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HomeMy WebLinkAboutT15N R1W SEC 4 E2NE4SE4NW4T15N, RIWO* Section 4 E2, NE4, SE4, NW4 #051-042-20 ;AB -HDI GRP UER ANCHORAGE AREA BORO*'F M HEALTH DEPARTMENT 1 J 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME C -J `G G—C- tl r� Cr F/EL✓ MAILING ADDRESS IJ�X 3 3 G5� PH ONE LOCATION �rlyl7�/7� IFrei nFSf PIPTlnN N Ie 3�' /,7 2_'Fo'f% C ?CT'.{� SEPTIC TANK: �� /NUMBER OF MATERIAL [ -OJN G/CE� G - COMPARTMENTS — LIQUID FROM WELL LIQUID _ LIQUID CAPACITY 7SU GALLONS. INSIDE LENGTH - INSIDE WIDTH—DEPTH— SEEPAGE IDTHDEPTHSEEPAGE SYSTEM: SEEPAGE PLT: NUMBER.i OF PITS OUTSIDE DIAMETER rte, OR WIDTH -_, LENGTH/ DEPTH / LINING,MATERIAL"[-_U/✓L%fl-"t_• !GnL Z� ,DISTANCEFR M.WELL ^//.1 BUILDING FOUNDATION -`0 6 NEAREST LOT. LINE - .- TOTAL EFFECTIVE ABSORPTION AREA (WALL ARE SQ: FT. �. TILE -DRAIN FIELD: - :- TOTAL LENGTH �. DISTANCE FROM WELL - - �- , FOUNDATIO NEAREST LOT LINE` -; OF LINES - - - 2 '.^ s NUMBER'OF LINES DISTANC EEN LINES TRENCH WIDTH' IN JOTAL _EFFECTIVE,5 ABSORPpON AREA- -- SQ. FT. LENGTH OF. EACH LINE - - DEPTH: TOP -OF TILE TTO�F�14I S�H GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILL WELL:"/ TYPE - - DEPTH 15O DISTANCE FROM - �' WATER -//-- ,BUILDING. FOUNDATION. SAMPLE, NEAREST ` - % LOT LINE SEWER LINE 3s' SEPTIC J /- SEEPAGE QTHER ',TANK -7Z SYSTEMS, �- -, , CESSPOOL SOURCES= -. - - - .- -DIAGRAM OF SYSTEM 9 _11L Arlwa =" n eT ;-. z'F ii � Aoocnvcn �///�/7��LA /1// �A.�i✓J�ill�_. GidEA'I'�� ANCHORAGE AREA :.._.Jf:;sOIJG�-� CaseNu.` IIEAL'I'1i DEPA1V1'A1EN'C Anchors a Akn4a 99501 2-49-251 1 3..7 Eagle St. g + I—i oU U 0 J t! U SEWAGE DISPOSAL SYSTEM _APPLICATI©N A PERMIT NAME OF APPLICANT " MAILING ADDRESS RESIDENCE ADDRESS _ LOCATION OF INSTALLATION _ LEGAL DESCRIPTION /. "2' ----- -- APPLICATION TD INSTALL: SEPTIC TANK SEEPAGE PIDRAINIFIELD_ ITV r —_ PHONE NO 01 HER --- TO SERVE THE FOLLOWING FACIL __ --- FINANCED THROUGH' --__ TO BE INSTALLED BV_ ---- T ANTICIPATED DATE OF COMPLETION_ PERCOLATION TEST RESULTS 1 — BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT PERMIT TO INSTALL A — ---- —" I ttIS IS 10 SERVE AS AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED -- SEPI It, TANK SIZE _ TYPE DISTANCES: , / Ki. - A Health Authority I� cert ify that I am familiar with the requirements of Greater Anchorage Area Borough ordinance No, 38-68 and that the above described system is in accordance pith said code. TYPE SEEPAGE AREA__ `' ' DATE APPLICANTS SIGNAL UBE —.' DL Form 241 WATER WELL DRILLER LOG DO NOT FILL IN 8/66 Drilling Co Driller %•i'/ay'r .. Well Owner ;4onflf7 Location (address of: /Cil, Well No. Permit No. Certificate No. Area Use of Well 11,' - wnship, Range, Section, if known; or distance main road Size of casing Depth of Hole /_5 : feet Cased to l?;' f.eet Static water level 0 ft. (abnve) (below) land surface open end ( V ); Screen ( ); Perforated( ). Describe screen or perforation Well pumping test at i gallons per of drawdown from static level. Was casing collar sealed with cement grout ///- Finish of well (check one) with -^- rt. WELL LOG_ Depth in feet from Give details of formations penetrated, size of material, color, round surface and hardness. TO TO TO TO TO TO /. 