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Home My WebLink AboutSKYLINE VIEW BLK 1 LT 27 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Nar. e DISTANCES ']'/~Y ~ ~ SEPIIC ABSORPTION Address TANK FIELO WELL Phone(s) Permit NO. No. ol~edrooms WELL /4) 3 / ~ o~scm,~o,-- LOT LINE .~ / I Btock Subdivision · Lot ~ 7 / ~/,~c_ ~/~ FOUNDATION -~.. I Township, Range, Section AS-BUILT DIAGRAM ~Show location el well, septic system, property lines, foundation, T / ~)~ ~ I t~ ~ ~ */~ driveway, water bodies, etc. TANKS N ~ SEPTIC ~ HOLDING Manufacturer~Z ~ ~/~ Capacfly/~ ~ln gallons ~ ~Etl I Material NO. ol Compadments ~r~ l TYPE OF SYSTEM /~ ~, / ~TRENCH ~ BED ~ W. DRAIN ~ OTHER original grade ~f ~ FT FT Fill added ~bove original grade Gravel depth benea{h pipe FT FT Gravel length Gravel width FT FT Total absorption area Distance between fines~ ~ SO FT ET Number of finesJ~ Soil rating Pipe material / Installer Date Installed ~ // WELLS F ~ PRIVATE ~ OTHER fldentifv) ~' Classification (A,B,C) Total Depth FI Cased to FI ---~ ~ "~ Installer Date Inslafled: REMARKS: , . Scale: E';~' 'E.E~'~ ~rY//,~c / ~/r ~F~r/~e~ ~ ~/e~/ InspectionsPedormedby: SEAL . Eagle River, AK 99577 69M5195 I ceflily Ihal Ihis inspe~10n was pefl0rmed according 10 all Munici,al and Slate guidelines la effe~l on Ibis dale: ~//?¢~/* ~/ Health Depa.menl Approval: : -----~'· 72-013 (3185) ':. L.;'; ':; ,:'" ~il:'?..L'5 I.. f!~'Lp~:..ec:~,"L~, P~r"~chor',~43~.~, (.~i~'4%1-::ax 99',501 F' IE R PI ]i 'T ]: i:::: ~iEl::l -I" :1: !::'V TI"I(Y'I :~ ].,, i[ ?:':Wn f.,':':~n;i.].:i, au". ~.,!:i.'Lh '!.:.h~)~! r'(.):.)qu:i.r.l::.)ln~.::.?r'H'.~i~ ~'cn" c:~n...-~.'L~:.:~ ~(av~,:.)p~ ;:w'~d ~;~:.'.)1].~ /:~ a'd"~i::l :i. rl (::c)i/ll::i].J.i~tr'ic:~:.4, ?,J:i.'Lh t. hc.:.1, c:l¢.?~.:i.~)i"! c'.l"'.i.'L(.:.M':i.,'~x ~::){' t..l'~:i.~!~ I::)~"~,l"f11:i.'t'..,, :[ v-.~:i,].l ?~:~c:ll'~cn',c.~ 'l:,c~ ~;~:I.:L I¥1(::~(~ ,'~:~l"~::l ~t,;.:':x'l:.~:~.~ ~::)~' (:~:!,~2~1.::~ r'~.~qt,,~:i.l'~.:.~m¢:,)rlt,~ fc)r' t'..h~:.~ ~i~.':.:,'~'.. Ct :i.!i~-'~L{'M'IC:(':')~ {' I'"Ciffl i:!tl"ly (':?)'( 'i.'~'L :i.l"l~::.l ~4¢".~]. ]. ~, L/.l~3.%'lt.~.~b~':U~'.l.~r'' d J,~;)(::)~!~i,':',~.;I. ~y~i'L~:,m c:ip I::)Ld:) ]. :i.c ~l~,i':(')l.~-.ll".':".'i"~(::Ji'L~ ~5~/~i'].LE'ifii 1::)1"/ 'Ll'lii.!3 tip ~ll"ly i:':ld..'j&C:i:.:.H3'l:.. CiP I'iiF)~':':ll"l::)~? ].Cit.,, any C:q"i;l.~.Pgl.:'~liiii?iTI,'., b.~:i.:ll ~'e)i;tll,.t:i,r'e ar'~ adcl;i,t.J.C)rla], peprn:i.L,, · ............ ......... .............................. ............... (I:;l~n"l¢-~:,~p) I'II,.I~:N(::~ ,: ....II"d::,~...d~l DI:::.VM....L)I-hlI:::.NI :[ ~.~r,c.~:~::l EIy ~ * D(.¥'I'E. :; ,,,~. .~, :I: NFdIFd¥I i:)~ I"1. H ,, ~i~ ,, I::'1:;i :1: (:)1::( 'T'[I 1 Ii3'f" ~.'. ;?:lxl:O :1: Nli!;I:::'IECT :I: Lll',! BY liEIxll3:1: I'~lE:l!ii:l:;:, :[ F (.~d::'Tliii:R DF:'F;' ]: C, IE I"IEIUI::i'.D~, C(.~I..I.,. ::'.!; 4 ::":, '"" /.I, 61:i1:1. ii:lxl~i!;'l"F.