No preview available
HomeMy WebLinkAboutFINCH LT 2AFinch Lot 2A #050-211-84 q • Z 0 Lni a%: qq 44: 00 ca ca -Ht : v Pat0: Pat 0%1 O: 0; i it 0 N LJ 3: 0 Ic Q >; i oi h; "1 0: 4-4 : ra: W: wt rrj z (A. �4 4i '4i• Wj to u t to: C,4 0 0 u Bit :s! z Lni a%: qq .L t. t, 89L 2 P, RECEIVED or -T 2 01993 mu an rSrvlcsf C)ept. Health& HUM 1 u1 ui wl U::"S Petu 0 ! : 4j; r4 (AS 0. u p cr\ 00; 00: f, i m C4: rl: QN; �: r,: co; oo: r,: t-. M: --T: 'T i Wit V) i iz X WE 0 0 w a°' 0 0 9 9 w m m P°C POG a04 P°G k. R. 4. W LL, U. w (14 U. LU 44: -Ht : v Pat0: Pat 0%1 O: 0; i 0 LJ 3: O Q .L t. t, 89L 2 P, RECEIVED or -T 2 01993 mu an rSrvlcsf C)ept. Health& HUM 1 u1 ui wl U::"S Petu 0 ! : 4j; r4 (AS 0. u p cr\ 00; 00: f, i m C4: rl: QN; �: r,: co; oo: r,: t-. M: --T: 'T i Wit V) i iz X WE 0 0 w a°' 0 0 9 9 w m m P°C POG a04 P°G k. R. 4. W LL, U. w (14 U. LU ONiiixaa SWO1711M AUf >; i oi h; "1 0: : ra: W: wt rrj z (A. �4 i '4i• Wj to u t u w w 0 oi co: :s! .0; 41 to; A: 10 FA: w n! c,4 i 03 r; N m F': 17c. 00 cn: a0 C rte: 00, 00 0 o 0 0 0 0 0 (t4' [IL'. Ni Oji 00 Ln rn a0: r, N! co i C-4 00: C14 M t ow a ix Ad 94 9d 04 ONiiixaa SWO1711M AUf PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW930319 DATE ISSUED: 8/24/93 DESIGN ENGINEER:DUMMY COMPANY EXPIRATION DATE: 8/24/94 OWNER NAME:FINCH LOUIS H & OWNER ADDRESS:10609 HIGH BLUFF DR EAGLE RIVER AK 99577 PARCEL ID:05021184 LEGAL DESCRIPTION: FINCH LT 2A LOT SIZE: 15211 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM 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 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE: ISSUED BY: JOI-N SiMc77� DATE: Z r 7w f'3 ' w �- i leo �7 v` Lo)e', z F 1 i Im W ro.J w �- i leo �7 v` Lo)e', �T ro.J Municipality of Anchorage O�dy ate( O Development Services Department -_ — / Building Safety Division " On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 9951945650 www.cf.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 050-.,m-84 HAA# o5n506 1. GENERAL INFORMATION Expiration Date: /— q-06 Complete legal description FINCH SUBDMSION: LOT 2A, Location (site address or directions) 10727 HIGH BLUFF DRIVE • EAGLE RIVER, AK 99577 Current Property owner(s) CAROUNE LANGDON/RUMANNE WISNIEWSKI Day phone 622-2922 Mailing address 10727 HIGH BLUFF DRIVE • EAGLE RNER AK 99577 Lending agency Day phone Mailing address Real Estate Agent TIM RITTAL w/ REMAX Day phone 248-2249 Mailing address 2600 CORDOVA • ANCHORAGE, AK 99503 Unless otherwise requested, NAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer 0 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) 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 (les and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lest, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. Those conditions are outside the control of the evaluator of the system. Satisfactory lest results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE _/ Approved for -3 bedrooms. Disapproved. Phone 337-6179 Date /off Conditional approval for bedrooms, with the following stipulations: Attachments: / HAA Checklisty Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other • 4 ' ON-SITE WASTEWATER By: �j'/&/ Original Certificate Date: - y s (Rw. 17101) Municipality of Anchorage ,y Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw, St. P.O. Box 198850 Anchorage. AK 995198650 www.ci.anchorage.sk.us (907)343.79W HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: FINCH SUBDIVISION* LOT 2A, Parcel ID: 0 S' 0 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 9/30/1993 Sanitary seal (Y/N) YES Total depth 630 ft. Cased to 287 ft. FROM WELL LOG Date of test 9/30/1993 Static water level 274 ft. Well production 0.47 g,p.m. WATER SAMPLE RESULTS: Coliform "& oolonies/100 ml. Arsenic: N/A mg./L. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Well Log (YM) YES _ Wires properly protected (Y/N) YES Casing height (above ground) 18+ in. AT INSPECTION 9/22/2005 312 ft. 0.34 g.p.m. Nitrate L' 2b mglL. Other bacteria colonies1100 mi. Date of sample: 9/22/2005 Colleted by: _ GEG. LtD. PUBLIC SEWER Date krsta Tank size gal. Number of Foundation cleanout (Y/NI Cleanouts (Y/N) over tank (Y/N) _ High water alarm (Y/N) uang Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d.fft'or ft%Wffn) _ System type Length ft. Width ft. G Blow pipe ft. Total depth ft. Elf. absorption area— ft Mon' ube _ Depression over field Date of adequacy test (Pass/Fall) For bedrooms Fluid depth in absorption fieldbotorer st _ in. Water added _gal. New depth _in. Elapsed Time: n. Final fluid depth _ In. Absorption rate >= g.p.d. uvenation treatment (past 12 mo.) (YM & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/' "Pump on" level at _in. "Pump ofP _ n. High water alarm level at in. Datu Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots 100'+ Absorption field on tot N/A On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: PUBLIC SENDER Building foundation Property line raid Water main eine Suffice water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water service line F. COMMENTS G. ENGINEER'S CERTIFICATION Building foundation-- S oundation S Driveway, parking/vehicle storage Wails on adjacent lots I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date!"�+ HAA Fee $ 1430 Date of Payment 9 Receipt Number 7y�3KYl— (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Nater Well Advisory Health Authority Approval # 050505 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block , Lot 2A of Finch subdivision, the well's productivity was determined to be 0.34 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. I LAJ a Q 7 [ Air �Ia Saga= N I� I�� I �Bm s YY�a3�Zas�fei2YYE�t`�yl<�4 3 09-30-05;16:12 ; SCS Rcf.# 1056268001 Client Name Garness Engineering Group, Ltd. Project Name/k Finch Lot 2A Client Samplc ID Finch Lot 2A bfnttlx Drinking Water PWSID 0 Supple Remarks: 907 561 5301 # 2/ 4 All Datesrrimcs arc Alaska Standard Time Printed Date/Time 09/29/2005 13:52 Collated DatelTime 09222005 10:00 Received Daterrime 09232005 7S0 Technical Director Stephen C. Ede Allowable Prcp Analysis Paramcta Ratulle PQL Units Method Container ID Limits Dntc Dote [nit Nitratc•N 1.30 Microbiology Laboratory Total Coliform 0 0.100 mWL EPA 353.2 B (<- 10) col/100mL SM20922213 A (41) 0923/05 AZS 0923/05 TLF Municipality of Anchorage O • Development Services Department Building Safety Division. :" �_ • " .. On -Site Water and Wastewater Program s 4700 South Bragaw St..' .R P.O. Box •196650 Anchorage, AK 99519-6650 www.ci.anchorag6.ak.us •(907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL' f ORA 51NGLE FAMILY DWELLING - Parcel I.D. • 050-211-84 HAA #_ • Expiration Date: _/ - q - O 3 '1. GENERAL INFORMATION Coti7pletelegal description Lot 2A: Finch Subdivision Location (site address or directions) 10727 High Bluff Dr- Eagle River AK 99577 Current Property owner(s) Mike Raker Day phone 694-3851 Mailing address same J Lending agency. Day phone Mailing address Real Estate Agent Tom Blake - Remax ANC Day phone 632-0573 Mailing Address ' Unless otherwise requested, HAA wX be held by DSD for pickup• . 