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Home My WebLink AboutFOX HILL BLK 2 LT 9 MUNICIPALITY Of ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT J~ NEW /?,4-A/)/~/ ~_~d~ ,~/c~ d hf/vt/q/v' LEGAL DESCRIPTION LOCATION ~. ., ~ NO OF BEDROOMS ~ ~ I] z ~bsorptionarea I Dwelling ~ ~* ~ERMITNO. ~ ~ DISTANCE TO: I /¢g I /o' I ~>-.' __ ~ ~ Manufacturer ~ ~' Z~Z** Material_ ¢ No, of compartments ~ Liq. cai~cit,~ in~ gallons IF HOMEMADE :Inside length ,-~ Width ~ L qu d deptb~ ~ Ma~ct;~rETO:I % -- F- ~ ' I Material ~ Liquid capacity in gallons / ~ I Well I Foundation I Nearest lot line / PERMIT NO. ~ % I DISTANCE TO: I I / I / ~Z ]No. ofl,nes Length of each l,ne Tota lle~/~ Trench width l Dstancebetween i nes ~ F- I Top ot the to TmlSU grade I Material beneath tile / Total effective absorption area = ~ I inches / ~/ Length ... ~- Width I Depth . ] PERMIT NO. ~ , ~--, ---- ~ ~.~1 Type of cr~ Crib diameter I Crib depth Total effective absor~o~r~ ~ ~ ~] Well I I Building foundation ~ Newest lot line f ~ / ~,~,,c. To: /¢0 + ~,-*' ~ /0" ~ lC ass ~ Depth / Driller ~stance to lot line I PERMIT NO, ~ ~ DISTANCE TO Bui ding foundation I Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS P_ IPHONEI SOIL TEST RATING INSTALLER REMARKS HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPEOTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Ju~y 20, 1986 ROBERT A. SHAFER ~UNICIPALiJY Or: ^NCH~,~I~,~NGiNEER DEPT. OF HEALTH 8~ 694-2979 [!NVlRONMENTAL PROTECTION RECEIVED Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 ATTENTION: Susan Oswalt REFERENCE: Lot 9; Block 2; Fozhill Sub.vision An on-site wastewater disposal system was installed on the referenced property under permit ~840104 on August 11, 1984. Inspections were performed and are documented on an inspection report on file in our office. This report has not been submi~ed for record due to non-payment of ~?ociated with thework. ~B~ T A. SHAFER, P.E. RAS/ss SRB 196X EAGLE RIVER, ALASKA 99577 [.'EI:::'I:::IR-FNlii~:I",I"i' 01:::' H[iZF:IL..TH FIN[::' IZNVII4':Oi",IMEi]",FT'I:::IL I:::'I:~:'.OTtZCTIOI",I ',i!!',25 L.. :!i;TF~:[i:[::"l'., FII",ICHC'IF[:f:IGE., ]=11< :E~Ca!:~hZk:l.. 2 6 4. "' 0 ';* 2 8 I::!] ":! ,/:;": i,...' :: ,;]. COIgTI::IC T PF'tOI",I!E:: ~i; L .I B [:' I V I '..'3 1 0 !",1: F' 0 ;:':: H I I... L :!!;Iii:CT ! Ol",l: 4. TCII.,.INSF'I .'l: F': I.,.!CIOI;)CI_ t [::'1:::' B'i:,~'. I VE 21: E:L~OC:I< [, ]: F::' I::1 L. :[ F:'T .":i;Tl:::l]' :1: ON I S I I",IS"I'FII. J_E[:, I N I::ll",l F]Fi'.['~F:I COVli!:Fi:EI:::, !:3"r' I'"ICIFI E:I.J I L.[:, I tqG TH!Z]'.,I ,:: :1. ::, f::ll",! [!!:L..l!ii:('::"l"l:i~: I C:]=II_ F:'[!!:FU"I I T I:::ff',l[) I N:ii.:,l:::'[3]:T I ON MUST E:[ii: OE:'I"FI I Iq[::[:,.~ ,:: 2 ::, I:::I~';-.BIJ Z I_T'.i!i; 1.,.I ~ LL. NOT' [:~:E': I:::ff::=PFi:OV[iiJ:) 1.,.I I THOIJT I:::IN I:~i:I....ECTP. I CI'::IL. I I",I:~i;I::'ECT :[ 01'.,I F~i:lii:l:::'Ol'X'/l".= I=1['.,!1:) ':: ::~: .':' THE EI..E!:C'I"Fi:]:C:FIL. I,.101:;i:1< MUS'I" I!i!:l!i: [:,OlqE BV I:::1 L..II::[il]'.,t~!;l!:'[) ~') ' [" I:IT~E:: :i!!; :!: ~:!i N i!!: [:, ,~_~_~ ~...~.- ...~- . PERFORMED FOR: LEGAL DESCRIPTION: /--------~'-- ¢ 1 2 4 5 6 7 9 b~. SOILS LOG L] PERCOLATION TEST MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST .....cc- .:~/~ ,*J..:' ?'