The URL can be used to link to this page

Home My WebLink AboutEKLUTNA HGTS STEWART ADDN LT 21Onsite File #051-063-38 Prior to COSA approval, well needs “cap, conduit & casing extension” per well inspection dated 6/27/19. Date: 6-27-19 P.O. Box 670269 Chugiak, AK 99567 P: (907) 688-2759 F: (907) 688-2259 TO: Mark Sliker 23627 Dolly Ave Chugiak, AK 99567 Camera Inspection Report Total Depth: 228’ Static: 123’ Casing: 132’ Needs cap, conduit and casing extension. Do not see any leaks or failures in existing casing. Onsite File � s � G-747",_ Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 �g ON-SITE WASTEWATER INSPECTION REPORT NO 1'5 2 Permit Number: OSP191354 PID Number: 051-063-38 Dwelling: FN Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New F01 Upgrade Name Mark and Julie Sliker ABZORPTION FIELD ❑ De Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 23627 Dolly Ave Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 RD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe Ft. Subdivision Block Lot Eklutna Heights Stewart Addition 21 Fill added above original grade Ft. G el length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distabetween lines Ft. SEPARATION DISTANCES Tol Septic Absorption Lift Station I Holding Sewer Total absorption area Number of trenches Dist. between nches From Tank Field Tank Line Ftz t Well >100' NA NA NA NA TANK ❑® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1000 Gal. Surface Water >100' NA NA f I NA Material Number of compartments Lot Line >10' NA I NA NA NA plastic 2 Foundation g' ( NA NA NA Li STATION Manufacturer Capacity Remarks Gal. Alarm location Electri Iled by PIPE MATERIAL House to tank D3034 dD3034 Installer Curt Whitters Excavating rainfieldTankto Drainfield Co/MTD3034 Inspector Curtis Townsend, PE BENCH MARK (Assumed elevation) 100 ft Inspdection 1s` 9/17/19 9/18119 Location and description 2M back door threshold 3'd 9/21/19 41h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date �co,�Q-,••'' Aft ..... .............. ® esee ....LY ..... �F�'sr% No. t 1 Septic System 44 Approved �yCt Date1 5 Cy / As o • • .... A`�� kikPROFESSWN o. Note: this approval does not include well permit requirements. (Rev uoiuzi i8) MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Etmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 htip://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP191354 Work Type: SepticTank Upgrade Tax Code Number: 05106338000 Site Legal Address: EKLUTNA HGTS STEWART ADDN LT 21 G:1460 Site Mailing Address: 23627 DOLLY AVE, Chugiak Owner: SLIKER MARK & JULIE Design Engineer: EKLUTNA ENGINEERING, LLC" This permit is for the construction of: ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy Effective Hate Expiration Date: Lot Size in Sq Ft: Total Bedrooms: llepartment 8/14/2019 8/13/2020 13370 ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received BN Issued By: Date: /'Ci/o Date: 3 Municipality of Anchorage_ P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 m (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section I. .Pia 1'r [lie l I r x x x x VARIANCE/WAIVER REVIEW x x x x Waiver#: OSV191071 COSA#: Permit#:OSP191354 PID#: 051-063-38 Legal Description: Eklutna Hqts Stewart Addn Lot 21 Engineer: Eklutna Engineering, LLC Applicant: Mark & Julie Sliker Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 0.0 feet. See engineer's waiver request for justifications. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ■ a ■ ■ ■ ■ ■ ■ ■ ■ ■ a ■ a ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ a ■ a ■ ■ a ■ ■ ■ ■ ■ ■ ■ ■ a ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ a ■ a ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ 1 Waiver is Granted: X Waiver is not Granted. Date: a � I 1 1 Approved by: � L ` �L (-�Iz7txc,/ Name of Reviewer ■■ a a a a a a a t a t a a a a a a t a a t o a a t a a a a a a a t a a a a a t a a a a a a a a a t a a a a a a t a a a a a a a t a a a a a a a a a a t a a l **** V YH MI6 N C EMO \IVE R REVIEW **** ERANS MUNICIPALITY OF ANCHORAGE Development Services Department ` , Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-063-38-000 Property owner(s) SLIKER MARK & JULIE Mailing address 23627 Dolly Ave Chugiak AK 99567 Site address same Day phone Z a L4y Legal description (Sub'd., Block & Lot) EKLUTNA HGTS STEWART ADDN LT 21 Legal description (Township, Range & Section) Lot Size 13,370 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ED (w/wo ADU) Septic Tank M Upgrade FX_1 Duplex Duplex {0) ❑ Holding Tank ❑ Renewal El Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water.Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: field to lot line Distance: 1 certify that tI)e above information is correct. I further certify that this is` in accordance with applicable Mulbicipal Codes. tl J property owner or authorized ag Permit/Rush Fees: g a5- Waiver Fees: oZ oLJ� Date of Payment: MA Date of Payment: /a 11q Receipt Number: D3�fuS"b Receipt Number: Permit No.S p��l� `�� Waiver No. OS V 19 IU?/ GADevelopment ServiceslBuilding Safetylon Site Water and WastewatefformsUient FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191354, Rebecca Carroll, 08/14/19 NEIGHBORING SEPTIC NEIGHBORING WELL IS IS APPROXIMATELY > 100' FROM 10' FROM PROPERTY PROPERTY LINE LINE v G. EENHOU'E Sc I EXISTING 70' x 7' EFFECTIVE DEPTH TRENCH NEIGHBORING SEPTIC SHED IS APPROXIMATELY 20' FROM PROPERTY LINE THERE ARE NO STEEP SL WITHIN 50' OF THE PROPi TANK. S 100' 100' DOLLY AVE NEIGHBORING WELL IS LOT 20 • > 100' FROM PROPERTY LINE E 35' SUMP FCO 3 BEDROOM HOME a L0 -;5"-1 INSTALL DOUBLE CLEANOUTS `— REMOVE EXISTING x 1000 GAL TANK 3 NEW 1000 GAL SEPTIC TANK :,i i, ;-r U I` J Q X Cry s ? t � I i I Z w V) C) Q = >: I � I t 1( I ` tft t } I DECK f I PAVED DRIVEWAY j f I t ti Ar, _ 1 j` SCOPE OF WORK ! 1. REMOVE EXISTING SEPTIC TANK. ! 2. PLACE NEW 1,000 GALLON PLASTIC SEPTIC TANK AND TIE [_ INTO EXISTING ABSORPTION SYSTEM. THE TANK IS TO BE PROVIDED WITH MINIMUM 20" 4 MANWAY RISER SERVING THE FIRST COMPARTMENT. 3. ALL CONSTRUCTION TO BE IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65. Tank Replacement Design Prepared for MARK AND JULIE SLIKER 23627 Dolly Ave Chugiak, Alaska 99567 EKLUTNA HEIGHTS STEWART ADDITION LOT 21 EKLUTNA ENGINEERING, LLC 19162 MOUNTAIN ROAD CHUGIAK. ALASKA 99567 (907") 355_9820 OSP191354 9/18/2019 CLT SCALE: 1" = 20' PID: 051-063-38 SHEET 1 OF 2 1 DURING CONSTRUCTION, IT WAS DISCOVERED THAT IF THE NEW SEPTIC TANK WAS PLACED 10' AWAY FROM THE FOUNDATION, THEY WOULD IMPACT EXISTING UTILITY LINES. IT IS DESIRED NOT TO HAVE TO MOVE THE UTILITY LINES. THE TANK WILL BE PLACED 8' AWAY FROM THE FOUNDATION. THE TANK WILL STILL BE ABOVE THE FOUNDATION SOIL PRISM. THE ELEVATION OF THE FOUNDATION CLEAN OUT HAS BEEN CONFIRMED. THE BOTTOM OF FOOTING IS NOT KNOWN. THE BOTTOM OF FOOTING HAS BEEN DRAWN AT THE MOST SHALLOW POSSIBLE LOCATION TO SHOW THAT THE TANK WILL NOT INTERSECT THE SOIL PRISM. Tank Replacement Design Prepared for MARK AND JULIE SLIKER 23627 Dolly Ave Chugiak, Alaska 99567 EKLUTNA HEIGHTS STEWART ADDITION LOT 21 EKLUTNA ENGINEERING, LLC 19162 MOUNTAIN ROAD CHUGIAK, ALASKA 99567 1`907) 355-9820 DRAWN: 0SP191354 9/18/2019 CLT SCALE: 1" = 5' PID: 051-063-38 SHEET 2 OF 2 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 LEGAL DESCRIPTION IPHONE [] NEW LOCATION _~- I DISTANCE TO'. , ~PO ~- Xbso~_.t~)onar~ie?L Dwellings_. ~ ~ Manufaotur~¢ ~' lLq.~apa~ty nga onsl Insidelength Wdth ~ I /~ O O I IF HOMEMADE: 9. ~~,~. ~o: i~'' ~ ~ ~ ] Top of tile to finish grade ~ ~ ~ Length Width ~ ~ ~ Type of crib Cri~ete~ r ~1- I ~ -- Bu I m foundauon .- ~ ~' DISTANCE TO: ~d g Dwelling ,J NO. OF BE~pMS PERMIT NO. Liquid depth PER.~ capacity in gallons PERMIT NO. Distance between lines inches Ma~J.~be~ inches Depth ~ PERMIT NO. Crib depth Total effective~ area Building foundation Nearest lot line ~ Driller Distance to lot line Sewer line Septic tank Total effective absorption area OTHER PIPE MATERIALS REMARKS PERMIT ~ Absorption area(s) PERMIT NO. I'~LII'-JZI.