HomeMy WebLinkAboutSUNSET HILLS WEST BLK 4 LT 9
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SFRVICES
I=nvlronmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
~r~ss TANK FIELD WELL
township, Range, Section
~S-BUILT DIAGRAM (Show location ol well. septic system, property lin~ ~'"'foundatlon,
TANKS" N
TYPE OF SYSTEM
RENCH ~ BED ~ W. DRAIN ~ OTHER
Number of lines Joil rating Pipe material
WELLS
~RIVATE ~ OTHER (Identify)
REMARKS:
~5 ~ ~l~O~ ~~ Inspections Pedormed by: ~'~
I ~ S & S ENGINEERING ;edlly that this Irlspe~lon was pedormed according to~
72-013 (3/85}
[) ~:':Uk (:, ]i !iii!iiH .!i:!C! Ir ' .'.2) / 12." .'.)/' ':~ '
}:;'I:: V :1: Al .17 Obi I::: R(:))"l I}:I',tG 1: hli::l::i:,: ' S DIE:!3 :[ {'.',1',t F,:EQI,J :t: RES Dill' 1S AI':'PFtOVf::&. PR ]: (]1:~ I 0
{:OIxI~::~'I'RUC, J:I:ON,, NOI:I!:::Y DIIJIS PR:I:OI:~ 'JO AI.,L 3NSPIG(:;'I'[f.)hIS,, I:::XCAVAJ':I:ONS
F? I RI:::S :1 .:'/3 :L/90, A I,. 1:i:::' f :'::'1 A t ]: COq RI::I:~tJ:~: I::",::R~ ,'::~',J AF:'PI:,'.OF'I:~:I:(:'I I:: E:L I::C
:(::){-'L!] 1::)': I'.11(:~ ["il..trl :ic :ip,.'2 I i'L:/ c:){ Arichor',:::,.g~-.:, (MOO)
//
: .' Municipalityof Anchorage
DEPARTMENT OF HEALTH & 14UMAN SERV{
825 "L" St,~eet, Anchorage, Al~tska
SOILS LOG -- PERCOLATION 'rES
7
8
· 9
10
11
12
,13 -
14
16-
17-
18-
19-
20-
Township, Range, Secdon:
PERCOLATION RATE _ (mln~c~'i~h! pERC HOLE DIAMETER
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AN[i/OR WELL INSPECTION REPORT
NAME
MAILING ADDRESS ,
LOCATION
Well Absorption are Dwelling
DISTANCE TO'. ~,~
Liq. capacity in gallons IF HOMEMADE: Inside leng~th
Well Dwelling
DISTANCE TO:
PHONE
/
DISTANCE TO: [Well/~.~
Length of ea h mine
Top of tile to finish grade ~ ·
Widtb
Foundation
Total len~l/ines
Material be~n~ath tile
Length
Width Liquid depth
Material
Nearest lot lin~/~
Trench width
~ {ge) "~' inches
PERMIT NO.
Liquid capacity in gallons
Distance between lines
Total effective absor
PERMIT NO.
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
Driller
DISTANCE TO:
Depth
Distance to lot line PERMIT
DISTANCE TO: Building foundation Sewer line Septic tank
OTHER
PIPE MATERIALS
SOIL TEST RATING
NSTALLER
REMARKS /
~.~ ~ CE-1516
860 West Benson Blvd., q¢207
Anchorage, AK 99503
'=~PPROVED DATE LEGAL
/
72-013 (Rev. 3/78)
PO, ,:~OX 6650
A~',ICHORAGE, ALASKA 99502-0650'
(907) 264.-4111
DEPARTMENT OF HEALTH & HUMAN SER¥1CE$
January 10, 1986
TO: Permit Applicant
Subject: Permit # 850614
Lot 9 Block 4 Sunset Bills West Subdivision
A permit issued by this Department for an individual well and/or on-site
sewer system has expired as of December 31, 1985.
Permits are issued on a calendar year basis by authority of Municipal
Ordinance. A new permit must be obtained from this Department for any
well and/or on-sits sewer system not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to this
Department for documentation of the installation and t:o close the permit.
