HomeMy WebLinkAboutEAGLE CREST #1 TR A LT 4Eagle Crest #1
Tract A
Lot 4
#050-303-07
\ ; MUNICIPALITY OF ANCHORAGE
1 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING
DIVISION
825 L Street . Anchorage, Alaska 99501
Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR
WELL INSPECTION REPORT
NAME
-7-
PHONE
NEW
iU
❑UPGRADE
MAILING ADDRESS
Q gk3 _Mir
LEGAL DESCRIPTION
LOCATION./ /
(,—
NO. OF BYOMS
DISTANCE TO:
Well
Absorpt,!r (�
Dwelling ( 14 -PER
T N9
U
S
EY
LuQManufacturer
2�P/
/
No. of compart(pcgts
W F
(J
`
Liq, ca ty in3lion
00 `
IF HOMEMADE:
Inside length
Wid h
Liquid depth
ox
DISTANCE TO:
Well
Dwelling
PERMIT NO.
.i0241
_ FQ•
Manufacturer
Material
Liquid capacity in gallons
m
:
DISTANCE TOUJ
Well
O
Founds ��
Neares �t Ime
PEFtMyT fes.
=
zi /
w Z
No. of lines
Length of++��c0-�inel
Total I�flt�of I' a
le r�
Trenc width r.
Distance a li s
f.?¢
.J%
J
LJ inches
h•
Top of file to lin h ade�
Ma erial be [h hie
(inches
Total effecti . absoryy��i area
O
.r
Lr=2. Lte S/e-
Length
Width
Depth
PERMIT NO.
W
V
d ~
Type of crib
Crib tliam
Crib depth
Total effective absorption area
W 1
y
DISTANCE TO:
Well
Building foundation
Nearest lot line
Class
Pw ep h 11f
Driller
Distance to lot line
PERMIT NO.
r
3
DISTANCE T0:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
c o
t
CAE
PIPE MATERIALS
pp
V
SOIL TEST RATING / �J C—a Q�
GJ
INSTALLER, /
C`/llG f Q rr
REMARKS
O
k
• •s •Rolan A. Shc r
•
1 %.��
1-711
AP i V DATE LEGAL
, Y, 4� x/,42
72WJ (Rev. 3/78)
r1Ur-J I r I F�Fi1L I T'r' ID F= F=fr4cHIDRF10E
DEPARTMENT HEALTH AND ENVIF'ONMENTALrO*'OTECTIOFJ
" 825 STREET, ANCHORAGE, AF;. 9S�.J1
264-4720
01r-J—� I TE �EF.•JEfR F ERr-t I T
PERMIT NO. ( 811154 )
APPLICANT ROSS CONST. C/O C. BARR PO BOK 541 E.R. 694-9010
LOCATION 4TH & HILLCREST
LEGAL L4 TR A EAGLE CREST LOT SIZE 17500 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSO FT/BR)= 125
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
F?EF•TH= 1 L_EZN0TH= 2:2 13FRF= Ve:L_ F?EF'TH=
THE LENGTH DIMENSION IS THE LENGTH CIN 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 CIN FEET).
THERE IS FJO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION CIN FEET).
FZEG!U I F?ECD • SEPT I C TFFr-JK �7, 12!! E: = :lLryIDr 13 F=l LFLOr-4E.
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE l•lELL WILL SERVE.
-- TWC, C ? I rJ5~P ECT I Or-J� FiF ZE F; E:I U I REO ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OF: 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.
OTHER, REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F'EFtrl I T E`r;P I F2E- QECEME3EFR = 3 s 1S+E:1
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 THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEIJER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
1 RESIDENCE IS,REMODELED TO INCLUDE MOPE THAN 3 BEDROOMS.
'i SIGNED:.ECZ-:,4--- -- "=_--------------
APPLICANT ROSS C NST. C/O C. BART:
'\`4r UED BY--------------- - -DATE----- Adl� / V4. 0
. n.
r) LOG
MUNICIPALITY OF ANCHORAGE
\� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
• 825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
//may// /� fi�'J�//�77 ��+, / . )
PERFORMED FOR: l . //C�r fC_�[/L / {" DATE PERRFFiORME
// C
LEGAL DESCRIPTION: f� T Fz / /^ ��� ✓r s --O
DEPT SLOPE SITE
IF Ef6T)
2 U
3-
rZfE5 �` (✓
6
7 �.
