The URL can be used to link to this page

Home My WebLink AboutEKLUND LT A1 OF TR AEklund Tract A Lot Al #050-531-01 Municipality of Anchorage Development Services Department i Building Safety Division .•,,,, On-Site Water and Wastewater Program, 4700 S. Bragaw SL P.O. Box 196650 Anchorage, AK 995196650 Page1 Gf3 www.d.anchorage.ak.us (907) 343-7904 / ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 4-5, Wn30 qq PID Number: (350-531 -Q/ Name:U 1 mei p. a u er Wastewater System: ❑New ,Upgrade Address: 5V ABSORPTION FIELD Pfwne: 8� U 5DD Nurtba a eedroarhs; (l k°eep Tmrh cl snaaaYr Trench O Batt O mmrd C1 Other: LEGAL DESCRIPTION Sod Rating: I,a De Tow Depth tam er final grade: 1 GPOTI= Ft. /l11 c TJX:: L I hat: A I suediNsim: / I14 n al � to me bottom tram ad grade: FL GnvA dept Donation pipe: � � Fl. Township: Range: section: Fa added above oipnal grade:Gravel �" Length: FL 2S Ft. Well: Upgrade El rade Or" 101114; NU be Distance between tines: FL Ft. Classtanoon(Pnvate.0. . C} Taal Depth: Cased b: +; �a FL Torah atxaryecn area: S FP q MatwF r g/ o DNIK ed: staucwater Level:, Gate FL If Yreld: Pump set al' /largnl Above (iraand: TANK GPM F,, FL SEPARATION DISTANCES t4S-p5c O Hokting O S.T.EP. ❑ Other. To From Septic Tank Absorption Field Lift Station Holding Tank ubrirJPdvate Sewer Line ad , , J411 t! �lp 't(LS Q Gel. wall Material:Material:Horsier bo �aCmCanmerns: surface water I , LIFT STATION Lot Line 6Lt , e: 11 Gal. Foundation I T-D% / �\ 'RnD on'levet at: 'Rmp ar I" as f4ph watn aurin at:. J� l/�% Curtan Drain O nal 610 wn ��- Pum Make i Model hfpetacns pert "need br. Remhka: E,r<s: r,.c S /F BENCH MARK Ut4Plbaom td Coevsl/•�.r and OesrnDam: � ON? `� o j i46.�,,, vv,v E - // evauon: Cottle l�lpu '100 Fl. Engineer's Stamp LOF ., G•N♦•N•••I., N A J 11 N RL f 17034 Eagle River Loop Road, Na- st Inspections performed by:ep, �ba(es: 1 �- - 3 ytt, 2 fid Development Services Department Approval y -ri s ROBERT C. COWAN fr^a Reviewed and approved by: _,83 Date: / � -/ 0 l#+c�l� CE-8801 r S tett l'_00) f�) ti.., ,p. tt�LZ)L %-6rL;ia��'^�-� PERMIT NO. SWO30492 PACE 2 OF Municipalit of Anchora e DEPARTMENT OF HEATH AND HUN'IAN 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 LOT A-1, TRACT A, EKLUND S/D P.I.D. NO. 050-531-01 r-------------------------------------------------------------- I I I I I I I I I I a ENCpy I N Sw[0 I I ' I Z I o s E0 �I WI W� LOT A-3 >1 JI 71 I 01 �+ I o ' 20W WC)z N I NEW 1000 GALLON1 OBL1 k DOL 2 HDPE SEPTIC TANK ECO Wmz n I COI S.. STl IBu 0 n y NEW TRENCH T \\ I ___ CO3 VIE RADIOS I _--I os 10D• _ � r I rSCALE:60' r r LOT A-2 ROBERTAN " ►y��. 8801 I ��. •.LEE.- r PERMIT NO. SWO30492 PAGE 3 OF 3 DEPARTMENT pHEA�TH ANDhHUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 •Anchorage, Alaska 99519-6650 • TeWL hone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT A-1, TRACT A, EKLUND S/D P.I.D. No. 050-531-01 ST1 ST2 ,,-82.0' FINAL GRADE NEW 77.7'1000 GALLON POLYETHYLENE SEPTIC TANK FINAL GRA 2" INSULATION 77.4' C01=79.6' =80.6' M l 1- U U. V NO WATER FOUND 62.6' B.O.H. 2" INSULATION D1=76.3' D2=76.3' N. T. S. MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW030492 Legal Descriptions. EKLUND LT ; Al OF.TR'A ...if Design Engineer: 0003 S & S Engineering Owner Name: James Brauer Owner Address: 29965 EAGLE RIVER ROAD EAGLE RIVER, AK 99577-9754 Date Issued: Nov 25, 2003 Expiration Date: Nov 24, 2004 Parcel 1D: 050-531-01 Site Address: 029965 EAGLE RIVER RD Lot Size: 107158 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By. Issued By: ,-2e& � - Z,,,, Date: // /a G /0 3 Date:ZI 2S 03 Municipality, of Anchorage • Development Services Department 0044� Building Safety Division On -Site Water and Wastewater Program s T y 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ok.us (907) 343-7904 ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. O SO - 5 3L - 0 1 Permit Number SW 304 Property owner(s) S A M ES S? -NA- Day phoneLf`11° - 15 $ ::V Mailing address (1 Mailing address (2 1 C1*1 �Pk Zip Code 9 9'Si q Legal description (Lot, Block & Sub'd.) Legal descri tion (Se ion, Township & Range) Lot Size ->'tcrEs q.F . Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above Information Is correct. I I`drther certify that this application is being made for a Single Family Dwelling and is In accordance with applicable Municipal Codes. /f � / 1 & S ENGINEERING �(�/71/ G/fz�r 17034 Eagle River Loop Road No. 204 w._ _i_ wf____-Al_ _ ww�-.i_ (Signature of property owner or authorized agent) Permit Fees: r 'Yoe ." Waivert=ees: Date of Payment: it io 41 3 Date of payment: Receipt Number: 6 q `l f: o o Receipt Number: (Rev. 12/00) S& -- �►1GIn�GlZIng ROBERT C. COWAN, P.E. CMLENGINEERS (907) 694-2979 FAX (907) 694-1211 November 19, 2003 HEALTH AUTHOR N APPROVALS MUNICIPALITY OF ANCHORAGE Services Department SEWER&WATEDevelopment MNNEXTENSIO AWNE7CTENSpNS P.O. Box 196650 Anchorage, AK. 99519 ' REFERENCE: Lot 1A, Tract A, Eklund Subdivision SEWER6 WATER MPECTION It is requested that you issue a permit to upgrade a septic system to serve the existing three bedroom dwelling on the referenced property. ENGINEERING STUDIES ANDREPORTS One test hole was excavated and a percolation test was performed on 11/13/03. The approximate location of the test hole is located on the attached site plan. Ground water was WELLNISPECTION monitored and after seven days the hole was dry as shown on the attached soils logs. aFLOWTEST We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The SITE PIANS construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Roan DESIGN Sincerely, SOILTEST 7Z'� �- . Robert C. Cowan, P.E. PE„OOLATION RCC/jhm TEST Enclosure STRUCTURAL& MECHANICAL MdSPECTIONS CNSITE WASTEWATER DISPOSALSVSTEIA DESIGN 17034 NORTH EAGLE RIVER L06P - SURE 2134 i EAGLE RNER. ALASKA 99577 SITE PLAN DESIGN 1" = 60' A V O Nwco .-j ANW Q0Am0 7EM �a O[O��"^ w�A x, cm, 7C Ash 00.'�m Z .'(Au..ai' 1 ANA yZ> ZMMM Np�+ci .Oio•�O ctii �-Ci� AIn >�pn ck, (lbw �� 1VOV0 b s$m >>Q z r O .O S o f 1 10' Util. EsMt, —� ---- ---T---- -----------------------, r 20 I �a e mO x N O tom$$ AFF I ^ \ \ zez \ \ �C_ I �\ \ > I I \ \ o N 1 � EXISTINC \ 3 �HOUSE M I = cn \\•.• \ \•\ rn I O �c8:3 I Z!3 O O'o ` Cm�= czm \ 00 ■ O GC"JOZ>�: • fn t COCC) mmnn �m0� tna •r iI Soils Log - Percolation Test Performed For: 12A—(iiL Date Performed: 1 1 Legal Description: LDT I h ; T2iE GT h E6�r_t J N� S 7 Slane Site Plan Depth 1- 0. 2- 3- 0 4- 5- 0 6- 7. o 10- • 0 11- • 12- 13- ' 0 14- 15- 16- 17- 18- 19- COA.1 .LENTS VIAS cPOut WATER N D 'OFA `ta c S IF YES. ATYP'ATDEPTH? '• LD Depth to Water After 4lonilodng? Municipality of Anchorage Dau: 'F j ; (ENGIN EA- fir, Development Services Department ;+W.Alt?Buldng Safety DivisionOn-Site Water and Wastewater Program 1,.a i4700 South Bragaw SL V ROBERT C. COWAN P.O. Box 196650 Anchorage. AK 99519-6650 �^�.: cc . 8801 www l] anchcrane.ak.us .0, %, e f', �... (c07) 343-7904 _ " ....• CDr, .•� . %y r,r Soils Log - Percolation Test Performed For: 12A—(iiL Date Performed: 1 1 Legal Description: LDT I h ; T2iE GT h E6�r_t J N� S 7 Slane Site Plan Depth 1- 0. 