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Home My WebLink AboutWOEBEGON LT 19B Municipality of Anchorage Page'. / al ~.~.--/ DEPARTMENT OF HEALTH AND HUMAN SERVICES " ENVIRONMENTAL SERVlOES DIVISION " P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 , On-Site Wastewater Disposal System and/or Well Inspection Report , Permit Number: .5/v c2//2£/'2 PID Number: O~/- ~ ~ ~ ~ Wastewaler System: ~New ; ~ Upgrade Address: Z~. ~x ~, ~,~,,~' ~75~'~ ·ABSORPTION FIELD "hon~:~S//, _ ~ ~No. of B~oms: UDeepTreuch 'b Shallow Trench ~Bed UMound OOther?' Total Depth from original grade: I I FIll added a~ove original gr.de: Gravel length'. ' Driller: Date Drgled: SlatlcWs[er Level:Fh Ins[nller:~ ~/~ ~, Datalnstolle SEPARATION DISTANCES ~s,,,~ ': ~Ho~d~.~ From Tank Field Station Tank Sower Lines ~/~ ~ Material', .. Number al Comparlments: Surface Remarks: ~ ~/~ ~ ~', BENCH MARK Location and De~crlpllon: Inspections performed by: Dates: Department of Heal approval ,~ page.' .~ .o1_ Z~ ..__ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report ,~. .g~ ,¢~/¢.V _~ PID No,: ~51 Legal Description: ~/¢ t ~'/~-/ ,' -- CLASS C WELL ~ ~_OT LINE I I 299,92 PROFILE GAL, SEPTIC ' TANK SCALE 1"i = 50' 72-013 A (2/91) MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW910317 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:BABB JOEL J OWNER ADDRESS:PO BOX 774233 EAGLE RIVER, AK 99577 DATE ISSUED:10/02/91 EXPIRATION DATE:10/02/92 PARCEL ID:05103239 LEGAL DESCRIPTION: WOEBEGON LT 19B LOT SIZE: 49469 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAAC80). THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: ~: · / DATE: DATE: Louis Butera, P.E. Registered Civil Engineer October 1, 1991 John Smith, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Woebegon, Lot 19B Narrative Dear Mr. Smith, The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The area has large lots allowing sufficient room for septic sites. There is a community water system in place. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity. 4. Drainage will not be effected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. P.O. Box 773294 · Eagle River. Alaska 99577 · Telephone {907} 694-5195 · Fax (907} 694-3297 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: LOT 19B, Woebegon GENERAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified or modified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. BED 1. 3. 4. 5. 6. The bed is to follow the natural land contour to maintain uniform total depth of the bed bottom. The bottom of the bed shall be level, plus or minus 1.5". The total depth of the bed excavation is not to exceed 4' at any point. The sewer line is to replace the existing sewer line that leads to the existing pit. The bed gravel is to be covered with typar fabric material. Soil or combination of soil and extruded board insulation to a depth of 4' or equivalent is to be placed over the leachfield. The area over the bed is to be finish graded to prevent ponding of surface water runoff. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to m~y Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 4' GRAVEL DEPTH = 6" under pipe BED LENGTH = 32' BED WIDTH = 18' SOIL RATING = 0.8 GPD/ft2 BEDROOM CAPACITY = 3 SEPTIC TANK SIZE = 1,250 (oversized) Twenty-four (24) hours notice required for all inspections. NOTES: Class "C" well distance 150' minimum EAGLE RIVER ENGINEERING SERVICES P. O. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 JoB Woebeqon~;~Lot 19B 91-135 SHEET NO OF CALCULATEO BY L.B. o^~ 10/01/91 CHECKED BY- ~ATE SCALE 3 Bedrooms Bed soil rating = 0i8 GPD/ft2 450 = 562 S.F., 28 18' x 32' N£IGHBORS LEACH KIELI) 4'~L N 89o!51'47" E 899.98 I_ ~ ~ ~e~ ~ ~ / ~T~ VE AERA U ~~ rcNc~ x I I ~ ~ N 89d5]'47' E 899.7] ~ - TEST HOLE · - MONITOR TUBE o - SEWER CLEANOUT NO SURFACE WATER + - WELL ,,,,,,,,,,, ........... - PROPOSED LEACHFIELD NO KNOWN CURTAIN DRAINS EASEMENT SEPTIC SITE PLAN ' LEGAL: 19B WOEBECON , '.