/ZS /QA
91
10
WAS GROUND WATER
! 11 , \o ENCOUNTERED] A/0
IF YES, //- f
13 CC" ,l j_/,I/O0 70,"
DEPTH7AT WHAT
V v v
14 v
o .1
15 `.p
18
,
l 17 ^r ,f �• Mi
18 ir,
19
f i
❑ PERCOLATION
TEST
L
!1
Reading Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
AS II
,;
Qr
20 " .rr A. S tye*
•:�: w, ta57•�ER w ION RATE r (minutes/inch)
j E
��a:•`,q'; f•T BETWEEN FT AND FT
COMMENTS
PERFORMED BY: IS II•S Eni
72-008 (6/79)
CERTIFIED
by
DOC Co. ODa
SULLIVAN WATER WELLS
P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759
OWNER OF LAND •'' tS DEPTH OF WELL 3 J Z l
ADDRESS STATIC LEVEL OF WATER FT. -> > 7
LEGAL DESCRIPTION 14 F A/.. c'a+ 5RAW DOWN FT. S '
DATE • Started 7 l G � Ended -7 F / GALS. PER HR `/ %' •�
PERMIT NUMBER KIND OF CASING
From Ft. to FL 'l f v r /)
From _?:�Ft. to -J S G Ft- Z/ T fi ✓D
From L Ft. to ? iFt.
From Ft. to 7-3" Ft. c'i rj r .i
From Ft. to Ft. ck yr 4=. i
From LL'IFLto?21Ft.
From Ft. to Ft. df�.g red,
E
From Ft.
From Ft. to Ft.
From Ft. to Ft
MISCL. INFORMATION:
From
Ft. to
Ft.
From
Ft. to
Ft.
KIND OF FORMATION:
Ft. to
Ft.
From
From
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From LL'IFLto?21Ft.
From Ft. to Ft. df�.g red,
E
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From Ft. to Ft.
From Ft. to Ft
MISCL. INFORMATION:
From
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DRILLERS NAME - el
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. o50 -3o3 -o7 COSA# OSC `;5 -
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Eagle Crest #1. Tract A. L014
Location (site address) 10410 Citation Road Eagle River
Current Property owner(s) Thomas & Amy Christopher Day phone
Mailing address 2g410
Citation Dr. Eagle
River AK 99577
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, COSA
will behold by DSD for pickup.
2. NUMf ER,OF BEDROOMS:
3PE.OF WATERSUPPLY:
TYPE OF WASTEWATER DISPOSAL:
n Ind ivid(ialWell
®
Individual On-site
Individufl Wgter:Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
public Water System
❑
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems 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 Pannone Engineering Services, LLC Phone 272-82z8
Address P.O. Box ioo2i7 Anchorage, AK ggS10
Engineer's Printed Name Steven R. Pannone, P.E. Date
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions
encountered at the time of the test, and separation distances measured to readily identifiable features.
The operational life of all wells and septic systems depend on the local soil condition, ground water
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 this system. All systems eventually fail ar
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future
performance nor give any estimate of how long the system will continue to meet the operational
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed
above. Any reliance upon or use of this report by any other person or party is not authorized nor will i
confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Lti Original Certificate Date:
Municipality of Anchorage p8
Development Services Departments
Building Safety Division
On -Site Water& Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99619-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Eagle Crest #1. Tract A. Lot 4 Parcel ID: oro -303-o7
A. WELL DATA
Well type Private If A. B, or C provide PWSID #
Date completed 711u81 Sanitary seal (Y/N) Y
Total depth 334 ft. Cased to _334 ft.
