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FOX HILL BLK 1 LT 9
Fox Hill Lot 9 Block #051-073-27 Municipality of Anchorage Page 1 of 5 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number:. SWO00,~68 PID Numbe~. 051--073--27 N°m':BERNADE'TrE OHLEMACHER Wastewater System: [] New · Upgrade 22250 WOODCLIFF COURT CHUGIAK, AK 99567 ABSORPTION FIELD Phone:(907) 271 --2206 3 m Deep Trench n ~:hctlow Trench · Bed [] Mound · Other * LEGAL DESCRIPTION ~' '~: '~ ~'~ '""" ~"~ · 2.0 ~o/s~. n *SEE REMARKS 9 1 FOXHILL *SEE REMARKS n 0.50 - -I - 0.5'+,/- n 30 WELL: n New [] Upgrade 12 n 6 ~,~ ~ ~ ,~60 so. I,t AS'TM D-3034/F-810/$CH 40 P~ rt EAGLE MTN. EXC. 10/30-31/2000 .~....."~ =,~ ~'"" ~ '= ~ IC'~ "~ ~' ~.~ **EXISTING TANK SEPARATION DISTANCES a ~,~ =,o,~., = s.~.~.. ~o ~pUc ~.~fion ~t ~ld[ng =~ ANCHO~GE T~K 1250 we, 100'+ 100'+ 100'+ - 25'+ STEEL 2 S~,oco ~00'+ ~00'+ 100'+ - - **EXISTING LI~ STATION Water Une 5'+ 10'+ 5'+ - - 1250~ ANCHO~GE TANK/ORENCO SY~EMS Foundo~on 5'+ 10'+ 5'+ - - TIMER TIMER 45' Cu~oin 20 OSI 05 HHF Dmln N~NE KNOW~ ALCAN ELECTRIC ~emorks: *mis IS A INNOVA~ BO~OMLESS I~RM~E~ BENCH MARK ~D RL~R. ~VA~ON W~ UM~D TO ~E REMOV~ BOSOM OF SIDING AT POI~ "A'. OF ~ CO~I~D ~TER~ (SEE PRO~ ~-BUILT). ~ ~ ~ ~ 2.28 ~ OF M.O~ ~PRO~D ~D RLTER ~DED. 100.00 · *I~GR~ ~R~O AND M~D O~DE W~LL ~DIUS. Insp~ons ~o~ed by: AWWC, INC. Dates: 1st ~o/3o/~ooo . ~ ~. 2nd-5~ ~o/3o-3~/oo ~ L~ [ Depadment of Health and Human Se~ices approval ~{ :,,..,... ......... , R~viewed and appmv~ DY~~ ~' ~ote: / I -~-0o ,,,..u.,.: AS-BUILT DRAWING SW000368 051-075-27 , , - _ ~ --'-' - -/ '_ / WOODCLIFF DRIVE / / ~ / A e C I PCO 3.25 -- 41.50 ~ ST1 12.17 44.33 48.00 I ~T2 1B.50 50.85 54.61 I dH 20.00 52.08 52.75 I ~T1 ~6.50 ~7,~8 79.25 ~ dT2 41.75 66.35 81.83 I dT5 65.00 7~.~8 109.85 / dT4 67,~ 84.58 110.50 ~ '~wNl1'2'2000': ~SI~ ~TER & ~STEWATER ~ CONSULTANTS, ~NC. F0XHILL SUBDIVISION; LOT 9, BLOCK 1, AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE P£RMff NUMBER: SW000118 AS-BUILT DRAWING NOTg: ~ I~XJf:~fl,~ 5.1'~'. f,a~R WA~ I~Y, CAVA~P Ai',~ 11~ INf~1Y ~EP ON I0/~1/00. 'fl'E 'FANY. WA%q.fx2 g~2V~ OIJf,~ C~ 1~ IGC)' W~LL PARCEL ID NUMBER: 051-073-26 /2/2000 J.gM. N.T.S. 30F3 AI~SKA WATER & WASTEWATER ,,, CONSULTANTS, INC. ' BERNADETTE OHLEMACNER (907) 271-2206 FOXHILL SUBDIVISION; LOT 9, BLOCK 1, PROFILE AS-BUILT OF SEPTIC SYSTEM UPGRADE Alcan Electrical Engineering, lnc, 6670 A~c~c Sp~ Ed, Anchorage, Al~ka 99518' Fax Cover Sheet DATE: November 14, 2000 TIME: ' 10:{31 AM TO: ^~NVC PHONE: 337-6179 Jeff FAX: 338-3246 FROM: Ncafl Electric PHONE: 5633787 Sklpp Brlr~r~'~ pax: 562-6286 Lot g, Block 1, Foxhill Sub ?'eft- [~ regards to d~e sewa§e IL~ station that Alcan connected at the a~ove mentioned location. Ail electrical work performed by Ale. an w~s done to 1999 National Electrical Code, If you have any questions please contact me. Thank you! Number of pagu Including cover sheet: i ~ il I II ,o~...,~,~. I ~, . \ \ / / // ~ /~ / / ( ( ', / ~. ~ox .,~ ~/~ .. =.~ .,,, ~.. ~ ~~-. /~ ._ .... - ............ ~ ~ /~ ~'k~~..~X I ............... ~~-- KIM~ON S/D KIU~ON ,, , , CONSULTANTS, INC.,, s~ BERNADE~E OHLEMACHER (907) 271-2206 1 ~,. FOX HILL SUBDIVISION; LOT 9,, BLOCK 1, SITE P~N FOR SEPTIC SYSTEM UPGRADE (BO~OMLESS ISF) ~ / ~ SEPTIC TANK NOTES: THE CONTRACT6R SHALL HAVE THE '~ ~ ~ ~ ~'~£ 100 FOOT WELL R,~IUS FI,~OED BY A REGISTERED ~ -- ~ LAND SURVEYOR PRIOR TO CONSTRUCTION. IF THE TANK / ~ '-----'-- IS FOUND OF GOOD INTEGR~I', THE: TANK IS TO BE RELOCATED Ot.~lD£ OF '~E: 100 FOOT WE:LL RADIUS. / PRO~SED U~E TO BE / ~V CONSULTANTS, INC. ~ 1 40' BeRNAD~E OHLEMACHER (907) 271-2206 2 Of FOX HILL SUBDIVISION; LOT 9. BLOCK 1, DESIGN OF SEPTIC SYSTEM UPGRADE (BO~OMLESS ISF) - ~LLl~f, lfi V/q.V¢5 I/~" I:~ 501 ~10 ~ C. OD~IL I~ITOI?.A~P ~I~N f~ (~X~ ~ ~) P~N VIEW NOT~: ~VATION DEPTH IS TO U' ~ ~ ~/~" ~A~ / .Z~ ~ ~- - ~AYIN~5~. ...,.,~, .. ~/2~/2ooo ~ O~..~L ~% J.k.~. ~: ~~ A~S~ ~TER & WASTE~TER ~ '.: ~'~ ,~ CON$ULTANT$, lNG., fox ~,~t ~u~o~ws~o~: ~o~ ~. ~o~ ,. ~;.~'. ............. .:tt~ D~AIL OF BO~OMLESS INTERMI~ENT SANV FILTER (ISF) ~M~%~~ .Sent By: Alaska Water & Wastewater Consu; 007 338 3246; Aug-23-O0 7=30; Page 212 PROPERTY OWNER MAINTENANCE AGREEMENT ON-SITE WASTEWATER DISPOSAL SYSTEM This agreement, dated A ~t o ~ ~ ,200~ is made between the Municipality of Anchorage Department of Heal~ and Human Servi-ces (DHtIS) and the propcrt7 owner(s) of This agreement is made for the puq~os¢ of maintaining an on-site wastewatcr disposal system on the subject property. The property owner(s) agree to the following: The property owner(s) will have an annual inspection of the system performed by a registered professional engineer. This inspection shall verify that all effluent and air pumps, timers, and alarms are functioning as designed. Any deficiencies shall be corrected and the engineer's statement that the system is functioning as designed shall be filed attnually with the DHHS. ' ?toiletry O~h~r Hame : :: (Notar . In witness whereof, I hereunto set my hand and o fr~ ~,? , Notary Pub, lie (signature). (NotarT's printed name) My commission expix'es: Municipality of Anchorage Page _ 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 Name: ~~ ~. .