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Home My WebLink AboutMOUNTAIN MANOR BLK 2 LT 6 He& ~UNICIPALITY OF ANCHORAGE and Environmental Prote Dn Fourth Floor West 825 L Street Anchorage, Alaska 99501 279-2511, x 224, 225 ............. ~],4-~'i~ECTJON REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE ? ~__ /)/) ,~1,~ NUMBER OF FROM WELL~ ...... '~N MANUFACTURER MA'I-FRIAI V~ COMPARTMENTS ~ INS r~F [ENGTH INSIDE WIDTtt LIQUID DEPTH LIQUID CAPACITY/~5. GALLONS. TILE DRAIN FIELD: TOTAL LENGTH ROT ~Y~ .... NEAREST LOT LINE ........... OF' LINE DiSTAf~iCE f ROM WELt ...... :__FOUNDATION ___ ~ O~ Lines ........... DISTANCE BEqWEEN LlPiES .......... TRENCI4 WIbTH-~.~-/IN. TOTAL EFFEC]IVE ABfiOP, PT:O;,; AI,'EA ......... SQ. Fl-. LENGTH OF EACH LINE DEPTIi OF FILTEF{ . ~ -- Il DEP1 t. - Gl' OF 1' '~O FIN St l GRADE ........ MATERIAL BENEATt4 TILE_~t, ...... IN. ABOVE TILE___~. IN. SEEPAGE PIT: DI,.AMETER ___~ OR WlOTtt .... LENGTH .., DEPTIt Log Crib Rings__ Crib Size: DI/.\METER .... DEPTH DISTANCE FROM: WELL. ] OT/~[. EFFECTIVE ABSORPTION AREA (WALL AREA) .SQ. FT. BUILDIHG FOUNDA-IION ....... NEARESq LOF LINE Well Class: Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: % of Bedrooms: Installer: Remarks: I='ERMI T NO. fiPF"L I CFINT L.ClC fi'T' I ON LE(.iiAL ....... ," ",-, ..... RND ENV I RONMENTRL, Pr;'OTECTI~ I...,E..F HE. I r IEt',I I O'':r HEfiL..TH ON ........L ~l. REEl., fiNCHORfiGE., ElK. li.~.~ . (;;~','" ¢l. ~[ 2 ..... --.=' .' .............. ' -' .......... '" ' l_h Ik--II E: IL.. It .... A I"-,I lC:, L..I INI ...... If' 'qF E: =:, i. lb-Il liE:. il:~-'.. F E. F. Ir 1 ]i:: T' 8,'.,. ,' .:.4...~ ~';'g,::t.-'~.7:1 5 _.I~J-~Z PO. ' .... """ =' E.R. · MC F..[ ..... EN[:, ....R. , ' .... ~ L. OT :.. 1 .~E L'T'. 6 E:K. 2:'. MT. I'IMNUF.. ,.7 "--'" 4'.a. 69]i: ':;¢.'Jtlfi['E FEET T'~.'PE OF ..,_ IL. HE,...,URE, I ION :.,t.=TE. I1 IS: TRENCH I"IR::.:; i ML.tM NL 11BER OF E:EE:,ROOMS = SOIL. RFI]"ING ,::SQ FT,.."BR)= ..-.,I~.E ,- ~ .=,tcTEI'I IL:.;: I.'HE REQUIRE[, '- '~'~' OF ]*HE =,JIL fiBSr-RPl.'ION '-'"' ..... .............. ,'" -- ~ L. FZI'-,IIC.~-rH= ~-'~--- L~I~..I~ ,.. F. ZI_. [-,E.F I H= ..... · ....... L.,E.F EH-- c,.'"" .... THE LENGTH I}IMENSlON IS THE LENGTH (IN FEET:) OF "FHE TRENCH OR DRfilNFIELD. THE DEPTH OF FI TRENCH OR. PIT IS THE DIS'I"FINCE BETWEEN THE SURFFIC:E OF I.'HE: GROUNI/;, FIN[) ]"HE 80'f'TOM OF ]'HE EXCRVFITION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE: GRfi'¢EL DEPI.'H IS THE MINIMIJM DEPTH OF GRRVEL E:ETWEEN I"HE OIJTFfiLI... PIF'E fiN[) THE BOTTOM OF ]"HE EXCAVRTION (IN FEET). P F:I i:]: I-:::: F:113 ~---]. F" L.. FI i%1 -r [:] F' 'T' ][ Cl I"-,I fi F'fiC'KFIGE PL. FINT r,'IR'¢ E:E INSTfiLLED FIT THE PERMITTEE"S OPTION SLIBJECT TO THE.: FOLLOW I NG CON[:' I T IONS: % EII.'HER fi CL. fiSS ! OR II NSF FIPPROVED PLFINT MFI'¢ 8E INSTALl_ED. 2'.. fi CONTINUOUS MFIINTENfiNCE FIGREEMENT IS REQUIRED. IF fi MfiINI.'ENFINCE AGREEMENT IS NOT KEPT CURRENT 9OU i'4fi'¢ BE REQUIRE:D TO ENLfiRGE THE SOIl... RBSORPTION SYS'fEM fiND/OR '¢OU 1'4FI'¢ BE SUBJECT T0 PROSECUTION '"IF' I-,-II [) ( :';_-' ) I !