~!,,L.. ~:ilEF:'T :[ C; ']"(:&ll'::: 713 Tl'"l:l:liil l:::'!!il:l::(l"l]:l" I]ii:Xl:::'J:l':il~:!iii :1.2/:::.!; :1./11!19 SPECIFICATIONS FOR SEPTIC I'ANK REPLPACEMENT 150' NEIGH, NEW ( APPROX, DRIVE EXISTING TRENCH :XISTING TANK JO WELL 150' WELL AND SEPTIC SITE PLAN LEGAL~ LOT 27 3LK I SKYLINE VIEW OWNERI HUD CONTRACTOR: N/A EAGLE RIVER ENGINEERING SERVICES PO BX 773294 EAGLE RIVER, AK, 99577 694-5195 EASEMENT EXISTINO LEACH FIELD NEW LEACH FIELD CLEANBUT - o SCALE, 1' = 20' MUNICIPALITY OF ANCIIORAGE Hea- h and Environmental ProLe( ;.on Four[h Floor Wes[ 825 I, Street Anchorage ~ Alaska 279~-25]1, x 224, 225 TILE [)RAIN FI[it.D: TOTAL I.I~NGTtl DIS'[ANC[. [ ROM WELl .............. i:OU,'q[)AIION ...... NL/\I,~[:!,I I OIL. INF .OF t. E of Lines ........... 1}1~, rANCE BEll Wi{L-N LIf4JJS . . . T d:NFII WIC) I'H '_~..'.._ IN. TOTAL_ EFF'I:'C] AB¢ORPrlON AREA_~ . SQ. [1. tENOrlt OF E. AE~ I [)EPTII: ~OP OF ]II.E TO [.Ir'4lSII GfiAE)E ..... MA1[ I~!AI_ IH:lhlE[Alit ] ILL[ ~ _.~ IN. ABOVE TILl[ ........... Ilq. DI/.\ME'I lei), ....... ()1,~ WIOTH . ., l [[I',~G'I't t ..... [)I£PTi I Log Crib Rings ...... Crib SJ_zc;: (]IAMETI.R_ _LH Pi'it ...... DISTANCE FROM: WELl ....................... '1' O'1 Al. [3LJII._DING I-OLJNDA"FION .......... NEAliEbT t.O[ IINE ...... AR:;ORF'TION AREA (WAI, L AR~A) ................... 5Q F']. "~: ~:- .... ' ":' ...... "~ = ~': '~':':'~'-':':'-':~'::-::,~ 7::::":T ::'T,' ~7~'--:'::::7'': :':::-::~ ~'--'-::':::-::: ....... ..... ' ' ' , I ' ~las.~. Depth , - -~.- -~ ~ -! h Wel~ .shance ~o. Lot L~nc ~ : ~ , 4 i , --~ / ~ , . Installor: ................. . : ::. I.; .~. il .... ~. ...................................... , ..,.. , i i ii: i i:::i',IIi!i i ii i:,'i i,ii::i'.,!';.:; i'i ii.,i 'i 'i:; il'il:: i i"]i",il'ii ii.ii:.:'i:,i:l:::'lli id:: i:;] i i:,:'i;.i.,ii :ii i iii::: r:~PF:!k,h::i i;,i.'i:"i i.i i '::; i'ii;: i','l'i h,i'i i',il lift i;ii'.,!i;, i iii:: i:.:=l'i'i i i ii',1 i'ii:' ii.i!:] i. i' ti- [;;ii.,t;.i.; ';:;'.~".:.;'i'i::. i,i i,.i Ii i ihd it' i:: 'i i'.,I!:::1t ;i i.,i'i:;i::",.:i ;:'i' i t'iiq i:::ii'.!i:, :::!::, ::;,!:;i,t'l~,.,~[;::ll ::"-~ i. ii:!; : . i,ii'i::ii.,i i:.i i,fii::'i [. :: I..F i:d'-,!~.~.~ lih,i...':; 'i ' ::.: ,. ::: I:ii.:: ~ ..,~. ir ",t'h ', ~ , ~ t , i:~'i:'i"ii:i',i i ':::; i'ii:l'~' ~:d':'i::'i "r' ':';i :'i :;i : ii: ;i [':i:::l ! ; '1 ',!':::; ~:"li",!l:~ 'i" 'i: :"1 Il':" i I'] i i,i'i;:;i ii;iq:- i:'i;i'i"ll:'i:i;i' i i',m:;il::'d i !:::['i'ii ii:::: ;:::-;~:; i; ':" ii ii ;;;" i,:::: '::.; !i ;;h, iii: i, ;:: i'::; ii ,,'ii ti::;; ii::::;i;;;':;" ii!:::' i! ,. "i "::;;~ ';;'' ',,::' ii:Ii' i'i 'i i:ii:;i: i,ii iii tlii: i,;'i'::t3ii!;i;i'i':;i'ii:;i',!F:i:'; l:t)l;;: rd-,!'-'::;; l I: ': ::'l.,.I ::l;i':: i:::li'qi;:~ ' ::i ':::; iii: I'"il ir,I i i':i i:'i:li i i'.,' Ill' : '.,ll"i. i'.,i'::;; i I':li i i iii: ':::;'."::; i .i' i i',i I:li ;:l';:l';d4:i':d:::li'..il;:l::' i.,.i;i; i I I il'il:; i;:l ':,~'lifl;:,i:i i:i:, ii'i ii',ii:i.ili:d'; rll)i,i'i:: 'il.li:li'-,I :i: ;! ;:: .,! m',~ :: ,:':.., i:i".,':,, OS-E GEOTr:CHNICAL 8' DEVELO°MENT Box 90, Davis St, Eagle River, Alaska 99577 694-2774 or 688-2280 CO. Russell Oyster Earl Ellis 694:2774 SOIL L0~ 688-2280 Soils 8' Foundations Land Development Performed for: Legal Description: o 2~ ].2 16 Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: No / If yes, Drain Field what depth Performed by.