HomeMy WebLinkAboutOVERLOOK ESTATES BLK 3 LT 2Overlook
Estates
Block 3
Lot 2
#068 - 041 - 16
PFRMIT NO:
DATE ISSUED:
�������������� ���� �e••"1��
DEPARTMENT OF HFALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORASE, AK 99501
870146
06/24/87
ENGINEERED DESIGN
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APPLICANT: f�0}� ^�ePRam��� NESLEY ROGERS ~~
ADDRESS: 18927 TWeNTY GRAND
EAGLE RIVER, AK 99477
CONTACT PHONE: 694-1869
LEGAL DESCR11":': SUBDIVISION: OVERLOOK E0h40ALa LOT: 2 B|OCK: 3
SECTION: 25 !UWNSHIP: 14N RANGE: 1W
LOT SIZE: • 49200 (SQFT, OR ACRES)
certify that:
I. I am familiar with the requirements for on-site ,sewcrs and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes ,,Ind regulations,
and in compliance with the design criteria of this permit.
3^ I will adhere to all MOA and State of Alaska reqYirements /or set back
distances from any existing well, wastewater disposal sysicm or public
sewerage system on this or any adjacent or nearby lot,
IF A LIF! STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS ..... BUILTS
WILL NOT BE APPROVED WITHOU! AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELEC|kICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED
ISSUED BY
/9. Pe /2 eit/../ ee-Fa. DOS 1-,0%.1
4�^ -w• ����x
� ^
ren..A.f 454 14.� bc"�
r
I
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y
DATE:
v
(1rnifir1 JriL1ingLfuj
DOC Co. tlba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759
OWNER OF LAND DEPTH OF WELL /;_), ' %� C
ADDRESS f �A4 STATIC LEVEL OF WATER FT
LEGAL DESCRIPTION /- , t> 4 3 tat.t.'4 4.-, (. 1[, DRAW DOWN FT
. t1
DADATE - Started (5' ✓ F 7 Ended � �J 1 GALS. PER HR
KIN[) OF CASING 0 L)
12.a(".'r4.+
r.,1 - 7 /.tl + ; ij t' % 4.041-0 O / .1`";
PERMIT NUMBER
KIND OF FORMATION:
From '» Ft to 6) Ft `- cl.t /,,ti CI ,1 7..k OP From Ft to Ft
From ,,ZFt. to < '/ Ft T 1 1, r - t
; I ''/9 c (r; +C) From Ft to Ft.
From Ft. to Ft..} r 4 i i 1 uJ 62 ` From Ft. to Ft.
From Ft to Ft. I3dUr.4,'Q.1. From Ft. to Ft
*,/-‘r MUNICIPALITY O'er
From ! Ft to J (t F3 Ft. �� . •`. E ' , 6lt'ac.,ac.;:e. `r' From Ft to DEPT. HEALTH &
ENVIRONMENTAL PKUItGTION
From Ft. to Ft. (.1:0 ( From Ft. to Ft.
t'-
From 1, Z Ft. to /A) Ft. N.1 r 3'' I.... ',%4J:: +a.% From Ft. to AlN 2 7 1987
From Ft. to Ft. C.-, d. r - 4-`-' fr From Ft. to R EC E I V E D
From 1 ( Ft. to 11/ Ft. •i.^i>r,..'(.2 6—X?/r`vii=c_ V From Ft. to Ft.
From Ft. to Ft. C 4. r1 i LA) +''(r4 From Ft. to Ft
From i 11 Ft to % s_1._ Ft C:. 44. J4i r .a +1a C r: : From Ft to Ft
From Ft. to Ft CJ's = t..S From Ft to Ft
From Ft to Ft (?e't-7' )4•.:;- 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
MISCL. INFORMATION:
3
I 1 t
DRILLER'S NAME
EAGLE RIVER ENGINEERING `SERVICES
‘4$Lou Butera, P.E,
P.O. Box 773294
Eagle River, Alaska 99577
Telephone (907) 694.5195
June 22, 1987
Mr. Dan Bolles
Civil Engineer, On-site
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
Services
1JUN 2 31987
RECEIVED
RE: Overlook Estates Subdivision: Lot 2, Block 3
Dear Mr. Bolles:
Attached, please find the revised well and septic site plan for
the above referenced lot.