7: �L ',� Lai TO TO r" TO /41�� TO i_ TO TO TO Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-042-20 1. GENERAL INFORMATION HAA # 0 3 0 21. Expiration Date: 10-2-03 Complete legal description E1/2; NEI/4; SEI/4; NW1/4; Section 4; T15N; RIW Location (site address or directions) 22469 Deer Park Dr. Current Propertyowner(s) Jim & Carolyn Spearman Dayphone 688-7869 Mailing address Lending agency Mailing address Day phone Real Estate Agent Kathy Geraci Day phone 694-9175 Mailing Address Grpatlan Realt3r 11411 Rld Glann Hr.TEagle Rive_ Unless otherwise requested, HAA will be held by DSD for pickup. a� � � 7 ! g /0 j 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Ei Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. AK 9957 4. 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 Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Engineering _ Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Date 6 /;L 3-103 .OF Additional Comments r ON-SITE WASTEWATER Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: 1& Original Certificate Date: 7-7-0-3 (Rev. 12100) P T 1 ROBERT C. COWAN i ie j �f+ 5. DSD SIGNATURE �'CE-8801 \% Approved for 3 It�e,.���•. bedrooms. ........... Pim"" Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments r ON-SITE WASTEWATER Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: 1& Original Certificate Date: 7-7-0-3 (Rev. 12100) Municipality of Anchorage F_ Development Services Department .° Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L 1/z� A%-: Yy SL �y, Ay/� Yy� SPC S{ %/S y' Rrc✓ Parcel ID: d s/- C)yJ - Z� A. WELL DATA Well type k'lfte If A, B, or C provide PWSID # = Well Log (Y/N) yPs Date completed la/y/69 Sanitary seal (Y/N) %'5 Wires properly protected/N) ""5 Total depth rscI ft. Cased to /S"% ft. FROM WELL LOG Date of test 1 a A'16 2 Static water level 40 /l0 ft. Well production WATER SAMPLE RESULTS: Casing height (above ground) t a in. AT INSPECTION g.p.m. `' -5- 9.p -m. Coliform _Zcolonies/100 ml. Nitrate � o O$ mg./I. Arsenic: 4A mg./I. Date of sample: 7,0'3 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size/ 00 gal. Number of Compartments I aL44 01r irJ cR wi f/'4ci Foundation cleanout (Y No Depression over tank (yo ti"Lt Date of pumping S/d Y/0 3 Pumper -� 2 5 . C. ABSORPTION FIELD DATA Date installed /l 616 Length )U ft. Total depth@ "L ft. Soil rating (g.p.d./ftZ oftZ/bdrr�7(oc Width /4 Other bacteria - ZK� — colonies/100 ml. �tA Collected by: �iN 585E E 17034 Eagle River Loop Road No. 204 Eagle Rivff, � slsa 98577 Date installed /C� �C� 7 Cleanouts (Y/N) Y�5 High water alarm (Yo /NC� System type 0121 0 ft. Gravel below pipe C ft. Eff. absorption area %d`S ftZ Monitoring tube yPs Date of adequacy test ';-/ I ') �V63 Results (Pass/Fail) P'�53 Fluid depth in absorption field before test (d in. Water added 4421 gal. Depression over field vu For 3 bedrooms New depth a 99 in. �.1 1 Elapsed Time: acv min. Final fluid depth �a in. Absorption rate >_ 'V S cJ r g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Pllf K..i0-, If yes, give date /�V117P D. L T STATION Date in [led Size allons Manhole/Ac ss (YIN) "Pump on" lev at in. "Pump ofP' I I at _ in. High water alar level Datum Cycles tested Meets alarm & circuit q E. SEPARATION DISTANC SEPARATION DISTANCES FROM WELLON LOT TO: Septic tank/Bftztatie�et % f�Dhj ('^,,4 On adjacent lots /UU ! Absorption field on lot /00 4 On adjacent lots /ou< Public sewer main 0/4 Sewer /septic service line 3 $- r,�L at Public sewer manhole/cleanout AJIA Holding tank N14 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation St Property line Sy * Absorption field 5-4 Water main A11A Water service line /U f