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Home My WebLink AboutDEER PARK BLK 1 LT 6Onsite File The 1982 absorption f ield not be tested for a future 4 bedroom COSA. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201416 Work Type: SepticTank Upgrade Tax Code Number: 05104233000 Site Legal Address: DEER PARK BLK 1 LT 6 G:1558 Site Mailing Address: 22150 DEER CIR, Chugiak Owner: LUBECK BRIAN S Design Engineer: FORGE ENGINEERING This permit is for the construction of: Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: DeI)artment 10/7/2020 10/7/2021 40010 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: Prior to placing the tank, locate the edge of the field to confirm thatthe 5' ,separation between the tank and field will be met. _ _-- - 1z1/61 -ZD c o # � Ab -'a A �-«� �, -to pe(m t+ Received By: Date: 10/8/20 Issued By: Date: 3 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-042-33 Property owner(s) Brian Lubeck Mailing address P.O. Box 670436 Chugiak, AK 99567 Site address 22150 Deer Circle Chugiak, AK Legal description (Sub'd., Block & Lot) Deer Park, Block 1, Lot 6 Legal description (Township, Range & Section) Lot Size 40,010 Sq. Ft. Number of Bedrooms Day phone 227-2659 Three (3) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade 0 Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. 1 further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees:4M,W W V I b- I I Date of Payment: 4 d 0 0 Receipt Number:I dy`il906 Permit No. 0S /M � t (0 Permit App_'-'- : :-'-:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. November 30, 2020 MOA Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Subject: Deer Park, Block 1, Lot 6 —22150 Deer Circle Septic System Design Dear On -Site Services Engineer: The owner of the subject property intends to expand the house footprint and must replace the septic tank to a location a minimum of 10' outside the foundation. The absorption trench will also be replaced. We are submitting this application for a permit to construct a new septic tank and absorption trench. The attached site plan identifies the location of the home, the existing well and the proposed and existing septic system sites. No conflicts exist between this proposed septic system location and any other well or septic system, whether on this lot or adjacent lots. The ground surface on the lot is virtually flat with a slight slope to the southeast. Ground contours are shown on the site plan indicating the grade and direction of flow. Stormwater drainage will not impact the proposed septic system. The new trench will be constructed parallel to the slope as much as possible. The new system will be a minimum of 1.00' from all wells and 100' from surface water and more than 5' from the septic tank. Please refer to the attached plan sheet for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, OF {4� 49 th rt�icHaEL F. AP»[RSGN jROFE5 S �M Michael E. Anderson, P.E. � f EXISTING�WELL f� ' l r DECOMMISSION EXISTING SEPTIC TANK PER U.P.C. 1= EXISTING ABSORPTION TRENCH TO REMAIN IN SERVICE. IT MAY / NOT BE TESTED IN THE FUTURE FOR A 4 BEDROOM C.O.S.A.,;—, x 63' LONG x T WIDE x 6' EFFECTIVE DEPTH` ABSORPTION TRENCH. YTH1 JENNI RS L.OT2� MT co NOTE: CONTOUR INTERVAL'5'. WELLS ON LOTS TO THE SOUTHWEST ARE GREATER THAN 1 00'FROM THE PROPOSED SEPTIC SYSTEM. eNcir+ O � E; PROPOSED HOME�ADD)- _.' ! z 1,250 -GALLON SEPTI t' TANK w/20" MANWAY w 200 < yo ALTERNATE SITE I LOT 6 1 LOT 5 1 �r NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. 0 50 100 Wm FEET 111=50' LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEAN( FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE DESIGN FACTORS: SYSTEM REQUIREMENTS: 600 GPD PEAK FLOW 6' EFFECTIVE DEPTH ABSORPTION TRENCH PERK RATE: 10.1 MIN/IN 1,250 GALLON SEPTIC TANK APPLICATION RATE:.8 GPD/SF 600 GPD /.8 GPD/SF /6' DEEP / 2 SIDES = 62.5 LF TRENCH REQUIRED (63 LF SPECIFIED) BOTTOM OF TRENCH: 10.0' BELOW GRADE FLOW LINE ELEVATION: 4.0' BELOW GRADE TOP OF TRENCH: 0.5' ABOVE GRADE �� LE FABRIC RATED PVC (HOLES DOWN) TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE T OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY o 01 i i E N G I N E E R I N G °• 49th •�: MICHAEL E. ANDERSON NO. CE -4381 •••'' 12/16/20 .••t 2O'•............••...• . ils!'ROFESS\Qt®m SOILS LOG AND PERCOLATION TEST E N G I N E E R f N G LEGAL DESCRIPTION: DEER PARK ESTATES B I L6 PERFORMED FOR: BRIAN LUBECK DATE: 11/6/20 PROJECT No.: PARCEL ID#: 051-02-33 TECHNICIAN: J. MILLETTE DEPTI-1 TEST HOLE 1 (feet) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 •: GP (SANDY GRAVEL <1 MPI) r ' • ) GM ( SANDY SILTY GRAVEL) SLOPE COMMENTS: DATE READING WAS GROUND WATER ENCOUNTERED? NO NET TIME (MINUTES) DEPTH To WATER (INCHES) NET DROP (INCHES) IF YES a WHAT DEPTH? - L 1 11:53 DEPTH TO WATER AFTER MONITORING: NONE 0 3 -s 2 DATE OF MONITORING: 11/17/20 P 3a/514 2is 3 E 30 3a/513 216 COMMENTS: DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH To WATER (INCHES) NET DROP (INCHES) 11/6/20 1 11:53 30 36 / 6 0 3 -s 2 12:25 30 3a/514 2is 3 12:56 30 3a/513 216 PERCOLATION RATE: 10.7 (MIN/INCH) PERC. HOLE DIA..6INCHES) TEST RUN BETWEEN: 5 FT. and 6 FT. ~~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street o Anr. hnrage, Ala~ka 99501 Telephnn~ 2~720 ON~ITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAILING ~ESS LEGA~ESCRIPTION - LOCATIO~ NO. O¢ BEDROOMS DISTANCE TO: ~ Well Building f~ndatlon Nearer lot line ~ DISTANCE TO: ~ Class Depth Driller Distance lo lot line