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Home My WebLink AboutDELUCIA LT 10 Municipality of Anchorage Page / of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ffbV' c,~D*'~E::~/'~ RID Number: ~1 - I~/'-~ ~ ~: ~ ~/¢~ ~r/~ Wastewater System: ~ New ~ Upgrade ,~e~:~ ~ ~..~ ~'~ ~h?,~k /~ ¢¢~x) ~z,~7,'~ ABSORPTION FIELD Phone: ~No of Bedrooms-- ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ther LEGAL DESCRI PTION GPD/Sq Ft Lot /O Block p Subdivision Depth to pipe bottom from ongma' grade: Gravel~neath pipe . ~ew ~ Upgrade Classdicatton (Private, A.BC) Total Depth: Cased To Total absorption area / Pipe material: Onller: Date Oril]ed: Static Waler .evel Installer:/ Date ~nstalled: Yield: Pump Set at: ICasmg Height Above Ground ~ ~ ~Z ~I ~4 ~ ~,'~ w'~¢ TANK - SEPARATION DISTANCES ~: SeCt~c ~ ~o~¢,.¢ TO Septic Absorphon Ldt Holding Pubhc PrpCate Manufacturer: ~ gallons: From Tan~ F,eld Stabon Tank Sewer Lines Well /~ ~ ~ ~ Material: Number of Compartments: Surface Water ~ ~ ~ 4 LIFT STATION Lot S,ze in gallons: Manufacturer: Line o." ,..e, .t: I,,¢ w,,er a,: Foundation I Curtmn Pu~odel I Electrical Inspections performed by: Drain I Remarks: .~~,//~ ~ ~ ~5 ~,~F'? BENCH MARK Locatlo~ and I Assumed Elevation: ENGIN~'~ SEAL Inspections performed by: ~¢yA ~,'¢~f ~/~¢-¢¢~Dates: 1st ~-/~'¢Z ~..~.~. ~'c~ 2nd ,~ -~,~ .... : ~.~ Department of Heal~-and,H~man Services approval ~.,,~ ~''" ~, c~.~.:~ Reviewed and approved by: ~~¢ Date: Z - 23 --7~ 72-013 (Rev 991) MOA 25 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: · 1 JPEG image 640x480 pixels file:///A[/Mvc-002f, jpg 1 of I 2/17/98 3:49 PM JPEG image 640x480 pixels file:///A[/Mvc-010f, jpg I of 1 2/17/98 3:41 PM JPEG image 640x480 pixels file:///AI/Mvc-007f, jpg I of 1 2/17/98 3:45 PM JPEG image 640x480 pixels file:///Al/Mvc-004f, jpg 1 of 1 2/17/98 3:46 PM JPEG image 640x480 pixels file:///Al/Mvc-003fdpg 1 of I 2/17/98 3:47 PM PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE~ SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW980014 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:MARIO GEORGIA LINNEA OWNER ADDRESS:19726 RANCH RD CHUGIAK, ALASKA 99567 DATE ISSUED: 2/06/98 EXPIRATION DATE: 2/06/99 PARCEL ID:05114136 LEGAL DESCRIPTION: DELUCIA LT 10 LOT SIZE: 20000 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: THIS PERMIT IS FOR THE CONSTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS {18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THIS PERMIT IS ISSUED FOR THE CONSTRUCTION OF A WATER STORAGE SYSTEM FOR WATER TO BE DELIVERED TO THIS DWELLING. RECEIVED BY: DATE: Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax January 26, 1998 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re.' Delucia Lot 10 Narrative & Water Storage Permit Application Dear Mr. Cross: On behalf of our client, we are requesting a permit for a water storage facility for the above referenced property due to a 14 mg/1 nitrate water quality problem. The storage facility will serve a 3 bedroom residence and will be located in the crawl space of the house. The tank will have a capacity of 1000 gallons and the system will use NSF approved materials and lead free construction. An access spout will be installed and marked in an easily accessible area of the structure. We will be applying for a health approval upon completion of construction. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. 998\98-001-NAR ,ou~ LO T 20 LOT 11 UNDEVELOPED (ABANDONED) LOT 22 LOT 21 HOUSE_ ~AN K. SEPTIC AP-. EA Note: Place 1000 gallon water storage system in home crawl space. Use NSF approved materials and lead free construction. Install secure outside fill access spout. S89'59'E EXISTING LOT 1 0 WELL \ I HOUSE oooo 5~PTI~. 