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Home My WebLink AboutTONJESS ESTATES BLK 3 LT 3 MAILING ADDRESS LEGAL DESCRIPTION /-0-7' LOCATION MUNICIPALITY OF ANCHORAGE (' ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE [] UPGRADE D~STANCETO= IW°ll 115'4 ~ Z Manufacturer Manufacturer i1 ,,STANC, TO: t.- Length of each I' e. :;:',l:,oL,h I grade tu Length Width . ~ ~ ~ t- Type ~f Crib Crib diameter u~ DISTANCE ,.I Cia s~__..~ ,,~/ Depth DISTANCE TO: Building foundation I/u~sorptmn a~.~ · ~ Insi~de len.lt h Dwelling Foun.ation ~ 0 Total lan th of liges Material~neath~) tile Depth Dwelling /~.. /~ Mat e'~Ll-"~"~ L. Width Material Trench wino Inches NO. OFBEDROOMS PERM O No. of compartments Liquid deRth PERMIT NO. Liquid capacity in gallons Distance ~t~en lin~ Total ef f~tiw abso~on area PERMIT NO. Crib depth Building foundation Driller Sewer line Distance to lot line I PERMIT NO. Septic tank I Absorption area(s) OTHER PiPE MATERIALS SOIL TEST RATING/ t Os INSTALLER REMARKS PERMIT N0. APPLICANT EARL CHAPPELL LOCATION_ LEGAL ~ ;'L~ B~ TONJESS EST. SA-2 BOX 66820 CHUGIAK LOT SIZE 99567 694-4994 59000 SQUARE FEET TYPE Of SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUI,I NUIqBER Of BEDROOMS '= ~ SOIL RATING (SQ FT/BR>= 85 THE REQUIRED size of THE SOIL ABSORPTION SYSTEM IS: DEPTH= ? LE~GTH= 4~: GRA%~EL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET>. THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMU~'I DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTO~'I OF THE EXCAVATION (IN FEET). REQU I RED SEPT I ~ TANK $ I ZE= 1OOO GALLON~ PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUI'IBER OF RESIDENCES THAT THE WELL WILL SERVE. TWO < 2 > I NSPEC:T I Obl:5 ARE REQV I RED BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE Of PUBLIC WELL. MINIMUI'! DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. -' WELL LOGS ARE REQUIRED AND> MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS OF THE WELL COMPLETIOH. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND> CONSTRUCTION DIRGRRMS ARE RVRILRBLE TO INSURE PROPER INSTALLATION. PERM I T E×P I RES DECEtlBER ~:~ ~-~8~ I CERTIFY THRT i: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND> WELLS AS SET FORTH bY THE MUNICIPRLITY Of ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN RCCORDRNCE WITH THE CODES. 3: I UND>ERSTRND> THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED> TO INCLUDE MORE THRN ~ BEDROOMS. APPLICANT EARL CHRPPEIJL MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 k. Street, Ancho~, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: OATEPERFORMED: '7'-- LEGAL DESCRIPTION: 12- 13- "~ ~ I O N;:':':':':':':':':'~cS.? Fc'<:..r: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 20- COMMENTS 72-008 (6/79) S L p, E Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE J ~T~A~ND TEST RUN BETWEEN , CERTIFIED ~ (minutes/inch) FT S & S Engineering SRB 196X Eagle River, Alaska October 3, 1983 99577 Mr. Earl Chappell SRB 126 Eagle River, Alaska 99577 Dear Mr. Chappell, Reference:· Lot 3: Block 3: Tongass Estates Subdivision As you rec~ested, a well inspection was performed on the referenced property. The well casing was found to .be equipped with an adequate sanitary seal and all'wires had been placed in conduit. The earth around the well casing adequately sloped away from the well. A water sample was taken in the Kitchen of the residence located on this property and submitted to Chemical and Geological Laboratories of Alaska for coliform bacteria analysis. The results of this test were satisfactory. ~ If we may be of further service, please do not hesitate to contact us. cc: Municipality of ~chorage Department of Health and Environmental Protection SULLWAN WATER WELLS OWNER OF LAND I~AP, L CIIAI'I~ELL ADDRESS .