If a private engineer inspected the installation of the on-site sewer system
the original as-built inspection report(three part form) must be sent to
this office for review and approval,and for documentation.
If there are any further questions, please call this office at 264-4720.
Sincerely,
Susan. E. Oswalt
Program Manager
On-site Services
SEO/ljw
enc: Copy of Permit
F't~:F;:I*I :( T
D~'I'E ]:!3SUIED:I
LIlT :: ~ E,I,,..LH..,I ..... .,':1.
R¢~N[~E: 7.:';N
:1.., :[ ','!xm f~mll:L,'~xr' ~q:i.*Lla
]:F J.~ I...]:F:'T ,r3TI-YI'ION ]:S :I:Iq~YT'/.~L.I..EI:) ]:lq AN [~RIEA &I]VF-'I'E.D BY I~1(3~ ELJ[I,D]IqB [.,ODI::,,~
'l"ldEl~l (1) ~N EI...IECTI:~]:C~/I.. I:::'EITVI]:T ~lklD 'fhI~3F:'IZC'T'~[]N flUS-I' EdE
tg]:L.I.. NEFF EdZ AF'F'ROVED bJ]:TH[]LI'f' ¢~lqEd...E.(,' ...... f~l U-/I.. :[N~I:::'E:f;',TZI3N. REFE)I I,"" "' ;"~"" ~l~ll:) C:S) THE;
I~H_.IEE;TIR]:C¢.~L.. ~(:)~:~t::{ I'IUST' EriE; [>E)I~IE I'3Y~ I_.]:CEIqS[E[)
' .~ll. ' SOILS LOG
MUNICIPALITY OF ANCHORAGE "
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION F1 PERCOLATION
TEST
PERFORMED FOR:
LE A,. DESCR,PT ON:__.h"I
4
:'
12
13
14-
15-
16-
17-
18-
WAS GROUND WATER ~
ENCOUNTERED? ...~0 pO
IF YEE, AT WHAT
DEPTH?
Gross Net I DePth tO Net
Date
Time Time Wa~er DroD
,.., ~', ,.~., ,,,
GRE'?ER ANCHORAGE AREA BOr' ;UGH
Q Department of Environmental Quality
3330 C Street
/~C9,~,/4//~/¥ }~?(:)/-3, Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~' "7~:'~'~>C) ~ PHONE
[~ - , -- MA~L~N~ ADDeeSS~r~~ *~ .~ ~
SEPTIC TANK:
DISTANCE
FROM WELL
· _ MANUFACTURER
NUMBER OF
COMPARTMENTS~/
INSIDE LENGTH ~ __ INSIDE WIDYH --- LIQUID DEPTH '~ .LIQUID CAPACITY /¢~,~.'~") GALLOI~S.
SEEPAGE PIT:
NUMBER OF PITS~/ , DIAMETER --- OR WIDTHcz~,4~', LENGTH/~,~f DEPTH ~_
LINING MATERIAL ~/~'~f?-.~. _ CRIB SIZE: DIAMETER ;/~'~ DEPTH~ DISTANCE FROM:
~ ~ TOTAL. EFFECTIVE
BUILDING FOUNDATION/~(2
ADDITIONAL ABSORPTION
WELL/O2
NEAREST LOT LINE ,,,~/~'¢". ABSORPTION AREA (WALL AREA)
.SQ, FT.
WELL:
TYPE .~////~/.) ___ CONSTRUCTION__~)' /~', DEPTH
BUILDING ~ NEAREST I NEAREST ] SEPTIC
FOUNDATION ---.'~" _, LOT LINE "-~' ., SEWER LINE /'¢9 "/~ TANK
CESSPOOL.
APPROVED
OTHER SOURCES ....
DISTANCE FROM:
SEEPAGE ,
SYSTEM
_ DISAPPROVED
REMARKS
DISTANCES:
INSTALLED BY: 7~/~/~¢'-~
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No, EQ-031
GREATER ANCHORAGE AREA BOROUGH
S£WAGE DISPOSAL SYST£M -- ,APPLICATION AND P~,RMFr
PHONE
FINANCED TrHRougFI TO Bm INSTALLED BY
CON1pLETiON DATE ANTiCiPATEi) __- /~'~' /~ _~
Well TO SEPTIC 'rANK
WA'ret MAIN TO SEPTIC TANK
DRAIN FIELD
Municipah[Yoi
Anchorage
P.O. B~.., 196650
ANCHORAGF, ALASKA 99519-6650
(907) 264-411 '1
TONY KNOWLES,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
March 19, 1986
Wayne Henderson, P.E.
