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Home My WebLink AboutGATEWAY TO THE PARK BLK 1 LT 6 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street. Anchorage. Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT "~"~'/~'~4 DISTANCES SEPTIC ABSORPTION .,~d,-~ TANK FIELD WELL Towns~p, Range, Sect)on ~ x driveway, water boches, etc.) TANKS N ~ SEPTIC [] HOLDING TYPE OF SYSTEM ~ /- "~ ~-c?. ~ L~ > \ [] TRENCH J~]~-SE" [] W. ORAl" [] OTHER Fill ad~,ed above originaJ grade Grave~ Oepth iae~eath pipe I ~ Grave~ mgth Total amp.on ,Tea~) ~-- D~stance between line~ ~---~ ~ FT (~ FT - WELLS [] PRIVATE [] OTHER (IdenUfv) Ct~ I FT FT ~.. 4 ~ ~.- ~ '~' ~ 1~1"2.. I'" Itl ,.~.,.. ~.,.,.~,.~: ,Ar ~- ~ ~,<.' REMARKS: ,,~.)~ ~ ~,~1 Inspecti~ed by: <. & $ ENGINEERING ,r, ~.~_ - _.-'2~.~ , ~/,,~A I. ~-,, .... ..- ~x~,,~' Date: · , From : ALPINE DRILL 9~? ~ ~4~ Apr. 18. 1991 09:~5 WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division ofGsolo0i¢ol & GeophyslcolSurveys DrillinG Permit Ha. LOCATION OF WELL (PH, ela eomplete ilar lo, lb or lc.) A.D.L. NO. Material Ty~ TOp B'oIJom · BOokflllln~ , , Groval peel la. WAT[R WELC CONTRACTOR'S C[RTIFICATION: IS. Wall~ Timper~iure .... o ~ F q ii t-~ ]~ ,- ~ D .x ~ ? T Y C~ F (~ N C H 0 R A Department of Health & Human Services P:':.'~ ~ S-Lreet,, Anrhr, rage, Al- " ~,o=,-)~ 343-4720 .,.,,~ y F. hon =,- B [ ,::,c k: b,-:, ~. ~.,,4~.,, ifii:~- ' ' ct-.'. --~epti tank c.apaczt'¥'-" l~' c.',:.u) qallons. Fach ~-~r:t lc tar,: ,':',,~x? x,a,.'m at i=~s.+ .2' compart-,.-~eFtts. Depth to top of septic tank(s) ::: :Fi'~;'?Z~J.i,Fd c::m the C~r!!-:: aRQ connected to the residence~ Depth to top of holding +.~i][:: -:: 4, t) feet. reouir, es insulation over tank~ ..... :'-"-"~EPi IfiUS'I or.: ,.,4=,,R~LEU II',l A,_,,...L,F~DAN,~E wI,H ]HE ENGINEER'S F'FC'I,:_-,4 DATE[) =' '=" "-'" AND u,c.."¢IMi ION THEREFROM REQUIRES DHHS APP- ........ - ....... -, - ........... r F, z~-' BEFORE ALL ..N.mFEE.~-,D,'~$. P'UVAL rr-.~.u,n., li~ I:;IF4.'zJiRUu]ION. .,I,_,T,. Y DHHS T ~'' 'I-T ~' ' !~,imi ..... ¢~' OF .... - ':P''-' THE "' '=' ' '- .... ' ..... ~,,--L.H ~,.l,~ A i TF~' STA'fION KE~.u~.I-<ES RF, ROFRIHTF-. ELECT-- ......... ~-, ............... ~H~.~ .-mr, F~.~, IS FOR 'F'.,._',~- BEDROOM SINGLE FAMILY r;.:=~ --.-:~i-c ;~,i v AND EXP-,r. ERS ON HAl ~ {amiJ zapwz=~,.~ +he rmquirements imp. _ om-site sewers and · ' ~ as set M ,..~ ,-. . of Amchor-age (MOA) and the ..... ' - ol Alaska. znsta~L t. he sVst. em ~n ac:co,dance with ali MOA codes and ..... compiJ, ance with the d~eszgn cP.~e, .~ o[ ~ - ........... t_ha · B~'J~.DF~ +m~ al ] r...!~'A A pe uicemeF~t.s {,:]P set ............d,i~ .:~L,:~Ud O{ ia~ka q __ ~'- .... a . pL~bl ic ...... 1ct ..... ~ ..... 4 }h~+ +h~s l:mr"m~f ~S vaI2d f'or. a maxLmum .,q__-, .... 4 t~---* the the ,:-F~J.~PCJedi~lqt ¢,~:[ ~ ~ PE:-qL[Z.P~ aF~ addit ~.onal permit. Municipalit~ of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCn,PT,ON: L-~ ~ t 1 2 3 4 5 6 7 8 9 10- 11 12 13- 14- 15- 16- 17 18 19 Township, Range, Section: 'T-I'~i,~ , ~ SLOPE SITE PLIAN 20 ENCOUNTERED? COMMENTS S ~ ~N~N~E~N~ ~ -- PERFORMED.Y= '~.~'~~~~~ CE.T* T.AT THIS TEST WAS P E*ORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI, CT ON THIS DATE. DATE: '-~~ PERCOLATION RATE ~ (m~nutes/mch) PERC HOLE DIAMETER Gross Net Depth to Net Reading Date Time Time Water Drop ~- L.,.