-41 '_:E; F" BfiCKFII...I...INC~ OF fiN'¢ S'¢S'T'EM WITHOUT FINFIL..T. NSPECTION FIN[:, fiPPROVfiL B'¢ THi'S DEF'FIR'TT,1ENI" 14ILL BE SUBJECT 'T'O PROSECUTION. MINIMUM D.'I.'STfiNCE BE'T'WEEN FI I.,.IELL FIND FINer' ON-SITE SE].,.IFIGE DISPOSFIL. S'¢STEM .T.S :1.1;Z10 FEET FOR R F'RIVFITE WELL OR 2'.OO FEE1'' FOR fl PUBLIC WELL_ WELL. LO6S FIRE: RE[4UIRED RND MUST BE RETURNED TO THE DEPFIRTMENT WITHIN ]:::0 DR'eS OF THE: WELL.. COMPLET'ION OTHER RE(.Z!UIREMENTS I',1FI'¢ FIPPL¥. SPECIFICATIONS FINI} CON'.E;TRIJCTION DlfiGRFII'"IS fiRE: FIVFIILFIBLE TO INSURE PROPER INS'T'fiLLfiTION. F" E:: [: Ir-ll ][ ']'- i:,"--:: P ]: RE:S; DE:&'Z:E f'lBiR 2~: :]1. ..... t CER]"IF'¢ THfi'T :1..: I Flf"l FFIMIL. IfiR WITH THE REQUIREMENTS FOR ON-SITE SEWERS; fiN[) WELI_.S fiS SET FORTH B'¢ THE PIlJNIC:IPfiLIT'¢ (:IF' FINCHORFIt3E. 2: I WILL. INSTFILL. THE SYSTEM IN fiCCOR[:,fiNCE WITH THE CODES. ]:: I UNDERS"FfiN[) "rHfiT 'filE ON-SITE SEWER S'T'STEf,1 i',lFl'¢ REQtJIRE ENLfiRGEMENT IF THE RES;IDENC'E IS REMODELED TO INCLIJf.)E MORE THRN :.~: BEDROOMS. r,E: LE,::,D E:ONST ]..::,.:,I...IE.[. EP¢. .................. [)F:ITE_ ,,,,r::.: ~iI ' ~ 0 Er E GEO iCHNICAL 8 DEVEL ~MENT CO. Russell Oyster 694,2774 Soils f~). Foundations Perfo~ned for: Name: Box 90, Davis St,, Eaule River, Alaska 99577 694.2774 or 688.2280 Earl Ellis SOIL LOG 688-22eo ' Land Development /,~'d:;Z:, (..:,,.~,<w/_ ~,.'~.//,~,/,/ Tel. NO. Hail tn9 Address: De~Eee~tZ 5 6 ,.-:: / 7 i{). ...... 13 ] 4 :].6 Grourid Water Encountered: 'Yes ........... No ~-.__ If yes, what depth_ · Proposed ~nstallation: Seepage Pit Drain Field Comments: This well is producing gallons of water per hour. MOON DRILLING SR BOX 668, BOGARD RD. P~MER, ALASKA 99645 TELEPHONE 745~1071 Lot BIk,, , Sub.~ INVOICE WELL LOG Set pump @ , _ feet. INVOICE NO.-- DATE YOUR P. O. NUMBER __ SALESMAN CABIN FORMATION FORMATION CAI]iN FORMATION 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 6; Block 2i Mountain Manor Subdivision Location (site address or directions) Property owner Mailing address Lending agency Mailing address Frank and Phyllis 18540 Roads End Circle, 18540 Roads End Circle Eagle River, AK Singleton Day phone 696-0751 Eagle River, AK 99577 Day phone Agent Vir,qinia Kohfield/REMAX OF EAGLE RIVER Address 16~00 C~.n~_~.fx'.~.d D~'_v~ Eagle River, AK Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: $ ~'~ TYPE OF WATER SUPPLY: Individual well X×X Community well Public water NOTE: Day phone 99577 694-4200 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: XXX 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 inves_ti_gation 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 __'.///~// Phone Address S & S ENGINEERING /// , 17034 Eagle River Loop Rg~.~.,.~, 204 ~ /'/,/~dfl ~ "? Engineers signature Eagle River. Alaslcn 99~.~//' .,,Y~ Date /:.z, -/ D,~HS SIGNATURE Approved for 'T"~C~edrooms. Disapproved. Conditional approval for 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 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 and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~.~c,-~ b ~2~£ ~ ~/~.~,.~,-~/~,,~ , A. Wall Data Well type Log present (Y~],~ r-~ Total depth Sanitary seal (_Y,)N) ,,/' Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed U IZ Driller Cased to z~<, \ ~ Casing height Wires properly protected ~N) FROM WELL LOG AT INSPECTION Date of test \ \ -- '~"5 ~c.~.