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HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 2 LT 11 MUNICIPALITY OF ANCHORAGE D[/"~RTMENT OF HEALTH AND HUMAN SER ES %. ' Environmental Health Dlvislon 825 "L" Street, Anchorage, Alaska 99502. Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ..mo DISTANCES WELL ^.d,~FROM -'"'~C.~ TANK FIELD I .5 -%- . FOUNDATION ,.%- TANKS 1~ SEPTIC 1-] HOLDING TYPE OF SYSTEM [~:TRENCH [] BED D W. DRAIN I-"1 OTHER I z.~, SQFT; ' /~/n FT ~,,r. WELLS '~ PRIVATE [] OTHER Ildentifvl REMARKS: Inspections Perto, mea by r.a~le River Engineering Services I ~, ~ cedJfy Ihat this inspection was pedormed according to all 72-O13 (:~85) MUNICIF'ALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 '264-4720 ON--SITE SEWER & WELL PERMIT PERMIT NO: DATE ISSUED: 850687 10/21/85 APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: MAX BEDR0OMS: SHUMWAY GRAIG/MARY P.O. BOX 1481 EAGLE RSIVER, AK 99577 694-4181 SUBDIVISION: EAGLE RIVER HTS. SECTION:.7 TOWNSHIP: 14N 10852 (SQ.PT. OR ACRES) 5 LOT: 11 BLOCK: 2 RANGE: 1W Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. TRENC;4 BED W. DRAI~4 DEPTH TO PIPE BOTTOM (FT.) '4.0 4.0 4.0 GRAVEL DEPTH (FT.) 8.0 ,0.5 5.5 -TOTAL DEPTH (Fl'.) 12.0 4.5 7.5 GRAVEL WIDTH (FT.) 2.5 19.0 5.0 GRAVEL LENGTH (FT.) 28.0 * 56.0 50.0 GR'AVEL VOLUME (CU. YDS. ) 22. I 25.4 57. 1 TANK SIZE (GALS) 1,000.0 ** 1,000.0 ** 1,000.0 ** SOIL RATING .(SQ.FT'./BR) 148 152 152 ** TANV MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1. I am familiar with the requirements for on-sit~ 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 ~ith all MOA codes and regulations. and in compliance with the design criteria of this permit. . 5. 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. 4. I understand'that this permit is valid for a maximum of 5 bedrooms and any enlargement will requi~e an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, ]'HEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT'BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (5) THE ELECTRICAL WORK MUST BE DpNE BY A LICENSED ELECTRICIAN. SISNED' . . J/ ~.,~., DATE. .............. ]_ _ APF'L I CANT: SHUMWA~¢~ GRA I G/MARY ~/ - Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~/'~,~'~ LEGAL DESCRIPTION: ~/- ~',,,~, ~,,,~,~.,"/ ~ Cz e' Township, Range, Section: SLOPE SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop 2 4 '~.,: 5 7- ' ~ ' I 1%&~ I I I I I 9- ~' ~. ~ I0 - "' ~*~ ~--~ ¢~ WAS 6BOUND WATERENCOUNTERED? - - DEPTH? 12 ~ ,~ E · · " ~ni~ing? 13 . .~ 14 '; ~, 15 ./ ,~ PERCO~TION RATE ~ (m~nul~mch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FTAND ~ FT 16 17- 18. 19. 20- COMMENTS P. 0. gl~ 7732~4 I ~..,~,e;~,,,-.-~,-- CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE A~*r~ICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) · McKay Well Drilling P.O, Box 557 Wasilla. Alaska 99687 [. Phone 376-5058 We,,Owner ~"~;J¥ ~//'/~ ~'~ ~ ~ . · Well Location/"3 ~/~?//, /~/,/~,~a'~,, [/.~ . . · ~/]?/g /~,*uc-/c- //~/,/~ Size C~ing ~/' Depth of Hole /'P ~' · S~tic Water Level, f~t Wel~ Test /~ Date of Completion /0 ' ? ~ - ~ ~' Phone * cesta to /~, ~-- Gal pe,r Minute for '/ . feet Hours AUTHORIZATION.TO DRILL I hereby authorize McKay Drilling to p~roceed with the abo,ve WOrk./[~ayment shall be made in the ~oUowing ~nanner: ,'~ · . ,. ~.' / ~ , .Balan~ d~ upon ~mplet~on. ~, ~P ~ , } / In the event it is n~es~w t0 insitute le~l proc~dings to coll~ any amounts due on th~s ~h- tmct,'l agr~ to ~y an addltio~l sum of fiE~n p~?en~ (15%) of the. original ~ntm~ pri~.. Plus att~rpey's f~s, and co~ for I~al pro.dings. '* .: ' Da~'e Na~e · ' Addri~ss RECEIVED · ~ MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services MAY 0 7 1999 On-Site Services Section ~UNICIPALI'i~ O1: ANCHOP.,a. GF- P.O. Box 196650 Anchorage, Alaska 99519-6650 i~NViRON,,VL~.t,~AL$[P, VICI[$DIVI$1ON 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~,50-281-$0 HAA# 1. GENERAL INFORMATION Complete legal description Lotll, Block 2, Eagle River Heights R Location (site address or directions) · Property owner Mailing add~ess Sarah DeSanto 10219 Wildwood Eaqle ~V~r, Ak 99577 Day phone. 