HomeMy WebLinkAboutEAGLE PARK BLK 2 LT 1AEagle Park
Block 2
Lot 1 A
#050-782-35
:.......
-.{
,.OWNER OF LAND W
ADDRESS ...bLd<:.i
. WELL SITE .... _......
DATE -STARTED
OF DRILLING by A & L DRILU-4G
£PTH OF WELL.../" 4 O •.:::':� `
STATIC LEVEL OF WATER FT. -.��D •_��y'�:.,
3�$ac- /7i
nwH;c�'£vU/Jf
DATE -ENDED _...... . �
......
.
1? -3
...
DRAW DOWN FT... D_
GALS. PER HR.
J
KIND OF CASING �... �,�__�.�•^»
KIND OF FORMANON:
TO..l..y.'--__:- ...FT. TO.1
// / _ / /
TO../.,?/.... . ./.lO .�.!C....» FROM.../.�1.:FT. TO._J.0_/.......27.&e..C..!`r
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..
... , ` AOM ................ TO..,.�_..--__...FT_.
. FROM.... // / f CA nc.. t`'.
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TO..`� �%._.,_ F•P�/4� 0 r IZ FitoM.._ , �_�IT. To.� _�_ r Ft - ._
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FROM.-f._C9% .4.. -_._._FT. TO'l P..:
MISCL. INFORMATIdAt
s`14-
7 e. C_
I
th
DRILLEWS NAME
cc-,' f>G 6S ,.
,.c` ,.ti L•.f�•
OF ANCHORAGE
.MUNICIPALITY
CEPT. OF HEALTH &'
i -' • • ;�:;,; ,,,
PROTECTION
ErVIRONMENTAL
MAR
ECEiVED`'
y�-':
Municipality of Anchorage
-� Development Services Department
\ . Building Safety Division
\_-,- On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
www.ci.anchorage.ak.us
(907)343-7904
2�� 5�
Avit r/oS
t �.���•i �i
{ O
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 0.§76-:
1. GENERA(INSORMATION,
G ,r
Corfiplete Ieescrtptibn�~�_
Location (site address or dire6tions)
7.
Current Pfoperly ownef(s) ' , on
Mailin9,'address:� ' 402104<
Lending agency
Mailing address
Real Estate Agent
Mailing Address
HAA # 65Z4--` 7—Q
Expiration Date: I / -7/ ` I lb
2 0 r:tOO R,4V1z--kl
Dayphone 694-/01s
Day phone
Da CP r lein. Day phone' ir94/- c/ 99!$�
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
_
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water 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 Firm ��r fit R,t*\ 15rr c
Address / 7a3 i �'Se x- A--
Engineers Printed Name �ST6/
5. DSD SIGNATURE
Approved for L_ bedrooms.
Phone S 95l — 70ZcP
Date 101411OS
6F4 ..gSpp,
........... a
PE 6256 .'vim
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: AA I. i A ` 1 ,t Original Certificate Date:
(R•, 01102)
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: F.=d� K . G ar 1A Parcel ID: of - 35
A. WELL DATA
Well type _P_ If A. B, or C provide PWSID # _ Well Log (Y/N) Y
Date completed 4611V17i Sanitary seal (YIN) Wires properly protected (Y/N)
Total depth! qq ft. Cased to NO ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test ��01?3 0" c
Static water level %o ft. ft.
Well production S Z g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform _colonies/100 ml. Nitrate mg./l. Other bacteria colonies/100 ml.
Arsenic: mg./I. Date of sample: &67e10S Collected by: a'l+ R,.r
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material 5�
Date installed =5_ 3
Tank size,(? SO gal. Number of Compartments Z Cleanouts (Y/N) X
Foundation cleanout (Y/N) Depression over tank (Y/N) At High water alarm (YIN) A(
Date of pumping Z�2 en Pumper _ A?J'
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d.W or ft2/bdrm) yLK System type (2.9/R
Length 14' ft. Width 2 % ft. Gravel below pipe akl& ft.
Total depth _40 _ ft. Eff. absorption area :Y&ft= Monitoring tube __�_ Depression over field Al
Date of adequacy test QS Results (Pass/Fail) �-fS For * bedrooms
Fluid depth in absorption field before test /,J' in. Water added O' gal.*- New depth?.?. in.
Elapsed Timer min. Final fluid depth /_ in. Absorption rate >= O Q' 'f-
g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
'Pump on" level atin. 'Pump off" level at n. High water alarm tavel in.