~-ZPFILZT'~' ~1:' I::lr-JC'-I-,-iORl::lGE DEPARTMENT O,~,HEALTH AND ENVIRONMENTAL ~-~tTECTION 825 "L STREET, 8NCHORAGE~ 2~4-4720 OIl--SITE SEIaER LIPGRI::IDE PEAr.1 IT APPL I ~.aNT LOCRT I ON LEGAL INGE NELSON ,.'~ STAR ROUTE BOX t96X 99o,'~ ~49-5~54 OBERG ROAD :~'~:~~:~8~'~::;,:~ LOT SIZE 1'~OO SOLIARE FEET TYPE OF _-,till ABSORPTION:.'-"c.'~'-~'r_.~r, IS: TRENCH MAXIMUM NUMBER Of BEDROOH_ =~ ~' SOIL RATING ,..=,Q FT/BR)= 26? THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH---- 10 LE~'JGTH= G9 GRL::IVEL [:~EPT: |~ ? THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE 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 OUTFALL PIPE AND THE BOTTOM OF THE E~CAVATION (IN FEET). REI_-~I_! I RED SEPT I L--: 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. tl.-~] ( 2 ) I I'-JSPECT IONS L::IRE REQIJ I BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN fi WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL OR i50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM fl PRIVATE WELL TO a PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILablE TO INSURE PROPER INSTALLATION. PERr~I I t E~-~P I RES DECEF~iIBER _~i .. ,1 _c~80 I CERTIFY THAT t: I tim 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 THE CODES. ~ I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. =, I GNED: flPPL I CANT ISSUED BY __DATE--] ~=-.~=-~") --- V4. 0 INGE NELSON 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 ] P_H ON ,,E~ I E~NEW ~ ~UPGRADE LEGAL DESCRIPTION LOCATION / ,~ } -- /' ~ell ~'~ ~/ ' Absorption~ I I DISTANCE TO: ~ ~ ' I " ILiq...capaclty in gallons I; HOMEMADE: Inside length D Well Dwelling Material~ W dth NO, OF BEDROOMS~ PERMIT NO. No. of compartments Liquid depth PERMIT NO. Material Liquid capacity in gallons DISTANCE TO: WepoO ~ ~ ~ No. of lines f Lengti~.j;zf eac~ Ij ne ~ li.~s · ~0 ~ Top of tile ~, Length Width Type of crib DISTANCE TO: Well Class DISTANCE TO: h widt~ _ inches inches PERMIT NO. Total effective absorption area Building foundation Nearest lot line Distance to lot line PERMIT NO. Driller Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATINP INSTALLEI REMARKS DATE LEGAL LOT SIZE I"~..~00 SC!URRE FEET ~:..::IMUM NUHE:ER OF E:EC, RL]OIdS = 3 SCIIL RRTIr. IG "S'2 FT,"BR)= '~.,.Io7 ~E REOIJIRED SIZE OF THE SOIL....RE:SI}RF'TION S"r'STEId IS: ,EF'Tt-I=: I0 LEI"-.I'3'T'FI .... (09 b-'iiF:Ft'"E[--'. . [:'EF'-FH .... / THE L_ENISTH DIMENSION IS THE L. ENGTt4 <IN FEET) OF THE TRENCH OR DRRIHFIELC'. I'HE £:'EPII4 OF R TRENCH OR PIT IS THE DIS;'RNCE BETWEEH THE SLIRFRCE OF THE GRE,JrlD RND THE BOTTOM OF THE E>;:CRVRTION <IN FEET::,. THERE IS rio SET HIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXC:RVRTION (IN FEET). :E,;:!I_I I F.: [:-.-: [-':' _:CEF'T I C: TRr-.II<: S I SE= /Ol~)O L-iRt_. 1_ ,'2,1'-1:~-: ]~:t'llT RF'PLICFtNT HR_S-, 'THE RESPONSIBILITY TO Ir,IFOF.:M THIS DEPRRTMENT DI..Ifi'INI] tHE ~STRLI. RI'IOr~ INSF'EI]:TIOr~S OF Rt-l'-,' WELLS R[:,JFtCENT TO THIS PF:EPERTY fiN[> THE .IMP.,ER CIF RFSI[~ENCES THRT THE WELL HILL SERVE. -f'l..IC~ ,.'. 2 ) I I'.ISPF_'E:T I CIl'-4:5 FiI~:E-] I;:E6:!LI I i~:Er.:, ¢].KFILLING OF RNY ._,'r",IEM HITHOLIT FINRL INSPEC:TIOrl Bt-i[:, RPPRF~%.'RL E:Y THIS ~F'RRTMENT WILL BE S_E.fECT TCI F'ROSECUTION. 'rIIMUM DISTBNCE BETWEEN R WELL RHD ANY ON-SITE SEI,IRGE [:,ISPOSRL ?'r'S?'EM IS ~0 FEEr F'OF: R F'RI',/BTE HEt_L OR 15(, TO 2E~O FEET FROM R PUE:LIC HELL DEF'EII[',IHG :'OH [HE TYF'E OF PUBLIC: WELL. HIMI_IM [:,ISTRNCE FROM R F'RI'v'RTE HELL TO A PRI',/RTE SEHER LINE IS 25 FEET ~ R COIdMLIf'IITY SEHER LINE IS 75 FEET. :LL LCIGS ARE REQUIRE[:, RND MUST E:E RETURNED TO THE [:,EF'RRTt'IENT I,I[-FHIN 3:0 file PlELL COMPLETION. 'HEP F:EQI.IIF:EMEN-FS tdRN' RPF'LY. SF'EC:IFICRTIOrIs RN[:' cor4s'TE:I_.tCTIOr4 DIRGF:RMS RF:E .'FtIt_RE:LE 'TO INSI..IRE F'ROF'ER INSTF~LL.~gT ION. C EF:T I FY 7 HF',,T I Rt.1 FH.