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HomeMy WebLinkAboutFIRE LAKE BLK 2 LT 1A Municipality of Anchorage Page of -_2_ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Numbe►�f.. S_ 0 o2 C3 PID Number: zr`1 - 36'/ -1S_ Name:Wastewater System: 0 New tg Upgrade JoA,V ar"o.ti Address: ABSORPTION FIELD l39 3� �+�� .,sr. -••,c .�1,- ,fir �c .f'.,,�. Phone: No. of Bedr o s: (Deep Trench ❑ Shallow Trench O Bed O Mound O Other Soil Rating: LEGAL DESCRIPTION Total Depth from original grade: GPD/Sq. Ft. /v Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe / ,. 1,4 ep, / /'C' 3 ' Ft. 7 Ft. Township: Range: Section: Fill added above original grade: Gravel length: 0—/ Ft. 6 3 Ft. WELL:"'-/""/ 'tfNew 0 Upgrade Gravel width: Numberoflines: Distance between lines: 3 Ft. / HI'a Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. SQ. FtI / ,1 ?t/ Driller. Date Drilled: Static Water Level: Installer. G�L'Gn./� Date installed: .3 Ft. —.-; S 0,0 Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES XSeptic ❑ Holding o S.T.E.P. To Septic Absorption Lift HoldingPublic/Private Manufacturer Capacity in gallons: From Tank Field Station Tank Sewer Lines 7;9"W�.'ri �f uv Well- f /�o f"/DU Material: ��s` f �TC�/ Number of Compartments: a Surface Water r DD 14- -1 LIFT STATION /✓�4 LotO �/o fjO Size in gallon Manufacturer. Line Foundation -3 G,� o "Pump on" level at: ump off' level at: D High water alarm at: Curtain Pump Make & Model Electrical Inspections _p4ftclyied by: Drain Remarks: BENCH MARK Location and Description: ® T / C/f Assumed Elevation: FtENGINEER'S SEAL ,4! t A, �4 +fir -Y xg+,"� `%s.� •�•31> !,. lb,'y, '` aka x� Inspections performed by: Dates: 1st 2nd-hr&tfl F3 T ,"dn�Pt36-.^.rCOffi sT4 s L4 igh Ai Butes s Department of Health and Human Services approval s a UE B726 � Reviewed and approved by: — Date: ` 2 _00 72-013 (Rev. 9/91) MOA 25 Permit No. • -,_� 6-, Page of ,�z a Municipality of Anchorage 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 Legal Description: * )- o Y- 1A of Fi , 4, ,c- PID No.: * U.S/ - 3� / iS Scale 1" =30' 0 0 co 0 N O 0 0 z N89059'30"W 170.00 63' -D Diverter_�, Existing Valve System o C On Line New Septic Tank A House Gravel Driveway Swin Ties A B C 23.3 27.0 D 59.7 40.0 �- Well ------------------------ N89059'30"W 170.00 ELEVATIONSTop Of Well ASSUMED ELEV = 100 (NOT TO SCALE) m ORIGINAL 1 GROUND = LEVEL AT- 86.0 m 3.2 TANK 69.0 NO GWT 84.1 3.9 82.8 82.8 \ 75.8 0 0 0 O N 0 0 0 0 z oR 0 lv' q� 4 y� JJ . m Lougis A. Biderael MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Mar 07, 2000 Expiration Date: Mar 07, 2001 Permit Number: SW000028 Parcel ID: 051-361-15 Legal Description: FIRE LAKE BLK 2 LT 1A Design Engineer: 0024 Eagle River Engineering Services Site Address: 013930 MALASPINA ST Owner Name: John Baiamonte Lot Size: 34000 SQ. FT. Owner Address: 13930 Malaspina Dr. Total Bedrooms: 4 Permit Bedrooms: 4 Eagle River , AK 99577-7504 This permit is for the construction of: ❑] Disposal Field ❑� Septic Tank E] Holding Tank F 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. PRIOR TO CONSTRUCTION OF THIS WASTEWATER SYSTEM, THE ENGINEER SHALL PERFORM A NEW SOILS TEST WITH A PERCOLATION TEST AND 7 DAY GROUND WATER MONITOR AND SUBMIT IT TO THIS OFFICE. —OG SE F Etv(r IA.,F&j2 'f AITl4C"&P )9mE 10Ep 0ESe6A1 OSTEO n9 y' IB Gi Received By: Issued By: Date: 7 levo U Date: 3-7-00 Eagle River Engineering Services Louis Butera, P.E., R.L.S. P.O. Box 773294 Eagle River, AK 99577-3294 February 22, 2000 Dan Roth Civil Engineer DHHS - MOA RE: Lot lA Block 2, Fire Lake Subdv. Dear Mr. Roth, (907) 694-5195 tel www.cagleriverengineering.com Attached is a new soil log and specifications for the leachfield upgrade under permit SW 