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Home My WebLink AboutCOLONIAL PARK BLK 2 LT 2Colonial Park Block 2 Lot Z #050-302-02 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES '~ ~ ¢q,,.3 ~~ ~0 SEPTIC ABSORPTION Address WELL ~ TANK FIELD Phonels) l Permd No~ INo ol Bedrooms WELL v') J J LOT U.E -- LEGAL DESCRIPTION Lot ~ I Block ~ ISub~ ' ~ ~~ FOUNDATION Township, ~a~ge, Section ~ ~ . AS-BUILT DIAGRAM (Show location of well, sephc system, properW Jmes, Ioundahon, TANKS ~-- ~_ N ~ SEPTIC ~ HOLDING Manutacturer Capaoty gallons ~J~ TYPE OF SYSTEM ~ TRENCH ~ BED ~W. DRAIN ~ OTHER Depth to p,pe bottom from I Total depth from original grade / Fill added above ongmal grade ~ I Gravel depth beneath p~pe I l ~ ,~ FT ~ FT ~S~ FT ~ ~ FT Number ~ hnes I Sod ra~mg Pipe material WELLS ~PRIVATE ~ OTHER fldentifv) ~-,~'1 Class,f,catton (A,B,C) ]otal Depth Cased to ~. ~ ~g I REMARKS: C L% Eg'ilU il] ' EN I ;S AL s~.,~: ~ = ~' ,. _~ ~. I ._ . . ' ' ceni~mat Ibis inspecli~n was p~nermed MU~I and State guidelines in effect on this date= ' -~ , ~.....~t'~v~ Health Depadment Approval:- ~ - g ¢ ~- : 72-013 (3/85) M U N I C I P A L. I T Y 0 F A N C H CI R A G E Department of~ Health & Human SePvices 825 L StPeet, Anchorage, Alaska 99501 343-4720 0 N .... S I 'r E S E W E R P E R M I T Per. mit Number: 880;[38 Date I ssLted: ........ 188 Up g rade Engineer' Desiq!ned Owner' Name: JOHN PARKER Owner' Address: 6()24 ALAMEDA AVENUE TACOMA, WA 98467 Day Phone: :2'.06-581-5105 Par'col Id: 050-302-02 Section: 7 Township: I4N Range: 1W Lot Size .694A (sq. ft. or acres) Max Bedrooms: This F:'ermit: 5 Total []apaci{y~ 5 SEPTIC TANK: Minimum total septic tank capacity: 1,500 gallons. Each septic tank must have at least 2'.:'. compartments. Depth to top of septic tank(s) < 4.0 feet nequir'es insulation over tank(s). ]:NFORM D.H.H.S. PRIOR TO 1ST & 2ND INSF'E[]TIONS BY ENGINEER, IF AF'TEi;R OFFICE HOURS, CALL 345-4681 AND LEAVE A MESSAGE. CONS'TRUC'T' PER ENGINE:E. RS A'T'TACHED APPROVED DESIGN. THIS PERMIT EXPIRES 12/:~1/88. THIS F'.'E. FddIT VALID FOR A SINGLE FAMILY RESIDENCE ONLY. I CERTIF'Y 1"HAl": :[,, I am t'amiliaP ~ith the Pequinement. s fop on-site severs and wells as set Cot'.th by the Municipality of Anchor'age (MOA) and the Sta'f..e of Alaska. 2. I will install the system in actor, dance with all MOA codes and r. egula{ions, and in compliance with {he design cr'itenia of this permit. 3.. I wilt adhere to all MOA and State of Alaska nequinements fop the set back distances fPom any existing well, wastewater disposal system on public sewer'a(le system o~ or any ad.jacent of neapby lot. 4.. t under'stand t~ 'thi~permit is valid for a maximum of 5 bedrooms. I al. so underst¢ that~he capacity o¢ the total system is 5 bedrooms and an',/ en:l. ar.~w~eoui~e a~itional per. mit. S i qn ed: DATE': ' q ~ .... lssued Er: ~~ ~ ~ DAFE.: 1! Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~'~ .~ LEGAL DESCRIPTION: L-~..,.-~:~7....- 1 2 3 4 DATE PERFORMED: 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 [;~'Z=,~f...~ownship, Range, Section: '1"'[~ '~L~ ' SLOPE '"SI~E 15LAN ; WAS GROUND WATER ENCOUNTERED7 IF YES, AT WHAT ~ljt~$ SL DEPTH? pO Depth to Water After MonilorinD? 