HomeMy WebLinkAboutT15N R1W SEC 8 LT 39ATI5N RIW
ction 8
Lot 39A
#051-092-46
MUNICIPALITY OF ANCHORAGE
DEPARTME:NT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE NEW
LEGAL DESCRIPTION -
NO. OF BEDROOMS
0.~ DISTANCE TO: L~II ~) ( a Dwelling ~0 PER_MIT'~-~2~_4~V~-
I-~. Man,fact,ret,~1,~~' <' t Ma~,~, N°' °f c°mpartcner} s ~.
~;~ Liq. ct~n gallons IF HOMEMADE: Inside len"t~ Width
~ ~ ~ Manufacturer ~ Material ---- Liquid capacEt~in ~allons
~0 DISTANCE 'O: Well ~ 0 ~ ~" Foundation ~0~ Nearestlotline ~0~ PERMITN~/UO~C/~ -
~ ~ ~ Top of tile to finish grade Material beneath tile
O ~ ~inches
~)- Type of crib ~ -- ~b diameter Crib depth ~. Total e[fective absorpti~l~area
~ Well Building foundation Nearest lot line
. . ~ · Depth .~ Driller --- Distance to lot line [O~ PE.MIT "O.
OTHER
PIPE MATERIALS --
SOIL TEST RATIN~o0 ~
REMARKS
-
72-013 (Rev.
PERMIT NO,
::IF'PI.. I CI::II",IT
_OCFIT I Ol",l
JEGFIL
II"d~ H I~ p-,,~ 1: lC: ]E fi:::::' ~:::'~ IL.. :E "'F' "~ [Q:n IF:= f:~ Ib',~ Z:: ~-~ Z:: IF;~: fl::;::~
[::,E~[;'Fff~'."~'M[D'~T OF HE]::iLTH FIN[:' ENVIP. ONMENTFIL. F'E'.OTE:C:T]:ON
825 '"k'" STi~:E[ET, F~NCHCI[~:FIGE., FIK. 9950:l.
C. 14. [,.IEI[:,NEI:E: ;,[, E,..I,., : ,. h C:HUEiZFIK ~ ......
E; BZP. C:HI.,.IOOD LF' &
'f"¥'F'E OF' '.~OIL. 1::II3':'~OI~'.BTIOI'~ S"r'STEiM I::-';: TRENC:H
"IFI',:'", I t"lUId NtJklE:EI:~'. OF' BE[:,I'~'.OOi'tS ..... :J: S;O I L [:;:FIT I
THE I;?.E(~:!IJ I [~:EE:, :~i: 12E OF' THE 'SO I L. IqE:SORF'T t ON S'Y~i;'['EM I S:
( ':T,Q I::'T,.-"E~F:'. ) ..... ::LO0
THE L..ENG'FH [) I MENS I ON I S THE I._.EIqGTH ( I i",1 FEET.':' OF' THE: -fREIqCH O[;[: I)~:;]::11 i'.,IF:' I E]..D.
THE: DEF"TH OF FI TP. ENCH OF4: PIT ]Z'Z TI'~IE E:,ISTI::Ii"K::E BETI4EEI',I THE EiL.II:;?.F;FK3E OF:
GP. OIJND I:~I'.,ID THE [30TTOM (::if:: THE E',:-::CFI',,,'FITION ,:Z IN FEET Z).
THEI~:E ZE; NO SET I.,.IIDTH [:'OF;: 'FFtE:NCHES.
]'HIE 1.3[;.'.FIVEI... [)EF'I-H IS 'l'l*'l[i[ M Z[i'qlMI..li'q [)EPTH OF GI'(FI',,,'EEI_ BfE'I"I.,.IEE:N "rl~lE: OUTI:::'FiI..L. I'::'II::'E:
FINQ "I-HI:E E~O'i'TOM OF THE E;:-:;C:FI',,,'FI'I"ION ,:: IN FEET).
F'EF:MIT f:ff::'F'IJ:E:FINT l.-II':lS THE RESPONSIE:IL. IT"r' TO INFORM
I N:~STf:ILLi':IT 1.' ON I NSF'ECT X ONS OF l::li",l"r' I.,.IELLS f:IDJ'FICENT TO
NI...IMBE[E'. OF [.?.ESI[)E:NCES TI'fi:IT THE I.,.IELJ_ I.,.III_L
Tt"I~S [)[EF:'f'I[;~:TMEi",I]" DIJR:II',IG 'I"IIE
'[I-'IIE; PF?.OF'[CFTF'~" F:ff',l[:' 'THE:
Bf:ICI".:F: I I...L. I NEi (IF F'IN"/ ':'!;"/ZTEM PI I 'T'HOUT F I J",ll::l[... ]: I",ISF:'E:CT l ON F:IF,I[) FIF'F>F?.OVFIL. E:"," TH ]: :E;
[:,EF'FI[~'.TMEi"4T I.,.IILL DE: .SL.IEk~'['£CT 'Fi::) F'g:OSECIJTtOi",I.
