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HomeMy WebLinkAboutGREAT LAND ESTATES #1 BLK 1 LT 2Greatland Estates #1 Block 1 Lot 2 #051-131-16 v GREff ANCHORAGE AREA BOJGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM `pp NAME 26W eS' GCOIQMkk MAILING ADDRESS (fO� Ea4�f -uKi PHONE �a �l LOCATION 166"-'' Cr&aC LEGAL DESCRIPTION Co?4_Zdk/ ./-fZ4 144 SEPTIC TANK: DISTANCE//'�/�/�'`, NUMBER OF FROM WELL MANUFACTURER ��MATERIAL e COMPARTMENTS— INSIDE OMPARTMENTS INSIDE LENGTH - INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS. SEEPAGE PIT: NUMBER OF PITS �. DIAMETER � OR WIDTH La/ LENGTH A�e, DEPTH 4o, ''// f r LINING MATERIAL CRIB SIZE: DIAMETER 7 DEPTH v DISTANCE. FROM: WELL TOTAL EFFECTIVE '�pQ BUILDING FOUNDATION_, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: At AWO a� f/e Of /iI GP/db► . TYPE _ CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES APPROVED - DISAPPROVED DISTANCES: INSTALLED �B�Y: �/� NK�AGLGKG 4& PIPE MATERIAL: DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE—,TANK—,SYSTEM_ DIAGRAM OF SYSTEM GUss uao�i to „Qrca�c aA+y- LOT SLOPE: n REMARKS: w &t4S u l DATE, Form No. EQ -031 E ft• -:y 46 1 0 GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274.4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT G NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED PERMIT NO. MAILING ADDRESS /A7( "0P F¢ A-4 PHONE 61�^z`e• SEEPAGE PIT& , DRMMN FIELD OTHER 11 . '4 'n fs _ /t .A / FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS 4 NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED 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 119-0 ® TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK 7,n/ r FOUNDATION TO SEEPAGE PIT `� �^ DRAIN FIELD / i r SEPTIC TANK TO SEEPAGE PIT WALL SEEPAGE AREA SIZE SEPTIC TANK SEEPAGE PIT -I/Iy DRAIN FIELD TO NEAREST LOT LINE. _ WELL TO SEPTIC TANK SEEPAGE PIT —. DRAIN FIELD ALSO CONSIDER AREA. WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD SEEPAGE PIT -0r SEPTIC TANK, ___:L—, SEEPAGE PIT ( O� DRAIN FIELD TO RIVER, LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S 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. 4� G.A.A.B. OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF DESCR D SYSTEM IS IN ACCORDANCE WITH SAID CODE. DAT -A2 �'�73 APPLICANT'S SIGNATURE FORM NO. EQ -016 TYPE DIAGRAM OF SYSTEM BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE wzsEzucEion E7esf Pa "One we is worth a thousand opinions" "? 5529 TUDOR ROAD, ANCHORAGE, ALASKA 99500 9 TELEPHORE 238-8402 Performed For Bowles -McCormack Date Performed 9-4-73 Leal Descrintion: Lot 2 B106" 1 Subdivision Greatland Estates This Form Renorts Soils Loq Yes Percolation Test tenth Feet Soil Characteristics l / Overburden ---------- C I i ---, I*L _ + i � I a s r , ---, n_, - �c r. tIZO erolation Rate u t e Prii! latl011 SeeDd06 Pit Drain Meld Deet,: let Death T-6—Bot—tom Of Nit Or Trench CrMMENT5: sqt—drain��r: - --- a—rea i°equirad�er bedroom r -- — _—�� ._. _210 bedroc Ft. hp nwY � n3 t -- Tr=st Pf i rme:i Dy ark--___. ----_--- Data Certified By; Construction i'soti4 Date: 9-7- 3 M -W .DRILLING, Inc. 1'. O. Box 1-f�21: • 21'11 1A1wxun A C 007.274.1711 ANCHORAGE:, ALASKA BONN DRILLING LOG Well Owner Wg-Tr of (.?r M"+3 Now 6Qow..t/8at.iN;s WLt.t. - Lo -r +� 1 —Use of Well Dom Location (address of: Township, Range, Section, if known; or distance mail road Ilia 1k°� Grout Land Eutates, Poters Creek Size of casing_. 