['.IILIF~R WITtt THE REC!UIREI'IENTS FOR OH-SITE SEHEPS RN[:, HELLS ~S SE.F IF'TH. E':,Y THE' l,lLIr41 F: I F'flL I T'¢_ ElF_ FIr~F H!-IF'FflI3E_ _ [ PII[_.L. Ii"lS~rft!.-L THE :,~_-,~c.~ IN F~'_':CI-3E'C'FINCE I,IITH THE I UfIE,EF'SI'RrJ[:, ~'H~Tr THE ON-SITE SEI.JER S'F%TEP1 r.lnY R[D}I_IIRE ENLFIRGE]'IENT !::I[:,Er,IC:E l'_5 REpll}[:,ELEC, TO INC:t_UE:,E MORE TPIfaH '; EEDF::OOMS ]771 .IE [', Er,'. .................... [:,F~TE_. ~ I F THE v4. CI PERFORMED FOR: LEGAL DESCRIPTION: 1 2 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION /-21 MUNICIPALITY OF ANCHORAGE 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SLOPE [] SOILS LOG PERCOLATION TEST SITE PLAN 11 12 13- 144 15- 16- 17- 18- 19- 20- /4ogF Robert No, COMMEN~ (~ / pERFORUED BY: 72-008 (6/79) WAS GROUND WATER WO S ENCOUNTERED? L 0 P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop ,~. ~ ~'~-s-t ~ i~" i~" ¢ ',V~s7 ~'~ ,, 1,~ " PERCOLATION RATE ~D (minutes/inch) TEST RUN BETWEEN ~ FT AND ~'? FT .-?' / CE' RTIFIED ?/'- / fl") ~A',.-HD-,. G~:""~ER ANCHORAGE AREA BOROI:'"~ DEr~RTMENT OF ENVIRONMENTAL OUALI'!~' 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME J~r~M'Z~ Lj SEPTIC TANK': MAll_lNG ADDRESS. ,PHONE LIQUID CAPACITY .... GALLONS. MATERIAL ~.~'T E C INSIDE LENGTH NUMBER OF r~ COMPARTMENTS J,! J--- JlJ: I/,~65'~' LIQUID INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS J OUTSIDE DIAMETER OR WIDTH I~yj' / LINING MA,EmAL_~NC~'F / '~-- J2-JN (,:],~ --. DISTANCE FROM WELL 105/ NEARESI [O1 UNE__ IOIAL EFFECTIVE ABSORRIION AREA (WALL AREA) LENGTH I~/ , DEPTH , BUILDING FOUNDATION,'~0),~ .~4 8, SQ. FT. TOTAL LENGTH x_... DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE__ WELL: TYPE J~J'-JI I~ , DISTANCE FROM WATER nl~j.) DEPTH ~ , BUILDING FOUNDATION._ - SAMPLE ~J._L~JJ_(Z~, NEAREST , NEARESTSEPT,C ~'0 SEE.AGE ob' o~ LOT LINE . J~ , SEWER LINE ~ ,TANK , SYSTEM_ J , CESSPOOL ~ SOURCES' " DISTANCES: ,~ ~.,/,: . , .P&~- /,... DATE DIAGRAM OF SYSTEM N ~7///// GreaTEr ANChorage Area BOroUgh ',? SEWAGE DISPOSAL SYSTEM APPLICATION AND PERMIT INSTALLATION LOCATION INSTALLATION OF: SEPTIC TANK SEEPAGE PIT j DRAI - , - HEALTH DEPARTMENT AUTHORI~ WILL BE SUBJECT TO pROSEGUTIO SEPTIC TANK SIZE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE Pit ~L~/ drain FIELD SEPTIC TANK TO SEEPAGE Pit WALL / . DRAIN FIELD SEPTIC TANK TO NEAREST LOT LINE. WELL TO SEPTIC TANK ~ ~J DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN field / ALSO CONSIDER AREA WELLS. SEEPAGE Pit SEPTIC TANK. ~{~/ -, SEEPAGE PIT · ,r-- DRAIN FIELD TO RIVer, LAKE STREAM. C~S.T 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 CAP~. DIAGRAM OF SYSTEM GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM iS iN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE ,~gEATER ANCHQRAGE AREA BOROUGH/"~ HEALTti ~EPAETHENT ,!327 EAGLE STREET ANCHORAGE, ALASKA 99501 CASE Th;s.. ~c-m, o. Reports a: Soils Log. , / .... Pepcoiatzon'· Ie~z~ -- ,,, , ,,. , Depth Feel: 'i 7 £ - Soil Characteristics Was Ground Water Encountered?.,,, ,t,J~5 Yes, At What Depth Location Sketch Reading Da~e GPoss Time Net Time Depth To H20 Net Drop ..~ ~ ' '~ ,~ ., .... . ............ .,, ~','.' ,.~! ~ .;;7; ~ -7.'_ ~ '~: . y' ,,: , .,: :, ez'co~.~zon R~t'e'"'l' '/' A~.n'~{e' ' ...... Frop~sed I~nstallaziO~: Seepage Pit Drain Field Depth'Of Inlet Depth To Bottom Of P~t Or Trench Test Performed B~: ¢~ , Dare Certified By, 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. # (~-~ - (~ln~- ~ HAA # ~ {~o~.