HomeMy WebLinkAboutHUNDRED HILLS BLK 2 LT 2Hundred Hills
Block
Lot 2
#078-181 -08
~~ Municipality of Anchorage
Development Services Department
Building Safety Division ~'~
On-Site Water & Wastewater Program, 4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW090186 PID Number: 078-181-08
Name:
TONY SLATONBARKER Wastewater System: [] New · Upgrade
Address:
828 HILAND ROAD *EAGLE RIVER, AK 99577 ABSORPTION FIELD
Phone: No. of Bedrooms: E]~
3 [] Deep Trench I-1 Shallow Trench [] Bed [] Mound
LEGAL DESCRIPTION ~i, Rating: Total Depth from oHglnal
GPD/Sq. Ft. J Ft.
Block: Lot: Subdivision: Depth to pipe bottom from origlnol grade: Gravel depth befeC'~eath pipe:
2 2 HUNDRED HILLS,~ rt.
Township: _ Range: Section: Fill sdded cbovs original grads: ·
__ __ length:
Gravel width: mb es: Distance between lines:
WELL: [] New [] Upgrade Ft.
Classification (Privcte, A,B,C): I Total Depth: ~ Total absorp a n
Ft. D 3034/ F-810
G ~. SQ. Ft.
~_~/'~-~'"~ I rt.,..- S CONSTRUCTION 10/1/2009
Yield: ~l Pump Set At: ICasing Height Above Ground:
GP. I rt. I rt. TAN K
SEPARATION DISTANCES · Septic [] Holding [] S.T.E.P. [] Other*
T~o Septic Absorption Lift Holding Public/Private Manufacturen Copoclty in ga,one:
Tank held Station Tank Sewer Lines PREMIER PLASTIC 1000
Material: Number of comp~rtments:
Wel~ 100'+ 100'+ - - 25'+ PLASTIC 2
Surface Water 100'4- 100'+ - - - LIFT STATION
Lot Line 5'+ 10'+ _ _ _ size in gall .... r Manufocturen
Foundation 5'+ 10'4- _ _ _ "Pump on" level at: 'Purer alarm at:
Curtain Drain - NONE KNOWN Pump bl~~cal Inspections performed by:
I I
Remarks: BENCH MARK
Location and Description:
OLD TANK WAS PUMPED AND COMPLETELY REMOVED BOTTOM OF SIDING ON NORTH END OF HOUSE
PER UPC. AT POINT A
A~ .... d E,svatlon: fl 00.00 Ft.
ENGINEER'S SI
Inspections performed by: OEO, Ltd. Dates: 1st 10/1/09
2nd -
3rd - ~:~q ~. ~' "%-.~/~0~,T
Development Services Department Approval /
Conditional approval: Da(e: i ,~ t ;f':¢ ~ ~ v~
Reviewed and approved by: ~'~'~./i ate' 6 -- / ?' ~//
PERMIT NUMBER:
SW090186
A B
DULl 42.62 39.54
DBL2 44.58 41.27
ST1 46.54 45.07
ST1 ¢9.88 46.20
DBL3 52.97 49.15
DBL4 54.55 50.51
MT 53.59 49.18
CO 57.40 53.55
AS-BUILT DRAWING
EXISTING DRAINFI
~,~'T") GROUND WATER
MONITORING TUBE
ADJACENT TO
NEW 1000 GALLON
SEPTIC TANK
SCALE:
I
1%= 40'
-ST1
/
/
//
/
ParCEl ID NUMBER:
078-181-08
OARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
3701 E, 31JDOE EOAB. SUffE 101 * ~CHO~ ~ ~7*~E (90~7-6179 * F~ (907)3~-3246 * ~ ~.ge~ngi~dng.com
PREPARED FOR: IPHONE NUMBER: I PAGE
TONY S~TONBARKER [ C/O AGENT [ 2~B~'
LEGAL DESCRIPTION: I D~WN BY:
~PE OF WORK:
AS-BUILT DRAWING 10/27/09
(Rev. 01105)
PERMIT NUMBER: AS BUILT DRAWING PARCEL ID NUMBER:
SW090186 - 078-181 -08
/-FINAL GRADE = 94.4-4-94-.45
ST1 / ST2 [4-" OF INSULATION PER CONTRACTOR
~ [~ v////////////~ ~ II
AT INLET = 90.99 NEW 1000 GALLON AT OUTLET = 90.80 II
"PREMIER PLASTICS" I I
SEPTIC TANK M
Bo'n'ou OF /
BOTTOM OF TANK
AT OUTLET = 86.89
GARNESS ENGINEERING GROUP,
CONSULTANTS & GENERAL CONTRACTORS
