The URL can be used to link to this page

Home My WebLink AboutEKLUTNA HGTS STEWART ADDN LT 11 ., 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 [] UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS J We I Absorption area Dwelling PERMIT NO, ~ ~ < Z Manufacturer ~~ Ma~ ~ N°- of compartments ~ ~ Liq, capacity in gallons Inside length Width Liquid depth /~ IF HOME,DE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer Material Liquid capaciW in gallons Q Well Foundation / Nearest lot line PERMIT NO. ~ ~ DISTANCE TO: /~ ~ ~ ~ / ~ ~ ~ NO. of lines Length of each line Total length of lines Trench width Distance between lines - / ~ / ~ ~ ~ inches ~ ~ ~. Top of tile to finish grade ' Material beneath tile Total effectiv~ausorption area n ~' ~ ~ ' ~ inches ~¢~ ~.~ Length Width Depth PERMIT NO. ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot Pine PERMIT NO. m Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS ~,r~.~ ~ ~//~ ~, SOIL TEST RATING IN~LLER I I~G'/ I~ r'~ /~.1 ' REMARKS APPR~ ~ ~ DATE LEGAL 72-0: lev. 3/78) DEPARTMENT HEALTH ~D EN¥IRONMZNT~ OTECTiON =.T~E~T, ANCHORAGE, AK. 9960i 264-4?20 ~ELL AN~ ON--~ITE SEWER PER~IT PERMIT NO. APPLICANT KURKA ALASKAN BUILD INC P.O. BOX 2i4 E. R. 99577 LOCATION LEGAL Lil EKLUTNA HTS STEWART ADD' LOT SIZE 84~8 SQUARE FEET TYPE OF' SOIL. ABSORBTION SYSTEM I$: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT?BR)= 250 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTI""~= --' :~::L LENI3TH= ~m~. 4 EiRFIVEL DEPTPI= 8 THE LENGTH DIMENSION IS THE'LENG~ (IN FEET)'OF'THE TRENCH OR DRRINF~LD. TIlE DEPTH OF R TRENCH OR PIT IS' THE DISTANCEBETWEEN THE SURFACE OF THE ~ROUND AND THEBOTTOM'-OF THE E~AVATION (IN FEET). TblERE IS NO SET WIDTH FOR TR~4CHES. THE GRAVEL DEPTH IS THE.~INIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE ,~CRYRTION (IN FEET). REQUIRED sEPTIC TR~41( SIZE= 1008 E~RLLOr~4S PERMIT APPLIC¢INT 'HRS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURIf~ THE I[,'STRLLm"ION INSPECTIONS OF ~N'/ WELLS ADJACENT TO THIS PROPERTY AND THE NU~,~,E~ ~F RESIDENCES THAT THE WELL WILL SERVE TWO ( 2 ) I ~.45PEOT I O~,45 REF r~FQU I RED ~CI(FILLING OF ~' 5'./5TEM WITHOUT FINAL INSPECTION AND APPROVAL BM THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTI~'4. MINIMUM DISTANCE BETWEEN R WELL RND ANY ON-SITE SEWAGE DISPOSAL SS'STEM IS 100 FEET FOR R PRIVRTE WELL; OR 150 TO ~00 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS 8RE REQUIRED AND MUST DE RETURNED TO THE DEPARTMENT WITIIIN OF THE WELL COMPLETION. OT|:ER REQUIREMENT5 MA~ ~PPLY. SPECIFICRTIONS AND CONSTRUCTION' DIRGRRMS RRE RVRILRDL. E TO INSURE PROPER INSTRLLRTION PEF~I~ I T E;-~P I f~FE. DFCF,"IE:F.R .3~::1..,, 1, 9?8 I CERT I F°',' THAT :L: I AM FRMILIRR WITH THE REQUIREMENTS FOR ON'"*SITE SEWERS AND WELLS RS SET FORTH D',' TI'tE MUNICIPALIT"*' OF RNCHORFtGE. ~: I WI-LL INST~LL TI~ 2,"5TE~J IN AOCORB~E WITH THE COPES. ¢: I UNDERSTAND TI.I~rTHE ON,-..SITE SEWE~'STEM MAY REQUIRE ENLARGEMENT IF THE RESIDEN~X~~,~~ ~0 I~D~E~ THIqN ~ BEDROOMS. SI8 aPP~O~NT-- I:URKa ~SKn~ILD IND .... I_.~UED D .... DATE .... O ,~ E GEC~ECHNICAL ~ DEVELOPMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 S0IL LOG Soils ~ Foundations Perfomed for: Legal Description: Depth (feet) 0 5 6 7 IAI 9, Earl Ellis 688.~1~0 Land Development .ailing Add~ess:~,~ ~;4 ~~,=~ ~ ~ Sotl Characteristics 15 Ground Water Encountered: Yes ,, No__ Proposed Installation: Seepage Pit Comments: ~ .~-~f~ ~x~ ~/ If yes, what depth Drain Field Performed by: ~~ Date: /~/?r 177~ DRILLING LOG Well Owner Walt Kurka UseofWe]l Dom, Location (address of: Township, Range, Section, if known; or distance main road Lot 11 Eklutna Heights' Subdivision ?~[v~A~q ~OC~-t~ Size of casing 6" Depth of Hole Static water level 100 ft. ~,~) Screen ( ); Perforated ( Describe screen or perforation N/A Well pumping test at 1~. gallons per (I~Y~; of drawdown from static level Date of completion 6 / 26 / 78 204 feet Cased to 136.5 feet (below) land surface. Finish of well (check one) open end ( ). xx ); (minute) for 1 hours with 100~ WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 TO. 2 Casing s tickup 2 TO. 4 TO. 25 TO 40 .TO 57 .TO 75 .TO 85 .TO 95 .TO 100 .TO 128 .TO 132 TO 136 __.TO. 204 .TO. .TO. 4 25 40 57 75 85 95 100 128 132 136 Organics Silty loose grave] Sandy gravel Sandy gravel: cabhly Gravelly hard pan Sandy gravel Silty cobbles Loose gravel Silty hard pan Water Erave] Hard pan NWWA Certified Contractor Certificate No's. 814 ~ Bedrnek: wmtmr ~oopm in sporadic fractures throughout 1 -- CUSTOMER 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. # O{;[ - 0~ ~ 1. GENERAL INFORMATION Complete legal description ' ~ · HAA # Lot 11; Eklutna Heights Location (site address or directions) 21624 Bearview Place Chuqiak, AK P~oPerty owner ".