0000028. The design assumptions on water table depth for this conditional permit are confirmed and this should satisfy the conditions listed on the permit. The soil perc rate is slightly higher than expected and this was compensated by increasing gravel depth and trench length. Site plan is attached. If I can be of further assistance please do not hesitate to call. Sincerely, Lou Butera, PE \2000\00-003nar Eagle River Engineering Services Louis i P.O. Box 773294 Eagle River, AK 99577-3294 (907) 694-5195 tel (907) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Lot 1A, Blk 2 Fire Lake subdiv May 18, 2000 A. GENERAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. SEPTIC TANK/LIFT STATION 1. Septic tank shall be 1250 gallon MOA approved construction. New tank is to be placed on original ground or a compacted base ofNFS material. 2. Existing tank to be pumped, removed and disposed of. C. TRENCH 1. The trench is to be located as shown on the site plan drawing. 2. The bottom of the trench shall be level, plus or minus 1.5" at an elevation of 14.0 feet below the top of a flagged nail in birch tree East of septic tank. 3. The total depth of the trench excavation is not to exceed I P at any point. 4. The effluent line from the septic tank is to be upgraded to a double cleanout.after.the septic tank with a diversion valve if called for by the new lot owner. The effluent line within the 'trench shall be laid level within 0.03'. 5. The trench gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = see #2 above GRAVEL DEPTH = 6.5' under pipe, 2" over pipe TRENCH LENGTH = 58' TRENCH WIDTH= 3' SOIL RATING= 0.8 GPD/ft2 BEDROOM CAPACITY= 4 SEPTIC TANK = 1250 Twenty-four (24) hours notice required for all inspections. \1997\00-003bspec ,r' g � Y3� rri�=;.o G`'�W' GINEfi ,:S F L) e �� 9ClM F'%=Slab�g2G?89�©B�''3 Jfi` "io0®S ® Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES �p•2�d 'v'.+'�OQo D90p0 oe 825 •'L•' Street, Anchorage, Alaska 99502-0650 4 Latus A.L ela 6736 o���,e SOILS LOG — PERCOLATION TEST '° ©°° PERFORMED FOR: 4 Nee,,a../+p- DATE PERFORMED: 5-10-60 LEGAL DESCRIPTION: Lof /A 8X 2 Fake Luke Township, Range, Section: ,�¢ T SLOPE SITE PLAN 1 / �op5o�l/oRga�tic 8>zown 2 0 -: SP Sandy �Aovel OARk bRown 3 G �, ~= ML silt layer 4 . • 6 sandy 9 Rave I 5 d. Liyhi goes/ 6- 7 d! a v�0 8 - 0 9 0 s' 10 G WAS GROUND WATER �O ENCOUNTERED? 11 0 S Q - IF YES, AT WHAT L S O DEPTH? p 12 O ; ; E Depth to Water After 7—'q v 13 , a , t Monitoring? � Date: S L � 14- 15- 16 415 is -G,- 17 18 19 Reading Date Gross Time Net Time �,, , Depth to Water Net Drop oq 5-10-00 1 112: LL7 30 '- + `F 'Y 1 1-5 301 `— 7/i4 it 13/q 20 UPERCOLATION RATE 6 a (minutes/inch) PERC HOLE DIAMETER 6 1 TEST RUN BETWEEN FT AND 7 FT COMMENTS PERFORMED BY: E • 51 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 00-003 Calculated By: LB Date: 5/18/00 Legal: Fire Lake Lot 1A Blk 2 Single Family 4 Bedroom Dwelling Deep Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = Percolation rate = Wastewater application rate = Required absorption area = Trench width (W) = Gravel depth (D) = TEST HOLE 1 600 gallons 6.2 minutes per inch 0.8 gallons per day per square foot 750 square feet 3 feet 6.5 feet Required length = Required absorption area / 2 / D Required length = 750 / 2 / 6.5 Required length = 58 feet Total Excavation Depth = 10.5 feet D ?� 49TH* y* ... LOUIS A. BUTERA_••� Q CE -6736 � AFF''••..........-• ��� �04� � PROFESS\ONPo� 00-003cal 2:13 PM5/18/00 DOha McI:EhIEIE REAL EST. TEL:9017-6�6-6900 Apr 02,96 8=43 No.001 P.02 we col %ANS • �%------------- p 3 471 ,- ,fes � 6' U 41 f Iri ao cly Q 3 F ��+4r-•3r,'aA65fj;�r>�or,®a�soen+ieao a9�Lsr 03 �@'Ct�ca ao o°9ao-PrTSoa � "Loids A. Buterk o % CE -6736 ir�t3 v - m r ASBUILT-NO C HERS SET THIS DATE. SEWARD Er ASSOCIATES LAND SURVEYING 688-4 6 I HI;,REBY CERTI THAT I HAVE SURVEYED THE SCALE, FOLLOWING DES IMO PROPERTY= + Of At s♦ Fire Lake,Alas SuM. Lat -.TX Zlk 2 DATF= r Q .