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HomeMy WebLinkAboutRIVER VIEW ESTATES BLK 2 LT 1MUNICIPALITY 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 PHONE FXI NEW Dennis Winter 344-0237 1 ❑ UPGRADE MAILING ADDRESS 616 N. Prince Anchorage, AK LEGAL DESCRIPTION Lot 1 Block 2 Riverview Estates LOCATION NO. OF BEDROOMS Hiland Road 3 Well Absor}}��tion area Dwelling PERMIT NO. Uy DISTANCE TO: 149' S' 8' 780447 EZ Manufacturer Material No. of compartments wF Sunset Fiberglass Fiberglass 2 N Liq. capacity in gallons Inside length Width Liquid depth 1000 F HOMEMADE: Well Dwelling PERMIT NO. J t7Z DISTANCE TO: Liquid in _ F Manufacturer Material capacity gallons O Well Foundation Nearest lot line PERMIT NO. wy DISTANCE TO: 161' 21' about 50' 780447 � W Z No, of lines Length of each line Total length of lines Trench width Distance between lines P z W 1 83' 8 54 inches ---------- oQc h Top of tile to finish grade Material beneath tile Total effective absorption area o Avg. 2.5' 24 incites 549 S Ft. Length Width Depth PERMIT NO. W F- Type of crib Crib diameter Crib depth Total effective absorption area fL W° W to Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J J 'u Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER b. PIPE MATERIALS Perforated lastic & castiron pipe SOIL TEST RATING 150 Sq. Ft. per bpdroom INSTALLER REMARKS r .o. f .41 V APPR VED - AT LEGAL AP 72,6<3 (Rev. 3/781 Df."PARTMENT k HEALTH AND OTE CT TION 82�5 `L` 'S. T F� F', E I FINCHORFIGE� AV". 264--4',`20 NO. 3 APF'L I CRNI' I)ENN1.15* WINTEP1. 616 N Fl,"INCE 1- 0 C fITY 0 N HILAND RD Lk"GAL Ll L;2 R I k. -'E R. V 1 14 F: T L.OT S I ZE r T41l,"k. OF 0 1 L ABSORBT' C-.04 TE M IS r.' -+?.A I NF I ELD 14-1.1.0,ER, Of"' felull r"IUVIBBEDF."Oorl'S, 'sl SOIL I'll"FING <S-0 r. ]HE P -':E- SIZE OF THE :501L. AF:,`._IORPTION l_`,YST0l IS: V" A- 11-4 'I"HE *LENGTH DIMENSION IS THE' LENGTH e:IN FEET) OF' THE TRENCH OR THE DEPTH OF A TRENCl-I OR PIT THE DISTFiNCE BETWEEN THE SURFACE OF THE. Gf,'WUNU) FIND "I'HE BOTTOM OF fLTHE' E"e"MAWITION "'IN FEET). Z_ -I , , , - . It _ K... V, A 11-4 1 ED -V R -j 1 -4. r C`.l MF: GRAVEL F)EPTH IS THE MINIMUM DE FITH OF GRAI;IEL BETVIEEN 'rHE ou'rF*ALL PIPE AND THE* BOTTOM OF THU EXCFiVATION clirl FEET). A L_ ii_ CA P.,J �J X IF"o W -,S 1_0 C F FIEP1,11T APF-,LICf- NT HAS THE* RESPONSIBILITY TO INFORM DIEPARTME-JIT f.)LJRYNGi THE INSPECTION'--.'. OF ANY WELL.S ADJACEN"I" TO THIS PROPERTY AND THF. hILWlI_:FR OF RES lf)ENG.E.S THFIT THE WELL WIL.L. ':':'.ERVE. C"; I - 31 C EE.": F -E., H--.! U 1, Pp BFiCk'FILLING OF ANY `:''''STEM 1-11"Fl-IOUT FINAL IN' PECTION AND APPROVAL E,'Y TH)".`.'.; DEPARTMEN"I" WILL BE SUBJEC"I' TO PROSE"CUTION. 1.11 1'.41PIUM DI:n­I-FlrA_:E BETWETEN A WELL AND ANY or-4---svi-E SEWAGE' c: isww'-_.AL. loo VE'ET F OF': A PRIVATE WELL; OV..' :L50 TIJ �lvllk-1 FEET' FROM A PUBLIC' WEIJ_ DEPIENDING UPON Tf,iE TwE 01'FIER MAY FIPPLY. AND COhISTRUCTION [:-IViGR.MeJS, ARE FiVAILAEAL.E TO INSURE PPI.OPEF' INSTPILLATION. d....:': . .. 41 FEV'-' VW I x ""it- C:: IE�, V.1 EE 1, E� I CERTIFY THAT 1: .1 AM FFIMIL-TAP WITH THE Ri"CIUMEMENT'Sn FOR SEWERS ANE, 14ELLS'.: W3 SE'r FORTH BY THE MUNICIPALITY 1"31" ANCHORAGE. 