~' ' OWNER: JOEL BABB i' .;~.. ..... .,' · N/A ~ '~t~ ..... ' CONTRACTOR: .... ,. ~ JOB ff 91 1351 DATE: 10/01/91~ SCALE 1" = 50' EAGLE RIVER ENGINEERING SERVICES ,.~,, c., ~,~.~ P.O. Bom 773294 . .4~,., .... , ~c .... EAGLE RIVER, AIl. 99577 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 826 L, Street, Anchorago, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: ~,~O ~' DATE PEREORMEO: LEGAL DESCRIPTION: / SLOPE 1 2 3 4 5 6- 7 g 10 11 12 13- 15 16 17 18 19 20 SITE PLAN GROUND WATER S ENCOUNTERED? ~/0 L O Gross Net Depth to Net Reading Date Time Time Water Drop ~oA,z ~/~,1~, s ::2?- 7~,~ & ' 7'~ " q ,'// ~ ,,,~ y ~ I, ~ ~ ,' / PERCOLATION RATE ]' ~ (minutes/inch) TEST RUN BETWEEN ~- FT AND ,S~,~ , FT COMMENTS PERFORMED BY: 72.008 (6/79) P. 0. Box 773294 E~101{ivor, AK 9'~77 69,~5195 CERTIFIED BY: ~ DATE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 826 L. Street, Anchorage, Alaska 99E01 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 5- 6- 7 9 11 12 13 15 18 COMMENTS (& P) SLOPE SITE PLAN WAS GROUND WATER S ENCOUNTERED? ~'VO L O P Gross Net Depth to Net Reading Date Time Time Water Drop ~ ~,'1~ /o~,~ 556 ~ ,o PERCOLATION RATE ~, ~ (minutes/inch) TEST RUN BETWEEN 3-- FT AND ~ FT PERFORMED BY: 72-008 (6/79) P. O. Oox 773294 E~21o 19ver, ^1~ 9U577 69~5195 CERTIFIED BY:~- DATE: ~ENT BY:ADEG ANGHORASE ; 7-18-92 ~ 2:11PM ~ANGHORASE/WESTERN D0~ 8~482971# 2 DEIP~'. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3~470 ANCHORAGE, ALASKA 99515 WALTER J. HICKEL, GOVERNOR RECEIVED ,JUL 1 4 1992 Municipality of Anchorage Dept, Health & Human Services 349-7755 July 9, 1892 Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 Eagle River, AK 99577 SUBJECT; Woebegon Subdivision lot 19B (property of Joel Babb), PWSID 217071 Dear Mr. Butera: A review of the records and information presently on file in this office Indicates that the Class 'C' Public Water System serving lots 19A & 'ISB In Woebegon 8ubdMslon is currently in compliance with the provisions outlined by Title 18, Alaska Administrative Coda, Chapter 80, (18 AAC 80), State of Alaska Drinking Water Regulations. Specifically Sections 005 through 070 (18 AAC 80.005 through 18 AAC 80.070). If the Department can be of further assistance, cio not hesitate to call us. Sincerely, Michael Lu, E.I.T. Project Engineer ML/pf Parcel I,D. # 1. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environrnental 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 051-032-39 ~ HAA # ~-~ GENERAL INFORMATION Complete legal description Woebegon Lot 19B Location (site address or directions) NHN Davidson Drive, Chugiak Property owner Mailing address Lending agency Mailing address Mike & Susan Damitio Day phone P.O. Box 672255, Chuqiak, AK 99567 City Hortgage/J.Mee Day phone 11901 Business Blvd., Eagle River, AK 99577 688-5168 696-0701 Agent Vista R.E./L.Baile¥ Address L6~ ¢'~ne~¢~=la D~qv~; ~gl~ RivRr, A~ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 3 Day phone 689-6464 99577 MUNICIPALITY OF ANCHORAGt: ENVIRONMENTAL SERVICES DIVISION SEP 1 2 1996 RECEIVED 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: X If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Eaqle River Enqineerinq Services Phone Address p ¢}. F~ 77~794. F:~gl~ Rivc, r. AK 99577 Engineers signature Date 694-5195 DHHS SIGNATURE ~' Approved for 3 bedrooms. Disapproved. Conditional approval for ..bedrooms, with the following stipulations: Additional Comments By: ~ ~'z,~, ~' Date 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 engir~eer 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. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: ,arcei 1.0.: (9 5/- O:Sz -$9 A. WELL DATA Well type If A, B. or C, attach ADEC letter. ADEC water system uumber ~7~/'?O ~ / L~( Y./N ) Dute completed t~- M~I~IPALIIY OF ANCHOP,~A~E Total depth ~ Cased to ~/ mvmg~lAb S~RVIC~IVISION Sanitau seal (Y~~ / Wires properly protected (Y~)~ AT INSPECTION RECEIVED Date of test Static w~ W~gl!dfroducdon g.p,m. WATER SAMPLE RESULTS: g,p,m, Coliform Date of salnple: B. SElVrlC,ff~Olgmt3 TANK DATA Fmmdation cleanout (Y~) ~ Depression (Y~) Date ofPomping /~/~% Pumper Length ~ '~ Width Nitrate //~aq//F/~z/g...-'~ Collected by: Other bacteria (/9 humediately after t/.~?) gal, water added (ia.): Absorption rate = ~' q'.5'~ g.p.d. /x¢//~ If yes, give dute ,~ Fluid depth in absorption field before test (ill,); __ Fhliddepth_ ¢ (ins.) Minutes later: /o Peroxide trcatnmtt (l)ast 12 months) (Y/N) Effective absorpfioo area 5 7b ~ Monitoring Tube present(Y/N) ~.~ Depressioo over field (Y/N) _Nt9 Date of adequacy lest ~- ?- ?.~. Results (Pass/Fail) /)/~,--~.~ For ~ bedrooms Soil rating (g,p.d./ft~-m:-ft'2&4n'a) 0 ~ ~ System type _,~j_5 / ~ Gravel thickness below pipe ~t 6 t Total depth /-~, q ] Ntullber of CoulpartlUeUls ___ /&]/2 High water alarm (Y/N) ~ Cleanouts (Y/N) XgS~ ?ifa Date inslalled Manhole/Access (Y/N) High water ahlnn level at* Size in gallons "Pump Ol," Icvel at* ~~' i~,,el at* SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holdil~g tank on lot Absorption field oa lot Public sewer main Sewer~e~,icc line /V//~ ;On adjac.cnMotS-~~, ~ent lots ...-.---~-~ Public sewer manhole/cleanout /,//.4 Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Building foundatiol~ (fi ~ / Property line ~'~ / Absorption field .~ ~" Water maildscrvice line 7"~ / Surface water/drainage ,p_/ppi Wells on adjacent lots p/St~) z SEPARATION D1STANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~/ / Water mafiffservice line Surface water P/bg(-) / Driveway, parkiog/vchicle storage area Curtain drain//}]~)fi]~ ./~t°tO~4~/',/7~Vells oa adjacent lois ?t_/5~ / Property linc F. ENGINEER'S CERTIFICATION I certiJP t/lal I have determined thrtt.riehl itt~7~ections and review o ia coq/brmaace with ~[O/I H/L,I guidelines ill ~/]bcl on t/ds date. Signature CE-6736 HAA Fee $ ~.~6~. ~ Waiver Fee $ Date of Payment Receipt Number Re,.,. 8/95 OSS: haa.wk.doc 0~/1~/~6 12:~ CTS, E ESI ~NCHORAE~: ~ 90? 6~4 ~2~? IqO.[~ gO~ CT&E Environmental Services Inc, Laboratory Diviaioq r. af~T~,~,~e'~ar~,~,,~mp'~,;~r~e'~r,~mP~r~'~P'~'i~mP'~J~ 200 W, Potter [)rive Anr, horage, AK 99518-1605 'Fei: {~q07) Fax: (~7) 561-5301 Z16790 Client PO# Printed Dale/Ti[ne 09//2/96 11:07 Collected Dated'lime 09109196 09:45 l~,ecelve{1 Dnte/Time 09/09/96 11:10 Technical DIr~eto]': Stephen C, li](te N~krate-N 1,98 0.100 mp/L EPA 35~.2 09/09/96 ESC ENVIRONMENTAL FACILITIES IN /CASK,% CAtlFOnNI^. FLORID.% ILLINOIS, ~/u~HYLAND, MICHIGAN, MISSOURI, NEW JEaSt:W, OHIO, W~gt' VIRGINI/ 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 Parcel I.D. # ZLSZ=03- 2.=3- 8 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # ~ ~0~ ~ ~ (~ 1. GENERAL INFORMATION Complete legal description Woebeqon Lot19B Location (site address or directions) NHN Dav,idson Drive, Chug~ak Property owner Joel Babb Mailil~gaddress ~P_O_ P,~ 774Pq3~,_~Eagl~ R4v~r: AK [_e~din~ agency N/A Mail~g add~ess Agent N/A Day phone 694-6685 99_577 Day phone Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: 3 Individual well Community well X Public water 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: X If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 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 Eagle River Engineering Services Phone 694-5195 Address P.O. Box--7JJ294, Ea~!e River, AK 99577 Engineer's signature ~.P~ ~ Date DHHS SIGNATURE X Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date /f - 2/- ?? The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~E~E¢ON I.-.o'¢ /~ A. WELL DATA Well type ~ If A, B, or C, attach ADEC letter. Parcel I.D. QG/~ OSZ-G? ADEC water system number ~./'70 '2/ Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Date completed Driller Cased to Casing he~ht~ . Wires properly protec~c~ed~/N) Well flow '~'~J g.p.m. Pump level SEPARATION DISTANCE~OM~OM WELL TO: Septic/holding tank/or~olot Absorption fiel~ Pu blic,~er main Se/~/er' service line AT INSPECTION MUNtCIPALRY OF ANCHORAGE ENVIRONMENTAl- SERVICES DIVISION lot ; On adjacent lots ; On adjacent lots . Public sewer manhole/cleanout WATER SAMPLE RESULTS: Petroleum tank AUG 2 0 1995 g,p.m. RECEIVED Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HQ~IG TANK DATA Date installed /~//7/42/ Tank size Cleanouts (Y/N) ~/~'~ High water alarm (Y/N) Date of pumpirlg Compartments Foundation cleanout (Y/N) )/'~'-¢ Depression (Y/N) /~"¢ Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ' 'A/'/~r On adjacent lots To property line ~¢ ~ I Absorption field Surface water/drainage ¢'- / ~ ¢) / Foundation ~'~ / Water rhea/service line 72-026 (Rev 7/9~) Fronl CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at j~ Meets MOA electrical codes (~/Ny SEPARATION D_..L~,~CE FROM LIFT STATION TO: Well...p4~ On adjacent lots D, AB§ORPTION FIELD DATA Manufacturer ~ M a n h ole/Acce~.-(-Y/N) .-- "Pump off" level at Cycles tested Surface water Date installed Length ,~ ~' ' Width / (~ / Total absorption area ;~ ¢O Depression over field (Y/N) /V/,,~ Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating (~. q ~.,,¢~,///¢/ Gravel thickness ~..~ · Cleanouts present (Y/N) Date of adequacy test for System type Total depth Z/./¢. / bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /"//,4 To building foundation On adjaoent lots Surface water /"//4 Curtain drain On adjacent lots /' /GO Property line To existing or abandoned system on lot Cutbank ,/V'/,,4 Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature '~~ ' Engineer's Name ,~,~. ~- ,Z~/,/-¢-.¢~ Date_ ~,'//~,/? 3 HAA Fee $ ~_~ O0 ~ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (ROY 3/91} Back MOA 21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage. Alaska 99519-6650 348-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 051-032-~ ~ 1. GENERAL INFORMATION Complete legal description Woebegon, Lot 19B T15N R1W Section Location (site address or directions) NHN Davidson Drive, Chugiak, AK Property owner _Joel Babb Mailing address P.O. Box 774233, Eagle River, AK Lending agency Day phone 694-6685 99577 Day phone Mailing address. Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 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. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: X If community wastewater system, provide written confirmation from State ADEC attesting fo the legality and status of system. ;'2-025 (Rev, 1/91) Front MOA ~21 5, STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 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 Eagle RivEr Enqine6~ring ,qerviceS Phone Address P.O. Box 773294, Eagle River, AK 99577 Engineer's signature DHHS SIGNATURE Approved for ~'J'~---~' (,_~./bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their [ending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev 1/91) BaCk MOA ~21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST If A, B, or C, attach ADEC letter. Parcel I.D. Legal Description: A. WELL DATA Well type ADEC water system number Log present(Y/N) Total depth Sanitary seal (Y/N) Date completed Driller ¢. / '2o / Date of test Static water level Well flew Pump level SEPARATION DISTA~WELL TO: Septic/holding.~ lot~ _ Absorpt~,~d on lot P u ~.~owor main S(~ver service line Cased to Casing height Wires properly prote~_ FROM WELL LO~G' ~.~.A~qNSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~" Nitrate Date of sample: 0~/~'//¢ ~ Collected by: Other bacteria B. SEPTIC/H~'-'C'~,~G TANK DATA Date installed /(~//'~/~ / Tank size / O Cleanouts (Y/N) ~/~¢'f~ Foundation cleanout (Y/N) High water alarm (Y/N) Date of pumping /V/./~ Compartments Depression (Y/N) A//~ Alarm tested (Y/N) /&/gCC., /¢~V~-~ ~,~g;'//) Pumper /V'//~ Well(s) on lot To property line ~' '.~ / Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: On adjacent lots 7L/~¢~) / Foundation 5 Absorption field ~ ~ / Water ma-k'~service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level-- Meets MOA electn'ca~__ SEPARATION D~NCE FROM LIFT STATION TO: Wel?.j~rrl'-ot On adjacent lots Manufacturer ~ Man h°l~evel at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed Length .Z~ 2~ Width / Total absorption area ~ -~_.~ Depression over field (Y/N) ,,%//2 Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) /V/~ Soil rating Gravel thickness ~), 5 / Total depth Cleanouts present (Y/N) · Date of adequacy test /Y'/~ for ~.~ System type If yes, give date bedrooms SEPAFIATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /V/.~ To building foundation On adjacent lots ;~ Surface water Curtain drain /V/./~ Onadjacentlots -/' /~) / Propertyline /'~' ~) / ~'~ / / To existing or abandoned system on lot /v'/~4 Cutbank /~//..z) Water mekq/service line //.~ / Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ;,:;~:: Oi" ¢t,,¢ Signature Engineer's Name HAA Fee $ , CD Date of Payment Receipt Number 72-026 (Rev 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt Number · STATE Of AL~ DEPARTMENT OF ENVIRONMENTAL CONSERVATION '~. :-:TCONSTRUCTION AND OPERATION CERTIFICATE . : [; , ~' ... ~ Plans for the construction or modification of by '- :' · .' :.:":. !: ... :..'~- . PUBLIC WATER SYSTE S ~ '. : A. APPROVAL TO CONSTRUCT :' public.water, system located. ~approved. , Alaska, submitted in accordance with 18 AAC 80.100 ~- 5 : · have been [] conditionally approved (see.attached conditions). . .. ,~, ,.)~.,. BY TITLE If construction has not started within two years of the approval date. th~s certificate is void and new plans and specifications must be submitted for review and ap~ royal before construction. -~_,. - .) APPROVED CHANGE ORDERS :'.:5" Change (conlract old8~ no. or de$~rll)ltVe relerenoe) Approved by APPROVAL TO OPERATE ,, ' ' : " .......... ~'" '=' ~ ''~ C. · ~t~.: . ,..: ~.,?~,~.. ,.,~ .... The "APPROVAL TO OPERATE section must be completed and signed by the Deoartment before an water''~:-'':'-J.; Is made available to the public. ..' The construction of the ' water system was completed on .(d~ granted Interim approval to o~erate for 90 days following the completion date..' -.' ' As but p aris subm tted dur ng the nter m approva period, or an Inspection by the Department, has confirmed '~. '" · · the system was constructed according to the approved pans The system s hereby granted final approval t~ 7.'~[~,: P ~ ..... ~ - · · '.. -:-' ~ .... ',- .. ::~..,.~ ....-. · ~..,, ,l:*-..~vk . ,'-. a' "'" .... ...... , . _ " '~ ':~ -' ' w)J.Z,: X'.,' ,':,' DEPARTM~ STATE OF ALASKA 3F ENVIRONMENTAL CONSERVATION APPROVAL OF ON.SITE RESIDENTIAL WATER AND SEWER SYSTEMS PROPERTY DESCRIPTION This approval does'not constitute a guarantee of any kind, explicit or Implied, as to the performance of the water supply and wastewater disposal systems. WATER SUPPLY A recent water 8ample was tested and found to meet De ,part;me, at of Environmental Conservation drink- lng water standards for total coliform becterla.~.) ~,, ,.~, (~ ~,~?,~J WASTEWATER DISPOSAL The domestic wastewater'eystem was; ', [] Inspected by the Depariment of Environmental Conservatlc)n'and'{ound to b'~ in compliance with ~p~llcabla requirements/, of 1~ AAC 72; "... /' '\,, // ,' ,' [] In~ps~t~d by a Prof~ssional E'~'glneer who ~ertlfls;~ha~/ths system'~,Fm'iles with ao~'licabls re. qu~rameh,ta of ll]/AAC 72; \ "~ /,. x\ // x\ ./ 'x ,.'" [] Installed by'avCsrtlfled Installer whoX~ertil'ies th.et'~he system complies ~h a~llc~5~ls renulrements / \ \ ../ / X . ~ / ',, [] tss!e.,d bX'~ Professional Englnesr wh.C'c~,rtifles that the perfor~.~cce of !l}6¢system la satisfactory an~ m/~l the syet~rg complies wl!~'tl~e m~lmum separation/dt~tEncss,i~peclfled In 18 AAO 72, /-- \ / Thl:/a'ppr°ve' Is valid ~(,~X,[] .'~ngle family ~'tl'femlly,~nit wit h a"'tq~al of bedrooms. DI6TRIBUTION: WHITE--BANKJLENDING INSTITUTION; CANARY--APPLICANT; PINK--DEPARTMENTS SEN'[ BY:ADEC ANCHORAGE ,' ?-13-92 ; 2:11PM ',ANCHORAGE/WE~ERN D0~ §94329~;# 2 DEPT. OF ENVIRONMENTAL CON~ERVATION~ WALTER J. HICK&'L, GOVERNOR ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 July 9, 1992 349-7755 Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 Eagle River, AK 99577 SUBJECT; Woebegon Subdivision lot 19B (property of Joel Babb), PWSID 217071 Dear Mr. Burets: A review of the records and information presently on file in this office indicates that the Class 'C' Public Water System serving lots 19A & 19B in Woebegon Subdivision Is currently in compliance with the provisions outlined by Title 18, Alaska Administrative Code, Chapter 80, (18 AAC 80), State of Alaska Drinking Water Regulations. Specifically Sections 005 through 070 (18 AAC 80,005 through 18 MC 80.070). If the Department can be of further assistance, do not hesitate to call us. Sincerely, Michael Lu, E.I.T, Project Engineer ML/pf Joel J. 13abb & Co. Inc. Real Estate Appraisers AUgust 17, 1993 Lou Butera Eagle River Engineering 11940 Business Blvd #205 Eagle River, Alaska 99577 Lot 19B Woebegon Subdivision Dear Mr. Butera, The above referenced lot was developed in the fall of 1991 by the installation of the septic system & installation of the foundation. ~]e residence was constructed in May & June of 1992 by Michael Quinn Construction. It was completed & initally occuppied by the Alan Jones family on July 7, 1992. See attached lease copy. The tank was pumped in the spring of 1993 by JR's Pumping. My invoice is Dated May 8, 1993. If you have any questions please contact me at 694-6685 (phone/fax) Sincere~, P,O. Box 774233 ' Eagle River, AK 99577 · 907 694-6685 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 8-470 ANCHORAGE, ALASKA 99503 (907) 349-7755 August17,1993 Mr. JoelJ. Babb JoelJ, Babb & Co.,Inc. P,O, Box 774233 Eagle River, Alaska 99577 Subject: Lots 19A & 19B Woebegon Subdivision, Birchwood, Alaska, Class C Public Water System, PWSID Number 218790 ADEC Project Number 9421-DW-228-031; Review Dear Mr. Babb; This letter Is In response to your August 18, 1983 fax In which you requested that the April 13, 1993 "Boll Water Notice" be lifted and a current compliance certificate for the existing water system be Issued, I have reviewed the submitted analytical results end find that the requirements notect In my April 13, 1993 letter have been met. Thus, the Boil Water Notice is now InvaLid, The Department is no longer requiring that all water be boiled prior tO use. With regards to the issuance of a current compliance certificate, I have reviewed the results of all the samples collected from the existing Ciasa C PubliQ Water System, Results from the recent water samples were satisfactory for total coliform bacteria and the results of my sampling event verify that the water is satisfactory for nitrate (as nitrogen), Therefore, for the concerns of this Department, this system is In compliance with State of AlaSka Drinking Water Regul[~tlons (18 AAC 80), Attached is an "Approval of On-Site Residential Water and Sewer Systems" certificate verifying the existing Class C Public Water System compliance. Thank you for your cooperation and coordination with this Department, As noted in the Department's August 6, 1993 letter, if the proposed well is Installed, all items of the letter will need to be met, If y~3u have any questions, please do not hesitate to contact Sincerely, Koran K Kleweno, P.E, District Engineer Enclosure: As Stated KKK/cf · '~UH 17 '9£ 10:33 HORTHERH TESTIH~, AHCHORA~E P. 173 ~agle River ~Dgineer£n9 p.O. Box 773294 Eagle R£v~.r ;%K 99577 Louis Butera NORTHERN TESTING LABORATORIES, INC. 3350 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 9970i (907) 456.3116 * FAX 45~,3t25 ANCHORAGE, ALASKA 99503 {907) 2?7.8378 · FAX 274,9645 2505 FAIRBANKS STREET , . , Report Date: 06/16/92 AZ18082 o~ Lab #'i Loeat£en/~roJect, - woebegon~ Your samP]ie ID: Sample Ma~ri~: Water Date A~ived: 06/1~/92 Date sampled: 06/11/92 Time sampled: 1905 Limit Defini~ions Below RegulatOry Min. Above Regulatory Max. B~low Dete¢~ien Limi% ~stima~ed Value ' Uni~s ~ult F~g 2DL Analyzed Method parameter .... mu/; ~ .......... ~ .................................................. 0.5 06/16/92 EPA 353.3' Nitrat~-N Miorobie~og¥ SuperviSOr DEPT. OF ENVII[ONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, AK 99577 Mr. Louis Butera, P.E. Eagle River Engineering Services PO Box 773294 Eagle River, AK 99577 RECEIVED JUN 2 2 1992 Municipality of Ancl'lorage Dept. Health & Human Services WALTER J. HICKEL, GOVERNOR 563-6775 April 24, 1991 Certificate to Operate, Woebegone S/D, Lots 19A & 19B; 8721-FA-O72, Class C Public Water System ID 217071 Dear Mr. Butera: This is in response to your submittal, received in this office on March 2, 1991, in which you requested a "Certificate to Operate" for a Class C public water system located on the referenced property. I have completed my review of the submitted information and this office's file on this project. The package has been discussed with the District Engineer and the following comments are offered. The Department takes exception to the amount of storage capacity provided. The fifth edition of "Community Water Systems Source Book" cites a need for eight gallons per minute per residence for twenty minutes to meet Instantaneous demand requirements. In this case a total of 160 gallons of water ia required. The well produces 120 gallons in 20 minutes leaving a difference of 40 gallons which should be In usable storage. These figures are for one single family residence. When the other lot is built upon the storage for the other home should be 160 total gallons. As there are no complaints in the Department files concerning the amount of water, the Certificate to Operate can be approved based upon historical sufficiency for the first property. Our recommendation for the storage is a recommendation and not a requirement. Based on the information provided by you and the data certified by your stamp, "Approval to Operate" can be granted. Any future expansion of the water system will require plan review in accordance with 18 Alaska Administrative Code 80.400. In accordance with 18 Administrative Code (AAC) 80.900 this system is a Class C Public Water System. It has been assigned a Public Water System Identification Number (PWSlD#) of 217063. Bacterial and nitrate sample analyses were within acceptable limits set in 18 AAC 80.050 as reported by Chemical & Geological Labs of Alaska. This approval does not imply the granting of any additional authorizations nor obligate any state, federal, or local regulatory body to grant required authorizations. ~ p4nled on recycled paper Thank you for your cooperation with this Department. If you have any questions, please do not hesitate to contact Keven Kleweno. Sincerely, Environmental Engineer enclosures cc: John Smith, DHHS w/o eric.