~,~z~_.- ¥~. '~',-. Date: mt~i$ w¢l( s,producmg,, ':';' gallor~s ~., watel per hour MOON DRILLING BOX 3370 PALMER, ALASKA 99045 TELEPHONE 745-4071 Set pump Ca .. feet. I~VOICI~ INVOICE DATE , // : , .: ' yOUR P. O, NUMBER WELL LOG DEPTH f,' ' DEPTII DEPTH 1~ PT. CASIN FORMATION IN FT. CASI~/ FORMATION IN FT. CA3IN FORMATION 4~.~ ~ ~ 1~~ ~ ~04 ~17 ~ ' ~, 117 ~ ~ 217 , 118 ~ 218 ~ ' ~ ~ ' ' ' 127 ~ 227- ~ ~ -129 F 229 , '131 J / 281 ~a a ~ 133 238 ~S4 [ "'~[,, - 135 235 ~? ~" [ ',h~' '~4s --~m ] 4" ~4~ I~ E~-- [ 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 ~ ~ \ - I °~ ~-'~ -.---'~(/'', HAA# 1. GENERAL INFORMATION Complete legal description Lot 27; Block 1i Skyline. View Subdivision Location (site address or directions) 19364 Dogwood Road, Chugiak, AK Property owner Mary EZizabeZh Ride. A Day phone Mailing address P.O, Box 244974, Anchorage., AK 99524 688-0816 5~3-5355 Lending agency Mailing address Day phone Agent Virgi~a Kohfie~d/REMAX ~AGLE RIVER Address 16_600 Cent¢.rfi2~d Drive., Su.Z~;¢ ¢201 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well XX× Community well Public water NOTE: Day phone 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 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/orwastewaterdisposal 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. S & $ ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Name of Firm Address Engineer's signature Phone Date DHHS SIGNATURE o~ Approved for ;;~.¢-~./¢~-~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Deparlment of Health and Human Sen/ices (DHHS) issues Health Authority Approval Oertificates 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. 72K)25 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-~,4' '2.~ ['~,~L. \ ~-~z_~.¢... ~¢.,~ Parcel I.D. A. WELL DATA Well type Log presenl~/N) Total depth ~ ~'q Sanitary seal ON) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~ ' ~ -']'] ' Driller ~\b~, Casedto ~'~ l~¢-¢-Px~d:~"~ Casing height /2.'4'/'- Wires properly protected f~YN) ¢ Date of test Static water level Well flow '~'. Pump level FROM WELL LOG g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~) c'° ~/~ ~¢'-k' Nitrate Date of sample: '~ - '2- S--- c/~ B. SEPTIC/HOLDING TA 5--A,~I'-~_I~' DATA Date installed \~% ¢% Cleanouts ~'N) k/ . High water alarm (Y~j~ Date of pumping Collected by: Other bacteria _ S & S ENGINEERING 17034 Eagle River Loop Road NO. ~ID4 Eagle River, Alaska 99577 Tank size \ ~. c,o Compartments Foundation cleanout ~YN) ~ Depression (Y~ Alarm tested (Y/N) ~"~ \ "~'~ Pumper -.~,_~.-. -~_~3 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ To property line .~ Q Surface water/drainage On adjacent lots ~,.~ ~k-- Foundation ~D ~ 4- Absorption field ~ Water main/service line \c) ~4- 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level ~-~'~'~"'"~ Cycles tested Meets MOA elec~~ S~ISTANCE FROM LIFT STATION TO: Welt on lot · On adjacent lots Manufacturer Manhole/Access (Y/N) ..