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Home My WebLink AboutSTEWART #1 BLK 2 LT 2 : oGRE~ ,eR ANCHORAGE AREA BOk~uGH Department of Environmental Quality 3330 C Street Anchorage, Alaska ggS03 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME l/~'- ,4' /2~.~ ~' M^,L,NG ^DD*ESS PO /~0~ 9/~--'~/~,'~/~"~PHONE ~q¢-qZCZ SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER INSIDE WIDTH MATERIAL LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY.__ GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE TOTAL LENGTH OF LINES NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE __ IN. ABOVE TILE IN. WELL: TYPE CONSTRUCTION BUILDING ~,, NEAREST ,,' NEAREST SEPTIC,~-~/ ~' SEEPAGE FOUNDATION__'~/~ LOT LINE ~O SEWER LINE '/~'///~' , TANK I~'~'' . SYSTEM /'/~ ' CESSPOOL _/[//z'/ OTHER SOU RCES APPROVED DISAPPROVED REMARKS DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL' LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM DATE'-~.,~/~.c"APPROVED G.A.A.B. Form EQ-032 LOG OF DRI/ JHG by A & OWNER OF LAND ~ ~'- L:~2.~ .......... !.%..;~4..:~!~, .............. :? ,.~ ~. /~. ~4%~......~./,<:~2.~...' f~.{~... ....... STATIC LEVEL OF WATER FT ..... ::L..~...~ ................. ADDRESS -.-~ .......... =,~., ~ ~ ~ y ~... "~ Y .~ ~ ~ ~ ~*~..~-/~ ) ~x=~ DRAW DOWN FT ........ :.-----~ ........... - ................................. WELL SITE ~-~-~----:~------~--~- ............................................................. ~ F~ ~ /~ '~ .. GALS. PE~ H~ .......... ~L_..~--...i ........ - .................................. KIND OF CASING ~ % W~ .~.,.~:~ ................................ DATE--ENDED ...................................................................... UE ............ KIND OF FORMATION: F~OM..~2--~ ............. FT. TO.....~L.5.! .......... FT.....n~.. t ............... ~- ' .................. F~OM....~--~ ............ FT. , ~ ~ , :, ~ FROM..~--~:.2~ .......... FT. TO ~ ' '~ - .......~ ........................... . ~ ~ ~ ~ b~%,~ ~ ~ TO .................... FT ............................... ~ao~.._j.::.~ ........ ~T. TO_....A..t--~----.~.. ~..z....-.-.~- ............ ~o~ ........................ ~ · FROM./---~--e ............ FT. ' / ' ~:~,~: ,~e er MISCL. INFORMATION: DRILLER'S NAME .._;!.:i::_.L.t:.- ................................................ GREA I ER ANCHORAGE AREA BORvUGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION ~/' :~'~'~'~-~'/~'/~/;'~' ~' LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER ~',j~,, A,~,~ ~' ~" NUMBER OF MATERIAL /~/~jt..~"/~) COMPARTMENTS INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /j ~h~ GALLONS. SEEPAGE~i'T'~, NUMBER OF PITS __ LINING MATERIAL BUILDING FOUNDATION ADDITIONAL ABSORPTION DIAMETER OR WIDTH CRIB SIZE: DIAMETER__ NEAREST LOT LINE LENGTH~'t~, DEPTH ,~* DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~~S~O. FT. WELL: TYPE BUILDING FOUNDATION __ CESSPOOL APPROVED T' .