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Home My WebLink AboutBIRCH TREE ESTATES BLK 2 LT 10Municipality of AnChOrage'~ Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage. Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~-~.~5 ~ O~1.~ PID Number: OJ"7-1~l'l ' ~ Name: ~ Upgrade ~~ A~O ~~ ~Y~ Wastewater System: ~ New Address: 1o~1~ ~ ~ ~e E~ ~v~. ~ ~ ABSORPTION FIELD ~'~0~/~4~'~ ~ ~ De ranch ~ Shallow Trench ~ Bed ~ Mound ~ r Soil Rating: ~ 'Total Depth from o~de: LEGAL DESCRIPTION ~ e,~/s,.,t. Lot: Block: S~bdiv~ion: Depth to pipe bosom from or~ade: Gravel d~ath pipe IO ~ ¢~ ¢~ ~. %,t. ,t. Township: I Range: I Section: Fill added above original grade: ~ ~ength: ~ ~ Ft., Ft. WELL: ~l,Tl~ew ~ Upgrade Grave, width: ~ Numbe~istancebe~een,i,es: Ft. Classification (Private. A.B,C): TotalDepth: ~ Total absorpti~~ Pipe materiah ¢ ~T~ ~ ~,. s~. ~t. )riller: ~Drilled: Static Water Level: Insta~ ~ Ft. ~ ~,. Date installed: SEPARATION DISTANCES ~ s~,t,c ~H;,~i~ ~ S.T.~.P. TO Septic Absorption Lift Holding ~ublic/Private Manufacturer: From Tank Field Station Tank Sewer Lines ~¢O~E ~1( Capacity i Wel~ , · ~ i Z0t~ Z{I~ Material:~~ Number of Co~a~ments: SuffaCewater ~ ~ ~ I oo ~ ~ LIFT STATION Lot ~ i~i ~ Size i, -g~ Line ~ ~ ~ "Pump on" level at: "Pu evel a i h water alarm at: Cu~ain Pure Electrical Ins~ctions pedormed by: Drain ~ ~O~ ~N0¢~ - Remarks: ~IEH W~7~ ~ ~~ BENCH MARK Location and Description: ~' A~umed Elevation: ENGINEER'S SEAL Inspections performed by: -~~ ~"','~'. Dates: 1st ~,~::~.;~ Depadment of Health and Human Se~ices approval v 't;~,,. c.~..., ,ewed d pprovedb ' -,- 72-013 (Rev. 9/91) MOA 25 lo' i1 t.qY ~ .4 ..... EXI~ 'NCH FINAl. GRADE ~ ~ ~ WJ:~[.j~ ~ ORIGINAL GRADE~ =: 96.41-. FAST 147th AVEN[JI~ , / ~ L 92,44__~ NEW 4000 CALl.ON I401_,DING TANK ALAS~ ~A~ A~ ~AS~A~ CONS~TA~S, ~C. ~ OF A / BIBOH TREE ESTATES SUBDIVISION, LOT 10, BLOCK 2, 49T ' " '~PE OF WORK: AS-BUILT OF HOLDING TANK , JAMES P. ~¢ILLIAMS: PREPARED FOR: PHONE ~UMBER: ~.~ " NO 9608 DANIEL & JULEE HO~YTE~ 694-120~/264-1246 /'~* "- ~ '... .... .... :~ 10/13/98 J.L.M. 1 = 40' 2 OF 2 '%~rofessTo~ MUNICIPALITY OF ANCHORAGE Department of Health and Human :Services ' On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 995'19-6650 (907) 343-4744 v~oo v\ ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 20, 1998 Expiration Date: Aug 20, 1999 Permit Number: SW980315 Legal Description: BIRCH TREE ESTATES BLK 2 LT 10 Design Engineer: AK Water & Wastewater Consultants, In Owner Name: Daniel & Julee Holayter Owner Address: 10519 High Bluff Drive Eagle River, AK 99577-8402 Parcel ID: 017-141-39 Site Address: 005260 147TH AVE E Lot Size: 29116 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. Received By: ~/,;iV~, ~ ~'J~~. Date: Alaska Water & Wastewater Consultants, 'Inc. 7;t20 East Che~ter Heights Circle ~ Anchorage ~ Alaska 99~4 Phone (907) 33'~-6179 - Fa~ (907) 338-3246 Consulting Ensineers August 7,1998 Municipality of Anchorage Department of Health and Human Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Sewer Upgrade for Lot 2, Block 10, Birch Tree Estates. HOLDING TANK To whom it may concern: The existing 4 bedroom house is served by a private well and a septic system that consists of a 1250 gallon septic tank and a trench type drainfield. The septic system has effluent surfacing and must be upgraded. Two test holes were excavated on the property and groundwater was found at 6 feet in both test holes (see attached soil logs). Two percolation tests were performed. In test hole #1, a percolation test was performed between the depth of 3.0 feet to 3.5 feet and found the percolation rate was 80+ minutes/inch. In test hole #2, a percolation test was performed between the depth of 2.5 feet to 3.0 feet and found the percolation rate was 120+ minutes/inch. Based upon our assessment of the site, it is unlikely that there is any suitable accepting soils (2 feet unsaturated), as required to install an onsite septic system. As can be seen from the site plan, the neighboring properties have similar condition as the referenced property. The neighboring property to the east is on a holding tank, and the neighboring property to the north has been deemed undevelopable by excavation of several test holes. It is our recommendation that your department allow us to install a 4000 gallon holding tank. The tank will be located east of the existing septic tank and 100 feet away from the well. A copy of the proposed design is attached. If you have any questions, please contact us at 337-6179. wn Cerely, ~ / ~ ~ iel} iramS, P'E' / ..... ~'~' EAST 1 45th AVENUE / ~r~' ~c~' t~ ~.