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HomeMy WebLinkAboutSAND LAKE #2 BLK 7 LT 2Sand Lake #2 Lot 2 Block 7 #011-132-35 Municipality of Anchorage Page 1 of. 2 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 545-4744 On.Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW990337 PID Number: 011--132--35 Name: JOHN BREWER Wastewater System: [] New · Upgrade ~ddress: 6223 WILCOX ST. ANCH. AK, 99502 ABSORPTION FIELD Ph°ne:(907) 248--5025/272-- 1571 No. of Bedrooms: 3 [] Deep Trench [] Shallow Trench [] Bed [] Mound [] Other LEGAL DESCRIPTION ,o,, RaUng: 0.8 GPD/Sq. Ft. Total 0epth from9.15_10.81origInal grade: Ft. Lot: Block: Subdivision: Depth fo pipe bottom from original grade: 0ravel depth beneath pipe: 2 7 SANDLAKE #2 1.65-5.51 FL 7.5 Ft. -- -- -- 0--0.5 F~ 42' WELL: [] New [] Upgrade~,.,//''- Gravel width: 2.0 FL Number of 1 lines= Distance --between ii.eS:Ft. Et. Ft. 630 SQ. Ft~ ASTM D-3034/F-810 Ft. G&G EXCAVATING 10/16/99 / ... I st,, FL TAN K SEPARATION DISTANCES [] Se.ti° ~ Nolding [] S.T.E.P, -rom Tank Reid StoUon Tank S~.r u... ANCHORAGE TANK 1000 Well 150% '135' 25'+ STEEL 2 Su~OCewater ~00'+ 100'+ - - LIFT STATION Lot *0 '10'+ -- - Foundation 5'+ 10'+ - - Drain -~ NONE KNOW~ I ~emark$: *SEE D.E,C. WAIVER LE-rI'ER (DATED: 9/lo/gg) BENCH MARK AND INGRESS/EGRESS EASEMENI'. CORNER OF CONCRETE PAD AT BASE OF STAIRS. IAaeumed B~v~Non: 100,00 Inspections performed by: AWWO, INC. Dates: ,st 10/16/,0 ~:;';t ~ ~/~..~. ~ !.' .... ,nd 10/16/99'~' * i ~[/'~ 3rd_ 10/19//99 Department of Health and Human Services approval ~(~. '.~ ~J ~ ...' Reviewed and approved by:¢¢~/,~_, ~¢. /<2¢-"%~ Date: /- '--/. ~ o PERMIT NUMBER: 011-132-55 sw~,o~ A S- B U IL T D IR A WI N O P^ROE~ .~ NU..ER= L NEW DRAINFIELD~~ TH~ 1~ .> ?'- / X ~. ::1 '-::-: -:- ~-- ~:'~/ ~X- ... ____. :.: ........ _ I ~ ~oo, W~ve~ ~ I ~- ~ - .Ea:E DESCRIPTION: ]~PE OF WORK: AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE PREPARED FOR: PHONE NUMBER: JOH~ ~EWER (907) 24~-5025/272-~S71 ~-7~ ..." OATE:lO/21/99 D~WN ~Y: SC~E: PA~E: ~ e'~rof.~ ~o~ J.L.M. 1 = 30' 2 OF 2 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Sep 16, 1999 Expiretion Date: Sep 15, 2000 Permit Number: SW990337 Legal Description: SAND LAKE #2 BLK 7 LT 2 Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: John Brewer Owner Address: 8223 Wi[cox Street Anchorage, AK 99502-4155 Parcel ID: 011-132-35 Site Address: 008223 WILCOX ST Lot Size: 13030 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: I~ Disposal Field ~ Septic'rank [] Holding Tank [] Privy [] PdvateWell [] Water Storage 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 ( 18AACS0 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ), 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Date: Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.cLanchorage.ak.us September 17, 1999 Jeff Garness, PE Alaska Water & Wastewater Consultants, Inc. 6901 De Barr Road, Suite 2B Anchorage, Alaska 99504 Subject: Waiver Request for Lots 1 & 2 Block 7 Sand Lake #2 Waiver Request #WR990063 Parcel ID #011-132-35 SW990337 Dear Mr. Garness: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 3.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-Site Water Quality Program DEPT. OF ENVIRONMENTAL CONSERVATION TONY KNOWLE$, GOVERNOR DIVISION OF ENVIRONMENTAL HEALTH DRINKING WATER and WASTEWATER PROGRAM 555 CORDOVA STREET ANCHORAGE, AK 99501 http://www.state.ak.us/dec/home/htm Telephone: (907) 269-7521 Fax: (907) 269-7650 September 10, 1999 Mr. Jeffrey A. Garness Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2-B Anchorage, Alaska 99504 Subject: Lots 1 and 2, Block 7, Sand Lake Subdivision #2, 8231 Wilcox Street, Anchorage, Alaska, ADEC Project Number 637, Two (2) Separation Distance Waiver Requests. Dear Mr. Gamess: This letter is in response to your submittal received in this office on Augus~ 16, 19~9 requesting separation distahce waivers between a proposed septic upgrade oh Lot 1, Block 7, Sand Lake Subdivision #2, and (i) the existing Class C Public Water System (PWSID #216211) Source Well located on Lot 3, Block 7, Sand Lake Subdivision #2, and (2) the existing Class C Public Water System (PWSID #217940) Source Well located on Lot 12, Block l, Sand Lake Subdivision #2. I have completed my review of the submitted information, which included a cover letter, a site plan, soils information, design infmxnation, topographical information, and recent nitrate and total coliform bacteria results. Based on this review, and a review of the department's existing file for this location, it appears that the proposed septic system upgrade on Lot 1, Block 7 will not impact either of the above referenced Class C wells. Therefore, in accordance with the provisions of 18 AAC 80.030, the following separation distances are granted: Between the existing Class C well on Lot 3, Block 7 and the proposed septic tank and absorption trench upgrade on Lot 1, Block 7 fi'om 150 feet to 100 feet. ' BetWeen the existing Clasg C well on Lot 12; Block 1 ,a.n.d tile pr0posed~septic :' tank' and abs0rp,}i0n trenel~ upgrade on Lot 1~ Block 7 ~ro'm 150 feet'fo 135 feet.: : '., ,.. . . . . . .. . . .. '.