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Home My WebLink AboutT15N R1W SEC 9 LT 62 SE PTN ~'I~ MUNICIPALITY OF ANCHORAGE !'~I~ ,~ DEPARTMENT OF HEALTH & ENVIRONIVIENTAL PROTECTION ENVIRONIVIEN'rAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT :EG~L DESCRIPTION -- 0/ . ~CATIO~ - NO. OF BEDRO~S ~ ~ Manufa~~rer I Liq. capacity [nflallons Inside length Width ' Liquid dep~ /~ ~ IF HOMEMADE: [ DISTANCE TO: Well Dwel[in PERMIT NO. ~--~OZ~ : Manufacturer -- / Material Liquid capacityin gallons ~'~ ~ No. of lines/ Lengtl,?~h ~ne Total le~o, I~es Trench3~ ', Distance bet~,7,~~ ~ Top of tile to finish grade / Material beneath the ~ Well Cu~ding/ou~tion Nearest lot line PIPE MATERIALS OTHER SOILTESTRATyG ~¢-- ~ REMARKS ' l~7-E APPROVED , ~ 8RB 1gSa' DATE LEGAL 72-013 (Rev. 3/78) ..:l L..I.(.,~.~1 I1 , A D )]) R E S S :: CONTACT I II(.)NI ..... SOLI'T'H I::'[)RK CONS'I". % S/S EI'~I(?~INIEI!![RING EAGI,,..E RI]VIER, AK 99577 694'"'-2979 I...I:::.(::~P~I..,, D,.,..,.. (,.,I .I. I , " ',' "~' ' '," NA LOT: IZ:'AI::UI'' 62 SE.]'T'I ] "~ 9 'TOWNSHIP: ,,. IJ,l"l..~l ..... I~.1. I/,~ I....OT I::,. "1 '~'~. I:::' ...... ,, '!. ...... ...,~ .I .... ~ ('SO ,i F"I" ~ OR ACRI!!!]'.: MAX BIEDROOMS: '.]; -. ]...ist(~d I::)e].c)v~ ape 'Ll"le (:]p'L:J, cH"I~B ava:i, lable to system,, Cl"lcio~;,'~e 'Ll']e (:)p'L:i.(::~r'i t. ha'L best fits .... It'"' II'::si','. IIEEL IP',,.II C7,: ~.-.,.1I E~: IEE] ]1[} fl,,,ql ,,,, jell, IF;if, ~l~:~ DEP'I"H 'T'O I:::' I PE' BO'T"T'OM (1::'.'"[' ,, ) 4 ,, 0 4 ,, () 4 ,, () GRAVIEI.,. DEP'T]"'I (I:::'"[' ,, ) 8 ,, 0 0 ,, 5 3 ,, 'T'OTAL., DEF:']"H (F'T' ,, ) 12,, 0 4,, 5 7 ,, 5 GRAVE].,,. WI L~"I]'"I (F:'T.) 2.5 ],4 ,, () 5,, 0 GF~AVEL, I,.,,EIxlGTH (FT.) 1,6 ,, 0 7:'.8 ,, 0 2.8 ,, () GRAVE],,,, VOL,.UME (CU,, YDS,, ) :1,[:~,, 6 14,, 6 2(),, E) "T'ANK S I ZE (GAL,.S) I, 00(),, () 'x"~' 1, ()Cx} ,, () '~")~' ]., CK)O ,, 0 SO]'.L I::~A'T'II',I(}} (SE.l,, I:::'T,, /BR) 85 85 85 .x-.~, "I"ANI'::i MUS'T' HAVE AT L.I:::.A,::tl 'T'WO COMI:::'AF:~'T'MIEN]"S I I:~:' A 'T'HEIxl WILl,... IE!].,..I!!E C 'T R I C A L,. I am familiar' v,,:i, th '~:.l'Ir;,,! I"E:)qLt:LP~i!tflel"l'lZS ~'ClP I:]l"l"'"!B:J.'~,~i(.) sev, lc~!l"!;;; ar'id ~,,l~.~]t.:l.~;; c).s .~;~:~.~'t',. fc)p'Lh by T,.l"ie Mur'i:i,c;i.l:~ali'Ly ~;:)~' ~.~r]c:l']cH"a~](~.:~ (MOA) ar'icl the S'La'L~::~ o{' A].a.;'.;;l::a,, I v,l:i.].]. :i.r'm;ta].l 't..l'le ~;y~;j'Lem :i,n accc)pdar'lc:,::.~ v,ci.'Lh all MOA c;c:~de~;~ ar'id ~),1"i d i I'] (z [)(11 p ], :J, ~:'~ I'] c: E) t,~ i t I'1 t h ~ d e s i ~] I"1 ~]i P ]J, t (:~ I" i ~;t, c) f' 'ti h :J, ~B p E, I" ii') J. 'L ,, , ~:. ~,~, ,..~t..,.:,Lu')f Alaska r,c.,("t~ip':.,m6',i t:' }~::~i" I.h ....... L I w:i, ], ]. .;ac::lher'e '1;,.o al, 1 MOA al"lcl ",' ' .''~ ....... (::l~,~J~'l'.~':~l"i(:::~:~J'~ {'I"(D[~ ~':l. ny ~:U-~:J.~B'(:,:J.I']~J W~M,:l.:, wastc~,~,~bM'.~H" d:i. spc)saI system cir' pub],:i,c I.,.,IF:'T S'T'AT~ON IS INSTAL. LI~',D IN AN AREA COVERIED BY MOA BUILDING CODI:ES~ (1.) ~1~1 EL. IEC"I'RICAI.... I:::'IE'RMIT AND INSP!ECT I[)N MLIS'F BE OBTA I, NED; (2) AS.,..BUI L..TS NOT B'E API:::'ROVIED W I 'T'HOLF[ AN IE],,,.I~:[]TR '.[ CAL I NSI:::'ECT I ['.)N REJ:PORT; AND (3) THE ~'T BE DONE BY A L] EI,,.Ijj~',CTF:~ICIAN,, AI;::'PL. ICANT:; SOL Elk: SOILS LOG PERFORMED FOR: LEGAL DESCRIPTIO~",~7, 1 4- 5- 6- 7 8 9 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST DATE PERFORMED: ~,~ SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O ENCOUNTERED? -- 0 P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) '*~ ~ TEST RUN BETWEEN , FTAND -- FT PERFORMED BY: ,a /~' ~ ~.",]al~l~l~a CERTIFIE DATE:~ /~ ~g by WggLS STATIC LEVEL OF WAT£1~ ,~'T, __-~( . .DRAW DOWN FT'. : ,~ : GALS. PER H~R :~ ~ KIND 6F C~StNG ~' From Ft: ~o +Ft z__ From __Ft. to~_ .___Ft._ :,(, Fr6m_ . _Ft~'to ~ Ft. Frqm ' , FL From --~-'F~ , FrOm __ F~ifi~ Ft~ t From . . ... Ft. F~ DRILLER'S Gl whos~ m 'ilin~g address :~s: ...... ' ....... ...... ~ .......... (~t~c[~]) 99577 All that portion of Government Lot SJxty-twn (62) , of Section Township 15 North, Range 1 West, Seward Merid:inn, more' described ~s 'follows: BeginnLng at the Northwest corner of Lot 62, in Section 9 Townshi>~ . ~ ~ , 15 North, Range 1 Wes~ of the. Seward Meridian, SI:ate ~f Alaska; ;"~South 165 feet; thence East 247.5 feet to the true point o~ beginning,,~. thence South 165' feet; thence East 82.5 .feet, thence Mortln 165 feet, thence West 82.5 feet to the point of beginn:ing in ~h~, Ancho~ Recording District, Third Judicial District, State of Alaska. SUBJECT TO reservations, exceptions, notes of record. SUBJECi' TO: of record. Third Judicial District, State ,of Alaska: That portion of Lot 62, Section"9 Township 15 North, Range 1 West, Beginning at the Northwest corner of Lot 62; thence South 165 feet to ~,the true point of beginning; thence East 247.5 feet; thence south 165 feet; thence West 247.5 feet; thence North 165 fe~ to the true point of beginning within the Anchorage Recording District, Third Judicial District, State of Alaska. All reservstions, restrictions, covenants, conditions, and easements Rick Mystrom, Mayor Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska99519-6650 http://www ci anchora e.ak us 907-343-474~ March 26, 1998 Robert C. Cowan, P.E. S&S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, AK 99577 Subject: / Waiver Request for T15N, P-s3:W, Sec 9 SEPTN Lot 62 Waiver Request #WRWR980010, PID #051-104-17 Dear Mr. Cowan: Your request for a waiver of the required 10 foot horizontal separation from the on-site wastewater disposal system to a property line has been approved. The approved separation distance is 6 feet. Also the separation distances from the foundation to the septic tank of 2 feet and the absorption field of 5 feet are also approved. This waiver approval applies to the existing septic tank and absorption field separation distances. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Donna C. Mears Civil Engineer On-Site Water Quality Program WR~ WR980010 PID~ 051-104-17 Date Received: March 17, 1998 Legal Description: T15N RlW Section 9 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet HA~ Permit SEPTN Lot 62 Engineer: Robert C. Cowan, P.E., S & S En~ineerin8 17034 Eagle River Loop Road, Suite 204, Easle River, Alaska 99577 Applicant: Stephen T & D~ane Y ~ayt Waiver Requested: Leachfield and to pro~ert~ line of 6 feet; leachfield to the foundation of 5 feet and the septic tank to the foundation of 2 feet. Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: Points: 3. Other~ Waiver is Granted: List Conditions or Reasons for Waiver is NOT Granted: above: Date: Rec ~: #03646/7827 Amount: By: $ 115.00 C Na~e of Reviewer Date Paid: March 17~ 1998 ROBERT C. COWAN, P.E. HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION &FLOWTEST ROAD DESIGN SOiL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL ~NSPECTIONS ONSlTE WASTEWATER DISPOSAl SYSTEM DESIGN March 11, 1998 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: SE Portion of Lot 62; Sec 9; TI5N; R1W Request you grant a waiver on the rcfcmnccd properly for the horizontal septlration distance between the leachfield ~nd the properly line tit 6 feet and fr?n die leaclffield to the foundation at 5 feet. ~0~40 We do not anticipate aoy adverse effect on the adjacent property. The adjacent property's well is over 100 feet from the referenced property's leaclff]eld (see attached asbuilt survcys aod CEOSS sectional drawing). If you require additional information, please contact tis. SincereLy, Robert C. Cowa ], P.E. RCC/gk ~'/IRONMENIAL SERVICES DIVISIL., eFCE,IVFD 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ~o o~ Municipality of Anchorage Development Services Department Building Safety Division .. On-Site Water and Wastewater Program " ;4700 South Bra(jaw St ' ' P.O. Box 196650 Anchorage. AK 99519-6650 www. ci. anchomge.ak, us (g07) 343-7904 CERTIFICATE OF HEALTH AUTHORITY ^ '~'~'~' '*' /~r rr~u V/AL .... ':" 'H'O'F~-A ~;I~Ii~LE 'PAMiEY DW~LLIN~ ....... ' ...... · ...... Parcell. D. OSt'/O~-/7. '' '' 'H~ ~~ ~ 7 ~ Current Prope'rty owner(s)-~./,,~ t~/~A~u~, ..... Day phone_,~Of- 2. B-ZO .Day phone Lending agency Mailing address Real Estate Agent Mailing Address...- Day phone .~'~.Z~_.- ~/<Z'?~ Unless.otheNzise requ. ested, NAA Wi//be held by DSD for pickup. . NUMBER OF BEDROOMS: ,-~ TYPE OF WATER SUPPLY:; ' Individual Well --.' Individual Water Storage Community Class ~ Well Public Wat~' System TYPE OF wAsTEWATER DISPOSAL: [] Individual On-site ~ 'D Individual Holding tank r'-I ' [] Community On-site [-'1 'l-I-- Public Sewer r-I The Municipality of ,Anchorage Development Servi'ces Department (DSD) Issues Cedificates oi Health Authori~ Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of He~-Ith Authority Approval are required for the transfer of title (except between spouses) for properties served by a singl~fernily on-site vr~stewater disposal and/or water supply system. DSD also issues HAAs upon request to hornaowners. Certificates of Health Authori~ Approval are valid for 90 days from the date of issue for proper'des served by a private or C:ass C wait and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with v---.lid water s~mples.) Certificates are valid for one ye.~r for properties served by Class A or B wails or a public water system. The Municipality of Anchorage is not responsible for errors or.omisslons in the-profession~l engineer, s work:'- .Municipality of Anchorage. ,,, DeVel opment' Services' Department · i i~,,' .... ., ,'", :. BUilding SafetyDivisiofi ' . ~ ,,;: I [ ~; :On-Site Water & Wastewater Program ~,; '..': '~ :. ' 4700 South Bragaw St. '~ ' ' 'il, P.'O.' Box196650 Anchorage.' AK 99519/6~'50 ' ~ h " www.ci.anchorage.ak.us !' ~; :i (907) 343-7904 i' !~ HEALTH .AUTHORITY APPROVAL Ci '"'-, c,.,,,-, o""" '"'"', A. WEI.L DATA .Well type p 'Date completed Total depth ~Z. ft. ;Legal Description:"'7' ,/~ gE fOg'r'tod Lo?- ¢~, g ~:6'r'roA ~Parcel ID:' f ' , :: - , : Date of test Static water level Well production WATER SAMPLE RESULTS:, Coliform (") colonies/100 mi. Arsenic: '" mg./!. If A, B, or C provide PWSID # ~ :,;. Sanitary seal (Y/N) ', Cased to ~/7_.ft. FROM WELl. LOG /-~ O. g.p.m. Nitrate / 05' mg./I. Otl~er bacteria__ Date of sample: / Z//7/o,3' Col!.ected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Mat,erial, Tank siz6. Foundati~)n clba~nout.(Y/N! Dat. e of pumping C. ABSORPTION FIELD DATA. Date installed .~/0~' ,- . .'Soil rating ~ orft~/bdrm) ~' Length / ~ '.:'.ft. ' ;: -. Width L./. ft. ', 'i Well Log (WN,) ', Wires': ,Pr°perly protected, , {Y/N) Casing height (above gr°~nd) AT INSPECTION ~ 20 ft. : ,. ~ ~g.p.m. Date installed. .~/,~&" cleanouts (Y/N) t y High water alarm (Y/N) d5 colomes/lO0 ml'.~ ~ '1 ', i i. System type--.'~'./~f'~'~'¢-H ' "" i ,.~oO i lfL Gravel below pipe Elapsed Time:~ min. Final fluid depth Any rejuvenation treatment (past 12 mo.) (YIN & type) Total depth,/'~, ft. Eft. absorption areaZ~'~'. : __.. ft' Monitoring tub~ ,~]Y----, ,'.,: DepressiOn ove;fiel~", '~.7~: · Results (Pass/Fail) f)/Z]'C.~,' ' For ~ ' bedrb~m~ Date of adequacy test ;/Z/~ 7/¢ ~ Fluid depth in ~bsorpti0n field before test O in. Water added~¢gal. New depth O iim ¢ in. .Absprption rate >= '/ ~ g,p~d. If yes, give date GS Ref. U :lient Name )roject Name/~ :llent Sample 1D latrLx All Date~.rfin,¢$ are Air Sl~ Standard PrlnteO Datefflme Collcctetl Date/rime Received Date2Timc TeehnlcM Director WSID 0 Relea~d By ample Remarks: ~.,zmcter Results POt. Units Med~od 12/23/2007. 9:38 12/17/2003 10:00 12/17/2003 13:20 Stephen C. Ede Allowablz P:~p Armlysis Container ID Limits DaM Datc lr it Nirrate.N i.05 0.100 msq. EPA 300.0 B (<-10) 12/I'//03 '~ c=obiology 'Lnbor&tory ToTal Coliform :ol/lOOmL SMll; 9222B A (<---1) 1~;17/03 E ~C 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. GENERAL INFORMATION ' Complete legal description Portion of'Eot 621 S6¢. ~,' T15N,R]W, S.M. Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address 22035 Aurora Bor6a~is Chugiak, AK 99567 Jordan Opp6rman 22035 Aurora Bor6a£is Chu~iak, Day phone 688-5667 AK 99567 Day phone Kathi O~mst~ad/ Jack White Co. Eag~ River Day phone 694-5500 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 ~ TYPE OF WATER SUPPLY: Individual well XXX Community well Public water 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: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~)25 (Rev, 1191) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approvat application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and t)/pe 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. $ & $ ENGINEE. RING . . ~ Name of Firm 17o3~ ~.~. ~ ..... Lc- - Phone Address Engineers signature ~~_ ~ Date 6. DHHS SIGNATURE Approved for 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 indepen,,dnt 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. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST If A, B, or C, attach ADEC letter. Legal Description?~-' · A. WELL DATA Well type Log present ~/N) Total depth Sanita~ seal ParcelI.D.. ~)~%'/- Date completed Cased to '/-~' J Wires properly protected (~YN) ADEC water system number ~ 4j ~'- Driller ,_~ Casing height ~Z. FROM WELL LOG AT INSPECTION Date of test ~-%~-' L~ ~ .~c~,~ Static water level ~' ~ "Z.-'~ t Well flow ,~¢c~, (~ g.p.m. ~, ~ '~ Pump level ~ ~"~ ~ ~ g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~'~ L"( Absorption field on lot \ \~ ~ Public sewer main ~'~',~- Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Date of sample: L,,-Z 2. ~'~ 5 / / SEPTIC/HOLDING TANK DATA Date installed \~ % ~' Cieanouts ~YN) ~ High water alarm (Y,~ Date of pumping Nitrate '"'~', \\ Collected by: Other bacteria S & $ ENGINEERING i)~:~q ~.agie kiver Loop Roa~; Eagle River, Alaska 99577 Tank size ~. o~ ~ Compartments Foundation cleanout(~/N) V Depression (.Y~ ~ Alarm tested (Y/N) ~ "'"~O ~c~ 7'~ Pumper Well(s) on lot ~"~ ~ ~ To property line [ c> ~ Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: On adjacent lots ~ c> c, Foundation Absorption field ~ ' Water main/service line 72-026 (Rev 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Manhole/Access (Y/N) gallons ~ieZn~ i(ny/N) "Pump on" level at ~level at High water alarm level ~~ycles tested Meets MOA electri~ A CN E FROM LIFT STATION TO: On adjacent lots Surface water VCell on lot D. ABSORPTION FIELD DATA Date installed \ ~ ~' "5' Soil rating ~:'~' ~ Length ~, L-¢~ Width '¢~ ~ Gravel thickness System type 'Tli~ Total depth Total absorption area Depression over field (Y/~) Results~ail) Peroxide treatment (past 12 months) (YI~ Cleanouts present {~,'N) Date of adequacy test for '~' ¢.~ ~,~ ,,.,L If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot \t'~ t To building foundation On adjacent lots ~ Surface water \ ~ Curtain drain ~/ On adjacent lots ~ ~ ~'~"~ Property line To existing or abandoned system on Cutbank ~/~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I havecheck/~ified, or conformed to all MOA and HAA guidelines in effect on the Signature Engineer s Nam(IXOa4 HAA Fee $ Date of Payment 72-026(Rev 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES ......... REPORT of ANALYSIS Chemlab Ref.~ :93.2696-1 Client Sample ID :SE PORTION OF L62 S9 T15N RlW Matrix :WATER 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Client Name :S & S ENGINEERING WORK Order :67023 Ordered By :RAY SHAFER Report Completed :06/14/93 Project Name : Collected :06/08/93 @ hrs. Project~ : Received :06/10/93 @ 16:00 hrs. PWSID :UA Released By Technical Director:STEPHEN ~. EDE Sample Remarks: ROUTINE SAMPLE COLLECTED BY: RAY. Qc Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 2.11 mg/L EPA 353.2/300.0 10 06/11 LLH * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than Member of the SGS Group (Soci~t~ G~n~,rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA MUNICIPALITY OF ANCHORAGE Department of Health & Human Services o. CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLINg//_ Parcel I.D. , O~/- /O~--/7 HAA~ 1. GENERAL INFORMATION (Musl be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) Location (address or directions) NHN Aurora Street 2..D-O'?' G ~..,c,~t..~-'t-.~,~ ,,~¢-~ .~:~ (b) Property owner A.H.F.C.#75958 Telephone: (home) Business Mailing Address ~Z0 East $4th Avenue, Anchorage, Ak. 99503 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent JACK WHITE COMPAJVY Address_ 10928 Ea.ql~ Riv~ Road Telephone 694-5500 (e) Mail the HAA to the following address: (or check here~ if hold for pick up.) List contact person and day phone number below: ATTN: K-~.thv;. 0 Emstcad Ak, 99577 S & S ENGINEERING 17034 Eagle Ri~ver L~p gea~ Eagle Rlver~ Alaska 99577 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms ~ '/ 3. WATER SUPPLY Individual Well t~x. Community [] Public [] Note: If community well .system, must have written confirmation from the State Department of Environmental : Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [2~ 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 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of 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 Firm Telephone Address $ & '~ I~NGINE£RING Date Eagle River, Alaska 9195~17~ 6. DHHS APPROVAL Approved for .,,~ Approved/.~ Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only u pon the representations given in paragraph $ 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 Mu nicipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 FNV~R~"NMEN rAL SERVICES DIVISION MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description:~-~J~.. ~.--r'~.,,J c~m /_<,-,- /_, Z. A. WELLDATA RE£EIVED Well Classification Well Log Present ~N) Date Completed '~' - Total Depth '~Z.' Cased to '~Z.' Depth of Grouting Static Water Level ~. 7 ' Casing Height Above Ground /2- # ~' Electrical Wiring in Conduit ~)'N) y SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments If A, B, C, D.E.C. Approved (Y/N) '"'//~ Yield ~,~ ~','"'/ l.z-3? Pump Set At Sanitary Seal on Casing~'N) Depression Around Wellhead (Y~ ; On Adjoining Lots ~c:~:~ + \ 1"5 ~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ~ ~_~.~,,.1~=~ ~.~.L~ ; Date 1~-~-5o B. SEPTIC/HOLDING TANK DATA Date Installed ~c~r~=,,~--- Size ~,c~,=.,= No. of Compartments Standpipes ~N) ~,/ Air-tight Caps~N) ",/ Depression over Tank (Y,t~ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) -- Foundation Cleanout Date Last Pumped~ ~.7.- ;for - Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ~ L,, t To Building Foundation 7_' To Property Line \c>~ ~ To Disposal Field ~-~ To Water Main/Service Line \ c>' ~ To Stream, Pond, Lake or Major Drainage Course \'~'--" ~ '~ Comments,,~ ~F'~f~l:) ~ "~..~, L~,~.~.~..~ -~ ~,~..~L~ -- 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field '~ Square Feet of Absortion Area Z~'~ ~' Depression over Field (Y,~ ~-/ Type of System Design Length of Field ~. ~'~ Depth of Field ~ ''z--~ Gravel Bed Thickness ~ ~ Statndpipes Present ,~N) Date of Last Adequacy Test Results of Last Adequacy Test ¢ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well //~' ~ To Building Foundation c/, To Water Main/Service Line ~c:~ *' To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line /0 ¢ 4- To Existing or Abandoned System on ; On Adjoining Lots ~c'~ ¢ To Cutback (if present) Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) Off" Level at "Pump High Water Alarm Level at ~ ~ ~ Tested for Pumping Cycles during Adequacy Test. ~l;emt~ eMnOt; Elect~ **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA inspection. Signed Company Date MOA No. in effect on the date of this l'za:',{4 f~,,~¢~ River Loop Road No. 204 , ~a~e~,ver, Alaska9957~/~/~ ~) Engineer's Seal 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 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order $ 30807 Date Report Printed: DEC 17 90 @ lO:O0 Client Sample ID:SE PORTION OF L62 SEC9 TLSN R1W SM PWSID :UA Collected DEC 12 90 ~ 12:00 hrs. Received DEC 13 90 @ 13:43 hrs, Preserved with :AS REQUIRED Client Name : S ~ S ENGINEERING Client Acer : SNSENGP P.O.# NONE RECEIVED Req # Ordered By : R. SHAFER Analysis Completed :DEC 14 90 Send Reports to: Laboratory Supervisor :STEP~ C. EDE/~ l)S & S ENGINEERING Special Instruct: Chemlab Ref $: 905226 Lab 8mpl ID: 7 Matrix: WA~ER Allowable Paremetes ~ested Result Units Method Limits NITRATE-N 2.1 mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE, Remarks: SAMPLE COLLECTED BY RAY. 1 Tests Petformed See Special Instructions Above UA=Unavailable ND- None Detected '* See 8ample Remarks Above NA- Not Analyzed LT=Less Then, GT-Greeter 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 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description(includelot, block, subdivision, section, township, range) S.E. Portion of Lot 62, T15N, R1W, Sec.9 Location (address or directions) NHN Aurora Street (b) Property ownerA.H.F.C. Mailing Address 520 E. 34th Ave., (c) Lending Institution N/A Mailing Address Telephone:(home) A~choraqe, A~ 99503 Telephone Business 561-1900 (d) Real Estate Company and Agent Jack Whi~e/Kathi Olmstead Address 10928 Eagle River Road: Eagle River. AK 99577 Telephone 694-5500 (e) Mail the HAA to the following address: (or check here [] , if hold for pick up.) List contact person and day phone number below: Pi~.k up by Engineer 2. TYPE OF RESIDENCE Number of bedrooms''~ 3 Single-Family [] 3. WATER SUPPLY Individual Well [] Community iq Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality 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 legality and status. 72-025 {Rev, 7/88) Page 1 of 2 · ~po~ s,~eeu!§ue I~UO!SSe;~oJd oq~ u! suolss!~uo ~o s~o~o ~oJ elq!suodseJ ~ou s! eSeJoqouv jo ,~!led!o!u nlAI eq.L 'penss! s! e~eo!J!~eo e e~o~eq e~ep oZ,~leUe ~o suo!~oedsu! ]onpuoo ~ou op SNHQ ~o see,~old uJ~ 's~ueLueJ!nbe~ e~e~s pu~ leJepej u!e~eo ,~Js!~s o] J@pJo u! 5u!puel ~!eql pue SeLUOq JO s~eseqoJnd o) ,%e~noo ~ se s!q~ seep SHH(~ eqj. 'e~lSel¥ ,~o e~e~S eq~ u! pe~e~s!§e~ Jeeu!l~ue leUO!SSejo~d ~uepuedepu! ue ~q e^oq~ S qde~§e~ed u! ue^!l~ suo!~e~uese~de~ eq~ uodn,~lUO peseq le^oJdd¥/quoq~,n¥ q~leeH senss! (SHHQ) seo!^JeS ueu~nH pue q~leeH jo ~ueLu~edeQ el~eJoqou¥ jo ~!led!o!un~l eqJ. le^oJddv leUO!l!puo0 ~o swJeJ. ~,,,,.. ,,, Ieee er]eau!Su3' :.,, 68/ET/ET oleo RECEIVED A. WELL DATA Well Classification ~,~-.~--~ Well Log Present (Y/N) /V Date Completed (~ MUNICIPALITY OF ANCHORAGE (MOA) iClPALIW (He~ll~tA~./ll~rlty Approval (HAA) NMENTAt- ~~NFEBRUARY 1984 343-4744 Legal Description: ~k~ If A, B, C, D.E.C. Approved (Y/N) "*~//~ Yield ?, ~ ~'~" /~//,¢ ~ Cased to ~/....2 "Depth of Grouting ~//.~ ~2 7/ ,~,~, ,~,,,~ ~,~' ~,,-,~.~ PumpSetAt ~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ~/'~" ,//~-- / ; On Adjoining Lots ~/~' To Nearest Public Sewer Cleanout/Manhole ; Date/~////-/'//¢: ¢ Total Depth Static Water Level Casing Height Above Ground 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 Line To Nearest Sewer Service Line on Lot Water Sample Collected by ~'~-~',5, Water Sample Test Results ~--~z B. SEPTIC/HOLDING TANK DATA Date Installed /~,~PJ'- Size ./~'~'~-./. No. of Compartments Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Foundation Cleanout (Y/N) Date Last Pumped /~/,,~.~ ; for -,~/-4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ?~' / To Building Foundation To Property Line /'/,~' ~ ,,~'~-,'~' x~',~- To Disposal Field ~ To Water Main/Service Line ,/~ ~,~.-, ,~-~c,~-~' ,z,~,,,- To Stream, Pond, Lake or Major Drainage Course //~,"f Comments 72-026 (Rev 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field _ Square Feet of Absortion Area Depression over Field (Y/N) Type of System Design Length of Field /~' Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation '~ ? Lot /~/4' ; On Adjoining Lots ToWeter Main/Service Line /~" ~ /¢-~,-~-',-~ x~r'To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ~"¢ ~ ~.~,~,¢ /.~-,r- To Existing or Abandoned System on Comments D. LIFT STATION ////,4 Date Installed Size in Gallons "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) Pumping Cycles 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 effect on the date of this inspection;_~..~.~ ~ Signed Eagle Rwor Enginesdng Services Company ¢, 0. ~c,× 7732~4 Date /,:z,//,.~/,~,~ ~¢e River,.~, .,~.AK 99577 MOANo. ~"'~'~ -)-~,~' 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 ~ FEDERAL TAX ID # 92-0040440 ANALYSIS REPOST 8Y 8AMPLE fox WeEk Oxde~ I 18605 Date ~,eport Printed: DEC ? 89 ! 17:53 Client Sample ID:L6~.TISW P~SID :UA Collected DEC 4 89 ! 14:46 h~s. Seceived DEC 4 Premexved with :AS EEQUIRED Client Na~e : EAGLE RIVER ENGR Client Acct : EIOLERP P.O.t NONE RECEIVED Req t O[de~ed By : LOU BUTEP~ Analysis Completed :DSC 6 89 Sene Aepo~te to: Labo[ato[y Supe[yLalii_.L~IEPIi~N C. EDE I)EAGL8 RIVER ENG~ Special l~t~uct: Che~eb Roi l: 8746 Lab Smpl ID: 3 Matrix: WATES Allowable NI~RATE-N 2.0 ~ng/1 EPA 353.2 10 Sample ROUTINE SAMPLE. SAMPLE COLLECTED BY LAB. Tests Pe[io[med See Special Ilutructlons Above UA.Unavailable None Detected "See Sample Rem[ks Above Not Analyzed LT-Le~a Than, GT-G[eate~ Th~n 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 264-4726 Application Date ~'ff:~/*~-~:<~'J¢'- ~,ti.; 1, GENERAL INFORMATION (a) Legal Description (include lot, block,.subdivision, section, township,.range) Location (address or directions) ~ . '77 (b) Applicant Name :~,:,L: :~' ¢~-'~/'--: ' Telephone: Home Business (c) Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other ~ (explain); (d) Lending Institution ~:~¢-?~' ~,~2~:~'-~-,::~;~-~Telephone Address .......... ~ -':'./~' 't~, ",-,- . ..... (e) Real Estate Company and Ag~n~D ] ~ ~'~:~. (. ~ .... Address Telephone (f) ~,a44 the HAA to the following address: TYPE OF RESIDENCE Single-Family ~ Multi-Family Number of Bedrooms ~ ~ Other WATER SUPPLY Individual Well [~' Community [] Public [] Note: If community wail system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite.[~' Public [] Community [] Holding Tank E] Note: If community well system, must have written confirmation from the State Dopartment of Environmental Conservation attesting to the legality and status. Page 1 of 2 72. 025 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 ~n ~esbgation of this Healtl'~ Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~i',~ Telephone Address ' · - ~ Date - Approved f~)7 ]~*~Jedroom~/,_~~___ Date ~"/~ ,~-?-- 7~'''~ Approved ¢,~ Disapproved 1- ~)__ 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 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 (MOA~ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4728 MUNICIPALITY OF ANCHOP, AGE DEPT. OF HEALTH & I~NVIRONMENTAL PROTECTION ,tJ6 26 Legal Description: ~"~ Well Classification Well Log Presentd~N) Total Depth ~'~' Static Water Level Cased to '~ ' Casing Height Above Ground Electrical Wiring in Conduit ~/N) Separation Distances from Well: To Septic/Hc',dlng Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ~'~ I ~. Cleanout/ManhOle ~ I~ If A, B, C, D.E.C. Approved (Y/N) Date Completed ~'/,~' Yield Depth of Grouting Pump Set At Sanitary Seal on Casing~N) Depression Around Wellhead (Y4~I) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments B, SEPTIC;'I~L~,,~,~ TANK DATA Date Installed '~-"~.~..~ I~,~' "~Size StandPipes~[~YN) Air-tight Caps Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) "~/"~ Separation Distances from Septic/~,-'t~l'~J Tank: To Water-Supply Well / To Property Line To Water Main/Service Line /o "'~' Course "~//~ No. of Compartments ~-. Foundation Cleanout([~l) Date Last Pumped ; 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) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed "~ ~ 2.?. -~5"' Width of Field ~'~:'~' Type of System Design "T"IZ.~=,,---~r-.P[ ~/' Length of Field I q,~ ~ ~ Depth of Field 12. Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well //~' ' To Building Foundation ./~[::~ Lot "J Gravel Bed Thickness Standpipes Present '~/N) Date of Last Adequacy Test To Property Line To Water Main/Service Line t c> ~ ~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons !'Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked,~verified, or conformed to all MOA and HAA guidelines n effect on the date of this inspection Sjgned ~R~ ! 9~.',-' Date ,~, ,,3LE RIVER, ALASKA Company PH. 69~.-P~479 MOA No. ~'..5-c~,.o Receipt No. Date of Payment Amount: $ Page 2 of 2 72*026 (11/84)