~u ;r411Cl) tJ T CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED __ REMARKS DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE TANK_ SYSTEM DISTANCES: INSTALLED BY: ~'~//// ~ ~)~f)/~'~) LOT SLOPE: REMARKS: ~/Z/~Z' ~ 7' DIAGRAM OF SYSTEM ORE,; .R ANCHORAGE AREA BO[~-"~JGH $~WAGE DISPOSAL SYSTEM -~ APPLICATION AND PERMIT NAME OF APPLICANT l NSTALLATION LOCATION INSTALLATION OF: SEPTIC TANK f~S ~ ' DRA'NiFIEL-- OTHER TYPE AND SIZE OF FACILITY TO BE SERVED ~ SOIL TE¢T RESULT5 ~OT~= THIS PER~IT IS NOT VALID WITHOUT SOIL TE~T COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK ~IZE / ~00 Ty~E ~U ~,~,~+ SEEPAGE MINIMUM DISTANCES, REQUIREMENT~ FOUNDATION TO SEPTIC TANK FOUNDAT]ON TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK . SEEPAGE PIT WEll TO SEPT,C TANK DRAIN FIELD SEPtiC TANK' I ~0~' SEEPAGE PIT . SEEPAGE pIT ALSO CONSIDER AREA WELLS. · SEEPAGE Pit DRAIN FIELD ! ~ CAST IRON INTO AND OUT Of SEPTIC TANK AND INTO CRIE~ CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 iNCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL BOROUGH REGULATIONS REGARDING INSTALLATION. DATE~FoRM No. BO-o, e' APPLICANT'S SIGNATURe ~L,// ¢" ~'~'~'~') ) ~-'¢~'~'~'~ O ~ E GEOTECHNICAL ~ DEVELOPMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Eerl Ellis 694-2774 688-2280 Soils 8- Foundations Land Development SOIL LOG Perfomed for: Name: ~V', /~. /~U~7- Tel. No. Matllng Address: Legal Description: J-~- ,~, z~/~ Depth (feet) 0 1 Soll Characteristics 3 6 7 8 g 10 11 Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: No ~ If yes, what depth ~ Drain Fie~d Perfo~ed by.' INSTALLAT[ON LOCATION 'EGAL DESORIPT'ON GREi ~R ANCHORAGE AREA BOI' !ICH PERMIT NO, DEPARTMENT OF' ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 -~ -- APPLICATION AND PERMIT SEEPAGE PiT DRAIN FIELD , OTHER TYPE AND [E OF FACILITY TO BE SERVED SOIL TEST F ULTS TO BE INSTALLED BY COMPLETION ANTICIPATED FINAL N: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF' NVIRONMENTAL G~UALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TAb MINIMUM DISTANCE FOUNDATION TO SEPTIC FOUNDATION TO SEEPAGE SEPTIC TANK TO SEEPA( SEPTIC TANK TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC DRAIN FIELD_ TYPE SEEPAGE AREA SIZE TYPE ~UIREMENT$ DIAGRAM OF SYSTEM DRAIN FIELD PIT DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS. SEEPAGE PIT DRAIN FIELD. CRiB CROSSINg GAP OF SEPTIC TANK, ., SEEPAGE TO RIVER, LAKE, STREAM, CAST IRON INTO AND OUT OF SEPTIC TANK AND EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTICTA~K ANDT~ K AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. ~ GRAVEL BACKFILL CONFORM TO BOROUGH REGULA~TIONS REGARDING INSTA OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anbhorage. Alaska. 99519-6650~ 343-4744 ' CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~-~(~ 1, GENERAL INFORMATION Complete legal description HAA Cf Lot 2; Block 2; Stewart SubdiviSion #I Location (site address or directions) 21154 LOwland Av6nu~ Property owner Mailing address 21134 Lowla~,d Av¢~u6 Day phone Eagle River. Ak. 99577 269-1103 Lending agency Day phone Mailing address. Agent Elcna PPH/Homequ~t¢ Address 1855 Gateway Blvd. Su.C~¢ 950 Day phone (415)246-6536 Concord, Calif. 