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HomeMy WebLinkAboutSCIMITAR #3 BLK 1 LT 10AOnsite File #051-132-89 trcev uo/u-,/-its) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191504 PID Number: 051-132-89 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New M Upgrade Name Steve and Leona Hakala ABSORPTION FIELD 0 Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 19606 Belduque ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 1.2 GPD/SF 8 - 9 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3 -4 Ft. Gravel depth beneath pipe 5 Ft. Subdivision Block Lot SCIMITAR #3 1 10A Fill added above original grade 0 - 1.3 Ft. Gravel length 38 Ft. Township Range Section Gravel width 2.5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 380 Ftz 1 Ft. Well >100'1>100' NA NA >25' TANK NSeptic ❑ S.T.E.P. ❑Holding El Other Manufacturer Capacity Surface Water >100' >100' NAI NA greer 1250 Gal. Material plastic Number of compartments 2 Lot Line >10' >10' NA NA NA Foundation >1 0' >1 0' NA NA _LLET STATION Manufactu Capacity Remarks Gal. Alarm location Electric Iled by PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer Whitters Construction Drainfield 3034 CO/MT 3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspdection is, 5/27/2020 5/28/2020 Location and description 2nd -- top of new tank manhole lid 3d 5i24i2ce 41"— ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: PP Date '�� • d',� Q ,irA T-1 �Z ....�lJclu,.s 19 • .. . F� <<- 0• dZ. `.' �`' Septic System ¢j �F�'••Qedo. C •c Approved _46V_4A4A��Date-1 �o Z(-� Note: this approval es not include well permit requirements. trcev uo/u-,/-its) DESIGN PARAMETERS PRIMARY SEPTIC TEM NO. BEDROOM: ] (450 gpd) TANK SIZE: 1250 C PERC RATE: < 1 MPI SOIL RATING: 12 GPD/SF AREA REQUIRED: 375 S.F. SYSTEM TYPE: DEEP TRENCH 38' X DEPTH, MIN J' COVER. MAX DEPTH WELLS LOCATED NEW 1250 GAL PLASTIC TANK— \SEPTIC SYSTEIV / / . / \ / JO'. X 5. EFFECTIVE \ OF EXCAVATION WAS < LOT 7/A SEPTIC LOCATED APPROX. OO' '�/ . / ~~ �. -v� ���� [ / / \ \ ` ` \ / l0O' \ \ \ A // J8RHOUSE \ \ ` ABANDONED JO'x B7FECT1vEDEP rH / / / / 1 vrw ��' �' rp . rn r^^~" r � . ..^. ~~ . ~ / / 100' \ \ SCOPE OF WORK l. REMOVED EXISTING SEPTIC TANK. 2. PLACED NEW 1.250 GALLON PLASTIC SEPTIC TANK AND TIED INTO NEW ABSORPTION SYSTEM. THE TANK WAS PROVIDED WITH MINIMUM 20^ w MANwAY RISER SERVING THE FIRST COMPARTMENT. THE TANK IS A MINIMUM OF 5' AWA, FROM ANY DECK OR STAIR SUPPORT. 3. 'SEWER PIPE' ON SURVEY IS THE T[STHOLE PIPE. THIS HAS SINCE BEEN REMOVED. 4, ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.55. Ton� and F;ef�l Reoo,d D^"my p,rpomg u,r Steve and Leona Hakala 19606Ae|rfUOUBC9ChUg'8kAlaska 99567 SCIMITAR #3 BLOCK 1LOT 10A OSP 191504 ��,/UTN� �N��/N���/N/` ///` DATE: 2MQ�O� '-/`�-`///v,� c-/v��//v�_u�//v��/ �_�_�/ �� �91G2 WOUMTA|M RO�D DRAWN: CLT CHU�|�K AL�SK� �B5G7 ' 8��LE� 1"�4O � (8O7/ 4O�-1O5O ~`~�� ' --` | PID: 051-132-89 SHEET 2OF3 \ ' / \ / / \ / / \ / | 91 ------------ q4 q / 1.250 G � / PLASTIC TANK \ -1oo.e -z-so.2 l. 2. I 4. EXISTING GROUND ALONG THIS PROFILE UNE IS APPROXIMATELY 64%. THE SLOPE DOWN GRADIENT OF THE SEPTIC TRENCHES WAS NOT DISTURBED. ALL EXISTING VEGETATION ON IT WAS LEFT IN PLACE TO MEET 15.55210 BJ.4�oj/i SOILS IN, THIS AREA HAVE A PERCOLATION RATE OF < l WPi AN IMAGINARY UN[ DRAWN AT 46% SL0PE, 2.5' ABOVE INVERT OF DISTRIBUTION PIPE DOES NOT INTERSECT SLOPE Of EXISTING GROUND FOR AT LEAST 35' TOPSOIL AND GRASS SEED HAVE BEEN APPLIED SINCE CONSTRUCTION. GROUND2. EXISTING IS w�rLLY G�� SLOPE r* owo DURING emvrx OF wOVswoco AND NO naouwoWmce WAS cwcouNTEReo� NO GROUNDWATER OBSERVEDw MAY 2020� 46% SLOPE---/ 35' SCALE: 1"=10' TnnK and F:e/u Record Dmwiog F+cpn'ed for Steve BDH Leona Aaka|a 19606 Be|dUOU6} [9 ChUO'Bk Alaska 99567 SCIMITAR #3 BLOCK 1 LOT 1 O OSP 191504 ��/UTkN [N/`/N���/N/` ///` DATE: 2dQ�O� `_'`._",'°,. uv`///v�_u`//,��/ �_�_�� � 19162 WOUNTA|N ROAD DRAWN: CLT CHU�|AK �LASKA 9g557 ' � SCALE� AS SHOWN /9O7\ 4OC-�O5� � PID: 051-132-89 SHEET 3OF3 LLJ C"i _ o� m m � 0 �+ o Z� o �� �� o [] || || |/ ------------ q4 q / 1.250 G � / PLASTIC TANK \ -1oo.e -z-so.2 l. 2. I 4. EXISTING GROUND ALONG THIS PROFILE UNE IS APPROXIMATELY 64%. THE SLOPE DOWN GRADIENT OF THE SEPTIC TRENCHES WAS NOT DISTURBED. ALL EXISTING VEGETATION ON IT WAS LEFT IN PLACE TO MEET 15.55210 BJ.4�oj/i SOILS IN, THIS AREA HAVE A PERCOLATION RATE OF < l WPi AN IMAGINARY UN[ DRAWN AT 46% SL0PE, 2.5' ABOVE INVERT OF DISTRIBUTION PIPE DOES NOT INTERSECT SLOPE Of EXISTING GROUND FOR AT LEAST 35' TOPSOIL AND GRASS SEED HAVE BEEN APPLIED SINCE CONSTRUCTION. GROUND2. EXISTING IS w�rLLY G�� SLOPE r* owo DURING emvrx OF wOVswoco AND NO naouwoWmce WAS cwcouNTEReo� NO GROUNDWATER OBSERVEDw MAY 2020� 46% SLOPE---/ 35' SCALE: 1"=10' TnnK and F:e/u Record