~ 1. GENERAL INFORMATION Complete legal description Lot 21; Eklutn~'H~ights~ (Stewart Addition) Location (site address or directions) 23627 Dolly Avenue Eagle River, AK Property owner Mailing address Lending agency Mailing address Agent Address Inez Lowe P.O. Box 771701 Ea~le Riv~r~ Northland Mortgage 11421 Old Glenn Hwy. Day phone 688-1210 AK 99577 Day phone 69~-787f Eagle RiveA~ AK 99577 Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 ~ 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72*025 (Rev, 1/91) Fro~nt MOA#21 J 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 inves.ti_,qation 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 Address 17034 Eagle Riva' Loop Eagle River, Engineer's signature Phone Date DHHS SIGNATURE Approved for -~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date "'~'he Municipality of A~chorage 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 DH HS 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 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~,c,'r' A. Well Data Well type g)l~.l ~.~-¢--- Log present (V/~). r,~ Total depth Sanitary seal ~/N) Date of test Static water level Well flow Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number Date completed --" \ ~"1 \ Driller Cased to ,,dr~ ~¥ Casing height y Wires properly protected (~) FROM WELL LOG AT INSPECTION ct ~ MuNIC PALI'JY Of: ANCHORAGE /\ ~ ~ ' i:NfiF, O~4;,,'?*-NTAL SERVICES D VISION g.p.m. JAN - 5 1994 g,p,m, RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~) Nitrate Date of sample: \.-~ ._,--~ _c~ '5 z~, ~-~5 Other bacteria Collected by: ~ c.~ B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts {~N) High water alarm (Y/~ Date of pumping Tank size [ o oz~ Compartments ~ Foundation cleanout (~/N)~J Depressio~(~j~) Alarm tested (Y/N) ~ J,D. - C/~ Pumper ~'-~. ~--~.~$ ?',~ c) Z-- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: k Well(s) on lot To property line Surface water/drainage On adjacent lots Absorption field Foundation Water main/service line 72.026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical co~ S~CE FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer Manhole/Access (Y/N) ...------ ''Pump on" level at ...------"~mp off" Level at ~les tested Surface water D. ABSORPTION FIELD DATA Date installed ~ ~'~ ~ Length ~ ~ Width Total absorption area ~ ~ c) ~ Date of adequacy test / ~ ~ -~ '~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y~JL~ Soil rating (GPD/FF) 'Z--b.-1 ~/'J~ System type ~'~.~4,~ ,'5 ' Gravel thickness "/~ Total depth I ~ ~ Cieanout present ~]) ~ Depression over field (Y~D ~( Result~[~/fail) ~.5 for ~ Bedrooms ~) After test 43 ~ ~J4 //-/~ ~'/~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /o~ / On adjacent lots To building foundation ~ ~' ~ On adjacent lots '~ ~ ~ ~- Cutbank Surface water / ~ z> ! '/' Curtain drain /J/~ Property line To/e~isting or abandoned system on lot Water main/service line Driveway, parking/vehicle storage area /o I E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformedtoyOA and HAA guidelines in ~" Signature S & $ ENGINEERING E ' , . 17034 Eagle Rive:L ~ad/,~,204 nglneers r~am.e. [ ~p~_ .,_~ ~_ Date ~//~/~5~'/~'.~'~//~'/ ,~ , ~ .,~., HAA Fee $ C:~)~. Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back REPORT of ANALYSIS Chemlab Ref.~ :93.6935-9 Client Sample ID :L21EKLUTNA HTS STEWARD ADD Matrix :WATER 5633 B STREET ANCHORAGE. AK 99518 TEL:(907) 562-2343 FAX: (907) 561-5301 Client Name :S & S ENGINEERING RUSH Order :74552 Ordered By :RAY Report Completed :01/04/94 Project Name : Collected :12/29/93 @ 11:20 hrs. Project# : R~ceived :12/30/93 @ 14:35 hrs. Technical Director:STEP~N C. EDE PWSID :UA Released By :~~ Sample Remarks: ROUTINE SAMPLE COLLECTED BY: RAY. ~ QC Allowable Ext. Anal Parameter '~ Results Qual Units Method Limits Date Date Init ........................2~.'~,~,2~ ~ ............................................................................................................ Nitrate-N 4.48 mg/L EPA 353.2/300.0 10 01/03 LLH * See Special Instructions Above UA = Unavailable ~ See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification ].~.mit. LT = Less Than D = Secondary dilution. '~T = Greater Than Member of the SGS Group (Soci~t~ G(~n~rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO. UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA. NEW JERSEY. SOUTH CAROLINA 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 21; Eklutna Heights Subdivision; Location (site address or directions) DoL6y Avenue, P~tcrs Cr~.