2- 3- 0 4- 5- 0 6- 7. o 10- • 0 11- • 12- 13- ' 0 14- 15- 16- 17- 18- 19- COA.1 .LENTS VIAS cPOut WATER N D ENCOUnE'•ED7 S IF YES. ATYP'ATDEPTH? '• LD Depth to Water After 4lonilodng? P _ky E Dau: Il- 26-03 Reading Date Gross Time Net Time Depth to Water Net Drop -P/A zl . n I r I /_ rr I -- O'4 j' '14 " IX�� orr rl 0 I17" Orr 'Olt 4_ IfJ �orr/rm- tePERC HCLE DIAE%I=TER e'Pc „Ol4TICH PATE t TEST RW E TNEE.I FT PAID FT PERFOPMED BY: CERTIFY THAT THIS Tc5 WAS PERFORMED IN ACCO DANCE WITH ALL STATE P?ID l.IUA:ICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 1� / � /t73 Tom Fink, Mayor Municipality Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 January 8, 1991 Knud Korsgaard PO Box 71 South Berwick ME 03908 Subject: Lot A-1 Block A Eklund Subdivision Permit #900217, PID #050-531-01 The subject permit, issued by this office for a single family' well and/or on-site wastewater system has expired as of December 31~ 1990o A new permit must be obtained from this office for a well and/or on-site wastewater system not installed by the expiration date° If you have drilled the well, a well log needs to be sent to this office for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site wastewater system, the original as-built inspection report (three-part form) must be sent to this office for review, approval and documentation° All inspection reports must be submitted within 30 days of construction completion° When applying for a new permit, the fees are: $90.0~ for an on-site wastewater permit; $50.00 for a well permit; $140o00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744° On-site Services JW/ljm:200 enc: Copy of Permit "Kids Are Our Future Nlunicipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG ~ PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15- 16 17 18 19 20 DATE PERFORMED: PERFORMED BY: ............ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEd 72-008 (Rev. 4/85) Township, Range, Section~:SI_OPE Ti ~sI E~PLANL'~-i -/ WAS GROUND WATER ENCOUNTERED? ~O S IF YES, AT WHAT L DEPTH? . pO E Depth to Water Alte~/ Monitoring? (_Iii'L4 Date: -:~- ~c~O Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN ~ BETWEEN FT AND FT COMMENTS __ _ S & ~ ENG~NF~F''~dNG . FECT ON THiS DATE. CERTIFY THAT/~HIS TEST WAS PERFORMED IN DATE: ~//~ ~///~¢¢ oGRF ....... ANCHORAGE AREA BO"'" Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~-~¢-tt,~]~) G(~¢I~'~, MAILING ADDRESS PHONE SEPTIC TANK: ~ LC' i~-I/~ DISTANCE <~jl/~.~ ~:l,t, F.OMWELL !1~~ MANUEACTURER INSIDE LENGTH INSIDE WIDTH ~ ¢if NUMBER OF ~'~ MATERIAL ~ ~-"~' L.~ COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY ~ GALLONS. SEEPAGE PIT: NUMBER OF PITS __ LINING MATERIAL I DIAMETER ~l~~ ~¢~4C1¢¢ ~ CRIB SIZE; BUILDING FOUNDATION__ OR WIDTH /~i LENGTH/ .~.i DEPTH DIAMETER DEPTH_ DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE ABSORPTION AREA (WALL AREA) ~-~' SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE"~AILL~o~ CONSTRUCTION BUILDING NEAREST FOUNDATION_ , LOT LINE__ CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED ~q¢ ~¢}I)AmD DEPTH ~' DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE TANK I~?~I SYSTEM /t¢¢' REMARKS DISTANCES: INSTALLED BY:_ PIPE MATERIA£ · LOT SLOPE: Form No. DIAGRAM OF SYSTEM GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 27/~-4561 PERMIT NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT '"1 ~ ~ ' / I INSTALLATION LOCATION [ ~ TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST rESULTS--~X~i'~. COMPLETION DATE: ANTICIPATED TO BE INSTALLED BY NOTE: TBIS PERMIT iS NOT VALID WITHOUT SOIL TeST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, BEQUiR~EMENT$ FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE Pit SEPtiC TANK tO SEEPAGE Pit WALl SEPTIC TANK "-} .. SEEPAGE PIT TO NEAREST LOT LINE. WELL TO sePtiC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK __ DRAIN FIELD SEPTIC TANK, ~; i~ _, SEEPAGE PIT TO RIVER, LAKE, STREAM. SEEPAGE AREA SIZE DRAIN FIELD ., DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS, ., SEEPAGE PIT ., DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS R~G~RDING INSTALLATION, TYPE DIAGBAM OF SYSTE~ [ CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH/~RD~!NANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE, ~ ', ~ ..... ~ / i ~ ? ~ by A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 ® TELEPHONE 694-2588 OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE - Started Ended PERMIT NUMBER DEPTH OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR KIND OF CASING KIND OF FORMATION: From Fi. to Ft. From Ft. to Fl From Ft. to Ft. From Ft. to ~ Ft._ From Ft. to Ft. From Fi. to_ Ft, From Ft. to Ft, Front Fi. to Fi, From Ft. to Ft, From Ft. to Ft. From _Ft. to _Ft. From _' Ft. to Ft. From Ft. to Ft. From FLto Ft. From Ft. to_ Ft. From Ft. to Fi. From Ft. to___.Ft. From__Ft. to Ft. From Ft. to Ft From Ft. to Ft From Ft. to_ _Ft From Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to _Fi From Ft. to_ Ft From Ft. to Ft. From _Ft. to Ft From_ Ft. to Ft._ From Ft. tQ Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. MISCL. INFORMATION: DRILLER'S NAME -� unicipalit), of Anchorage ,..0, Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw Sl. P.O. Box 196650 Anchorage. 6650 •�= www.ci.anchorage.ak.us (►� (907) 343-7904 �® CERTIFICATE OF HEALT H AU i'HORiTY APPROVAL FOR A SINGLE FAMILY DWELLING 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 regdest to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private 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 br a public water system. The fA.inicipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. t -")O 13 Parcell.D. 050-531-01 HAA# Expiration Date: 3 — D -- O jy' 1. GENERAL INFORMATION Complete legal description Lot A -ice TrartA F.k1,nr� ��n Location (site address ordirections) 2995 Eagle River Rd. Eagle River, AK 99577 Current Property owner(s) James Brauf Day phone696-1547 Mailing address same ......... ... Lending agency Day phone Mailing address Real Estate Agent Claudia mmit- nary Day phone 688-9500 Mailing Address, PO Box 671923 Chuoi nk, AK 99567 HAA be held by DSD for pickup. 02.47--. "' I r r to 3 Unless otherwise requested, will 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 regdest to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private 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 br a public water system. The fA.inicipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION 13Y 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 S & S Engineering PaW e 694-9979 Address 17034 N. Eagle River LP RD, EaPle River.,. -AK 99577 Engineer's Printed Name Robert C. Cowan Date _/ 711/ola 3• - .......... _ 5. DSD SIGNATURE Jt R06ERi C COWAN 4 I/• Approved for bedrooms. �•,, f,:�rtSS Disapproved._ Conditional approval for bedrooms, with the following stipulations: Attachments: NAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By:Original Certificate Date: ! — / — 0 3 (Rev Ov07) Municipality of Anchorage }•� Development Services Department Building Safety Division - On -Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: (iOT X ^ %/.4iGT Z : 6<1-U�15 5/0 Parcel ID: d SD -S3 / -O/ A. WELL DATA Well type,L If A, B, or C provide PWSID # = Well Log (YIN) y' Date completed ,��6 Sanitary seal (Y/N) Wires properly protected (Y/N)_i1� Total depthi-ft. Cased to 4o "'ft. Casing height (above ground) n. FROM WELL LOG Date of test q 7-�r, Static water level ft• Well production g.p.m. WATER SAMPLE RESULTS: Coliform D colonies/100 ml. Nitrate 0.1P mg./l. Arsenic: '" mg.A. Date of sample: *03 B. SEPTIC/HOLDING TANK DATA Tank Type/Material 6t p nu 1 t4'D P r Tank size loco gal. , Number of Compartments Z Foundation cleanout (Y/N) Depression over tank (Y/N) N Date of pumping A/ EYJ Pumper C. ABSORPTION FIELD DATA Date installed If 3-0 03 Length �_ ft. AT INSPECTION _j Z I f S I 10;� X150 ft. 4.0 g.p.m. Soil rating (g.pAA2 or felbdrm) ° Z Width Other bacteria colonies/100 ml. Collected by. EiV G)J-J<F L/nlc� Date installed f 2 b 3 Cleanouts (YM) High water alarm (YM) Ari System type Gravel below pipe Total depth 10 ft. Eff. absorption area.. Monitoring tube Depression over field Ai Date of adequacy test Results (Pass/Fad) As For 3 bedrooms Fluid depth in absorption field before testin. Water added_ gal. ew depth_ in. Elapsed Time: _ min. Final flu' depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Al If yes, give date D. LIFT STATION Date installed A11A "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons "Pump ofr level at _ in. Cycles tested Manhole/Access (YIN) High water alarm level at in. Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/IA-s tion on lot 100 14- On adjacent lots 1 AD it - Absorption Absorption field on lot / DO 1+ On adjacent lots / OCA �+ Public sewer main N Z A Public sewer manhole/cleanout n! / A ,Sewer /septic service line ZS tw Holding tank A) SEPARATION DISTANCES FROM SEPTIC/HOtDttQG TANK ON LOT TO: i Building foundation �J� f Property line 5- 'i- Absorption field )} r tT. Water main ti 1A Water service line Surface water loo Wells on adjacent lots 100 t -r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1 D �r Building foundation f O �f— Water main ' �- Water Service line i t+- Surface water Driveway, parking/vehicle storage Curtain drain Nclur K^j0-w Wells on adjacent lots X 00 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 Rota ier C. C'aw,4r Date 1--)//0/0- HAA Fee $ 3 7 S, u" f' / r� �. R"f �> Waiver Fee $ Date of Payment /,I- /f o 0 3 Date of Payment Receipt Number C7 4 S Y S \ Receipt Number (Rev. 12101) l'; :^,1 ROBERT C. COWAN Iti CE -8801 tai cV�,:.......... ..,,�\. yw 12- 9-03:13:39 :CT and E 5 a S Engineering :5615301 2/ 2 CT&E Environmental Services Inc. 200 W. Potter Drive Anchorage, AK99518-1605 Telephone: (907) 562-2343 Facsimile: (907) 561-5301 200 W. Potter Drive Drinking Water Analysis Report for Total Coliform Bacteria r lc(so7i e, 999518-t sos 43 uFAn.rNCTRur-noNSONARYERS,USia,E$F+FORECOLLECTINtiSAMPLE Fax: 19071561 -sant MUST BE COMPLETED BY WATER SUPPLIER oPUBLIC WATER SYSTEM I.D. W TI I1/PRIVATE WATER SYSTEM Send Rfn O Send Invoice mbee omnumtwr as u Wvia SAMPLE DATE: ' Afontlt • . Day `SAMPLE TYPE: ' 1 /l� RoEtlne . q lfepeat Sample (for rogfitte saitiple wltlt lab rFf +.o, p Speclal Purpose SAMPLE,LQCATIOiY e -SID �• . Kam Year O Treated Water p' Vntrbated•Water Time • CoIlected t:ollectei! .By. • rkN•hint M Analysis shows this Water SAMPLE to be: 1�5` Satisfactory O Unsatisfactory' • Sample.over30hours old, tesultsmay be unreliable . O• Sadh'Ple too l'd)ig iri.tM'nsit, sample should notbopvoal ours old'ateitamtnation to indicate relic le results: Please send .nety sample via special delivetymail. Date Receive d Time Received to f3 Analysts Began Analytical Method: X Membrane Filter ' o MMCF -MUG 1037794Result' "x" Analyst `7EJ .6 Fbks Jun ❑ Faxe,d Date: _ Time: Client potlfled of tinaatisfaetory resuI'.s: ❑ ❑ Phoned Spokewtth Faxed Date, Time: BACTERIOLOGICAL WATER ANALYSIS I,2ECORD blAO-MUG Result: Total Coliform E. Coli hlembrane Fl ter. Direct Count --r� Colonies(100 ml Verification: LTB BGB • COLIFIRM TMC- roe Nummus re Coma ., Fecal Coliform Conrirmation 03-orn.rl!"A';a FinalMembraneF ter Results _l Coliform/100ml Reported By Date Time %,!