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Home My WebLink AboutMEADOW BROOK BLK 3 LT 12 MUNICIPALITY OF ANCHORAGE D[ FITMENT OF HEALTH AND HUMAN SER ES Environmental Health Division b ~() / ~ ~ ~ 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT 'S DISTANCES SEPTIC TANK ADSORPTION FIELD WELL I FOUNDATION A~-BUILT DIAGRAM (Show Ioc~[~on oi well. sephc sys[em, p~operty hnes Ioundahon, drJVeWay, water bodies. [] HOLDING TYPE OF SYSTEM ~'TRENCH ~,, BED L~ W. DRAIN ~ OTHER ~,C) FT ~,~ FT WELLS PRIVATE ~ OTHER fldentifv) REIVIARKS: Inspechons P,e.~d by: "7-'5- D'J 17034 Eagle River Loop Road No. 204 Municipal 211d Slate guidelines in effect on IhJs dale: ~_ 72 0~3 (3/85) ENGINEER'S SEAL (]:I')ViJ;I;~ iJ)l:;l:;:' I'I'i ~'.1. I. Ii:: hlit~ I I ! I. ::!!; ~ l;J Zt i/ I i t :? ,, ,,-.~ ~::!;l-..! I:' i ,, :I. D,:b ' ' MUNICIPALITY OF ANCHORAGE DEl- ,TMENT OF HEALTH AND HUMAN SER~'..-"S (~ ~ ~ t ~ ~" d) ~i Environmental Health Division 825 %" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELL INSPECTION REPORT TANKS ~P'"-SEPTIC ~-K/5'//A/L~ [~ HOLDING TYPE OF SYSTEM L~'~ENGH [~ BED ~] W. DRAIN [] OTHER ' DISTANCES ~:::~-' TO SEPTIC ABSORPTION WELL FROM ~ TANK FIELD WELL /'-///,~_ LOT LINE //~ ~ /~ ~////~ FOUNDATION /~.-, / "~- //,4 AS-BUILT DIAGRAM iS ~ow gsa o o well, sephc systenl, properly bees, Iounda~mn, driveway. ~,ate~ bodies, etc original grade ~,/ F~ FT ~ ,~L FT (,, Fl' FT SO FT Date Installed WELL5 [] PRIVATE ~'~q'HER (Identify) ~lass~ftca'Ii~o-~ (A/'~8'6) j ] oral Deplh Casco ~o ..... z--r j F1 F1 REMARKS: Scale: .h,.I inspections Perlormed by: Dale ,Lo - Io-gq ~=e._~.~p_tqoad I',Jo~=,?,J~t=~,~.ceriily Ih~lhis inspection was periormed according Ia all ale lyer~ A asea 99 77 /,~ · ~unicipal aed~la~ gUll~ellee, in ellesl on Ihis '~ale: . - -~/1 ~ Y Health Depamnenl Approval: ~ Date: 72 013 (3/85) ENG i . I: i".ii'-i i i 'l Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 10 11 12 13 14 15 16 17 18 19 2O /(,4/~.,¢¢¢~ ~,~;[ownship. Range. Section: SLOPE §ITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Alter ,_ // MonJlorJnl~? ] ~/O./t/~ Date; Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ (mmutes/mch) PERC HOLE DIAMETER TEST RUN BETWEEN __ FT AND __.FT COMMENTS ~) ~.~ L~~ [SLD ¢b]/~ ~ ~ ~ ~, g~~) ~~ S & S ENGINEERING ~/, ~///~ PERFORMED BY .~-* ---., . / ~/ THA-r THIS TEST WAS PERFORMED IN ACCORDANCE WITH~Ig~iY~r~M~,~L7OU*DEUN~ECT ON TH~S DATE. DATE: ~ ~ 72-008 (Rev. 4185) ~,~ GREA ,_R ANCHORAGE AREA BORL,..GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LEGAL DESCRIPTION_~ / SEPTIC TANK: DISTANCEFRoM WELl C'~I~:"-"ffh~ANUFACTURER. INSIDE LENGTH INSIDE WIDTH A NUMBER OF ? LIQUID DEPTH LIQUID CAPACIT~ALLONS.,~ 'rILE DRAIN FIELD: DISTANCE FROM WELL~--~'P~'~'~)UNDATION/0 C.~ ,,,.~ ~ TOTAL LENGT, ~ f NEAREST LOT LINE ,~ OF LINES .~.X V NUMBER OF LINES___t_~DISTANCE BETWEEN LINES ~/~ TRENCH WlDT~Z~:IN. TOTAL EFFECTIVE ABSORPTION AREA__~ SQ. FT. LENGTH OF EACH LINE Zt, DEPTH OF FILTER ~ / ~PTH~ TOP O~ TILE TO-FI~ISH ~AOE ~ATE~IA~ BEneATH TILE ~ ABOVE TILE I~. WELL: TYPE ~ . BUILDING FOUNDATION CESSPOOL APPROVED _CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED NEAREST SEWER LINE __, REMARKS DEPTH SEPTIC SEEPAGE TANK SYSTEM.__ DISTANCE FROM: DISTANCES: INSTALLED BY ~m~./~ SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: Form ED-D32 D M OF S~T~.