~-o~ '~..~,~ ~1~' t ~ IF YES, AT WHAT Mmit~'i~? '~,--~ MunicipantYof Anchorage P.O. ,5, .,' 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLE$, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES January 9, 1987 S & S Engineering SRB 196X Eagle River, Alaska 99577 Subject: Lot 6 Block 1 Gateway to the Park Subdivision On-site Sewer Permit #860398 Eric Jensen Property A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1986. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a Well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as-built inspection report (three part form) must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4744. Sincerely, Program Manager On-site Services RWR/ljw enc: copy of permit ,_.H' ...... ~=- ISSUED= DEPAR~hiENT HEALTH AND ENVIRONMENTAL ROTECTION ~ ~ 8W5 L ~Tr..=~ , ~ ~NUHOR~oE, AK 9950 1 ~4-4/~ ON--S I ]~E SE~ER F'E~M I T i 0 ./.'-2 uuNTRui r--hJi4,--. ERIC JENSEN % S&S ENGINEERING EAGLE RIVER, AK 9957'7 694-2979 MAX BEDR. OOMS: SI.!BD!V]SION: GA]EWAY TO ]-HE F'ARKK LOI: ~ SECT ION: 4 TOWNSHIP: !.];N RANGE: !E 55695 (.SE!. FT. OR ACRES) l_isted below ape +.he options available to you in designing your septic Sv-stem. ,-.L ...... L.~L,S~ thE. option that best. i~*=~ yOUP. site. DEPTH TO PIFE BOTTOM (FT.) GRAVEL DEF"IH (Fl'.) iOFAL DEF'TH (FT.) GRAVEL WIDTH (F'T~) GRAVEL LENGTH ',.FT. ) GRAVEL VOLOME (CU.YDS.) TANK SIZE (GALS) SUIL RATING (SQ.FT. /BR) BEI_} W - bRA I P4 4.0 4.0 4.5 5.5 17, 0 = '-' 34.0 59. C, ~:.5 .'7"1.9 1 - ex-x-)· 0 ** i, (-x-x-). c) ~. 1~5 1~5 =,~ ,H irE BOFTOM ::: .; .... FT. REQUIRES INoUL~.ION Dc.,'~n IU PIF'E BOTTOM < 4.(] FT. MAY REQUIRE A LIFT STATION ** -~" '" 1'"' ....... ~mN~... P.u-~T HAVE AT Lr_R._~i TWO '~ ~ ...... ~" '~¢' i cc:'r tif./ that: I am f-~mi'i4mr' with the requirements. For on-site sewers and wells as set fort. h,~."-.- the MunicipaIity. oF Anchoraqe_ (MOA) and the State of' Alaska. 2. ~ ~-:~1~ ,~t~ll the system in arcordance with all MOA codes and requlations~ and in compliance with the design criteria of this permit. 3 I :~i]l adhere to ~!i MOA and ouot= Of ...... r'e ...... A~a~:.~ quirements for the set back di:.t, ances From any existing well, wastewater disposal system or pu. blic :,:%~erage system on this OF' any adjacent or nearby lot. ~ i ,~'.M .... 4 - -~ ...... +his permit Js val:d For imum oF 3 bedrooms and an'v en~ar(~ement will require an additional permit. iF: ;.~ i,"~ ,:,:~*TION :S t,~¢,HL_,__.EI_, tN AN AREA COvEn.:D BY MOA BUILDING CODES, 1,,=:, I. ~-~r.,'- EL:,~lr;iCAL F'ERM*Tz, AND zNoFE=.TION MUo, BE OBTAINED: ,.='°) AS-BUII_-FS ~'~i [ .~,r,r,c, ,, , r , ~-~ L- NOI'[ ~¢E ;qFF,,IO.¢ED WITHOUT AN ~', =r'~ ............ = · ~'5: ~ ...... r~ICAL zi~rEui ION REPORT, AND ,-) THE ELEC]K:*:''u W~qRk :fiU~: BE DONE BY A ! zUEN.~ED EL~UTHICzmN DA TE: iSS,JEi) BY' ~ DA]'E: ;o"r ,,ZV =,4,:,:-; ax) m, u DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~ I LEGAL DESCRiPTiON: Z ~ ~J~ I ~'/1~'/,¢/'/~/~ Township, Range, Section: T/.~/~j' {~ ,,~)~::) 7'~ r'~"- p,~-"~'~. SLOPE SITE*LAN / '/ / / / / .111 ,~,HI / III III 1 2 3 4 10 ~ ~'~ C~-- ~ EW~cSoGuR2TUENRDEDW~TER ~ 11 IF YES, AT WHAT DEPTH? 12 / Gross Net Depth to Net Reading Date Time Time Water Drop ~J/~ ~-/~ 14 15 16 17 18 19 PERCOLATION RATE inch) PERC HOLE DIAMETER ~ TEST RUN BETWEEN .,--- ,~"r~"~ND ~ PERFORMED BY: ~ ~ i~X I j~.