2: 1 14I LL INSTALL ­rm-_ 'S,.YSTEVI IN ACCORDANCE WITH THE COIAES'. It - JelL -Tr Ti RUX ILARGE -.1 1 F, I UNDER.'S.TANI' THAT THE' Of+ --SITE S'EWER MA' -4 Ul FV E t RESIDENG"E IS R.EMODELED To INCLUDE MORE THAN —if IFEDROOM."-.. APPI.- I CANT DENNIS, WINTER. rm®njt%14ctt®n �.Jz.4t L alY *Ono tut it wanh is thousand pettlaffe 2204 Cleveland Anchorage, Alaska 99503 Performed For Dennis Winter Date Performed 6/10/7s Lenal nescrintion: Lot 1 Block 2 Subdivision Riv, ,rv;LeW FGr This Form Renorts Soils Lon yes Percolation Test._. neDth Feet Soil Characteristics___ 2® 4— Brown Silty Sandy Gravel 6 6- 8 --- Pr q' 10- 12 ----� (3 0 rA 14- 16— is- 20— Was 416- 18- 20- Was Ground Water Encountered? �,PC If Vest At what Depth? 9' Readinq I Date I Gross Time MMMM MM ■w NAMEiM-! . �Rmorn ��1!>i!i• - Net Time I Depth to H2O I Net Dro Percolation Rate Minute Proposed Insta at on: 'Seenane Pit Drain Field Deoth of Inlet _ _ Dent o Bottom Of Pit Or -Trench V mVENTS: 150 sq. Ft. drainage area reuired per bedrpo_m from minus Test Performed By ) _ Data Certified By: ;" David Paul Date'./ / DOP e1IHf1,66NI©91 4N F_ '7 I.r_T,1_?\ rl'i KS a ..}� ;d ' y.,, � #_369 SKr' Route p n (t,O n r f r. : v %� 4clrg 90502 Dec..' WKS ('+ 1.. ,s , t L2°i11�c1 Indlomed amt, to the c+ of Jnr te.t �, '77 s! it the rate of $16A v : per. af6oto .A-1T'UrJ9"+t•r owpor 1 1'tr ° Jof _.n „y F,711._r•� - � . } t y,x 0chtion of 1vhl). S9.tF �� �, D C �, IQ/•.✓E,�2 /EGfi., A1AJ7/io17­oeet S SGI,��%f r; IiriF�et1. Be�nic� (1.a,ts of Rampor!- Prt,lln_ dU7l V. QL ! y'rhvol with sev�Nc� f, L11 1 r v l __ tiJC2rl i ^t a feet. 2 4�' J2 08 r • SY>.al e ''98 «100° Wator bearing* " with ^ Y•x� t L'Iri �:"t0 OhE .^ a'�lo tC l7'!^t),'rt LL•14_.�.1n',K'_' `v'• L I L�`{ " fvt 3' t h -, :> kzm O ¢r 1 r�vtIt Yi�Uh:3�h�,RkT�r10y r t't3 (�r.•y /` r ''�, n 0:. III � v {' 61 1t Ir ? riyr i li'h _. /t+_ ^l� C,r1 .�lttil c' r^t^ r o, X16°DO her foot, ��''' ��. • John rZOS.; i+nchu_.+CePrLc,ui,A tp J:ACatior a 1.jb11 Sites �l, �,• t ,�>�t, 'r' vit } A'' 4 ,i,yY`4 _ ti`.tr ♦- i! - .7:. . . r i. Sjrj},�F , v14f '�- 1A; li`n`t E �i J�r ller , pE'Y'YIi 4 . a.£luJ of R.'tl^.1•1rt I'i ':1. �. � in>' 'lVl' .5 � iill+,..!771 %�. - `r _�,!'2ryev' IK 1' t� 1 N l•' C. y r. s Y *??a,4rye ' � t tt' y r+xlfi tr{ Y�L�+15d'). rr;,�LiG'01 and bodIderS '7"l .t(?�• h '1 / } irl " , � ,fin+ 3GA ug: _ Hn. {to�rrJ]'ii roc. �] �� �... 56wt'y.4�'U, tc'l�r'C ,..L lie +hroll h c. 14 Not 1J(`-1�.C1C:"•-at 105 � f Fs � .•y .a �t��,'� t��.y("-. �t t, i13'.�{�I11Fo dE1C si.�:� ?ki-1-ler to sty 1='S "r^^_t.^_er than , i, tf Y,; A� <4YH SSP. •. an. CO t the C�lStJnnr more, S St t ;:fAot3e S Tot rt, L. 1 1 4f _ + r 1 ' ,.,, T L' t !; -4t F� r�f ,:i(1 1'1 �• � - I i u,r7I f: ..:. . .VE Tlnh3 +g i.. lrT,lt fl{ti ivj, V �,(7 vf�r`�<.,�F}I,� y,;`.�, y... t,r. i •,! 1. �' , - li� � �S+ 1 VI. �. o Municipality of Anchorage o .