(, ; ... State Drinking Water Regulations require a fee be charged for each separation distance waiver for each Public Water System. The required fee for this project is $460. Please submit an additional $230 to this office. This approval does not imply the granting of additional authorizations, nor obligate any federal, state, or local regulatory body to grant required authorizations. Thank you for your cooperation with this department. If you have any questions, please contact me. Sincerely, Alaska Water & Wastewater Consultants, ][nc. 6901 Debarr Road, Suite 2B - Auchorage - Alaska 99504 (907) 337-6179 ~ Fax (907) 338-3246 Cousultiug Eugineers August 15, 1999 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Reft Septic Upgrade Design for Lots 1 & 2, Block 7, Sand Lake Subdivision #2 To whom it may concern: The existing 3 bedroom house is served by a private septic system and a class "C' well located on Lot 3. A 100 foot waiver was granted from the existing septic system to the existing class "C" well (which serves this property). We have requested that the waiver be amended by A.D.E.C. (see attached letter). Also, we are have requested a 135 feet waiver be granted fi'om the class "C" well on Lot 12, Block 1; Sand Lake S/D #2 to the proposed septic system by A.D.E.C. The existing septic system consists of a 1000 gallon septic tank and a deep trench type drainfield. The existing drainfield is surcharged and at times backing into the house (per homeowner). The homeowner owns both Lots 1 & 2, Block 7; and considers the property to be one parcel. A test hole was excavated on the Lot 1, Block 7, for the purpose of upgrading. We propose that a ne;v septic tank be installed on Lot 2 and drainfield be installed on Lot 1. Comments regarding the proposed design are smnmarized as follows: 1. SOILS: Attached is a log which shows the soil profile, and the percolation test results. The soils below the organic layers are a SM/ML material to a depth of 17 feet (bottom of test hole). No ground;vater was encountered during the excavation of the test hole. A percolation test was performed between the depth of 7.5 feet to 8.0 feet which had a percolation rate of 9.6 minute/inch. 2. TRENCH DESIGN: a. Percolation Rate: 9.6 minutes/inch b. Allowable Application Rate: 0.8 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Ivlinimum Absorption Area: 563 ft2 f. Total Depth: 11 feet (max.- at any point) g. Effective Depth: 8 feet h. Width: 2.5 feet i. Reduction Factor: N/A j. Minimum Length: 40 feet long k. Effective absorption area -- 640 ft2 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: Both lots are generally flat, in short; there are no slope concerns. 5. WAIVER OF SEPARATION DISTANCE TO PROPERTY LINE: Based upon the as-built smwey prepared by Lantech Surveying (8/92), it is apparent that the clean-out located at the north end of the existing drainfield is only about 5 feet from the north property line. Given the fact that the trench is 3 feet wide, it is reasonable to assume that the edge of the trench is only about 3 feet fr'om the north lot line. The bordering lot is vacant and is also owned by the same persords as Lot 2, Bk 7. The objective is to retain the old drainfield as a reserve field that flow can be diverted periodically to it. Consequently, we are requesting that the separation distance to the subject lot line be waived to 3 feet. There no lmown adverse impacts associated with this waiver. The $I 15.00 lot line waiver fee was sub~nitted with the sewer permit fee. 6. CLOSING: i am unaware of any adverse impacts this installation would have on adjacent wells or septic systems, if you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. Sincerely, NOTE; Attached is a site platt drawiug, a design drawing, and a 4 page construction specification letter which are all part of the design pacIcage for this septic system. LOT 17, BK2 I LOT 8, BK 1 LOT 17. SK1 I I ~X~O,<' LOT 10, BK 1 \ LOT 15, BK 1 I SUNDI S/D SANDLAKE S/O #2 SANDLAKE S/D #2 , ~ND~KE S/D ~2 ' ~ ~ND~E/S/D ~2 ~ND~KE S/D ~2 ~ND~E S/D ~2 ~ND~KE S/D ~2 ~ '' LOT 12, BK 1 ~NDI~KE S/D ~2 ~ SAND~KE S/D ~2 ~ / ) ~/ ~ · ~ // (SEE DESIGN, PA~E 2 OF 2) I ---/" ...... /- ~-- ~ ~~ ~/ ~~LOT 24 m / LOT 24/ ~ t~ EXISTING 3 X t / / ~' )BEDROOM HOUSE~m ~ ~ ___ ~ ...... ~- . , . __ ~ /~- I ~ ~ ~o~ ~ ~~&~ - --m~ ,~ ~ ~ ,~ .