Surface water /oa t Wells on adjacent lots /00 t' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 50 � Building foundation S'V { Water main A,'119 Water Service line /Q* Surface water lou t- Driveway, parking/vehicle storage 5'04- Curtain o+ Curtain drain Mwwe /4 = Wells on adjacent lots Ivo � �KHirilr'd��Y�9 S&,4Ti L 'Toi,..k i0 W✓'c�l G..RRNx1C.4r�fr/lq.7 — irS>A��-:1D _ 196 G. ENGINEER'S CERTIFICATION r ©� .. i ��'+ •..... i Ys t certify that I have determined through field inspections and + a 4+ review of Municipal records that the above systems are ini ' y • n, r conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name �POa@• T C. C©a n�✓ p ROBERT C. COWAN t Fs, a O C, •� CE - 8801 Date G �33- 0 3 HAA Fee $ 3 Z S Waiver Fee $ Date of Payment Receipt Number (Rev. 12101) 6/a -c /oi n -; 7 �`tz Date of Payment Receipt Number 17iA GRAWL DRIVEWAY 329.64' (COMP) I+ 0 /00 ttt^^^ �y 100.3' + � - ino Parcel I.G. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051-042-20 iWMAZI ' ' ►_ • i �i ' 3C�l HAA # O 3 0 -2- � 8 Expiration Date: 0 - 7-0_❑ Complete legal description E 1/ 2; NE 1/ 4; S E 1/ 4; NW 1/ 4; Section 4; T 15 N; R 1 W Location (site address or directions) 22469 Deer Park Dr. Current Property owner(s) Jim & Carolyn Spearman Day phone 688-1869 Mailing address Lending agency Mailing address Real Estate Agent Day phone Kathy Gprari It . . . Mailing Address GrPat1nn Raa1tg1141101r1 Cjpnn P Unless otherwise requested, HAA will be held by DSD for pickup. 7 / 11/0.3 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On -site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On -site ❑ Public Water System ❑ Public Sewer ❑ AK 995' The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on -site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on -site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on -site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Ea le River, AK 99577 Engineer's Printed Name Robert C. Cowan Date /xr%3 h........... ,1x t ,5NGINE d.�, � } ti 7s ROBERT C. COWAN 2 5. DSD SIGNATURE t `moo s CE - 8801 Approved for 3 bedrooms. Disapproved. r Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory OF Jam: ON -SITE ``-�► : IAIAT= AN WASTEWATER ; ,.. s - snnt+n n n a - '�NT SE&) Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 7--7 " O.3 (Rev. 12100) Municipality of Anchorage • ''� Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L '12- NL ��� ` SL Y, A4�1V41,' .SA 'S' %/S.v; R1L✓ Parcel ID: CS-/" U`f,� — Z� M A. WELL DATA Well type �-+'Itte If A, B, or C provide PWSID # Well Log (YIN) yes w Date completed 1) 1%/� Sanitary seal (Y/N) 0 Total depth IS�� ft. Cased to /9g ft. FROM WELL LOG Date of test I a A-16 5 F Wires properly protectedo/N) Casing height (above ground) a in. AT INSPECTION '5 /,� srv� Static water level ft. Well production 7 g.p.m. WATER SAMPLE RESULTS: Coliform „i colonies/100 mi. Nitrate II.0?) mg./I. Arsenic: 4A mg./I. Date of sample: 5LZ710-3 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size gal. Number of Compartments f Foundation cli Depression over tank (.Y& A`e_1 Date of pumping Pumper -� S I - ft. s• Other bacteria colonies/100 ml. Collected by: c 2A 'h S & S ENUINEEKINU 17034 Eagle River Loop Road No. 204 Eagle Riw A?s{yaa g577 Date installed Cleanouts (Y/N) Y`'S High water alarm (Y/4� /jam C. ABSORPTION FIELD DATA Date installed I / 616 ` Soil rating (g.p.d./ft2 o ft2/bdr tov System type C1,2 r Length )o ft. Width