~- ~ x., ~' '~:. ,~' ..... :""-:'- "" 7. __T--L-- / L .......... ~ .... '., i ' ,, I.O" U'TtLfT'L~ eLI:::J~F.~T" . t ~, .., ). 'C~O' .'~ ~:,~ y~ ~ · ~,.~.,o?~..~i~ ' .-~,,:. qAP.?ROVED 'D/x,VI ID AVE; ~/. .-. - o ' ' ....g~te. _~/- ~-~,~' '" -~-' · ' .-.' : '...~," ' ~o~ - . ~II wor~ dudl b~"done a,' gww, on ' . ,... '... . · ..~Lo · ~. ~LL '~_ELCC~.~ I M t !: ' 'e cation, slmll ~zot be chtmged, modtJt;½1 or altered udthout [ir,'t obtaining a'ml~l¢>~b,.(,~,.' : ' ¢ ¢,,,_~.~.. . . CAange order. ' a" ' ~ '~' "'" :, ' ( ,, '. .. : z,. ,,- ... , ':. SURVEY CERTIFICATE I horoby corfify ~hot ! hovo .urveyod ~ho followlno } ~ ~ __~, doscribod propor~y LoT' I0, BL~0 Co 0 0 0 0 0 0 0 0 0 0 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. GENERAL INFORMATION Complete legal description Press HAA # ~, Subdivision Lot 10 Block 6 Location (site address or directions) 10l ]~ wren T,~n~ Eagle Rlver Ak 99577 Property owner Richard Krieqer Mailing address 10114 Wren Lane Lending agencyCity Mortgage Mailing address _p.o. Box 92810 Agent Don Presser Eaqel River Anchroage AK Address Day phone 694-1280 AK 99577 Day phone 563-0700 995~, Day phone 694-8505 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 3N NOTE: Individual well x Community well Public water 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 X Holding tank Community on-site Public sewer If communiO; wastewater system, ,,iq,= pro,, ....written confirmation from State AD£-'C attesting to the legality arid status of system, 72-025 (Rev. 1i91) Front MO;~ As certified by my seat 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/orwastewater disposal system is safe, functional and adequate for the number of bedrooms and typeofstructureindicated herein. I furtherverifythat based on the information obtained from the ,Municipality of Anchorage files and from my investigation and inspection, the on-siZe water supply and/or wastewater disposal system is in compliance with all Municipal and State coaes, ordinances, and regulations in effect on the date of this inspection. NameofFirm Eagle River Enqineerinq Services Phone 694-5195 Address P.o. B_ox 773~_94 Eagle River AK 99%77 Engineer's signature .--7~ .¢>-~--'-E_ p Date bedrooms. DHHS SIGNATURE Approved for ~ Disapproved. Conditional approval for 1/3/92 bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72q)25 (Rev, 1/91) Back MOA ~f21  Munlc~pauty cT Ancnorage ' Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~¢,7- /~) ,,~//-x ~, ~'¢~.~,--,~,~.f' Parcel I.D. A. WELL DATA Well type Cf'~, ~'~''z~ If A, B, or C, attach ADEC Fetter. ADEC water system number Log present (Y/N) ?/ Date completed 2//-~'~//;> ? Driller Totaldepth ~ ?¢ / Casedto ~ 75 / Casing height Sanitary seal (Y/N) ~ Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 75-~ ~"~ Absorption field on lot /~)z)' Public sewer main ~./~4- Pub{~. sewer service line ~- .3-~- ' AT INSPECTION '//~-/<~ %'¢j;4:C:PAUTY OF ANCHORAGE ~ ~.- ~ E~IRONMENTAL SERVICES DIVISION ~/, $-JA~l~.p.(~. i992 RECEIVED ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate ~-,-- s/~_ Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed /~' ? 2 Cleanouts (Y/N) /V High water alarm (Y/N) Date of pumping Tank size /~"~ '~ Compartments Foundation cleanout (Y/N) ,.!/' Depression (Y/N) Alarm tested (Y/N) "~/~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot "Z:; .... To property line -:;~Z_~' Surface water/drainage /.~-~,-~"( On adjacent lots ¢-¢- ~"~ "~'"'/ Foundation Absorption field ~g ' ~'~<='~' .Water main/service line 72*026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Surface water Date installed /¢ 2 ,P Length '~¢ Width Total absorption area ~¢4. Depression over field (Y/N) Results (pass/fail) ./¢~-, Peroxide treatment (past 12 months) (Y/N) Soil rating /'/¢* System type Gravel thickness ¢ '/ Cleanouts present (Y/N) Date of adequacy test for Total depth //' £- / '.7 bedrooms If yes, give date, SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /'~ ~-~ To building foundation ,~- ~ ' On adjacent lots /~ .?,* ' Surface water Curtain drain ,,,~,~,c_ On adjacent lots ¢-/¢"" Property line To existing or abandoned system on lot Cutbank /'% ~ "~"~/¢~atermain/serviceline ,~/~" 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 the date of this inspection. Engineer's Name HAA Fee $ // Date of Payment Receipt Number 72-026 (Rev. 3/gl) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number NORTHERN TESTING LABORATORIES, 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 Eagle River Engineering P.O. Box 773294 Eagle River AK 99577 Attn: Louis Butera Our Lab #: Location/Project: Your Sample ID: Sample Matrix: Comments: Method Parameter EPA 353.3 Nitrate-N Al15771 L 10 Blk 6 Pruess Water Units mg/1 Report Date: 12/26/91 Date Arrived= 12/20/91 Date Sampled: 12/20/91 Time Sampled: 0910 Collected By: LB Definitions MDL = Method Detection Limit B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Result Flag MDL 0.8 0.1 Date Analyzed 12/24/91 Reported By: Wi~[liam E. Buchan Anchorage Operations Manager k.