Dmwiog F+cpn'ed for Steve BDH Leona Aaka|a 19606 Be|dUOU6} [9 ChUO'Bk Alaska 99567 SCIMITAR #3 BLOCK 1 LOT 1 O OSP 191504 ��/UTkN [N/`/N���/N/` ///` DATE: 2dQ�O� `_'`._",'°,. uv`///v�_u`//,��/ �_�_�� � 19162 WOUNTA|N ROAD DRAWN: CLT CHU�|AK �LASKA 9g557 ' � SCALE� AS SHOWN /9O7\ 4OC-�O5� � PID: 051-132-89 SHEET 3OF3 Municipality of Anchorage P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 a Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV241001 COSA#: Permit#:OSP191504 PID#: 051-132-89 Legal Description: Scimitar #3 Blk 1 Lt 10A Engineer: Eklutna Engineerinq Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the old absorption field has been approved. The approved separation distance is 4.5 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: C( Approved by:��rrZ Name of Reyaiffwer **** VARIAN C E/WAIVER REVIEW **** Eklutna Engineering, LLC curtistownsend@gmail.com February 19, 2024 Subject: OSP191504 Septic Field Waiver Narrative The existing house was damaged in the 2019 earthquake. The house was rebuilt on a larger footprint than original. This necessitated constructing a new septic system. The existing trench was abandoned in place. In an attempt to stay away from the top of slope, the new trench was constructed closer to the existing trench. The way it was constructed did not allow for the full 10' separation between new and old trenches. There is a portion of the new trench that is 4.5' away from the existing trench. For the reasons below, a waiver is being requested for this. The soil in this area has a percolation rate of < 1 mpi. The wastewater will travel vertically in this area and less so horizontally. When this portion of the trench was dug, the walls in the area near the existing trench were dry indicating that there is sufficient native soil that hasn't been compromised. The monitor tube in the existing trench is dry. There is no evidence that wastewater effluent from the existing trench has ever daylighted out the steep slope below. Water was not observed in the testhole in May 2020 during construction of the new field. If effluent were to travel from the new field towards the old field, there would still be sufficient vertical separation between the bottom of the rock and groundwater. The proposed installation will not affect the future development of this or the surrounding lots. Sincerely, Curtis L. Townsend, P.E. GW D 0% A0'££ M1100.91o00 N iE +�OJOOWOgO0 FW - Z O Z W W p Z O Z p ~ in 0 Z 3 S Cl)O = Op 229F WV xoe w0 WZp (A — O W U FU 0 U oz Z �' �n ix -i � �o o wo Ix U tiUp WWUW0 w© W E3� p 0 j p Z U W Z O Z Z N O W WWpzF�� W = U F- woIX O Z o— adp.�0w �C z =a.wCOcp.)a�2W 0n vi {y� 0 U-4 ='0* N O_ '� o J0: N ® per' Y to Q Om LO — Z O .- 0 — Z N W 3WW M �'�o�o W 0 p a o yp V �_ Z m N OO 4. N � A 2020-042926-0 S Recording District 301 Anchorage cc K A 09/18/2020 10:43 AM Page 1 of 2 MATANUSKA ELECTRIC ASSOCIATION, INC. LETTER OF NON -OBJECTION September 15, 2020 Steve R Hakala and Leona L Hakala 19606 Belduque Court Eagle River, AK 99577 Re: Lot 10A, Block 1, Scimitar Subdivision, Unit No. 3, Plat 83-20, Anchorage Recording District, Encroachment of well in 15' undeveloped utility easement, as shown on the attached As -Built Survey dated October 21, 2019 Dear Steve and Leona, MEA has no objection to the encroachment of a well located in the 15 ft. undeveloped utility easement as shown on the attached As -Built survey dated October 21, 2019 subject to the following conditions: 1. The improvement will in no way restrict or limit the current or future ability of MEA to fully enjoy the benefits of the easement for any and all utility purposes that it presently enjoys under the easement. 2. MEA will be held harmless by the landowner from liability for any and all damages or injury to any person or property that may result from the existing and future use of the easement by MEA, its contractors, or assigns. 3. MEA will be held harmless by the landowner for any and all liability arising out of or relating to any use of the easement by others under a Letter of Non -Objection. 4. The landowner will be liable for any damages caused to MEA facilities by the improvement in the easement. 5. The landowner will be responsible for any special construction costs incurred by MEA due to the improvement in the easement. 6. The landowner will assure compliance with all applicable safety codes relating to the improvement in the easement. 7. Use of this letter by the landowner, their successors or assigns will constitute acceptance of these conditions. 8. Alteration of these conditions shall invalidate this letter. 