The URL can be used to link to this page

Home My WebLink AboutRIVER VIEW ESTATES BLK 2 LT 2Riverview Estates Lot 2 Block 2 #050-.721-13 Municipality of Anchorage Page _ DEPARTMENT OF HEALTH AN[) HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. E~,ox 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~g.-I ~}~:~d2i"~-- PID Number:. Wastewater System: Address: LEGAL DESCRIPTION Lot: ~ Slock: ~,~ Subdivision: Township: Range: WELL: (~ New Classification (Private, ;): Driller: Yield: J Pump Set at: GPM [] New ~"~4.J pg rade ¢:t~5.(,,fCF ABSORPTION FIELD [] Deep Trench ,~Shallow Trench f3 Bed [] Mound [] Other Soil Rating: ~' ~ GPD/Sq Ft Total Depth from original 9rade~:~ ~ e bottom hem originalgrade: Grave~ depth beneath pipe ~7.~ / Ft Fill added above origi al grad Ft. J '~'~/Ft [] LJpgrade ~ ~Ft Date Drilled: Static Water Level: Installer: .~,-~-- '~f Oate installed: ¢ . %i F, TANK SEPARATION DISTANCES [] Holding [] S.T.E.P. anufacturer: Capacity in gallons: Remarks: BENCH MARK Location and Descript[om Assumed Elevation: 17034 Eallle River Loop Road, No. 204 Inspections performed by: ~agleRl~er,~Alaska99577 Dates: Department of Healtlva~Humaf~ervices approval . vi w d a.d a rov d * 0.,e: / ;15 72-013 (Rev 9/91) MOA 25 Permil No. ~"~ ~'~--? ~ ~''~-~~ Page 7.-'"' _of ~ Municipality of Anchorage DEPAR'rMENT 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 Legal Description.'~_','d,~-~/Id~,¢~) ,~"',c~"t"t?..,~, t:~ ~,.-, )~,~ ~-- PID No,: ~.'.?~'~::::2~ ~-II ~..~_ 12-013 A (Rev. 9,91) MOA 25 PAGE 1 OF 1 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 (UPGRADE) PERMIT PERMIT NUMBER:SW930012 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:ALASKA USA FEDERAL OWNER ADDRESS:P.O. BOX 196613 ANCHORAGE, ALASKA 99519-6613 DATE ]iSSUED: 2/08/93 EXPIRATION DATE: 2/08/94 PARCEL ID:05072113 LEGAL DESCRIPTION: RIVER VIEW ESTATES BLK 2 LT 2 LOT SIZE: 61689 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALI, 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 (18AACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING S]?ECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: January 18, 1993 ROBERTSHAFER, P E ROGERSHAFER. PE CIVIL ENGINEERS (907) 694-2979 FAX 69,!. 1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELl INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIl TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT.OF HEALTH AND HUMAN SERVICES 825 L. Street Anchorage, Alaska 99501 REFERENCE: Lot 2, Block 2, River View Estates Request you issue a permit to upgrade the septic system serving the reference property. For purposes of performing an adequacy test a monitoring tube was installed within the existing leachfield. At this time we found the leachfield saturated. Since the house is currently vacant we suspected groundwater intrusion and excavated a test hole nearby. We did not find groundwater within the test hole, however, we did find the existing system encroaches bedrock. To complete a septic upgrade design we additional test holes on January ll, 1993. proposed upgrade design. excavated two Attached is the We do not anticipate any adverse effects on neighboring properties by the installation of the proposed system. If you require additional information to complete your review please contact us. Sincerely, 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 I I"= 40' J UPGRADE I SCALE ~ 8 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TES'D DATE PERFORMED: 1 2 3 4 5 6 7 8 9 10- 11 13- 14- 15- 16~ 17- 19 2O Township, Range, Section: SLOPE IF YES, AT WHAT DEPTH? Oepth to SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ['¢p' ''¢~ (m~nutes/mch) PERC HOLE DIAMETER TEST RUN BETWEEN ~'~ FTAND ~" COMMENTS PERFORMED BY: 5 & S ENGINEERING ~ 17034 Eagle River Leop Road No. 20~ ACCORDANCE WlTl~.