~ G~A.A.B. ~; 'I"~'F'E OF SOIL RE~SCIIE:F:"I"ZON S;~'STEI"'I... F:']:T '~ ' NLINBEJR CF BEE:'ROOHS :~: 'q'liL R' ' ' THE: ~E'i'31 ~'EB ~I~E iZiF T~E :,I..[L HE-~J~.FIIUN .~=,TEtl IS:DEPTH= ~C~ LENGTH= THE: HINIHLIH DEPTH OF 13F~R',,~EL [.,ErNEEN THE OUTFRLL PIPE ~ND THE E~{OR'v'~T[I[IN BOTTOVI 1. .;, - .. ,... HEI.~. :. ~ :, NO ~ THE bEPTFI OF' T' ..... RENE. HEb. F3P E:'RRINFIELD,~., THE NIDTH I~; ~: FT. RENL. H 'ZR' PIT If; 'THE [[:,1 ffNC. E BE:TNEEN THE O~'nlIND ,: BOTI"3t,1 OF' THE .... · ..... LIRF~C.E laND THE THE LENGTH DZHEN'~Ir~N IS THE LENGTH OF E~C:H ,- ~ ....... , - ~ =,lEE FL~ ~ SEEPRGE PIT OR THE LENGTH OF' THE TRENCH., OR THE [~E':~IIIRE[:, cE "F' E'RC:k:FI'LLZNG OF' AN~' S~'ST'Ef,1 NI'rHOIJT FINFtL INSPECTION B'~' THIS DEPRRTNENT NILL L,E ;~;IJB...I'EC'F TO -~-c ....... ' PR J-,E:L.U F[E N. t'l ]: N ~ PIUF1 ", ,z ........ ,.., E. Z_,] F NUE FELt1 NELL TO RN~r' SEPTZC TRNk:,'"PRC~ERGE PLRNT OR 'g*h~L RBSORPTZOI'.4 E:~E~'TEF1 Zf~; ~OC~ F'T F'("l[e R PRZ'qRTE NELL RND ,~3¢3 FT FOE' F~ F'I BLZC NELL. :,FEE. iF. ]:C:RI":[ON~; RNE:, - · - - " z ....... L:ONSTRLICI"J[ON E:'I'RORRH':; RRE RVRZLRE=LE 1"O ZN.=LRE PROPER ].N._ [HLLH ICN. - - '- I '- :[ C:E:F~"I"~F'.ff THaT :[ Rt'~ F[~f'IIL[RR NZTH THE RE~..U[REHENT~, F'OR ON-S[T[~ SENERS aND NELt. S ZN 0 8-E Russell Oyster 694-2774 Soils 8' Foundations Performed Legal 0 ~. C H N i'~ '~', ~" .... Box 90, Davis St., Eagle Riveh Alaska D95T/ 694-2774 or 688-2280 Descrl priori L_~2' /Z, LOG Earl Ellis .......... 688-2280 [.and Development 2 ]6 PItl,]I,IM INARY I hereby eorti£y that I have sm'vevcd thc described properly: ~ o 7 / '/ i %: , po:4e(] iml)roveDiellt8, as p]allmtd lhOl'eOll by lhc buikl;,r, will he within lira prolml[y linc~ and will not Of (~llfrlO&Ch Oil l}lO pl'Op(H't3r yin. adjacent thereto, lha[ ]):tlpd ht I;',~g]O 'l[iver, I )ll[,:lIT C .iOJINF;ON 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. Cf 050-192-07 1. GENERAL INFORMATION Complete legal description Lot 12; Block 3; Meadowbrook Subdivision Location (site address or directions) %: 18054 Sanctuary Drive Eagle River, AK . Property owner ;: Mailing address '; ken'ding agency ' Ma. ilin. g address Paul & Julie Dusenbur¥ 18054 Sanctuary Drive Eagle Day phone 694-4037 River~ AK 99577 Day phone_ Agent Mary Cox/ Remax Properties Add tess Day phone 257-01 12 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well Community well Public water xx NOTE: 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: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. XX 72-O25 (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, 1 verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm AI.A~ICu~ WA~.~ ~/.W~ _~_'rEWAI'E~ Phone .~ 7'- ~ / 7~ Address 8~1 D~i~J~ SUITE 2B _ Engir~eer'ssignature ~ ..... ~_1~ A~99504 Date - .. Alaska Water & ~. ~U, be PAID ¢ /~ _ ~ DHHS SIGNATURE ' ' ~ : ~ Approved for F0 U~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-325 (Rev. 1/91) Back MOA ~21 JUN 28 199~ Municipality of Anchorage ...... ..-.MUNICIPALITY OF ^NCI-[~) DEPARTMENT OF HEALTH & HUMAN Sb. HVIL;~iRONMENTALSERVIC~~ '. Environmental Services Division ' 825 L siiee~, Room 50,2 ,. Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklis~t.. ¥ Legal Description: ¢/~¢_.,~ Oo~ ~¢-oo~.