-~--'"'P~ p Off" level at Surface water D. ABSORPTION FIELD DATA Date installed \°~'1 ~ Length ~ ~ Width Total absorption area Depression over field (Y(~ Results ~ail) ~2¢,~..¢ ~ Peroxide treatment (past 12 months) (Y/~ Soil rating ~< ~ [~'¢'"' System type Gravel thickness ~¢~ Total depth \ Cleanouts present(~N) ~/ - Date of adequacy test ~ ~ ~ ~c.~ for '~-¢~6-¢¢-~ (.."'%'~ ~ bedrooms t~ ~E..- I¢4..~v..kt.-k If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ ~o To building foundation On adjacent lots ~'~o \~ Surface water \ C~c~ Curtain drain ~\ ~ E. EN'GINEER~S CERTIFICATION On adjacent lots ~oc~~ ~ Property line To existing or abandoned system on lot Cutbank ~',¢~' Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines itl effeci s & s ENGINEERING 17034 ['.'agio River Loop Road No, 204 Signature ~.,i. ~;,,~,~ AI:~M~a 99577 Engineer's Name Date ~-%~ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ [)ate of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX:(907) 561-5301 Chemlab Ref.~ :93.1230-3 REPORT of ANALYSIS Client Sample ID :L27 Bt SKYLINE VIEW Matrix : WATER Client Name :S & S ENGINEERING Ordsred By :R. SHAFER Project Name : ProJect~ : PWSID :UA Collected :03/25/93 @ 11:00 hrs. Received :03/25/93 ~ 15:45 hrs, WORK Order :64328 Report Completed :03/26/93 Technical Director ~ST~P~N C, EDE Released By Sample Remarks: ROUTINE SAMPLE COLLECTED BY: RAY. QC Allowable Extract Analysis Parameter Resulte Qual. Unite Method Limits Date Date Init NITRATE-N 3.36 mE/1 EPA 353.2/300.0 lO 03/26/93 LLH ' See Special Instructions Above UA - Unavailable " See Sample Remarks Above NA - Not Analyzed U ~ Undetected, Reported value is the practical quantification limit. LT - Less Than D - Secondary dilution. GT - Greater Than (¢ SGS Member of the SGS Group (Soci~t~ G~n~rale de Surveillance) MUNICIPALITY OF ANCHORAGE Department of Heallh & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ~"[--~ '~ \ - /~'~, ,-C3. - ~-~'-'-~,/'¢~ HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 27, Block 1, Skyline View Subdv. TZ5N, R1W, Sec. 16 Location (address or directions) NHN Do~wood (b) Property owner Mailing Address (c) Lending Institution Mailing Address H.U.D. 222 W. 8th Ave. N/A Telephone:(home) (Box N-64), ~choraqe, Telephone Business~71-4342 99513 (d) Real Estate Company and Agent Associated Brokers / Sandy Hjelmstead Address 640 W. 35th Ave. Suite #1, Anchorage, Ak. 99503-5807 Telephone (907) 563-3333 (e) Mail the HAA to the following address: (or check here B2, if hold for pick up.) List contact person and day phone number below: Pick-up By Engineer '. Single-Family [] 3. WATER SUPPLY Individual Well [] 2. TYPE OF RESIDENCE Number of bedrooms Community [] Public [] Nole: 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 [~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. 