~ Peter Dekreon ~,', Mailingraddress 6..~ate Whipple Hw~;. ~204 Lending agency i~ ":Mailing a dres A'~ent Barbara Crittenden/ Jack White Real Estate Day phone Day phone (401) 658-4699 Cumberland, Rhode Island Day phone 694-5500 Ad dress Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER sUpPLY: Individual well Community well Public water NOTE: xxx 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: xxx 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 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. S & S ENGINEERING Name of Firm 17034 ~_-~- giver Ln,,p Reed No. 204 Phone (~' Eagle River, Alaska 99577 Address ~_v--~/~.~w~-_ / / Engineer's signature , Date o DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms, bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or Omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA i121 ManhOle/Access (Y/N) High water alarm level at* Size in gallons ~ at*Datum C Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot '~ 80 z Absorption field on lot Ic~ / ~ Public sewer main k) !.~ "Pump off" level at* On adjacent lots On adjacent lots Public sewer manhole/oleanout Lift station Sewer/septic service line '~ ~' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: FOundation ~ t -~ Property line ~' ~ 4- Absorption field. Water main/service line Io~ f' Surface water/drainage ~o ~'~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain /L~'~ :~_)Building/' ~ foundation (O,~ Water main/service line 4.- Driveway, parking/vehicle storage' area ,5 ~ Wells on adjacent lots ~ ~ ~ ENGINEER'8 CERTIFICATION Signature ~ Engineer's Name Date / HAA Fee $ ~,'~"0 Date of Payment Reoeipt Number 72-026 (Rev, 3/96)* Waiver Fee $ Date of Payment Receipt Number 0CT-20-1999 16:04 CT~E ES ! ANCHORAGE Zt~_~ CT&E Environmental Services 90?5615301 P,04/O? CT&E Re£# 976335003 Client Name $ & $ Engineering Project Nme/// N/A Client Sample ID Lot 11, l~ldutna Heigh~ Matrix Drinking Water Ordered By PWSID Sampl~ Rema~i Client PO// Printed Date/Time 10/20/97 15' 15 Collected Date/Time 10/1]/97 12:45 Received Date/Time 10/14/97 10;50 Technical Director: Stephen C. Ede Parameter Atto~ab~e Prep Ana~¥s;s Method Limits Data Date Nitrete-N 3,80 Total CoLiform 0.00 0,100 mg/L cot/100mL EPA $00.0 10 max 10/15/97 GCP $H18 92228 10/14/9r RAM CT&E Environmental serViCes Inc. Laboratory Division ~'~'.d'.d'.d'-d'd'.drdrd'd'.e',p'~:e:d~,drd..dSp.~S, ............... .. ,. Drinking.Water Analysis Report for Total Coliform Bacteria 2oo w. Po,er Or,va ?~4D /NSTR~/CTION$ 0/¥ R£F'£~9~£ SZD£ B£FOR£ CO£/.£C2/'IiYG S,4MPg£ Anchorage. AK 99618-1605 MUST BE PUBLZC WATER SYSTE/~4 I.D. #. PRIVATE WATER SYSTEM YATER SUPPLIER Year- Treated Water UnfFented. Water Tel: (907) 562-2343 Fax: (907) 561-5301 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE th'be: Satisfactory UnsatiJfactory n Sample over 30 hours old, results may be unreliable Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via special delive~ mail. on,...e,~.d _ /o-/~ ,? ? ~nnl~tal MIl~od~ Memb~e Filter O MM~MUG * Numberofcolonie~100 mi. ~b ReK N~ R~ulI* Analyst Fa~d Date... TOme: _ SAMPLE DATE: ~ loath. SAMPLE TYPE: ~ Routine 0 Repeat Sample (for murine sampler. with lab re£ no. ) 0 Special Purposn Time Collected Client notified of unsatisfactory r~ult~: SAMPLE LOCATION ~:: '~.. Colleetad,. By ~ . BA~OLOG[C~ WATER ~YSIS ~CO~ Fsxed Membrane FilleK DIreet Coua~:~) Verffletffon: LTB_ BGB,. _- Fecal Coliform Conllrma/lo! _ r. vrc- r. ,vu,.~, r, _. E Cell Colonle~lO0 mi COLIFIRa~.. MUNICIPAL Box 196650 99519.6650 Parcel I.D. 1. ~, GENERAL INFORMATION DWELLING HA950110 Locabon (s~te address or directions),, · , ~ Prone~ owner r,,': Micha~ 'M~6~?'":~:~"~[~'~?' ~ Day phone Mailing address C/O..G~d, ~V,~hl l 41.1,~O~r G~EE H~V. E~Ze,. Lending agency" ' . ....... , , ay phone Mailing address ,'" . . , .... ~,:F~l~;~t~;~,~..~: .::,.,?;... Agent ~'' Joh~ ~/GEEATLAN~'EEALT~,~',~,~i~'~:?~:?~'~: Day phone Address 11411 O£d g£enn H~/. '~.