This revised distance shows actual slope distance with a note of
the 50' setback distance to the road. Would you please provide us
with a septic permit, based on this revised plot plan
If there are any questions or concerns, please
me at 694-5196.
Louis Butera, P. E.
LB: bls
feel free to call
_
o-/- pewro.Cla) 57075 Site: c� f
a'fra ye . /E3
!o Q
7 v a s
UTIL. ESMT.
DRIVE
resery area
reserve area
TEST HOLE LOC, SEPTIC TANK 57.
y 11 111/1H111lh>--4/1250 GAL. m'r
35' LONG
NO CONFLICTING
WELLS
NO CONFLICTING
WELLS
7' high road cut bank
RIGHT OF WAY — —
EXISTING LEACH FIELD +«x««—
NEW LEACH FIELD +++4"—
CLEANOUT –•
SCALE i 1•= 40'
WELL AND SEPTIC SITE PLAN
LEGAL' LOT 2, BLK 3, OVERLOOK ESTS,
OWNER! WESLEY RODGERS
CONTRACTDRIN/A
EAGLE RIVER ENGINEERING SERVICES
P❑ BX 773294
EAGLE RIVER, AK, 99577
694-5195
armVh •®1
49TH. g
e°otS•eoe: : 0•0ea0eeee0099eSoee
it tie 000 age e•
, o Louis A. Butera a
®�t J>a CE -6736 a =®
PERFORMED FOR:
LEGAL DESCRIPTION:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
blies /5 /ods -ear
2-
3-
4=
5-
6-
7
. , i
l•
'D."•
.r SOILS LOG
D PERCOLATION
TEST
DATE PERFORMED: L iJ2- / 'fes 7
r
Lt, 1 c /!r ? D//e• /e .4- ^r 72 7`e -r 77/714/ i? //e/ -ree,ar
SLOPE SITE PLAN
70/4" ;/
(G7'''')
SDMC s.//yea", Ye.vt r`/'
Dews e- /S° 0/a
8-
9-
10-
0
O
v t,
6 q
P)
SQ -,0( f1 5 re ✓e I
Loose w//G.- a .eo&Ft
/ 2S f-''/nR
12-
13-
14-
15-
16
`
v'
r r
.OV(
'0-
•
17-
18-
19-
20 —
G
Oro
COMMENTS
,0cccOoopo
f
rJ
o,_
< t-
ooC.000 CUGO.^pSEGODOCOC CC
°°e °° o o, ��
J
�$°o Louis A. I;utera o .Q.-;',-../
,;-"r, 0, CE -6736 043k' a
"...-•
°Oo° oo° � � P-ERCOL-A— VON -RATE
II ,,s-,PROFESS_\O\ ,O• TEST RUN BETWEEN FT AND FT
v
Sri./ ✓ Y'1�. 4r -/a' aeiot>. - 130 '`'67/3,C' SSre S',eu.e
WAS GROUND WATER
ENCOUNTERED? No
IF YES, AT WHAT
DEPTH?
7 d ams
S
L
0
P
E
87
f
7D
O-
S
Reading
Date
Gross
Time
Net
Time
Depth to
Water-
Net
Drop
/�//4
lit S cc et I
PERFORMED BY:
72-008 (6/79)
Eagle River Engineering Services
P. 0. Box 773254
Eagle River, AK 99577
694-5195
44.s' .4 a
CERTIFIED BY:
(minutes/inch)
DATE:
/07
2
CZ GRAIN SIZE DISTRIBUTION TEST REPORT
.r,
c cc
. 04 . •r-1 • N 'i
• inl
:-.1I ,.., ::,, -r ,--! • •1 • - •.,, ,-a IN
••u V IN ,-. ,-. r i * ,7 :44: * * 4l *f 4# 444
1gin
90
I
-3
.~E1
reel
cc
1.0 60
11
I
I
1
H
L
74
1.1.1
Ci
Of 40
W
tc
T,A
•
1
10
A
200 10n 10 13
1.3 0. 1 .n1 .001
OPENI •113 SIZE - mm
%.4-3 •
;, GRAVEL.:
SAND 1 , . SILT
I ': CLAY
y
10
n.0
38.0
58.2 M 7..8
1
I--
C1«�_i-Pica-tion
{ 1-:1-ILLI-1II1:=:
LL
PT
Den
D30D10I-.,
I'1_.