-- .... -~ ~ .............. [XX LOT 22 [~% ~'~ /~OT 3 ', ~ EXISTING SEPTIC m ~ X ~ ~ ~ WELL S~ ~m= I // SYSTEM ,I ~ -~:--~----~C---~- =~.~------/ ......... ,/ LOT ~1, ~~'1~ ~OT ~, .LOC~ ~' %~ X ~ ~ ~ LOT 4 / ~ 'L~' m ', SUNDI ~/ ~ LOT 20 /'~ I / LOT 5 / -- I ~ LOT 4. BLOCK SUNDI B ~ [ LOT 6 ...... ~ ~ ALDER PARK LOT 16 ~ LOT 9 LOT 16 ~AS~ WATER ~9 WASTEWATER CONS~T~TS, ~C. ~ ?.x~' ~ ~ ~AL DESCRIPTION: s*,o ~K~ ~ SU~D,V,S~O~; ~0~ ~, ~:OCK 7 ~:.~?..I.., ~/~...~ f~ ~ A. Came%. PREPAREO FOR: PHONE .UU~[R: Fh~Y~.l L E 7953 248-5025/272-1571 vita' · U - " JOHN BREWER (907) . ~ .. ... DATE:8/1/2/99 D~WN BY: SCALE: PAGE; K.D.W./J,L.M, 1 = 100' 1 OF 2 '%~X~~ 3 WEST 82nd AVE. \ Ld Ld C~ X 0 © .J \ PROPOSED 1000 GAL N ~ / SEPTIC TAN~ J M1 CO CO EXISTING THREE BEDROOM HOUSE / ! / / / / / ~ / / FCO ID Bo~rMLESS SAND FILTER ~F~ ~2~o GAL'O. -- STEP TANK \ ,.. ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 2B. ANOHORAOE, AK. GOSE4 PNONE: (007) 337-E179/FAX: (007) 338-5246 F~OW DIVERTER DOUBLE CO'S TRENCH TO BE USED AS A RESERVE SITE. -_'GAL DESCRIPTION: SAND LAKE SUBDIVISION #2; LOT 2, BLOCK 7 3YPE OF WORK: DESIGN OF SEPTIC SYSTEM UPGRADE AND WAIVER REQUESTS, PREPARED FOR: PHONE NUMBER: JOHN BREWER (907) 248-5025/272-1571 IDRA¥/N BY: I SCALE: PAGE: DATE:8_12_99// K,D.W,/J.L,M, 1 = 30' 2 OF 2 ALASKA WATER & WASTEWATER CONSULTANTS, INC. [SOIL LOG - PERCOLATION TEST[ ?~,." ~l,fl~ ~:/-~"..~,' LEGAL DESCRIPTION:_SAND LAKE i~2 SUBDMSION~ LOT 2, BLOCK 7 _ ,~.;_'.1 .l.,j ,/v~"'~'/ ............ PERFORMED FoR: OH..R ER DATI" PERFORMED: 7/19/99 _ I '"' '" ORO~qlcs r_ST HOLE ~ ~EPTB .P~-~ ~'1 feet)' 3~:!i--""~ GW ~ ORB __ .~ W~ I"= I00' J~ GC OL X '~ X ~ PROPOSED t,~%~ SP '_/~ CH 9DR~ HOUSE \\ ..~ ~ \, ~L ____~_ i ~m EXISTING SEPTIC GROUNDWATE~ i~ ~STE~ DRY 7/19/99 ' · WELL SEFNES --/2,3,24,._~3,~/,B?< 7 I[ LOT 21A SM/ML __ ~- DRY 7/26/99 / / j_/~ o 11 , DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) 12 7/20/99 PERC, HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTIN_~ 13 1 ;~:43 - 2 4~13 30 2 5/8' 3 3/6# 14 3 4:14 15 : -- - - 4 4:44 30 2 3/4" 3 1/4-" 5 4:44 6" 16 ' ' --- 6 5:14- 30 2 7/6' 3, 1/6" 7 5:15 6" PERCOLATION RATE 9.6 .(MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 7.5 FT, AND 8.0 FT, COMMENTS: PERFORMED BY ALASKA WATER ~ WASTEWATER. I, dEFFREY A, GARNESS, CERTIFY THAT THIS WAS PERFOR~MEI~ IN ACCORDANOE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE' ~ DEPTH TO DATE GROUNDWATE~ DRY 7/19/99 DRY 7/26/99 EASEMENT GRANT made this -~ ~ day of September, 1999, between Jonathan J. Brewer, 8223 Wilcox Street, Anchorage, Alaska 99502, hereinafter referred to as the grantor, and Jonathan J. Brewer of 8223 Wilcox Street, Anchorage, AK hereinafter referred to as the grantee. WHEREAS, the grantor is the owner in fee simple of the following described realty: Lot 2; Block 7; Sand Lake Subdivision #2 according to the official Plat P-176 in the Anchorage Recording District, Third Judicial District, State of Alaska, and, WHEREAS, the grantee is desirous of enjoying the use of a certain portion of the grantor's land for the sole purposes of ingress and egress to Grantee's land for the purpose of installing and maintaining a private septic system, and, WHEREAS, the grantor has agreed, in consideration of $1.00 (one dollar and no cents) and other good and valuable consideration, the receipt of which by Grantor is hereby acknowledged, to grant to the Grantee as easement solely for said defined purposes and for no other, NOW, this grant witnesseth that in return for said specified consideration paid by the Grantee to the Grantor, the Grantor hereby grants unto the Grantee, his heirs and assigns, full and free right and authority to install and thereafter maintain a private septic system upon a portion of Grantor's land as shown by the "septic syste~n design and as-built" by Alaska Water and Wastewater Consultants, Inc. dated August 12, 1999. This Grant of Easement is intended to be appurtenant to Grantee's above-described land and touches, concerns and runs with said lands. This is not intended to he an exclusive easement: the Grantor herein expressly reserves unto hin~self equal rights of ingress and egress and all other rights as the owner in fee simple of the described premises. 