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HomeMy WebLinkAboutJUNIPER VALLEY BLK 1 LT 2Juniper Valley Block 1 Lot 2 #050-751-32 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE -NEW ❑UPGRADE MAILING A DRESS 5 U_ LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS UY DISTANCE TO: Well Absorption area DwellingPERMIT N O 2— N F Manufacturer Manufacturer Materi No. of compartments Liq. c achy in gallons IF HOMEMADE: Inside length .� Width Liquidslepth 6C7Z DISTA NCET Well Dwelling PERMIT NO. SZFQ- Manof rer a i capacity in ons D w= DISTANCE TO: Well _ ,� , /V�y–Z' �,\ Foundation tc. a� Nearest lot line -��� ' PERMIT NO. �/ O Q 1— � u. Z No. of lines 42_Length of each line Total length of lines Trench width !CT Distance bet 7Nme G H Top of rile to finish grade I Material beneath the 7 ! iilZ Total effectwe abSopryji�area �% w C7 Length Width Depth - PERMIT NO. a F wa Type of crib rib diam Crib Total effec "on area yell (STANCE TO: Building foundation Nearest lot line J ss Depth Driller Distance to lot line PERMIT NO. Building foundation DISTANCE TO: Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS ZJ363y SOIL TEST RATING �S INSTALLER REMARKS is 'A S t t c r APPROVED - DATE LEGAL 3� ( L a / /c 72-013 (Re .3178) I rlUr-411:::T`0 CIF= * DEPARTMENT W HEALTH AND ENVIR8NMENTHLWnTECTION ' 825 /L/ STREET/ ANCHORAGE, HK. 99501 264~4720 " "�_" " ��.� __ i �_ r'c'� I � ���� ���� ������� ��W�� F��FZMI� ��� NO. ( 810602 ) APPLICANT STEVEN L GOFF LOCATION LEGAL 1405 SUMMIT VIEW LOT SIZE 44000 TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: L'- E: F� -r " = -1 ::L L_ 1-= r-4 'a -r "� -1 _'4 'a FZn %.P F� L_ / I -^� .|'� ��,._~v ]]8 22 2-0-9\ SQUARE FEET � �E: F=� -r " �� �r THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). FR E= In- U I FZ E: C� �F= F� -IF I f-- �n r-4 K �I -_-Z E=� -1 RD 10 121 C3 F=l L_ I C) r -A E: PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. _r t4 ci < � > I " _�, F� F7 fl:� -r I ID "!E� �F�."F= FR F= U-4 U I F;Z E= E.- BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ��F? M I -r F= X F� I F;PF-- _�, E� E=- P1 ED I=- F�? :3: -1 I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED APPLICANT STEVEN HND WELLS AS SET ENLARGEMENT IF THE � ISSUED -..'.~_--- -_�~~_-..G^____�. -'^ V4 0 mum r'L< I F;>IZVL_ r -r=te C21= 09PAR I'mf T :7F # �t_Tfi ENY Ii 3NAhENTF3L STI c T I QN E� Lii^i�L_ f=ItFG� 3�t<�-�. � �'� ��i•i�� s-'�``�f'�.is$ I i' PERMIT na- t 8is3 + VV pppL €cm r s ro," L- oew i4t39 3L i r Y f Eu 3M-2220 a LE3M L.2 at uiril Ep ' I_£§" . LOT SIZE 44919 sojFw tri VOFE )IF S3IL ReSOFP I' 113N S'i`s TEii IS. T&Ck" P"."IPIlii M.MBER 13F $EOR URS = 2 SJ31L RATIM CS'2 FCAW)? 83 TW REQUIRED SIZE OF TrI£ SOIL Rs-si3pwrioN 3-i-sTEm IS: C>V:F=— 1-3= 7 Tim La4um Prmrz:v3N Is ri-x LErdArw t IN Feer) cr rrx maic.H +3R opAiw ELo_ §� TiiE DEPTH 1-9� A TREt" ox P i r iS mE v I a rR4QE E£ i mri v4E suRpnix ]F THE 13W -V" AJW TtK DQTTO! OF n-iE t x#'MrION { IN FOU). TH I'3 W SPET WIDTH FOR TR£NF:31�1 mE mbrti tS rN€ m f N Its Vii'! ojepn4 +3F t3i2fi',lEi_ GlE rWEN THE IIU TFgLL PIF;*-; f; i* rHe wr r:moi or 7'me oiet Ar i+3N < IN FeEn. C: &n L_I 13:Za✓Liiw Fscmtr APPLICANT $FiS TW RE PO SIBL'i_Iri TO ITFt3Wi