9. This letter is not effecti a unless it is recorded in the Anchorage Recording District before ownership of theKefereNed propeftyNp changed fpm the above-named landowner. Manny Lop Land Servi Man STATE OF ALASKA) SS - THIS IS TO CERTIFY that on this day of 2020, before me, the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn as such, personally appeared Manny Lopez. SRIWA, MEA Land Services Manager Known to me and to me known to be the individual(s) named in and who executed the foregoing instrument and acknowledged to me that he/she/they signed and sealed the same as a voluntary act and deed for the uses and purposes therein mentioned. IN WITNESS WHEREOF, I have hereunto set my hand and official seal the day and ypar`frst a6bvq written , Embossed Hereon is My \ Stale Of Alaska Notary Public Seal I- , c(. My Carnmiss?on Expire u 26 202 - ��j . �• . s _ Notary blic in and of Alaska My commissimi±E�i�HEF ha I tot:. Return to: MEA, PO Box 2929, Palmer, AK 99645 :`y PLAT NO. 83-20 SCIMITAR SUBD., UNIT NO. 3 681.5 LOT 10A, BLOCK 1 54,814 S.F. r 0 9�.�eti a• r � ANCHOR ESMT. 15' T. A E. ESMT. X07.5' �9 ri o eELDUOUE COURT 1I iw 7dd' REVISED 10/30/2019 ADDED WELL AND SEPTIC SYSTEM. LLGYAIIUN5 BAStU UN MOA AERIAL 1DP0. PLOT PLAN 1 HEREBY CERTIFY THAT I HAVE SL*4yw TIRE PROPERTY DEPICTED ABOVE AND THAT GASTALOI LAND THE PROPOSED %6MOVEMENTS AND DRAINAGE SURVEYING. LLC JEFF A. GASTALDI. i%L.S. PATTERNS ARE AS SHOWN HEREON. IT IS THE soap C. oo11a.9Ic Ra. SM a REQ OF THE OWNER, PRIOR TO ANCHORAGE. ALASKA 99507 CONSTRUCTION. TO WRWY THE PROPOSED PHONE 248-5454 BUILDWG LOCATION ON LOT. BUILDING DR 10 DATE DIMENSIONS GRADE AND UTILITY CONNECTIONS MNH2dI 10/21/2019 AND TO DETERuK THE ENSTENCE OF ANY f.ASEMEM COVENANTS" OR RESTRICTIONS F.B. JOB NO. WHICH 00 NOT APPEAR ON THE RECORDED SS31GAI SUBDIVISION PUT. J BUILDING DETAIL SCALE: 1"-20' ��I'I��l'IIIII�I��I:IL�IIL'�Ilul.11il��lli.l' 2 Page 2 of 2 2020 —042926 —0 DocuSign Envelope ID: 586ABBD7-372E-4695-BD09-525566D12D53 'GCI August 18, 2021 Parcel: 051-132-89-000 STEVE R & LEONA L HAKALA SCIMITAR #3 BLK 1 LT 10A 19606 Belduque Ct Chugiak AK 99567 To whom it may concern, Subject to your agreement to indemnify the company as set forth below, GCI Communication Corp has no objection to the existing well encroaching into the T&E easement of SCIMITAR #3 BLK 1 LT 10A, also known as 19606 Belduque, city grid NW1261, GCI WO#. 21-0340-24. This letter of non -objection in no way precludes GCI Communication Corp from full use and enjoyment of any rights it may have within any portion of the utility easement and or the right-of-way, including unlimited access for servicing its facilities. Also, any additional and extraordinary costs incurred during any future required construction, repair, or reconstruction of GCI's facilities to accommodate any or all the encroachments shall be paid by the property owner. By signing below, you agree to indemnify and hold GCI Communication Corp harmless, now, and forever, for any damage, costs, expense (including reasonable attorney's fees), liabilities and injury to any person or property occurring as a result of the encroachment. Please indicate your acceptance by signing and returning this letter to me at the address below. Sincerely, Docu5lgned by: Signature /a 157t i C{tc. Cka�,Ftt,�G� Date 1F5A4F48D5F1410... Steve Hadfield GCI I Mgr, Operations & Construction Network Services Statewide OSP Maintenance P.O. Box 3550 | Palmer AK 99645 | mtasolutions.com | 907-761-2510 NON-OBJECTION TO EASEMENT ENCROACHMENT DOCUMENT By this document Matanuska Telecom Association, Inc. (MTA) declares that it has no objection to the encroachment of the existing well located in Lot 10A, Block 1 of Scimitar Subdivision Unit No. 3 files as Plat Number 83-20 in the Anchorage Recording District. ****************************************************************************** Please be advised that MTA through the issuance of this document does not forfeit any of its rights to the use of the area cited. In the exercise of these rights MTA will, if needed, upgrade, maintain, repair, and/or replace buried or aerial telecommunications facilities within the easement. Any repairs that may be required to the encroachment as a result of utility construction will be borne by the property owner of record. This document does not authorize the placement of any additional encroachments within the easement area. Property owners are required to obtain utility locates before doing any kind of work in the utility easements and will be liable for any damages caused by their construction work in the easements. This document is in no way an agreement to vacate any portion of the utility easement and should not be interpreted as such. Issued for Matanuska Telecom Association, Inc. this 20th day of August, 2021 by, _________________________, Jessica Burnett, Real Estate & Properties Supervisor Matanuska Telecom, Association, Inc. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http:/Iwwvj.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP191504 Work Type: Septic Upgrade Tax Code Number: 05113289000 Site Legal Address: SCIMITAR #3 BLK 1 LT 10A G:1261 Site Mailing Address: 19606 BELDUQUE CT, Chugiak Owner: HAKALA STEVE R & LEONA L Design Engineer: EKLUTNA ENGINEERING, LLC* This permit is for the construction of: Q Disposal Field d Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date Lot Size in Sq Ft Total Bedrooms t�,er�c 4"1 i v 1 eparti11et1t 11/20/2019 11/19/2020 54614 ❑ Private Well ❑ Water Storage All construction shall 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 (18AAC80) 3. The wastewater code requires inspections during the installation_ The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417). 4_ From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: Prior to inspection report approval, letters of non -objection shall be obtained from the applicable utility companies for the well located in the T&E Easement. Received B) Issued By: Date: Date: �� r 9 c if'l ams MUNMPAUTY OF ANCHORAGE DevelopmentSe rvices Department / Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 051-132-89 Property owner(s) HAKALA STEVE R & LEONA L Mailing address PO Box 672387 Chugiak AK 99567 Site address 19606 Belduque Ct Chugiak AK 99567 Legal description (Sub'd., Block & Lot) SCIMITAR #3 BLK Legal description (Township, Range & Section) Lot Size 54,614 Sq. Ft. Number of Bedrooms 3 Day phone 1 LT 10A APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade nX Duplex ElHolding (D) Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the abovef information is correct. I further certify that this is in accordance with applicable Municipal ' odes. j. (Signature of property owner or authorized agent) Permit/Rush Fees: 675 ^ Waiver Fees: Date of Payment: 11-9-1 Date of Payment: Receipt Number: 6 21r3 Receipt Number: Permit No. Q5elg15b`4 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\FormsOient FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191504, Rebecca Carroll, 11/20/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191504, Rebecca Carroll, 11/20/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191504, Rebecca Carroll, 11/20/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191504, Rebecca Carroll, 11/20/19 REV 1/21/19 3335 ARCTIC BLVD, SUITE 100, ANCHORAGE, AK 99503 Phone: (907) 564-2120 Fax: (907) 564-2122 PROJECT NAME:DATE TAKEN: PROJECT NO.:DATE TESTED: CLIENT:TESTED BY: SAMPLE NO.:REVIEWED BY: LOCATION:DESCRIPTION: SIEVE ANALYSIS TEST (ASTM D422) SIEVE DIAMETER TOTAL %% GRAVEL:39.5 SIZE (mm)PASSING % SAND:56.0 6"152.4 % FINES:4.5 4"100.0 D60=4.65 3"76.2 D30=0.68 2"50.8 100 D10=0.18 1"25.4 96 Cu=25.3 3/4"19.0 90 Cc=0.5 1/2"12.7 80 % .02 mm 3/8"9.5 74 % Moist.:= 4.3 #4 4.75 60 Fine Modulus:= #10 2.00 47 (ASTM D4318) #20 0.85 35 Liquid Limit.= #40 0.425 23 Plastic Limit.= #60 0.25 14 Plastic Index. = #100 0.15 8 (ASTM C127) #200 0.075 4.5 Bulk SpG= SSD SpG= HYDROMETER TEST Apparent SpG= (ASTM D422)% Absorption= ELAPSED DIAMETER TOTAL % TIME (mm)PASSING (ASTM C128) 0 Bulk SpG= 0.5 SSD SpG= 1 Apparent SpG= 2 % Absorption= 5 (ASTM D1557) 8 Dry Den (U) = 15 Dry Den (C) = 30 M % (U) = 60 M % (C) = 250 SpG (assumed) = 1459 M-D Test Method = 2750 CLASSIFICATION:Poorly Graded Sand w/Gravel USC:SP FROST CLASS: COMMENTS: BLOCK 1, LOT 10ABELDUQUE-SCIMITAR 3 TEST SVCS 19-400-2 EKLUTNA SVCS 19-P1507 AGGREGATE/SOILS TEST REPORT 11/8/19 11/9/19 DEM JAB 110.0 115.0 120.0 125.0 130.0 135.0 140.0 145.0 150.0 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0DRY DENSITY (PCF)MOISTURE CONTENT (%) MOISTURE-DENSITY RELATIONSHIP 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 0.0010.010.1110100% FINER BYWEIGHTGRAIN SIZE IN MILLIMETERS GRAIN SIZE DISTRIBUTION E-- W 0.9 L.00 N l_j 11 0 r C) • ui i• r • i w • rt • i •- i ! ` , Ui in • i i;. t •i �. tn ;cc ODLLJ i. •• • • •: i0 UJ i • • •uj i. •LLJ i • ui i i o t. • CL i • r M • . i i i 00 i • �a • i • L.jGi • ED t • • • • Ld • ii • • •M • Ci i. • u im •e • • ' to • • • i • to I''' ♦ • • • to c♦ - • !• •... • i. • Q. LU • '! • C) .• w • Q.� • o �OTa� N II •°® '• s Q ••® Opo -0AV ®•°® gyp' ® ® • ® } Aff � • oyy • C) • ON s � U_ ® o o tO � • o • Q O ®' _ va ,1�••p� ® ••° ea 0 r C) • ui i• r • i w • rt • i •- i ! ` , Ui in • i i;. t •i �. tn ;cc ODLLJ i. •• • • •: i0 UJ i • • •uj i. •LLJ i • ui i i o t. • CL i • r M • . i i i 00 i • �a • i • L.jGi • ED t • • • • Ld • ii • • •M • Ci i. • u im •e • • ' to • • • i • to I''' ♦ • • • to c♦ - • !• •... • i. • Q. LU • '! • C) .