200.00'S~1~1"~'1[ LOT 9 NO 200.00' ~-- [] -- TEST HOLE · - MONITOR TUBE o - SEWER CLEANOUT ~ - WELL EASEMENT PROPOSED LEACHFIELD EXlSTINO LEACHFIELD WELL/SEPTIC SITE PLAN LEGAL: DELUCIA LOT 10 OWNER: MARLO CONTRACTOR: NIA JOBl¢ 98-001 DATE: 1/26/98 I SCALE 1" = 60' EAGLE RIVER ENGINEERING SER WCES A P.O. Box 772,294 EAGLE RIVER, AK. 99577 (907) 694-519.5 FAX: (907.) 694-329?' Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax LEGAL: SPECIFICATIONS FOR WATER STORAGE TANK SPECIFICATIONS Delucia, Lot 10 1/27/98 1. 2. 3. GENERAL This plan is for a single family residence only. The drawing and or site plan shall be a part of this specification. All materials and workmanship shall meet the Anchorage Department of Environmental Conservation requirements. Department of Health and State B. WATER STORAGE FACILITY SPECIFICATIONS Specifications and requirements for water storage tanks interior application is as follows: 1. Water storage tanks shall have National Sanitation Foundation (NSF) approval. 2. Water storage tank materials and coating used in construction shall be either U.S. Food and Drug Administration (FDA) or NSF approved food grade. 3. All components of water storage facilities shall comply with the latest adopted edition of the Uniform Plumbing Code as amended. 4. Water storage tank shall have a minimum capacity of 1,000 gallons. 5. An exterior or easily accessible fill point shall be provided. 6. Access or fill point to water storage tanks shall be clearly and permanently marked "potable water". 7. A water pressure system shall be installed to provide a 5 gpm water flow to the house at a minimum pressure of 20 psi. A captive air bladder type pressure tank to be proved that will limit pump cycle time to 1 minute or more. \1998\98-001-spc.doc 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 PHONE Dwelling Material~, W dth [] UPGRADE NAME MAILING ADDRESS ILEGAL D'ESCRIPTION ILOCATION ~ Well ~v DISTANCE TO: ~ Z I Manufacturer ~ DISTANCE TO: Well ~ DISTANCE TO: ~ell Top of ti)e to finish grade inside length NO. OF BEDROOMS PERMIT NO. No, of compartments Liquid depth Length Ty~f crib DISTANCE TO: Class DISTANCE TO: Dwelling Foundation / Total length of lines Material Nearest lot line / ~- / width .-~'~;( ,.,~?, * inches PERMIT NO. Liquid capacity in gallons PERMIT NO., gL,.~Z C Distance between lines Material beneath tile Total effective absorption area ~ inches ~' ~: ~ Width Depth PERMIT NO, Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL "f' beST RATING INSTALLER REMARKS APPROVED DATE LEGAL ,_., ' 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE f Health and Environment~ Protection Department 825 L Street, Anchorage, AK. 39501 264-4720 Permit .... y~,, //..,, HANDWRITTEN PERMIT ~ .~?~, ,17/.~.mND~ON-SITEW~:,^ SEWER PERMIT ,9 Applican ___ C2.~'~ Mailing Address: /C~. Location: Phone Numar: ~~'~~ Legal Description: C~ /- /~ ~~C/'~ ~Lot Size: Type of Soil ~sorption System Is: Trench: Drainfield: Seepage Bed: Maximum N~ber of Bedrooms: ~ Holding Tank Soil Rating (sq. ft/br) /~/~ The Required Size of the Soil Absorption System Is: ,. GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of th~ trench or drainfield. The depth of a 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 outfal! pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~.g.~i GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this departmeni will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feel for a private well or 150 to 200 feet from a public well depending upon the type cf public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) i will install the system in accordance with codes· (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more th~fi~}3 bedrooms. S igne~ '~ ' ~ ·..~. ~, ,~, ~..~//~. ?.~.~...