FROM WELL LOG
Date of test 7/1981
Static water level 207 ft.
Well production 1s g.p,m.
WATER SAMPLE RESULTS:
Coliform Ngg_colonies/100 mL Nitrate ND mg/L
Well Log (Y/N)
Wires properly protected (Y/N) Y
Casing height (above ground) 18 in.
AT INSPECTION
3/20/2012
298 ft.
6.9+ 9 -
p.m -
Arsenic: ND ug/l Date of sample: -4119/2022 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic / Steel Date installed 11/1/1081
N
Tank size l000 gal. Number of Compartments 2 Cleanouts (Y/N)
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping -4/20/2012 Pumper 1R's Septic
C. ABSORPTION FIELD DATA
Date installed 11/1/1x81 Soil rating (g.p.d./fiz or ft2/bdrm)12 br System type Deep Trench
Length 32 ft. Width 2.5 ft. Gravel below pipe 6 ft.
Total depth gd ft. Eff. absorption area x84 ftz Monitoring tube Y Depression over field N
Date of adequacy test 3/2o/2o= Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 32 in. Water added485 gal. New depth422 in.
Elapsed Time: 3.6o min. Final fluid depth 32 in.
Absorption rate >= qso+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
in.
Size in gallons Manhole/Access (Y/N)
"Pump off' level at —in. High water alarm level at
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot ioo+
Absorption field on lot ioo+
Public sewer main _75+
Sewer /septic service line 25+
Animal containment areas 50+
On adjacent lots zoo+
On adjacent lots ioo+
Public sewer manhole/cleanout loo+
Holding tank ioo+
Manure/animal excrete storage areas ioo+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation s+ Property line io+ Absorption field s+
Water main io+ Water service line 25+ Surface water ioo+
Wells on adjacent lots ioo+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line zo+ Building foundation io+ Water main _7s+
Water Service line io+ Surface water ioo+ Driveway, parking/vehicle storage io+
Curtain drain 50+ Wells on adjacent lots ioo+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that / have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name _ Steven R. Pannone, P.E.
Date
COSA Fee $ Waiver Fee $ _
Date of Payment a Date of Payment
Receipt Number i:tDdk-D ! C, Receipt Number
(Rev. 11105)
S
ren R. Ponn(
No. CE 8149
Rif
SGS Ref.#
1120828001
Client Name
Pannone Eng. Srv.
Project Name/#
Eagle Crest 1 TRA Lot 4
Client Sample ID
Eagle Crest 1 TRA Lot 4
Matrix
Drinking Water
Sample Remarks:
Parameter
Metals by ICP/MS
Arsenic
Waters Department
Total Nitrate/Nitrite-N
Microbiology Laboratory
E. Coli
Total Coliform
Page 2 of 4
Results LOQ
ND 5.00
ND 0.100
Negative I
Negative 1
Printed Date/Time 03/22/2012 13:06
Collected Date/Time 03/15/2012 17:00
Received Date/Time 03/16/2012 13:30
Technical Director Stephen C. Ede
Allowable Prep Analysis
Units Method Container ID Limits Date Date Init
ug/L EP200.8 C (<10) 03/21/12 03/21/12 ACF
mg/L SM214500NO3-F B (<10)
100mL SM219223B A
100ntL SM219223B A
03/20/12 AYC
03/16/12 MEM
03/16/12 MEM
MAR -22-2012 15:03 FROM:JR'S SEPTIC PUMPING 9073449821 TO:2728211 P.1
JRs Pumping
PO 13ox 7734 t 5
Eagle River, AK 99577
(907)694.6454
Billing Information
Amy Christopher
19430 Citation Road
Eagle River, AK 99577
(907)726-9043
00b Site Information
Amy
19430 Citation Road
Eagle River, AK 99577
(907) 726-9043
Job Descriptlon: 10008
P.O. Number:
Terms Not 30
Selesrep: Dawn -Dawn
Map Book:
Cross Streets: Crest View Lane
Service Agreement
Number:
035336
Order Date:
15 -Mar -2012
Service Date:
20 -Mar -2012
Technician:
Hoover
Tax W 0
Job Type: Repeat
Map Grid; 100. .