4;
SW
NP
4.40
1.144
0.2532
1.17 52.4
L�
MATERIAL DESCRIPTION
TYPE OF TEST
Q SILTY GRAVELLY SAND
ASTM D 422-63(72)
Mechanical an:aly=i •
Project No.: 1099B _. _.
Pr
Project: EAGLE RIVEF: ENGINEERING SERVICE=:
fi Location: LOT 2. ]33 oveRdouK
Date: 6-17-8?
Remark_.:
GRAIN SIZE .tIISTRIBIITION TEST REPORT
RODNEY P. KINNEY ASSOCIATES
Plate No. 1
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: OVERLOOK ESTATES: Lot 2, Block 3
A. GENERAL
1. The well and septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall, meet the ,anchorage Department of
Health and State Department Of Environmental Conservation require-
ments.
�4. All soil tests are advisory to the design and are to be verified or
modified in the field by the engineer.
5 All excavations and depths are advisory and are to be verified or
modified in the field by the contractor to meet Municipality of
Anchorage, Department of Environmental Conservation requirements.
6. It is the responsibility of the owner- to obtain all necessary permits
or easements and to locate any adjacent multi --family wells.
7. The excavation is to be (exactly in the area shown on the sit e plan,
any deviation requires engineer approval,.
8. It is always recommended that a surveyor locate the nearest lot line
position and the location of any easements.
Q TRENCH
1.. The trench le to follow the natural land contour to maintain uniform
total depth of the trench bottom:.
2. The bottom of the trench shall be level, plus or minus 1 .:5" .
3 The total depth of the trench e;.;cavat:ion is not to exceed 12 at any
point.
�.
The trench gravel is to be covered with typar fabric material.
Soil or combination of soil and extruded board insulation to a depth
of 4' or equivalent. is to be placed over the leachfield.
6. Tire area over the trench is to be finish graded to prevent ponding of
surface water runoff,.
7. The septic tank and le<ac hl i_eld must not be closer than 100' to any
existing pr r_vatl well, 150' to any (lass "C" well, or. 200 feet to any
community well,
RECOMMENDED LEACHFIELD DIMENSIONS
TOTAL DEPTH =- 12' GRAVr.l. DEPTH ?' TRENCH LENGTH -= 35' TRc..NCH WIDTH 30"
Soil Rating =_ 188
Bedroom Capacity 4
Septic .. tic Tank ` :.i. 6;2 .. 125
TEST HOLE LOC. SEPTIC TANK
1, 1250 GAL
TRENCH §§/1 NO CONFLI T NWELDS35'LO G
RESERVE AREA
///
100'
NJ CONFLICTING
WELLS
RIGHT OF WAY — — —
EXISTING LEACH FIELD "+H—
NEW LEACH FIELD +HH.H—
CLEANOUT —°
SCALE 1'= 40'
WELL AND SEPTIC SITE PLAN
LEGAL: LOT 2, BLK 3, OVERLOOK ESTS,
OWNER: WESLEY RODGERS
CONTRACTOR: N/A
EAGLE RIVER ENGINEERING SERVICES
P❑ BX 773294
EAGLE RIVER, AK. 99577
694-5195
® ��seo
fnesem e000.134,1004:N
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Tca )40
aoo°e G0 •°cameos eeeoe<° 9
o•ee ao m•m •coca• ••°° •°�>
�e Louis A. Butera °
®�® J'ee CE -6736 �®
4�B��PROFESSION_ 4u7
mom, \ T°0 \ Z
N -- T
7'ni, -Q,
\ \ \ 1-t
\1i
z�-165i56—
T
rfl
29, 70.00' 41_4_____,--6°10'02"E. \\ m
0 1 2971 1. 8 \
io
53,&53 S.F.
h M
—177. 9-
200'
—200' — \0 5'
10 a' 2
W
in co
M
0
Cri
4
50,10 S.F
232.3i'
19° 48' 21; W. 664.86; Meas.
19°57'00 W. 665.28 Rec. BL.M. 1974
N
NOTES:
50' TEMPORARY TURNAROUND EASEMENT
TO BE AUTOMATICALLY VACATED WHEN
DEDICATED ROAD IS EXTENDED.
FOUND 3 1/2" B.LM B.C. ON
2 I/2" LP 0.5'AB0VE
GROUND.