Datum Cycles tested Meets alarm & circuementsl
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot /O C �f
Absorption field on lot /Q '*"
Public sewer main AJI-f
Sewer /septic service line /00 iif-
On adjacent lots /O 0 'r
On adjacent lots /
Public sewer manhole/cleanout WA
Holding tank .0J/-+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation SS ferty Propline �t' Absorption field S
�t
Water main AVA• Water service line Surface water /00,./-
Wells
00,'fWells on adjacent lots Oo of
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /O f Building foundation /Q ro' Water main .✓��
Water Service line 2 S Surface water /OQ f Driveway, parking/vehicle storage 2S �-
Curtain drain U/`rt'- Wells on adjacent lots 00 It
F. COMMENTS
• .�-.\'4.1.1 .
G. ENGINEER'S CERTIFICATION ,:"'•,;S'�
�; .,•y6l
i certify that i have determined through field inspections and 0,
review of Municipal records that the above systems are in • "
conformance with MOA HAA guidelines in effect on this date. .....
•
S77
25. 6Engineer's Printed Name 110-0 4
Date �Q�/�s °9�'•........ •' ���..
HAA Fee $
Date of Payment 10
Receipt Number �Icl so IF
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
v)tl)
P°Tµ*
v
r
ti� \ 0
.,o
m
Zy�
s =. 9lulA% :
pt!tr. «...».p»
• 7�i 4.*j VIM. A. Moil •.1 �
�i soh._ �+::1>i,NI+ ..•r �
THE INFOLWTIQN MEREON 11 fm -Tog w OF LEIIDIMO
IMSIITVTIONII.MFFCIFICAU TO. 210 ANT..00IIFLICTS tASI MTS .OF RECQIIOt OTNEH
UTIUM EXISTIMO ITFLCT 94 AMO PLATTED LOT LIMES THAM TOM SMOIM CN 1NE
OR EAS9K 78 AND IS NOT TO SE LM® FOR POSITIOMIW EECDRDED FLAT, AHt NOT .
ADDITIONAL STEUCTIMSS CIS FENCELIMSS IMOIII NEESOM
Et�
is s34,
AS -BUILT SURVEY (NO CCRHERS SET THIS DATE)
1 hereby oertlfy that I have perforsed a
MortSa#"Of Inspection of the follortra
described propertyi
LOT IA, BLOCK i, EAOLS FARC SUB.
Anchors" SocoNIm District, Alaska and
that the lapnvernts altuated thereon
aro within the property llrns and do not
overlap or oncroutt on_ the property
lylnu 1djo mt thereto, that no
IsprgWml tf on praparty (yin adjacent
0v.j #wmnh an the promises In
yW"Jkn wo tMt then are no roadway.,
(r,"!Olan lines, or other vlalble
B4Bpunts b said property except as
lhc$144tod Mnon.4atod at Anchorage,
1
Aluka thle ' day of 7-
lf. r Ad X7.4 Z.
NOLT AND ASSOCIATES LAND SAVETORS
. Sei9
I
Mat -Su Text Lab
90774MOLC 09/39!06 C7t Z2prn P. 002
'`
water ALsI� Tac:: �.
MIN 3 3 Pxlmar-Wasilla 1rwy.
Midtown Community Walrwss Park
Phonic (907) 74rr3004 Emit: tn4`. e.:toatlab., r et0wcor•
Chant: North R m Cmin)erir rj
17237 0 or ?aw Ci cle
Ea01a kPw7, Ak 94'S77
Mr.:
Client 10: 1A Clock 2 Lsig1a F'atR
PWSID 4.
Source:
kt.S.T.L.t1: 51!.:<
5 stple Ma-nx
Comments:
P.O. Box 2749
Palmar. Ak. 9044S
Fax:(907)744-3010
Date Arrkeei: 906x'35
report Data. 9,12946
Sample Oale. 9120.175
3amplo -i cre: 140..1
Collected By: BE
ME,Parameter
ME
Una s
Resttbc
WIL
Date Prepo ad DaA Analyzed
MCL
SM 4500-NO3-E Nitrate•N
mg1L
1.60
0.50
3/29105
9/29/05
10.0
SM 4500.1403-E Nitrite -N
mg/L
0.09
0.05
9129/05
9/05
1.0
Total Nitrate/Nitrite
mg/L
1.80
050
9/29105
9129105
100
Legend. MRL • Method Report L"A
MCL • Max ContaTinatc level
C = Presenl In Meths! alana
E Esttmahxl Vakte
M • Abova MCL
D • 1.04 to Dalaxxt
i
ReporCed By Jor, Paul Campbell
Lab Manager
MUNICIPALITY OF ANCHORAGE
O DEPARTMENT OF HEALTH & HUMAN SERVICE
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
Parcell.D.HAA# 0119'�n2a9,
1. GENERAL INFORMATION ' IRt.
Complete legal description
Location (site address or directions) _.2 o6af�a �2�.yE�! EamcE ,2,yEe
�aart��
Property dwner - �Ew. ✓A ! Au.� Base. Day phon�e•!124r6— 9>,rs
Mailing address
Lending agency
Day phone
Mailing address
Agent
Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS. V
3. TYPE OF WATER SUPPLY:
--- T ""Individual well ✓
-.:
Community well
Public water.
NOTE: - If community well system, provide written confirmation from State ADE& attest-
ing to the legality and status of system.
)i
4. TYPE OF WASTEWATER DISPOSAL:-
ISPOSAL
l
Individual on-site '�
Individual
f
Holding tank
Community on-site
•
`,�
;;
Public sewer
NOTE: If community wastewater system, provide written
confirmation from State ADEC
attesting to the legality and status of system.
txan m«. inv rye wog m
S. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
Investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify 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 Oo�.c� -as TC.cJcEj� Phone
Address kpi &6 3 wz.
Engineer's signature Date � ' Ito -91
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Coi
State and
•continued suitabi
: The well for th
Codes. There are
trates present. It is
ty. :Nitrate concentration is 5.31 mg/1: EPA
Date 2— 7-9'j-
`., The Municipality of Anc6rage Department of Health and Human Services (DHHS) Issues Health Authority
Approval certificates eased only upon the representations given in paragraph 5 above by an independent
prhfegsiogal engineer~ registered in the State of Alaska.The DHHS does this as a courtesyto purchasersof homes
and their lending rAsi titutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data beforea certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
r.+=M•+•IM) 010 MWm
-B
: The well for th
Codes. There are
trates present. It is
ty. :Nitrate concentration is 5.31 mg/1: EPA
Date 2— 7-9'j-
`., The Municipality of Anc6rage Department of Health and Human Services (DHHS) Issues Health Authority
Approval certificates eased only upon the representations given in paragraph 5 above by an independent
prhfegsiogal engineer~ registered in the State of Alaska.The DHHS does this as a courtesyto purchasersof homes
and their lending rAsi titutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data beforea certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
r.+=M•+•IM) 010 MWm
® Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: /a E 4e0 eA—'Parcel I.D.
A. Well Data
Well type It A. B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) y Date completed -41.I6 fo, Driller fid Oc.«,�1s Geo.
Total depth i Cased to /-J,/V C` 4 Casing height
Sanitary seal (YM) YWires properly protected (Y/N) y
FROM WELL LOG AT INSPECTION
Date of test /,. uE o 1979 iS i99�r- o
Static water level n
Well flow �! L g.p.m. Q, o
g.p.m.
Pump Ievelt 'C o
•
SEPARATION DISTANCES FROM WELL TO: Z c
0
Septic/holding tank on lot On adjacent lots
Absorption field on lot 7F'` ; On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer service line i Goi'! Petroleum tank
WATER SAMPLE RESULTS:
Coliform 't7 Nitrate X f Other bacteria 41
Date of sample: -X/ ,-s6 'J""" i 9 !PSS Collected by: /-�-
B. SEPTIC/HOLDING TANK DATA
Date installed -`/g>' 0'97Y Tank size Compartments
Cleanouts (YM) A.1 Foundation cleanout (YM) 't% Depression (YM) ti
High water alarm (Y/N) A�/' Alarm tested (YM) • • '��it r
Date of pumping Pumper r ' �•Q �S
�.
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK TO:
Well(s) on lot On adjacent lots "'Oe AW V, Foundation
�� r .
To property line y,ZF� Absorption field Water maintservice line
Surface water/drainage A��
72-M (ate• From
z..rxW
(oO'`-X-74-
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
r
at
Meets MOA electrical codes (Y/N)
SEPARATION D E FROM LIFT STATION TO: _ .
Well on lot On adjacent lots Surfacewater_
D. ABSORPTION FIELD DATA
Dateinstatled O Av i;" Soil rating(GPD/Ft2) ti/A System type
/O Fig For!
