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Home My WebLink AboutCOLONIAL PARK BLK 2 LT 3 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 ' wet ~,s~c~o: ] /~O '- I ~ '~ ~o. ~Z Man f(~,~ ~)~~ -- ~~ ~i~~ No. of compartments ~ L~~ ~allons I~HOME~DE: Inside length Width Liquid depth ~ -- ~ Manufacturer Material Liquid capacity in gallons ~ ~ ~ DISTANCE TO: Well/4 ~ ~ Z No. of lines Z m / Length~e~ E~ Tota~ ~ I~s Tren~h , Distanc~~nes of t~o ~n~ grade M~terl~l.beneath tile Total ~ -- Wid~ Depth ¢- / inches ~ Length ~ ~2 ~- PERMIT NO. ~ ~e~;~ ~ ~i~a~t~ . Crib depth ~ , Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ iClass Depth Driller Distance to lot line PERMIT NO, ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS ~ ~ _ I R EMAR KS io0 ,, ~ . ~?. . ' . .......... 72~ Rev. 3/78) F'ERMIT NO. t.ll_lr4 I L--: I F'RL T T'T" !--'1 ,F~ RI"-IF:HF"E:Rt3E __ . ; ..... DEPFIRTMENT (. HERLTH RN[> EN','IRONMENTRL ,_.~.]TEC:TION_ ..~,,~-~~ 8'-"F, '"L"~ C, TREET, RNr:HOF.'RGE, RK ':3cjF, O:I. 0'~ ,,~ ~' CII'-.I--S I TE SEI4EF'~'-' LIPt.~RRE:,E PEE."F11 T (:3~b'-~588) RPPL I CFINT Lor_:RT I ON LE :l-iL FRRNKLIN B. MORSE COLONIRL PRRK _,,. C L3 B2 COLON IRL PRRK S/D SE: 500~L., E.R. LOT SIZE 38115 SQURRE FEET TYPE OF SOIL IIB:,DEPTION =,'r=,TEM I=,' TRENCH MAXIMUM NUMBER ElF BEDROOMS SOIL RRTING (SD FT/BR)= 195 THE REQLIIRED SIZE OF THE SI]IL RBSORF'TION SYSTEM IS' E:,EF'TH= 10 LEI'4GTH= 4'...fa- I]RR'v'EL E:,EF'TH= 6 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND 8ND THE BOTTOM OF THE ENCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE 8ND THE BOTTOM OF THE EXCRVRTION (IN FEET). E:E~ql_IIREC, SEF'TI~2 TRf4PC SIZE= i~3~ GRLL,DF~S PERMIT RF'F'LICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT [:,LIRING THE IN_~TRLLRTILN INSPECTIONS OF RNY WELLS 8DJRCENT TO THIS F'ROPERTY RN[:, THE NLIMBER OF RESIDENCES THRT THE WELL WILL SERVE TPlID ,:-. ~'":' ", I !"-,,I S P E IS T I DP.iS RI~:E R E'~]! LI I F~: E E:. BRL. kFILLIN', OF RNY:,~'_.r-. WITHOUT FINRL INSPECTION RND RPPROVRL._ BY THIS DEPRRTMENT WILL BE SLIBJECT TO PROSECUTION. MINIMUM DISTHNCE BETWEEN 8 WELL RND 8NY ON-SITE SEWRGE DISPOSRL SYSTEM IS lO0 FEET FOR 8 PRIVBTE WELL OR i50 TO 200 FEET FROM 8 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTRNCE FROM 8 PRIVRTE WELL TO 8 PRIVBTE SEWER LINE IS 25 FEET 8ND TO 8 COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MBY 8PPLY. SPECIFICHTIONS 8ND CONSTRUCTION DIHGRBMS 8RE AVAILABLE TO INSURE PROPER INSTBLL~TION. PEE'r-11 T E:=<F' I E:ES [:.Em::Et. IE:EE: 31.. 19E:1 I CERTIFY THRT !: I Rhl FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I WILL INST8LL THE SYSTEM IN 8CCORD8NCE WITH THE CODES. ~: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RES IE:,ENCE IS REMODELE[:, TO INC:LUE:,E MORE THRN=. ? BEE:,ROOMS. S I G I'-, E [:,: p~~z~_ ~'~___~~. / RPPL I OFtNT FI~.'FtI'.~(L I N B. MORSE I S S U E D O & E ENG..NEERING & DEVELOFwlENT CO. Box 90, Davis St,, Eagle River, Alaska 99577 694-2774 or 688-2280 RuMell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Performed for: Name: /~-, /~/~,A/'/4_ ~//~/~%~"" Tel. No. ~' Z~ Mailing Address: ~ '~--~ / ~~ ~U~ ~I~ ~~7 Depth (feel) Soil Chara~erlsllcs 13__ 14 15__ Ground Water Encountered: Yes No Proposed Installation: Seepage Pit Drain Field Comments: ~-,~;P-- _ Performed by: PLOT PLAN PERC. TEST If yes, what depth GA~,B-HD- I ~tj G,'~"~.TER ANCHORAGE AREA BOROI'*~H HEALTH DEPARTMENT 327 EA~LE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION MAILING ADDRESS LEGAL DESCRIPTION PHONE SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY MATERIAL '- COMPARTMENTS GALLONS. INSIDE LENGTH INSIDE WIDTH ~ ! DEPTHLIQUID ~'"""/ SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE SEEPAGE PIT: / OUTSIDE DIAMETER OR WIDTH ~" , LENGTH , DEPTH ~.