05 287 A ,~., RECORDING DISTRICT ] d'"I999SP-9 AHII: I0 REQUESTED BY If Public water and sewer become available, this easemeut becomes null and void and the Grantee can abandon the encroaching system aud connect to the public utilities. Any dispute or disagreement arising under or in any way concerning this instrument shall be submitted for resolution to the process of binding arbitration in accordance with the Alaska statutes made and provided for said arbitration. The jurisdiction of the Arbitrator shall commence 60 days from the onset of the dispute and shall operate to toil all applicable Statutes of Limitation. IN WITNESS WHEREOF the Grantor and Grantee have hereunto set their hands the day and year above written. .~REWER - GRANTOR ~)'iqX~q~L'N J. B~R- G~TEE STATE OF ALASKA ) THIRD JUDICIAL DISTRICT ) THIS IS TO CERTIFY that on this ,~ r--~ay of September, 1999 before me the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn, personally appeared JON BREWER to me known to be the person described in and who executed the above and foregoing instrumant, and acknowledged to me that she signed and sealed the same freely and voluntarily for the uses and purposes therein mentioned. WITNESS my hand and official seal the day and year in this certificate first above written Not--for Alaska My commission expires __ , MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL FNGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT =~AME P H 0 N-~- 'D NEW MAILING ADDRESS LEG L DE IP~ N ~ . ' ' - LOCATI~ ~ ~ ' ' _ q ._ ~ z Manufacturer Material No. of compartments LiE. ~sa~:~ gallons IF HOME MADE: Inside length ~ Width ~ 'Liquid depth ~)~ ~ DISTANCE TO: Well ~A Dwelling PERMIT NO. O ~ ~ Manufacturer Material Liquid capacity in ~allons .~ . DISTANCE TO: Well /O~. ' F°undati°n,~.* ' Nearest lot, lineo ' -.-I ~ ~ No, of lines~ /~~OtLength of each mine Total Ion~lth of lines Trench2~width inches Distance~tbetweon mines ~' ~ ~ Top of tile to finish grade Materia] beneath tile -~ I ~3 ~b~TQe?ab~orpt on area ~ ~ Type of crib Crib diameter Crib depth Nearest lot line ff~ ~o ~ Well Building foundation ~ __¢ DISTANCE TO: = Class ~ Depth Driller Distance to lot irne~, ~ OTH E R . ' / ~ ~ - ' PERMZT NO. DEF'Fi[~'.TMEN'F FIEFILTH FIND ENVIRONME:NTFIL .OTECTI ON 82:5 "'l_' STREET., ~NCHORFIGE, FIK. 9950:t 264-4720 ,[ 82:008:~ ) FIPF'L I C AIq'l" L, OCFIT I ON LEGAL EI'"IMFI ..TEFIN TFIIDMPSON t_RB7 SFIND LFIKE 22:'L.'1 E. NORTHERN LIGHTS LOT SIZE 279-8486 SQUFIRE F'EET T"¢F'E OF SOIL FIBSORF'TIOIN S'¢S'TEM 15;: TRENCH HFI',".','IMUM NUMBER OF BEDROOMS = _].': SOIL. RRTIf',IG (SQ FT,"BR)= t50 " ? z,,~.':,TE'.fl lb':: THE R. E6.!LIIIRE[:' _.,I~E OF THE q"IL ' ": ..... .... HE,...,LII~.F1 IuN '-' i,- ~ ,- lbs IP THE LENGTH [:'IMENSION IS TFIEE LENGTI4 (IN FEET) OF THE T'RENCH OR E:,RFtINFIELD. ]"HE DEF'TFI OF FI TRENCH OR PIT IX THE [:,ISTRNCE E:ETHEEN THE SURFFICE OF THE GROUND FIND THE BOTTOH OF THE E;,-,;C:R'v'Ft'f'ION (IN FE;ET.'.,. 'THERE IS 1'40 SET HI[:,TH FOR TRENCHES. THE GF,.':R',,,'EL DEPTH IS THE MINIMUH DEPTH OF' GRR'v'EL BETNEEN THEE OUTFRL..L PIF'E': FIND TFIE BOTTOM OF THE EXC:FIVFITION (IN FEET). PERMIT RPP[_ICF~NT HRS THE RESPONSIE:ILIT'¢ TO INFORH THIS DEF'RRI"HENT DURING INSTBLLFll'ION INSPECTIONS OF RN"r' I.,.IELLS R£'JFICENT TO THIS PROF'ER.T'¢ FIND ]"HE] NUHBER OF RESIDENCE'=; THF~T THE P.tELL HILL SERVE. THE E',FICKFILLtNG OF I=li",l"r' S"r'S'FEI"I HITHOLI'r FINRL INSPECTION I}EPRRTMENT HILL BE SLIBJECT TO PROSECUTION. F-.: £=2 6':-., Lg ][ ~'~;: E: RPPROYi::IL B'¢ THIS I,'IINIMLIH C, ISTRNCE BET!.,.IEEN FI HELL FIN[:, RN'.r' ON--SITE SEP.IFIGE [:,ISF'OSFIL S'YSTEM &00 FEET FOR FI PRIVFITE HELL OR ::L50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC P.IEI_L. HII'qIMUH DIS'f'RNCE FROH R F'I'..".I',,,'RI"E !.,.IELI_ TO R PRI',/RTE SEWER LINE IS 25 FEET Ri'.,ll} TO R COhlHUI'.,IIT'¢ SE!4ER LINE IX 75 FEET. 14ELL LOGS RRE REQUIRED FINE:, HUS:;T E:E RETURNED TO TtiE [:,EPRRTMENT WITHIN 2i:0 DR'.r'S OF THE 1.4ELL COMPLETION. CITHER REQUIREMENTS HR"r' RPF'I_'¢. SPEE:IFICFITIONS FINE.:' CONSTRUCTtOI',I DIFIGRI::tI'"IS FIRE RVRIL. FIBLE TO INSURE PROPER II",ISTRLLRTION. i CER'FIF"¢ THFIT :L: I FIM FFIMILII=IR 14I"FH I'HE REQUIREMEI",FI'S FOR ON-SI'TE SEWERS FIND WELLS RS SET FORI"H B"r' "tHE HUNICIPRLIT'¢ OF I=INCI-.IORRGE. 2: I !41LL INSTRLL THE S"r'STEH IN RCCORDFINCE ,WITH THE CODES. ]:: I LIN[:'ERSTRN[:, TPIRT THE ON-SITE SEWER S"r'STEM I"lFi"r' REg!UIRE Ei",ILF~RGEMENT IF THE RESIE:,ENC:E IS F~:EHOE:,E~LED TO IiqCLUE:,E MORE THFIN _.7: E~E[:,R. 001"IS. ......... RF'PLICFtNT 'XI~I~FI .TEFIN THOMFSON V4. 