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Home My WebLink AboutMOUNTAIN MANOR BLK 4 LT 3AOnsite File w�a Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water & Wastewater Program 4700 Elmore St. - P.O. Box 196650 Anchorage, AK 99519-6650- http://www.muni.org/onsite- (907)343-7904 ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 191182 PID Number: 050-671-52 ❑ New ®Upgrade Name: LEE GABRIELSON ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench 0 Bed ❑ Mound Address: 18826 STILLWATER DRIVE, EAGLE RIVER, AK 99577 ❑ Other Phone: No. of Bedrooms: Soil Rating: Total Depth from original grade: 230-9199 (C/O WALLEY BOSSERMAN) 4 0.8 4.16 (MAX.) GPD/Sq.FL Ft LEGAL DESCRIPTION Depth to pipe Invert from originalgrade: Gravel depth beneath pipe: SEE DWG, Fi 0.58 Ft Subdivision: Block: Lot; MOUNTAIN MANOR 4 3A Pill added above original grade: Gravel length: SEE DWG. 50 Ft. Ft. Township: - Range: _ Section: - Gravel width: Beds Number of lines: Distance between lines: 15+ FI. 3 5 Ft. SEPARATION DISTANCES Total absorption area: 750+ sn. PL Number of trenches: Dist. between trenches: To From Septic Tank Absorption Field Lift Station Holding Tank PublidPrivato Sewer Lines Ft. Well 100'+ 100'+ 100'+ - 25'+ TANK ® Septic ❑ S.T.E.P. ❑Holding ❑ Other Manufacturer: Capacity. Surface Water 100'+ 100'+ 1 100'+ - INFILTRATOR 1530 / 540 N/A Gal. Lot line 51+ 10'+ 51+ - Material: HDPE/PLASTIC Number of compartments: 211 Foundation 101+ 10'+ 10'+ - LIFT STATION Curtain Drain NONE KNOWN Manufacturer: INFILTRATOR W/ PUMP SYSTEM Capacity 540 Gal. Remarks: *PROPOSED 'Pump on' level at: *32e •Pump ofP level at *28e High water alarm at *40^ Pump (take& Model: Electrical Inspections performed by E51 M E51M P NORTHERN TECHNOLOGY SOLUTIONS PIPE MATERIAL 02665/ House to tank D3034 Tank to D1785 drainfield Installer GREEN GENERAL CONTRACTING Drainfteld D3034 CO/MT D3034 Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 100.00 Ft. Inspection Location and Description: Dates: 1st 10/22/201 g 2nd 10/29/2019 3rd - 4th - BOTTOM OF SIDING @ HOSE BIB NEAR FRONT STEPS ENGINEER'S SEAL Community Development Department Approval Conditional approval: Date: A s•i0 ,...... ............... ,r..: 0., ....... ............. . .� .:10 ♦ cn �; rey arness : tv . Air .� P:+ Approved: pp Date: �� p• `4 ROF SN LICENSE �� ,, ji '&'L W ECC884 InepeOtim Keport 1.1-141= PERM T NUMBER OSP191182: RECORD DRAWING \ \ LOT 1, BLOCK 2; \ \ Is' MOUNTAIN MANOR \ WELL AND SEPTIC ON `\ 1 NORTH SIDE OF PROPERTY � 1 EXISTING WELL L)R /,h,v,, z \ ?&f m h d .. - FASEy1ENT z H Z ' 100 - d S II d + + d. � + d d , G 1: _L\li�E O00 hQ'�OOJS� i NEW BED 1/ DRAINFIELD—\ / PARCEL ID NUMBER: 050-671-52 — EXISTING GARAGE. NO WATER SERVICE FROM HOUSE OR WELL PER CONTRACTOR. / FOUNDATION CLEANOUT FOR GARAGE FLOOR DRAIN 15' UTILITY EASEMENT - APPROXIMATE TRANSITION LINE FOR SLOPE INCREASE ) \-1981 TRENCH DECOMMISSIONED IN — INSTALLED DOUBLE PLACE PER CONTRACTOR \ \_ CLEANOUTS (DBL1 & DBL2) APPROXIMATE LOCATION OF 4" SEWER LINE FOR NOTE: OLD SEPTIC TANKS NEW 1530 2-COMPARTMENT GARAGE FLOOR DRAIN PER PHONE CONVERSATION WAS DECOMMISSIONED PER INFILTRATOR SEPTIC TANK WITH DAN GREEN (GREEN GENERAL CONTRACTING) UPC PER THE CONTRACTOR NEW 540 INFILTRATOR PUMP TANK N INSTALLED DOUBLE NOTE: LETTERS OF NON -OBJECTION BEING CLEANOUTS (DBL3 & DBL4) OBTAINED FOR EDGE OF TANKS BEING INSIDE THE 15 FEET UTILITY EASEMENT GPI LOT 6, BLOCK 3; SCALE: l i�P ROSEBERRY PARK EST. 1"=40' GROUP,GARNESS ENGINEERING Ltd ENGINEERING SALES CONSULTING 3701 E. TUDOR ROAD. SUITE 101 ' ANCHORAGE. AK 99507 -PHONE (907) 337-6179 - WEBSITE: w ..gamessengineering.00m PREPARED FOR: I PHONE NUMBER: PAGE NUMBER: LEE GABRIELSON (C/O WALLY BOSSERMAN) 1 907-230-9199 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: MOUNTAIN MANOR S/D; BLOCK4, LOT 3A J.L.M. TYPE OF WORK: DATE: RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 4/22/2021 'Olt +r\!!►i lA ys 14 AV ®.. .... ...0 `.� , .... .... ...... ............ ♦ r� e ey A. arness .8,� ♦AV 0�'J,' C -7 53 � .,�i ®j®``�Fa''..11. � ..-* ''LICENSE o p�oFess�oN®.