102~9 Wildwood, Eagle River, Ak 99577 696-1137 .4. Lending agency Mailing address Agent /~"- Av'~';/ Address I~'°° Unless otherwise requested, HAA will be held for pickup. NUMI~ER OF BEDROOMS: 3 · TYPE OF WATER SUPPLY: Individual well x Community well Public water ~ay phone Day phone ~=.~[~ ip~,% ,.~v-. ~'q~"-/q NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site . x Holding tan. k.. ·. Community on-site · ' ~" Public sewer · NOTE: If community wa~tew'aier system, provide' written confirmation from State ADEc attesting to the legality and status of system: STATEMENT OF INSPECTION BY ENGINEER As certifie, d 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 further verify that based on the information obtained from the Municipality of Anchorage files and from my invest, igation 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. Nam'e of Firm' '~ ~-e.~le-.~ [ "~, ~. Address Engineer's signature DHHS SIGNATURE · ["/' Approved for '7"//'//~,~"~bed~ooms. Phone ('~o~ Date ~"' Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given In paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to pumhasers of homes and their lending institutions in order.to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate Is issued. The Municipality of Anchorage is not responsible for error~ or omissions in the professional engineer's work. · .. RECEIVED MAY 07 1999 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SE~4~,y ~, Af~a%~al .. Environmental Services Olvtsion ~qVIIIOI,~N. I,ERYI~ DIV~ION I~i 825 L Street. Room 502 · Anchorage, Alaska g9501· (907) 343-4744 Legal Dcschpfion: A. ~ DATA Be Co Health Authority Approval Checklist Lotll, Block 2, Eagle Well t.vpe private Log pmseut (Y/N) Y Tot~der~h lO5 ' Samt~..; seal (Y/N) 050-281-30 If A. B. or C. attach ADEC letter. ADEC wat~' system numbe~ Date completed 1 0 - 2 9 - 8 5 Cas~m 105 ' Y FROM 10-29-85 Niuate Date of lest Static water level WcU production WATER SAMPLE RESULTS: Coliform [~ Date of sample: ~. %. o~o} SEPT~CAIOLDING TANK DATA Y Fe,,-d~!on cleanout (Y/N) Dateot'Pmnpmg ~", 7' ABSORri'tON F11~.n DATA · I)ate installed lllllS5 ~ 29' Width' Wires properly protected (Y/N) AT INSPECTION 4-29-99 63.7' GT6GPN CoH~by: SCuar: Gilbert Soflm!ing (g.p.d./ft~o.rf~Axirln), 152 Sy,~e~n .tTpe deep trench 30" Oraw, ithlckncssbclowpipeS, ( 9 6 " to~ ~ 138" F_.ff~fix,~absoll}fiona.v~a 4648f MoMtofiflsTobopre~tttff]N) Y Depfessionovzrfield(Y/N) N Date of adc~Hacy t~l 4-29/99 ReSuJts (~aSs~ail) Pass For 3 bedrooms Fluiddeptbinabsorpfionficldbefomtest (m.); 52.75~fla~atelyalter 45~.wa~radded (in.): 69" Flu~ddcpth 52.75 "(ins.)lvl!n,~Tcs lam.: lO0 Absorptlonrate = 6- ,fa~ g.p.d. Peroxide treatment (past 12 months) (Y/N) a; if yes, gt~e date a;/~t Dateiastafled 11/1/85 Tanksiz~ /.O00 Npmh~ofComparlmcots 2 Cleanouts(Y/N)__ Depn=ssion (Y/N) ~ High water alarm LiI~ STATION Dale installed Manhole./^ _ _n:e~s_ High water alarm level at* Cycles tested E. SEPARATION DISTANCES Sizc in gallons "Pump on" level at* *Datum "Pump off' level at* Public ~ver znnnhole/cleanout R~. 8/95 OSS: htm, wk.doc La station ~/a SEPARATION DISTANCES FROM SEPTIC~OLDINO TANK ON LOT TO: Building foundation 1 0 ' ~ line 2 7 ' Absorption field Water m~ed_se_r~_~_...U_ne__ G T 2 ~Suffacc waterldmin~ge no ev.