20 PERCOLATION RATE__'") (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~" FT AND ~ FT P'I-HFORMED BY: ........ ,. al,,,,m~. I ~ I~.~! IdA '"J~l~i//~" ~ CERTIFY THAT THI~ TEST.WAS PERFORMED IN 72-008 (Rev. 4/85) Gross Net Depth to Net Reading Date Time Time Water Drop "UNICIPALITY OF ANCHORAGE Hea~..~ and Environmental Protec Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 )n II',j_St,,~CTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ,'-.._ . . SEPTIC TA K: DISTANCE ~'~ ~ i NUM, BER OF INSIDE LEtqGTH INSIDE W DTH ........ LIQUID DEPTH LIQUID CAPACITY /O~ALLONS. DISTANC~ r-r-~oM WELL ~C_FOUNDATION-3~ ..... NEAREST LOT LINE ......... ~a' TOToF LINEAL LENGT~/ DEPTJt: TOF OF TILE TO F!NIS~t ~],RADE ~ MATERIAL BENEATH TILE ~ f ~, ---. IN. ABOVE TILE IN. SEEPAGE PiT: Log Crib .Rings__ BU i LDI !',,~(3 FOLJNDATIO~',i __ DP;,METER ~ OR WIDTH ~, LENGTH ..... DEPTH Crib Size: DIAMETE,q ..... L)EPTH..__ DISTANCE FROM: WELL TOT,aL EFFECTIVE NEAREST LOT L:NE .... ABSORPTION AREA WALL AREA) SQ. FT. Well Class: 0 Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: ~ of Bedrooms: Installer: Remarks: /~ ~// ~/~ F'ENr,iI 'i NEI. -.IF'PL. i L:FIN 1 ~:j ii..-. E:LI 1LDEI;.'~ '_41:;.: BL]::-:; 2.'5.L51 E. ._E:...L~iHI._ LOl" ~ E:L. OI_":t<...'":' IJ:OLCIr. II FIL F'HI~tl..'.'. ~.;LI LUI 2E~24-F~ SL-:IL.IFIF.:E: FEE'I · HE,::, JRF I 1 UN S'~'5;"I"EM I E'; ' t'HE ~I...:Ii~!LtI~E[:, E;iZE (iF t'HE SOiL -"-I'-'"' t HE LENG 1' H [) 1 HEr.dE; t ON i ~., / HE: L.P~I-H ~.. I N FEE"t" 2:, OF THE t'RENCH UR L>F.:Ft i NFi ELL:,. 'tHE DEPIH OF Ft I'I~'.ENCH OFt PI'I 1E; 'file DIS'FF-iNCE BEI'NEEN 1HE ~;LIF,'FFiCE OF THE: t~F,'OL.ir.,t[.:, FiI'.~[.', 1HE E:UI"I'Ot'I OF ]'HE EXCFIVFIliON (1N FEET). 'iHEt-;.'E .i.L:, NU SE'/ 14iE:,'/'H FO~.'. 'I-RENCHES. IHE Ei~fN',,,'EL [:,EP1H 1":; THE l',llNi[,1urq C, EPTH OP' GF..'HVEL E',ETNEEN i'HE OUIFHLL F'iF'E HND iHE BO['lOt"l OF tHE EXCFt'v'Fit'ION ,:.IN FEE[.). F' I':1 IjL: I-<L I-:-I iL~i E F:' L I:'1 I'-,1 l- 'L., P -I -' ]: ILl 1`-1 -t F'HI,:t'::.HIjE F'LFiI",ll' f'lFl¥ EIE Ir.,I'RIFILLEiL:, Fit 'iHE F'EN'.r'ilrt']EE"~; I..IPl jil~lr',{ '.-.;IjBJEJ,.:I '1'1.~1 ~- I.~.ILLIJL,.i J. ["ti_ti L:I...INI.) 1 1 i CINS ' '. ,,~,,"' '~'" "'1 .... 't ' ' .......... :t. EI'IHEN: R L. LH_:, t ONt I1 I'.,i~'F HFFN_~I-L. F'LFIr-ii" P1FI¥ E:E IN:,IHiL_I_EIJ. PI I..~:I:IN'i if.,iI_IULI~; f,IFiir..iI'ENFiNL::E FiEiI.~:EEHEN'I' IS 1A:EL::!UI~'.EU,. IFil i,IF~INiENFINE:E H~3NtEI:.}'IENI tiE; i",IL'JFI' I.::;EP1- L. LF:.RENI ',r'OU r'tFiY E:E F?.E~;!tJIF.:EE:, 'i'O ENI_Rt~:iSE i HE 5uiL FiE:E, Cit~:P"iION S"r'Sl'Ei"l FIr.,Ii':,,,"OR "r'i-~U I'IFiY BE: Si..IE:..]ECI' lEI PF.'.OE'ECU'I'IUN. MINIML.tr"i L:,I$1FINCE DE'INEEN FI NELL FiNE:, FINY ON-SITE SEHFIGE [:,ISPOSFIL L~;Y?.;IEM i'_-; 'l.~!E~ PEEt F'OI~: FI PF:'.I'v'FIIE HELL OR 2C~E~ FEE'[' FOF~ Ft PUBLIC i.,IEI.~L. NELL LOI3E, PINE I~'.EG!LIIRE[:, FiND rIUST BE t~'.EI'LII~:NE[:, 10 1HE-[:,EPFIIRI'r'IENI' HIIHIN 2.:~ [.', Fi '-r' k, UP 'THE NELL Ctlr,IPLEII'II3N. uIHEN ~:E(~UIRE~'IENI5 P1FiY FIPPi_'~'. ':;PECiFiIjFiTIONS HND CONS1P, UCI'IUN [)iHij~:HP1S HNE Fi'v'HII_FiB'LE I U INSUA:E P~.~OPEN: INSTHLLFITION. i I..