~ ~C) Static water level [ ~ ~ ~ ~ g.p.m. --,--~ g.p.m. ~ Well flow Pump level1 ~ O~ ~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main ~\~ Sewer service line ~ ~ \ OC~~' ; On adjacent lots ; On adjacent lots \~o Public sewer manhole/cleanout ~\J~ Petroleum tank WATER SAMPLE RESULTS: Coliform C) Nitrate Date of sample: ~ \, 'Z,"/- ~c1.5 \ ,L~ Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~. ~"'~ Cleanouts ~N) High water alarm (Y/~) Date of pumping Tank size \ ~/.~ 5- ~, Compartments Foundation cleanout ~1) ~/ Depression .(Y/~ Alarm tested (Y/N) ~//' ,2-~'- ~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot / ~ o 1 To property line / D ! '/' Absorption field Surface water/drainage / Foundation Water main/service line //WI 72-026 (3/93)* Front CONTINUED ON BACK PAGE 11¢ oO~' ~.3 12_: 45 CTSE ENU I RONHEHTAL LAB SERtJ ICES HO. 883 ,! . ENVIRONMENTAL LABORATORy SERVICE8 Chemlab Ref.% :93.6337.43 Client Sample ID :L6 82 ~INT. MANOR :WATE%~ REPORT of ANAEY$IS 5633 B STREE~. /~NCrIORAGE, AK 99516 TEL: f907) 562,234'3.' FAX: (901) 561-S301 Client Name Ordered By :RAY Project Name Project# PWSlD :UA :S & $ £NGIN~ING Sample Remarks: ROUTINE SAMPLE CO[J~ECTED BY: RAY, WORK Order :73524 Report Completed :11/30/93 Collected :11/22/93 ~ 14:30 hz Received :~/2~/93 @ 16:00 hz Technical Director:gT~P}~N C. EDE P ~ Qc All, oweDle Ext0 Anal arameter Results Qual Units Method Limitz Date Date Nitrate-N 1.6 mg/L EPA 353.2/300.0 l0 11/24 C~: * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above N~ = Not Analyzed U = Undetected, ~epo~ted value ~ the practical quantification limit, bT = Les~ Than D = Secondary dilution. GT = Greater Than 11, 00/9o 12:48 CT:LE EN~I REINP1ENTAL LAB ~-' m '!C'ES :,Er,, NEI. 883 ~:AX: (ECT', .58~ 5301 ,~$'I' BE COM, .,~El r.,_, t-3Y WATER Pi;BLJ_C ~'ATER ~, .... v,.,t LD. -"~ PRIMATE 'WATER SYSTEM SAN~LE D,~, z .. ~_.j ,~ ............ :'*fonth Da~ Your S AMI-'LE TYPE: Routi~e with lab vet, Speci;lI Purpose (5' ected SA ~{PI2,E I ..OCA.t Coi['o¥~cnL~q $atisfactozV '- ~nm. ~, 33 '-~ .... v.~ over hours old, :'~lts may new s~p~c P ' 2-5 l, nv!2'sit, Be?,an ................................ 'D · . ~ ,, r~otifi,--d r.u uas;di5 :~ctory resu ts: · ",'~cne,l Si;,: ,.e ','dt;~ ?axed B A(T]i E~RIO [. O G I C.U, 5~'A2 ER .&N'~UL 5'S fS Rt~ C O t~ 5~IO-MUG Result: Tara] Co f'( rm ........................ ~' ~embrane Filtee: 'Direct Count ...................... ~2~ Colonlex/U;O mi Verification: LTB BGB COL~M .................. Fecal Collfo~ Confirmation Final Membrane Filte,' Resu]}5 ~ Member: ~h5 SGS Co'oup {Sa:,eh PAR]' ONE OF TWO: 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 GENERAL INFORMATION (a) Application Date December 31 ~ 1986 Legal Description (include lot, block, subdivision, section, township, range) Lot 6, Block 2 Mountain Manor Location (address or directions) Eagle River TI4N R1W Sec. 6 (b) Applicant Name David Brock Telephone: Home 694-6090 Business 562-7653 Applicant Address 3000 A. Street Suite 101 Anchorage~ Alaska 99503 (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); ~ (d) Lending Institution City Mortgage Telephone 26~-2~79 Address P.O. Box 2117 Plaza 7~ #5~2 Eagle River, Alaska (e) Real Estate Company and Agent Fortune Properties David Brock Address 3000 A St. Suite 101 Anchorages Alaska 9950.3 Telephone ~62-76%3 (f) Mail the HAA to the following address: Pickup By Engineer 99577- 2. TYPE OF RESIDENCE Single-Family [] 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. 