HomeMy WebLinkAboutEAGLE PARK BLK 2 LT 2AEagle Park
Block 2
Lot 2A
#050-782-34
02/14/2013 00:02 9072430742 AWPS, INC. r^^AGE 01/
t
Mark Beglch
Mayor
Pump Installation Log
Well Drilling Permit Number: SW— � Date of issue:
Parcel Identification Number:__
Legalr Description
i'roperlty Owner Name & ,P,ddres
Pump lnstallationDate: T//—%3
Pump Intake Depth Below Top of Well Casio g:
s
j00 feet �$
Pump Manufacturer's Name:� „'
/
IP
Pump Model:
Pump Size ��p
Pitless Adapter $aria] Depth; /AP feat
Pitless Adapter Manufacturer's Name: #iPV.w..
pill ees :,:Jap te'r Itas [:altlo=rd1"�
Well D'31nif,c"2d JIS3n
IYl.thUt��±✓:Sua �9xa:e:
I
Comments:
Pump lastaller Name•+
AndloYF3GL' lam' ui74}7 & SEI$ "uQrViCa
330 Past 76th Avenue
Anchorage, Alaska 99518
Phone. 907-243-0740
Attention The purnp installer shall provi: e a piip installation log to the DSD within 30 days of pwxap installation.
4
s
7
a
MUNIOPAILITY OF ANCHORAGE
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL PROTECTION
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
I A 1 i< 1900
825 "L" Street. Anchorage. Alaska 99502. Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name RECEIVED
DISTANCES 0ro=7Q.>,-31;4
Na. of Companments
TD
SEPTIC
ABSORPTION
CXII"
WELL
Aoo'ess
❑ W. DRAIN ❑ OTHER
FROM
TANK
FIELD
original grace
' FT
31-611
FT
Fill acral" above ohgmal grace
Gravel oeptn beneath pipe
Ynone(5)
Pe'mc No
F1
No of Bemooms
WELL
s
/Z5, • +
Z
Total absorption area
Distance belween hoes
5e, DCg vl uG
LOT LINE
Sd SO FT
F1
IVTIOM
LEGAL pf aCASODclw500
Lot
tlippa
Q
77S SO FT
A 4 Ora c P)PC'
FOUNDATION
40'60"
7�1 t
Township. Nange. Section
Township.
ra 0 P 10 C /-7
AS -BUILT DIAGRAM (Snow locahon of well. septic system, wopeny lines. louneahun.
dhvewav wafer boeles. etc I
I TANKS IIA 11_ In-7lf I I I I I I/ I I/ I INTI
SEPTIC a HNh/L.II•a �lr� HOLDING •
Manutaamer
Capacity in gallons
O
C
Malenai
Na. of Companments
TYPE OF SYSTEM
❑ TRENCH x BED
❑ W. DRAIN ❑ OTHER
Depth to pipe bollarn horn
Iotal depth horn onginal grade
original grace
' FT
31-611
FT
Fill acral" above ohgmal grace
Gravel oeptn beneath pipe
Zl * )Dc. S FT
a)
F1
Gravel leng:h $t[ DlAt✓Ia
Gravelwialn SC[ DCALwA(b
S ' E kl n FT
FT
Total absorption area
Distance belween hoes
5e, DCg vl uG
Sd SO FT
F1
NumWf of lines
Son ralmg
vlpe matenal AST O 03034
Q
77S SO FT
A 4 Ora c P)PC'
E.19o- 101 ILO WELLS
`% PRIVATE ❑ OTHER Itdentifvl
(Iassillwllan (A.FI.LI --\\ Iola, Dlpth GSI" 10
FT FT
mslanel (- U• nate lnstalea.
REMARKS:L -f SREMARKS:L��,�����/1e,1�_
L;fa Sia+I,,.T Was retvl,ed tx to
o -F lana RT Fee
NOR
ling
Em"
•pii'�liS,a7�������ir'Gi�17��LRSi
N�il�.�ii�■Q��Ili�ii���®■■�
moms
Mani
.ZMEN
ieMu
2
xafe: N-r� ENGINEER'S SEAL
SE i ry 1 �sprec�boDns, ,PeAofmEO by: •� ?' '•�.
EXIST.
e_) 13 L,/RS I16 AlVOA)=y3 -�T iPFSS rrs' %i• '`
E 4 D S Pcc SD
ata
��
✓nIG1�411{� Gi I10f11<II� -f �4'i �nf ffut�'lo,l (P � )
1990 CLcio-ca 1 " }'
�+
�rurr F _ _ Cciuu y ti
I /eerti/ltd that this inspection was performed atxordinp m all ^•• ,
1 / le •. [o«c'I:t• a `��
Municipal and Stale guidelines in Bled on this date: �.C..1 ` v'h•ry )+;� :•.",.'ki :.:r ;y
Health Department Approval: Date. k':. ,•
.013(3/85) -•
South Fork Construction
P.O. Box 770567 • Eagle River. Alaska 99577 • 907.6944351
JANUARY 12, 1990
LOT 4/2A BLOCK 2 EAGLE PARK SUBDIVISION
20614 RAVEN DRIVE
EAGLE RIVER, ALASKA
DUANE E. WERT INSPECTED THE ELECTRICAL WIRING AND
TERMINATIONS OF THE ADD-ON LIFT STATION FOR THE UPGRADE
OF THE SEPTIC SYSTEM REFERENCED ABOVE.