~~ ~ ~ , Wastewaler System: ~ New U Upgrade ~: ABSORPTION FIELD Phone:~.~ of Bedrooms:~ ~ Deep Trench ~ Shallow Trench ~ Mound ~ Other LEGAL DESCRIPTION sod Rating: ~l Depth from original grade: GPD/Sq. LoI:~ Block:/~Subdivision:~,~ Deptl, to pipe bottom ,rom origin~ Fl G ravel depth beneath pipe Ft. Township: [ Range: Section: Fill added above orig~ade: Gravel lenglh: WELL: U New ~ Upgrade Gravel width: ~ Number of lines: Distance between lines: / Ft. Ft. Totalabsor ion area: Pipe material: Classification (~rivate. A.U.C): ~ Total Depth: Cased To: absor~ Driller: Date Drilled: Static Water Level: ~~ Instal r: Date installed: Ft Yield: GPM Pump Set at: F Casing Heiglq Above Ground:Ft ~l[~ TANK SEPARATION DISTANCES u Septic ~ Holding ~F.E.P. To Sepec Absorption Lilt Holding ~ub~ic/Private Manulacturer: From Tank Field Stahon Tank S .... Lines ~~~ Well j¢¢/ 1¢¢~~ ]~/ ~ _Z~% Material~~ Number of Compartments: SurfaCewater 10~ [¢% f~ ~ ~ ~ LIFT STATION Lot ~ Size in gallons: ~Man~fac~urer: Foundation ~ I ipl¢ ~1 ~ "Pump on' level at: I"Pumpo "e~e a: waleralarm at: Pump Make & Model Electrical Inspections performed by: Remarks: BENCH MARK Location and Description: ENGINEER'S SEAL nqn¢cf nnq n¢rfnrm¢d hr. Eagle River, Alaska ~11 Dates. 1 72-013 (Rev 9/9I) MOA 25 Permit No. SW930095 Page 2 of 2 - Municipality of Anchorage 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 Legal Description: FOX HILL SUBDIVISION, BLOCK 1, LOT 9 PID No.: 051073~? FCO 3' C VER CO CO I /FINAL ~H NEW .... ~ S.T.E.P. ~ SYSTEM ~ GRADE WOODCLIFF COURT 1'0-0' WELL RADIUS NO POINTS OF DRWE 3 BDRM HOUSE N SCALE 1' 1250 SYSTEM C0 COO o MT REGRAO~N G CO~IPLEIED 5~JR FACE PONDING ELIMINA~EO 72-013A (Rev 9/91) MOA 25 3LIM 09 '97 ~3~45 RE/I"IA× O? ER,2L£ RIVR P.1 ED'S ELECTRIC INC. $outh£ork Con,~ructlon 15230 Springbrook Dr~ve ~a~lc Ri¥ox', Alaska 99~77 Thankyou, PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930095 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:REMMLER JAMES W JR & OWNER ADDRESS:3409 GIBSTAY CIRCLE ANCHORAGE, AK 99516 DATE ISSUED: 5/12/93 EXPIRATION DATE: 5/12/94 PARCEL ID:05107327 LEGAL DESCRIPTION: FOX HILL BLK 1 LT 9 LOT SIZE: 39999 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AACS0). 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 BY: .? ISSUED BY: /Z~'~ ~ / DATE: DATE: ROBERT SHAFER, P.E. ROGER SHAFER, P.E. May 7, 1992 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPOFITS WELL INSPECTION & FLOW TEST ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ~unicipality of Anchorage )EPARTMENT OF HEALTH AND HUMAN SERVICES 25 L Street '.O. Box 196650 ~nchorage, Alaska 99519-6650 ~EFERENCE: Lot 9 Block 1 Foxhill Subdivision ~equest you issue a permit to replace the septic tank and lift ~tation serving the 3 bedroom home on the referenced property. ~he existing septic tank and lift station has ground water ~eeping in. Because of the unsanitary conditions we would ~ppreciate you expediting a permit to replace the existing septic tank and lift station. If you have any questions or require additional information [or your review, please contact us. aymond L. Shafer ENGINEERING TECHNICIAN 17034 NORTH EAGLE RIVER LOOP , SUITE 204 · EAGLE RIVER, ALASKA 99577 1" = 40' SCALE t;F. d I IL; lANK REPLACEMENT O© MUNICIPALITY OF ANCHORAGE DE ,:ITMENT OF HEALTH AND HUMAN SER .ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Address Phone(s) LEGAL DESCRIPTION TANKS :,~BYPE OF SYSTEM ED [] W. DRAIN [] OTHER TRENCH Dep[b [o p~pe bottom hem Fdl added above ollgmal grade 7_~r t2~ + Z~' FT $0 FI SQFT WELL: FT FT FT [;%PRIVATE/-~X/57/N6, ~J OTHER ftdentifv) FT REMARKS: WELL LaT LINE FOUNDATION DISTANCES SEPTIC TANK ABSORPTION FIELD WELL AS-BUILT DIAGRAM tShow Iocabon of ',veil. sephc system, property hnes. foundation, Scale: J II .--.:.,3"-~ ENGINEER'S SEAl_ InspectiDns Pedormed by. SR B '196X Municipal an.~ cerlily thai Ihis inspeclion was pedormed according Io ail Heallh Department Approval: 72-013 (3/85) ~ / SCALE SCALE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST /,.