~,~" ~ CERTIFY fTHAT THIS/~TEST WAS PERFORMED~. IN ACCORDANCE WITt~I~T~I~I.~~ELINES IN.~aEFECT ON 'EH S D~'[E. DATE: 'i~Z' ,.~?/'~' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# ~--~_(~¢~.\ _~"'~ (._~n,, , JL'~ 1. GENERAL INFORMATION Complete. legal description /-~' ~ ~/ocl< -~ Location(siteaddressordirections) ~E ~fl ~ /~f, /~oro,~.r~ d,'~.j Property owner ~? ~ (~r~[?~ H~/~¢_F Day phone Mailing address ~8?/~ ~ ~oro~u~ ~'r.~ ~¢~/~ ~ ~ ¢9~77 Lending agency - Coa~/~7 ~,~ ~m~ ~ Day phone ~ ~ ~ - ~ ?o5-- Mailing address ¢¢7 ~. ~o¢~r~ ~ ~/~ ~,~ ~ ~ Agent ~ ~/c&~n~ ~c~ ~,~o Day phone 7~-~ Address ~20( '~"~ ~ ~o~ ~n~o~, ~ Unle~ othe~ise requestS, H~ will be held for pickup. NUMBER OF BEDROOMS: ~ ~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(1~w. 1/91) Front IdOAI21 o STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature bedrooms. DHHS SIGNATURE Approved for ~ Disapproved. Conditional approval for Phone Date bedrooms, with the following stipulations: Additional Comments Date ~"/~'¢(~ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The 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. 72-02~(Rev. 1/~1) Beck MOA~'21 · -~NMENTAL SERVICES DIVI$. Municipality of Anchorage~:[B 1 i 1998,~ DEPAR;MENT OF HEAL;H & HUMAN SERWCES F. £ E IV Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: L~' A, WELL DATA Well type Log present (Y/N) Total depth ~' ? ' Sanitary seal (Y/N) Health Authority Approval Checklist Cased to IfA, B. or C, attach ADEC letter. ADEC water system number Date completed ~'/ 8Y ,6' '7 ° Casing height (above ground) Wires propedy protected (Y/N) FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~ Co [//C,~ Date of sample: ~ / Y / B. SEPTIC/HOLDING TANK DATA Date installed d'/?-5-/~' Tank size Foundation cleanout (y/N) Date of Pumping J / ?_7 / C. ABSORPTION FIELD DATA Date installed b//~-,,r-/ Length 5'f' Width Effective absorption area Date of adequacy test '~ / AT INSPECTION g.p.m. 7. ~- 't' g.p.m. Nitrate Collected I c,o~'v,e Number of Compartments Depression (y/N) N' High water alarm (Y/N) /v'. Pumper Fluid depth in absorption field before test (in.); Fluid depth <~7 (ins) Minutes later:. Peroxide treatment (past 12 months) (Y/N) /V Soil rating (g.p.dJfF or ~/bdrm) ~-~'f ~ System type ~D~ Gravel thickness below pipe Monitoring Tube present (Y/N) Y' Results (Pass/Fail) ?~t: ~- Immediately after ?/I gal. water added (in.): Absorption rate = ~ ~"~_~ q.p.d. ~--'~'~'~ If yes, give date /v'. A. C~.,~-° Total depth 3' ' __ Depression over field (Y/N) __ For ,~ /v bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION IVo o (~ Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Al:lsorption field on lot Public sewer main Sewer/septic service line '~ ZS' ' Size in gallons "Pump on" level at* *Datum On adjacent lots ~ / oo ' On adjacent lots '> / oo, Public sewer manhole/cleanout Lift station "Pump off" level at* SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ,3~" Property line > to' Absorption field Water main/service line ~ lO' Surface water/drainage '> ~ oo Wells on adjacent lots ";> ~ oo ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ;> (0' Building foundation ~> 5/0 ' Surface water ;> / o{2' Curtain drain Mo ~e s e e,~ ENGINEER'S CERTIFICATION I certify that I have determined thru field inspec#ons and review of