FOUND 1 I/2" B.C. ON I/2" COPPERCI
STEEL ROD. 0.5'AB0VE GROUND
6" ASPEN B.T. N.E.
6"ASPEN B.T. SW.
N. 89°46'41"W. 332.64' Meas.
N. 89° 57' 00"W. 332.64' Rec. B.L.M. 1974
FOUND 1 I/2"B.C.
ON COPPERCLAD
STEEL ROD IN MOUND
OF STONE,
1.4' A.O. G.
I. T. a E. EASEMENTS, (TELEPHONE aELECTRIC),ARE FOR
THE PURPOSE OF TELECOMMUNICATIONS AND ELECTRIC LINES.
2. SEPTIC SYSTEMS MUST BE CONSTRUCTED IN AREAS WITH
LESS THAN TWENTY-FIVE PERCENT SLOPES.
3. THE WEST BOUNDARY OF TRACT A FOLLOWS THE STREAM THREAD
MEANDERS OF THE EXISTING CREEK.
4. SOILS INVESTIGATION PERFORMED BY R.W CHRISTENSEN, CONSULTING
ENGINEER, ON DEC. 2,"1983, SHOWS THAT SOILS ARE ADEQUATE TO
SUPPORT CONVENTIONALLY DESIGNED FOOTINGS_
5 5/8"x 30" REBAR WILL BE SET AT ALL LOT a TRACT CORNERS
BY 10-31-84, UNLESS NOTED OTHERWISE.
6. DEVELOPER MUST CONSTRUCT SEPTIC SYSTEMSIN AREAS LESS
THAN 25% SLOPE.
0
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 068-041-16
1. GENERAL INFORMATION
HAA # 6505-1
Expiration Date:
r/iy/er,
Complete legal description l.nr 2: Alnrk 9. rlvprinnk Patnrpa
Location (site address or directions)
27502 Paramount Dr. Eagle River
Current Property owner(s) Barbara Cryder Day phone 696-3766
Mailing address PO Box 771698 Eagle River, AK 99577
Lending agency Day phone
Mailing address
Real Estate Agent Petty Valdes Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
4
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
❑ Individual Holding tank
❑ Community On-site
❑ Public Sewer
0
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HM) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. 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,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) 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(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm S & S Engineering
Address 17034 N. Eagle iverLp Ste. 4 Eagle River, AK 99577
Engineer's Printed Name o t ,4 (cha.-te f Date /0 //SAT -
Phone 694-2979
5. DSD SJGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
.0 ;.
tb.r1 A. Stitch.
1 f77•'! ••'r'
bedrooms, with the following stipulations:
Additional Comments
By:
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
(Rev D1N2)
Original Certificate Date: /O//f/G
Legal Description:
A. WELL DATA
Well type TittYRTE If A, 6, or C provide PWSID #
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Parcel ID: O&, 8: ' cfY11 ') 6
Well Lo
As
Date completed $ Sanitary sealdVN) Yes Wires properly protected /N) /CS
II Total depth 129i ft. Cased to 1@31 ft. Casing height (above ground) /Ain.
FROM WELL LOG AT INSPECTION
Date of test a2
Static water level 1 :J ' ft.
Well production 3 a g.p.m.
WATER SAMPLE RESULTS:
loMeg
17 f ft.
1c, I+ 3 g.p.m.
2eccveQA(ti tt
Coliform 0 colonies/100 ml. Nitrate IoZb mg /I. Other bacteria 6 colonies/100 ml.
Arsenic: – mg./I. Date of sample: Collected by: So S Eao&/►vsnano4
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material St -PT -IC / ST6et. Date installed
tolev
Tank size 17.40 gal. Number of Compartments Z Cleanouts&l) YOS
Foundation cleanoutt»N) )QS Depression over tank (Ye, IL9tt High water alarm (Y/121) 40
Date of pumping lD/SIDS Pumper J be -1c 7o onrIA) et
C. ABSORPTION FIELD DATA
Date installed /070)9 Soil rating (g.p.d./ft or ft2/bdrm) 138 fig System type T2.E/.1GF4
Length 3Ci 1 ft. Width ft. Gravel below pipe @ a 0. ft.