~/"~ d --6 PERFORMED FOR: LEGAL DESCRIPTION: ~, ~' ,~/ 1 2 3 4 5 6 7 8 9 lO 11 12 13 14 15 16 17 18 19 2O ,<////I WAS GROUND WATER ENCOUNTERED? DATE PERFORMED: si'rE PLAN Township, Range, Section: SLOPE IF YES, ATWHAT t ~ 0 DEPTH? ~ p E Depth to Water Aft~r.,~ ' ' ~ ~/~/~ f~onilorin§? ~ .,'Date: __ Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE .'""~/__ (m~nutes/~nch/ PERC HOLE DIAMETER ~:~ ¢ / TEST RUN BETWEEN __ FTAND __ FT COMMi:.NTS~--~/~4~.¢'' ~'~/t./¢' ~'(,2,,,*~ /~. ~¢2 ///,,~/ .~ 1~ ~/,f~/~. ~~ PERFORMED BY ~ ~ ~*~ I ~ v TI : ¢~ 17gA I/~ CER FY THA~ THIS TEST WAS PERFORMED IN 72-00~ {Bev. 4/85) ~.t~----~. MUNICIPALITY OF ANCHORAGE ' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE MAI LINO'ADDR ES.S LEGAL D~RIP~ION / LOCATION ~ ~ DISTANCE TO: IWell 7~,~'-- ~ ' ~osorption ~1- ~ Manufacturer ~ ~ / Liq.~pacity in gallons Inside length Width Liquid depth /~ IF HOMEMADE: ~ ~ DISTANCE TO: Well ~w~il/, PERMIT NO. ~Z O ~ ~ Manufacturer~ Material Liquid capacity in gallons ~ Well ~oundation Nearest lot line PERMIT NO. ~ ~ DISTANCE TO: ~ ~ ~ No. of lines Length of each Ii Total length of lines Trench width Distance between lines ~ -- ~ inches ~ Top of tile to finish ~roOe Moterial Deneath tilo Total offectivo absorotion ~ inches ~u kength~ / Width ~_~ ) Depth ~',~ Type of crib Crib diameter Crib depth Total Buildi~ foundation wo,,/7o/ Depth ~ Class ~ ~ Driller Distance to lot line PERMIT NO, ~ DISTANCE~ ' TO:I ~-~lding ~u~d~on ~ Sewer line Septic tank Absorption area(s) OTHER PIPE MAT E~ALS INSTALLER ..,, ..... ., .~,,. ~ %. , ~* ~'5'~'" -, "" ~" ~'' by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION : DATE - Started , Ended DEPTH OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR KIND OF CASING KIND OF FORMATION: From__Ft. to Ft From Ft. to ' Ft, From Ft. to From ( Ft. to 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 From :' · From Fronl From - From · From From From From MUNICIPALIty OF ANt"-HORAk..~-ffom DEPT. OF H~.ALTH & ENVIRONMENTAL PROTECTIO~roln From From. From From Ft. to _Ft, __.Ft. to_ Ft. Ft. to____Ft. __Ft. to__Ft _ Ft. to_ _Ft ____Ft. to _Ft. ____Ft. to__Ft. __Ft. to _Ft. __Ft. to Ft. Ft. to.___ Ft Ft. to_ Ft, __Ft. to__ Ft. Ft. to Ft. Ft. to___ Ft. __Ft. to___Ft. Ft. to Ft. Ft. to ___Ft MISCL. INFORMATION: DRILLER'S NAME Eft = HI:~iFIL. TH FIIX!D E;NV'.[F;:Eff.,II"IF. Et'.,ITI:~II.... PF..'.EITE:E:"F '.[ ON L. STREET., F::II'.,IC:HCIf;i'.F::IGE;., I=11'( ;i;.:"'. F:'l:!i:.Fiff't :[ T I",I0: [::,I::tTE :1: SSt..mEI3,: CONTF:IC'T' I:::'HOI'.,tE: S C: H L.I C:HI"I F:iI'.,I C: Ol'.,l:~i; T Fi'.. L, OT S :[ ;:!lie: L.O'T' I....EIE:FIT ]: Ell'.4: I"11:::1:>:: E:I._OCt.::.': :1. (;;:IEFi: T :t: F:'"r' THI::IT: ::1...:[ F:II"1 I:=l:::thl]:l._:l;l::ll:;i: I.,.I:I:TH 'T',HIZ ,~'.E(;d...I:t:I:;i:[/.t"IEI",ITS F'Ot::;: Ot'.,I.-.S]:TE :!i;IEHEI:;.'.S I=:1t',!13, HIEL. L..S I:::IS SET I::'OF;;:TH E',"¢ THlii!: I'"11...11'.,I :[ E: ;1: F::'RI... :t: Th" OF=' I:::Ii",ICI'"IOF~'.FIGE: (HOF:I ::' I:::I1",t[) THE S'T'FtTE OF FILF:ISI<:I::I. 2. ]: I.,.I]:L.I... ]:l",l:ii;'T'I:::tl....L. THE S"r'S"f'E:H ]:1",1 F:IC(::OFd)I:::II",IC:E I.'.t];TH I:::IL.L HOI:::i CODIES FIND I::II",ID ]: t",! ('::O!'ql:;:'L. :1: FII",ICE t.,.I :1: TH THE [::'E:'~; .J: GN CR Z 'l't!'Zl:;;'..l: F:I (:)F TH :1: :E; I='EFi:i"I ]: T. :!i:. ]: I.,.I]:I....L. I:::I[)HEF;?.E TO FII...L I"IOFI I:::11",11:::' :~i;TI=I'T'E OF F:IL.I:::I:~!;I<:F':I Fdiii:(;:!I...IZREHE:NTS I='OR THI!i: SET 1'31:::ICK !3']: S'TI:::ff',IE:E:~i; I'='F;;:OI'"I I:::11",!"¢ Ii!!::":: :1: S'!' :[ 1",1(3 I.,.IEL.t .... I.,.II=IST[!i:HFITEI:;: [:' :[ SPOSF:IL. :!i;"r'STEIq OP;: F'UBL :1: E: SIEl.,.iEi~:l::f(:ii[ii; S"FS'T'EH Ol",l 'T'H;!::i'30i;;: Ffl",l"r' FI[::'..]'I::IC:IEt",IT OF;: I",lEi;F:ll:~:Eff'r' L.OT. 4. :1: L.iI",tl)ER:iii;TFIi",tl:) THI::iT TH ): :i!!; I='EI:;i:PI :[ T ]: :~i; ',,,'I::IL ].' [:' I::'1~1:;','. F:i I'"II:::IX ]: FtL.IH OF::' :i: E',IE[)F;;'.OOH:ili; 1=11",113' l:::ff',!"r' [i:I",IL..I::!Fi:(3iiEIdE;I",IT I.,.I ]: I....I... REE!I.J ]: F.:['~; F:II",I I:::IDI::' :t: 1" :[ Ot",IF:II... I='Et:;iff'l :[ T. !.... :1: F:'T Si"I:::I'T' :1:Oi'4 ]: :ii; :1: I",I:i!;TI:::IL.I._E":I3' ]: I",1 FIN I::IF;'.EF:I ':: :1. ;:' I:::11",1 iEL%(:::TF;i: ;[ I::::Rt.... I::'EF;:H :t: T FIND :1: i",t::~;F'EC:T NOT E:IE FIF::'F'F?.OVED I.,.!]: THOI...IT F'IN I~ii:LECTR ~t: C:f':IL. :I:I",tSP[:::E:T :1: Oiq I';~'.i'ZI:::'Cff;UI".~ F:lhl[:' ':: i:.:: ::' THE t. EGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SLOPE SOILS LOG PERCOLATION TEST SITE PLAN 14 16 17 COMMEN~~?