4. 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. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDIhG 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 Heatth 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 Telephone Address ~^m: ~,~ ~-.~.~ ,,,., ~. - ~, Date ./,~/'~7/~ 7 ~GLE RIVER, ,qK 99577 P. 0. BOX 773294 694-5195 DHEP APPROVAL Approved for Approved Terms of Conditional Approval bedrooms by. Disapproved Conditional. CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OI= HEA~-'I~j[/~I"'TI=rAUTHORITY APPROVAL (HAA) ENVIRONMENTAL ~OTE~CKLIST- FEBRUARY 1984 264-4720 [,tAN ,5 t987 Legal Description: /--07- o/ ,~Z. Well Classification Well Log Present (Y/N) Total Depth '+ ,~ / Static Water Level Casing Height Above Ground 2. / Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot ~O~..; u,.~-.,.. If A, B, C, D.E.C. ApproVed (Y/N) ~/,~ ~J Date Completed HHt~/.,o,.-,H Yield '~' Cased to ~ "fo ' Depth of Grouting ~ A Pump Set At ~; o-H-,, .--, Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ~- ~oo ~ ; On Adjoining Lots ~/o,, Y To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments WA.' To Nearest Public Sewer /~ P. To Nearest Sewer Service Line on Lot + Z.C ' ;Date 1z-3/-8~, B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line '~-/o" Course ~' Ioo ' Size ,/ Z.,,.Co No. of Compartments Air-tight Caps (Y/N) "(' Foundation Cleanout (Y/N) ¥ Date Last Pumped ~,~//~..o- /'/~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation IL/ / TO Disposal Field I~ / To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) 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 GENERAL INFORMATION (a) Application Date May 12 ~ 1986 LegaIDescription(includelot, block, subdivision, section, township, range) Lot 6, Blk 2~ Mountain Manor Est. T14N R1W Location(addressordirections) Roads End Circle (b) Applicant Name Irene Naylor Telephone: Home N/A Business _~5-2858 Applicant Address National Bank of Alaska, POB 7-025; Anchorage~ 9951n-997-7 (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution (applicant) Address Telephone (e) Real Estate Company and Agent Fortune Address 300 A St. Suite #101. Telephone 562-7653 (f) Mail the HAA to the following address: plckup by Realtor - please call Properties/ David Brock Anchorage, AK 99503 TYPE OF RESIDENCE Single-Family [~ Multi-Family [] Number of Bedrooms ~3 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. Page 1 of 2 SEWAGE DISPOSAL Onsite E-I Public [] Community [] Holding Tank [] Note: If corn reunify well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 72-025 (~ 1~84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION /',,s certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on tile date of this inspection. Name of Firm Telephone Address EAGLE RIVER ENGINEERING SERVICES EAGLE RIVER, AK 99577 P, O, BOX 773294 694-5195 Seal D H E P AP PR OV~.~.) ~ Approved for ~-,~£.~ bedroor~s by~~~"~'J~-c~--~Date Approved /~'/ Disapproved Conditional Terms of Conditibnal Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ANCHOP, AGE CHECKLIST . FEBRUARY 1984 ENVIRONMENTAL PROTECTION 264-4720 M,A,Y 'J 2 ~ Legal Description: Z~ WELL DATA RECEIVED Well Classification /o~_~' ~, ~. Well Log Present (Y/N) Total Depth '/- / / ,~ f Static Water Level ,// '-/' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot If A, B, C, D.E.C. Approved (Y/N) ,/bY Date Completed c~,vA-~.,~, ,~, Yield Cased to ~-¢"g / Depth of Grouting c'.