Job Comments: Last Service "06/0712010'
tank full
clean out clear
back flushed 3 times
tank normal & clean
Additional Location Comments: Diagram: $:�fls rg ams z2e55 bmo
Cedar w/ Ws on side of home
House & garage doors are mustard
colored
Pipes in back(visible) by flat stone
sidewalk T � I H
• 19
Service Type Qty Price Each Tax?
Septic Sery 1000K 1 $0.00 No
10009 ---
Gallons Planned: 1000
Gal, Actual:
Hose Length: 4
Double Tank: ❑
Pump System: R1.,�
Baffles Inlet: ❑
Baffles Outlet: f I
Extension Actual
$0.00
NonTaxablo Total Taxable Total Tax Total Grand Total
Eatimoted Chargee:
Actual Chargee
Customer agrees to the terms and Conditions shown. THIS IS A BINDING AGREEMENT.
nature,aln�d lTittlle of Customer Representative Date
A 6111 1 IV
Accepted by JR5 Pumping Date Accepted
For your added convenience we accept; Olcover, Visa end Master Card payments over the phone
After 30 Days account will be turned over to COLLECTION$. $30.00 For N$F Chocks Returned.
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a 0m N00. 09' 00.' W (REC.), 137.91 FT.ig 12
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S 00- W 00' E (REC.). 137.42 FT.
I W I
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Municipality of Anchorage
• Development Services Department • #Ac
Building Safety Division 4 IsOn-Site Water and Wastewater Program4700 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
Parcell.D. aSO- 303-47-rJoc HAA#�����U�
" Expiration Date:
1. GENERAL INFORMATION
;Complete legal description fAGGF C2f�{T�e .4 07-
Location (site address o� directions) !/?2f 7_43A4
Current Property owner,(s)AlClisfE �—p STEL Day phone �Z00
Mailing address
Lending agency
Day phone
Mailing address
Real Estate Agent oedl oytC4 /), ,Vl
Day phone 612-C f4'FC
Mailing Address PRO 16F.cPT., .- Iir_rr� .,c
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
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 watr
e
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. (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.
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 watr
e
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. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 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
Phone 7oe1 e
Address I A2s
Engineer's Printed Name S7`6JE F�r6' Date
5. DSD SIGNATURE
Approved for 3 bedrooms.
p��•OF•Ak4%%l
OF �~••�NGI ~••,�9 �I�
49$r
io
cSteven w. Eno
�� sT ,•• ►E 6256 • ; V-�
Mw
�11� pROFESSt�N�
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
WATERAND
Additional Comments
PROGRAM
00
NT
���/111►111111�,
Attachments:
HAA Checklist X Maintenance Agreements
Supplemental Engineer's Report
Septic System Advisory
Well Flow Advisory Other
By: Original Certificate Date: —03
(z.v. ouoz)
w
Municipality of Anchorage `4
' Development Services Department
Building Safety Division
On -Site Water & Wastewater Program 3
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: ('G� C' PFsi S[1� /�T 2Rdi1TA Parcel ID: QSD-;QS_a�-coci
A. WELL DATA
Well type 2 If A, B, or C provide PWSID # _
Date completed 7Sanitary seal (YIN)
Total depth 33 ft. Cased to JU4 ft.
FROM WELL LOG
Date of test
Static water level Z17 ft.
Well production 'Foo g.p*y.
WATER SAMPLE RESULTS:
Coliform 90 colonies/100 ml.
Arsenic: mg.A.
B. SEPTIC/HOLDING TANK DATA
Nitrate 0, l mg.A.
Date of sample: /r1i °3
Tank Type/Material fQf056e.I CTEFL
'Tank size /000 'gal. Number of Compartments z
Well Log (Y/N)
Wires properly protected (Y/N)T
Casing height (above ground) n.
AT INSPECTION
0
2� 7 ft.