� Development Services Department Building Safety Division _•��' '' On-site Water and Wastewater Program = .4700 South Bragaw SL 7 e T' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.ancharage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FUR A SINGLt FAMILY OWEt_LiNG Parcel I.D. { 16 7dI- fZ - HAA# 42�,C7t-(`l� ". -Expiration Date: 1. GENERAL INFORMATION , Complete legal description LOT /. e4ock- 2 Location (site address or directions) : 0:� 74/ t,J/f�r42er5#"- • AMI✓E Current Property owner(s) /��r G '406fi L5 Day phone _ Mailing address 6 7yt� Gr/�1�-f4t- l2lL//F • E�64F fl1d�R Lending agency Day phone Mailing address _ Da hone Real Estate Agent's � y phone Mailing Address �R�IDr:�rTi�L d/-fTf! "F�lG.r Ri/ Unless otherwise requested, HAA wN be held by DSD for pickup. . 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: ' TYPE OF WASTEWATER DISPOSAL: Individual Well H Individual On-site A . Individual Water Storage ❑ Community Class - --- Well ❑ Public Water System ❑ Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Health Authority Approval (HAA) 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 13Y ENGINEER " As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, basedon 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, l 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 wastenrater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Mane of -Firm _dole ph„ca::;�`! '7G ..- .. = --.... Address /7x37 8 P '�2C�1,x µ-.r i� :.• Engineer's Printed Name S7—���,�%!�' Date, of: At o '( e..e•.eee..e S 1 _ . ...:. ...:.w40 _.... _ - :'• . �� L Steven W. fn9' 4r/ ,/ �� �•: .. PE 6456 5. DSD SIGNATURE f >�F :.:,•.. ;.• ��'� Approved for 3 bedrooms.;.. ::.•...: - 1+�� �..•a��•''y Disapproved. Conditional approval for - --bedrooms, %%4th the following` stipulations: Additional Comments” ` -�? �T •'� >.WATERAND PROGRAM •: .. z `\ Attachments: HAA Checklist X Maintenance Agreements' Septic System Advisory Supplemental Engineer's Report Well Flow Advisory .Other By: 141 ginal Certificate Date: 10-3-03 100000r/—F 45;117 (Rev. C1102) Municipality of Anchorage • 6 � i.e4 Development Services Departments 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 Legal Description: R/ L 0r- /, X4 Parcel ID: 650- 7.2t -/Z A. WELL DATA Well type If A, B, or C provide PWSID # _ Date completed �!f Sanitary seal (YIN) V Total depth 600 ft. Cased to ft. FROM WELL LOG Date of test Static water level Well production 3 WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: , 00 2 mg A. B. SEPTICIHOLDING TANK DATA ft. g.p.m. Nitrate mg./I. Date of sample:S' a1 c3 Well Log (YIN) Wires properly protected (YIN) Casing height (above ground) 0 O in. AT INSPECTION 5 �i o3 / 5- -7 3 _ g.p.m. Other bacteria O colonies/100 ml. Collected by: Tank Type/Material S lJnr cosi Fsky aajj Dale installed Tank size (% G G gal. Number of Compartments Z C)eanouts (YIN) Foundation cleanout (Y/N) = `,Depression over tank (YIN) Ar High water alarm (YIN) &41,&_ Date of pumping, (:)-j ' 0 Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d.M2 or felbdrm) ISO System type 771,53,4r. N Length w ft.. Width ft. Gravel below pipe 2 ft. Total depth S' 7 ft. Eff:'absorption area 50 ft2 Monitoring tube __)LII Depression over field W Date of adequacy test 1512110-Y Results (Pass/Fail) R,44f For .7 bedrooms Fluid depth in absorption field before test S* in. Water added X00 gal. New depth a in. Elapsed Time: 60min. Final fluid depth /Z in. Absorption rate >= SOQt g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) Al If yes, give date * A /',' S fFdc PiPMO wOT P (N4 w r#00 Aq. 7.