Total depth 12' ft. Eff. absorption area (4U.) ft2 Monitoring tube Vey Depression over field PO
Date of adequacy test 1 OHO S Result as ailla-SS For y bedrooms
Fluid depth in absorption field before tesfD'ki in. Water added 1, 0Ggal. New depth 31" in.
Elapsed Time: 120 min. Final fluid depth 2'i° in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y(f1;& type) ISO
If yes, give date —
D. LIFT STATION
Date installed Size in gallons
'Pump on level at _ in. 'Pump off' level at
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100 + On adjacent lots
Absorption field on lot 100 'F On adjacent lots
Manhole/Access (Y/N)
water alarm level at
Meets alarm & circuit requirements?
Public sewer main Ni'i
Sewer /septic service line
(00 I -f-
in.
(001*
Public sewer manhole/cleanout PA'
Holding tank 10 A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 1,17 1 Property line I 014" Absorption field 5
I
Water main N A Water service line 10it' Surface water 1 OO 'fr
Wells on adjacent lots 1CC) 14-
SEPARATION
+SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
1
Property line 1 01-I- Building foundation 10 -I- Water main 10 11
Water Service line (0 I} Surface water (00 14" Driveway, parkinglvehicle storage 10 I.4_
Curtain drain WOVE ICICet143 Wells on adjacent lots 1CC) 14-
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field inspections and
review of Municipal records tha bove systems are in
conformance with MOA HAA ide ' {s in, effect pq Qhis da
Engineer's Printed Name D in -
Date
Date /0 Asi, S
C130 • ire
HAA Fee $
4
•
r
? x'.
I •
Na. 1457-0
Date of Payment
Receipt Number
(Rev. 12/01)
/0/13 )os
15325
Waiver Fee $
Date of Payment
Receipt Number
10-03-06;11:29 ;
SCS Rai/
Client Name
Project Name/N
Client Sample ID
Matrix
1056308001
S & 5 Engineering
Lot 2 B3 Overlook Estates
Lot 2 B3 Overlook Estates
Drinking Water
;907 661 6301 # 2/ 4
All Dotes/ Imes are Alaska Standard Time
Printed Date/Time 09/29/2005 13.53
Collected Date/Time 09/23/2005 13:08
Received DateMme 09/23/2005 15:48
Technical Director Stephen C. Edo
SampleRemarks:
Parameter
Results
POL
Allowable Prep Analysis
Units Method Container ID Limits Due Dsie Ink
Nitnte•N
Microbiology Laboratory
Tont Coliform
128
0
0.100
rniJl. EPA 3532
B (0.101 09/23/05 AZS
coV100mi SM20922213 A (o-1) 09/23/05 TLP
10-03-05;11:29 ;
SGS/CT&E ENVIRONMENTAL SERVICES
Drinking•WaterAnalysis Report for Total Coliform Bacteria
READ INSTRUCTIONS ON REVERSE SIDE BEFORE COU.ECUIG SAMPLE
MUST BE COMPLETED BY WATER SUPPLIER
❑ FUBUC WATER SYSTEM IDS . 1 .
• VATEWATER SYSTEM . • •
0 Sand Rauh 0 Sand Imola
Iwrranls�-wa-rC.-arw—
Ma
•
moan—
Cy
tam
As GAB
SAMPLE COLLECTION:
re.•-,+-..r...r .WZ+wle Oa ••••••••11101✓J
Data: '
1
zoos
Mew COI rr
Tlrna: 1:0Q'‘ AM
u'tM.1ra...I
Location: Lor 7.5 F3 3 - GXITltWict S
Cotladon •
room Sao
Transponad ,,_
to Lab Br• 11$.1IgraS collector
0 Send Raul*
:907 661 5301 # 4/ 4
200 W. POTTER DRIVE •
ANCHORAGE, ALASKA 99518
Tol: 907-562-2343
Fax 907-5615301
•
Lab Ref Na
IIJLVEIIIN,� -
13 Sand eneloe
'Wow%Sri llwTweery Mw
CMle..no-.•
ti lame
have Aeew•
Cr
Sen
SAMPLE TYPE:
0 Routine
Other.
❑ Repeat Semple
(rotor to lab no.
❑ Special Purpose
0 Treated Water
❑ II Mrs eted Water
Mils. wen,.
TO 8E COMPLETED BY LABORATORY
Sarno,* Ratak/km:
Date: `•-9-3-QS" ❑ Semple over 30 hounad;
Rawl% maybe unloose
Time: • 151T
Temp:
Delivery Method:
Received By.