i'q I i'.41 MUM [:, I S'f'I::INCE E:E'i'HEEi]'.,I 13 NELl.. Fti'.,I[) FIN's' Oi'.,I-S I "I"E '_.E;ENFI(:iiIE: E:, 1:5POL:;FIL. S'./S'FE!:M I S
::LOO I::'EET F'O[[: FI F:'F~I',,,'Fff'E: FIE]..L.~
~12:50 TO ;:_'OO FEET FROM FI PUI3L. IC NEI...I._. [:,EPENDING L.I[:,ON THE T'¥'F'IE 01::' I:::'LIIE:L. IC I,IEL. I_
O"FI.-IEF?. [;?.EQU I P.[.:.i',I[.':]'qT:~; MFI"r' FIPPL'T'. SF'EC I F' I C:FIT I ONE: FII".I[:, COI",I:[;TIRUCT I Oi",l [) I FIC~P. Fli"I'.E; FIP. EZ
FI',,,'FIILF:IBL.E TO INE;L.IF?.E F't~:OPE[;~'. INE;TF]IJ_FtTION.
i CEP. I"IF:'"r' THFIT
:1..: I FIM FFIMIL. I FIF?. I.,.IITH THE I;'.E(/~I..II[;;:E]'"IE]'.~TEi; FOR ON-:E;ITE SE!.,IEI:;:::E; I:'1i'4[:, I.,.IELL:i5
FOf~:'FH E:',' THE: MUNICIPFII....I-I".r' OF
2: I NIL.L. Ii'.,I:E;TFII.L THI'£ S'~.'ST[CM IN FIC:CCIREaFINCE .WITH THE
::~:: I L.li'.,![:,[:~R:STFINC, THI::IT THE ON-S ti"[':-' '.'-};[!:FIE":[;['. ':T..,'./:.::71'E:M i'ql::l'./ i~:EZ(;!IJII:~:E: ENI..FI[~'.GE]',IEI",IT IF TI.IE
I:;.'.E::~iI[:,ENC'E .I~: P. EMO[:,ELE[:, TO II'.,ICLIJC, E I','I0[~'.E THFII'.,I 2;: E:E:[:,F~:OOMS.
I::IF'PLIC:FINT C:. W. W[EI
0 Et I-' G EOT
Russe# Oyster
694-2774
Soils~ Foundations
Per¢omed for:
,HNICAL 8- DEVELC
Box 90, Davis St,, Eagle River, Alaska <,)9577
694-2774 or 688-2280
Legal Description:: Z~
Depth (feet)
/i[:NT CO.
Earl Ellis
688-2280
Land Developrrmht
i~m
~!m
Groond Water Encountered: Yes.___ No ~ If yes, what depth___=
Proposed Installation: Seepage Pit~ Drain Field_~_
Co~ents'
Municipality of Ahchorage
Development Servlces Dei ai*tment
Building Safety Division
On-Site Water and Wastewa{er Program
,{700 Sou{h Bragaw st.
P.O. Box 196650 Anchorage, Al< 99519-6650
www.cLanchorage.ak. Us
(907)
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
GENERAL INFORMATION
Complete legal description ,Lo 7-
Location (site address or directions)
Current Property owner(s) ~/~7-J¢
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS: ~
Expiration Date:
Day phone
Day phone
Day phone
o
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site
[] individual Holding tank
[] Community On-site
[] Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 5 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 less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid fo~ one year for properties served by Class A or B welts 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 cedified by my seal affixed hereto and as of the valkJation da{e shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approva~ Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal sy§tem is(am) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein, i fUdher Verify [ha{ 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.
S & S ENGINEERING
Name of Firm 17034 Eagle River Loop Road NG.. 204
Address Eagle River, Alaska 99577
Engineer's Printed Name
bedrooms.
DSD SIGNATURE
/ Approved for
Disapproved.
Phone
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
StJpplemental Engineer's Report
Other
Original Cedificate Date:
0
E. SEPaRAtION DISTANCES
· :...;:.:::.'..~,.;:.:!!~.~ ':, ::'.-
Size' in .ga!lons'.::ii,'. '~;, .L~'.',..: .~.,.~:-:::...: ~,.... :,Manh~ e/AcceSs (Y/N)
· -.... - :'":;-:,';~'.':'..': ': ;' :.;',~': .' 'i'.'"":.... .