~)F~),, DISTANCE FROM WELJ /~OT" ~/"~ BUILDING FOUNDATION ~ ~J- TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA/ ~ 8 ~ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE WELL: TYPE FOUNDATION DISTANCE BETWEEN LINES SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE. , NEAREST LOT LINE TRENCH WIDTH DISTANCE FROM WATER TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE IN. ABOVE TILE LOT LINE ~ DEPTH NEAREST SEWER LINE BUILDING FOUNDATION. SAMPLE NEAREST SEPTIC SEEPAGE OTHER ., TANK SYSTEM , CESSPOOL , SOURCES__ DISTANCES: I B- e:. tOO DIAGRAM OF SYSTEM DATE APPROVED HEALTH AUTHORITY GAAB-HD-2 GREATEr.. ANCHORAGE AREA JROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 Case N o. . SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT RESIDENCE ADDRESS LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH MAILING ADDRESS LOCATION OF INSTALLATION SEEPAGE PIT , DRAIN FIELD TO BE INSTALLED BY PHONE NO ,OTHER PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS (/'~/2- ~--'~ , PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BESER~VED ~ · SEPTIC TANK SIZE / 0~ ~, TYPE (~r~J SEEPAGE AREA DIAGRAM OF SYSTEM DISTANCES: TYPE Health Authority 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 APPLICANTS SIGNATURE PRELIMIN~XRY ! hereby certify that ! have surveyed 'thc 'l'oilowmg described property' d-~ ;' ~ Anchorsge Recording Precinct, Alaska. a]~d tha~ lhe pr~ ~sed imp~vements~ as planned ~,erevn by tr~<~ buHaer. ,a'~ be ,~'~thm the ~op~ty line'~ and w]]] n(~t ov,',rlap or encroach on the p~p~ty'ix'mg ad~cent thereto, that no ~mpro~ements on prover:y iym~ adm~-c~:t thereto encroach on the premis~ in question and th~l there, are no ~adway~ ~an~missmn ]in(s or other v~sible ~e- ments on sa~d pro~rty ~xcept as mdicat~ hereon. Dated at E%~]e River. A~ka ROBERT C. aO~SON ~A~:, ~gL~e~ Land Surveyor No. ~-~ 2 2~ ~ F'~ Phone 694-2543 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 AU?HORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Coionial Park Lot 3, Block 2 Location (site address or directions) 19910 Third Street, Eagle River Property owner Mailing address Joseph Lyons P.O. Box 2495, Kenai, AK 99611 Day phone 694-5500 (m~g-Rparrow) Lending agency N/A Day phone Mailing address Agent Address Jack White/Shirley Sparrow Day phone 694-5500 11825 Old Glenn Hwy., Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State AE)EC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer x NOTE: 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 e STATEMENT OF INSPECTION BY ENGINEER . :~ '~ '::~ · AS certified by my seal affixed heret° and as of the Vali~lation 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. 694-5195 99577 Phone Name of Firm E~gle River E~g~_neer~ng Services Address P.O. Box 773294, E~qle River, AK Engineer's signature ~~~~--"~~ DHHS SIGNATURE ~.. Approved for Disapproved. bedrooms. bedrooms, Conditional approval for Date /~ ' -~ ~' -99' with the following stipulations: t Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professiona!.e.ngineer's,w0rk. , . , 72-025(Rev. 1/91) Back MOA~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A, Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed //~ ?~ Driller /'///,~ Cased to -f z~Dt Casing height y./~ t, ?