(/ '~ ~/-,~'~ ¢¢ PERFORMED 72-008 (6/79) Reading Date Gross Net Depth to Net Fime -rime Water Drop ~' ff'~/~ ~:o : ¢.,,,,.19u (minutes/inch) ---- FT Parcel I.D. # MUNICIPALITY OF ANCHCRAGE ~-~ DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Sen, ices Se~on P.O. Box 196650 Anchorage, AJaska 995196650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR a SINGLE FAMILLY DWELLING 051-073-27 1. GENERAL INFORMATION Complete legal description FO×HILL SUBDIVISION: LOT g. BLOCK 1 Location (site address or directions) 22~50 WOOBCUFE- COURT CHUCIAK. AK 99567 Property owner BE'RNADE-TI'E OHLE-MACHER Day phone 271-2206 Mailing address 22250 WOODCLIFF COURT CHUCI,'~K. AK 99567 Lending agency Day phone Mailing address Agent DELLA THOMAS w/ PRUDENTI,% VISTA Dayphone 689-1808 Address 16635 CE-NTE-RFIE-LD DRIVE'. SUITE- 103 -EAGLE- RIVE-R. AK 99577 Un/ess otherwise requested, HAA wi//be he/d for pickup, NUMBER OF BEDROOMS: TYPE'OF WATER SUPPLY: Individual well Community well Public water NOTE: 3 XXX ff 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: XXX If community wastewater system, provide written confirmation from State ADEC lng to the legality and status of system, 72-025 (Rev. 1/91) Front MOA #21 Computer Version · Note:Alaska Water. and Wastewater Consultants, In.c.. shall be paid $1,400.00 at, or pdor to, closing mr the engineering sen,~ces pro~qaea. · 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system Is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ALASKA WA,TE~& ~V~ST~TER CONSULTANTS, INC. Phone (9071337-6179 t Address 6901 DEBARR ROAD, SUITE ~B 6NC:,HORAG~, ALASKA 99504 ~ ,! Engineer's Signature ~__ .~r ~),,, , Date /(/[c/cO telenode eng/neednlana~ysis of the system In accordance with ADEC end MOA DHI-{S Gu/dellnes & Regulations. The reported results desc~bed the performance of the system under the conditions encountered at the b'rne of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate dudng the year, and the water usage of the family being served by the system. These conditions are outs/de the control of the evaluator of the system. Satisfactory test results do not guarantee fulure performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the system will con§hue to meet the operational requirements of the ADEC or MOA DHHS. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or par~y is not authorized, nor will it confer any legal fight whatsoever. 6. DHHS SIGNATURE ~ Approved for ~> Disapproved Conditional approval for bedrooms bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct Inspections or analyze data before a certificate Is Issued. The Municipality of Anchorage is not responsible for e~Tors or omissicns in the professional engineer's work. 72-025 (Rev. 1/91 ) Back MOA #21 Computer Vemion Municipality of Anchomge R E C E I DEPARTMENT OF HEALTH & HUMAN SERVICES Envlronmentel Sewlces Division NOV 1 4 825 'L' Street, Rm 502 Anchorage, Alaska 99501 (g07) 343-4744 Legal Dasctlption: A. WElL DATA Well Type PRNATE Total depth Sanlter/seal (Y/N) Date of test Stetio water level Well production Health Authority Approval Checklist ENV~0~ENTA[ SERVICES DIVISION FOXHILL SUBDNISION; LOT 9~ BLOCK 1 Parcel I.D.: 051-073-27 IfA, B, orC, attechADEC ~tter. ADECwater~ystem number YES Datecompleted 4/1984 1~.~'-0' Cassd~ 140'-~' 18"+ YES YES FROM WELL LOG 4/1984 11g' ,,35 g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nm,ate Date of ~ample: 10/30/2000 B, SEPTIC/NOLDING TANK DATA Date installed '5/22/93 Tank size 1;~50 Foundation deanout (Y/N) YES Depression (Y/N) NO Date of Pumping 1 1___10_/_~. l_./~.0_(~p~ pumper JR'S PUMPING C. ABSORPTION FIELD DATA (INTERMITTENT SAND FILTER) Casing height (above ground) ,VV]res properly protected (Y/N) AT INSPECTION 6/25/1 .',/ 1.39 m.q/L Collected by:. 11{~' WEll FLOW TEST PERFORMED BY $ & S ENGINEERING High water alarm (Y/N) g.p.m. Other bacteria 0 A.W.W.C.~ INC. *TANK EXCAVATED AND INTEGRITY VERIFIED. ALSO, TANK MOVE0 OUTSIDE WELL RADIUS. Number of Compartments ~ Cleanouts (y/N) YES YES *BELOW FINAL GRADES TO TOP OF SAND. Datelnstelled 10/3o-11/1/o0 Sollratingi~orfl2/bdrm) 2.0 System type BOTTOMLESS ISF Length 30' W]dth 12' Gravel thickness below pipe o.5o' Total depth -4.8' Effective absorption area 360 SQ.FT. MonltorlngTubepmsent(Y/N) YES Depresslonoverfleld(Y/N) NO Date of adequacy test NEW Results (Pass/Fall) - For. 3 Bedrooms Ruld depth in abeorpllon field bofom lest (In,); - Immediately after - Fluid depth - (ins) Minutes later. - Absorption rote · Peroxide tmalment (past 12 months) (Y/N) - If yes, give date gal. wateradded(in.): - D. LIFT 6TATION Data installed .5/22/1993 High water alarm level et* Cycles tested. *NEW *$.T.E..P. TANK EXCAVATED AND MOVED OUTSIDE WELL RADIUS, ALSO, NEW CONTROLS INST,~Ir'O IN THE S.T.E.P. TANK, Size In gallons .1250 'Pump on' level at* TIMER 'Pump off' level et** TIMER *Datum BOTTOM OF TANK 6EPARATIOH DISTANCES SEPARATION DISTANCES FROM WEM. ON LOT TO: 100'+ Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/esptic esndce line 100'+ 25'+ On adjacent lots 100'+ On adjacent lots. 100'+ Public sewer manhole/cleanout N/A Mit station. 