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HomeMy WebLinkAboutT15N R2W SEC 25 LT 26 W2 __ MUNICIPALITY OF ANCHORAGE DE/ "ITMENT OF HEALTH AND HUMAN SER~ -:S Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name C_/o DISTANCES Addressrnum ~ TANK FIELD WELL Phone(s} 8~O M/O NO of Be~ WELL Z GA ~ FOUNDATION ~EPTIC ~¢5y1~ Q HOLDING TYPE OF SYSTEM O, ~ENCH ~ BED ~ W. DRAIN ~OTHER / WELLS ~ ~IVATE ~ OTHER Hdentifv) ' ' REMARKS: S & S ENGINEERING I ~ .... 0 a ~o~'" ce~ily that this inspection was. pedormed according Io all 72-013 (3/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGINEER'S SEAL) PERFORMED FOR: "~m~ ?,/,~' /~ ~.c')),J%7/~'. LEGAL DESCRrPTION: ~.,. ¢..~'~ 4- 5- 6 7 8 9 10 12 13 14 15 16 17 18 20- COMMENTS Tow.sh ,. Range. Seot on: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? ' p E Depth to Waler ADer Moniloring? ~ Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~' FT AND ~ FT PERFORMED BY: ~ [--~--~. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) 11/ ..... L,.:, cce:" t J. { y tI-i a'L ~ !. :I: am f'ami].iap fI:i"t.l': by 'l:h:~ F'hznic:i.t~alJ'LY c:If (.::nc:hci!-age (HD(-t/) arid the St.a'Li.:, cl:i!:~'Laric:i-:,::!, fpom any :::~;.i:i.!:it:i. ng :~:~].:1.~, l.~a-;:it,~:'~:a'LG!i< di::~po:ia:l_ ::y::'L:::~m :)n pl..,'.L~],ic s!.,'.:?i,,Jet'agl:! siysi'l:.,:~.!m Ol'i '{.. i-~ :i, .:: l:iP a!"ly al:i,jai::::~[i'l'_ (:il-. ni:!ar',l::iy SCALE S 8, S, ENGINEERIN~ SRB 196X EAGLE RIVER~ AK 99577 SUBJECT: O...,vlPUTATION SHEET DATE: SHEET BY CKD OF ~- /OO LP Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: DATE PERFORMED: Township, Range, Section: //5;~-,' /~.v~ ~.¢-- ~----~- 1 2 3- 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth Io Water After I'ilonilorinD? /~4¢'-''J'c~' Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER __ COMMENTS 5.. 796× ACCORDANCE WI~H ALL STATE AND MUNICIPAL GUIDEL~FECT ON THIS DATE. 72-008 (Rev. 4/85) TEST RUN BETWEEN __ FT AND .-- FT $ & 5 ENGINEERING ~ , DA~IE-CERTIFY THAT THtS TEST ~W.~ PERFORMED IN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: I~----- L~ .x.J. ~,v~ . DATE PERFOF Township, Range, Section: /('~..( 5 6- 7- 8- 9- 10- 11 SLOPE WASGROUNDWATER ENCOUNTERED? IF YES, AT WHAT DEPTH7 14-l 15- 16- 17 18 19- Deplh lo Water Alter Monitoring;' SITE PLAN S L O P E Gross Net Depth to Net Reading Date Time Time Water Drop 20- PERCOLATION RATE ~ ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN ~ETWEEN ~/ ' FT AND ~ FT COMMENTS S 8. $ ENGINEEI~iNC. SRB 196X ~~/~ PERFORMED BY;~LE RIVER,AK 99577 I~~ CERTIFY THAT THIS TEST WAS PERFORMED IN 72-008 {~ev. 4/85} GREA, .~ ANCHORAGE AREA BOR ,~H Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION SEPTIC TANK: DISTANCE FROM WELL _~)7' INSIDE LENGTH MANUFACTURER MATER IALCO NUMBER OF COMPARTMENTS INSIDE WIDTH LIQUID DEPTH __ LIQUID CAPAC ITY/OI~ GALLONS. SEEPAGE PIT: ?e~im;~'ev' I/~/ NUMBER OF PiTS i DIAMETER --OR WIDTH LENGTH DEPTH /~)/ LINING MATERIAL,-~, I/~;7.~ CRIB SIZE: DIAMETER__DEPTH ~' DISTANCE FROM: WELL BUILDING FOUNDATION ~'~)/, NEAREST LOT LINE ~O/ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ SQ. FT. ADDITIONAL ABSORPTION WELL: · YPE 4hdCONSTRUCT,ON BUILDING ,.~.,~/.. / NEAREST FOUNDATION , LOT LINE DEPTH ~----~'~-'- / DISTANCE FROM: NEAREST SEPTIC B~t SEEPAGE SEWER LINE TANK SYSTEM . CESSPOOL APPROVED OTHER SOURCES DISAPPROVED DISTANCES: INSTALLED BY: ~'/~ //~ LOT SLOPE: REMARKS, DIAGRAM Of SYSTEM DATE ~'-Z- q- 7 APPROVED Form NO. EQ-031 (~REATER ANCHORAGE ARrfA BOROUGH SEWAGE DISPOSAL SYSTEM -- APPLICATION--~,AND PEP, MItt INSTALLATION LOCATION WATER MAIN TO SEPTIC TANK ~0 ~ct · O.A,N ~o 10 f~. 