•' #AECC884 +®d\\\\w0♦ 135.19 PLAT NO. 90-42 MOUNTAIN MANOR SUBDIVISION LOT 3A, BLOCK 4 0000 WELL ` Im -.. `, -/, �.0 1 1 ,;e B Lu NG DLIAIL Ss 1 11 = 2' "I �, i `+- ,--- . "'"►ram 1� �-.. -Ops 4G SEPTIC SYSTEM to 6�§AGE o o _ 15' UT L.1Y ESMT. 008' 1 "E 18.19' S 89051'39"E 663.71' Azj�BU I LT I HEREBY CERTIFY THAT I HAVE SURVEYED TH PROPERTY DEPICTED ABOVE AND THAT NO !'ENCROACHMENTS► CEPT AS INDICATED, !IT IS THE RESPONSIBIL17Y OF OWNERDETERMINE THE EXISTENCE OF ANY EASEMENTS, OVENANTS OR RESTRIC11ONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT, PHONE 248-5454 R NO CIRCUMSTANCES GRID DATE HEREON BE USED FOR CONSTRUCTION OR FOR N MABLISHING BOUNDARY .: NOTE: NO CORNERS SET TH IS DATE **% s o o OF A4 *t�� *go****i • ii;0 AV r*# ii • i# #.###ii.. #!►#.# i 0 0 #i #### #####•##i# co AN i Jeffery A. Gastaldl i i L — 609 1 � �� AV i�# 3/15/2021 #i# � ► AV 40 "0feSSiona Sal& ►�`` ill =50s SoLutions, LLC Northern 1-15-2021 Re: Gabrielson Septic 18816 Stillwater Dr. Eagle River, Alaska Northern Technology installed the electric for this septic system and we confirm that the installation was installed per methods required by the current NEC codes. Thank You, Jaimey Sapp Owner Alaska Electrical Administrator 9EADE 1533 Alaska Specialty Contractor # CONS38147 �lnen t MUNIUPAL1ET Y OFANCHORAGE �° 's Deve➢opmenl Services Department q Right of Way Section Department ENCROACHMENT ENTl' P ERMT R25218i THIS AGREEMENT, made this 29th day of September 2025, by and between Lee & Greta Gabrielson and their heirs, administrators, and assigns, hereinafter called "PERMITTEE", and the Municipality of Anchorage, a municipal corporation organized and existing under its Charter and the laws of the State of Alaska, hereinafter called the "PERMITTER". WITNESSETH: WHEREAS, PERMITTEE is the owner of the following described real property MOUNTAIN MANOR, BLK 4, LT 3A, according to the official records thereof, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTER owns and/or maintains the real property more particularly described as follows: The 15 FOOT UTILITY EASEMENT, immediately on the south side of PERMITTEES property as shown on Plat No. 90-42, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTEE has placed a deck, septic tank & a leach field pipe upon the referenced real property which encroaches 2', 1' & 1' upon the PERMITTER'S 15' utility easement. NOW, THEREFORE, it is mutually agreed between the parties hereto that: 1. The PERMITTER, acting through the Director of Development Services Department, hereby grants to the PERMITTEE the privilege of allowing the deck, septic tank, & leach field pipe to encroach 2', 1', & 1' upon the PERMITTER'S 15' utility easement, as shown on "Attachment A," included herewith. 2. The PERMITTEE agrees forever to indemnify, defend, save and hold harmless, the Municipality, its officers and employees, from any and all lawsuits, claims or actions brought to any person for or on account of damage to property or injury, disease, illness or death of persons, including all costs and expenses incident thereto, arising wholly or in part from or in connection with the existence of, alterations, maintenance, repair, renewal, reconstruction, operation, use or removal of the encroaching well, as placed upon the PERMITTER'S 15' utility easement. 3. The PERMITTEE shall not assign or transfer any of the rights granted herein to another individual or company without first notifying and securing the approval of the Director of Development Services Department. 4. This Agreement and Permit grants PERMITTEE no interest in PERMITTER'S real property whatsoever, except only the encroachment rights described herein. 5. The PERMITTER reserves the right to revoke this permit upon twenty (20) days written notice to the PERMITTEE. The PERMITTEE agrees upon such notice of revocation, to move said encroachment(s) from the 15' utility easement in which it is placed. Should the PERMITTEE refuse or fail to comply with said written notice, the PERMITTER may, without further notice to the PERMITTEE, remove or cause to be removed the encroachment(s), and the PERMITTEE hereby agrees to reimburse the PERMITTER for all costs incidental to the removal thereof. In addition to the mutual promises heretofore made, the PERMITTEE has paid the PERMITTER a one-time permit application fee of $120.00. The PERMITTER hereby waives the annual fee of $315.00. IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seal the day and year first hereinabove written. GRANTEE: T PP (:ohrialcr-�n 7 GRANTOR: MUNICIPALITY OF ANCHORAGE '�� j ovi- John Snelson Right of Way Supervisor MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 . 