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, lverifythat my investigation oft~is Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional end 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 Eagle River Engineering Services Telephone (907) 694-5195 Address P.O. Box 773294, Eagle River, Ak. 99577 Date / / 6. DHHS APPROVAL ' ~ Approved for.? bedrooms by Date Approved ~, '" .Disapproved Conditional .-/3 -?: Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated 6ased 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. 7/88) Back Page 2 of 2 ,¢%_¢ Well Classification MUNICIPALITY OF ANCHORAGE (MOA) Health Aulhority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: ~ Well Log Present (Y/N) Y~ Date Completed {¢1-/"? Total Depth I ~'] ' Cased to_*~o'p~,C Depth of Grouting Static Water Level (--t 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 To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results , If A, B, C, D.E.C. Approved (Y/N) r3/^ Yield I..~ ~p,,-, 4-.~,,~ ,~/~s Pump Set At +' ~. ~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots +' IOO' 1o,5 ; On Adjoining Lots ~. 100 To Nearest Public Sewer Cleanout/Manhole Q/,~, ~'26 ' Comments B. SEPTIC/HOLDING TANK DATA Date Installed I~ Scl Size Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on FiFe (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: ~ooo~1 No. of Compartments Air-tight Caps (Y/N) %0~ Foundation Cleanout (Y/N) Date Last Pumped ~ ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Fronl Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ '-/~ Width of Field ~' _cs Square Feet of Absortion Area 300 Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field ~' Depth of Field I O Gravel Bed Thickness ~' Statndpipes Present (Y/N) Date of Last Adequacy Test ,,¢¢,,¢ .~-,..,.- ~, ~ ..'... SEPARATIO'N DISTANCE FROM ABSORPTION FIELD: ~.O5 ' To Water-Supply Well To Building Foundatiori ~¢o' Lot ~ / ~ To Water Main/Service Line ~ ~o~ 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 ~- To Cutback (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) "'""'"'% Pumping Cycles during Adequacy Test. **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 Company [agle River Engine0rlng Services P. O. Box 773294 ~"'//~//~'¢ Eag[0 RIver, AK 99577 Date 6~I-5195 MOA No. ~'~ - Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 '-,: .... · En~iheer's Seal Eagle River Engineering P.O. Box 773294 Eagle River, AK, 99577 NORTHERN TESTING LABORATORIES, INC, 2505 ~AIR/JANK$ ,~TREET GO0 UNtVERSITY PLAZA WEST. SUITE A Attn: Louis Butera ANCHORAGE, A~$KA 995~ ~IRBANK,,R, ALASKA 9~9 Date Arrived: Time Arrived: Date Sampled: Time Sampled: Date Completed: 907-277-83Y.~ · FAX 274-§645 907-479,3115 · FAX 479,0547 04/10/90 1Il5 04/10/90 1005 04/11/90 source: Skylinm View, Lot 27, Blk. 1 Sample ID#: A041090~33 Parameter Unit A041090~,33 ADEC MCC* Nit rate-N ag/1 2.5 10 Francois Hodigari, Anchorage Operations Manager $ MCC = Maxim~ Contaminant Concentration 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 27 Block 1 Skyline View Subdv. r~15N R1W Se.c:. 16 Location (address or directions) (b) NHN Doc[wood Property owner H.U.D. Telephone: (home) Business 271-4342 Mailing Address 222 W. 8th. Avenue (Box N-64), Anchorage, Ak. 99813 (c) Lending Institution N/A Telephone Mailing Address (d) RealEstate Company and Agent_ Rea3. by Store / La~ry Hardesty Address 8040 Opal Circle, Anchoraqe, ~. 