94520 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: _~ '~ 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: lng to the legality and status of system. 4. TYPE OF wASTEWATER DISPOSAL: Community on-site No'~E: If community well system, provide written confirmation from State ADEC attest- · If commbnity wastewat~r system, pro~,ide Written confirmation frbm state ADEC ' attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 '~JO~ $,JS@U!SU8 leUO[SSe,toJd eM1 u! suo!ss!Luo Jo s Jo J J8 JOJ elqisuodseJ lou si ebeJoqouv jo /~l!led!olun~ eq.L 'penss! s! eleo!J!Pa3 e eJoJeq elep @z,~leue Jo suo!loedsu! ~onpuoo 3ou op SHHQ jo s@e/,old u J3 'slueLueJinbeJ elelS pue leJepeJ u!e)~eo ,~s!les ol JepJo u! sUO!lnl!~su! 8u!puel J!eql pue seu~oq jo sJeseqoJnd oh,~sepnoo ~ se siql seop 9HHQ eqJ.'e~iSel¥,to elelS eql u! pe~els!BeJ Jeeu!bue leuo!ssejoJd luepuedepu! ue ,~q e^oqe g qdeJSeJed u! ua^lb suo!lelueseJdeJ eq~ uodn /~luo peseq se~eo!J!~JeO le^oJdd¥ ,~lpoqlnV qlleeH senss! (SHHO) seoiMe9 ueuJnH pue qlleeH ,to lue~upedeg eSeJoqouv jo ~l!lediolun~ eq/ s~ue~uuuoo leuo!3!pPV suo!lelnd~ls ~u!~OllO~ eq~ q~!~ 'SLUOOJpeq 'swooJpeq JoJ leAoJdde leUO!]!puoo 'peAoJddes!Q :la rlJ.'CN~DIS SHHa '9 'uo!3oedsu! s[q3 J~O e3ep eq3 uo loejJe u! suo!~eln6eJ pue 'seoueu!p~o 'sepoo e),e3S pue [ed!o!unlAl lie q~!~ @oUe!ldLuoo u! s! uJe),s,~s lesods!p ~e3e~e3se/~ ~o/pue ,~lddns ~e3ef~ e~!s-uo eq3 'uo!~oedsu! pue uo!~e6p, se^u! ,~LU LUO~J pue sel!J e6e~oqouv Jo/~!led!o!unVq eq3 u~o~ peu!e,',qo uo!~,euJ~oJu! eq~ uo peseq ~eq~,~J!Je^ ~eqMnj I 'uie~eq pe~eo!pu! e~n~on¢~s jo ed/~l pue SLUOO~p@q JO JequJnu eq~ Joj elenbepe pue leUO!),ounj 'ejes s! ~ue~sXs lesods!p ~e3e~e~se/~ ~o/pue ~lddns Je~e~ e3!s-uo eq~ 3~q3 st~oqs uo!~eo!ldde le^o~ddv ,~H~oqinv q~leeH s!q~ ~o uo!3eS!lse^u! /~Lu ~eql ,~jpe^ I '/~oleq u~oqs e~ep uoReP!le^ eq~ jo se pue o3e~eq pexljJe leas/~uJ ,~q pe!j!~Jeo sV t~=I~NIeN~I AB NOIJ.O=IdSNI -lO J.N=IIN~J.VJ.S (~ Municipality of Anchorage · Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-~,"~¢/D ~t~.--'~.- ~'~-~,~"'~[~'~'1 Parcel I.D. ENfAL SERV~vES DIVISION JUN - 4 1991 RECEIYLD A. WELL DATA Well type Log present (~N) Total depth Sanitary seal (~/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~C>- L~ -'~ ~" Driller ~ Cased to ~'C)~ Casing height Wires properly protected (~N) Date of test~ Static water level "¢*'?~ ~ ~ Well flow "~'~. ~;;~ Pump level t.) ¢-- FROM WELL LOG AT INSPECTION g.p.m. ~_~.,~ 4- g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main P,j,j~lic sewer se r vi;e line_ sJ'/Ar WATER SAMPLE RESULTS: Coliform (~ ~°~'~ / ~0o~. Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed fl-l..q-15' Cleanouts (~/~N ~ V High water alarm (Y~I.~ Date of pumping ~- I~ I ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria S & S ENGINEERING 170 .... ~ .................... - - Eagle River Alaska 9957? Tank size ~ oc~c~ Compartments Foundation cleanout.