1.0 ft~ 25 100 ft FITTED WITH AIRTIGHT REMOVABLE CAPS. IIOUS[ DATE ~;~J~~APPLICANT'$ SIGNATURE Performed Legal Oescription: %his Form Re~orts Lot 20 Block___Subdivision Soils LoQ yes ~colation Test____ Date Performed 8-28-73 .neath Feet Soil Characteristics 1 2.-- Sandy Gravel 9-- Was Ground Water I~ Yes, AL what Tg_psoil ~ 11 L- Sall6~- k~Y '--~.v e i mlXCU~Fe with oobb~es and .... Ld, . Encountered?__!tl~.L. Denth? ................ Date Gross Time Net 1-ime Depth to H20 Hinute Net Dron · pe]rcolation Rate ~ Proposed Installation: SeeoaQe Pit yes Drain Field ] ~]~::]: l~ ] J) ~ ~ t~' of Inlet.__- b_~__~__~- f~. Deoth T~-Bottom Of Pit Or--ch ~o~{ ~,, r~ ~aina~e .area reauj.red~~. . :~::u :?~?aM~ENTS: ....... ~-Z~-~'~'~~7~}-~b below seepa~b . Construction Data Certified By]~~--~ Date 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. # 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Location (site address or directions) / Property owner Mailing address Day phone Lending agency Mailing address Day phone Agent Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~'~ Day phone 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~)25(Rev. 1/91} Front MOA#21 So 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 ali Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~K~..D, Engineeri~ Address Eagle River ~ ~87~ EngineeYs signat~~ Phone Date DHHS SIGNATURE / Approved Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments~-~¢- (%~0o~-(¢_¢~ c)~ J¢>~5 C~C~'~co~~-~ 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 . profess!onal engineer registered in the State of Alaska. Th~ DHHS does this as a courtesy to pumhasers 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 MOAf¢21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744 Health Authority Approval Checklist Legal Description: W' i/'~. LotL ~ ,~cc ~,;~'-"7-1~-(~//~,,3- ~ Parcel I.D.: ~ ~ / -- ~-~ ! -,~- A. WELL DATA Well type / Log present (Y/N) ,/~ Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water systemnumber Cased to Z//~) / '~ Casing height (above ground) /-r~ /' y Wires properly protected (Y/N) Date of test Static water level Well production FROM WELL LOG AT INSPECTION g.p.m. ,~ ,~, g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ,/?~,~ Tank size Foundation cleanout (Y/N) ,/V Date of Pumping ~///~//~ C. ABSORPTION FIELD DATA Date installed ///~ Nitrate ;~'. ~'~ Other bacteria Collected by: /+/~/L~ ~-~J/n ~ ~/'~ ~)~)~) Number of Compartments /~ Cleanouts (Y/N) Y Depression (Y/N) ~ High water alarm (Y/N) ,A,/A Pumper /~ Soil rating (g.p.d./ff~ or ffa/bdrm) ~-' ~' / Gravel thickness below pipe Effective absorption area /~L-~, ~ Monitoring Tube present (Y/N) Date of adequacy test ~'/?/~ ~ Results(Pass/Fail) Fluid depth in absorption field before test (in.); ~! '" Fluid depth ~/~ # (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) /~/ System type ~,/~ /-~/ Total depth /~ / . Depression overfield (Y/N). /~/ For -~ bedrooms Immediately after~gal, water added (in.): Absorption rate = z/~) ./_ g.p.d. If yes, give date' ~ ~ 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles test~ siz "Pum~t* "Pump off" level at* *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: / ~/;,~, 1¢75 ~-~d~ ~ ~ / (,~o ~¢.