HomeMy WebLinkAboutDEER PARK #1 BLK 2 LT 1Deer Park # 1
Block 2
Lot 1
#051-042-66
n
\\ �` MUNICIPALITY OF ANCHORAGE
t, \ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
I ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 2644720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
an guilt Qui' Cl/„
PHONE
77— %8 ❑UPGRADE
NEW
MAILING ADDRESS i a/% -/C O Ln- AhCi!
j
Aff
LEGAL DESCRIPTION
trtl illk 2 Perr Park Firtatr
fill
l
LOCATION
Off / Prive elet7 (trek
NO. OF BEDROOMS
u
DISTANCE TO:
Well , /
Absorption area 7 /
Dwelling 7
PERMIT NO. /,
_Y
i Q
Manufacturer rr�r
Material
No. of compartments 2
Liq. capacity in gallons
coo
IF HOMEMADE:
Inside length ...�
Width
Liquid depth
d Y
Jt7Z
DISTANCE TO:
Well
Dwelling
PERMIT NO.
_
Manufacturer
Material
Liquid capacity in gallons
O
W =
DISTANCE TO:
Well / O
Foundation n ��
L34
Nearest lot line /
PERMIT NO.
_,Z2
f E W
No. of lines /
Length of each Ime35-i
Total length of hnei , f./
7
Trench width to hes
O Inc
Distance between line,
o f
Top of tile to finish grade y
Material beneath tile
6(lmches
Total effective absorption
1
W
U
Length
Width
Depth
PERMIT NO.
<I-
W a
Type of crib
Cribdiameter
Crib depth
Total elfectrve absorption area
UP
w
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
J
Class
Depth
Driller
Dist.tNce to lot line
PERMIT NO.
W
�+
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
61 PVC
I I AtiQ
SOIL TEST RATING
100 f t' red«om
INSTALLER
Mr
REMARKS
Ad- arr r 7P .
4
4 IL
mm,
APPROVED / DATE LEGAL
/ _- -f 3 L o i /
�/� 2 A,,p
��jj
Ark 1-- a tef 5u
72-013 (Rev. 3/78)
' MI -l" I VZ� I F•FiL I TY ID F= nrJCHQF2FiC�E
DEPARTMENT r1r, HEALTH AND ENVIRONMENTAL w"uTECTION ,
'825 '1 STREET, ANCHORAGE, AK. 9S 1
264-4720
44ELL nrJE> OlrJ-S I TE SEWEFZ F}EF?r•1 I T
PERMIT NO. C 821188 >
APPLICANT VAN BUILT BUILDIFJG 3820 PATRICIA LN. 337-7789
LOCATION PETERS CREEK
LEGAL LT. 1 BLK.2 DEEP. PARK, S/D LOT SIZE 99999 SQUARE FEET
TYPE OF SOIL' ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSO FT/BP.)= 100
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
C>EF}TH= S;l LErJGTH- MID GFRF=IVEL L,EFaTH= S
THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR. PIT IS THE DISTAFJCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET).
THERE IS FJO SET WIDTH FOP. TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND .THE BOTTOM OF THE EXCAVATION CIFJ FEET).
F=:EE: ID. U I FZE:E> SEF='T I C TFirJK S I -E= 1UUL-3 GF-ILFLOrJSi;
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 WILL SERVE.
--- TW Q C 2 > I rJSF"ECT I OFJ=. F=IFZE FZEQU I FZE: > ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTAFJCE 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
UP014 THE TYPE OF PUBLIC WELL.
MINIFJUM DISTAFJCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LIFJE IS 75 FEET.
I -JELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE'WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
A',IAILABLE TO INSURE PROPER, INSTALLATION.
F=*EFZM I T EXP' I FZES [>ECE1hlF3EFZ :3:1. 1.�E�2
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE UNICIP ITY OF ANCHORAGE.
2: I WILL IFJST L THE SYSTEM IN ACCORDANCE WITH THE CODES.
1: I UNDERSTAND HAT E ON-SITE SEWER. SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE j5 REM EVEQ TO INCLUDE MORE THAN 3 BEDROOMS.
SIGNED
APPLICANT VAN
ILT BUILDIFJG
ISSUEG-1r-----GATES/--&! v----- V4.0
SOILS LOG `
r MUNICIPALITY OF ANCHORAGE
%' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ TEST
OLATION
l\
625 L Street, Anchorage, Alaska 89501 2643720
- SOILS LOG — PERCOLATION TEST
PERFORMED FOR: JAu h v t It R.. ( Ol N C / DATE PERFORMED:
LEGAL DESCRIPTION: �-� 7�0 .De('., Pr_rh S`/ o Arl cf t L.f—IoM 40 (
� �L/G SLOPE SITE PLAN
1
2
3 , y
4
5-
6-. 6 7-
9-
10-
11 910 11
12
13
14
15
16
17
18
19
20
G P t0.�9� cobbles
OC4L0.J/oAjo ( ssNo
SCAM
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND FT
PERFORMED BY: AAAA TA+�LiIUE CERTIFIED
72008 (6/79)
DATE: -��—F2
JAN -24-95 TUE 11:20 AM SULLIVAN. _WAT€R WFtiLLS„ 669 2739444444444444,t
• Cn�e� ���t�ed ��tlti� �r�
by . �W
Doc Cole&
SULLIVAN WATER WELLS
P.O. BOK 272, CHUCIAK, ALASKA 119567 • TELEPHCNE666.2769
OWNER OF LAND IC Wjt 0 t(egAo r f IGC ✓r! t'EjU DEPTI'l OF WELL lolb r8 1/
ADDRESS 6 STATIC LEVEL OF WATER FT. a r ,
LEGALDFSCR1PT10.+L_z1 /3tJl Del��
DATE • started Ended .-
PERMIT
-PERMIT NUMBER
RIND OF FORMATION;
'�SDRAW DOWN Ff
GALS. PER HR IT an
KIND OF CASING
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M6CL. INFORMATION;
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Municipality of Anchorage
Development Services Department
Building Safety Division
\_ 4
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FORA SINGLE FAMILY DWELLING
�1 �/
Parcell.D. 05,1 `611IA-L COSA# DV0 VS'
Expiration Date: 10 -Cl
1. GENERAL INFORMATION
Complete legal description Lot 1; Block 2; Deer Park subdivision #t
Location (site address) 22538 Oak Knoll Dr.
Current Property owner(s) vA
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Kathy Olmstead
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well❑
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Day phone
Day phone
Day phone 244-8020
TYPE OF WASTEWATER DISPOSAL:
Individual On-site❑
Individual Holding Tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 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.
4. 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 Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-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. 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(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm S a S Engineedrg
Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567
Engineer's Printed Name RobertA Sharer
Phone 694-2978
DaW vv
0V' 4."' 000
A. ihafs
5. DSD SIGNATURE
_Z� Approved for _� bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By:/V /JItyOriginal Certificate Date: % - --eq
JR. 11M)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www muni org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Zor �; � x.11 / ,C�AR�' ffA� / Parcel ID:D J �� b y.Z -( C.
A. WELL DATA
%
Well type r Kt VAM If A, B, or C provide PWSID # = Well LoggN
i,
Date completed 1 I O5 Sanitary sea)Dl) Wires properly protecte<g)N)
n
Total depth M66" ft. Cased to 170!9 ft. Casing height (above ground) 8 "Fin.
FROM WE L LOG AT INSPECTION
Date of lest 2- �J
r �
Static water level 0?5 ft.
Well production o2S g.p.m. 7* g.p.m.
WATER SAMPLE RESULTS:
t
Coliform ! colonies/100 mL Nitrate 1L) t7 mg/L Other bacteria colonies/100 mL
Arsenic: ug/L date of sample: $ 2`x/0% Collected by: `a S F-/t76/KCL/�Ea
B. SEPTIC/HOLDING TANK DATA Q
Tank Type/Material Srrrv- J
Tank size _ /C&O gal. Number of Compartments
Foundation cleanoAt ) JL*5 Depression over tank
Cleanouts0l)
High water alarm
Date of pumping ! D Pumper 5
C. ABSORPTION FIELD DATA
Date installed) PJ Soil rating (g.p.d./ft' ft'/bdr �� System type / E'-b►lx'IF
Length BG ft. Width 5 ft. Gravel below pipe 5 ft.
r ���,,
Total depth 19 ft. Eff. absorption area ft' Monitoring tube i M Depression over field lb
Date of adequacy test 5 D? Resul( as / ail) For _:L> bedrooms
u ,1
Fluid depth in absorption field before test � in. Water added 51D gal. h
New deptin.
Elapsed Time: -M min. Final fluid depth -3 5: in. 1 Absorption rate >= 5� + g.p.d.
Any rejuvenation treatment (past 12 mo.) (l� type) AJD If yes, give date
-OpmE V*CAf-"F 91AX& LMiST 'TbC.O a- 01 T, i�c4E1'S - rrtf4C6
A
D. -LWT-STA:FIeN-/U/6
Date installed Size in gallons
'Pump on' level at_ in. 'Pu i"-tevera—t-- in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
I
Septic tank/iiftstation on lot /OD 4 -
Absorption field on lot /6W
Public sewer main VM
%1
Sewer /septic service line 8`255 '4-
Animal containment areas 60' 4-
High water alarm level at
Meets alarm & circuit requirements?
r
On adjacent lots /OD E
On adjacent lots /60 f
Public sewer manhole/cleanout
Holding tank A)1J+
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
I r
Building foundation S f Property line 5 + Absorption field S �'
!
Water main A) Water service line /D t Surface water
r
Wells on adjacent lots !Dm 4 -
Rr1
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
I r
Property line /D ,` Building foundation /o t Water main A.)
Water Service line 10 ! Surface water /d-)0 f Driveway, parking/vehicle storage D Z
Curtain drain fl XM%1t Wells on adjacent lots .J6D 4--
F. COMMENTS
�Ll.f . Ft o�J 2E3T�zICTt�fl f3U PvmP a- ?I 0M3/X ^ 1
R,u>4 J4�l7TEED-SC335E6tU$1lT( �/ /�T10AJ GLV oCe�y�2,
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined th ugh field inspections and
review of Municipal records th th above s are in
conformance with MOA COSA ideli sin e!f t r th d e.
Engineer's Printed Name
Date % /2 1 9
COSA Fee $ �7�i) ^ Waiver Fee $ _
Date of Payment / — L5—'— o -i Date of Payment
Receipt Number % G Receipt Number,
(Rev. 11105)
SCS Retia
1092242001
Client Name
S & S Engineering
Printed DateMme
06/112009 11:16
Project Name/N
Lotl,Block 2 Deer Park N 1
Collected Date/Time
05272009 12:45
Client Sample ID
Lotl,Block 2 Deer Park #I
Received Date/rime
05272009 15:45
Matrix
Drinking Water
Technical Dimetor
Stephen C. Ede
Samplc Remarks:
Allowable Prep Analysis
Parameter Results PQL Units Method Container ID Limits Date Date [nit
Metals by ICP/M9
Arsenic ND 5.00 ug/L EP200.8 C (<10) 06/02/09 06/10/09 NRB
Waters Department
Total Nitrate/Nitrite-N ND
Microbiology Laboratory
Colony Count 0
Total Coliform 0
Fecal Coliform 0
2of4
0.100 mg/L SM20450ONO3-F B (<IO)
col/IOOmL SM20 92228
col/IOOmL SM209222B
col/IOOml. SM209222B
A (<200)
A (<1)
A (<I)
06/04/09 LCE
0527/09 DLC
0527/09 DLC
0527/09 DLC
i'1
O
J
cc
0
J
M
V
CD
N
L-)
0
O
O
iU
9.2
LOT 3
N89°54'40"E
3.58 .
fence
Window we1F-C_
;1
GC Lel C,
4 \d
Septic vent
under
LOT 2
Metal
2go
SCALE: 1"= 30'
\
S
\
\
LOT 1 \\\
Window well /
a% Ad
y+ / WI
/
/
/
/
/
O
O /I / �
I/
en
i
O •Q
O0-
Z-� OF A 4,1
* : ATH !/J
• Fred V:a!a:ka /
f ujF-. No. 3255-S
6-4-09
25I EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. FB 09-3, pg 4849
8340M
z
AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortgagee's Inspection
of the following described property: I OT 1. BLOCK 2.
DEER PARK St IRDIVISION ADDITION NO. 1
Anchorage Recording Precinct, Alaska, and that the
Improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no Improvements on the property tying
adjacent thereto encroach on the premises In question and
that there are no roadways, transmission Ines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage. Alaska
this 29th day of MAY .2009
FRED WALATKA 8 ASSOCIATES
Engineers and Surveyors
BE 1 (907-246-1666)
INN
fence
Window we1F-C_
;1
GC Lel C,
4 \d
Septic vent
under
LOT 2
Metal
2go
SCALE: 1"= 30'
\
S
\
\
LOT 1 \\\
Window well /
a% Ad
y+ / WI
/
/
/
/
/
O
O /I / �
I/
en
i
O •Q
O0-
Z-� OF A 4,1
* : ATH !/J
• Fred V:a!a:ka /
f ujF-. No. 3255-S
6-4-09
25I EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. FB 09-3, pg 4849
8340M
z
AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortgagee's Inspection
of the following described property: I OT 1. BLOCK 2.
DEER PARK St IRDIVISION ADDITION NO. 1
Anchorage Recording Precinct, Alaska, and that the
Improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no Improvements on the property tying
adjacent thereto encroach on the premises In question and
that there are no roadways, transmission Ines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage. Alaska
this 29th day of MAY .2009
FRED WALATKA 8 ASSOCIATES
Engineers and Surveyors
BE 1 (907-246-1666)
Municipalityof Anchorage ` =.,e�
• � Development Services Department <<
: > . I, •
t �OgS!!q Water and Wastewater Program
..4700 South`BfagawSt '" "'
I'. 1 'f 1, `"o '.i• S� ti � ♦ � �
,P.0 Box ]96650, Anchorage'AK 99519-6650„
•www ci.aricho�age.ak:usr I ' ` '
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
- ` FOR A SINGLE-FAMILY, DWELLING
Parcel I.D.
OS l -'o qz-G6_.::.. HAA#,',h�61:o 1.c{3
Expiration Date:'
1. GENERAL INFORMATION
Completelegal'description Lot 1; 'Block 2;: Deer Park Estates # l
Location (site addressordirections) 22538 Oak Knoll Dr. Churiak, AK 99567
2
Current Propertyowner(s) Kevin & Katherine Smiley
Mailing address
Lending agency
h
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 3
_ Day phone 694-9267
Day phone_
Day phone
C1 4� yI/6 /of
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Weli
Individual On-site
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 5 by an independent professional civil
engineer registered in the Stale 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 andlor 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 less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) 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.
4. 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-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. 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(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm
S & S Engineering Phone 694-2979
Address 17034 N Eaple River Loon RD F.R.—AK 99577 rt«
Date 4 /4101
Robert C. Cowan
Engineers Printed Name
ENGINEER`S
C_ -63D1 i
D SIGNATURE '
5, DSD
Approved for_ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments rcvvwur
tt��
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements —
Supplemental Engineer's Report
Other
Original Certificate Date: ,L � (� O I
By:
(Rev. 12,00)
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.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L 7, tf�iL ��k LtL 1^' I Parcel ID: Ce
A. WELL DATA
Well typef yea I - If A, B, or C provide PWSID #
Dale completed 47- 2 Ig3 Sanitary seal (Y/N)4S
Total depth �u'•�ft. Cased to O-Lft.
FROM WELL LOG
Date of test
Static water level
Well production g.p.m.
WATER SAMPLE RESULTS: :.
Well Log®/N) _/&S
Wires properly protected (Y/N) 7 E s
Casing height, (above ground) )gam in.
AT INSPECTION
4111011
24
_ft.
�o • 3 g.p.m.
Coliform _J2 colonies/100 mi. Nitrate il�-7 mg.A. Other bacteria colonies/100 ml.
5 & S ENGIN'cERING''
Date of sample: Collected by: 17n�z =, 1,1 r'.4 e } 1F,2 Gad No Z04
B. SE 1G, ANK DATA Eagle River, Alas4:a ??577
Tank Type/Material PITC Date installed 1
Tank size ! 000 gal. Number of Compartments 4- Cleanouts '(Y/N)
Foundation cleanout (Y/N) Depression over tank (YIN) Zv High water alarm (Y/N) NIA -
Date of pumping v t Pumper
C. ABSORPTION
,FIELD
nDATA 7—
Date installed Soil rating (g.p.d.lft� J / -/bdrm System type )7&IGff
Length � ft. Width 57 ft. Gravel below pipe F ft.
Total depth ft. Eff. absorption area F60fe Monitoring tube 7,�5 'Depression over field Jit J
Date of adequacy test 4) O Results (Pass/Fail)TA:55 For bedrooms
1
Fluid depth in absorption field before test in. Water addedM@ gal. New depth in.
Elapsed Time: tt&mirl Final fluid depth L in. '/. Absorption rate >= SD g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONF ? NO A/ If yes, give date --
D. LIFT STATION
Date Installed
`Pump on" level at in.
Datum
E. SEPARATION DISTANCES
in gallons
'Pump otf" level at _ in.
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift-station on lot IX104-
Absorption field on lot Imo% 1'-
Public sewer main f I/ IA-
/
I
-6-mer /septic service line Z5 4"
Manhole/Access (Y/N)
High water alarm level at
Meets alarm 8 circuit requirements?
On adjacent lots /00 /'t'
On adjacent lots leo /t
Public sewer manhole/cleanout N A
Holding tank N h—
SEPARATION DISTANCES FROM SEPTIC/HOtMNG TANK ON LOT TO:
/
Building foundation 5 //- Property line 5 If- Absorption field
Water main At A- Water service line /O / Surface water
r
Wells on adjacent lots
I1
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /0 t Building foundation Water main JV A
Water Service line /O>� Surface water Driveway, parking/vehicle storage
Curtain drain NONb ,L f4*/ Wells on adjacent tots 00
F. COMMENTS
G. ENGINEER'S CERTIFICATION „ ;, '
I ceRity that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date. S " •' NGINEE J7/•7
� ROH T C. f0; AN
Engineer's Printed Name 0 E �� C ' `1W� tf+r 1l'`
Date
HAA Fee $ 3 0 0• J G Waiver Fee S
Date of Payment �// /u �o / Date of Payment
Receipt Number O O J 7 3 (o Receipt Number
(Rev. 12/00)
1 f'
MUNICIPALITY OF.ANCHORAGE
• - DEPARTMENT OF HEALTH d 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 l.D. # I HAA 11 _ "j N-1 I 1 ) <�',-)44
1. .-GENERAL INFORMATION
Complete legal description' lEti:2r rt t� SAO x{00' Lor , 14CKZ
'LZ
catign (site address or directions) A253 $ OAIK rj swc_ DR,
�• ; •-.;Ltn)-T r I -JO M4y6uQ
Propefty owner Day phone 6 8 9 - 5578
oi;d9�z8rbC)C
• �Mallingaddresst.r�
�1L'eriding agency• Day phone
�.. i.
Mailing.addddress
Ly j 64SZAr_-r-T-
AgenY ISi�
�l,l ��V4 Day phone �73-75�0
34503
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
Community well
* di-oSi�1Cr ti SCI�.tJ�ulP�
Public water Frn- iz�iq/qq
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. 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(A". 1191) Fro l'MOAF21
S. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed he 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 Alastia Water & Wsetew ter Phone 3 3 7'6 it 7c
Mo East C ter
Address a o /Al 9.04
Engineers signature � Date
PA 0 @ cc o s a[s Fd'—
Q(t-DV 1flrr.� • tNJO�c.-� SVgMrr�`FJi i�
Pt2�DF�T�-Ll�ti'� , t,yt �-�a2lLe=-r—r
6. DHHS SIGNATURE
Y Approved for 3- bedrooms.
Disapproved.
Conditional approval for
Additional Comments
A.
bedrooms, with the following stipulations:
By:Date /2 —/S- 97
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 ti�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 engineers work.,
......�.. KI Y lir
.'ONMEWAL SERVICES DIVISIC..
Municipality of Anchorage DEC 11 1997
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division R F C F I V E R
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 4
Health
h Authority Approval Checklist
Legal Description: 0192.,
REEL AAr- -5/0 �ttlP-4/ Parcel I.D.:04Z—
A. WELL DATA
Well type IUA`JE If A, B, or C, attach ADEC letter. ADEC water system number /J1
Log present Date completed J$3
Total depth I AI Y Cased to ia6 Casing height (above ground) o//�yr/f
Sanitary seal &9N) yEs Wires properly protected 61N) !FJ
FROM WELL LOG AT INSPECTION
Date of test 11102///;z5hgL
Static water level
S L% p;
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform
N
/ Nitrate o.lo R'VL Other bacteria 0
Date of sample: ///Re h ri Collected by:
B. SEPTIC/HOLDING TANK DATA
S. P. 0j.
Date installed 0110315? Tanksize /DOC Number of Compartments Cleanoutsj2N) -2
Foundation cleanout ON)_ Yes Depression (YV� High water alarm (Y/& tyl,+
Date'of Pumping )1.15 9y- Pumper 7 •- S PUMPIP""
y
C. ABSORPTION FIELD DATA ;
Dato, installed 01-0383 Soil rating (g.p.d./ftz or &I C_ System type I REW H
FIEco Mv.
p
Length'_3 -SWidth 5 Gravel thickness below pipe
d_ , Total depth ,1 •83 6 MT/SGMP•
Effective absorption area 350 SF Monitoring Tube present & c� -a Depression over field (Y/A ' NO
Date of adequacy test 9_ Results (Pass/Fail) PA .5 5 For TYR EF bedrooms
� n r '�
Fluid depth in absorption field before test (in.); a /A Immediately afterSct� gal. water added (in.): 5 �Z
l tt
Fluid depth >1 (ins) Minutes later: y5 M111- Absorption rate = Y,�-o a- o.p.d.
Peroxide treatment (past 12 months) (Yo NST V—NNA-� If yes, give date #,J%A
72-026 (Rev. 3/96)'
D. LIFT STATION /1/0
Date installed Size in gallons "
Manhole/Access (Y/N) N//9 "Pump on" level at' &A "Pump off" level at' W4
High water alarm level at* H1,4 *Datum PIA
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot /OV t On adjacent lots
Absorption held on lot /00 �+ On adjacent lots /00 ,+
Public sewer main Public sewer manhole/cleanout N�a
r
Sewer /septic service line a S / Lift station N4�
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation Property line /U Absorption field �En Zhsp. P&OXT,
Water main/service line Surface water/drainage /Gb+ Wells on adjacent lots /00 f4
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line /0 a- Building foundation /4 't Water main/service lineytiJUloulh!
Surface water / 00 f'_ Driveway, parking/vehicle storage area yo
Curtain drain Nor -E Wells on adjacent lots
F. ENGINEER'S CERTIFICATIONAidelli
-A �� A11,4 �64E
��.0� F
1 certify that I have de ininspections and review of Municipal recordr Afie �b�� f are
1n con/orman�w%h /4 tA;ZAes in effect on this date. � : _ l�
Signature
Engineer's NameV E (WL> -/ /i • Q:ZW2,Qt
Date _ 1211%-7-
HAA Fee $ a Ua ' O" Waiver Fee $ _
Date of Payment A, /9 7 Date of Payment
Receipt Number 2 /2 (0'-3 —3 Receipt Number
72-026 (Rev. 3/96)•
. .l, .:. .
,♦ ..'22-:nwF
7953
p60rESSO'_� I
Alaska Water & Wastewater
7320 East Chester Heights Circle — Anchorage — Alaska 99504
Phone (907) 337-6179 — Fax (907) 338-3246
Consulting Engineers
December 10, 1997
�POF ....q 11 (•, .•• 1
r M •M b•.•.
M. • Hu •N..
Municipality of Anchorage / A. ea�u f
Department of health & Human Services If `'� E•7953
Division of Environmental Services �/ f9'••.., •'••�`'%.•
;��pAO
On -Site Services Section 1�`""�.FESVSO'.�
P.O. Box 196650 "
Anchorage, Alaska 99519-6650
Subject: IIAA for Private Well & Septic System. Lot 1, Bk 2, Deer Park SID Addn. 01
To whom it may concern:
The subject lot has a 3 bedroom house on it which is served by a private well and septic system.
The results of the field investigation and adequacy tests are summarized as follows:
A. WELL: The static water level on 11/25/97 was 26 feet below the top of the casing (BTC).
Water was pumped from the well at an average rate of 5.74 gpm for a total of 170 minutes (976
gallons). During the first 52 minutes of the test the level in the casing dropped 26 feet, to 52 feet
BTC. The level remained unchanged for the next 20 minutes, at which time the flow rate started
to drop off and the level in the casing began to rise. Prior to this time the average flow rate had
been 6.75 gpm. The cause of the flow reduction turned out to be the result of someone in the
house using the washing machine. The test was continued for an additional 98 minutes, during
which time the level in the casing stabilized at around 44 feet B.T.C.. The average flow rate
during this 98 minute period was 5.0 gallons per minute (490 gallons). In short, at 5.0 gpm the
water level remained stable in the casing, indicating that the recovery rate was equal to the
pumping rate. After the flow was shut off the level in the casing recovered to 28 feet BTC within
40 minutes. Based upon this data it was determined that the capacity of the well exceeds the
Municipal requirements for a 3 bedroom house (.31 gallons per minute).
B. SEPTIC SYSTEM ADEQUACY TEST: The trench is 5 feet wide, 35 feet long, and has an
effective depth of 5 feet. Prior to starting the adequacy test, the MT had 2.5 inches of liquid in
it. The introduction of 897 gallons of water caused the level to rise 3 inches, to a total depth of
5.5 inches. Forty-five minutes later the liquid level had dropped 2 inches, indicating that
approximately 598 gallons had been absorbed. Based upon this data, it was determined that the
absorption rate of the trench exceeds 450 gallons per day, as required for a 3 bedroom house.
NOTE: 77re adequacy of a septic system is influenced by mrmerous factors, including, but not
limited to, seasonal surface water itfltratiott, groundwater variations, septic system
maintenance (frequency of septic tank pumping, usage of biological additives), condition of
drain pili and pipe joints (which can be damaged by seismic activity and deteriorate with age),
type of substances deposited in septic system (cigarette bulls, sanitary napkins, mist. objects),
and the amount of water being introduced on a continual basis. Consequently, the results of this
adequacy test are only valid for the specific day of the test Furthermore, because of the limited
nature of this investigation, it is possible that there are hidden defects which may not have been
detected No warrantee is made regarding the fruture performance r f this well or septic system
C. SEPTIC TANK: The existing septic tank was installed on 1/3/83 (almost 15 years old).
According to the M.O.A records, it is 1000 gallons, has two compartments and is made of steel.
Most tanks of this type have a structural life of approximately 20-25 years. No warrantee is
made regarding the future life of the tank.
D. LOCATION OF WATER SERVICE LINE IS UNKNOWN: In the DIIHS hard file there
is documents which indicate that the original well (log dated 12/24/82) on this lot was drilled too
close to an adjacent septic system. The location of the well was not noted in the DHHS files. On
11/2/83 a new well was drilled, and is shown on the most current as -built survey (copy of the
survey is attached with this package). There is no documentation on file at DHHS which shows
the location of the "new" water line. According to the 1/25/95 IIAA done by Eagle River
Engineering Services (ERES), the water service line is greater than 10 feet from the septic tank
and the absorption field. Perhaps this information was conveyed to ERES by the previous owner.
It is not possible for verify the subject separation distances without having the water line
professionally located. Please provide direction from your department as to what will be required.
E. CLOSING: If you have any questions, please contact meat 337-6179, or 244-9612. Thank
you for your assistance.
M.S.
ERERY CERTIFY *THAT I HAVE SURVgyED 7
.LOWINGDESCRIBE,
p �
wv TYr
Nn:/ q•-/
I THAT . E M Is EXCEPT A'
ICATED. IT IS
IER THE RESPOO(SI®ILITY OF TH
TO DETERMINE THE EXISTENCE OR ANY
EMENTs,COVENANTS OR RtSTRICTIONS
:FI DO NOT APPCAR "THE ROMED SUBDI,
ON PLAT. UNDER NO CIRCUMSTANCES SHOU
DATA HEREON BE USED FOR CON
'ENCS LINca. no a . .._._. STRUCTION
MUNICIPALITY OF ANCHORAGE AL
O DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section In
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 051-042-66 HAA # N AQ; 003 I
1. GENERAL INFORMATION -
Complete legal description
Deer Park - Lot 1, Blk 2
Location (site address or directions)
22538 Oak Knoll Drive
Property Owner Reinhardt Riacielsen Day phone 688-3968
•- now 6700150 r.. .
Lending agency —?yA Day phone
Mailing address
Agent Aurora Properties/Nancy Stahly Day phone 688-4939
Address P.O. Box 671923, Chugiak, AK 99567
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
3
12+N
NOTE: If community well system, provide written confirmation from State ADEC attest -
Ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site X
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State AD EC
attesting to the legality and status of system.
72425(A".1191) From MOAM
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 furtherverifythat 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 Services phone 694-5195 '
Address P.O. Box 773294, Eagle River, AK 99577
Engineer's signature
6. DHHS SIGNATURE
Approved for 05- bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Date /— ad -T
Jr 7 %
in d.��ifi V•�� • A
i''% t:-4735
"r
P
........ .�L' a
bedrooms, with the following stipulations:
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 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.
reams fin... wig e.a Mw m
Municipality of Anchorage
ARM
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: D6i-2 /P/iRz Parcel I.D. 051- 047-40(l
LoT / 8L-4 Z
A. Well Data
Well type PXIk' i M If A, B, or C, attach ADEC letter. ADEC water system number N/✓/
Log present (Y/N) NO Date completed 3 Driller
Total depth / a r ' Cased to / a Casing height ZO"
Sanitary seal (Y/N) Y65 Wires properly protected (Y/N) YE S
FROM WELL LOG AT INSPECTION
Date of test "/'/r� D/�2oJ9 S o z
Static water level
Well flow
Pump levell
ter' 23' rn z
n N L
S g.p.m.7. Z g.p.m. T p
bo VIVeNoL/V C e r, z
SEPARATION DISTANCES FROM WELL TO:
Septicftmkbng tank on lot /50 ; On adjacent lots
c
In C
ti4v' z° R
Absorption field on lot t /LO' ; On adjacent lots f /SSD '
Public sewer main n//A Public sewer manhole/cleanout N/.a
Sewer service line f/Z0' Petroleum tank n/o/Vd 6M4X ,&1T
/Yo76: No eteceep /r/ rl« or xE« ygyNDoNME�vT COULD NOT vEa/Fy Ozi6i,.i'PL
WATER SAMPLE RESULTS: /Vet -1- 1✓4S /9$i9NDONED.
Coliform ¢ Nitratey /0 �1 /. Other bacteria S"
Date of sample: 3195 Collected by: E.Vb/N,564Z
B. SEPTICMOt MG TANK DATA
Date installed 01103193 Tank size YWO Compartments
Cleanouts (YM) yes Foundation cleanout (YM) NO Depression (Y/N) ND
High water alarm (Y/N) N/`1 Alarm tested (Y/N) /y/1q
Date of pumping 0/10519 S Pumper
SEPARATION DISTANCES FROM SEPTIC/HO 3iNG TANK TO:
Well(s) on lot /50' On adjacent lots �_ /go � Foundation
i
To property line 4-10 Absorption field wt IN zp Waterma;n/service line */O'
Surface water/drainage
1\11noeT
72-026(393)'Fmt CONTINUED ON BACK PAGE
C. LIFT STATION 11114
Date installed Manufacturer
Size In
Vent (Y/N)
High water alarm level
Meets MOA electrical codes
'Pump on" level
SEPARATION DISTANCE FROM LIFT STATION TO:
adjacent lots'_
D. ABSORPTION FIELD DATA
"Pump off' Level at
tested
water
Date Installed 1)//P Soil Soil rating (GPD/Fe) 1110 !tf 61Z System type S• ItU106 T,iWNGH
Length 3; Width
Gravel thickness S r Total depth /a
Total absorption area *00 Lit Cleanout present (Y/N) YE5 Depression over field (Y/N) _6k
Date of adequacy test Results (pass/fail) IP19 S 5 for 13 Bedrooms
Water level In absorption field before test O After test 2 31q
Peroxide treatment (past 12 months) (YM) If yes, give date N//9
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /' /20 On adjacent lots f /If0 r Property line 7L- /O
To building foundation 7` /D i To existing or abandoned system on lot MIA
On adjacent lots f r /50 Cutbank LVM Water meWservice line fVo -
Surface water Nth Driveway, parkingNehicle storage area f ZO
Curtain drain
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature _�j//'- �f... R .�T `•• ?'
Engineers Name LoUrS BaTsr"l. �E. `'.•••• "" ,
Date —s r -s 6- lc Cil C 5136CAD
a
HAA Fee $✓ ` Waiver Fee $
Date of Payment / - eZ 7— l"� Date of Payment
Receipt Number 45-3 Ca znq) Receipt Number_
72-026 (3:99)• Back
TRIAL COURTS FOR THE STATE OF ALASKA
THIRD JUDICIAL DISTRICT
ANCHORAGE, a municipal )
corporation, )
Plaintiff(s) )
VS. )
JOHN VANOER VEUR, d/b/a )
VAN -BMT BUILDING, )
Defendant(s). )
Case No. 3AN- 83 - 7146 CIV
S U B P O E N A
TO: Les Buchholz, Anchorage Department of Health & Environmental Protection
YOU ARE CO101ANDED to appear in the Trial Courts for the
State of Alaska, Third Judicial District, in Courtroom K
at Anchorage, Alaska, on September 28-1 1983 ,
at 2:30 o'clock P
plaintiff
.M., to testify on behalf of
in this action.
Clerk of the Trial Courts
.;(C
o t• .t
r'• +fP
y'••............
ly�RD DISSRGoldeen Good ellow
Scott T. Fleming
ttorney or:p in
632W.
6th Avenue, Anchorage
ress
Phone No.: 264-4545
DATED: August 30, 1983
If you have any questions, contact the attorney named above.
--------------------------------------------------------------------1L
I hereby certify that I served the annexed subpoena on
by delivering a copy thereof to him
and by ten er ng to m the fee for one day's attendance and the
mileage prescribed by the Rules Governing the Administration of All
Courts.
DATED:
Service Fees:
Travel $
Services $
TOTAL $
c
ASC -10 (6/81) (St. 3)
TRIAL COURTS FOR THE STATE OF ALASKA
THIRD JUDICIAL DISTRICT
ANCHORAGE, a municipal )
corporation, )
Plaintiff(s) )
VS.
•i •211 a , . ..
11911 ..4
Defendant(s).
Case No. 3AN- 83 - 7146 CIV
S U B P O E N A
TO: Robert Robinson, Anchorage Department of Health & Environmental Protection
YOU ARE COMMANDED to appear in the Trial Courts for the
State of Alaska, Third Judicial District, in Courtroom K ,
at Anchorage, Alaska, on September 28 , 19 83 ,
at 2:30 o'clock P M., to testify on behalf of
plaintiff in this action.
�`'�P� CDTA.~
PX : J
Clerk of the Trial Courts
o .�.�UUK1�0�tLJ
•'' ry
yjRD T USSR\G�
D Goldeen Good ellow
Scott T. Fleming
Attorney or: Plalnttfr
632 W. 6th Avenue, Anchorage
A ress
Phone No.: 264-4545
DATED: August 30, 1983
If you have any questions, contact the attorney named above.
--------------------------------------------------------------------
I hereby certify that I served the annexed subpoena on
by delivering a copy thereof to him
and by tendering to him t e ee £or one day's attendance and the
mileage prescribed by the Rules Governing the Administration of All
Courts.
DATED:
Service Fees:
Travel $
Services $
TOTAL $
ASC -10 (6/81) (St. 3)
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