•• S',�, 4 AND THAT NC EN73 EXIST EVI" AS 4-16-91 s INDICATIM IT I THE RESPOWBILITY OF THE � •`,':4-9LH : t r• ••. r ■ . •a. U4VN>t TO DETER INE THE EXiSTE>;1GE OF ANY GRIDS .•.e•r EA EMENTS, COV OR RESTRIC CNS NW 453 A ..� WHM" DO NOT ON TWE RECORDED SUSDI- ilg :• w.A. t s.w..a ; VISION PIAT, IER NO CIRCt*=MCEs SHOLLD FB' ¢r -•,� GiYd91 e s AW DATA H 8E t1SED CONSTRUCTION I9-61 t%lip •... ' OF FENCE LINES, OR FOR MA48WSHING WJND- AR'l E_r�tES. .. pRaWN� itxg•R,.+•~ _ Eagle River Engineering Services Louis Butera, P.E., R.L.S. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 www.eagleriverengineering.com February 22, 2000 Dan Roth Civil Engineer DHHS - MOA RE: Lot I Block 2, Fire Lake Subdv. Dear Mr. Roth, We are applying for a conditional approval for the above lot. The septic system failed adequacy testing due to being in a surcharged condition. There is no immediate health danger or surfacing effluent as evidenced by the ability of the system to absorb 600 gallons during the test. We are requesting a conditional due to frozen ground and winter conditions. The 1984 soil log for this lot shows a sandy gravel (GP) to 12' with no water table encountered. From our experience in the area the soil is a sandy gravel and there is no seasonal water table. We have designed based on a 16' test hole with no water however there is enough reserve area in the north section of the lot to design a bed system if needed. The design assumptions for this conditional permit will be confirmed by a test hole, percolation test and ground water monitor prior to construction. We have instructed the Realtor that an escrow will be made from 3 bids with 1.5 times to cover the cost and held with the mortgage company for completion. We will .be. involved. in the permitting and construction this May. We had obtained the prior health approval for this lot in 1996. If I can be of further assistance please do not hesitate to call. Sincerely, Lou Butera, PE �1AR p 3 2000 1,1�Y OF pivLHv�'`C'E M oN!*IVMTP.I SERVICES p,V�� DON McKEtIZIE REAL EST. TEL:909-696-6900 Apr 02.96 8=48 No.001 P.02 /tea Y" O w T,,1::. /Y39 p��/ r.7c7,14i�v ��a . oQ • .. .. q 7415-q , P '61 .1 s S•i/F = 60o 6,-4 J. _ col vj As9�c000�a. aoa CE -67M e?• H °en®9n P -2 _ a t32 Ca.B �' OA �/ 6 = a sr no9 ,mss•. z .:� Sn /v y l� �,,oz . ,rc.+.�Y s�s►�V ASBUILT-NO C HERS SET THIS DATE. SENARD & ASSOCIATES LAID S"YF'Yil k' 6 7� 6 I HEREBY CERTI THAT I HAVE SURVEYED THE. 1"'90' 6 7 • �1 10 40 Fire Laka,Alas AND THAT NO Subd.,Lot'rA.-Bli 2 ENTS'EXIST l En AS DATEt 4-16-91 ri ' o . ;:;A, Y/ 6 = a sr no9 ,mss•. z .:� Sn /v y l� �,,oz . ,rc.+.�Y s�s►�V ASBUILT-NO C HERS SET THIS DATE. SENARD & ASSOCIATES LAID S"YF'Yil k' 6 7� 6 I HEREBY CERTI THAT I HAVE SURVEYED THE. 1"'90' 6 7 FOLLOWING DES IBM PROPERTYt +� Q� ���•s Fire Laka,Alas AND THAT NO Subd.,Lot'rA.-Bli 2 ENTS'EXIST l En AS DATEt 4-16-91 Q ;••'••..•,••"9S♦4 INDICATO. IT i , THE RESPONSIBILITY OF THE. . ;:;A, OWNER TO DETER INE TI•IE 003TENCE OF ANY GRIDS J�EASEMENTS, *vjll'I3--;d COV OR REMCMONS NW 453 WHIW DO NOT ON THE REQ SMI- NO GIRCW37ANCES SHOED RD' as'•a,..,;VISION � HAT. CR 19-61 .. ANY DATA 8EUSED FOA CONSTRUCTION BOUND- i�.y�;•:;•:;•,. OF FENCE LINES, OR FOR E3 JkKISHING Eagle River Engineering Services Louis Butera, P.E., R.L.S. P.O. Box 773294 Eagle River, AK 99577-3294 February 22, 2000 Dan Roth Civil Engineer DHHS - MOA RE: Lot I Block 2, Fire Lake Subdv. Dear Mr. Roth, (907) 694-5195 tel www.eagleriverengincering.com We are applying