/o 9 -
p.m -
Other bacteria G colonies/100 ml.
Collected by:
Date installed
Cleanouts (YM)
Foundation cleanout (Y/N) Y Depression over tank (Y/N) iti High water alarm (Y/N) --&
Date of pumping ci 3 Pumper. �✓
C. ABSORPTION FIELD DATA
Date installed _//��/ Soil rating ( or ft2/bdrm) ,L2.T System type Arri,*
Length 32 ` ft. Width Sort ft. Gravel below pipe
Total depth /Z ft. Eff. absorption area.3-75ft2 Monitoring tube --y Depression over field At
Date of adequacy test Q3 Results (Pass/Fail) P T For -S- bedrooms
Fluid depth in absorption field before test " in. Water added gal. New depth .33 in.
Elapsed Timer min. Final fluid depthin. Absorption rate >= -S6 f- g,pA.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) /J/t If yes, give date
D. LIFT STATION
Date inLe
d Size in gallons Manhole/Access /N)
"Pump vel at in. "Pumpoff le t _ in. High w:M/8,11circuitrequirern
r arm level at in.
Datum Cycles to ed Meets a ts?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 1001-0
On adjacent lots 160 '-r-
Absorption field on lot ZQ L, T' On adjacent lots 1 OQ `+`
Public sewer main R/I/� Public sewer manhole/cleanout
Sewer /septic service line %-5 Holding tank N/,a
SEPARATION DISTANCES FROM SEPTICAI TANK ON LOT TO:
f
Building foundation � ( Property line � Absorption field S
Water main IVA4 Water service line /0 `+ Surface water /Qo
Wells on adjacent lots 10U `r
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /6 �r Building foundation D `T' Water main X'A
Water Service line �r� Surface water 10c' -f- Driveway, parking/vehicle storage
r
Curtain drain VA19AAW& Wells on adjacent lots /Oo
F. COMMENTS
OF A4` t1
G. ENGINEER'S CERTIFICATION �,`Q��••"•'•"'•.aS� PD
I certify that I have determined through rie/d inspections and
review of Municipal records that the above systems are in �.... : •. • ••••• �,
conformance with MOA HAA guidelines in effect on this date. p
o-�
v? c�"t. • Steven W. E fi
Engineer's Printed Name _ Jf e `(c c' •`
�Q �l ;•. PE 6256
Date l��C�OJ �CI��pROF�SS:q��a��V'I
RSG
HAA Fee S 5 / 7 —
Date of Payment l
Receipt Number
(Rev. 12/01)
Waiver Fee S
Date of Payment
Receipt Number
_ C3; ....94" ;
.EC- ?F :. LC. n _ 10
GS Rcf.A 103.7=5001
All Datallimts areAlasi a S~amSard :Istt
'hent haaw. Kart'1i',rci Enzineering
Printed Date/Time
11/12/2003
';13
'rojcdNamdx yy�,��.
lient:G�pte1B lj";Iifual E,g6(_ECX9,f '
tt ColledeJDatrlfimr
�/ L11.177 --7—A
11/0612003
12:00
1tec:fvzdDat.;Tisac
i1/072a.3
13.30
Citrix 1)rin:cin; Wafer
TepWralWrWV,.,ephe
WSM 0
I�rk-srti;y cf
�.