Length /6Wi
A4 dth .� 9« Gravel thickness 'v_Total depth -zmc•w-c o.,..c.to
b•f>4i� yu4s < '� 7..& De ession over field N
Total absorption area •Cleanout present (Y/N) H.•• pr (YIN)
Date of adequacy test if •'`P¢ -f Results (pass/fag) -,02s,s for Bedrooms
Water level in absorption field before test �• s• ✓ After test
Peroxide treatment (past 12 months) (YM) If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot F� On adjacent lots /40 Property tine
To building foundation -�z c!�f To existing or abandoned system on lot
On adjacent lots /O ,A X-/ Cutbank de+JB Water mainlsenrice line 6 oFf
Surface water tie ✓6 Driveway, parkingNehide storage area /oo
Curtain drain
E. ENGINEER'S CERTIFICATION
•w
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effec,J,9& 116 "'Is inspection.
x'48 '✓ •••*��d
1 •�
Signature
l� ala eir....
Engineers Name
Date
�.�� �9�CtCtlo
0 ��q' •'Ce_:
HAA Fee $ Waiver Fee $
Date of Payment �� " %S� Date of Payment
Receipt Number �9� Csla) Receipt Number
72-026 r -W)' Back
w
4.
Douglas T. Kenley
Civil Engineer
State of Alaska C.E. 8176
HUSTON.XLS
SEPTIC SYSTEM ADEQUACY TEST
Legal Description Lcs a-
Applicant
Date of Test 199.4—
SYSTEM DATA
Tank Volume
Number of Bedrooms
Absorption system
Number of Bedrooms
Absorption required (1.5 daily flow)
�rq... Qi/7/✓ OF K%6c�C.
t4--or.e ts'✓a•- 8L.8F�
p°4-/•i�r v,Gv.✓pc.c�.J
Lr6 ,ud•50�04-oUSC .fS2 «
TIME
FLOW -VAI-
pm (gals)
TEST DATA
TANK LEVEL TUBE LEVEL
Drs/r- „✓./> P.e.e
COMMENTS
/�� �
Loll
s'9/v' dB /,sem/ 6 B
� •:
Ho'
>
LdB
9.i zZ If
r -r-
16097
of •
/. df
-Pl
1.79
L47 XX
OL
�
y 1, 1, �sr3
System Passed
j -Z.,.-- L.fB ;1
Jlyrr
� raz io
e r s
6L '/If
706. f
Sysytem Failed
A"'w. 'CLO. cJ. 0 3/• s Ca c _ w/ e. a '4
zit. -...J � ..✓
>•.e r S 4-'•1.
Page 1
»e.
•Fv
�II/I� L Ai IA.) IV Nx''
f e✓4t yii.N.
� ,bio/v60 �St
lzx✓ ef.✓ 6 9d-
06/21/95
CT&Z Rei.#
Matrix
Client Sample ID
11:25 COMMERCIAL TESTING 4 907 248 5774
ME Environmental Services Inc.
Laboratory Division,
95.2602-1 Laboratory Analysis Report
NATER
LSA E2 IAOLE PARK
NO. 692 M
client Name DOUGLAS Xr=Y,P.E.
WORK order 15476
ordered By DOUGLAS KENLEY
Printed Date 06/21/95 i S1t1S hre.
Project Name
Collected Date 06/11/95 0 17101 hrs.
Project#
Received Date 06/14/95 0 15350 bra,
PWSID UA
Units
Method
Technical Director STEPHEN C. EDE
Date
Released
Sample Romarkst SAMPLE COLLECTED by, rRED A. KENLEY.
.................................................................................................................
• ice Special Instructions Above VA . Unavailable
�• See Sample Remarks Above NA • Not Analyzed
tx . undetected, Reported value is the practical quantification limit. LT • Esse Than
Q.. secondary dilution. OT . Creator Than
200 W. Potter Drive, Anchorage, AK 99518.1805 —Tel: (907) 582-2343 Fax: (907) 551.5301
�p.n nnnuueu... e.PWT
oc
Allowable Ext.
Anal
Parameter
Results Qual
Units
Method
Limits Date
Date
Ini
..................................................................•---_-.........................................
Nitrate -N'
5.31 D
mg/L
EPA 353.2
30.
06/16/95
OA
.................................................................................................................