Pump.' off, lev, e! at:,,. · ~:'.. ~;,in. ;:.:....~ ...,, .,.;..High ,water,:alarm level .a~
Cycles.tested -Meets alarm & CircUit. reqUirements? __
in.
:SEPARATION DI~TANCES'FROM WELL ON LOT ':TO:
Sep~ic"tank/lift,~ta~n..0n"lot /.OO %"~" '-'' """~"'"' ' ''~'::'
~ ...,:0 n.~.adjacedt.:tots ~... ............ /'~:::~
Abs0.rption field on lot / ~D(~:/'/-' On adjacent lots /.(,.),~' t'.~..~
Pubhcs~Werman .... :..../.2,/:~ / ........ h.',"l~Q~i~'.!~m;~h~ieibeanout
.~ePfiC'.~,~Vi~:iin~'"',":.'"'"~,~'~".'~ -... 7¥ H~!~i?~.!~'k".":"."
~:sE.~.','....;~;..: .:...:...............,..' ,.::..,: ;... .... ...:,.. :. . ...~ ':..:.. :; .'.:,, { :::..-., ..., .'.
· ARA:TION:'DISTANCES FROM SEPTIC/H0~gf~G TANK-'ON:EOT TO: - ' .-/
~""~" ! ...... '".' ~' ~" 'Absoq~tion field
Building foundation /'~C'':'~ ~t~rPr°p~rty Ii.ne ~:7
Water main /~J/z §efvice line / ' Surface water /.~-~
l~..--
Wellson adjacent lots /..~.~.~ ';"f'~
SEPARATION DISTANCE'FRC~M:;ABSORPTIO'N FIELD ON' LOT TO: ..... ' · ~ ........
! -·
Property line g'~) ~ Building foundation /'~) ~ water main '
, ; .. 1:.: :;.:..,'.,:, ..., ..' · ...".... v,. ~.;,:...: j::., ' =. . ' ....
water serVice.line - ',/~(~ "~--:'~' sdrfacewater_ , ';~..'..~"'Dfi~eway, pa'rkln~/v~hi~le StSrag'e; ;//~' !cP~-.,
COMMENTS .........
· ,,,,~ ~-...? ..:_~'):_' ~,.
· -:-.. · .... '~'"'%"· .. ~ L. '.',,,~l~'~.
'- '.-':;".' .
·.: .'- .....
I certify, that ii have determined
conformance Wi~fi MOA';H~'g~ideline~':in &ffect
Engineer's Printed Name
'
Dat~:'~'
--;-.
.... ,~.~. ,~'~;~SS~5,~ ~ .....
I.'~
HAA Fee. $.'. · :~'.7~"- *'~
· Date .of. Payme'p~
- .W.a~ver~ Eee.i.$ .-....
...... -- Date.:oflPayment,;
.......... .,. ' ReCeipt Ngmb~......,.:
Receipt.Namber
(Rev. :12/01 )
CT&E Environmental SOtVices inc.
~00 W. P~tter Dri~
Dri~g Water An~ysis Repo~ for Tot~ Colifom Bacteria a.~o,.~o.
Tel: (907) 562-2343
~ ~TRUC~IONE ON ~E ~ BEFO~ COLLECTING 5~P~ Fax: (907) 561-530~
MUST BE COMPLETED BY WATER ~IPPLIER
PUBLXC W* RS ST MX.D.# I I I t I I i
~RIVATE WATER SYSTEM
Send R~ ~ ~ Send ln~olce
Send Results El $&ut Invoice
SAMPLE DATE:
Month
SAMPLE TYPE:
~ RoUtine
u Repeat Sample (for routine sample
with lab ref. no. )
[] Special Purpose
Day Year
S,&Mi*LE LOCATION
B Trestid Water
D Untreafl!d Water
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
~ Satisfactory
o Uhsatisfactory
n S~unple over 30 hours old, results may
. be tmreliablc
[] Sample too long in kansit; sample should
not be over~l~l~ouTs old at examination
to/ndicate reliable results, Please send
new sample via special deliverymail.
Date Received
Time Received I
Analysi~ Began [ ''~ ~'~
Analytical Method: ..~ Membrane Filter
u MMO-MUG
Number of colonies/100 mi.
ResUlt*
Comments:
10E Ei I
~ ~ ~ ach Fbks
Time Collected
Collected B~
Jun
Date: Time:
Client notified of unsatisfactory results:
Phoned Spoke with
Dat~: _ Time:
BACTEiHOLOGiCAL WAY, it ANALYSIS RECORD
MMO-MUG ]~esuit: Tots} CtdJ{oi~i E. Coil _
Membrane Filter: Direct Coast 1~ Cel~rfies/100 mi
Verification: LTB BGB _.. COLIFIRM
Fecal Coliform Confirmation
Final Membrane Filter Remits
Analyst
Coliform/lO0 ml
Time f~t~. hrs
.....
