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Home My WebLink AboutFIRE LAKE BLK 2 LT 3AFire Lake Block Lot 3A #051-361-14 Municipality of Anchorage Page i DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: .~OOC)O. t% ~ PID Number: O~1- ~-- N~: ~ ~ ~ ~ Wastewater System: .D New ~ Upgrade ~,o ~ ~e~ 77o~3 ~ ABSORPTION FIELD Phone: ~No. of B~ms: ~O~pTrench ~Sha~low~rench ~Bed ~Mound DOther LEGAL DESCRIPTION so,..~,~: 1.2 ~.o~q., : WEL~ D New ~ Upgrade ia.lwidth: ~ Ft. J Ft. Ft. ~ O SO. Ft. Date I~1~: ~,,,~: ~ ~,,,:~n~ ~,~,,~ a~,,: TAN K SEPARATION DISTANCES ~Septic D Holding ~ S.T.E.P. s~na~ N 1o N/o LI~ STATION Water Line ~O ~oundation 7 Cumin ~O ~ ]~ Drain Remarks: BENCH MARK Inspections pedDled by: TS. Dates: 1St ~/'~ "~", ...:'h:~v · .."' ' .... . '" 2,,- Depadment of Health and Human Se~ices approval "*"~ ,". g. ~.,-.. .... ..... ..~ ~..-"-'~'%' Reviewed and approv~ bT: ~~ ~. ~Date: JO - ~ ' o/ MULD£OV STREET $~ING] AC $0.$ FT Bo I ~1.2 AD ~ 62.5 BO ' 71,4 A£ A£ I 0 0 IOBBEM SPURKLAND P.E. 203 Y/ 15TH. AVENUE ANCkl. AK. 99501 (9OX) PERMIT # SWO0115 11.$ /7 1250~A£ S£PBCZ £E¥££S£~ 25 0 ~5 50 75 100 SCALE: 1' ,= 50 FT. 125 150 BENCH MARK: CONCR£T£FLOOR ASSUHEDELE~ IO~OOFT II .f"IRI~' LAAZ' ALAS'AA LOT ~A BLOCK 2 18136 I~ULDROIV STREET SE~'r,C SYSTE, AS O~,,Lr I DATE: AUG. l, 2000 I SHEET: 2/3 GRID: NY/ 453I I FL AO23A2.DVG PIP # 1751-2~I-14 S~andard ~rench: 2' 40' Lon9 11.5' Deep 5.0' Sewer rocR 6' Cover NO SEALE 90.80 Silt 85.5 5.0 F't oF Sept;c Rock Effective -- Monitor Cleonouts 6' Cover 97,5~ NO SCALE 0 0 0 ~ 9o.8 ~ 8fl.5 90.88 r~_._ INV 91.01 1250 Oct. sept~ tonk BENCH MARK ¢ONCREXE SI. AB A$SU~£O ELEV. I00.00 t7 IUBBLN SPU~KLAND P,L. 203 W15th Ave Anchorage A~ 9950L FIRE LAKE ALASKA LOT 3A BK 2 GEORGE SEPTIC SYSTEM SCHEMATIC DATE~ AUG. I, 2000 SHEET, GRID= NV 453 PER,I/IT # SV/O00115 PARCEL ID II 051-361-14 FIAO2$A$.O~/G MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 22, 2000 Expiration Date: May 22, 2001 Permit Number: SW000115 Legal Description: FIRE LAKE BLK 2 LT 3A Design Engineer: 0007 Tobben Spurkland, PE Owner Name: George Humm Owner Address: PO Box 770530 Eagle River. AK 99577- Parcel ID: 051-361-14 Site Address: 018136 MULDROW ST Lot Size: 34000 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage construction must be in accordance with: 1. The attached approved design. 2. ,NI requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15. a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Date: ~"- 2 ~ - O~ 203 W 15th. Avenue, Suite 203 ANCIIORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 3A BLOCK 2 FIRE LAKE ALASKA S/D GEORGE HUMM Municipality of Anchorage Department of tlealth and Social Services 820 1 Street Anchorage, Alaska 99501 May4, 2000 We are submitting an application for the upgrade of the septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following: No Ground Water or Impervious Layer to 17.5 ft. Use Standard Trench Soil Rating. From Testhole 04/27/00 2.5 rain/in = 1.2 gal per sq.f'Jday No. of Bedrooms 3 Required Area per Bedroom: 150/1.2 = 125 sq.ft. Total area required: 125 x 3 = 375 sqft Testhole depth 17.5 feet Bonom Rock At I 1.5 feet Top Rock At 6.5 feet Rock Depth 5 feet TotalTrench Length 375110 = 37.5 ft. USE 40 LF SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTtl 40 FT TOTAL WIDTll 2 FT TOTAL DEPTH I 1.5 FT ROCK DEPTtl 5 FT COVER 6 FT SEPTIC TANK |~ GAL The installation of this well and septic system will not prevent development of adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Pooding and/or concentration of surface runoffwill not result from this installation. ~- IVell MULDROW STREET I I I-OBBEN SPU£KLANO P.E. 205 lq 15TH. AVENUE ANCH. AK. 99501 J PERMIT # SJVOOYYYO5!