Peninsula Engineering
440 West Benson Boulevard, Suite 206
Anchorage, Alaska 99503
Subject: Lot 9 BLock 4 Sunset lltlls West Subdivision
Waiver Request, WR86-037
Dear Mr. Henderson:
Your request for a waiver of 100 foot separation distance required between
the well and septic tank on the subject lot has been'granted. This distance
has been waived to 93 feet.
This waiver is valid for a four bedroom single family dwelling only.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
SSM/lJw
~I-W DRILLING, Inc.
P.O. Box 10-378 · 10300 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
86-122
DRILLING LOG
Well Ow:er Great Lakes Construction Use of Well Domestic
Location (address of: Township, Range, Section, if lmown; or distance main road Lot 9 Block 4 Sunset Hills West
Size of casing 6"
Static water level 87
Screen ( );
Describe screen or perforation
Well pnmping test at 50 gallons per 0it~lrr~
of drawdown from static level,
Date of completion December 11~ 1985 .
Depth of Hole__16l feet Cased to 161 feet
ft. (~B~-~X) (below) land surface. Finish of well (check one)
Perforated ( ),
(minute) for ]
open end ( X );
hours with 1 Off%
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, eolor and hardness
ft.
0
2
18
46
95
124
151
.TO
TO
TO
__TO_
TO
TO
TO.
.... TO
__ _TO 2 C,a~in[~ ~tlc~.p
___TO 18 Silty sand & gravel
__.TO 46 _ Silty sand
_TO 95 Gravelly hardpan
__ .TO 124 Silty gravel
.TO 151 Silty sand
_TO 161 Water bearing grave].
q
iqWW.t,,~er t!fl~,~t C%ntrmetor
Cerit£teate No's, 814 & 973
1 -- CUSTOMER
INVOICE N° ', 3 1 5 1
IVI-W DRII_LING IN(,'. DATE
k'.u, DUA IIU.1/O UNIT
ANCHORAGE. ALASKA 99511 QTY. MATERIALS PRICE AMOUNT
PHONE 349'8535
DESCRIPTION OF WORK
All charges shall be paid in full within ten
days unless other arrange,ments are made
prior to drilling. The customer shall pay in-
terest at the rate of 1 ~ % per month on any
amount not paid within ten days, Failure to
pay tnay result in a lien agafiTst the property.
CUSTOMER SIGNATURE
OUT
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St,
P,O, Box 196650 Anchorage, AK 99519-6650
www,ci.anchorage.ak,us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 018-203-26
1. GENERAL INFORMATION
Expiration Date: I _ O
Complete legal description
Location (site address or directions)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
14220
MIKE KELLY
14220 HANCOCK
SUNSET HILLS WEST SUBDIVISION; LOT 9~ BLOCK 4
HANCOCK DRIVE * ANCHORAGE~ AK * 99515
Day phone 345-0596
DRIVE * ANCHORAGE, AK * 99515
Day phone
WENDY THOMAS W/ REMAX PROPERTIES Day phone
2600 CORDOVA * ANCHORAGE, AK * 99503
222-8800
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well ·
IndiVidual Water Storage r-]
Community C!ass Well D
Public Water. System r-]
TYPE OF WASTEWATER DISPOSAL:
Individual On-site . I
Individual Holding tank I-'l
Community On-site D
Public Sewer D
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 ah 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 propedies 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 propedies served by a priva~te or Class C well and may
be reissued with new water samples. (Cedificates may be reissued for a period of up to one year with valid
water samples.) Cedificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
4. :STATEMENT OF INSPECTION BY 'ENGINEER
Se
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
'information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments: .'
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance With ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate durfng the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee futura performance of the system, horde they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or futura estimate of how long the system will continue to meet the
· operational requirements of the ADEC orMOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by a~y
other percon or party is not authorized, nor will it confer any legal right whatsoever.