741/,X? 4 11-7ol,0-3 0-3 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: ' TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer }� The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with hew Water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION 13Y ENGINEER' As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation; based on procedures outlined In the Health Authority Approyal Guidelines for this application, shows that the site water supply and/or wastewater•disposal systemis(ire) safe; fiiractional and adequate for the number of bedrooms and type of structure indicated herein. I further verify thatbased on the infor{paGon obtained from the :' ;:;•}• Municipality of Anchorage files and from my investigation, and,' inspection,•the on -sit e water supply and/or . , wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances: and regulations in effect at the time of installation:. r° ie :b94 Pitl�' Name of Firm _•S_& -•S Engineeri-ng`_ _:: _�'=:•>; _ �''' l+ _ -2979 r°. -• a l'ef'R •vet-;, _ 17034 N. Eagle. River -It -old'. -AK :••• i:r„• Address .Date . C] /� `t /o .3 Engineer's Printed Name R oha r Y ' 'i• It:„ 4._ ,1., •:, tar: ,.r. .,.. \ t' ... al Cape :ri• •'�yi!':t'7 .e�,•. ,",.i••. �.,«.isi 41✓�A r. . _ -. .r .'.�' -” :'''•; �G 'fin,?['�'1"� � " Iwi.i i .. • 5. DSD SIGNATURE ; ta• A:< <,. • ��.,, �••, •' .q't'r �'•' �i:I;�+: �;j:. r`�.-, !. , AN Approved for 3 bedrooms. ":1:-::s.•;=''.. �-. �._.. �" a •;..;: :' {ISO Disapproved. - .:,pl':.r.',,.;..�z;,..«},,` �FcS=�''"•+"'' . bedrooms with the following stipulations: Conditional approval for - :. ; Additional Comments' Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory' Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: 2-29-Q3 (Rev. 01102) Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: T zA • P I ac k4 Parcel ID:Gt-Z1I $� A. WELL DATA Well type 4e Date completed �3 Totaldepth J� Qft. < FROM WELL LOG Date of test 9 30 :3 Static water lavel Well production Q- Vit_ g.p.m. WATER SAMPLE RESULTS: If A, B. or C provide PWSID tt = Sanitary seal (Y/N) Cased to �ft. Coliform O colonies/100 ml Arsenic: mg./I. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size gal. Nt Foundation cleanout (Y/N) _ Date of pumping C. ABSORPTION FIELD DAT Date installed Length Well Log (Y/N) Wires properly protected (Y/N) y r Casing height (above ground) in. AT INSPECTION ®3 -o ft. Vol g.p.m. >V-0) W-0 -r ti/ S2S G C.a/^ /oo G w5 Nitrate ©.SS'7mg.A. Other bacteria D colonies/100 ml. Date of sample: �J/ 7 to 3 Collected by: "715 (:7VC 1 n) ega / #J6, Date installed Compartments _ Cleanouts (Y/N) ,ion over tank (Y/N) _ High water alarn Pumper Soil rating (g.pAA2 or ft2/bdrm) _ Width type ft. Gravel below pipe ft. Total depth ft. Eff. absorption area ft2 Monitoring tube Date of adequacy t t Results (Pass/Fail) Fluid depth in abs rption field before test _ in. Water added gal. Elapsed Time: min. Final fluid depth _ in. sorptioi Depression over field rate >= For ^ bedrooms New depth_ in. g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) L If yes, give date Pk W STS) /y✓ Cie~- WA<,e- 1,*�Ks Arlt 6ozx10114— uy /444 l� GL4'!.v /t`GG�sS /5 5r7z'I C -T 1Ly CWAJ L4 C-0 tgo( vme?ot% wsT, r -o *I' -&f2-0 /—�VL-o-.4-7-A^J s D. LIFT STATION /V Date installed 1A "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off' level at` in Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main l00 r {' i Sewer /septic service line 0,6- -P Manhole/Access (Y/N) _ High water alarm level at in. Meets alarm & circuit requirem nts? On adjacent lots On adjacent lots Public sewer manhole/cleanout r'f Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation� Property line Absorption Water main Water service line Surface w< Wells on adjacent lots SEPARATION DISTAN E FROM ABSORPTION FIELD ON LOT 1'O: Property line Building foundation Water in Water Service line Surface water Drivew y. parking/vehicle storage Curtain drain Wells on adjacent lots F. COMMENTS _ OF APO G. ENGINEER'S CERTIFICATION N; `'' I certify that I have determined through field inspections and i ` • •: review of Municipal records that the above systems are in /I. w ......... ......www.' .I. conformance with MOA HAA guidelines in effect on this date. NOGM c COWAN i p X42 CE 880# ``: Engineer's Printed Name �` 13k2?' _ C aWA-) .cid i Date 91 LY)03 l�� CFF�__�.now.'