• ice Special Instructions Above VA . Unavailable
�• See Sample Remarks Above NA • Not Analyzed
tx . undetected, Reported value is the practical quantification limit. LT • Esse Than
Q.. secondary dilution. OT . Creator Than
200 W. Potter Drive, Anchorage, AK 99518.1805 —Tel: (907) 582-2343 Fax: (907) 551.5301
�p.n nnnuueu... e.PWT
Doughu T. Kmlr3. PE 11C01 Box 6011. Pawn, Alwka 99615 (907) 746-1073
July 22, 1995
Municipality of Anchorage
Health & Human Services
On-site Services
Re: Percolation Test Results, As -built drawing and General Site Investigation Report
of Lot IA, Block 2, Eagle Park Subdivision, Eagle River, Alaska
haracterictic.v
On July 19, 1995, the above -referenced site of approximately 35,224 square feet was inspected in
conjunction with soil perk tests being performed for application of a standard Health Authority Approval
by the Municipality of Anchorage. The system had been in use as an undocumented on-site disposal
system. At the request of the city the existing system was exposed and documented and a percolation test
performed to ensure its adequacy and compliance with current city requirements.
The existing system is comprised of a 1,250 gallon steel septic tank of unknown manufacturer, a 1,000
gallon steel tank crib measuring 36 -inches in diameter and 6 -feet tall. The crib appeared to have been
backfill with native sandy gravel material as there was no distinction between the material immediately
adjacent to the tank and that exposed at the nearby percolation test pits.
A total of three test pits were dug to both verify the extent of the crib system and to observe percolation
rates. Percolation rates observed ranged from 8-10 minutes per inch.
The site is on the south side of Raven Drive with a slope ranging from approximately 1% -2% south -
north direction. It appears that there are no obstructions that would prevent surface water runoff.
The property is served by a private well system. On-site observation and physical survey shows that
there are no private or community water wells within a 100' radius of the proposed system. No surface
water was observed at the time of the inspection. Subsurface soils were found to be medium -dense,
sandy gravel with some silt overlain by 12" of surface organics.
Both the on-site well and wastewater disposal system were tested and found to be working adequately for
a (4) bedroom residence. Attached are test data sheets and as -built drawings of the documented system.
If there should be any questions concerning the percolation rates or characteristics of the site please call
Doug Kenley at 1-907-746-1073.
Sin�cerel ,
Douglas T. Kenley, PE
CE #8 176
Permit No. Page of _
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: Lot 1A, Block 2, Eagle Park Subdivision PID No.:
72-013 A (2/91) MOA 25
UJ
XI•:3. :5 U .
Permit No.
Page of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: Lor/ -7 2 4—.00e f P.o.e a PID No.:
Ec6d
s7ocJJ Fo
OoCuHs
! naripvd�
�`Xi3r�.✓
6Y.sr2fy
G
97y'
9s�
I 959«
9c1,
92Zi
�—
9V, _�s
! -r
' 91
` r /ot7d Ga
S�sc
` `
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72-013ApMM•
'•' GtREE 5
• ��P,• ;:fit
Municipality of Anchorage'4'9 1," •• ••' 1r
• rr ••
DEPARTMENT OF HEALTH & HUMAN SERVICES r U4 ,� f
825 "L" Street, Anchorage, Alaska 99502-0650 / 9 ; D0 LF.S T. I(cKLEY-;!Z�
SOILS LOG — PERCOLATION TEST /+�' CE 6176
11''
PERFORMED FOR:t`•t•t'(y%t4 8oDATE PERFORMED:_
LEGAL DESCRIPTION: (.e•�- P` a I?i�V 7 S2nt� f�,„ Ij..Township, Range, Section:
DEPTH r SLOPE SITE PLAN
(FEET) a yW(�ds,w
1t7d N
2
3
4--
6-
7 6 7 y
8
9
/O
,A q� cJ jrLqt1 sa.l a.la.
10
• ri
Net Depth to
Time water
11
12-
2
7•I�I.�
Il:lOA.
13
13-
`
It -.744-
14-
14
a
Sakd �, yvnwj1W tli,
15
i
�j6WtC 5�ti
s
16-
i
0
17
17
`•
11: O
0
18
'L:DD
19
WAS GROUND WATER aI
ENCOUNTERED? e
S
IF YES. AT WHAT L
DEPTH? ( P. p
Depth to Water Aller, 11a•• `?.iy.
Maule(II ` root
Reading Date
Gross
Time
Net Depth to
Time water
Net
Drop
7•I�I.�
Il:lOA.