]701 E. ~IDOR ROAD, SUITE 101 * ANCHORAGE. AK g9~07 * PHONE (907)~,~7-6179 * FAX (907)~,~8-;$246 * WEBSITE: wvn~.garne~engineerlng.com
PREPARED FOR:
TONY SLATONBARKER
LEGAL DESCRIPTION:
HUNDRED HILLS BLOCK 2, LOT 2
TYPE OF WORK:
PROFILE DRAWING
(Rev. 01105)
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(gO7) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Sep 25, 2009
Expiration Date: Sep 25, 2010
Permit Number: SW090186
Legal Description: HUNDRED HILLS BLK 2 LT 2
Design Engineer: 0855 GARNESS ENGINEERING GROUF
Owner Name: TONY SLATONBARKER
Owner Address: 828 HILAND ROAD
EAGLE RIVER, AK 99577-9401
Parcel ID: 078-181-08
Site Address: 000828 HILAND RD
Lot Size: 0 SQ. FT.
Total Bedrooms: 0 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw St.
P.O. Box 196650
Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERHIT ~,PPLICATION
FOR ,b, SINGLE FAHILY DWELLING
Property owner(s) TONY SLATONBARKER
Dayphone C/O AGENT
Mailing address
828 HILAND ROAD *EAGLE RIVER. AK
Site address
Zip Code 99577
Legal description (Sub*d, Block & Lot) HUNDRED HILLS BLOCK 2. LOT 2
Legal description (Township, Section & Range) N/^
Lot Size Sq. Ft.
Number of Bedrooms
THIS APPLICATION IS FOR ( [~all that apply):
Absorption Field
Septic Tank
Holding Tank
Pdvy
Private Well []
Water Storage []
THIS APPLICATION IS AN:
[] Initial []
[] Upgrade []
Renewal []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal codes.
DARNESS ENGINEERING GROUP~ Ltd.
Permit/Rush Fees:
Date of Payment:
Receipt Number:
(Rev. 11/05)
Waiver Fees:.
Date of Payment:
Receipt Number:
GARNESS ENGINEERING GROUP, Ltd.
.... · * CONSULTANTS & GENERAL CONTRACTORS
September 24, 2009
Municipality of Anchorage
Development Service Department
On-Site Water & Wastewater Program
4700 Elmore Rd.
P.O. Box 196650,
Anchorage, Ak 99519-6650
{907) 343-7904
Ref: Proposed Septic Tank Upgrade for llundred Iltlls; Block 2,.Lot 2,
To whom it may concern:
The existing 3 bedroom house is served by a private well and septic system. The 1000 gallon septic tank
is collapsing and needs to be upgraded. We are proposing to install a new 1000 gallon septic tank outside
of the driveway area as can be seen on the attached drawing. We are unaware of any adverse impacts this
instalk, tion would have on adjacent wells or septic systems. Ifyou have any questions, please contact us
at 337-6179. ?~k you~for your assistance.
Jeff're 'P~./G~&~,/P.E., M.S.
Presi ~/
NOTE: Attached is a site plan drawing, a design draw&g, which are all part of the design package for this septic
system. (Contact G.E.G. Ltd. for 7page construction specification letter.)
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengincering.com
\
CONCERN
HUNDRED HILLS
BLOCK 1, LOT 7
HUNDRED HILLS
DLOCK 2, LOT 1
HUNDRED HILLS
BLOCK 5, LOT 4
INO CONCERN I
HUNDRED HILL~
ADDITION 1
BLOCK 4, LOT 7
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
i
i
\\
\
\
\
\
\
\
\
%
- PROPOSt'D
ON. LON X
%
EXISllNG
BEDROOM
HOUSE
I
100'
HUNDRED HIMS
BLOCK 1, LOT 8
\
\
\
\
\
\
HUNDRED HIMS
ADDITION 1
BLOCK 5, LOT I
GARNESS ENGINEERING GROUP, Ltd.