• w  MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROI'ECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264..4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PR ON-~--- NE~/' ~-AME ~[~UNPG RADE MAILING ADDRESS ~GAL DESCRIPTION / LOCATION NO. OF BEDROOMS ~ Liq. ca acity in gallons Inside length Width Liquid depth ~¢ ¢ IF HOME~DE: O ~ ~ Manufacturer --'~/ ~-~ Material Liquid capacity in gallons -- ~: Total length o~inesr ~ Dis,anco between lines ,t.ength of ea¢~ line~ Trench wldt ~ No. oflines [ ' ~O O ,~ ~ inches ~ ~ Top of file to finish grade ~/ / Material beneath tile Total effective absorptig~area inches ~ Length Width Depth PERMIT NO. ~ DISTANCE TO: Bu Id ng foundat on Sewer line Septic tank Absorption area(s) OTHER ~"E MATERIALS ~'_ / INSTALLER (Rev. 3/78) MUNICIPALITY OF ANCHORAGE f Health and Environment; Departmen~ 825 ~ Street, Anchorage, AK. ~9501 264-4720 ,/"~? * * * HANDWRITTEN PERMIT * * * Permit ~ .... L~'~' WELL AND/OR ON-SITE SEWER PERMIT Protection Location: Legal Description: /{! ~'~[~)/~/~'~ Type of Soil Absorption System Trench: ~( Drainfield: Maximum Number of Bedrooms: ~ The Phone Nul~ber: .~,/~/~/~/~,, Lot Size: Seepage Bed: Holding Tank: Soil Rating(sq0ft/br) /~D Required Size of the Soil Absorption System Is: LENGTH .Z(~)! GRAVEL DEPTH ~'7 / WIDTH DEPTH c~ The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~)~D GALLONS * * Permit applicant has the responsibility to inform this department during 'the installation inspections of any wells adjacent to this property and the number of residences that the well ~ill serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final will be subject to prosecution. inspection and approval by this department Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the 'type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 1 9 8 3 * I certify that: (1) I mn familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if that 3 bedrooms. / //~/~t~ residence is rem°deled t° include m°re ~. t~~ ~./~" '" :-,,~/~c '~-~. z ' ~ Issued by: S igne~: ~ ,, ~pplicant , ~,< ~' SWP/024(1/81) SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchora(~e, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST PERCOLATION TEST PERFORMED FOR:. · EGAL OESOR,PT,ON:__ ~/O /lq7 SLOPE SITE PLAN 10 11 12 13 14.- 15- 16- 17,- 18.- 19- 20~ W^SCROUNDWATER A)o t ENCOUNTERED? O P IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading [)ate Time Time Water Drop / PERCOLATION RATE ,(minutes/inch) TEST RUN BETWEEN - FT AND /? F.~' COMMENTS ~ ~['~ ~oo;~, ~ CERTIFIE 72-008 SOILS LOG MUNICIPALITY OF ANCHORAGE �) DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST j 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ZL� v :rx,S 6'11'181 _ DATE PERFORMED: LEGAL DESCRIPTION: �.UT AU SLOPE SITE PLAN R)f '1101 tti0i A ni, p (✓9�a.: il,�.Lu ...� ur 2 �y. 3 4 C7 ' ♦i 5 �1 s - i 9 10 . . 11 14 •;'(� Gross WAS GROUND WATERS 1—u Net . ENCOUNTERED? LnL Water t O 12 „ �y P v / lYj , IF YES, AT WHAT E _ DEPTH? 3 13- 14 LY qva ae srq ,� 16 17.�� a Robert A. Shafer U 1$ i®o No. 1457-E a � � Reading a Date Gross Net :Depth to Net Time Time Water Drop v u _ 20 PERCOLATION RATE_(minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS /i J 1,34 b' � v" „��! � l PERFORMED BY: y� 9 )Yi r;4 f s% CERTIFIED ly1_1 �� DATE: / TTT--- s { 72.008 (6/79) i NOV WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologicol & Geophysicol Surveys DrlHIng Permit NO. LOCATION OF WELL (Pleole cemplele either lo, lb or lc.) A.D:L. NO. I~.]DISTANCE ANO DIRECTION FROM ROAD INTERSECTIONS S* OWRER OF WILL: Mr. Paul Nyers Address: Myers Construction Sand, gravel, siltf water 165 178 6. ~Ceble Black slate ~60 665 u.~ee~s~one 6~5 ~O 9. FINISH OF WSLL: Grey rock 7lO 730 ~]re~' Z'OC~ ?~ '/{~'/ Backfilling Gravel pack ~C)%~~' Equipment used: ~<%: 15. PUMP: (If ovelleble) HP ~*'"~M~"~S:Perforations from 164-171 Magnuson Drilling AA 5385 Address; P.O. BOX 504 Eagle giver~ Ak, 99577 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete'legal description Lot Location (site address or directions) 19606 Belduque Chugiak; AK ,!$~. Ii" '~') >/"- ~,' Prd@ ~e ~ty.owne r ,. ?!'r!3- m h~niey . r%,?.,." /,, ',,', j~la, dlngr~d;crress P0.,~!ox 102143, Anchorage, ~Lend~ng agency Day phone _688-7730 AK 395___10__ Day phone _ fv1~,l,no,~.._..._~ address <-':-'"-7 ; ' ~';' '- Agent 1' Ad d r(~ss :_ ~ ·' ',~ayphone NOTE: Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well Public water 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-sRe XXX Holding tank Community on-site Publi'c sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-02§(Rev, I/91) Front MOA~I 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 verifythat 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 disp0sai system is in compliance with all Municipal and State codes ordinances, and r.egulations in effect on the date of this inspection., Name0fFirm '' S&SENGINEERIN6 Phon~ ~[z¢_~.