-1 Fait AO f Gj rr,-1 4015?71 f D. LIFT STATION Date installed Size in gallons Manhoie/Acces YIN) "Pump on" level at in. "Pump off" lav at High water arm level at in. Datum Cycles tes .d Meets rm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ��S/, _ On adjacent lots Absorption field on lot 160"0. On adjacent lots /00 ' 'r" Public sewer main 'J114 _ Public sewer manhole/cleanout Sewer /septic service line r /40 Holding tank N1iP SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation // Property line 3A'r Absorption field S 7� Water main �� rt Water service line Surface water /a0 Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 32 Building foundation _ Z 2 r Water main 16 J-~ Water Service line �Q � Surface water lad �t Driveway, parking/vehicle storage 76` Curtain drain/A/A Wells on adjacent lots F. COMMENTS /r S7 6606, �ioF_ DQrr��l Wo e-. a , GaR M. 7: G. ENGINEER'S CERTIFICATION... Of q`4\%1 AV V- I certify that I have determined through field inspections andir�Q': i review of Municipal records that the above systems are in r �:' conformance with MOA HAA guidelines in effect on this date. 0 �; 4'J 1 �e Engineer's Printed Name TFyF Steven Date 1�Q ? It s�% PE 6256 .��� t�_ A_ s•._ .•O ;L i HAA Fee $-->- S Waiver Fee S _ ( Date of Payment —1 Z Date of Payment Receipt Number C—�� Receipt Number (Rev. 12101) .'L . _SGS SGS Ref.# 1032814001 Client Name NorthRim Engineering Project Name/# NA Client Sample ID Water Fall Dr. Hose Tap Alatrix Drinking Water PWSID 0 All Dates/rimes are Alaska Standard Time Printed Date/rime 05/30/2003 16:59 Collected Date/rime 05/21/2003 13:00 Received Date/time 05/22/2003 10:25 Technical Director. y Stephen C. Ede Released By -J� Sample Remarks: EP 300.0 - The sample was run past hold time to confirm the original non -detect result. The original result is reported. Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Metals Department Arsenic 0.00200 U 0.00200 mg/l, EP200.9 (<=0.05) 05/28/03 05/30/03 !MP Waters Department Nitrate -N 0.100 U 0.100 mg/L EPA 300.0 (<=10) 05/22/03 1S Microbiology Laboratory Total Coliform 0 cot/l00mL SM18 9222B (<_]) 05/22/03 KAP PO Box 7734Tumpinv1 `. Service Agvie iliaTti .moi• Ssni.�•.;7•G�: •7�^::.1.2Cf.� t2:00an: �pYn0lntormatlon �,_� T��I.^4•len: 7';r.y Chile Q Pat 0' Donoha Job DeeolpWrs: 11509 6741 Walsdall Or P.O. Nur•bte: Eagle Rlwr• AK 91.577 Toms;: Nut 0r (907)094.8414 Sweew: Nlkote Job Type: Repeat Wep lurk: L49 Grid: 164- - ob Sitehtlw,ea0on � ~ i Cross Streets: River Vlew Q-lve Pat Job Comments: Los�et%** W20= 6741 Waterfall Or IMalnlenartcs L,,t 1 Dlk 94 hyrk 3 ticxee Past Involve ix Slew - w7::..9 tame L aglo Rtwr. AK 00677 (907)594.0414 Tax Portent .nn t-•hoosoeauo Co e iarvica Type Q: " septic Service Lk-dw2k Addalonal Lowson ComMonts: tat ow ader d9 rock • 9 bdrm Gray Moa. satellite dish Pipes visible In beck yard - Gingl4 sea*aa Pr cs Es: h r 2 Men Tax Exlanabn Actual $115.00 No No $11500 IL-•K'— Gallon s•K'Gallons Planned: 1250 • • �.Tartk Gal'ars Actual 0 Hose Length. Double Tank: Q „ Pump System: [] ,� naf ; Inlet: ❑ _ Baffles OUW; ❑ (; � hoc k/s �;v vo--k� ' NonTaxable Tool TaxableToW : tit tart•?%o n' _:ictal d Crrp,t: 3113.00 $0.00 $0,00 $116-00 ../ ! .... .�.. erg, �....