~,v~,'/~¢4¢--'~/,~n adjacent lots Septic/holding tank on lot Absorption field on lot / ~)~-- / On adjacent lots Public sewer main / O 0 ~ '~ Public sewer manhole/cleanout Sewer/septic service line ~.,~' / -h Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation '7 / Property line /O i .y Absorption field / Ob Water main/service line 2-~ Surface wateddrainage /~ O f-f- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /D Surface water /(~ Curtain drain Building foundation .~ ~ I Water main/service line Driveway, parking/vehicle storage area ~,~ Wells on adjacent lots / DO t ~ F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records in confo~d~~in effect on this date. Signature Engineer,~'Na/me Date HAA Fee $. Date of Payment _ Receipt Number Waiver Fee $ Date of Payment. Receipt Number 72-026 (Rev. 3/96)* 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, # t.~-~- :-~ ¢-i- ,~'~ NAA ~ 1. GENERAL INFORMATION Complete'legal description ~t)~/?..;~L'cr~ ~ (~,, .~¢d.. 2~'~ T/~-/1,/ / /2,2/~ / ?~, /¢.Y. Location (site address or directions) Property owner //v/i//r,m /"//¢44/? /~/4/~,~ Day phone Mailing address Lending agency. Day phone Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 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 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 ~'/~'z~ Address 2~' / ~,~,~,~ Engineer's signatur~ Phone Date /-~,~/~ 6. DHHS SIGNATURE By: __ Approved for bedrooms. __ Disapproved. __ Conditional approval for bedrooms, with the following stipulations: Money shall be put in escrow in the amount of $20,000.00 to locate all cleanouts & monitor tube~ for th~ ~,lhj~t wm~t~w~r ~y~m ~nH p~'~n~'m ~n ~ql,~oy ~ nn the ' · absorption field. Money in escrow shall also be used for repair or upgrade of the June 15, 1999. Money in escrow shall not be realeased until this office issues an '~ ......... f ......... ty A~F 1 Add[tio~ Comments The well for this property meets Municipal Codes. There are nitrates present. It is suggested that periodic testing be performed. The current nitrate level is 6mK/L, the EPA max. concentration is 10 m~/L. Mor~ ~nform~P~nn OD nitrates is available from the On-Site Services Progra, DHHS, 343-4744. ~~ C ~~ Date ~/.o~-~ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given ~n paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a cou rtesyto purchasem of homes and their lending institutions in order to satiety 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 errom or om~ssions in the professional engineer's work. 72~25[Rev. 1/91) BaCk MOA~21 Municipality of Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SERVICES MAR 3© ~c)c)cj Environmental Services Division MUNICIPALITY OF ANCH 825 L Street, Room 502 · Anchorage, Alaska 99501 · (90~k~SERVICES Di¥1SlOr~ Health Authority Approval Checklist Legal Description: A. WELL DATA:~ Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Parcel I D. If A, B, or C, attach ADEC tetter. ADEC water system number Casing height (above ground) Wires properly protected (Y/N) Date completed Cased to ZT/~ / '/' FROM WELL LOG Date of test ~ Static water level ~ ~' ~ Well production g.p.m. AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform (~ Nitrate Date of sample: B. SEPTIC/HO LDING TAN K DATA Date installed Foundation cleanout (Y/N) C, ABSORPTION FIELD DATA Date installed Length 5'1' ~ ~; 7 ~'¢~)Width Effective absorption area /'~'l~ate of adequacy test ~, ~ Other bacteria Collected by: Number of Compartments / Cleanouts (Y/N) . Depression (Y/N) /~J High water alarm (Y/N) ~ Soil rating (g.p.d./fF or ft=/bdrm) ~. ~ / Gravel thickness below pipe /~?