THIS DEPARTMENT OURIM THE [USTNLLNTIOn wsF'FCrit3m re ANY i -s AojAoENr ro rms ppopEkry Am THE F R t3F sE3fim-cEs rmr TT - wa.L siiuia s -- a T-1-30 I t`t f' -4: T I i F?4'm 1=1fR E� lzI=-i!f 1 If2EC3 - - iii..Itis 13F Fit{Y ve5mf idIproir FinsL IN t3TfCiti filiV} b'!1L & THtS rM5NT DILL SE 9J8�3T TO PRO79€CUTft3N. i'iINfi'AJN 01STRIXE BETWEEN A WELL ffiD FiiV ONSITE "3E DISa"TJ'°.HL SYSTEM IS t T FIX? fl PRI` ATE i -ELL OR i*Q TO 2L.0 FEET FROM FT i't"LIC HELL DEFeVINQ UPON THE TYPE tJF Pl" IC �iEt L M[Nihf9Mi t3fiSTtdieE MM A f'RTYAT£ 1,9"- ra ti PREYA E ! lw I5 25 FEEr Fm TO A r%Y*IMIT'J > LfW IS ?S FeEr. WEI-L LCm2S ARE REMKEV r'ffv tfJST 8E R.ETURNE0 TO THE DEPARTMENT WITHIN �g € R Cr rrb5 L C23MPLETIt3i'!. t3Pi-eR RESwipalalls t`iR"i APPLY. SPECL=ICATICV4 tV40 QA36Tf?fXrIL)N 0IF)rlm4S i R' ILACILE TO €N93W F R'3FER INSTf)LL.f`lTILW f +"i'T€F'1 TMAT i.: f FI} FAM IL I.RR WITH rHF. i vRlj I Rf #T5 FOR ON-SITE SEWERS AM AS ET F+3F.TH W THE PAINICIiAITY QF t %31' a, I WILL INSTFkL TW S'r'lrOT R IN WITH THE fAX*-S. 3_ t i!1-imizsTIvo mAr rw an -Sire `a�3-iEs? .3resT`rm r4R'. izEQUw ____s>__v__.__ ENi.Fim,lu"r IF THE V4. a, LOT 1 - - ' _t -r bi[lii - -. LOT 2 .. _ T B 3 H. -8 LOT 3 � T.H.-y LOT "4 - ,yIL T.H.-6 LOT 1 d 3' ® T.H.-3 LOT 2 LOT 1 - - 16 BLK. 2 B E$ T.H.-2 - O T.H.-4 - - - - LOT - 2 LOT 3 - Bill Lloyd ` Location Diagram �C Consultants Inc Anchorage, Alaska ANCHORAGE FAIRBANKS ALASKA JUNEAU CnTc 10-27-]J 3GaLE 1"=_oa OWN DY �; O".Kp HY S3ED F OJ`No. 551083 1 OWO NO.II-01 0.0' 11.0' 14.0' 180' GRAVELLY SAND (SW) o. • �o 0//-�• - O V. v%O •0.^a _ as SANDY GRAVEL w/OCCASIONAL COBBLE, TACE SILT P.O. (GW) Q.a 01- .0 'op 0 - �• o SANDY GRAVEL w/SOME SILT 0_Q MANY COBBLES (GM) CT c s.4 6 c L ?.c2 GRAVEL w/SOME SA20 . ;, MANY COBBLES 94, e OCCASIONAL BOULDER (GW) b•p` o 0.0' 11.0' 14.0' 180' t 3.0' TD NO WATER TABLE - Log represents location of test hole, Lot 2, Block 1 Consultants Inc. Bill Lloyd ANCHORAGE FAIRBANKS ALASKA JuNEAu _ - Log of Test Hole SIL Anchorage, Alaska 10-17-75 ISCALE 1"=3' I OWN By WED ICNKO BY 14-tD 1PR0J. No.571083 Owo No. B-02 ic w-wtifirb � tllirt �r�ag by DOC Co. db8 SULLWAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE - Started PERMIT NUMBER 't , 1_ _ f o 1. !.I K t Ended DEPTH OF WELL -- STATIC LEVEL OF WATER FT. J , a ,: , ,` ' %< ' DRAW DOWN FT. r GALS. PER FIR KIND OF CASING KIND OF FORMATION: U. From Ft: to Ft. - x �,,... _ ...� From Ft. to Ft. From -- Ft. to Ft. Gi' '_. i s •'4'--• = 4-- From. Ft. tQ Ft. From " f. Ft. to ,.3*Ft. - + - t� L 'From Ft. to Ft. Fromto Ft '� _ -;'From Ft. [o F[ 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 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 MISCL. INFORMATION: gWM0W"AtiBERVICEB DlYWW wim 141997 DRILLER'S NAME KIND OF FORMATIO VE 'TV, STj „.. I11 / XIV From` "0' Ft. to 8 `Ft. S R<v0 (oRir f'4y From Ft. to Ft. From Ft. to Ft.Uaw-O%/i s$ .. From ' : Ft. to--."' " Ft. From D Ft.+to From Ft. to Ft 8 ` {t From` Ft to Ft. From Ft. to Ft - cLJJ From —LFt:to Ft.4110' 9^j From Ft. to Ft From Ft. to26-i'—Ft AC -LA", S �� ' i L From Ft. to E ' From. -Ft. to—L K . Fitt. c /a / /9' tic ; From Ft to— From—Ft. oFromFt. to Ft. JO From Ft. to Ft. G s. From Ft. to�Ft l / uE ��wa :-li+f !