~. I s sued b ~P liCan~v Date: SWP/024 (1/81) SOILS LOG :i MUNICIPALITY OF ANCHORAGE · DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST yATE PERFORMED: SITE PLAN I 10 11 12 13 14 15 16 17 18 19 2O ENCOUNTERED? O P IF YES, AT WHAT E DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) COMMENTS TEST RUN BETWEEN PERFORMED 72-008 (6/79) FT AND ~ FT DATE :////'~~ ,./-// ANCI:ORAGE ~ESTEq~( DISTRICT OFFICE 437 "E" STREET, S~)ITE ?rhq Anchorage, Alaska 9gSO1 August 274-2533 Tohben Spurk!and, P. E. 203 Uest 16th Avenue Suite ?gl Anchorage, Alaska go5~1 Lot Ih, 9elucia S/D, Eagle River, Alaska ~5~I-DA-O3g gear Hr. ~purkland: MUNICIPALITY OF ANCHORAGE DSPT. OF HEALTH & ENVIRON!v!ENT/~L PROTFCTION SEP I 84 RECEIVED We have reviewed the plans and specifications for the subject project. The plans are a?prnved, conditioned on adherence to the following items. 1. Screened rock back fill in deep and wide trenches (3/4' - ~"). Screened rock hack fill in absorption hod (3/4" - 1 1/?"). Sufficient area plotted on as-built for ~'placement system. 4. A t.5 safety factor is used for square footage, therefore resulting in ~DO square feet of leach area. This letter constitutes the per~.Jt required by A.S. ~-6.03.720(a) for plan approval of sewerage It should be re~e,,~,er~d that final approval will necessitate the of Engineer As euilt Plan~ to include photographs as indicated on page of enclosure. This will cons,quently mandate that a professional engineer conduct basic inspection of this project so as to be able to sign off on as built plans. Arrange~e..nt for this in~pection work is the responsibility of the developer. Sincerely, jFH/dd Enclosure cc: Rohhie Ro'.>inson ,,'~!OA) As Built Plans suhmitte,~, by James F. Hayden Environ~ntal Field Officer Date Approved by ~te nicipality of MEMORANDUM DATE: TO: FROM: SUBJECT: August 23, 1984 Laura Crow Health and Environmental Protection Request for Refund - Account #2460 Please make arrangements fox a refund for the following applican't. The applicant paid for a Municipal inspection, however, had a private engineering firm perform the inspections. Van P. Williams, Jr. Receipt % 275273 Post Office Box 771986 ~nount $120.00 Eagle River, Alaska 99577 Account # 2460 On-site sewer and well permit engineer inspected is $30.00. Permit ~ 840713 Lot 10 Delucia Subdivision Thank you. Laura J. Ward Office Associate LJW cc: File 9t-010 (5/78) ~ . W,~TER WEt.[, RECORD Division of. ~Geologico, I B'~ Geophysical, Surveys · · F..f 8crew 4. WELL DEPT~: (Ileal} ~. DA~E OF COMPLETIO~ ~ ' '""~ , L ~?~rc .... Set between : ft. an'4 ft. ' , 6o 9 i . Equipment .sad: -"~ '~ II. PUMPING LEVEL belo~ lend .urfo¢e .nd YIELD ft. of tlr hr~; pumping g.p.m. /~ Il. GROUTING : W. II Grouted: ~ Ye, ~ NO ': ~' ,~- Materiel: ~Neat Cement ~Othtr: 13. PUMP: {if Length ef Drop Pipe ft. ~ope~ity " " g.p.m. 16. WATER WELL CONTRACTOR"5 CERTIFICATION: 15. Wotlr Templr~turl ~ ~..F '? ~ C Th[~ llll le~ 4eill/d'eedl~ ~ ]~ c [ ~ and th[I report Il true to the blat of my knowledge ~nd ~ - · _ · Aulhorlzed RepresentatiVe ~ , . · ' Form O2-WWR (11/81) :' . ' .... COp~ Distribution: WHiTE'State DGGS, PINK-Driller, C~NARY-Customlr &'Y4-~-, 1 '75 ar, d ~i,..'.'r',,:~',. l.,:-r. '.,.:c-~..'.~iLf, tri 50 Cm'/s c,f w~].l, ac~mg, let-~on. "'.~L':".I' ':- ', '~ ......."'" 'f: '"'._~-': I.OG UPON C.C'HF'LE '~, !ON OF COl' ,,o~,~,RL,~,.-~i,~N... : ... ..-' _ : ;. , < ~ : ~ : f. ' . : i:.~ + !-; ', ' -:} , · :. __. _ r :*.' .1 ' ,Wi,F1 i- r ' ,'_:!" Jr. L,. MUNICIPALITY OF ANC't-tO~ D?",:'I OI~ Hr:-ALT~-' & EI.?vI~CNMENTAL PROTECTION RECEIVLD 100' 200' EXISTING WELL / \ / \ 182.6' / \ ! ...' ':: / / 82.5' ° 81.5' WELL SEPTIC SITE PLAN __..L_ E G A_ __L_:____.L__0._?_... !_0 ___D E. !~9_c_1 ~ _S_U_B_~ V_.. OWNER: H.U.D. PROPERTIES CONTRACTOR' N/A JOB # 89-o84[~.D?T]F:'ff_~_~_iSZ/2-.~Z~-_-~[iii~C_'-~.-'~i_-~-~'~.'-_~.~]'~Z' EAGLE RIVER ENGINEERING SERVICES A P.O. Box 773294 EAGLE RIVER, AI-f. 99577 (907) 694-5195 .FAX: (907) 694-3297 0 - SEWER CLEANOUT -¢- - WELL 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 ONMENTAL SERVICES DIVISION RECEIVED Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description /.