~ r,,.75 Pump Set At ~ Sanitary Seal on Casing (Y/N) ,.v Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhoie Water Sample Collected by Water Sample Test Results Comments To Nearest Public Sewer To Nearest Sewer Service Line on Lot t ~.5- / ;Date -~--/~/~'~ B. SEPTIC/HOLDING TANK DATA Date Installed /,9 ~7 ,~ Size ? ..::z 5~.~ No. of Compartments Y Standpipes (Y/N) Air-tight Caps (Y/N) ,v Foundation Cleanout (Y/N) Depression over Tank (Y/N) -/vi Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ./t//.~: ; for Holding Tank High-Water Alarm (Y/N) /'~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ./~ ~ z To Property Line ~'/~ / To Water Main/Service Line '~/g / Course To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) EAGLE RIVER ENGINEERING SERVICES Lou Butera P.E. P.O. Box 773294 Eagle River, Alaska 99577 Telephone (907) 694-5195 May 12, 1986 Mr. Steve Morris Civil Engineer, On-site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 REF: Lot 6, Block 2, Mountain Manor Subdv. Dear Mr. Morris: On behalf of my client, Mrs. Irene Naylor I am submitting the information necessary for a determination of Health Authority Approval for the above referenced lot. The septic system absorbtion rate has been tested and found adequate for a 3 bedroom use. The leachfield was installed in 1977 by Mc Lead Construction and was inspected and approved by the Municipalit: at that time as per the inspection report enclosed. The soil log enclosed shows a total depth of 12.5' with no water table. The system however was installed to a depth of_~10._5~ which is beyond the permitted depth for that soil log. The area in question, to my knowledge, does not have a water table problem. However as the system was previously approved by MOA the matter of verification of 4' vertical separation to water table, and resulting approval is left to your determination. If there are any questions or if additional information is required please feel free to contact me at 694-5195. Sincerely, Lou Butera, P.E. Encl: HAA application soil log inspection report CHEMICAL & Gl. LOGICAL LABORATORIES ~ / ALASKA, INC. Drinking Water Anal ysis Re port for Total Coil form Ba ct eria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I.D. NO. Water System Name Phone No. Mailing Address City State Zip Code MO. Day Year SAMPLE TYPE: [3 Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. , l 4 I 5 LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: [] Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received Time Received Analytical Method: [] Fermentation Tube [] Membrane Filter Lab Ref. No. Result* Analyst L I *NO Of colon~es/100 mr or No of Positive DOrtions READ INSTRUCTIONS BEFORE COLLECTING SAM PLE 06-1220 (b) Rev. 1978 BACTER IO LOG ICAL WATER ANALYSIS RECORD Date Collected Source Date Received Time Received o.m, Lab. NO. · resumptlve 1Omi 1Omi ~Oml 1Omi 1Omi 1,0mi OJ, ml 24 Hours 48 Hours :onflrmatory 24 Hours 48 Hours EMB_ Broth 24 hours: Multlole Tube Report: Membrane Filter= Direct Count Verification: LTB Final Membrane Filter Results Reported By Broth 48 hours: 10mi Tubes Posltlw/Total 10mi Portlonl Collform/100rnl BGB Date Collform/lOOml #1: Time Date Insp 'NICIPALITY OF ANCHORAGE F~jl ~--~ DEPARTMENT ur HEALTH AND ENV}RONMENTAL FROTECTION 825 L Street, Anchorage. Alaska 99501 ~ ~ Date Received: April 20, 11~ a.