~b,~"~'~A~/~/~,f,.i~ ,J~l~,~'/~ GUIDELINES IN ?2-00S (Rev, 4/85) CER1 IFY THAT THIS TEST WAS PERFORMED IN EFFECT ON ~ HIS DATE. DATE: \~"~-'¢\ ~2~3 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: J~/-"" L)~,~' ~"~---.,L-~ DATE PERFORMED: Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 13- 14- 15- 16 17 18 19 2O COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN PERFORMED BY: S 8, $ ENGINEERING 72-008 (Rev, 4185) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: \ _,.~__\ ~c:~ ~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION 'rEST LEGAL DESCRIPTION: L.--'~- ~"~- "'~.~__.~'~J ~ ~:A,~ Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS SLOPE SITE PLAN WAS GROUND WATER , I ENCOUNTERED? ~ DEPTH?IF YES, ATWHAT E Depth Io Water ADer Monitoring? ~:::~"'~ Date: Gross Not Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ {minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN__"~ ET AND ~' FT PERFORMED BY $ & ~; ENGINEERING , ~ ,,./~ · i-~§~~o~ ~o~1 No. 204 ._t ACCORDANCE WlT~bk~,~~ GUIDELINES IN EFFECT ON /HIS UA1.. 72-008 (Rev. 4/85) CER] IFY THAT THIS TEST WAS PERFORMED IN °ATE: \ 71' MUNICIPALITY OF ANCHORAGE Hea .h and Environmental Prote ion Fourth Floor West 825 L Street Anchorage, Alaska 99501 279-25].1, x 224, 225 IJ)ISPECTION REPORT ON-SITE SEWAOE DISPOSAL SYSYEM SEPTIC TANK: DIS1 ANCE FROM WELl_ NUMBER OF MA I-ERIAL COMPARTMENTS LIQUID DEPTH LIQUID CAPACIT'Cj''~° O_ GALLONS. TILE DRAIN FIELD: ~J-/.~7~ ' TOTAL LENGTH DISFANCE FROM WELl ......... FOUNDATION ...... Nt:ARESI LOT LINE .......... OF LINE ~ ~_,F/ ~ O~ ~S .~ DISTANCE BE1WEEN LINES ..... TRENCH WIDTFI~IN, TOTAL EFFECTIVE ABSORPTION AREA.:~.G~J __ __ SQ. FT. LENG'FH OF EACH L,NE DEPTI{ OF FILTER / t ~/ DEPI}I: TOP OF TILE TO FINISII GRADE ....... MA-~ERIAL bENEATH TIL_E ~ .IN. ABOVE TILE__~ __.IN. SEEPAGE PIT~ DIAMETER __ OR WIDTH___, [_EN6 l'H___, DEPTH Log Crib Rings Crib Size: DIAMETER .... DEPFll .... DISTANCE FROM: WELL TOTAL EFFEGTIVE BUILDING FOUNDATtON ~., NEAREST LOt t_INE ........ ABSORPTION AREA (WALL AREA) S~. FT. Well Class: Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: ~ of Bedrooms: Installer: Remarks: rE;El:IL. [;:I:::IT:[F,IG ,::rE;6! F"I"/E:R:: ..... 'FHI:: I~l:iih,l~.'."i"f'l'"l I'::,:[I'"IEN~i;]:CII'.,I :[!:_:; THE L. Ei',IG'TH '::IN F'I:.ET::' O1::: THE 'I'I4:IENCI~I OF;! DI.?.I::~];I",IF:'IE~I..E:,. FI~IIE DIEF:'TH CII::' [::1 'f'F~'.I::I",IC:H O1:;~: I:::'IT ]:'.!~', 'f'l-II~ I::,I!~;Tlai",IC:E: E~[C'I'I,JIEIEIq TI"'II!E :!~;I...ll:;;'.l:::'l:::ll::Jii!: O[:: 'Fl"l[!!: I:iI:;::I:ILIN[> I::11",11::, THE: I!E[I:)T'I'OI"I t'I"ItEF~:[E: :l::il; 1"4CI :E;E:'I' I.,]IDI"H I::'O[;;'. I"I-'IE: GI:;~:FIVI:'_:.L. I::,EF'TI~I :['.:¢ THI: I'I:I:N:[I"II...II"I I:)[i:I:::'TI-~ Eli::' [aF,:FIVEI_. E~E:TI.41?:[:i",I THE: OUTI:'F~L..L. PIF'E FIN[::, 'TH[E BOTTCII"I O1:::' THE: lii:',='~',CF:IYF'I~I' ]; ON (:[Iq F:'EEiT). :[ C:[~I:,~:TIF'¥ "I'I-IFIT :L: ); I:::IH F:'FII"I:I:I...IFIF~'. I.,4:[TH THE: F['.E(;:!U'I:REMENT'.5 FOR ON-"SI'f'E: S~;[~:I,.IE:I;~'.S F'CIi:4'.'I"H E~"t 'T'HIE I'"IUI'.,I:[E:ZPF:IL. IT"r* OF' I:~I",IE:HO[~:I:~G[~:. 2.: ]1 I,.I :1: L.L.. I N:E;TI::IL.I... 'THE; :E;"r'~(;TEP1 ~ I",1 [:ICC:EIRDFIIqC:E I.,.I I TH 'FIDE; 1:[:: ]: UF,IDE;I:~r~;"I'I:::IN[;, '['ldl::lT THE ON'"-~;Z"I'IE 5EI.4E[~: %'¢':J;TEIq FIR"r' F;:E6:iUIF;'.E: ENL.