...... ~ ......... CONSULTANTS & GENERAL CONTRACTORS
PREPARED FOR: PHONE NUMBER:
TONY SLATONBARKER C/O AGENT
I.[GAL DESCRIPTION:
HUNDRED HILLS BLOCK 2, LOT 2
'i~fPE OF' WORK:
SITE PLaN
PAGE NUMBER:
1 01:'2
DRAWN Ry;
PNB
9/24/09
TANK UPGRADE ~ .OTE:: THE: CONTRACTOR
% FLAGGED BY A REGISTERED
GEG. Ltd, HAS A 7 PAGE SPECIFICATION LAND SURVEYOR PRIOR TO
.rl'~Ro~r,~TH~ [EcoRTAi=,~,~So~OTHllli~IS~_~S~.~N' ~ CONSTRUCTION.
CONTACT GEG. BY PROCEEDING FORWARD ~ ~
WITH ~HI$ INSTALLA'RON. THE ENGINEER, ~ / ~
WElL DRILLER, CONTRACTOR AND ~ ~ x ~
PROPERLY OWNER AGREE ~'~AT THeY
GARNESS ENGINEERING GROUP, Ltd.
,~,. ~ ~ ~,o,.--~ ~ ~,. ~ ~,~.,~ ~..~-~--~-
I I
TONY S~TONBARKER C/O AGENT 2 Or 2
TANK UPGRADE DRAWING
ECEIVED
by JUL 8 1992
OOC Co. dba
SULLIVAN WATER eurficipality of Anchorage
~', l~l~j;;~, t. Health & Human Services
P.O. BOX 670272, CHUGIAK, ALASKA 99567 ' TELEPHONE 688-2759
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION / o~. /~L.~ _~ d,) Y0<9'~'~-&?
DATE-Started Ended 7,t o
1
PERMIT NUMBER
DEPTH OF WELL ¢',,~--
' W
STATIC LE~ELOF ATER FT.
DRAW DOWN FT.
GALS. PER HR 4c~
KIND OF CASING
KIND OF FORMATION:
From ,L/ Ft. to 5% Ft.
From ,-~ Ft. to ~ Ft.
From ,7 Ft. to /~' Ft.
From ]-~ Ft. to--Ft.
From 4~. Ft. to%:.'~' Ft.
From Ft. to Ft.
From. . Ft. to Ft.
From __ Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From -- Ft. to- Ft.
From Ft. to Ft.
From Ft. to . Ft.
From Ft. to Ft.
From .Ft. to Ft.
From Ft. to Ft.
From Ft. to
Ft.
From . Ft. to Ft.
From ,,.Ft. to Ft.
From Ft. to
From Ft. to .Ft
From .Ft. to Ft.
From Ft. to Ft.
From Ft. to . Ft.
From Ft. to Ft.
From Ft. to Ft.
From.---FL to.~--Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft
From FL to Ft.
From~Ft. to Ft.
From Ft. to.~Ft
MISCL. INFORMATION:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL SYSTEM PERMIT
PERMIT NUMBER:SW920123
DESIGN ENGINEER:DUMMY COMPANY
OWNER NAME:WALTI MICHAEL E &
OWNER ADDRESS: 67 TH EVAC HOSPITAL UNIT 26610
APO AE09244 NEW YORK NY 09244
PAGE 1 OF 1
DATE ISSUED: 6/03/92
EXPIRATION DATE: 6/03/93
PARCEL ID:07818108
LEGAL DESCRIPTION: HUNDRED HILLS BLK
2 LT 2
LOT SIZE: 60959 (SQ. FT.)