for a conditional approval for the above lot. The septic system failed adequacy testing due to being in a surcharged condition. There is no immediate health danger or surfacing effluent as evidenced by the ability of the system to absorb 600 gallons during the test. We are requesting a conditional due to frozen ground and winter conditions. An escrow will be made to cover the cost as estimated by myself and we will be involved in the permitting and construction this May. We had obtained the prior health approval for this lot in 1996. If I can be of further assistance please do not hesitate to call. Sincerely, Lou Butera ._____/~l--~%~ MUNICIPALITY OF ANCHORAGE ~'"~ ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENV,RONMENTAL ENG,NEER,N D,V,,',ON ©:;/- 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~ UPGRADE LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS ~g ~ufoctur~d:N: /~ M~ /" No. ofco~rtments Liq~n~l°ns IF HOMEMADE: inside length,. Width _ Liquid depth .~ ' DISTANCE TO: WellV/.~veIli~ PERMITNO. O Z ~ Manufacturer - J Material Liquid capacity in gallons ¢ Well ~ Fou~datZ~ , NearesF~ne DISTANCE TO: (~ ~--/ i ' ~ /~O ¢ lentil.es Trench ~th ~ ~.~ [ ~ "o. S Len~tl~Ze"':l'l~'e/~ 713 /~'9 ~ Total ,~O 'inches Distance betw~in~ ;[I ~ Top of tile tofinish grad~ ¢ / Material beneath til~ .... ~ t¢inches, Total~~ef ctive or ti~ Length Width Depth PERMIT NO. ,--<~ Typeofcrib Crib diameter Cribdep~// Total effective absorption area ~ Well Buildin~u Nearest lot line ~ DISTANCE TO: ~ ~ ~/~,~ ~ Depth Driller Distance to lot line PERMIT NO. ~ ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER SOl L I INSTALL~ APPROVE~ O ~ t~ E:'IGINEERINR DATE , /~EGAL/// ~ ¢' ~ ~) ~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION S,.5 L STREET~ ANCHORAGE, AK 99501 264-4720 ON .... S ! T'E PERMIT NO: 840515 DATE ISSUED: 06/27/84 APPLICANT: ADDRESS: CON PA{.,? PHONE: DON SLAUGHTER SR 42 MALASPtNA EAGLE RIVER~ AK 99577 688-5542 LEGAL DESCRIP: LO]' SIZE: MAX BEDROGMS: SUBDIVISION:~ FIRELAK£ AK. SECTION: 56 TOWNSHIP: 55000 (SD.FT. OR ACRES) LOT: lA BLOCK: 2 15N RANGE: 2W Listed below are the options available to you in designing your septic system. Choose the option that best ~its your site~ 'TRENCJ| BE;D W. DRY'IN DEPTH TO PIPE BOTTOM (FT.) 5.0 6.0 5.0 8RAVEL DEPTH (Fl'.) ~.0 0.5 TOTAL DEPTH (FT.) 8.0 6.5 8.0 GRAVEL WIDTH <FT.) 2.5 20.0 5.0 GRAVEL LENGTH (FT.) 84.0 ** 58.0 5~.0 GRAVEL VOLLJME (CU.YDS.) ~7.2 28.1 58.2 TANK SIZE (GALS) 1~250.0 ** 1,250.0 ** 1,250.0 SOIL RATING (SQ. FT./BR) 125 1~5 :[25 ** GRAVEL LENGTH > 75 FT. REQUIRES MIJLTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I c~erti~y that: 1. I am Camiliar with the requirements for on-site sewe.rs and wells as set forth by the Municipality o~ Anchorage (MOA) arid the State o~' Alaska. 2. I wJ. ll install the ,system in accordance with all MOA codes and regulations, and in complianc, m with the design criteria o~ this; permit. 5. I will adhere'to all MOA and State of Alaska require~ts ~or the ~et back distances eros any existing well, wamtewater disposal system op public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a m~ximum o~ 4 bedrooms; and m~y enlargement will r~equire an additional permit. IF A LIFT STATION IS I~LLED IN AN AR~A COVERED BY MOA BUII_DIN6 CODES, THEN (1) AN~IOA~ PER~T AND INBPEOTION MUST'~ BE OBTainED; (2) AS-BUlL, TS WILL NOT ~APPROV~ ~ITHOUT~N ELE~ INSPECTION REFORT~'AND (J) THE EL~CTRIC~ ~RK ~Sl B~DO~Y A ~ICENSED)ELECTRICI~. ' SIGNED ~ ( / ~ /~~ / DATE, ~/~/~ APP,_ I CAN]~DON ~~~ / / MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99§01 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 -- 6 7 8 9 Z_o ' IR SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19- 2O COMMENTS PERFORMED BY: WAS GROUND WATER ~ SL ENCOUNTERED? O P E IF YES, ATWHAT DEPTH? 