- .~ ~ --'I-Z ~ Parcel I.D.: O~o -- J~ Z~ o~ A. WELL DATA ~Lt~~ Well type ~ If A, B, or C, aEach ADEC letter. ADEC water system n~~ Total depth ~/~to -~~t (above ground) SanitY) '- ',.. Wires ~r~'Perly P~ FROM WELL LOG Date of test Static water level Well productio'n WATER SAMPEE RESULTS: AT INSPECTION g.p.m. '~, g.p.m. Coliform Nitrate Other bacteria Collected by: 17-~ Depression (Y,~ /4,~ __ Pumper '-~ ¢-- ~u¢¢ml ~ Number of Compartments 'Z_ ' Cleanouts I~/N) High water alarm (Y/~I~ Soil rating (e~r ~ I~0 ¢,,~'~lr~¢stem type Date 'of sample: B. SI-'PTIC/'MC"4'~;NG TANK DATA Date installed ~/,&/'7 (~ Tank size Foundation cleanout ¢~/N). Date of Pdmping ~1/~, o/~1'~ C. ABSORPTION FIELD DATA al,~l", ~ Date installed --/~ Length '7~ ~T'o-r~ _Width Z. ~; - '~ .o Gravel thickness below pipe Total depth ~/. 5 - I o~ Effective absorption area '~H'8'¢ Monitoring Tube present ~N) '¢~ Depression over field (Y/~ ¢',Od Date of adequacy test ~'/'~'t/~/ff Results (L'-P~/F--4~ t¢~ c,.c' For z.jL Immediately after $/¢' gal. water added (in.): Absorption rate = ~,O¢p -F- g.p.d. I¢--~¢'~ If yes, give date Fluid depth in absorption fiald before test (in.); Fluid depth O (ins) Minutes later: Peroxide treatment (past 12 months) (Y,~. bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION i,,] /pc Septic/holding tank'oP, Jo.~.~ On adjacent lots Absorption field on lot ~. Public sewer main ~~'~ ~ole/cleanout Sewer/sep~~Lift station SEPARATION DISTANCES FROM SEPTIC/I-,I~TL:;ER~76 TANK ON LOTTO: Foundation .~, I -t-' Property line ~ o t ~ Absorption field ;.~ Jr- Water main/service line to~' Sudace water/drainage I, ooI-e Wells on adjacent lots '3,oo Lt- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: IO I-'t- Building foundation I ~) J -I- Property line Surface water Curtain drain Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots ~.,~o~ I F. ENGINEER'S CERTIFICATION,,,// Icertifythat l ~-'~etF~n~/~fiel~'"~/ inspections and review of Municipal re~¢~,~ ~~ms are Signatur: ~/~ D~ ~ HAAFee $ ~;', ~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* -13- /".- 50' ;,~EMENT8 OF RECORD, OTHER THAN 'HOSE SHOWN ON THE RECORDED SLAT ARE NOT SHOWN Alt. BUILT q CORNeaS S~'THIS ox'rE I i hereby certify IhS1 I haY9 I~ertormed g uongagea'~ Inap~ion .,-" S ' :.~.. ; Of the fodow ng doscr ~e~ prOpe~y: ~ , , : ,, : , ¢ )Anchorage Recording l recruit Alaska. and th~t ~ . . ;'.3;' T;',~.,~A ..... ¢ ~- .,1'~ ]rnpro~menls siluated thereon are within t~e properly line :; ~r,~ ~ ~<.,J ¢ OD not ~eriap 6~ encroacll on Ina property lying adj~enl '. ........ %" ~"¢ [¢ Ihsl ne im¢¢ovements on p~epe~y I/,ng adacent ~hetato , .. ' ;,-<~'.':.~u~ ,'~.~ encroach on he promae~ nq~esion a a hatt~ereate no . ', . '~ '~, =~.~.,~ .2.0 ~ re&always, tr~9~18~l~ line8 or other visible eesemenls q'~.'x'~i,',~,,,. ~-~"~',~:~j properly except as in~icated J FRED WALA?~ & ~ J (907) 248.1666 Englne0r, and MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAETH & 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 {c]~2 - ~'? HAA# "F"~ ~'~c~(.F:,('",'¼~'~- 1. GENERAL INFORMATION Complete legal description Lot 12~ Block 3; Meadowbrook Subdivision Location (site address or directions) Properly owner Mailing address Lending agency Mailing address 18054 Sanctuary Drive Rie!:a4.d Porter Eaqle River, AK P.O. Box 91308 Anchorage, Day phone AK 99509 277-3180 Day phone Agent Address Kathi'0£~stead/ Remax o~ Eagle River Day phone 694-4200 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well Community well NOTE: XXX " Public water If community well system, provide written confirmation from $~ate AD£C, attest- ing to the legality and status of system .... 