~,t,e ~. .~ i;AK Unless otherwise 2. NUMBER OF BEDROOMS:,~. 3. TYPE OF WATER NQ,TE: 4, TYPE OF WASTEWA ,:'~,~, ~ "~': '"~, I; ~,~,~?~-~!h NOTE: If communi~: attesting ,my ipal~ty o~, i'ordinanCes!!and ,reg, S'ENGII~ I verify that my )llcatlon~show$ that the on-s te water supply amber of bedrooms 1'{he Information obtained from the on;site water pal and State codes, ::,.~ , · , Condltlonal'a ROBERT C. COWAN E-8801 : :b~lrooms4with the following Stipulations: Date :::' ~:: professlonalen ~ ISSUes He~:lth Authority 5 above by an Independent ! to purchasers of homes L~immentS, Employees of DHHS do not of AnchOrage Is not ,~ .,' DEPARTMENT .,.;.;~.~;~.,.?: ~ Division .... ' ...... , ;: :~ -~.'-. P.O. Box 1~0 .; ' ': '~ '~-,-'~.?~,'~ CERTIFICATE OF H~LTH ' :' . APPROVAL FOR A SINGLE Parcel I.D. ~O~1- ~- ~ r :.,,: . GENE~ INFORMATION _~-':-,"..~.~' ' ' ~ .r. :::.: -:- ' .., ~.:;- ~:';- - ..~,,-,~-- Complete legal descnpbon. ..... Lo~..4 &. :..::.~,,?:~' ~r~i-~Sl~;,m.~/-~e~i~affix~Kl.heretoand aSof the validation date shO~O'~below,, ver,~ that my ". '" ' ori A roval application showstfi~~:th'e-~n'site W~teisuP~l¢'-; inv~ti atlon of.~.th~s Health Auth,..~.~ pp~. .........: . __, ms and/o~teWater dispo~l sysmm is ~fe, fun~lonal ana adequate for the numar of b~roo '~ .~, ~- and ~pe of structure indi~t~ herein. I fU~he~ veri~ that'bas~ on the info~atlon obtain~ from ,.,' ~:~ th~ Mun~oi~li~ ol ~n~o~ fll~ an~'~;~'mv inv~atlon and ink.ion, t~ on-~t~ w~t~r;~ ~u~ly and/or ~t~t~t.~i~po~l ~y~t~m i~ Incom~li~n~ with all Municipal and 8tat~ ~oa~,,:. , :'~:~-'~{:~'~ ~ '"~, ~ ~ -"~* ~ ~'-? ~ ~'~'~ ~ ~k,.,.~.,~ "" ' ' Phone ' -- - '- ' ~ '~: ' ....... ~'~:~ ' 'm-~rtlflcata~: b~ ~ii y'upon thempresentatlons "!~!~..' ~ ~,'~~i~¥~p~r~i~(~miss[$ns In the professional eng Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~ \/ ~ ~'r'~,~- ¥-~"~ Parcel I.D. A. Well Data If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~ ~ ~.L~ ~ '7~ Driller t~ Cased to ~ L. ,'5' ~a~ing height Wires properly proteeted~l) x] AT INSPECTION Well type ~, ~>~.~ Log present ~) ~ Total depth ~ "-{ ~ Sanitary seal(~l) ~-~ .g.p.m. Date of test Static water level Well flow \, Pump level1 FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ ~c~ ~ Absorption field on lot \ c,~ ~ Public sewer main ~ Sewer service line WATER SAMPLE RESULTS: ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ~-~ Coliform ~:~ Nitrate '~-~, ~ Other bacteria Date of sample: "'~ -~ 7~"/.--~ ~'- Collected by: <~4t~ B. SEPTIC/HOLDING TANK DATA Date installed ..~;,.~!~ ~...-~.. Tank size ~c~cx~ ~._w,~-~ Compartments Cleanouts~)~ "7/' Foundation cleanout(~N) ~ Depression ('~ High wate~i' alarm (y~i;~ ~ . ~,' Alarm tested (Y/N) ~/~ Date of pumping ~'~-~o --~5'~ Pumper .--~_~- . ~o ~.P,~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: To property line Surface water/drainage 72-026 (3/93)* Front On adjacent lots Foundation Absorption field Water main/service line ~,D CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N). High water alarm level Meets MOA electrical codes ~ SEPARAT~J*~'~CE FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer Manhole~ ~ "Pump on" level at ~ "Pump off" Level at ~ Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed ~o -'Te, Soil rating (GPD/FF) Length ~ o t Width ~ * ~ Gravel thickness Total absorption area .~c~ ~' Cleanout present(~/N) Date of adequacy test "5 -~ - ~1~ Result~ail) Water level in absorption field before test'~'"~ Peroxide treatment (past 12 months) (Y~[~ System type B ~ Total depth / / Depression over field (Y~ for ~ Bedrooms After test ~/~J( ~z~ ~.~ ~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~.O '~ To building foundation _~'2.- / On adjacent lots ~'~ ~+~ Surface water /~(~ ~ 'P Curtain drain 'J ~ On adjacent lots \ ~ ~'~ Property line ~ To existing or abandoned system on lot ~-[ IA Cutbank ~l~ Water main/service line 1 ~ ~' Driveway, parking/vehicle storage area ~o ~ Jc E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guideline~this inspection. Signature .... · '~:.!~ ,... HAA Fee $ ~L~) ' ~J~ Waiver Fee $ Date of Payment .~ ~ / ~ ~'~- Date of Payment Receipt Number ~ 7~ (~-/,~-~/~ 1 Receipt Number / 72-026 (3/93)* Back 05/30?95 15:39 COMMERCIAL TESTING ~ 90?6941211 N0.094 P02 cT&E Ref,~ Matrix Client 8ampls ID CT&E Environmental Services Inc. Laboratory Diviaion ....... 