72-008 (6/79) Gross Net Depth to Net Reading Date Time Time Water Drop / PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) __ FT CEJ ty q/°gy��• """""""""IIS ' ' : /�+p; �:q meq: pq: yq: : � : � : : }.L: °�, � {per: R9 : j ¢ `M • T"""': wit 3� 1 Yid �Y �t lea9 ume b� b�+t �i AnHi 001. i� � � �/ MSH � .. • .. �.P �•+ c+��� _ e,,,,. .. � ,�f � Q LL.. (� 'pmgd p® �ppxi�a bpf,�✓ m�m�Jd baagd �µd�1 � `y��y 4�uie 4yc�d Sema/ pVd IIQ ' "•wer `•• Zd ["'^ i'� � •^�yy�q o[_���{}S `W bd (Mi�+A ft.�1 WaW rW.d WW t.�t msi 4dW G� An�f � /� lsuW ktm.Eq /W�b9 t� imd rb�1 #� rb_L0 �"W 6r..40 M+M {�A•%. M1� �.` `�`}} W 1111°4• m Jp < r i ui LL J : y. tel: 6T. G�. 6�m f�&a L&n iia T6.a LO q ry . fZ. dna 47) 0a: ® z (0: t ��..yytqq • : {��, K'"' rhud C^ 0 L'�' C0 C" [0 ['e' [0 t'^ 0 b d�w,` (0 C"" C"' `ami i'md (0 ['^ mi $9 1'C: t �N LLuu L' "'"""��"���• C!) ; S,&a f T Sid Gzm G�dT 6&a 6iG� 43.a v i LU Fr C0 LLJr- -a `�wde 4pwp ®e 4,sg� ipu�/bWl iqw�✓ pWb�psq�d'�Ky •b�if .®/ rn®J p®� qM.�` EAGLE RIVER, ALASKA 338-5312 JOE GIELAROWSKI DRILLING CO. LIFETIME ALASKAN SERVING ALASKA PO BOX 772847, EAGLE RIVER, ALASKA 99577 OWNER OF LAND ......... ~=,.---; ........... -' ...................................................... ADDRESS ......... :- .................. ':-."-"----'-~ .......................................................... WELL - SITE ........... ~.--:, ....... '.,a,:;a.. 'L....;..:o.-::~;~.;:::...,;d. .......................... DATE - STARTED ........ ~.:':..~:.~: ................................................................... DATE - ENDED ............ .~::......'..::::'. ............................................................... DEPTH OF WELL ....................................................................................... STATIC LEVEL OF WATER FY ................................................................. DRAW DOWN FY ...... :; .......... :- .................................................................... GALS. PER HR ........................................................................................... KIND OF CASING ...... '...-~ .............................................................. KIND OF FORMATION: FROM ...................... FT. TO .......... ~ ........... FT ........ ~,:~.~.::..-~/.:~:~ ...... FROM .....................FT. TO .......... ~'.-i.'. ........ FY....~!':-.~-:~...::.~i:."i':!.~:¢.L~': ..... FROM ........ ~:.~ .......... FY. TO .........::.;i ........ FI' ........ ~.~.~..: ................... FROM ...................... FT. TO .......... --2 ......... FT...~.:.z.~ ...... '.~:.~z..'~£.Z..,:.. FROM ...................... FT. TO ...................... FY .................................... FROM ...................... FY. TO ...................... FT .................................... FROM ...................... FY. TO ...................... FY .................................... FROM ...................... FY. TO ...................... FY .................................... FROM ...................... FY. TO ...................... FY .................................... FROM ........... : .......... FT. TO ...................... FY .................................... FROM ...................... FT. TO ...................... FY .................................... FROM ...................... FT. TO ...................... FY .................................... FROM ....................... FY. TO ....................... FT .................................. FROM ....................... FT. TO ........................ 