~%~ /~ ~ ~ .0~c$~ / , / [ ~ '_ ~ ~ ...,~ _ ~-' (SEE PAGE 2 OF ~ / ' ' ~' ~ / :~ ~', ~'C E3%%1' 147th AVENUK I ~" . ..... 7520 E. CHEWER HEIOHm CIRC~, ~CHO~E. AK 99504 .,O.E: (007) ~7-s~e/~: (~o7) ~S-~2~O BI,CH T~EE ESTATES, LOT 10, BLOCK 2 "' F ........ :/"~:T~'~": .... 'REPARED FOR: PHONE NUMBER: JULIE HO~YTER 694-120~/264-1246 '~ yr,, '... .......... ."¢~ ~r~:8.7 ~w~ .~: ~.[: ~,~: d.L.M. 1 = 100' 1 OF 2 10' UTILITY FASEMENT f~a ""?_~ ~ ~ ~% ~ , -EXlS-r,NC SFPTIC ~ANK i [. ~ 0o ITO D~ ABANDON-ED COMPL.Eq'EL~¢ I ~ ~ /--PROPOSED 4000 GAN_ON ~ ~ .,,~~ I ~o /~ HOt_DING TANK EXISTING DRAINFIELD-~ . ~ ~ ) / ~ ~ ~0 BE ABANDONED COMPI%l'~Y ~SHEt)~ // ~ ~ 100 WELt. RADIUS~J I ~ m I ~ .... ~i~6~FL%~TC~~ I ~ " I ...... M~ ~ ', ' ~ ~ WLI. I~' ~ t-.Au t I 4-TLh AVL{NLJE ..... ~,~S~ WA~ A~ WAS~WA~ CONS~T~S, ~C. ~o ~. c,~, ,~,~s c,,c~. ,,c,o~. ~ ,,~o4 ~.. ....... ....~. BIRCH TREE ESTATES; LOT 10, BLOCK 2, . . DESIGN OF SEPTIC SYSTEM UPGRADE (HOLDING TANK) ~JAM~S P. PREPARED FOR: PHONE NUMBER: ~h ~ ". NO. 9608 .' JULIE HO~YTER 694-120~/264-1246 ~t~ ".. C,E. J.L.M. 1 = 30' 2 OF 2 J SOIL LOG - PERCOLATION TEST I 9, LEGAL DESCRIPTION: BIRCH TREE ESTATES, LOT 10, BLOCK 2 ';~'i '"~'~'J'~[~--~ DATE PERFORMED: 7/24/98 lq~ '. NO. 9608 .' (feet) :,::'1 TEST HOLE ~1 ' z--- ~ , ME SOIL C~SSIFICATIONS , ~ H~W SID~ALL ~ GP ~ HL ...... [~' i~ I DEPTHTO DATE 9~r I~ BLUE-DENSE ISITE PL~r x 11 -- ~; ' CLOCK NET TIME WATER LEVEL I NET DROP __ ~,,, , ~ DATE READING ~, it, ~ TIME (MINUTES) READING (INCHES) 12--~ B.O.H. 7/24/98 BEGAN PF',ESOAK ~ 1, :50 AM , 2 3:55 55 5 5/8" 16-- 17-- 19 -- PERCO~TION ~TE 80+ (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) 20 TEST RUN BETWEEN 3.0 FT. AN~ 5.5 FT. PERFOMED BY A~SKA WATER , WASTEWATER .. /t~ / ~J~ , CERT,~ THAT THIS WAS PERFORmeD ~ ACCORDANCE WITH ALL ~T~ AND MUNICIPI L GUIDELINES IN EFFECT ON THIS DATE. DATE: DEPTH TO DATE GROUNDWATER SEEPS ~ 6' 7/24/98 7320 E. CHESTER HTS. CIRCLE * ANCHORAGE, AK. 99504 ,~.~\,,. , [SOIL LOG - PERCOLATION TEST I ~'~¥'4g/ '" LEGAL DESCRIPTION: BIRCH TREE ESTATES, LOT 10, BLOCK 2 ~ (.~)~.~.. .~ ~ :JAMES P.W~/ILLIAMS: DATE PERFORMED: y/an/sa tjk% '... ¢.E. ...' .,,,~9 DEPTH I TEST HOLE #2 I Xtl{~',,," ........... "~,~ 2-- ' ' ~ SOIL C~SSIFICATIONS [ [] ' W/ LI~LE GRAVEL. ~ GM ~ CL ........ ' ' ' ~ DEPTH TO DATE t SlZE'F ~J ~ ~ ' GROUNDWATER ~ 1OO' WI-Il.. NAI~IHS ', BLUE-HARD PAN k~ A : ;~ I ,,;, ~, ISI~EPLANr x 11 -- DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) 12 -- 7/24/98 3 3:55 55 6" 14 ~ ~ 4 4:25 ~0 5 7/8" 1/8 15-- i 19~ PERCO~TION ~TE 120+ (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) 20 TEST RUN BETWEEN ~ 2.5 FT. AND 3.0 FT. COMMENTS: ~ /~ PERFOMED BY A~SKA WATER ~ WASTEWATER ', ~ , CERTI~ THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL IS¢A?E AND MUNIdlPAL GUIDELINES IN EFFECT ON THIS DEPTH TO DATE GROUNDWATER SEEPS {~ 7' 7/24/9B ~'(~ el~/~, MUNICIPALITY OF ANCHORAGE DE ~TMENT OF HEALTH AND HUMAN SER ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~ame DISTANCES ×ddress ' TAN K FIELD WELL P~°ne(s}~ ' INooI Bear°°ms ~kk ~- ~ ~ I ~bo~ ~ LOT LINE ~ t m ~ ~ ~ - Lot t Block ~ubdiwslon I~ ~ ~~~ ~ FOUNDATION Township, Range, Section AS-BUILT DIAGRAM (Show tocahon of well, septic system, property lines, foundabon, ~~ ~ ~ ~ ~.~w.~. w~,~r ~o,.~. -- ~J~ ~ TANKS N ~ SEPTIC ~] HOLDING Man~iact'u~er Capacfly m gallons Material No, of Compadmenls TYPE OF SYSTEM ~ TRENCH ~ BED ~W. DRAIN ~ OTHER ~. ~,~ Depth to p~pe bottom from 1 ota~ depth from original gr~d~ orlgJnalgrade J~O ET ~ 0 FT ~ Fill added above original grade Gravel deptb beneath p,pe ~'¢¢ ~i Gravel lenglb Gravel w~dth ,OFT ~'0 FT ~s~ FT ~,~ FT N~mber oJ I-;nes Pjp~ material J Soil rating Installer Date installed WELLS RIVATE ~ OTHER {Identifv) Ciassdlcation (A,B,C) ] oral Depth ~ Cased to h/stallel Date Installed: ~ SR B ] 96X ~,~i~ lhat this inspection ~s pedormed according to a~l ' ~~~~~" J ~ 0~ ~.