� v HAA Fee S 3 7 ,S. a Waiver Fee $ Date of Payment "t �� /03 Date of Payment Receipt Number y 2 61 Receipt Number (Rev. 12101) 04-20-2000 09:54AM FROM LORI/MARY TO D 9916 'M •160 ,9060 N v3 4O Y • gP � V h o� � TpW� IY u F 6941211 P.01 � � 6 O ---------- - -, --- - ov5�`P� '•Op4��0 P`• •F-•• LOO .ruttmuuwrxr DOv. � • � • � � L£'98 M.160,90,0 N 0 o: PQo��• � �h •'•ca ______HIGHBLUFFDRIVE____�_--_`_^_T., TOTAL_ P.01 9-23-03; 5:17PM; ;907 5615301 0 3/ 7 SGS Re1:M 1036082002 All Dates/Times are Alaska Standard Time Client Name S & S Engineering Printed Date/Time 09/23/2003 17:06 Project Name/H Various Collected DstdTime 09/17/2003 15:02 Client Sample ID Lot 2A Finch S/D Received Date/I•inte 09/19/2003 13:15 Matrix Drinking Water Technical Director to hen de PWSID 0 Released B Sample Remarks: Anowabte prep Aaatysis Parameter Qualifiers Results PQL Units Method Container ID Date Date Init Waters Department Nitrate -N 0.557 0.100 mg/L EPA 300.0 B (<--10) 09/19/03 71B Microbiology Laboratory Total Coliform 0 col/100inL SM 18 92228 A (<=1) 09/18/03 KC MUNICIPALITY OF ANCHORAGE t • Auk • DEPARTMENT OF HEALTH & HUMAN SERVICES AEPM 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. # ©S'D —'21 — g HAA # 11 [ f1 A 01 �L93 1. GENERAL INFORMATION Complete legal description Lot 2A; Finch Subdiv.iaion Location (site address or directions) 10727 H.ighbtubb 9, i.ve - Eagte Riveh., AK 99577 Property owner Bob Mitchett C/0 Spinett Homey Day phone 344-5678 Mailing•address • 9210 Vanguard DrLive Suite 102 Anchorage, AK 99507 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-026 (Rw. 1/91) Front MOA #21 . / f 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 SBSENGINEERING Phone 6gy--A_g7*j 1/034 E.59115 River toup Rand NO. 204 Address Eagle Ri laa 577 Engineer's signature A Date 9 Ar q 6. DHHS SIGNATURE Approved for bedrooms. By: Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: aI- 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 orderto 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. 12.= (R9v.1/91) Back MOA 021 Municipality of Anchorage Department of Health and Human Services 10 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L c. -r 2A 56 Parcel I.D. A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC water system number 3 Log presentON) Date completed Driller S�� ��lrx�ns Total depth U3 0 _Cased to 26 7 Casing height 12- Sanitary 2 Sanitary seal OI) Date of test Static water level Well flow Pump levell FROM WELL LOG 61 -30 Wires properly protected LYN) rn AT INSPECTION s"T7 Z n , r f rn N 5 EfL GII°�( �t Q� y O Ls 2S co 11 Z ® ti O 0 SEPARATION DISTANCES FROM WELL TO: p rn Septic/holding tank on lot ; On adjacent lots ho'k z Absorption field on lot '� A ; On adjacent lots Public sewer main 7 Public sewer manhole/cleanout 0 C> Sewer service line Petroleum tank A WATER SAMPLE RESULTS: Coliform O //00 Nitrate f) . S� 1 M w A- Other bacteria O / i 00 AIL Date of sample: `t / /6 l9 Collected by: 'i (!A B. SEPTIC/HOLDING TANK DATA Date installed Tank size Cleanouts (Y/N) Foundation cleanout (Y/N) Compartments Depression (Y/N) High water alarm (Y/N) Alarm tested (Y/N) Date of pumping Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDI K TO: Well(s) on lot �0 djacent lots Foundation To property line Water/drainage field Water main/service line 72-026(3=)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at ffel at High water alarm levelycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: lot On adjacent lots D. ABSORPTION FIELD DATA Date installed Soil rating (GPD/Ft2) Length Width Gravel thickness Total absorption area Cleanout present (Y/N) Date