~adjaccntiots G ~ I O 0 ' SEPARATION DISTANCE FROM ABSORPTION iq~l .n ON LOT TO: Bldldhlg fOUlldalJon 1 8 ' Wage! rain/service line G T 1 0 s Surface water no evddonco Driveway, paflfing~ehlcle storage a~a Cm~aindtain no evidence WcllsonadJaCentlots GTIO0' Propertyline I0'; ENGINEER'S CERTIFICATION I ceftin, that I have determined thru field inspections and remew O. IMunicipal reco~l_~.t~]ao_eb~l~i~jcl~H are in conformance with MOA HfL4 guiflelmes in effect on als date. ,~'..~'2 L'a'~-'T,,',-Is ' Sisna e -- .-~.. ,.. ".-..- - Waiwr Fg= $ Da~ of Payment 4' to center of trencl Receipt Numb~ Septic/holding lank on lot 1 1 2 ' Absofl~tion field on lot 1 1 4 ' Public sewer main Sc'wer l_?u_*c_sc,vic= linc a ~ 8 0 ' SEPARATION DISTANCES FROM WELL ON LOT TO: ; On adjacent lots GT1 O0 ' : On adjacem Iota GTIO0 ' Lot1..1, Block 2 Eagle River Heights (10219 Wildwood, Eagle River, 99577) Homeowner - Sarah DeSanto TAX ID 050-281-30 4-29-99 Well and Septic Adequacy Test (HAA) WELL TEST A four hour test was conducted using an acoustic well probe and 20 GPM capacity water meter. Total depth of the well was 105' below grade. Static was found to be 63.7' below the top of the well casing. 1,470 gallons were pumped at unrestricted flow rates that varied between 5.6 and 7 GPM. Level in the casing dropped 11' from 63.7' to 74.7'during the first hour of pumping and stabilized. Level remained at 74.7' below top of casing during the remainder of the test. Recovery was 100% in 2 hours. RESULTS: YIELD WAS IN EXCESS OF 6 GPM. Well satisfies the MOA requirement for a 3 bedroom house. Lot11, Block 2 Eagle River Heights (10219 Wildwood, Eagle River, 99577) Homeowner - Sarah DeSanto TAX ID 050-281-30 4-29-99 Well and Septic Adequacy Test (HAA) SEPTIC TEST The septic test was begun at 12 noon on 4-29-99. The 3 bedroom residence was unoccupied during the test and recovery. All cleanouts were in place: 1 at the foundation, 1 for each compartment of the septic tank and one monitorlcleanout at each end of the trench. The trench length was 29' with 96' of sewer rock below the invert. At the beginning of the test the static level in the trench monitor on the north end of the trench was 52.75" above the bottom, which allowed 43.25"of remaining capacity below the invert. Flow was added to the monitor at the south end of the trench at an unrestricted flow rate that varied between 5.6 and 7.5 GPM. 870 gallons were added during the 2 hour and 14 minute flow period. The level in the north monitor rose 25.25" during the flow period. During the first 8.5 hours of the recovery period a drop of 22' was recorded, which represented 87% recovery of the 870 gallons added. Recovery of the 870 gallons was 100% in 20 hours. However, the required 450 gallons was absorbed during the first I hour and 40 minutes of the recovery period. RESULTS: System satisfies the MOA requirements for a 3 bedroom house. (The test was conducted with more than the required number of gallons to insure that the absorbsion would take place in the upper unused portion of the trench) · MAY-0?-Gg 11:06 FROU-CT[ EN¥II~0~HTAL $6t5301 ?-564 P.03/04 F-506 CT&E Environmental Service& Inc. C"f&£ R~.~ Client Name Project Name/m Client Sample ID Ordered By PWSID Sample 991798~0! SO Tcchmcal Eagle R~ver Heights tot 1 Blk 2 E~le lurer Hts D~-g Waler 0 Client ~ Primed l~te/Tlme 05/06/!,~ 16.15 Colleeted Date/Tbne 05/02/99 12 UO ~.~eived ~e~e 05~3/99 09 US T~ ~ur: ~ephen C. ~e Atto~a~te pre~ A~atySiS ~lt$ ~etflo~ LImitG Date Date Init Toter ¢otfform 0 eot/TO~ SK18 9222B 2.2~ 0.500 mg/k EPA 300.0 Io max 0S/03/99 r.~P gs/o.~/99 0S/0.3/99 scl MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # {"~-?-~'~- - .~%~ ' ?"~, ''''~''' HAA # 1. GENERAL INFORMATION Complete legal description Location (site address or directions) 10519 Property owner F.