HomeMy WebLinkAboutGREAT LAND ESTATES #3 BLK 4 LT 3Greatland
Estates #3
Lot 3
Block 4
#051-133-17
Municipality of Anchorage Page Z of�
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: S %✓ 9301'79 PID Number: 951-13-31;7
Nam/V//ZrH y
Wastewater System: XNew ❑ Upgrade
Address:
/9 95a ��T � N C�., E. �7
ABSORPTION FIELD
Phone:, // ^
/Y t'!
No. of Bedrooms:
El Deep Trench ❑Shallow Trench Bed ❑Mound ❑Other
LEGAL DESCRIPTION
Soil Rating:
/
Total Depth from ori anal grade:
/ GPD/Sq. Ft.
Lot: Block: /� Subdivision:
3 2E/lr L l* EST
(tet
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
D/
Ft.
Ft.
A/
Township: /,5
Range: /
Section: /
0
Fill added above original grade:
1-//0
Gravel length: �j
/�
/ r
Ft.
`7` Ft.
WELL: ❑New Upgrade
Gravel deatn:IVID7# /5
Number of lines:
Distance, between lines:
Ft.
1137Ltt
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
(10 30
Pipe material:
3037 ��/O
P•Q�V�%�
.�-Ft-
Ft.
SO. Ft.
AST/>i
Driller: , fI
Date Drilled:
Static Water Level:
Installer:
Date Inst I ed:
I�
Ft.
Jlvice
07 ZCo q-3
Yield:
Pump Set at:
Casing Height Above Ground:
- TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
Ixteptic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Pebdc/Private
Manufacturer:v� _ ,t
Capacity in gallons:
1(/0%%
From
Tank
Field
Stenon
Tank
Sewer Lines
��C%�h/��6 7 �rK
Well
Nor iw
err<t E»
Th
Tim.
Material:
C,T���
Number of Com artments:
WaterSurface
1117 r
t/la'
NIA
/ 11, 1
A100'
LIFT STATION
LotZ5
!
%�
�`� /1
�1/�
�!
Size in gallons:
Manufacturer: IA
Line
Foundation
ZQ !
7 O !
A1114
N 1A
1-11,4
"Pump on" level at:
"P off' level at:
High water alarm at:
Curtain/I
�J�/!A/
f!/A
�!/�
�! 1 A
Pump Make & el
Electrical Inspections performed by:
Drain
Remarks: Z'/>ieO� IU _5 M
BENCH MARK
Location and Description:
lLf�i
" vL,47zD1-1 041a r1rLD,
4r i1?rrl-O-ArA/CP
Assumed Elevation:
n
ENGINEER'S SEAL
OF.4Z Al
'0w 'fio'�
sial •
Inspections performed by: EN�iN Dates: 1st 7W19-1
Y
* ...0 ,6`,
2nd 01 V
�... .. ... ..
Louis A. soMrr
�i
Department of Health and Human Services approval
s'•. C&6736
,`
�J 0L -r j 1 ! � C1j
Reviewed and approved by: �u -� Date:
��,`OF SS10 �1►�
� E
72-013 (1/91) MOA 25
Permit No. 5'tj 9 3 o i 7
Page 2 of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 a Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: bn%aT E5l *,3 Lot 3 , 81-9 ZA
�\ T
\ T
9� \
CRPPk P��91 T \
TO
ry Nq PNgN�\
fpG
e,9�. OE
50' MAINT.
EASEMENT
– TEST HOLE
• – MONITOR TUBE
o – SEWER CLEANOUT
- WELL
– – EASEMENT
D EVATI M;
(NOT TO SCALE)
2' 35PS1 INSULATION '.
+1' ADDED FILL
1
TANK
5.8 %5.3
FIELD
72-013 A (2/81) MOA 25
5/8' REBARR
ED
'F TDP
V7 \V y�0
V�el�s F -A
�s.00
o.
TO_P�COONC—RE—TE FOUND; WALL
A�1 SUMED ELEV = 100.100' .. ..