r/P i
�d�e�(/
ample Remark::
uarrcxr Results
IQ[. Unib VrY d Corr.x&rlD
Allowable • Prep
Limits Date
Analysis
Dy Ir it
r
'stern Department
Nitri c -N' OXWJ l.1
O.ICO hell. EPA 300'. B
(<-10)
11107/03 7B
iicrobiology Laborateiry
Tctal Coliform 0
rm 114" smixy?ru
(c s'
11/17"1? r
MUNICIPALITY OF ANCHORAGE
• DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIROXXENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date 1401.Qilry
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lt 4 7-R A Ea 5 4 Cra,rl
(address or directions)
(b) Applicants Name_ Uij-5.lr.-..4 4;;/glelephone - Home — Business d P*_'V.2co
Applicants Address .4 Iy%u'1 08FL4 /%ave r
(c) Applicant is (check one) Lending Instit tion ; Owner/builder ;
Buyer � ; Other ro (explain); .41/r�,-
(d) Lending Institution Telephone
Address
(e) Real Estate Co. b Agent -AG/er,r Zee.' -e
Address * l[
Telephone
(f) Mail the HAA to the following address:
2. Type of Residence
Single -Family r4.Z71, Multi -Family =
Number of Bedrooms
3. Water Supply
Individual Well Community =
Other (describe)
Public
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 Community Holding Tank
Note: If community well system, must have written confirmaticn from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
n
5. Engineering Firm Providing Inspections, Tests, File Search, Data and Informatiop
As certified by my seal affixed hereto and as of the validation date shown below,
verify that my investigation of this Health Authority Approval shows that the on-aite
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 regula-
tions in effect on the date of this inspection.
Name of Firm-S.�f �.rl /�� Telephone
Address .24, .103 A.7e-lo.-4r-e ALi S9S'�/
Date OF q �\
(ENGINEER SEAL) �e k:4
6. DHEP Approval
Approved for .� bedrooms
Approved _X_ Disapproved
Terms of Conditional Approval
1. I1,. 2225-E
B
Conditional
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS 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 REQUIRE-
MENTS. 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.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2] 7-19-84
-- •- - -----. _...----.---- - MUNICIPALITY OF ANCVORAC:
DEPT. OF KALTII
n, CN MOPLNLNTAL K. ECT:Ci j
0 T. 2 9 1994
MUNICIPALITY OF ANCHORAGE (MOA) RECEIVED
HEALTH AUTHORITY APPROVAL (HAA)
CHEQCLISf - FEBRUARY 1984
A. WELL DATA Legal Description:
�c5/e 'Creft
Well Classification /����' If A, B, or C, D.E.C. Approved(Y/N) /A
Well Log Present (Y/N) Y Date Completed rr / Yield�py
Total Depth 33 e/ Cased to 3 3 y Depth of Groutinq �✓ /.V
Static Water Level X97 0� Punp Set At /--.7vt-A*-,,
Casing Height Above Ground R ' Sanitary Seal on Casing (Y )
Electrical Wiring in Conduit (Y/N) Depression Around Fbllhead (Y/N)AJ
Separation Distances from Well:
To Septic/Holding Tank on Lot /oo t On Adjoining Lots /GC
To Nearest Edge of Absorption Field on Lot /OD '` ; On Adjoining Lots /ao
To Nearest Public Sewer Line /Lbn•Q To Nearest Public Sewer
Cleancut/Manhole A/0'-4 To Nearest Sewer Service Line on Lot AV c; -T'! -
Water Sample Collected By 4FN i• ,e g . ; Date /-0,42
Water Sample Test Results Ss t-, i 0% Aew L
Camments &,e//gW4..�a 41-JArCI 4-71e?.6 6f0/*1
B. SEPTIC/HOLDING TANK DATA
Date Installed /?o V Sim /Go o CAI No. of Compartments -a
Standpipes (Y,M) _,V Air -tight Caps (Y/N) V Foundation: Cleanout (Y/N) Y
Depression over Tank (Y/N) N Date Last Pimped /O -L y y
Pumping/Maintenance Contract on File (YM) for i
Holding Tank High -Water Alarm (YM) Alii Temporary Holding Tank Permit (Y/N) .v/q
Separation Distances from Septic/Holding Tank:
To Water -Supply Well /GD 7" To Building Foundation�lr
To Property Line /i t To Disposal Field $
To Water Maini/Service Line /�'� To Stream, Pond, Lake, or Major Drainage
Course Alo)'%e.
Comments
[Page 1 of 21
+5 (0
Soils Dating in Absorption Strata /P S 06 Type of System Design %IP EtiC/y
Date Installed / ice/ Length of Field '3 -1
Width of Field -30", Depth of Field
Gravel Bed Thickness G
Square Feet of Absorption Area 3 7S" 46 f Standpipes Present (YIN) �/
Depression over Field (YM) /V Date of Last Adequacy Test /o/a
Results of Last Adequacy Test S V% o7�w y
Separation Distance from Absorption Field:
To water -Supply Wall /cu To Property Line /CJ 4
To Building Foundation S 9 To Existing or Abandoned System on
Lot On Adjoining Lots 3 o 4
To Water Main/Service Line S'v f To Cutbank(if present) Nax
To Stream/Pond/Lake/cr Major Drainage Carse n/an.G
To Driveway, Parking Area, cc Vehicle Storage Area vW=w to t
Comments
D. LIFT STATION
Date Installed
Siwe in Gallons
"Pum On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Comments
Dimensions
Manhole/Access (YM)
"Ramp Off* Level at
Vent (YM)
Pumping Cycles during Adequacy Test. Meets MDA
** Check Permitted Bedroom Rating Against HAA Request *'
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on the date of this inspection
!L&� SignedDate /��Z s/dye
Coopany e 6 . MOA No.
KB1/d5/s
[Page 2 of 21
-!.•••• •-•1IfA
V'
r 4 h`Di63 N28R5
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/�' •�''
JUNE 25,21371
2-15-84
203• IJ O ° LSU�l ��V U1 W LS(i�U�DO �015o AN HORAGE,V ALASKAIT99501
CONSULTING ENGINEER TELEPHONE: (907) 279-3916
Virginia Kohefield
Re/Max Realtors
Eagle River, AK 99577
October 23, 1984
WELL AND SEPTIC SYSTEM ADEQUACY TEST
LEGAL: Lot 4, Tract A, Eagle Crest Subdivision
LOCATION: Eagle River
RESIDENCE: Single Family, Three Bedrooms
WATER SYSTEM: On site well test pumped at 2.6 GPM for 4 hours
Well has potential of 5 GPM flow rate
SEPTIC SYSTEM: From Municipal Records:
Tank: 1,000 gallons
Absorption System: Trench, 32� feet long, 12 feet deep,
6 feet of rock
Absorption Area: 390 square feet
Soil Rating: 130
Installation Date: 1981
DATE OF TEST: 10/23/84
TEST PROCEDURE: Drainfield was charged with water at a steady flow of 2.6
GPM. A total of 630 gallons of water was added to the trench over a 4 hour
period. Both the septic tank and the sump of the drainfield was monitored.
The water level in the tank did not change during the test. The water level
in the sump was measured at 8" above the bottom of the sump at the beginning
of test and 12" above bottom after addition of fresh water. Sump level
returned to 8" after 24 hours, indicating acceptance of water. The tank
was pumped on October 20, 1984.
TEST RESULT: Both well and septic system meets the requirements of the
Municipality of Anchorage for residential use as of the day the system was
tested. There is no guarantee that the system will continue to meet these
requirements. The operational life of all septic systems depends on the
local soil conditions, groundwater levels that may fluctuate during the
year, and the water usage of the family being served by the system.
r•
MUNICIPALITY OF ANCHORAGE
STREET LOCATION
#E
DEPARTMENT OF HEALTH A ENVIRONMENTAL PROTECTICW NICIPALITY OF ANCHORAGE
6. TYPE OF RESIDEN
891 DEPT. OF HEALTH 8
825 L Street • AneMnee, Atoka60
ENVIRONMENTAL PROTECTION
0*
ENVIRONMENTAL ENGINEERING DIVISION
NOV 13 1981
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWEW�lrl r D
DIRECTIONS: Complete all parts on page 1. Incomplete regsssats will not be processed. Please allow ten (10) days for processing.
1. PROP RTY OWNR
PHONE
521II
AO Bits
o1s
-
MAI LI NG ADDRESS
1A
depth (attach log if available.)
P OPERTY ESNT hf tlifIt'
[ hom above)
HON
give
If system is over two (2) years old an adequacy test is required
2. BUYER Jr
/Oeflf
by this Department.