-~ 7- /O Location (site address or directions) Property owner ~_~/'~z Mailing address Day phone /. Lending agency Day phone Mailing address Agent Day phone Address 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: ./ Individual well 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 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. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposa! system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Ea¢le ver Eng eer Sez'-,r~ce~ Phone. P.O. Box 773294, Eagle River, AK 99577-3294 Address Engineer's signature Date DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of A~chorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificat~ based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev. 1/91) Back MOA~21 Municipality of Anchorage £NVIRONMENTAL SERVICES DEPARTMENT OF HEALTH & HUMAN SERVICE~[E~ Environmental Services Division 825 L Street, Room 502. Anchorage, Alaska 99501. (907~~'~t]t/~ Legal Description: L~' T' [ 0 Health Authority Approval Checklist [-'~c./,~, 0'~'~. .~'~.,/2, Parcel I.D.: A. WELL DATA Well type Log present (Y/N) Total depth /L ,'4 Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to Casing height (above ground) Wires properly protected (Y/N) Date of test Static water level Well produ.~ WATER SAMPLE RESULTS: FROM WELL LOG AT INSPECTION Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Tank size /6'~¢..¢~,/ Number of Compartments .~ Cleanouts (Y/N) ~"~..J Depression (Y/N) High water alarm (Y/N) ~.,~ Soil rating (g.p.d./ft2 or ft2/bdrm) I~' /~r~'~4'~ System type Gravel thickness below pipe d?..¢-- ¢/ Total depth Monitoring Tube present (Y/N) ~/c:~ Depression over field (Y/N) Results (Pass/Fail) [~:~ For '-~ Immediately after z/,£~ gal. water added (in.): Absorption rate = ~' Lf~--~ .g.p.d. If yes, give date Foundation cleanout (Y/N) Date of Pumping C. ABSORPTION FIELD DATA Date installed O'- Length .-~ / Width Effective absorption area ~"~¢ Date of adequacy test '~-/?~ Fluid depth in absorption field before test (in.); Fluid depth ~ (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) bedrooms 72-026 (Rev. 3/96)* D. UFT STAT,ON Date installed M a~Y./.~.)..~... _.... High water alarm level at* '~ Cycles tested Size in gallons "Pump on" level at* *Datum E. SEPARATION DISTANCES "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /~,//~ Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots ,.~/,'~ Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation / ~7 t Property line / ~ ~ Absorption field / Water main/service line /1//,'~ Surface water/drainage/'1//~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Curtain drain ,4/','/ ,4, Building foundation ~5- / Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots .,,- ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal record~.~t f~e ~v~e~tems in conformance with MOA HAA guidelines in effect on this date. Engineer's Name ~*,~,J ~ ', ~' ~'' Date ~ - / ~ - ? '~ HAA Fee $ '~f~O' ¢ Date of Pa~,ment o~/I ¢/~/,¢ Rece~ptNumber 0-~; // (_ are Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING HAA # *?~tL'-~C,~(~-~°t \ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Delucia Sub. Lot 10, Block N/A T15N, R1W, Sec.9 Location (address. or directions) 19726 Ranch Road Chuqiak, AK 99567 (b) Property ownerH.LT.D. Telephone'(home) Business 271-4342 Mailing Address 222 W. 8th Ave. (Box N-64) Anchoraqe, AK 99813 (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Associated Brokers Address 640 W. 36th Ave., Suite #1 Anchoraqe, Telephone 563-3333 AK 99503 (e) Mail the HAA to the following address: (or check here I-q, if hold for pick up.) List contact person and day phone number below: Pickup_ by Engineer 2. TYPE OF RESIDENCE Number of bedrooms Single-Family [] 3. WATER SUPPLY Individual Well [] ~3 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. SEWAGE DISPOSAL On-site ~ Public [] Community [] Hold~ng 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 IRev. 