M
M
97.6
as
ORIGINAL
AZ GROUND
LEVEL e 96.6
-2' 35PSI INSULATION
GWT 88.9
95.3
D -
\
[
A -
^�
64.5
D -
F
= 23.3
1�
I
- G
= 29.5
A
\P9sP6sl�'
SWING
TIES
loo'
D
= 32.9
- I =
50.3
C - D
_ 52.9
26.3
A - E
= 70.8
ED
'F TDP
V7 \V y�0
V�el�s F -A
�s.00
o.
TO_P�COONC—RE—TE FOUND; WALL
A�1 SUMED ELEV = 100.100' .. ..
M
M
97.6
as
ORIGINAL
AZ GROUND
LEVEL e 96.6
-2' 35PSI INSULATION
GWT 88.9
95.3
D -
E _:
23.5
A -
F =
64.5
D -
F
= 23.3
52.9
D
- G
= 29.5
A
- H
= 48.9
D
- H
- 31.9
A
- I =
50.3
D
- I ='
26.3
26.8
D
- J
= 61.4
A
- K
= 22.9
D
- K
= 60.8
A
- L
=. 19.3
D
- L
= 60.4
SCALE 1" = 60'
Ie " •' l
*= 491H
Louts A. Butero
CE -6736
4j" AOFE
by
DOC Co. dba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759
OWNER OF LAND �:r'�Il/dui I DEPTH OF WELL 1 i f
ADDRESS 'q -76- O ..L_AtiI'
^IRC'• cr
AST. TIC LEVEL WATER FT
O%
LEGAL DESCRIPTION
`�AT4lld{'
DRAW DOWN FT.
DATE - Started 2 Ended �� GALS. PER HR J�Cb
PERMIT NUMBER (" i-1 ot KIND OF CASING
(C) I - r 1'2) �
KIND OF FORMATION:
From 0 Ft. to�
Ft.
'C✓/•JC-,
-S
S %
1 e-1C0'd _ From
Ft. to
Ft.
From Ft. to
Ft.
® VE9 PilVOEAl
From.
Ft. to
Ft.
t
�
From r Ft. to J
Ft.
s//-
114 NO
` C rC �ti; ce��tt�C� i
� '� J-# U From Ft. to
Ft.
From4.Ft. to�Ft.
//
/'1 "�•�'J�il��
From
Ft. to
Ft.
From C9 ` Ft. to-OE—Ft.
�%?r`I�
•4� � From Ft. to
Ft
From Ft. to
Ft.
From
Ft. to
Ft.
Froin Ft. to
FL
From
Ft. to
Ft.-
From -Ft. to
FL
From
Ft. to
Ft.
From Ft. to
Ft
From
Ft. to
Ft.
From Ft. to
Ft.
From
Ft. to
Ft.
From Ft. to
Ft.
From
Ft. to
Ft.
From Ft. to
Ft.
From
Ft. to
Ft.
From Ft. to
Ft.
From
Ft. to
Ft.
From Ft. to
Ft.
From
Ft. to
Ft.
From Ft. to
Ft.
From
Ft. to
Ft.
From Ft. to
Ft.
From
Ft. to
Ft.
From Ft. to
Ft.
From
Ft. to
Ft
RECEIVED,
MISCL. INFORMATION:
JUN 21994
Municipality of Anchorage
Dept. Health & Human Services
DRILLER'S NAME
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW930179
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:WIRTH SUSAN Y & JEREMY D
OWNER ADDRESS:19750 GREAT LAND CIR
EAGLE RIVER, ALASKA 99567
PARCEL ID:05113317
LEGAL DESCRIPTION: GREAT LAND ESTATES #3 BLK 4
LT 3
LOT SIZE: 72745 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
PAGE 1 OF 1
DATE ISSUED: 6/24/93
EXPIRATION DATE: 6/24/94
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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED B
ISSUED BY:
2"30
DATE: '/Z V5/ 3
DATE: 2 Y -53
Louis Butera, P.E.
Registered Civil Engineer
June 14, 1993
John Smith, P.E.