~ ~ Monitoring Tube present (Y/N)__ Results (Pass/Fail) b System type ..~w? Total depth Depression over field (Y/N) __ For bedrooms Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.): Fluid depth (ins) Minutes later:. Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* ~¢'~ ('g*c'r/ ~¢c Tr'/t~ ~e~/~ o~ g',~>¢ --- ~/~"¢'~/ //~. D. LIFT STATION ~ Date installed Size in gallons Manhole/Access (Y/N) ,,Pum~ "Pump off" level at*. High water alarm level~.~_ / *Datum _ Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: / ]~/C- Foundation '2 Property line Absorption field Water main/service line Sudace water/drainage /~b/~- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /~ / Building foundation ~ ~ Surface water /~ /4- Curtain drain /~P /~ Water main/service line Z 5- '''/- Driveway, parking/vehicle storage area Wells on adjacent lots /~ F. ENGINEER'S CERTIFICATION I certify tha, I have determined thru field inspections and review of Municipal reco~,~.~..?..e.~.e,l~s~tems are in confo~ance with MOA H~ guidelines in effect on ~is date. Date Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* ~D ENGINeeRiNG MAR ~0 1999 (907)696-6111/FAX (907)696-8111 March 25, 1999 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: W1/2 of Lot 26, Sec. 25, R2W, T15N, S.M. - HAA Gentlemen: The owner has requested we proceed forward to obtain a Health Authority Approval for the referenced lot. At this time there has been no adequacy test performed for the subject lot. This is due to the inability to locate the septic stand pipes which according to the owner have been cut off at or below grade and the previous house burned down negating the use of the previous swing ties. At the owners recommendation we contacted the installer and he has been unable to locate the pipes. A well flow test and water sample was conducted and shown to be satisfactory for the three bedroom dwelling that was constructed. Based on the above we are requesting the issuance of a conditional Health Authority Approval to May ist so that we can locate pipes and conduct an adequacy test of the system. Per our discussion, $20,000 will be escrowed to cover the estimated construction cost of a new system with the bank to cover the adequacy test and tank and field replacement if required. While this is an unusual request we do not feet that the existing system is a health hazard or is out of compliance with the code for the following reasons: The field was constructed in September 1986 with the latest HAA issued in October 1994. The HAA, which was conducted by Eagle Engineering Services, indicates that the system initially had only 13" of effluent within 60" of effective gravel in the deep trench and that it returned to the original level. · The septic tank was pumped by JR's Pumping and there was no sign of surcharging from the field which is in continual use. · We have conducted a site survey and determined that there is sufficient area to construct a new septic field if necessary. · Review Of surrounding soils indicates that the percolation rates average around 20 min. per inch. We have assumed for purposes of this exercise that the soils will be in the 20 