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INFORMATION: DRILLER'S NAME ................................................................................................................... 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.# 051-361-15 1. GENERAL INFORMATION. Complete legal description Fire Lake Lot lA, Block 2 Location (site address or directions) 13930 Malaspina Drive, Eagle River Proper~y owner Victoria Childers Day phone Mailing address 13930 M~l~qp4n~ D~iv¢: ~gl~ Riv,~.r. AK 99.577 Lending agency N/A Day phone Mailing address 696-2173 Agent Don McKenzie R.E./Lola Pederson Day phone Address 13135 Old Glenn Hwy., Eagle River, AK 99577 694-9035 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 ~ TYPE OF WATER SUPPLY: Individual well ;~ 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 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 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 Eagle River Engineering Services Phone 694-5195 Address P.O. Box 773294. Eaqle River. AK 99577 Engineer's signature ~~ Date DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: By: Additi,onal Comments Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suqqested that a periodic testing be performed to insure the wells continued suitability. Nitrate concentration is 6.39 mg/1. EPA m~timllm ~nnn~nt-maf_ion is 10.0. rog/l, ~~/~- ,~ Date~-2~-~ 'f-'%'Ji['i; The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA F21 Municipality of Anchorage _ DEPARTMENTOF HEALTH & HUMAN SERVlC E C Environmental Services Division 825"L' Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth Sanitarr seal (Y/N). Date of test Static water level Well production Health Authority Approval Checklist /.-4/,'£ ~oF/,,4, 8L/d_ 7_._ ?arcel LD.: 05 / -$ ~ I IfA, B, or C, attach ADEC letter. ADEC water system number ./V/~ FROM WELL LOG Date completed Cased to ~/' Casing height (above ground) //~.~ ]/~'5 Wires properly protected (Y/N) AT INSPECTION zCu' /~) g.p.m. ~;, 7 Nitrate ~p. _~(fiJ'v/~/Z_.. Other bacteria "~ Collected by: WATER SAMPLE RESULTS: Coliform Date of sample: S. SEPTIC/NOtd~ TANK DATA Date installed /~-/~/'/ Foundation cleanout (Y/N) Date ofPumping / c. A som,,nos toLD DATA Date installed / ~,/~ g.p.m. Soil rating (~ or fl%drm) / Z- ~ System type Length ~ Z~/ Width ,.~ Gravel thickness below pipe .,.ff / Total depth Effective absorption area ~) i~ Monitoring Tube present(YfN) Y~Depression over field (YfN) ,/~/~) Date of adequacy test Fluid depth in absorption field before test (in.); ~[~ Fluiddepth ]0 (ins.) Minutes later: ~ Peroxide treatment (past 12 months) (Y/NJ /'V/~ Immediately after ~15' gal. water added (in.): Absorption rate = ~ 6'0o g.p.d. If yes, give date Tank size /500 Number of Compartments ~-~ Cleanouts (Y/N) Depression (Y/N) /A/O High water alarm (Y/N3 D. LIeF STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons ~  "Pump off' level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/&e!~ng tank on lot 7t/0(9 / Absorption field on lot ~/00 t Public sewer main ix/lA Sewer/s~i~c service line ~/~ 3100/ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout ,&///4 Lift station ~///Jr SEPARATION DISTANCES FROM SEPTIC/HOL=I~NG TANK ON LOT TO: Building foundation (,.o I Property line /'- ~-~ ' Absorption field Water medrdservice line ~ Surface water/drainage. ~-//)0 ' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPI~ON FIELD ON LOT TO: Building foundation Surface water Curtain drain F. ENGINEER'S CERTIFICATION Property Line /_t-~/D ' Water maia/service line Driveway, parking/vehicle storage area 3o/~ tc Wells on adjacent lots I certify that I have determined thru field inspections and review of Municipal re~ords in conformance with MOA HAA guidelines in effect on this date. Signature ~ Engineer's Name Date ?