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Great Land Estates #3, Lot 3 Block 4
Narrative
Dear Mr. Smith:
The proposed septic upgrade will have very limited impact on adjacent properties for the
following reasons:
1. The area has large lots allowing sufficient room for septic sites.
2. Immediate neighboring septic systems are all +30' distance.
3. Reserve space is adequate, due to absorption capacity.
4. Drainage will not be effected and is not a major consideration in our design.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\1993\93-031A.NAR
P.O. Box 773294 • Eagle River, Alaska 99577 • Telephone (907) 694-5195 • Fax (907) 694-3297
----- -- ------ ----------SPECIFICATIONS_FOR-ON-.SITE SEPTI_C_SYSTEM--_--
Revised 06/23/93
LEGAL: LOT 3 BLOCK 4, GREAT LAND ESTATES #3
A. GENERAL
1. The well and septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health
and State Department of Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the
field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the
contractor to meet Municipality of Anchorage, Department of Environmental
Conservation requirements.
wner to obtain all necessary permits or easements
6. It is the responsibility of the o
and to locate any adjacent multi -family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line position and
the location of any easements.
B. BED
1. The bed is to follow the natural land contour to maintain uniform total depth of
the bed bottom.
2. The bottom of the bed shall be level, plus or minus 1.5".
3. The total depth of the sewer gravel layer is not to exceed 2.0' or 5.25' below top
of concrete foundation at any point.
4. A 2' sand filter layer is to be placed under bed gravel by over excavating Sand &
to 4'.
and placing uncompacted ADEC approved filter sand (from Quality San
Gravel or AAA).
5. The bed gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 4' or
equivalent is to be placed over the leachfield.
7. The area over the bed is to be finish graded to prevent ponding of surface water
runoff. Bed is to be top soiled and seeded.
8. The septic tank and leachfield must not be closer than 100' to any existing private
well, 150' to any Class "C" well, or 200 feet to any community well.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH = 2.0' GRAVEL DEPTH = 1'
BED LENGTH = 42' BED WIDTH = 15'
SOIL RATING = 0.7 GPD/ftz (filter) BEDROOM CAPACITY = 3
SEPTIC TANK SIZE = 1,000 gallon
Twenty-four (24) hours notice required for all inspections.
\1993\93-031B.SPC
EAGLE RIVER JOB
ENGINEERING SERVICES SHEET NO. 93-031 B. OF
P. 0. Box 773294 LB 06/23/93
EAGLE RIVER, ALASKA 99577 CALCULATED BY DATE
Phone 694-5195 CHECKED BY DATE -
SCALE
.. ... . ......
..... .... . -
REVISED 06/23/93
.. . ....... . ............
..........
3 Bedroom 'Single--Familyi Dwelling.
......... .
3 BA 450 gpd
Soilrate (filter) 0.7 gpd/W.
bed
.............. . .......... . ..........
Required absorption._ ATM:
........... ..........
450. 0.7 = 643 square feet
..... ..... ........ . .....
...... . .. . .............. .... . .............
Bed
.... . ......... . . . .............. ..... ..... - . .........
Width 5,
........ .. . ...... i- 01.111
1 43 Length ........
.......... ..... ...........
Depth 2'.
... . . .....
. . .......... .. .....
2 Bedroom: Smi: g16 Family Dwelling(optional):.
.... . .......
...........
........... .. ........ ..... . ......... .......... . ......
'BR = 300 gpd
....... ... .... .......
izequired absorption area: ..... .... .
0.7 420 square feet
. .......... ........... .... . .. . ....... i .............
Bed size-
. . . .. ......
Width,
. ...... ..... . . .......
Length 28'
Depth L-
oA
. . ..... ... . -
v
go
tuiuft A. ButarG
i CE -6736
4 5j)
..........
<Z
4.
... .......
.......... . . ............
X1993\93 -031B CAL
.......... . ........ ...
...... . ......... .....
........... .... ...... .......... ... .........
in
NEIGH. WELL
r
PRIMARY
BED Ty-\
S\ T
O \
f CRf f�\
t0
AR by%f\
\ fd� f4f OE
eyr \
5/8'
NO WELLS
OR SEPTICS
�L I
9� 9/
6 \�
/Il � 100' \ \ I
\ 57
3- ^
lOP \
\ ffio- PROPOSED \9 SJ
\ \ TOE WELL LOC. \�6
9y \ TOE \ �q
LgTfR \ L \ fyr \
50' MAINT. \ \
EASEMENT \ \
/ c�911- TOP \ \ \
9 "O
�p \ \
2 \
o, \
® - TEST HOLE \ ��
• - MONITOR TUBE \ IN1lgp.