min./in, category. Subject:W1/2 of Lot 26, Sec. 25, R2W, T15N, S.M. - HAA March 25, 1999 Page 2 of 2 Due to the depth of frost, anticipated soils percolation rate (20 min./inch) and the depth anticipated to conduct the percolation test testholes and percolation tests may not be advisable until we have warmer soils conditions. Based on the above we do not feel that there is a health/safety issue and request that a conditional HAA be issued for the referenced property. It is our understanding that DHHS is requesting that funds be escrowed for the proposed work, which the owners do not object to. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, ~_) Engin~eer~h;rg ~uffus, P.E. attachments: 1994 Inspection Report HAA Request/Inspection Report .. ON,~/~OJ, J~/ ..,,,.. Casing height . ,Ig' '*' . ~) .- ~5 ~r~ pm~ p~ ~) , y~ ~' ':' FROM ~ LOG AT INSPE~oN t~t (J~,Y) bleO ,,~, . Well flOW Date of sample:. ....,:...,._D. ISTANCE~FBOM WELL TO: -? P0bTIc-~wer main WATER Sa~aPLE RESULTS: ':1 _i , Other bacteria Co,ected by:. _.. · ';~i;" . ',j.;,. D,~ of pumping ' ~ ?/ZZ/~y ~.,, ~ ~ ' ~:; We~'i~t '~/: ~ ~adja~nt o~ ~/~/ F~ndafl~ ;:~' :-:.--~9 P~ line . ~ O~ A~ field. ~ / .... Sud~ ~ter/dralnage ~/H Tank size / ~ $ ~ Compartmenls Foundation cleanout (Y/N) .A/~ Depression (y/N) . Water mel~se~ce line , -'/' ~) / -CONTINUED ON BACK PAGE ..J Waiver Fee $ Date of P,m/ment Receipt Number. .~ .,7" ' Date of Pe~m~ent ENGINEER'S CERTIFICATION ~m /~ //- ~ ~ e~ % ;,.'~ RELDTO: On ~dJ,~ce. nt ,lots .,. ././~:) t ~'7/ To ex~ng m' ebandoned system o~ let /~ · ,[TO bul/olng f~ ~efom test (psst ~2 months) (Y/N) \ :3:t'" ~ :.~(; . MuNIcIPALITY OF ANCHORAGE DEPARTMENT OF'HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH INSPECTION FOR HEALTH AUTHORITY APPROVAL '~r~,~D CERTIFICATE OF OF ON-SITE SEWER AND WATER FACILITY 264-4720 October 16, 1986 · Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 26A; Section 25; T15N; R2W; Location (address or directions) 2nd left - Shims - let right South Birchwood Exit - Hillcrest; End of road, right side Applicant Name William Hahn Telephone: Home 688-2195 Business 688-9101 Applicant Address (b) (c) Applicant is (check one): Lending Institution r"l; Owner/builder:J~; Buyer F1; Other [] (explain); (d) Lending Institution Al~m~m IVh~ml Telephone Address Ar~R~3r~T(~'_ ~(3~ rPhnm~nn/R~g]~ ~{~! Al~m]cR (e) Real Estate Company and Agent Address Telephone (f) H~the HAAtothefollowing address: S & S Engineering SRB,196XEagl? River Road Eagle Riveri Alaska ~ 7~ TYPE OF RESIDENCE Single-Family ~K Multi-Family [] 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. '~ h:~c, SEWAGE DISPOSAL ; , , . Onsite ~] Public [] Community [] Holding Tank [] Note: If community well system, must have written conf rmat on from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 t. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE ~EARCH, DA I'A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown b~low, 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 ~GLE RIVF~. Telephone Approved for bedrooms ate Approved .~*-~- Disapproved' Conditional ~ Terms of Conditional Approval x CAILIT ON ~ The Muncipality of Anchorage Department of Health and Environmeptal 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',{h~s'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) MUNICIPALITY OF ANCHORAOI~ DEPT. OF HEALTH & "%ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) NOV 1.. ~, ~ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 .RECEIVI:D Legal Description: /__-,~ ~&,A /1¢;.