ALL WIRING DONE MEETS ELECTRICAL CODE.
r O
PHYLLI JANK TOWNER
SOUTH FORK CONSTRUCTION
--WANE E. WERT
STATE OF ALASKA ADMINISTRATIVE
LICENSE. #D778658
CERT. OF FITNESS #880415
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
Tom Fink,
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
January 8, 1990
Fannie Mae
3201 C Street
Anchorage, Alaska 99503
Subject: Lot 2A Block 2 Eagle Park Subdivision
Permit #890277, PID #050-782-34
The subject permit, issued by this office for a single family
well and/or on-site wastewater -system has expired as of December
31, 1989.
Permits are issued on a calendar year basis by authority of the
Municipal Code of Regulations. A new permit must be obtained
from this office for an well and/or on-site wastewater system
nD-t._installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this office for documentation of the installation and to close
the permit.
If a private engineer inspected the installation of the on-site
wastewater system, the original as -built inspection report
(three-part form) must be sent to,this office for review,
approval and documentation.
When applying for a new permit, the fees are: $90.00 for an
on-site wastewater permit; $50.00 for a well permit; $140.00 for
a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
Sincerely,
John Smith, P.E.
Program Manager
on-site Services
JW/ljm:200
enc: Copy of Permit
"Kids Are Our Future"
M U N I C I P A L I T Y' O F A N C H O R A G E
Department. of Health & Human Services
825 L Street, Anchorage, Alaska 99501 343-4720
O N- S I T E. S E W E R & S E P T I C T A N K P E R M I T
Permit Number: 890277 Upgrade Stc18 j�27%
Date Issued: 12/15/89 Engineer Designed
Owner Name: FANNIE MAE Day Phone:
Owner Address: 3201 C STREET 561-0828
ANCH, OK 99503
Parcel Id: 050-782-34
Lot Legal: Subdivision: EAGLE PARK Lot: 2A Block:: 2
Section: 17 Township: 14N Range: 1W
Lot Size 38683 (sq.ft. or acres)
Max Bedrooms: This Permit:. 4 Total Capacity: 4.
SEPTIC TANK: Minimum total septic tank capacity: 1,250 gallons. Each septic
tank must have at least 2 compartments. Depth to top of septic tank(s) < 4.0
feet requires insulation over tank(s).
DE:VIA'TION FROM ENGINEER'S APPROVED DESIGN REQUIRES DHHS APPROV-
AL PRIOR TO CONSTRUCTION. NOTIFY DHHS BEFORE ALL INSPECTIONS.
EXCAVATIONS MUST BE OPENED/CLOSED THE SAME DAY OR BE HEATED OVER
NIGHT. THIS PERMIT IS FOR A 3 BEDROOM SF RESIDENCE, AND EXPIRES
ON 1/31/89. THE EXISTING TRENCH MUST BE PROPERLY ABANDONED. A
LIFT STATION REQUIRES THE APPROPRIATE ELECTRICAL INSPECTION.
1 CERTIFY THAI:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set bac):
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 4 bedrooms. I
also understand that the capacity of the total system is 4 bedrooms and
any enlargE.ent will ll)requiire,an additional permit. /� g
Signed:K/l=n' C IJIG�c� �L(/lldf ----- DATE:
(Owner) FANNIE MAE
Issued By:
DATE:
CORWIN & ASSOCIATES, INC.
1000 E. Dimond Blvd. Suite 205
ANCHORAGE, ALASKA 99515
(907) 522.1311 FAX (907) 349-2236
KgpCTM'cftwwn:K.6a KO, T.6MA4(RKMmaO
JCB L 2A % .2 E-A�&c
SHEET
CALCULATED
CHECKED
OF
DATE
DATE
DEPV of HEALTH &
C.0
Municipality Anchorage
DEPARTMENT OF.HEALTH &HUMAN SERVICES
825 `L" Street, Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
■■■■ ■■■■■■■m■■
®'
NONE ■mmmommlamm
■mmm ■ENNE:i 1mmom
■m!1■ ■ENEENNEE■
■N1Z■ ■mo0516114mo■
5
6
7
8
9
10
11
12
,3 Dcy
14-
15-
16-
171
4151617
16
19
r�
PERFORIAE08Y:
ACCORDANCE WITH ALL STATE AND
72-035 (R". 4/851
IF YES, AT WHAT
DEPTH?
CIA to Witrt R.•.er ,
Monvrinpl,�� Ostc
PERCOLATION RATE-� (ninutes/u hl PEAC HOLE DIAMETER 6/p
1
TEST RUN BETWEEN '3 FT ANO, 'L FT,
1 --CERTIFY THAT THIS TEST WAS PERFORMED IN
:S W EFFEC ON THIS DATE. DATE:
,�
-�VfA!