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field 5'+ Watarmain/es~celine 10'+ Surfacewatarldndnege 100'+ WelisonadJacentlota 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Surface water 100'+ Driveway, pa~ng/vehlde storage area, 50'+ Water main/esrvlce line 10'+ Waiver Fee $ Data of Payment Receipt Number Data of Payment Receipt Number ~-~~ Curlaln drain NO;/ KNOWN Wells on adjace 100'+ F. ENGINEER'S CERTIFIC~,'no of Mun dp t lhe l ,tY;e I.; tema em c r rmance Signature ~ __ Engines~'$ Na~EFFREY A, CARNESS .eta. I1-07o00 13:~? FI~:)U-CT; E~VIRe~I~NTAL ~1~K CTIE Environmental ~ervlces Inc. 5515301 T-367 P.0I/0Z F-$59 Client Name Project Name/# Client Simple ID Matrix Ordered By PWSID Sa~nplcRcmarks: 1006950001 AK Water & WasTcwater Consultants Inc. Foxhitl S/D Ln, BI Fox, ill $/D L9, BI Drink/rig Water 0 Client POH Printed Dnle/Time 11107/2000 13:33 Collected Dale/'Pime 11/01/2000 12:15 Received Date/Time 11/02/2000 10:20 Technical Direcfgr Stephen C.. £~1e · Nitratc-N Rooutts 1.39 U~lto Hethod 0.200 mg/L EPA 300.0 Allowable Prep AnaLynll Limits Dote Dote Init 10 max 11/02/00 SCL M:Lerobtolow,, To~al Coliform 0 col/100mL SMIS 922213 11/02/00 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A S NGLE FAMILY DWELUNG 051-073-27 ' HAA # 1. GENERAL INFORMATION Complete legal description Lot 9/ Block 1, Foxhill S/D Location (site address or directions) 22250 Woodcliff Court 249-1455 · ~'" Ernesto Gonzalez Day phone ~ 'Pr0perty owner ,., ,i' :'~lailing address ..22250 Woodcl££f Court, Chugiak, AK 9956? '.,· Lending agency Day phone Mailing address Ageot Prudential Vista/Lola Pederson Day phone Addre'~s16635 Centerfie]-d Drive, Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 689-6464 TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. o TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1191) Front MOA ~21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms' and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & $ ENGINEERING Phone _ (; q ~/' - ~' '~ cj ]7034 Eagle River Loop Road No, 204 Address Eagle River, Alasl(a 99577 Engineer's signature DHHS SIGNATURE Approved for -/-//-7/~ _-F' bedrooms. Disapproved. Conditional approval for ..-" ¢~ ~ ROBERT C. COWAN '~ 5:' % ." ,~ bedrooms, with the following stipulations: Additional Comments The Munici: · iity of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval C.. ;ificates based only upon the representations given in paragraph 5 above by an independent professiona, =ngineer 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 JUL 0 DEPARTMENT OF HEALTH & HUMAN SERVIG~B~P^u-r¥ Environmental Services Division ,~NVIP, ONMENT^LSERVIC;E$ D 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: ~¢7' d~..., ~,/_¢.j(../( ~/ ~X////LZ6, 67~.,~ Parcel I.D.: O,¢~'/~ (-~ :~'-5 ' ~.~z _ A. WELL DATA Well type ~/ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~/.~ Cased to //~OO / ~) ¢~' Casing height (above ground) Wires properly protected (Y/N) 1 <-/- Date of test Static water level Well production FROM WELL LOG g.p.m. AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform O Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate Collected by: Other bacteria O S & $ ENGINEERING 17034 Eagle River Loop Road No. 204 Date installed Foundation cleanout (Y/N) "/¢~.~ Date of-Pumping C. ABSORPTION FIELD DATA Date inStalled '/~1/~-[7~:. _ size /~? ~-7~ ~ Eagle River,.~laska 99577 Number of Compartments ~"~- Oleanouts (Y/N) ?k/O High water alarm (Y/N) Depression (Y/N) Pumper -.~.~ ____Soil rating (g.p.d./fF 0~_~1~ System type Length --'~ ' .Width. ~2_~"/- ' Gravel thickness below pipe ~ ,'2 _Total depth ('7/ / Effective absorption area, //~L¢~' ~ Monitoring Tube present (Y/N). ~/'(~Depression over field (Y/N) Date of adequacy test _ Results (Pass/Fail) _.~-~% For //~/7~_¢~ bedrooms Fluid depth in absorption field before test (in.); ~ Immediately after.~/¢ gal. water added (in.): Fluid depth "~' (ins) Minutes later: '~('~ Absorption rate = ~//5~) '-/- g.p.d. Peroxide treatment (past 12 months) (Y/N) /4,/~ ~-- If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested ~' E. SEPARATION DISTANCES Septic/holding tank on lot Absorption field on lot Public sewer main "Pump on" level at* *Datum ~ Size in gallons SEPARATION DISTANCES FROM WELL ON LOT TO: /0¢ Sewer/septic service line "Pump off" level at* ~ 2 'FOP On adjacent lots On adjacent lots Public sewer manhole/deanout ./V//~- / Lift station // SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ,/'(_.