~'~ Wires properly protected (Y/N) )/~5 FROM WELL LOG AT INSPECTION Date of test ,/Y/l~ / /D/ ~,. ~ / ~ ~ / Static water level / z~o° / // Pump level1 I)/,/I,~/'.1~)1~/,-/ g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/hot~limj tank on lot Absorption field on lot '~/~ Public sewer main Sewer service line 7 ; On adjacent lots ~/~ j ; On adjacent lots ~/~ Public sewer manhole/cleanout I'.1/~ Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Date of sample: Nitrate z~-, 5~ /~/~.//- Collected by: Other bacteria B. SEPTIC/H~=DI'NG TANK DATA Date installed / Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size /~O Compartments Foundation cleanout (Y/N) /~/D Depression (Y/N) /V'//~ Alarm tested (Y/N) ,/V/~ tll/~J/~l'j Pumper SEPARATION DISTANCES FROM SEPTIC/H(N;~G TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots -/'/(~0 / Absorption field ¢-/~o ~ Foundation Water rotan/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical cod~ ~ . "Pump off" Level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed Length /--/? / Width Total absorption area Date of adequacy test ! · Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) . '~0 '~ Gravel thickness Cleanout present (Y/N) Results (pass/fail) System type Total depth yE~ Depression over field (Y/N) ~P/~r55 for ...'~ Bedrooms After test ~)/~ ~/ If yes, give date ,~.//~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot -J-/OD' To building foundation On adjacent lots Surface water Curtain drain On adjacent lots '/"/O~ · Property line ,_~ ? ' To existing or abandoned system on lot Cutbank /'-//~ Water--service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION Signature Engineer's Name Date /'~' ~ --~ I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effec( on thedate,Of~hi{ inspection. HM Fee $ ~ Date of Payment Rece,,t.umber Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back 1~/24/94 ~9:56 CT~E ENUIRO~ENTPL LAB SERUICES -' 98? 694 ~ N~.~65 QB4 ~].ienl= ~mp].e Commercial Testing & Engirmcring Co. Envtrenmental Lalx~ato~/Services ! ¥ ...... LABORATORY ANALYSIS REPORT 94..~.6 9-$ COJ,~INIAL pAIU[ I..3 wATeR Sample Roumz'ks: R(~TXMB ~LI~ C*OI~ BY: 0c Allo,~able Y.x~, NJ. Cx-a t:e-N 3,113 m0'/[, ][PA ~6~, ..2/300.0 10 2.0/21/'94 ** g~ Sa~lm ~rks ~ ~ ~33 8 Strut, A.~Y~e, AK 99618-1600 -- Tel: {~7) 662-23~ F~ {~7) 561-~1 ----' 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 27,1986 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 3, Blk 2~ Colonial Park Subdv~ T1./4N R1W Sec.7 Location (address or directions) 3rd St. Ea~le River (b) Applicant NameRuth L;yons Telephone: Home 69/4-4/444 Applicant Address POB 774068, Eagle River, AK 99577 (c) Applicant is (check one): Lending Institution I-I; Owner/builder [~; Buyer D; Other I-I (explain); BusinessN/A (d) Lending Institution Alaska Mutual Bank Address Eagle River ~ Alaska 99577 (e) Real Estate Company and Agent N/A Address Telephone 6 9 4- 9 5 71 Telephone (f) Mail the HAA to the following address: pickup b_v aoolicant TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms 3 Other WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite E"I 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 (11i84) ENGINEERING FIRM PROVIDING I'~SPECTIONS, 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 suppiy 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. * all tests are current (less than tw° years elapsed) Name of Firm Address Date ~"/~"~ ?/~' g* EAGLE RIVER, AK 99577 P. 0. BOX 773294 694-5195 Telephone Seal DHEPAPPROVAL 5"-~3 ~ ~ ~ Approved for/~-'-~ bedrooms ~,~-''J~ ~'~'?.,~-Bate Approved _.~' Disapproved '- ~'/ Condition ,a~ Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA '- MUNICIPALITY OF ANCHORAGE (MO~7' HEALTH AUTHORITY APPROVAL (HAA) · CHECKLIST- FEBRUARY 1984 NtUNICIPALJTY OF ANCHOP, AGE 264-4720 DEPT. OF HEALTH & Well Classification ENVIRONMENTAL PROTECTION MAY 2 ? 