�._ . . Customer u,.a.. �.'1e W -11s e.d ,O,nr�i.o pdnlod on the hack. THIS IS A! INDI VG A3RE?ME JT, — m� &9naure w4 "oR,toreliomie a n.r. ACCSPI&4 5y IRS PL..."Ping For your a dded ppnv miens' -..x r–m :rn take credit card payments over the I horx. rti Z OF A4 >1 A V Duan Mark Seward A LS -691B 4r I1 Revised 11/18/91 ASBUILT—NO CORNERS SET THIS DATE. SEWARD I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE= FOLLOWING DESCRIBED PROPERTY Lot 1, 1" = 40' Block 2, River View Subdivision ' DATE. 11/18/91 AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE 5/31/91 OWNER TO DETERMINE'THE EXISTENCE OF ANY GRID. EASEMENTS, COVENANTS, OR RESTRICTIONS SW357 WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' ANY DATA HEREON BE USED FOR CONSTRUCTION 21-11 OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. AMS OF A4 >1 A V Duan Mark Seward A LS -691B 4r I1 Municipality of Anchorage Development Services Department • �.e Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Steve EM Legal description: Riverview Estates Block 2 Lot 1 The attached paperwork has been reviewed and Is being returned for the following reasons: ❑ Original signature or stamp missing on ❑ Calculation error in design. ❑ Additional soils information needed. ❑ Water monitoring results inadequate. ❑ Discrepancy in information submitted. ❑ Topographic information missing or inadequate. ® Incomplete; missing Pumper and date ? ❑ Incomplete; missing ❑ Additional adequacy test information needed. ❑ Water sample unacceptable. ❑ Measured/proposed distances/dimensions missing. ❑ Locations of all soils, percolation and water monitoring tests not shown. ❑ Proposed system too deep for soils information submitted. ❑ Well log required. ❑ Omission in narrative. ❑ Insufficient fill over tank or field. ® Other. Well log states there was 2 wells drilled on this property. Are there still 2 wells 7711M. MYl Name of reviewer. Jeff Poe Date: -25 5-03 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK 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 Parcel I.D. # 050 721 12 �' HAA # 1. GENERAL INFORMATION Complete legal description RIVERVIEW ESTATES, L1, B2 Location (site address or directions) RIVERVIEW DRIVE WILLIAM M. ROSETTI Day phone 696-6819 or Property owner 762-9145 Mailing address 9311 HILAND ROAD EAGLE RIVER, AK 99577 Lending agency Day phone Mailing address Agent GREATLAND REALTY Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water 694-9125 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X 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 921 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 re ul do s in eff ct on the date f this inspection. agle Iver engineering 6ervices Name of Firm P.Q. Box 773294, Eagle Rivet AK 99577-3294 Phone 694-5195 Address Engineer's signature Date 9-19-97 Additional Comments ,•,...,—p Ly u1 rvlcrlorage uepartment 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 engineers work. 72-025 (Rev. 1/91) Back MOA #21 A�T' E.'tta as rapt Nf iyb�sF u X r s y y � , �•1�.ra ®.. r+.r eae R'artMs.