~k, Ak. Property owner Mailing address Lending agency Mailing address Agent Address Rich Bos ~la P. O. gn~ A71~04 Front~&r Alaska Day phone A2a,~ba 99~7 Day phone 688-1210 Day phone w Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 'w · TYPE OF WATER SUPPLY: XX Individual well Community well NOTE: Public water If community well system, provide written confirmation from State AD£C attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. XX 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 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 Address Engineer's signature DHHS SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for 17034 Eagle Ri,vet Loop Road P..agie kiver, Alaska ~5/-~. Phone Date bedrooms. bedrooms, with the following stipulations: Additional Comments By: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates b~sed 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 institution~ in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or ~nalyze data before a certificate is issued, The Municipality of Anchorage is not responsible for errors or omissions in the professional engineeds work. 72-025 (Rev. 1/91) Bac~( MOA #21 (~ Municipality of Anchorage - ' Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-~'¢ ~.t. ~-.V-,~,~-r' ~.~. ~'~. Parcel I.D. A. WELL DATA Well type "~¢-~'4~'T'¢~ Log present (YZ~ Total depth Sanitary seal (~N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~?P¢-~¥, · t,'~,-'] I Driller Cased to ,~; c> ~ v- Casing height Wires properly protected (~N) FROM WELL LOG Date of test Static water level Well flow Pump levei~ g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ ¢~'~ ~ % Absorption field on lot \ c~ c> AT INSPECTION q .L~+ ; On adjacent lots ; On adjacent lots Public sewer 'main Sewer servic~ line WATER SAMPLE RESULTS: Coliform Public sewer manhole/cleanout Petroleum tank Nitrate Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (~N) High water alarm (Y~ Date of pumping= Other bacteria S & S ENGINEERING 17034 Eagle RiVer Loop Road No. 204 Eagle River, Alaska 99577 Tank size ~ ~:::~ Compartments Foundation cleanoutl~/N) y ~ Depression (y~'~ - /'-~. Alarm,tested (-%5N')' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ c>c::) ~ To Propertyline ~c> ~''~ Surface water/drainage On adjacent lots ~c~c> ~*' Foundation Absorption field ~_c~ i Water main/service line 72-026 (Rev. 7/91) Front ~ , CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level ~ Meets MOA el~ SEPARAT~DISTANCE FROM LIFT STATION TO: We~on lot -- On adjacent lots Manufacturer Manhole/Access (Y/N) ~~'~ ~evel at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed ~C:~ - ~ Length 'Z.-~ * Width_-"Z. Total absorption area c~ Depression over field (Y/~) ' Results~)/fail) Peroxide treatment (past 12 months) (Y~) Soil rating ?.-~,-1 · Gravel thickness Cleanouts present.N) Date of adequacy test for ~-~ ~'-/~J If yes, give date System type Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: On adjacent lots Surface water Curtain drain Well on lot lC)c:~ To building foundation -z~ E. ENGJNEER'SCERTIFICATION ' ': On adjacent lots t. ~ W Property line To existing or abandoned system on lot Cutbank ~l~ Water main/service line Driveway, parking/vehicle storage area I certify that I have Cl~ecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & S ENGINEERING Signature ; 7654 Eag;e ~i~er , Eagle River, Alaska 99577 Engineer s Name Date ~'~ HAA Fee $ // Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. Client Sample ID:L21 EKLUTNA HTS. S/D PWSID :UA Collected SEP 3 91 ~ 13:15 h~s. Received SEP 4 91 @ 14;30 hrs. Preserved with :AS REQUIRED 5633 S STREET ANALYSIS REPORT BY SAMPLE for WORKorder# 37880 Date Report Printed: SEP ? 91 @ 11:52 Client Name Client Acct Roq $ Ordered By ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ENGINEERING :SNSENGP PO # NONE RECEIVED :R. SHAFER Analysis Completed :SEP 6 91 Send Reports to: Laboratory Supervl~or.