~ '..... ~'~ .' Health DepaAment Approval: ~/~ ./ ( ~_/~ ~_ Date: 72-013 (3/85) I""1A X B E :(.)R .ill ] M iii;: SLIBD I V I S I ON: B ]t] RCHTRIEE EST ,, SIECI 1 L~I',I ~; ;]!;4 "f' OWI',.tSH I t:::' ,", :I. ;?.1',.t ;::'i':.;~' 11 ,~!:~ ( SQ, I:::'"f ,, Cif;:,'. ¢-.:iCRE% ) .... ~. '~,'~'.. (.:.::,'::1 I;:)(.:.:.;, t ,;;:~...¢ a r' c~97 t l"[e opt 'i. ,::~1"~ :~i..'- ava :i. 1 al;::, I (.'.:.:, t (::~ ',..,'(:~..~ ;i. r'i d~.;~;,s :i. ,:;:'p'"~ :i. n c. y,:::x..tr, set;::, .!:.. :j. 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"l"Alql< M!,.IST !'"IAVtE A"f' I....IEAS'I' TWO COMI:::'ARTMt:.!]'q'I'IS ,:;;: e r' t :i !- 'y -I:.. h a t ',~. 1,, ..Il am i.am:i.l:i..:':~,.r~ ~.~...,:i.'l:.h 't.h,~>~:, vc.:,qu:i.i"emer'~i'..s fc::,r' c,n...s:i, te .~;ewe:-:,r's and ,,.,..~.;.:.:,lts as for'th I::',y th,:.'.;:, Mt..tr"~;i.c:i.l::~al;i.t':,/ ,.';::,l.' Ancl"'~or'age (MOA) and the Stat,?:-;.:, ,;:)~: A'.i. aska.,, 2:'. i ~.,,..~:i. I I :i.r"~stal 1 t. he, s'y~!.d'..em :i.n ac,::::nr'dar'~c;e w:i.'l:..h al. i MOA ,:::: o,;;.t es and r' ':.':q" ,it. a'l' i,::::,r'~s~ and :i.n cc, n"q::~t:i, ar"~ce ~,.,,i'l;..l'"~ t:.l":.,e des;i, gr"~ ,'.:::r'.:i. ter'.:i.a c,','.' th;i.s t::),."::.:r'm:i.t,, 3, ill w;i. 1'.t. a,:::ll"ic-;,r.(!?! -i:..o all I"IOA and Stat,:.;.;.:. of Alaska r'.~:.~.?qu;i.r-(~:;.;,mc.;,nts -,'.'clr -t.h(.;¢ -:~ii.'..::~:,-i:.. ba,:;:;l< d J, Ei,'t.,,~;tl"iEiIE, E~. ~' r' c,m ariy e;:.:: :i. st :i. r'ig ~:...~(-;~:, ]. ii., ~.,-,~ast c..,.~,,',:.::~'t.,.;er' d :i. s!::.~osa .'I. s';.,.'s'Lem c;,r' i:::,ul::~ 1 :i. c !S (;.:) t/-.J (.:.:,) l'" i:':~(;~j(,..:,, --:i!:,'?."E~t(.i.'.~fil iiid'"~ '1.'.1'",, :i..iii; of :'i).r'~v adjacent (]:,r'. .r'i,:.i.:.?/:':':r' I1::,¥ i crl:., ,::', ,, .,.~ u.r"~cl,.':+?r' !ii!,t.~'~d'!(] "~. 1 ........ ~ .:::~, [. 'I',.. I"1 ;i, :~[.; i;] E-? I" f¥'t i 4-u ].' ,.'.~ v,.-.,.'" ~1. i d I:' cir'. a ma.x :i. mum f1::,/.' 4 bed r' ,:::x:iirns ,.'.gnd ,:¢:,.r"~y 81"1] i::r'(~:jE:ffii.:;:.,r'it k.,~:i. ). ;t. r-,:.;.:~,'.;:tu:i.r'e ar',, ad(::l;i.t:i, cn'"~aI per'm:i.'k.,, PERFORMED FOR: Municipality o! ,Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: L.~ lc;, I~ "Z...-'~..e~"'T~y~Township, Range, Section: ---T--~7~_l.~ ,'~-.~--~_.h ~(-~_~ SLOPE SITEIPLAN 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT ~ O DEPTH? f p E Depth to Water Alter ~ Monitoring? ~ Date: ~ ~' Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~,(,/,_/~, (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN __ FT AND __ FT COMMENTS s & s CERTIFY THAT THIS T~ST WAS PERFORMED IN EAGLE RIVER. AK 99577 ~/~ DATE: ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE~FECT ON THiS DATE. 72-008 (Rev. 4/85) GREA,ER INSPECTION ANCHORAGE AREA BOR JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 REPORT ON-SITE SEWAGE DISPOSAL SYSTEM PHONE SEPTIC TANK: DISTANCE /[~¢ FROM WELL INSIDE LENGTH INSIDE WIDTH_ LIQUID DEPTH LIQUID CAPACITY/ __ _ GALLONS. j~__~) / NEAREST LOT LINE '-~'_c''5 / TOTAL LENGTH,.~ DISTANCE FROM WELL /~?~__FOUNDATION .... OF LINES NUMBER OF LINES___ / DISTANCE BETWEEN LINES TRENCH WIDTH]~' IN. ABSORPTION AREA ,F~~t / SQ. FT. LENGTH OF EACH LINE ~EPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE ~lN. ABOVE TILE TOTAL EFFECTIVE TYPE ~--CONST BUILDING NEAREST FOUNDATION ..... LOT LINE __ NEAREST SEPTIC SEWER L,NE TANK DEPTH DISTANCE FROM: SEEPAGE SYSTEM CESSPOOL_ OTHER SOURCES DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: ._~~-~.)-' REMARKS: DATE G.A.A,B. ~ ,. Form LQ-032 r.-~B~ "~'..., '[ ,::: ~: :~L :~'"r"-,-" ,::::,F" ~N,:::::~-..~ ~:~::ir~':Z~}'__ ~~ ~/~_ L:,EP~:"~ME:NT L,,- HERLTH ~N[::, EN',,,'~RONMENI"~L ~ ,<OTEC"r~O~~ . ..,.. ,_, ,::. ,::, ~,~ ~Z: L. ~. ......~::] ~"..~ [:::,, a:::::~ ~-~ ..... :E% ]: '1- EE ~E; ETF: ~..,~ ~ ~L~N ~ SRFI '"'~"' . L. OC~T~ ON E:F~E~;"I" :~.4';:"]'H ~',,,~E [...EGf~L L::LC~ B2 BIP. CH "rF~EE EST~TES L..OT S I ZE: 2!~kl.:l.