19t~. RECEIVED Legal Description: /~,'/'C If A, B, C, D.E.C. Approved Well Log Present (Y/N) Total Depth ~'/'~ ,~- ' Cased to Static Water Level /o 5- / 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 /t'/ Water Sample Collected by Water Sample Test Results Date Completed /~' 70 Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) · On Adjoining Lots · On Adjoining Lots ~'/0¢ To Nearest Public Sewer To Nearest Sewer Service Line on Lot -~ 5"' Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) ~V Depression over Tank (Y/N) /t/ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) "~/,,4 Separation Distances from Septic/Holding Tank: To Water-Supply Well /~ / To Property Line .5"_s- ~ To Water Main/Service Line *'/'~ / Course ~-/'~ ~ Size /~ ~"f- No. of Compartments '/ Air-tight Caps (Y/N) )/ Foundation Cleanout (Y/N) Date Last Pumped 5/°° ~' /~"/4 'for -- ,/u,/~ Temporary Holding Tank Permit (Y/N) To Building Foundation 5" / To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed / ~' '~' ! Width of Field ,Jo" Type of System Design Length of Field /-/E" Depth of Field / '~ / Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~/~o Gravel Bed Thickness ~ ' Standpipes Present (Y/N) Y' Date of Last Adequacy Test /o./',p ,cf, 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 /"" ~-'"'- ,"- ', ¢-, '"~ -,,j To Property Line To Existing or Abandoned System on · On Adjoining Lots "30" To Cutbank (if present) D. LIFT STATION /1//~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments Signed /~/~-f' ~~ Date Company ~- ~ '"~'~"~ '~'~,~"5~'~'~MOA No. Receipt No. ~ ~ ~~ Date of Payment ~/~ ~/~ ** 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· Page 2 of 2 72-026 I11/84) MUNICIPALITY OF ANCHORAGE -- DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal/~Descriptio~n .(include~ -~!.~_ ~ ~~/~/t' bio, ck. su~division,~cttpn,v~V.~ ~ ~ ~ ~/'~t°~ship'~ ra~e) Location (~dreas or di~ectio~) (b) Applicants Name06 ~, qO~ ff Telephone- nome Business (c) Applteane ts (check one) Lending ~uyer ~; Other ~ (~plain); ' (e) Real gsraee Co. & Agent Address (f) Telephone Mail the HAA to the following address: 2. Type of Residence Single-Family['~'~ Multi-Family,--t Number of Bedrooms~[~' Other (describe) 3. Water Supply Individual Well ~ Community ~-~ Public~-~ Note: If community w~ll system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite blic F--] Comm, ity [CT .olding ,an Note: If community well system, must have written corffirmatton from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] En$ineerin~ Firm Providin~ 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 regula- tions in effect on the date of this inspection. DHEP Approval Approved ~' Disapproved (ENGINEER SEAL) By Telephone Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEA~LTH 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- b~NTS. 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 A® MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AlYl~ORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: MUNICIPALITY OF ANCHORAO~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OCT 5 lg Z, gElVED Well Classification Well Log Present (Y/N) /~/ Total Depth ~/~3- ~ Static Water Lev~.l /o 5- w Casing Height Above Ground Cased to Electrical Wiring in Conduit (Y/N) Separation Distances f~om Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot /~ To Nearest Public Se~r Line Cle anout/Manho le Water Sample Collected By Water Sample Test Results Comments If A, B, cr C, D.E.C. Approved(Y/N) Date Completed /~ Yield ~/'.