Comments
Ct.w ❑ 4e Hour Waiver
0 RUSH SAMPLE
Phone t
Fax #:
pactorlotoolcat Water Analysts Record:
Analysts Bean:
Mayas:
M th r • tree
`lam
Analytical Wept
Reported By
Membrane Filter
0 MMO-MUG (PIA)
MMO•MUG (P/A) RESULTS:
Total Cotfomt
E. Cop:
MEMBRANE FILTER RESULTS:
Diad Count
Vedncalen:
vamoose„CLTt
BGB;
Ass Omen { E
CotoMnrlOOrL
Sent to ADM
ANC FIX JUN
Datamna:
rni lo dent
Phoned Q Faxed Q
OaWTimr
Soak* win
gSa isfactory
Urtsatisfactory
Date/Time: •-” 3 7 eo / ?-7.70
tluseelna1011ANKSMupOsUWubnetDOCUMENT FORMS approndCo Form 1217034s
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Form # FW- 0053 12/17103
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1 hereby certify that 1 have surveyed the following described
property 1.0 t Z Gyle' a if e, • .
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Anchorage Recording Precinct, Alaska, and that the impruve-
nlenls situated thereon are within the properly lines and do not
overlap or encroach tin the property lying adjacent thereto, Ilial
no impmvenlents on property Ivlrigg adjacent thereto encroach
on the premises in question and That there are no roadways,
transmiss lines or other visible easements un said property
es.rpl as indicated hereon.
(rated at Eagle River, Alaska
I•
this_J-7 121 day of /I�,/- r / 192.0__
RODERrC.101INSON '.1r •
SCALE:, Registered Land Surveyor No. 8& LS
I•' - /b nos 77-0456. Eagle River, Alaska 99577
Phone (907) 694-2543
.4
MUNICIPALITY OF ANCHORAGE
Department of Health & 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
Parcell.D.# 1)n9,-C>L-k\-\In
HAA # \� \ic1c r'\L-11
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Overlook Estates, Lot 2, Block 3, T14N, R1W, Sec. 25
Location (address or directions)
Paramount Drive
(b) Property owner Wesley Rogers Telephone: (home) 694-1869 Business
Mailing Address 13927 Twenty Grand, Eagle River, Ak. 99577
(c) Lending Institution North Land Morgage Telephone 694-7872
Mailing Address 11421 Old Glenn Hwy, Eagle River, Ak. 99577
(d) Real Estate Company and Agent
Address
Coldwell Banker
4105 Tudor Centre Drive, Anchorage, Ak. 99508
Telephone
561-2488
(e) Mail the HAA to the following address: (or check here El, if hold for pick up.) •.
List contact person and day phone number below:
Pickup by Engineer
2. TYPE OF RESIDENCE
Single -Family El Number of bedrooms
4
3. WATER SUPPLY
Individual Well n Community 0 Public 0
•
Note: If community well system, must havewritten confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL .
On-sitePublic 0 Community 0 Holding Tank 0
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, 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 Eagle River Engineering Services Telephone 694-5195
Address P.O. Box 773294, Eagle River, Ak. 99577
Date
6. DHHS APPROVAL
Approved for 1 bedrooms by
Approved )<., Disapproved
Terms of'Conditional Approval
Conditional
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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. 7/88) Back
Page 2of2
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A. WELL DATA
Well Classification
/9-1;4 7-e_
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description
4-r /--,e /4/'v /et w Sec . S�
Well Log Present (Y/N) Y
Date Completed
8187
If A, B, C, D.E.C. Approved (Y/N)
Yield /.3 6 -fir" /eecerwry y/90
Total Depth /-2
1/ Cased to /" 3 / Depth of Grouting
Static Water Level i
/
Casing Height Above Ground
3/
Pump Set At
t -/off/
Sanitary Seal on Casing (Y/N)
Y
Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) /✓