2-i'~ 1- Laboratory Analysis Report WATER Lll EKL~TNA HTS Client Nam~ ~ & ~ E~GINEERZNG WORK Order 134~5 Ordered By RAY SHAFER Printed D&te 03/30/95 · 1~t40 hrs. Project Naive Co~e¢=e~ D~te 03/27/95 ~ 11:45 hr,. Project~ Received Da~e 03/;8/95 ~ 08:45 hrs. PWSID UA Technical Directo~ STEPHEN C, EPE Sample Re~mrk~: ROUTINE SAMPLE COLLECTED BY: RAY. QC Allowable ~xt. A~al parameter R~s~lt~ Q~al uD~tc Method Limits Date Date Init ~lt. rate-N 3.20 ~%~/b EPA 353.2 10. 03/29/95 CMR * $~e Special In~/..r~ctione Above UA - Unavailable ~ See SaJ/~ple Remarks Above NA - ~o~ Analyzed ~; = Und. b~C~d, R~por~ed' va~ue i~ the praot&cal ~ant~ficatio,] limit. LT = Le~s Than ~' = Secondary dilution. GT = Greater 200 ~. Po~e~ Odve. A.ch~a~e. AK 99~ 8-1805 -- Teh (907) 562-2343 ~a~: (907) ~51.5301 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA. ILLINOIS, MARYLAND. MICHIGAN, MISSOURI, NEW JERSEY. OHIO. WEST VIRGINIA 15:39 COMMERCIAL TESTING ~ 9076941~11 · . CHEMICAL & GEOLOGICAL &ORATORY ~ DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. Drinking Wate[ Analysis Report for Total'Coliform Bacteria PRIVATE WATER sYSTeM N0,094 TO BE COMPLETED BY LABORATORY Mo. Day Year Analysis shows this Water 8AMP,LE to be; SAMPLE TYPE: Routine Check Sample (for routine sample with lab ref. no. Special Purpose READ INSTRUCTIONS S,~MPLE No. ·LOCATION BEFORE COLLECTING SAMPLE Treated Water Untreated Water 2 3 4 T~me Collected By I 1 ~"'S atist aCiD "Y [] Unsatisfactory Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results_ Please send new Sam,ole via special delivery mail. Date Reeeivea ~?~,/~ Time Received ~ Analytic. el Method: Membrane Filter · No, of colonies/lO0 mi. Lab Ret No. Result* ,,l Analyst Coliform/lO0 mi Fecal Cetifei'm C~nfirmatien , Fi~t,I Membrane Filter Results TNTC = Too Numerous To Count OB = Other Bacteria D03 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 Parcel I.D. # ~) ~l ~&, ~ ~-~' HAA # ,.'~L~,_¢-¢ C~,// 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, sectionl township, range) Location (address or directions) N/J' (b) Property owner k!' d, b, '~ Mailing Address (,,¢ C~' (c) Lending Institution Telephone: (home) Telephone · Business Mailing Address (d) Real Estate Company and Agent 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 & S ENGINEERING 17034 Ea~_le River Loep Read No. 2G4~ Eagle River, Alaska ~577 2. TYPE OF RESIDENCE Single-Family~'v 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. SEWAGE DISPOSAL On-site J~ 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 (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 end 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 s & s ~.NGiNF. F-~,;~'4G Telephone ~ ~'~ ~-"~ ~ Address 17034 Eagle River Loop Roa~ No. 2~ Eagle ~iver, Al.,k~ 225~ Date ~/~,~ ~ Approved for _~ bedrooms Approved Disapproved Conditional Terms of Conditional Approval Date' / -/ 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 om issions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 A. WELL DATA Well ClaSsification u~y MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) , ,CHECKLIST- FEBRUARY 1984 0;~ ^, ,:C,I ,.~ :,,.,,~r. 343-4744 ~.NVTT~oNM~N~AL SE~V~CE~ DiVISl~ Legal Description: ~-~'1'" /I Well Log Present ~.~).~ y Date Cop:~p/eted Total Depth~o .~r' "'Cased to ! ~'~'~Depth of Grou~tJ.qg ' Static Water Level ! ! 'Z-- ' ~ Pump Set At "'- I ~ Casing Height Above Ground / ~ ff'p ,..-~"~-_~anitary Seal on Casing([~:;/N) Electrical Wiring in Conduit~:~/N) ~ Depression Around Wellhead (Y<Z3~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot "~ ~O ; On Adjoining Lots To Nearest Edge of Absorption Field on.Lot / 05' ' ~ ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot 'Z~ ~ + Water Sample Collected by ~,~lp ~ ~::::::~/~E:~,"/~-I~)~ ;Date 7-~ Water Sample Test Results ~,¢5"/'75~~ ---- ~/~__.~z Comments ¥- [,,~,~31/lCr'Z~ ~--'~-~-'~ ,~l'k---~O, . D.E.C. Approved (Y/N) ~ ,~ Yield ~ 4J:::)~ ~ ! B. SEPTIC/HOLIDI~_~ TANK DAT.~' Date Installe~1~ /J/7~ Size. Standpipesd~/N) '/ Air-tight Caps ~'N) Depression over Tank (Y/<~) No, of Compartments Pumping/Maintenance Contact on File (Y/N) / Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SE~LDING TANK: To Water-Supply Well ~c~/// To Building Foundation' Foundation Cleanout ~N) y f4//~ate Last Pumped '7- ~ ~'~' ; for Temporary Holding Tank Permit (Y/N) T° Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments To Disposal Field 72-026 (Rev, 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~/.o / Width of Field {~//~//? ~-' Length of Field z:~ / ~ Depth of Field // I Bed Thickness 'l~ / Square Feet of Absortion Area ~,'~o '~ G,~e Statndpipes Present (~'N) Depression over Field (Y~[~ ~-~ Date of Last Adequacy Test Results of Last Adequacy Test '.