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP191182 Work Type: Septic Upgrade Tax Code Number: 05067152000 Site Legal Address: MOUNTAIN MANOR BLK 4 LT 3A G:0254 Site Mailing Address: 18826 STILLWATER DR, Eagle River Owner: Gabrielson Lee Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Q Disposal Field 21 Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: enr .S' f LLT - De PailtIII C'lir 7/17/2019 7/16/2020 63305 ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received B) Issued By: 1, f/ 4/� Date: / Date: 4 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling _ Parcel I.D. C/O WALLY BOSSERMAN Property owner(s) LEE GABRIELSON Day phone 907-230-9199 Mailing address 18826 STILLWATER DRIVE, EAGLE RIVER, AK 99577 Site address 18826 STILLWATER DRIVE, EAGLE RIVER, AK 99577 Legal description (Sub'd, Block & Lot) MOUNTAIN MANOR: BLOCK 4, LOT 3A Legal description (Township, Section & Range) Lot Size Sq. Ft. Number of Bedrooms 5 (CURRENTLY 4) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (®all that apply) Initial ❑ Absorption Field ® Single Family (SF) Upgrade ® (w/wo ADU) Septic Tank ® El Duplex (D) ElRenewal Holding Tank ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: DRAIN FIELD OVER TEST HOLE/ ABANDONED DRAINFIELD TO NEW DRAIN FILED Distance: 0 FEET / 6 FEET I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: '5_q5_ Waiver Fees: 'A R 15 - Date Date of Payment: 15771 '-71 Date of Payment: 51-t 2P Receipt Number: 01D Receipt Number: Q-,,-yq DC7 Permit No. JSP 1 R G1'ya Waiver No. 66 y L g 1631 (Rev. 01 /11) Municipality of Anchorage On-site Water and Wastewater F CODE COMPLIANCE OSPi9�l 1 2 �becca Carroll, 07117119 Ruffaim-§ , .Ad"'w"Ccd F; c en,c,rd Svscc,�r, A NESS ENGINEERING ROUP, Lt ENGINEERING SALES CONSULTING Revised — July 5, 2019 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic System Upgrade for Mountain Manor S/D; Block 4, Lot 3A To whom it may concern: The referenced property has a 4 -bedroom home on it that is served by a private well and septic system. There is a detached garage on the east side of the property that has major foundation damage caused by the November 30, 2018 earthquake. This garage currently has an upper area that is currently being used for gardening per the owner. This garage is proposing to be moved west of the existing location and a new foundation be installed. The septic system consists of a 1,250 -gallon steel septic tank and a deep trench type drainfield that were installed in 1981. We have recently checked the liquid levels in the septic tank and the tank appears to be operating below normal levels. This would lead us to believe the septic tank is of poor integrity. We have recently checked the liquid level in the drainfield and found it operating just below the invert of the distribution line. It was conveyed to us that a geotechnical engineer who assessed the property for property damage related to the earthquake has recommend the drainfield be upgraded. Due to the age of the septic tank and drainfield, the owners would like to upgrade the septic system. A test hole has been excavated and we have designed the drainfield to be within the 30 foot radius of this test hole. Attached is a design drawing showing the proposed septic system upgrade. We are proposing that the existing septic tank be decommissioned per UPC and the existing drainfield be decommissioned in place due to it encroaching on groundwater. We are also proposing a new 1530 two-compartment Infiltrator tank septic tank, a new Infiltrator 500 - gallon pump tank, and a new bed type drainfield be installed. Per the owner, the MOA accessor office has recently assessed the property and determined the total number of 4 bedrooms for the property is 4 bedrooms. We have sized the proposed drainfield to serve a total of 4 bedrooms. 1. SOILS: Attached is a soil log which shows the soils classification, percolation test data and 7 -day groundwater monitoring. The percolation test was performed between 4.0 to 5.0 feet and had a percolation rate was 1.25 minutes/inch. We are proposing to use a 0.8 gpd/sq.ft. application rate for this design with a bed type drainfield. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface water concerns. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179' Fax: (907) 338-3246 * Website: www.garnessengineering,com Page 2 of 2 4. TOPOGRAPHY: The topography is generally flat in the area of the proposed drainfield. There is a slope that is greater than 25% over 50 feet downhill (south) of the proposed drainfield. In short, there are no slope concerns with this installation. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you, ha e any questions, please contact us at 337-6179. Thank you for your assistance. Sincerely, 4 Jeffrey A. of Qss, P4".' M.S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246' Website: www, garnessengineering.com Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191182, Rebecca Carroll, 07/17/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191182, Rebecca Carroll, 07/17/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191182, Rebecca Carroll, 07/17/19 0 U] w H c ;u- 0 v . itiG�✓ 48;!/� r a W 7 ! 0 m 10 LLJ Z < W f eZ)d d e -z [dy_ W V� U� C) F w m U D > F- -JUt- F�-Qui V) e- z V \�cpC7V)ft W� W� n, W i r U tr irzc/)p0U)C) Est W— ��— fe- Z D U- cn \Litwv:a 0 z zww my v U) uj r n z wow c1 C z � c5 U) Z -J w Wa Z a: o m O zow W _! O Z 0 a NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE MAILING ADDRESS LEGAL DESCRIPTION Well DISTANCE TO: Manufacturer (~*' I~--~ ~- LOCATION Liq. capacity in gallons DISTANCE TO: DISTANCE TO: IF HOMEMADE: Inside length No, of lines Well Dwelling l.~?'h °f 'a?_~n~7 Top of tile to finish grade Length Type of crib Width Dw~elling ! __ Material.~, *' Width "' 't Foundation Total length of Hnes Material benea{h til;a Depth NO, OF BEDRL..~OMS PERMIT NO, No. of compartments Liquid depth PERMIT NO. Material .......... Liquid capacity in gallons I Nearest Io~,~ PERMIT NO~_~ ,~O. j Tr..ch w,dth inches Distance between lines Total effectiv.,e absorption area PERMIT NO. Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO.. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS DATE LEGAL PERMIT NO. FIPPL I CANT LOC:FIT I ON LEGAL [:,EF'FIRTMENT Or HEFILTH AN[:, EN',,,'IRONMENTFIL F't,::C]TECTION ~ ,:,o~ "' L" ::,] REEF., RN':Hr]~'RGE., BK. ::_ :,~:. ~ 264-4720 ~ S. FINB, ERSON BROS CONST PO 80X J. 2La E.R. 9La577 ST [ L..LHFITER DR ~ ',,,'E L3~ 84 HT M~NOR LOT SIZE 4]:500 SQLIF~RE FEET TYPE OF SOIL FIBS-';ORPTION SYSTEM IS: TRENCH MFIXIMUM NLIMBER OF BEE:,ROOM.S = 4 SOIL RFITING (SL.] FT',..'BF.':::,= t50 THE REQUIRED SIZE [DF THE SOIL ABSORPTION SYSTEM IS: 'TFIE LENGTH DIMENSION IS THE LENGTH ,'.:IN FEET) OF THE TRENCH OR [:,RRINFIELB,. TFIE DEPTH OF' FI TRENCH OR PIT IS THE [:,ISTRNCE BETHEEN THE SURFFICE OF' ]'HE GROUND FIN[) THE BOTTOM OF' THE: EXCR',/RTION ,::IN FEET). THERE IS NO SET HI[:,TH FOR TRENCHES. THE GRFIYEL DEPTH IS THE MINIMUM DEPTH OF GRFIVEL BETHEEN THE OUTFFIL. L. PIPE AND 'THE BOTTOM OF THE EXC:FI',,,'RTION (IN FEET). PERM:IT FIPPLICRNT HFIS ]'HE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTFILLR'rION INSPECTIONS OF FINY HELLS FIDJFICENT TO THI'S PROPERTY F~N[:, THE NUMBER OF RESIDENCES THAT THE HELL HILL SER'v'E. ............... 'T t-.I ~'Z:~ ( 2 ) I ~-.! :_---. F' E C: T I El I%! '_.:.; A !:~: E--_ F,.' E: ~,:-:." L.I I ~,.': E: [:~ ............... BraCKF'ILI_INC~ OF FINY SYSTEM HI]'HOU]' FINFIt_ INSPEC:TION FIN[:, FIPPROVFIL BY 'I'HIS DE'F'RRTMEN'r HILL BE SUE:JEC:T TO F'ROSECUTION. MINIMLIM [:,ISTRNCE BETHEEN A NELL FIN[) ANY (IN-SITE SEWAGE DISPOSFIL SYSTEM IS ]..00 FEET' FOR Ft F'F.'~IVFITE NELL OR ~50 TO ':200 FEE:T FROM FI PUBLIC HELL DEPENDING UPON THE TYPE OF F'UBLIC HELL MINIMIJM DISTFINCE FROM A PRI'v'RTE 14ELL TO FI PRIVATE SEHER LINE IS 25 FEET FIN[:, 'TO R COMMLff4ITY SENER L. INE IS 75 FEET. OTHER REI;!UIREMENTS MFIY FIPPLY. SPECIFICFITII3NS FIN[.., CONS'I"RUC'FION DIRGRFIMS ARE RYFIILFIBLE TO INSURE PROPER INS'rRLI_FITION. I CERTIFY THFIT :1..: I FIM FFIMIL..IFIR HITH THE REQUIREMENTS FOR ON-SITE SENERS AND HELLS FIS SET FORTH BY THE MUNICIF'RLITY OF FINCHORFIGE. 2: I HILL INSTALL THE SYSTEM IN FICCORDRNCE HITH THE COB, ES. ]:: I UNDERSTRN[:, THR'r 'THE ON-SITE SEHER SYSTEM MFIY RE6!LIIRE ENLFIRGEMENT IF TFIE RESIDENCE IS REMODELE[:, 'TO INCLUDE MORE THFIN 4 BEDROOMS. S:' I iNEt'.':,: ...