>��tiom Ft. to Ft. From Ft to Ft. w 06 i From Ft. to Ft. FromFt. to o 4� �; �� SAS From Ft. tot ' 00 From DO to Ft. From Ft. to t. From `- Ft. toFt.Zl w 0" " 6 R t L S From Ft. to Ft ' From • } Ft. to }� Ft C4/�' ` �� i ~ From Ft to Ft` �� ' by OOC Co. dbo SULLIVAN WATER WELLS P.O. BOX 272, CHUG IAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND DEPTH OF WELL i r ADDRESS i $ f '9.�'�/r`_' STATIC LEVEL OF WATER FT. - LEGAL DESCRIPTION r': 1_. i !: / /ir�'I` DRAWDOWN FT. DATE -Started ! / j Ended - �/� GALS. PER HR i f PERMIT NUMBER 0 /0�b KIND OF CASING z KIND OF FORMATION: From %') Ft. to__�Ft-n,uAK�I/^11,�From _ Ft. to Ft. From Ft. toy Ft. O41 �( 11. 'k� s% Yir. l From Ft. to Ft. From Ft. to__ Ft. f ? 4 �At / _/ From Ft. to Ft. From, Ft. tom_: Ft e,- t44�/kp i'I ' � From Ft. to Ft. From- Ft. to Ft �`� ? ,�Jp `? l r/ From Ft. to Ft Fromm Ft. to✓f,/4--/j"W-1 / m 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 Ft. to - Ft. ' From Ft. to Ft. From Ft. to Ft. From Ft. to—Ft. From Ft. to FL From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft_ MISCL. INFORMATION: DRILLER'S NAME Municipality of Ancho "rage • t Development Services department Building Safety Division On -Site Water and Wastewater program 4700 South Bragaw St. P.O. Box 196650 Anchorage, Ak 99519-6650 www.ci.anchorage. a k.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-751-32 HAA # /-i Q O/ 06 6 0 II ,> Expiration Date:- — I --?- .GENERAL GENERAL INFORMATION Complete -legal description L2; B: -I Juniper Valley S/D 'Loth tion(siteaddress,ordirections) 3612 Delores Dr. Eagle River AK 99577 Current Property owner(s) Art Isham Day phone 269-3015 Mailing address Lending agency Day phone Mailing address Real Estate Agent Ail rjre r Malo Day phone 694-49nn Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS:. I 3. TYPE OF WATER SUPPLY: Individual Well a Individual Water Storage E] Community Class Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site Q Individual Holding tank El Community On-site E] Public Sewer El 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 si ipply 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 seater system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER.. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Engineerin Phone 694-297 Address 17034 N Fag_la R;var Loop Ste 240 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan, PF, Date S'/za/o? O ^� 5. DSD SIGNATURE !/ Approved for 3 bedrooms. Disapproved. ROBERT C. OGWAN CE -E30,1 Conditional approval for bedrooms, with the following stipulations: TYI15 (/'e- IP/o—S(°—i C- Dliljl l loG,4- ( HHI� ly Z Attachments: HAA Checklist Septic System Advisory Well Flow Advisory WASTEWATER X Maintenance Agreements Supplemental Engineer's Report Other By: - �'�� + y (� / ✓� Original Certificate Date: (Rev ivom Municipality of Anchorage Development Services Department Individual Well Building Safety Division _ On -Site Water and Wastewater Program 4700 South Bragaw St. Individual Water Storage P.O. Box 196650 Anchorage, AK 99519-6650 Individual Holding tank www.ci.anchorage.ak.us Community Class Well (907)343-7904 Community On-site CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE.FAMI•LY DWELLING Parcel I. D. D 5'(3 — 7S) — HAA # Expiration Date: 72� - %— O -2- 1. 1. GENERAL INFORMATION Complete legal description L2; B1; Juniper Valley Subdivision Location (site address or directions) 3612 Delores Dr. Eagle River, AK 99577 Current Property owner(s) Ar t I sham Dayphone 269-3015 Mailing address 3612 Delores Dr. .-eagle River, AK 99577 Lending agency Day phone Mailing address Real Estate Agent Audrev Mason Day phone 694-4200 Mailing Address % Unless otherwise requested, NAA will be held by DSD for pickup. �L t Xh,� - /0 / 2. NUMBER OF BEDROOMS: 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. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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. 5 & S ENGINEERING Name of Firm 17034 Eagle ,ver Loop ResMa 04 Address "a Ie River Alaska 22177 Engineer's Printed Name C, Lo IJA,-� n .$, !� o - , _ �i,s; co,.,a;r,u,.,�� NAA — , /3 1 '9 E -i y J-� rt I i 3 G u ;z , Phone G Cl `i —X �? -7 9 Date /.) / a y /o I s1 5. DSD SIGNATURE R09.RT C. COWAN i � Approved for bedrooms. Disapproved. X Conditional approval for 3 bedrooms, with the following stipulations: $500 to be placed in escrow for septic tank pumping. Work to be completed by 6-1-02 Money in escrow is not to be released until this office has given final approval. _ PROGRAM Attachments. HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By; LLQ_ /� Original Certificate Date: — aZ 7— (Rev, 12100) Municipality of Anchorage ' Development Services Department ° Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LO 7- 1 13 LeC rL / J ✓r�1r/'rc A V/i LLd y s/Oarcel ID: 0 S -o - 7.rl - 3 A. WELL DATA Well type02 t'MjM Date completed 3 / q7 Total depth )Ly 9 ft. Date of test Static water level Well production If A, B, or C provide PWSID # Sanitary seal (9N) Cased to �01L ft. FROM WELL LOG 3/q. ?,03 WATER SAMPLE RESULTS: Well Log ®'N) Y f S Wires properly protected &N) Y6 J Casing height (above ground) a H f in. AT INSPECTION / a�r3�d1 g.p.m. } 9.p -m. Coliform O colonies/100 ml. Nitrate GJ 6 mg./I. Other bacteria d colonies/100 ml. Date of sample: t 13 ®! Collected by: S 4 S ENGINEERING 17034 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Tank Type/Material -5 60 rtc / -C YYo i L Date installed _ .31lt / 8 / Tank size 0S-0 gall. Number of Compartments Cleanouts (Y/N) _Y f 1 Foundation cleanout (ON) Y4 Depression over tank (Y/O N a High water alarm (Y40 1" D Date of oumoina j /0 % Pom P 10 Pumper 1144 R li (1 v4 5 r e j C. ABSORPTION FIELD DATA Date installed -3)1, Length a I ft. /�7'>Ac.Nk7 r-rEtTri .2.f rR�,y TwC N:;n/-'e%J. Soil rating (g.p.d./ft' or Z/bdrm . TV- Width SWidth 'V— ft. System type T r2 4 N c 4 Gravel below pipe 7 ft. Total depth I I r�i ft. Eff. absorption area 3 q'j ft' Monitoring tube Y40 Depression over field 0"C Date of adequacy test /a 13)04 Results P sFail) AW-( For 3 bedrooms Fluid depth in absorption field before testi r r� 3 in. Water added regal. New depth } U in. Elapsed Time: 60 min. Final fluid depth"in. rr in. Absorption rate >= Ll S-0 g.p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) Po /- K N ° - ^- If yes, give date 'f( Atq,Y6<-uk.i 1 b1 `-44�L�Dw'C e.. HS L2_ A- 7- if<rS Lii_ _Nh"L a D. LIFT STATION Date installed "Pump on" level at —in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/ _ "Pump off" level at i igh water alarm level at SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ) O O t Absorption field on lot /60 fPublic sewer main i✓ / "t Sewer /septic service line oL 5– 14 Meets alarm & circuit requirements? On adjacent lots On adjacent lots 04 + in. Public sewer manhole/cleanout Holding tank A// SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r I Building foundation S 7" Property line �+_ Absorption fiel Water main %) /R Water service line 10 4 Surface water Wells on adjacent lots % 0 0 �4' WA i Jr 100 11 - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: / Property line 10 f Building foundation 10 -t_ Water main N / Water Service line i0 4- Surface water )OQ Driveway, parking/vehicle storage Curtain drain NJNt K Nc wN Wells dh'adjacent lots % 0 L4__ F. COMMENTS a G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and r yr review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. p""'r ER EFS' r� 0(3#Rr C. RQSBERi C. COWAN C®way✓ �, ��s:, M�sot Engineer's Printed Name Date t aI a `t / O t HAA Fee Date of Payment Id -6,-v �0/ Waiver Fee $ Date of Payment Receipt Number 0137 it o Receipt Number (Rev. 12/00) Ip �f- 12/21/01 FRI 11:18 FAX 6945432 December20, 2001 S & S Engineering 17034 Eagle River Loop Ste 2 Eagle River, AK 99577 Office (907) 694-2979 Fax(907)694-1211 To Whom It May Concern: Regarding the property at 3612 Delores for Art Isham. Due to the weather and terrain we are unable to service this property at this time of the year. We can schedule this service for the springtime. Sorry for any inconvenience. Please contact us with any questions. Sincerely,��c/) _ JR'S Se rvi )e, P� 1 �J JR's Septic Services • PO Bort 773511 Eagle River, AK 99577 0 Office (807) 694.6466 fax (907) 696.5632 12002 I 1 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES - Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# 050-751-32 HAA# HA930325 1. GENERAL INFORMATION Complete legal description Lot 2 Block 1 Juniper Valley Subdivision Location (site address or directions) NHN Delores Drive Property owner Art Isham Day phone 694-3671/267-6214(w) Mailing address HC 83 Box 2409 Eagle River, Alaska 99577 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: Three (3) 3. TYPE OF WATER SUPPLY: Individual well XXXXXX 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 XXXXXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 921 5. t� 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 Phone 694-2979 Address 17034 Eagle River Loop Road, Suite 204, Eagle River, Alaska 99571 Engineer's signature Requesting a three (3) bedroom approval rather than the orignial request for a two (2) bedroom approval. DHHS SIGNATURE Approved for '71v�9�63 bedrooms. Disapproved. Conditional approval for Additional Comments Date 6 bedrooms, with the following stipulations: By:©,r chi Date 9l1TIC 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(RwAM1) Back MOAN21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: k -v< Z ?7-4-- } SJ rS %PV -r,- Parcel I.D. A. Well Data COQ 0-7,S/-32- Well type If A, B, or C, attach ADEC letter. ADEC water system number r�,\p Log present&N) k Date completed 19 $5 Driller SJ w % vr't Total depth Zot Cased to Zo t} Casing height Sanitary seal (&N) 4 Wires properly protected 6)N) FROM WELL LOG Date of test 1`1 2>5 - Static water level 1 0.5 Well flow o AT INSPECTION Lo -21 -9 Pump levell J tz- lc--4 SC1-fin, V &r, - C kq,5k) P� V>OA V Obi� C SEPARATION DISTANCES FROM WELL TO: zi, p g.p.m. k Septic/holding tank on lot t oa t ; On adjacent lots \L> Absorption field on lot \ ; On adjacent lots At, \ o Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank -2-5- WATER S WATER SAMPLE RESULTS: Coliformy Nitrate 0. A I, Other bacteria c7 Date of sample: Collected by: s & S ENGINEERING 1104 Eagle Rive, kmp Read No 204— B. SEPTIC/HOLDING TANK DATA Eaglo River, Alaska 99577 Date installed 1`t 8 1 Tank size 12-527 Compartments Z Cleanouts j,YVN) q_Foundation cleanout &N) T_Depression (YAO ^� High water alarm (Y& Alarm tested (Y/N) Date of pumping S� �`�'� Pumper ZYS- _sS ¢ oa L SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot Vo a \ � On adjacent lots \0o \J6- Foundation 10 , To property line t L� \ } Absorption field S\ Water main/service line 10 + Surface water/drainage t c> k } 72-026 (3/93)* Front CONTINUED ON BACK PAGE NMI 6,, 3--0 --C/-3 56s 0 . G. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) tested at SEPARATION D E FROM LIFT STATION TO: /0 c W 1 on lot On adjacent lots Surface water n o � D. ABSORPTION FIELD DATA �o rft u+ Date installed VA 16 1 Soil rating (GPD/Ft2) �`� Bp System type Length 21 , Width 45' Gravel thickness -11 Total depth t h, Total absorption area Z1 �I Cleanout present&N) Depression over field (Y4% Date of adequacytest L 2 1 —`l3 Resul pas ail) PP, --S for 4 3 Bedrooms Water level in absorption field before testes 1 D After test Peroxide treatment (past 12 months) (Y& r� 1�' � 61-S If yes, give date , `A O4L►1 g4--& J �u,s w P Zr� - DP P SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1 o a On adjacent lots 1 C>0' Property line t o To building foundation l o To existing or abandoned system on lot On adjacent lots 12 Cutbank 1�` 1c Water main/service line lC> Surface water t 0o kA-- Driveway, parking/vehicle storage area 3a Curtain drain A,S, E. ENGINEER'S CERTIFICATION /certify that/ have checked, verified, or conformed to all MOA and HAA guidelines in effects iJa, A (tars inspection. y6 7 S & S ENGINEERING Signature ). e X,ver Loo Engineers NameEagle River, Alask P R o' 04 t Date 12- j /y� HAA Fee $ l %0 Db Waiver Fee $ Date of Payment — z2— [ / Date of Payment Receipt Number ��� ��s��i Receipt Number 72-026 (3/93)' Back Z JOP 7-93 WED 11 :36 FNBA FAX 907-265-3094 FAX N0. 9072653094 P. 02 L�aa gS(@al allp4' eVLIMNC YT9Aai - �_ \ F. attE eVleM¢ 2!k.A AFAII eJl-EVlC 4'IEtIX q J0 Ne 4r) tv t. 1 td lew TAY Ute/ e�•Y,/ '\\� wv',� �y -1. � �`.,�! '\ I / U4T CRY Ff.gru� �...,a.•s \�\ \ 9'2 � I 10-UiIt1T1' EAiE Ment „F SY UNDEk h'O PRCL%L(STANCES SNO'Jt.D A.7. AS --904T BE USED FOR CONS'1RJCT.ON OR FOR ESTAB!J&;NG UWNDARY to FENCE LJXFS THE SURvE'r0R `kv,;:S RESPONS,5!J7Y FGR NE INITIAL TRANSACTION ON'_Y AND AS''JLiu FINANCIAL L:ABIUTf ONLY FOR THE =,7 OF THE 5URVtY. _ USTED DISTANCES PREVA!L OVER SCALING. REPRODUCTION WAY. CAUSE ERRORS I.N SCALE L LOT SJFY —_ SURVEY TYPE SYh1B0ES Cl e[UnbanDN As-auL� ,,,,w� ,.