6 Depth of Hole 176 feet Cased to___il`—._feet Static water levet 155 ft. (8%V%) (below) land surface. Finish of well (check one) open end ( X ) Screen ( ); Perforated ( ). Describe screen or perforation None _ Well pumping test atm—gallons per (9&d} of drawdown from static level. Date of completion 29 Oct 73 (minute) for -1 --hours with 100% ft, WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 TO 1 Silty Gravel 1 TO 2 Boulder g 2 q O 20 20 TOS ?o _ rB TOS 70 TO 7f� 9$ 96 TO 174 Z l4TO_176 To— O TO— TO TO— TO— TO- TO -TO- TO -TO— TO Small Small Gravel NECEIVED Loose Bouldor Grnvel MAY 7 jqqj Cemented Boulder Gravel, p Municipality of Anchoerra vices Boulder -/i�.f , n Cobble Gravclt remi-c)neolidated Modiun Water Grai&l__ Wayne E. Westberg I — CUSTOMER Municipality of Anchorage Development Services Department =iiim Building Safety Division on -Site Water and Wastewater Program N4700 South Bragaw St. " ETY P.O. Box 196650 Anchorage, AK 99519-6650 www.ci. anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-131-16 HAA# a1�27� Expiration Date: %' i/ - i 1. GENERAL INFORMATION Complete legal description Lot 2, Block 1, Greatland Estates h1 Location (site address or directions) 23327 Greatland Drive Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent William Bach Dayphone384-6487 23327 greatland Drive, Chugiak, AK 99567 Day phone Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site X❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. A. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S ENGINEERING age rver oop asi No. 264 Address Eagle River Alaska 99577 Engineer's Printed Name M1 O@ R ; C CL) wati 5. DSD SIGNATURE i/ Approved for Disapproved. 3 bedrooms. Phone b 1:1 q -D-9 -77 Date Old,) ld,) / �Z _ter- .;, ROBERT C. COWAN, f•�r �� '•� CE -8801 at, < Conditional approval for bedrooms, with the following stipulations: VAJ I CVYH I CR Additional Comments „e-,FIB,h• Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other By: Lv . Oriainal Certificate Date: 6 - / 7 - q j (Rcv. 12100) Municipality of Anchorage p,�E • Development Services Department ' Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: parcel iD: I A. WELL DATA Well typel/4 ✓A¢ If A, B, or C provide PWSID # — Well Log OI) Date completed IC Sanitary seal (Y/N)4 Wires properly protected (Y/N) t Total depthCased to Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test 10 -Z Static water level Li S ft. Well production S g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 ml. Nitrate 3 6-1 mg./I. /52 ft. Other bacteria bacteria 0 colonies/100 ml. Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA J Tank Type/Material l�L- '1 r, ' I (VN ( y-'eiz— Date installed 3 Tank size 000 gal. Number of Compartments L Cleanouts (Y/) I/&n Foundation cleanout (Y/LV Nv Depression over tank (Y6P J/0 High water alarm (Y/N) A/ A J INS Df SA -lid I Txt7zZ Date of pumping �/ Q � Pumper C. ABSORPTION FIELD DATA Date installed c7Soil rating (g.p.d.lft2 or bdr } System type Length ___A2,__ft. Width Z- ft. Gravel below pipe 6 ft. Total depth /0 ft. Eff. absorption area 'ft' Monitoring tube h_ Depression over field /J�) Date of adequacy test 10 t Results (Pass/Fail) � s For 3 bedrooms Fluid depth in absorption field before test *- in. Water added gal. New depth�Sin. Elapsed Time: � min. Final fluid depth `7i� in. Absorption rate >=f� g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) IVeAk- )k AVnVA/ If yes, give date D. LIFT STATION Date installed _ Size in gallons — "Pump on" level at in. "Pump off' level at Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanWlSLstaHon on lot /CO -/Z ca Absorption Feld on lot / 00 Public sewer main r Seweqseptic service line s t Manhole/Access (YIN) in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots __. LOO r f On adjacent lots / a0 r a Public sewer manhole/cleanout Al 1.4 Holding tank ne_L a SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: i Building foundation � Property line —51 +- Absorption field r Water main M LA _ Water service line r'O 4- Surface water 1 0 o r + Wells on adjacent lots 100 + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ' nl R Property line 10 I + i D d Building foundation -- Water main Water Service line 10 —1-t- Surface water / b0 / — Driveway, parking/vehicle storage Curtain drain /V6&/6/ Wells on adjacent lots /moi® F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name KO Q kAi C. Date C. /g /o/ HAA Fee $ 3(20 - Date vo. Date of Payment Receipt Number (Rev. 12/00) 005'bos- Waiver Fee $ Date of Payment Receipt Number ROBEg[T-W C1.' Ilk ffal 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 /�h Parcel l.D. # �S�- l3 1 - �% HAA # A990t45 1. GENERAL INFORMATION Complete legal description Lar Z ° /; �sl2��r%zr�,v� 0—s -17a-T�s Location (site address or directions) Z 3 3 Z 7- 6)r-C--1Q--F 4—�_Q D�Z- I VE - ;Property owner NSG/�J may% a-/ - _"j Day phone h Mailing address 23Z� .-Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone 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(8ev.1/91) Fmnt 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 forthe 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 5 & 5 ENGINEERING Phone 17034 Eagle River Loop Road No. 204 Address Engineer's signature 6. DHHS SIGNATURE 0 River Approved for TH2 641bedrooms. Disapproved. Conditional approval for Additional Comments Gly--a97y Date 9/q/ q bedrooms, with the following stipulations: 1IITIC Date / () `1.2 -!79 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-0 (R ..1/91) Back MOAN 1 Municipality of Anchorage RECEIVED DEPARTMENT OF HEALTH & HUMAN SERVICESSEp 49 1M Environmental Services Division mu 14 825 L Street, Room 502 • Anchorage, Alaska 99501 •6( �/ouNcolumol AL S@RVIEgJ DIVISION Health Authority Approval Checklist Legal Description: Lor 2' zkon6 r ° r —777 4 n Parcel I.D.: ®>/ / :E� A. WELL DATA Well type Rz I VA I& If A, B, or C, attach ADEC letter. ADEC water system number Log present 6N) y/ -S Date completed /C &Z/�:;;2 S Total depth /:7c- // Cased to /S Casing height (above ground) ���� / Sanitary seal �N) 7�S Wires properly protected &Y N) 7E6 FROM WELL LOG AT INSPECTION Date of test Static water level 15-51, Well production l s g•P.m. To 4� + 9 -P.M. WATER SAMPLE RESULTS: * R',JT L 4T f.6 8 y p,,,,n Coliform 3 Nitrate 3 . N Other bacteria O S & S ENGINEERING Date of sample: I o t `I 9 Collected by: 17024 Fagle River Inect, Road ft. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 ��//� Date installed Tank size /f%�lr Number of Compartments Cleanouts ))_�� Foundation cleanout (YO—Ale) Depression (Y14 -AA) High water alarm (Y/N) Date of Pumping 7 Pumper 's :)(e 1-2i7 2 r el - C. / C. ABSORPTION FIELD DATA Date installed 973 Soil rating (g.p.d./ftz or z/bdrm e5Zi System type l- �/ 3 Length /; Width % 7 / Gravel thickness below pipe 61 Total depth /O Effective absorption area Zee '0 Monitoring Tube presentejjl)jL- Depression over field (Y/6' Date of adequacy test 2 9 a Results as ail) SS For bedrooms Fluid depth in absorption field before test (in.); Immediately after 2gal. water added (in.): 3 Fluid depth / '/ 0 r (ins) Minutes later:/ 1 -7 Absorption rate = _x_450 a.P• d. Peroxide treatment (past 12 months) (Y/N) AICNC- K//6Zcllll If yes, give date 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Manhole/Access(Y/N) High