~c,/ 17034 Eagle River Loop Road No. 204 Address Eal~le Rivam. Al..b. eo~?? ' Engineer's signature '~//~ &' --~¢-'~r~"-~ Date ~' ///~ / ~/~ DHHS SIGNATURE //"/" A.pproved for T'HREE bedrooms. Disapproved. Conditional approval for 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 orderto satisfy certain federal and state requirements. Employees of DH HS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errom or omissions in the professional engineer's work, Environmental services Division ~4UNICIPA~.rr¥ O? 825 L street, RoOm 502. Anchorage, Alaska 99501 Health Authority Approval Checklist Legal Description: ~.)~'/~.4-/' .¢.¢.¢.¢.¢.¢.¢.¢.¢~¢~/' //~ .~'~:/~r', ;,-/55.~. ~$ . Parcel I.D.: A. WELL DATA Well type Log ereeem (~) Total depth ~7 / Sanitaw seal ~ If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~'/~ -~/~ ~ Cased to /d"¢O r Casing t~eight (above ground) Wires properly protected~,-~) YE5 Date of test Static water level Well production FROM WELL LOG AT INSPECTION ,'/ g.p.m. J, ~' g.p.m. WATER SAMPLE RESULTS: Coliform O Nitrate ], o ~, Date of sample: _ /~/~'/~ d~ Collected Dy: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~'~/~-'~ / ~'~"~ Tank size / ~:)~'¢)C7'' Number of Compa~ments / / Foundationc!eanout~) ~5 Depresslon~ ~¢ .,gh water alarm (Y/,) Date of Pumping :¢~.~.¢¢ Pumper C. ABSORPTION FIELD DATA.- Date installed ~¢'/Z ~/~ ~ Soil rating (g.p.d./f¢ o~)_/ Length_ ~O / Width ' .~/ _ Gravelthickness below pipe. ' ' ( _2 ' ' ~/¢¢ Results ~)-/~¢-~ For ~ bedrooms Date of adequacy test _~/ / Fluid depth_~/~// (ins) Minutes later:. ~0 Absorption rate = ~'~ ~ g.p.d. Peroxide treatment (past 12 months) (Y/N) zV/J,'V'(¢ xA¢'¢~ It/A/If yes, giw; dato 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles ~ / /'//,/¢.- Size in gallons / E. SEPARATION DISTANCES "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /~O/7z'- Absorption field on lot Public sewer main A///4- / Sewer/septic service line /f~ ~z_ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~-/~' Property line ¢ /"/- Absorption field Water main/service line /~/~z Surface water/drainage /O~)/~z'- Wells on adjacent lots On adjacent lots On adjacent lots Public sewer manhole/cleanout I00/'/- / ioo×¢- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Sudace water Curtain drain Building foundation f0 ~ Water main/service line //0 /~- DrivewaY, parking/vehicle storage area ,.~',z,/',,-/~./A/ Wells on adjacent lots [ O~ F. ENGINEER'S CERTIFICATION I certify that lhave determined thru field inspections and review of Municipal records~fl~~ are in conformance with MOA I-:fAA guidelines in effect on this date. j~,~/'~'- HAA Fee $ C_~,~Z~D' So 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 of Environmental Services On-Site Services Section P,O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATF OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWFLLING 1. GENERAL INFORMATION Complete legal description Lot I OA: Block 1: S~mitar Subdivision #3 Location (site address or directions) Property owner Mailing address 19606 Belduque Joe Sohlberg c/o R~max of Eagle River Chuqiak, AK Day phone 16600 Centerfi~ld Drive Eagle River, AK Lending agency Mailing address Agent Address Day phone Day phone 2. NUMI=IER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well XX× Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA #21 4. TYPE OF WASTEWATER DISPOSAl..: 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 d.e.e.e.e.e.e.e.e~is inspection. Phone .5 & 5 ENuiN~ 17034 E agl¢,..Ei E~gle/~, Al Name of Firm Address EngineeYs signature DHHS SIGNATURE ~ Approved for .-~ ~o.p'~oad Ne 204 99577 Date J'-/z' ~/~'' bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Oate ¢-/ - ~'¢: The Municipality of Anchoraqe 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. 72-025 (Rev. 1/9~) 8ack MOA ~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAl. CHECKLIST Legal Description:_ A. Well Data Well type rC>/C(~/a, 7-~ Log presen ) Tote depth _ Sanitary seal ~',~) ~:'.~ /O A /~(..~' r ,5'c-1~/7-~/,. Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~'<~/2..~/~)~-~ Driller Cased to / 90 ' Casing height Wires properly protected(~N) ~/~-3 FROM WI=LL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout .Petroleum tank Septic/hc!d!n.3,tank on lot Absorption field on lot / Public sewer main "~ Sewer service line ~- ~- ["/'- WATER SAMPLE RESULTS: Coliform Date of sample:_ ,~'/Z.~/'~- Nitrate (~),/~) /¢~/,~ Other bacteria ._.~/~Oo~ Collected by: ~'¢- ,~' ~7-~& //.-" '~-U~-/?--//'J ¢-=- B. SEPTICYefOL-OtNO-TANK DATA Da,e,nsta,ed Cleanouts~.Y~N) High water alarm (Y~). Date of pumping_ Tank size /d) oo ~(-- Foundation cleanout ~/N) _~7"Fc~,f- Compartments Depression ( Y/,.