LOCATION
pelVf
Nave been Deteralned by Use Or Cloth
fX
'WELL
z /
(7~,
PAFT""'slo�
,W 6
00' WELL/ WELL
SHEET I OF
EXLST. TEEWC.H
ILl`�
_E -SEPTIC. SKrEH�
Sit. /,
I,zso-,l TAtJK
F-KKT. GLIB.
— — —
P20P. 1,66'01(-F4
2"
Fr. n t L•//S on 1
)d/.TIVE FILL
PROPOSED: BED
(4 BDRM)(275 soil)(1.5) 2
= 1,650 sq. ft.
o.
Construct Bed , �2.•
as shown. GEOFAEEK j lilt z Li
0 0f13�0 0 0 C 0
Install new 1,250 gal tank �.;�3 0
Install GEO fabric over rock. Lg-
Properly abandone existing SEuEt jj�I , V
septic system
NLL CONSTRUCTION TO MEET I ZYc'�
M.O.I. SPECIFICATIONS.
13'
NOTE:
All Dimensions And Locations Must Be Field verified
SEWER
SYSTEM
LOCATION
PLAN
Nave been Deteralned by Use Or Cloth
fX
I `l!"
I EAGLE
PAFT""'slo�
a�
NORTH
"a Accuracy Of L tion of Eslalting Andproposed reoperty Corners. wells. and SePUe
Syates Indleated Is Not baaet. OlseaslonsIMleated
Nave been Deteralned by Use Or Cloth
Tape aM/se Nualelpl beeords, AM Not by
Suweyln9 TocNniquas
FFAWKI-
A
IE MAE AK
DATE. I B 1
SHEET I OF
/ t MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 89501 Telephone 264-4720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME4n 5G r //
L/A-142
PHONE /
� l' ,33%(O
e❑J%NEW
IPGRADE
MAILING ADDRESS ZZ_
� LF 2/ q
LEGAL DESCRIJTION
LOCATION��'
NO. OF BED ROOMS
Well Absorption area Dwelling
PEHMIT NO.
O
DISTANCE TO:
E 2
Manufacturer TI"W serial
No. of compartments
W f
length Width
Liquid depth
Lip, capacity in gallons
IF HOMEMADE:
Inside
6Ose
DISTANCE TO:
Well
Dwelling
PERMIT NO.
SF
Manufacturer
Material
Liquid capacity in gallons
DISTANCE TO:
Well D
Foundati / t
Nearest l0 110.e�
PE I 77
=
C
E
No. of lines J
Length of irle
Total len h lines
Trench wi i
Distance etween lines
X
W
/
inches
F¢-
Top of file to finish grade (
Mit rigI benea/ the 4
"% 2
Tot eftiZ sorption area
r�
1 Inches
CC//
Length
Width
opt h
PER 1T N 7.
W
Q s-
Type of crib
Crib diameter
Crib depth
Total effective absorption area
a.
W L
W
a
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
Class
De th
941ler
Distance to lot line
PERMIT NO.
J
W
A E TO:
i1djIfig fou do
wer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIFj,J_S
SOIL TEST RATING
L
INSTALL
REMARK
—rUlS /S
t
z 2.TVaz
.! A PFraz, -;" f .1s
L U �•= ofa•A L4.1
�r
or
•
i
7
APPROVE T LEGAL �• E`lGIFIEERI
�i 8111381113103X y
-%DA % r.XILE RIVER. ALASKA I:77
72-013 1F/v. 3/78) - -
MU" I C I FAIL I TY OF AIdCH0F2AGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99501
264-4720
C3 I TE SEWEFZ F}EFZZM I T
PERMIT NO: 840577 UPGRADE
DATE ISSUED: 07/16/84
APPLICANT: C/O S & S ENG'G. LAWSON EY�STi�lC� - ��,u 2 �3�u.►�8.
ADDRESS: SRB 196X
EAGLE RIVER, AK. 99577 T 779t4 -
CONTACT PHONE: 694-2979
LEGAL DESCRIP: SUBDIVISION: EAGLE PARK. LOT: 2A BLOCK: 2.
SECTION: 17 TOWNSHIP: 14N RANGE: 1W
LOT SIZE: 38683 (SQ.FT. OR ACRES)
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOTHE APPRDV THOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL'WORK T Pt DONE BY A LICENSED ELECTRICIAN. .