// °cC'/~' 6 Date 0f Payment Receipt Number /Ti'7-t9 f~/)¢~///), Waiver Fee $ Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc 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, Cf CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot IA; Block 2: Fire Lake AlasEa Location (site address or directions) 13930 McJ. ispirm D~.v¢ Property owner Mailing address Lending agency Mailing address A_H.F.~. #78755 520 East 34th AvenL~e Anchorage. Day phone Alaska 99503 Day phone 561-1900 Agent Sharon Minsch RE/MAX OF EAGLE RIVER Day phone 694-4¢00 Address 16600 Centerfi61d Drive Eagle Riv6r, Alaska 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: XX Public water 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 NOTE: XX Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 S & S F:NGINEERING Add ress 17()3~ ~:a~la R i var Loop R~.~ ~ ~ Eagle River, Alaska 9957Z, Engineer's signature Phone DHHS SIGNATURE Approved for ¢ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: By: AdditionalComments Note: The well for thin property State and Municipal Codes. There are nitrates present. It is --== ........... ~- .............. ~ ~ ~ ....................... ~'clls continued suitability. Nitrate concentration is 6.3 mg/1. EPA 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 professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ¢1 ~--~--- ~,~ Parcel I.D. Legal Description: ~-.~'¢ A. WELL DATA If A, B, or C, attach ADEC letter. Date completed Cased to ~ I ~ ADEC water system number ~-".,-7.,, ~ ~ Driller Casing height Wires properly protected (~)'N) Well type Log present ~N) Total depth {~ I ~ Sanitary seal ~)'N) Date of test Static water level Well flow Pump level FROM WELL LOG g.p.m. AT INSPECTION MUNICIPALI IY OF ANCHC)I~AGE ENVIRONMENTAL SLRVICFS I)JVISiOhI [,, o .... 1992 EIVED Absorption field on lot Public sewer main Sewer service line SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Ic~ ~ ~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout ~'~, Petroleum tank WATER SAMPLE RESULTS: Coliform ~ C~/~3 ~..[. Nitrate Date of sample: '~ '~'~-~-" '~1 ~ Collected by: Other bacteria /~.o ~ ~ 17034 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Date installed \~'- ~"/~-gz{ Cleanouts ~/N) ? Tank size ~,~ C:) O ~ Foundation cleanout ~VN) V Eagle River, Alaska 99577 Compartments ~ Depression (Y~ High water alarm (Y~) ~ Alarm tested (Y/N) te of pumping ~(' ~ -' ~,1::) ¢ ~ ~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ c~o ~ e-- On adjacent lots ~ o o k ~r Foundation To property line IQ ~¥ ~- I Surface water/drainage Absorption field 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) High water alarm level Meets MOA electrical co~~~~'~ SEP~~d~ANCE FROM LIFT STATION TO: Wetron lot On adjacent lots Manufacturer Manhole/Access (Y/N) ~ "Pump on" level at ~' level at -~~-CCycles tested Surface water D. ABSORPTION FIELD DATA Date installed Length ~'~- ~ Width Total absorption area ~'~ ~ Depression over field (Y,~ R esu I t~;~fail) ~?~-~ "~ Peroxide treatment (past 12 months) Soil rating \7.-~' ~'/("~,~.-- System type Gravel thickness "~ Total depth Cleanouts present (~ZN) Date of adequacy test '~ - for ~'c~Iz'' //-~ ~,1~ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I. oc=, ~' ~ On adjacent lots ~. c,c, To building foundation "~'~-~ To existing or abandoned system on lot On adjacent lots '~c~ I~ Cutbank Water main/service line Surface water ~ ~ c~ ~ z-- Driveway, parking/vehicle storage area Curtain drain ~-~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. .... 