PERMIT NO. OTHER SOIL TEST RATIN~ 724)13 ( ev. 3/78I PERM I T ~PPLICSNT LOCSTION LEGAL NORTH I.iESTS CORNER LOT 6 EJ, I DEER PARK SUE SRA 14142 ANCHOF:AGE LOT SIZE 40010 SOURRE FEET TYPE Of SOil RE:SORPTION ~- .c :,Y_,TB'I IS: TRENCH MP~-.'ir.lur,1 NLiMBER OF BEDROOMS SOIL RRTING <SO FT?BR>= 2S0 THE REQUIRED SIZE OF THE SOIL AE~OF. FTIOr~ SYSTEM IS: DEF'TH-- -1¢~ L EI'-.t rJ TH = E:4 P~ R R'-,-' E L DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRINFIELD. THE DEPTH OF A TRENCH OR FiT IS THE DISTANCE BETHEEN THE SURFRCE OF THE GROUND AND THE EOTTOr,1 OF THE EXCAVATIOH <IN FEET>. THERE IS NO SET I,IIDTH FOR TRENCHES. THE GR~VEL DEPTH IS THE r,IlNIMUr,I DEPTH OF GRS'¢EL BETI,IEEH THE OUTFALL PIPE AND THE BOTTOM DF THE EXCA?STION (IN FEET>. F: E t-~. LI I RED_'=,, E P T I C T R r-.I I< _-'=- I ---~' E--' = lEtO0 G i::1L L I3 I',.I L~. PERMIT APF'LICRNT HRS THE RESF'ONSIE:ILIT'~ TO INFORM THIS DEPRRTMENT DLIRING THE INSTRLLRTIOr; INSPECTIONS OF ANY I,{ELLS RDJRCENT TO THIS PROPERTY AND THE NUMEER OF RESIDENCES THRT THE I,~ELL I,IILL SERVE. TFIO <2;, IblSPE~;TIObl--c, '.RRE REQLIIRED BRCKFILLING OF RNY SYSTEM I,IITHOUT FINRL INSPECTIOH RtlD RPPROYRL BY THIS DEPRRTt'~ENT I,~ILL BE SUBJECT TO PROSECUTION. MINIMU~,I DISTANCE EETI,JEEN A I,~ELL AND RHY ON-SITE SEI,IRGE DISPOSRL SYSTEM IS i0£~ FEET FOR A PRIVATE I,tELL OR 150 TO 200 FEET FROr,1 R PUBLIC I,~ELL DEPENDING UF'ON THE TYPE OF F'UBLIC I,IELL. MINIMU~,I DISTRNCE FROM R PRIVRTE I,IELL TO A PRIVRTE SEI.IER LINE IS 25 FEET AND TO R COMMUNITY SEI,IER LINE IS 75 FEET. OTHER REOUIRE~IENTS HRY RPPLY. SPECIFICATIONS RND CONSTRUCTION DIRGRRHS RRE R',,"RILABLE TO INSURE PROPEP. INSTALLATION. PEF.'r'I I T E>-'.F' I RES [:,ECEr'IBER _.~:.-1., I CERTIFY THRT 1: I Rt,1 FRMILIAR I,IITH THE REQUIREMENTS FOR ON-SITE SEI,IERS AND I,IELLS AS SET II ' FORTH BY THE M_tllCIPALIT~ OF ANCHORAGE. 2: I I,IILL INSTRLL THE SYSTEM IN RCCORDRNCE I,IITH THE COE~ES. '~-_.: I UNDERSTAND THFtT THE ON-SITE SEI,IER E. YSTE~,I ~IRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS S I GNED: ........................................ RRPL I CANT DONR MORRISON V4. 0 ., .....t Hl r:iour ;'{l'c'~..[l'l-;_~:.;,..:rlON ?i;.D F~-:.-'.'~,rcN ~"/ rill5 O & E ENG,NEERING & DEVELO,,VIENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Rustell Oyster 694-2774 Pedormedfoc Legal Descrtptlon: Depth(feet) 0 1 2__ 3__ 4 8__ 10__ 11 12 13__ 14 ,15 16. Name: /~'~ Malling Address: Soil Characlertsllca SOIL LOG /. Earl EIIIo 688-2280 PLOT PLAN PERC. TEST I*li -*~ Or ~1 · ' " .'T~-~..."';'. ~v-... A '". ~ 'l. Or~'und Water Encountered: Yes__ No /If yes. what depth ~ ~y Proposed Installation: S~page Pit Draln Field ~ ~,-.'"."*~ ..... Comments: "~ ~ ~,~j'. .... ..'X~%~ Pedormed by Date: ~O '2, ,IS"' ~V~-W DRILLING, Inc. P. O. Box 4-1224 · 1310C International Airport huad (907) 274-46! ] ANCHORAGE, ALASKA 99509 DRILLING LOG Well Owner Dana & Terry Morrison Use of Well Residential Location (address of: Township, Range, Section, if known; or distance main road Lot 6 Block 1 Dear Park Estates Size of casing 6" Depth of Hole Static water level 20 ~t. (~'~) Screen ( ); Perforated ( Describe screen or perforation N/A Well pumping test a~ 18 gallons per of drawdown from static level. Date of completion October 30: ] qg ~1 feet Cased to 6.0 feet (below) land surface. Finish of well (check one) ). open end ( X ); (minute) for ] hours with WELL LOG ~epth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 TO' ? TO 3 TO 8 TO 29 .TO 35__TO TO. TO .TO TO .TO .TO TO .TO TO 2 Casin~ 29 Sandy Gravel 35 41 'Gravely Hard Pan Sandy H20 Gravel (15 GPM) 1 --CUSTOMER 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-042-55 1. GENERAL INFORMATION HAA# 030454 Expiration Date: I '7- o Complete legal description DEER PARK ~3f~.~ SUBDIVISION; LOT 6, BLOCK 1 Location (site address or directions) 22150 DEER CIRCLE * CHUGIAK, AK 99567 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address TERRY & MICHELLE FOREMAN Day phone 688-3807 P.O. BOX 770186 * EAGLE RIVER, AK 99577 Day phone Day phone 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 · Individual Water Storage I'~ Individual Holding tank [-'] Community Class Well r'-] Community On-site [~ Public Water System [~ Public Sewer D The Municipality of Anchorage DeveloPment Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given' in paragraph 4 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 samples. (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. Leg~l ~;SCrJption: 'uni ipality Of iVl c Anchorage Development-- SerVices Department.. '. ...... , Building Safety'Division ' .!. ,~! ,r i', On-Site Water & Wastewater Program ' . 4700 South Bragaw St. . P.O: BOX 196650 Anchorage, AK 99519-6650 ~ · , "; : : . Www.ci.anchorage.ak.us :~I : .,' ' ~'i (907)343-7904 ,FiEALTI-:I / UTHORiT, 'ApPROvAL CHECKLI'ST ,,I, ;. ,. ! !,:;:; !:i: ~DEER JPARI~ iESTATES 'S/D; LOT' 6, BLOCK 1 ., ;,Parcel ID: 051-042-33 We t ': PRIVATE: ! ~'C P 09ldo I~WSID# N/A ' ":'!i":: .' ' W~ll Log (Y/N). YES Date completed 110/30/1981 ,Sanitary.seal (Y/N) YES : ,: ( -YES , ~ '~ :. , . ...... Wires properly protected Y/N) ,I~: ',!i~' ' ,~ ~ '~ ~ .', ~ ': :~ : :;":;~ '~ '~ : ~ .' ~ '~?~': : : ' Totaldepth w~' ~. :: ,~ ;~'~:;CaSedto,~:~;40 ~.~r ; ', ~ ,, Casinghei~ht(abO~eground) 12+ ,in. ": 'tli~:~" ~ 'j t FROM WELLLOG~;,.' ;" ~ ' "f =::~' AT INSPECTION ;; . . Wellproducbon .. ; : ~,' -',18 ..~ ~.,~g.pm.-r , ~ .~::, 4.12 ~ ,, ~ - ~.D.m. WATER SAMPLE RESULTS.., . i ......... ~ Col form ~:: ' : colonies/lO0 ml ','" [ Nitrate 0:26 mo/U~ .... ' Othe¢'b~cteria'f ~ colnni~/18n . ~ ! ~ ' ,,[ ; ' ~ ~ ' ~ / · Ars~nic~ :i:,N/A mg./L.. ~ ' ": ~, 'Date'~fsa'mplb: 7~.14Z2003 ColleCted b~ ''.~ AK~C, INC; I ', i L .... ~ ' '' ' ~ ~"' ' ' ' ' ' ' B.' SEPTICIHOLDING TANK DATA :.; ;.' .,'~ . ": : N :C~WLSPACE .:~ Tan~ ~yp~/Matenal ~: t ;l~ ~ , ' ~ .~ 'i ' Date lB?tailed ~ '; 6/28/1982 ; t ;?.. · . . :' ." i; ~'.:':.. '~ , r ' '~. ~ ' ' .,;: ! j; ,, Tank s~ze .... ---- gal. ; Number,of Compadments .,~ .' , Cleanouts (Y/N), YES FoundatiOh cleanout (Y/N) 'YES., Depression bver tank:(Y/N): NO ' H gh w~ter a arm (Y/N) D¢~b~of p, Umping~ b/z~/zuu5 ?;:i i[Pu~per ';. ' ~ ~;, :: . dR 5~PUMPING ' ' EXISTING GRADE '.,' ...... C. ABSORPTION FIELD DATA~ ,: ~. . ~ .......... ' · , ~ ' ,:' .. ,': iLIQUID~ L~EL1 FOOTi BELOW INVERT :, SEE ,A~ACHED L~ER Date'installed 6/28/1982 :~ Soil ,tipg~ p:d./ft~o~).280 ' 'S~Ste~':type .. TRENCH ~ .... , ~ ........ Length!~,l: 86 i fl..,... ,.... ,,:W,dlh ~~3 %~'~; fl. · Gravel belowp,pe . 6 ff. Total depth . *9.5 :iff. Eft. absorption ar~ a A 008 fl ' Monitoring tube**YES; ~,Depression over f eld NO Dat~'of:adequacytest 6/21/2002.,:f :;. ResUlts(Pas~/Fai) PASS ' ;;.~, ;.-.~:.:-, For 5' bedrooms Fluid depth in absorption field before'.tes :;lO~:!in. ;. ¢ .water added 845 gai;..: ~:: New depth**25 in ElaPsed Time: ~ u 'min.' ? ' : ' 'Fin~l'flJid jepth i! 21 n...J '~: Absorpt o~ 'r~te >= 450+ ~ o d , , I , , ...... , ~ ,~,, ,. , ~, ~ , ,, : ~ .... Any rejuvenabon treatment (past 12. mo.). ¢ N & typ)e ....r . ~ ',tNONE KNOWN. ' .... ....~lf yes._ ~ive date - , , , . , ,.,; F, ~1" ~ ', ' , ~ '' . , : ' mmm 02-09-04 07:55AU FROU-CT&E ESI, SGS ENV SERVICES mmm Nmi Imm ~ 9075615301 SGSICT&E ENVIRONMENTAL SERvicEs Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON ~E 81DE I~EFDRE COLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPLIER E] PUBMC WATER 8YI~TEM ID~ , '~PRIVATE WATER SYSTEM PHONE: 337-6179 FAX: 338-2 246 3701 E~ Tudor Rood. Suile 101 Anchorage. Ak~ 99507 T-283 P.01/01 F-354 2OO W. POTi'ER DRIVE ANCHORAGE, ALASKA 99518 Tel: 907-562-2343 Fax: 907-561-5301 Lab Re~ Ne. 0 Sa.d Ream 3701 E. Tudor Rc~d R,,it~ Anchora e. Alask 99507 SAMPLE COI [FCTION: Tranmpofted to Lab e~ ~,Same as collector Other:., TO BE COMPLETED BY LABORATORY Sample Receivlnn: Temp: I~ v'~,*-- C~I ~=~ [] 4a HourWa~er Delivery Method: ~-~ iA't/_~'3 ~'Routine [] Treated Water [] Repeat Sample ~Untreated Water · (refer to lab no. .) [] Special Purpose Phone Fax #: [] RuSH SAMPLE. Bac~erio!o,qical Y,'aier Aqalvsis Record:' Analytical Method: · ~bmne Filter · [~ MMO-MUG (P/A) Reported By: :' MMO-MUG {PLA) REBULTa: T~ Coliform: E. Cd~ MEMBRANE FILTER EEsULTa: Veflllcatim: T,~ ~ r-LTB: FBK JUN Data/Time: ii ' C~mi~/100mL IDate/T~ma.' ,, ~t~fam6~ ~ 'Unsatisfa~o~ t~.~tm~ublic~)OCUMEN'T~ORMS~licro~,o{i F~rn l'21703.xls Form t FW- 0053 12/17/03 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us . (907) 343-7904 Parcel I.D. 051-042-33 1. GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Expiration Date: Complete legaldescdption DEER PARK ~ SUBDIVISION; LOT 6, BLOCK 1 Location (site address or directions) 22150 DEER CIRCLE * CHUGIAK, AK 99567 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address TERRY & MICHELLE FOREMAN Day phone 688-3807 22150 DEER CIRCLE * CHUGIAK, AK 99567 Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ~ Individual Holding tank Community On-site [~ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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 samples. (Cedificates may be reissued for a pedod of up to one year with valid water samples.) Cedificates 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. Note:Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or pdor ] to closing for the engineering services provided. I 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal afl?xed 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 heroin. I further vedfy 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 ALASKA WATER & WASTEWATER CONSULTANTS. INC. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS. P.E. Date 557-6179 Engineer's Comments: In conducting this evaluation, AKWI/VC, Inc. attempted to provido a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identitiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the solo benefit of the owner listed above. Any relianco upon or use of this report by any other person or party is not authorized, nor will it confer any Iogal right whatsoever. DSD SIGNATURE Approved for ,.~ Disapproved. Conditional approval for bedrooms. bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety ONIsion On-Site Water & Wastewater Program 4700 South Bragaw 6L P.O. Box 196650 Anchorage, AK 99519-6650 www,d.anchorage.ak.us (907) 343.7904 Legal Description: A. WELL DATA HEALTH AUTHORITY APPROVAL CHECKLIST DEER PARK ESTATES ,,S/D; LOT 6t. BLOCK I Parcel ID: 05!-042-55 Well type pRrvAT[ If A, S, or C provide PWSID~ N/A Date completed 10/50/1981 Sanitary seal (Y/N) YES Toteldepth,, ,41 ~ Casedte,, 40 ~ Date of test Static water level Well production 18 WATER SAMPLE RESULTS: FROM WELL LOG lo/ o/ 9B 20 Coliform 0 colonies/100 mi. Arsenic N/A mgJL. SEPTIC/HOLDING TANK DATA Tank Type/Material ~ g.p.m. Well Log (Y/N) Wires pmpedy protected (Y/N) Casing height (above ground) AT INSPECTION ,., 6/21/2002 32 .ff. 4; 12 ,. g.p.m. YES YES 12+ in. Nitrate 0.26 mgJL. Other bacteria__ Date of sample: 7/! 1/2003 Collected by:. · IN CRAWLSPACE STEEL Date installed 0 colonies/100 mi. AKWWCt INC. 6/26/ 962 Tank size ?_000, gal. Foundation cleanout (Y/N) *YES Date of pumping . 6/25/2003 ABSORPTION FIELD DATA Date installed 6/28/1982 Length 86 .ft. Number of Compartments 2 Depression ever tank (Y/N) ,,NO Pumper .... *BELOW EXISTING GRADE Cleanouts (Y/N) YES High water alarm (Y/N) _ N/A JR'S PUMP, lNG **UQUID LEVEL I FOOT BELOW INVERT - SEE AFl'ACHED LETrER rating (g.p.d~ft=o(~)) 28_.._~0 System type Soil TRENCH Width ,.3 lt. Gravel below pipe 6. Total depth '9.5 , ft. Eft. absorption area 1008 ft= Monitoring tube,*'YES Date of adequacy test _6/21/2002 Results (Pass/Fall) PASS Fluid depth in absorpflon field before test t0 in. Wateredded 6~45ga1. Elapsed Time: ,10 min. Final fluid depth 2~ in. Absorption rate >= Any rejuvenation tmatrnent (past 12 mo.) (Y/N & type) NONE KNOWN Depression over field NO For 3 bedrooms New depth**.25 in. 450+ g.p.d. If yes, give date. - D. LIFT STATION Date installed "Pump on" level at ~ ~ Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Fo Size in gallons ~ in. "Pump off' in. High water alarm level at Septic tank/lift station on lot100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N,/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO'. Property line I G IJi- Water service line 10'+ Curtain drain NONE KNOWN COMMENTS N/A Building foundation 10'+ Surface water 100'+ Wells on adjacent lots. 100'+ G. ENGINEER'S CERTIFICATION I certify that I 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. Absorption field 5'+ Surface water 100'+ JEFFREY A. GARNESS Water main N/A Driveway, parking/vehicle storage I 0'+ SS." Engineer's Printed Nam~ . Date f~ /2. ~) /o.~ in. HAA Fee ' Date of Payment ¢~ - · O,~ Receipt Number ~ (1:~. 12~Ol) Waiver Fee $ Date of Payment Receipt Number ALASI WATER $ WASTEWATER CONSULTANTS, INC. August 27, 2003 Municipality of Anchorage Development Service Department Building Safety Division On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Reft Additional pipes added to septic system for Lot 6, Block 1, Deer Park Estates Subdivision To whom it may concern: Per the request of the owners of the referenced property, a site visit was performed to obtain current water samples and check the liquid level in the drainfield in order to renew the Health Authority Approval. During our site visit, the liquid level appeared to be above a assumed invert. Elevation shots were taken and found the liquid level in the drainfield to be well below the liquid level in the septic tank. The monitoring tube for the drainfield is at the beginning of the drainfield, therefore we recommended that a new monitoring tube and cleanout be installed at the end of the drainfield. At the beginning of August of 2003, the owner installed new double cleanout after and had the line snaked and traced in order to find the end of the drainfield. Once the end of the drainfield was found, the owner had a new cleanout and monitoring tube installed. Also, the owner had the distribution lines jetted by the pumper during the snaking procees. On August 14, 2003, the liquid levels in the drainfield were checked and found to be at 2 feet below the invert of the distribution line. Based upon this reading, the data from the septic adequacy performed on 6/21/2002, should still be valid and we request that an updated Health Authority Approval be issued. If you have 7Y~uestions, please contact us at 337-6179. Thank you for your assistance. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com _ ~R~-4566 .q~.t-'ilitrl &. ACL'I' 'fi'T~e I 4t','~ ~,.,,o,.~ Municipality of Anchorage ~_.~{.. Development Services Department Buitding 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 Parcel I.D. 1. CERTIFICATE OF HEALTH AUTHORITY APPROVAL' FOR A SINGLE FAMILY DWELLING o51-o42-33 HAA~ Complete legal description DEER PARK ESTATES SUBDMSION; LOT 6, BLOCK 1 Location (site address or directions) 22150 DEER CIRCLE * CHUGIAK~ AK 99567 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address DANA CHURCH[L Dayphone.688-0472 22150 DEER CIRCLE * CHUGIAK, AK 99567 Day phone. Day phone Unles$otherwiserequested, HAAwillbehe~byDSD~rpick~. 2. NUMBER OFBEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ~ Individual Water Storage Community Class Well D Public Water System II TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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 samples. (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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ ! ~,~ ~ at, or pdor to closing for the engineering services provided. 4, STATEMENT OF INSPECTION BY ENGINEER As ceA*fled by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Health Autho#ty 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 bedmoms and type of structure indicated herein. I further vedfy that based on the information obtained from the Municipality of Anchorage §les 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 installaEon. Name of Firm ALASKA WATER &: WASTE-WATER CONSULTANTS. INC. Address 6901 DEBAER ROAD, SUITE 2B * ANCHORAGE. AK 99504- Engineer's Printed Name JEFFREY A. GARNESS. P.E. Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provfde a thorough, conscientious enginee#ng analysis cf the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results desc~fbed the performance of the system under the conditions encountered at the time cf the test, and separation distances measured to readily identifiable features. The operational life of ali wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the eva/uator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. can therafora not provide any warranty or future estimate of how long the system wi//continue to meet the operatiohal requirements of the ADEC or MOA DSD. The content of this repor~ is for the so/e benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorfzed, nor wi//it confer any legal ~fght whatsoever. Phone 337-6179 Date '"J ,/~ ~0 ~ ~,' · ....... DSD SIGNATURE ~ Approved for -~ Disapproved. Conditional approval for bedrooms, with the fllowing stip~: ON-SITE ~.-' WATERAND : r~ ~ . WASTEWATF-R : % · PROGRAM ,' Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Municipality of Anchorage Development Services Department OmSlte Water & Wastewater Program 4700 Soulh Bmgaw SL P.O. Box 196650 Anchorage, AK 99519-6650 w~wv.ct.anchorags.ak.us (;07) ~43-7;04 Legal DescflpUon: WELL DATA Well type mag HEALTH AUTHORITY ~,PPROVAL CHECKLIST D~.~.~ PARK ESTAm'r.~ S,/D; LOT 6t BLOCK 1 Parcel ID: 051-042-33 If A, S, or C provide PWSID# Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 6/21/2002 32 fl. 4.12 g.p.m. Date completed 10/50/1981 Sanlta~/seal (Y/N) YES Total dept~ 41 ft. Cased to 40 lt. Date of test Static water level Well production WATER SAMPLE RESULTS: FROM WELL LOG lO/3O/198' 20 It. 18 g.p.m. Coliform 0 colonies/100 mi. Arsenic: N/A mgJL. SEPTIC/HOLDING TANK DATA Tank Type/Material Nllrate 0.254 mgJl.. Other bacteria Date of sample: 6/25/2002 Collected by: *IN CRAWl. SPACE Date installed 0 colonies/lO0 mi. AKWWCt INC. 6/28/1982 Tank size 1000 gal. Foundation deanom (y/N)tYES Date~pumping 6/21/2002 ABSORPTION FIELD DATA Number of Compartments 2 Depression over tank (Y/N) NO Pumper Cleanouts (Y/N) High water alarm (Y/N) JR'S PUMPING Date inatalk~l ~ Soil sting (g.p.d./ft;o(~)) 280 Langlh 86 fl. Wid~ 3 It. Total depth 8.4 fl. Eft. absol~fion area 1008 ft= Monitoring tube Date of adequacy test 6/21/2002 Results (Pass/Fall) PASS Fluid depth in absorption field before test ** 10 in. Water added 845 gal, Elapsed'rime: 10 min. Flnalfluiddepth 21 in. Absorpfionmte>=. Any rejuvenation treati'nent ~ast 12 mo.) (Y/N & type) NONE KNOWN *SUMP ONLY EXTENDS 31" BELOW *'21' BELOW INVu<~ N/A System type TRENCH Gravel below pipe 6 fl. Depression over field NO For 3 bedrooms New depth 25 in. 450+ g.p,d. If yes, give date -- D. UFT STA'RON Date installed Size in gallons ~~ _ "Pump on" level at in. 'Pump off' n. High water alarm level at ~ in. ~ Cycles tested. Meets alarm & circuit requirements?. Septic tankaifl station on lot Absorption field on lot Public sewer main Sewer/septic sewice line Property line *UNKNOWN Water service line 10'+ Curtain drain NONE KNOWN F. COMMENTS E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ I00'+ ./^ 25'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots I00'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundaUon 10'+ Surface water 100'+ Wells on adjacent lots 100'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/deanout N/A Holding tank N/A Absorption field 5'+ Surface water 100'+ Water main N/A Driveway, parking/vehicle storage 10'+ I certify that I 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 Pri~ed ~ame Date ~7/~/OZ. · JEFFREY A. GARNESS Waiver Fee $ Date of Payment Receipt Number G. ENGINEER'S CERTIFICATION THERE IS NO CLEAN-OUT g} THE $8' SEGMENT OF THE DRNNFIELD. 10°+ TO PROPERTY UNE PER 1982 INSPECTION REPORT. ALASICt~ WATER & WASTEWATER INC ~ .... CONSULTANTS ....... i $ SEPTIC ADEQUACY TEST DATA ST~ETADD~SS: ~%19o ~ ~tc~ ~I,IE~: ~% ~kot~kfX~ PHONE NUMBER: ~g~-~ ~BER OF BEDROOM: ~ G~LONS PER DAY ~EDED: SE~IC: *SEE H.A.A. SITE ~SIT CHEC~IST* DATE OFTEST; FIELD MEAS~EME~S: TOP OF ~T/SDP TO ~OGOM: ~0 · ~T1) / . ~) TOP OF ~T/S~P TO DIST~ION L~: H~~' ~TI) / (M~) STICg-D OF ~T/S~:. 20 ~TI) / ~} TOP OF ~T/S~ TO LIQ~ LEVEL: gLo (MT1) / ~) M~"I'ER NUMBER OF SEPTIC TANK MT/SUMP RISE (+) I 'I~IE READING GALLONS LIQUID LEVELLIQUID LEVELFALL{-) !o'.~o i~~ cuI ~. / ~ ~ ~,, h~, / t :-z.¢- Io '~ to ~1~/¢~ ~ ~" -~/~S'~ ASSED ABSORBED GALLONS IN MINUTES ( GPD) FAILED - SEE ATTACHED LETTER Signature: Date: 6~1 Deba~r P,~d. Suite 2-B * Anchorage. Alaska 99504 * Ph: {~07} ~7-6179 * Fax: {907) 3384246 * awnvs/~alaska.net MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 A~chorage, Alaska 99519-6650 343-4744 ParcelI.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 6; Block Location (site address or directions) Property owner Mailing address Lending agency Mailing address 22150 .1o6~h Lochn¢,~ C/0 storz FcJu~ R~.oc~on Day phone 688-4857 FcJu~ Plaza, Bloorm~.nqton Day phone Agent Address Day phone 2. NUMBEROFBEDROOMS: 3. TYPEOFWATERSUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well XY, X Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site XY, X Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 6171~, 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verity 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 verity 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 ENGINEERING Name of Firm ~-7-n?- -==;!: ~?:;; '.-~p =,..J :;,,. ;.~ Phone ~' ~1',./ _ 3-q 7 ¢/ Address E~jle River, Alaska ~g$77 Engineer's signature ,---~.,-~'7/~/. t/~.~-.- Date 5'-/~; / ~ C / DHHS SIGNATURE ,X Approved for -~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date ..0'-- / 7 - ~'~ The Municip,~lity 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 profe.",sional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SERVICI~N~,,~Ty c~ ~ Environmental Services Division 825"L" Street, Room 502 · Anchorage. AlasKa 99501® (907) ~N/~ SL~WCeS C t/AY 0 ~ 1996 A. WELL DATA Well type ~ ~eq.~_ If A. B. or C. attach ADEC letter. ADEC wafer .system number Looo present ~)N) TotaJ dcpd~ ~ t * Sanita~.' seal (~ Date of lest Static water level WeU production WATER S,ANWLE RESULTS: Date complctcd C_.ased to Jao~ FROM Wr:~ ~. LOG Casing height (abov~ gmumi) t'~.'~ ¥ Wi~es pn:~mrly pmtm'tcd~N) ¥ AT INSPECTION ~ T,t~ · g.p.m Cot~onn ~ Nitrate I, / 7 Dateof~mpi¢: J~-t~-~,(,,/4.-a.q-](, CoUectgdby.: snmc ou o TA. DATA S & S ENGIN~RING 17034 Eagle River Loop ROad NO. 21M. Eagle River, AJoska 99~77 Dateinst~cd t-.-7..e'~"L. Tanksize ~ooo NumberofCompartmcnts. '7-- Cleanouts~N) L/ Date of Pumping q .'~'.,-+1 i, Pumper ~ Peroxide 13'eaunent (.mrs! 12 montbs) (Y~ A.) U'yes, give dal~ D. LIFF STATION Date installed Size in ~110~ Manlmlc/Acccss (Y/N) ~" ' t* 14~gh water alarm level al* ~ ,~a E. SEPARATION DISTANCES SEPARAT{ON DISTANCES FROM W~I.I_ ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sc. wet mniu Sewer/septic scndce line ; On adja~nt lots ; On adjaeenl lots Public ~ew~r nmnholc/cleanout Lift ~tion ,'VIA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~. t ~. ~ linc t ~ xJ'' Absorption field Wa~rmnin/servimlin~ ~pt~. Surfaeewnter/d~i~e ~o~~4'' WeHs on adjacent lots SEPARATION DISTANCE FROM ABSORPTION ~ ON LOTTO: Building foundation ~ o x ~'' Water maln/mrvic~ linc t o ~ 4- Surfa .cc water ~1~,0 t~' Drive~ay. parking/vehicle storage a.-za ~-"0 Curtain drain ~- Wells on adjacent lots t. oo *.4- Prope~,.' line K Jr- ENGINEER'S v,.:KKTIFICAT1ON ------'-- E,~"sNa.~ ,~',,~cer C. C~,,~ ~..~s~.~,,.~.-~ % ~'~.~.. .., -,., ~:i~:" f *J~'-'..:': *"* ,, ,. '_:*~::,. Wa~,gr Fee $ Dam of Payment Receipt Number 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 HAA # 1. GENERAL INFORMATION Complete legal description e e Location (site address or directions) Property owner Mailing address Lending agency Mailing address £5150 P¢e~c CZ,~c~e Gene $a~o6 Day phone Day phone Agent NANCY STAH£Y/ A~o~ P~ope.~,J.e.6 Day phone Address P.O. Box 671955 ChupZ~E. AK 99567 Unless otherw~erequeste~ HAA willbe held forpickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 6gg-4959 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: If community Wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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 17034 Eagle RNer Loop Ro~d No. 2~4 Name of Firm Address Engineer's signature ~HI-;S SIGNATURE ..~'~ Approved.for '-~ Disapproved. ~ Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: The Municipality of Anchorage Department of Health and Human Servlces (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality 'of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~...-','r' L, ~.4z. ~, '~ ~.-¢.-.- Parcel I.D. A. WELL DATA Well type ~2¢.~q~,,~ Log present {~YN) '~ Total depth ,Z~ ~ Sanitary seal (~N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~,o o 5~ - ~St Driller Cased to z¥~ ' Casing height FROM WELL LOG AT INSPECTION Static water level .... Well flow Pump level ~,~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot ~ 0~' ; On adjacent lots Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: '~'"'-' B, SEPTIC/HOLDING TANK DATA Date installed ' ~""Z'°~ .~'Z.-- Cleanouts ~TN) High water alarm (Y,~) Date of pumping Nitrate Collected by: Other bacteria S & S ENOINEIERIN~ E~gle River, Alaska Tank size ~ oc>o Compartments. '7.-- Foundation cleanout {~N) \[ Depression (Y~) Alarm tested (Y/N) ~.~cc. r,!.,?, ,~- ,~,*. :,., _ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \ o c>~ On adjacent lots' To property line ~ ,~ ~ .,t. Absorption field Surface water/drainage ~ c, ~ Foundation Water main/service 72-026 (Rev, 7FJI) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level Meets~MOA electrica~ SEP~TANCE FROM LIFT STATION TO: W~II on lot On adjacent lots Manufacturer "Pump on" level at ~."~- "Pump off' ~level at ~ Cycles tested Surface water D. ABSORPTION FIELD DATA : ~Dat6 I~stalled t.~ -- '~ - ~'z-.-- Soil rating "~'~'~ ~'~"- System ~pe ~ * ,~ Length ~' ~' Width Gravel thickness ~' Total depth ~ ~ ' Total absorption area [ ~3 ~ ~ Cleanouts present ~N) ~ ~ Depression over f e d (Y~ Date of adequacy test ~- I~- ~ ~ Results~fail) ~ ~ for ~ bedrooms Peroxide treatment (past 12 months)(Y~ ~ ~ ~ If yes, give date ~ On adjacent lots Surface water Curtain drain Wellonlot ~o~ To building foundation SEPARATION DISTANCE FROM ABSORPTION FIELD TO: .. On adjacent lots ~ oc~ ~ ,t- Property line ~ ~ ~ TO existing or abandoned system on lot Cutbank ~'~ [-,~- Water main/service line Driveway, parking/vehicle storage area * E. ENGINEER'S CERTIFICATION ,.,,*, I certify that I have chec~ed~ied, or conformed to all MOA and HAA guidelines in effect ~n th~ dat~ of this inspection. '/1 / . Signature : . ,.- :, ~' .. . ~,. . 1~ Eagle RI~ L~ R.d ~/_ //~~~:. :--~ ~ · HAA Fee~ //'~ Date of Payment 5"-~/,,,~ --~_:~ Receipt Number ,~/-~'cO Waiver Fee: $ Date of Payment Receipt Number / MUNICIPALITY OF A~CHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot. block, subdivision, section, township, range) Location (address or directions) (b) Prope~owner AEFC ~ 38447 Telephone: (home) ~ ~ 702-3E5-22 " Mailing Address CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING .Business (c) Lending Institution Mailing Address Tel~phone (d) Real Estate Company and Agent R~./J{~Jc o1~ E~tg~.~ I~v~ Al'TN: S~on ~ Address 16600 E~Z~d O~u~ ~201 E~Z~ ~u~, A~. 99577 ~-' Telephone 694-4200 ~ : (e) Mail the HAA to the following address: (or check here EX if hold for pick up.) List contact person and day phone number below: -. S & S ENGINEERING ~iu,~ F. agle ~h,m L~,~, ;~-' Eagle Rlve~, Alaska 2. TYPE OF RESIDENCE 'Single-Family [~( Number of bedrooms 3 ''~ 3. WATER SUPPLY Individual Well 1~( Community i-I Public I-I · Note: I! community well system, m.ust have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. '" 4. SEWAGE DISPOSAL On-site B~ Public r'l Community I-1 Holding Tank I-I Nole: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as (~f the validation date shown below, I verify that my investigation of this' Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe. functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm $ _~ ~ ENGINEERING 17034 Eagle Rivet' Loop Road No. 204 Address w_.:~.. ~r, ~la~ka 99577 Telephone Date 6. DHHS APPROVAL Approved for 3 bedrooms by App~'oved ~ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in 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. ?~-e2s (.~,. 7/~) B.c~ Page 2 of 2 Well Classification MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: Z_~"/'- If A, B, C, D.E.C. Approved (Y/N) AJ/~,q Well Log Present (Y/N) I1 Date Completed Total Depth ~/[ ' Cased to Static Water Level I Casing ·Height Above Ground Electrical Wiring in Conduit (Y/N) ' Depth of Grouting ' ' Pump Set At ' ~ ~" ~ / ~ ~ Sanitary Seal on Casing (Y/N) ~ Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot · To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot ; On Adjoining Lots ' / ~ '/' ; On Adjoining Lots To Nearest Public Sewer CleanoutJManhole 25'/1- Water Sample Collected by Comments - ;Date A - ~, ~'O B. SEPTIC/HOLDING TANK DATA Date Installed ~--2,q'~ZSize Standpipes (WN) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (WN) Holding Tank ~igh-Water Alarm (Y/N) ./ f~O No. of Compartments Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) .~__ ~ Date Last Pumped ~ _ /*")/~ ' ;for Temporary Holding Tank Permit Y/N) SEPARATION DISTANCES ,FROM SEPTIC/HOLDING TANK: . To Water-Supply'Well TO Property Line ! C) 'f" To Water Main/Service Line To Stream, Pond, Lake*or Major Drainage Course Commer~t', '~7~c- To Building Foundation To Disposal Field /0o 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed (~ -- Width of Field Type of System Design Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test · Length of Field ~ ~ · Depth of Field I O Gravel Bed Thickness fo ~.. z~ Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-SupplyWell / C)o//" To Building Foundation' ~.0 ~ ~ Lot ~)/~ To Water Main/Service Line / O ''/* " To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line ! 0 '/-' To Existing or Abandoned System on ; On Adjoining Lots ~,~O To Cutback (if present) Tested for Meets MOA Electrical Codes (Y/N) Comments D. LIFT STATION Date Installed, Size in Gallons "Pump On" Level at /~, High Water Alarm Level at Dimension's ~ .- Manhole/Access (WN) "Pump Off" Level et Vent (Y/N) Pumping Cycles during Adequacy Test. '*Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, Verified, or conformed to all MOA and HAA guidelines in effect on the date'o~,this inspection.'~* Signed $ & S ENGINEERING Date Eagle River, Alaska 9957"~. ~_./.5r..-~¢:> Receipi No. 'c~/7 Date of Payment Amount: $ Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 6; B~ock I; Deer P~k S.bdlvl~lon Location (address or directions) (b) Property owner AHFC Mailing Address (c) Lending Institution Mailing Address Telephone: (home) Business Telephone (d) Real Estate Company and Agent TARGET, INC. REALTOP-.S/Di~ Address P.O. Bo~ 774627~ Eaq~ RZv~. A~a~ha 99577 Telephone 694-2588 (e) Mail the HAA to the following address: (or check here.~[, if hold for pick up.) List contact person and day phone number below: S ~ $ ENGINEERING/694-2919 17054 EaqE~ E.i.u¢~. Loop Rq~d. Su.i~ 504 2. TYPE OF RESIDENCE _ /' Single-Family~/ Number of bedrooms 3. WATER SUPPLY Individual Well~l~~'' Community r-I Public CI Note: If community well system, must have written confirmation from the State Department of Environmental 'Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site IXI ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As ce rtified by my seal affixed hereto and as of the validation date shown below, I verify that my investigatio n of t'i3is Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional end 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 pith all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ...... ,,,~- 17034 Eagle River Loop Road No. 204 Address , . ,-- ??577 Eagle K¢*'er, Date Telephone Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate Is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 A. WELL DATA Well Classification {,,w l~rl~{]~j~Y OF ANCHORAGE (MOA) ~': ~"' __~.l~,a~t~Atllherlty Approval (HAA) [N;~ ==K ~ECKLIST - FEBRUARY 1984 r - 343-4744 · AUG - 9 Legal Description: ~ ~ ~ RECEIVED ' t ~O~t ~' If X,'B, C, D..E.C: Approved (YIN) Well Log Present ~N) ~ Date Completed I~'- ~~/ Yield ~,~ TotalDepth ~l%aseJ,o' ~O~DepthofGr0uting'' - Static Water Level I ~ ~ d Pump Set At Casing·Height Above Ground ~H~ ~ Sanita~ Seal on Casing ~) Electrical Wiring in Conduit ~N), 7 Depression Around Wellhead (Y~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot .' .. ~ ~l / , ~On Adjoining Lots '"' ~t~ / '; On AdjoJnin~ Lots To Neares~ Edge of Absorption Fieldgn Lot To Nearest Public Sewer Line ~/~ To Nearest Public Sewer Cleanou~Manhole To Nearest Sewer Se~ice Line on Lot ~ I~ Water Sample Collected by ~ ~l~~;Date ~'~--~ Water Sample Test Results ~~ ~~ ~ ~ t~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~ize~ [ ~ Standpipes {:~/N) ',~ Air-tight Caps ~'N) Depression over Tank (Y'~) ~ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~/~' No. of Compartments ~-~ Foundation Cleanout ~31~N) Date Last Pumped ~)'"~ ; for Temporary Holding Tank Permit (Y/N) I'-~/~, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:: TO Water-Supply Well ~ t:~;='! ~' TO Building Foundation '~ .' T(~ Property Line ~ ,.