`
It -.744-
1D
(1,9D
10
1
Dw
0
`•
11: O
0
1-50
'L:DD
O
"
20 -{
IL_ JI PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND 5 FT
COMMENTS
PERFORMED BY: rtI I l M CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. TE •'j
72-008 (Rev. 4/65)
i
APPLIC`VT
FILLS OUT UPPER HAL 10NLY
•Propertyowner F,Q9nG/S /-!Ji/[us �r �E,QG,�9/'/ �• /���LUsk� Pnone
,%
Mailing Address 4 /
C�-
Code �j' 67 V-z,.t /,
4
Buyer wc- /- (/ice if -0c3 ch
IllZlp
Address
Zip Code S.
^
Lending Institution/1/959
F�
Phone
Address',270X/"
Zip Code / d
Dat
01
Realty Co. & Agent
Inspector
Phone
�1
Inspector
Address
Zip Code
Legal Description DoT / ,�CucK O%
Er7 Ej/� PACK S4'6dr0 Si*Aj
Street Location
Type of Residence
j
Single Family '
No. Bedroom
Multlple Family of
I1
't�,-73 � A "Municipality of Anchm,"Y'
❑ Other
'CONDITIONS OF APPROVA E eat
Em�roamProtection"
Water Supply
(21 -Individual
(JL,
ATTACH WELL LOG. A wall log Is required for all wells drilled since June 1975.
❑ Community
For wells drilled prior to that date, give well depth (attach log if available).
❑ Public Utility
Date Sewer Installed
.Sewer Disposal
Well Log Received
Individual
Year Individual Installed:
Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time/ , D
Time
v
Date
Date
Date //n
�"
Dat
01
Inspector
Inspector
Inspector
Inspector
/ 'T�
Field Notes: (.tet q� ya -f.! tall �� r* /( / LOU
EII
C�
MAY 3 11983
O,K
I1
't�,-73 � A "Municipality of Anchm,"Y'
( ) APPROVED BEDROOMS
'CONDITIONS OF APPROVA E eat
Em�roamProtection"
(�)entat
DISAPPROVED
( ) CONDITpNA APPROV L'
(JL,
DATE
BY:
VV
N4 0
Soils Rating
Date Sewer Installed
Well To Absorption Area ....
Well Log Received
Septic Tank Size so
Well to Tank
Mr. Tim Pauluoski
SR 1, Box 6024
Raven Drive
Eagle River, Alaska
Dear -Mr. Pauluoski,
EXCAVATION
ROBERT A. SHAFER
WORK CIVIL ENGINEER
6942979
June 10, 1983
99577
Reference: Lot IA; Block 2; Eagle Park Subdivision
A sewer system adequacy test was performed on the system located
on the referenced property as you requested. The septic tank was
pumped and verified to have a capacity of 1250 gallons. The seepage
pit was tested by charging the system with 600 gallons of fresh
water and after a period of 24 hours all the water which had been
added to the crib had percolated out.
It can be concluded from this test that the waste water disposal
system serving the four bedroom residence located on this property
is currently functioning adequately. However, this system cannot
be guaranteed against subsequent failure.
If we may be of further service, please do not hesitate to contact
US. ,
Sincef¢ly,
SHAFER, P.E.
ss
cc: Alaska Federal Credit Union
Safeco Title Company
Municipality of Anchorage
Department of Health and Enviornmental Protection
SRB 196X EAGLE RIVER. ALASKA
S. LEGAL DESCRIPTION
DA [RECEIVED
INSPECTION APPOINTMENTS
i'LAIe SL/6'4)fvlS/o.v
STREET LOCATION
Ti r1
TIME
TI E
6. TYPE OF RESIDENCE
DATE
DATE
DATE
_ ^
`
INSPECTOR
INSPECTOR
INSPFf�TOR
I
7. WATER SUPPLY
MUNICIPALITY OF AN
MUNICIPALITY OF ANCHORAGE
DEPT. OF 1'"•LLTII &
' DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTECTIOlfNVIRONMENTAL
i..,.J_CTION
825 L Street - Anchorage, Alaska 88801
depth (attach log if available.)
S. SEWAGE DISPOSAL SYSTEM
APR 1 1 1980
ENVIRONMENTAL SANITATION DIVISION
%3 YEAR ON-SITE SYSTEM WAS INSTALLED.