0 PERFORMED FOR: LEGAL DESCRIPTION:_ 1 2 3 4 5 6 7 8 9 10 11 13- 15- 16- 17- 18- 19- 20- COMMENTS SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HFALYH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 09501 264-4720 SOILS LOG- PERCOLATION TEST [] PERCOLATION TEST OATE FERFORMED=. ~ C~ J'!..Z ia' 2-- SLOPE ~ I L'F' 2225-,5 1971. NC> SITE PLAN Lc"[' :5 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTN? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (mim~tes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY:. 72-008 (6/79) CERTIFIED BY:__ ~'"~ .,~ .Permit #: 821184 January 31, 1983 TO: Permit. Applicant Subject: Lot 2 Block 7 Sand Lake Subdivision ~2 A permit issued by this department for an individual well and/er on-site sewer system has expired as of December 31, 1982. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If yeu ?lave drilled the well, a well to this department for documentation date and[ to close the perrait. log needs to be sent of the installation If a private engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files and documentation. If there are any further questions, please call this office at 264-4720. Sincerel~ Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/ljw enc: Copy of Permlt SWP/057 PERMIT NO. DEF'ARTMENT ~ .... FIEAL. TH FINB, ENVIRONMENTAL ""~*OTECTION ,:,~ .... ~ .....TREE r., 264-4720 0 t'~.! --'.~]. I -f'E 5 [-Z l---Ii F..: F° E F-:' f'l Z 'r ,:: 822184 ) RPF'LICRNT LOCRTION L. EGRL ROVCO INC. LOT 2 BLK 7 SAND LAF.:E ~;UB. ~700 SPENARD ROAD LOT SIZE 2~0000 272-~755 SQUARE FEET TYPE OF SOIL ABSORPTION SVSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT/BR)= THE REQUIRED 'SIZE OF THE SOIL. ABSORPTION S'¢ST[:'M IS: THE I_ENGTH DIMENSION IS TH[:' LENGTH (IN FEET) OF THE TRENCFI OR DRRINFIELD. THE DEPTH OF Fi TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND laND THE BOTTOM OF 'rilE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. ]'HE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFFILL F'IF'E AND THE BOTTOM OF THE E2,'C:A',/ATION (IN FEET). I[~:EZL'Z!U ]] F..: E [::, SEF)'T I C ]r'R N ~-:.'-':. '._-]; :[ Zl~== :.1L,~'~10 "3RL_L. ON~; PERP'IIT RPPLICANT HRS THE RESPONSIBILIT'¢ TO INFORM THIS DEPI--IRTMENT DURING TI-IE INSTALLATION INSPECTIONS OF ANV WELLS RDJRCENT TI] THIS PRCIPERT'¢ AND ]'HE NUMBER OF RESIDENCES THFI'F THE WELL WILL SERVE. ]- ~,,-I ']~ ( ;-2 ::.., :[ I'...! :_-]:; P i----- ,]': T I C, I~-.! --¢-; Fl 1'4." E R E L::.] U :E F:: EE [::, BRCKFILL. ING OF RNV S'T'STEM WITHOUT FINRL INSPECTION RN[:' RPPROVAL BV THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND RN'.r' ON-SITE SEWFIOE DISPOSRL SYS]"EM IS d.00 FEET FOR FI PRIYRTE WELL OR :t50 TO 200 FEET FROM R PUBLIC WELL DEPENDING IJPON THE TVPE OF PUBLIC WELL MINIMUM DISTANCE FROM R PRIVRTE WELL TO R PRIVRTE SE:WER LINE IS ;;.'5 FEET RND TO R COMMUNITY SEWER LINE IS 1"5 FEET. OTWER REQUIREMENTS NRY RPPLk.'. SPECIFICRTIONS AND CONSTRUCTION [:,IRGRRMS ARE IhVRILRBLE 'TO INSLIRE PROPER INSTRI..LRTION. I CERTIFY THAT :t: IRM FAMILIRR WITH THE RE~.;!UIREMENTS FOR ON-SITE SEI4ERS RND WELLS RS SET FORTH 8'¢ THE MUNICIPRLITV OF ANCHORRGE. 2': I WILL INSTALL. THE SVSTEM IN RCCORDANCE WI'tH THE CODES. .'.~: I UNDERSTAND, THRT THE ON-SITE SEWER SVSTEM MRV RE)..]UIRE ENLRRGEMENT IF ]'PIE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. ... _ ............................. s ~ & ENGINEERS, INC. 7125 OLD SEWARD HWY. ANCHORAGE, ALASKA 99503 349 -6561 SOILS LOG PERCOLATION TES1 3 12 w^s ~o~.o w^~-~-~ I/ /0.'o2 PERFORMEDBY: CERTIFIED 8Y DATE: 72.008 ~Permit ~: 82].13]_ January 31, 1983 TO: Permit Applicant Subject: Lot 2 Block 7 Sand Lake Subdivision #2 A permit issued by this department for an individual well and/or on-site sewer system has expired as of December 31, 1982. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log needs to be sent to this department for documentation of the installation date and to close the permit. If a private engineer inspected the installation of the on-site sewer system, please have them send us the as.~builts for our files and documentation. If there are any further questions, please call this office at 264-4720. Sincere~ Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/ljw enc: Copy of Permit SWP/057 PERMIT NO, I"1 El Il"...! ].: ,'-'_. ]] "I:::~ L :[ -I~ '-r' O F F1 I'-,I C: t- -.~1:-?'.. IF-II L~ E- ..... L.') c') l DI:'PRRTMENT ... HEFtLTH laND ENV~RONMENTlaL ..OTECTION 825 "L" 'Z<TRI:'ET., RNCHORRGE., FIE. 99.