~; SQFT ' ~'" ............. ; ......... "] "i '"' ............... ~'~ .......... ~" ...... ~F.E .... F :....EL.. HE,:~.F.I~ :,~.:,IE:.M... IB, E.N_.H NL.IME, E.F~ UF E,E.I., Ed Jut1:, (r~ :::,u ~ L ~.H I 1 bib .....t.:..F I ,. E,~., ~ ~ THE MINIMLIM DE:F'TH OF G~:~',,,'EL E:E:"I"L,~EEN THE OI..rl"F'~L..L F'~F'E: ~NE:, THE IS ';:~' F:"I THERE: IS NO SET NID"I'~H FOR TRENCHES. F'OK: E:,R~NFIELDS., 1"HE NIDTH IS 2:FT. THE DEF.'TH OF TRENCH OR F'IT IS THE DISTANCE E:ETNEEN THE: GROUNE:, SI. JRFE~CE: ~ND THE BO]"TOH OF' THE E',,.,',C~',,,'~T I ON. THE: I_ENGTH [:,IME:NSION IS THE: LENG"IH OF E~E:H SI[)E: F'OK'. ~ SEE:PFIGE F'IT OR THE L..EI'.~G"I"H OF' THE: "t"I:RENC:H,, ')R B, RFI I NFl ~ THE REQL I RE[:, SEF:'T I C "I'RNK: :,.[ ~..E. Z _~2._,D GFILLONS ~ DE~C:KF ZLLZNG OF RN'~' SYSTEM NI THOU ~ ~ ].~L ].~4~,W'~.L:I'~ ON E:'~" THZ S E:,EF'FIRTMENT NZL. L. DE SUB..TEC'I .... ['0 PROSECUTION. H~NIMUM DIS'I"RNCE F'P. OH NELL TO RNY SEPTZC "I"RNK,.."F'RCKF~GE PLE~N'I" OR SOIL RDSORP"I"ION S'~"SI"E:H IS :[.E~ F"I" FOR'. F~ F'RIVFITEP~ELL. RND 2C~E~ F'"I" FOR rR PUDL. I C NELL .... NEL. L.. LOGS MI...IS"[' E:E: RETURNED TO THE [)EPRR"FHENT NI1'H~N 2i:E~ DRYS OF' THE: NELL COHF'LEI" I ON. SPECI F ICFIT'IOBIS F~N[:' CONSI"Rt. JCT ~ ON E:' ]: RGR~HS E~RE ER',,,'RZ LRBLE: TO IN%U~'.E PE'.OPER I C:E:F;::T I F:"-r' TI.-IFYI" I FIM F'FIM I L. I FIE: N I "['H 'THE F. tEQU I F..'EMEI'.~"I-::5 FOR ON-S I TE :-~;EHERS FIN[:.', NEL..I_S FtS SE"t"FOR]"H B'~.' THE: MLIIq I C: I F'I::tI_ I T'~' OF' I:~NC:HORFICiE FIN[::, FI I EL I NS'I"FII_I_ I N [:IC:COR[)FII'.,ICE [,.I I TH THE COE:,E. S I G N E 12:, ............. .............. ,..c. ATER ANCHORAfiE DEPAP, Tr'!Er,IT OF EN\IIRONI"~EI',i!'AI_ 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 Le,al Description: Lot/7 Block This Form Re~orts Soils Log .~ Percolation Test ~emth Feet Soil Characteristics 6-- 7 9 --TT D. Was Ground Water Encountered?'~v~'-~/-~ It Yes, At what Depth? .... z ....... J__i i L_J } Readinq Date Gross Time Net Time Depth to H20 Net Drop Perc'o'l'atio-~ R-~te ~linute Proposed Installation' Seenaqe Pit Drain Field Deoth of Inlet Den, th To Bottom Of Pit Or Trench Test Performed By ~~'~~~ ..................... By Para ~ertified Pate: ',i':it2.5 t... S'I'.. r. eet, An,.:::: h ~::, r' ag e, A 1 ask a .:, .,',, (. '.[ 3.,':t. 3-.~/ (] 1"-,I ..... S I T E W E I .... I .... F' E 1:::-,' M ]: i" ANCHOI::;:AE)iii:~, AK 995 16 Sect i or'l: 34 t' ov,.¢nsh :i. p ',: t2N Ran~;:!,;.:.:,: 3W .... ,Lt. · ::::, :i. ::.:', (.3;, ~.'.'"' ............... f:: ~,"::i (';,';'} ( '~; (::I ,, -,.': 't'.. ,, (;:) r" .:~i. (:;: ...... ". 6~ % ) Bl(:)ck~ 2 t,'-,llEl...,t....: L.,'.::)g taus'!:.. ):lc subm:i.'l:.ted t:..(:)Mun:i.c:i, pal:i.'l:..¥ of A¥'u.:::!"',cir. age Del::'~ar"'t..men'l:. c:~.f Hea].'t'..l"'~ ari,t:l 1-..h..~.ri'~i~',.r'i !i!i~l.;~..',r'"v':i.,.';;:(~:;~,s w:i.'l:,.h:i, rl 3() days of: w.e].l cc~mplet:i.c~n,, 'TH i :i!!i F'EI::i:M ]: T EX I:::' I ~..I ,.:;~ ON 1/89 AND I !ii; .!..:::~,::UI:::..O f'" ...11'", THE I ST I NG 4 ;(}i:f'~E()I':;:OOM S :I: I",IGME FAM I L'Y OWl~ii:l....I.... I NG OIqI....Y ,, CIEI::;'.'f' [~:::? THAT :I ~c~r"l'..h by 'l:.he Mun:i.c:.i. pa:!.:i, ty of Arlchl:.~r..age (MOA) and the State of Alaska,, t w;i. lt :i. nstall the Sy'..~F!'..6'..~f'fi .'i.r"~ ac:c:c.~*clar'~ce with a].l MOA codes and and in c:,::;m'q::~:l.:i, ar'~c:e w:i. th the d6..'.s:i.~jr'~ c::r..'i, ter':i.a c::,f th;i.s I t,~:i.].l .adher'e -!:.c:~ all MOA and S't;.a't.e o,l:' A].asl.,:a r'equ:i.r'ertierlts .for' t. he set I:::,ac:k d :I,'..::~.i',,.~:.4i .... t,..:.~5 f f" ,:.':.) f0 ~'..u"iy (.:.:.)::,.'. ;i.!i~'~.. ing we], ]., i.,,,~as'l:..e~a'l.'..er, d.:i. spc~sa]. ~.',,'.':..=,'t em c:~r' pub t :i.c: sswer'age system c)t"~ th:i.s ,'.:::,r' any adjacent or' r'~eapt;::,¥ lcd:., I L.tl'](:l(Dp¢iiF[.ar'i~:] 'l:..ha'[ 'l:.,h:i.s pel".ir~:i.'l'.. :i.s ',,,,'~::',,;[:i.d for', .~?. f'fiax;i,i¥'lL!ffi E){' 0 bec:lr'c, oms,, ;.;~ ]. t:..iE) t..lr'ti::i(.:.:.~P s't'..al"'~d 't'.ha'l:.. 'l:. h i(.:.: .r.:;al::;,i..?tc: ;i. 't'..y (::~ f the tota ;I, syst, er¢l ;ir .i!!.~ 4 bed r' (:;)f.;;;~ttl~.i!i al]Et ,.!:). r'l ':?* el"l].,?.:~.l-(:jeff~er"~'L ~,,.~:i.:l.,'l. i"(~,~?(:tLi:i.l%l.;-.'i, ar'~ adi;:!itior~al ' ........ ': .......................................................................... ....... (Owr'le!:r') ,.]tl/OHN & CH¢~.I..J!!]xlIE Wt::IZIEStI\ISI<E ' ,'....,u~.,,I.. B',/:: DA'FIE: WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological ~, Geophysical Surveys Dr,llin, Perm,t No. LOCATION OF WELL (Pleoee complete either Ia, lb or lc.} A.D.L. No. - [ ~_~. Borough iiSub~.i~ieion Lot Block ~ l/4qtrs. Section No. Township N[~ Rang ISTANC E AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF~ELL Street Addres~ and Area of Well Location 2. WELL LOG Feet Below 4, WELL DEPTH'. (ftc Material Type Top Bottom ~ ~- Equipment u ~ ~ / DEP" OF HEALT~ & Material: ~ Nec Length of Drop Pi 16. WATgR WELL CO~TRACTOR'S CERTIFICATION: 15. Water Temperatu~ This well was drilled under~ jurisdiction ~egis't~red ad'ess ~onfroct License Number Authorized Representative Form OZ-WWR (11/81) Copy Distribution: WHITE-State DOGS, PINK-Driller, CANARY-C WE[~ Meridian ~ Rolory 0 Driven 0 ~ ,Jotted ~ Bored ~ Other: ~ Public Supply ~ Industry ~ Recharae ~ Commerlcol ~ Other: Threaded ~ Welded ft. Depth StJcRup~.ft, Length: ft. end ft. '~ Gravel pack '~', below land surface and YIELD hrs. pumping ~ g.p. hrs. p~mping e~outed: [~Ye= ~No Cement ~ Other: Ioble} HP ~ Jet ~ Centrific~l ~ Other belief; Customer [~] Below land I~urface . , MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner %~'--~ ~'~¢";~.-¢l ~'4%~ Telephone' (home) Mailing Address ~--~7...Lca~ ~'~¢~.d'" i,¢¢~~ \ /G.-~¢_~.¥~.~.(.~, (c) Lending Institution Telephone Business Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here~-Af hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle RNer Leel~ Read Eagle River, Alaska 99577 TYPE OF RESIDENCE Single-Familyl~ 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 th legality and status. SEWAGE DISPOSAL On-site ~ 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 .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 Date 17034 Eagle River Loop Road No. 204 ~.a~:~ P,:;'~r, A!=-"k~ 99577 Telephone 6. DHHS APPROVAL Approved !0r ~ _bedrooms by Approved_ ~_ Disapproved Terms of Conditional Approval Conditional 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 omissions in the professional engineer's work. 72-025 (Rev, 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) ..~ CHECKLIST-FEBRUARY 1984 ~~~ 343-4744 ~l~ Legal Description' ~ A. WELL DATA Well Classification /t'~'~\k) ~O'-/,~ Well Log Present (~¢N) ~-/ Total Depth ~,'¢~f"~-' Cased to If A, B, C, D.E.C. Approved (Y/N) ' /,~ Date Completed ~ - 'Z--'::t - 'i~q ~-~ Yield ,¢¢, ~'- ~_~ ~r--~ ~ Depth of Grouting ~ ~ Pump Set At ~--' Sanitary Seal on CasingC~'N) ~'J Depression Around Wellhead (Y/4~ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit~:~N). SEPARATION DISTANCES FROM WELL: ; On Adjoining Lots ; On Adjoining Lots To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field, on Lot / To Nearest Public Sewer Line ~;ilLN To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results ~~ Comments ¢;~-.-E:~ 'V~'~L. B. SEPTIC/HOLDING TANK DATA Date Installed '~1 -"L.'q -"/~ Size Standpipes (.~/N) Depression over Tank (Y/~;~' Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) 1'7~5'-c:' No. of Compartments Air-tight Caps ¢i~/N) Foundation Cleanout~'/N) '7' Date Last Pumped ~-~- ;for ---- Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ~ ~ (''~ To Property Line \ *¢'~4'~ To Water Main/Service Line ~I ~ To Stream, Pond, Lake or Major Drainage Course Comments ~"~ \~:x-IE.. ~'~~t~ To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~E5 - \~ - 'Es~. Width of Field ~- ~- Square Feet of Absortion Area Depression over Field (Y~ Results of Last Adequacy Test Gravel Bed Thickness \ Statndpipes Present Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line \ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Des gnl,~~ ~---~--~ Length of Field Depth of Field I ! To Property Line \ ~ To Existing or Abandoned System on ; On Adjoining Lots · ~ ~ To Cutback (if present) Comments D. LIFT STATION Date"~statled Size in G~ "Pump High Water Alarm Level at ~'~-----. Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~ ~.