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot 41/45—/
; On Adjoining Lots t„°
To Nearest Edge of Absorption Field on Lot f /�S— ; On Adjoining Lots
/
tlao
To Nearest Public Sewer Line "//`' To Nearest Public Sewer Cleanout/Manhole ^N/4
To Nearest Sewer Service Line on Lot
8a
Water Sample Collected by '�r f. ; Date $''//,/so
Water Sample Test Results N/ '`< _ 0, /6 "'sA
Comments
Co/.ts+-... > 0
B. SEPTIC/HOLDING TANK DATA
Date Installed /%7 Size /2 S-22 No. of Compartments
Standpipes (Y/N) i Air -tight Caps (Y/N)
Foundation Cleanout (Y/N) Y
Depression over Tank (Y/N) Date Last Pumped 51/40 1ie's
Pumping/Maintenance Contact on File (Y/N) ''//'
Holding Tank High -Water Alarm (Y/N) '"/4
; for "/�`r
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well /°s/
To Property Line �/D
To Water Main/Service Line (5—
To
5To Stream, Pond, Lake or Major Drainage Course
Comments
To Building Foundation
To Disposal Field
N/9
72-026 (Rev. 7/88) Front
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata /3,, Type of System Design
Date Installed /9p ? Length of Field 35 '
Width of Field 3/ Depth of Field / 2
Gravel Bed Thickness
Square Feet of Absortion Are Statndpipes Present (Y/N) /
Depression over Field (Y/N) Date of Last Adequacy Test y//0o
Results of Last Adequacy Test '- 1'J / c am ! 6 r �. S/.. �t •Fe rte- 5i �� e ,
SEPARATION DISTANCE FROM ABSORPTION HELD:
To Water -Supply Well 7/75 / To Property Line iO
To Building Foundation 3S To Existing or Abandoned System on
Lot N/A ; On Adjoining Lots 30
To Water Main/Service Line tdD To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course /'1/�
To Driveway, Parking Area, or Vehicle Storage Area 7-70
Comments
D. LIFT STATION /2/4
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at "Pump Off" Level at
High Water Alarm Level at Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test.
Meets MOA Electrical Codes (Y/N)
Comments
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines j -effe'ct`s ti -:the date of this
inspection. -`` ' h "^r..
Signed
Company
Date &/2°/50
MOA No. 50 _
Eagle River En;reer.;ca -.
P. 0. 9oa
Eagle River, Al(
694,5195
Receipt No '�` l Ya
Date of Payment Lt
/bio
Amount: $ ` 2
72-026 (Rev. 7/88) Back
Receipt No
Waiver Fee: $
Date of Payment
Page 2 of 2
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EAGLE RIVER ENGINEERING SERVICES
P.O. BOX 773294
EAGLE RIVER, ALASKA 99577
(907) 694-5195
TEST RECORD
LEGAL: LOT a- , BLOCK 3 , Aver-/ad/r 15_""r
OWNER: let 2�S��f
G✓c// ,l Septic
TYPE OF TEST:
DATE : 4///9/s,
SUBDIVISION
TIME
METER
READING
(WATER IN)
/3 r-et.>tiK 2000
LEVEL
IN
MONITOR
TUBE
5Q/
LEVEL
IN
WELL
LEVEL
IN
TANK
FLOW
RATE
G.P.M.
-
LINE
PRESURE
P.S.I.
NOTES
9:00
.2 39 ,r/0
a
0 /A6.. -e,_ &,Y
97 ,
N /4
^//a
STq,PT
4:6 3
G
/0 3
3, 75—
. 39 72o
0
0
SYo/o
8.'e'i/,,,,
.2 75 7
0
97
Ili, C
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v/,y
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a [/DE�f
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2 44)634
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wsfer 4)/F
2:00:36
y; 03:3-r
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",
NOTE: AFTER TURNING WATER OFF, OBTAIN 4 RECOVERY READINGS AT 10 MINUTE
INTERVALS OR UNTIL FULLY RECOVERED IN LEACHFIELD. USE SEPERATE FORM FOR WELL
RECOVERY.
(Jlrrtiftrb rtLLing ?Qug
b,
DOC Co. dba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759
e �
OWNER OF LAND t S i:iz CA: S DEPTH OF WELL /014 /Gq�c.
ADDRESS 1 rgc�7 •! wii.J f i 6it/i. o. �, STATIC LEVEL OF WATER FT. "13
LEGAL DESCRIPTION L A Lice 3 OU LQ t PC DRAW DOWN FT.