water alarm level at* Cycles E. SEPARATION DISTANCES *Datum Size in at* SEPARATION DISTANCES FROM WELL ON LOT TO: ( g5ifc,�'r ATrAoll4 )� Septic/holding tank on lot ICV' Td aZ5,?n/ OUr On adjacent lots "Pump off" level at* /Oc l�— Absorption field on lot /cc ^/-- On adjacent lots /CO -/-- Public sewer main N11q- Public sewer manhole/cleanout N i Sewer /septic service line 2e E,' ?I— Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation '5 / f Property line Absorption s /a -- Water main/service line Surface water/drainage /CVlfi Wells on adjacent lots &r //- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /,O r7'Building foundation /0//- Water main/service line l0J /fi Surface water 10C1/ 7'- Driveway, parking/vehicle storage area 5 Curtain drain AK U h/aJ - Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records�tCfke gp16Lc# s are in conformance with M A H guidelipes in effect on this date. Zy{-- *} Signature 4t 966Cit7— Cp_ Co Engineer's Name / 9/ �/ ` RQBERT C CaWAN j �Q� �c�s .�, CE - 8801 -1 f Date HAA Fee $ X 0 Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 1�ZLPH,,UR1UNE PRiFERIIE5xe-e- N0. 161 P.2 , Z3 T �✓✓G Ll !: /i0ll/j 0 N ASBULLT-No CORNERS SET THIS DATE. H! REBYTLFY THAT I HAVE SURV! MED THE =6LL.0WLN0 DESCRIBED RVARD SCALE pfiOPERTYt W0 THAT NO ENCROACHMENTS DATE .FAST EXCEPT AS HDICATEp, IT 1& THE NE9PONSlBILITY. OpTLiE TO QE1 FiIiMINE THE EXISTENCE p� ANY ASEMENTS, COVENANTS, OR RESrpICTlON9 iHlCH DD ORID� NOT APPEAR ON TME RE(;DR St1BDl- 1S10N pLAT. UNDER N0 CIRCUMSYANCES SHOULD F DATA'*'ON REUSED EOR CONSTRUCTION F FENCE LINA OR SM fig, MR �'ABLI Ry LINES. f3oUN0. ........ Q.b/•f' 7 MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services r, r On -Site Services Section r ' P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 J U L 2 19 9 7 CERTIFICATE OF HEALTH AUTHORITY Municipal ry ut Anchorage APPROVAL FOR A SINGLE FAMILY DWELLING Dept. Health &Hum_an Services Parcel 1. D. # ✓ ''� —� f ^ �� HAA # 1. GENERAL INFORMATION Complete legal description Lot 2; Block 1; Greatland Estates #;1 Location (site address or directions' 23327 Greatland Chuciiak, AK Property owner Dana &Debra Lukens Day phone 688-7768 Mailing address 23327 Greatland Chugiak, AK 99687 Lending agency Day phone Mailing Agent Alan Ward/ Remax Day phone 276-2761 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 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. 4. 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(R.v.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 forthe 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 Phone �� `i -� ci 7 Address 17034 Eagle River Loop Road N0. 204 Eagle River, a 577 Engineer's signature Date /�! 1 q 7 �rOF A`' C7 RE 8£RT<}C COWAN r^� ,,,OL 8801 22 6. DHHS SIGNATURE sX fit. D pHA' Approved for bedrooms. ��;,, ••vrES..� Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 0 rl-, h4,aAw 511TIC Date 9 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 purchasersof homes and theirlending institutions in orderto 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 engineers work. 72-M(FI v.1/81) Back MOAN MUNICIPALITY OF ANCHORAGE • ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage JUL 21 1919 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Divisionj� � ' E I V 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4 Health Authority Approval Checklist Legal Description: Cllr 2 &a -K I 6ezQgvMi9 Parcel I.D.: &STA -res 41 A. WELL DATA Well type Pit IVATE If A, B, or C, attach ADEC letter. ADEC water system number Log present 1&) !IaS Date completed /D—.1,9-75 Total depth !4rCased to /j�5' Casing height (above ground) Sanitary seal©Y N)s Wires properly protected &) 1) FROM WELL LOG AT INSPECTION Date of test /- M - �5 I i Static water level �t Well production /5 g.p.m. 6 4 g.p.m. rF kbsS•4:c:�9 Fay WATER SAMPLE RESULTS: Coliform 0 Nitrate © • 3 G Other bacteria O Date of sample: -5h7. Collected by: 7f�aS ENGINEER11Vta B. SEPTIC/HOLDING TANK DATA P/4.4'g. 4 /1444 's 0va2 r^c+✓ 17034 Eagle River Loop Road No. 204 „r= 514)-rL TOI. K Eagle River, Alaska 99377 Date installed 9-7-75 Tank size 1490 Number of Compartments I Cleanouts �/ fl V) Foundation cleanout (Y(9 de) Depression (Yr) --A&— High water alarm (Y/N) Date of Pumping g Pumper a C. 'ABSORPTION FIELD DATA z Date installed `� -,� " 3 t Soil rating (g.p.d./ft2 or ft2/bdrm) 814 System type 36C-PAGe, Prr Length 1Z, Width !Z Gravel thickness below pipe V Total depth II S Effective absorption area Z-86 F4Z Monitoring Tube present &N) -j&5- Depression over field (`r'@N O0 Date of adequacy test �_ Results Pass)ail) M55 For 3 bedrooms Fluid depth in absorption field before test (in.); 114 Immediately afters gal. water added (in.) Fluid depth 24 FAL rr � (ins) Minutes later: 131- Absorption rate = 450 g.p.d. Peroxide treatment (past 12 months) (Y/N) ij0I6 R*" If yes, give date 72-026 (Rev. 3/96)" * caEAl- v y56.n,�„"/0'4 ate. \ XuST 86roas THA SEEA94 F- PIT --WL COs D. LIFT STAT Date installed Manhole/Access (Y/N) _ High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES Size in gallons n', level at* *Datum "Pump off" level at` SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot S,0 f On adjacent lots wo i+ Absorption field on lot too 't On adjacent lots IOti 4 - Public Public sewer main 41A Public sewer manhole/cleanout 41A Sewer /septic service line a S f Lift station _ _ tJ,A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 10 Property line IDr Absorption field 14/ Water main/service line 10''x' Surface water/drainage ID -0 Wells on adjacent lots IOD + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line to + Building foundation ID' } Water main/service line 4D� -I" Surface water lDb ,+ Driveway, parking/vehicle storage area O Curtain drain F. ENGINEER'S CERTIFICATION Wells on adjacent lots 1 certify that / have determined thru field inspections and review of Municipal in conformance with M A HAA u'delines in effect on this date. Signature 7 � `— A Engineer's Name A d f -C C, Ce wife✓ Date 7/d1/77 HAA Fee $C-76 ' Date of Payment % / 7 \ Receipt Number -2--`f � 7 z -Zi l 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number CE -8801 are E -3j MUNICIPALITY OF ANCHORAGE • 'T 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 l.D.# —1°i1-hn-L� 1. GENERAL INFORMATION Complete legal description HAA # � 1f -V 1 'DL, -a Gl2-,r.4T' IAN Cs-,yV-G_s 4l Location (site address or directions) 233 Z7 l';"AT LATj0 b )21V Property owner S C OP I 'l x n 4 ( Day phone Mailing address Lending agency Day phone Mailing address Agent sv C- " Fi;rLT'u^I E Day phone d Z- -X S' 3 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 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. 1191) Front MOA 421 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 i,� p i�2lor) Cnr L /nlr �n 1A1 L Phone Address PO ?ox Y07 IS 4-v 0/04n&j ML e49.5 LY Engineer's signature lt e, auk� Date yLs©Ig-5 6. DHHS SIGNATURE Approved for �L�� bedrooms. Disapproved. Conditional approval for Additional Comments (31 bedrooms, with the following stipulations: By: P �P,a a °�� Date /0 - F — '? The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev.1/91) Back MOA421 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: to r-ZI A",a, 1 6r"LO r Z�"d E=SF Parcel I.D. A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed /��2 "1 �7!i' Driller�/ Total depth /74 / Cased to /75- / Casing height Sanitary seal (Y/N) I/ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test /° �S f /7f L %3 Static water level /5�5_ /SS Well flow Z�14-11 rtf Pump level U'�/�'v SEPARATION DISTANCES FROM WELL TO: i Septic/g tank on lots/� Absorption field on lot } /20 r Public sewer main Sewer service line > So WATER SAMPLE RESULTS: 7 2i g.p.m. On adjacent lots ? On adjacent lots > /Soy Public sewer manhole/cleanout. Petroleum tank - G 5 Coliform q/ Nitrate t'$ 9 Other bacteria Date of sample: _1 3��3 Collected by: A B. SEPTIC a TANK DATA r-"rEx"vc dCc "A Tu AtioIYIF_P��� Date installed 9/7/73 Tank size Compartments Compartments — O,�) .1'eP77Cd Cleanouts (Y/N) Y Foundation cleanout (Y/N) W Depression (Y/N) N High water alarm (Y/N) —a-- Alarm tested (Y/N) Date of pumping ( �1 7� q Pumper �IJdy SEPARATION DISTANCES FROM SEPTIC/ TANK TO: ' r ) /S Wel I(s) on lot' /OA On adjacent lots /LS Foundation i To property line /a Absorption field - WaterineWservice line a z/S/ Surface water/drainage } /0,5� 5,cpv(:, i�^PIt. IS CoC-A'rC'9 A PorLxo,,) 0H, —,WC 4)20JC&U '1, 72-026 (Rov.7/91) Front 'b0LJ4Ct tJA-y S1 tVQ tis I'IG'i3 t-4.7'» SC fir~/L6NTINUED ON BACK PAGE 000:= ,Jo,- PAS1 b#ae-C Gy oVCIL Wig-. voc-CL rr, 7C A C 1 O n riR �K ^fes m C N rt O Z O,�) .1'eP77Cd Cleanouts (Y/N) Y Foundation cleanout (Y/N) W Depression (Y/N) N High water alarm (Y/N) —a-- Alarm tested (Y/N) Date of pumping ( �1 7� q Pumper �IJdy SEPARATION DISTANCES FROM SEPTIC/ TANK TO: ' r ) /S Wel I(s) on lot' /OA On adjacent lots /LS Foundation i To property line /a Absorption field - WaterineWservice line a z/S/ Surface water/drainage } /0,5� 5,cpv(:, i�^PIt. IS CoC-A'rC'9 A PorLxo,,) 0H, —,WC 4)20JC&U '1, 72-026 (Rov.7/91) Front 'b0LJ4Ct tJA-y S1 tVQ tis I'IG'i3 t-4.7'» SC fir~/L6NTINUED ON BACK PAGE 000:= ,Jo,- PAS1 b#ae-C Gy oVCIL Wig-. voc-CL C. Date instal Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical SEPARA' "Pump on" FROM LIFT STATION TO: On adjacent lots D. ABSORPTION FIELD DATA Manufacturer "Pump off" level at rcles tested Surface water Date installed 17/ /73 Soil rating 8S System type PiT Length A— r Width I%r Gravel thickness (0/ Total depth Total absorption area Z0B Cleanouts present (Y/N) Depression over field (Y/N) Date of ade uacy test i, -,c /93 Results (pass/fail) f'�5 for : \ 74, ) bedrooms Peroxide treatment (past 12 months) (Y/N) /1/r If yes, give date y/.uJFsr Al/s / iw p�� fjrrsa^ AS IS74r/6 a SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot > &0 Onadjacentlots >/5a Propertyline >.`D To building foundation 5/O To existing or abandoned system on lot a �/ On adjacent lots >5-01 CutbankYzd-- Watermain/service line Surface water Curtain drain E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area, s I certify that I have checked, verified, or conformed to all MOA and HAA Signature y r (t c"^^c E C Engineer's Name til rr f/. +-7 /-JnroCn '0tJ Date C)S-2S-i HAA Fee $ 3 0 d ` -JZ Date of Payment /6 Receipt Number 2 72-026 (Rev. U91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number i on the date of this inspection. /J;1-hc1o1 F. nndErson MUNICIPALITYOF ANCHORAGE • �' DEPARTMENT OFFHEALTH &HUMAN SERVICES y 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. # - �! \ - Flo HAA # VA M � C)\ I. 1. GENERAL INFORMATION Complete legal description Lot 2; Block 1; Gnea-t2and E3ta#eb Subdivi4ion 4 � Location (site address or directions) 23327 GKeat2and Dhi ve Property owner Michele Baown and Jew Bet,P.i.neK Day phone 561-2101 Mailing address HC 79 box 4290, Chug.Lak, AYaska 99567 Lending agency PACIFIC ALASKA MORTGAGE Day phone 258-7534 Mailing address 2600 Denati., Anchoaage, Akaaka - ATTENTION. Rhonda Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 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 X Holding tank Community on-site Public sewer NOTE: if community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1191) Front MOA #21 5, STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and 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 ca;,ie River LOP�f'Road,40. 204 Address Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments 0 bedrooms. Phone 44 1 Z_Z 70�7 . Date bedrooms, with the following stipulations: 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 courtesyto purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA k21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:/ tz; Elm 1AAkJC6tt,- arcell.D. A. WELL DATA Well typeiE)ihjqL If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Total depth Sanitary seal(Y/N) Date of test Static water level Well flow Pump level Date completed (O - 2-cl - Driller M `I' hJ ft_ Cased to —Casing height [ 2 Wires properly protected (Y/N) FROM WELL LOG (n -zq - S L)IK g.p.m. AT INSPECTION .5- 3-q I 3 / -9-P.M. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ( n0 t ; On adjacent lots Absorption field on lot ( rpo t ; On adjacent lots I OC) t Public sewer main &)lA Public sewer manhole/cleanout i Public sewer service line A/ /(A Petroleum tank 25 fi WATER SAMPLE RESULTS: Coliform sA I C,toi 4 Nitrate�� A<_ for Other bacteriaZC-J'o Date of sample: 4 - 2 S_-5 j Collected by:S S L nJG t tj .e;pi B. SEPTIC/HOLDING TANK DATA Date installed 1- :1- _13 Tank size I C©o Compartments 1 Cleanouts Y/N Foundation cleanout Y/N w1 ( ) ( ) Depression (Y/N) n1 High water alarm (Y/N) hi 1/A Alarm tested (Y/N) ; JA Date of pumping L{ ` Z !J q SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot (OLD -f / On adjacent lots ( Do 1- Foundation- To oundation To property line 10 t Absorption field 2- Water main/service line / D t Surface water/drainage J 00 .t 7M26 (Rev. 3191) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump oX level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION T Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 1XL - a 3 Soil rating _ System type'�.CC62A4TP Length (Z r Width (Z Gravel thickness—Total depth l�f� Total absorption area Z 86 go , Cleanouts present (Y/N) 14 Depression over field (Y/N) id Date of adequacy test !S-- 3 - (3 1— Results (pass/fail) for Peroxide treatment (Past 12 months) (Y/dR N16 If yes, give date Ai SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ( no On adjacent lots ( OD fi Property line (a '(- I To building foundation (n t To existing or abandoned system on lot UA r < r On adjacent lots 30 t Cutbank S0 t Water main/service line—( n � r Surface water (no t Driveway, parking/vehicle storage area Curtain drain A)111t E. ENGINEER'S CERTIFICATION bedrooms I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the.,c(afe of this inspection. 4i Fn J i. heif;3eJ1 t'.iiVV Signature Eagle River, Alaska 99577 Engineer's Na e Date av HAA Fee $ Date of Payment _y Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number 1-1 s pr DATE RECEIVED . INSPECTION APPOINTMENTS -�t, \,: l�'�-�"? TIME NUMBER OF,BEDROOMS TIME TIME Two ❑ Five ❑ MULTIPLE FAMILY p Cr_ T . DATE DATE DATE ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY I [3' INSPECTOR INSPECTOR INSPECTOR n �� E-1PUBLIC UTILITY Iq 7' NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. N' RAGE MUNICIPALITY OF ANCHORAGE DEPT j ENVIROi C_ :! .CTION DEPARTMENT OF HEALTH &ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Co all on page . Incomplete requests will not be processed. Please allow ten (10) d s for wmplete 1. pgOPELa'i'T-�� R I�411 l 1parts /1 ��71"1� /processing. MAI LING9DD ESS _ J� rA lS.,°f DENT PROPERTY RESIDENT (If different from above) - 2. BUYER A -fes I I5 C�t_ PHONE 7 76 MAILING ADDRESS 3. LENDING INSTITUTION rt �f —{�/�+ _ <� `, S jj((w-�� l�i lrl}.11.�/- * , LLL/JJJ1 PHONE MA NCy A D�IjjTT,.ttiF�—�S--� t C7D I QFhJ.�YC1Lr/'1` 4. REALTOR/AGENT �_ PHONE ikk'J MAILING ADDRESS 5. L AL DESCRIPTION STR E�'fy.,i].C� I `Q♦\1���'��'� Cc,. � � �-lam � l �l-�� -�t, \,: l�'�-�"? 6. TYPPEEIOFF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY INDIVIDUAL* *ATTACH WELL LOG. Awell log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM I INDIVIDUAL/ON-SITE**EAR ON-SITE SYSTEM WAS INSTALLED. E-1PUBLIC UTILITY Iq 7' NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 ( Rev. 6/79) 72-010 ( Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE -E7 SINGLE FAMILY C] MULTIPLE FAMILY NUMBER OF BEDROOMS ' ❑ ONE 1E1 THREE ❑ FIVE ❑ TWO ❑ FOUR ❑ six ❑ OTHER _ 2. WATER SUPPLY b INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM _NIINDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER E lSeptic Tank or ❑ Holding Tank Size: I Cin If Tank is homemade give dimensions: SOILS RATING Q rt) TYPE OFTANK MANUFACTURER R�( COC. TOTAL ABSORPTION AREA Ra MATERIAL pk j C Lm )-�tv-,c. 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS (� �v r�A' t ce Ci % l C�L`ll &?'APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accor}pa y certificate) ElDISAPPROVED DATE 4 - -��� BY 72-010 ( Rev. 6/79) ,UNICIPAI.ITY OF ANCHORAGE �., r,EPARTM`-"dr HEAD Int AND ENVIRONMENIOPROTECTION iI)j 825 L Str(_(• AnchorC e, Aldska 91,5 - OE Dai.e Received: Auqust 15,1977.__ 41: Time 11:Ved .m. µ2: . me �d f2 Yl_ k2: Time ----- — ✓1 Date 8-1 Tuesday Date,',] _ 1+2 Date_.��. 13?sp Ken Tnsp /, / r ��Lnso //. I / eIs;. 4 R1r;7[IPST FOR 11PROVAL OF TJDJVlWSAL :li57F.111 Ai. ,��tr;R FZiCT_ f7Ir,5 1, lendiinq Institution Req.iest: Teamster's Federal Credit Union I-ailir-g Address: 1200 Airport Heights P1'."D _. Proi-ert,; Owner: t3.a A inq Address C/5 eaze Stephen B./Sandra A. Passmore r.e: 688-2032 PSC#@ Box 3063 APO Seattle, 98742 3. regal Drscri-ption: Lot 2 Block 1 Great Land Estates Subdivision 4: Single Family Residenc,: (x) Number of Bedrooms: Two Multiple Family Rec;idence: ( ) Number of Bedrooms: S, Well System: Individual. Well (X) Cor�rnunit-y/Public Svstem ( ) Permit t Depth of Well 76' t^ell Loc, on File { ) Construction Bacterial Analysis 6. Sewage Disposal System: On -sill- System. (x) Public Utility ( ) Permit ti Instal led 1973 InstallerC>_{�{ Septic Tank Size�QD[>--- -._- Manufacturer Absorption Aroa �j i ( Soil ate -- -- Aateri ✓a ne 7, Distances: Well to Septic 'rank to Ahsorption Area to Sewer Line Nearcczt _.nt: line �bsorpti.or. Area to Nearest Lot Line d'! Dapartn:ent of Tleai-ih a.nd £ vironiientay Protection I Request f•or ApprovaI of _nd J,.V idea i $ ewe r and wa`.: e "tic i iit; Legal Desc-rl.ption: CyOl:tme2's t.S: Lot 2 Block 1 Great Land Estates Subdivision A I Affadavi.t Attached: ! } Le'r-ter Attached: j Approved: �Cr Datr= r Z -- --- -- Di.sappr.ovW: ---�.----..._ .._---- ---- 'Mte: _---- -------- Department. Worksheet: Cj C-)