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site XX× Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State AD£C attesting to the legality and status of system. 72~)25 (Rev. 1191) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm s & s ENGINEERING 'i)034 F. agJe ~lver L~p Roa~ No, .~04 Phone ~ ~ ~/- ~ ~ 7 ~] Address Eagle River, Alaska 9~)577 [:)ate ~/33/¢6 DHHS SIGNATURE /~ Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not Conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~025 (Rev. 1/91) Back MOA #21 6N¥iRONMEN'fAL Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: ~_~v- \7~ ¢-~,-V- 7, 1~¢>/~3)¢,~t ~.:~,~dlz~L.,'Parcel I.D.: A. WELL DATA Well type ~ t3 ~ Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPL~SUkTS: ~Date of sample: If A, B, or C, attach ADEC letter. ADEC water system number .~¢ Date completed ~ Cased to. ~§hf'(above ground) properly protected (Y/N) FROM WELL L,~,/./' AT INSPECTION /~ g,p.m, g.p.m. Nitrate Other bacteria Collected by:' B. SEP'rlC/HOLDING TANK DATA Date installed Foundation cleanout (Y~blT)). Date. Si Pumping ~...2-~ ..: 7.0 Pumper C. ABSORPTION FIELD DATA Date installed '~'~"~'7 . Soil rating (g.p.d./fFor fF/bdrm) Length '?"] '7~,'r;~Width ~.iT //' J ' Gravel thickness below pipe Effective absorption area c/~/¢y / Date of adequacy test ~//'- ~' ¢' Tank size VZ¢!~'--o Number of Compartments ',Z-- Cleanouts~N)4- Depression (Y/,~i)_ ,-J High water alarm (y~-'¢ "'J/.A System type Monitoring Tube present ~.~/N) ResultsL'i~Fail) (~" Total depth /o . Depression over field (Y~'~ For Fluid depth in absorption field before test (in.); O Immediately after,~'3~ gal. water added (in.): Fluid depth /~' '~'~ (ins) Minutes later: /o Absorption rate = .g.p.d. Peroxide treatment (past 12 months) (Y/~)). ?,J.~/v'~ /~_ ,u),..) ¢¢.,~/If yes, give date bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on"?q..~.~ High water alarm level~ *Datum - 6'~]'Ei~ tested "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjacent lots Absorption field on lot On adjacen?q~~ Public sewer main ,...~--~-~ Public sewer manhole/cleanout ~rvice line Lift station SEPARATION DISTANCES FROM~HOLDING TANK ON LOT TO: Foundation -~- ~'J¢ Property line to t4-~ Absorption field Water main/service line /,,,~ /,r- Surface wateddrainage {0 b /'~' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /~) u/-' Building foundation /o / 4- Water main/service line Surface water /';'~ / '¢ Driveway, parking/vehicle storage area Curtain drain f//,-l- Wells on adjacent lots ENGINEER'S CERTIFICATION I certi¢ that/have determined thru field inspections and review of Municipal e~ in conformance with Engineer's Name HAA Fee $ ~ ~)~') Date of Payment ¢/TLZ//~ Receipt Number ~-'Z'~.