Telephone 264-4720 TRUHYLIA
/05f CTO 10/22/76
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTYOWNER nn �I
F Lr1,V
PHONE
MAILI G ADDRESS
sok GOZy lCAtl� F_RGL� ,('/USC
PROPERTY RESIDENT (If different from above)
PHONE
2. BUYER
-IJNCis 9 0651s e,a t 0S, i
PHONE
S2 --30S1
MAILING ADDRESS
�+
hoX 1403 ML fge i1/: �j4lvS
3. LENDING INSTITUTION
PHONE
MAILING ADDRESS
/ !r), h'_e^)Srx)
4. REALTOR/AGENT
IL°A! 4/0A Ce C �/N
PHONE
2 rJ�OSS/
MAILING ADDRESS '
S. LEGAL DESCRIPTION
,Cly /A
i'LAIe SL/6'4)fvlS/o.v
STREET LOCATION
kd LlE C7C •
— EIi6L E /C'/ v'r C'
6. TYPE OF RESIDENCE
NUMBER OF�BEDROOMS
0 One Four ❑ • Other
($� SINGLE FAMILY
❑ Two Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
121 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
-
INDIVIDUAL/ON-SITE"
%3 YEAR ON-SITE SYSTEM WAS INSTALLED.
/05f CTO 10/22/76
❑ PUBLICUTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) AO
W�s��sry�n/
1
72010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY ._
1. TYPE OF RESIDENCE
O SINGLEFAMILY
❑ MULTIPLE FAMILY
❑ ONE
O TWO
NUMBER OF BEDROOMS
❑ THREE ❑ FIVE ❑ OTHER
❑ 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
SOILS RATING
OSepticTankor [:]HoldingTank
Size: If Tank is homemade
give dimensions:
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL TO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
—
I
APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must acc(Atificate)
lbDISAPPROVED
DATE /-7
�. t�(-�%
BY
C [a
72010 (Rev. 6/79)
6 I h 6's-1- 8(O
- - �• D�VII) A. SLP.KA!' I- •A-�, •,r
MD/LI Cossc7llDLtuJL . --- - —
t
r., 1S P,
i ,1n
April. 1511
T;t:alcI'.i^:car,P9`�77
Melvin/JO Ann,.Bosch
Box 6024 -Raven y
Lagle River,. Alaska .99577
Subject:— Lot IA, ,Block, 2•_Laglc.Park Subdivision t;,,' refcrc,cam_:
ern ^rt,. P"'r vc,ur T-"(-; t^<,h r,i1C r -,:+;.1C t'.[I:" F; ..-i �'. f), :J"(i Oil
Approval for,,your; individual Ise.war and ,water -;facilities
can .mot be ,granted .until ,the ,following ito�s, have ,been,t
completed •„• c:f n 24 L;ur I 'ic,;l n11 of t'
„,.,-.:: -c? 1'^rc:�l;:tc:i pro:; nc� criir. •
(1) A water sample needs to be collected from the above
t property. ;...There was ,no,loutside faucet yavailable at
,,
�,the,,time of.,the ,initial, inspettion.,;.Please contact!r
t ,,this office ,for, re -scheduling.
(2), f The ;top (of ,the ,well L;casing, isealed with ;a (sanitary!,,i I-zi C to
cz_•scal so that is air tight. This needs to be re—inspected
by this office.
3) Theiseptic tank pumped with a receipt submitted to
this office::'
(4)41,An-.ad uacy;test be performed on the existing leaching
This',test will determine if the system is adequate
I„^- according to National Standards. A listing of private
firms performing the test is enclosed. This rpport needs
c to *be 'subxaitted (to,this department for our review.
..:tr,et. of I:1 �'.t.. a:�.-. E;.. viorr.r:,-':,tz] T'rot�•ctioa
If there are any further questions, please contact this office
at '344-4720.1 1 t.^
Sincerely,
i+ariti-
Robert C. Pratt, R.E.
Associate Specialist
RCP/ljw
cc: Alaska Pacific Bank
101 Wast Benson Boulevard 99503
(..0
3
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality Id- a a -7Lo
3330 "C" Street, Anchorage, Alaska 99503 274-4561
o �tS Fif
b pLA,�µ�d� i5" Date Received October 9,, 1976
00�1 rAp Time of Inspection
V�� L100 C Date of Inspection
,w ° tiJl1�
REQUEST FOR APPROVAL OF �
`C)'% � INDIVIDUAL SEWER & WATER FACILITIES 11 �gc Il.