NUMBER OF BEDROOMS: 2 THIS PERMIT: 2
THIS PERMIT IS FOR THE CONTRUCTION OF:
WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
THE WELL MUST BE LOCATED NOT LESS THAN 100 FEET FROM ANY
SEPTIC SYSTEM. A COPY OF THE WELL LOG MUST BE FURNISHED TO
THIS OFFICE WITHIN 30 DAYS FROM THE WELL COMPLETION.
ASBUILT-NO CORNERS SET THIS DATE.
SEWARD & ASSOCIATES LAND.SURVEYIN~ 688-4566
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
Hundred Hills Subd.,Lot 2,Blk. Z
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNE~ TO DETERMINE' THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
iVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
SCALE:
1"=40'
DATE:
7-22-91
GRID;
SW 1160
2?-47
_,_
" ",. MULTIPLE LIS1 .... AUTHORIZATION AND EXCLUSIVE RIGHT SELL AGREEMENT
1. EXCLUSIVE AGENCY: Owner hereby employs and grants ~'F-~""~¢~/' O? ~_~GI,--EF' ~[\/E~ hereinafter called
,19
"Broker", the Sole, exclusive and irrevocable right commencing on /,~ ,4¢¢p'?//, ,, . ., ; and expiring at midnight
on r~ .~'dr';'"O. ',f~-~- , 1 9 ~-/',/ , to sell or exchange the real property/( t~e property ) described as:
HtJRCJl-C'~'J ~{'~jJ~.i [..'0'~ ;~ Dil:,, ~: , , /.\~Or~].~ Recording District, Stat~, of Alaska.
2. TERMS OF SALE: The purchase price shall be~'.')~, ~ ~ ~>P,~t> -~ ~:.T',~-?/J ~; ~-[ V~ /-//~'/~ Y'~' 1'~¢?'~'~'
($://'./7~,-~-~ ), payable as foliows: ~A~ ~e..- .~_,.~'7~.1"~.,~'~h ~^N~ PI.15'~I~ ~ ~.E-~-~---~
3. DEPOSIT: Broker is authorized to accept and hold a deposit by a prospective buyer.
4. TITLE INSURANCE: Owner warrants they have the right to sell the property on the terms herein, and agrees to furnish and pay for
a policy of title insurance showing marketable title to the properly. Owner agrees interest, taxes, rents and insurance will be prorated to
the date of closing.
5, COMPENSATION TO BROKER: Owner agrees to compensate Broker, irrespective of agency relationships, __% of the sale
price, or $ i~ , if: (1) Broker procures a Buyer on the terms of this Agreement or other terms acceptable to Owner; (2) The
prope'rty is sold or transferred by Owner during the term of this Agreement or any extension hereof; or (3) The property is sold or
transferred within ~ days after expiration or termination of this Agreement to anyone to whose attention it was brought through the
signs, advertising or other action of Broker, or on information secured directly or indirectly from or through Broker or any other person
authorized by Broker to sell or negotiate the sale of the properly, during the term of this Agreement. Provided, (3) will not apply if the
property is sold or transferred through another member of Multiple Listing Service, Inc. Owner agrees to compensate Broker as above
if the property is withdrawn from sale, transferred, conveyed, leased, or rented without consent of Broker, or made unmark~etable by
owner's voluntary act during the term of thi~s'ag~e~~ Owner ~uthqrizes Brol~er to cooperate~ with ethel brokers/to appoint
subagents, and to divide with 0[her brokers such compensation ih any manner acceptable to brokers.
6. MULTIPLE LISTIN0 SERVICE: Broker is a participant of Multiple Listing Service, Inc. This listing and sale information will be
provided to MLS to be published and disseminated to its participants, financing institutions, appraisers, other real estate related
organizations and to prospective purchasers and sellers. IT IS UNDERSTOOD THAT MLS IS NOT A PARTY TO THIS AGREEMENT,
AND ITS SOLE FUNCTION IS TO FURNISH THE DESCRIPTIVE INFORMATION SET FORTH ON THE INPUT SHEET OF THIS
LISTING TO ITS MEMBERS, WITHOUT VERIFICATION AND WITHOUT ASSUMING ANY RESPONSIBILITY FOR SUCH
INFORMATION.