~,~'!~_~..~ ,~'~ ~ 2-- SEPARATION DISTANCE FROM ABSORPTION~LD: To Water-Supply Well / '~'~ To Building Foundationl ~'Z~ ~-' To Property Line ~,~ To Existing or Abandoned System on Lot ~/'~ ~ ; On Adjoining Lots/ ~'~/'~ To Water Main/Service Line /o ~1- To Cutback (if~Present) To Stream, Pond, Lake, or Major Drainage Course / c~ ~ To Driveway, Parking Area, or Vehicle Storage Area ~,1~ ~ ~ Comments Date Installed Dimensions Size ir~.~o n s "Pump On"~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments 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 guidelines in effect inspection. Signed $ & $ ENGINEERING 17034 Eagle Klear Company ~..~. m,,~r. Alaska 99577 MOA No. ~/' ~ Receipt No. C~' Date of Payment Amount: $ 72-026 (Raw 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 act (;Lr'~t~_e date of, ,tl~js CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX iD # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order ~ 15206 Pate Report Printed: JUL 27 89 @ 13:39 Client Sample ID:Lll EKLUTNA HGTS PWSID :UA Collected JUL 24 89 @ 18:30 hrs. Received JUL 25 89 @ 16:00 hrs, Preserved with :AS REQUIRED Client Name : $ & S ENGR Client Acer : SNSENGP ?.0.~ NONE Req # Ordered By : Analysis Completed :JUL 26 89 Send Reports to: Laboratory Supe~v~q~:.STEPHENC~~ EDE 1)S & S ENGR Released By Special Inetruct: Chemlab Re£ $: 6564 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result/Units Method Limits NITRATE-N 2.5 ms/1 EPA 353.2 Sample ROUTINE SAMPLE Remarks: 1 Tests Performed ' See Special Instructions Above UA~Unavallable ND- None Detected ** See Sample ~emarks Above NA~ Not Analyzed LT-Less Than, GT-Graatez Than CHEMICAL & GEOLOGICAL LABORATORIES OF TELEPHONE (907) 562-2343 .5633 B Street ~! , Anchorage, Alaska Drinking Water Analysis Report for TOtal Coliforn TO BE COMPLETED BY'WATER SUPPLIER ~:~PRIVATE WATER SYSTEM Name Phone No. S & S ENGINEERING Mailing Add[~,~{lle River, Alaska City SAMPLE DATE: TO BE Analysi ~ Sati~ State Zip Code } Year Time rr Analyti SAMPLE TYPE: ~ Routine ~' [] Check Sample (for routine sample with lab ref. no. [] Special Purpose 95181LASKA' INC. ~ ,i~ Bacteria :OMPLETED BY LABORATORY shows this Water SAMPLE to be: ,factory ) [] Treated Water [] Untreated Water [] Uns;tisfactory [] SamJ31e too long in transit; sample should not ~).e. ever 30 hours old at examination to indicate reliable results. Please send new!sample via special delivery mail. ,ceived 2- :al Method: Membrane Filter * No; if colonies/100 mi. SAMPLE . Time Collected NO. , LOCATION Collected By 31 41 Lab R~f. No. I Result* Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count Collform/100ml BEFORE COLLECTING SAMPLE Verification: LTB Final Membra ne Fil~le/~ll: t,, '~ BOB. i Collform/lOOml Time: / ~)"~ a.m. : p.m. TNTC = Too Numberous To Count OB = Other Bacteria PART O.~' or TWO unicipality of Anchorage Department of Health and Human SerViCes Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 August 14, 1989 Robert A Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 11 Eklutna Heights Subdivision Waiver Request 9WR890043, ~HA89-311, PID ~051-063-28 Dear Mr. Shafer: Your request for waiver of the required 100 foot separation of a septic system to a private well has been approved. The approved separation distance is 80 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Si~erely; ~ Robert W. Robinson Civil Engineer On-site Services RWR/ljw ~6 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION RECEIVED ROBERT SHAFER, P.E. ROGER SHAFER August 8, 1989 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN Muni~pality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519~6650 REFERENCE: Lot 11; Eklutna Heights Request you ~sue the attached Health Authority Approval and grant a waiver for the horizontal separation distance b~tween the private well and septic tank located on the referenced property at a distance of 80 ft. The septic system was installed and inspected in October of 1978, with the lesser separation distance noted. An approval of the water and sewer