t ft. Gravel below pipe C ft. Total depth 01 `IL ft. Eff. absorption area 410'�4 ft2 Monitoring tube ,yF�, Depression over field AlU Date of adequacy test /a *16.3 Results (Pass/Fail) pis For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added S%71 gal. New depth a 9in. Elapsed Time:dC) min. Final fluid depth �t in. Absorption rate >= —'/' SU - g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date '►E 1iaL"ll�-� :) l3 Y � v ►I�iWG — & I D. LIFT STATION Date in Iled "Pump on" lev at Datum E. SEPARATION DISTAN Size i allons — in. "Pump oft' I I at. Cycles tested Manhole/Acipss (Y/N) _ in. High water alarn\level at Meets alarm & circuit SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/liftsteies-sa-let 7� j°"' �r7°" On adjacent lots Absorption field on lot /CN O + Public sewer main! Sewer /septic service line /vJr On adjacent lots pouf ents? Public sewer manhole/cleanout Holding tank A)Ilfj SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main ,✓/A Wells on adjacent lots /0c1 r Property line fir) r Absorption field S Water service line /U � Surface water �Uc' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line -G) � Building foundation �-O' Water main Water Service line 16 t- Surface water loci t- Driveway, parking/vehicle storage Curtain drain Nv''f F. COMMENTS Wells on adjacent lots ivi i(- 5 T-, L T.J-k r 0 w4,1,L OF G. ENGINEER'S CERTIFICATION :.�°........ 0 I certify that I have determined through field inspections and review of Municipal records that the above systems are in t �� conformance with MOA HAA guidelines in effect on this date.- r� �.♦ .f• .. ... .........fir.... �.ILI� Engineer's Printed Name /�� /3�•� T C, Ci�a. �t�✓ �F,� ROBERT C. COWAN 19 . Cr. - 8801 Date HAA Fee $ 3 7 Waiver Fee $ Date of Payment �' ( Date of Payment Receipt Number c -37 Receipt Number (Rev. 12101) in. Municipality of Anchorage � Department of Health and Human Services 1 �41 Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel I.D. 051-042-20 1. GENERAL INFORMATION Complete legal descriptionE 1 / 2 , NE 1 / 4 , Location (site address or directions) HAA# Expiration Date: SE 1/4, NW 1/4, Section 4, T15N,R1W 22469 Deer Park Drive Current Property owner(s) Matthew Nolin Mailing address 22469 Deer Park Drive, Lending agency Mailing address Real Estate Agent Mailing Address Day phone Chugiak, AK 99567 Day phone Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well X1 Individual On -site Individual Water Storage ❑ Individual Holding Tank Community Class Well ❑ Community On -site Public Water System ❑■ Public Sewer 688-0252 i n The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates c- Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independer- professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval arz- required for the transfer of title (except between spouses) on properties served by a single family on -sit= wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served 'c. a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificatez are valid for one year for properties served by Class A or B wells or a public water system. The Municipaii'_ of Anchorage is not responsible for errors or omissions in the professional engineer's work. -2 ,hov I! oui" As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show that the on -site water supply and /orwastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated heroin. | further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inopeotion, the