7. INFORMATION: Owner authorizes all mortgage and other lienholders to provide Broker, on request, any and all information
concerning the property including, but not limited to: current and past loan balances and interest charges; reserve accounts; insurance;
credit; and taxes.
8, ' KEYB0X: Broker is authorized to install a Keybox on the property for the use of MLS participants. Neither Broker, Multiple Listing
Service, Inc., nor any participants of MLS shall incur any liability for loss, theft or damage of any nature or kind whatsoever to the
property and/or to any personal property therein.
g. SIGN: Owner authorizes Broker to install a FOR SALE/SOLD sign on the property.
1 0. DISCLOSURE: Owner agrees to provide a statement concerning the condition of the property and agrees to save and hold Broker
harmless from all claims, disputes, litigation and/or judgments arising from any incorrect information supplied by ow~ner, or from any
material fact known by owner which owner fails to disclose.
1 1. TAX WITlffi0LDING: Owner warrants they are U.S. citizens, permanent residents or otherwise exempt from the requirements of
FIRPTA (internal Reven~e Code 1445) that requires payment of part of the sale proceeds to the IRS.
1 2. EQUAL HI~ISlNG OPPgRTUN, ITY: This property is offered in compliance with federal, state, and local anti-discrimination laws.
1 3. ATTORNEY'S FEES: In any action, proceeding or arbitration arising out of this agreement, the prevailing party shall be entitled to
reasonable attorney's fees and costs.
,.,
1 5. RECEIPT: Owner acknowledges they have read and received a copy of this agreement and the attached data sheet this
day of & X/~/~ ,19¢f
~ , ~. City, State:~/?: ,/~/" ~,,,
Broker agrees to use reasonable effo~s in procuring a purchaser: ~ .-'"~?
~...-'
Broker (Off ce)F~/~ Of ~]~ F~V~F by(Agent) eV~
Address: lF, G~Q c~nt~rfl~]d fir. 'F~l~ River~ [~,
Copyright 1988 Multiple Listing Se~ice, inc. ALL RIGHTS RESERVED. '
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
NAME /'
P,ONE l' , NEW
MAILING ADLER ESS
LEGAL DESCRIPTION--
~ DISTAN:~ TO:' IWel'~~ I Absorption area ,~ Dwelling q ~ , PERMIT N
No. of ~mpartments
Liq. capacity ,n[oo~gallons IF HOMEMADE: ~gth Width' Liquid depth
Dwelling
~ ~ Z DISTANCE TO: PERMIT NO,
~ -- ~ Material Liquid capacity in gallons
I
~ Foundation , Nearest lot line ~
_ No. of linesc ~ ~ L~ngth'of each ~ Total length of li~ ~ Trench widt~,.~ ~inches Distance~be~wee~ ~, lines
~ ~ ~ Top of tile to finish grade Material beneath tile
i Total effective ~,~ption area
Q ~ ~ inches
Length t. ~ Width Depth PERMIT NO.
O~ Type of cribt~ ~
~ ~ Crib diameter Crib depth Total effective absorption area
~ ~ DISTANCE TO: Well Building foundation Nearest lot line
~ ~ss ~ ,.. Depth Driller Distance to lot line PERMIT~,~
~ ~ · ·
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS ~
SOl L TEST R~TING
INSTALLER ~ I'~ ~
:i.i::"16 FEF...TF t::'O.~: Fi !::',~;~:i'v'F!'.r'E F.!E%L...;
!..%G T'O :::.::G6 F'EiET' F'RC~P! Fi F:'UE',L.!'C !.,!Fi'LL !i:,EF'EN[i:,ZNG I_tF'O~.,I "FHa:f: T'T'F'E il)F:: ?L.!~-i~!..i{:: i.,.!~ii:i.! ....
[,~EL.L LCff.:JL::; aF.:E REQU:[F:.r::-?::, iq. NE:, HLY~:'T'
OF' 'T'FIE HEL.[
O-FHEF: F:EC:'U i F.'.EbIE'N'T:E: fqF':]'-.," ~PF'L."r' :F.,F'E!"': i r: I CRT ! C,'N:~ F~N[) C.C. ihI:L.:TF:LiE:T j' QN L':, ); FiiX.,!:;::F:!?.i:::7: !::fi;::'-..::'
R',/Fi i i...FiBL. E 'i"C~ :!: H:iF.;UF~:E F'F::OF'EEi:;;: ); NS'TFiL_L.F!T i ON.