~../ ~-;'w ~c~c-~.S' WELL DATA Well Classification We Log Present (Y,~ ~ ?~c~> Date Completed (4'"~ Yield Total Depth ~-,~,,7~.,f.' ;Cased t~ ~'¢,' :J Depth of Grouting Static Water Level ~. ;~ Pump Set At /,.-A~ Sanitary Seal on Casing(~/N) Depression Around Wellhead (Y~_~ ~ -~.. If'A, B, C. D.E.C. Approved (Y/N) /"'/~//~ Casing Height Above Ground Electrical Wiring in Conduit Separation Distances from Well: To Septic/Holding Tank on Lot ~"-~ ! ; On Adjoining Lots /¢~ To Nearest Edge (~f Absorption Field on Lot /o~'¢ ; On Adjoining Lots /0¢ To Nearest Public Sewer Line ~/~ To Nearest Public Sewer Cleanout/Manhole NI ~ To Nearest Sewer Service Line on Lot Water Sample Collected by ~ ~ ~ ~/~ ~ ; Date / ~ ' ~ Water Sample Test Results .~t ~c~,~/ Comments ~ V~%~5 ~ ~o~ o~ /m'&o-~ ~u~-~ SEPTIC/HOLDING TANK DATA Date Installed /-/~-T5 Size Standpipes ~,N) Depression over Tank (Y(~ Pumping/Maintenance Contract bn File (Y/N) Holding Tank High-Water Alarm (Y/N) Separat on Distances from Sept c/Ho dng Tank To Water-Supply Well ~,_~;:: !?¢ To Property Line /O To Water Main/Service Line /o r~, Course Air-tight Caps ~/N) No. of Compartments ¢-~,"¢- Foundation Cleanout (Y~ 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) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata L/~_ 5/¢'//~/~_ Type of System Design /%, Date Installed //-/C, -¢G, (u4j~¢~/~P£,¢)Length of Field /~ Width of Field ~, g ' Depth of Field /o r Square Feet of Absorptio~r Area Depression over Field (Y/~"~ Results of Last Adequacy Test Separation Distance lrom Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line / O ! ¢ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Gravel Bed Thickness (~ r Standpipes Present ((~¢~/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) N/,~ N,/~A Comments LIFT STATION Date Installed Size in Gallons "Pump On" Level at __ High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signeds & S ENGINEERING Date SRB 196X Company EAGLE RIVER, AK 9957.7 Receipt No. ;P--,~/ O~ 2-5 Date of Payment '////,~.,///¢z" Amount: $ ~_C~"-, ~-~ MOA No. _~¢ ~,~:~ .'¢ Page 2 of 2 72-026 (11/84) MUNICIPALITY OF ANCHORAGE ~'_ DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AFrHORITY APPROVAL CERTIFZCATE t. General Information Application Date ,~-~_~-~- ~,~- (a) Legal Description (include lot, block~, subdivision, sectlon~ township, range) z_ Location (red. tess or dlr~c~ons) (e) Applican~ is (chack~ Lending ~nst~ion, ~ ; OEar/b~lder ~ ; (d) Leuding IusClguglou__ ~/C~ Telephone Address (e) Real Estate Coo & Agent Address/fO9 ~ ~>~ .~?~ ~'~ _~ ,~ ~. (f) ~e ~ to the follo~ng ~dress: T~of Residence Single-Family~ Number of Bedrooms Multi-Family ~ Other~ Water Supply Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesti~g to the legality a~ status. Sewase Disposal Note: If community well system~ must have written confirmation from the State Department of Environmental Conservation attesting to ~he legality and status. [Page I of 2] Ensineering Firm Providin~ Inspections~ Tests~ File Search~ Data and Informati~ 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 wast,water disposal system is safe, functional and adequate for the number of bedrooms and ~ype of structure indicated herein.