770~4 Signature ~nglneer s Name ~ Date ~ / ~ HAA Fee $ / ~ o~ Waiver Fee: $ Date of Payment ~ "~ ' ~',~ Date of Payment Receipt Number ~ '~ ~ Receipt Number 72-026 (Rev 3/91) Back MOA 21 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONmeNTAL HEALTH DEPARTMENT OF HEALTH A~,rD ENVIRONMENTAL PROTECTION APPLICATION FOR HF~LTH Ab"fHORITY APPROVAL CERTLFICATE I. General Information Location (address or directions) Applicants ~x~dresa-~; ./ -- 7~/~/ z%~ F// (e) Applicant is (eneeg one) ~ending Institution ~ ; ~er/builder~ ; Buyer ~ ; Other ~ (~plaln>; (d) Lending Insti=ution~'/~>: ~/Z~ ~~z'/ Telephone Ad.ss (e) Real Estate Co. & Agent _ Address (f) Telephone 2. T_avpe of Residence Single-Family.,~, Number of Bedrooms 3. W_3ter Supply Individual Well~ Multi-Family Other (describe) 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 D_is_~osal Onsite~ Public ~q Community L,'--~ Holding Tank ~ Note: If community well system, must have written confirmation from the State Department of Enviromnental Conservation attesting to the legality and status. [Page 1 of 2] Engineering 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 tTpe 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 Mmnicipal 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 /i~:[ Approved ~_~ Conditional ~..-bedrooms Disapproved Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ~IALTH AND ENVIRON-MENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASFD SOLELY UPON THE IiEPRESENT- 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 igNDING 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 TH~ PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/eJ/D18 [Page 2 of 2] 7-19-84 As MUNICIPALITY OF ANCHORAGE (MOA) HEALT~ AU~O~TY A~PROVAL (HAA) CHECKLIST - FEBRUARY 1984 WELL' DATA Well Classification Total Depth.. ~/' Cased to Static Water Level ~3~O ' Casing Height Above Ground 30 Elect=ical Wiring in Conduit ~/N) SeDa=ation Distancss f~cm Well: Dep=ession A~ound Wellhead NOI.ID]IO~d IYJ,N:IWNO~IIAN::I ~' HJ.1VJH 40 Legal Description: ~j~95~¥ ~V~N~N If A, B, C~ C, D.E.C. Depth of G~outing Sanitary Seal on Casing ~/N) To Septic/Holding Tank on Lot /~J- / ; On Adjoining Lots /&;o To Nea=est Edge of Absc~ptton Field on 5o~F~2~S"'.~-. ; On Adjoining Lots /~u To Nearest Public Se~r Line /<~ //~ To Nearest Public Sewer Wate~ Sable Test Results - ~-~ -~f J~ ~'~ 6 'r~/a % B. gEPTIC~ TANK DATA Date Installed /.2-/~o~' Size /O-'OO No. of Cc~,~a=tments Stan~i~s ~) Ai=-tight ~gs ~) Foun~tion C~eanout ~) ~ession o~ Ta~ (Y~) ~te ~st ~d ~ ~ ~ Holding Ta~ High-Wate= ~a~ (Y~) ~/~ ~=~ Holdi~ Tank ~t ~ation Distan~s ~ ~pti~olding Ta~: To Wate=-Supply ~11 /~J--' To ~ilding F~ndation TO P=operty Line _/~ '' " To Water Main/Service Line /63 f~ Course To Disposal Field _~'f To Stream, Pond, Lake, c~ Major D=ainage Com~nts [Page 1 of 2] Receipt % Date Paid: Amount: ~ 2-15-84 C. ABS~RFI~ON FIELD E~TA ' Soils Rating in Absorption St=ara Date .Installed /_~ -/=1 - 8 ~ Width of Field ~O" Square Feet of Absorption A=ea Depression ove= Field (Y~ Results of Last A~lequacy Test Separation Distance f~cm A~sc=ption Field: To Water-Supply Wsll /490 ~ ~ To P=operty Line Depth of Field Gravel Bed Thickness Stan ims Resent Date of Last bzlsquacy Test To Building Foundation Lot /j //~ ; On Adjoining Lots ~O ~ ~ To Water Main/Service Line /'dP ~ To Cutbank(if ~resent) To St~eam/Pond/Lake/c~ Major D=ainage Course ~ o /~J ~= To D~iveway, Parking Area, c~ Vehicle Stc=age A=ea ~<73 ~ To Existing or Abandoned System cn D. LIFT STATION Date Installed Size in Gallons "Pump On" Lavel at High Water Alarm Level at Tested for Electrical Codes(Y/N) Meets MOA ** ** Check Permitted Bedrocm Rating Against HAA Bequest I certify that I have checked, verified, or confcmTed to all on the date of this inspection. Signed Con. any KBl/d5/s Date MOA NO. [Page 2 of 2] MOA FAA Guidelines in effect ..*.,,,.'" ~.; l~ 2-15-84