~EPHEN C. EDE 1)S & S ENGINEERING Released By :~ C.~ 2) Chemlab Ref #: 914580 Lab Smpl ID: $ Matrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATB-N 4,2 mE/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: RAY. Remarks: I Tests Performed ' See Special Instructions Above UA-Unavailable ND- None Detected "See Sample Remarks Above NA- Not Analyzed LT-Less Than, GT-G~eater Than ~r~s Member of the SGS Group (Soci6t6 G6n~rale de Surveillance) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTALi (a) LegalDescription(includelot, block, subdivision, section, township, range) Lot 21; Eklutna Heights Location(addressordirections) Dolly Ave. January 14, 1988 (b) Property Owner H.U.D. Mailing Address Telephone: Home Business (c) Lending Institution Home Savings and Loan Telephone Mailing Address Attn. Dabble Newton (d) Real Estate Company and Agent Re/Max Darlene Nicolaysen Address 16600 Centerfield Drive ~201 Eagle River, Alaska 99577 694-4200 Telephone (e) Mail the HAA to the followina address: or: Check here [~, if hold for pick up. List contact person and day phone number below. Eagle River, Alaska 99577 TYPE OF RESIDENCE Single-Family [~ Number of Bedrooms WATER SUPPLY Individual Well ~ Community I-I Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL OnsiteJ~ 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 I of 2 72-025 (Rev 8/86~ Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone S & S ENGINEERING Address ....... ,- .., .... , --- ,.--J -,- ,.-. Date Ea~lle Ely, r, Alaska ~577 /-- ~-0 "" ~:~:> DHHS APPROVAL Approved for ~'~ (-'~bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional CAUTION 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. Page 2 of 2 72-025 IRev 8/86) Back MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: ~..-~.o~ ~,.-'1 WELL DATA NOISIAiO S:flOIA3~S lV.LNBWNO~iAN3 NowOH3NV tO X.i.I'lydoINf/W Well Classification ~ I"J[''~ ~[ ~'P3/~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/I~ Date Completed ~. t~'~ I Yield Total Depth ~,~" Cased t~o ~ c:~ --~ Static Water Level \ Casing Height Above Ground ~ '~ Electrical Wiring in Conduit~l) Separation Distances from Well: To Septic/Huldi~rg Tank on Lot To Nearest Edge of Absorption Field or~ Lot To Nearest Public Sewer Line ~/,~/ Cleanout/Manhole MUNICIPALII'Y OF ANCHO?,AGE ENVIRONMENTAL SE (VJCES DIVISION " :"2 ]. RECEIVED Depth of Grouting Pump Set At O/ Sanitary Seal on Casing ~N) Depression Around Wellhead ; On Adjoining Lots ! ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by ~---~ ~' ~-~ ~:~ [ ~;:::~:~ ;Date Water Sample Test Results 5.e"~'-'tc~'/'~'"~' , --"~L-"~/ ~ ~'~='~--""1~' :~ I~~ Comments ~ '~4r'~f'~' t,./_~... ~ ~ ~ B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (~?N) Air-tight Caps CN) Depression over Tank Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) '--/~' Separation Distances from Septic/f-~Tank: To Water-Supply Well \ ~::~C::) I ~- ~,~ ~ Size \ ~5:~"-~(~ No. of Compartments Foundation Cleanout (~N) Date Last Pumped \ ; for \ o I-,c- To Property Line To Water Main/Service Line Course Comments Temporary Holding Tank Permit (Y/N) t To Building Foundation ' To Stream, Pond, Lake, or MajOr Drainage Page 1 of 2 72~026 ?Rev 8/86~ Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed \ ~ ~ Width of Field ~--.~" Type of System Design '"~.~ Length of Field '"'~ ! Depth of Field Gravel Bed Thickness '"7 Standpipes Present 4~N) Date of Last Adequacy Test Square Feet of Absorption Area Depression over Field (Y/~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well \ ~ To Building Foundation ~ Lot I[~[~/i' -,-/ To Water Main/Service Line \ ~ 1"~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line I ~:,~ 4-- To Existing or Abandoned System on ; On Adjoining Lots "~ To Cutbank (if present) Comments "Pump On" Level at High Water Alarm Level at ~ Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) uring Adequacy Test. Meets MOA ** 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. Com,~4 Eagle Rivet' Leep R_ea~ ~__.