~ 72~026 (Rev. 8/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE 0 ~-~ () ! ~ ~ 0'7 DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY H86-1341 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 12 Block 3 Meadowbrrok Subdivision (T14N R3W Section 12) Location (address or directions) 18054 Sanctur¥ Drive, Eagle River, Alaska 99577 (b) Property Owner R. Keida Telephone: Home 694-5058 Business Mailing Address 18054 Sanctury Drive Lending Institution Lomas & Nettleton CompanYTelephone Mailing Address (c) (d) Real Estate Company and Agent Address Telephone MailtheHAAtothefollowinoaddress:or:CheckhereD, ifholdforpickup. Listcontactpersonanddayphonenumberbelow. S & S Enqineerinq 17034 Eagle River Loop Road ~204 Eagle River, Alaska 99577 (e) TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms four ( 4 ) WATER SUPPLY Individual Well [] Community L~X:Z-Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [~x 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. Page 1 of 2 72-025 trey 8,861 Front 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 flies 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 reguJations in effect on the date of this inspection. Name of Firm S & S Enqineerinq Telephone Address 17034 Eaqle River Loop ~204 Date Engineer's Seal This department has received written confirmation from the engineer regarding the Conditional Approval of December 16, 1987. The corrections have been accomplished and an inspection has been completed by the engineer. The subject property meets with Municipal standards and is now approved. This property has also been recently upgraded to a four(4) bedroom on-site disposal system. Permit #870151, inspected by S & S Engineering, and installed on July 3, 1987o DHHS APPROVAl.. Approved for four (4) bedrooms by ~ '"~ ' '~¢"'~ Date Approved ×××××××× Disapproved¢/ Conditional Terms of Conditional Approval July 7, 1987 CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate Js issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 fRev 8/86) Back ROBERT A. SHAFER HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUC'rURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER OISPOSAL SYSTEM OESIGN July 5, CIVIL ENGINEER 1987 ~UNtCIPALI1Y OF ANCHORAGF- 694-2979 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 J(tL 619 7 RECEIVED REFERENCE: Lot 12; Block 3; Meadowbrook Subdivision The on-site wastewater disposal system was upgraded to t~ee bedrooms under permit #870083 as a result of a conditional Health Authority Approval which was issued in December, 1986. It was determined after the upgrade work had been completed that the residence contained four bedrooms. Therefore the system was upgraded a second time under permit #870151 and a copy of the on-site inspection report for this upgrade is attached. Request you amend the final HAA dated June 15, 1987 to reflect four bedrooms and provide us an original copy of the amended HAA. If we may b~b ~ further service, please contact us. SRB 196X EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SiTE SEWER AND WATER FACILITY 264-4744 Application Date June GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) (b) (c) 15~ 198'7 Lot 12 Block 3 Meadowbrook S/D T14N R3W Sec, 12 Location (address or directions) 18054 Sanctuary PropedyOwner 3R. Keida Telephone: Home 694-5058 Business Mailing Address 18054 Sanctuary Dr. Eagle River, Alaska Lending Institution T,r'z~,sN~+'+"i ~-n~ C!n. Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or: Check here BI, if hold for pick up. List contact person and day phone number below. Hold for pick-up TYPE OF RESIDENCE Single-Family:~[~X Number of Bedrooms ~ (~) WATER SUPPLY Individual Well [] Community;[]{ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public[] Community[] Holding Tank[] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 IRev 8/86t Front 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 flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S&S EngineerJ.~g Telephone 694-2979 Address 17034 Eagle River Loop Rd. #204 Date .... E~ineer's.~al This department has received written conzmrma~zon z-rom tne engineer regarding the Conditional Approaval of December 12, 1986. The corrections have been accomplished and an inspection completed by the engineer. The subject property meets with Municipal standards and is now approved. DHHS APPROVAL Approved for Three(3)bedroomsby Approved ×X××XX**×;K Disapproved Terms of Conditional Approval Conditional Date June 16, 1987 CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 77-025 fRev 8.'86} Back ROBERT A. SHAFER June 14, 1987 CIVIL ENGINEER 694-2979 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON StTE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage Department of ffealth and Human Services 825 L Street Anchorage, Alaska 99501 ATTENTION: Dan Bolles REFERENCE: Lot 12; Block 3~ Meadowbrook Subdivision A conditional Health Authority Approval was issued on the referenced ~roperty in December, 1986. The conditions under which this approval was granted required that a soil t~st and permit be obtained and the absorption area upgraded to meet the requirements for a three bedroom home. At~ached is the on-site s~wage dispos~ inspection form showing that the system has been upgraded in accordance with Municipality of Anchorage )ermit ~870083. ~equest you issue a final HAA at this time. t~LINICIPALI~, ~- ~ :.. DEPT. OF ~ ~;. ~¥IRONMENTAL PRO I ~ C JUN J 5 SRB 196X EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4'720 Application Date /' ~ ~ & -¢¢~ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ¢¢~,.~-~,M'~,'~ /~-¢~ ~,'~ Telephone: Home Applicant Address / ~¢ ¢¢ &~7(¢~¢ ~ (c) ~, ~'~/~ s-¢ 5-,55 Business Applicant is (check one): Lending Institution [~; Owner/builder []; Buyer F'I; Other [] (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address (f) Telephone Telephone 1~4.'~he HAA to the following address: TYPE OF RESIDENCE Single-Family [~'/Multi-Family [] Number of Bedrooms '.~ Other WATER SUPPLY ~ Individual Well [] Community blic [] Note: tf community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWA~31SPOSAL Onsite L2 Public IZ] 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 Page 1 of 2 ENGINEERING FIRM PROVIDING ~NSPECTIONS, TESTS, FILE SEARCH, DA'fA 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 sho~vs 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 tt~e Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with ali Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Telephone 6 ~ ~---~¢' ~ ~ SEI~ ~96X Address Date EA(~LE RIVER, AK 99577 DHEP APPROVAL L~~} ~'~a Approved for __ ~'~ _ bedrooms by te Approved Disapproved Conditional ~ TermsofCo~ditionalApproval /"~0,.