/ hrs Comments: (®) -CIL- . CIL nun t2-10-03: t2:26PMt ;907 5615301 a 2/ 2 E 1 1441 E. SGS Rel.11 1037794001 Client Name S & S Engineering Project Name/p L 4-t Tract A, Eklund SID Client Sample ID 1,A-( Tract A, Eklund S/D Alatrix Drinking Water Sample Remarks: All D2tes/1'imcs are Alaska Standard Time Printed D21e/rlme 12/10/2003 11:22 Collected DateM= 12/08/2003 10:00 Received Date/rime 12/08/2003 10:34 Technical Director Steph C. Ede Released Ij 4 Allowable Prep Analysts r Parameter Results PQL Units Method Container ID Limfts Date ate Init 4iaters Department Nitrate -N 0.100 U 0.100 mg/L EPA 300.0 D (<=10) 12/06/03 JIB ..;__1~ DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR &U~ ~JF~LITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE ~NVI: DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVI RON~ENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Comptete all parts on page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE MAILING ADD~ E~ PROPERTY RESIDENT(If different from above) ~~ PHONE 2. BUYER ~AILING ADDRESS MAILING ADDRESS 4. REALTOR/AGENT MAI LiNG ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 5. TYPE OF RESIDENCE [~SING LE FAMILY MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One E~ Four [] Two [] Five [~Three E~ Six [] Other 7. WATER SUP/~t-Y ~ INDIVIDUAL* [] COMMUNITY PUBLIC UTI LITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975, For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [~IN DIVI DUAL/ON-SITE~ [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS E~ SINGLE FAMILY [] ONE E~} THREE [] FIVE ~ OTHER [] MULTIPLE FAMILY [] TWO E~] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY b~_] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY '~'7' '-~ Connection Verified INSTALLER []Septic Tank or ~ Holding Tank Size: /.~ ~!~ ~' ~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I WELL TO: __ Absorption Area to nearest Lot Line 5. COMNIENTS ~ APPROVED FOR /~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72 010 (Rev. 6/79) EXCAVATION ROBERT A. SHAFER WORK JUly 5, 1982 CIVIL ENGINEER 694-2979 MUNICIPALITY OF ANCHORAGE DFr~T C?': I-'~'~T't ". Dynamic Realty, Inc. A~T~TION: Petie Strang 501 W. Northern Lights Boulevard Anchorage, Alaska 99503 RECEIVED Reference: Lot [LA~ ¢~.L~trz~ £ubd~v±s±o~ A sewer system adequacy test was performed on the system located on the referenced property at the request of Robert Ballay. The septic tank was pumped and verified to have a capacity of 1250 gallons. The seepage pit was tested by charging the system with approximately 1000 gallons of fresh water and after ~ period of 24 hours the water level indicated all the water that had been added had percolated out of the crib. It can be concluded from this test that the waste water disposal system serving the three bedroom residence located on this property is currently functioning adequately. However, the system cannot be guaranteed against subsequent failures. If we may be of further assistance, ~lease do not hesitate-~ to call. Sinc y. ,~/~T A. SHA~R,~P.E. cc: Municipaltiy of Anchorage Department of Health and Environmental Protection SR8 196X EAGLE RIVER, ALASKA MUN C PA_ TY