-; DATE PEREORMED:,-Z"--/ ?-- 10 11 12 13 14 15¸ 16- 17 18 19 20 COMMENTS PERFORMED BY: 72-008 (6/79) SLOPE f. IF YES, ATWHAT SITE PLAN Reading Date Gross Net Depth to Net Time 'rime Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT by DOC Co. dDa SULLIVAN WATER WELLS P.O. BO~272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND .~<~/.~ (,.d <'~.,,.d ADDRESS /o~ 7 c?/¥tr,. ~,q_~ ~,o E LEGAL DESCRIPTION Z' c~ ~, g~ _L;;~ DATE- Started a°/ ~'~ Ended _ PERMIT NUMBER ! iI DEPTH OF WELL STA'HC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR / ~J:;~1% K nD OE CASino. .... KIND OF FORMATION: From_ 0 Ft. to ~ Ft. From_ -,~ Ft. to 0°~ Ft. From_ ff Ft. to / '7 Ft. From Ft. to From I '7 From 7~Ft. to ~',~ From. ~'~" Ft. to_ tO / From. Ft. to Ft. From to t .Ft. to lSg"'Ft. From ./,~CFt. to lq/ Ft. From____Ft. to___Ft. From___Ft. to__FL From _Ft. to__Ft. From Ft. to Ft, From Ft. to Ft. From Ft. to_ Ft. From Ft. to Ft From ........ Ft. to __Ft. From Ft. to Ft. From ...... Ft. to_____Ft. Ft. ~ I/%-"-~i3 Ft. P/~'~ (~ /O/q,O From Ft. to Ft From Ft. to Ft. From ........ Ft. to__ Ft. From ......... Ft. to__Ft From Ft. to Ft ~"From ____ Ft. to From__Ft. to____Ft From Ft. to Ft From .... Ft. to__ From Ft. to___ From__ Ft. to_ __ From Ft. to From Ft. to From Ft. to_._ Ft FI Ft. {1~.. ~. ,'~ ~ Crlol~ Ft. RSCE/ _Ft VSD ! MISCL. 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1, GENERAL INFORMATION Complete legal description Lot 9; Block 2; Fox Hill Subdivision; Location (site address or directions) 21616 Wood~i~f Drive Property owner _ Mailing address Lending agency Mailing address Agent Address ~ohn Woodard Day phone 276-2412 Day phone Day phone. Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 ~ 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. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEO attesting to the legality and status of system. " --- 72-025 (Rev. 1/91) Front MOA ~21 STATEMENT OF INSPECTION BY ENGINEER ¢ As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/orwastewaterdisposalsystem issafe, functionaland adequate for the number of bedrooms and type of structure indicated herein. I furtherverifythat 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. Approved for ~ Disapproved. Conditional approval for Name of Firm Address Engineer's signature DHHS SIGNATURE $ & $ ENGINEERING 17034 Eagle River Loop Roa~ No, 204 Eagle River, Alaska 99577 Phone Date bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS 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 omi'ssions in the professional engineer's work. 72-025 (Re'.'. 1/91 ) Back MOA ~Y21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~--c, 1" ~'~ ~.~,z.._ % ~'f.p¢. ~-~¢,~4..-';grcel I.D. A. WELL DATA Well type ~:;~¢,~k.l/~l-Cz~ Log present ~)'N) Total depth Sanitary seal ~.Y..~N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~ ~ ~ Driller Cased to ¢¢[' ~ ~ '~ Casing height Wires properly protected (~N) FROM WELL LOG Date of test Static water level Well flow Pump level g.p.m. AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate 0,~'~ / "~"~ ~ ~' ~' Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~- \\-'%~ Other bacteria I~I~ S & $ I~NGINEERING 1703~ Ea~tie ~iver Loop Cleanouts ~/N) High water alarm Date of pumping Tank size \ oO (~ O~'~-- Compartments '~' Foundation cleanout ~/N) ~ Depression (Y~) Alarm tested (Y/N) Pumper :~'.