~ t~. ~ To Disposal Field .: To Water Main/Service Line ~. ~=, t %.'-To'~J~eam.'.Pond, Lake or Major Drainage Course comm~'t~' "~__.~-/-~ ~..~".*-~.~:',,=,.o~.-. ~,ST--~',r~ · Page 1 of 2 C. ABSORPTION FIELD DATA ' .~ /~-" Soils Rating in Absorption Strata "'"'~'~ ~ Type of System Design Date Installed ~ -'~.'15 --~:"7..- /~ Length of Field Width of Field ,, Square Feet of Absortion Area .Depression over Field Resu ts of Last Adequacy Test ..~ , r- Depth of Field ~,,~ .~ *- · Gravel Bed Thickness · l~. ' J \ '~'"~'?---"~'/ 8tatndpipes Present (~TN) r-.3 Date of Last Adequacy Test . ~'- '2- - ~.~ ~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation * Lot To Water Main/Service Line To Stream, Pond. Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments t ~ I.~ / To Property Lin~ · ' ~ ~ ~ ' To Existing or Abandoned System on ; On Adjoinir~g Lots ~. c;, L.~ ~'f To Cutb'ack (if pre~ent) D. LIFT ST~ ' Date Installed Dimensions Si~,e in Gallons Manhole/Access (Y/N) "Pump On" Level at ~ at High Water Alarm Level at ~'t ~;~I) Tested for ~3w~..~Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ~ **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, Verified, or conformed to all MOA .and HAA guidelines in effect inspection. ; · . - S & S ENGINEERING ' S~gned - , ..,..--, -...,.. ~,,.~ ~.-. ]TUJ~' r. ag~ ~. ...... , ........ Company ~-,n__la RJver~ Alaska 99577 Date ~5""/~/~,, MOA NO. ~' 'f~ ~'~ ~'~ Receipt No. Date of Payment Amount: $ · ' Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907)'562-2343 5633 B Street Anchorage. Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER r-I PUBLIC WATER SYSTEM I.O.# ~ PRIVATE WATER SYSTEM EHGINE£RING Alaska t957~. Phona No. City State Mo. Day Year Zip Code SAMPLE TYPE: : ~ Routine D Check Sample (for routine sample with lab ret. no. [] Special Purpose ) I-I Treated Water [] Untreated Water ~AMPLE NO. /LOCATION 31 41 I 51 I Time Collected Collected By TO BE COMPLETED BY LABORATORY saSlS shows this Water SAMPLE lo be: tisfactory D 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 mall. Date Received Time Received Analytical Method: Membrane Filter * No. of coloniesll00 mi. Result* Analyst Lab Ret. No. I C~ I ~ I ~ BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filler:. Direct Count ~ Collform/100ml Verification: LTB .BGB Final Membrane Filter Results ~ . Collform/100m! TNTC = Too Numberous To Count OB = Other Bacteria pART I OF 2 R~MAINDER TO FOLLOW CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. A]ALISIS I~E~'OE! 8I SAMPLE for Wozk Ordec 8 IS489 Client ~anple ID:L6 P~ID :UA Collected AOG 2 09 ~eceived AUG 2 89 t 16:30 hze. Preserved with :AS Client Hame : $ & $ EHCR Client Acct : SHS~HG? P.O.I ~}AL {eq 8 Ordered E~ : Anal~i~ Completed :AUG 4 89 L&bo~&to~y Supery~?I :$TE?HZ~ C. E~E ~eleaeed 8~: ~~ ~ Special Irmt~uct: to: Chemlab Eel 8:67S8 Lab Smpl ID: 7 ~atr~x: W~TE~ Allowable ~arametec Teete~ ~esult/Urdte Retho~ Limits ~IT~T~-~ 0.32 m~/1 ~PA 353.2 10 ~emple SAMPLE COLLECTEO 8I ~P ~ema~ks: Tests Pe~[orme~ See Special I~tzuctiorm Above UA-Unavailable ~one Detected "See Sample ~emazke Above Hot Analyze~ LT-Lese Than, CT-Czeater Than J ' .' ' APPLI('-~IT FILLS OUT, UPPER HAI--uNLY Buyer Type of Resin.ce ~Slngle Family ~ Other ~ Holding Tank NOTE: ~HE INSPE~ION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~E~ING CAN BE INITIATED, Time Time Time Time ( ~ APPROVED BEDR~MS~ 'CONDITIONS OF APPROVAL { ) DISAP~OVED ( } CONDIT~NAL APPROVAL' ~ --~ ~ Well to Tank Septic T=k Size CHEMICAL & GL 'LOGICAL LABORATORIES..LALASKA, INC. TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL CENTER :274-3364 5633 B StrNt ~ Drinking Water Analys!s Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I.D. NO. . · Phone No. w.,.,~,,,.,~,.,.. -~. o. ~,×. /0 - Mailing Address City State Zip Code Mo. Day Yea/ SAMPLE TYPE: I-I Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Treate~ Water [] Untreated Water SAMPLE / /' Time CMlected NO. LOCATION ' ' Collected By 4 I I TO' BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: xE[.~atisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample· DateRecelved /~"'-..~ -/ ~ , Time Received Analytical Method: [] Fermentation Tul~ t3 Membrane Filter Lab Ref. No. Result* Analyst I ~ I M-Cl. II-FI BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE August 5, 1982 Dana Morrison P.O. Box 10-1402 Anchorage, AK, 99511 Subjectl Lot 6 Block I Deer Park Approval for the individual sewer and water facilities cannot be gr,~anted until the following items have been completed~ '~/A well log submitted to this office for our files and review. ~%e top of the well casing sealed with a sanitary seal so that it is water tight. /The depression or pit around the well casing needs to be filled with'impervious type soil so that it slopes away from the well casing. · The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. ! b~l~cere~y~ Robert C. Pratt Associate Environmental Specialist RP179/p/EH Enclosure