99502 Telephone ~907) 243-1022 (e) Mail the HAA to the following address: (or check here [~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family I~ Number of bedrooms ~ 3 3. WATER SUPPLY Individual Well [] 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 ~ 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 5. 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, l verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functiona .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 Eagle River Engineering Services Telephone (907) 694-5195 Address P.O. Box 773294, Eagle River, Ak. 99577 Date 5/3/1989 6. DHHS APPROVAL Approved for _Z Approved. ~ bedrooms by Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph § 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 inordertosatisfycertain federal and state requirements. Employees of DHHSdonotconductinspections or analyze data before a certificate is issued. TheMunicipalityofAnchorageisn°t responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) B.ck Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: A. WELL DATA Well Classification /°r ~ d4- 2"4E' Well Log Present (Y/N)/V ~' .Bate Comp~!eted /2'2? Total Depth//? Cased(to _z/¢?¢,¢,Depth of Grouting Static Water Level ¢.7 / ~ 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 To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results ('~?'"~"-'" If A, B, C, D.E.C. Approved (Y/N) Yield /', ? ¢~'0"'n Pump Set At ¢ f'4' / Sanitary Seal on Casing (Y/N) ,Y Depression Around Wellhead (Y/N) /05- ¢ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ;Date .~.J-~ ; On Adjoining Lots Comments B. SEPTIC/HOLDING TANK DATA Date Installed /'2E~¢ Size Standpipes (Y/N) ~ Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) J¢o~..~ No. of Compartments Air-tight Caps (Y/N) ,,,v Foundation Cieanout (Y/N) ,'~ Date Last Pumped Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well /'¢¢-~ / To Property Line 3 -~ / To Water Main/Service Line ~'-/¢ / To Stream, Pond, Lake or Major Drainage Course To Building Foundation To Disposal Field ~ Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /'~ ~ '~ Width of Field -5~ / Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field /~o' Gravel Bed Thickness ~z' / Statndpipes Present (Y/N) _ Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation 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 /-.¢~ r To Cutback (if present) '"~/'~ Comments D. LIFT STATION ~/~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in,.effe:ct'-o'h.. . ~ , . 'the,,¢,ctte. · of this ,d: ;, '::: ' ': :'- ': ::, inspection. ~....., .... :.,. - . ... ., Signed Company Eagle River En¢~eering Services F, U, Box 773294 (:)ate G/Z/,r~' Eagle River, AK 99577 694~5195 MOA No. Receipt No. o~//, ~) Date of Payment Amount: $ 72-026 (Rev. 7/88) 8ack Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HtLiLTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR ItF~,TH AUTHORITY APPROVAL CERTIFICATE 1. General Informatiou Application Date _~ -~_~_~ (a) (b) Legal Description (include lot, block,~subdivision, section, township, range) Locatiork (address or directions) Applicants Name ~ Applicants Address. Address Real Estate Co. & Agent Address Telepho ne - Home lsd ~/5/ Bus iness ~ ~eg_ .