~,~, 2' .~o× 66~9 Chul~imk~ ~k 90567 LEGALD~CRI~ION l.nt 3 ~lock :3 Ton{~ss [:st~t~s P. O. BOX 272, CHUGIAK. ALASKA 99567 · TELEPHONE 688-2759 Ft. Ft. Ft. Ft. Ft. .Ft. Ft. Ended annd & ~ravet blue clay sand with water DATE Z~tarted PERMIT NUMBER KIND OF FORMATION: From 0 ~ Fi. to ? From 2 Ft. l~' .1 2 ' From ' 12 Ft. to 30 From 33 F,t.t? ~6 From £6 Fi. to 96 'From q6 Ft. to 10! From~Ft. lo From~Ft. to From FL to From~FI. to From Ft. to Ft. Ft. Ft. DEPTH OF WELL 100' STATIC LEVEL OF WATER FT. DRAW DOWN FT, GALS. PER HR 1800 KIND OF CASING 6 5/8 O.13. From FI. to Ft. From Ft. to Ft. From--Ft. to Ft. From__Ft. to Ft- From Fi. to Ft From Ft. to Ft, From Fi. to Ft, From. Fi. lo Ft. Fmm FI. to Ft. From__ FI. to Ft. From Ft. to Ft. From~Ft. to From~Ft. to From Ft. to From:" Ft. to From Ft. to From .~..~-Ft. t~ "'Ft. '~ "~ "~" Ft. Ft. Ft. ~' Ft. -~L,~From ,""~'.-'~FtZto~. - Ft. From.~Ft. to FI. · 1::Fromm' Ft. to '~" Ft. From Ft. to Ft. F~om __ Ft. to Ft' 63 MISCL. INFORMATION: Parcel I.D. # On-Site Services Section P.O. Box 196650, Anchorage, Alaska 99519-6650 343-4744 MUNICIPALITY OF ANCHORAGE · ,~ DEPARTMENT OF HEALTH'& HUMAN sERvicEs Division of Environmental Services CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051_831-08~Oo~ 1. GENERAL INFORMATION · Complete legal description 'r.o~- 3, Block 3 ~onJess HAA # Location (site address or directions) 24918 Jessee r.®e ct:. e Property owner Joe and Deb Servel Day phone Mailing address Lending agency Mailing address Agent Lvrm swanson, Jack White Co, Eaqle River Day phone Day phone 694-5500 Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 ~ TYPE OF WATER SUPPLY: Individual well Community well Public water x X NOTE: If community well s~,stem, provide written confirmation from State ADEc attest- · lng to the legality and status of system. X TYPE OF WASTEWATER DISPOSAL: Individual on-site .. Holding tank rn nity ' ' Go mu on-site Public sewer . · .' NOTE: ~ If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. · Engineer's signature ~ ~'~"~"~ Z '"" ':~' Date STATEMENT 'OF INSPECTION BY ENG NEER'" / ;. . As certified by my seal affixed hereto and as of the validation'date shown below, I verify that rdy' investigation'of this Heal!h, Auth0r!tYApProv~l application sh0ws 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 fUffher 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.e .ffect on the date of this inspection. Name of Firm Anderson Engineering Phone 563-7155 Address P.O. Box 240773 Anchorage, AK 99524 6. DHHS SIGNATURE ~'~ Approved for '~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority Approval Certificate§' ba~ed only upon th~ representations given in paragreph 5 above by an independent professional engineer registe red !n the State of Alaska. The DH HS 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 d° not ~:onduct 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. -. ~.' ' ; Legal Description: Ao WELL DATA Well type pz'i tare Log present (Y/N) Y Total depth 101 ~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICER E C E IV E O Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501e (907) 34%7~ ~7 7 1997 Health Authority Approval Checklist ~ot 3, Block 3 TonJess Y Municipality of Anchorage Dept. Health & Human Services Parc~ll.D.: 051-831-08-000 IfA. B. or C. attach ADEC letter. ADEC water system number Date completed Cased to unknown Date of ~ Static water level Well production WATER SAMPLE RESULTS: Coliform 0 Date of sample: 6/23/97 B. SEPT1CJIIOLDING TANK DATA Date installed 7/28/85 Tank size Foundation cleanunt (Y/N) ¥ Date of Pumping 6/25/97 C. ABSORFTION ~.n DATA .Date installed 7/28/83 Length $0 ' Width Effective absorption area 255sf Date of adequacy test 6/20/97 715183 Casing height (above ground) 28" Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION 7/5/83 6/20/97 63 * 16.7 g.p.m. Nitrate 73.7 Below Top of Casing 6 g.p.m.. 3.37 mg/L Otherbac~da Collected by: Stuart Gilbert 1 ~ oo0 DePression (Y/t0 r High water alarm (Y/lq) Pumper JR* s Pumping Soil rating (~.p.d./ft2 or fi2/lxina) 85sf/br System UPe 5 *wide trench Gravel titicla~:ss below pipe 36"' TotaJdepth 8'i0" Monitoring Tube present(Y/N) Y Depression over field (Y/N) N Results (PassW*il) Pass For 3 BR bedrooms lm~m_edi*tely a~r 480ga]. wamr~aa~ (in.): 12" Absorpfio~ rate = 8, 640 g.p.d. U'yes. give date Number of Compartments 2 Clcanouts (Y/N) Fluid depth ia absorption field bet'om lest (in.); 12" Flniddepth ]2" (ins.) Minutes later: lO Pemxida treammnt (past 12 months) (Y/N) A' LIFt STATION Date installed NONE Size in 8aliens Manhole/Access (Y~) High water alarm level at* "Pump on" level at* *Datum -Pump off' level at* Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 1 i0 * : On adjacent lots G?IIO ' Absorp6on field on lot GT110 ' : On adjacent IoL~ G2'l l 0 ' Public sewer nmin Public sewer manhole/cleanout Lift station None N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 14 ' Properly line GT 20 ' Absorption field unknot. (no a~ £er tank CO) Water ~lain/sen4ce line GT20 ' Suff~ce water/drainag~n°ne Dba .Wells on adjacent lots GTI l 0 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~'l $ ' Water main/sen4ce line GT20 ' Surface wa~r none observed Curtuia drairo no evidence Driveway, pafldng/~hicle storage area GrlO' Wells on adjacent lots G~120 ' Property line G~20' F. ENGINEER'S CERTIFICATION I ceftin: that I have determined' thru field ir~pect~ons and revie~ ofMunicil~d.records~a,~.syster, u.? ,~.. are in conformance with MOA HA,4 gaideltnes in effect an this date· _~_-OF Date 6/26/97 HAA Fce S ."~- ~ Waiver Fee S Oa~e of eayment ~. ~'~.a, Receipt Number O~Q ~.~-k ~'/~) Date of Payment Receipt Number Rev, 8/95 OSS: hna.wk.dac 'i!~' :}:, . '; 'J:'"~i~.:~':: "':. ' .~: MUNICIPALITY OF ANCHORAGE '~:-~.:.~:~*~.;(.'.:~',:~'~'~52'~',~-'''~ ' ".' .' 'Y~ '~ ~' '~ · ~ {~l ?:~ DEPAR~E~ OF H~LT~ & HUMAN sERVi~E~"~'~'~' ~'~'": ';)' ': . '~.'-..' ~'i.'""'"~,.x_'~'}~;,g~.~g~ Division of ~vlmnmental Se~ices ~[,.~ :~:~c~ -;-~-~}-'~. ' . ...... : - : P.O. Box 19~. Anchomg Alas ~51~0 ..~, ....~...~ ...... ~ ~..~ -; CERTIFICATE OF H~L~ A~HORI~ "'" .- = .... - ....... : ';-..,i 'APPROVAL FOR A SINGLE FAMILY DWELLING ~ -~ ~ -'~ - - ' Parcel I.D. ~ · 1.. GENERAL INFORMATION .... · .... ' ........... ,. -' .'- V:'~'~.Lo~tion (s te addr.s or dlr~ionsl :~ ~ ~ I ~ ~_~ · ~;)'.J-.A.n.di~.g agen.cy:. · Day phone .............................. . .. ..~ ...... ~',~.