~:EN I iF"r' IHFII i' i Hr,1 FFti"IlLiHN b. lllH 'tHE F.:EI..::!I_tlk'EPtENI'E; F'EI~: CIN-E;It'E S.'ENEF.:S HN[:, HELLS I':-tE; SET PLIR'IH E:"r' THF: I"ILINIC:IPFILII~" 13F FiNI:;HORFIGE. L-~:' I NIL. L iNSI'FILL. 1HE S"r'SI'EP1 I1%t FIC:CO~'.I)FII"JC:E HI]'H 1'HE I-:CIE:,EE'. '- ......... ' _-,'r =, 1EF'i HFi"r' l.~EI]).t~l I RE ENLFiF.:I3Er,IEr.,ti i F i'HE. .;:.'4- i LINE:,ERST'HND I"HR"I' -I'HE UN-SiTE --,ENEk '""'" ......... BM ..... :.,. N'.EL-., 1 [;,ENCE ]. '_i; RENCIE:,ELEE:, l"lZI INCLUDE [II3RE THaN 3: .... E',Rllf"lPl'- _ O&E GEO'~CHNI CAL ~ DEVEL~)MENT Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 CO. Russell Oyster Eerl Ellis 694-2774 SOIL LOG sss-22so Soils ~ Foundations Land Development Performed for: Legal Description: Depth (feet) Soll ¢haracterlstlc~ 0 4 10 1~ ,,, 12~ 14 15 16 Ground Water Encountered: Yes~ Proposed Installation: Seepage Pit Comments: ~ If yes, what depth Drain Field No Performed by: Date: .( - ( eriifie Drilling A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588 OWNER OF LAND ADDRESS LEGAL DESCRIPTION DEPTH OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR gOO KIND OF CASING KIND OF FORMATION: From () Ft. to From ~ Ft. to From ~cy Ft. to ~c~ From ~:~. Ft. to From ~,-~,a~L Ft. to From /;~'rt. to From / 7~ Ft. to / From / 7~Et. to From .) c~, O Ft. From~ ~ Ft. From -3~d'-~ Ft. From ~;-~i: Ft. to -~C_';'~Ft. From Ft. to Ft, From Ft. to Ft. From __Ft. to. Ft. From Ft. to Ft. From Ft. to.__Ft, _ Ft. _ Ft. Ft. From From ~ 6'~0 ~ ~¢.=~',~r o m Ft. ~'"~]'~O ~4~/,q~z_ L,O~ From__ . Ft. C4~tY' t~/'~'~. ~-~00~-,~'~ From . Ft. ~ ~ ~c V /g0 oz ~From~ ._ Ft. 5/d~ From~ to--Ft. ~/~ ~ From to 3~ ~Ft..ff~ ~a~ ~/Zoo~O~om From From From From From Ft. to Ft. Ft. to Ft. __Ft. to Ft Ft. to Ft Ft. to Ft. Ft. to Ft. Ft. to__Ft Ft. to__Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft, Ft. to Ft Ft. to Ft Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft MISCL. INFORMATION: DRILLER'S NAME 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' ,/~ Parcel I.D. ~)~O - ~){~:~ --O'~ HAA# H,~ Expiration Date: 1. GENE~L INFORMATION Complete legal description 0~ 0~ (~ Location (site address or dire~ions) 'J~ ~ ~ ~ ~ I~ Current Prope~owner(s) ~; I I ~C Mailing address J~R ~(~ ~1 ~ ~. ~- Lending agency Day phone · Mailing address Real Estate Agent Day phone Mailing Address Un/ess otherwise requesled, HAA win be held by DSD for pickup. 2. NUMBER OF BEDROOMS: ~ 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class .~ Public Water System Well 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 (HA, A) based only upon the representations 9ivan in paragraph 5 by an independent professional civil engineer registered in the State of AJaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with vaIid water samples.) Certificates are valid for one year for properties served by Class A or B weIIs or a public water system. The Municipality of Anc,horage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm HaE]e ]~iver ]~nl~ixteer;_n~ Se~rlces Address P.O. Box ?732q4., Eagl~ ~-~r, A~ q9577-3:L~4. Engineer's Printed Name ~)£t'{ 5' 5. DSD SIGNATURE ~ Approved for .~ Disapproved. Conditional approval for Phone Date "7 - ~-0~. bedrooms. ~ ..%~",,.. bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 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 Parcel I.D. HAA # ,'-) ~ Expiration Date: 7 - .9.. ~ - O .;2. 1. GENERAL INFORMATION Co. p,ete,ega, deso p,on Location (site address or directions) t~q ~96' -"r'J~'l ~.dl~ Current Prope~ owner(s) Mailing address Lending agen~ Day phone Mailing address Real Estate Agent Day phone = Mailing Address Un/ess otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: ~ 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well [] [] [] [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer [] The Munidpality of Anchorage Development 8e~ices Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Ce~ificates of Health Authority Approval are required for the transfer of title (except be.~,een spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upcn request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid fcr cne year for properties served by Class A or B wells or a public water system. The Municipality of Anchom.ca is not responsible for errors or omissions in the professional engineer's wcrk. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furlher verify that based on the information obtained from the Municipality of Anchorage flies 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. Eagle River Engineering Sezvlces P.O. Uox ~73294, Eagle River, AK Name of Firm Address Engineer's Printed Name-~.Z~ i.5' ~, ~-~3- uc'f~K'~-- 5. DSD SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for Phone bedrooms. bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: /2-74 - ..~ ;~..-- (.O -'~ Legal Description: A. WELL DATA we, Pr,g- Date completed ?/72 Total depth '~g t" ft. Municipality of Anchorage Development Services Department Bulldtng Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anctmrage. AK 99519-6650 www.ci.anchorage.ak.us (907) 34.3-7904 HEALTH AUTHORITY APPROVAL CHECKLIST If A, B, ~ C provide PWSID # /'//~ Sanfla~7 sea (Y/N) Y Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform d~ colonias/100 mi. Date of sample: ~'- 3' - ~ a. B. SEPTIC/HOLDING TANK DATA Tank Type/Material 5"-r,ee / FROM WELL LOG ~/-~,17 ~ '~ ~ ~ ft. /~ , g.p.m. Nitrate/, 19 mgJI. CoUected by: £, ,'~,~', Parcel ID: t~'o - ~'~--~ 0-% Well Log (Y/N) Wires proper~y protected (Y/N) Casing height (above ground) AT INSPECTION ~',~ ~' g.p.m. Other bacteria J colonies/100 mi. Date instelled /9:~) Cleanouts (Y/N) ~" High water alarm (Y/N) Tank size /J'~ gal. Number of Compartments ~' Foundation cteanout (Y/N) hJ Depression over tank (Y/N) A~/ Date Of pumping /~ / J' / ~ ~ Pumper ~' ~' C. ABSORPTION FIELD DATA Date installed /~'~' Soil rating (g:fl:d-./flaer ft=lbdrm) Length 76 ft. Width 5- t ft. Total depth ~,J- ft. Eft. absorption ares ~'Y' ft= Monitoring tube ~,' Data of adequacy test. z,/. 3- a ~ Results (Pass/Fail) Fluid depth in absorption field before test O in. Water added/,tap gel. Elapsed Time: ~'o min. Fi~el fluid depth ~/,v in. Any rejuvenation treatment (past 12 mo.) (YiN & type) System type ~"re,wJ, Gravel below pipe ;3 ' Depression over field For ~ bedrooms New depth ~ in. Absorption rate >: f- 7~a g.p.d. If yes, give date O. LIFT STATION ~/A Date install~ 'Pump on" leveler in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off" level at __ in. Cycles tested ManholeJAccess (Y/N) High water alarm level at Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/tiff station on lot Absorption field on lot -/- Public sewer main Sewer/septic service line -~',~.~' / On adjacent lots On adjacent lots Public sewer manhole/ctaanout Holding lank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ..o Water main A/JA Wells on adjacent lots Property line~/o / Water senace line .' '/'1o / SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line '~ I a / Building foundation ~' f / Water Service line ~-,,.3~- / Surface water /- / ~ ~) · Curtain drain /V /A (',v~C) Wells on adjacent lots '~'~"/ Absorption field .7~ · Surface water 'f ~ = a / Water main pJ/,~ D~eway. pa~ng/vehicle storage ~'/~ / F. COMMENTS .*/ ~,,~.~.,~,,,.~ ~..f~.~..,~.,,-.~ ,"~-.-. /~,~ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Mdnicipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name ,,~4,/-..~ Date HAA Fee $ Date of Payment Receipt Number (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number Louh A. Butera CE-6~6 Z~m~ C F&E Environment~! Services In<:. 1021.730001 Eagb Rive~ En~ncc&g Colonial. Park Lot 2 Black 2 CT&E Re(.e .MI Da~e-./Tlo~s are A~sl~ Standard Time ~entNa~ P~t~ Da~me ~ I1~ ~j~t Na~ Co~td Da~ne ~I0~002 13~0 ~eat Sample ID Rec~v~ Da~me ~l~2 Mat~a ~nlcM DI~ ~ ~ID 0 R~ By S~ R~: ~ ~ ~ ~i~ M~ ~ Dam ~e Inlt 1.19 0.200 mg/L EPA 300 0 (<I0) JDT If,/c*z-o~ *1 o logy Labo~a to~, To~ Coliform cel,'100~.. $M1~9?'~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES D,V,S,O. OF E.V, RO.ME.TAL SERV, CES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~:~g-~)~ ~O OF ON-SITE SEWER AND WATER FACILITY 264-4744 ApplicationDat(; i~J~. ~' I~:::~~ GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) . (b) Property Owner ~c:~t--~ci'J '~ .~ Telephone: Home~ TM) ~"~i~-~'[C~Business Mailing AddreSs I,~(:~'2,~, j3w~,~ I¢::~/~, ~ --'-~~~ . ~_),¢,_~ c:~ ~¢3¢~-7 (c) Lendi.,n.g.ln.st!tutiOn" ~ Telephone Mailing Address '" (d) Real..Estate comPahy and Agent Address -" ., ' ', Telephone (e) Mail the HAA to the followina address: or: Check here~, if hold for pick up. List contact person and day phone number below. $ & $ ENGINEERING Eagle River, Alaska 99577 TYPE OF RESIDENCE Single-Family,J~ Number of Bedroom~ WATER SUPPLY Individual Welr'~- Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL onsite/~L 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. Page 1 of 2 72-025 fRev 8/861 Front 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 _~ & ~, ENGINEERING Address 170~4 Eagle River Loop Road Ne. 204 _. .,-.u. ?9577 nagie Klvur~ ~'~ Date Telephone Approved for -,~ bedrooms by Date Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-o75 ~Rev 8/86'~ Back ~'~ .O~'q\G MUNICIPALITY OF ANCHORAGE (MOA) ~.,~c..,\'~:~.'~~' ,Ck~,,<~ HEALTH AUTHORITY APPROVAL (HAA) ~:~ M~CIPALI~F AN~~ECKLIST- FEBRUARY 1984 ,q~ /~. DEP~.,~ ~EAL~ & 2~-4744 ~ E~IRON~E~T~L PROTE~ION -'- "AU6 9 1988 WELL DATA RECEIVED Well Classification ~ t'3 ~2~J~ t._''')0/>'rb'' Legal Description: ~:~ ~- l~t,-~, 7-- If A, B, C, D.E.C. Approved (Y/N) Well Log Present.N) Total Depth /'37L~' Static Water Level Casing Height Above Ground Electrical Wiring in Conduit(~.~) Separation Distances from Well: To Septic/Pfol~l~__Tank on Lot To Nearest Edge of AbSorption Fieldp To Nearest 15ublic Sewer Line . Cleanout/UanhOle Y Cased to '~ ' Depth of Grouting - ' Pump Set At ~ C:~ Sanitary Seal on Casing f:~J~) ~' Depression Around Wellhead (Y~J~ Water Sample Collected by Date Completed ~ -"-~"7 - '7'7 Yield \ ~1~'~'1. Jr- Water Sample Test Results / t, O'i~:~ ; On Adjoining Lots Lot \~'¢:~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Se~ice Line on ~1~~~ 'Date Comments SEPTIC/I"IG~.D.I.~LG TANK DATA Date lnstalled 10/"/1 ,1~ ~/'~Size Standpipes ~N) "f Air-tight Caps41~;~N) Depression over Tank (Y/~ Ir~ Pumping/Maintenance Contract on File (Y/N) rj~j Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/~nk: To Water-Supply Well To Property Line To Water Main/Service Line Course ' ' '~,- ,~;t::~ ~'c~ '1'"~ No. of Compartments "7" Foundation Cleanout (Y/~ / Date Last Pumped ~ ~'~.4:2-- I'~/~'~ ;for Temporary Holding Tank Permit (Y/N) J / ~ ~:> To Building Foundation ~, ~ To Disposal Field '~c> I ~ !~ I.~ To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 '~' , : 72-026 CRev ~/861 F'ror~t C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 1 '~'~'~Z~--~ Date Installed '~ "' '~p "" ~<~5 Width of Field Square Feet of Absorption Area Depression over Field (Y~:) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well i ~2 ~.~ To Building Foundation Lot TO Water Main/Service Line Gravel Bed Thickness "~ Standpipes Presentd:~N) Date of Last Adequacy Test To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field ,'7' ! To Property Line Comments To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) / LIFT STATION Dimensions "Pump On" Level aSize in Gallons t ~ ~__ Ma'~lme/p'~)fcf':'~e(vYe/INa)t High Water Alarm Level at ~ Vent (Y/N) Tested for Electrical Codes (Y/N) Comments Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all ~OA and HAA guidelines in effect on the date of this inspection. Signed ~_ ~=u~-IHEERING: Date ~/¢/~ ~ ...... ~er I. Road No ~ / ~IeRi. · ~ · - ~o Comp~ .... ~=~ M~ NO. ~ Receipt No:', ,, -.. o, - "':' A~eu,t: $ ,/~ ~ o o · Page 2 of 2 72-0?6, !Re~ 8/863 Back CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAi4PLE rom Work Orde= ~ 8297 Date Repoxt Printed: AUG $ 88 ! 08:24 C:.l~tt Sample ID:L2, B2, COLONIAL PARK Collected ~UG 3 88 @ h~s. Rece].ved AUG 3 88 ~ 17:00 b~s. Preserved with ;4 DEG. C Client Name : S ~ S ENG!NEZR!NG Cllent Acct: SNSENGP P.O.~ NONE REC'D 5eq # Ordered By : ~.r,a!yszs Completed :AUG 5 88 Send Reports to: L~boratory ~upervlsor :$TEP~{EN C. EDE lis & S ENGIIqEERING Rele~.~d 8y : ~<!~ ~ ~'" 2) Special !ns~uct: Chemlab Ref ~: 2070 Lab Smpl ID: I ~at:iz: Watex Allowable Parameter ~ested Result/Units Method Limits NITRATE-N 0.27 ~/1 EPA 353,2 10 Sample ROUTINE SABLE, [{ernazks: I Tests Pezfo~med ' See Special Instructions Above UA=Unavailable ND- None De~acted '~ See 3ampZe Rema~s Above NA- ~ot Analyzed LT-Less ~ha~, GT*Greatez Shah