-~ q~ ~ (c) Applicant is (check one) Lending Institution ~-~ ; Owner/bt~i4x~r ~-~ Buyer ~___~--~ ; Other ~ (explain); _~ ~.~./_~f.~L,~q ~-,~_--~ .... (d) Lending Institution 1~~~ ~~ Telephone (e) (f) Telephone ...Ma-i~ the ILIA to the following address: ; {J~: .I ~ ..... ; ,.',,~ ~ %., .>J 2. TyPe of Residence Single-Family~-~[ Number of Bedrooms 3. W_!ate__Lr u?p1X Individual Well~ Multi-Family ~_--~ Other (describe) Community ~-~ Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status° S ewa e~_sj?os al_ Onsite ~ Public E~-q Community E~ Holding Tank ~--~ Note: If community well system~ must have written confirmation from the ~t~'~ 3~par~aeaz .of Eav£ro~e;tCa2 C'oa~erwa¢toa a~estlsg co the iegaiigy and status. [Page 1 of 2] 5, En$ineering. Firm Providi_~n~ Ins~ections~ 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 regula- tions in effect on the date of this inspection, Name of Firm Telephone Address 8 :l ] ~lq~".~-' . :,o I J & roved ~ ' pp for % bedrooms By -z-~.~' ~ Date Approved ~ Disapproved //// Condition~ -'V' Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRO~.iENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT~ ATIONS GIVEN IN PAKAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN TIlE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS, EMPLOYEES OF D~EP 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, (DHEP SEAL) RR4/eJ/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY O/~ ANCHORAQI~ DEPT. OF HEALTH & MutczczP.,z,i~ oF ~CHO]~E (MOA) - R E C E iv E Well Classif tcati~ ~ Well Lag P~esent((~/~) Total Depth v---d~)' ~cased to Static Water ~1 ~ Casing ~ight ~ Ground ~O l, .Elee~ical Wiring in ~nduit~) Sep~ation Distan~s ~ ~11: To ~ptic~~ Ta~ ~ ~t /~O If A, B, o~ C, D.E.C, Approved(Y/N) / Date C~p, leted ~ ~ ~pth'/of Grouting. ~' ~t At Sanit~y ~al on Casing/(~) ~ession ~ound ~l~ead (~ ; On Adjoining Lots To NeaL~est Edge of Absc~ption Field on Lot ./OO '~ ; C~1 Adjoining Lot.s /~)O To Nearest Public Sewer Line ~///~ To Nearest Public Se~er ' Cleancut/Manhole /J /~ To Neap. est Sewer F~rvice Line on Lot Wate~ Sample Collected By~T', ~ ~;~/hF~ , Date /~. /~'% Wate~ Sample Test P~sults .~/9 ~/~-/~)/c-~--c~9, B. SEPTIC/N~NI~W~ TANK DATA Date Installed ~/~ Size //~O~ No. of Ca,pa~tments ~-~ Standpipes ~) ' <~ Air-tight Caps (~) Foundatfon Cleanout~) Depression Over Tank (~ Date Last ~Pumped ' /~/F Pumping/Maintenance O°ntra~ ct on File.(,Y/~//F~; for Holding Tank High-Wate~ Alarm (Y/~///~- Tempora~-y Holding Tank Permit Separation Distances from septic/~ Tank: To Water-Supply Well /d~)O ~ ! To Property Line /CD To Water ~Service Line Course Co~nents To Building Foundation To Disposal Field _. ./ To Stream, Pond, Lake, c~ Major Drainage Receipt Date Paid: Amount: []?age 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Type of System Design~4C~. _ Length of Field ~ >-- ~ D~pth of Field z'o ~ Soils Rating in Absorption Strata Date .Installed ~//7 ~ Width of Field ~ ~" Gravel Bed Thickness ~.