facilities was issued on November 16, 1978 by the Municipality of Anchorage (MOA). The septic tank was excavated at this time and water tight couplings installed. The topography of the area is generally flat. Area well logs show various layers of soil with a "silty hard pan" from 100 ft. to 128 ft. on the well log for Lo~ 11. A risk analysis has been performed and it appears that no bacterialogical pollution is possible from this source. Attached for your review are the following documents: A. A plot plan showing relative distances betweeen wells and septics. B. Risk analysis waiver review worksheet. C. A flow test report for the referenced well. D. Well logs for the referenced and neighboring wells. E. Coliform and nitrate analysis of water taken from the well located on the referenced property. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Page Two Lot 11; Eklutna H~ights August 8, 1989 It is our opinion that the horizontal separation distance prescribed by 18AAC72.021 is not required in this case. If you ~uire)additional information for your review, please contact us. / ,, SCALE I SCALE t ~ASEMENTS OF RECORD, OTHER THAN T~OSE SIIOWN ON TH] ~ECORDED PLAT ARE NOT SHOWN I{EREON. ~he!information hereon is for the use of lending .nstitUtionS showing the relationship of existing ;trUctures and Platted easements and lot lines. ~t is~'not'.to be used for positioning additional ~truct~u~.es, or fen¢elines. ~RAWN: DMS I ~ DATE: 5-25-89 :~ALE: 1"=20' FB: 8-04 ' -- ~ NWl460 I herebyi certify that I have performed a Mortagee'e b~-!: ~pection of the lollowi~g described property: Eklut.~a ,Heights Subd., Lotll' __: Anchorage Recording Precinct, Alaska, and that the improve- merits situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent there- to, that no improvement~ on prol:~rty lying adjacent thereto encroach on the prernkses in question and that ther~ are no roadways, tra.nsmission lines or other visible easemeat:~ on ~aid property except -. lndicalzd hereom Dated at Anchorage, Alaska this 25 __._day of May __ lO 89 , _ 688-4566 S['_'NA}U) & ASSOCIATES LAND SURVEYING 17034 Eagle River Loop Road Eagle River, Alaska 99577 PROJECT LOCATION OF WELL {Legal Description): ~' WELL DEPTH:_ '"'~:;>~C' FT. CASING: \~ DATE DRILLING COMPLETED:_ {Y~ --'~Z"t'~O ' ~ ~ ROBERT A. SHAFER CIVIL ENGINEER 694-2979 FT. SCREEN: STATIC WATER LEVEL (top of Casing): ___~_ _~-~_~ FT. DATE: _ .~ ~ ~ ...~.~.~,c~ ELAPSED TIME SINCE DEPTH TO DRAWDOWNI PUMPING CLOCK PUMPING STARTED/ WATER, FT. RECOVERY RATE, GPM REMARKS lIME STOPPED, MIN. , ' ,' ~::~ 0 Start . ~. f> ~o \[2.- (sw,) o 5 ~ ~"- ~' ~,~ ~~ ' 45 1 r 50 55 60 (1 hour) ----- 120 (2hou rs) ~ 150 ~-- ~ 210180 (3 h°urs) / -'] ~/ _~' '~'~ -------- 240 (4 hours) ~~~ RECOVERY (/~, 15 20 25 30 35 Flow is not Guaranteed ~bsoquont Variations Can Occur. Depth in feet frmu 2 [' £°o ,,TO 85 95 ,,t2,,~ (_minute) fm'~ WJ,h Olw det~l_~ of forndt!~m~-~ penetrated, size e~ nmterl~ ~ .~n Lc~ ! Sandy C~avel~7 hard Sandy ~ravel Silty cobbles lOl~ tlL~ 3 - CONT/U~GTOR MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ¥~(,,~_:~ -- f' ~[ ~,~ / DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) Application Date September 8, 1986 LegaiDescription(includeiot, block, subdivision, section, township, range) Lot 11 Eklutna Heixhts Stewart Edition T15N tlW Sec.~ Location(addressordirections) Anchorage" (b) AppticantName Chris Kilday Telephone:Home ~J37- Business 265-8767 Applicant Address 4840 E 43rd Apt' d-1 Anchorage; Alaska 99~08 (c) Applicant is (check one): Lending Institution []; O,,wner/builder []; Buyer []; Other [] (explain); (d) Lending lnstitution 1st Interstate of Alaska Telephone 276-7200 Address Pou. ch 70~ 2 Anchorage ~ Alaska 99510 (e) Real Estate Company and Agent N/A Address N/A (f) Telephone N/A Mail the HAA to the following address: p-i~k~? by ang-ineer TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms ~ 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 PROVIDIN~ INSPECTIONS, 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 tills He41th 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 dompliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. * With apProval of well to septic tank separation of 80' Name of Firm Address Date FA6LE R!VER ENG!NEER!NG SERVICES EA6LE RIVER, AK 99577 P, O, BOX 773294 694-5195 Telephone DHEP APPROVAL Approved for "/'¢'"'~--~- bedrooms by Approved Disapproved Conditional Terms of Conditional Approval Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) ANCHOI~G~HECKLISTc ' FEBRUARY 1984 NUJNICIPALITY 264-4720 DEPT. OF HEALTH & Sm - RE CEIV.ED Well Classification Legal Description: Well Log Present (Y/N) ~' Total Depth ~, o ~ / Cased to ,/*~; Static Water Level [ O 7 ~ Casing Height Above Ground 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 Cleanout/Manhole ,V./~- Water Sample Collected by ~J Water Sample Test Results ~ ~ ~' '~'~-'~'~' Comments '~CuC// -- 7-~ ~,~ ,~..