0 - SEWER CLEANOUT \
- WELL
- PROPOSED LEACHFIELD VAC;
- — - - EASEMENT
NO KNOWN CURTAIN DRAINS
WELL 8c SEPTIC SITE PLAN az;-
LEGAL: LOT 3, BLK 4 GREAT LAND EST. #3'£=`i"'-
OWNER: J.D. WIRTH '
CONTRACTOR: N/Acca?
60'
JOB # 93-031 DATE: 06/07/93 SCALE 1" =
?_
EAGLE RIVER ENGINEERING SERVICES
P.O. Box 773294 Op ..:
EAGLE RIVER, AIS. 99577 %v,
(907) 694-5195 FAX: (907) 694-3297
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(ENGINEER'S SEAL)
y
U*-
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "U' Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: 1/j// y- DATE PERFORMED: �6 /y f 3
r cvT ? Township, Range, Section:
LEGAL DESCRIPTION: G/i��i4iL/�tJ1) fsr/� IdLK y
DEPTH SLOPE SITE PLAN
FI
1 (FEET)
pK4A���
21 I Sp
3 7
4
0 0 GW s/wo7 Gcave.I
5-" 0
°a 6.V. Rork
6 V.- Loo SE/ e /�rr
D°
8
9
10
11
12
13
y
WAS GROUND WATER
V- w/Wr}tY/L S4
lVri4vj ENCOUNTERED? 5
S
IF YES, AT WHATr L
DEPTH? 7,7s' P
E
Depth to Water After
Monitoring? -7.�J� Date:
Reading Date
Gross
Time
Net Depth.to
Time Water
Net
Drop
N
20 -{
II_ JI PERCOLATION RATE �' / (minutes/inch) PERC HOLE DIAMETER `S
TEST RUN BETWEEN —L_ FT AND y FT
COMMENTS &frzS4 'ae y;/g° o.+, O. 7 --' b/ t
PERFORMED BY: �J4; 'e-,'-�' I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Municipality of Anchorage O
Development Services Departmentt,_ ,1.�
Building Safety Division . -• '�.. _
On -Site Water and Wastewater Program t
4700 South Bragaw St. '
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTFI AUTHORITY APPROVAL
FOR H SINGLE FAMILY DWELLING
Parcell.D. 051-133-17 HAA# 0-2:-OL4 (09
Expiration Date: J a - zlac - p
1. GENERAL INFORMATION
Complete legaldescription Lot 3; Block 4; Rreatland Estates #3
Location'(site address or directions) 19750 �eatland £i�71 ekVQ_
Current Propertyowner(s) Paul Broach Day phone_ 257-9140
Mailing address
Lending agency
Mailing address
Real Estate Agent
Day phone
r.Arr3-Rass- Buyers R.B. Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY: '
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
QC
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with
new water sample .results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid far one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4.
5.
STATEMENT OF INSPECTION BY ENGINEER ' .'•'
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, ; .,', ,.! +,;. •.
based on procedures outlined In the Health Authority Approval Guidelines for this application, shows that the on- >'>:f Y;`:•s.:
site water supply and/or wastewater -disposal system Is(are) safe, functional and adequate for the number of
bedrooms and type of structure Indicated herein. l further verify that based on the information obtained from the '
Municipality of Anchorage files and from my investigation; and inspection_, the'an-site water supply and/or
wastewater disposal system is(are) in compliance with all a pficatile IVlun�cnpal and State codes, ordinances,
and regulations in effect at the time of installation.'
Name of -Firm �. $Y.&.' S.:Engi e. _, P' 44=221
� £.�l.Il _ _ Il 1r.•
Address 17034'N. Eagle River'�Loon Stea ,J&`1Ziver,: AK 9957.7'
Engineer's Printed Name Robert 'C. "Cowa'n " Date" 1. S" 03
rr
• _ 4• : ', �'I.•.[•.I'I• ..j.•.:•.�.:•��-„'1111.•^.I.'..�i••.�•.Yylu
DSD SIGNATURE.. .;,;, fs',;;. :i t,� a,�Rosair"C Cowan 14ci ;
Approved for bedrooms.
Disapproved.