F{3F'~:Ti-~ E~"r' 'T!q[J: HUN i C !' F'FiL. Z 7'"/ OF' F!?',EJ:HC!F:FiGE~.
· .. ~ -c, , ::H':2TF:il .............................
2 'r ,4 ~ L.L "i"FiE '::.'; "? :::; T' E: M T i".; FKi:C:ctrq:DFt?.,!C:E H): TH "r'H~: r': F~ !' :, !::"::::
2::
i:~:E':"~;:[DE!'.~(::E; i::_:: F:EFK3DEi:i...L:i:D 70
N
· ~~ !--:; Fi E: L ~,.i!:!L "!" :!: '~j .......................................................
CHNI CAL Er DEVE
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
694-2774 S0IL LOG
Soils Et Foundations
Performed for: Name: /~'//// ,./
Hat]trig Address:
Depth (feet)
0
MENT CO.
----~ 4
5 ,
10
i1
Earl Ellis
Land Development
, Tel. No.
/ / ! ~-'~ ~ ,: ~' t ,v"X'
Soll Charq,ctertsttc~
15,
16
Ground Water Encountered: Yes
No , If yes, what depth
Proposed Installation: Seepage Pit
Drain Field_____
Comments:
Performed by: ":'..''
m
Date:
r'/i .
by AENTAL
A & L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588
OWNER OF LAND ,'//
ADDRESS
'" ~ ~ ~ ~/~)~" ~/~RAW DOWN Ft.
LEGAL DESCRIPTION ~, ~ r-~' . .
DATE-Started ./(~ '- ~ ~' - ~ Ended /~ '-~ ~ - ~ ~ GALS. PER HR
PE~IT NUMBER 77'6 7~ ~ KIND OF CASING
JAN 4 1979
RECEIVED
DEPTH OF WELL -/~
STATIC LEVEL OF WATER FT.
KIND OF FORMATION:
From ~@ Ft. to ~ Ft Otd~/~O~O~-,"o From Et. to
From ~ Et. to /.~-- Ft.._~,,~,-O~'d /9,q~u~'L ~yC~-r~r~om Et. to
From J,<)'~ Et. to ~ Ft. J-~/SZ~ /",q,,,O vt' ~Oat~<~ro~m Et. to
From "~ O,. Ft. to ~4~ Ft. J--"/~l~7' .~/c~-,-oO e~ 6 q~o~'~rom~// ~,~t'Z
__ Ft. to
From Ft. to Ft From Ft. to
From Ft. to Ft. From__ Ft. to
From Ft. to__ Ft. From__ Ft. to
From__ Ft. to__ Ft. From__Ft. to
From__ Ft. to Ft From Ft. to_
From Ft. to.___Ft. From Ft. to
From Ft. to Ft. From Ft. to
From Ft. to Ft. From Ft. to
From Ft. to Ft. From Ft. to
From Ft. to Ft From Ft. to
From__Ft. to Ft. From Ft. to
From__Ft. to Ft. From Ft. to
From Ft. to Ft From Ft. to
Et
Ft.
Ft.
Ft
Ft.
__Ft.
Ft.
__Ft.
Ft.
Ft.
Ft.
Ft
Ft
Ft
Ft.
Ft.
Ft.
MISCL. INFORMATION:
DRILLER'S NAME "
SUBJECT '
DUPLICATE
SIGNED
DATE
Redi~orm
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROi ~CiiON
APR 8 i977
RECE!__YED
SIGNED
4S 469
SEND PARTS ! AND 3 WITH CARBON INTACT -
DETACH AND FILE FOR FOLLOW-UP
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
GENERAL INFORMATION
Complete legal description
Lo -
Location (site address or directions) ~ [ ~-<--.