MAILING ADDRESS
3. LENDING INSTITUTION
PHONE
owoo,"#*
rre
6
7MAI ING ADORES$
-AX'
/ �0 JC d* 9r,
1. REALTO /AGENT
• •
—
MAI IN49AbDREST
•AN Awr
AsAoRld-45rove-pp
S. LEGAL DESCRIPTION
Tit'Ao E
C,trr>� t1V
STREET LOCATION
#E
6. TYPE OF RESIDEN
NUMBER-0—MBAMUS
gK SINGLE FAMILY
❑ One ❑ Four ❑ Other
❑ Two ❑ Five
❑ MULTIPLE FAMILY
Three ❑ Six
7. WATER SUPPLY
INDIVIDUAL*
*ATTACH WELL LOG. A well log is required for all wells drilled
COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
S. SEWAGE DISPOSAL SYSTEM
**If individual/on-site, installation date_
INDIVIDUAL/ON-SITE"
give
If system is over two (2) years old an adequacy test is required
❑ PUBLIC UTILITY
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
r<v i uwi ror
VOTOO
THIS SIDE FOR OFFICIAL USE ONLY
INSPECTION APPOINTMENTS
DATE RECEIVED
TIME
TIME
TIME
DATE
DATE
DATE
INSPECTOR
INSPECTOR
INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLICUTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON-SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATEINSTALLED .
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER ..
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL TO:
Septic/Holding Tank
Absorption Area
Seoer Line
rest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
Q'.APPROVEDFOR 3 BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certifirate)
❑ DISAPPROVED
DATE I
BY,' (Title)
LEGAL DESCRIPTION
72-010 (Rev. 31781
ri
5. LEGAL DESCRIPTION
/- INSPECTION APPOINTMENTS
DATE RECEIVED
ry /
STREET LOCATION
4p,
TIMFs ,
TIME
TIME
DATE
❑ One ❑ Four ❑ Other
DATE
DATE
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
l t
INSPECTOR
ATTACH WELL LOG. A well log is required for all wells drilled
INSPECTOR
INSPECT.`
❑ PUBLIC UTILITY
depth (attach log if available.)
S. SEWAGE DISPOSAL SYSTEM
F INDIVIDUAL/ON-SITE"
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE
�\ 1
•
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF 825 L Street • Anchorage, Alaska 89501 ENVIRONMENTAL P;:CTcCTION
ENVIRONMENTAL SANITATION DIVISION OCT Z; 0 1981
Telephone 264-4720
Dp C��• CC ``//
REQUEST FOR APPROVAL OF INDIVIDUAL SEWEMFF�LICIUVI D
WATER AND
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten 110) days for processing.
1. PROPERTYOWNER
PHONE
MAILING ADDRESS
/�
PROPERTY RESIDENT fit Vifferent fro above)
PHONE
2. BUYER9.1
PHONE
7s/
�t�
AV.
MAILING ADDRESS
3. LENDING INSTITU ION
PHONE
a
MAILING ADDRESS
"0
44
-�_,rtzev
0. REALTOR/AGENT
PHONE
yy-
MAILINGA DRESS
ri
5. LEGAL DESCRIPTION
ry /
STREET LOCATION
4p,
4V
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
�J SINGLE FAMILY
❑ One ❑ Four ❑ Other
0 Two 1:1 Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
Q� INDIVIDUAL' '
ATTACH WELL LOG. A well log is required for all wells drilled
(� COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
S. SEWAGE DISPOSAL SYSTEM
F INDIVIDUAL/ON-SITE"
YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72010 (Rev. 6/79) / I
tL71 _
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLEFAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE GRILLED
LOG RECEIVED -
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE -
❑PUBLIC UTILITY—ae„
Connection Verified
PERMIT NUMBER
DATE INSTALLED
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: IEJ60 If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL /
ill
/1. DISTANCES
WELL T0:
Septic/Holding Tank Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
C3 APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
el
DATE
BY }
111
72-010 (Rev. 6/79)