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 FirmEagle River Engineerinq Services Telephone 694-5195 Address P.O.B. 773294 Eaqle River, AK 99577 Date 6. DHHS APPROVAL APproved for 'J~ Appro,.~ed ,~'~/.~_.j Disapproved Terms of Conditional Approval Conditional 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 (Bev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) '' ~ CHECKLIST- FEBRUARY 1984 Legal Description: A. WELL DATA i'~ ~' ~.--it" Well Classification /or-, ,.,4 Well Log Present (Y/N) /v Date Completed Total Depth /d.¢" Cased to .~-~c./ Depth of Grouting Static Water Level ¢5-' ,,5~/~,~.*' /'?~ ~r,,-,.,r Pump Set At Casing Height Above Ground" X.z "/ Electrical Wiring in Conduit (Y/N) .)/ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Col lected by '~-"~'~' '"" ~" Water Sample Test Results ~',~/,'"~',----- Comments .~.~ If A, B, C, D.E.C. Approved (Y/N) Yield _<-~"~ _~'"~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots /~.~¢ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole "~/~' B. SEPTIC/HOLDING TANK DATA Date Installed /~',;r-x-~ Size Standpipes (Y/N) )/ Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ""'/~' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: /~'~-~_~( No. of Compartments Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Date Last Pumped ?//o~ ; for Temporary Holding Tank Permit (Y/N) To Water-Supply Well //~ ~ To Property Line / ? / / To Water Main/Service Line ~-/~ To Stream, Pond, Lake or Major Drainage Course To Building Foundation To Disposal Field /~' / Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 'i J~'.=F-.~' ! Width of Field ¢-z¢, Square Feet of Absortion Area 0~',¢z~ Depression over Field (Y/N) /-v' Results of Last Adequacy Test Type of System Design Length of Field G',¢ / Depth of Field ~ / Gravel Bed Thickness ~'~ / Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well /. 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 To Property Line /"'~ / To Existing or Abandoned System on ; On Adjoining Lots ~" ~ / To Cutback (if present) Comments D. LIFT STATION ,,,~,,,.,~ 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) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guideline.s,[rt effect,On the date of this inspection. Signed ~ Eagle Rivcr Engineering Services Company ,". 0. Box 773294 Date /.z/c-/x--~ Eagle River,^~ ..... AK 99577 o b',~ - c, I ~,~ MOA No. Receipt No. ,_~ Date of Payment Amount: $ Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order ! 15022 Date Report Printed: 3UL 20 89 ~ 18:59 Chent Sample ID:LiO DELUCIA PWSID :UA Collected JUL 18 89 $ 20:20 Received JUL 19 89 ~ 1S:O0 Preserve8 with :AS RE~UIR£D Client Name : EAGLE RIVER ENGR Client Acct : EAGLERP P.O.{ NONE REC'D Req l Ordered By : Analysis Completed :JUL 19 89 Send Reports to: I)EAGLE ~IVER ENGR 2) Spec ial Instruct: Chemlab gel I: 6432 Lab Smpl ID: 1 Matrix: WATER Allo~able Parameter Tested gesult/Umts Method Limits NITRATE-N 8.0 ~g/1 EPA 353.2 i0 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY L.A.B. i Iests Performed ' See Special Instruct:ons Above UA-Unavailable ND- None Detected "' See Sample Remarks Above NA- Not Analyzed LT-Less Than, GT-Ozeater Than MUNiClPALITY OF A NCHORA HE DEPARTMENT OF HEAL TH A ND HUMAN SER VICES MEMORANDUM DATE: December 12, 1989 TO: Ail parties concerned. FROM: D.N. Bolles, On-site Services ~ SUBJECT: Lot 10 Delucia Subdivision, PIN 051-141-36. Ail concerned parties are hereby notified that the well serving the above mentioned property does meet the minimum standards of the Municipality. The production of the well was rated at 0.38 gallons per minute. This exceeds the minimum requirement for production by 0.07 gallons per minute. The presence of nitrates in levels of 7.4 PPM to 8.0 PPM are high. Nitrate concentrations may fluctuate seasonally, therefore it is recommended that periodic samples be tested to ensure continued suitability. Should the nitrate levels exceed the EPA's maximum concentration level of 10 PPM an alternate drinking source may be necessary. db/108 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY S.