Property owner ~'(/,,--1-~ tg/,~/~;
Day phone
Mailing address
Lending agency
Mailing address
Day phone
Agent '-~'~ ~{,~ ,.~ ¢,~-,~ l-~ ~.,',~-,-,--
Address ~-~. v',~ ~,~
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
NOTE:
Day phone
Individual well ~'
Community well
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:
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
ordinances, and regulations in effect on the date of this inspection.
Name of Firm "'~ b/¢ ~ ~
Address 203
Engineer's signature
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,
D~HS SIGNATURE
Approved for bedrooms.
Phone ~,"'] '~- 7>~'1 ~
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
The Municipality of A. nchorage 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:
Parcel I.D. 0"~0- 7Ol - o ~
A. Well Data
Well type ~.
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
7'
If A, B, or C, attach ADEC letter. ADEC water system number I"q///~
Date completed "z//? Z- Driller
Cased to /'/-~ Casing height
Wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static water level ~ Z~
Well flow -~ '7'
Pump level1 ~ ~
SEPARATION DISTANCES FROM WELL TO:
AT INSPECTION
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
g.p.m. ,~. g.p.m.
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank t'-.l I O
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate o ~ J Other bacteria
Collected by: ~ --%
B. SEPTIC/HOLDING TANK DATA
Date installed ci'l:~/'7 ~ Tank size
Cleanouts (Y/N) ~
High water alarm (Y/N)
Date of pumping
Compartments
Foundation cleanout (Y/N) 7/ Depression (Y/N)
W//'/~ Alarm tested (Y/N) I"/~A
'ti 7--b' ] ~J ::5 Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot [ O _~ On adjacent lots ;:>') 1 ~ Foundation
To property line ~ O Absorption field ..~ Water main/service line
Surface water/drainage /%~ ~ ~ ¢'
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Manufacturer
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
Length Z~ 7
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
D. ABSORPTION FIELD DATA
Date installed ~/~ / 7 ~,
Width
Soil rating (GPD/FF)
Gravel thickness
Cleanout present (Y/N) /%/'~
Results (pass/fail)
System type · I ~-,~_.~ ~/_,/
Total depth I
Depression over field (Y/N)
for ~ Bedrooms
After test /'7/ ~'
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot / I,..-~
To building foundation
On adjacent lots
Surface water
Curtain drain
On adjacent lots ~'~ l ~ Property line
To existing or abandoned system on lot
Cutbank r~ o ~/~ Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effdct On the cla~t~' of this inspection.
Signature ame-~~/~~,
Engineer's N ~
Date '~--~---( ~. ~ ~ ~ _~
HAAFee$ ~,~
Date of Payment
Receipt Number
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
COMMERCIAL TESTING & ENGINEERING CO.
ENVIRONMENTAL LABORATORY SERVICES'
Chemlab Ref. ~ : 93.6318-1
Client Sample ID :2/2 HUNC, R!i]D HILLS
Mat r ix : WATER
REPORT of ANALYSIS
5633 B STREET
ANCHORAGE, AK 99518
TEL: (907) 562-2343
FAX: (907) 561-5301
Client Name :TOBBEN SPURKLAND, P.E. WORK Order :73[)17
Ordered By :TOBBEN SPURKLAND Report Completed :1i/30/93
Project Name : Collected :!1/22/93 @ 15:45 hrs.
Project~ : Received :1t/23/93 @ 09:00 hrs.
PWSID :U.~ Technical Direc'tor:
~I[?HEN/C., EDE
Sample Remarks: ROUTINE SAMPLE COLLECTED BY: T.S.
QC Allowable Ext. Anal
Parame't~r Results Qual Units Method Limits Dace Date Ini~
Nit:cate-N 0.il mg/L EPA 353.2/300.0 10 11/24 CMR
See Special Instructions Above
See Sample Remarks Above
Undetected, Reported value ~s the practical quantification limit.
Secondary dilution.
Member of the SGS Group (Soci~tb G~n~rale de Surveillance)
UA = Unavaii. able
NA = Not Analyzed
LT = D~s$ T~n
G? = Greate~ Fhan
ENVIRONMENTAL SERVICES IN ALASKA COLORADO, UTAH ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY. SOUTH CAROLINA
/./