{~ /"J Depression Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ qO~ I To propertyline ~0~'~ Surface water/drainage 72-0~6 (Rev, 3/91) Front MOA 21 On adjacent lots Absorption field Foundation Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) ~:~i (wY~:)r alarm level "Pump on" level at __~ Meets MOA electrica~ S~NCE FROM LIFT S~ATION Tef¢on lot On adjacent Ic~; Surface water D, ABSORPTION FIELD DATA Soil rating t ~0'¢f~/¢'~--- Date installed Length '~'O ~ Width ~.~ Total absorption area Depression over field (Y~) Result~fail) Peroxide treatment (past 12 months) (Y~) Gravel thickness ,--~. ~.- ' Cleanouts present ~/N) Date of adequacy test for ~"~ ¢-¢¢,¢~ (~'~') t~,) I~ If yes, give date __ System type Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot itc> To building foundation On adjacent lots '~t, Surface water leo Curtain drain /'//~ On adjacent lots ~oc:~ ~4-- Property line To existing or abandoned system on lot Cutbank ~J/~' Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature '; ;~03 ~ !.~.¢~. !dy,,!' ! ,~,,,~ ......... m~:,,4 r,,_ ~04 . Ea~Ja [;ivar, Alaska 995YZ Engineer's Name %; Date of Payment Receipt Number 72 026 (Rev. 3/91) Sack MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALYSIS REPORT BY SA}(PLE £or WORKorder$ 34677 Date Report Printed: 5IAY 31 91 @ 16:19 FAX:(907)561-5301 Client Sample ID:L2 B2 STEWARD S/D PWSiD :UR Collected I,~¥ 29 91 @ 15:00 hrs. Received ~Y 30 91 ~ 14:46 h~. Preserved with :AS REQUIRED Chent Name :S & S ENGINEERING Client Acct :SNSENGP BPO $ PO 8 NODE RECEIVED Req ~ Ordered By :R. SIiAFER Analysis Completed :I,~tY 31 91 Send Reports to: Laboratory Supezviso~ ;STEPHEN C. EDE 1)$ & S ENGINEERING Chemhb gee ~: 912342 Lab Smpl ID: 9 Matrix: WATER Allowable Parameter Tested Result Units }~ethed Limits IIITRATE-N 1.1 mR/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLEC?ED BY: RAY 1 Tests Perioz~ed . See Special Instructions Above UA~UnaYailable ND~ None Detected "See Sample ge3~lazks Above l!l= lief Analyzed LT=Les~ Th~n, GT=Greate~ Than ' MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 050-472-62 HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 2, Block 2, Stewart #1 R1W,T14N, S15 Location (address or directions) 21134 Lowland Ave, Eagle River, AK 99577 (b) (c) (d) Property owner Sandra Cole Mailing Address C/O Realtor Telephone: (home) 694-420QBusiness Lending Institution Commonwealth Mortgage Telephone 278-5229 Mailing Address 3333 Denali, Anchorage, AK 99503 Real Estate Company and Agent Re/Max Eagle River, Ray Herberer Address 16600 Centerfield Dr. Suite 201 Eagle River, AK 99577 Telephone 694.4200 Mail the HAA to the following address: (or check here ~, if hold for pick up.) List contact person and day phone number below: Hold for P/U by Mark Pearson, Mountain Engineering, 696-1700 (e) TYPE OF RESIDENCE Single-Family [~ Number of bedrooms WATER SUPPLY Individual Well E~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site I~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev, 7/88) Page 1 of 2 ')po~ s,Jeeu!Bu9 IBUO!SSe~oJd @q~ u! suomm~o Jo sJoJJa Jo~ elq!suodsaJ ~ou s! eb~Joqouv jo ,~Hled!o!u nlAI eq.L 'penss! s! emo!Hpeo e eJojeq B~8p @Z,~l~Ue Jo suoi~osdsu! lonpuoo 1ou op SHHQ ~o see~old~3 's~ue~@J!nbaJ e~m,s pue leJ@peJ u!elJeO ,~s!