~.MPLE for Work Order ! 18605 Date Report Printed: DEC 7 89 ! 17:52 Client Sample ID:DELUCIA LIO PWSID :UA Collected DEC 4 $9 ! 10:16 Received DEC 4 89 ! 16:30 Preserved with :AS REQUIRED Client Name : EAGLE RIVER ENGR Client Acct: EAGLERP P.O.! NONE EECEIVED Req t Ordered By : LOg B[CIEI~ Analysis Completed :DEC 6 89 Send Reports to: Laboratory Sup~r~PHEN C. EDE 1)EAGLE RIVER ENGR Rel,a,ed By :~~_ ~ 2) Special Ir~truct: Che~ab Ref t: B746 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result Units Method LlnLtts NITRATE-N 7.6 mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE. SA~iPLE COLLECTED BY LAB. Remarks: 1 Tests Performed ' See Special Instructions Above UA-Unavailable ND- None Detected "See Sample Remarks Above NA- Not Analyzed Ll-Less Than, GT-Greate: Than 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 May 30, 1986 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 10 Delucia T15N R1W Sec. 9 Location (address or directions) Chugiak, Alaska (b) Applicant Name Kevin Taylor Telephone: Home 694-7286 Business694-7286 Applicant Address POB 774274, Eagle Rlver, AK 99577 (c) Applicant is (check one): Lending Institution [] · Owner/builder [] ' Buyer [] ' Other [] (explain); (d) Lending lnstitution Alaska USA Credt Union Telephone 563-/-t567 Address 4000 Credit Union Drive, Anchorage, AK (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: pickup by applicant TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms 3 Other WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11,84) 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 alt Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. ' ~ EAGLE RIVER EN~i~ERIN6 SERVICES Name of Firm EAGLE RIVER, AR 99577 Telephone Address J~, 0, BOX 773294 694-5195 Date Seal DHEP APPROVAL (~-~ ~ ~ Approved for ~ bedrooms b Approved -~... DisapproveC'd Date 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 independe?t 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: /-¢:, 7' WELL DATA Well Classification '¢"/(~ / u'.~ TZ: If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) / Date Completed ~--,2 - ,~ ~t Yield Total Depth i~' ~-- / Cased to ~-'~- / Depth of Grouting /~'/'~ / '~' ;"~.¢; ~ ~,.~. .... '~ Pump Set At -" Static Water Level ,',/ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Sanitary Seal on Casing (Y/N) ~ Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results · On Adjoining Lots /_.2. ~ / · On Adjoining Lots :"/~'c To Nearest Public Sewer To Nearest Sewer Service Line on Lot Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size Standpipes (Y/N) ~' 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 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 Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) /~' Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation -//'.5- / Lot To Water Main/Service Line ~/'~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Fiel~l Depth of Field Gravel Bed Thickness ~ // Standpipes Present (Y/N) Date of Last Adequacy Test .Y To Property Line To Existing or Abandoned System on · On Adjoining Lots ~' .-~ / To Cutbank (if present) Comments 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 L--: ~-~'~-- ~'-~'-'~ Date Company ~"4' '~ _S" MOA No. Receipt No. ~ Date of Payment Amount: $ Page 2 of 2 Eagle River Engineering Services P.O, Box 773294 Eagle Rive~ AK 99577 694-5195 72-026 (11/84)