~r~/, R t ~,~ ,~_ R~'~,.i~,~t~.~ Mailing address ov~.6~.~ O/C[IVA~/A Day phone e Lending agency Mailing address Day phone Agent .l,~n~. H~,?~ ('~FAT[AI~IO ~EA~TV 11411 O.t.d G.t.e.m,t Hi~t'u, uccV Address E~gt~ R,/_v~. A~a~Jz~. 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: $ XI TYPE OF WATER SUPPLY: Individual well Y,X Community well Public water NOTE: Day phone 694-91 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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. 5. 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 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~ & $ Ei, iG;i, iEE~iN~, Address '~7c~ ,'. '~.:.~!e River L~p Road Eagle River~ Alaska 995~ Engineers signature Phone DHHS SIGNATURE ~ Approved for //~'~Jbedrooms. __ Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage ~i~ . Department of Healtt3 & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~'~" ~\ "~-'~L..\/--, ~ A. WELL DATA Well type'~'~--\~.~'~;' If A, B, or C, attach ADEC letter. Log present~C~N) "~ ~ Total depth I ~ Sanitary seal~) ~ ADEC water system number - Datecompleted ~C>-''7'-~5- ~ Driller Cased to \ ~:x-~ ' Casing height Wires properly protected (~) FROM WELL LOG -. ~ ~' Date of test Static water level ' Well flow' IQ Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ I''Z''~ g.p.m. Absorption, field, on lot Public sewer main Sewer service line ; On adjacent lots ~ ~::~1 ~ Public sewer manhoi:e/cleano~t ' I~ /~- Petroleum tank ~ O~'--~,- WATER SAMPLE RESULTS: Coliiorm '~ Nitrate \- ~ ~ ]'~ Date of sample: ~)'" I"~-~¢~'Z" Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date Installed / ~ '" I'- ~:~ Tank size Compartments High wa!er'al.arm (Y/N) '"-"' Alarm tested (Y/N) I,'' Date of pum~3i~ .... ;~'" J"7 - ¢=J~'' Pumper, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot "' ' ~''Z'''t' : Topropertyline" ~' ~ Surface water/drainage 72-026 (Rev. 7/91) Frc~t Foundation cleanout~r~N)~ ;-.~al -~ ~ ;)~D~);~'{~ion (V,41~ On adjacent lots Absorption field ~ 4:::::~ Jr" Foundation_ ~ * ~ ~ ....... Water'm~in/servic~e line · CONTINUED ON BACK PAGE C. LIFT STATION Date Installed Size In gallons Vent (WN) ' High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) sEPAR,~TION "' ' : .... ' " DISTANCE FROM LIFT STATION TO: Well on lot '" On adjacent 10ts D. ABSORPTION FIELD DATA Total absorption'ar?a Depression over ii;Id Results Peroxide treatment (past 12 months) Manufacturer ' ' · ' Manhole/Access (Y/N) ' ' ' "Pump off"levelat ' Cycles tested Surface water: ' Gravel thickness ' {~ Total depth .Cleanouts pres. e.nt,~rCN) -y Date of adequacy test for ' bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot ' / i'''~'~ On adjacent lots ~ ~ Jr P~ropertyline To building'foundation - ~ {~1 ,, , To existing or abandoned system on On adjacent lots .~1~ Cutbank //[' Water main/service line Surface water__ --~ c::~:>t ~' Driveway, park,ing/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this ~nspe~tion ' · .. ~. . . __,,~, ..~.,~'~',~.~,.~. , ~ Signature 17034 Ea:!e RIv~' LeeP Read No. 2~4 -~5~;." - '~'"7~.~..el, ' Riel', ,,,,_,,. ~,, .. ,......= .-... ~ .~ , · .~, ~ · , '. , ;. , , . ~"¢.~,."'.;,_.._ .__.__...., ',o,* ~'~.,,. , . .~.l ~n. ¢,--'~' - HAA Fee $ Waiver Fee: $ Date of Payment W / /2 / ¢~- , Daieof Payment '" Receipt Number c>~.~-~--~ Receipt Number 72-026 (Rev. 3/91) 8~Ck MOA21 CHEMICAL & GEOLO,G,I..CAL I, ABORATORY A DIVISION OF CO &'IIdI~.'RCIAL TEoTINO & ENGINEERING CO. ~ ,I~MUNICIPAMTY OF ANCHORAGE ~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECT!ON DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date June GENERALINFORMATION ~ (a) ~galDescription(includelo~block, subdivision, section, township, range) l,n~ 11 Rln~k ? Es[le Rivep height~ TlhN RlW Sec. Location (address or directions) 23, 1986 (b) Applicant Name t,~-~v gh~m'~y Telephone:Home Applicant Address ~,,, lti~l ~.;~['lP R-IvPt-: A'lagk~. (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution N/A Telephone Address (e) Real Estate Company and Agent ~,lat'y .C;humwR¥ ~ VI .~t:R Address (f) Telephone Mail the HAA to the following address: P'l ckup hy ,~ppl 4 t-nnf. TYPE OF RESIDENCE Single-Family [] Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well[] Community[] 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 confirmati(~n from the State Department of Environmental Conservation attesting to the legality and. status. -.... 12.025 {11164) Page 1 of 2 · 5. ENGINEERING FIRM PROVIDII.. INSPECTIONS, TESTS, FILE SEARCH, D~,. A AND INFORMATION As certified by my seal affixed hereto and as of Ihe validation date shown below, I verify that my investigation of this Healtl; 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 lurther verify that based on the information obtained from the Municipality of Anchorage files and Irom 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 EAGLE-RIVER-ENGINEERING SERVtCE-(~ Telephone Address EAP, LE RIVER, AK 99577 ....,/, /,.~. P.O. BOX 773294 Date 1~94-5195 DHEP APPROVAL Ap'~roved for 7'~'~-~'~,) bedrooms by Approved ~' Disapproved Terms of Conditional Approval ~'?~-'~-'~ Date Conditional. CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. -. Page 2 of 2 72-025 (11/84] ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field 3,~/'' Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well / ~ ? / To Building Foundation /~'" Lot To Water Main/Service Line ~/~ / To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field "~ ~ / Depth of Field /'"~ · Gravel Bed Thickness <~ · Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line /o" To Existing or Abandoned System on ; On Adjoining Lots '~ .3'~ · To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test, Meets MOA Comments °* Check Permitted Bedroom Rating Against HAA Request ** HAA guidelines in effect on the date of this inspection. I certify that I have checked, verified, or conformed to all MOA and Signed ~ Date MOA No. Company Receipt NO. Date of Payment q-/-C~'~ Amount: $ Eagle River E~oineeflng S~rvices P. O. Box 7732~4. Eagle River, AK 99577 694-5195 Page 2 of 2 WELL DATA Well Classification ,/~/~' / ~',~ ~' -~* Well Log Present (Y/N) ,Y Total Depth /0.5- · Cased to Static Water Level Casing Height Above Ground "~ · Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line "75-/ Cleanout/Manhole ~-"¢~ · Water Sample Collected by Water Sample Test Results Comments MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal D, escription: . ~¢~ ~ ~' If A, B, C, D.E.C. Approved (Y/N) Date Completed /~-"-~- -~- Yiel~,E' ~-,"~', ~',-,.,-- Depth of Grouting ~-~'~ Pump Set At ~ ='~"'- Sanitary Seal on Casing (Y/N) )/ Depression Around Wellhead (Y/N) DEPT. OF HEALTH & ENVI~N. MENTAL PROTECTION RECEIVED_ ; On Adioining Lots ~'/~ /~ 7' · ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~-~& ."~'~ ~*"'~";'""~'"'~'~ ;Date B. SEPTIC/HOLDING TANK DATA Date Installed //////E,( Size /.~..~ c./. No. of Compartments ~ Standpipes (Y/N) ./v Air-tight Caps (Y/N) ,~ Foundalion Cleanout (Y/N) ~ Depression over Tank (Y/N) ~ Date Last Pumped ,,~'c'¢~' ~.~-.~.~.,..~. Pumping/Maintenance Contract on File (Y/N) '4'/,~'/ ; for - Holding Tank High-Water Alarm (Y/N) ""~'~./.-~ Temporary Holding Tank Permit (Y/N) ~ Separation Distances from Septic/Holding Tank: To Water-Supply Well /,y,,o · To Property Line ,.,~o · To Water Main/Service Line '~/~ / Course ~*~/.m To Building Foundation -5-/ To Disposal Field 5- / To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84)