I~ i~IS iviember otil~a §§S Group ISocifnl G~nArale de Surveillance)
Faxed
[]
Fsxed
TIVTC - Too Numerous T~ Count
ENVIRONMENTAL FACILITIES IN ALASKA. CALIFORNIA. FLORIDA, ILLJ~I~ilS, MARYLAND. MICHIGAN. MISSOURI, NEW JERSEY. OHIO. WEST VIRGINIA
FLAY--11--98 I"ION 89:45 C. ROLF. I"IILTOIq I 800 898 T655 P. 02
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Fnvironmental 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
1. GENERAL INFORMATION
Complete legal description .
Location (site address or directions)
20714 Crabtr~
Darwin Thompson Day phone
Property owner
Mailing address P. 0. Box 672308 Chu.qiak, A~zs~za 99567
Lending agency C.C~ty Mortgag6. ATTN: Don Pr6ss~r Day phone
Old Gl¢.nn Highway, Eagl6 River, Alask~ 99577
Mailing adclress
688~5474
Agent
Address
Day phone __
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATFR SUPPLY:
individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WAS'TEWATER DISPOSAL.:
Individual on-site
Flolding tank
Community on-site
Public sewer
NOTE:
XX
If community wastewa'ter system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
s~uewwoo leuo!~!pp¥
:suo!~elnd!js ~U!MOIIOJ eq~ q~!M 'SLUOOJp9q
euoqd
'su~ooJpoq
'9
· uol~oedsu! s!ql ~o e3ep eq~ uo ~,oege u! suo!lelneeJ pue 'seoueu!pJo
'sepoo e~e),S' pue led!o!unl~ lie qi!t~ eoue!ldLuoo U! S! Lue3sXS lesods!p Je~eme~,seM ~o/pue Xlddns
Je~eM e3!s-uo eq~ 'uop, oedsu! pue uo!lel~!~se^u! XLU cuo~ pue sell~ eeeJoqou¥ ;o Xl!led!o!unlAI
LUO~ peu!elqo UO!~eLU~O;U! eq~ uo peseq 3eq~/~He^ JeqlJnJ I 'u!e~eq pe~eo!pu! e~n~onJ~s ~o edX3 pue
sLuoo~peq Jo ~eqLunu eq~ ~o~ e~enbepe pue leUOROun~ 'e,tes s! Lue3s4S lesods!p ~e~,e/~e),se/~ Jo/pue
Xlddns ~e~,e/~ e~!s-uo eq~ ~eql s~oqs uoceo!ldde le^oJdd¥ X~Moq~n¥ q~leeH s!q~ ~o uo!~el~!~se^u!
XLU leql/~!Je^ I 'MOleq UMOqS elep uo!~ep!leA eq~ ~o se pue oleJaq pex!Jce leas 4LU ~q pe!~!lJeo sV
a:I~NION::I AG NOI/O=IdSNI .dO .LN=IIN=I/¥/S
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~'="~ -z~--~/~ ,, ~.~ ¢.4.... ~ ~"T't~'r,-.~ ~_ Parcel I.D.
A. WELL DATA
Well type '~¢'¢.~ ~l ~.~ ¢..-
Log present (Y~).
Total depth
Sanitary seal.N) __
Date of test
Static water level
Well flow
Pump level
If A, B, or C, attach ADEC letter.
/'~ Date completed L) I/--, Driller
L) J"- Cased to_ '~'C) ~' Casing heigllt
\/ Wires properly protected ~'~N)
ADEC water system number _
FROM WELL LOG
g.p.m.
AT INSPECTION
_
_ ¢1~~
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot .
Absorption field on lot
Public sewer main
Sewer service line "~'
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform (.~ ~:"~" ~/~¢o ~,..(, Nitrate
Dateof sample: _ c~ ~ _c//
Other bacteria ,~ o ,d t~.