Municipal reaord$ that the above systems are in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name Date ~ / 72-026 (Rev. 3/96)* Water main/service line '~ lo ' Driveway, parking/vehicle storage area ~ 5-o ' Wells on adjacent lots '~ i oo ' 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 067-601-01 HAA # 1. GENERAL INFORMATION Complete legaldescription LT6 BK1 Gateway to the Park Subdivision Location (site address or directions) 32472 Eagle River, AK Property owner Ms. Lynne Balogh Day phone Uailingaddress 3:~477 ~f~. Wn,-nh,]~W Cir. Eagle River. AK Lending agency Day phone Mailing address. Mt Korohusk Circle 99577 Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well Public water MuNICIPALI'I%' OF ANCHORAGE r~qViRONIV~-.NTAt- SERVICES DIVISION SEP 0 3 1996 RECEIVED NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: 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 121 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Phone 344-].9:28 Name of Firm Theta Environmental Enqineerinq Address 905 Javme Ct., Anchoraaa-~"~K 99~[D Engineer's signature ~-~"~~-f ~ bedrooms. o DHHS SIGNATURE \ Approved for Disapproved. Conditional approval for Date 8/29/96 bedrooms, with the following stipulations: Additional Comments By' Date c/_/~) -~',/ 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. 72-025 (Rev. 1/91) ~ack MOA ~21 Legal Description: LT A. WELL DATA Well type Private Log present (Y/N) Total depth 8 9 ' Sanitary seal (Y/N) Date of test Static water level Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) ~ o~Ac~ s~wcEs Health Authority Approval Checklist $EP 0 3 ~996 6 BE1 Gateway to the Park Parcel I.D.: Subdivision If A, B, or C, attach ADEC letter. ADEC water system number N/A ¥ Date completed 6/24'/90 Cased to 87 ' FROM WELL LOG 6/24/90 5' Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION 8/25/96 2.0 4.9' Well production 15 g.p.m. 6.4 g.p.m. WATER SAMPLE RESULTS: Coliform 0 ~ j~_ Date of sample: 8/25/96 B. SEPTIC/HOLDING TANK DATA Nitrate ~ ID Other bacteria Collected by: R. Godden *Data from Indirection Report Date installed *,?/13/9,0 Foundation ~leanout,(Y/N) - Y Tank size * 1000ga 1 Number of Compartments * 2 Depression (Y/N) N High water alarm (Y/N) __ Cleanouts (y/N). Y N/A N bedrooms 0 Date of ~umping 8/24/96 c. ABSORPTION FIELD DATA Date installed '9/13/90 Length '54' Width*24' Effective absorption area * 1296 Date of adequacy test 8 / 25 / 96 Fluid depth in absorption field before test (in.); Fluid depth 0 (ins) Minutes later: Pumper J & R *Data from In_S[~ection Report Soil rating (g.p.d./~ or ~/bdrm) * 225 Gravel thickness below pipe * 6" System type * Bed Total depth * 2.5 ' Monitoring Tube present (Y/N) Y Depression over field (Y/N) __ Results (Pass/Fail) Pass For 3 0 Immediately after I 15 ~lal. water added (in.): 0 Absorption rate = at least 450q.p.d. Peroxide treatment (past 12 months) (Y/N) u~o~n __ If yes, give date N./A 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested N/A E. SEPARATION DISTANCES F. N/A N/A GT 25' Size in gallons "Pump on" level at* N/A *Datum N/A SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot G T 100 ' Absorption field on lot GT 1 OO ' Public sewer main N/A Sewer/septic service line N/A "Pump off" level at* N/A On adjacent lots GT 100 ' On adjacent tots GT 100' Public sewer manhole/cleanout