-361-14 PID # PlR~' L4A'~,' ALASKA LOT SA BLOCK 2 18156 ktULDROI'; STREET J J SEPTIC SYSrEU OESICM J DATE: APRIL 50, 2000 J SHEET: I/$ CRID: NW 455J I FL AO23 41.DIVG J MULD££W STREET $£PTlC TANK D.O. 0 0 0 N 50 SCALE: 1' IOBBEiV SPURKLAND P.E. 205 rZ ISTH. AVENUE ANCH. AK. 99501 6~o~) :79-3916 PERMIT # Sh/OOYYY PID # YY )IRE i_~KE ALASKA LOT 3A BLOCK 2 18136 IdULDRO~V STREET ~5 100 1~5 15'0 = 50 FT. CONCRETE F~OOR ASSUMED ELEV. 10~00 FT IISEPTIC SYSTEM OESION DATE: APRIL JO, 2000 SHEET: 2/J CRID: N~' 45J FL AO23A~D~G Stondord Trench: 2' Wide 40' Long 11.5' Deep 5.0' Sewer rock 6' Cover Silt £orrler 5.0 £t o£ Septic Rock Effective 0 0 0 NO SCALE Monitor NO SCALE 1250 gol. septic tank BENCH klARK CONCRETE SL4B ASSU~Efl ELEV. I00.00 FT lrlBBLN SPU~KLAND PO3 WlSth Ave Anchoroge Ak 99501 FIRE LAKE AL,4SKA LOT JA BK 2 CEO£6E HUN~ SEPTIC SYSTEH SCHEMATIC DATE: APRIL JO, 2000 SHEET, GRID, NIV 453 PERMIT ~e SP/OOOOXX PARCEL ID I~ 015-271-32 FLAO2$A$.DWG PERFORMED FOR: LEGAl. DESCRIPTION: I 2 3 4 5 6 7 8 g I0- 11- 12 13 14 15 16 17- 18- lg- 20- Munl'Jl:allly of Anchorage r~, ~.~.~.,;.,),,.,.,,.,,etl,,,,,.,../ / ~'l /) ~,, ,,//1/~./l' ' DEPARTMENT O; hEALTH, HUMAN SERVICES 825 "L" Street. Anchorage. Alaska 99502-0650 ¢~., Tut SOILS LOG- PERCOLATION TEST CATE PERFORMED: Township. Range. Sec[ion: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED}* DISCLAIMK~' ArnundwateP Past and future presence IF YES, AT WHAT pO DEPTH? ~e~..l' I0 Water Alter / ~:)/__..*/,~ / v/,, ~o ~7 ~q /o q o ~ o PERCOLATION RATE (mmuleumch) PERC HOLE CIAMETER Z~ II TLST RUN BETWEEN ~ FTAND ~" ~' FT rond~t4nn~ indicated ar~ for th~ dates shown only. &nd/or depth of groundwater can not be predicted trom these ol~_ervaT, lons. ~ PERFORMED BY: ~ '~ I Io ~ __ CERTIFY THAT THIS TEST WAS PERFORMED IN · ACCORDANCE WITH ALL STATE AND MUNICIPAL GOLF. Et. INES IN EFFECT ON THIS DA1F. CATE: ~' ~ 7 -- ~ 72~ (R~. 4/~) T.SPURKLAND P.E. 203 WEST I STI I. AVENUE SUIT~ 203 ANCl IORAGE, ALASKA 99501 (907) 279-3916 Fax (907)276-6013 George t lumm P.O. Box 77053 Eagle River AK 99577 Subject: Municipal Approval of Septic System September 10, 2001 Dear Mr. Humm; I recently received the attached "pink sheet" from what used to be called the Health Department. Apparently a Municipal inspector stopped by your place to verify the information I submitted in May of 2000 and could not locate the clean-outs for the septic tank and drain field. I suggest you identify the location of the various pipes by placing a stake adjacent to the pipes. This way you will be able to find the pipes in the winter, and the municipal inspector may be able to locate the pipes and issue the final approval for the sustem. Yours truly, Tobben Spurkland P.E. GRE' ANCHORAGE AREA BOP' 'IGH Depar'cment of Environmental Quality 3330 C Street Anchorage, Alaska g9503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LEGAL DESCRIPTION/('~/c~? '" ' SEPTIC TANK: DISTANCE ~_ NUMBER OF FROM WELl /~'~O /. MANUFACTURER,.~J -~"'~%-<3'~2/~'~'~MATERIAL ~/~ '¢~'/,'¢'~//,~2"~<'/ COMPARTMENTS INSIDE LENGTH 'f INSIDE WIDTH ~- .LIQUID DEPTH - LIQUID CAPACITY ./,.~-D~D GALLONS. SEEPAGE PIT: NUMBER OF PITS / LINING MATERIAL ~ BUILDING FOUNDATION ADDITIONAL ABSORPTION DIAMETER - OR WIDTH/'-'/,/ LENGTH/~,¢ DEPTH CRIB SIZE: DIAMETEt~-~-~EPTH ~'r~ / DISTANCE FROM: WELL / TOTAL EFFECTIVE NEAREST LOT LINE;~ -~'~-" ABSORPTION AREA (WALL AREA} ~ F,~''--~' SQ. FT. WELL: TYPE CONSTRUCTION BUILDING NEAREST FOUNDATION ~ LOT LINE CESSPOOL OTHER SOURCES DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE -- TANK /~2~ ' SYSTEM / ?c'2" APPROVED DISAPPROVED REMARKS DISTANCES: INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No. EQ-031 DIAGRAM OF SYSTEM Gri~ATEr ANCHORAGE Area Borough DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO, INSTALLATION LOCATION MAILING ADDRESS PHONE INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PIT ~ , DRAIN FIELD FINANCED THROUGH SOIL tEST RESULT DOMPLET~DN DAtE aNtIcIPatED , OTHER NOTEz THIS PERMIT IS NOT VALID WITHOUT' SOIL TEST ._D INAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE EPARTMENT OF ENV RONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, MINIMUM DISTANCES, REQUIREMENTS FOUNDATION tO SEPTIC TANK BEPT,C TANK TG SEEPAGE P,T waLL SEPt,CTaNK , EEPAGEP,T TO NEAREST LOT LINE. DRAIN FIELD ____ ~//~:/J j DRAIN FIELD ___~2 / SEPTIC TANK, .~~/~JO/, SEEPAGE Pit TO RIVER, Lake, STREAM. , SEEPAGE PIT , ALSO CONSIDER AREA WELLS. , SEEPAGE PIT DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CR]B CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND BEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE caPS, DIAGRAM OF SYSTEM GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. ....... , ...... __ S~f'FARD & .THAT ~ ~V~ SURVEY~ T~E ~ L,,~. - " ~ ~S~ FOR CON~UC';'~:~ 20-63 27_~ ASSOCIATES ~L.~D Sr. TRY~'l'~G_6__8_8~,4566 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 3A/ Block 2; Fir~ake Alaska Location (site address or directions) Property owner Mailir~g address Lending agency Mailing address 18136 Mu~drow Street Eagle River, AK Richard & R~ne Sharer I'7034 N. Eaql~ River Loop Rd. Day phone 694-1373 Suite 202 Eagle River, Day phone AK 99577 Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 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. 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 attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. s & s ENGINEERING ,, ~ ,, ~,,~ Phone ~//'f - ~-q '7 ~'~ Name of Firm Eagle River, Alaska 99577 Address Engineer's signature DHHS SIGNATURE ~ ~- Approved for T~ ~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department bf 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. 72-4~25 (Rev. 1/91 ) Back MOA ~21 ENVIRONMENTAL,SERVICES DI¥1~ION AUG 26 1995, Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES R ECEI VE Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: ~.--o~'~ :~ ,~ ~)~-V.-'Z- ~'tf..r~t,.~,-~.- J~l~--- Parcel I.D.: A. WELL DATA Well type Log present ~N) Total depth '7Cl Sanitary seal ~N) Date of test Static water level Well production If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~)t.~pf-.- Lo- -/'5 Cased to ~ ~ '~ Casing height (above ground) WATER SAMPLE RESULTS: Coliform (~ Date of sample: B. SEPTIC/HOLDING TANK DATA Wires properly protected (I~N) AT INSPECTION FROM WELL LOG 19.,-,~' g.p,m. 'i~ "/,'Z.-- ~ g.p.m. Nitrate , [ o Other bacteria S & S ENGINEERING Collected by: i~O~i Gag~ ~,,-~ .....n "-: ..... Eagle Ri~er, Alaska 99577 Date installed L~- '/'5 Tank size Foundation cleanout(~N) ~ ~ Depression Date of Pumping ~.-/.-.~-~L. Pumper ~-J~-- C. ABSORPTION FIELD DATA Date installed . ~-~'/~ Length ( ~ ' Width, Effective absorption area .7, E ~/~ Date of adequacy test 9--2. 3~-~ ~, Fluid depth in absorption field before test (in.); Fluid depth -77" (ins) Minutes later: Peroxide treatment (past 12 months) (Y~ Number of Compartments ~, Cleanouts ~N) ,,./ High water alarm (Y/N) Soil rating (g.p.d./fF or ft=/bdrm)/w.