~ing 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 inspection. Signed S & S ENGINEERING 11034 Eagle Ri~er L~p Road No. 2~ Company =--I- m..._ AI.ika ~9577 Receipt ,o. ~ //7 2 g pO ~ Receipt ,o. Amount: 72-026 (Rev. 7/88) Back Waiver Fee: $ Date of Payment Page 2 of 2 PROJECT: 17034 Eagle River Loop Road Eagle River, Alaska 99577 ROBERT A. SHAFER CIVIL ENGINEER 694-2979 DATE OF TEST: LOCATION OF WELL (LegaI Description): ~ \o ~:>~,.~_-. ~ 1~\¢.~_.~ ""~~ ~ WELL DEPTH: DATE DRILLING COMPLETED: FT. CASING: \z~''7'''''' FT. SCREEN: - ~'"' '7.~ - ~>'~ DRILLER: V~'~-"I~'~ '~\'?-"t L.,L~ ~,-~(~, STATIC WATER LEVEL (Top of Casing): FT. DATE: CLOCK ELAPSED TIME SINCE DEPTH TO DRAWDOWNI PUMPING PUMPING STARTED/ WATER, FT. RECOVERY RATE, GPM REMARKS TIME STOPPED, MIN. ~ ~. ', '~p ~:;' 0 ~%'.~d 5 ~ ~' ~,¢ ~x~ %~ ~ , 20 25 45 120 (2 hours) 180 (3 hours) 210 240 (4 hours) RECOVERY 5 ~0 ~5 20 25 30 35 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE,FEDERALALASKATAx ID #9951892-0040440TELEPHONE (907) 562-2343 ~.NALYSY,3 RE?ORT B't BAMPL~ £oz Work Date R'epo!'i ?tinted: MAY Coil~cted MAIl 30 89 ~ 12:5fl kece:.ved MAY $0 ~9 ~ 13:50 Preserved with :AS. REQUIRED CiJ e~.t Name Client Aect ?.0.~ NONE '~,EC' Orderod ~y ?malys~t~ Compietod Re]eased gv : :-'~ Spo,z.tal g & S ENGtNEER3-NG AUfItORI~EI) COPT OF P, BPOP, T TO BE PlCg. ED tJP I4¥ Instruct: ~P,, JOH~ B, OSENSKI UPON COMPLE'~[ON. ',~/:~0/899, Chemlab get- !~: ,~49., Lab Smpi II): I Matrix; WI~TER Parameter Te~ted Result/'Onlts ~ptllod I, imJ Ls: NITR~TE-N 0.1,t rog/1 EPA .4q~.'Z i0 :~ar6pl e ROUTINE S~btPD; I{emarks: ,.RAMPL~ COLLECTED ACHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER [] PUBLIC WATER SYSTEM I.D., ,.~.,_PRIVATE WATER SYSTEM Na~e& $ ENGINEERING 17034 Eaale River Loo~ Road ~/~ 0~. UalF,~gle~i~r, Alaska 99577** Phone No. City State Mo. Day Year Zip Code SAMPLE TYPE: cRoutine heck Sample (for routine sample with lab ref. no. [] Special Purpose ) [] Treated Water [] Untreated Water SAMPLE NO. LOCATION 3 I 5 I Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: atisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received 5""" '-~"~ Time Received /r''~ ~4~:) Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* I 7-7] Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count ~ Verification: LTB__ / BGB Final Membrane Filter Rcisults ~ Time: TNTC = Too Numberous To C, OB = Other Bacteria Coilformll00ml t Coilformll00ml Z/-,-,%~ ) .. a.m, p,m, PART ! OF 2 REMAINDER TO FOLLOW MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 10; Block 2; Birch Tree, Subdivision Location (address or directions) 5260 East 147th Avenue, Anchoraqe~ Alaska 99516 (b) Property owner Mailing Address John Wrze~ins k~ same as above Telephone'(home) 345-0642 Business (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address 207 East Northern HERITAGE REAL ESTATE/Robin Ward Lights Boulevard, Anchorage, A~as~a 99503 Telephone 276-4824 (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/694-2979 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 ordered by owner 2. TYPE OF RESIDENCE Single-Family,~ Number of bedrooms ./3" '¢' 3. WATER SUPPLY Individ,~al 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-siteE~( 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 .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 S & S ENGINEERING Telephone 17034 Eagle Ri~er Loop Road No. 204 Address Ea~le River, Alaska 99577 Date 6. DHHS APPROVAL Approved for ~' bedrooms by Approved ..~- Disapproved Terms of Conditional Approval Conditional Date .-,~2/~z,' _~,_,/ .-~"Z¢,Pc. The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 ~ MUNICIPALITY OF ANCHORAGE (MOA) ..... ~,~(~.l~th Authority Approval (HAA) · x,,. ~,~/,, ~s [~I,,~KLIST - FEBRUARY 1984 iRO~¢'¢'L SERV lC: '' ?'': ' 343-4744 A. WELL DATA RE C ~ IV ~ D Well Classification 1 .~d! ~6,.¢''q.~- Well Log Present (Y/<~. I,-~' Date Completed Legal Description: If A, B, C, D.E.C. Approved (Y/N) l~z~to¢')-- I~1-~ Yield '~ ~::~ (-~¢'l'~t TotalDepth ,~_,~t, Casedto /-'~'~¢Depth of Grouting '-'---- Static Water Level [ c:~'~> Pump Set At Casing Height Above Ground [~-" "~ Sanitary Seal on Casingd~) Electrical Wiring in Conduit ~1) ,~.r Depression Around Wellhead (Y~:~[~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ; On Adjoining Lots ; On Adjoining Lots To Nearest Edge of Absorption Fiel~o/~Lot To Nearest Public Sewer Line To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by ~[~J-~ '~.