�y �r•r 5 �, •>�+.va\fi.w as t. s ava 4 - F 6. DHHS SIGNATURE ' t is •Baa ° 11�" Approved for _—_ 10 bedrooms.'r Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments ,•,...,—p Ly u1 rvlcrlorage uepartment 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 engineers work. 72-025 (Rev. 1/91) Back MOA #21 SNWRONMEWALSIRY 8DIVISION Municipality of Anchorage SEP 19 1997 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division R� � E I VE 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: Ridtrd �w 'ts7'e./&s Lor/ "� Parcel I.D.: �S 7a-/ - / A. WELL DATA Well type /W- I'lliTF If A, B, or C, attach ADEC letter. ADEC water system number N /� Log present (Y/N) Y Total depth Sanitary seal (Y/N) Date completed 61f Cased to FROM WELL LOG a Date of test dy /5 Static water level Well production ' 6 �M WATER SAMPLE RESULTS: -d Coliform Nitrate Date of sample: `J 5 B. SEPTIC/HOLDING TANK DATA /oo Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION g.p.m. o, / 14 Collected by: Gid!=f Other bacteria J. / g. P.M. Date installed Tank size /40� «,./ Number of Compartments -2Cleanouts (Y/N) Foundation cleanout (Y/N) ? r Depression (Y/N) _ Y High water alarm (Y/N) 'V""/ Date of Pumping l7 Pumper Tic s C. ABSORPTION FIELD) DATA Date installed / 7d Soil rating (g.p.d:/ftl orftz/bdrm) System type 6 6"2' ° u/esu: rveeri Length Width Z-/- s Gravel thickness below pipe Total depth Effective absorption area s`/y Monitoring Tube present (Y/N)_ V Depression over field (Y/N) �✓ Date of adequacy test 9 ' Results (Pass/Fail) For 3 bedrooms Fluid depth in absorption field before test (in.); Immediately after 33Ggal. water added (in.): /e) ll Fluid depth U (ins) Minutes later: 30 Absorption rate = � �' g.p•d• Peroxide treatment (past 12 months) (Y/N) "/ i-1 If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATI N Date installed N 14 Manhole/Access Y/N) High water alarm le I at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Js'v ' Absorption field on lot t /,6o ' Public sewer main /,//I/ Sewer /septic service line / Z/o "Pump off" level at* On adjacent lots -7''/e),)'" On adjacent lots lie_-) Public sewer manhole/cleanout Lift station /V SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Property line 3a Absorption field ,5 Water main/service line 'f7v ' Surface water/drainage ` Wells on adjacent lots 7,/ora' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 3a / Building foundation Surface water ilio v' Curtain drain Al F. ENGINEER'S CERTIFICATION ",P7i Water main/service line f/o11 Driveway, parking/vehicle storage area Wells on adjacent lots -'-loo ! certify that l have determined thru field inspections and review of Municipalr. cords that I": a, in conformance with MOA HAA guidelines in effect on this date. {TF s nod $;. i 1 Signature � � „ ,^ Engineer's Name 4" x S���tti ,g ttt � Loin A. iluiot[t. Date i"1 Yryg HAA Fee Date of Payment �� J Receipt Number_. 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number are CIME Ref.9 Client Name r>rajeut Nawj# client sample ul) Matrix Ordered By PW511) GME Ennvironmental Services Inc. 9751$5001 Eagle River Engiueesing Lot 1, Blk 2 Rivervlear Est. Lot 1, Blk 2 Rivervhm list. DEnking Water 0 Clift PO# Printed Weffiule 09/09/91 15;44 Collected Dateffinle 09/03/97 10:35 Rmived Dour lime 09/03/97 16:40 Technical llirrttar: Stephen C, lade Relmsed By Attowa6le Prep AItiatysis Parameter Results PUL Units Method Limits [late 00te Init Nitrate -N 0.100 u U. 100 m9/L 5M1D 4500-NO3F 1n rax 09/05797 JBL Total Coliform 19 06£ 100 ml smia 92228 69/03197 TMU SEP -25-1994 6849 CTBE ESI P&KI-ORRUE •ATr.