~es o~ JgpJo u! 6u!puel J!eq~ pu~ se~oq Jo sJeseqo~nd ol ~se~Jnoo e se s!q~, seop SHHQ eql '~4Sel¥ ~o e~e~S eq~ u! p@Je~s!DeJ j@eul6u~ leUO!SSe~oJd luepuad@pu! u~ ~q a^oqe ~ qdeJ§e~ed u! ue^!b suo!le~uesaJdOJ eq) uodn ~lUO peseq le^OJ'dd¥ ~!Joq~n¥ q~leeH senss! (SHHQ) seo!^Jeg us~nH pue q~l~eH jo ~u@~lJedec] ebeJoqouv jo/[~!led[o!un~ eql J~AoJddv iE~UO)lJpuo0 j.O SLU.I~/ leUO!~.jpuo0 peAoJddes!a--~"-.,~--- p@AoJddv 9VAOt:iddV SHHa '9 lees 68/6/0I elea sseJppv 00LI-969 euoqdelel 5u~a~u~bu~ u!e~uno~ ~J~J°em~N pUB led!olunR lie ql!M eoue!ldmoo u! s! ~e%sXs lesods!p JeleMejS~M Jo/pue ~ ddns Je%BM B%.S-UO eH% 'uo!medsum pue uo3e8gsaAu! Xm moji pue sel!J e~eJoqouv 1o ~Hed!o!un~ eq~ moji peu!elqo uo!l~mJolu! eq~ uo peseq leqi ~.JeA Jeq~Jnj I 'umeJeq pe~eo!pu~ aJnlonJj~ ~o ed~l pue s~ooJpeq ~o Jeq~nu eql Jo; elenbepe puc leUO!lounj 'eles s! me,sAs lesods!p JeleMelSeM Jo/pu~ ~lddns Je~eM el!s-uo eql ~eql SMOqS I~AoJddv ~poqlnv qlleeH s.q1 jo UO3e~3SeAU! ~m i8ql ~JUeA 'MOleq UMOqS elep uojlep!l~A eqi ~o se pu~ o~eJeq pexijje leas Xm ~q PelJ!lJeo sV NOI~V~BO~NI QNV ~a 'HO~V3S ~llJ 'S~S9~ 'SNOI~OgdSNI 9NIOIAO~d ~BI~ 9NI~NION3 '~ A. WELL DATA Well Classification Well Log Present (Y/N) N Date Completed Total Depth 305' Cased to 305' MUNICIPALITY OF ANCHORAGE (MOA) HeeJ[th_Authority Approval (HAA) OCT 9 t,989 Legal Description: Got [C[.tVED Residential 10/6/75 Depth of Grouting -- 2, Block 2, Stewart #1 If A, B, C, D.E.C. Approved (Y/N) __ Yield 4.5 GPM Static Water Level 228 ' Casing Height Above Ground 26" Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: PumpSetAt 275 +/- Sanitary Seal on Casing (Y/N) ¥ Depression AroUnd Wellhead (Y/N) N To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line N/A To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments 90'(see waiver) 104' ToNearestPublicSewerCleanouUManhole N/A Mountain Engineering ;Date 10/1/89 Passed Coliform & Nitrate ; On Adjoining Lots > 130 ' ; On Adjoining Lots , >130' N/A B. SEPTIC/HOLDING TANK DATA Date Installed 9/24/75Size Standpipes (Y/N) ¥ Depression over Tank (Y/N) N Pumping/Maintenance Contact on File (Y/N) N Holding Tank High-Water Alarm (Y/N) NA SEPARATION DISTANCEs FROM SEPTIC/HOLDING TANK: 1,000 No. of Compartments Air-tight Caps (Y/N) ¥ Foundation Cleanout (Y/N) N Date Last Pumped 10/7/89 ToWater-SupplyWeil 90' (see waiver) To Property Line >10 ' To Water Main/Service Line N/A To Stream, Pond, Lake or Major Drainage Course Comments ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field 12 ' None 19' Waiver was approved 6/11/86 for 90' separation to well 72-025 (Rev. 7/88} Front Page :1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 9/24/75 Width of Field 2 ' Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test 145 sq ft;/BR Type of System Design Trench Length of Field 50 ' Depth of Field ? ' Gravel Bed Thickness 5.5 ' 440 sq ft Statndpipes Present (Y/N) ¥ N Date of Last Adequacy Test 9/31/89 Passed - 3 bedroom To Property Line >10' To Existing or Abandoned System on ; On Adjoining Lots >100 ' To Cutback (if present) None SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well 