~ ~, Square Feet of Absorption A~ea ~ ~ Standpipes PreSent ~/N). Depression over Field (~i~ Date of Last Ac~quacy Test-/2~/. ~' 3 v / Results of Last Adequacy Test.~/~-~ S ~¢-r~/' .. / ,~ , Separation Distance frc~ Absorptlon Field: To Water-Supply Well /dO ~- To Property Line . /O ~ To Building Foundation ~<) ~ To Existing or Abandoned System cn Lot /ur~'-~ ~ ; On Adjoining Lots ~ ~ ~ ._ To Wate~ Ma4~r/Se~vice Line ~%-~D ~_ To Cutbank( if _present) TO Stream/Pond/Lake/c= Majo= Drainage Course ~ ~3 ~ TO D~iveway, Parking Area, c= Vehicle Storage Area ~--7_D ~ Comments /~3-~0 ~ ~ D. LIFT STATION Date Installed Size in Gallons "P~.p On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) "P~ Off" Level at i~j'-~'-~//~'^ Vent (Y/N) Pumping C~cle~lng Adequacy Test. M~ets MOA Conments ** ** Check Permitted Bedroom Rating Against HAA Pequest I certify that I have checked, verified, or confc~red to ali. MOA HAA Guidelines in effect on the date of this inspection. KB1/d5/s [Page 2 of 2] 2-15-84 ROBERT A. SHAFER December 11, 1983 CIVIL ENGINEER 694.2979 ADEQUACY TEST WATER ANO SEWER INSPECTION WELL INSPECTIONS AND FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN EXCAVATION WORK Jerry Braman Today's Realty P.O. Box 279 Chugiak, Alaska 99567 Dear Jerry, REFERENCE: Lot 27~ Block 1: Skyline View Subdivision A sewer system adequacy test was performed on the system located on the referenced property, as you requested. The septic tank was pumped and verified to have a capacity of lO00 gallons. The absorption trench was tested by a continuous flow of water over a period of 48 hours without any adverse effect on the system. It: can be concluded from this test that the waste water disposal system serving the three bedroom house located on this property is currently functioning adequately. However, the system cannot be guaranteed against; subsequent failure. If we may be of further service, please do not hesitate to contact US. .3 s/ss cc: Municipality of Anchorage Department of Health a~d Environmental Protection SRB 196X EAGLE RIVER, ALASKA 99577 PRELIMINARY " I hcrcby certify that I bavo surveyed the following · /~p z.:z__~ ~/~i.~ l "'" dcsel'lbcd PI operW: ............... : ............ ~-~} .... Anchora e ll(.~ordln~ }'retract Alnska and tlmt thopro- posed improvem{.nt~t tm planad lhereon by the v.ql} be within lira propm'ty lines and will ilot .overlap or encroavh on the propm'ty lying adJacellt thru'bio, thht no iml)rovements on property lying ndjacent thereto encroach on the premises m question anti that tliel'o are no ro:tdwavs, iransmission ~ines or other visiblc ine,¢s un s'ald property except as indicated Dated at Eagle River, Alaska I~OBERT C. JOHNSON ,~'*~'.,W- , SCALE: Registered [mnd Surveyor NO. ~" :~ ,,;_ ,:, Box 458, Eagle River, Alaska· ,. Phone 694-2543 .'.