~,v'e~,,- ...~-~-J If A, B. C. D.E.C. Approved (Y/N) Date Completed ~/.~, ~,/7~ Yield Depth of Grouting A,//',,c Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ~'/O~D ~ /,~o ~ ; On Adjoining Lots ¢-/o ,~" To Nearest Public Sewer To Nearest Sewer Service Line on Lot ;Date ~/.~7--/,~ ~' SEPTIC/HOLDING TANK DATA Date Installed /'~ ~'''~ Size /,~..~ ~ L No. of Compartments Standpipes (Y/N) ~ Air-tight Caps (Y/N) .,Y Foundation Cleanout (Y/N) Depression over Tank (Y/N) "~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ~//'~ ; for ~"~ Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: Temporary Holding Tank Permit (Y/N). ,~x~ To Water-Supply Well ~'~ To Property Line /~ / To Water Main/Service Line Course ~'/~ / '/-/O" To Building Foundation / I To Disposal Field ~ CZ ¢ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata '~-~-~ ~'~'~ Date Installed Width of Field z./~" Square ~-eet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test ~ f~c ~--~/~,~, 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 7-~¢,~,c Length of Field /-~"~ Depth of Field // Gravel Bed Thickness Standpipes Pr~esent (Y/N) Date of Last Adequacy Test To Property Line ~:' To Existing or Abandoned System on ; On Adjoining Lots ~'o · To Cutbank (if present) LIFT STATION ~//~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions __ Manhole/Access (YIN ~"~'~'/~ - "Pump Off" Level Vent (Y/N) Pumping Cy( ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelir Signed J.~~ Date ~///'"~ / ~6 Company ~'~'~ ~, _F, MOA No. '-~" ~-'""~- ~*,~ Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) ~ DEPARTMENT OF HEAL'TH & ENVIRONMENTAL PROI~;/,~/jR · LTH ~ 825 L Street-At,chorage, A,aska 99501 ONMENTAL PROTECLTi~(~-~ IJ-,,~-')~,~, DIR[CTION8: Oomplete ail parts on page 1. Incomplete reques~ will not be processed. Please allow ton (10) days for processing. ~a~te~ ~. ~a~ka L 69~-3493 MAILING ADDRESS ~ost O~&ae ~o~ 2Z~ 99577 2, BUYER PHONE Chris Kilday MAll.lNG ADDRESS ...................... 3. LENDING INSTITUTION ~ PHONE Alaska Bank of Co~erce 279-5641 MAll_lNG ADDRESS 3230 C Street 99503 4. REAL3'OR/AGENT [ PHONE =oh e=a =rea =ea=or .............. MAILING ADDRESS Post Office Box 249 99577 ~: 'L~GAL ~ESCR,.T,ON Lot 11 Eklutna Heights Subdivision STREET LOCATION 6. TYP~ OF RESIDENCE NUMBER OF BEDROOMS ~ One L-~ Four Lq Other ~ SINGLE FAMILY ~ Two ~ Five [~ MULTIPLE FAMILY $ 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 data, give well ~ PUBLIC UTI LITY depth (a[tach log if available.) "8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** ~*lf individual/on-site, give installation date_ 1~3_8 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. 72~10(3/78) THIS SIDE FOR OFFICIAt. USEONLY f~AI ~ HECEIVED INSPECTION APPOINTMENTS ' ........................... * To '--; ............................. INSPECTOR i rJ~PECI )R INoPECFOR /1, 1YPE OF RESIDENCE NUMBER OF BEDROOMS L ~ SINGLE FAMII.Y ~i~; MULTIPLE FAMILY 2, Nr'JAI'ER SUPPLY INDIVIDUAL COMMUNITY " PUBLIC UTILITY Co,mection Verified 3 :EWAGE DISPOSAL SYSTEM i)INI)IVIDUAL/ON -SITE E:] ()NE [:] THREE [23 FIVE [Lq TWO [~] FOUR ~_1 SIX PERMIT NUMBER DEPTH OF WELL_ I)ATE DRILLED LOG RECEIVED F___.] OTI4ER PERMIT NUMBER DATE INSTALLED UTILITY (%al;J~ection Verified .................... ~'-,~ L. L E F~ .................................... T,mk or [~]]Holding Tank /¢O ........ If Tank is homemade SOILS RATING ANK MANUFACTURER ABSORPHON AREA MATERIAL '5 L;;CWiMENTS APPROVED FOR _.__~__~___ BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) OISAPPROVED ~ d q (l~v. 3/?8) 'REALTORS' REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO 2. Property Owner: Mailing Address: 3. Name of Buyer: VA FHA CONV ~ o Mailing Address: Day Phone Name of Lending Institution: ~//"/,'~-r///? :' >,?