104 ' To Building Foundation 14 ' Lot None To Water Main/Service Line None To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area 80' Nolle Comments D. LIFT STATION Date Installed NONE Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Comments Signed Company Date MOA No. **Check Permitted Bedroom Rating AgainstHAA Request** Icertifythatlhavechecked, verified, orconformedtoalIMOAand HAAgL inspection, n~~ Mark Pearso Mountain Engineering 10/9/89 Receipt No. Date of Payment Amount: $ 72-028 (Rev 7/88) Back CE89-007 / o--7- F¢ Recei¢i~No. __ Waive¢"¢:e~: $ Date of Payment Page 2 of 2 in effect on the date of this Engineer's Seal CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 'j~,~ 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ~~.,~ FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SA~SLE ioz Work Order ~ 17189 Date ?,epo~t ?tinted: OCT 6 89 E 13:01 ?~3ID :UA Collected OC~ 2 89 ~ !5:00 Receive~ OCT 2 89 ~ 16:00 Chent Acct : ~RENGN P.O.9 NONE RECEIVED Req ~ Ordered By : Ana].yeis Completed ;OCT 4 89 Send Repo~ta to: Laboratory Supc~viso~:STEPHEN C. Special HOLD ~0R Ch~m].ab Ref $: 783~ Lab Dmpl ID: 1 Matrix: WATER A1].owablo Pazamete~ Tooted Result/U~ts Method Lll~its NITRATE-N 0.43 mE/1 EPA 353.2 10 Tests ?e~formed ~ 3oe Special Instruction~ Above ))one Detected *' See S~pl~ Re,turks Above Not Analyzed LT-Le~ Th~nl GT-~eate~ Than 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 264-4720 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions)~ ' (b) Applicant Name .~'x-~J~' ~r/~ Telephone:Home _~¢Z'..~/~.., Business Applicant Address ,,'¢~',~° /~/1" 77'-- ~' (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer.J~; Other [] (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family,S' Multi-Family [] Other WATER SUPPLY Well.~ Community [] Public [] Individual Note: If comm unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL onsiteJ~ Public[] Community[] Holding Tank [] ....... Note: if corn mun[ty weft system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11i84) Page 1 of 2 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, fu nctional and adequate for the number of bedrooms arid 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 ~'~ /'~/'~;~ Telephone Address F~:~ ,/~ ~"7/ ~/~'~/'~'/~ ~ DHEP APPROVAL Approved for '/4'~'"'~e~'?/oedrooms by "'~-"' '"~:~' '"~'~"'~ Date Approved ~ Disapproved Conditional Terms of Conditional Approval 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 coudesy to purchasers of hemes 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 cedificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 i~UNICIPALITY OF DEPT. OF HE~,..,{ & ENVIRONMENTAL PROTECT~NIclPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MAY 1 6 CHECKLIST- FEBRUARY 1~84 264-4720 RECEIVED Legal Description: ~ WELL DATA Well Classification ' 5'/,~/~Z--~-.~.. Well Log Present (Y/N) Y~ Date Completed Total Dept~ '~i"~ ! Cased to Static Water Level ~'~, Casing Height Above Ground Electrical Wiring in Conduit (Y/N) If A, B, C, D. EC. Approved (Y/N) /¢.//~//7.