on -site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name ofFirm S&SENGINEERING phone � *ooreon Engineer's Printed Name Robert Q. Cowan usOe ' tNG va- .27ik-, O. DHHS SIGNATURE Approved for bedrooms. Disapproved. ---_ Conditional approval for bedrooms, with the following stipulations. Additional Comments Attachments: HAACheck|iSt Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other Bv� [}hginEd Certificate Date: EXciraticin Date: Reissue Date: 7z�Oz .ne`n,00r Municipality of Anchorage R E C E I V E • �Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 S E P 2 2 2000 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us MUNICIPALITY OF ANCHORAGE (907) 343-4744 ENVIRONMENTAL SERVICES DIVISION HEALTH AUTHORITY APPROVAL CHECKLIST egal Description: NE V y S 1 '41 At w Vy , 94e_;14,v y r 1v , Ri +�' Parcel I.D.: US- / -Otia - A WELL DATA Well type j'RI 1/4 T F_ Date completed )-11*69 Total depth / S t? ft Date of test Static water level If A, B, or C provide PWSID # = Sanitary seal YG J Cased to ) ,q ft FROM WELL LOG %/o ft Well production WATER SAMPLE RESULTS: 9-p.m Well Log Wires properly protected 'Y -S Casing height (above ground) i 3 in. AT INSPECTION 0)/'s/CC. j� ft �° • �� f g.p.m Coliform D colonies/100 ml Nitrate (% `i 1 < mg/I Other bacteria 0 colonies/100 ml Date of sample: "0 410 c Collected by: S & S ENGINEERING . SEPTIC/HOLDING TANK DATA 17034 C-:.,,r Loop Road No.204 Eagle River, Alaska 99577 Tank Type/Material St•";' C_/ CAN Date installed )I/ 06`1 Tank size '7 S gal Number of Compartments Cleanouts yEs Foundation cleanout Depression over tank N e High water alarm N `' Date of pumping `t % -e/ cc Pumper s . ABSORPTION FIELD DATA Date installed t' / G 1,6 % Soil rating (g.p.d./ft2 ork 2/bdrm 100 System type C, 1 13 Length )-0 ft Width ) I ft Gravel below pipe 6 ft Total depth 9 �.Lft Effective absorption area W 5 ft2 Monitoring tube yEs Depression over field Date of adequacy test 9//ego; Results Pass ail) A4S-s For -3 bedrooms Fluid depth in absorption field before test a i `I in Water added J� 7 7 gal. New depth 3 "3 in. Elapsed Time: I G% min Final fluid depth 3t t i 0 in Absorption rate >= y s U g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) IJ6"' 4- K^' 'V, If yes, give date 72-026 (Rev. 01/00)' 0 D. LIFT STATION Date installed Size in gallons "Pump on" level at in "Pump off" level at _ in Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot -7 A ( " -,;''4' 1:" O) adjacent lots Absorption field on lot / 0 a �4" On adjacent lots Public sewer main Manhole/Acces High water alarm level at in Meets alarm & circuit requirements /Oo '4 Public sewer manhole/cleanout Sewer /septic service line P_S 4 Holding tank N /R SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation S Property line g 0 �t Absorption field Water main H 44 Water service line / Q � Surface water N / .4 Drainage to /,+ Wells on adjacent lots /'00 + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r Property line �� f Building foundations �' Water main N lA r,% / sq i j �- Water Service line / 0 f Surface water 0 Cl` t Driveway, parking/vehicle storage f- Curtain drain ��^' k�''`=� " Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name RD 6,�,g-r C Date Ci / a' a'' / o C. HAA Fee $�O Date of Payment Receipt Number hb3cy 6D 72-026 (Rev. 01/00)' Waiver Fee $ Date of Payment _ Receipt Number P�vr.041 A, �. p ROBERT C. COWAN •• f CE - 8801 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. # HAA # 1. GENERAL INFORMATION Complete legal description Ek;NE!4;SE%;NWk; Sec. 4; T15N; R1W Location (site address or directions) 22469 Deer. PdAk D4AVe Chuciiak, AK 'Property owner Matthew Notin Day phone 688-0252 vailing address' PA., Box 190452 Ancho-.age, AK 99519 , Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 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., 'V, 4. TYPE OF WASTEWATER DISPOSAL: Individual on -site XXX Holding tank f r. 