~-~---~t I ~~ ;Date Water Sample Test Results ._~"'~~--~ ¢'/~.r_.~.~_f Comments B. SEPTIC/HOLDING TANK DATA Date Installed~"Z"~ -"~ Size ~ No. of Compartments Standpipesd~/N) ~ Air-tight Caps,/N) Depression over Tank (Y/<:~ ~ Pumping/Maintenance Contact on File (Y/N:)., / Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: / To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments Foundation Cleanout ~!~N) ,~l~;eLast Pumped ,¢,lf....-?__j,~.~:::%c~ .~ ; for "' ,/ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~- ~,~'~ - Width of Field ~-~' Square Feet of Absortion Area Depression over Field (Y/&;~ Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness ~'~--~- '=~ Statndpipes Presen(~N) ~ Date of Last Adequacy Test To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well \"Z--¢~ To Property Line \ To Building Foundation ~ '"'~ To Existin~g or Abandoned System on Lot \~::~ ~ ; On Adjoining Lots t~, ,Ir · To Cutbac.k (if present) Comments D. LIFT STATION~/~. Dat~.lnstalled ~ ' Size "Pump On" Level a~Et----,.~_ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~ing 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 on the date of this inspection. Signed Company Date 5 & $ ENGINEERING 17o~zt Eagle River Loop Road Eagle River, Alaska 99577 MOA "O. ¢' '¢ "-~ ~ Receipt No. ('~)- ,,~ Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ~q ~ CHEMICAL & GEOLOGICAL LABORATORIES OF'ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street: Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM I.D.# I JilVATEWATER SYSTEM Name Phone No. S & S ENGINEERING 17034 Eagle M'."c,r L~-,p Road No&204. Mailing AdC~le River, Alaska 99577 City State Mo. Day Year Zip Code SAMPLE TYPE: ~tl~Routine Check Sample (for routine sample with lab ref. no. :~ Special Purpose Treated Water Untreated Water SAMPLE NO. LOCATION 2 3 l 5 I Time Collected Collected By READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: (~atisfactory [] unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: * No. of colonies/lO0 mi. Lab Ref. No. Result* BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter. Direct Count Verification: LTB BGB Final Membrane Filter Results Timei TNTC = Too Numberous To C( OB = Other Bacteria Membrane Filter Analyst Colilo~ Coliform/100ml /~'"~ a.m. p.m. PART I OF Z REMAINDER TO FOLLOW MUN~CIPAMT¥ O~ 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 GENERAL INFORMATION (a) (b) (c) Application Date ~-'~..E~- ~5L¢ Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name ~Pq.-. \ ~¢-~ _'"~=¢=~ Telephone: Home ¢-~ .¢r¢' O~ Business Applicant Address ~__~¢-~_~.~ ~... )tJ~-~'l~ ,~-~/~,__~_,~ ; .¢=~, '=~.~,tl, Applicant is (check one): Lending institution [] · Owner/builde,¢~ Buyer []; Other [] (explain); (d) Lending Institution J~./~...k)~C~.,ct.~O_¢-~ ~ Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: S & S ENGINEERING SRB 196X EAGLE RIVER~ AK 99577 TYPE OF RESIDENCE Single-Family,!~- Multi-Fam~F1 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~l~ 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) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, D~rA 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 _~ & S I=NG!NEER!NG, Address SRB 196X Date EAGLE RIVER, AK 99577 Telephone DHEP APPROVAL Approved for /~-- ~/-7/~) bedrooms by Approved /~ Disapproved Terms of Conditional Approval Conditional 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) /,L..L..c MUNICIPALITY OF ANCHORAGE (MOA) ~,. '~.-.~:i~,ff~-,... HEALTH AUTHORITY APPROVAL (NAA) ~,,;~,,. '~ ,'~ ,,'~,.~ ;.::,.t',,-..,.i.."t'~.~:/, CHECKLIST - FEBRUARY 1984 · i.~ , . . '...."'