N/A Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDINGTANK ON LOTTO: * Data from Inspection Report Absorption field *GT 10 ' Foundation * 38 ' Propertyline *GT 10 ' Water main/service line *GT 50 ' Surface water/drainage GT 100 ' Wells on adjacent IotsGT 1 O0 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO?Data from .In_spection Report Building foundation *GT 50 ' Water main/service line *GT 25 ' Property line *GT 10 ' Driveway, parking/vehicle storage area * GT 8 0 ' Surface water GT 100 ' Curtain drain N/A Wells on adjacent lots G T 10 0 ' ENGINEER'S CERTIFICATION Ice~i~tha, I havede,rminedthrufieldinspectionsandreviewofMunicipa~;~Z~~sare Signature [~T ~ DateEngineefsName8/29/96R°nald E. Godden, P.E. ""~~--'~~~ Date of Payment Receipt Number'~~~--~~__ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 2 THETA ENVIRONMENTAL ENGINEERING 905 Jayme Court Anchorage, Alaska 99518-2'!.~.~. (907) 3~.~.-1928 Fax: (907) 349-2363 Ms. Lynne Balogh 32472 Mt Korohusk Circle Eagle River, Alaska 99577 August 29, 1996 Re: Lot 6, Block 1, Gateway to the Park Subdivision, Municipality of Anchorage, Certificate of Health Authority, Approval for Single Family Dwelling, 3 Bedroom Home. Attached is a completed Certificate of Health Authority (Blue) and Health Authority Approval Checklist(yellow). These documents are for submittal to the Municipality of Anchorage, Department of Health & Human Services, Division of Environmental Services, On-Site services Section. The Municipality fee for the Certificate of Approvalmust be submitted with the blue and yellow document. In order to prepare the documents, I performed a well flow test, on-site waste water disposal system adequacy test, and verified all separation distances, in accordance with Municipality policy. I performed a separation distance verification. I did not note any violations of code, other than those mentioned below. Two water samples were taken. The first sample was for coliform bacteda and the results were "0". The second sample was for nitrate level. No nitrate was detected in the analysis. The allowable limit of nitrate is 10 mg/L. Further, since the amount detected was less than 5 mg/L, nitrate results are not noted on the final approval form. I perforated a well flow test on the well, August 25, 1996. The well has a surge capacity of over 1,000 gallons and was able to produce 6.4 gallons of water per minute for 3 hours with stable static water level. The well recovered to the begining static water level within 15 minutes after the test was completed. The well appears capable of producing 9,216 gallons of water per day which exceeds the 450 gallons of water per day requirement for a 3 bedroom home. The well is satisfactory. I performed an adequacy test on the soils absorption field, August 25, 1996, using the Reid Method. The field was capable of absorbing a 1151.5 gallon surge in three hours with no apparent liquid reaching the monitor tubes. This exceeds the 450 gallons of wastewater per day requirement for a 3 bedroom home. The soils absorption field is satisfactory. If you desire further information, or have any questions, please feel free to contact me at your earliest opportunity. RG:rg Enclosures: As Stated. ~,_~,__,~ 27, lgg6, BAJ-OGH2.L~& 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION Complete legal description