�,ry-, r. -. V FINAL STRUCTJRE AS-e,1IL' • S.T RE6AA s ;.A DRAINAGE `--""' ASPHALT 0 FOUND REBAR ^"I t° T' PLOT 5JRKY , . , iCPDCRMHY �t'"9 WOOD FENC€ 1-�:°-= CU.ti CRETE Dna AN3LlMED EL"-II--N--y METAL FEN IF =1 WOOD DECK IT IS THE RESPON$!DlITY OF THE BUILDER OR OWFlER, PRIORvTO ONLY THOSE tMPROVEMENTS APOVE GROUND AND Js!eLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING 'RApE R€LA71VE SHOWN. FENCES, WELLS, SEPTIC CLEA.NOUTS, SIDEWALKS. DRIVEWAYS, TO FINISHED GRADE AND UTIUTY CONNECTION$ AND TO DETERMINE E'FC., ARE BROWN IN THEIR APPROXIMATE LOCATION, ONLY, SNOW THE EXISTENCE OF ANY EASEMENTS, COVE NAN73 OR RESTR!CTICNS MAY PREVENT SOME IMPROVEMENTS FROM PEWS SEEN ANC LOCAFFA. uennu nn urt eeoowu nu .< ,�..� �,....,.,,....,.. ..� ... _.._... .___ SURVEY CERTIFICATION OT PLAN YNY WIN Nrt I ., . OIN!wl Yi.."I. FOUNDATION AS—BUILT 4 Ra4r(F Ar+a .1., Irrf e✓.M1 M.I I Pm.ran• ma nwnm en .. w.m w.a r• w• me na �eee�+m.lo .aK Saw, �`. F`INAL STRVCTJRE ,AS-BINLT 4 �W�'4 e..M.Y J, lw.a� 1•lYy Nal f •vlamM M AHaII wM) N n. 4121-S rL npu[vu:-uy. - Robert E. Johns, Jr. & Assoc. Professional Lond Survoyors Seale; 1 oO Rea. Lot S.F.: IRM. Pict "a,h J.. Data Surwyod Drawl bX Checkad by 4 r�Jr Date D awh 6-11-93 �E -704 W'D 93--076 • ' A eqa Dwariptlnrr {�, �)yYY 4t \<f,V 1 \ J C IPRUDHOE BAY AvL-. SURVEY TYPE ❑ AS-13U,ILT Cl PLOT PLAN ❑ LOT SURVEY ® RECERTIFICATION AS -BUILT 17t 35lORY FRI House 1D U111 ItY EASE ME r.i �o r / F \. \ b 5 r L F,ST 33'i3Lh1 Role nESEi=.�.=11ouI SYMBOLS' Q ELEVATION DRAINAGE a -Y 'AO06 FENCE �;- CHAIN LINK FENCE NOTE; FENCES ARE SHOWN IN THEIR APPROXIMATE LOCATIONS It. Is the responsibility o! the buitder or owner, prior to LEGEND hub Q toJ-found 0 set ■ construction, to.errfy proposed boddmg grade relative Iron rebor -found O set • to finished grade and utdrty connections and to determine iron pipe -found. O set O the existence,of any easements, covenants or- restrictions bross cpp -found set which do not appear on the recorded subdivisioa_ploi'• 4 alum. cop -found set L&SSUrveyCertlfication �s�OF Q %Jt Pre aredby I? o0 therebyccrhfyttvIhavesuv t �e�,.. .... I . BENCH PARK I N eyed thea tr.sh'*'^� �,f; /�A''. z_ s Professlonat Lond Surve ors Z 6-6329 desalted tereon, and fhol lte E17 �/?^{f1 ,mprove"nfs sttuoted thereon PC,,) X41' TFI• � •.;9ic Scale. .1"= 100' .. ;;. Drown by: BJH 3... donotoeerbpor encroach on ^',L { ..,�;' p Date Surveyed: Checked by: prcp .odtaceniertyvdthotho %..� .. ^- -24-83 DGM rr+proer,nnl six, 6djo,!erNDrsP';Ine.in� %«ei..7•.• / Date Drawn Grld; w0y, tri yo.erlop or encraachon rM t``' L , . - 3-24-8. p!sromfusnp,e.+ionf7d tnat w"s} ••• 41215:• . -. trnicbTroraod+oyt u+dny.-. ..` Q �, p•�,;......•'� i Legal DescrlptiOn: - .--'�V � � °. ,. rte•: hne5 a.dher nstrkraocrenU. �,' ek /Vf ` , - �. ,.IT a,'i soul propertyextxpt os .. - �>,V r - Lot 2 B r -.• . lock;'1; Juniper Valley Subdivision A 1 11,IVED a INSPECTION APPOINTME TS Sub TIME T - n ME NRP7 Delores Dr. ` 9 DATE DATE DATE wo ❑ Five 3 -D 83 INSPECTOR INSPEC R INSPECTOR INDIVIDUAL* Attache A well log is required for all wells drilled I^ ells drilled prior to that date, give well MUNICIPALITY OF ANCHORAGE ilable.) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 • ij 81 YEAR ON-SITE SYSTEM WAS INSTALLED. ENVIRONMENTAL SANITATION DIVISION j,. ee attached inspection report Telephone 264-4720 PA EAC� REQUEST BEFORE ROCESSING CAN BE INITIATED. REQUEST FOR APPROVAL OF INDIVIDUAL WATER ANDS CILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER PHONE Steven and Beverly Goff 694-3177 MAILING ADDRESS SR 2409 Eagle River Rd. Eagle River, AK 99577 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE Arthur and Tamea Isham 428-2000 MAILING ADDRESS 119-B Iliamna Ft. Richardson, AK 99505 3. LENDING INSTITUTION PHONE First Alaskan Mortgage & Escrow 694-4533 MAILING ADDRESS Box 1748 Eagle River, AK 99577 4. REALTOR/AGENT O Sharon Dunckle / Dynamic Realty, Eagle River h 6—�� hm MAILING ADDRESS P.. 0. Box 677 Eagle River, AK 99677 5. LEGAL DESCRIPTION Lot 2 Block 1 Juniper Valley Sub STREET LOCATION , NRP7 Delores Dr. 6. TYPE OF RESIDENCE R OF,BEDROOMS SINGLE FAMILYne ❑ Four ❑ Other wo ❑ Five ❑ MULTIPLE FAMILYhree ❑ Six AJun3yl 7. WATER SUPPLY INDIVIDUAL* Attache A well log is required for all wells drilled ❑ COMMUNITY i ells drilled prior to that date, give well ❑ PUBLICUTILITY / ilable.) 8. SEWAGE DISPOSAL SYSTEM IIN INDIVIDUAL/ON-SIT ij 81 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY j,. ee attached inspection report NOTE: THE INSPECTION FEE MU T ACC PA EAC� REQUEST BEFORE ROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) f "IF THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE El PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER El Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS — !� ❑ APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY 72-010 (Rev. 6/79) 1 �. --RECVED INSPECTION APPOINTMENTS TION TIME �flvti'',d4all TIME t M`E i \s"r�SINGLE DATE FAMILY DATE DATE TwoFive❑ MULTIPLE FAMILY - is r3 7 INSPECTOR �ZL INSPECTOR INSPECTOR COMMUNITY MUNICIPALITY OF ANCHORAGE PUBLICUTILITY DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION SEWAGEEDISPOSAL • 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION UTILITY Telephone 264-4720 NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFCESSING CAN BE INITIATED. REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER P MAILING ADDRESSrVPROPERTY RESIDENT (I different)rom above) 2. BUYER MAILING ADDRESS MPHONE 3. LENDING INSTITUTION MAILING ADDRESS 4. REALTOR/AGENT MAI LING AD UH ESS 5. LEGAL DESCRIPTION STREET LOC TION �flvti'',d4all 1'lli �L:) l-� �:6. TYPE OF RESIDENCEOFMS i \s"r�SINGLE FAMILY ❑ OneFour ❑ Other❑ TwoFive❑ MULTIPLE FAMILY ThreeSix7. WATER SUPPLY �ZL INDIVIDUAL* * ATTACH WELL LOG. A wrequired for all wells drilled❑ COMMUNITY since June 1975. For wellsior to that date, give well❑ PUBLICUTILITY depth (attach log if availab8. SEWAGEEDISPOSAL SYSTEM{QINDIVIDUAL/ON-SITE**`U YEAR ONTEM WAS INSTALLED.PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) pl _j -------- Ask Adk THIS SIDE FOR OFFICIAL USE ONLY v t, 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER =Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ElDISAPPROVED DATE / /''/) ,J BY 72-010 (Rev. 6/79)