�biZ�i to. eiZni IL CTE Environmental Services .Inc. Laboratory O slop ------------- eking `Vater Analysis Report for Total Coliform. Bacteria ,�;;�;. r its -teas P IAFSMIVC770M 01v RSvMgS1DE36F'0RWC0LLE 7RVGSAMPLE Tek 19071592,2343 Pax: (9071891.6301 MUST Cl PUBLIC WATRII SYSTEM LM P. 71 11 1 1 ' i,PAIVATK WATER SYSVM SendRcrdtr §sad I� Tr.' a S"d aagaffir e,7 smd more,,. "Now KM ..�. !AMPLE DAM Moallk AMPLE TYPE- t/ Pontine, witA Ixb ae>~ as special Purpaar AMPLE r 1�w M 22. Day Yar 1 Treated Water uarr..ra-watm Tule Coned" Celleelnnni 8P lMpr.�ire To Be COMPLETED I3Y LABORATORY Analysis shoes this Wau:r SAMPLE to be: satisfactory � utooer .(3 Sample, awr70 hows aid, results may be tmt+eliabltt a Sample too long n transit; sample should am be over 43 hours old at examination to indicate reliable r MML Pleaao send new ismple via special delivery mail. Date, Raeelvetil . 172. Time Reeely" / 7 •tai 7 Analysis Begs■ = t Analytical Methordr Ae Membttn d Filter a MMO-MUG NumberofcaloMesnp0 ad. :'110th• Analyst Paz J raw. Chest aatilted etaanfisfiietory racks: 13 Mew& SOON widi Ptxe4 own Tuoc'� BACTERIOLOGICAL WATER ANALYSIS RECORD NIA143.MUC Koala TftalCelilbrw l^ Celt Mewbraae I hw. 11h*d Cat■! ® CoftnieV1110 nai WriRtatlear LTt o iii ��®OOL>Ttit6t �p»w.u.rr�Ceuw Fee(. CsU bm CesArsswdm� Feat Mush"" four Rewire Sr In eftm, ceulrwnalt Int Tu.e, c , hrs. J 1M6nlhw g, Ore SGS &00lS N" a"&aw rta 8itrrvaUteneel TOTAL P.61 97.5703 -- - � Jan El T. Faud Paz J raw. Chest aatilted etaanfisfiietory racks: 13 Mew& SOON widi Ptxe4 own Tuoc'� BACTERIOLOGICAL WATER ANALYSIS RECORD NIA143.MUC Koala TftalCelilbrw l^ Celt Mewbraae I hw. 11h*d Cat■! ® CoftnieV1110 nai WriRtatlear LTt o iii ��®OOL>Ttit6t �p»w.u.rr�Ceuw Fee(. CsU bm CesArsswdm� Feat Mush"" four Rewire Sr In eftm, ceulrwnalt Int Tu.e, c , hrs. J 1M6nlhw g, Ore SGS &00lS N" a"&aw rta 8itrrvaUteneel TOTAL P.61 1. GENERAL INFORMATION Complete legal description Riverview Estates, Lot 1, Block 2 T14N R1W Section 20 Location (site address or directions) NHN Waterfall Drive, Eaqle River Property owner Dennis C. & Debra S. winter pay phone 552-3335 Mailina address SR Box 9311, Eagle River, AK 99577 Day phone _ Day phone to 201, Ei 694-4200, ;le River; ,AK Individual well X Community well -r> c,uliuuu; mupecuons; or, analyze_,oata, before a ycertificatey Is Issued,zThe , iAunic(pajity of%Anchorage is riot responsible for errors or omissions in the professional engineer s work „; r a fc, r r r 'D Y x$026 (ABV 1/v 6Mek MOA 11Aj4, r�,ui�!_��]!��.�i,.�H.aft`i€kdd'T����rt}I�.�P.Y�,3,�,.