~ Alarm tested (Y/N) ,4--2///4, Pumper ~)~ .1/~, r~- /C)c,,/v4 ,~.,/A/( SEPARATION DISTANCES FROM SEPTIC/H~:DIN(~T"ANK TO: Well(s) on lot /(-~ f"/ On adjacent lots _/O(,,O ~--~ To property line _¢/~ ~ Absorption field Surface water/drainage Foundation /CD Water main/service line 72-026 (3/93)° Fror~t CONTINUED ON BACK PAGE C. LIFT STATION /'] ~ haL"'¢' ,P~J'~-;"~'"~-- Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) / SEPARA~LIFT STATION TO: yot On adjacent lots D, ABSORPTION FIELD DATA Date installed .~'/5[/?..~ Soil rating (GPD/FF) Length ~ r Width Gravelthickness Total absorption area ._~o© ~ Cleanout present~l) '~ Date of adequacy test ~/27/~'~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Manufacturer / Manhole/~ "Pump on" level at J "Pump off" Level at ...----'"'"'/Cycles tested Sudace water System type ~'--,/~,,'dd 14 Total depth Depression over field (Y/~ Resu,s a,) for ..~'~ After test ~? ./(~/--)~ .~-'"AJ~~--~,'-D Ifyes, givedate Bedrooms Well on lot //d...~C~ To building foundation ~_~..~ On adjacent lots '-~ © ~ -~-- Surface water Curtain drain /©0 On adjacent lots /COo ~-/ Property line To existing or abandoned system on lot /t--// Cutbank ,/U///-~- Water main/service line / 0 "':/'- Driveway, parking/vehicle storage area ~0 ~ E. ENGINEER'S CERTIFICATION Signature ~ ~~e ~:~ver/~,Oop..R/dad/'No. 204 · glo River, Engineer's ~~ Date ~-~ ~ HAA Fee $ ..~O0,'~// Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back 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 AUT'HORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. · 1. GENERAL, INFORMATION Complete legal description r, ob IOA; Block 1; ScLmL[za~ £ubc]ivis~_on ~;:3 Location (site add'ress or directions) 19606 Belc]uQu~, ¢.hu~3iak, hla~kr~ Property owner Mailing address Lending agency Mailing address Michael Goetz Box 67].833~ Chuqiak~ Al.aska 99567 Day phone 688-1380 hm 269-5483 Day phone Agent Sharon Hinsch - RE/MAX OP EAGr~E RIV~'~R Day phone 694-2979 Address 16600 Centerfie].d Drive, S~lJ. te 20].t E~g].e River, A~k~ 99577 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.. lng to the legality and status of system. 4, TYPE OF WASTEWATER,DISPOSAI.: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. '72-025(Rev. 1/91) Front MOAtt21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that ~n~, investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature '~ ~ ~ FNGINEERING 17034 Eagle Rid'er Loop Road N(~, 204 Phone. DHHS SIGNATURE Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAl. CHECKLIST Legal Description: A. WELL DATA Well type ~¢-v4/','fc¢-- If A, B, or C, attach ADEC letter. Log present~/N) ~ [)ate completed Total depth '1 [.~'1 ~ Cased to Sanitary seal ~/N) y Date of test Static water level Well flow I ,0 Pump level FROM WELl. LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer m~in ~'//~' Sewer service line "P'~ ~ ADEC water system number ~' 7-% ~ ~"5 Driller i'~x~J,~3~¢ ~ ~O ' Casing height Wires properly protected ~/N) y AT INSPECTION z g.p.m. ) ,%" p _ _g.. ; On adjacent lots ; On adjacent lots _ Public sewer manhole/cleanout Petroleum tank WATER SAMPLE! RESULTS: Coliform C) 2"'~"~/)0 ~ Date of sample: Nitrate _ Collected by:__ Other bacteria /~D/'.~ 'C- S& $ ENGINEERING "J~1)34 Eagle River Loop ROad No. 204 Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date installed ~ Cleanouts~5/N) ~ Foundation cleanout ~/N). High water alarm (Y~) Date of pumping \\ Compartments ",¢ Depression (Y~ Alarm tested (Y/N) "'J/,,~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ ¢~o ¢¢- On adjacent lots 1 oO ~' ~' To property line ~, r2 ~ 4-' _Absorption field ~" l Surface water/drainage t~O ~ ~' Foundation Water main/service line. 72-026 (Rev, 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed ' Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes SEPA~ROM LIFT STATION TO: ,...W. etCon lot On adjacent lots Manufacturer Manhole/Access (Y/N) ~ ~level at ~'~~Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed Length '2Pc:¢ Width '"~t Total absorption area ~ ~'~ Depression over field (Y~) R e s u I t s4.4.4.4.4.4.4.4.4.~/f s i I) Peroxide treatment (past 12 months) (Y~ Soil rating \¢>r~'~/¢,0- System type Gravel thickness ~ ~ Total depth Cleanouts present ~/N) ",/ Date of adequacy test ~,~- for '~'"¢ ¢--¢~¢-...- ("5') IZcJ'~ ¥j~'*j If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / r~c~ ~ ~ On adjacent lots \ c~ c, ~ 4- Property line To building foundation '2-"%~ To existing or abandoned system on lot On adjacent lots '"~o ~'~" Cutbank ¢ I /k- Water main/service line Surface water Curtain drain E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area Signature Engineer's Name Date I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect :, d, 5 ENGINEERING ,.:,~,~ ~agle Rivet' Loop Road NO. · ~'l!