~ f7z- Property line / ~) f'-/-- Absorption field Water main/service line /'(~z_ Surface wateddrainage /,¢~O~- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /~:~ /~ Building foundation //(~/?z_ Water main/service line Surface water Curtain drain Driveway, parking/vehicle storage area Wells on adjacent lots / ENGINEER'S CERTIFICATION ~,- OF 4' ~-~ I certify that I have determined thru field inspections and review of Municipal recor_C~.~C.~fl~e abov~'~J~¢, are in conformance with MOA HAA guidelines in effect on this date. Signature ' HAA Fee $ ~/'¢ °' ~ Date of Payment "~"2~ /¢¢ Receipt Number ~¢) ~ 9~"~ 6&f~'¢/~'"~?~ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number JU~(-30-9~ 08:~9 FROM-CTE EiIVIRONk(ENTAL 5G1530) T-309 P.02/09 F-~58 993002001 S & $ E~gin~ering L9 BI F~xhill S/D L9 B1 Foxh~ll $/D Dnnking Wat~) Sample Rema*ks: Cliem ~ lhintcd [Dale/Time 06129/99 16:54 Colle~lep Date/Time 06/28/99 10:00 R~eiv~ ~te/Time 06/28/99 11. T~h~I D~r~or: Stephen C. Rel~ g Results PQL Uni[s AlkOwabKe Prep Analysis kimi[~ DaTe DaTe init col/lOOmg stq18 922~B 0.500 mfl/L EPA 300,~ SCL 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 9; B16ck 1: .Foxhill Subdivision Location (site address or directions) 22250 Woodcliff Court Property owner Mailing address Lending agency Mailing address James and Nancy Remmler Day phone 3409 Gibstay Circle, Anchoraqef Alaska 99516 Day phone 345-8202 Carolyn Griener - RE/MAX OF EAGLE RIVER Agent Address 1660o C~nh~wfi~]d Driv¢_, Snlt.~ 201, Eag]~ Unless otherwise requested, HAA will be held for pickup. 3 'N xxx NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: Day phone 694-4200 99577 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XXX NOTE: If community wastewater system, provide wriften 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/orwastewater 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 $ & 17034 Address EnCe Engineer's signature Phone ~' ~/~ ~--¢ ;?? DHHS SIGNATURE X' Approved 'for ~-~JcJ-~'~ ~'~"/) bedrooms. / Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date ~_ /O-¢'-~ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors Or omissions in the professional engineer's work. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L~,-¢ o~ ~¢_ \ ~¢6~\L~ ~/~ Parcel I.D. A, WELL DATA Well type ~'~'J ~-r~__ If A, B, or C, attach ADEC letter. Log present I~/N) Total depth Sanitary seal Date completed Z~-, ~)~ Driller Cased to ~,~ ~)' ~'~ Casing height Wires properly protected (~N) ADEC water system number FROM WELL LOG AT INSPECTION Date of test Static water level \\ Well flow $~', Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line g.p.mt.~l ; On adjacent lots \~ ; On adjacent lots Public sewer' manhole/cteanout Petroleum tank '7_...~- \ WATER SAMPLE RESULTS: Coliform (~ Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ~"' -¢-% ~ ¢t~ Cleanouts (~/N) ~ High water alarm (Y,(~b Date of pumping Collected by: Tank size Other bacteria $ & $ ENGINEERING 17034 Eagle River Loop Road No. 204 Eaglo River, Alask,~ 99577 Compartments Foundation cleanout I~/N) ~/ Depression (Y/~)) Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~,~ () To property line \ ~ Surface water/drainage On adjacent lots Absorption field . ~undation Water mair /service line 72-026 (Rev. 7t91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (~N) ~ High water alarm level Meets MOA electrical cedes Y~N) "Pump on" level at Manufacturer Manhole/Access (~N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot / o b ~ On adjacent lots ,) co Surface water D. ABSORPTION FIELD DATA Date installed ~\ ~ '7~. ~ L.~ Length ~-~ ~ Width Total absorption area Depression over field (Y~ Results ~;~fail) Peroxide treatment (past 12 months) (Y,~ Soil rating Gravel thickness Cleanouts present ~/N) Date of adequacy test for ~t~ If yes, give date System type b'~oO Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot \ o~ To building foundation On adjacent lots Surface water \ Curtain drain On adjacent lots \°c'~ ~- Property line '~ ~ To existing or abandoned system on lot ~ Cutbank ~'l/~- Water main/service line ~, ~-,~ ~ ~ Driveway, parking/vehicle storage area ~ E. ENGINEER'S CERTIFICATION Icertifythat~~~formedtoallMOAandHAAguidelinesineffectonthe~at~b.~:inspection. Date ~/)71° River, Alaska_ 99577 HAA Fee $ / 7/ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number P.O, Dox 770567" E~gl¢ River, Alo~ska 99577 · 907-694.45fil 25 May 1993 RE: l,ct 9 BloCk 1 Foxh[ll Subdivision Dear Ray, The septic tank and ]iff station placed on the proper[:y meI~tioned above ar'e ~anufac%,ured and wired ~n accordance ~4unicipa].ity of Anc]uorage mut~icipal codes, South Fot'k Constt'uchlor~ inst. alJ. ed tho tank a~ld %irt station purchased from ~r~chorafje Tan}: and Welcl~ng, no ~;iri~g was aecessary. Respect ful 1 y, South Fork Construction Chemlab Ref.