=;01 264-4720 b4ibL. FI ~"~,1[:, E~N---"_-~. :1: TE SEl-.-IE~ i::'E[e£"i ][ ':; 821±]!::'L ) RPPL I CANT LOClaT I ON LEGFIL EMMR ,.TERN THOI'IF'SON L2B7 SFIND LFIKE ~2 NORTHERN LIGHTS LOT SIZE 2?9-8486 999999 SQURRE FEET TYPE OF' SOIL RE:SORP'FION SYSTEM IS: ]'RENCH MRXIMLIM NUMBER CIF BEDROOMS = .3-': SOIL RRTING (S6! Fr,.."BR)= ±50 THE REQUIRED :SIZE OF THE SOIL 8BSORPTION SYSTEM IS: ]'HE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF' ]'HE TRENCH OR DRRINFIELD. THE DEPTH OF' F~ TRENCH OR PIT ~S THE DISTRNCE BETWEEN THE SLIRFFICE OF THE GROUND RND THE BOTTOM OF THE EXCR',,,'R'T'ION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRR'¢EL DEPTH IS THE MINIMUM DEPTH OF GRRV£:L BETHEEN THF OI..ITFRLL PIPE RND THE BOTTOM OF THE E~4CRVRT]:ON ,:lIN FEET). PERMIT laPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPFIRTMENT DURING ]'PIE INSTFILLRTION INSF'ECTIONS OF RNY WELLS RDJRCEHT TO ]'HIS PROPERTY FIND THE NUMBER OF RESIDENCES THFIT 'THE WELL WILL SERVE. ....... ]~l-,.~C" ( 2 :) ][ N-C=;F'IEC:"f' ][ [3 i';1'__:; RRE R E:(~'). L! IIRE[> DRCKFILLING OF' RNY SYSTEM WITHOUT FINRL INSPE(.':TION RND RF'PRO"/FtL 89 THIS DEPRRTMENT WILL BE SUBJECT TO PROSECLITION. MINIMUM DISTFINC:E E,'ETWEEN R WELL FIND RN'.¢ ON-SITE SEWFIGE DISF'OSlaL c;"r'STEM iS :l. 00 FEET FOR ¢~ PRIVlaTE HELL OR ~50 TO 200 FEET FROM R PUBLIC WELL. DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTlaNCE FROM la PRI'¢FITE WELL TO la PRI'v'P]TE SEWER LINE IS 25 FEET laND TO FI COMMUNITY SE.I.,.IER LINE IS 75 FEET. WELL LOGS RRE REQUIRED RND MU'.:..;T BE RETURNED TO THE DEPFIRTMENT WITHIN -?.0 DR'CS OF THE HELL COMPLETION. OTHER REQUIREMENTS MRY laF'PL"r'. SPECIFICRTIONS FIND CONSTRUC'FION DIFIGF.'.FIMS FIRE la',/FtILRE:LE TO INSURE PROPER INSTRLLRTION. I CERTIFY THFIT l: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEI4ERS laN[:, WELLS RS SET FORTH BY THE MUNICIPFILITY OF BNCHORRGE. 2: I WII_L INSTRL. L THE SYSTEM IN RCCOR[:,RNCE WITH THE CODES. 3: I UNI)ERSTRN[:, THRT THE ON-SITE SEWER SYSTEM 1'4BY RE~LIIRE ENLRRGEMENT IF' THE ~.Ez, IE.,ENL. E I=, REMOE:,ELED TO INCLUDE MODE THRN ~: E, EDKuOH_,. :* . ~ IL.~ 2 4 7 ~ i:,,:...,t F'~E IL:_:_!:.., 14 16 18 19. 20- ¢) ¢ TES'[ RUN BETWEEN FT AND I Y COMMENIS PERFOnMEO BY' , , --- '~'~ · %.- -~.,~ ...... ~,.,F,EO~¥. ._]7:_1._,~ '~ ,~- 72,008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Serv ces On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 2; Block 7; Sand Lake Subdivision #2 Location (site address or directions) 8223 Wilcox Drive Anchorage, AK Property owner Mailing address Ronna Blakeley Day phone_ 248-3939 3514 w. 41st Avenue #B Anchorage, AK 99517 Lending agency Mailing address Day phone Agent Arnie Tigner/ Key Properties Address ~!.Day phone 248-8785 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 x~ TYPE OF WATER SUPPLY: Individual well Community well Public water xxx 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 XXX 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 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 ENGINEERING Name of Firm 17034 F..agie EiYer Luop k~,d No. 204 Address Eagle River, Alaska 99577 Phone Date DHHS SIGNATURE Approved for ~.~__ Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Mut~icil~ality of An~fiorage Department of Health and Human Services (DHHS) issues Health Authority Approval C(Jrtificates 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. 72~325(Rev. 1/9t) Back MOA#21 MuN¢.,IFALITY OF A~r,;HORAGi- ~NVIP, ONM[N'[^L ~RVICES DNI$1ON ~unioipnlity of Anohornge ~0V ~ 5 1BB~ HEA H HUMAN EnvirOnmental Services Division ~ ~ C E ~ V E D 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: ~O ~Y- o~_ ([ ~-o r¢¢._ ~ 5~]~0~/~,¢~. ¢/~Parcel I.D.: A. WFLL r)ATA Well type Log present (Y/N) Total ds 3th C; If A, B, or C, attach ADEC letter. ADEC water system number [)ate completed Casec to ~ Casing height (above ground) ~_/'- Wires properly protected (Y/N) LOG AT INSPECTION g.p.m, g.p.m. Sanitary seal (Y/N) Static water/Jev~ W~l~ction WATER SAMPLE RESULTS: Coliform O Date of sample: fi / / 3 / (i G B. }_S_~]HOL. DING TANK DATA Date installed I! )1i/~7~ Tank size Foundation cleanout (~/N) '"/~ -'f Date of Pumping. )///~/9~ Nitrate o. / Other bacteria / o o Collected by: /ooo Depresmon (Y/~") _ Pumper /J' -~- //o,-~ ¢- S & S ENGINEERING '~7C,=4. E.e;e ~iver Loop i'(oacJ No. 204 Eagle River, Alaska ~9577 Number of Compartments '~ Cleanouts~'~/N). ~'¥.J' High water alarm (Y/~ /,-, o ~'E,¢ w c,t J C. ABSORPTION FIELD DATA Date installed I) //~ / ~' ~' Lengthl(~)~, -~- ~ Width Effective absorption area /-/0 Date of adequacy test /~ /~3 Seil rating (g.p.d./ft~ or/f.t~/b_?