SIGNED - DATE:
APPLICANT: O S & S ENG'G. LAWSON /I-Lq
ISSUED BY ,�` Q4.t !!fit G� DATE:�(o-----
7_/2 e-'k/c/i
A'^5
ASO
/C. a39/17v3.0,
4D Z) E/
L! SES��c r�✓���
Te i..lro d52-'r/r7rA;16
d-e-rB
r MW
I I f 1 ❑ SOILS LOG
MUNICIPALITY OF ANCHORAGE
\ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION
• �+� TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: / a10,5 -c:7 N DATE PERFORMED: ;Ah
LEGAL DESCRIPTION: L 6 7A C ����2� /0
9�!. / i L �fTITE PLA 77
I I I 'l i f M i
4 T H p r C
2-
3-
C/
4 e /•
5 /
6
xv
7
8-
10-
11-
12
1011 12
13--
14-
15-
16-
17-
18-
19-
20-
PERFORMED
314151617181920
PERFORMED
72.008 (6/79)
MUNICIPALITY OF ANCHORAC
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTIOI
CEi IED
('r^
5L_
Z�a.� A
2-3
A
(�}A � WAS GROUND WATER
1 1 ENCOUNTERED?
IF YES. AT WHAT
DEPTH?
/JD
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
t
IL
`(
`(
% yv A
to `t
y
3
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND S FT
�1
UTO
Z5V 0/1
„�UNICIPALITY OF ANCHORAGE
Hea : and Environmental Protece",4�n i
U.
51 / Fourth Floor West
(�1�{ r/ 825 L Street ,
Anchorage, Alaska 99501
264-4720
�I
INSPECTION_ REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME '/ t! /fc `r MAILING ADDRESS
LOCATION 1�47 S7Rt-1r771' LEGAL DESCRIPTION__ P K ”
SEPTIC TANK:
DISTANCE O Sr / r—�/ COMPARTMENTS
NUMBER OF 1�21
FROMWELL 1MANUFACTURER— MATERIAL
INSIDE LENGTH INSIDE WIDTH - LIQUID DEPTH. LIQUID CAPACITY/GTv�GALLONS.
TOTAL LENGTH /
DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE /f OF LINE ��
# of Lines / DISTANCE BETWEEN LINES TRENCH WIDT EYLIN. TOTAL EFFECTIVE
_ e-6' n FT LENGTH OF EACH LINE
ABSORPTION AREA SQ.
( DEPTH OF FILTER L
DEPTII: TOP OF TILL TO FINISH GRADE MATERIAL BENEATH TILE IN. ABOVE TILE `� IN.
SEEPAGE PIT:
DIAMETER OR WIDTH_., LENGTH_, DEPTH
Log Crib Rings_ Crib Size:; DIAMETER_DEPTH_DISTANCE FROM: WELL -
TOTAL EFFECTIVE
BUILDING FOUNDATION_. NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT.
Well
Class: Depth:
Well Distance To: Lot Line _
Bldg: Sewer Line:
Pipe Materials:
# of Bedrooms:
Installer:
Remarks:
DATE Za'IC4' 9-&v
�"'�
Ll
I
j
1
JI -
DATE Za'IC4' 9-&v
�"'�
Lrk e
• .: r-� a n+ 1(1 I {_ ► + 1_ l: Tom• �� {_ {=i t�1 H H
/ DEPARTMENT GY~EALTH HND ENVIRONMENTAL FCI ECTC:
d LIOFJE
i 525 'L' STREET, ANCHORAGE, AK. 995��
• 277-2511
QtJ— l 1 E :EWEF;. UF-1:3F-;:r'iIOE F=^ERI•l I "T
FtRr1IT NO. C 77878 )
Fox
HPPLICANT PHIIL i,;Fr PU BOX 515 CHUGIAK' 6552555
LOCHJIUN RHVEN
LEGAL L2 B2 EAGLE PARK S/D LOT SIZE 0 SQUARE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 105
THE kE06t-kED SIZE OF THE SOIL ABSORPTION SYSTEM IS:.
C7E{= 1 H= �_4 1_[=tJ�� T -H= L• ��{2H4'1=1_ pEP i'H= -4-
THE
THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRHINFIELD.
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 I5 NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
HND THE BOTTOM OF THE EXCAVATION CIN FEET).
{=•H��F�:HUE FsL1=Ih1T OFsT I Ot-1
H PACKAGE PLANT MAY BE INSTALLED AT THE PERMITTEE'S OPTION SUBJECT TO THE
FOLLOWING CONDITIONS:
1. EITHER A CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED.
2. A CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF A MAINTENANCE
HGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL
HBSORPIION SYSTEM AND/OP. YOU MAY BE SUBJECT TO PROSECUTION.
----------------------------------------
--- T4J�J C 1' Qt 1S F(=CJJ -! ---
FZ E.I
SACKFILLING 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 OR 200 FEET FOR A PUBLIC WELL.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
HVHILABLE TO INSURE PROPER INSTALLATION.
F?EFRt•7 I -1' E>4F=l I 1cE1 [Do [=(--Et•7F3LF;;_ 1
I CERTIFY THAT
1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON -SIZE 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 SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED:-_�-- i____ v -------------------
APPLICANT ATFL C7
ISSUED BY_'v=&--//--------------DATE--9_ °Z (Q-' -- V3. 0
.::moo.✓,l.:.a'uta.�......ra-:.:.;Yi.,..,:n�-.. �... v....... .....�. �.. �. ... ...