. "<: ,;: "-:~V Legal Description: WELL DAT '~ ;: '~ · ~ Well Classification Well Log Present (Y~) Total Depth ~ qr~'~ ~ Cased to Static Water Level ~ O~' Casing Height Above Ground Electrical Wiring in Conduit (:~/N) Separation Distances from Well: To Septic/I-iek~t+ng Tank on Lot I ~;2 ~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line r5 ) ~ Cleanout/Manhole If A, B, C, D.E.C. Approved (Y/N) Date Completed '"~=~t:;trz'' t~t"L~' Yield u¢~/.,~ '/Depth of Grouting ~ Pump Set At 0 tL,-- Sanitary Seal on Casing (:~/N) Depression Around Wellhead (Y/~ ; On Adjoining Lots ; On Adjoining Lots Water Sample Collected by Water Sample Test Results Comments To Nearest Public Sewer To Nearest Sewer Service Line on Lot 1~'"-~'-...~,~,.5~'~--~-n~ ; Date , '"1 ~"2..I -~,L~ B. SEPTIC/~TANK DATA Date Installed °1 -'7..-'~ _ '~Lo Standpipes (~N) Air-tight Caps (.~N) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) . Holding Tank High-Water Alarm (Y/N) ~' Separation Distances from Septic/Heldmg-Tank: Size ~;) No. of Compartments 'Z.- Foundation Cleanout~N) Date Last Pumped '7-"Z..?..~ ~L~ ~ ,.3/~ ; for ~ Temporary Holding Tank Permit (Y/N) ~/~t To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation To Disposal Field 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 ~ "Z~ ~-t..)~,..,,.- Type of System Design Date Installed '~"- I~ -~L~ Length of Field Width of Field Square Feet of Absorption Area Depression over Field (Y/(~? Results of Last Adequacy Test ~-~,...I ~ Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation t Lot ~ C~ To Water Main/Service Line Depth of Field Gravel Bed Thickness ~--C~ "~='~,-' Standpipes Present (~/N) Date of Last Adequacy Test To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on I · On Adjoining Lots To Cutbar~k (it present) Comments D. LIFT STATION Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Manhole/Access (Y/N) t~//~ "Pump Off" Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MO.A and H.~A guidelines S & S ENGINEERING - · ~'/-z. ,~ ,/s-" ~ Signed ..... L)a~e / / ~ SKu ~yo~ --- ~ Company. ................. MOA No ~)~-~ .-.~o_~ ~.J~,~LI: KIVEK~ AK YY:)ll ' Receipt No. ~'~ t~ \. i~ ~'-~ \ Date of Payment '~ I ,;~o ! ~, ~ Amount: $ ~'~ ' D~ Page 2 of 2 72-026 (11/84) in effect on the date of this inspection. APPLI~ '~NT FILLS OUT UPPER HA~ -' ONLY Property Owner ,,~'_ i:~.~~ ~ , ~ ~ /r ~ ;~/~ ~ ,~' .'; ]:'?? ?' ~. Phone ~ t ~ '~ ~' / , .-" · , /~:") . - ( Zip Cede '~7 / Address '~7 .:;~Z~ ';~J/.~ /~//,~/.:'-,.?z~ .~ /' '' " ..... ' Lending Institution ~-y~:~'~.. ~7 1~,>. /,?~::~: y.~./~..~, Phone Address Zip Cede ~)>) 'J Realty Co. & A~nt /Z'.~,;),~,?/~:~z / ,)~' /' .t:.5~.Lx,-~7~:.:~ ~ ~Z~ ~:~' ~~ ' '-' % Phone Legal Description ,~', ~ /~j ~>Z;~Li~' .~ '~ ~ ~,:: ,~Z;: Type of Resi~nce .:. ~ .~/>~ Water Supply ~i~idual ATTACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Se~ ~o~a~ ~dividual Year Individual Installed: . : Public Utility When Connected to Public Utility: ~ Holding Tan~ NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OGESSING GAN BE INITIATED. Time Time , ( ) DISAP~OVED II Soils Rating Date ~wer Installed Well To Absorption Area ~I ~)'~ Well Log Received ~.--¢~ Well to Tank 72-023 (3/82) ALASKA ui1UIROFliTI FITAL COF1TI OL SeHUIC $, IFIC. ~nqi~eerinq 6 ~nuironment(d Studies APRIL 22 1983 MORRISON & ASSOCIATES/BILL MORRISON 1601E. DIMOND ANCHORAGE AK 99507 SELLER - VITTONE/PASLEY SUBDIVISION-BIRCHTREE ESTATES BUYER-WRZESINSKE BLOCK-2 LOT-10 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 340 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 554 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 4/29/83 . SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. The surface area around the drainfile had standing surface water when an adequacy test was performed. System failed immediately as system was flooded. Returned a few days later and retested system; Note standing surface water removed. System checked as adequate and better khan that required for a 3 bedroom house. Recommend that to prevent system from flooding in the future during wet periods ifollewing action be taken. dscape lot such that there is no low spot for surface water to pond about ~ infield. Also, divert surface water run-off so that it does not enter area of ~ infield. If following action is taken the system will be adequate. Iff not, / n drainfield will again fill with surface water ponding above it and cause ~ nadequate. ~ 1200 U Jest 33rci Auenue, Suile ~ · Anchoraqe, Alask, 99503 · (907) 276-1361