Conditional approval for---; -.,bedrooms; with the (o llowing'stipulations:
.; ,j f•,i .t•^,, �. .(t:. r.w fps :' `' 7" `C.
- � . ..'srtt :'iL�.t.i)• ''' .rt`j'j}� .=:bl,••.,;,,” Y
UN
Additional Comments' _,l'\ ''`` "' `""' •''� 'WATEI
, .. . > • WASTE
t rr r �' '•' PRO(
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X Maintenance Agreements
Supplemental Engineer's Report
Other
) TE • ^
IAND•::m.
Nam
By: lit/, Original Certificate Date: 4:1 — c2— 44 — D 3
(Rev. elm)
Municipality of Anchorage
' Development Services Department
Building Safety Division
�— On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ek.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lor 51; r> GO[- K '4 ; `?eC.ArZ 4-e4D 4=r Parcel ID:_ 0S/' l.3.31 T
A. WELL DATA
Well type1_.0
Date completed 414
Total depth J Laft.
If A, B, or C provide PWSID # —
Sanitary seal (Y/N)
Cased to AP -5t.
FROM
�! WELL LOG
Date of test 5 94
Static water level �(Z% / ft.
Well production Z5� g.p.m.
Well Log (YIN) y
Wires properly protected (Y/N) �4
Casing height (above ground)MP3 i.
AT INSPECTION
T{o ft.
S� g.p.m.
WATER SAMPLE RESULTS:
Coliform lr� colonies/100 ml. Nitrate /'SZm�g../II.. Other bacteria colonies/100 ml.
Arsenic: 6� mg./I. Date of samplef.7 l�/V 3 Collected by: S C �✓G/N€EZl�1/�i
B. SEPTIC/HOLDING TANK DATA
E•
Tank Type/Material its
Tank size gal. Number of Compartments Z
l f.
Foundation Cleanout (Y/N) ___� Depression over tank (Y/N)
Date of pumping �1 d _ Pumper
ABSORPTION FIELD DATA
Date installed Z( .?i Soil rating (g.p.d./ft2orfe/bdrm)."
Length z,, ft. Width ft.
Date installed :;L/ zo 13
Cleanouts (Y/N) 7 /
High water alarm (Y/N) N
System type
Gravel below pipe ft.
Total depth 5 ft. Eff. absorption area JL�fc Monitoring tube
Date of adequacy test 3 Results (Pass/Fail) L-4s's
Fluid depth in absorption field before test_Sin. Water added s/tt gal.
Depression over field /I
Elapsed Time: _7min. Final fluid depth 1.5 in. Absorption rate >=
For 3 bedrooms
New depth�Sn.
46;t) g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) /"%( If yes, give date r
D. LIFT STATION
Date installed A//
.4
"Pump on" levelat in.
Datum
E. SEPARATION DISTANCES
Size in gallons
"Pump oft" level at _in.
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Manhole/Access (Y/N)
High water alarm level at in.
Meets alarm & circuit requirements?
Septic tank/lifLstaftn on lot r co r} On adjacent lots /001"- -
Absorption
00r+ -
Absorption field on lot / too I+ On adjacent lots /00 '+
Public sewer main A) % A Public sewer manhole/cleanout N A-
S�septic service line Z� tf Holding tank 14
SEPARATION DISTANCES FROM SEPTIC/1-19LOtI16 TANK ON LOT TO:
_ r
Building foundation f Property line i + Absorption field S %
Water main NIA Water service line /0 •f Surface water 1001 -4-
Wells
001-+-
Wells on adjacent lots 00 �r
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line / O ar Building foundation /0 f+ Water main
Water Service line 10 '+ Surface water 100 r'f Driveway, parking/vehicle storage to 1r
Curtain drain NPrJC KNojJfI Wells on adjacent lots j C50 f'
F. COMMENTS
G. ENGINEER'S CERTIFICATION ,'� ��:= • 4
._
I certify that I have determined through field inspections and i....y�..�.,.c. ,
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date. v"' '= """""""""'^ "~
ROBH2T C. COWAN �+
Engineer's Printed Name le
o84--Z7- Co&vf,'� yl+��sl., CE -8601
S'�o� Ott' ;:� ;� ,...
A
Date 9 L ,' .:�_!.-% .`_%"
HAA Fee $ 3 '7S -
Date
SDate of Payment `7 / 6 ?0 3
Receipt Number O H 1 7 W
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
IGS Ref# 1035341001
:Ileut Name S & S Engineering
Project Name/# 1.3. B4 Greetland Est * 3
.hent Sample ID L3, B4 Greatland Est R 3
►atria Drinking Water
Sample Remarks:
All Dates/Times are Aloka Standard Time
Printed Datelrlme
08/29/2003 10:39
Collected Datelrime
08/20/2003 13:30
Received Date/Time
08/20/200 15:30
Technical Director
Steppe Ede
Released Z .ytu�
Pammetar Qualifien
Results
PQL
Units Method
Container ID
Allowable
Limits
prep Analysis
Date Date
Init
Metals by ICP/MS
Arsenic
5.00 U
5.00 ug/L EP200.8
C
08/27/03 08/27/03
SCL
Waters Department
Nitrate -14
1.52
0.10 ' mg/L EPA 300.0
B
(<=10)
08/21/03
JIB
Microbiology Laboratory
Total Coliform
0
coV100tnL SM1892228
A
(<=1)
08/20/03
JS
968-1 90/ZO'd 118-1 10ES199106 S33lAS3S AN3 SUS 'IS3 371"081 YIY9l:II EO -80-60
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Municipality of Anchorage
Department of Health and Human Services 1i�s
Division of Environmental Services
On -Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci. anchorage. ak. us
(907)343-4744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FORA SINGLE FAMILY DWELLING
Parcel I.D. C S-) -t 3 3 -17 HAA# //;f ,o zY �
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Lot 3
Location (site address or directions)
Block 4, Greatland Eatates #3
19750 Greatland Circle
Current Property owner(s) Shaun Burke
Mailing address % Partners/11940 Business Blvd
Lending agency
Mailing address
Real Estate
Mailing Address
Partners/Cindv Wilson
Dayphone 688-4424
Eagle River
Day phone
Dayphone 694-4994
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
lZ Wt�
q // JCC
®
Individual On-site
❑
Individual Holding Tank
❑
❑
Community On-site
❑
❑
Public Sewer
❑
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of
Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent
professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are
required for the transfer of title (except between spouses) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by
a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates
are valid for one year for properties served by Class A or B wells or a public water system. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
72 025 (Rev. 01'00)'
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation
based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval
application show that the on-site water supply and/or wastewater disposal system is safe, functional and
adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-
site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation
S & S ENGINEERING
17039 E„ -;i= R`i�r Loop Road No. 204
Name of Firm Eagle River, Alaska 99577 Phone
Address
Engineer's Printed Name
6. DHHS SIGNATURE
Robert Cowan
Approved for 3 bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Date
s a
4 Y�NGINEER s��s�
q.+ ROBERT C. COWAN �2 J
t`�CV •.� CE -8301 ;•`,`'.,d�
.✓
aat..\.,
bedrooms, with the following stipulations.
Attachments:
HAA Checklist Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other_
By: . �i Ll/ o—� Original Certificate Date: 'l - tJ o
Expiration Date: //-/63-00 Reissue Date:
75-025 (Rev 01 OOP
RECEIVE
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES AUG 14 2
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907)...� Ir or VICAhleE
AL SERVICES DIVISIOr
Health Authority Approval Checklist
Legal Description: Parcel I.D.: 0,�l
A. WELL DATA
Well type h2i ✓M x If A, B, or C, attach ADEC letter. ADEC water system number
Log presentl&N) u Date completed
Total depth //3'r Cased to /17 ,7'' Casing height (above ground) 2-1
Sanitary seal &/N) 0 Wires properly protected (&N)
FROM WELL LOG AT INSPECTION
Date of test S i 8 '!' 6c>
Static water level
Well productiong.p.m. —
9 -p.m -WATER SAMPLE RESULTS:
Coliform n Nitrate Other bacteria O
Date of sample: 8-5-60 Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed �-1?3 Tank size Number of Compartments Z Cleanouts (S/N)
Foundation cleanout Q/N) y Depression (Y& '3 High water alarm (Y/N) "114
Date of Pumping. 9;�_� Pumper J`� &Ili -/J4
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft2 or ftVbdrm) b7 System type z-3Fb
Length 212- r Width Gravel thickness below pipe eU Total depth 2 yL1x'44-Aa�
Effective absorption area G3o Monitoring Tube present 69N)r Depression over field (Ya J
Date of adequacy test " B'9 -cap Result ass ail) e'f� For �' bedrooms
Fluid depth in absorption field before test (in.); � Immediately afters gal. water added (in.): /"
Fluid depth / (ins) Minutes later: O Absorption rate =
Peroxide treatment (past 12 months) (Yo
72-026 (Rev. 3/96)'
If yes, give date
IJIA-
g.p.d.
D. LIFT STATION
Date installed
Manhole/Access(Y/N)
High water alarm level at
,Cycles-tes e�
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at* _ "Pump off' level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
00,1-
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
loo /✓
IJ1
Foundation In i� Property line /e ra _ Absorption field .1 fi
Water main/service line a6 Surface water/drainage /00 i-')— Wells on adjacent lots /,'o r
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line /o /Y Building foundation /0 r+ _
0 -
Water main/service line /° /f
Surface water 106 Driveway, parking/vehicle storage area
Curtain drain /(A& Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
1 certify that I have determined thru field inspections and review of Municipal
in conformance with MORA HAA guidelines in effect on this date.
Signature Z z�,
Engineer's Name P06 eA T C. cow/I")
Date S Jl y /o O
HAA Fee $- '20a
Date of Payment/L/-0
Receipt Number o(o16
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
-0 O ROBERT C. COWAN
I�C,j-,-% CE -8801
are
RUG -16-2000 09:10 S&S ENGINEERING
AIL. CT&E Environmental Services Inc.
4rrisr.��,.riririrrrr/r
CTSE Re%x
1004465001
Client Nara
S & S Enpaneerirg
Project Name/p
L3 B4 Cncariand Est #3
Client Sample ID
L3 $4 Grcatland Est o3
Matrix
Dnnkine water
Ordered By
MID
0
Sample Remarks:
Parxmetar Fc Irl
Waters Doparca}anc
Nitta N 1.59
NicrobioSogy Laboratory
Toral Coliform 0
907 694 1211 P.02iO3
3615301 T-727 P.02/03 F-674
Client POa
PriatedDaterritne 08/152000 16:43
Collected Dammme 08/09/2000 15.28
ReceivedDaterrime 08/102000 14:30
TeaLalcal Director Sscp6ep C. Ede
Released -4�
PQL unit, Method 411owaok Prep Annirsis
Ltmtts Dart Due Imt
0.500 nVL PPA 300.0 10 rna,c 08/10/00 SCL
eol/lOOmL SM189222a
08110/00 JDT
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICESi
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. # 051-13-317 HAA #
1. GENERAL INFORMATION
Complete legal description
Great Land Estates #3 Lot 3, Block 4
2.
4.
Location (site address or directions)
19759 Great Land Circle, Eagle River
Property owner i hn F Thrxnsnn Day phone 696-5670
Mailing address 17343 Santa Maria Drive, Eagle River, AK 99577
Lending agency
Day phone
Mailing address
Re/Max of Eagle River/Eva Loken Day phone 694-4200
Agent
Address
16600 Centerfield Drive Suite 201 Eagle River Ak 99577
Unless otherwise requested, HAA 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:
R,
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. 1191) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and typeof 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 Eagle. River Engineering Sen7iroG Phone 694-5ig5
Address a.n Rev 77;;294, gagie Ri-vee, AK 99577 —
Engineer's signature 77 1_ Date 3
6. DHHS SIGNATURE
Approved for 7 bedrooms.
Disapproved.
Conditional approval for
Additional Comments
By:
%HTIC
bedrooms, with the following stipulations:
Date J' - 28 - Z/
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 (R". 1/91) aaCk MOA #21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division p AN�«hlUKA%BL
825"L" Street, Room 502 • Anchorage, Alaska 995010 (9@ �t*121 440
ENVIRONMENTAL SERVICES DIVISI0
1A
tAAR 15 1996
Health Authority Approval Checklist
Legal Description: (;IzOV Ll9NV �T!tj 1p,1— 6kzl- Parcel I.D.: �� �
A. WELL DATA
Well type ?,OVIY-%r If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N)
Total depth /
Sanitary seal (Y/N)
Date of test
Static water level
yes
Date completed
/ Cased to
Yrs
FROM WELL LOG
0r/94f
7[r '
Well production % j g.p.m.
WATER SAMPLE RESULTS:
Coliform
Casing height (above ground) so /
Wires properly protected (Y/N) yl�{
AT INSPECTION
, I g.p.m.
Nitrate �� S�' no & Other bacteria
Date of sample: D �/� %/��? Collected by: 610- F--5
B. SEPTIC/HOLDEVG TANK DATA
Date installed 0219 3 Tank size 000 Number of Compartments Cleanouts (Y/N)—&-4s
Foundation cleanout (Y/N)_ Depression (Y/N) —O— High water alarm (Y/N)
Date of Pumping �112 iS Pumper
C. ABSORPTION FIELD DATA
Date installed (% i�%3 Soil rating (g.p.d./ft2 or_ Zc+dfM) �� % System type E E/)
Length tlZ' , Width / 5 Gravel thickness below pipe to /, Total depth1,9 `
Effective absorption area 4930 Monitoring Tube present(Y/N) Yes Depression over field (Y/N) /Y P
Date of adequacy test O3P� 9c/' Results (Pass/Fail) &SS For 3 bedrooms
Fluid depth in absorption field before test (in.), _�� Immediately after -gal. water added (in.): (?
Fluid depth L (ins.) Minutes later: /o Absorption rate = t <fs"D
Peroxide treatment (past 12 months) (YIN) IVJ If yes, give date
D. LIFT STATION /k//n
Date installed
Manhole/Access (YIN)
High water alarm level al*
E. SEPARATION DISTANCES
"Pump
Size in gallons
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
J
Septic/Holding tank on lot /U
i
Absorption field on lot
Public sewer main
"Pump off" level at*
On adjacent lots �-/00 _
On adjacent lots 1-100 /
Public sewer manhole/cleanout Nm
Seer /septic service line _
p ��j Lift station
SEPARATION DISTANCES FROM SEPTIC/14-0 BINE TANK ON LOT TO:
J i �
Building foundation Property line 2�L� Absorption field
Water main/service line Surface water/drainage �-//h Wells on adjacent lots .74 /OD
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation '32"
2 " Water main/service line
Surface water ¢// (% J Driveway, parking/vehicle storage area
Curtain drain Wells on adjacent tots / ZOZ2 Property line
F. ENGINEER'S CERTIFICATION
1 certify that 1 have determined thru field inspections and review of Municipal records ?cllh�:a(��u}e systenrs are
in conformance with L10A HAA guidelines in effect on this date.
Signature. x% - ?i�—t% F�, C;, ti °
-A,
Engineer's
aP, .,ry .,fl -
Engineer's Name L�UiS 13U7Fd1 AG , %��
� yy /,
. .......... A '49q �,n
err' l,k .i 4r ba n..P Pib.f n.J> �Y
Date _ ' / 3 -" %rzry Y4� Louis A. "utero
Q---736 o-`�rn 'J.
HAA Fee $ `
Date of Payment
Receipt Number
Rev. 8/95 OSS: haa.wk.doc
Up
Waiver Fee $
Date of Payment
Receipt Number
ME Environmental Services Inc.
'CAL,& Laboratory Division
Laboratory Analysis Report
CT&L iRef.li 960804-5906 Collected Date 03/07/96
Client Sample 1D GREAT LAND BST #310804.01
Matrix Drinking Water Technical Director
Sample Remarks:
Paramleter
Nltrata•N
Released lly_!5r--` f r
ac ALLOWable Prop Analysis
Resuits 8ual PQL units Nethod Limits Date Date _ ]rift
1.58 tl.t ar1IL CEPA 353.2 w� 03l09/g6 EtAB
200 W. Potter Drive, Anchorage, AK 9955IR-1605 —Tel: (907) 562-2343 Fax: (907j 561-5301
3180 Peger Road, Fairbanks, AK 98769-5471 -- Tel: 1907) 474_8656 Fax: (907) 474-9685
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA
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