�.2t�.:. Municipality of Anchorage Department of Health & Human Services HEALTH AUTH61400 APkbVAL CHECKLIST Legal Description: &1AP91114CA) F1T /OT/ &k 2 Parcel I.D. t� 50 - 272-1 Z Tiy�tl /3/w sec. zo A. WELL DATA Well type Af111Aa If A, B, or C, attach ADEC letter. ADEC water system number IVfA Log present (Y/N) Y Date completed /01 i 7!9 Driller___ RA/'/?4 7 - Total depth /00" Cased to /DD ' Casing height /4, Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION 6 Date of test —/ 2�%4 // /04/91 pn Static water level 9U' 2 —9 z �, �, I a 'V, Well flow 13 g.p.m. g.p.rmj 14- Pump level IJN/<A/0luhl SEPARATION DISTANCES FROM WELL TO: Z. Septic/holding tank on lot /S`D ; On adjacent lots Absorption field on lot '�/� o ; On adjacent lots Public sewer main Public sewer manhole/cleanout y/p Sewer service line /yO ' Petroleum tank AJ /-' WATER SAMPLE RESULTS: Coliform « Nitrate D�� Other bacteria Date of sample:01 Collected by: fN&/ME�� B. SEPTIC/HOLDING TANK DATA Date installed ��%�y Tank size 1406) Compartments Z Cleanouts (Y/N) Y Foundation cleanout (Y/N) /u Depression (Y/N) N High water alarm (Y/N) %`/ Alarm tested (Y/N) A/ Date of pumping / d % 9/ Pumper ,Tg S SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /,61) 1 On adjacent lots 7`�vv Foundation S To property line 30/ Absorption field Water main/service line Surface water/drainage ,vIQ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes Manufacturer Manhole/A9csssJY/N) SEPARATION-D4,STANCE FROM LIFT STATION TO: Weal of On adjacent lots D. ABSORPTION FIELD DATA "Pump off' level at Cycles tested Surface water _ Date installed 0YA?r Soil rating /51� y" /;? System type De4/IJF/C/,b Length 83 Width s Total absorption area SY9 Gravel thickness a Total depth '?, /rem Cleanouts present (Y/N) Depression over field (Y/N) _ Al Date of adequacy test - � //�/J Results (pass/fail) PASS for 3 bedrooms Peroxide treatment (Past 12 months) (Y/N) (/A6k',0kull If yes, give date N�.4 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: f Well on lot /60 To building foundation On adjacent lots 7"1 Surface water On adjacent lots D' Cutbank Curtain drain ✓ aao4Y� �t E. ENGINEER'S CERTIFICATION t/V4) Property line—�, _)_ To existing or abandoned system on lot Water main/service line Driveway, parking/vehicle storage area 7`10' w l certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name �`°'✓ �N+ Date 11�DC� HAA Fee $ Date of Pay Receipt Nur 72-026 (Rev. 3/91: Waiver Fee: $ Date of Payment Receipt Number NOV 14 '91 08:59 N.-TESTING-LABS..INCAIRRARAARARA P.1/2 NORTHERN TESTING LABORATORIES, INC� FAX 4W125 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907)45&3116 ANCHORAGE, ALASKA 99503 (907)277.9375 • FAX 274.9645 2505 FAIRBANKS STREET Report Date: 11/14/91 Eagle diver Engineering p.0. Box 773294 Date Arrived: 11/06/91 Eagle River AK 99577 Date Sampled: 11/06/91 Time Sampled: 1330 Collected By: LB Attn: Louis Butera Definitions MDL = Method Detection Limit B = Below Regulatory Min. Our Lab #: A115210 H s Above Regulatory Max- Location/Project: - E = Below Detection Limit Your sample ID: Riverview Lot 1 Blk 2 Estimated value sample Matrix: Water Date Comment S : Unite Re>xult Flag MDI, Analyzed MethodParameterw---_....------�-W----------------------- -- -- --------------------------------------------- ------------------------------_- - - mg/l <MDL 0.5 11/13/91 EPA 300.0 Nitrate -N Reported >3y: William ->4lrehan Anchorage operations Manager Eagle River Engineering Services 11940 Business Blvd, Suite #205 694-5195 P.O. Box 773294 Fax 694-3297 Eagle River, A. 99577 Legal: k!t ���z -r Date: i, Owner w����� Type of test: O Well Flow Test ❑ Septic Test Only Well & Septic Test ❑ Other: