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BAUMER LT 4 TR 10 REM
SL *,() 4 0 --- ol k --- 16 GRE' ER ANCHORAGE AREA B0r 1JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYST M NAME ��D �� %� MAILING ADDRESS A0 = 1-1Zy fikr PHONE LOCATION � ��7`1�{ ^ Jdl/� X04 -0 -LEGAL DESCRIPTION �� �% 1_)" irk �lU SEPTIC TANK: DISTANCE 1" iltl(`� /���� FROM WELL S MANUFACTURER (9 INSIDE LENGTH SEEPAGE PIT: INSIDE WIDTH NUMBER OF MATERIAL ��CC1" COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY 1400 GALLONS. NUMBER OF PITS DIAMETER OR WIDTH & LENGTH��, DEPTH A LINING MATERIAL iPlf3 CRIB SIZE: DIAMETER_e_19EPTH l9 DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION < NEAREST LOT LINE tD0 ABSORPTION AREA (WALL AREA) —_SQ. FT. ADDITIONAL ABSORPTION WELL: CESSPOOL —tkSTAIIeD /f/ //Mc OF J�OSPeC%%;,J l TYPE CONSTRUCTION DEPTH BUILDING NEAREST NEAREST SEPTIC FOUNDATION—,LOT LINE SEWER LINE—,TANK- ANK_ CESSPOOL APPROVED DISTANCES: INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No. EQ -031 , OTHER SOURCES DISAPPROVED REMA R o �z I e 1�e,S DATE fQ t DIAGRAM OF SYSTEM 00 A i9- 7_ APPROVED. DISTANCE FROM: SEEPAGE SYSTEM W c ri 1v v rr Z',vS7'%1e, �9 r 'r SPe e. ri 6� 12,fi/2-X/Z s�rr9i �9 l� ol G.A.A.B. a:30 GREATER ANCHORAGE AREA BOROUGH tg'J N t$ DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT ;a - MAILING ADDRESS/ 049 4AZY ly.7^4JV NE INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK v SEEPAGE PIT _ 41---*�, DRAIN FIELD OTHER , TYPE AND SIZE OF FACILITY TO BE SERVED Q� 8-&4V�P%?y-'� '511/1-/o i. FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS as 9NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED ` 715- FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE &WWR TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK '5_1 ��jJ //''J� 1 � FOUNDATION TO SEEPAGE PIT 9- , DRAIN FIELD ` / SEPTIC TANK TO SEEPAGE PIT WALL /L5- SEPTIC TANK , SEEPAGE PIT DRAIN FIELD 1ST TO NEAREST LOT LINE. WELL TO SEPTIC TANK fiJ�l SEEPAGE PIT l"- o , -, DRAIN FIELD ��%�� I ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK �© P SEEPAGE PIT DRAIN FIELD 1 l� SEPTIC TANK, 1 , SEEPAGE PIT 10v I DRAIN FIELD Z642 TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. - �1�t -, a d� G.A.A.B. OR LICENSED DESIGNER SIZE I A /1IOn I4444"N W 4fl • DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. i _ DATE 10 -2 N _ 9. APPLICANT'S SIGNATURE FORM NO. EQ -01 6 4\�n moi\ I 11.r11Vi\!"\UL n \�.n vv nvv u, Depar*ment of Environrcnta1 Quality 3330 "C" Street ,nchorage, Alaska 99503 Performed for Date performed Legal Description: Eli 5 This form reports: Soi s log "�pK Percolation tes Depth Feet 2 D ➢ `sfE s t L--1 3- 4- 6- 7- 8- 9 10 1t 12 - 13- _ 14 I�1 as ground water encountered? Se' B&7,auJ If yes, at what depth? Reading Date ! Gross Time I Net Time Depth to H201 Net Drop ,Nercolation rate minute, Proposed installation: Seepage Pit�_ Drain Field ... Depth of Inl gt Depth to bottoir m ofit or trench ,.COMMENTS: f/�S/ � /Z�? 'Um7�� SE 9P // - A / l Performed By: r±,/����,A Certi f i ed By OF oa — ..cC-- $ e Z'QOOiw0' .:z�ay ..K' • LYNN P. WA,. ; 'E 3450 K•'' ;�.e� REGISTERED y,•;�.:;�•jl _____ --- --__.._ 3 SDy STY G2�r/d3t- 67,,EWti c�2ctyl�a•�/ �� /1'! L`- &9TTo/ti OF oa — ..cC-- $ e Z'QOOiw0' .:z�ay ..K' • LYNN P. WA,. ; 'E 3450 K•'' ;�.e� REGISTERED y,•;�.:;�•jl _____ 4 TO f Rodlrm® 4S 472 Poly Pak 150 ses) 0472 SEND PARTS 1 AND 3 WITH CARBON INTACT • PART 3 WILL BE RETURNED WITH REPLY. 0 Ft E GEO'.. "CHNI CAL Et DEVEL ''MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Earl Ellis Russell OysterSOI LOG 68$-2280 6942774 Soils & Foundations (� Land Development Performed for: Name: A%jr>tj?- Tel . No. Mailing Address: r �b 16 ' 3 ."�A Legal Description:ys Lac '\:Z� �— '``51:>Ip Depth (feet) Soil Characteristics n 1 2 6. G - 5,._�Y e---> %I ��Qv�+-� Wvvo 41P "N'C,f a C.".r-ou gid Water Encountered: Yes NoIf yes, what depth,_ °`ropcsed Installation: Seepage Pit Drain Field, ✓ Comments: r �'rA,�1�R�n Q,?':�ab�t �MQrr�ty 3���d �') r r-.,.{,s°ormed by: Date: '\4!L, - U Off r. 64 N AS -BUILT I hereby certify that I have surveyed the following describel property. 1-407" FA✓A4xA 7". ! at Al . t tw . --f A-1 . -- -- -- Anchorage Recording precinct, Alaska, and that the improvements situatted thereon are within the property lines and do not overlap or encroach on .the property lying adjacent thereto, that no improvements on. pro erty lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except a- indicated hereon. Dated at Eagle River, Atxaska this. -�. .._day ofy 40-A-1 1 C. lommm SCALE: istered L>#ud 8No. 80 -LO 1" y -c Hou 4H Is& Rivet, Alaska Phone +# 25U 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. # 16 HAA # 1. GENERAL INFORMATION Complete legal description Location (site address or directions) S"' 5sz- S�icS3L Property owner Day phone (.g4-6 Mailing address _E i-7 )3 514 b44,a- Pa�o 4r- T3 T7 -7 Lending agency N J3 � . ' rc. Day phone -257-35�zJr' pa ev -- I010 ,6 - Mailing address r A V_' 99s1 o Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: f- 3. 3. 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. 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 (Rev. 1/91) 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 type of structure indicated herein. I furtherverify 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. David R. Dayton P.E. Name of Firm 10210 Donalar St Phone Chugiak, Alaska 99567 Address Engineer's signature Date ZVW R- � 1 •%e �. 22054 o' er r PRO � S\4Si 4001 6. DHHS SIGNATURE ,/� �_ Approved for l/Z w`� bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By. (' t— Date�- 1I ITIr 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) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST �L Legal Description: L&'7- 7-P- 10 Parcel I.D. 8AQmL-R_ 5v6, A. WELL DATA Well type f24y4'rZt' If A, B, or C, attach ADEC letter Log present (Y/N) A/ Date completed _ ADEC water system number 97ir Driller. oix"OewJ Total depth 100 t Cased to �6 ,�— Casing height Z"" Sanitary seal (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG 64 Wires properly protected (Y/N) 4 AT INSPECTION &nMUNICIPALITY OF ANCHORAGE g.p.m. /� ® nont.I AEWT bURVICES DIVISION 7� 6 P 2 g 1992 SEPARATION DISTANCES FROM WELL TO: Septic/bokl+ng tank on lot 13 n ; On adjacent lots '" D —Absorption field on lot �� 7 ; On adjacent lots -f.- Public }Public sewer main N�rv� Public sewer manhole/clea ��n ��out Sewer service line �e�r� Petroleum tank IVOA,1 ' WATER SAMPLE RESULTS: Coliform / Nitrate NDS Olpko—Other bacteria IN - Date of sample:i;qZ_ Collected by: '1>0-0 B. SEPTIC/H13*:91Nf TANK DATA Date installed 18Z31 95' Tank size l oaa Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) Depression (Y/N) /V High water alarm (Y/N) Alarm tested (Y/N) Date of pumping ��� Z Pumper iG 5 SEPARATION DISTES FROM SEPTIC/H0b9+N4,- TANK TO: 13 Wells on ld On adjacent lots Foundation To property line 60 1 *7 Absorption field Water rpaiR/service line Surface water/drainage Igo i- 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed N Manufacturer Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA "Pump off" level at Cycles tested Surface water Date installed 7� Soil rating /zS ��41r_ System type !02W-"- Length 1 Z- Width I?— Gravel thickness Total depth 1,0 J -- Total. absorption area Cleanouts present (Y/N) Y Depression over field (Y/N) Date of adequacy test Results (pass/fail) for bedrooms Peroxide treatment (past 12 months) (Y/N) ,u,- oiUow "J If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot �,� On adjacent lots 100 Property line To building foundation 6*46ip- EOE To existing or abandoned system on lot Nom —r On adjacent lots ti� 111,Cutbank ) Water main/service line 7 b -}-- Surface water 100+- Driveway, parking/vehicle storage area Curtain drain�aA¢ 141�y cw J E. ENGINEER'S CERTIFICATION is— certify s— certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. David R• Dayton P.E. 20210 Donalar St. f- 44%-4 Chugs k, Alaska 99567''®�cp`a�f,L� "aid Signature •• x ° ° Ft Engineer's Name s•i9Mais�r�•••esa o•Eg. ax, �. Date Lir �L • David R. w •p••go. go aN'Q���s FESS`©N.. �-7 0 0 HAA Fee $ 1 / 6 Waiver Fee: $ — Date of Payment -9- a _91`1 Date of Payment Receipt Number 1 40 -9 Z gl� Receipt Number 72-026 (Rev. 3/91) Back MOA 21 D. R. DAYTON, P.E., R.L.S. MUNEMIMS Chugiak, Alaska 99567 (907) NNUM 20210 Donalar Street 696-2417 October 21, 1992 Municipality of Anchorage Dept. of Health and Human Services P.O. box 196650 Anchorage, Alaska 99519-6650 Re: Lot 4, Tract 10, Baumer Subdivision Attn: Susan Oswalt Dear Susan, This is to inform you that on Oct. 14, 1992 a monitor pipe was installed on the subject lot. The pipe was installed 30 ft. from the seepage pit to an elevation 13.5 ft. below the ground level at the seepage pit. As of Oct. 21, 1992, there is no water in the monitor pipe. Also, a broken culvert pipe carrying the previously re-routed surface water ( West of the system) has been repaired. I trust this will enable you to complete the Health Authority Approval for this lot. Sincerely, -6LA- P 4e,41 David R. Dayton seolNeS uewnH,g e8eio4oud10 4111e�di� Un�aQ assn z leo (73AI3)3� ((D F, F, IJ F H m rt En (D to rt O rt N J F-� 10 N w � N N H N ro M N 1-3 I -j CL w "" FH,• �r 0 (D p �V rt O 4 CO n 0 0 d (D W rt 0 0 (D W S O (D 0 rn H. rt H. W. rt 5 E t -h (D E 0 5 0 S Oa :31 (D w H m (D :3 r• sv C O w (D rt (D 0 N :3 :j rr F-' :� " rt (D (D N n N G Q+ (D N Q. G$ CA ri H rt H. rt:3(D .0 ro r• (D rt r• rt ::I N t+ rt En m � (D 0 N N (D P. 0 rrr (D N c W E W (D N O ro G rc n r rs w (D F� O 0 h awfi 0�r + �r 4 pn' 8 v N � C UU) � (~D rt n W. to rt Lrl 1-3 f]• ¢ o O ft w 0 W F• Ami N G '< c 0 C ,L1 110 rt, 0 P. V (D rt w w N H. En ri (D rt H C %Qj (D O W 0 AA) m O E w N r• w E w `Q .A ►G-� rt (D0 (D ((DD �` c n a rt 0(D ¢' n En w w rwr F, (D rh (o w r• H I:$ O, J 10 -h N W N 4P 0, (D w r H n Cf FJ 0 1-h "C (D a 0Ul(D poo N (D rt a0 O m ((D F, F, IJ F H m rt En (D to rt O rt N J F-� 10 N D. R. DAYTON, P.E., R.L.S. Mxx4 JxK Chugiak, Alaska 99567 (907) 20210 Donalar Street 696-2417 September 17, 1992 Adequacy Test: Legal Description: Lot 4, Tract 10, Baumer Subd. Date of Test: September 11, 1992 Septic Tank: 1000 gallon, 1 compartment, steel tank (DHHS Records) Absorbtion System: 12' x 12' x 6' seepage pit (DHHS Records) Soils Rating: 125 sq. ft. per bedroom (DHHS Records) Daily Design Flow: 2 bedrooms - 300 gallons per day Test: 300 gallons of water were injected into the seepage pit in 74 minutes with a 0.41 ft. rise in the pit liquid level. The liquid level was monitored at 20 minute intervals until the liquid level returned to the original level. Results: The liquid level in the seepage returned to the original level in 2 hours. Conclusion: The absorbtion system is currently functioning adequately for a 2 Bedroom home. CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 Client Sample ID : L4 TRACT 10 BAUMER SUB PWSID UA Collected SEP 2 92 6 17:00 hre. Received SEP 3 92 8 09:00 hre. Preserved with AS REQUIRED Analysis Completed : SEP 4 92 Laboratory Supe v or TEPHEN C. E/�DQ�E Released By C GII� ANALYSIS RESULTS for INVOICE # 57844 Chemlab Ref.# 92.4662 Sample # 1 Matrix: WATER Client Name :DAVID DAYTON, P.E. Client Acct :DAVIDDA BPO# : Req# : Ordered By :DAVID DAYTON Send Reports to: 1)DAVID DAYTON, P.E. 2) PO# :NONE RECEIVED .................................................................................................................................... Parameter Results Units Method Allowable Limits ------------------------------------------------------------------------------------------------------------------------------------ NITAATE-N ND(0.10) mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: D.A.D. Remarks: .................................................................................................................................... I Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected " See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than r�1 mSGE3 Member of the SGS Group (SociBtd GBndrale de Surveillance) MUNICIPALITY OF ANCHORAGE v 5 DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL�� OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date z2zSAP7 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal ription (include lot, block, subdivision, section, township, range) �J alt"y Location (address or directions) (b) Property Owner Telephone: Home Mailing Address (c) Lending Institution Telephone Mailing Address gy (d) Real Estate Company and A ent Address i Telephone �a y Ssa d (e) Mail the HAA to the following address: or: Check here El, if hold for pick up. List contact person and day phone number below. S 6 S ENGINEERING 17034 Eagfw River P Road No.20p4 Earle Rlver, Alaska 99577_ 2. TYPE OF RESIDENCE Single -Family I Number of Bedrooms �- Business 3. WATER SUPPLY Individual Well X Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/861 Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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. 9 /i Name of Firm S & S ENGINEERING Telephone 1/9-34 Eagle RI.ver Loop Road No. 204 Addre Date 6. DHHS APPROVAL Approved for Approved fWo C2ledrooms by 'Q -/ o`a Date Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (Rev 8/86) Back o` 101, 'Ain A. WELL DATA Q eV MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: 'Lc Well Classification .g' If A, B, C, D.E.C. Approved (Y/N) A -11A Well Log Present (Y�� Date Completed Yield Total Depth -- env" - Cased to `!p-' f Depth of Grouting ---- Static Water Level yy� Pump Set. Aty c Casing Height Above Ground .r Sanitary Seal on Casing &N) Electrical Wiring in Conduit/N) Depression Around Wellhead (Y Separation Distances from :Well: To Septic/Holding Tank on Lot /00 On Adjoining Lots (�c� To Nearest Edge of Absorption rField on Lot. wy �"� ; On Adjoining Lots l �{ To Nearest Public Sewer Line 'q To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot - e- Water Sample Collected by Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA. Date Installed ILD -31—i!; Size /400 No. of Compartments / Standpipes &N) Air -tight Caps O/N) Foundation Cleanout (Y/A Depression over Tank (Ya Date Last Pumped Pumping/Maintenance Contract on File (Y/N) - Nl ; for/ Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) 111.4 Separation Distances from Septic/Holding Tank: To Water -Supply Well 14 To Building Foundation To Property Line To Disposal Field To Water Main/Service Line 2 To Stream, Pond,. Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELID DATA D. LIFT STATION Date Installed Size in Gallons — "Pump On" Level at High Water Alarm L Tested for Electrical Codes (Yi Comments ** Check Permitted certUhat 1. 61*1 Signe57Q24-EA9 e 1 Company River, A Receipt No. -,lil Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) at — Dimensions Manhole/Access (Y/N) _ "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA room Rating Against HAA Request ** pd, verified, or conformeVall A and HAA guidelines in effect on the date of this inspection. Loop Road No.2%ate 6 "5n MOA N v �„... „fi-1 J" -,L •. mi A. Sfi e Je� �'.o. w ear°_ �.��► /�� Soils Rating in Absorption Strata y Z S Type of System Designert)71 Date Installed Z D ' 3 Z - s' Length of Field Z Width of Field 1Z Depth of Field w� Gravel Bed Thickness G Square Feet of Absc rption Area e> 6.5 Standpipes Present( /N) Depression over Field (Y& Date of Last Adequacy Test Results of Last Adec uacy Test – _S�FTldi"�/it I?7�Ly %rte 2%j,e. Separation Distance from Absorption Field: To Water -Supply Wi lII Tcw �"% To Property Line /y To Building Founda ion Seo To Existing or Abandoned System on Lot q • ; On Adjoining Lots Z ag To Water Main/Sere ce Line _ !o'er To Cutbank (if present) 4-0 To Stream/Pond/Lake/or Major Drainage Course /ao �f To Driveway, Parkin Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons — "Pump On" Level at High Water Alarm L Tested for Electrical Codes (Yi Comments ** Check Permitted certUhat 1. 61*1 Signe57Q24-EA9 e 1 Company River, A Receipt No. -,lil Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) at — Dimensions Manhole/Access (Y/N) _ "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA room Rating Against HAA Request ** pd, verified, or conformeVall A and HAA guidelines in effect on the date of this inspection. Loop Road No.2%ate 6 "5n MOA N v �„... „fi-1 J" -,L •. mi A. Sfi e Je� �'.o. w ear°_ �.��► CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562.2343 5633 B Street _ Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D.# ET PRIVATE WATER SYSTEM S t-> C A-/ L---, Name Phone No. ! x-03 L� 011LP 4 Mailing Address A -A- lrS City State Zip Code SAMPLE DATE: WD I I J I Mo. Day'Year SAMPLE TYPE: routine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE NO.II LOCATION l 1 %- -' Z-/ 2 1 /�r�sg 3 4 5 Time Collected Collected By i :80 .2P� / TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: I� Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received q - 1 S - g 2 - Time Received (6130 Analytical Method: Membrane Filter * No. of colonies/100 ml. Lab Ref. No. 5�43- Result* BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count BEFORE COLLECTING SAMPLE Verification: LTB BGB Analyst ptl-6 Coilforml100ml Final Membrane Filt esults ,d CCjoilforml100ml Reported By Date Time: a.m. TNTC = Too Numberous To Count OB = Other Bacteria p.m. ./61 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 1. GENERAL INFORMATION 2. Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 4 Baumer Subdivision Location (address or directions) (b) Applicant Name Connie Bates Telephone: Home Applicant Address Business 694-5500 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other [3X(explain); (d) Lending Institution (e) (f ) Telephone Address Real Estate Company and Agent Address Telephone _ Mail the HAA to the following address: S & S Engineering SRB 196X Eagle River, Alaska 99577 TYPE OF RESIDENCE Single -Family a Multi -Family ❑ Number of Bedrooms two (2) Other 3. WATER SUPPLY Individual Well ®X Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. r 4. SEWAGE DISPOSAL Onsite W Public ❑ Community ❑ Holding TaAk ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-02e (11ie4) 5. ENGINEERING FIRM PROVIDINu INSPECTIONS, TESTS, FILE SEARCH, DA i A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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 S & 5 Engineering Telephone Address Date Engineer's Seal This department has received written confirmation from the engineer regarding the Conditional Approval of April 8, 1986. The corrections have been accomplished and an inspection has been completed by the engineer. The subject property meets with Municipal standards and is now approved. 6. DHEP APPROVAL Approved for two (2) bedrooms b - e August 6, 1986 4 Approved Disapproved Conditional Terms of Conditional Approval ,CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOm) DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) FWIRO14MENTAL PROTECTION CHECKLIST - FEBRUARY 1984 264-4720 �� Legal Description: LorV� A. WELL DATA Well Classification ��_ yllt If A, B, C, D.E.C. Approved (Y/N) _fisiE' L Well Log Present , Date Completed I Cl� s Yield ,r Total Depth ~ IOo Cased to U Depth of Grouting Static Water Level - - So Pump Set At 44 Casing-Height Above Ground Z Sanitary Seal on Casing:. V" iQ) Electrical Wiring in Conduit6l ;Drlj' - Depression Around Wellhead (yo Separation Distances from Well: , To Se tic/Holdin Tank on Lot �a o %GD } Septic/Holding g ; On Adjoining Lots To Nearest Edge of Absorption Field on L t %�a r r ; On Adjoining Lots lOg + To Nearest Public Sewer Line N To Nearest Public Sewer S" t Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by S S f r-Itl'�I�fZ'�jI- ; Date Water Sample Test Results'cs ra�'�'a z.� Comments B. SEPTIC/+t0t9ff4G TANK DATA Date Installed ly 31 Size J 6 O No. of Compartments Standpipes a.Pd'J` Air-tight Caps &< Foundation Cleanout{, CA Depression over Tank Date Last Pumped .5, I Z_- (n Pumping/Maintenance Contract on File (Y/N) _ N [.,- ; for Holding Tank High-Water Alarm (Y/N) ��°' Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well Imo _ To Building Foundation 10 To Property Line ©� To Disposal Field Zo To Water-AMsopa Service Line To Stream, Pond, Lake, or Major Drainage Course ` b ` 'c AA > n Comments 51WrA-,o � li-TO,> v -root 4v a 7- 92 - Page 1 of 2 72-026(11/84) C. ABSORPTION Soils Rating in Date Installed Width of Field Square Feet of Al Depression over I Results of Last A( Separation Distar To Water -Supply To Building Foun Lot To Water Main/Ser To Stream/Pun Lf`E To Driveway, Parki Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level High Water Alarm Tested for Electrical Codes Comments DATA Drption Strata Zs �_ Type of System Design 10 " 51,'I S Length of Field ( Z r (Z & Depth of Field Gravel Bed Thickness Drption AreaZ �i f j� Standpipes Present,6/w Date of Last Adequacy Test quacy Test SA n from Absorption Field: 'ell jyu + To Property Line 10 4 - (tion yO " To Existing or Abandoned System on On Adjoining Lots rice Line 16 ` ~ To Cutbank (if present) Zo 70,W44071 TrrN M �. -11 ilteOer Mede e in Area, or Vehicle Storage Area S� - at —1, itJ — Dimensions Manhole/Access (Y/N) — "Pump Off' Level at — Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted! Bedroom Rating Against HAA Request ** certify that I have c iecked, verified, or conformed to all MOA nd HAA guidelines in effect on the date of this inspection. Signed S & S Engi giDate ng 2 Companf 4gie_Ri r.- Alas" 99y,*V MOA No. - 1GI C ` 3 Receipt No. Date of Payment Amount: $ — Page 2 of 2 72-026 (11/84) �92- 3--I <- M, August 5, 1986 ROBERT A. SHAFER CIVIL ENGINEER 694-2979 MUNIC1FALM OF ANCHORAGE DEPT. OF HEALTH & LrlV;t Cr�MENTAL PROTECTION HEALTH AUTHORITY APPROVALS FAU6 Mun.ic i.pat ity o4 Anchon.age Departtment o4 Heatth and Human Services RECEIVED 825 L Street SEWER &WATER Anchorage, Ataska 99501 MAIN EXTENSIONS ATTENTION: Steve Monnis REFERENCE: Lot 4; $aumen Subdivision SEWER & WATER INSPECTION In Manch, 1986, you .issued a eond.itionat Heatth Authotity Appnovat bot the ntes.idenee toeated on the nte4eneneed pn.openty. The conditions o4 this appr.ovat nequ.ined an .intewittent strteam to be removed on ptaeed in a cutver.t on pnopenty jo& a distance o4 100 fleet 64om the existing NE STUDIES ANDREPORTS on-site wastewater disposal system. It also nequ.ined the nemovat o4 ORTS a eanpont that had been constructed ovek the seepage pit. Att work n.equ.in.ed by this conditi,onat approvat has been eompteted .in WELL INSPECTION a satis4aetory manner, and .inspected by us. & FLOW TEST Request .issue the 4.inat HAA. Sin rely, SITE PLANS R A. SH EER, P.E. AS/ss ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN SRB 196X EAGLE RIVER, ALASKA 99577 S -IJ 5. ENGINEERING FIRM PROVIDIN a INSPECTIONS, TESTS, FILE SEARCH, D�.. A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation ofthis Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigationand 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 Telephone Address SRS i196x Date Eagle aivar, Alaska 94 �, 2 . of All AC Conditional Approval: Letter from engineer certifying � - •v.a arrNre• that stream is greater .then one—hundred (100) feet from ` existing septic system.. Remove carport over seepage � I* I+li7.i pit. Funds escrowed to assure work is completed not •,� �."� later than June 15, 1986. 6. DHEP APPROVAL] Approved for ` bedrooms by Date April 7, 1986 Approved Disapproved' Conditional :SEE fo"DITIONS AS SET ABOVE. Terms of Conditional Approval !VO OF /N 74ge!�lO / 7"T,Fiy T X 72COAP AO Ct-rea R1 CGl G vc T G! N 0 ii /2 leo .410 0*AJ 0 Q2 A / N l Aj c )P0^0 D/ 7[' a u S' S' 2•a ooeT' A.167,044 X4 7/ C S f 7795''44-f , IF2 WC) t!(S' CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions' in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTEC=TION DIVISION OF ENVIRONMENTAL HEALTH C1 -H111 ICA [1- OF: INSPLC] ION I OH I I[ --AI- I 1 I AIJII IOHIIY APPROVAL 01 ON -SI I 1 -';V -WL -I1 ANF) WATLH LACILI I 264-4720 Application Dato _ 3�iL3�t36 1. GENERAL INFORMATION (a) Legal Description (include lot, hlock, subdivision, section, township, range) Lot 4; Baumer Subdiv.isim Location (address or directions) Mile 5.31 Eagle River Road - C'or►n:ie Hater; _Business 694. 5500 (b) Applicant Name -- -- -- - - - - - -- I elemmne: Home _ - Applicant Address - hick White Realty (c) Applicant is (check one): Lending hisMHHon EJ ; Owner /builder L 1 ; Buyer Cl ; Other N (explain); Re"ITOr (d) lending Institution - - - -- -- -_ I elephone - - Address _ (e) Real Estate Company and Agent - - - Acldress l elephonc _ - - (t) Mail the IlAA to ihc,,following address: S & S Engineering SRB _l_9FX Eagle River, Alaska 99577 2. TYPE OF RFSIDENCE Single -Fair b to MuMA amily 11 Other - - - Number of Bodrooms 2 - - - - - 3. WATER SUPPLY Individnal Well Lq Community U Public 11 Note: If cominnnity well system, must have written a»affirmation frons the Stato Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite W Public H Conunuraity ❑ Holding Tank L] Note: If community wall system, must have written confirmation (corn the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 0 on 0 pm) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE. SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the mi -site water supply and/or wastewater disposal system is safe, irmctional 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 - - S & S EIngfnemiing Address __ -- $RR 1966 ante '�ivmr, Afar ka x'9577 �y / sl Date -ONS f Ir n 4 PQM ge4M �..w �IpCe.��iM �-v rflIl�'1 a dli 6. DHEP APPROVAL -- — E,� - Pl�ri_1 Approve for -- bedrooms b )ate - - - Appioved -- - -- -- Disapl_noved - _ --- -- - Conditional AS, _:>J'IV'-Cl ;.�_ f3T,T.C)W: Terms of Conditional Approval . __Loiter from -engineer- certifying �t,roam_ 1,,i greater _ Chau one -hundred (100) feet from ex:i.sL'Ing Remove cart)or_t over. seepErge pit. hunds escrowed to a.ssur_'e work_ ir, coru}_)leiao(j rroh laiier than 'June 7.5, 1966. L CAUTION The Mtrncipality of Anchorage Uepartrnent of Health acrd Fnvironmental I'rotection (DI iF={') issues Health Authority Approval certificates based solely upon the repiosentations given in paragraph -1) above by an independent professional engineer registered in the State of Alaska. 'I he DHEP does this as a conitesy to purchasers of horses and their lending institutions in order to satisfy certain federal and state requirements. Employees of [)I U' do not conduc=t inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 7? n)r, (11 MM i i, l��1lRi C1� �1h,0�r�OGICI.Y R � Imo/. 1?01?1j7' f'?11 l(' k"4 �e;I'A' 'X/9.g INC. —_ 1 n � r -- - '�C33 13 `�trcet TFLEi lIC)NI- ( 907) ,)62 2343 r�,v__ Anchor �gc, AI a -Ica 995113 Drinking Water Analysis Report for Total Goliform Bacteria TNTC ; Too Numberous To Count OB = Other Bacteria Io Rj- GOMPLEIED BY LABORATofiY TO PE COMPLETED BY WATER SUPPLIED I Ll PUBLIC WATER SYSTEM I.D.# I_ __1-—[ r-- AI»lysis shows this Water SAMPLE to be: (fi; _PRIVATE WATER SYSTEM`_� ,�f_ Satisfactory 4 co -i f-/�C, - (_� l -� ? _ l - Ll rJnsatisfac:tory Name Phone Na. Sample too lona in transit; sample should not be over 30 hours old at examination Mailing Address �- to Indicate rellablP, reSURS. Please send new sample via special delivery mail. Gity State Zip Code � E 10-p)- LG'� _3— a Date Received _ —_I— SAMPLE PATE: 1 ime Received r!_A Mo. Day Year Analytical Method: Membrane Filter SAMPLE TYPE: #4FIoutine f I Check Sample (for routine sample with lab ref. no. __-- -___ -_—) I_J Treated Water - No. of colonies/1ClQ ml. i) Special Purpose c�-4Untreated Water SAMPLE Time Collected Lab fief. No. Result* Analys NO. LOCATION Collected L_ - -- I I- H] - - - -- --- -1 - -- - - -_ ----1 BACTERIfOLOG[CAL. WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count __ Coilform1100m1 BEFORE Verification: LTB_ ---- COLLECTING SAMPLE ----- Final Membrane FilterResuHs � � � Collform1100ml � �` Date � "�/C�)j�j ^_ Reported By--- — -- — _ ll/ Time: a.m. p.m. TNTC ; Too Numberous To Count OB = Other Bacteria ar Prof -Fly Uwmlr Maiw,g Address lip C;odo Buyer Address Zip (;ode Lending Institution - Phone Address l.ip Corte Healty Co. & Agent Phone Address i_ip Code Legal Description Street Location Type of Residence (- Single Family I I Multiple Family No, of Bedrooms I 1 Other Water Supply -� Individual ATLACH WFLI_ I_OG. A weal loll it', rerluirocJ for all wells drilled :;ince ,lune 1975. I Community For wells drilled prier to that Ante, give well ric!pth (attach log if available) - 1 Public Utility Sewer Disposal b l Individual Year Individual In:atalled: I I'uhlic Utility When Connected to Public Utility Holding Tank NOTE: THE INSPECI-ION FFE MUST ACCOMPANY EACH HFCNJFST BEFOLit- I'HOCEStiIN(, CAN 13F INITIATED. 1 imc- � Dime I Date Date Inspector Inspector ( 1 � Field Notes: ( )_)-APPHOVI--D 13EDROOMS ( ) DISAPPROVED ( ) CONDITIONAL APPHOVAI DATE 3 HY:f , inr. I I mile Date - Date ( ` ri In "Pcctor Inspector Soils Rating Datn L�"wel Instnllerl Wn.11 1r, Al,;orptlon Arc;, Well l0 latik ��-n2s pin') °CONDI i IONS OF Al'PHOVAI_ Woll I on I teceivnd .`;epilr krill`..`;IZn FXCAVATION WORK septombeu 28, 1982 Wynamic Realty ATTENTTON: Linda Parker P.C. Box 1796 Ragle River, Alaska 99177 near Linda, Reterenco: lot 47 Block 17 BaUMM SUMMON HOBFIATA. SHAFF-A CIVIL ENGMEM Gq4-)9 /9 A sewer system adequacy Lost was porfnrmed on the system located on the referenced propert-y as you rnquested The septic tank was pumped and varykind LO hOvP 0 "Pa"Y of 1500 -gallons. The seepage pit was charged whhh goo gallons of water and after a povind oL M hours all the water which had =teen added to the crib had perMAUnd out. 0 rt- can- ba concluded- from- this test that the waste water disbosal system serving the two bedroom residence located on this property is currently uncLionknq adequately. However the system cannot be guaranteed against subsequent failure. if we may be of further service, please do not hositate to call. cc: MunicipAlity of Anchorage, -j)(-�partmont of Health and !,;nvironment-.a] 17 uLoc Liot) SIM 196X FAGLF MV111, ALASKA CHEMICAL & GL LOGICAL LABORATORIES oF ALASKA1, ANCA TELEPHONE (907)-279-4014 ANC HORAGF INDUSTRIAL CENTER 274-3,"164 C 62"! B Street lAADAATOAIl9 Il rll IKi q �0 Lt -I F�11a Y�IJ Il�Pll!� ,dS'' 14l `I_I� 4s 0.?Il�"I-I11 I��pJ REfI'� TO BE. COMPLETED BY WATER SUPPLIER TO 13E COMPLETE=D BY LABORATORY WATER SYSTPM; — _-� --- _-� Atmlysr; shows this Water SAMPI_F to he: I.R. NO. Water System Name Phone No. Mailing Address City F-1-1 ( 1 (State l Zip Godo SAMPLE DATE: L— 1-1 L - �- J L_ 1_ 1 Mo. Rey Year SAMPLE TYPE: C7 Routine ❑ Check Sample (for routine sample with lab ref. no. ___ _ - _ ! [ 1 Treated Water ❑ Special Purpose 1-1 Untreated Water SAMPLE NO. LOCATION - - - - _ --- - - -- -1 �- - F' Time Collected Collected By �1tl.z i I C oly I_i lJnsatisfilctory SaIlnplc too lonc;j in transit; samplo should not he over X4£3 horns old nt examination to indj(-a1W reli;a)le results. PIWISo send lww sample. Time Received -- Analytical Method: I I Fermentation -Tube I I Membrane Filtov Lab Einf. No. II Besuit`' Analyst I - ----I L_1 �.Nn. of , olunu / 100 ml. nr N2 ui I'ositivc pnrlinns_ 06-12z0 (b) BACTERIOLOGICAL, WATER ANALYSIS RECORD Rev, 1978 DateCollectofl.. .--.- - __ _.-. ._._.__._.__ _ _ _ Sonrce.. RUCTIONS READ INSTRUCTIONS ----_ Date Recelverl-___—-_..._. _. _11"T Rw:elvd _._ _p,m. ! Wa. No Presumptive 1 xOmi tpml l 101111 i0m1 0ml �,4m1 (l.iml -- --, 24 Homs II 48_Hpurs BEFORE ---- Confirmatory 24 Hours1.--- 48 24 honrf:_ _ _.€froth 48 hours:"__._ p C� COLLECTING SAMPLE COLLECTING WIWI- Tuhn RePort:-- -- --- - - _ - ;oral roh®; Pocltiva/[otnl 1.4ml Pnrtionn - - Membrane Fliter: Dlr+ctConnt._. ___.._ - _ _.--.-Collform/An"ml Verification: 1. T R-- --- - - - - _- - FICA ---- Final Membrann Filter Rasults _ - -. _ _ _.._._.. _ .___.Coliform/xonvnl Raporta•dlQy-. --- - _.._.-- -- - - -. _ _._.. Dntr---...__ p.m. C om(nems - - - - 1 � ' ol! 't, C' I, 'i t onditiom:l Approval Il,at" lownr Iw Ir 311-d 1 fioiin Hatinil _ - V�f(I11 Ill. Jlt� pticm Alri I tnlCl! i r}fl - - P 3 PPI]'=.Pte N i LL—Sp R -R- (7)W F B W a 0'P'' i'roperly Ownin E'i1 1n 1 Address:; I I endnic� Ill stiiuhnn I .'Iumr 9 Add ro!; 1 1ietjlt}r r o. AqFmi ( .'11oo Address r (1111 F'I � t,r• , � is f indlvi(,�_.al ;il,�r t. _, - - , _ - R H9_A,ArAA"L & G) LOGICAL AL LIP.A- OR ATORUES !'ALASKA, INC. ) t111;, l 0 ~^ TELEPHONE (907)-2794014 ANCHORAGE INDHSTRIAI CENTI-11 274-3364 5633 B Street a ne�AnroraMs _ Drinking Water Analysis Report for Total (aoli orm Bacteria TO BE COMPLETED BY WATER SUPPLIER TO RE COMPLETED BY 1__ARORATORY WATER SYSTEM: ET-_� J_ _� 1_ I Analysis ;bows this Waf€ r `�/�MI'I_I-: to ho: Ln, NO. L� <,. . Water Systmn Name Phone No. Mailing Address City Stato /_i1, Codn SAMPLF DATE: L.—�_ I. ,_� _� l Mo. Day Yoar SAMPLE -TYPE DJ Routine 1-1 Check Sample (for routine sample with late rot. no. --_ - -- - } I I Treated Wator 17 Special Purpose I I Untreated Water SAMPLE Time Collected NO. WCATION Collactod Fly I- - -- - - -- -- - -- - --1 ---- ,),1 LI:,l-W 101 y Un ;atisiactmy Samhlr. too (()11(1 in transit; SM1)p1e Should [lot he over /1H hours old at oxal�linGltion to indi olo, reliahle re sults. Pleasc sand nr�W t -mill lle. Data Revoivod Linin Received --- Analytical Method: I I Fennontation Tltibe I I Mennhra.nn Flitni 1 -ab Rot. No, Handl " Analyst 06-122n (b) BAGT F_FtIoL.OGICAll WATER ANALYSIS RFCOnn Iftev. 3,97n trate Collectni.i - - _ _ -. - -.. _ ourm. READ INSTRUCTIONS a.m. QateRecelved-----...—.... ___TWon Rerelved_.. .p.m, I_.ab,No. presumptly- I 101111L 101-.11I Anml I Antral Perm A.01111I 01ml 24 hours LC �i@�1 I��R1=. - Confirmatory 24 Hours FMD_ ___ __. _. _._. _. €troth 24 hnter3:.. _. _._ _Broth 48 hour%:-_ s''��yg �a ®© b- O LEC INO SAMPLE tAolt€ple Toho Report:- _. _ _. tnml rubes poslthro/rotal 7.01111 Vortlong --- ---- ------------------- Membrane Fllter: 171rect Count - _enllform/A00mi Vorlfication: I_T€1._ _._ rtG11_ Final Membrane Fllter Results. _ — _ — _-coliform/100Ml Reported Hy -- ---- - _ _ -. - - - - _- - - - __ rlatn PAW Baumer Tract 10 Lot 4 #050-611-15 Municipality of Anchorage Development Services Department Building Safely Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us 10 15 (907)34$-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Off- & // - 1. GENERAL INFORMATION HAA # 1-114C) QC) (-//I Expiration Date: / /- tel .0-9— Complete legal description Lot 4; Tract 10; Baumer S/D Location (site address or directions) 24 20 5 Eagle River RD. Eagle River, AK Current Property owner(s) Brent DeMoss Mailing address Same Lending agency Mailing address Real Estate Agent Day phone 696-8225 Day phone Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 17 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Individual On-site %© Individual Holding tank ❑ Community On-site ❑ 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 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. DSO 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. (Certiricoles 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. NameofFirm S 8, S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Rd, E.R., AK Engineer's Printed Name Robert C. Cowan Date S))7`fjo 2L 6 i( 5. DSD SIGNATURE tee,\ ROBERT G COWAN r / C CE -8801 V Approved for bedrooms. �1offq'�,,, Disapproved. 11��si���;' Conditional approval for bedrooms, with the following stipulations: 1; ````�SP�\ 1(r0f•AN�y�. ON-SITE •'�= WATER AND • m'. Additional Comments 1NASTEWATERT PROGRAM •.. .••'Sd��N Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory By: In« I'MI Maintenance Aoreements Supplemental Engineer's Report Other Original Certificate Date: 4 - i q - Ci 2 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water S Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-650 www.cl.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: [.v1 Q; TgACT � �� MC�7L— S�7 Parcelll): O d -O _ (Oil— 15— A. WELL DATA Well type if A, B, or C provide PWSID # = Well Log (Y/N) J- Date completed Sanitary seal (YM) Wires properly protected (Y/N) Total depth711W ft-- Cased to 4� t R Casing height (above ground) r in. F OM WELL LOG AT INSPECTION Date of test ��� �l4' OZ Static water level ft ft. Well production g.p.m. �.6 9— p.m- WATER SAMPLE RESULTS: Coliform colonies/100 ml. Arsenic: 111g.11. Nitrate a ?Sl mgA. Other bacteria © colonies/100 ml. Date of sample: 9"3/* 2 Collected by: .54!; B. SEPTICIHOLDING TANK DATA aL Tank T i -OMPT IL Ype/Materlaf Tank kite 160 gal. Nprnber of Compartments Foundation cleanout (YM) �L. Depression over tank (YIN) Dateof pumping ���i ��i` Pumper J Q I S C. ABSORPTION FIELD DATA Date installed S( ?)"' Soil rating /P/bdrm) 12!!� Length 12 ft. Width I Z R Date installed 10' 31 /.:PL5- Cleanouts (YM) Y High water alarm (YM) A]/ System type 45;F0P/Y6tAP1- Gravel below pipe 6, ft. Depression over field A For —Z --bedrooms Total depthl?-!5� R Eff. absorpon area �fe Monitorin tube Date of adequacy test 110-1//0& Results(Pass/Fail) mFluid depth in absorptioid before test � in. Water added1590al. Elapsed Time: lmmin. Final fluid depth in. Absorption rate >_ New depth in. Any rejuvenation treatment (past 12 mo.) (YM & type) t If yes, give date ... i D. LIFT STATION Date installed 'Pump on' level at in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump air level at _ in. Cycles tested ManholetAccess (YM) High water alarm level at Meets alarm 3 dreu t requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankA(f xtatibn on lot 1670 I4- On adjacent lots Absorption field on lot 106 rt On adjacent lots ADO Public sewer main r J/A Public sewer manhole/cleanout N /R S�/aeptic service line 7-f- lot- Holding tank SEPARATION DISTANCES FROM SEPTICIHO�G TANK ON LOT TO: Building foundation / Property line 5 �1 Absorption field /f I 1 Water main � /Ar Water service tine 104 Surface water I Wells on adjacent lots / d, in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line � 0 4 Building foundation 10 L 0 4 Water main /0 / >` i Water Service line/,,, 119 Surface water IM Driveway, parking/vehide storage � I '� Curtain drain 1!/—E KNPA/ Wells on adjacent lots �4- F. COMMENTS G. ENGINEER'S CERTIFICATION *�kA Nl � 1 certify that 1 have determined through field inspections and i review of Municipal records that the above systems are inppp...% conformance with MOA HAA guidelines in effect on this date. r ig ygw�++W j Engineers Printed Name R084AT C. Caws . jf "{ 80t `rw� Date Q / °f/& Z t �' 1 •..-:' .rte HAA Fee E 3 .7 6", " +' 1 t o • (R-rw) Waiver Fee $ Date of Payment t//.q/0 Z Date of Payment Receipt Number 0/ Receipt Number (Rev. 12101) r I P3,�•6lR�fi; � .,.. . r . r ' t \ 1 4 AS -BUILT ^ . `,1 ,: • t f here6y tarilty that Ii have surveyed the following L 7`• desetl pfbotly:Y-_��AUMr R a V^ .i' '•,+.•��•_,.,`.' Anchofag4t ecotding Precinct. Alaska. and that the ltnptbvetnelhtt,a alluafed thereon are within the properly and shot bVcrlhb pt encroach on the property ' y ng ik t thereto, that ho Improvementq on prop- ertq iql g g Jbceht thereto encroach on the premises n �." pueshon ah llhhn there it* no roadways, (rinemletton tinea or elIt vla�ble easements oh said property except en Indle6ted heteon: baled at Lagle River, Alaska • thlt I r Any, b? J:,e-y fi?Z jlontltT c. 401tN90N Ttv9^ scALki Registered Land Surveyor Ha. AgatB .. 1'>=tl.p a Box 458 to River, Alaska Phone 64- 843