of adequacy test Results (pass/fail) Water level in absorption field before test - Peroxide treatment (past 12 months) (Y/N) Surface water _System type _ Total depth Depression oye" ,After test yes, give date SEPARATION DISTANCE FROM ABSORPTION FIE 0: Well on lot On cent lots Property line To building foundation To existing or abandoned system on lot On adjacent lots Cutbank Water main/service line Surface wat Driveway, parking/vehicle storage area drain E. ENGINEER'S CERTIFICATION (Y/N) Bedrooms 1 certify that / have checked, verified, or conformed to afl MOA and HAA guidelines in effect o to of this inspection. k OF'4L� Signature - � Engineer's Name JCOQE,e r-- C • Ow i4•J Date � /a, J– A f HAA Fee $ , n , CRI Date of Payment � / oar'— 1 \ Receipt Number a,* ( 2ceo 1 72-026 (3(93)' Back 1= Waiver Fee $ _ Date of Payment Receipt Number. ROBERT C. COWAN he, CE - 8801 fjt� ren %. MUNICIPALITY OF ANCHORAGE M E M O R A N D U M WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO. 4A 9 4 O Iq During a. recent Health Authority Approval or. -site inspection and test of the potable water supply well on Lot Block of r f\1 o Subdivision, the well's productivity was determined too be 0,41'gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a I bedroom residence is C)AZ gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties ccncerned are advised that the production capacity of the we -11 may fluctuate. Restriction of non-critical water ,ses Bach as a;ashing cars and watering lawns and gardens may be required. This advisory mutt be attached to all copies of the subject Health Authority Approval. A I. Commercial Testing & Engineering Co. A4wL Environmental Laboratory Services so.�iiseioi�roiiiir�i►oma-v��►oiii'rr�rii� h1WA 14:. LABORATORY ANALYSIS REPORT C:T&ERef.# 94.4756-1 Client Snrlpie II) LUT 2.4 F(NCI I S/I) Matrix WATER CllentName S& SRVC91NF.ERINO WORK Order 5233$ Ordered By R. SHAFER Printed Date 09/20/94 &;09,30 lus. PrgjectNamo CollccteciTme 09/15/f)4 (q) 09;30 lu's. Project# Reccived Data 09/16/94 @ 10:00 firs. PWSED LTA Technical Director STTV1,1111113 3N C. EDE Released By: -----------------------------------------..,.-...--------- —---- --------------- ,_..----- Kmuple Relnnrkw ROUMT, SANIPLECOLLECTF.I) ff:1LAY, --------- OC: AlloAahle Lx9. Anal Yorametcr Re alts Qual iTnits Method Limits Date D:itc Nit --- _----------------------- ---- .....,......-------------------- .-------------------- ---- ---- – Nitratc•N U.S2 ing/L EPA 353.2/300.0 10 09.16/94 CMR " SccSpecialLtstlw ionsAl.+ovc 1JArlhrnvoilable ---- * * Sec Sample Remarks Above NA NotAittayzcd ll = Untletec ed, R ported v &Ii e I q the pnwtical quantificatio I lirnil, LT= f eas'lhon U= Secondary elilution, CYT= QuterThan 6633 8 Street, Anchorage, AK 99698-1600 — Tel: (907) 662-2343 Fax: (907) 561.5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO. UTAH WEST VIRGINIA MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services ik 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. # 1 \ - Q�_ ` - firy'l HAA # 1. GENERAL INFORMATION Complete legal description Lot 2A• Finch Subdiv,L6ion Location (site address or directions) Property owner Lou.L6 Finch Day phone 694-2563 Mailing address 10609 High B&AA Dkive EagZe Riven, AK 99577 Lending agency Day phone Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4- 3. 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank , Community on-site XXX 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 pf 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 Address Eagle River, Alaska Engineer's signature 6. DHHS SIGNATURE 0 Approved for _ bedrooms. Disapproved. Conditional approval for Additional Comments Phone��'Zy%% Date Z01114 bedrooms, with the following stipulations: 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 orderto satisfy ce tain 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. 