% :93.1537-5 Client Sample ID :n9 B1 FOXHILL S/D Matrix : WATER CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 8 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 REPORT of ANALYSIS Client Name :S & S ENGINEERING Colleoted :04/12/93 @ 16:30 hrs.~ Ordered By :R, SHAPER Received :04/13/93 @ 14:00 hrs. Project Name : WORK Order :64895 Project# : Report Completed :04/15/93 PWSID :UA Technical Director :STEPHEN C. EDE Sample Remarks: ROUTINE SAMPLE COLLECTED BY: RAY. QC Allowable Extract Analysis Parameter Results Qual. Units Method Limits Date Date Init NITRATE-N 0.99 r~/1 EPA 353.2/300.0 10 04/14/93 LLH ' See Special Instructions Above UA - Unavailable " See Sample Remarks Above NA - Not Analyzed U ~ Undetected, Reported value is tho practical quantification limit. LT - Less Than D = Secondary dilution. GT * Greater Than ~S~S Member of the SGS Group (Soc,¢,6 G~n~rale de Surveillance) MUNICIPALITY OF ANCHORAGE Department of Health & Human Sen/ices DIVISION OF ENVIRONMENTAl- SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~'~ / ~ (-~--~ ~ - ;~.'~ NAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 9; Bloc~ I; Fo~ Hill Subdivision Location (address or directions) 22250 Wood Cliff Court (b) Property owner James & Nancy Remmler Telephone: (home) 688-0532 Mailing Address IfC 80 Bo~ 5078 Chu_qiak, Alaska 99567 (c) Lending Institution Telephone Business 265-6463 Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here ~if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 ~9l~ EagJe River, AJasEa 99577 2. TYPE OF RESIDENCE Single-Family [~¢c Number of bedrooms 3",, 3. WATER SUPPLY Individual WelIX~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~x 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. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of thevalidationdateshown below, l 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, ordinences, and regulations in effect on the date of this inspection. Name of Firm Telephone ~ ~:~'/~""~'?? ? Address Date S & S ENGINEERING ]7034 Fagle River Loop Road Eagle River, Alaska 9957,7 6. DHHS APPROVAL Approved for -~ bedrooms by Approved ___ ~ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph5abovebyanindependent 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 DHHSdo 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. 7/88} 8ack Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Healt_h..~,plhorily Approval (HAA) o? A ' ~ALt~'f ~¢-tt~J.S,'I'- FEBRUARY 1984 ~.NVt~--~ON~ENTAL S~_~,vtC~S DIVi$~u~J43.4744 i 2 1990 A. WELL DATA Well Classification Well Log Present (Y/N) ~ Date Completed ~/ Total Depth /~ // Cased to_//ff/ ' Depth of Grouting Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) ? SEPARATION DISTANCES FROM WELL: Legal Description: /---Ct ~i L%/oc../~. ~. ) If A, B, C, D.E.C. Approved (Y/N) ~ To Septic/Holding Tank on Lot / O ~-' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /~/~ To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Yield "¢'q ~- ~¢ AA Pump Set At ~2 Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots { ¢'~O ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Comments B. SEPTIC/HOLDING TANK DATA Date Installed Si:,e Standpipes (Y/N) ~ Depression over Tank (Y/N) _ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~ [~ ,/O00¢[~l No. of Compartments Air-tight Caps (Y/N) ? To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments ~P~c.- ~9~Jt~C~ ~ Foundation Cleanout (Y/N) Lc Date Last Pumped __~£J',L~'ff) I¢~) t',J//°l;for ./~/¢i Temporary Holding Tank Permit (Y/N) /~/~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: / LO ~' TO Building Foundation { O t'7~ To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ,~2_~ ¢/~i~' Type of System Design ~-2~/euC~f~c~ Date Installed / //.2f / ~(/) Length of Field ~'"-O ' Width of Field ,;L z-f' Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test I / ~g ¢~ Statndpipes Present (Y/N) t,.) Date of Last Adequacy Test I SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line IOr-L Depth of Field '~- [. ~ Gravel Bed Thickness o %~ To Property Line To Existin/g or Abandoned System on ; On Adjoining Lots To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ~0 "tt Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes~N) Comments / Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/4~ Pu?ing Cycles du, ring Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. : · Signed Company Date MOA No. '!703~. Engle River Loop Ro~d .Nc. 204 Receipt No. Date of Payment Amount: $ 72-026 (Rev 7/88} Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 BSTREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE £or Work Order ~ 22302 Date Report Printed: JUN 12 90 @ 07:45 Client Sample ID:L9, Bt FOX HILL PWSID :UA Collected JUN 7 90 ~ 11:35 hrs. Received JUN 7 90 @ IS:O0 hrs. Preserved with :AS RZQUIRED Client Name : S & S ENGR Client Acct : SNSENGP P,O,~ NONE RECEIVED Roq ~ O[dered By : g. SHAFZR Analysis Completed :JUN if 90 Send Reports to: Laboratory Super¥¢s,or fSTEPHEN C. EDE 1)S & S ENGg Released,y : ~~ ~ 2) Special PLEASE FAX RESULTS UPON COMPLETION TO 694-1211. Instruct~ Chemlab Ref ~: 901758 Lab Smpl ID: 1 Matrix: WATER Allowable Paramete~ Tested Result Units Method Limits NITRATE-N 1.0 ,g/1 EPA 353.2 10 Sample SAMPLE COLLECTED BY RDJ. ROUTINE SAMPLE. Remarks: Tests Performed ' See Special Instructions Above UA=UnaYailable None Detected "See Sample Remarks Above Not Analyzed LT=Less Than, GT~Greater Than 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 GENERAL INFORMATION (a) Application Date September 26, 1986 Legal Description (include lot, block, subdivision, section, township, range) Lot 9; Block 1; Foxhill Subdivision Location (address or directions) Applicant Name Bruce Phau Telephone: Home Business 786-6364 Applicant Address United Bank of Alaska (b) (c) Applicant is (check one): Lending Institution ~; Owner/builder []; Buyer [~]; Other [] (explain); (d) Lending Institutibh United Bank of Alaska Telephone Address 440 -.East 36th Avenue, Anchoraqe, Alaska (e) Real Estate Company and Agent none Address 786-6364 99503 Telephone (f) ~A'lXthe HAAtothefollowingaddress: S & S Engineering SRB 196X Eagle River, A].aska 99577 TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms 3 Other WATER SUPPLY Individual Well [~ 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 E] 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 (11,,84) ENGINEERING FIRM PROVIDIN~ INSPECTIONS, Ti=STS, FILE SEARCH, DA1A AND'INFORMATION ;' ' As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of thi~ 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 Firr~; ~ 5 ENGINEERING Telephone ~ .¢~,~¢~ 2J~¢''7 ~ SR B ~ 96X Address Approved Disapproved Conditional Terms of Conditional Approval z:¢~¢ ~ 7"/-) '~,~ ,,¢~o/'f.~, 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 (i 1/84) WELL D ATA~)~~ MUNICIPALITY OF ANCHORAGE (MO,~i HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264..4720 Legal Description: /--, Well Classification ,,~,,.~/~2~.. ,,~ If A, B, C, D.E.C. Approved (~/~N) Well Log Present N) Date Completed ~ ~ Yield Total Depth / ~/ ' Cased to / ¢/ ' Depth of Grouting ~ ~ Pump Set At ~ ~ Sanitary Seal on Casing (~..,)'J) Depression Around Wellhead (Y~ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (~N) Separation Distances from Well: To Septic/Holding Tank on Lot /(~2 ~-- f ; On Adjoining Lots /'¢O ¢/4 To Nearest Edge of Absorption Field on Lot /2..0 ~ ; On Adjoining Lots To Nearest Public Sewer Line ~/~//-'~ To Nearest Public Sewer Cleanout/Manhole ~/ ~ To Nearest Sewer Service Line on Lot 2 ,~ Water Sample Collected by ...%' :f,5"' Z'""I'V,/,/¢'~'"¢///'~// ,'Date Water Sample Test Results ~(",5~ '-,'~¢' ,,¢ ,/¢,'¢) ¢- B. SEPTIC/~TANK DATA Date Installed ///~/¢ Standpipes (Y/N) Air-tight Caps (Y/N) Depression over Tank (Y~_~ ,// Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ___~:2,_<J'-- ? To Property Line /o r ./ To Water Main/Service Line ,,/¢ ~/ Size ,/d2¢ c.} No. of Compartments Foundation Cleanout (~N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field Course To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ///2./,/~ 6 Width of Field .2. ~' r Square Feet of Absorption Area Depression over Field (YN,~ Results of Last Adequacy Test ,,'/'J//~ Separation Distance from Absorption Field: To Water-Supply Well /Oo / To Building Foundation , Lot ,cd /~ To Water M2~r~/Service Line /O e..~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~ o ~ Type of System Design Length of Field Gravel Bed Thickness Standpipes Presenti~N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~ ih To Cutbank (if present) /'o o ,,,,.~' _,_,¢ /,JO /-J ~_--' D. LIFT STATION Date Installed /,/A//r&~' Dimensions Size in Gallons ~ ¢~ Manhole/Acces N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at ~ ~ " Vent (Y~ Tested for ~ ~ ~ Pumping Oycle8 ElectricaICodes~N) ~ ~ ~~~ Comments ~/~¢/~ Z~ ~/~ ~2 ~ /~¢~ ~r~¢ ,. ** Check Permitted Bedroom Rating Against HAA Request ** I certify tli~a&l ~a,v~ ~¢~b.~d~verified. or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ~ ~ · ~:r~r~ERING Signed e~ Date Page 2 of 2 72-026 (11/84)