- I further verify that, based on the information obtained from the M-nicipality.of Anchorage files and from m~f investigation and inspection, the om-site water supply and/or w~stewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection° Name of Firm ~'~ ' '' ' "~h~'~ .Teleph°ne (E DHEP Approval~; Approved for Approved ~/~ bedrooms Disapproved Terms of Conditional Approval Co .tion~ Date~ CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRON~IENTAL PROTECTION (DMEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELt UPON THE REPRESENT~ ATIONS GIVEN IN PAi{AGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN T~ STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. ~PLOYEES 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 T~E PROFESSIONAL ENGINEER'S WORK° (DHEP SEAL) RR4/eJ/D18 [Page 2 of 2] 7-19-84 aJ Well ClaSsification Well Log P~esent (Y~ Total Depth ~ ~'/ Cased to Static Water Level ~--/ ! Casing Heiuht Above Ground Electrical Wiring in Conduit ~Y?N) Separation Distances f~cm Well: To Septic/H~ Tank on Lot MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHoRITy APPROVAL (HAAi CHECKLIST - FEBRUARY 1984 Legal Description: MUNICIPALITY OF ANC.~.ORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAR ?, B If A, B, C~ C, D..E.C. Approved(Y/N) Date Completed ~/0/~ /~ /~O ¥ieldL~.F~-~ ~-~ /~ /~ of ~outing ~ ~t At ~ ~ Sanit~ ~al on ~si~~ ~essi~ ~nd ~l~ead ; On Adjoining Lots To Near. st Edge of Absorption Field on Lot//O~ [/; On Adjoining Lots/ To Nearest Public Sewer Line /~J //'~ To Nearest Public Sewer Cleanout/Manhole /~/ / ~9~ To Nearest Sewe~ Service Line on LOt Wate~ Sample Collected By ~ 9~ ~c~/~,?//;~//~;/ Date J-- ~ ~ Water ~le Test Results .-~g~// ~/~=,~ "~-,:~,"~-/~_~ / CC~ren~7 /~//-/-/~' //~J ~',~ /./~ /~'~. ~c/ ,.~ / 4/ ~;?,~ SEPTIC~HOLDING TANK DATA ta±~a 17 / ~ Size No. · A~_-tlght Caps (~) Foundation Cleanout Standpipes (.Y~N) '~ ' _ Dep~essiOn over Tank (Y~ Date Last~Pumped ~Z Pumping/Mainte?ance Cont=act on Fil9 (Y/~9~ , for Holding Tank Hlgh-Wate= Alarm (Y~ //$ Teapota~y Holding Tank Permit (Y~//~ Separation Distances f~cm SePtic/Holding Tank: To Building Foundation To Water-Supply Well To P=operty Line To ~ater Main/Service Course To Disposal Field ~ ~ f ~- To St~e~l~, Pond, Lake, ~ Major D~ainage Contents Date Paid: ~-,~,'~- '~', , Amount: [Page 1 of 2] 2-15-84 ABSORPTION FIELD DATA Soils Rating in Absorption St~ata ~.~'-,~/~ Type of System / Des ig~/~ Date Installed ~/~-~ Length of Field ~-- Width of Field ~_~ / Depth of Field /2 ! Gravel Bed Thickness Square Feet of Absorption~ea ~'f~ Standpipes P~esent/~Y~) Depression ove~ Field (Y~!/ Date of Last Adequacy Test Results of Lest Adequacy Te~'st_~7-/.~/~' ~%~V /~ ~ /~ To kt~te~ Supply Well /dO ~ To P~operty Line /~7 /~ To Building Foundation ~ ~ ~ To Existing or' ~ndo~d System Lot ~/~ ; ~ ~joining ~ts .~g' /~ To Wate~ Main/~vi~ Line /O ~ To ~t~(if ~e~nt) To S~e~ond~ke/~ ~jo~ ~aina~ ~se ~r ~ ~ ~ To ~i~way, P~ki~ ~a, ~ Vehicle St~a~ ~ea ~ ~ / C~nts ~ ~ ~f ~ D. LIFT STATION Date IDstalled Size in Gallons "Pump O~" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Di~ensipqs Manhole/gc~ss (Y/N) "Pump Off" Level at g/ Vent (Y/N) . C~lng Adequacy Test. Ymets MOA C~nts ** Check Permitted Bedroc~ Rating A(3ainst HAA Request I ~tify that I have checked, verified, or confc~ed to all MOA'HAA on the date of this inspection. ':, ,,,,~I.E B ~, ALASKA Company p/~. ~.9~?, MOA No. KB1/d5/s [Page 2 of 2] in effect 2-15-84 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMEN~EAL HEALTH DEPARTMENT OF tiF~LTH AND ENVIRONMENTAL PROTECTION APPLIC3tTIQq ~X)R HEAL~{ AUTHORITY APPR(~fAL CERTIFICATE General Information Application Date _~--~v8 C/__ (a) Legal Description (include_lot. L, block~ subdivision, section, tc~nqshipr range) T_~ of t~sidence %ngle-Family~ S Nun~er of Bed~:oc~s Water S uppity_ Individual ~11 ~5~[. ~alt i-F~m~lr ~ Community ~ Other (describe) Public Note: If ccmwunity v~ll system~ must have w~,itten confirmation f~ the State Department of Environm~ntal Conservation attesting to the legality and~atus. Is the ~ell adequats fo~ the number of bedrooms specified in this ~.~/N) Sewa D__q~_~sal Is the vmstewate~ disposal s~stem adequate for the riunber of b~drocmS' [Pa~e 1 of 21 O- ~,~( ~ / ~7~. 2-15-84 En~q~ineerin_~q Fi~~, t>£ovidiz~_~ctions~ %'ests, Data ~d in_ ~o~t_ _ ~.o~ ' ~ c~tify ~-have d~cked, verified~ or confornmd to all FDA ~ ~i~li~s in effect on t'~ d~ ~s~ction. . Date (ENGINEER SEAL) Disapproved ~ Conditional 6.~HEP ~proval Approved App~oved[-~_.~ Date Te~irs of Conditional App~oval The Municipality of Anchorage Department of F~alth and Enviror~ntal F~otection dc~s not guarantee the continued satisfactory p~fc~mance of the wate~ supply and/c~ the wastew~te~ disposal system. This approval indicates that, as of the ~]idation date sh~.;n above, based on tb~ data and infc~mation furnished by an engir~er registered in the State of ,k~aska~ the wate~ supply and wastewater disposal system is safe and func- tional fo~ the nu~3e~ of bedro~s and type of structure indicated. 2-15-~4 ae MUNICIPALITY OF ANCHOI~AGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification~ ~_ ~ Well Log I~esent (~/~)~ Total Depth ¢~ ~ Cased to Static Water Level O'~r Pump Set At Casing Height Above Ground /__~_~./ Sanitary Seal on Casin Electrical Wiring in Conduit~ Separation Distances f~cm We][l: To Septic/%l~l~i~j-Tank on Lo ; On Adjoining Lots To Nearest Edge of Absorption Fiel~o~n-L-~_~_~_~ ! ; On Adjoining L°ts__/t///¢ TO Nearest Public Sewer Line /~/~ To Nearest Public Sewer C leanout/Manhole ~/ Wate~ Sample Collected By,~%"~% ~'~~; Date____~_~/~ f/- ~,, Water Sample Test Results SEPTIC/F~I;Ut~ TANK DATA Date Install/¢~ ~/~7 ~-~ Size ~No~ of C(~rEDartmer~ts Standpi~(y~~ ~ ~i~-tight Cap~ ~ Foundation Cl~a~t ~ession o~ Ta~ ~)~ ~te ~st~d ~ ~ P~ing~intenan~ ~n~a~ ~ Fi~6 .~Y~ 2 fo= Holding Ta~ High-wate~ Ala~ ~~ ~ya~y Holding Tank ~t ~p~ation Distan~s TO ~o~rty Li~ -/~ ~ ' TO Disposal Field ~-~2 To S~e~ Pond, ~e¢ ~ ~]or ~aina~ TO Water Main/Se=vic~ Lir~ Course . Corm~nts~ [Page 1 of 2] 2~15_84 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~_,~/'7-'~ Width of Field ~ /2 f~/~ System Design~%)~F /~ng~ of Field ~-:J of / ~i~ '~ S~e Feet of ~sorption ~ea __~! Stan~i~s ~e~nt~ ~p~ession over Field Results of ~st A~a~ ~st ~p~ation Distan~ fr~ ~s~ption Field: To ~ter-Supply ~11. To Building Foundation LOt To Water ~rvi~ Lin~ To St~ond~ke/~ ~ajor ~aina~ To ~i~way, Parki~ A~ea, Do LIFT STATION Date Installed __ ~ Dimensions Size in Gallons .,~/ ~ Manhole/Access (Y/N) "Pump On" level at/' ~ / /~- "Pump Off" level at High Wate~ Alarm level at / ' Vent .(Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) Co~tu~nts ~* Check Permitted Bedroc~ Rating Against HAA Request I c~le'tify ~ve chJ~.a~d, verified, o~ conf(y£'med to all MOA HAg. Guidelines in effect on the ~ of~~i~. C~an~ ~ MOA No. [Page 2 of 2] 2-15-84