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. 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. S & S ENGINEERING ly-.19 -7cl Name of Firm I/ EA916 River LOOP Koad No. 204 Phone / cl Address Eagle River, Alaska 99577 Engineer's signature Date S-/-17 / c) p. .0 ... . ...... OF C2 X ROB RT r- COW;r4 J* Ile 6.DHHS SIGNATURE _X Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments V_ Date 'P CAUTION -,,-The M6Aibip#Iity of Anchotage Department of Health and Human Services (DHHS) issues Health Authority Anchorage only ' Approval Ce"Oificate�� upon the representations given in paragraph 5 above by an independent P rofessionai enginee , r L registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes ' �J' and their lend ingiAstitutions 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 Environmental Services Division 825"L" Street, Room 502 *Anchorage, Alaska 995010 (907) 343-4744 Health Authority Approval Checklist Legal Description: ��L , �� L 14, S L— '14 t�,4 Parcel I.D.: () 5- 1 , f� Ll )L A. WELL DATA t Well type 1?(Z �y Arrr,-- If A. B. or C, attach ADEC letter. ADEC water system number Log present 61) 4 Date completed - a - t.Cl Total depth 1S0' Cased to 144, Casing height (above ground) 90 Sanitary seal (91) _ y Wires properly protected (PN) FROM WELL LOG AT INSPECTION �0- JrJPr6�C � Date of test S krti- Static water level t) IL Well production 9-P.M. (D 9— P.m-WATER SAMPLE RESULTS: Coliform Nitrate D, 7iS Other bacteria C-) Date of sample: S - L —5le Collected b_v: S & S ENGINEERING Eagle River oop oa No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 -r * Date installed Tank size 1 baa Number of Compartments Cleanouts (�1) Foundation cleanout (Y/-, Depression (Y�� High water alarm (Ygl Date of Pumping Pumper Sn TafL LoLo�-� „i K,(` C. ABSORPTION F L)�J DA A�µrt 0 /ccc C-AL Date installed I I 't--C,I Soil rating (g.p.d./ft` or ft'/bdrm) d�� System type Length Z, Width Gravel thickness below pipe L. ` Total depth cl.51 Effective absorption area �as Monitoring Tube present(LDN)-4— Depression over field (YO) AJ Date of adequacy test ! (o -9 L Results 4Ea ail) &laSS For 3 bedrooms Fluid depth in absorption field before test (in.); ID 4 Immediately after ?20 gal. water added (in.): ly Fluid depth 1-0 ~ (ins.) Minutes later: 95? Absorption rate = Y, —O g.p.d. Peroxide treatment (past 12 months) ()o IJ0eJE 1-da )lAf yes, give date '` A D. LIFT STATION Date installed Manhole/Access (YIN) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump on" level *Datum "Pump off' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: �k Septic/holding tank on lot "So ; On adjacent lots tt>a Absorption field on lot 1 ba`k ; On adjacent lots Public sewer main �l Public sewer manhole/cleanout �k Sewer /septic service line 2S Lift station p. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10 Property line \0 kk Absorption field \o Water main/service line to 'd- Surface water/drainage 1 o a '� Wells on adjacent lots \ o SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation \ V kk- Surface water \o fl .k Curtain drain r1 F. ENGINEER'S CERTIFICATION Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots \-0D0P Property line \ t7 1 + 1 certify that 1 have determined thru field inspections and review of Municipal records[�i�bo�e� 3j11q(ms are in conformance with A10A H.L4 guidelines in effect on this date. ��..••• ""•••. �S f.Ql�t Signature01 �C_ . �t✓z-1;� ' 0Ai W�1 ••.. {.14 .S's. •.� Engineer's Name W U P i ti T C C, t",4," ;0 d.. RO •�.M.r... ROBER7 C. COWAN Date `� �• CE - 8801 ' HAA Fee $� 7- Date of Payment Receipt Number �a d 0 Waiver Fee $ Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc 263.9' + a Q N M 6' C,L FENCE 9Tp- PII.PE t � C c r@ o i k2' e EXISTING °fie �a HOUSE c' ram{ �, WELLO „f i � /6s c u 5 00°05'35"E 659.4 (COMP) AS BUILT SURVEY E. 1 /2, NE 1 /4, SE 1 /4, NW I /4, SEC. 5/29/03, F8 58-75, SCALE I "e 50'. GRO M Mi R= D. Fling LS-5773 r�► arpfs.. M...et t.0 +1 a3 n b.vy ,j.pl^W W AYM3Iiltlp RM1tltl9 (dW00) ,0'6Z£ 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 l.D.# 051-042-2.0 HAA#tA4i�icl�''z 1. GENERAL INFORMATION Complete legal description T1gN a1w S P r a Finn of N16n' of SW4NW4 Location (site address or directions) 22469 Deer Park Dr Chuaiak Property awner...a?'''`RW Robinson Day phone 688-2910 Mailing'wddress-'z�* 12-0- Rnx 670309 Chugiak AK 99567 Lending agency Day phone Mailing'` address ., Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well X 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 X Holding tank Community on-site Public sewer iy NOTE: if community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Fiw.1191) Front MOAN21 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 KND Engineering Phone 696-6111 Address 90441 Ptarmigan B1 u Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments — Date 11 11141/94 bedrooms, with the following stipulations: By: (-�*+ V�"' L--/!��' I Date- ',,The ate—',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 orderto 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. < M4025(Bev.1R1) Beek MOAP2f ....* . ® Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST T15NRIl4 Sec 4 Legal Description: E 300' of N 630' if Si•14NW4parcell.D. 051 -042 '0 A. Well Data Well type I n d i v i d u a 1 If A, B, or C, attach ADEC letter. ADEC water system number N / A Log present (Y/N) v Date completed 9 14 i Fg Driller MIJ Total depth 15 0Cased to 14 4 Casing height 9" Sanitary seal (Y/N) v Wires properly protected Date of test Static water level Well flow Pump levell FROM WELL LOG 12/4/69 11 n' 7 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 72' (MOA. f i t Absorption field on lot 1 n n I + ; On adjacent lots 1 n n' + Public sewer main N / Fl Public sewer manhole/cleanout N / A Sewer service line 251 + Petroleum tank N WATER SAMPLE RESULTS: Corrform Satisfactory Nitrate 0.88 mg/1 Other bacteria 0 Date of sample: 1 1 1 3 and 1 1/ 1 0/ 9 4 Collected by: g N n F n g in e er i n g B. SEPTIC/HOLDING TANK DATA Date installed 1 1/6/69 Tank size 1 0 0 0 gal Compartments 1 Cleanouts (Y/N) v Foundation cleanout (Y/N) v Depression (Y/N) N High water alarm (Y/N) N / A Alarm tested (Y/N) N / A Date of pumping 9/23/94 Pumper Sanitary Pumpers SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 72 ` ('i0A f 1 e6n adjacent lots 100' + Foundation 7' ( MOA F 1 e ) To property line � n I + Absorption field 4 3 ' (M n A) Water main/service line 251+ Surface water/drainage 1 0 0 ' + 72-026(3W)•F=t CONTINUED ON BACK PAGE AT INSPECTION o z 11/2/94 T c $ n enable to remove w--(', se -el 0 3. 