MUNICIPALITY OF ANCHORAGE
• -- Department of Health &Human Services 1
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcell.D.# n��%—� -�� HAA# "1gC)QCI1 L\
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
Z0.6L4 PAVFLI DEIVF_ /t F_ Fj'UFI? AK
(b) Property owner
n.,.,,� pr
--
AY Telephone: (home) Business
�� �.,. _.M�
A K
Mailing Address
Y (c) Lending Institution A Telephone
Mailing Address bilk
(d) Real Estate Company and Agent
Address
Telephone N 14
(e) Mail the HAA to the following address: (or check hereV, if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIID/ENCE
Single-Familyyp Number of bedrooms
3. WATER SUPPLY
Individual Welix Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (A". 1/58)
Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, l 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 Firmrr,P j4 l Kf d AgcC Telephone S77-1 zJ /
Address 1('rn F RI Mali D A r
Date Toho
6. DHHS APPROVAL
Approved forrvu^- edroomsby Z�� ("'e_ttDate
Approved X Disapproved Conditional
Terms of Conditional Approval
Seal
/- IV.c
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in orderto 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.
72-0251R". 7/88) Book
Page 2 of 2
I1Y �A �ITY OF ANCHORAGE (MOA) AUL
AL SERVI WST - F Approval (HAA)
E ST -FEBRUARY 1984
343-4744
JAN 161990 L„T � rzt_V Z
Legal Description:
RECEIVED cArl� P>�e
A. WELL DATA
Well Classification , —C i LkZ4,r If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) M— Date Completed (lIl I L LICKL, l j Yield 44P14
Total Depth�Cas�ed to Depth of Grouting (�VC GC1cJl�1
Static Water Level Q I ` Pump Set At
Casing Height Above Ground e ` Sanitary Seal on Casing (Y/N) ►
Electrical Wiring in Conduit (Y/N) %( Depression Around Wellhead (Y/N) �(
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot 1� 7 ;On Adjoining Lots 1 `
To Nearest Edge of Absorption Field on Lot -;- ICY) ` ; On Adjoining Lots >'1001
To Nearest Public Sewer Line loll, A To Nearest Public Sewer Cleanout/Manhole KI
To Nearest Sewer Service Line on Lot *:'P 4' t
Water Sample Collected byFP_ P ✓ E Bess ; Date
Water Sample Test Results 5 AT/ I
Comments G1,xal�
11 /9 cz - lee-, 1/O` ,g c
—wll mote n -r
llyo5 uct
/pa✓ kale Len L41o. o -P edf ll — LlUI /1 /v4
B. SEPTIC/HOLDING TANK DATA S'pfi -Q" ,C - /,.,f44- E44w, (om 6j�af w
Date Installed1� % Size/S�No. of Compartments c�
Standpipes (Y/N)—Air-tight Caps (Y/N) Foundation Cleanout (Y/N) _
Depression over Tank (Y/N) ►.I Date Last Pumped A191)
Pumping/Maintenance Contact on File (Y/N) M 11A ; for l.11A
High -Water Alarm Y/N Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well 1 i ` To Building Foundation 401
To Property Line SS To Disposal Field -"10`
To Water Main/Service Line >ZS
To Stream, Pond, Lake or Major Drainage Course
Comments Man Lb 14ffeiT . S'FvT- TMMC LIFT iTo'rtokl COMRD Sclrrti :b IZV
Af.ndoeAGE' -LAMK -
72-M (A". 7/08) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata22:44 Type of System Design R E D
Date Installed 1996 LengthofFieldSO'Ks4'r35'xZo'.LR' SFE Cez_4
Width of Field SFE DCA -1 Depth of Field s'–
Gravel Bed Thickness,
Square Feet of Absortion Area ft6SG Statndpipes Present(M*) Y
Depression over Field (Y/N) Date of Last Adequacy Test __klEL,1
Results of Last Adequacy Test k F t/ / 90
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well 12 S` To Property Line 10
To Building Foundation - do + To Existing or Abandoned System on
Lot 10 ' +,111jR1' I2' ,o T.r ,.t —;On Adjoining Lots >>S'
To Water Main/Service Line :--40, To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course - %/p
To Driveway, Parking Area, or Vehicle Storage Area 70' +
Comments SE IOCIJee OF %FA l.r ldfSu�stirtn
D. LIFT STATION OlSEP;Tic TA"K GOMI;O ; AMCHOCr145E _r04MK
Datelnstalled AAUQAE_y 1990 Dimensions 40'x -Tl" S8"o/A L�S
Size in Gallons Z:TCQg�/ ratl ; 5-Ql„2/ LS Manhole/Access (Y/N) Y
"Pump On" Level at �R " "Pump Off" Level at 42"
High Water Alarm Level at ` y Vent (Y/N) y
Tested for 3 CIW-les- Pumping Cycles during Adequacy Test.
Meets MOA Electrical Codes (Y/N) _Y
"Check
certify that
Inspection. j
Signed 1Z
Company
Date `/.4
MOA No. e5;�_
Against HAA Request"
or conformed to all MOA and HAA
I
Lv.r ,••
�
3196KR
�c
Receipt No. /& Receipt No.
Date of Payment — Waiver Fee: $ _
Amount: $ Date of Payment
72-026 Oft. 7/88) Beck Page 2 of 2
effect on the date of this
OF 4
• t. Ce1.1,
Engineer's Seal
f
i• -+-ire
PROJECT:nT %4 K/_[. /_ - —,i„ ( DATE OF TEST: 1 li?
•LOCATID71 OF WELL (Legal Descri,tl•tion): _
WELL DEPTHS FT. CASIRG: F7 SCREE I:
DATE DRILLING CONPLETEO: DRILLER:
• STAT(C SEATER LEVEL (Top of Casing): �l FT Der.-'- > ;/O' 4J(?!:,r
✓F cJ i�0
f Clock
1 Tine
apses. ime Sincel
Pumping'Started/ Depth
Stopped, (fin. I (later,
to
ft.
Orawdawn/
Recovery
Punping
Rate, r,Pt1
Renarks
0
1
swl
0
0
J Start
0
0
�'
i`
2U
' 7 7
JU
• Inv4Uo•
/z
so
A2,
•' Z`
hour
'
.14u 2 hours
IEEE]
lbu
180 hours
l
21U
l
C . hours
RECOVERY
<:
lu
l
2530
I
4
50I
60 t hour
CHEMICAL & GEOLOGICAL LABORATORIES OFALASKA, INC.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343
FEDERAL TAX ID N 92-0040440
ANALYSIS REPORT RI SAMPLE for Work Order 8 17987
Date Report Printed: NOV S 89 1 16:17
Client Sample ID:L21, 12 - EAGLE PE
PWSID :UA
Collected NOV 1 89 4 16:00 hre.
Received NOV 2 E9 / 09:00 his.
Preserved with :AS REQUIRED
Client Nana : CORWIN L ASSOC
Client Acct : CORWIN?
P.0.1 NONE RECEIVED
Req 1
Ordered By : J. ERESS
Analysis Completed :MOV 3 89 Send Reports to:
Laboratory Superv__i��s__o__r{_::S�TEPHEN C. EDE 1)CORWIN 6 ASSOC
Released By 2)
...................................................................................................................................
Speelal
Instruct:
Chemlab Ref 1: 8362 Lab Smpl ID: 2 Watrix: WATER
Parameter Tested Ruult/Units Method
------------------------------------------------------------------------------------.
NITR►TE-N 2.2 aq/1 LPA 3S3.2
Sample ROUTINE SAMPLE.
Remikx: SAMPLE COLLECTED 1I L1.
Allowable
Limits
10
..............................................................................................................
1 Tests Performed . See Special Instructions Above Uk-Unavailable
MD. None Detected " See Sample Remiks Above
NA. Not Analyzed LT -Less Than, GT -Greater Than
n r�"
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIROIDENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
(a) Legal Descri
/_z'4
Location (ad
(b) Applicants
Application Date �O 9
include lot, block, quV ivision, Seepion, township, range)
or directiony)
Applicants Addresssi
(c) Applicant is (check one) Lending Institution OwnerAbatid" ;
Buyer E:�7 ; Other E:] (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Co. S Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. Type of Residence
Single -Family Multi -Family r_1 Other (describe)
Number of Bedrooms
3. Water Supply -
Individual Well 1�ff Community M Public M
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 Q 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)
��
5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information
As certified by my seal affixed hereto and as of the validation date shown below, I
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal system is safe, functional and adequate for
the number of bedrooms and type of structure indicated herein. I further verify that,
based on the information obtained from the Municipality of Anchorage files and from my
investigation and inspection, the on-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm
Addres
2:Tf
(ENGINEER SEAL)
6. DHEP Approval
Approved for bedrooms By
Approved Disapproved
Terms of Conditional Approval
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 DUEP 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 21 7-19-84
A. WELL DATA
r'1
MUNICIPALITY OF ANCHORAM
MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984 JUL 17 94
RECEIVED
Well Classification J F'. If A, B, or C, D.E.C. Approved(Y/N)
Well Log Present (YdU Date TTleted (% K, Yield. PX4-
Total Depth � i Cased to Zjd 7•f' Depth of Grouting
Static Water Level 7,08 Pump Set At tJ<-
Casing Height Above Ground �O Sanitary Seal on Casing
Electrical Wiring in Conduit &N) Depression Around Wellhead ( )
Separation Distances from Well:
To Septic/Hsi*ft Tank on Lot b S / On Adjoining Lots ZOO /'f
To Nearest Edge of Absorption Field 'n Lot -&Q- On Adjoining Lots '1<2 in
To Nearest Public _Sewer Li %V To Nearest Public Sewer
Clsanout/Manho, To Nearest Sewer Ser ice ine on Lot �s
Water Sampie Collected By 5 �i/t/�Q f Date�SY
Water Sample Test Results�,k�lS L—A-czy.LG
Comments 7 �-ST WEAA� -/-C) PRO oyGc'
eA/ r mss df'
B. SEPTIC/41RJ== TANK IATA
Date Installed [),,e Size l ZSR No. of Compartments 7-
Standpipas q) Air -tight Caps 6*Vh) Foundation Cleanout (YAD
Depression over Tank (YdO Date Lastp7pe
Pumping/Maintenance Contract on File (YZN y14IQ for
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) /Q
Separation Distances from Septic/Holding Tank:
To Water -Supply Vbll /057/
To Building Foundation LO) /zt
To Property Lina 14' To Disposal Field S f
To Water Mair,/Orvice Line ;7,ItA To Stream, Pond, Lake, or Major Drainage
Course
Ccmrants
tP�loi7" ° ` Y6
2-15-84
1/7/ j -4t-
C. ABSORPTION FIELD RATA
Soils Ratingin Abs ion Str to Z7o a R)g
orp � p/j Type of System Design / c2)B
Date Installed /`%72 �l'77Zf 6 5,z Length of FieldO016 - 6D6F-J ¢SG.F
Width of Field Depth of Field
Gravel Bed Thickness o • %2 ��
Square Feet of Absorptioq Areae&02 Standpipes Present(Y
Depression over Field ( /N) Date of Last Adequacy Test x i�
Results of Last Adequacy Test f>/%�.J�o �✓,l Z B,e (,i,r��� G C�,�+
Separation Distance from Absorption Field:
To Water -Supply Well 110 To Property Line f
To Building Foundation To Existing or Pbandcned System on
Lot 90 f ; On Adjoining Lots
To Water Main/Service Line 30 To Cutbank(if sent) /J
To Stream/Pond/Lake/or Major Drainage Course lr f To Driveway, Parking Area, or Vehicle St&8 Area 5O 74--
N
D. LIFT STATION
Date Installed
Sias in Gallons
"Pump On" Level at
High Water Alarm level at
Tested for
Electrical
Cements
** Check Permi
Dimensions
Manhole/Access (Y/N)
"Amp off" Level at
Vent (Y/N)
Cycles during Adequacy Test. Meets MOA
Rating Against HAA Request **
I certify that) checked, verified, or conformed to all MOA HAA Guidelines in effect
on the da sof ction.
Signed Date .+0 At
1
CaRany FSA �i y NGo
f �t
8 & f EAWNEWNA ' pts
KBl d5 s SRS 19ex
1RNM ALASKA Z�.M
PK fiw2^.iJ .r�
[Page 2 of 21
�`%A=4 f5 -8a
r
MUNICIPALITY OF ANCHORAGE.,
�, r► ,�'. DEPARTME( �OF HEALTH AND ENVIRONMEN1 I.PROTECTION
. 825 L Street, Anchorage, Alaska 99501�,,J,. Q_
279-2511, ext. 224 or 225
Date Received: August 23, 1977
#1: Time
Date
Insp 1
Lai
REQUEST
REQUEST FOR
#2: Time IO:fV) #3: Time IntZY-)gnL
Date Date -03 / 7 ] (tJfe/
Insp nInsp �M•
oIGP �{lu1I Q.41 L,�t ub � .0 uL., t4w 7t)L au_ -)h, 1 e
AL OF INDIVGDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: State of Alaska, Veteran's Affairs
2.
Mailing Address: 907 West Northern Lights Blvd. 9VEGae:
Property Owner: Paul E. Fox Phone: 694-2243
Mailing Address: Star Route Box 6022 272-4551/w
3. Legal Description: Lot 2A Block 2 Eagle Park Subdivision
Single Family Residence: (x)
Multiple Family Residence: ( )
�. Well. System: Individual Well (x)
Number of Bedrooms: Four
Number of Bedrooms:
Cor„munity/Public System ( ) A
Permit #
Depth/ of
Well 110'
Well Log on File
Construction
Lo C% S
Bacterial
Analysis
6. Sewage Disposal System: On-site jy stem (x) Public Utility ( )
q
Permit # Installed Unknown Installer , n
Septic Tank Size _�-��p Manufacturer
Absorption Area K 8 `({o Soils rate Material LEI
7. Distances: Well to Septic Tank 10
to Sewer Line Nearest Lot line
to Nearest Lot Line
One Aac ova
to Absorption Area
Absorption Area
r
r
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 2A Block 2 Eagle Park Subdivision
Comments:
40,0
9
Affadavit Attached: ( ) Letter Attached: ( )
Approved:
Disapproved:
Department Workshcet:
^UNICIPALITY OF ANCHORAGE ^ 1
c:l
;Department of Health and Environmental Protection
;I•'
,'
825 L Street, Anchorage, Alaska 99501
�� %
� 279-2511, ext. 224, 225
�l1C4�,_
1 T�-stequest
1 r
for Approval of Individual Sewer and Plater lIraGY'i}y�ie)
11.