Phone 337-6179
Date
...... ....
DSD SIGNATURE
~ Approved for ~ bedrooms.
Disapproved.
bedrooms, with the fllowing stipulations:
·
' '.
. ,,~ ee ~. -~_ ~-
;.WASTEWATER:
.
~.~ .. .. ~-,
:,'.,/"' '<Om..; . -
Conditional approval for
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
(Rev. 1~11
Original Certificate Date:
Mun cmpality of nchor age
Deve!opment Services Depa me
':' , Building Safety Division
On-Site water & WaSteWater Program
Ii ;~.. .' ~., '.. 'P.O. Box.196650Anchorage, AK99519- 650 , , :
'~ ~ ~, .w~vw.ci.anchorage.ak.us
HEALTH, UTH Rim : APPROVAL CHEC,,fflST
Legal Description: SUNS~ HIL~ ,WE~ ~SUBD~ISION; LOT9~ BLOCK 4 :',P~rcel ID: 018-203-26
~ [ ....
Well" ::'type' '~=; r :PRNA~[ ' ' "If ~ B,';o~ C r0vide PWSID~ '" :Well Log (WN) YES
Date completed 12/1 i/1985 :Sanita~ s~ai (Y/N) YES . Wires prope~l~ ~rotected (Y/N) , YES
' "' ~ ']~ ~:' ' ;.161 ff. Casing heig~t (above ground) 12+" in.
Total~ePth 161 ~ ff. ~;Cased
' ~'[ [ [;: ' , FROM WELL LOG ,. ,AT INSPECTION
. , ' ' 5/5/200
S i W~ter level' :~187 : ~72 ~: .ff.
Well;PfOdu~ion , :i50 : ~ ~g.p.m. ,, L .,3.8~ ~ g.p.m.
Arsenic:: ~N/A mg./L. : ~,~ :~ :- Date,of sample: 5/5/2004: CollectedbY:.~. .GEG, Ltd. __
TankType/Matenal ~EP~IC ~E~ ' ' . Date installed : 12/17/1985
Tank ~i~e~ 1250 gal. - Number of Compa~ments, 2 [- Cleanouts (YIN) :- · YES
Foud~a~io'h cleahout (YIN) YES '..~ Depres'~io'~ over tank (Y/N)' NO ~ High ~at~r~alarm (YIN) ' N/A
Date of pumping 5/4/2004, . . Pumper. · ROTO -~ROOTER
ABSORPTION FIELD DATA ' :~' ' : ~ :~BELOW EXI~ING G~E ~ ,~.: I ~ ', ' ,
Date'ih{talled' 3/20/1990 Soil rating (~.p'.d./ff~or~*~O ~ .. SySt~type_' DEEP TREECH _
Total depth *8,0 ~, Eff.'abs'orption area**486 ~ Monitoring tube YES ,,, ~ Depression over field NO
Date of adequacy test ' 5/5/2004 . .,~ j JResults (Pass/Frei) PASS , :;', · ,For 4 bedrooms
Fluid depth In absorption field before test J15 ~n. ' Water,added,736 gal.': New depth , ~n.
ElapSed Time: 647 mtn. ' ~: Final fluid dePth 15 In.' .' ,'; AbsorPtiOn'rate >= 600+ . g.p.d.
Any rejuvenation treatment (pastil2 mo.)'(WN & type) NONE KNOWN :;:: ~ :~, if yes, give date -
D. LIFT STATION
Date installed
"Pump on" level at in.
E. SEPARATION DISTANCES.
·; Size' in gallons. " Manh~
"P~ .... High water alarm level at
,Cycles tested. ' · Meets alarm & circuit requirements?.
SEPARATION DISTANCES FROM WELL ON LOT.TO:
Septic tank/lift station on lot '95'+ '
'Absorption 'rfield on lot /- -'100'+'
Public sewer main N/A
On adjacent lots 100'+
°n~adjacent lots" .'- *'98'+
Public sewer manhole/cleanout . :N/A'
sewer/septic service lin~ 25'+ ... Holding tanl:( "
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:"
Building foundation ! 5'+ ~ "Property line
Water main N/A .Water service line 10'+
Wells on adjacent lots 100'+ .