FOR l�
1. Approval requested by:
Mailing Address: 3201
2. Property Owner
V.A. a -V '
Spokane Mortgage Company -
C Street, Suite 250 Phone: 277-0543
Robert P. Mahoney
Mailing Address: Star Route Box 166-A
3. Legal Description: Lot lA Block 2 Eagle Park Subdivision
4. Location: North on Eagle River Road, right on Wren, left on Raven
oc
5. Type of facility to be inspected Single Family No. of bedrooms 4
6. Well Data: Individual
A. Type B. Depth 140'
Phone: 694-96W279-6491
+'uctlllssivn
C. Construction
7. Sewage Disposal System
A. Installed
D. Bacterial Analysis
On-site system
B. Installer v6 ,- r
C. Septic Tank:- 1. Size 2. Manufacturer
L
D. Seepage Pit: 1. Absorption Area 2 Material,
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank .4�6 L, Absorption 'area lee Sewer Lines
Nearest lot line Other contamination
B. Foundation to septic tank Absorption area
C. Absorption area to nearest lot line
EQ -034 (1/74)
Page 1 of two pages
Page 2\tfItwo pages - Re 'lst for Approval of Individual mer & Water Facilities
•Legal Description Lot lA Block 2 Eagle Park Subdivision
Approved
sapproved
Date7,�
Approval.,'6ai�id for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the inforvo o
accurate representation nth
are operating satisfac r
SIGNED
EQ -034 (1/74)
Z -L—
contained in this request for approval to be a true and
subject sewer and water facilities and these facilities
Date
MUNICIPALliy OF ANp ORAGE
I)EPT. OF I . EwRONMENTALEALTH &
PROTECTION
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL DUALITY OCj —
• 2510 E. Tudor, Anchorage, Alaska 99503 -276-2221 Ex. 283 4 1976
REQUEST FOR APPROVAL OF
RECEIVED
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA X% FHA CONY
2. Property Owner: Robert P. Mahoney
- work 279-8491
Mailing Address: Star Route Box 166-A Day Phonehomo 694-9663
3. Name of Buyer: Melvin Aloysius Bosch
LOCAL
Mailing Address: 21 CES (AAC), APO Seattle 98742 Day Phone 752-2067
4. Name of Lending Institution: Spokane Mortgage Co. 550
Mailing Address: 3201 "C" Street, Suite 250. Anch..99Phone 277-0543
5. Name of Realtor or Agent: Mr. Arnold - Bowden
Mailing Address: 301 E. Fireweed Lane, ANch., 99503 Phone 278-3541
6. Legal Description: Lot JA. Block 2. Eagle Park Subdivision
Location: Eagle River - North on Eagle River Road- right on Wren (at yellow
rook). lt on Raven- 1 binrk.
7. Type of Facility to be inspected: ROME No. Bdrms. 4
8. Water Supply
Type of Supply: Well-Watefublic Utility Individual 140 Feet
If Individual, number of dwellings presently served 1
If Individual, depth of well 140
9. Sewage Disposal System
Type of System: Septic Public Utility
If Individual, date of installation unk
EQ -037 (1/74)
Individual (on-site) xx
Fd
(00�
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
Date Received October 3, 1973
Time of Inspection 2:00 P.M.
Date of Inspection October 4. 1973
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER S WATER FACILITIES
FOR
VA
1. Aoproval Requested By: Smiley's Realty
Address: Box 1086 Eagle River Phone:
2. Prooertv Owner: Walter Fitzpatrick Phone:
3. Legal Description: Lot 1 Blk 2 Eagle Park Subdivision — --
4. Location:
5. Type of Facility to be Inspected: Single Family Dwelling
Number of Bedrooms: Four (4
6. Well Data:
A.
Type Drilled
B.
Depth
C.
Construction Standard
D.
Bacterial Analysis' Satisfactory
7. Sewage Disposal System:
A. Installed May 1973 B. Installer Start Excavating
C. Septic Tank: 1. Size 1250 Ga152. Manufacturer Stack Steel
D. Seepage Pit: 1. Size 16'X29' 2. Material log crib
E. Disposal Field: Total Length of Lines
S. Distances:
A. Well To: Septic Tank 121' Absorption Area 137' Sewer Lines
Nearest Lot Lire , Other Contamination
B. Foundation to Sentic Tank > Absorption Area
C. Absorption Area to Nearest Lot Line •`46 •
4
Req:e:t for Approval of Inoividual Sewer b Water Facilities
Page Two
9. Comments:
Disapproved Date
Ap?roval Valid for One Year From Date Signed
ter Anchorage Area Borough, Department of Environmental Quality
DIAGrRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true
ani accurate representation of the subiect sewer and water facilities located at:
Signed Date