~/ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL ~ROTECTION DIVISION OF ENVIRONMENTAL HEALTH 264-4720 Application Date April 14, 1988 7/- 2_ 3 GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) LOT 10, BLOCK 6 pREUSS SUBDIVISION UNIT #3 T14N, R1W, SEC. 8 Location (address or directions) 10114 Wren Lane Eaqle River u~.-4~-=q~ ~^~;~ Telep_hone' Home n/a Business 694-4994 licant Name ............. · -- Applicant Address Attn: Dale Pr3.ce Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); Realtor (d) Lending Institution MerrJ ] ]. - Lynch Relocation Telephone Address 10900 N.E. 4th St., Bellevue, WA 98004 (e) Real Estate Company and Agent AppliCc-Lnt Address :~ ~. ...................... .:,~, ~Telephone. 206/455-3560 (f) Mail the HAA to the following address: Pick up_ by Engineer TYPE OF RESIDENCE Single-Family [~ Multi-Family [] Number of Bedrooms 3 Other WATER SUPPLY Individual Weft ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDIN"c~NSPECTIONS, TESTS, FILE SEARCH, DA,...~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 F~c;f.~ RIVER ENGIN~:~.'RING SERVZCES Telephone 694-5195 Address P.O. BOX 773294 EAGLE RIVER, AK 99577 Date E n .~.i [~e.(~ r_'s Seal Approved for ~ bedrooms by Date ~ ~/~-88 Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHORAGI~EALTH AUTHORITY APPROVAL (HAA) ENVII~ONMFNTAL SFRVICE$ DIVISION CHECKLIST - FEBRUARY 1984 264-4720 Well Classification Legal Description: If A, B, C, D.E.C. Approved (Y/N) ,3/ Well Log Present (Y/N) _ ¢v Date Completed ///~-~?/? 2' Yield Total Depth .~ 79 / Cased to ~.'~,9 / Depth of Grouting Static Water Level ,.~ ~'" Pump Set At Casing Height Above Ground /'r~--" Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) .)/' Depression Around Wellhead (Y/N) /L) Separation Distances from Well: To Septic/Holding Tank on Lot ~" "7"5~ / ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~ /¢¢ ' ; On Adjoining Lots '/'/'~ ¢ To Nearest Public Sewer Line /'J/~ To Nearest Public Sewer Cleanout/Manhole /¢/~ To Nearest Sewer Service Line on Lot ¢--,_.:z s'--/ Water Sample Collected by ~/Z',,,'~,(¢¢,~,- ; Date 41~-/s~ ~' Water Sample Test Results Co/'"Z~'*-~ ~ ~d~"'~¢~ /¢"/~-"¢~ = 0,3-/ Comments ~/' c..,~ ~,,~'. 5 ~ '¢~/ B. SEPTIC/HOLDING TANK DATA /¢?? Date Installed Standpipes (Y/N) ,"P' Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) '/~///~ Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ¢ ~'~-- / To Property Line ~.3- / To Water Main/Service Line -/-~25~ Course Size /d¢¢ No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped JCP~'~/ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation // / To D sposal Field ~Q-¢' / To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /'~ 77 Width of Field ~ / Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /O~ / To Building Foundation ,:;--~¢ / Lot To Water Main/Service Line ~-/¢' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field ,:2 .¢" / Depth of Field //, .5- Gravel Bed Thickness ~ / Standpipes Present (Y/N) Date of Last Adequacy Test Y To Property Line ?O To Existing or Abandoned System on ; On Adjoining Lots z To Cutbank (if present) ,.~./,0 /,- 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 Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed _ ~~'~ Date /' ~'T ~- Company ,~'~'-,,/t',~~, 5", MOA No. Receipt No. ~ ¢3 '~ Date of Payment ~¢'~//~'/'~ ~ Amount: $ /' '¢'-¢ ~ Page 2 of 2 72-026 (11/84) ~ MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 10 Block 6 Preuss Subdivision T14 N R1W Sec.8 September 24, 1986 Location(address ordirections) Eagle River (b) Applicant NameSheryl-Lee Carnegie Telephone: Home Business Applicant Address 10~.1b, Wren Eaxle River Alaska 99577 (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer F-]; Other [] (explain); (d) Lending Institution First National Telephone Address p.O. Box 770548 Ea~le River, Alaska 99577 (e) Real Estate Company and Agent N/A Address (f) 694-2109 Telephone N/A Vlail the HAA to the following address: pickup b,y engineer TYPE OF RESIDENCE Single-Family [] Mul..~F~y [] Other Number of Bedro~m~x~/ WATER SUPPLY , Individual Well [] Community i'-I 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 I-I Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status,. 72-025 (11/84) Page I of 2 ENGINEERING FIRM PROVIDinG INSPECTIONS, TESTS, FILE SEARCH, ~¥A AND INFORMATION ~ As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this i-(ealth 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 Anchorag~ 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 Address EAGLE RIVER ENGINEERING S~RVI(~E,c /~./~/~c~ EAGLE RIVER, AK 99577 Date PT0. BOX 773294 694-5195 * With a waiver of septic tank separation distance to 75'. DHEP APPROVAL Approved for Approved bedrooms by ~ -'/~' Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MO~// HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~ '-~ ~-/~::~ ,/~/,~ WELL DATA Well Classification Welt Log Present (Y/N) /J/' Date Completed I//~?./7 ,~ Yield Total Depth ~ 7 ? / Cased to ,,~ 7 7 ' Depth of Grouting Static Water Level ~'Z" ,¢¢/,¢~- Y-5o ~,~' ~,r,-,?; PumpSetAt Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: ./S /' To Septic/Holding Tank on Lot ~'¢- / To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole tz.,'/'~ If A, B, C, D.E.C. Approved (Y/N) '~./~ Water Sample Collected by Water Sample Test Results Sanitary Seal on Casing (Y/N) '/'" Depression Around Wellhead (Y/N) ; On Adjoining Lots /~ / ; On Adjoining Lots /~) To Nearest Public Sewer To Nearest Sewer Service Line on Lot Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) ,J/ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well '?'~- ' To Property Line ~ ~-~ / To Water Main/Service Line '¢-/'¢ / Course Size //-'¢~-~,~/, No. of Compartments ~ 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(1 ~/84) P.O. BOX 6650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES October 9, 1986 Lou Butera, P.E. Eagle River Engineering Services Eagle River, Alaska 99577 Subject: Lot 10 Block 6 Preuss Subdivision Waiver Request WR86-148 Dear Mr. Butera: Your request for a waiver of the 100 foot separation required between the well on the subject property and septic tanks located on the subject property and on Lot 9 to the north has been granted. These tanks are located 75 and 95 feet from the well respectively. This waiver is valid for the existing three bedroom single family dwelling only. Sincerely, Stephen S. Morris Civil Engineer On-site Services #1: Time Date Insp 'DEPARTML~,' OF HEALTH AND ENVIRONMEN,~=L PROTECTION 825 L Street, Anchoraa~. Alaska 99501 264-4720 Date Received: February 21, 1978 9:30 a.m. #2: Time #3: Time 2-22-78 Wednesday Date Date Pratt Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: First National of Ketchican Mailing Address: Phone: 2. Property Owner: James P. O'Hara Mailing Address: Star Route Box 5410 99577 Phone: 694-2080 Legal Description: Lot 10 Block 6 Preuss Subdivision Corner of Wren & David, "A" Frame house 4: Single Family Residence: (xk Number of Bedrooms: Three Se e Multiple Family Residence: ( ) Number of Bedrooms: Well System: Permit # Construction Individual well (x) Depth of Well Sewage Disposal System: Permit # Septic Tank Size Absorption Area Community/Public System ( ) 280' Well Log on File ( ) Bacterial Analysis ?~D~'<~t2%t~cq~.~. On-site System (x) Public Utility ( ) Installed 1977 Installer /~OO Manufacturer ~~ Soils Rate ;~O Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 10 Block 6 Preuss Subdivision Comments: Affadavit Attached: (/)/ Approved: Disapproved: Letter Attached: ( Date: Department Worksheet: f i ~-o~-~.o ~o=,oao~ IIV~I 1VNnlIVNBIlNI BOJ ION tL6t '=dy ~ ~0~ ~::'~'~ ......... XlNO 33$S3BQOV 01 B3AI930 (~llel~od Snld 3dO0 dIZ GNV 3l~.~'O'a ~O£--ql¥fl 031.-IIJ.~30 blO:l idl303U ~~ i Department of Health and Environmental Protection ~ (l~. i~,/ 825 L Street, Anchorage, Alaska 99501 ~'quest for Approval of Individual Sewer and Water Facilities 1. Property Owner: j/~..~F ~ ~,~/~;/?/~ Mailing Address: ~ ~ ~ _F~ ,_~-~/ ~ Phone: ~ ?~--3 2e Name of Buyer: Mailing Address: Phone: Mailing Address: Phone: 4e Se Realtor/Agent: Mailing Address: Legal Description: Street Location: Phone: Single Family Residence: (/~ Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: o Water Supply: *Individual Well (,~f Public/Community System If Individual Well, well depth ~O' If Community System, name of system Sewage Disposal System: *~Dn-site System (~J Public System ( If On-site System, date of installation: O~_~ y~ *NOTE: A well log is required on ALL wells drilled since 6/75. ** If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77