~'/~A/ o':/ Mailing Address: C~' ,j~:- :: ,-_~; -//. Phone Name of Realtor or Agent: (:,5,e :// :~J/:~ ., , : ' o o Legal Description: Location: Type of Facility to be inspected: No. Bdrms. - Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served / If Individual, depth of well 9. Sewage Disposal System .Typ6 of System: Public Utility __ If Individual, date of installation: Individual (on-site) · REALTOR® AREA, INC. REALTORS ~l~ Anchorage "C" St. Office 3300 C Street (907) 278-2525 [] East Anchorage [] Eagle River Eastgate Office Parkgate Office 5437 E. Northern Lights P.O. Box 249 (907) 278-2525 (907) 694-9555 ACHEMICAL & eEOLOelGAL LA ORATOI E80 Ai. ASi( INC. P.O. BOX 4-1276 ANCHORAGE, ALASKA 99509 4649 BUSINESS PARK BLVD. Drinking Water Analysis Report for Total Coliform Bacteria TELEPHONE ~(907) 279 ~014 TO BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM: I.D, NO. Public Water System Name Me ng Address' ~:-.; , ~.~ ~ ' ~,': ' ~ ] ~ ¢ ' -~ City ./ Stale Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no [] Special Purpose Zip Code [] Treated Water E] Untreated Water SAMPLE NO. 1 2 5 LOCATION Time Collected Collected By -. TO BE COMPLETED BY LABORATORY LABORATORY: NAME ADDRESS [ CITY Date Received Time Received Analytical Method: [] Fermentation Tube fl~ Membrane Filter Lab Ref. No. Result* Anal~yst READ INSTRUCTIONS · BEFORE COLLECTING SAMPLE Form No. 18-310 (3-78) 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected Source Lab. NO. Presumptive 1Omi 10mi 1Omi 1Omi 1Omi 1.0mi 0.1mi 48 Hours Confirmatory 24 Hours 48 Hours EMB Broth 24 hours: Multiple Tube Report: Membrane Filter: Direct Count Verification: LTB ReportedFinal MembraneBy Fll~~ Broth 48 hours: ]Omi Tubes Positive/Total 10mi Portions Date / unicipaHty Anchorage P.O. BOX 6650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES September 19, 1986 Lou Butera, P.E. Eagle River Engineering Services P.O. Box 773294 Eagle River, Alaska 99577 Subject: Lot 11Eklutna Heights, Stewart Addition Waiver Request, WR86-139 Dear Mr. Butera: Your request for a waiver of the 100 foot separation required between the septic tank and well on"the subject lot has been granted. This distance has been waived to 80 feet. This waiver is valid for the existing three bedroom single family dwelling only. Sincerely, Morris Civil Engineer On-site Services SSM/Jw EAGLE RIVER ENGINEERING SERVICES Lou Butera P.E. P.O. Box 773294 Eagle River, Alaska 99577 Telephone (907) 694-5195 September 12, 1986 Mr. Steve Morris Civil Engineer, On-site Services Municipality of Anchorage P.O. Box 196660 Anchorage, AK 99619 REF: Lot 1! Eklutna Heights, Stewart Edition Dear Mr. Morris: On behalf of my client, Chris Kilday, I am submitting the information necessary for your determination of a waiver of separation distance, well to septic tank, to 80' for the above referenced lot. The septic system absorbtion rate has been tested and found adequate for a $ bedroom use. The leachfield was installed in 1978 by Kurka Alaska Builders and was inspected by Earl Ellis and approved by the Municipality at that time as per the inspection report enclosed. The request for approval shows the well to septic tank distance as ,.~ 80' Our field measurements confirm the tank inlet to be at 80' from the well. The enclosed well log shows that the well draws from a ~ bedrock confined aquifer at a depth of 136-204'. The casing is ~entinuous to 136.6' where it is seated into bedrock. The surface · topography is level from the well location toward the septic tank with ~the house located directly between the two. The subsurface soil is a ~M type with a perc. rating of 255. A water sample for coliform ~acteria was satisfactory. This area, due to small lot size, has a number of wells that contain waivers of separation distance. It is expected that since the installation was inspected by an engineer, the connections to the tank are as required in 1978. If there are any questions or if additional information is required, please feel free to contact me at 694-5195. Sincerely, Lou Butera, P.E. Encl: HAA application soil log inspection report ! ! ! I ! I ! ! ! ! ! E;KLUTNA HEIGHTS SUBDI~¢9510N "~ ' ' ~.H.$TE;WA~T I~}$P. Al)BI'IlION ~1~ I,£~:O001,LCl EKI .UTNA. HEIGHTS S U P P L E- ME, FtTAL PLAT AT MILE ~3 GL~ HIGHWAY WITHI~ THE S~ RE{SW~ 5EC-3 ALL I~ T-I~_~,E ~W, 8-M ALA3KA $C,~LE ~ 1% 100' ~KLUTN~ MEIGHTS SUPPLE M~TAL PL&T ANCHO~OE P[[CIH~ ~ e DTI000273