~_~_~_~ ................... :._.:__ ............. _. ........... FIPPL-- I CFIi'.,FF /¢INE:,E:RSON'"'E, ROS C:ONST MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST DATE PERFO.~ED: /~ ? i~ I U_ Z.~' ~ i LEGAL DESCRIPTION: 4 7- SLOPE SITE PLAN 10 15- 16- 17 18 19 20 11 12 ~--~ 13 WAS GROUND WATER IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop ~iPERCO LATIO N RATE (minutes/inch) COMMENTS TEST RUN BETWEEN ,, FT AND FT PERFORMED BY: 72L008 (6/79) MOON DRILLING BOX 3370 PALMER, ALASKA 99645 'TELEPHONE 745-4071 FORMATION PLEASE PAY FROM THIS iNVOICE FORMATION YOUR P O. NUMBER TERMS . , t, ,,I ,, DEPTH CASIN FORMATION '211 ' ' =233 ' ' 2~5 ' 246 '268~ ~-~' ', '~ / ' 270 -' ~ '~ .... ' 272 AMOUNT Parcel I.D. # 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 1. GENERAL INFORMATION Complete legal description Lot SA; Block 4; Mountain Manor Subdivision Location (site address or directions) Property owner Mailing address Lending agency Mailing address 18826 STill~ter Drive Eagl~ River, AK Howard and Fa~6 Simpson Day phone 18826 Stillwat6r Drive Ea~l~ Rivert AK Day phone 694-5586 99577 Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: 4 ',4 Xxx Public water If community well system, provide written confirmation from 'State ADEC attest- lng 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 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~. Name of Firm _~ & $ £NG!N_~:_~!N~ /'~ ~/Phone ~~'~ Address 17034 Eagle R. I, ve,r L_oo_p._R_oa~i I~ / Engineer's signature ~-~ " ; ~' o DHHS SIGNATURE Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The 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. 724725 {Rev, 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. Well Data Well type Log present {j~) ",J Total depth If A, B, or C, attach ADEC letter. ADEC water system number Date completed C~ ~ ~1 c:) Driller ~¥--~ Cased to AbC)' Casing height j¢..~ Jr" Sanitary seal ~1) Date of test Static water level Well flow Pump level1 FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot \ Public sewer main Sewer service line Wires properly protected ~1) ~ g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Date of sample: Nitrate \. ~ Other bacteria Collected by: ~ ~ ~ B. SEPTIC/HOLDING TANK DATA Date installed Co ~<;'~ - '~ \ Cleanouts ~1) High water alarm (YI~ Date of pumping Tank size j ~..:'% c;::, Compartments Foundation cleanout ~'N) ~ Depression Alarm tested (Y/N) --~;~ c~ /.( Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ ~ On adjacent lots To property line \ o Absorption field Surface water/drainage ~ ~ ~ ~ ~- Foundation Water main/service line 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) ~ SEPARATION DIST~ANCL~ROM LIFT STATION TO: WeE'~ lot On adjacent lots Manufacturer Manhole/Access (Y/N) at Sudace water D. ABSORPTION FIELD DATA Date installed L~'~%~J Length [ .~"/ ~ Width Total absorption area L~'"[ c~ ~ Date of adequacy test "/~ I ~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y~ Soil rating (GPD/FF) I~ ~/~' ~ System type "~.~-~ Gravel thickness Total depth Cleanout present~b'q) ~/ Depression over field (Y~ Results~5~ ail) ~A--~ ~ for ~ Bedrooms After test I t~o~[,~ If yes. give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot l To building foundation On adjacent lots Sudace water Curtain drain To ~xisting or abandoned system on lot Cutbank ~1,~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION · I cer~'~y that I have che~nformed to all MOA and HAA guidelines Signature . / ~ ,r~ ~ .<~.~,..~ ~*~: ~.~;~. '~" Engineers Na~E~ ~ Date Eag~v~ka 99577 ~~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number WATER WELL ADVISQR~ During a recent Health Authority Approval on-site inspection and test_of the potable water supply well on Lot JA . Block ~ of ~T~ /~o~ Subdivision, the well's productivity was determined to b~ O.~O gallons per minute. The minimum well prodqctivity required by this department (AMC 15.55) for a ~ bedroom residence is~.