~_~/ } D-,5-- System type 7- ~ Gravel thickness below pipe t-j Total depth Monitoring Tube present ~)Y,~ J' Depression over field (Y/g Results ~Fail) /o/) ~ .f For :~ bedrooms FlUid depth in absorptk)n field before test (in.); ,1, (o Immediately after//¢~ gal. water added (in.): $~O Fluid depth ~] 7 (ins} Minutes later: ~4 -~ 6, Absorption rate - ~$-0 Y g.e.d. Peroxide treatment (past 12 months) (Y/N) ~,~,,z k:,,~o~,,,~,' If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons ..~-' Manhole/Access (Y/N) "Pu~ev et*c~'~'Pump off" level at* High water alarm level at* ~ *Datum Cycl~ E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ¢~/4 - dO,,,14o,v,TY 1,.,,,[. ~.c. ~.9--'"'~'E.~holding tank on lot Absorption field on lot Water main/service line On adjacent lots ~..~l,'¢a'd~e n t lots --~-'~blic sewer manhole/cleanout Public sewer main Sewe~./se~tlc s~rvice line Lift station SEPARATION DISTANCES FROM S~PT_~HOLDINGTANK ON LOTTO: Foundation ! 0 4- Property line / o ¢- Absorption field. I0 '~' Surfacewater/dranage /00 ~ · '¢" Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /0 Building foundation Surface water ) 0 o -f- Curtain drain 3' ~(¢.7~ ENGINEER'S CERTIFICATION Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots ,,oo'+ I certify that I have determined thru field inspections ~ S ignaturein conformance with~//~ ,MOA HAA~idelines~in~effect on this date. Date II /,~'~ /~ ~ HAAFee $ ~l~ Date of Payment //'//~"~/'~ ~, Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division o[ 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. ~ _~'_~ I \ - ~ ,z~ ~'Z~, - ~?~b % NAA ~ ~-~ ~ °t ~-'~[~ ~,3:~3~__ 1. GENERAL INFORMATION Complete legal description Lot 2; Block 7; Sand Lake Subdivision 112 Location (site address or directions) ~25~2.Z~o.~., Armhole. ac.6, ~.£,~s.k~. Property owner __ Mailing address Day phone 243-3297 Lending agency Mailing address. Day phone Agent Rocky/VISTA REAL ESTATE Address 3000 C Street, Anchora,~_,_ Alaska 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 '~ TYPE OF WATER SUPPLY: NOTE: Day phone. 562-6464 ~XX _ Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and sfatus of system. XXX TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmatioa from State ADEC attesting to the legality and status of system. 5. STA'f'EMENT 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 -~-& $ ,.ENGINEERING 17'034 E~gle River Loop Road Address ~:,~ Ul ~l~ive r 7-Al a skor 995~/~- Fngineer's signature Phone Date ~t- I .-'¢[?---- . Approved for h~¢~' 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 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. Legal Description: A. WELL DATA Well type ~'~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAl. CHECKLIST If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) [::)ate completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Date of test Static water level Well flow Pump level FROM WELIL LOG Wires properly protected (Y/N) AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Sewer service line WATER SAMPLF RESULTS: Petroleum tank Coliform _ Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed _~1 '-- [ ~.' ~'~ Cleanoutsd~C~;~N) y High water alarrn (Y/N) Tank size ~ (::::~ Compartments _ Foundation cleanout ~N), "7/ Depression (Y~ Aiarm tested (Y/N) Date of pumping SEPARATION DI~/TANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I O~ On adjacent lots To property line l~ ~ '¢'' Absorption field Surface water/drainage [ OO~ _Foundation Water main/service line 72-026 (Rev. 7/9~) Fronl CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~-'E::~ Width Total absorption area Depression over field (Y~ Results f42~fail) Cleanouts present~N) Date of adequacy test for "~ Soil rating t'~ ~"/'¢""~'- System type ~ ~'--~"t ~----~1__~. , Gravel thickness Total depth bedrooms Peroxide treatment (past 12 months) ('¢.~ I'--.~-~ ~'"1'---~'~-.~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: ~c~.,4,~ ~ ....'c~'m¢~ Wellon lot j ~ Jcc-- On adjacent lots IO!' To building foundation ,.~_.~ i 7/ ing or abandoned system on On adjacent lots ~ I ~ Cutbank Water main/service line Surface water I~o ~J¢ Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. 