[~I;;'.EiEME:N'[' IF:' THE RE::5 ]: I:)IEi",IC:E I :E; I:(:EI'dCID[EL.E[) '1'O :[ I",ICLUD[E f'IORE 'FI-fi:IN ,::[ E~E[::,ROOI"12;. I:::~'~':'[... I C:FII",I'I" ..:rEIHN C:[~.CI.~;.~; · OErE 694 2774 Soils Et Foundations Perfo~ned for: Lega] Descriptten: 0 GEO', .-:CHNICAL ~ DEVEL, Box 90, Davis St, Eag e River, Alaska 99577 694-2774 or 688-2280 ?MENT CO. Ear/Ellis SOIL LOG 688-2280 Land Devdoprnent Name: ..... _~._,A , ~_0.%~ ..... ]el. No. Matltnp Address: "~ ~k~X ~Y~, ~ t~- ~ Soil Characteristi~ 8 ].2~__ ~. Ground Water Encountered: No ........ If yes, what depth_~(P_, Proposed Installation: Seepage Pit_ ..... Drain Field SUBJECT DATE Redi~rrn ® ~ SEND PARTS I AND 3 WiTH CARBON INTACT 4S 46¢) PART 3 ~ILL BE RETURNED WITH REPLY Pol¥ Pak (50 sel~l 4P469 DETACH AND FILE FOR FOLLOW-UP Municipality of Anchorage Department of Health and Human Services 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 CERTIFICATF OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# ,'~¢/3~P, ~L3 ,P Expiration [)ate: Parcel I.D. 0 5- O ---~,~,/ -~ 1. GENERAL INFORMATION Completelegaldescription Lot 2, Block 2, RJ. verv±ew Estates Location (site address or directions) NHN Waterfall Drive Current Property owner(s) Hary Jepson Dayphone 564-5504 Mailing address H'C85, Box 9884, Eagle River, AK 99577 Lending agency Mailing address Day phone Real Estate Agent Day phone Mailing Address Unless otherwise requested, H AA will be held by D HHS for pickup. HAA picked up by: 7/Z~'*/Z NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) 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) on properties served by a single family on-site 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 propedies served by a private or Class C well and may be reissued with new water sample results less than 30 days old. 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. 72 025 ~Re,., 01 091' 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 based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Engineer's Printed Name S & S ENGINEERING Name of Firm__~TJ~ F~gle ~iver Loop Roa'4 No. 204 Phone Address Eagle River, Alaska 99577 DHHS SIGNATURE Approved for __ Disapproved. Date .~...-~ .... ~ ,., ~-*-.;,/.,,¢f,,,,X,,..¢,,.~.,..,,,:,... ~ bedrooms. '¢.~. ', ~-' ~*~' ..'.~' ~ Conditional approval for ~ bedrooms, with the following stipulations.'';~:;~ Additional Comments Attach ments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: Original Certificate Date: Reissue Date: 75 025 iRev OI RECEIVED Municipality of Anchorage. MAY 18 DEPARTMENT OF HEALTH & HUMAN SERVICES ' ' ~, ' ' ' MUNICIPALITY C)F ANCHO Environmental Servlceo Division o ~1~ 825 L Street, Room 502 · Anchorage, Alaska !)9501 · (907) 3-43:z~744- ' Health Authority Approval Checklist / ¢/,-, A. WELL DATA Well type Log present ('~') ,~/O Date completed "?-- / ¢' ¢ ~ Total aepm / ~.~,, /~z_ Cased to ~7z'E:)/'/- Casing height (above ground) Sanitary seal (Y/N) ~f/~,,~ Wires properly protecte~;~N) FROM WELL LOG Date of test / Static water level ,.- Wel 3roduction // / WATER SAMPLE FIESL _TS: AT INSPECTION / /4- g.o.m, g.p.m, Coliform O Nitrate ~ . I (, Other bacteria O Date of semele: "'-/11 / ~ o Collected by: $ & S I-'-N61NEERIN6 17034 Eagle River Loop Road No. 204 B, SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed ~./~-~/~,,.,'¢Tanksize// /J~)O ~lumber of Compartments ~- Cleanout~,~N) Foundation cleanou,~N) t¢-~'~ __ Deoression (Y~ //,,/(~ High water alarm (Y/N)_ Date of Pumping ~,~/~/~7~ Pumoer ~,'"~'~.~ / / C. ABSORPTION FIELD DATA Date installed ~/~.