~-. ~¢..c.~.~ Poo ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \0~ \ To property line ~.o Surface water/drainage On adjacent lots Absorption field \ t~o \'~- Foundation \ ¢ ~ .Water main/service line 72 026 (Rev 7/91) Fronl CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at Meets MOA electrical codesCf. Y~'?~ SE~ROM LIFT STATION TO: W~II on lot On adjacent lots Manufacturer Manhole/Access (Y/N) ~) off" level at Surface water D. ABSORPTION FIELD DATA Date installed ~ "\\ -~'-~'~ Length '~ ~ Width ~.'l...3 Total absorption area ~ (¢, 1~ Depression over field (Y/~) ~ Results4~/fail) I¢~>~ Peroxide treatment (past 12 months) (Y~.7.~) -- Soil rating Gravel thickness Cleanouts present.N) _ _ Date of adequacy test for ~¢~.- ¢-~J~'J ~ If yes, give date System type _~6¢-~)~-~¢~ ~ Total depth ~ ~ bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots "~-2 P \~ Surface water ~,0o \ '~' Curtain drain On adjacent lots \oo \'~ Property line_ To existing or abandoned system on lot Cutbank ~//~. Water main/service line Driveway, parking/vehicle storage area 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. Signature Engineer's Name Date S & S ENGINEERING 17'034 Eagle River Loop Roac~ No. 2~ ;~agie River, ~das~<a 9Y577 ','~AF~fl 2 HAAFee$ / 7C~ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 [3 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE ~ 51965 Chemlab Ref.~ 92.1013 Sample $ 3 Matrix: WATER Client Sample ID : L9 B2 FOX IllLL S/D PWSID : UA Collected : MAR 16 92 @ 10:30 hrs. Received : MAR 17 92 @ 15:15 hrs. Preserved with : AS REQUIRED Client Name :S & S ENGINEERING Client Acer :SNSENGP BPO{ : Req~ : Ordarod By :R. S]{AFER PO# :NONE RECEIVED Analysis Completed : MAR 18 92 Send Reports to: 1)8 & S ENGINEERING Parameter Results Units Method Allowable Limits NITRATE-N 0.58 mR/1 EPA 353.2 10 Sample ROUTINE SABLE COLLECTED BY: Romarke: 1 Tests Performed ' Soo Special Inetructlone Above UA-Unavailable ND- None Detected "See Sample Remarks Above NA- Not Analyzed LT-Lees Than, OT-Groatez Than Member Of the SGS Group <SocibtO Gbn~rale de Surveillance) 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 September 26, 1986 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 9; Block 2; Foxhill Subdivision Location (address or directions) Applicant Name Bt'ucc Phau Telephone: Home Business ?86-6364 Applicant Address United Bank of Alaska (b) (c) Applicant is (check one): Lending Institution IXI; Owner/builder []; Buyer []; Other [] (explain); __ (d) Lending Institution United Bank of Ai~ ;;,,_~. Telephone Address 440 East 36th Avenue, Anchoraqe, Alaska (e) Real Estate Company and Agent none Address 786-6364 99503 Telephone ; D (f) ~4~the HAAtothefollowingaddress: S & S Engineering SRB 196X Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family ~ Multi-Fam~Lq~/__! Other Number of Bedrooms ~.