~, gallons per minute. Although the subject well currently exceeds this minimum requirement, all part'les concerned are advised that the production capacity of the well may fluctuate. Restriction of noncritical water uses such as washing cars and Wat%ring lawns and gardens may be required. This advisory must be attached to all copies of t'he subject Health Authority Approval. MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 3; Block 4; Mountain Manor Subdivision (b) Location (address or directions) 18826 Stillwater~ Eagle Rive% Alaska Property owner Freddie Mac Telephone '. (home) Business Mailing Address #29-64004-IC (c) Lending Institution Mailing Address Telephone (d) ,J~,? ~ COMPANWL~'nda Banner RealEstate Company and Agent JACK '""-': Address 10928 Ea~le River ~oad, Eagle River, Alaska Telephone 694-5500 (e) Mail the HAA to the following address: (or check here,~ if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 17034 Eagle River Loop Road~ Suit~ 204 ~agle River, Alaska 99577 2. TYPE OF RESIDENCE Numberofbedrooms 4 Single-Family [] 3. WATER SUPPLY Individual Well E:X Ordered by Lynda Banner Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site~Z Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 '~JO~ S,JeeU!~U@ IBUO!SSejoJd eH) u! SUOlSSlUJO Jo sJoJJe JOj elq!Suodse~ ~ou s! e~BJOqOU¥ jo ~!led!o!un~ eq/'penss! s! eleo!jRJee B DJojeq B~Bp eZ~IBUB JO suoilo~dsu! lenpuoo leu op SHHQ to seeXold LU:t 'slueuJeJ!nbeJ el~s pue leJepeJ u!B~Jeo ~Js!l~s ol JepJo u! suoRnlp, su! §u!puel J!eq~ pue seLuoq jo sJesBqoJnd ol ~se~Jnoo e sB s!q~, seop SHHQ eH± 'e~Sel¥ ,to e~,elS eq~, u! peJels!6eJ Jeeul6ue leUO!SSejoJd ~uepuedepu! ue ~q e^oqe S qdeJSeJed u! ue^l§ suop, elueseJdeJ eql uodn ~lUO pesBq pe~,eo!,tHeo le^oJddv/~lpoq~nv q~lBeH senss! (SHHO) seo!^JeS ueLunH pue q~leeH ,to ~ueLu~edeo e6e~oqouv,to ~,!lBd!o!unlAI eqj. le^oJddv leUOp,!puoo ,to SLUJe± leUOp,!puoO pe^oJddBs!Q .~. pe^oJddv 1Y^Ol~ddY SHHO '9 euoqdele± wJ!-I ,to @WBN 'uo?,oedsu! s!4~ ,to e~ep e41 uo loe,t,te u! suoRBInbeJ pub 'seouBu!pJo 'sepoo e~B1S pue led!o!unlAl lib 41F~ eoUe!ldUJoo u! s! welsXs iBsods!p je~eMe~,sBM Jo/pue Xlddns je~Bt~ e~!s-uo eq~, 'uo!~oedsu! pue uo!~BS!),se^u! Xw wo~,t pue Sel!t eeeJoqou¥ ,to /q!lBd!o!unl/~ eq~ LuoJ~ peu!e~qo uoRewJoJu! eq~ uo pesBq ~Bq~,X,tHeA Jeq~Jn,t I 'u!eJa4 pe~Bo!pu! eJn~3nJls,to ed~l pue swoo~peq jo ~eqwnu eq~ ~oj elenbepe pue IBUO!~un,t 'e,tes s! we~sXs lesOds!p ~e~,B~e~se~ ~o/pue ~lddns Jele~ eHs-uo eq~ leq~ s~oqs IBAoJddv X~Hoqlnv qll~eH s!ql,to uo!lBB!lse^u! ~w leq~;~,tpe^ I 't~oleq ut~oqs e~Bp UO!IBp!IB^ eq~,to se pue oleJeq pex!,t,te lees Xw ~q pe!,t!Heo sV .... NOIJ. YINI:IO.-INI aNY V.LYa 'HOaV~]$ 3lid 'SJ. SqJ. '$NOIJ. OqdSNI 9NlalAOtJd INI:II=I ONIEI=~qNION:3 'g ,~,~ MUNICIPALITY OF ANCHORAGE (MOA) ,(~'~r'~' ,/~'~¥' Health Authority Approval (HAA) "' ',1 ?~~,~}~ CHECKLIST - FEBRUARY 1984 ,,~, , ~ ,, ~ 343-4744 Leg De iptio .:, ~ ",., al scr n: A. WELL DATA Well Classification Well Log Present (~/N) Total Depth ,.?...¢,~..i Cased to Static Water Levet Casing Height Above Ground Electrical Wiring in Conduit ~'N) Date Completed ~ ~ ~:~ Depth of Grouting Y SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot \ ~C~I To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line IfA, B, C, D.E.C. Approved (Y/N) Gift' Yield \ ,'7~ ~., ~'~1 Pump Set At t~""5 '~ Sanitary Seal on Casingd~/N) ~ Depression Around Wellhead (Y,d~) To Nearest Sewer Service Line on Lot Water Sample Collected by '~'¢~f'~'~ ~ Ir~r~ ; Date Water Sample Test Results '~/"~'"1~\ Comments ~ ¢'q..~t~ ~ ~ ~.~ \~ ~ "B,~ . ; On Adjoining Lots \ ~'~=~f ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TANK DATA Date Installed ~2-' ~" ~,1 Size Standpipes ~/N) '7/ Depression over Tank Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) I'¢'~'~ No. of Compartments Air-tight Caps~iyN) Foundation Cleanout~,%~N) ~-./ Date Last Pumped [ ~ ; for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well \ To Property Line To Water Main/Service Line \ To Stream, Pond, Lake or Major Drainage Course Comments To Building Foundation To Disposal Field I.4- 72-026 (Rev, 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ -' Width of Field '~- Square Feet of Absortion Area Depression over Field (Y~¢~ Results of Last Adequacy Test ~ '¢~//'"~¢-- Type of System Design Length of Field (.~"7 I Depth of Field Gravel Bed Thickness Statndpipes Present (~:TN) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundatio~ Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ~ To Existing or Abandoned System on ; On Adjoining Lots '?