Property Owner: f�rau� �Ox
(Mailing Address: S)` Box [02'7 Phone: ??L-S4S/ pays,
I: EcS/e iC'�ver� Ak- 99577;
I
.i
12 .
i
Name of Buyer: Wa I L, � n
EE
I4 1
1
'1
IMailing-Address: Phone:
I
13.
iLending Institution: S?ATS'y..A-
Mailing Address: Phone:
I
4.
1 Realtor/Agent: None'
(Mailing Address: Phone:
1'
;5.
;Legal Description: Lvf 2AT $locA. 2 Ea3�e Rare Sli�•
Street Location*' have Drive
. 16.
ISingle Family Residence: Y)• Number of Bedrooms:_
!Multiple Family Residence: ( ) Number of Bedrooms:
1•
r
1
.:',7.
iWater Supply: *Individual Well Public/Community System ( )
1'If Individual Well, well depth //yf
!If Community System, name of system
-'18.
iSewage Disposal System: On-site System Public System ( ):
l'If On-site System, date of installation: lMknv, )J_ Qnor iu 1_973
•
1
*NOTE: A well log is required on ALL wells drilled since 6/75.
1
,
I
f
3/77 .
I �I
r,.
August 31, 1977
State of Alaska
Veteran's Administration
907 Nest Northern Lights Boulevard
Anchorage, Alaska 99503
Subject: Lot 2A Bbock 2 Eagle Aark Subdivision
The sewer absorption system must be upgraded. In order
to bring the system into compliance with our requirements
and upgrade is required. A soils test must be conducted
on the property (refer to the enclosure) and a permit
obtained fw= this department onee the specifications
are known.
This department would ran racy approval if funds
are escrowed to ads the ""orbt n system to soil tort
specifications y October 1, 1977. Yunds should be set
aside for inter pumpiri until the upgrade
is complete.
If there are any further questions, please contact this
office at 264-4720.
Sincerely,
Cory Willis, F.S.
Sanitarian
CI•T/l jh
cc: Paul E. Fox
Star Route Box, 6022
Eagle River, Alaska 99577
R&M ENG. _ERING & GEOLOGICn CONSULTANTS
_ 229 EAST 51st. AVE. — P.O. BOX 6087 — ANCHORAGE, ALASKA 99503
'1 TELEPHONE 907-279-0483 TELEX 090-35419
Civil Engineers Geologists Land Surveyors
JAMES W. ROONZY, P. E. RALPH R. MIGLIACCIO
MALCOLM A. MENZIES, P.E., L.S. Engineering Geologist
JAMES H. WELLMAN. P.E.
May -14, 1973
Mr. Mike Fitzpatrick
P. O. Box 614
Eagle River, Alaska 99577
R & M No. 36608
Re: Test Hole and Soil Log Report for Sanitary System
Lot 2, Block 2, Eagle Park Subdivision
Dear Mr. Fitzpatrick-
We
itzpatrick
We are submitting herewith the test boring results and our comments regard-
ing soil conditions encountered at the subject site. This investigation was
performed in accordance with your request of May 8, 1973 and those procedures
outlined in a letter dated September 13, 1971 by Mr. Rolf Strickland of the
Greater Anchorage Area Borough, Department of Environmental Quality.
A single test hole was put down within the Lot 2 area for the purpose of
defining general subsurface soil conditions for the proposed sanitary system.
Excavation was accomplished with a tractor -mounted backhoe and the test hole
was extended to a total depth of 15 feet below ground surface. The final log
prepared for the test hole has been included in Drawing A-01.
Ground water was not encountered in the test hole.
We appreciate being given this opportunity to be of service to you. Should you
have any questions with regard to the above, please do not hesitate to contact us.
Very truly yours,
R & M ENGINEERING & GEOLOGICAL CONSULTANTS
`� 1�
James W. Rooney
Partner
JWR:wb
Enclosure
xc GAAB
/�z
ANCHORAGE FAIRBANKS JUNEAU
IFM=
ORGANICS WITH SOME
SILT
SAND SOME SILT (SP)
SANDY SILT TRACE
GRAVEL ( SM -GM) /
Z fT V2
M
SANDY GRAVEL TRACE
SILT (GW -SW)
15.0,
No Water Table T.D.
Note: Test hole excavated with tract mounted backhoe.
`6
Mike Fitzpatrick Property
Engineering 5 Geological Consultants LOG OF TEST HOLE
ANeHow.ee rmno&mwe ALASKA ♦ums^u Anchorage Alaska
oAre 5- 10 -7 3 1 SCALE 1 e 2' JOWN BY G.A,W, JCHKO BY W. E.D. rrtoj. No. 36608 lowallo. A-01
:oo
'0 8_
b5�
C
15.0,
No Water Table T.D.
Note: Test hole excavated with tract mounted backhoe.
`6
Mike Fitzpatrick Property
Engineering 5 Geological Consultants LOG OF TEST HOLE
ANeHow.ee rmno&mwe ALASKA ♦ums^u Anchorage Alaska
oAre 5- 10 -7 3 1 SCALE 1 e 2' JOWN BY G.A,W, JCHKO BY W. E.D. rrtoj. No. 36608 lowallo. A-01