~ 3. WATER SUPPLY Individual Well I~ Community [] Public [] 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 SEWAGE DISPOSAL. Onsite .~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (~ 1/84) ENGINEERING FIRM PROVID~,,,G INSPECTIONS, TESTS, FILE SEARCH, b~ FA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that rny 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 s~stem is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspeofi~t~.$ ENGIN~EEIIN6 Name of Firm 5~ J~ ~ 9~X Telephone ~; ~ r~?_.,¢ ~ ~ Address F~O~.E ~V~ A~( 9~7' Approved for ~."~/~¢'~.~_~--Idedrooms by -~ E~- . o.~- /~ ~ , ~, . Approved ~~ Di~spprov~d Gonditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approvai 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 cond,~ct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for error~ or omissions in the professional engineer's work. Page 2 of 2 72~025 (11/84} ENVIRONMENT^L PROTECTION WELL DATA MUNICIPALITY OF ANCHORAGE (MO...,/ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~ ~,~ OCT RECEIVED ~'/~5' x.J .,~ ,,~ 1/..-) Casing Height Above Ground Electrical Wiring in Condui~'~'~N) Separation Distances from Well: Well Classification ,,¢,/,~/(../~,/L;_ If A, B, C, I'),E.C, Approved (Y/N) Well Log Present~'~.N~ ___ Date Completed _ (~/~ ¢ Yield ..¢~-X('(-~/'5"' Total Depth /~ /'~ / Cased to /¢ / Depth of Grouting Static Water Level ~ ~¢¢¢' ' Pump Set At /'~ "/'/" Sanitary Seal on Casin~'-~/N) Depression Around Wellhead (Y(/N)) To Septic/~ Tank on Lot /¢~'~) ¢' ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot //¢9z'1 lC" ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole /¢//~ To Nearest Sewer Service Line on Water Sample Collected by ~'"~ ,-~ ~/?/-4:~//'/.~C/'////I.~.1 ;Date Water Sample Test Results Comments /(.~'~(ff' '/¢'~:~4-''/ ~'~'~'C¢'¢-~._)- ~ ,,.5-- // B. SEPTIC/HOLDING TANK DATA Date Installed ~/~// Standpipes ON) / Depression over Tank (Y(N~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~//~ Separation Distances from Septic/~ Tank: To Water-Supply Well __ TO Property Line /.~ To Water~/Service Line Size //0~0 NO. of Compartments ~ Air-tight CapsON) Foundation Cleanol~t(~) Course Date Last Pumped ,,¢~/~&.¢..,)' '/') /'~ ;for Temporary Holding Tank Permit (Y/N) _ To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA / / SoilS Rating in Absorption Strata Date Installed '~ Width of Field Square Feet of Absorption Area Depression over Field (Y~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ?-- c--- Lot /12 To Water ~'.i~-~/Service Line /6) -./- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ,/"¢~ , ~ / Type of System Design Length of Field Depth of Field _ Gravel Bed Thickness Standpipes Present ~__,,)N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ,~c) To Cutbank (if present) /L) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) / "Pump Off" Level at ]~ Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments Page 2 of 2 72-026 {11/84) ** Check Permitted Bedroom Rating Against HAA Request ** I certify t h~at~ h'Sa~'e~e~,?¢~ ~1~, or conformed to all MQA and HAA guidelines in effect on the date of this inspection. SE B Signed ~GLE RIVER, AK 995. MOA No, ~~O~ Company __~¢~~_ .~, Receipt Amount: $