~~ #2: 4~- ~ ~Tue~day Time .. /;. Time Date _/~-~/~ /~g~q Date ~ratF Insp ~ tnsp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Mailing Address: Lending Institution Request: Arctic First Federal Savings 701 West 4th Avenue 99501 Phone: 278-9541 2. Property Owner: Mailing Address: Duncan Mc Leod Phone: % Jo Davis, Executive Realty, 276-7777 3. Legal Description: Lot 6 Block 2 Mountain Manor Subdivision 4: Single Family Residence: ( Multiple Family Residence: Number of Bedrooms: Three Number of Bedrooms: Well System: Permit $ Construction Individual Well (~ Community/Public System ( ) Depth of Well Well Log on Fi~~ Bacterial Analysis Sewage Disposal System: Permit ~$ 77685 Septic Tank Size Absorption Area On-site System ~ ) Public Utility ( ) Installed lqq~ Installer ~.~ ~,~ ~%. Manufacturer 9 Soils Rate ~ Material Distances: Well to Septic Tank to Sewer Line NearesE Lot line to Nearest Lot Line to Absorption Area Absorption Area Page Two Department of Health'and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 6 Block 2 Mountain Manor Subdivision Comments: Affadavit Attached ~ e ( ) .__ ~ : ) L tter Attache. d: Approved:~ ~..~~ Date: ~)~ ~ ~' ' '' Disapproved: Date: Department Worksheet: MUNICIPAI..ITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor' Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL, SEWER and WATER FACI[.tTIES 1. Type of Inspection: 2. Property Owner: ._.~ CMRO ............... VA ................. FHA, .... CONV Mailing Address: .............................................. Day Phone: Mailing Address: ................................... Day Phone: Mailing Address: .............................................. Phone: 5. Name of Realtor or A(:!ent:__~ .... ' ' Mailing Adclress: Phone: .... 6. Lerjal Description: Location 7. 'Type of Facility to be inspected ................. '? ..~,.'__;': ........... No. Bdrms 8. Water Supply Type of Supply: Public Utility Jndividual___.~__ if Individual, number of dwellings presently served if Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility ................ Individual If Individual, date of installation ........ ,~ ......... 72-003(3/76) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ANCHOP, AGE CHECKLIST- FEBRUARY 1984 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION WEL,.ATA RECEIVED Well Classification Well Log Present (Y/N) 264-4720 Legal DescriptiOn: If A, B, C, D.E.C. Approved (Y/N) Date Completed M,u~-,¢¢~,,~/ Yield ~ ~ '~'~ Total Depth ~- / / ? / Static Water Levet // '7' t Casing Height Above Ground ~, Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ~/~ Cased to rz/'~" Depth of Grouting c-~ r,~:5 Pump Set At '~'¢'~ '~-~'~' Sanitary Seal on Casing (Y/N) Y Depression Around Wellhead (Y/N) ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /V//~ Cleanout/Manhole Water Sample Collected by ~5/-'' /~' ~';¢-'q ~ ~ ' Water Sampte Test Results Comments r'/°~ / ; On Adjoining Lots ~'7¢,; z To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~,~ S- ~ ;Date _5--/3'/~ B. SEPTIC/HOLDING TANK DATA /? ? ? Date installed Standpipes (Y/N) )" Air-tight Caps (Y/N) Depression over Tank (Y/N) / Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) /~,~ Separation Distances from Septic/Holding Tank: To Water-Supply Well '/~ ~ To Property Line t/~ / To Water Main/Service Line */c, / Course Size ? '-:~ 5-w No. of Compartments ~ Foundation Cleanout (Y/N) Date Last Pumped --~--/~ g ; for /'~,/~ Temporary Holding Tank Permit (Y/N) To Building Foundation /¢'" / To Disposal Field /.5- / 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 Date Installed ./~' ?? Width of Field //-5~ // Type of System Design ,7-~-¢.~, ¢ ~ Length of Field 7¢" Depth of Field _ z/~'' ~- /' Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test ,~'~ Separation Distance from Absorption Field: To Water-Supply Well ~'~" To Building Foundation '-~ Lot To Water Main/Service Line '~/~ / To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Gravel Bed Thickness ~" ~ / Standpipes Present (Y/N) /v Date of Last Adequacy Test ~-/,~,/~'~¢ To Property Line ¢-/42" To Existing or Abandoned System on ; On Adjoining Lots ¢--~ To Cutbank (if present) 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 ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~¢~-~';~ Date :-'-~.~.~.//-¢d Company ~_z-~',~,/~, .C MOA No. Receipt No. Date of Payment Amount: $ Engineer's Seal Page 2 of 2 72-026 (11/84) ~' ' --' DA'I'E RECEIVED INSPECTION APPOINTMENTS ~-L~ c.~- TIME TIME TIME )ATE DATE DATE I NSPECTQR INSPECTOR INSPECTOR ~ MUNICIPALITY OF ANCHORAGE MUNICIPALI~ OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONDEPT' OF HEA~TH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P,~OTECTION ENVIRONMENTAL SANITATION DIVISION MAY 2 0 1981 Telephone 264-4720 FO. PP.OW OF DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1, PROPERTY OWNER ~ PHONE 1 MAI LING ,~R ESS - PROPERTY RESIDENT (If different from above) ' PHONE O ~ /~7 ~ PHONE / MAILING ADDRESS ~ 3, LENDI~ NSTITUTIO~---. ONE MAILING ADDRESS ~ /_ ? ~ PHONE' 4. REALTOR/AGENT~ STREET LO~A~'~ ON . 9. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four [] Other ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Six ~] Three 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY *ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 9. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SiX [] OTHER 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: ~ , If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER ~ MATERIAL Septic/Holding Tank Absorption Area Sewer Line INearest Lot Line 5. COMMENTS [J~'~'APPROVED FOR Z . BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~//~ DATE I BY 72-010 (Rev. 6/79) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL pttOTEC~I~CKLIST- FEBRUARY 1984 264-4720 !,:tAN 5 1957 Legal Description: /--oF RECEIVED Well Classification Jg~; ,~,-~.~, If A, B, C, D.E~C. Approved (Y/N) Well Log Present (Y/N) ~ Date Completed HpK/~o~r~ Yield Total Depth + /~ / Cased to ~' ~/o ' Depth of Grouting ~ A Static Water Level lo6 ' g.,.h,~ ~.