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT-TO:"
Property line 10'+' . .... Building foundation "10'+
Water service line 10'+ Surface water 100'+
Absorption field
Surface water
100'+
Watermain N/A.~ - '
Driveway, parking/vehicle storage 10%t-
cudain drain .NONE KNOWN. Wells on adjacent lots[ 100'+
F. COMMENTS
*WR86-057 **WR000071
G. 'ENGINEER'S CERTIFICATION
I. certify that I have. determined through field inspections and
-- review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name JEFFREY A. GARNESS
Date:
HA,& Fee $
Date of Payment
Receipt iNumber
(Rev. 12/01)
Waiver Fee $
"Dale of Payment
R'eceipt' Uumbei-
in.
r BY:PACIFIC NW TITLE-AK
'~uL-,~I-UU l'{UN LFE:I ( Fi'{
; 7-81-0 ; 4:02PM ; P,Xq' ALASKA-TITle
F~ NO,
.~,,
iAl~J{kf{ O~ IICOID, OT~II
lkOSE Id~ ON
PLAT, A~E NOT
BO7 888 8246;# 2/ 2
P. 02
./
1# · 20'
~t 9, IL~ 44 ~JET kILLS
tr~lell~ &l~l, or other Vflibll
~y~
05-11-04 11:50AM FROM-CT&E ESI, SGS ENV SERVICES 90?5615901 T-275 P.02/03 F-881
SGS Ret#
Client Name
Project Name/#
Client Sample ID
Matrix
104227500 l
Gamess Engineering Group, Ltd.
Sunset Hills West Lot 9. B4
Sunset Hills West Lot 9, B4
Drinking Water
Sample Remarks:
All Dates/Times are Alaska Standard Time
Printed Date/Time 05/10/2004 15:07
Collected Date/Time 05/05/2004 12:40
Received Date/Time 05/05/2004 14:40
Allowable Prep Analysis
Parameter Results PQL Units Method Container ID Limits Date Date Init
Waters Dspartment
Nitmle-N
0.416 0.100 mg/L EPA 300.0 B (<=10) 05/06/04 JMP
Microbiology Laboratory
Total Coliform
0 coV100mL SMISP222B A (<=1') 05/05/04 DKC
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF'INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. #
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t,'block, subdivision, section, township, range)
Lot .~ Block 4~ Sunset Hills West
Location (address or directions)
14220 Hancock
(b) Property owner ~6~dy~4c. eft 29- 606146- 8C Telephone: (home)
Mailing Address
Business
(c) Lending institution
Mailing Address
Telephone
(d) Real Estate Company and Agent JACK WHITE COMPANY ATTN: KJ~S Kurtz
Address ___~0J~~~~~a~&~ 99503
Telephone __Z~_-~
(e) Mail the HAA to the following address: (or check hereE~ if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING
17034 Eagle Ri,vet Loop~o.
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single-Family Ek Number of bedrooms
3. WATER SUPPLY
Individual Well ~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to tE I~gality and status.
4. SEWAGE DISPOSAL
On-site ~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ~'
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigatic~n of th i~"
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Fir & a., .............
17034 Eagle Ri'~er Loop I~oad No. 204
Address ...... . .~taska 9~577
Telephone
Date
Approved for ~/~ bedroomsb~~/~
Approved_ /V',~ Disapproved Conditional
/
Terms of Conditional Approval.