~'~/¢~ Soilrating rf¢/bdrm) ~),~ Systemtype ' ' ~-'~ / *'7--,¢E':¢,./ Length /,~Z Width ~ Gravel thickness Od,OW pipe ~.. Total depth Effective absorption area ,~'¢~-,~'¢TMonitoring Tubeprese~N)~_ Depression over field (Y~) Date of adequacy test'"!z~'/~/~-/./¢ ¢ Results (Pass/Fail) <~/'-'-'-'-'-'-'-'-'~ For _~_'~,~/~- bedrooms Fluid depth in absorption//field before test (in.); ,.~ ~/~,/' ~ Immediately after~'~:Jal, water added (in.): 4~// // Fluid depth _ (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72r026 (Rev. 3/96)* Absorption rate = If yes, give date g.p.d. D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested ./~ //,¥' / Size in gallons / .,.,,/~"Pump on" level at* *Datum / "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /~ / '/-- Absorption field on lot Public sewer main /V //'~' Sewer/septic service line 2~--/.~z On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station ,/ET~) ./- Wells on adjacent lots SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~_/"/- Property line ~- /'/'- Absorption field Water main/service line /(~ /'/- Surface water/drainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / (~ / '/-' Building foundation / (~) /M- Water main/service line / O / Surface water / O ~) / .:¢- Driveway. parking/vehicle storage area Curtain drain /',_ /o /k/ ~-- //~/a-~//V Wells on adjacent lots /oo /,/- F, ENGINEER'S CERTIFICATION I certify that l have determined thru field inspections and review of Municipal re~d~.,~'the in conformance with MOA HAA gui¢lines in effect on this date. ~.. ~/ ~,~:;~' '~ ~ ~ OIgH~LU/M U~' [~/ ~. ~ ~' ' ~ Engineer's Name ~b~ C~ ~8~ ~,~,~ ~OB~TC. COWAN / , f~ '¢,'., CE-8801 Date -~//r/O O ' '~t~?: ..... "'(~ ~'( are HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 05-15-00 18:§3 FEO~-CTE ENVIRONMENTAL 6615301 T'IZ9 P.02/03 F'638 CT&E Environmental Services Inc. CT&E Ref,# Client Name Client PO~ Prelect NameJ. Printed Da~e/Time 05/16/3000 16:58 Client Sample. ID Colleered Da~e/Time 05/11/2000 12;00 Matrix Received Date/Time 0511212000 12,50 Ordered By 2 ethnical Di~ r Stephen C. Ede Sample Remarks; 1002227001 S & S Engineering L2; B2; Rivervlcw L2; B2: Rivcrview Drinking Water 3.16 O.SOO mg/L EPA $00.0 10 max o5/1z/00 SCL ~IORO LA8 cot/lOOmL SH18 9222B S5/1~/00 JDT 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 DWFLLING Parcel I.D. # 050-721-13, HAA # ,,~\\,'~i-~ ('- \ ',,-~ 1. GENERAL INFORMATION Complete legal description Lot 2, Bloqk 2, Riverview Estates Location (site address or directions) NHN Waterfall Drive Property owner Dave Stevens Mailing address Day phone 862-4?50 .L~nding agency Mailing address Day phone Agent Prudential Vista/Linda Banner Day phon~89-6464 Address 16635 Centerfield Drive, Eagle River, AK 99577 Unless otherwise requested, HAA willbe held forpickup. 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. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: xxx If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (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 wastewatar 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 flies 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 ENGINEEEING ~7054 Eagle I~Jver Loop I~oad No. 204 Eagle River, Alaska, 99577 Phone Date ~'/~- ~ / cT ~ S, .ATUR 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 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 ,wUNiCIP^LIT¥ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907~)'.9~(3~'~4¢~I. SERVICES Legal Description: L-O ?"' ~ Health Authority Approval Checklist /~,oo~' -~ /¢~'~x)~/~ Parcell.D.: A. WELL DATA Welltype pvt~//¢~-~. IfA, B, orC, attach ADEC letter. ADEC water system number Log present (Y~,~ /v O Date completed ,~/ / ~¢ '7 '/ Total depth I ~ ~ -ff- Cased to //0 ~ Casing height (above ground) Sanitary seal ~/N) Y ~ ~ Wires properly protected (~N). g.p.m. FROM WELL LOG AT INSPECTION Date of test ~ ~//~' / ~ ff Static water level ;~ "/ Well production g.p.m. /- ~ / WATER SAMPLE RESULTS: Coliform , O Nitrate /- ~' Date of sample: L// P-I /' ~ Collected by: o Other bacteria S & $ ENGINEERING 17034 Eagle River Loop Read No. 204 Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date installed ~[&7/c/j Tanksiza j~oo Number of Compartments ~ Cleanouts(~)N)__ Foundation cleanout (~)N) v,~[ - ~Y ~4.~,¢ Depression (Y/~,~ ~vO High water alarm (Wi~ o / Date of Pumping ('t//7 / ¢'~ ~ Pumper C. ABSORPTION FIELD DATA . Date installed ~"/'~'~ /~ ~ Length ) ~'~ '~r4~'Width. ' '~1 ~-/,t.¢ /:r Effective absorpbon area Date of adequacy test z//;~l /¢/~,/ Fluid depth in absorption field before test (in.); Fluid depth ~' (ins) Minutes later:. Soil rating ~'~ff/_~/~ar fF/bdrm) · ~' Gravel thickness below pipe '~ Monitoring Tube present ~,¢N). Results (Pass/Fail) ~ '/.)./' System type '7 Total depth __ Depression over field (Y/,~/ '"' ° For ~-- Immediately after~ 2-~' gal. water added (in.): Absorption rate = 'Ti- ¢ /- g.p.d. bedrooms Peroxide treatment (past 12 months) (Y/N) rw,.,~ ~,~'¢-'~J If yes, give date - 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cyc I~s~t est e~ -'"-"---~ Size in gallons - "Pump on" leveLat~/ "Pump off" level at* J.~-'~-"-' *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots / Public sewer manhole/cleanout /v //) Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation &'~ + Property line C + Absorption field Water main/service line [ 0 '~- Surface water/drainage / 0 0 ~ Wells on adjacent lets SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /~ ' Building foundation /~ ~-F Water main/service line ! o Surface water ! Do -I Driveway, parking/vehicle storage area Curtain drain r,, CN 6. ¢¢ '"' ~""~ Wells on adjacent lots / ¢ 4) F. ENGINEER'S CERTIFICATION ~"~..~-'~,~ · . I ce~fy that I have determined thru field ~nspect/ons and rewew of Municipal record~'J~ above(~ ~¢~,are ..... MOA ~u/define~ In on /' ~- in S~nature ~ ~'. ~ ~'~'~'""~ '~.Z~:I.... ' ~,., ' ~ ~ L ~ ~, ~ ROBERT C, COWAN Engineer s Name 1(~/5 ' ~ '~,~ ~ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number ^P1~?~99 16:10 FROI4-CTE ENVIRONUENTAL 5615~0t T-33g P.02/03 F-1BZ CT&E Environn~enlal Services Inc. CT&.~: .kef.# ~>~'oI ec~ Name/;! Ctieu~ ~nmple Ordered 9916770O1 S & S lfinginc~rmg L 2 B 2 Riwrview l~sr S/D L ~ B 2 RP~ermew Esr. S/D Drinking Water 0 Sample Remarks: Client pOt Printed Date/Time 04/27/99 16:09 Collected Date/Time 0q./21/99 14'45 Receivedl, Date/Time 0~/22/09 10'50 T~hnical Dir~tor: Stephen C. Ede 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 # I,~ (~ o~ 4.h th ~ (-'~f"/ 1. GENERAL INFORMATION Complete legal description Lot 2; Block 2; Riv~vi6w Estat6s Location (site address or directions) NHN Waterf¢~l DJ~ve, Ea.~le Riv~ Property owner Mailing address Lending agency Mailing address. ALASKA USA F..C..U.,/PROPERTY MANAGEME~ay phone P..O.. Box 196613, Anchorag6, AK 99519-6613 Attn: Day phone 786-2709 Jim Lcvra Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. 'FYPE; OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well xxx Community well Public water 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. 