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Home My WebLink AboutUS SURVEY 3043 LT 6 OF LT 11 T10N R2E SEC 18 WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologicol 8~ Geophysicol Surveys lc.) A.D.L. No. DISTANOE AND DIRECTION FROM ROAD INTERSECTIONS $, OWNER OF .... '~, Oa~';y Jo~:oph Street Address and Arco of Well Locotion Oirdwood~ ;~k, 99989 ~ ~ ~ Other: ~ 1 t; ~p ~.~) 7. USE?.~Oomeltic ~ Public Supply ~ [ndu,try ~{~ ~0 3.~ ~ Irrigation ~ Recharge ~ Commerlcel d~om. ~ in. to ..~tJit. Oeplh Weight _17 lbs./fl ~0. STATIC WATER LSV~L: ft. __~ / ~ Above or ~ Below lend lurface I~. PUMP; (if available) HP ~/~ ~' . -/ DEPT. OF ENVIRONMENTAL CONSERVATION ANCtIORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 July 7, 1986 BILL SHEFFIELD, GOVERNOR Anchorage Water & Wastewater Utility 401W. International Airport Road Anchorage, Alaska 99518-1195 Subject: GA-2 Trunk, Girdwood, Alaska (8721-DA-803) Dear Sir: We have reviewed the plans and specifications for the subject project and are hereby issuin9 this letter which constitutes written conditional approval required by A.S. 46.03.720(a) for construction of the sewerage system. Variance approval is given between class "C" well and trunk line from sta. 109 + 35 to sta. 111 + 15 to not less than 40 feet. Conditiona~ approval is given upon the requirement for prior notification to our office of initial construction for special protection around well radius. Final approval will require the submission of Engineered as-built plans. Inspection and sign off of as-built plans shall be performed by a Professional Engineer registered in the State of Alaska. Arrangements for this inspection work is the responsibility of the developer. In addition, the owner's signature, address and telephone number is required. The "Certificate to Operate" the water system will be issued when the Department has approved the applicant's as-built plans. Any future expansion of the subject project will require additional approval from this office. All future correspondence should include the above assigned project number. Si ncerely, / : /: ........ Michael P. Lewis Environmental Engineer NPL:caa Ton), Knowle$, Mayor ANCHO WATER & WASTEWA' -.R UTILITY Engineering & Customer Service Division 401 W. International Airport Road Anchorage, Alaska 99518-1104 (907) 562-4497 Owned by the Municipality ol Anchorage June 23, 1986 Mr. Steve Eng Alaska Dept. of Environmental 437 "E" Street, Second Floor Anchorage, Alaska 99501 Conservation SUBJECT: SNOW VALLEY LID 60-3/GA-2 TRUNK GIRDWOOD Dear Mr. Eng: Plans and specifications and a Construction and Operation Certificate for approval of a "Class C" Public Well Development & Distribution Plan on this project were submitted by AWWU's design firm, USKH. We have received a copy of your approval letter'dated June 17, 1986 (copy enclosed). As a point of clarification, no reference is made in your letter that approval of GA-2 Trunk project plans and specifications is included. I have included another set of plans and specifications for your reference and approval if required. Should you require additional information, please contact this office. Sincerely, C RIGGANJ · . Engineering Technician Anchorage Water & Wastewater Utility CSR/16.16 Attachments ~91LL SHEFF!ELD, GOVERNOR DE~'. OF ~N¥1RONMENTAL CONSERVATHON ANCHORAGE/WESTERN DISTRICT OFFICE 437 'E' STREET, SUITE 303 ANCHORAGE, ALASKA 99501 274-2533 June 17, 1986 USKH ATTN: Terry Waldele, 2515 A Street Anchorage, AK 99503 PE SUBJECT: Class C Well, Lot 131, USS 3043, 8621-FA-153, Girdwood Girdwood/Snow Valley Sewer LID 60-3, Lot 11 of USS 3043 8621-WA-078 Dear Sir: We have reviewed the plans and specifications for the subject project and are hereby issuing this letter and a "Certificate to Construct" which constitutes written approval required by A.S. 46.03.720(a) for construction of the sewerage and water systems. Final approval will require the submission of Engineered as-built plans. Variance Request No. 9 for the private well on Lot 11F of USS 3043 is hereby approved to 65 feet to the proposed specially constructed sewer. Inspection and sign off of as-built plans shall be performed by a Professional Engineer registered in the State of Alaska. Arrangements for this inspection work is the responsibility of the developer. In addition, the owners signature, address and telephone number is required. The "Certi?icate to Operate" the water system will be issued when the Department has approved the applicant's as-built plans. The former well must be abandoned according to AWWA specifications. Any future expansion of the subject project additional approval from this office. All future should include the above assigned project number. will require correspondence Sincerely, /Ste'ven W. E~.g/, PE Oistrict EEr~ineer SWE:pkk ENCLOSURE · :~i;:'DEpARTMENT;OF-ENVIRONMEN!AL CONSERVATION ~f~-:~;~,':'. ~'~;~:~ ~'5~:~ '~i. ~.' t ID; ERATION~CERTIFlt ocated.~.:: :.. (' BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 274-2533 May 21, 1986 USKH ATTN: Terry Waldele, PE ' 2515 "A" Street Anchorage, Alaska 99503 SUBJECT: Horizontal Separation Waiver Between Wells and Main, GIROWOOD SEWER L.I.D. 60-3, Girdwood, Alaska 8621-WA-078 Sewer LOT 13 o~ USS 3042 Dear Mr. Waldele: The department has reviewed the subject waiver request and hereby approves the attached waivers submitted in your April 30. 1986 letter, This approval supercedes the waivers ~ormerly approved in our October 24, 1985 letter, Construction practice described in your April 30, 1986 letter are required, in addition, this o~?ice must be notified o~ construction timetable for observation. Sincerely, Steven W. Eng, PE District Engineer SWE:pkk ATTACHMENT , I LOT 104 FURNISH AND INSTALL DUCTILE IRON PIPE LOCKING /'c~rr~u CT c / x, (")1 STA 93+05J9: ,/ 0 E ~OT 103-] LOT !04 i/ j / / \ / i~ \ i 53+00 54*00 55+00 54+00 55+C~) 56+00 57*00 'SCALE V~RTICAL DATUM DATA SEAL MUNICIPALITY OF ANCHORAGE ANCHORAGE WATER & SEWER UTILITIES SNOW VALLEY Ll.D. 60-3 GA-2 TRUNK (PHASE ~.) SCHEDULE A M.H. 9 TO M.H 2 MUNICIPALITY Ottl, F ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 075-092-32-000 Expiration Date: 9/5/2025 Legal description US SURVEY 3043 LT 6 OF LT 11 T1 ON R2E SEC 18 Site address 161 TELEMARK WAY Girdwood AK 99587 Current property owner(s) JONAS MARK T & JULIE W X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 10/4/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approvaijune 2022 MUNIUPAUTY OF ANCHORRA, GE Development Services Department Y !'hone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 075-092-32 Complete legal description US SURVEY 3043 LT 6 of 11 T1 ON R2E SEC18 Location (site address) 161 Telemark Way*Girdwood, AK 99587 Current property owner(s) Mark Jonas 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 907-227-0576 3. TYPE OF WATER SUPPLY: X Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank 0 Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ _L o_'6 Date of Payment/-z-3�Z V COSA # 5 c 2 y 1 2 Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 COSA Checklist Legal Description: US SURVEY 3043 LT 6 of 11 T1 ON R2E SEC18 Parcel ID: 075-092-32 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA A Well log is filed with Onsite (or attached) Date drilled 9112/82 Total depth 160 ft Cased to 160 ft A Sanitary seal is functioning correctly H Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 9/5/24 Static water level at beginning of test 60.2 ft. Comments TANK DATA operating fluid level in septic tank Date of p ❑ Required Comments: completed, if AWWTS D. ABSORPTION FIELD DA Which system tested (date installed ❑ ALL standpipes present per record dra ' g Total measured depth from grade ft (m Measured depth to pipe invert from grade ft (mi ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced _gallons date Any rejuvenation treatment (past 12 months) If yes, enter date COSA Checklist June 2022 Well production at time of test 6.1 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes ® No 0-doliform bacteria is Negative Nitrate mg/L N it rate less than MRL (ND) Arsenic ug/L ❑'Arsenic less than MRL (ND) Collected by Garness Engineering Group Date 9/5/24 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results ❑ Pass Fluid depth prior to test in Water added gal New fluid depth in lapsed time min Fina id depth in Absorptio to gpd FIELD STATU POST RECOVERY Effective depth (per ord drawings) in Effective depth used in Effective depth remaining in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' NSA Community Sewer Manhole/Cleanout > 100' 65'+* Q Yes if No ft ❑ Yes if No ft �Q600p�O practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may depend Neighboring Tank > 100' no Yes if No ft Private Sewer/Septic Line > 25' 1J Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No n/a ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' the future performance of the well or septic system. GEG makes no representation whether an alternative well fail to Animal Containment > 50' O Yes if No ft ❑i Yes if Noft Manure/Animal Excreta Storage > 100' (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. Community Sewer Main > 75' ❑ Yes *65'+ if No ft Q Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' es if No ft Tank to Property Line > 5' ❑ Yes if No ft Wells . ent Lots: Field to Property Line > 10' ❑ Yes if No Private Wells > 100' ❑ Yes if No ft Water Main > 10' es if No ft Community Wells > 200' ❑ Yes if No ft Water lne > 10' ❑ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *Waiver Granted `Per AWWU Record Drawings. GEG did not locate AWWU Sewer Manhole/cleanouts in field. G. CERTIFICATION & 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gamess Engineerinq Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrev A. Garness Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry �Q600p�O practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may depend o OF �Q o 4� o S Q exist that were not identified during the evaluation. The operational life of all wells and septic systems variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate upon a variety of the construction (materials and workmanship), and the water usage of the family utilizing during year), quality of the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not • • ... • • . . - • . • . • • ... • . guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding �, the future performance of the well or septic system. GEG makes no representation whether an alternative well fail to ......... .......� Q f A: or septic system can be installed on the property in the event either of the current systems perform that retained GEG ey s: G Q4 adequately in the future. The content of this report is for the sole benefit of the person/party to perform the evaluation. Reliance upon the information provided in this report by any other person or party C 795 i O� (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. o COSA Checklist June 2022 UCENS a4��Oe s 10" � Portion Lot 11 4-9 Tract 18A Portion Lot 11 W 2nd CO 'IV Portion Portion 63- Lot 11 16 0. Lot n TY Portion Lot 10 _q OF 49t 's Star ri surve Ul y 9 4QI TH 0 is 30 K i e;rieZ;ry A Rur t* MMMMMMML— _j L 177 ar US SURVEY NOTES -All dimensions shown are grid bearings and ground distances, record are Per Warranty Deed Bk 2909, Pg 534. -49th Star has conducted a physical survey of the Property and all details shown on this Asbuilt Survey are correct. Under no Circumstances should any data hereon be used for construction or the establishment of property lines. It is the owners responsiblIfty to determine the existence of any easements, covenants, or restrictions; no title research performed. ASBUMT SURVEY LEGEND 49th Start rveying LLC @ Well PO Box 738 A Portion of Lot 11, 0 clean Out Girdwood, AK 99587-0738 US Spey Na, 3043, (907)891-6111 Girdwood, AK MEL Pedestal JeremARD49thStarSurveying.com U111. Pole W.O. 2456 DATE 9/9/24 I SCAM I -W 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 1. GENERAL INFORMATION Complete legal description Lot 6 portion of Lot 11; U.S. Survey 5043 Location (site address or directions) Alyes ka Hwy Gir~uood, AK Property owner Mailing address Lending agency Mailing address Agent Address Garq and Sue Joseph Day phone 783-2362 P.O. Box 562 Gir~ood~ AK 99587 Day phone Judy Bau~t/Remax o~ Al~eska P.O. Box 1029 Gir~oood, AK 99587 Day phone 783-2010 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: XXX If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4, TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature S & S ENGINEERING 17034 Eagle River Loop Read No. 204 Eagle Riverf Alaska 99577-' Phone G"i,--/ - .).~,~ 7~! Date DHHS SIGNATURE /~ Approved for '¢ Disapproved, Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based onty upon the representations given in paragraph 5 above by an independent professior]al engineer registered in the State of Alaska, The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~Y25 {Rev. 1/91) aacx MOA Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 34~¢~AI41 Legal Description: A. WELL DATA Well type ,06-~qp4~-f~ Log present (L~q) '--] Date completed Total depth \ [~ ~' Cased to t [~ ~ ~ Sanitary seal (~,1) y Health Authority Approval Checklist If A, B, or C, attach ADEC letter. ~EC water system number ~ Casing height (above ground) I ~ ~ Wires properly protected ~) ~ ~OM WELL LOG AT INSPEC~ON ~. o ~ g.p.m. ~,~ g.p.m. MAR 2 0 1~96 RECE! ED Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform O Nitrate O, / (.9 Date of sample: ,~ ~ ]oZ ~ ~'6 Collected by: Other bacteria C_~ SEPTIC/HOLDING TANK DATA Date installed Foundation eleanou[ (YfN) Tank size Number of Compamnents __ Cleanouts Depression (Y/N} ~ ~ltigkwateTfil~r~(Y/N) Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 or fl2/bdrm) . System type Length Width Gravel ttfickness below pipe Total~depth/ Effective absorption ama Monitoring Tube present(Y/N) ~ ~D~pression over field (Yfi"4) __ Date of adequacy test Re~ For bedrooms Fluid depth in a~t (in.);. Inunediately after__ gal. water added (in.): FI~ (ins.) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date D. LIlT STATION Date installed Size in gallons ~ Manhole/Access (Y/N) "Pump m~mlp offf level at* High ~v~atum C~stcd E. SEPARATION DISTANCES Septic/holding tank oil lot Absorption field on lot Public sewer nlaiH (a~~'~ SEPARATION DISTANCES FROM WELL ON LOT TO: '~] A' : On adjacent lets ~'1~ : Oil adjacent lots ~-~.~ g 6e~ (¢- 04 t,,}ublic sewer manhole/cleanout Sexver/septic service line '~t>I ''~ Lifistation SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property lille Absorption field Water mairdservice line ~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Water maill/service line ~ ~qge area Wells oil adjacent lots Property line F. ENGINEER'S CERTIFICATION I certi/y t/tat lhave detemnined thrufield inspectio ~s a ~cl 'eviev of Municipal record~ th,~.~ are ia confi, rmance wifl, MOA [[zM guidelines i:, effect oa this date. ~a,e '~ ' ' '' ' ~ ~,~?, CE-Sam ,,,',¢,~ ............................................................................................................. HAA Fee $ ~ e ~ Waiver Fee $ "'~'~ . Date of Paylnent ~/~ 3~ Date of Payment Rev. 8/95 OSS: haa.wk.doc 05~19×96 16:36 CT~E ESI ANCHORASE ~ 907~9~11 N0.69~ Q06 CT&E Environmental Services Inc. Laboratorv Division ~a~,~.a~J,e',~.~,'.~f. wr~-.~-.~,w-.~,~.~-.~arf~jf~jfff~j~jjs~ Laboratory Analysis Report CT&E Ref.# 960859.6328 Client .Sample LD L6 Ll I, US 5UR 3043 J0559-01 Matrix DrinY. mg Water PWSID 0 Sample Remarks: Collected Date 03/12/96 Technical Director Released By_~-,,- 03/14/95 g~8 200 W. Potter Drive. Anchorage, AK 99518-1605 -- Tel: (907) 662.2343 Fax: (907} 561.5301 3180 Peger Road, Fairba~ks, AK 99709-5471 -- Tel: (907) 474-8656 Fax: (907) 474-9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNJA. FLORIDA. ILUN0iS, MARyLAN0, MICHIGAN. MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA 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 Lot 6 por,~on of Lot 11; ~U$S Suru~,y $045) Location (site address or directions) Property owner Mailing address Lending agency Mailing address Gary St~v~n Joseph and ~n~ ~A9 ~J~nnd. AgaAb~ qq~7 Day phone Day phone Agent Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 '~/ Day phone TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1191) F~ont 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 (hat m.7. investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature $ & $ ENGINEERING 37034 Ea~le Ri,/e~ LooI~ Road Ea,gle River, Alaska 99577 Phone Date DHHS SIGNATURE __~/..._ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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 LegalDescription: L~T ~,~"r(o~ oF LoT /( ParcelI.D. A. WELL DATA Well type Log present ~N) Totaldepth If A, B, or C, attact~ ADEC letter. yE. ~ Date completed I~0' Casedto ADEC water system number /~/?~' c1-l~.-~2. Driller/V)/-)(.,-~J~;~ON Casing height Sanitary seal CN) y~_.s Wires properly protected i~'N) Date of test Static water level Well flow FROM WELL LOG Pump level iSTANCES FROM WELL TO:"~/ Public sewer main AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewe'~m,~mb o lc/cica n o u t Sewer service line ~._~r .~ %,,t~o,~'/,ol,., c'/'O Petroleum tank I"~O:Ntl~' ', Krq, o~iv2 WATER SAMPLE RESULTS: Coliform C) Nitrate Date of sample: ~ ~)~-(~ I~)er~6_ ~6c~r~.o Other bacteria Collected by: S. SEPTIC/HOLDING TANK DATA ¢j//~f ~d Tank size Compartments Cleanouts (Y/N)-'~"~ _........~ndation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) Alarm tested (Y/N) Date of pumping ~'~.~ Pumper ~ ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK T~--~_... Well(s) on lot On adjacent lots Foun~ TO prOperty line Absorption field Water main/service line-'""--~ Surface water/drainage p,~.,C, ~ 72-026 (Rev. 7/91) Fron' ~' ~E:~..~ LP-'C~P-~ DPr'fP-.13 6'[~'-~ ~&" :" ' ]bONTINUED oN BACK PAGE C. LIFT STATION / Da~ Manufacturer Size in gallons % Manhole/Access (Y/N) Vent (Y/N) ~.e~.l at "Pump off" level at High water alarm level ~ Cycles tested Meets MOA electrical codes (Y/N) ~~ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA ~~ ~ --- -~..~..,..,~)/'~' Soil rating . System type _LC n g.t ~.__ w~.....~ _ Gravel thickness Total depth Total absorption area '"'"'~..~....~..._ Cleanouts present (Y/N) __ ;;sp~ i;;s;; ;s;/~;; if)i e I d ~.Y/N) __ '~"~ ~uacy test ___ bedroom~ Peroxide treatment (past 12 months) (Y/N) if ye~~ SE~ON~I:~I~,,TANOE FROM ABSORPTION FIELD TO: Well o~~/~ On adjacent lots Property line adjacen/OtsbuildingtfOundatiOn~'''''~~ To existing or a bv~e~ nmea~ ~ss~ ~v~c ~ i i ~ t- ~___. _. Surface water Curtain drain ~ 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. ENGINEERING 7{334 Eagle River Loop Road No, Signature ~,3~11~ River, Alaska 9957;7 Engineer's Name Date HAA Fee $ / "~-(~) Date of Payment Receipt Number 72-026 (Rev. 3/91 ) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number 17034 Eagle River Loop Road PROJECT: ~'~y ~T~u~ LOCATION OFWELL(Leoal Description): /~r3T WELL DEPTH: ' [6(~ FT, CASING: DATE DRILLING COMPLETED: <~- ROBERTA. SHAFER Eagle River, Alaska 99571 ** WELL FLOW TEST DATA SHEET ** CIVIL ENGINEER 694-29?9 STATIC WATER LEVEL (Top of Casing): DRILLER: /~ (-,-'/g'~ ~'0 / FT. DATE: Comments: W~/..~ ~/'~gDuCeO tdr F~o~ ~ ~,% GP/w, ;I,w is not Guaranteed 0~ A ~ ~ ~o, ~hsequent Variations C~n Occur, CLOCK ELAPSED TIME SINCE DEPTH TO DRAWDOWNI PUMPING TIME PUMPING STARTED/ WATER, rT. RECOVERY RATE, GPM REMARKS STOPPED, Mm. ~ {% 55 ~AD 60(1 hour) q:70 180(a hours) RECOVERY t 0 0 5 10 15 20 25 30 35 · ~ CHEMIL..~A..L & GEOLOGICAL LABORATORY ~~ ~G,~3 ~ SIREET ANrJHOBAOE ALASKA 99)18 ,ELEPHONE (g0~) 562-2343 FAX: (gOD 661-6801 Cltmnt Client ~Illl~-~ ~D(0.IO) .,~/1 ~PI 353.2 10 I 80d 860 O00O000¢000000000000 00000000000000000000 0~:5I. 88-~0-86E