The Municipality of Anchorage Department of Health and Human Services (DHHS), issues Health Authority Approval
cerificated based only upon the representations given in paragraph 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 o25 IR,,,. ?/e~) e~c~ Page 2 of 2
~. ~.~^UI¥1~N,f~J~[/~F¢ OF ANCHORAGE (MOA) ~
ENTAL SF.~,~II~P~[~ity Approval (HAA)
CHECKI..IST - FEBRUARY 1984
MAR 2 ? 1990 343-4744
Legal Description: %~' ~:~
RECEIVED
A. WELL DATA
Well Classification
Well Log Present (~)N) __',,~
Total Depth_/(-~t ~ F Case~to
Static Water Level
Casing Height Above Ground /'~'l~r'--
Electrical Wiring in Conduit ~N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Fiel.dto~.Lot
To Nearest Public Sewer Line
Date C..o m pleted
~t~. Depth of Grouting
'~¢-~ Pump Set At __
If A, B, C, D.E.C. Approved (Y/N)
Yield _
Sanitary Seal on Casing (¢~/N)
Depression Around Wellhead (Y/_J~
To Nearest Public Sewer Cleanout/Manhole
; On Adjoining Lots ~, ~
; On Adjoining Lots
To Nearest Sewer Service Line on Lot
Water Sample Collected by ~--~; ¢¢r¢-~ ~..~ I~l~ ;Date
Water Sample Test Results ~/~~~_
Comments ~ ¢~'~ ¢(~
B. SI"PTIC/HOLDING TANK DATA
Date Installed ~ /L~' Size [¢,~'~"-'~ No. of Compartments
Standpipes/C~/N) ',¢ _Air-tight Caps fC~'N)
Depression over Tank (Y~f;) ¢"~
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water A arm (Y/N) r-t//~.
SEPARATION DISTANCES FROM SE,P.T)AC/~OLDING
To Water-Supply Well '¢~"~" ~ To Building Foundation
To Property Line \ ~::'tJr To Disposal Field
To Water Main/Service Line ~ o I~
To Stream, Pond, Lake or Major Drainage Course \
Comments ~ ~:2!-''''-)c¢ -~--~"'"~--' d~-~r'~'~,/~d-~'~ ~'"
Foundation Cleanout ¢~N) "-/
E}ate Last Pumped
Temporary Holding Tank Permit (Y/N)
TANK:
72-026 [Rev. 7/88) Front Page 1 of 2
C, ABSORPTION FIELD DATA
Type of System Design~"'~
Soils Rating in Absorpti~on Strata \ ¢~6;~"¢¢/¢¢/f~''
Datelnstalled '~'~ ~' /~. _~
Length of Field
Width of Field .~ {.-~r, Depth of Field '¢~ X'~
Gravel Bed Thickness
Square Feet of Absortion Area t~,';:2~'cr' '"~ Statndpipes Present ~.~¢~'N)
Depression bver Field (Y/.~ f4 ~ Date of Last Adequacy Test
Results of Last Adequacy Test ~
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well \ c;~ ~-" ~
To Building Foundation ~ I
Lot "¢~¢;' ~ ~¢'
TO Property Line
To Water Main/Service Line
To Existing or Abandoned System on
; On Adjoining Lots
h
To Cutback (if present) I~/'~
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments '~ O ~2~ ¢'/>¢//=--~ ¢¢¢-~"~or~-%,
D. LIFT STATION /X~ /~r
Date Installed
Size in G~
"Pump On" Level at ~
High Water Alarm ~
Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
~ ~s during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
inspection.
S & S ENGINEERING
Signed ..................
Company Eagle RJver~ Alaska
date ~Si;'tbis
~eal
Receipt No,
Date of Payment
Amount: $
72 026 (Rev. 7/88) Back
Receipt No
Waiver Fee: $
Date of Payment
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
FEDE'RAL TAX ID # 92-0040440
ANALYSIS REPORT BY SA[,IPLE for t'lo~k Order ~ 20445 Date Repo~t Printed: ~AR 20 90 @ ID:09
CLxent Sample ID:SUNSET HILLS
P¥1$ID :UA
Collected MAR 16 90 6 i5:45
Received MAR 16 90 @ 16:15
PresezYed with :AS REQUIRED
Client llane : S & g ENGR
Client Acct: SNSENGP
P.O.~ NONE RECEIVED
Roq ~
O~detod By : ROBERT SHAEER
Analysis Completed :MAR 19 90 Send geport8 to:
Labczatozy Supezwxs~r,:STgPNgN C. EDE L)S R S ENGR
Special
Chemlab ge[ ~: 900501 Lab Smpl ID: 1 ~atrix: WATER
Allowable
NITRATE-N 0.57 lng/1 EPA 353.2 I0
Sample ROUTINE SAMPLE
Remarks: SA14PLE COLLECTED BI R.P.