~ ~ ~ ~pth of G~ting ~ ~t At Sanit~y ~al on Casing (Y~) ~essi~ ~nd ~l~ead (Y~) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public se~r To Nearest Se~r Service Line on Lot B. SEPTIC/HOLDING TANK DATA Date Installed )~ ~ Size I~0~ Ge// NO. of Cc~parhrents / Stan~i~s (Y~) .y Aid-tight Caps (Y~) ,~ Foun~tion Clean~ (Y~) ~pression o~ Ta~ (Y~) ~ ~te ~st P~d , /? P~ing~aintenan~ Con~a~ on File (Y~) ~/A ~ for Holding Ta~ High-Wate~ ~a~ (Y~) ~/~ ~ra~y Holdi~ Tank ~r~t (Y~) ~ation Distan~s ~ ~ptic~olding Ta~: To ~te~-Supply ~11 /DDt To ~ilding F~ndation To Property Line 1~ ~ TO Water Main/service Line Course ~~ To Disposal Field ~k; To Stream, Pond, Lake, or Major Drainage Receipt 9 ~o77~/~ Date Paid: Amount: [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /~/ ~/~~ Width of Field ~D /' Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test / ~ ~'- ~ T~vpe of System Design Length of Field .... ~f ~ z Depth of Field '/~ ' Gravel Bed Thickness 6 z ~-g-g~ ~ Standpipes Present (Y/N) /~/ Date of last Adequacy Test /~//~,~ Separation Distanoe from Absorption Field: To Water-Supply Well /z3~~- To Pr_operty Line /~ To Building Foundation ~ 3// To Existing or ~J~andoned System cn Lot /~2' -~ ; On Adjoining Lots ~ ~- To Wate~ Main/Service Line ~7 7~ To Cutback(if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area /~,; ~ LIFT STATION Date Installed Size in Gallons "Pump On" Leml at High Water Alarm Level at Tested for E le ctr ical Codes (Y/N) Dimensions Manhole/Access (Y/N) '"Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments Check Permitted Bedroc~ ..Rating A~ainst HAA Request I certify that I have checked, verified, or conformed to all MOA H~3% Guidelines in effect on the date of this ip..~pectic~n~ compan - KB1/d5/s [Page 2 of 2] Date MOA No. 2-15-8~ To'bbe'n Spurkland P.E. Joe Lyons 2865 Leawood Drive Anchorage, AK 99515 October 4, 1984 SEPTIC SYSTEM ADEQUACY TEST LEGAL: Lot 3, Block 2, Colonial Park LOCATION: 3rd Street~ EaRle River OWNER: Joe Lyons RESIDENCE: Single Family, Three Bedrooms MUNICIPALITY OF ANCHORAQE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED WATER SYSTEM: On Site Well SEPTIC SYSTEM: From Municipal Records: Tank: 1,000 gallon concrete Absorption System: Deep trench, 49 feet long, 10 feet deep, 6 feet of rock Absorption Area: 588 square feet Soil Rating: 195 Installation Date: 1970 Upgraded: 1981 DATE OF TEST: 10/3/84 TEST PROCEDURE: Drainfield was charged with water at a steady flow of 4.5 GPM. A total of 1,100 gallons of water was added to the trench. 24 hours after the start of the test 450 gallons had been absorbed by the soil. Both the tank and the sump of the drainfield was monitored. The water level in the tank did not change during the test. The water level in the sump rose with the charging of the trench. The tank was pumped on October 4, 1984. TEST RESULT: This system meets the requirements of the Municipality of Anchorage as of the day the system was tested. There is no guarantee that the system will continue to meet these requirements. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. ~l'obben Spurl~land P.E. Joe Lyons 2865 Leawood Drive Anchorage, AK 99515 WELL INSPECTION October 4, 1984 LEGAL: Lot 3, Block 2, Colonial Park TYPE OF WELL: Private CASING ABOVE GROUND: 24" WIRES IN CONDUIT: Yes SEPARATION DISTANCES: 100+ to Septic System SURFACE UPGRADING: Satisfactory LAB TEST: Satisfactory WELL STATIC LEVEL: 105' WELL YIELD: 4.5 GPM for 4 hours DEPTH OF WELL: 105+ The sustained 4 hour yield of this well is adequate for the residence described on this date.