~ ;:~t. ,f ....................... . .............................. ~ .......... . . .... :~. _-.==*=s~,.,a,,,,.,~ ??,tess - ...... =...- ............................. · ...=~._ ~... . ..1.,,..*~ ~ - otne~tse r~uest~, H~ will be held fornickun.- ..... ~. ~.. ~.NUMBER OF BEDROOMS ..... -~ ...... · 3.. '~PE OF WATER SUPPLY: '-: ". ; ,*, NOTE: If communi~ well s~tem, provide walden confi~ation from State AD~ ..~-:,, '* '~ing to the I~ali~and sMtus ofs~tem. ~ ........... ~-~-~*-'.--'- ;-' ,-' ............ :::-'- ':'.- -.-~;,2~'~ = '~., .-...- -.. ... . · . .: ...... ......: , .... '":: ~.~ . ' ., *.- .= ...... -. :; '2.; ;.'. "* '* ......... Holding tank ~ :~ ............... , ........ . .... ~ ...... . ..... ~....~..__ .~ .._. ,. * , - OommuRl~oR-site. ,.' ' ~ .. ~.' .~ ~..: ..';..~ .......... ~,~2.7.~,. :< ~' NOT~ ~-~ If communi~ wastewater s~tem, provld~ wri~en a~esting to the legali~ and status of s~tem.' ..... ::.. '- - ......... ~ 5. ~.STATEMENT ,OF INSPECTION BY ENGINEER ................... :'~ '* :' :' ';'" ~' ' ' "; ....... ........ · · myth ....... lu c.~.rt f ed by mY seal affixed hereto ~nd a~ of the vahdaflon date shown below, I ye at my.: ..... inv~tigat on of th~s Health ^uthori~ .~proYa app mt on sh0w~ that the or.ire water supply ..7: . ...-. and/or wa~tewater disl:ki~l system Is ~afe, fun~ional arid ~/d~li~a~e for the numar el ~room~ -. -. ' :' - ' and ~ o~ ~tm~um Ind~t~ horo~n. I fu~h~rv~ that ba~ on tho In[omation og~m~ kern . ~,-. .... · e Municipali~ 0f Anchomge.fil~ an~ f[0m my ~[g~tio~ ~nd. ins~on, the o~tte water.;:,~'}~ : supply an~or ~tewater dis~l ~em Is in 'compliance with all Municipal and S~te ~,~- 2. , . . - -,. om~nan~, [~u~auo~ ~. ~ff~ ~. ,ns~d~n., ....... ;~ =.,~...... . .. ~.~ -~.xx~,~?~'r'-~ m~*~,~-~ndffiom -aoor~ for ............ ~ ~r~ms, xw~,~e .follo~ng ~pulafiom.~,.~. ~.:.-.~-- ..~ ......... ~Add t ona ~mmen~ ' . e,~<:5.. z..;. ~-:~e Munlcl~ll~ of ~chomge ~ent of H~l~.and H~~,(~,H~) ~.~[~.A~ .. :. ',':', ::~prof~onalengln~r~i~e~n~eS~teofAl~k~D~HSd~.~u~p~ofh~.~4'::,:~ . .:.: -:~ ~ ~ ~ir lending In~o~ In offi~ to ~ ~ln f~eml and ~ ~ul~B. ~ p!~ ~ DHHS ~n~[ ~-~' · ,.,-condu~ ins~ons ~iana~e ~'~fom a ~ffifl~ ~ ~.~ Mdnlcl~l~ of ~chomge b not -~nsible f i~lo In ~ pmf~io~l · gin~s ~ ........ ' ' or effom or om ~ n ·.'~%, ...... ,.,. ..:,~'~.. . Municipalibj of Anchorage Department o,f Health and .I-I,,u, man Services HEALTH AUTHORITY APPROVAL CHECKLIST Log present (Y/N) · y Total depth I O1' Sanitary seal (Y/N) Y Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed '7/~/1~'~ Driller Cased to U~.Lvt0cu~ Casing height FROM WELL LOG Date of test '?/~/~ :~ ' Static water level ' ' ' ~,~ ~ We, flow l/.,,.'7 ' Pump level1 U~t (~ vie u.,H Wires propedy protected (Y/N) AT INSPECTION " ' 'Tz.q g.p.m. ~ ' ' SEPARATION DISTANCES FROM WELL TO: I I D ' -,I- ; On adjacent lots I I I) + ; On adjacent lots Septic/holding tank on lot Absorption field on lot Public sewer rnain Sewer service line WATER SAMPLE RESULTS: Colitorm - C:) -- Date of sample: g.p.m, ri'l__ # Public seWer manhole/cleanout H Petroleum tank Nitrate Collected by: B. SEPTIC/HOLDING TANK DATA Date install~d ' I ~ /Z e/~ ~ Tanksize It oOo .~ ( Cleanouts' (Y/N) '--."' ': Y ',' .','" Foundation cleanout (Y/N) ~/ Other bacteda -- 0 --' Compadments Depression (Y/N) High water alarm (y/N)':.'