35 g.p.m.< V co m n z rry a r. p x C7 <$ om z On adjacent lots 1001+ Absorption field on lot 1 n n I + ; On adjacent lots 1 n n' + Public sewer main N / Fl Public sewer manhole/cleanout N / A Sewer service line 251 + Petroleum tank N WATER SAMPLE RESULTS: Corrform Satisfactory Nitrate 0.88 mg/1 Other bacteria 0 Date of sample: 1 1 1 3 and 1 1/ 1 0/ 9 4 Collected by: g N n F n g in e er i n g B. SEPTIC/HOLDING TANK DATA Date installed 1 1/6/69 Tank size 1 0 0 0 gal Compartments 1 Cleanouts (Y/N) v Foundation cleanout (Y/N) v Depression (Y/N) N High water alarm (Y/N) N / A Alarm tested (Y/N) N / A Date of pumping 9/23/94 Pumper Sanitary Pumpers SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 72 ` ('i0A f 1 e6n adjacent lots 100' + Foundation 7' ( MOA F 1 e ) To property line � n I + Absorption field 4 3 ' (M n A) Water main/service line 251+ Surface water/drainage 1 0 0 ' + 72-026(3W)•F=t CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons— Vent (Y/N) allons_Vent(Y/N) High water alarm Meets MOA elect SEPARA Well on" level at codes(Y/N) DISTANCE FROM LIFT STATION TO: D. ABSORPTION FIELD DATA adjacent lots ss (Y/N) "Pump off" Level at Cycles tested water Date installed 11 //6 /69 Soil rating (GPD/Ft2) I n n s f System type e Q o ., pit Length 2 0 ",)^.0 A) Width 14" (MOA) Gravel thickness 6( M 0 A) Total depth 9- 5' o r n h e d Total absorption area 408 s f Cleanout present (YIN) y Depression over field (YIN) N Date of adequacy test 1 1/2/94 Resufts (pass/fail) P a t s for 3 Bedrooms Water level in absorption field before test 3311 After test 3 3 " Peroxide treatment (past 12 months) (Y/N) N n If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1 1 5 ' On adjacent lots 1 0 0 ' + Property line 20 ' + To building foundation 50"+ To existing or abandoned system on lot N / A On adjacent lots 10 0 + Cutbank P 0 1 Water main/service line 29, + Surface water 1001+ Curtain drain 100'+ E. ENGINEER'S CERTIFICATION parking/vehicle storage area 50' + I certify that t have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. o<li \, j,•1,, Kenneth M Duffus Signaturet a KND En Merin Engineers Name 9 i 9 Date 11/14/94 HAA Fee $ '.30 o- Uy Date of Payment //�/A L / Receipt Number F4.3 C Y ?S) 72-026 (393)' sack Waiver Fee $ Date of Payment Receipt Number PM61- /� 0 SF_ E SM T 6<-7/0, P& 972 i i , 6'k' jXEI Z NNSE'. F4 WEL-t-- /2 r _ f5°46d [�AM P o yam,; z It x U �i p lw -'s p. �t - P /4, SEA. 41 771 S'AA, W SM . in tj Ifj • .�, IMF M FLEMING SURVEYING SERVICE$�T 8221 DEL STREET ANCHORAGE, ALASKA 99502 PHONE 243-4890 O //i /a •,• .; Vriu3 D. M�It-g a :: •. LS- 5/i3 .• 'y'� NOTES : Easements not appearing on record subdivision plat are not shown unless description of easement is provided by client. it Is the responsibility of the owner or builder, prior to construction, to verity proposed building erode relotive to finish trade and utilities connections, and to determine the exiettnce of any 009ements, covenants, or restrictions which do not appear on the recorded subdivision plot. Elevations based on assumed datum unless otherwise inditated, and bearings and distances are record data. CLIENT 5 5� S '- AJG1AJ,, LEGAL DESCRIPTION A: rc./O DATE SCALE FIELD 8K. I GRI D io /9p / "! /00� 13 - s ;N�/ 1558