~OA No, bsrr, Receipt No. ~o o / o O O ~ Date of Payment /--~/--~ Amount: $ ¢/ ?0. ~ Page 2 of 2 72-026 fRev 8/86) Back CHEMICAL & GEOLOGICAl, LABORATORIES OF ALASKA, INC. ~*~o,~.~d, ds'~'~ FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE Client PO# : VERBAL Req ~: Client Smpl ID: LT 21EKLUTNA HTS Sample Rec'd : JAN 15 88 Ordered By : R SCHAEFER Send Reports To: S & S ENGINEERING R SCHAEFER 17034 EAGLE RIVER LOOP RD., #204 EAGLE RIVER, AK. 99577 Work Order No. : 4766 Client Account : SNSENGP Date Report Printed: JAN 19 88 9 08:16 Released By Reports Address ~2 Special SAMPLED ! -I 4.88 @! 650 HRS bY Ro SCHAEFER Instruct: Chemlab Ref ~: 8860 Lab Smpl ID: 1 Matrix: Water Allowable Parameter Tested Result/Units Method Limits NITRATE-N 3.1 mg/I 10 Sample ROUTINE SAMPLE Remarks: ANALYSIS COMPLETED: 1-18-88 LABOHATORYSUPZ~"'$OR~,~ : STEPHENC, EDE._.~~- ~ 1 Tests Performed * See Special Instructions Above ND= None Detected ** See Sample Remarks Above HA= Not Analyzed L?,-L~3s Than, GT=Greater 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 GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) I Location (address or directions) .... ~,~ , '-r-/" .... ~-~ Applicant Nam~/~cl~°W Telephone: Ho~e _ Applicant Address ~- ~ ~ ~ ~ ~/~ ~ Applicant is (check one): Lending nstitution ~; Owner/builder~ Buyer (d) (e) Lending Institution Address Telephone Real Estate Company and Agent Address T. eJephone (f) '4~m~-the HAA to the following address: 2.' TYPE OF RESIDENCE Single-Famil~..- Multi-Fam~ [] Other Number of Bedrooms 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 Onsit~-.--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 cert;hed by my seal afhxed hereto and as of the va dar on date shown below, I verify that, my ~nvesbgat~on, of thru Hea th / Approval shows that the on-rote water supply and/or wastewater d sposal system s safe, funct onal and adequate the number of bedrooms a~d type of structure indicated herein. I fuAher verify that based on the information obtained pality of Anchorage files and from my investigation and inspection, the on-site water supply and/or posal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on *{h'm;date of this inspection. Firm Telephone /// ~D 6.DHEP APPROVAL ?/ ' ~'~pproved for "' "~'~" ~ I~edrooms by ate ~ Approved ", .~'~ Disapproved Conditional '~erms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HE~TH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE (a) Legal Description (inalude lot, block, subdivision, section, township, range) Location (address or directions) Telephone - Home Business Applicants ~dress ~~ ~ Z~'/~ ~. ' ~/ (c) Applicant is (check one) Lending Institution ~ ; ~er/builder~'; Buyer~ ; Other~(explain); (d) Lending Institution ~ ~ Telephone Address (e) Real Estate Co. & Agent Address Se e Telephone (f) ~the HAA to the following address: ~ ~,,~LE DIVER, A~S~ ~ Type of Residence Stngle-Famtly~ Mul~i-Family ~ Number of Bedrooms ~ Other (describe) 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. Sewage Disposal 0nsite ~ 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] e 5. Engineering Firm Providin~ Inspections; Tests~ File Search~ Data ~nd 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 regula- tions in effect on the date of this inspection. Name of Firm Address Date Telephone DHEP Approval Approved for Approved ..... Disapproved ~ Conditional Terms of Conditional Approval ~::=/Y/.fT'/,,t/6- ~5~-'/~T/d 7",~f,a,'~"t' CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 Soils ~ati.~ in Absc=ption S~ata ~ T~ of Date .I~tal~d ~ ~ng~ of Field Wid~ o~ Field ~0 ~r ~p~ O~ ~ield . Gravel Bed Thickness ~ ~ /' Dep=ession ore= Field ~ Date o~ ~,ast ~eeul~s o~ ~aet Adequacy~ '~~ ~ ~epsration Distance ~ ~pti~ Field: 'To S~ond~ke/= ~J~ ~ai~ ~ ... To ~i~y, ~i~ ~ea, ~'Vet~c~ S=~ Date Ine~alled Dimsnsions Size in Gallons Manhole/Access (Y/N) Tested f~ i 2-15-84