7? -025 (Rev. 1/91) Back MOA 021 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �� ^ �� L,� S `-D Parcel I.D. A. Well Data Well type Pci-f- If A, B, or C, attach ADEC letter. ADEC water system number r /� Log present j',y�, N) Date completed ' 3 ' 13 Driller C Total depth [ �3� t Cased to sq,- ` Casing he'ght — Sanitary seal(WN) J) Wires properly protected ( N v ('o FROM WELL LOG AT INSPECTION ro C Date of test - 3 b s13 o Static water level �� 4 / f'i't Well flow V��-,, '�B g�',{�ern. g.p.m. y� Pump levell 1 a2's �\R fi- GsJ i r�6-o Q'a-f--hP. Ever t Uac� S� rP� So SEPARATION DISTANCES FROM WELL TO: I r y Septic/holding tank on lot /)W- ; On adjacent lots Absorption field on lot A- ; On adjacent lots e\ALy- Public sewer main _Public sewer manhole/cleanout l o a Sewer service line "1 /� Petroleum tank r\ 4• j � 7 6fx� p PPiD P (yLt � �1` <rt oS Ti Jit � WATER SAMPLE RESULTS: Coliform 0 Nitrate k • -2, -1 Other bacteria � o -9 Collected b Date of sample: y S & S ENGINEERING 034 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA pljy�i\t� �.-w� fs-2- Eagle River, Alaska 99577 Date installed Cleanouts (Y/N) Tank size Compartments Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) Alarm tested (Y Date of pumping SEPARATION DISTAN=On DING TANK TO: Well(s) on lotts Tr prope ' e Absorption field water/drainage ndation Water main/service line 72-026 (3/93)• Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump o High water alarm level ested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed Length Width Total absorption area Cleanout present (Y/N) Date of adequacy test Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) Gravel thickness SEPARATION DISTANCE FROM ABSORPTION Well on lot On elrcent lots To building foundation On adjacent lots Cutbank Surface water System type _Total depth Depression ovepfi6rd (Y/N) .Cfter test _ If yes, give date Property line To existing or abandoned system on lot Water main/service line Surface w Driveway, parking/vehicle storage area drain E. ENGINEER'S CERTIFICATION l certify that l have checked, verified, or conformed to all S & S ENGINEERING 17034 Eagle River Loop Road Signature Eagle River, Alaska 99577 Engineer's Name Date aI� HAA Fee $ goo Date of Payment Receipt Number n�uv �✓� (% 72-026 (3/93)' Back Bedrooms Waiver Fee $ Date of Payment Receipt Number_ WAITER WELL ADVISORX HEALTH AUTHORITY APPROVAL NO. During a recent Iiealth Authority Approval on-site inspection and test of the potable water supply well on Lot Z_A_._ Block of ___ r- I Subdivision, the well's productivity be Q,4 was determined to _�Vgallons per minute. The minimum well productivity required by this department (AMC 15.55) for a —4 bedroom residence is _"Z gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of noncritical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES SINCE 1908 Chemlab Ref.# :93.5250-1 Client Sample ID :L3 FINCH S/D Matrix :WATER Client Name :S & S ENGINEERING Ordered By :R. SHAFER Project Name Project# PWSID :UA REPORT of ANALYSIS 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 WORK Order :71735 Report Completed :10/08/93 Collected :10/04/93 @ 12:00 hrs. Received :10/04/93 @ 15:30 hrs. Technical cor:STEP EN,C. EDE Released ed BBy Sample Remarks: ROUTINE SAMPLE COLLECTED BY: RAY. QC Parameter Results Qual Units Method ------------------------------------------------------------------ Nitrate-N 1.37 mg/L EPA 353.2/300.0 Allowable Ext. Anal Limits Date Date Init 10 10/06 LLH * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than '130BGS Member of the SGS Group (Soci6t9 Generale cle Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA