HomeMy WebLinkAboutTONJESS ESTATES BLK 2 LT 4Tonjess
Estates
Block 2
Lot 4
#051-832-25
UBMITTA
Municipality of Anchorage V L
On -Site Water and Wastewater Program • (907) 343-7904 JUL 2 Aag913i of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP131184 PID Number: 051-832-25
Dwelling:
I
Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ■
Upgrade
Name:
JEFF RICHIE
ABSORPTION FIELD
Address
25145 PRINCE CIR, CHUGIAK AK 99567
■
Dee
Deep Trench
■
❑Shallow Trench ❑Bed •
Other
Mound
Phone
Number of Bedrooms
4
Soil Rating
GPD/SF
Total depth from original grade
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Gravel depth beneath pipe
Subdivision Block Lot
Ft.
Ft.
TONJESS ESTATES 2 4
Fill added above original grade
Gravel length
Township Range Section
Ft.
Ft.
Gravel width
Beds: Number of Lines
Distance between lines
SEPARATION DISTANCES
Ft.
Ft.
To
From
Septic
Tank
Absorption
Field
Lift Station
Holding
Tank
Sewer
Line
Total absorption area
Fe
Number of trenches
Dist. between trenches
Ft.
Well
100'+
TANK ❑ Septic ■ S.T.E.P. 0 Holding • Other
Manufacturer
Capacity
Surface Water
1001+
GREER
1250 Gal.
NA
Material
STEEL
Number of compartments
2
Lot Line
10'+
Foundation
5'+
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
N.0
Remarks EXISTING TANK ABANDONED PER
Pump on level at
Pump off level at
High water alarm at
MOA REQUIREMENTS
in.
in.
in.
Pump make and model
Electrical Inspections performed by
Installer
PIPE MATERIAL House to tank 3034 d a Tank
3034
DEAN CONSTRUCTION
Drainfleld CO/MT
Inspector ANSON MOXNESS
BENCH MARK (Assumed elevation) 100 ft
Inspection 1s' 7/11/13Location
dates: 2nd
and description
3rd e
BOTTOM SIDING AT SE CORNER OF HOUSE
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Conditional Approval: Date
Em�ateer' Stinlpt`
�• t QF A<q
i y t
It
i
• 1- //
49`+
A k % ii
1.rn.
SPURKLAND;c, %
Approve r QcwVtj � /` i Date g /3 /3
C' 15 0 •$95
(�t;�\1� � GmP".'�
gport t-1 Z.doc
ABANDONED EXISTING
SEPTIC TANK PER MOA
CODE REQUIREMENTS
INSTALLED NEW 1250 GALLON STEEL SEPTIC
CONNECTED TO DRAIN FIELD
C
D
E
5WIN0 17E5
A
33.0
38.5
40.0
B
27.0
35.0
39.0
TONJESS
ES TA TES S �p" RIN/6EGIR // I
P
25 0 25 50 75 100 125 150
SCALD 1' = 50 FT.
NOTE THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC
LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATION ALL LOCAT/ONS SHOWN ARE
APPROXIMATE.
4 FEET COVER
CONNECTED TD
EXIST IIRAINFIELB
1250 GALLON SEPTIC TANK
FOUNDATION
CLEANWT
114 •
*♦
i 4 9 t s
• t •
• •
•
' "LAR" PURKLANDa
•VNo. C -11500 `ti
•
BENCH MARK: BOTTOM OF SIDING AT A'4 l ",it���
ASSUMED ELEVATION 100 FEET
SPURKLAND ENGINEERING
203 W 15TH. AVENUE
ANCH. AK. 99501
(907) 279-3916
TON/ESS ESTATES BLK 2 LT 4
JEFF RICHIE
e 747 / RINCE C1R, CHUGIAIC ATC, 55567
SEPTIC SYSTEM ASBUILT
DATD JULY 12, 2013
SHEEPI/1 GRID' N11146E
PERMIT 11 OSP 131184 P111 N 051-832-25
TONJ£SSESTAT£SB2L4-ASB.DWC
On -Site Wastewater Disposal System Permit
Permit Number: OSP131184
Tax Code Number: 05183225000
Work Type: Septic
Permit Effective Dates: July 10, 2013
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
to July 10, 2014
Design Engineer: SPURKLAND ENGINEERING
Subdivision: TONJESS ESTATES
Site Legal Address: TONJESS ESTATES BLK 2 LT 4 G:1462
Owner/Address:
RICHIE JEFFREY W & MELISSA A
25145 PRINCE CIRCLE CHUGIAKAK 995675723
Site Mailing Address: 25145 PRINCE CIR, Chugiak
Lot Size in Sq Ft: 41900
Total Bedrooms: 4
This permit is for the construction of:
N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By: I' _ t Date: 7A1/12
Issued By: Date: -7(4°/(3
MUNICIPALITY OF ANCHORAGE
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-832-25
Property owner(s) JEFF RICHIE
Day phone 863-5510
Mailing address
Site address 25145 PRINCE CIR., CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot) TONJESS ESTATES BLK 2 LOT 4
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(El all that apply)
Absorption Field 0 Initial ❑ Single Family (SF) 0
Septic Tank 0 Upgrade 0 (w/wo ADU)
Duplex (D)
Holding Tank ❑ Renewal 0 Multiple Dwellings
Privy 0 (SF and/or D)
Private Well ❑
Water Storage 0
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
NONE
Distance -
I certify that the above information is correct. I further certify that this is in accordance with
applicable julu 'c'.al Codes.
(Signaturh'of property owner or authorized agent)
Permit/Rush Fees: ao0 — Waiver Fees:
Date of Payment: 1 1 3 113 Cha Date of Payment:
Receipt Number: 01334. £ Receipt Number:
Permit No. 0591311S-9 Waiver No.
Permit App_9-1-12.doc
Environmental Consulting and Design
July 2na 2013
Municipality of Anchorage
Development Services Department
Building Services Division
On-site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
Subject: SEPTIC TANK PERMIT APPLICATION
Tonjess Estates Block 2 Lot 4
Ladies and Gentlemen:
We are submitting an application to upgrade the septic tank for this lot. The existing septic tank serving
the above referenced property is 30 years old and the owner would like to replace it. The submittal
consists of one (1) drawing showing the present improvements on the lot and the proposed improvements
of the lot, of which only the septic tank is subject to this permit application.
The installation of this septic tank will not prevent wells and septic systems from being installed on the
adjacent lots. There are no developed or natural surface / sub surface drainage courses within 100 feet of
the proposed septic tank location. The proposed septic tank will not change the general slope of the area.
Ponding and/or concentration of surface runoff will not result from this installation.
If you have any questions or are in need of additional information please contact me at 279-3916.
r
urkland, P.E.
203 West 15th Avenue Suite 202, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (907) 276-6013, SpurklandEng@gci.net
N
ABANDON EXISTING
SEPTIC TANK PER MOA
CODE REQUIREMENTS
INSTALL NEW 1250 GALLON STEEL SEPTIC
CONNECT TO DRAIN FIELD
TONJESS
ESTATES Sri -
25
r:
25 0 25 50 75 100
SCALED 1' = 50 FT
125 150
NOTE: THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC
LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE
APPROXIMATE.
4 FLET COVER
CONNECT TO
EXIST DRAINFIELD
1250 GALLON SEPTIC TANK
FOUNDATION
CLEANOUT
:co./
:
( .., ..,UNICIPALITY OF ANCHORAGE (
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
4 0,; j` ENVIRONMENTAL ENGINEERING DIVISION
" 825 L Street • Anchorage, Alaska 99501 Telephone 264-4720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME IPPIONE
Shasta Construction, Inc.
® NEW
❑ UPGRADE
_337-0892
MAILING ADDRESS
6710 E. 16th Avenue, Anchorage, AK 99504
LEGAL DESCRIPTION
Tonjess Estates L4 B2
LOCATION
Peters Creek, Alaska
NO. OF BEDROOMS
V Y
tZ
W
w
DISTANCE TO:
Well
103'
Absorption area
10'
Dwelling
24'
PERMIT NO.
E.R.
Manufacturer
Greer
Material
steel
No. of compartments
2
Liq. capacity In gallons
1250
IF HOMEMADE:
Inside length
Width
Liquid depth
d w
.O,iz
2 —"11
DISTANCE TO:
Well
Dwelling
PERMIT NO.
Manufacturer
Material
Liquid capacity in gallons
TILE
DRAINFIELD
TRENCH
DISTANCE TO:
Well
117'40'
Foundation
Nearest lot line
22'E.R.
PERMIT NO,
No. of lines
1
Length of each line
40'
Total len4i0th of lines
'
Trench width
24' inches
Distance between lines
— -
Top of tile to finish grade
3
Material beneath tile
72 inches
Total effective absorption area
480 sq. ft.
w
0
41-i
W6
w
Length
Width
Depth
PERMIT NO.
Type of crib
Crib diameter
Crib depth
Total effective absorption area
DISTANCE TO:
Well
Building foundation
Nearest lot line
w
W
3
Class
Depth
Driller
Distance to lot line
PERMIT NO.
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption ereefs)
OTHER
PIPE MATERIA O �; f 10 cast iron 4";
24'sch.
.■■�
■■■�.
■■R
�-
RIE
�■��ERRI■�■
�jt���
��T1'J
NRIP,
■IA
■
SOIL TEST RATING
125 Sq. ft./bedroom
INSTALLER
G. W. Bailey A.E.C. Cert. No. 83-06,IIMLS'�•
I�
RIIEWIFIEN■���1■
imill
REMARKS
System changed from seepage pit to deep
trench with verbal ok by Eagle River
i!I1IIE4!!!!!!1
�
gi■■■■■itard.11iiiiia'
ilibi
Dept. of Health
/ OF ACq:
/II
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';JOHN E SWANSON� �Q
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veh9Fa •.. ...... • �a i
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APPROVED DATE LEGAL
72-013 (Rev. 3/78)
L.& Q'2
• r
LOCATION OF WELL .
(Please complete either lo, Ib or lc.)
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological a Geophysicol Surveys
Drilling Permit No.
A.D.L. No.
a. 'Borough
,;nc .
Subdivision
n jcrr'
Lof
L
Block
2
Ib. 1/4 qtrs.
_of_of—of _
Section No.
Township No
S❑
Ronge E a
WO
Meridian
1121 DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS
Street Address and Area of Well Location
3. OWNER OF WELL:
f.re RC:) Pelletier
Addreu:
6710 ,e 16t?: A.Voe
P,rrM r,7' 1trn, I'}r• Gq:jnt,
2. WELL L0G
Feet Below
Surface
4. W (final)
F�,,,V H:
I 3. DATE OF COMPLETION
/ O r 0
it.
-- -'- --
Material Type
Top
Bottom
57ft$, t;rnVel, Lilt
0
...)•••••
6. 0Cobe tool :0 No ory 0Driven CIDug
T{1:,ci;. rnrk
z^
179
0 Auger 0Jet Ied 0 Bond
•
Other :
Grut:nrtoue
175
leo
Y.USE: Q.Oomestic 0 Public Supply 0 Industry
Laycry cf binca and Crcen
lw.,
1;�j
Permi #; R
Applicant: 51/4Z; CoNSr Mailing Address: 67/0 1-...,/4441. 4udi
Location:// Phone Number:
Legal Description: 7o/✓3 SS EST 2,T4 es/h 2 Lot Size:
Type of Soil Absorption System Is:
Trench: Drainfield: _ Seepage Bed: Holding Tank: (`SP'
Maximum Number of Bedrooms: y' Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:'
DEPTH // LENGTH / GRAVEL DEPTH 6 ? WIDTH -/ /
•
:P?nC
The length dimension is the length(in feet)of the trench or drainfield. The
depth of a 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).
* * REQUIRED SEPTIC(HGLB+NG) TANK SIZE = /,ASO GALLONS * *
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.
* * * TWO(2) INSPECTIONS ARE REQUIRED * *
Backfilling of any system without final inspection and approval by this departme
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fe
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
MUNICIPALITY OF ANCHORAGE
Department: Health and Environmenta rotection
825 L Street, Anchorage, AK. 9950161
264-4720
HANDWRITTEN PERMIT * * *
WELL AND/OR ON-SITE SEWER PERMIT
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlarge ent if
the residence is remodeled to include more that 7ftbedroom
Signed: Issued by: N_
Applicant Ql
/� .
Date:
SWP/024 (1/81)�/ 5.74j pea blot
77c
t oif !o'
9-6- �3
diteit 7125 OLD SEWARD HWY.
. & . ENGINEERS. INC. r ANCHORAGE, ALASKA 99503
,' ' ' 349 - 6561
,6099
1.1:1111111MI. 1) 1 O l
SOILS LOG PERCOLATION ''ESI
Sort: L'OG
11111:1)1 A1111N
11 S1
Sh,4/4. Ce..s/ l ol:D.''\-hc. l C.w. 13,1 yJ ,bA1 I•G111'1111ME1) S 23
I.Er.AI. UESCIIIrTION To S E5 q'/eS .
3 -
4
5-
6-
7 -
8-
9-
10-
11 -
12 -
1;1
DC re r.1
111'1'el
-.
•
14 -
15 -
16-
17 -
18-
19 -
20 -
Mater;. -1
S^^ 411..1 w/ Fe-Ceb bks
Gt.LV �1 I...IS4".41
Nerows
MD;st
GP so. )
a_
A SOFA S..
•••9
'.asth 11.11 •
F, :• JOHN E. SWANSON: W
ran sl 1834-E 4' i'
"I' FoPAoFESSIONP",Jr
of
2-4z t3 -a
Pe/et-3 CP el+raC /PC
SLUrr.
r
T.
WAS GROUND WATER
ENCOUNTERED'
IF YES. AT WHAT
DEPTH'
Na
S
L
0
P
E
SITE PLAN
Li)
03)
Readhn9
Dale
Gott
Time
Net
Time
Depth to
Water
Net
Drop
6'/
7-5
q:43
0
0
PERCOLATION RATE
} TEST RUN BETWEEN
CO'AMENTS CC4 h S C D /e Al Sga eC
1Fv. c..cst S erpa P p:1-.
PERFORMED BY G
12.001 1,191
.P,, T.tu
2-3
(0 •nulet/:nehl
FT AND 6 FT / /
I ti )-;i/ toll gta;!. e-4 d(e4tp
SSS En..3;.esors z wC 5;) 4
CE11TI5iE00Y
DATE:
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Eragaw St.
P.O. Ecx 196650 Anchorage, AK 99519-6650
www.ci.anchoraee.ak.us
(907) 343-7904
0
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Farce! I.D. 057 - 5 73-2
HAA T `l/1 oz cc)7
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Lot 4: Bloc's 2: Toniess Estates
Location (site address or directions) 2 514 5 Prince C i r
Current Property owner(s) Shannon Garris Day phone 227-1407
Mailing address
Lending agency Day phone
Mailing address
Real Estate Agent Paula (4 Vanguard Day phone 522-7002
Mailing Address 1325 Acaderiy Dr. Anchorage, AK 99507
t1/Z.4"__7 /� m./o7
1105 San Antonio St. Anchorage, AK 99508
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:
0
0
C
Individual On-site
individuai Holding tank
Community On-site
F ublic Sewer
M'4. P. I. rY..'A. 5,o..
The Municipality of Anchorage Deve!oprnent Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional c:vii
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spcuse_) for properties served by a single-family cn-site waste.rat r dis^.csal and:or watar
supply system. DSD also issues HAAs uoen request to homeowners. Cartincate.s cf Health Authority Approval are
valid for 90 days from the date cf issue fcr properties seried by a private cr Cass C well a.'1d may be reissued with
ne'.v water sample results. (Certificates may be reissued fcr a period of up to one year with vapid :Yater samc;es.)
Certif c. tes are valid for c'le year for properties served by Class A cr E wells cr as public water system. The
Municipality of Archorace is net responsible fcr errors cr emissions in the prefessicr al an_ir.eer s work.
4. STATEMENT OF INSPECTION EY 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 cf Firm S iy S Engineering Phone 694-2979
Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577
Engineer's Printed Name Robert C. Coban Date 3/1/0 3
5. DSD SIGNATURE J
Approved for 1T bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
OF At
At 1 %II iit.
1111►�- RC2ERT C. Co'Na`1 f ti
�t<<,.• C_ -ss
ti
jci :,�
Additional Comments
Note: The well for this property meets existing State and Municipal Codes. There are nitrates
present. It is suggested that periodic testing be performed to insure the wells continued suitability.
Cur
information on nitrates is available from the On -Site Services Program, at 343-7904.
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Repor,
Well Flow Adviscry Other
Ev:
(Rev. CVC:;
1J I
Original Certificate Date: `" / 1- Ct 3
11
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 995195650
www.cionchorage.ak.us
(907) 343-7904
HEALTHAAUTHORITY APPROVAL CHECKLIST
Legal Description: !. OT 7r `i: 2/ / ON 11.-6S gSi Parcel ID: 0.6—/- g 32.-.2.6—
A.
3Z-.2.S`A. WELL DATA
Well type j� If A, B, or C provide PWSID # i Well Log (Y/N) y
Date completed B3 Sanitary seal (YIN) Y Wires properly protected (WN) `7.
Total depth i I / R Cased to 3 ft. Casing height (above ground) 1 z a- in.
-b
FROM WELL LOG AT INSPECTION
Date of test q J i /! E33 03 0 3 o
Static water level LAe•!/.0 ft. 4-47 ft.
Well production W ^/ K g.p.m. 52. 0 g,p,m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 5,11 mg./I. / Other bacteria 0 cotonies/100 ml.
Arsenic: _ mg./I. Date of sampte:3/�/O 3 Collected by: . ' S &v 6 iAu
B. SEPTIC/HOLDING TANK DATA !
Tank Type/Material 1�Pl`1C./ -[� Date installed q/eg 3
Tank size 1 5D gal. / Number of Compartments _ Z Cleanouts (Y/N) Y
Foundation cleanout (Y/N) I Depression over tank (Y/N) High water alarm (Y/N)
Date of pumping >f 3///0 2- Pumper -S4-sv i 7•-01-+2y
C. ABSORPTION FIELD DATA
Date installed _ Soil rating (g.p.d./ft or ''/bd )2S— System type 7.Q6"VG-t/
Length 40 ft. Width 2- ft. Gravel below pipe 6,ft.