Lot 6; Block 1; Gateway to the Park Subdivision Location (site address or directions) ~ Korohusk Circle, Eagle River, Alaska Property owner Mailing address r,~benow Day phone Lending agency Mailing address Day phone Bob Wombolt - RE/MAX OF EAGLE RIVER Agent Address 16600 Centerfield Drive, Suite 201, Eaqle River, Alaska Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Day phone 694-4200 99577 Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72'025 (Rev 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I 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 Address Engineer's signature DHHS SIGNATURE _ Approved for Disapproved. Conditional approval for '?C34 Eagle River Loop Road No. 204 Phone bedrooms. bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The 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. 72~25 (Rev 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. Legal Description: A. WELL DATA Well type ~?~d ~,~ Log present ~/N) Total depth Sanitary seal ~N) If A, B, or C, attach ADEC letter. Date completed Cased to ~-~ ' ADEC water system number L,, ~Z. zl --c[c~ Driller Casing height Wires properly protected {~N) V FROM WELL LOG AT INSPECTION ~_ Date of test (.~--'Z~ ...dj o ~'- Io -~ I ~ >_ ~ o= Static water level ~ ~'T'~~.,~-~ (.~_~ ,5_~ Well flow t, ~.C> g.p.m. ~ ,3..4' Pump level O ~.~_.~ ~- SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ ~' ; On adjacent lots Absorption field on lot ~ c'~ ~ 4' ; On adjacent lots Public sewer main ~tl~ Public sewer manhole/cleanout Sewer service line 'z.~' t~ Petroleum tank WATER SAMPLE RESULTS: Coliform ~:> 4.~-~. '/~oo ~ J[ Nitrate Date of sample: ~ ~ [ ~'' '~ Z- Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed (~,-*'3,- .~-- '~1 ~D Cleanouts High water alarm (Y~) Date of pumping Tank size ~ DZ>(~ Compartments Foundation cleanout {5~N) ~ Depression (Y~) ~ Alarm tested (Y/N) ~ ~_c[~. Pumper '~,~, ~-..~;fooL. ,./ Well(s) on lot To property line ~ Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ~c~~ ,t, On adjacent lots ~c,c~ Absorption field Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pu~ High water alarm level .~C~ycles tested Meets MOA electrical codes (Y/N) ~ SEPARATION D~ STATION TO: On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~'-z/- ! Width Total absorption area Depression over field (Y/~D ~-~ Results (~_a_.~fail) Peroxide treatment (past 12 months) (Y~ Soil rating Gravel thickness __ ~' ' Cleanouts present~/N) Date of adequacy test System type ~_~ t-~ for Total depth 5';', 5'- / "~'v~ ~-~P~- ~.-~ bedrooms If yes, give date ~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~. ~c~t '~' To building foundation On adjacent lots Surface water Curtain drain On adjacent lots \c>O t J('' Property line ~.~t ~- ~, L~\ ¥ To existing or abandoned system on lot ~J~' Cutbank ~'~ ' 'k Water main/service line j c~ ~'/' ~' Driveway, parking/vehicle storage area ~"~) / ~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ............... S~gnature .-,~ .............. ',~ - Eagle River~ Alaska 99577 Na e · HAA Fee $ / ~ 0~ Waiver Fee: $ Date of Payment ~ ~/~ ? ~ Date of Payment Receipt Number '~ ~. 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# 1. GENERAL INFORMATION Complete legal description Lot 6; Block I; G~eway To The Park Subdivi~ioni Location (site address or directions) NHN Korohu~k Property owner Mailing address Lending agency Mailing address Agent Ad dress 258-7822 Jmes & Jill Lib~now Day phone HCR 83 Box 2439 Eagle River, Ak. 99577 C~y M~r~gag~_ ATTN: Carol Georg~ Day phone 471 273-8260 West 36th Avenue Suite #201 Anchorage, Ak.99.503 Day Ph0n~ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well NOTE: Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~25 {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. i7034 Eagb River Loop Road No 204 Engineer's signature DHHS SIGNATURE /¢~'_.~ Approved for Disapproved. __ Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Depa~ment of Health and Human Services (DHH$) issues Health Authority Approval Oe~ifieates based only upon the representations given in paragraph 8 above by an independent professional engineer registered in the State of Alaska. The DH H$ does this as a courtesy to purehasers of homes and their lending institutions in order ~o satisiy ce~ain federal and state requirements. EEmployees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage ~i~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Z_/.. } L3. ! ~ ~,4'~4~ T~ _~-J'~_ P~rk" Parcel I.D. A. WELL DATA Well type ~ If A, B, or C, attach ADEC letter. Log present (Y/N) Total depth Sanitary seal (Y/N) , fl Date completed Cased to ~ '-~ Date of test Static water level Well flow Pump level FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot / Absorption field on lot Public sewer main Public sewer service line /,J/P, ADEC water system number ~ -Zq-~) Driller lp,' c Casing height Wires properly protected (Y/N) L~ I g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots I Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate ~'~T~'~--'-JEet~ ~_~J.l~-'~Otherbacteria Z~.t'O B. SEPTIC/HOLDING TANK DATA Date installed /'-~ - ~- ~ ° ~ ~) Tank size ./c~3o ~ ~ Compartments 2. Cleanouts (Y/N) ~ Foundation cleanout (Y/N) ~/ Depression (Y/N) High water alarm (Y/N) k)/~ Alarm tested (Y/N) ~J/~ Date of pumping t~/~ ~ / SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I To property line Surface water/drainage On adjacent lots Absorption field -'t Foundation -~ ~' Water main/service line ~-~- ~ (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons "~ Vent (Y/N) "Pump on" lev~at High water alarm level ~, ~ ~ Meets MOA electrical codes (Y/N) ___ _ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed (,~ - 2 ~--- ~'0 Length ~, ' Width ~__ z.~ Total absorption area !;~ ~'- h Depression over field (Y/N) /~ Results (pass/fail) ~/~ Peroxide treatment (past 12 months) (Y/N) ~ _{~,z,~. Ct System type Gravel thickness ! ~---" Total depth Cleanouts present (Y/N) JL~/~, Date of adequacy test for ~J//q bedrooms ,-,J/~ If yes, give date Soil rating SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot ! _~o -/- On adjacent lots ! (20 ¢' Propertyline / ' / To building foundation J Q /' To existing or abandoned system on lot On adjacent lots ~C) '/' Cutbank ~-O ¥' Watermain/serviceline Surface water ( DO '/- Driveway. parking/vehicle storage area ~'0 Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effe~c~oo~Ji,(~ate of this inspection. S & S ENGINEERING 17034 Rag o R ver Loop Road No · z~ ~;"~ , /' ' ~ ~: ' Signature Eagle River, Alaska 99577 Engineer's Name .... HAA Fee $ //.~ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number