5 & $ ENGINEERING 1702~4 Ea~le Rive~* Loop Rea~ Ne. ~-~ Eagle River, Alaska 9~57~ Signature Engineer's Name Date HAA Fee $ Date of Payment Receipt Number 72-028 (Rev. 3/91 ) Sack MOA 21 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1, GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address ~r, directions) (b) Property own'er Mailing Address '~' Telephone: (home) Business (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here)!2¢, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms 3. WATER SUPPLY Individual Well [] Community ~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ¢ Public E] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status· 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm .,,"¢~-~'J' Add ress ,~ ,~' Date Telephone 6. DHHS APPROVAL,.^~ ,~~ ~ Approved for bedrooms b Approved ,/~, Disapproved Conditional Terms of Conditional Approval Date / ¢//~-7///~' The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 72-025 (Rev 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) [C~'AUlY oHei~tthl~,utbDrily Approval (HAA) NMEN'rAL s~,~J~NFEBRUARY 1984 0C'!" 2 5 1989 RECEIVED Date Completed _/~ _ Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) 343-4744 Legal Description: If A, B, C, D.E.C. Approved~N) _ Yield _$b ~t~/~ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole A. WELL DATA Well Classification __ Well Log Present C/N) Total Depth Cased to _ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL.: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Z, ~,.¢/~/ ; Date Water Sample Test Results /~.¢,' ~) ./[/¢ ¢.¢-., ¢~-£: /,J ~ (¢~ Comments_ ~ ~/~ ~ ~.~ B, SEPTIC/HOLDING TANK DATA Date installed _ //~/.z/¢'¢/ Size ~L~' Standpipes ~'4) Air-tight Caps.) Depression over Tank (Y/L'~ Pumping~Maintena.n~e Cqntact on File (Y/N) No. of Compartments ~. Foundation Cleanout~N) Date Last Pumped /'~/~o/~'~, ~'~- ;for Holding Tanl~ High--W-a'~er:Al~rm (Y/N) /1/'/,,,,2 Temporary Holding Tank Permit (Y/N) SlZPA'RATION Di~T.,ANC,ES M SEPTIC/HOLDING TANK: To Water-Supply Weil" /~¢/ To Building Foundation To Disposal Field To Propsrty Line': To W~te~ Main/S~rviCe Linb: . To Stream,' Pond, Lake':O[ Major Drainage Course 72-026 (Rev. 7/88) Fronl Page 1 of 2 C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata /~J%~' ~'~'~- Date Installed Width of Field ..~ Type of System Design Length of Field '~'"~" Depth of Field ~>'/ Square Feet of Absortion Area Depression over Field (Y~ Results of Last Adequacy Test Gravel Bed Thickness Statndpipes Present,N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation ~ Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line /¢ f' To Existing or Abandoned System on ; On Adjoining Lots ~ /~/' To Cutback (if present) Comments D. LIFT STATION Date Installed Dimensions .-~ Size in Gallons Manhole/Ac~ "Pump On" Level at __ "P/gini:tOff" Level at __ High Water Alarm Level at ~/~)...---'"~ Vent (Y/N) __ Tested for ~.--'"'- / / ' Pumping Cycles during Adequacy Test. ~: emt ~ eMnOt sA Elect rica~ **Check Permitted Bedroom Rating Against HAA Request** I certify that l have check.~d, verified, or conformed to all MOA and HAA guldell~n~e(l~n~.~ ~date of this inspection, ~ ~ / / Signed Company ~/~ ~:~ ~~ ~o Seal Receipt No. ~/L/q ~ q4 ')~ Receipt No Date of Payment /¢ '-~ ~ ~ Waiver Fee: $ Amount: $ /~¢ '~) Date of Payment z2-026 (R~ z/~)B~ Page 2 of 2 API:'LI(:, FILLS OUT UPPER HAL ONLY PrgpedyOwner Emma Jean Thompson/Bruce J. Kiessling Mailing Addre,~m 2211 E. Northern Lgts. Blvd., Anchorage, Ak. zip Code 99504 Buyer Address Lending Institution Address Zip Code En~a Jean Thompson and Bruce J. Kiessling 2211 E. Northern Lgts. Blvd., Anchorage, Ak. 99504 310 E. Northern Lgts. Blvd. Alaska State Bank mpCode 99503 Realty Co. & Agent None Phone Address Zip Code LegalDescription Lot 2, Blk 7, Sand Lake #2 8223 Wilcox Street Locatic43 277-5661 Type of Residence EX Single Famgy 3 [] Multiple Family No. of Bedrooms_ [] Other Water Supply '~- [] Individual ~c~O(~-~ '(%'~"('~ ATTACH WELl. LOG. A well log is required for all wells drilled since June 1975. X] Community ~. For wells drilled prior to that date, give well depth (attach log if available). [] Public Utility Sewer Disposal 1982 X~ Individual Year Individual Installed: Public Utility When Connected to Public IJtility: ~) Holding Tank NOTE: TNE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 'rime Bate Inspector Time Date Insp6ctor Time Date Insp6ctor Time Date Inspector MUNICIPALITy OF ANCHORAGE DEPT. OF H~ALTH 8, ENVIRONM2N rAL PROTECTION AUG 2 6 i:¢c.,:; RECEIVED ( ,? ) APPROVED BEDROOMS ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE '/ (-' c.~.___! ,] ,, F' 'CONDITIONS OF APPROVAL Soils Rating Date Sewer Installed ~., (cc '- ~:~- '% Well To Absorption Area Well to Tank {~)4.~ Well Log Received Septic Tank Size