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 vedfy 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 furtiler 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 s & S ~.NGINt~ERING 17034 Eagle River Luol,,,~Ro~c, ~0~ _ Phone Address Eaflle River, Alaska 9~)577 Engineer's signature Date DHHS SIGNATURE Approved for '~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: 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 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. 72~25 (Rev, 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAl. CHECKLIST Legal Description: ~.2~.-0~-¢-~ '"'~--: t~"F ~-- Parcel I.D. (~2¢(¢-tt~"~ A. WELL DATA We IIt y p e'~(2 ~ V'¢="~ If A, B, or C, attach ADEC letter. Log present (Y~_ ~ Total depth [~..-~. ' -l-- Sanitary seal~)N) / ADEC water system number Date completed L,~ ¢.- Driller Cased to ~¢'~ '-~ Casing height Wires properly protected (i~N) __ ~ FROM WELL, LO//~ A'[' INSPECTION '~./~Y g.p~ Date of test Static water level Well flow // g.p.m. Pump level / SEPARATION DISTANCES FROM WELL. TO: Septic/holding tank on lot ~) ~,~ / Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank_ WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: ¢ "' ~'~ ~'~ ~ Other bacteria co,,eeted B. SEPTIC/HOLDING TANK DATA Date installed ~'~¢-~ ~ 'rank size_ J~¢d:9 ~'¢,,.L.~__Compartments Cleano ut~)/N, "-/ _ Foundation cleanou~N) V Depression (Y~ High water alarm (Y/~ _ J _ Alarm tested (Y~ /~ Date of pumping I..J ¢..~x_~ -F;C~-A [/--~ Pumper k.9/~ . SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots I ~"~¢ ~ ~ Foundation ['~' / Abso rptio n field _~--'~/ _Water main/service line JO 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer / Size in gallons Manhole/Acc~) Vent (Y/N) "Pump on" level at ~' "Pump off" level at High water alarm level ,~/ Cycles tested Meets MOA electrical codes (/__ SEPARATION DIS~bI6E FROM LIFT STATION TQ: Well on lot .-/ On adjacent 10ts Surface water D. ABSORPTION FIELD DATA Date installed -~,¢ ¢.;2-~ ~¢:~ ,'"~ Length F'~'~ / Width Total absorption area Depression over field (Y~_~ Results (pass/fail) t-~,~_.u..D Peroxide treatment (past 12 months) Soil rating Gravel thickness ~"/ Total depth Cleanouts present/N) Date of adequacy test k--)/''~' , for ~'~ J System type If yes, give date /")/¢~ . bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot To building foundation ~J'~/ On adjacent lots On adjacent lots } (~.) ~ ~g Property line To existing or abandoned system on lot Cutbank '~'2 I...~ Water main/service line Surface water Curtain drain Driveway, parking/vehicle storage area I ~ / E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA of this inspection. S & S ENGINEEEING Signature 170~4 E~rjI~ RIv,~l' L¢IO!~ I,~a~l Eagle Rivet', Alaska 99577 Engineer's Name HAA Fee $ Date of Payment Receipt Number 72-028 (Rev, 3/9~) Sack MOA Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX:(907) 561-5301 ANALYSIS RESULTS for INVOICE t 61942 Chemlab Ref.# 92.?016 Sample # 1 Natrlx: WATE~ Client Sample ID : LOT 2 BLK 2 NIVERVIEW ESTATES PWSID UA Collected 12/29/92 Received 12/S0/92 ~ IS:30 Client Name :S & S ENGINEERING Client Acct :SNSENGP BPO# : Naq# : O~dared By : PO# :NOllE RECEIVED Analysis Completed : 12/31/92 Send Reports to: Laboratory Supervisor :, STEPHEN C. EDE I)S ~ S ENGINEERING Released By : ~,9./~__ 2) Paxamete~ Results Units ~ethod Allowable Limits ........................................................................................................................................ NITRATE-N 1.?1 rng/1 EPA 353.2/300.0 10 Sample SA}{PLE COLLECTED BY: RAY. 1 Tests Performed Nee Special Instructions Above UA=Unavailable ND= None Detected "See Sample Remazks Above NA= Not Analyzed bT=Less Than, GT-G~eater Than Mernber of the SGS Group (oociGt6 GGnGrale de Surveillance)