¢, ~"~"~3 Pump Set At I~o-H-,~ ~ Casing Height Above Ground 2. / Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) '[ Separation Distances from Well: To Septic/Holding Tank on Lot ~:~ ~' To Nearest Edge of Absorption Field on Lot Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole Water Sampte Collected by Water Sample Test Results Comments /do ~,,., c I~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B, SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line '" Io/ To Water Main/Service Line Course ~' ~oo ' Size j 2~ No. of Compartments Air-tight Caps (Y/N) Y Foundation Cleanout (Y/N) ¥ Date Last Pumped ~'/.~ /L//% ; for Temporary Holding Tank Permit (Y/N) To Building Foundation j'u// To Disposal Field I $ ' 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 Date Installed Iq'77 Width of Field /-'J~ ~/ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: .r~l~/ To Water-Supply Welt To Building Foundation Lot To Water Main/Service Line + I,J" To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field "7o" Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots -13° / To Cutbank (if present) +'Co / · t loc)'" D. 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 ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ...~ .~~' Date '//~/~ ? Company F_-~ C=_,3 MOA No. Receipt No. G O0/ OOO_~ Page 2 of 2 72-026 (11/84) Date of Payment /~0~" "-'0~.,.~ Amount: $ ~ ,~"~1~t~ ~agte River Engineoring Se~lces P. O. Box 773294 Eagle River, AK 99577 6~5195 ·: ~"; Engineer's Seal Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type Log present (Y~:¢) r~ Total depth Sanitary seal (~N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~)//--- Driller Cased to z3~,,, ~ ,~ Casing height Wires properly protected ~f_,~N) Date of test Static water level Well flow Pump level1 FROM WELL LOG AT INSPECTION J g.p.m. ~',G'+ g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ Oc>\~ Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots ,\ Public sewer manhole/cleanout ~\f* Petroleum tank '~'$ ~ ~ Z WATER SAMPLE RESULTS: Coliform C~ Nitrate Date of sample: / \ - 'z.'/- ~1.5 \, L~ Other bacteria Collected by: ~t~ ~_..-r.~C~¢.. B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (~q) High water alarm (Y/~} Date of pumping Tank size \'7,,5, ~' Compartments Foundation cleanout ~N) k/ Depression .(Y/~) Alarm tested (Y/N) ,2.~,- '~.~ Pumper ~-"~_~. ~..¢~$$f5o SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot / o o 1 P- On adjacent lots To property line / ~ 1 ¢' Absorption field Surface water/drainage / ~ z~ Foundation Water main/service line 72-o26 (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 "P~m~p-Off~evel at High water alarm level ....~ycles tested Meets MOA electrical codes (Y/N).~.~ ~ SEPARATION D.~S.T-AI~E FROM LIFT STATION TO: V~on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~ J Width Total absorption area ~ / ~ Date of adequacy test / (- ~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y~ Soil rating (GPD/F¢) ~-~'~-~ ~/~/-~ System type '~ / Gravel thickness /-~',~- j Total depth Cleanout present ~;~1) ~/ Depression over field (Y~) Results~[~ail) /~,4'~-~ for ~ After test ~ ~ /./~.[~ /Z.,~ ~.¢ If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain "J'//-t-- On adjacent lots /~'~ / ~ Property line -z~ ~ r To existing or abandoned system on lot / ~ Cutbank ,5~,~ ~ ,c Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION Signature Engineer's Name Date H~ Fee $ Date of Payment Waiver Fee $ Date of Payment Receipt Number ,nspection, ! / 72-026 (3/93)* Back