~ ~;~;r, Alaska 99577 rte of this inspection. HAAFee$ / ~' ~ Date of Payment //'~ / '~ ~ ~' / Receipt Number '~ ;~2_~.~, ~ C"'-~-~/'~'7~,..~ 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTIC)N FOR HEALTH AUTHORITY APPROVAL OF ON-SI'T'E SEWER AND WATER FACILITY 264-4744 Application Date Apri¢. II~ 1988 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, sec ion, town'hip, range) Lot 10A; BC. ock I; ScimZtar Subdivision #3 Location (address or directions) B~uque Court (b) Property Owner Rabki~,, Telephone: Home .Go6tz- Buqzr Mailing Address. ' (c) Lending Institution AC._aska, U.S.A. Fed. (]~.. U~.. Telephone Mailing Address (d) Business Real Estate Company'and Agent RE/MAX OF EAGLE RIVER - Eva Loken Address 16600:'Cznterfi&gd Driv&~ Suite 201~ Ea,ql6 Rive&, Alaska Telepbone 694-4200 99577 (e) Mail the HAA to the followina address: or; Check here ~, if hold for pick up. List contact person and day phone number below· 3 & S ENC~INEERINC~/694-2979 .~:~Z~._~_~2d.. L~'mp Rnad: Su,i,f'~_ 904 Eag~a. ~u¢.~; A.PaAba qg~77 TYPE OF RESIDENCE Single-Family I-~ Number of Bedrooms ordered by Eva Loken 3 WATER SUPPLY Individual Well,~ Community [-i Public [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. SEWAGE DISPOSAL OnsiteJ~ Public [] 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. Page 1 of 2 72-025 IRev 8/861 F¢onl 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 this 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 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 $ & $ ENGINEERING 17034 Eagle Ri.vel' LOOp l~oat~ NO. 2{54 Address __~t~c, tei. T~_~n qq~77 Date Telephone DHHS APPROVAL Approved for JC- :-"bedrooms by Approved t~5~ Disapproved Terms of Conditional Approval CAUTION 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. Page 2 of 2 72-025 fRev 8/86i Back WELL DATA ~:NVi~,oNMt~NTAL S~l~l~fY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) APR 2 5 19~HECKLIST: FEBRUARY 1984 264-4744 Legal Description: ~'r~'- /0/'~' 'A2--/b'¢-' Well Classification I bA~-~ ~x//'C)O/g>-q.__ If A, B, C, D.E.C, Approved (Y/N) Well Log Present ~,)N) ~/ Date Completed ~-)~'Z/'~) ~ ~"~ Yield Total Depth ~ ('¢"'7 I Cased Static Water Level /'¢~ Casing Height Above Ground Electrical Wiring in Conduit(~N) Separation Distances from Well: To Septic/Ne il.d~g. Tank on Lot Depth of Grouting Pump Set At _ Sanitary Seal on Casing([~gN) Depression Around Wellhead (Y/~ \ c-'~:~ / ; On Adjoining Lots \ TO Nearest Edge of Absorption Fie~ ~ Lot }_~. ~ ; On Adjoining Lots To Nearest Public Sewer Line ~ /~' To Nearest Public Sewer /_~ I.~ Cleanout/Manhole r~/¢~. To Nearest Sewer Service Line on Lot __ "~ B. SEPTIC,~I'tOLI:)tNG TANK DATA Date Installed ~"~7,~\ ~ ~P Size __\ Stand pipes C(._~4) "'/ Air-tight Caps~Y~N) Depression over Tank (Y/I~ Pumping/Maintenance Contract on File (Y/N)~ r_ Holding Tank High-Water Alarm (Y/N) Separation Distances from SepticPrteMhag_Tank: To Water-Supply Well \ To Property Line \ c~ To Water Main/Service Line \ Course \ ~c;> I...~. No. of Compartments '"// Foundation Cleanoutd~N) t.~//~ Date Last Pumped ; for Temporary Holdieg Tank Permit (Y/N) r~/zA/ To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026/Rev B/861 F~onl C. ABSORPTION FIELD DATA Square Feet of Absorption Area Depression over Field (Y/~ Results of Last Adequacy Test Soils Rating in Absorption Strata Date Installed ~--'~-I -'~¢~ Length of Field Width of Field '~D ~ Depth of Field Gravel Bed Thickness '~¢~Z:~CJ~ Standpipes Presenl:C~N) ~ Date of Last Adequacy Test Type of System Design Separation Distance from Absorption Field: To Water-Supply Well \ \ To Building Foundation '"~-"~ Lot rb [ ~ TO Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~ / To Cutba~nk (if present) Comments ~llecL_ -_ --_ Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~'~P-.u.L~ping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MpA and HAA guidelines in effect on the date of this inspection. Signed$ & $ ~.'O?!EFF. EING Date ¢/~_ Eagle River, Alaska Receipt No. / 0 ~ ~ Date of Payment ~/r ~ ~ Amount: $ Z~ ~ Page 2 of 2 72-026 (Rev 81861 B~ck APPLI~, UT FILLS OUT UPPEFI HA[ ONLY MalllngAddre~ '~)0_ }30:,~ 1596, . ~?'.e.,,. !~.lvo~, h~ Z~pCo~, 995?? 694-42~2 Address Zip Code Lending Institution Phone Address Zip Code Type of Resi~nce ~ Single Femlly Water Supply ~ndividual ATTACH WELL LOG. A well log Is requked for all wells dulled since June 1975. ~ Community For wells drilled prior to that date. 01ye well depth (attach log if ~vallable). ~ Public Utility Sewer Disposal Public Utility When Connected to Pubgc Utility:- ~ ~ Holding'rank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector ( ~ ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* Soils Rating Date ~wer Installed Well TO Abso,ption Area / ~ ~ ~ Well Log Received