~ Iz,~il~stem type J ~'Gravel thickness below pipe Monitoring Tube presentJ~N) ~/ Results ~;:~[~'Fail) f~,~--~' /p' Total depth · Depression over field (Y~ ~J For 3 bedrooms Immediately after ~"/° gal. water added (in.): Absorption rate = .g.p.d. If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump on" level at* *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots \ oc~ On adjacent lots [ c~c~ Public sewer manhole/cleanout ~ k Lift station ~ [ ~, SEPARATION DISTANCES FROM~HOLDING TANK ON LOT TO: Foundation ~,~ Property line j ~ ~'~ Absorption field Water main/service line Surface water/drainage t~,c, ~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ~ ~ O'-- Building foundation Water main/service line Surface water Curtain drain Driveway, parking/vehicle storage area Wells on adjacent lots / ENGINEER'S CERTIFICATION in conformance with M~A~u~elines i~ect on this date. Signature.__~ C_ ~ ~ Engineer's Name ~ ~ ~ [. ~O~ - .... HAA Fee $. Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev, 3/96)* ~.uu ui- uI(ILLING by A ~ ADDR~s,G ....'. ................................ , ' D ATE--STARTED ...................................... j .............................................. DATE~'--NDED ............................ : .................. i .................................... KIND OF FORM~ATIONI 1~' FROM ........................FT. TO ..................... ~. MI'SCL, II~IFORMATI{~N': 08x21xg~ 13:~7 CT&E ESI ANCHORA6E ~t~ CT&EEnvironmentalServices Inc. Laboratoo/Division Drinking Water Analysis Report for Total.,Coliform Bacteria 2oo w. Po.er Drive AnchOrage, AK 99518-1605 READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Tel; {907) $62-23G3 "Fax: {907) 561.5301 C~ Sfnd ~ult~ 0 Send ln~'olce SAMPLE DATE: Month SAMPLE TYPE; Routine u Repeat Sample (for routine sample with lab ref. no. ) C] Special Purpose s,~L~ LOC,T~O~ g~_ _ Day Year Treated Water Untreated Water Time Collected Collected By -?;~ ~ TO BE C~MPLb't~D BY LABORATORY A~aiy~}$ shows this Water SAMPLE to be: ~ satist'a;to,~. O Unsatisfactory 0 5ample ov;r 30 hours old, results may be unreliable Sample too oas in trans t; s~ple should not be over ~8 hours old at exam nation to indicate reliable result. Please send new sample via special del{ve~ mail. Time Received~ ~c~' 'C'~('~ " A~alysis Began Analytical Method: .j~-'l~emb~ane Filtec o MMO-MUO · Number of colonies/100 mi. Lab Ref. No. Result* Analyst Sent lo A.D.E.C. Anch Fb~ Jun Time: Client notified of unsatisfactory results; Phoned Spoke wi~h Date: Time: [] Comments: BACTERIOLOGICAL WATER ANALYSIS RECORD E. Coli ~ MMO-MUG Result: Total Coliform ._ Membrane Filter: Direct Cou~t ~_~ ColonJcs/100 mi Verification: LTB ~ __ BGB, COLIFIILM Fecal Coliform Confirmation '" Fins{ Membrane Filter Resulu Coli~rml]00 mi Reported ]By _,/. ' '" / '- Date ..... ~m~S Mem0or of ;he $G$ Group ($ociate G~narale de Surveillence) 08x22xgG 12:21 CT&E ESI ANCHORAGE ~ 90769d1211 N0.8~9 QO~ CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSW $~mlple l~e~narkR: CT&E Environmental Services Inc. laboratory Division 200 W. Potter Drive Anchorage. AK 99518.1605 Tel: (907) 562-2343 Fax: (907) 561-5301 963812001 S & $ ~in~in~it~; N/A L3A 82 .Fir¢lake,AK Drinldng Water Client PO# Primed Date/Time Collected Date/Time Received Date/Time Technical Director Rd~l SL_~---/.~__,~_.- ,,~,~. ~ 08/21/96 16:10 08/15196 08:30 08/16/96 08:00 MLowabte Prep Analysis Parameter ResuLts PQL Units Method Limits Date Date ln~t Nitrate-N 0,100U O,100 mg/L EPA 355,Z 08/16/96 ESC Toter Coiffop~ 0 0 ¢oI/lOOmL SH18 9Z2~B 08/16/96 TAV .., ~~ Memberofthe~GSGroup(S?ci~,~G*n~braledeSurveillsnce) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA. ILLINOIS, MARYLAND, MIC"IGAN, MISSOURI, NEW JERSEY. O"10. WEST VIRGINIA 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 Compl~et,e !e.g,al ,description Lot 3A; Block 2; Fir~ak~ Alaska Location (site address or directions) 18136 Muldrow Street Property owner Mailing address Lending agency Mailing address Agent Address Robert Sharer Day phone 694~2979 '17034 No,th. Eag?.¢. River Loop Road, Ea9l~ Riv~, Ak.99577 First National Bank o~ Anchoraq~. Ea~l~ River, Alaska Day phone Day phone = Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 '-4 TYPE OF WATER SUPPLY: ' Individual well XX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing t° the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/gl) Front MOA i¢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 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 ENGINEERING Address ~"~.. v.. __~.-~~~ ~¥er ~_,,,,p ~,,-_~ N~ ~_n,~. , . Eagle River, Alaska 99577 Engineer's s~gnature Phone 6. //~S SIGNATURE % Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date The Municipality.of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: b~- '5,~, ~..¢. ~._ ~~ ~.. Parcel I.D. A. WELL DATA Well type Log present (Y/~ Total depth Sanitary seal If A, B, or C, attach ADEC letter. ADEC water system number Date completed /2£,o¢- 1~}75 Driller Cased to ~l'b~+ Casing height Wires properly protected~.~/N) FROM WELL LOG AT INSPECTION Date of test ~ - 3.-'[- ~ I Static water level /~ ,?.,~ ~ Well flow g.p.m. ~ ,~ ~' Pump level ~)~._ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot IC~) ~ Absorption field on lot 1 oC) Public sewer main >'~1~. Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform C~ /I°D ~'~- Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ~ _ Cleanouts(~/N) High water alarm (Y~ Date of pumping Collected by: Other bacteria S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Tank size ~, Oc:)~::> Compartments Foundation cleanout ~)4~. {~1l Depression (Y~ /~ Alarm tested (Y/N) ~J/~ Pumper .-~'~-. ~_.~_.~f,o~ ~. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~o~ ~ On adjacent lots ~ c~o ~+-' Foundation To property line ~5) t ~ Absorption field. 'Z--~-~' Water main/service line Surface water/drainage I c~c> 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Manufacturer Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at .,.-~'~5~ump off" level at High water alarm level j..~/ Cycles tested Meets MOA electr~-- SEPARAT~.~TANCE FROM LIFT STATION TO: W~ lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed '~ - '~ Length I ~' ' .Width 1'~ Total absorption area Depression over field (Y/~, "~ Results~ail) Peroxide treatment (past 12 months) (Y~/~ Gravel thickness ~ C eanouts present. N) Date of adequacy test for "~.¢...¢~ ('-5~ Total depth ~orJ~ ~-~.~,,~ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water ~,~c~ ~'~" Curtain drain On adjacent lots \ c~c> ~'~ Property line To existing or abandoned system on lot Cutbank ~J.~. Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signature S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Engineer's Nam(Eagle River: Alaska 99;77 AAFee $ /.~¢~ (/7) ate of Payment ¢~F~/' Receipt Number ~0¢~7- '1 ~ '<',~,.. . .. t %~_-'""' Waiver Fee: $, Date of Payment Receipt Number 72~026 (Rev 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANALYSIS REPOT BY SABLE for WORKordezt 38166 Date Report Printed: SEP 14 91 ~ 12:18 Clie~ Sample ID:L3A B2 FIRE LAKE PWSlD :UA Collected SEP lO 91 @ 09:45 hrs. Received SEP 11 91 ~ 14:30 Preserved with :AS REQUIRED Analysis Co~leted :SEP 13 91 Laboratory Supe,~EPHE? C. EDE ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 Client Name :S & S ENGINEERING Client Acct BPO t PO # NONE RECEIVED Req ! Ordered By :R. Send Reports to: I)S & S ENGINEERING Chemlab Ref t: 914745 Lab Smpl ID: I Matrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N ND(O.IO) ~/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECYED BY: RAY. Remarks: 1 Yeats Performed ' See Special Instructions Above UA-Unavailable NDm None Detected "See Sample Remarks Above NA- Not Analyzed LT-Less Than, GT-Greater Than ~SGS Member of the SGS Group (Soci¢tO OdnOrale de Surveillance) CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. '~.,e*i% TELepHONE (907) 562-2343 5633 B Street ~o ~ Anchorage, Alaska 99518 ~ [~ Drinking Water Analysis Report for Total Coliform Bacteria ..... ® [] PUBLIC WATER SYSTEM I.D.# ~ PRIVATE WATER SYSTEM TO BE COMPLETED BY WATER SUPPLIER Name Phone No, $ & $ ENGINEERIN~ Mailing Addr~le River, ~a~l ~$~ City State Zip Code Mo. Day Year SAMPLE TYPE: I~ Routine [] Check Sample (for routine sample with lab ret. no. [] Special Purpose ) [] Treated Water [] Untreated Water SAMPLE NO. LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY Date Received Time Received Analytical Method: sYatiS shows this Water SAMPLE to be: isfactory [] 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. . J Membrane Filter * No. of colonies/100 mi. I ah ~}of ~,t.-, Result* Analyst I / / BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TNTC OB Membrane Filter: Direct Count (~) Verification: LTB BGB Final Membrane Filter Results, Time: = Too Numerous To Count -- Other Bacteria Collformh00 mi Collformh00 mi DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 July 9, 1991 Mr. Harry R.J. Bates Bates Technical Services P.O. Box 671674 Chugiak, Alaska 99567 WALTER J. HICKEL, GOVERNOR 563-6775 Subject: Lot 3A, Block 2, Fire Lake Alaska Subdivision, Chugiak, Alaska, ADEC Project Number 9221-DWW-003, Wastewater Disposal System; Review Dear Mr. Bates: This is in response to your submittal, received in this office on June 11, 1991, which included information on the existing wastewater disposal systems serving the duplex on the above-referenced lot. I have completed my review of the submitted information, this office's files on the subdivision, and have discussed the property with Mr. John Smith of the Municipality of Anchorage, Department of Health and Human Services and have the following comments. From the submitted information it appears that the wastewater disposal system was installed substantially in accordance with State regulations and guidelines at the time. The results of the adequacy test performed on both wastewater disposal systems also verifies that on the day the adequacy tests were performed the wastewater disposal system was accepting the necessary flows. Therefore, the wastewater disposal system is approved for the concerns of this Department. The enclosed signed Approval of On-Site Residential Water and Sewer Systems, constituting this approval, is enclosed for the existing wastewater disposal system. Thank you for your cooperation with this Department. If you have any questions, please do not hesitate to call. Keven K. Kleweno Environmental Engineer Enclosure: As Stated cc: John Smith, DHHS, w/o Enc.