I Tests Perfo~ned See Special Instructions Above UA=UnaYai].abla
ND= None Detected "See Sample Remarks Al)owe
NA= Not Analyzed LT-Less Than, G'f=Groater Than
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTFCTION
DIVISION OF ENVlRONMFNTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date_ "~J*~/~=~:~
GENERAL INFORMATION
(a)
(b)
(c)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions) ..
Applicant Name .~~~ Telephone: Home
Applicant Address
Applicant is (check one): Lending Institution
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f)
Mail the HAA to the following address: . ~ . ~
-
TYPE OF RESIDENCE
Single-Family,~ Multi-Family []
Number of Bedrooms ~
Other
WATER SUPPLY
Individual Well(~" Community [] Public FI
Note: If community well system, must have written confirmation from the State Department of Environ mental 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 ol Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025(11/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ,,. ' t .!
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health ""
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Date ~
Engineer's Seal
DliEP APPROVAL
Approved for '~'"
Approved
bedrooms by ~ ~:~'
Disapproved Conditional
Date .5 --~ ? -- ~'~,
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certific, ates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHf:P 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. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
WELL DATA
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE (MO~, DEPT. OF HEALTh &
ENVIRONtvENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (tIAA)
CHECKUST-
264-4720
Legal Description:
Well Log Present (Y/N) _~ $ Date Completed __ / ~//'¢'/~¢"'.-~'"' Yield
/
Total Depth L~ / Cased to / ~/ ~
Static Water Level ~ 7 /
Casing Height Above Ground .~r?~ ¢ ~
Electrical Wiring in Conduit (Y/N) ~---¢
Separation Distances from Well:
To Septic/Holding Tank on Lot '¢~ /'
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer t_ine _ /*~2~,¢..¢~.,
Cleanout/Manhole
Depth of G routing ,~'*~' ~ ~
Pump Set At /"~"~
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N) _
· r On Adjoining LOtS
To Nearest Public Sewer
~ ~O/-~.. On Adjoining Lots
Water Sample Collected by
Water Sample Test Results
Comments
¢~'/~,¢~' ~---.. Tc Nearest Sewer Service Line on Lot ~ ~
~'/.-~¢/~,.'~'~ t~ ~'~ Date "',¢~-~/,'//~'"~ ~
B. SEPTIC/HOLDING 'rANK DATA
~ ~'~/~'~ Size /~-,~"~ ~ No. ol Compartments -~"-
Date
Installed
Standpipes (Y/N) _ Air-tight Caps fY/N) ¥'~-'~ Foundation Cleanoul (Y/N)
Depression over Tank (Y/N) ~'~ Date Last Pumpea . ~'/~
Pumping/Maintenance Contract on File (Y/N) /f'/'/~ : for ~
Holding Tank High-Water Alarm (Y/N) /"¢'/,~ Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course /C:, ~
To Building Foundation '.,~'~' /
To Disoosal Field _ ~ /
To Stream Pond. Lake. or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata /'~'~ Type of System Design
Width of Field
Depth of Field
Gravel Bed Thickness
~'O~ Standpipes Present (Y/N)
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Date of Last Adequacy Test
To Property Line
Separation Distance from Absorption Field:
To Water-Supply Well / ~ O f
To Building Foundation ~:~ ·
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Existing or Abandoned System on
; On Adjoining Lots -,~ ~ ~""~"
To Cutbank (if present)
Comments
Dimensions
~ize in Gal, l, ons ~'~'~'~_ Manhole/Access(Y/N)
Pump On Level at ~"'"'"~-~ "Pump Off" Level at
High Water Alarm Level at ~ Vent (Y/N)
Tested for __ __ ~ng Adequacy Test. Meets MOA
~1; Cmt rmi Ceal t~ od es (Y/N, ~ ~.~_
** Check Permitted Bedroom Rating Against HAA Request **
I certify theft I b/~ve c,~,~ed/yv~ied, or conformed to all MO~_~n~AA guidelines in effect on the date of this inspection.
Signe~ Date ~/~///~::~'~'
Company ~
Receipt No. ,:~,-7 ~p~ .~, ~
Date of Payment
Amount: $ ~ (r~°,~ Engineer's Seal
Page 2 of 2
72-026 (11/84}