~(' /-'~I4~T ,OE E.(~/'¢.O~t') /~OR 7-F/E CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. -I'he Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNl¢lP^t.rPr OF ^N~,,~PALITY OF ANCHORAGE (MOLt t)EP¥. CF H~AL'flHEALTH AUTHORITY APPROVAL (HAA) E~VIRONMENTAL PROTECl'I~ECKLiST _ FEBRUARY 1984 264-4720 Legal Description: / -)~ [; ECEIVED WELL DATA Well Classification ,T~u/~-/(- ~ . ' Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground F-lectrical Wiring in Conduit (Y/N) Separation Distances from Well: ~"~,¢,~.~ F~7C~ A, B, C, D.E.C. Approve~N) Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) / To Septic/Holding Tank on Lot 'To Nearest Edge of Absorption Field on Lot ~ ~/'-~ 'To Nearest Public Sewer Line Cleanout/Man hole Water Sample Collected by Water Sample Test Results Corn ments /~p/5) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~-/.~-~'~ Standpipes (~N) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~ ~C)d:~, To Property Line / To Water Main/Service Line Course / ('~:".~ r Size / ?_ ~ r.~ No. of Compartments ~ Air-tight Caps fl~4) Foundation Cleanout ~¢~/N) r,../c) Date Last Pumped _ /~-- - /)- ~(-~' )'J//./~ ;for Temporary Holding Tank Permit (Y/N) / To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026{11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /,~' ~;~///~/'E Type of System Design Date Installed ~ - / ~' ~ Length of Field ~ ~ f Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area ~ ~ Standpipes Present ~/N) Depression over Field (Y~. Date of Last Adequacy Test / Results of Last Adequacy Test ~ ~/~~Y ~ / Separation Distance from Absorption Field: To Water-Supply Well ~/¢ To Properly Line ,~4~ To Building Foundation ~ ¢/ ¢ ~ To Existing or Abandoned System on Lot ~ ; On Adjoining Lots To Water Main/Service Line ~_O / ¢ To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course ./¢ ¢ ¢ ~ To Driveway, Parking Area, or Vehicle Storage Area ~ r Comments ~ ~A ~ ~ ~V.s ~ ~ ~.~% ~ ~ ~/~1 Dm LIFT STATION Date Installed Size in Gallons ,/~//) "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify th~ Lba~e.6b .e.c,l~e,d. verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~ i~SX Date Company~ ~ ~ ~ ~ ~iV~ A~ ~ MOA No. ~ ~ ¢¢¢ / ¢; Date of Payment ./~ ~ ~~' Amount: $ ~ Page 2 of 2 72-026 (11/84) NOIIO~lO~d q¥IN~WNO~IAN~ GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received October 7, 1976 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Cony. 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: Peoples Bank and Trust Pouch 7007 995].0 Phone: Eric Johnson -Associates Bui]LdersPh0ne: Lot 12 Block 3 Meadowbrook Subdivision 3. Legal Description: Lot 12 Block 3 Meadowbrook Subdivision 4. Location: NHN Santu%r.y Drive 5. Type of facility 'to be inspected Single Family 6. 279-7511 x 42 Well Data: A. Type C. Construction Community 7. Sewage Disposal System: A. Installed C. Septic Tank: 1. D. Seepage Pit: 1. No. of bedrooms B. Depth D. Bacterial Analysis ~~/ On-site system ~ ~ B. Installer_~%:,z~'~ ~_~_~'~.~CI, , _ ., Size _~,~.~... 2. Manufacturer Absorption Area ~. 2. Material ~<~ E. Disposal Field: l'otal length of lines Distances: A. Well to: Septic tank &~m~u,~}~aAbsorption area . .U Nearest lot line , Ot~er contamination , Absorption area B. Foundation to septic tank C. Absorption area to nearest lot line , Sewer Lines ___, EQ-034 (1/74) Page 1 of two pages Page 2 of tWO pages - Re~ t for Approval of Individual ,~ ,r & Water Facilities Legal Description Lot 12 Block 3 Meadowbrook subdivision Comments '" # Approval Valid for one year from date signed q~/Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true ~nd accurate representation of the subject sewer and water facilities and these .Facilities are operating satisfactorily. Date SIGNED EQ-034 (1/74) '1. Type of Inspection: 2. Property Owner: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES CMRO VA FHA Eric Johnson - Associate Builders CONV ____ Mailing Address: Name of l}uyer: Box ll01~..Eagle River ~ AK Glen D. Eakins Day Phone 694-2794 Mailing Address: 4. Name of Lending Institution:. IVlaifing Address: 5. Name of Realtor or Agent: k/biling Address: Eagle River, AK Peoples Bank and ~¥ust Pouch 7007, ~c~rage, ~( Day Phone Phone 279-7511 ext. 42 Phone Legal Description: L_o cat ion: Lot~___~.,, Block 3, MeadowbrQok Subdivision NHN S~Lutuarv Drive, Eagle River, AK 7. Type of F:aciliW to be inspected: _ S. Water Supply Type of Supply: Single Family Residence No. Bdrms. 4 Public Utility community Individual If Individual, number of dwellings presently served If Inclividual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation Individual (on-site) septic LQ-037 (1/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO"f ECTION 825 L Street - A,chorage. Alaska 99501 Ii( ENVIRONMENTAL ENGINEERING DIVISION Tele phone 264-4720 , REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1, PROPERTY OWNER PHONE Merrill Lynch Relocation MAILING ADDRESS Seattle, Washinqton PROPERTY RESI DENT df differen[ from abOVe) I PHONE na 2, BUYER PHONE Richard P. Keida na MAILING ADDRESS 9310 Jade Street,__Anchoraqe, Alaska '~, LENDING INSTITUTION Coast Mortgage Co. MAILING ADDRESS P.O. Box 12_0_0, Anchoraqe, Alaska 99510 4. REALTOR/AGENT Dynamic Realty Clarence Kinq VlAI hi NG ADDR ESS 501 W. Northern Lights, Anchorage, Alaska 99503 PHONE 279-0665 __ PHONE 279-7611 5. LEGAL DESCRIP'r'ION Lot 12, Block 3, Meadow Brook Subd.' STREET LOCATION 3020 SanctUary Drive , Eagle Rvr, Alaska 99577 6. TYPE OF RESIDENCE 111 NUMBER OF BEDROOMS '" [] One 5] Four [] Other_ [] SINGLE FAMILY [] Two E] Five [] MULTIPLE FAMILY [] Three E~] Six 7, WATER SUPPLY [] INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well E~¢] PUBLIC UTI LITY depth (attach log if available.) 8' SEWAGE DISPosAl' S~:rEM" ' ' (/~1 .3~ E~ INDIVIDUAL/ON-SITE~* **If individual/on-site, give installation date 9? If system is over two (2) years old an adeq~S required [] PuBlIc UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BE REP OCESSING :AN BE INITIATED. 72.010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR ]NSPECTOR I NSP ECTOR DIRECTIONS: 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX 2. WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG R'~CEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or E]Holding Tank Size: If Tank is homemade: SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: I Absorption Area to nearest Lot Line 5, COMMENTS [~:~'~PROV E D FOR Z~--/ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE . BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78)