DATE - Started 8/9% Ended - /ff7 GALS. PER HR % 0
PERMIT NUMBER KIND OF CASING 6 °O
KIND OF FORMATION:
From
0 Ft. to 0 Ft. C #1Si.� E S`iiG iJ 1° From Ft •u Ft
From a Ft to G 9 Ft Y 1 ‘-r"r/ t4 'd(d 4 From Ft to Ft.
From Ft. to Ft.., +7V 6' hi& 4.-,/ From Ft. to Ft
From Ft to Ft. �/33t;1E,v't�' From Ft. to Ft
From Y Ft. to I 0 0 ' Ft. J f L I 1 6410114e.;G if From Ft to Ft
From Ft. to Ft. Si8414rai,5' From Ft. to Ft.
From /00 Ft. to//I� _JFt. 47y 6 ''a4JCG 41 From Ft. to Ft.
From Ft. to Ft. ectig 9<.cs ' td.1+s / From Ft. to Ft.
From 10th Ft. to /// Ft. Ji9I4 (1,40111 _ Si From Ft. to Ft.
From Ft. to Ft. C <. A 1' •-4./ of T6/Z From Ft. to Ft.
From 11/ Ft to Inl� Ft. C'i 4i 6,-?9va.G From Ft to Ft
From Ft to Ft. CO 844. = s From Ft to Ft
From i0' 3 Ft. to Ft. /?C t%a 3 c. e 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
MISCL. INFORMATION:
Ct �9S a .v C PHA PoR.4Tf r0
lAare' fO
To 1 1 0
DRILLER'S NAME /3-4.1—i-
d�+�—�
"-APR 201 '90 12:14 NTL -ANCHORAGE 91=7 274-9645
P.5/5
.....,mss
NORTHERN TESTING LABORATORIES, INC.
2505 FAIRBANKS STREET
800 UNIVERSITY PLAZA WEST- SUITE A
ANCHORAGE, ALASKA 99503
FAIRBANKS, ALASKA 99709
907.277.8375 • FAX 274-9645
907.479-3115 • FAX 479-0547
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY CLIENT
�} PUBLIC WATER SYSTEM I.D. #
PRIVATE WATER tSYSTEM
e,frea 'is
NAME
," 723 a-5l—,/
Mailing Addr
ess
577
City State
SAMPLE DATE:n. ., - 90 Phone L'3`
Day Vont
Purchase Order No.
Zip 0044
SAMPLE TYPE:
I0( Routine ❑ Treated Water
(] Special Purpose 7' Untreated Water
0 Check Sample (sot original contaminated
sample with lab reference no
Sample
No.
Location
3
4
5
7
8
9
Tlmo
Collet -Lai Collected by
Laboratory Ref. No.
10
Signature of Representative'
FOR LABORATORY USE ONLY
GASH
CHACOE
PREPAID
TRANSMITTAL
SPECIAL INSTRUCTIONS
i
JAAH
HOW Ppa
PICKUP
11
TO BE COMPLETED DV LABORATORY
Received at: 0 ❑ Flaks.
Date Received�I—
Time Received /._62 c 1( )
Next Sample Due
COMMENTS:
SATISFACTORY
UNSATISFACTORY
RESAMPLE
OTH R BACTERIA
TOO NUMEROUS
TO COUNT
Direst
Count LAB 900
Verification
U
Fi
08
TNTC
Final
Result* Comments
0
"No. of Total Coliforms Colonies per 100 rills.
Reported by
Date P''( 1
LID
Time
SPF 2A '9A 12:12 NTL -ANCHORAGE 917 274-0E45
P.1/5
NORTHERN TESTING LABORATORIES, INC.
2505 FAIRBANKS STREET
600 UNIVERSITY PLAZA WEST, SUITE A
gagle River Engineering
F.O. Box 773294
Eagle River, Alaska 99577
Attention! Louis Butera
S amp'
samv, r04
1890-7
ANCHORAGE, ALASKA 99503 007-277-937Q • FAX 274-9645
FAIRBANKS, ALASKA 09769 907-479-3115 • FAX 470-0547
Date Arrived: 04/18/90
Time Arrived: 1620
Date Sampled: 04/16/90
Time templed: 0849
Date Completed: 04/19/90
Unit
Nitrate -N ADEC MCC*
A041890.7
Reported By:
mg/1
0.16 10
Date: 04/20/90
Francois Rodigari, Anchorage Operations Manager
* MCC = Maximum Contaminant Concentration