OF ANCHORAGE DEPARTMENT OF HEALTH 8, ENVIRONMENTAL PROT~CTi'O~ 825 L Stree~ - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISK) N Telephone 264-4720i~%~'~1 ~l~, ~? ~ L ~ ~,i ~'! i' :i ~ 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. PROPERTY OWNER Adt~f~Y~i-~ Edward B. & Judith L. Coleman work [ 274-1534 x 26 MAILING ADDRESS P.O. Box 746 Eagle River, Alaska 99577 PROPERTY RESIOENT(Ifdifferentfromabove) PHONE -same- -same- 2. BUYER PHONE Robert E. & Annette P. Ballay --- MAILING ADDRESS P.O. Box 360 Anchorage, Alaska 99510 JPHONE 274-8683 3. LENDINGINST]TUTION Fred Meyer Savings & Loan MAI LING ADDRESS 1000 E. Northern Lights Blvd. Anchorage Alaska 99503 4. REALTOR/AGENT D~namic Realty, Inc./Ron Huffman PHONE 279-7611 MAI LING ADDRESS 501W. Northern Lights Blvd. Anchorage, Alaska 99503 5. LEGAL DESCRIPTION Eklund Tract A-1 (050-531-01) S-FR EET LOCATION Mile 10.5 Eagle River Road 6. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY home is located on the north side of the road d~civew~z is marked with sawhorse with"Private ~7~ ~-~UR o--d-~ [] One [] Four E~] Other L~ Two [] Five [] Three [~] Six 7, WATER SUPPLY [] INDIVIDUAL<' ~'ATTACH WELL LOG. A well log is required for all wells drilled [] ' COIVIMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~] INDIVIDUAL/ON-SITE"* ~*[f individual/on-site, give installation date_ 1 !~ !~- If system is over two (2) years old an adequacy test is required [] PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) Drive!! sign THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS; 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [~ FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED E~] PUBLIC UTILITY '-~ Connection Verified INSTALLER E~]Septic Tank or [] Holding Tank ~, Size: /~..~--C) If Tank is homemade SOILS RATING give d)mensions: TYPE OF TANK __ MANUFACTURER 4. DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS · ' APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) Oc hobc. r }.8~ .~ ........ ~: c,~c]~ma Sub(Sivi,sion ClX/l! f!!Y( !NI ER (~94 2979 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OCT 2 3 1979 RECEIVED · ..... 'd '-o Oc'I;oL, er 13 .nd ]Z'~ 1t.979 and -~nc]um;d 'bhe tank axd .... n( .e ~., s; ',' '! ...'. ~::] I ] o SRB 193X EAOLI: RIVER, ALASKA GR'EATER ANCHORAGE. AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 DATE RECEIVED:. INSPECT: //- / ~-7/ TIME: REQUEST FOR APPROVAL OF INDIVI-DUAL SEWER AND WATER FACILITIES FOR 1. APPROVAL REQUESTED BY: ADDRESS: /,S, ~, PHONE: 2. PROPERTY OWNER: /~'~ ,/~ ~ LEGAL DESCRIPTION: ~/~)t-~ 4. TYPE FACILITY TO BE NUMBER OF BEDROOMS: 5. WELL DATA: B. DEPTH ,~(~) ~ ~3o~ ~'[[ t,~_ '~-'~,~.. 1. SIZE 2. AGE /~' 3. MANUFACTURER 4. INSTALLER APPROVAL REQUEST FOR SEWER PAGE TWO & WATER FACILITIES SEEPAGE PIT 1. SIZE 2. LINING DISPOSAL FIELD 1. NUMBER OF LINES 2. TOTAL LENGTH MEASUREMENTS TO SEPTIC TANK ~ WELL TO ~SEEPAGE PIT WELL TO SEWER LINE WELL TO PROPERTY LINE REQUIRED A. WELL B. C. D. E.. WELL TO OTHER F. FOUNDATION TO G. FOUNDATION TO H. SEEPAGE COMMENTS: POSSIBLE CONTAMINATION SEPTIC TANK SEEPAGE PIT PIT TO PROPERTY LINE APPROVED: DATE: APPROVAL VALID FOR ONE YEAR GREATER ANCHORAGE AREA DISAPPROVED: DATE: FROM DATE SIGNED. BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY ~ovember 54, 1971 3~E, ~ear $!rs~ A~ inspect!on on Xove~be~ lg, 1971 revo~led that e cess- po'el was servtn~ as ~he se~er system, The cons~ructto~ and iocat~on of the ~ell can be approved by this Dap~rtmen~. approved system ~tii need to be installed ~J~h proper ~ence$ to the ~e11. Sincerely, Lynn $. Coed R=lph Eeklun~