~ Yield Depth of Grouting ~ Pump Set At ,~--7~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: n L~o~t % To Septic/Hold!ng Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field o · ; On Adjoining Lots To Nearest Public Sewer Line ,'~/~',,"~' To Nearest Public Sewer Cleanout/Manhole /V'/~ To Nearest Sewer Service Line on Water Sample Collected by ,,7--'~--'I~,~'¢',~~¢~'/'~'~ ; Date Water Sample Test Results S E PTI C/I-~_L-~_ ..."~G,, TAN K DATA Date lnstalled ?/~--¢/7.',',',',',',',','~ Size /'~'~/ No. of Compartments ~/ '' StandPipes (Y/N) /~-'~ Air'tight Caps (Y/N) .'~_~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) ~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) /~//,,~t ; for Holding Tank High-Water Alarm (Y/N) ,/I//.,~ T~mporary Holding Tank Permit (Y/N) /fJ//¢ __ Separation Distances from Septic/~ d~in/~Tank: To Water-Supply Well ~ 7 ~ / To Building Foundation ! TO Property Line ¢~' ~,~"/ To Disposal Field To Water Main/Service Line /~"/¢'¢'- TO Stream, Pond, Lake, or Major Drainage Course JU//~' .~ . Page 1 of 2 72-026(11184) ABSORPTION FIELD DATA Soils Rating in Absorption Strata .,., ¢-- ./,~,,,~/,,,f/'Z..,/~,~,~ Type of System Design Date Installed Width of Field ¢.,~¢2./,~.~..,~,~ Square Feet of Absorption Are~¢' Depression over .Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ,4/'/'~¢-. TO Water Main/Service Line Length of Field ,.~"O Depth of Field ~ i Gravel Bed Thickness ~ ~ Standpipes Present (Y/N) Date of Last Adequacy Test /,/~ / To Properly Line · ~'~ ! To Existing or Abandoned System on ; On Adjoining Lots /V/'/¢ TO Cutbank (if present) '"'~'//.-'"¢ To Stream/Pond/Lake/or Major Drainage Course /f~.//,~ To Driveway, Parking Area, or Vehicle Storage Area ~'O ! Comments ~"/~-¢~¢~¢~' ~ ~ ,~;~,~¢~'~'¢'~--~',,~ .'?"//'~/~"~' D. LIFT STATION Date Installed S!ze 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~~~ve~r~f~o~r conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signe~,~'¢'''~~ Date Cor~¢/~'~ ,~~¢~7g~:~ MOA No. Receipt No..~ Date of Payment ~ ~/~--~ Amount: $ ~¢ ~ r Engineer's Seal Page 2 of 2 72-026 (11/84) nchor e P.O. E ; 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 70NY KNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES June 11, 1986 John R. Chambers, P.E. P.O. Box 671 Chugiak, Alaska 99567 Subject: Lot 2 Block 2 Stewart Subdivision Waiver Request - WR86-062 Dear Mr. Chambers: Your request for a waiver of the minimum separation distance required between a well and septic tank has been approved for the subject lot. This distance has been waived to 90 feet° This waiver is valid for the existi~g three bedroom single family dwelling only. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/ljw CTS ASSOCIATES P.O. Box 671473 Chugia~, Alaska 99567 Phone 688-4442 May 28, 1986 Department of Environmental Health Municipality of Anchorage Anchorage, Alaska 99501 ATTN: Mr. Steve Morris SUBJECT: Separation Waiver Request Lot 2, Block 2, Stewart Subd. Eagle River, Alaska MUNIC PALI1Y OF ANCHO/~(~I~ DEPT. OF HEALTH & r:NVIRONMENTAL PROTECTION RECEIVED Gentlemen: This letter is a followup to my phone conversation with Mr. Steve Morris regarding the subject property. The system has been in existence since 1975 with no apparent malfunctioning or contamination. The most recent water quality test (bt) was satisfactory. The well is located approximately 90 to 95 feet from the septic tank. This is very close to the required separation of 100 feet. The topography is favorable for a waiver, that is the well is lo- cated approximately ten (10) feet vertically above the septic ~ank and leach field. A copy of the "as-built" is in the MOA file. On behalf of the present owner, Sandra Cole, granted for the separation distance between well. Thank you for your consideration. I request the septic a waiver be tank and the Ifryou~'~"questi°nsr : please call. Since~',e !y, __MUNICIPALITY OF ANCHORA~¥ DEPARI'M~d ~OF HEALTH AND ENVIRONMEN~r ? PROTECTION 825' L Street,~ Anchorage, Alas~ 9950]. 279-2511, ext. 224 or 225 Time ~~I .... 92: Time #3: Time Date Date Insp Insp REQUEST FOR APPROVAL OF 2o Lending Institution Request: Mailing Address: 4797 Business Park Boulevard Property Owner: William Rust Mailing Address: 3. Legal Description: 4: Single Family Residence: (x) Multiple F~ily Residence: ( ) 5. Well System: Individual well INDIVIDUAL SEW~,R AND WATER FACILITIES Coast Mortgage % Cathy Phone: 279-0665 Phone: 694-9242 0 Lot 2 Block 2 Stewart Subdivision Number of Bedrooms: Three Number of Bedrooms: (x) Conm~unity/Public Sys~.em ( ) Permit 9 Depth of Well 265' Well Log on File ( ) Construction Bacterial Analysis Sewage Disposal System: On-site Syntax) Public Utility Permit # Installed 1975 Installer Septic Tank Size J~ Manufacturer Absorption Area ~/~ Soils Rate l~- .... Material ( ) Distances: Well Lo Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF IN DIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FHA CONV 2. Property Owner: (J~ I LLI ~ ~ t~ tJ Mailing Address:_~'/7~L ~-- ~Oid~-/p,,, ~ ~, ffYs'7~ay Phone: 3. Name of Buyer: -~~ ~' ~ ~ ~ Mailing Address:-~o ~ zdc~ ~c/~' Day Phone: ~ ¢ ~/~ / 4. Name of Lending Institution: ~ ~ 5"~ ~ ~ ~ Mailing Address: ~~. ~ Phone: 5. Name of Realtor or Agent: ~/~ ~-~ /~/~' Mailing Address: ~&c~ ~/~ ~q~ Phone: ~-~//~ Legal Description: Z¢~ ~/,~ ~ ~~ Location: ~//~ ~ ~ ~ ~/~ ~ 7. Type of Facility to be Inspected: Co/~ ~ No, Bdrms, Water Supply Type of Supply: Public utility. If Individual, number of dwellings presently served If Individual, depth of well Individual Sewage Disposal System Type of System: Public Utility If Individual, date of installation /Y/~ Individual (on-site), NOTE: 72-003(3/76) The fee schedule has gone into effect as of'May 27, 1977' all requests must have a $25.00 fee attached with request form before we can set up the inspections. Thank you. Any questions, call me at 279-2511, extension 224 or 224. Laura Pag'e ~ Two Request Department of Health and Environmental Protection for Approval of Individual Sewer and Water Facilities Legal Description: Lot 2 Block 2 Stewart Subdivision Co~nents: Affadavit Attached Approved: Disapproved: Letter Attached: ( ) Date: Department Worksheet