~ ] l.J Date'of j~Jmping'" ~1 .... o Pumper SEPARATION DISTANCES '~ROM SEPTIC/HOLDING TANK TO: Well(s) on lot .... Il0 lJ~,/, On_a. djacent io!s To property line ~.o ~ d- Absorption field ( .Surface water/drainage t'~*~ Alarm tested (Y/N) N !A Foundation I q Water main/service line '2. o -I-- ~-~2~ CJaaI'F~r~ : , ' ...... CONTINUED ON BACK PAGE Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) 'Pump on'~ ~ 'PUmp oft`. Levelat High water alarm level Cy ."cl~ * ' Meets MOA electrical codes (Y/N) ., -~ Well on lot - I ~ ' On adjacent lots '--'. - Sudace water D. ABSORPTION FI~! n DATA >Datelnstalled 7/?-'~/'¢'~ Soil rating (GPD/FF) ~- e~..L/FS~. Systemtype :L~ngth' ~-)0 ' ~ 'W~h Cj'~ ..... Gravel thickn~s~ Total depth ,~Totalabsoq:~t.~narea.~ : . . ~ Z.~5"' .... CleanoUtp~esent(y/N) Y ...... DePr~ionoverfield(Y/N) : Date of adequacy test :~17. ~- , Remits(pass/fail) ~, tot ~-~ Bedrooms · Water leva In also.ion fi~U I~lom test ~v'~t - ,~er le~t' __ Peroxide treatment (past 1,2 months) (y/N) I'~ ":': I~ ye;]giVe date N/A SEPAFI~TION DIST/~ICE FROM ABSOR~rlON FIELD TO: Well on lot I I 0 ~ + On adjacent lots I I 0 & P~roperty line To bu~ing foundation. Ic~t+ To existing or abandoned sl~tem on lot On adjacent lots IO0~ Cutbank Mo3u. ~ -f" Water main/service line go Sudacewater kl~t~ ol~e-vue-~ Driveway, parki_ngNehicle storage area ' 'l'b'A---L' ' '"¢; E. ENGINEER'S CERTIFICATION I cer~fy ~hat I have checked, ye#fled, or conformed to all MOA and HAA guidelines in .......... ~', : -:. -:~,..:~ . : ~ -. - - . ~_ . Date HAAFee$ .--~'D. ~f-~ - '" ::~ "' Receipt Number 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 Parcel I.D. # ', CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION · Complete legal description Lot 3; Location (site_addre.s.s or. .directions) Property owner'~=: L~u~/W-~, S. za.~. Coo~. Mailing address '" Lending agency Mailing a~dress Agent Day phone--694~4Z00 ~ ~-~ .,, Day phone Sc~zc~ Coo~. ]~E/~fAX OF EAGLE RZI/ER .Day phone .'~94-4~00 ! Address 16600 ¢¢n~,'c~.~.t.d Z)/~:u~ #201 E~ta~.~ P,~uc/t, A~.. 9957~" Unless otherwise requested, HAA will be held for pickup. - .......... ,,.] .... e NUMBER OF BEDROOMS: .,., .TYPE OF WATER SUPPLY: Individual well ~ommunity well Public Water X~ e NOTE: lng to the legality and status of system. If community well system, provide written confirmation from State ADEC attest- T~PE OF W. ASTEWATER DISPOSAL: ' ' Individdal 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. 72-025{Rev. 1/91) F~ont MOA.21 '5. STATEMENT OF INSPECTION BY ENGINEER As cerhfied by my seal affixed hereto.and as of the vahdabon date shown below, I verify that my investigation of this Health Author!ty 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 vedfy thai 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'~ '; ~ Phone ' $ & 5 F. NGINEERING Address 17034 Eagle R;ver Loop Road No. 204 ' ' Eagle River, Alaska 99577 Engineer's 'signature -' ~ · 'Ap~proved for ,x~ bed~'ooms. ~ Dis~l~proved. · ' ' Co~'ditional approval, for '*' bedrooms, with the following stipulations: Additional Comments '.::'· t', :: Date The Municipality of Anchorage, Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given jn 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 ~mis~i°n$ in the professional engineer's work. · .~ "-~ '> -'MunicipalityofAnchorage, ~ ~ , Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST L~gal Descripti(~: [-~'"~ ,[:z~..~_--z~ '-'["=,.3.1'e5,$ ~-~.'C, 'Parcel I.Ol A. WELL DATA :: ,. Well type '~>¢~.~k/*,.-~'¢- If A, B, or C, attach ADEC letter. ADEC water system~number ": Log present {~/N) ~ Date completed '~ ~-~'~5 Driller S,~ t~, ~'~J Totaldepth [c>~-,' 'E,'~ Casedto ~ 0 ~ ~ ar Caslngheight Sanitary seal ~'N) '~' Wires properly protected {~/N) FROM WELL LOG,. AT INSPECTION Static wat6r level L~'~'P .... ' ~ ' ~ * (~,~=~ ~ :~ u c Well flow ', ' '"~::>.O glp.m. ."Z. g.p.m~ Pump level' ~ '"' t~-; ' - '. (.~ ',, . ~. . ; ~,~: SEPARATION DISTANCES FROM WELL TO: SepticJhoiding tank on lot % c>c> t*- ; On adjacent lots ~, c>o Absorption field on lot \ o (:> ~ e. : "; on adjacent lots ' I C::) 0 t ,,- .: Public sewer maih : i~U~iic sewer manhole/cleanout Public sew~r'service line ' h~- Petroleum tank WATER SAMPLE RESULTS:' ' I Coliform t'~ ~.o~ ~C:O~.~ ': " :' Nitrate ,1 Other bacteria. $ & $ ENGII~EERING Date of sample: ~- I~r'-~ I Collected by: Eagle River, Aliski 99577 B, SEPTIC/HOLDING-TANK DATA Date Installed ~ ~ Tank Size ~ ~c>o Compartments Cleanouts~)'Ni ~1 Foundation cleanout (~)N) ~ Depression (Y~;) High water alarm (Y~ /~/ ' Alarm tested. (¥,/N)~ ~'~ ":' "': ~ .... ~" ':':. t":' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot t c:>c> ~' On adjacent lots I~'' Foundation To propertyline tc:> ~*'' Absorption field ..... ~ ~' .... Watermaln/serviceline I ~ t,,- . Surfacewater/drainage - - - . lc> ~-o2e (n~,,~)~=~o~t uo^ ~ . ' , . . "'" ' CONTINUED ON BACK PAGE C. LIFT STATION Date Installed Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at ~ ~.,~ '.~ .'j~,'~. ,,!:, High water alarm level Cycles tested Meets MOA electrical codes~(YJN]~ ' '~' { "': ' SEPARAT~TANCE FROM LI~ STATION TO; . , On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date Installed ~ ~ Soil rating ~ ..... ~ystem ~pe Tota absorption area Dep-ression over.field Pe'ro~ide treatment (past Gravel thicknes_s_ .C!,e.a. no_uts pres_east ~_N) Date o1~ .a_d _eqljac_Y.test.- for "1"'~ e--.~..-.~- bedrooms .,.~ _l~ , .,~._., ,. :11 ;l;, · If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: '" / Wellonlot ~,DC'~'' On adjac, ent lots ~c:~o ~ '' Propert~line To building foundation J- I c, ~ ~ ~" TO existing or abandoned system on lot On adjacent lots '~ Cutbank ~ ~ Water main/se~ice line Surface ~ater ~ o~ ~ Driveway, parking/vehicle storage area ' ' .....Cu~ain drain E. ENGINEER'S CERTIFICATION I ce~i~ that I have checked, verified, or conformed to all MOA and H~ guidelines In effect on the date of this inspection. , , ,. -,, ~. O~ A~ ~t- . -, ' H~Fee$---' / 7~ ~ ....... Waiver Fee: $ . Date of Payment ~-~7~ ' ' Date*of - Payment Receipt N~Se? ~ ~O// 7 ~ ~ Receipt Number STATIC WATrR LE¥£L (Top o! Clslng}: ROBERTA.$HAFER CIVIL ENGINEER $94 ~70 CLOCK ELAPSED TIUE gINCE DEPTH TO STOPi'ED, UW. WATER, FT. DRAWDOWN/ PUMPING RECOVERY RATE, GPM REMARKS t 0 .6 $S How I. not O~al, at~atd Subsequent V~rlations CJn Oc~r. Address ,~,~ ~ / ~ ~ ,~'~*~:~ ~_. Realty Co. & Agent Address Legal Description '~ APPLI('"~NT FILES OUT UPPER HA['"~. ONLY Zip Code Phone Zip Code Street Locetlc~ Type of flesl~ence ~ Single Family D Multiple Family ri Other Water Supply i"l Individual I-1 Community ri Public Utillt~ Sewer Disposal f-I Individual r-I Public IJ~illty ri Holding Tank No. of Bedroorm ~ Phone ATTACH WELL LOG. A wall log Is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log If available). Year Individual Installed: When Con~ected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: (..,~) APPROVED BEDROOMS ( ) DISAPI~:IOVED ( ) COND]TIO~IAL APPROVAL* *CONDITIONS OF APPROVAL MUNICIPALITY OF ANCHORAGE DEPT. OF H~-~.LTH ENVIRO~M3NTAL PROTECTION OCT 6 1~3 RECEIVED Soils Rating JDate Sewer Installed Welt TO Absorption Area Well to Tank Jwell Log Received Septic Ta~k Size t . CHEMIC.4L & GEOLOGICAL LABORATORIES OF ~4.LASKA, INC. TELEPHOhE (907) 562.2343 ANCHORAGE NDUSTR AL CENTER Drinking Water Analysis Report for Total Coliform'Bacteria Check ~ple (for routine 8ampi ' / with lab ref. no- ~ Treated Water . ~eclal Pu~ose ~ntreated Water, SAMPLE Time R~DINSTRUCTIONS ~ ' ' BEFORE ~LLECTING SAMPLE TO BE COMPLETED BY LABORATORY Anal~is shows this Water SAMPLE to be: ! [] Unsatisfactory [] Sa4ple t~o long In transit; sample should not ~)e over 48 hours old at examination to Indicate reliable results. Please send new san~le via special delivery mall. Date Received 'l;~mefRecelved Analltl~al Method: i:] Fermentation Tube 'i ~, embraneFllter Le~. Ref. No. Result* Analyst CHEMICAL & C,E'~.OGICAL LABORATORIES ~ ALASKA, INC. Dn, n. ktng.,Water Analyms Report for'Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: Water SyStem Nome I.D. NO, Phone No. ldo. Day Yur SAMpLE/TYPE: ~ - ~'l-I Check Sample {for routine ~mple . with lab ref. no. ) ' [] [] Special Purpose . SAMPLE ~ r Treated Water ,~ Untreated Water -' .... ' ' Time , Golle~ted :.).. .~.- . ;, o4.122a Rev. 1978 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ~'Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results· Please send Date Received ".Time Received · Analytical Method: [] Fermentation Tube ne Filter Lab Ref. No. Analyst Result* BACTERIOLOGICAl. WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TIME DATE INSPECTOR INSPECTION APPOINi:MENTS' ' TIME DATE INSPECTO~ DATE RECEIVED _ . TIME . _/ ' J~NIOPAU~' OF ANCHORAGE MUNICIPALITY OF ANCHORAGE D;PT. OF I-T,"LT'.I & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOLI~/I~. };~/,Ei,~A,' f;~O: ECTI.- 825 L Street - Anchorage, Al~ka 99501 ENVIRONMENTAL SANITATION DIVISION AU~ ~ 6 i982 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEI6 I DIRECTIONS: Complete all par~s on page 1. Incomplete mquN~ will not ~ pr~. Please ;llow ten (10) days for pr~sing. 1. PROPERTY OWNER PHONE MAILING ADDRESS PROPERTY RESIDENT (If dilferent from ~bo~) PHONE BAILING ADDRESS ~ LENDING INSTITUTION PHONE MAI~IN6 ADDRESS 5. LEGAL DESCRIPTION FAM,tY I--I MULTIPLE FAMILY 7. WATER SUPPLY [~'~DIVIDUAL~ I-'1 COMMUNITY I--I PUBLIC UTILITY SEWAGE DI$1~)SAL SYSTEM [~'~NDIVl DUAL/ON.SITE°* I--I PUBLIC UTILITY NUMBER OF~BEDROOMS l--] , One ,- ~"'Four r I.. Other ri Two i--J' Five I--] 'Thre~' r-I Six ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) '.: /~P~ YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ~2-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY ~;, . 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS r--i SINGLE FAMILY [] MULTIPLE FAMILY [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX 2. WATER SUPPLY INDIVIDUAL COMMUNITY PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified r-lSeptic Tank or I--IHolding Tank PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER Size: If Tank is homemade SOILS RATING give dimensions: ~ TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL - - 4. DISTANCES ~eptic/Holding Tank WELLTO: Absorption Area to nearest Lot Line -- Area ISewer Line 5. COMMENTS OTHER DATE [~"~PPROV ED FOR ~'~' BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79) '