Q
Total depth / • C it Eft. absorption area 49ft2 Monitoring tube Y Depression over field ^//
Date of adequacy test 3/ S /LAS Results (Pass/Fail) _,A25.5 For ii' bedrooms
Fluid depth in absorption field before test 0 in. Water addedkagal. New depth in.
Elapsed Time: cr min. Final fluid depth 0 in. Absorption rate >= 5 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) 4 If yes, give date ^
D. LIFT STATION
Date installed Size in gallons
'Pump on" level a _in. "Pump off" level at,
Datum Cycles tested
E. SEPARATI . DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankfy.atattin on lot /
Absorption field on lot
Public sewer main
S er /septic service line
Manhole/Access (Y/N)
in. High water alarm levet at
Meets alarm & circuit requirements?
On adjacent Tots / OO /4-
On
*
in.
On adjacent lots / bQ / r`
Public sewer manhole/cleanout Ay 4
Holding tank
SEPARATION DISTANCES FROM SEPTIC/H03 G TANK ON LOT TO:
Building foundation 5 4- Property line 5 t Absorption field 1-fr'
Water main Ay A, Water service line l D 4 Surface water / Of7
Wells on adjacent Tots /00
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line (0 -r
Building foundation / 0 rr Water main
Aor
Water Service line / O r'.- Surface water 1 Driveway, parking/vehicle storage /0
rr
Curtain drain /Yon/EN`r0i!/N Wells on adjacent lots /00
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAAA guidelines in effect on this date.
Engineer's Printed Name e0/3 t4 T C • COw4.0
Date '3/// / 0 3
HAA Fee $ 37S.°° + /$O."' CR JH)
Date of Payment 3 // /0 3
Receipt Number 0 3 a 3 a 3
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
' h).
I �T
`�0 L1 d
t.
11.64:4. 11.
71/
A'
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``�TacK: r�i X11
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11419.rw44,64w 1 I !l`
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071
..1 1j•
0.4
•
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AS -BUILT
I hereby certify that I have surveyed the following described
property: _ J s 74 A 1l 04:
••a•e:14 .t_ Z. .77/ / R 114 ..*4-r,
Anehooi3 a Recording Precinct, Alaska, and that the improve -
meats situated thereon are within the property lines and do
not overlap or encroach on the propeity:lying adjacent there-
to, t.hat•no improvements on property lying adjacent thereto
encroach on the premises In Question and that there are -no
roadways. transmission lines or other visible easements on
said property except as indicated hereon.
Dated at Zaptle River, Alaska
this ' day o�SiI
ROB T C. JOHNSON 'PiAli,.
SCALE: Registered Lend Surveyor No. BB0•LS
1" = !fo' Box 456, Eagle River; Alaska .
Phone (907) 694.9543
03-10-03 15:01 FROM-CT&E ENVIRONMENTAL SRV
SCS Rcf.#
Client Name
Project Name/#
Client Sample ID
Matrix
1031258001
S & S Engineering
1A.132 Tanless Est
1A, B2 Tanjess Est.
Drinking Water
9075615301 T-893 P.02/02 F-218
All Dates/Times are Alaska Standard Time
Printed Date/Time
Collected DaterTime
Received Date/Time
Technical Director /
A
Released II
03/10/2003 15:00
03/07/2003 1:00
03/07/2003 11:20
StephenC. de
Sample Remarks:
Parameter
Results
PQL Units Method
Allowable Prep
Limits Date
Analysis
Date Inil
Waters Department
Nitrate -N
Microbiology Laboratory
Total Coliform
5.91 0.200 mg/L EPA 300.0
0
co1/100mL SM18 922213
(<=101
03/07/03 IS
(<=1) 03/07/03 KAP
Municipality of Anchorage
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.ak.us
(907) 343-7904
•
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING :
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. l 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 Mt rkn e ($• JL a ers un Jam• Phone 3�s-33�p
Address 144 CfQ S4 54 n.` Arich A 11f SY&
Engineer's Printed Name ter leC»e( ACAAi ei* • -Date &(z//0e
001 u
- • 0.•°, ee e. O. ',Cr? g.°42 • t• tiGkayS °cis
•
5. 'DSD SIGNATURE
�, ON-SITE •, mI.: .• l�Y.fp to /WATER AND , :WASTEWATER •.n: •
MICHAEL N. ANDERSON: /
PROGRAM • S 1 rec., C 9 69
_JG Approved for 14. bedrooms` •,•••��\*•\ ii, a- /�•.• �`..• .
Disapproved. ' (• O NT BEN IMI 8,�c-` "•• -;.����
))))))JJJ 1 Mj1 • �ri��
Conditional approval for bedrooms, with the following stipulations:
Note e
Atiowe nai1 or Eomments
s ptupes ty areata exhting State and Municipal Codes. i nere are nitrates
present. It is suggested that periodic testing be performed to insure the wells continued suitability.
Current nitrate concentration is 5.95 mg/l. EPA maximum concentration is 10.0 mgfl. More
infor
8
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
(Rev. tSoo)
Original Certificate Date: G - S' 0 1
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: b.A* Wk. L Tvnr.at 4/0 Parcel ID: 01/— el--or
A. WELL DMA
Well type QCAkle If A, B, or C provide PWSID #
Date completed T/ir/eSanitary seal (YIN) 2t
Total depth _Litt Q ft. Cased to 3S1 ft.
FROM WELL LOG
Date of test
Static water level u ft.
Well production 3 g.p.m.
WATER SAMPLE RESULTS:
• Well Log (WN) /"
Wires properly protected (WN) V
Casing height (above ground) Z -L In.
AT INSPECTION
Sl/7/Cf
we
G,!
ft.
g.p.m.
Conform colonies/100 ml. Nitrate 1, Wmg./1. Other bacteria colonies/100 mi.
Date of sample: 7L/9 /0/ Collected by: 4st ken C1/21v• !s< >; <,c..
B. SEPTIC/HOLDING TANK DATA /
Tank Type/Material 6 get ( Date installed 7f S� }
Tank size j 2S0 gal. Number of Compartments Z Cleanouts (Y/N)
Foundation cleanout (WN) Y Depression over tank (WN) ,L High water alarm (WN) N�.4
Date of pumping s/lr f'o, Pumper Z WS
C. ABSORPTION FIELD DATA
Date installed 7/to 3 Soil rating (g.p.d.lft or ftr/bdrm) ! 2
System type Or et) tette/I ,
Length 440 r')) ft. Width 2.0 ft. Gravel below pipe 6. O , / ft.
Total depth ift. Eff. absorption area q W ftW Monitoring tube y Depression over field ry
Date of adequacy test SA7/0 r Results (Pass/Fail)
Fluid depth in absorption field before test (() in. Water added ft,
Elapsed Time: min. Final fluid depth 5 in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type) None. kn.w n If yes, give date
For bedrooms
New depth # in.
(pew f g.p.d.
D. LIFT STATION
Date installed
'Pump on" Iev
Da
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL. ON LOT TO:
Septic tankfift station on lot /0 3t
Size in gallons
Pump off'
Manhole/Access (WN)
High water ala
C ted alar & circuit requirements?
Absorption field on lot
Public sewer main t4`4
rooff
r
Sewer /septic service line 25 f
On adjacent lots
On adjacent lots
loo (1 -
in.
/00t1�
Public sewer manhole/deanout
Holding tank /00 r. 1't'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Property line / 0 fit
/44 Water service line -15 r >F
Building foundation /0
Water main
Wells on adjacent lots / 00' t'E•
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line / 0 r'f
Water Service line 2 s r f Surface water
Absorption field /0 f
Surface water /0.
Building foundation /0 Cit Water main K/
r
/00 r+� Driveway, parking/vehide storage Z S 1
Curtain drainNitre. Wellsorradjacentlots /00 14
{r lrev►et
F. COMMENTS
G. ENGINEER'S CERTIFICATION
$ 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 affection this date.
Engineer's Printed Name KA. c� /440J, fowl ea
' Date • G/•J/0(
�P
��. of . (qsl�'
f
If
90
ANDCR$CN•:�
0? • °,•
• .-
ep F.^.1r.Err•tt
et 41:
/.. •
0 y. AMC
HAA Fee $ ?f G O . O o
Date of Payment ti(3/41
Receipt Number c 0 'S 2 Sq
(Rev. 12100)
Waiver Fee $
Date of Payment
Receipt Number
MAY-23—NL 109:27 AM
Wv-j3-01 03:54 FFk'-
�. C7&Q Envtrocmental Services Irv.
CTsl:Rec,
Clicat Nene
PrejtCl Nanyte
Cllcnt Sample ID
Matrlt
Ordered By
PWSIn
IG127,1901
Susan Oswalt x r1SSJcta:CS
1.4 4 tonuss Est 2511 Prince
14 02 l¢gesi Est 2534 Prince
Thinking Wates
U
Seary!e Renro:ka
T-313 P .2/03 r -iii
Cunt ea,
Primal Date/1=
Collected U:ttrTmte
Received Ilatb'Tlum
Technical DirectorStephen C.
Releared 114..140/J �
P. et
O5.22,2t.tG I 11.29
05/i77o1 9 30
05/17/20I !3:33
;tie
P.r antt.;
PQL Liens aceto.
wYcnaU_ nto Nnl/eta
I.nnet Doc Dat bet
Waters Department
*teratology Laboratory
Thal Cvl'.foho
595 050'_ net EPA3w.O
0
OM Vol ACL
0 eoU!OO/it SML89Z22R US.IZUI SnW
Parcel I D #
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
1. GENERAL INFORMATION
HAA # tU ct \ O\cell
Complete legal description Lot 4; B•2odz 2; Tonfe64 Es•ta.tea Subdiv.i.s.Lon
Location (site address or directions) 25145 Pni.nce C.iAete
Property owner Kurt R. & Shayne P. Steevy Day phone (719)495-0636
Mailing address 14720 Camp Robbelc Count Co.fonado Spn,Lnga, CO. 80908-2228
I Lending agency STEWART TITLE ATTN: Satty Gneen Day phone 561-5122
Mailing address
•
Agent Geonge Penf i.n.e PERKINS REALTY
Address
Day phone 694-3594
Unless otherwise requested, HAA will be held for pickup.
4
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
1
1.,
1'
i,
/�. 1.111`;.'
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
XX
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 121
ST
LZM vow Vga (161 74E11 00 -U
"um slaaul6ua Ieuo!ssalaad a43 u! suo!ss!wo JO sloaaa ao; e!q!suodsaa
lou s! 06eaoyouy ;o Al IShco!unN a41 •panss! s! mowing a aaolaq elep azAIeue ao suo!loadsu! lonpuoo
lou op SHH010 saaAo!dw3 •sluawaa!nbai ems pus !amps; uppao /Clslles olaapao u! suo!lnl!lsu! 6u!pual alayl pue
sawoq to saaseyoand o3 Asalanoo ase sly! scop SHHO e41 •eNse!y;o ale3S NI u! paJals16aa aaau!5ua leuolssalcud
luapuadapu! us Aq anoge g ydea6eaed u! uan!6 suo!leluasaadaa eyl uodn Apo paseq saleo!;!pa0 Ienoaddy
/L!aoylny y2leaH sanss! (SHHO) Se !Mas uewnH pue tpleaH ;o luawlaedaa o6eaoyouy to i(3!led!o!un!N eyl
also
vaa 'Z/btu T•9 sT
•T/F" '0'OT ar TT'T1 inanunn mnvrr -�
uOT vigueou00 egva4T(y •44TTTQEgTns panup.uoo
sz gI •q.uasaad sa4ez;Tu 0.1S eaeLjy •sepo0 red -Fp -rut -1w pus aTpl.s
U Lob LXd b4ddU1 ddu..ui b L44 .Luj t Lcun dqj, • d.}Uj\L sluawwo0 leuoll!ppy
:suo!3e!nd!3s 6ulMoll0; ayl to!nn 'swooapaq
•swooapaq
ao; lenoadde Ieuoll!puo0
•panoaddes!O
ao; panaddy
3dfLLVNJIS SHHO '9
6LbZ-i auoyd
•uolloadsul sly3lo alep ay3 uo loa;;a u! suolleln6aa pus 'saoueulpao
'wpm als3S pue Ied!olunlnl Ile w!M aouendwoo u! s! welsAs lesods!p aaleMalseM ao/pue,(!ddns
aaleM ems-uo ay3'uo!loadsu! pue uolle6!isanu! /w woo; pue sal!; 06eaoyouy;o i(1!Iedlo!un!M ayl
woo; paulelgo uo13ewaolul ey3 uo paseq ley! Alpanaagpn; I 'want.' paleo!pul aanlonals;o ads pue
swooapaq;o aagwnu awn; elenbape pue Ieuonoun;'a;es s! walsi(s Iesods!p aaleMa;seM ao/pue
Klddns aa3eM ails-uo a43 win smogs uol3eolldde lenoaddy i(3uo43ny U31eaH s143;o uo!1e6llsanu!
Aw ley! yuan i 'Molaq uMoys awl) uollepllen a43;o se pue olaaaq paw;;e pas /w /(q pal;llaao sy
aanleu6ls s,ieeui6u3
LLS66 r'S'et7 saMU *PS
bOS •oN peoa dool 1aA! 1 otEe3 KOLL
rtll��=l�j �i�j s ns s
ssaappy
walllo aweN
1:133NION3 AS NOI103dSNI d0 1N3W31V.S .9
v
Municipality of Anchorage
Department of Health &Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 1.-dr4 gti - Z 1 7,& SC767.. Parcel I D
A. WELL DATA
Well type Qe-A.J— If A, B, or C, attach ADEC letter. ADEC water system number 1/4.
Log present (l)
Total depth 141`1
Sanitary seal aYN)
Date of test
Static water level
Well flow
Pump level
Date completed 1 - 1 41 - 83 DR—tt...s.JuaL
Cased to �� -AN2-0e-tz--Casingheight
FROM WELL LOG
Ofhi-iloJ4
v�y-rSD.J �
V IJ ILI.� Cb I f.1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Public sewer service line
1t73`
1('�I
WATER SAMPLE RESULTS:
.(rpb\
Coliform 400„,&•
Nitrate
Date of sample: S- 20 - 9 /
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts RN)
High water alarm (Y()
Wires properly protected a(N)
AT INSPECTION
21-�11 •
4131
g p mI-
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
U./ fml/t
Tank size
Collected by"
l2S•p
.1 ea
1
Other bacteria
S & S ENGINEERING
17034 Eagle River Loop Road No. 204
Eagle River, Alaska 99577
Foundation cleanout (ON)
y
Compartments Z
Depression (YeI /.1
Alarm tested (Y/N)
Date of pumping <-23-511 Jt. SSS P3 PJ/ -1 P/d4b
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 1 t:>-1- On adjacent lots 1 O0k Foundation 2-•4
To property line ?� �
�•Absorption field
Surface water/drainage 1 Ob
b` Water main/service line
72-026 (Rev. 3/91) Front MOA 21
ie'
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Manufacturer
Size in gallons Manhole/Access (Y/N
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical c
SEPAR
ell on lot
/N)
DISTANCE FROM LIFT STATION TO:
D. ABSORPTION FIELD DATA
Date installed
"Pump off" level at
Cycles tested
•
On adjacent Tots Surface water
Length 40 1 Width - ' 7-4 "
Total absorption area 4ao+
Depression over field (Y&) ^�
Results ,; fail) PASS
Peroxide treatment (past 12 months) (Y&P 1.14a/46614
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Soil rating 1 LS' kr-•
—
Gravel thickness
System type 1--$ 4-4-1
Cleanouts present (5N) •
Date of adequacy test
for
Total depth
y
c\t
02- 60 bedrooms
If yes, give date �A
Well on lot 1111 On adjacent lots 'too r Property line z'1
To building foundation n1
On adjacent lots o Cutbank
Surface water
- -,.
Curtain drain -
1DL>`
1
1.4^.32 fire 11 it I 217 r
E. ENGINEER'S CERTIFICATION ;. _,.
To existing or abandoned system on lot
SIA
Water main/service line 10 `T
Driveway, parking/vehicle storage area
�4b`y
.
1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effectgntbe d
•„G .CF
Signature
Engineer's Name
Date
5 A 5 ENGINEERING
17034 EagIa River Loop Road No. 204
Eagle River, Alaska 99577
9/
this inspection.
VA.
114,
• t V#
{ 14.1...•42.•••••••
: iu/'
�E
Na. 1457-F ? •
........,•
4t' a.. 1.,11.'
HAA Fee $ lip tp
Date of Payment
Receipt Number
2w20 (7r 1)
72-028 (Rev. 3/91) Beek MOA21
Waiver Fee' $
Date of Payment
Receipt Number
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301
ANALISIS REPORT BY SAMPLE for WORKordert 34406
Date Report Printed: MAT 22 91 118:47
Client Sample ID:L4 B2 TONJESS EST. S/D
PWSID :UA
Collected MAT 20 91 4 14:00 hre.
Received MAT 21 91 1 14:35 hre.
Preserved with :AS REQUIRED
Analysis Completed :MAI 22 91
Laboratory Supervisor : HEN C. EDE
Released By : ,f
Client Nese :S & 3 ENGINEERING
Client Acct :SNSENGP
BP0 1
Req t
Ordered By :R. SHAFER
Send Reports to:
1)S & S ENGINEERING
2)
PO 1 NONE RECEIVED
Chemlab Ref 1: 912146 Lab Smpl ID: 9 Matrix: WATER
Parameter Tested
Allowable
Result Units Method Limits
NITRATE -N
Sample ROUTINE SAMPLE COLLECTED BI: RAI
Remarks:
6.1 ng/1 EPA 353.2 10
1 Teets Performed ' See Special Instructions Above UA -Unavailable
ND- None Detected " See Sample Remarks Above
NA- Not Analyzed LT -Less Than, GT -Greater Than
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH ANO ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL i?�-itS92
OF ON-SITE SEWER AND WATER FACILITY
2644720
Application Date
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
1.-c"T 4 st.1L. Z "re,p\TSS
Location (address or directions) •
-6-4.-V—
(b) Applicant Name 7'�oU' Ltkflv.3� Telephone: Home tc' € - 4 23 Business
Applicant Address G[o - bE-t�12 m -t "Cbl r3IA
(c) Applicant is (check one): Lending Institution 0 ; Owner/builder Buyer 0 ; Other 0 (explain).
' (d) Lending institution
Address
e- S3'r111/4 t Ijio tZ 4 . eenelephone
.A.G6. �
(e) Real Estate Company and Agent -17151r—V— ,t31A-Yid Art -VS . GQti1t-1C. 7
(- 14-1
3c�
Address 1- VOCat.,
Telephone
L PI4 — 55cx�
(f) Mail the HAA to the following address:
S & S ENGINEERING
•. _ `_ SR B 19ex
EAGLE RIVE, AK 99577
...
2. TYPE OF RESIDENCE
Single -Family Jif• Multi -Family 0 Other
Number of Bedrooms
3. WATER SUPPLY
Individual Well Pt. Community 0 Public 0
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite tir Public 0 Community 0 Holding Tank 0
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2
72-025 111, 841
r^, r^,
5. ENGINEERING FIRM PROVIDINL..NSPECTIONS, TESTS, FILE SEARCH, DA1.. AND INFORMATION \1
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 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. 1 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
Address
Date
5 8 S ENGINEERING
SR g 196X
Telephone 69 e 79
EAGLE RIVER, AK 99577
/212 ff/t? ro
6. DHEP APPROVAL \\\ \\ _
Approved for '��"'' C4) bedrooms by li2-•• �• ^^-`'d Date ^'- O "7-4
1� Disapproved l/ Conditional _
Approved � .
Terms of Conditional Approval
A/Se. : -i-t .- ..bs.ia*,b•• ,Rha/.2 -t' ,. /&s1_ s#.7%.- iys.,„„...•.
is .1./..34#/y e.....Csrss ir.Q. T1ie.. A..le st...o...a tor- 417
/4,3,,, -et, MRL ' .vtoq cats,.+ ret.....•.'.,.. e..,..ts.
CAUTION
The Muncipaiity of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given In paragraph 5 above by an Independent professional
engineer registered In the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their tending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate Is issued. The Municipality of Anchorage Is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72.025 (»lea)
r%sipRAGE
wNtGtppt oZEP�Ttit &MNNICIPALITY OF ANCHORAGE (MOA)
pEPla pROO' }` EALTH AUTHORITY APPROVAL (HAA)
y190CHECKLIST - FEBRUARY 1984
264-4720
CGr/
Legal Description: 1-1="4"
RE�E�v
Z -
A. WELL DATA
Well Classification �' If A, B, C, D.E.C. Approved (Y/N)
1-1l,A
Well Log Present CON) Date Completed /-14-83 Yield 4•o 6.1?6.1?,-)1/41P►
Total Depth t"l9 • Cased to '6$ Depth of Grouting
Static Water Level 40 • o`• Pump Set At t..ZLL
Casing Height Above Ground ''= Sanitary Seal on Casing (37N)
Electrical Wiring in Conduita7N)
Separation Distances from Well:
To Septic.GJ#ltlfg'Tank on Lot
03'
Depression Around Wellhead (Y
To Nearest Edge of Absorption Field on Lot t l7 1
a•
To Nearest Public Sewer Line • A'
; On Adjoining Lots l enc.' A-
• On Adjoining Lots
to0r-1--
To Nearest Public Sewer t
Cleanout/Manhole 1J /P To Nearest Sewer Service Line on Lot 25 +
Water Sample Collected by 6 4 6:161►ti t -tit ; Date
Water Sample Test Results
Comments
lt-CU 'Pe9Rd tom.
B. SEPTIC/NOESii1-ia TANK DATA
Date Installed 71 83 Size
Standpipes 1PN)
VZ -50
No. of Compartments
Z
Air -tight Caps (9N) Foundation Cleanout(DN)
Depression over Tank (Y/jamate Last Pumped S ' yp- 436
Pumping/Maintenance Contract on File (Y/N)
DA ; for
Holding Tank High -Water Alarm (Y/N) to `� Temporary Holding Tank Permit (Y/N) NIA
Separation Distances from Septic/4 luldiinj Tank:
To Water -Supply Well 11 1 To Building Foundation
To Property Line ?.-c, 14- To Disposal Field t o '
To Water Main/Service Line toy-(' To Stream, Pond, Lake. or Major Drainage
Course 1-1'P (tn.c )
Comments
1
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 125
/83
Width of Field
Date Installed
Type of System Design Ike
Length of Field
Depth of Field °11
Square Feet of Absorption Area
480
410'
Gravel Bed Thickness
Depression over Field (Y(9
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well
To Building Foundation
Lot
117
log
Standpipes Present ON)
Date of Last Adequacy Test
.P-nSc. — 4 •i
401
0
t'JA
To Property Line 22
To Existing or Abandoned System on
30'+
• On Adjoining Lots
To Water Main/Service Line 10 I+ To Gutbanls (if present)
To Stream/Pond/Lake/or Major Drainage Course Ie (100'4-)
To Driveway, Parking Area, or Vehicle Storage Area Aro 1-E
Comments
a)1,
D. LIFT STATION
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at 'l { "Pump Off" Level at
High Water Alarm Level at Vent (Y/N)
Tested for Pumping 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 AA guidelines in effect on the date of this inspection.
Signed S 8 S ENGINEERING Date / 212-7 of
SR B 196X MOAN
ompany o.
EAGLE RIVER, AK 99577
Receipt No. /� 2�o//lX✓%
Date of Payment /r-/-�D`!I
Amount $ ‘re D7)
Page 2 of 2
72-026 (11184(
............r.
A. *A.►u .:k
%,'. Nn 1467•1,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL. PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date ?(ay 16, 1986
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 4; Mak 2; Tonjes6 Estates
Location (address or directions)
P'.Lnce C.incee - th,Lnd house on the £elft
(b) Applicant Name Stochhowe Telephone: Home 688-4123 Business
Applicant Address
(c) Applicant is (check one): Lending Institution 0 ; Owner/builder Lt ; Buyer 0 ; Other 0 (explain).
(d) Lending Institution Home Equity Telephone
Address CaeLt onnia
(e) Real Estate Company and Agent Jack White Re tty/Connie Bates
(I)
Address Eagee R.iveh, Ata6ka
�TelLLephon° 694-5500
1N filthe HAA to the following address:
S g S Engineen.ing
SRB 196X
Eagte Riven. Ataska 99577
ondened by Connie Bates
2. TYPE OF RESIDENCE
Single -Family `± Multi -Family 0 Other
Number of Bedrooms 4
3. WATER SUPPLY
Individual Well E0 Community 0 Public 0
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite ® Public 0 Community 0 Holding Tank 0
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2
72-025111/B41
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION •
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 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 Telephone
Address SR B 196X
Date EAGLE RIVER, AK 99577 MAY 2 3 1986
6. DHEP APPROVAL
Approved for bedrooms by %! 7vi7 ��ti y�� ( Date
Approved ' \ Disapprove(V Conditional / C
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) Issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage Is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
i�
MUNICIPALITY OF ANCHORAGE (MOAT
HEALTH AUTHORITY APPROVAL (HAA)
CHECKUST - FEBRUARY 1984
M NICIPAUTY Of ANCHOttAGE 264-4720
DEPT. Of HEALTH &
DIVIRONMENTA. PROTEC.wN Legal Description: L + 5 z 7 JSESS �S;
MAY 27 1986
A. WELL DATA
Well Classificat S
cEi�
If A, B, C, D.E.C. Approved (Y/N)
Well Log Present 6;yr Date Completed 7- Pi- 8'3 Yield , S t a Prv(
Total Depth / 99 • Cased to SE Depth of Grouting
Static Water Level "VL r Pump Set At QA"
iL rAF
Casing Height Above Ground
Sanitary Seal on Casing N'
Electrical Wiring in Conduit Fes) Depression Around Wellhead era
Separation Distances from Well:
To Septic/Holding Tank on Lot 1 • On Adjoining Lots 1.0'D `—
To Nearest Edge of Absorption Field on Lpt 1 � ; On Adjoining Lots 1. bD ( #
To Nearest Public Sewer Line A To Nearest Public Sewer SO 1+-
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by Et 5 'p....LC-1' L • Date
Water Sample Test Results /t77 to
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed 83 Size /25 No. of Compartments Z
Standpipes 49/N)- Air -tight Caps tcniir Foundation Cleanout
Depression over Tann-('r Date Last Pumped — ea - 0 to
Pumping/Maintenance Contract on File (Y/N) � ; for
r
Holding Tank High -Water Alarm (Y/N) '-" Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well '' 3 To Building Foundation Zyr
To Property Line Zo To Disposal Field 1 Q'
To Water-Main/Service Line 301 r41To Stream, Pond, Lake, or Major Drainage
Course
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata �
Date Installed - e3
Width of Field Z9'
/Zsi%Ble
Square Feet of Absorption Area 9&b fe
Depression over Field -r6
Results of Last Adequacy Test
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
yo
G'
Standpipes Present61.14)
Date of Last Adequacy Test Z 3-8 4
SA -ns Fi42 V Icy F 'VAC
Separation Distance from Absorption Field:
To Water -Supply Well ///7(
To Building Foundation
Lot ' A-
4/0,
To Property Line Z Z
; On Adjoining Lots
To Existing or Abandoned System on
So
To Water Maim/Service Line 30 To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course 'a/
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed Dimensions
Size in Gallons anhole/Access (Y/N)
"Pump On" Level at d "Pump Off' Level at
High Water Alarm Level at Vent (Y/N)
Tested for
Electrical Codes (Y/N)
Comments
Pumping Cycles during Adequacy Test. Meets MOA
•' Check Permitted Bedroom Rating Against HAA R
certify that I have checked, verified, or conformed to
Signed & S ENGINEERING Date
Company SR B 196X OA No
EAGLE RIVER, AK 99577
Receipt No .7i 6
s��77/66
&5": 00
equest •*
all MOA and HAA guidelines in effect on the date of this inspection.
MAY 2 3 1986
Date of Payment
Amount. $
Page 2 of 2
72-026(11,M
• orf. OF •A��1s%41 )
1r4..4.1f-
0
. `�:,.^
lit
or
c ; Robert A. Shafer
gin '•. No. 1457.
• eQ�•..N..Ny.
•
•
,• APPLICAT FILLS OUT UPPER HAI('"'ONLY
Property Owner 5/7/45 714 Con/ST,Q0Cr/b/V
Mailing
Mailing Address ' �mD (,0 , y_ 5,J.7c
S ( 4g -
Zip Code 9 957 '
,Zip Code
Phone
&9Z -
337-
Buyer. /J)/f( c $7t%C/G PFoW/`
Address.
Lending Institution �.0//1 4 S OJE 7 -Ti. -ice --re N •/
Address Zip Code
Phone
Realty Co. & Agent co A R raj 0,t/ t4j 4 LT/- ;4 P/= 4-, /NC,
Address i /.4C L/. IQ I V i. 41.4 Zip Code
Phone
69y_9sss'
Legal Description r , 17z-oC /.c a TO'!E. 4. rr, -773,_5
Street Location Fp Ill/C/Ir ' c (P , CN (J N'
Type of Residence
/❑CSingle Family •
Multiple Family .`� , o. of Bedrooms
Field Notes:"witemic-/47—r7157'43
S4Q
42-6 kr\44 — iliU-) //&
❑ Other
Water Supply ^
yiK Individual
•❑ Community
❑ Public Utility
ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975.
For wells drilled prior to that date. give well depth (attach log If available).
/
Sewer Disposal
divldual
❑ Public Utility
❑ Holding Tank
Year Individual Installed. /9 R'..?
When Connected to Public Utility.
Soils Rating
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date 9�
Inspector
Inspector
Inspector
Inspector
Field Notes:"witemic-/47—r7157'43
S4Q
42-6 kr\44 — iliU-) //&
() APPROVED BEDROOMS
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE 9..'14/". 4-1
'CONDITIONS OF APPROVAL
BY:
�rWI•r
Soils Rating
Date Sewer Installed
V " 0 3
Well To Absorption Area /0 O "( •
Well to Tank f o 3
Well Log Received
Septic Tank Size /v rJ r)
72-023 13,82)