~¢~Jr To Cutback (if present) Comments D. LIFT STATION Date Installed Size~ "Pump On" Level at ~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at PumpingS. 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 th!.s inspection. Signed Company Date MOA No. ENGINEERING Receipt No. 2 ('~ ~:2 // / ~/(~ ® ~ Receipt No. Date of Payment ///-c~ ~ --'°c~' Waiver Fee: $ Amount: $ ./?¢ ~ Date of Payment 72-026 (Rev 7/88) Back Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order ~ 10523 Date Report Pxinted: NOV 21 88 @ 23:22 Client Sample ID:L3, B4, MOUNTAIN MANOR PWSID :UA Collected NOV 16 88 @ 16:10 hrs. Received NOV 17 88 @ 15:15 hrs. Preserved with :4 DEG, C Client Name : S E S ENGINEERING Client Acct : SNSENGP P.O.{ NONE REC'D Req # Ordered By : Analysis Completed :NOV lB 88 Send Reports to: Laboratory Supervi~er~ .~:~33~PHEN C. EDE 1)S & S ENGINEERING Released By : ~C.-~._ ~ 2) Special Instruct: Chemlab Ref ~: 3483 Lab Smpl ID: 4 Matrix: WATER Allowable Parameter Iested Result/Units Method Limits NITRATE-N 1.8 mE/1 EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY RP 1 Tests Performed ' See Special Instructions Above UA:Unavailable ND= None Detected "See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include tot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name J-~,rE./'L-~T"-.4 G,,~_. ~-'~.~,V~/felephone: Home ~r-d~" q °~°1L~ Business Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution NZ,/£ Address (e) Real Estate Company and Agent Address Telephone Telephone (f) Mail the HAA to the following address: S & S Englneerln~ SRB 196x TYPE OF RESIDENCE Single-Familyl~]..~Multi- Family Number of Bedrooms Other WATER SUPPLY Individual Well~ Community [] Public [] Note: If corem unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [~ Public D Community [] Holding Tank [] Note: if community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. Paoe 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm $ & S Engineering SRB 196x Address EagJe ~,iver, Date Telephone Approved for ~"~ .~ bedrooms e Approved /~'/ Disapproved~/' ' Conditional Terms of Conditional 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. MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 MUNICIPALITY OF ANCl"IORAJ~' DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION ; E B 0 1986. 264-4720 Legal Description: ~-- ~'~'~ ~EIVED WELL DATA Well Classification "~(~.l. ~/~'~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present~/NT~ Date Completed ~'~-~ ~' O Yield Total Depth 7_..~"~" / Cased to Static Water Level /oc~ Casing Height Above Ground Electrical Wiring in Conduit Separation Distances from Welt: To Septic/Holding Tank on Lot ,/Oo / /Z. Ii ~- To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample ColleCted by Water Sample Test Results Depth of Grouting Pump Set At /'~'~' I Sanitary Seal on Casing ,~/.N) Depression Around Wellhead (,Y'~) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Comments /oc~ B. SEPTIC/HOLDING TANK DATA To Water-Supply Well To Property Line To Water Main/Service Line Course Comments Date Installed /-~-~"'f-~( Size /~"~ No. of Compartments Standpipes (~N) Air-tight CapstANS' Foundation Cleanout(~bl,)' Depression over Tank ~-Y~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) '/'~" ; for Holding Tank High-Water Alarm (Y/N) /'J'~- Temporary Holding Tank Permit (Y/N) "~'/_,4-- Separation Distances from Septic/Holding Tank: ~/z~o / ~ To Building Foundation ~ [ ¢'- To Disposal Field '-~ To Stream, Pond, Lake, or Major Drainage Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~;~ -,-.%~- ~ / Width of Field ~::'~ Square Feet of Absorption Area ~¢~0 Depression over Field,~V~ 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 Type of System Design Length of Field Depth of Field / Gravel Bed Thickness ~" Standpipes Present Y~.~;~I) Date of Last Adequacy Test To Property Line ~----~ ~ To Existing or Abandoned System od ; On Adjoining Lots ~'-~ t- To Cutbank (if present) Comments 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 S 8, S £.gineering Date ~-~ -- ~:~'-'~ ~' S~B 196x Company ,,;,~]~ Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) '1. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date _/7/~'~,/ GENERAL INFORMATION (a) Legal Description (include lot, block, subd~wsion, sechon, township, range) Location (address or directions) / (b) App cantName~~_~ ..... ~Z Tolephone:~mo _;~-~f~/ Business Applicant Address (C) Applicant is (check one~. Lending Institution (d) (e) Real Estate Company and Agent Address Tglgphone (f)""'l~' the ~AA to the following address: TYPE OF RESIDENCE Single-Famil¢ Multi-Family [] Other Number of Bedrooms ..... _~_ ......... WATER SUPPLY Individual We,U,~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public[] Community[] Holding Tank[] Note: If community well system, must have written confirmahon from the State Department of Environmental Conservation attesting to the legality and status. ENGINEERING FIRM PROVIDING 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 invesbgation of this Hee th Authority Approval shows that the on-site water supply and/or wastewater disposal syslem is safe, funchonal 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 Telephone DHEP APPROVAL , APproved for //~'~¢-~'¢) bedrooms by Approved /'~ Disapproved Terms of Conditional Approval Conditional Date CAUTION The Muncipality of Anchorage Department of Plealth 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 C- WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY '1984 264-4720 Legal Description: ,,~ Well Log Present(~/J~f~ Total Depth ,~o,¢" Cased to . Static Water Level /~ Casing Height Above Ground Electrical Wiring in Conduit{~/,t~ Separation Distances from Welt: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /v/'4' Cleanout/Manhole If A, B, C, D.E.C. Approved (Y/N) Date' Completed Water Sample Collected by Water Sample Test Results Depth of Grouting Pump Set At / Sanitary Seal on Casing~/,~ Depression Around Wellhead ; On Adjoining Lots ,/de z ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Yield : Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed (.¢'-'~"'-8 I Standpipes ~/N,)' Air-tight Caps {~'/4~t) Depression over Tank,4~j' Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well .,/~O To Property Line c~o To Water Main/Service Line Size } "~ ~-C:~ No. of Compartments Foundation Cleanout t~/-NT" I~)ate Last Pumped "~ ~'/,4,- ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field Course To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed (¢2"~'~ ~'~ Width of Field ~'~ ~ Square Feet of Absorption Area Depression over Fields Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present {~') Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /~23~O ! ~ To Building Foundation ':~ I ~ Lot ~"~' To Water Main/Service Line ~ / ¢' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~.~ ~ 4- To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Man/ole/Access (Y/N) ~/'/Pump Off" Levet at ~//,,j,, Vent (Y/N) //~'J¢' 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 M(~A and HAA guidelines in effect on the date of this inspection. ComDan,v. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~UNICIPALITY OF ANCHORAOE 825 L Street - Anchorage, Alaska 99501 DFr~T ~ r ENVIRoi4M :h ,A.,; .,~)4LCT ENVIRONMENTAL E~GINEERING DIVISION , ~ Telephone 264-4720 &~ ]~ g DIRECTIONS: Complete all parts on page 1. Incomplete requ~ will not be processed. Please allow ten (10) dags for processing. 1.~OPERTYOWNER~ , , · _ ~ . ~ . PHONE MAILING AQDRESS , ~' ' · , _ PBOPEaTY BESIDENT (If diffeTent from a~ve) ' ? - 2. BpYER . , ' ~ ~ PHONE 4. REALTOR/AGENT PHONE S. LEGAL DESCRIPTION STREET LdCATIONs ' 6. TYPE OF RESIDENCE SlNGLEFAMILY MULTIPLE FAMILY [] One ~i~ Four [] Two [~ Five [] Three [] Six Other 7. WATER SUPPLY ~, INDIVIDUAL* ' ' [] COMMUNITY '1-'1 PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if availabl ~.) 8. SEWAGE DISPOSAL SYSTEM '~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date ~,, s¥'stcm i~ ov~r t;;'c (2} 7eam-oNf~adequac,.y-te~t-~r~qui4~ed by-this Del~m~ NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. p' 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER [~]Septic Tank or [] Holding Tank Size: I ~-c~'-O If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area ISewer Line I Nearest Lot Line WELL TO: ~/ cw 1 Absorption Area to nearest Lot Line [] APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) ~'~)ISAPPROV ED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78)