Collected by: S & S ENGINEERING
B. SEPTIC/HOLDING TANK DATA
Date installed '"/-"7"'~=~-I '~
Cleanouts~N) _ ~/
High water alarm (Y(~
Date of pumping ~ ~ L~
17034 Ea~j · River Loop Road No, 204
Eagle River, Alask= 99577
Tank size ~,c~,_.~o _Compartments _ '7--
Foundation oleanout (d~N)_ y Depression (Y~) _
/'J Alarm tested (Y/N)
~ J Pumper _L.-~..¢-, (-.-_E~.~, poe
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~ot~ Onadjacentlots ~o~ ~'~ Foundation_ ~o ~
To property tine IO ~ 4- Absorption field ~- ~ Water main/service line I o ~'
Surface water/drainage ~,¢ o ~4-'
72-026 (Rev, 7/9t} Fron[ CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Manufacturer
Size in gallons . Manhole/Access (Y/N)
Vent (Y/N) "Pump on" level at .~-~'~ ul~u~mp off" level at
High water alarm level ~~"/ Cycles
tested
Meets MOA
ANCE FROM LiFT STATION TO:
On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed
Length '¢¢ 1 ~ Width
Total absorption area
Depression over field (Y/~
Results<~fail)
Peroxide treatment (past 12 months)
Soil rating /o~ ~/~ System type
Gravel thickness ~- ~ Total depth
Cleanouts present ~N)
Date of adequacy test ~ ~
for ~
~ ~ If yes. give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
To building foundation
On adjacent lots
Surface water
Curtain drain
E. ENGINEER'S CERTIFICATION
On adjacent lots ~c:~ ~A.- Property line
To existing or abandoned system on lot
Cutbank rJ )/.~ Water main/service line
Driveway, parking/vehicle storage area
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
~ of this inspection.
Signature
Engineer's Name
Date
S & 5 ENGiNEERiNG
17034 Eagle Ri,vet Loop Road
Eagle Kiver, Alasl(a Y'~77
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA
Waiver Fee: $
Date of Payment
Receipt Number
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ~,~z..- Type of System Design
Date Installed ~ -- '"~,~ '"'"7 ~> Length of Field
Width of Field "3'~ ,~j I
Depth of Field
G~'avel Bed Thickness ~" !
Square Feet of Absortion Area '~ ~ c>'~' Statndpipes Present(~:~TN)
.Depression over Field (Y/~) r"3 Date of Last Adequacy Test
Results ,of Last Adequacy Test ~ ~. ~' .,~--~s~l "'"' ~ ~
SEPARATION DISTANCE FROM ABSORPTION FIELD: ,.
· I t ~' I To Property Line ~
To Water-Supply Well
To Building Foundatior) ~>z::~'A~'-- ' ~'o Existing or Abandoned System on
To Water Main/Service Line I '==' If-
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area ·
Comments
To Cutba~:k (if present)
D' LIFT STATION ~/2j~. ,
Date Insti~d
Size In G allo'~--~
"Pump On" Level~
High Water Alarm Level at ~'~
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
' Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
~ ~ Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
inspection. S & $ ENGINEERING
Signed 170~
Eagle River, Alaska ~9577
Com.a.
Date
MOA NO.
Receipt No. c:~ / YC~",-7,,/~/~:'~ c'~''
Date of Payment ~- ~{' ~
Amount: $ I~O'~
72-02~ (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
this"
CItEMICAL & GEOLOGICAL L4BO..RA TORY
A DIVISION OF COMMERCIAL ~ESTING & ENGINEERING CO.
,~"~'~o.~""~ 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301
ANALYSIS REPORT BY SAMPLE fey WORKo~der% 37932
Date Repo~t Printed: 8EP 7 91 ~ 12:01
Client Sample ID:L39A SEC 8 T15~ R1W S~
PWSID :UA Client Name
Collected SEP 4 91 ~ 14:15 ~a. Client Acct
~PO {
Received 8EP 5 91 ~ 16:00 hrs,
O~doxod By :R, ~{~FER
:S & S ENOINEERIN6
:SNSE~GP
PO ~ NONE RECEIVED
Analysis Completed :SEP 6 91
Lebor~tory Superviegr .:STEPHEN C. SDS Send Ropo~t8 to:
Relee,,e6 ~y: ~~.~'~.~.-~ 1)S & S ENGINEERING
Chemlab Rof ~: 914620 Lab Smpl ID: 3 ~atrix: WATER
Patametoz Tested Allowable
Result Units Method Limits
....................................................................................................................
NITRATE-N ND(O.iO) rng/1 EPA 353.2 i0
Sample ROUTINE SAMPLE COLLECTED BY: RAY.
Remarks:
1 Tests Po/formed ' See Special Instzuctlone Above UA-Unavailable
ND,, None Detected ** See Sample Romam:kg Above
NA,, Not Analyzed LT-Lo~s Than, GT=Greater Than
~>SG~ Member o¢ tho SG8 Group (SoctOt¢ G~,n~rale de Surveillance)
CItEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING ~. ENGINEERING CO.
TELEPHONE (907) 562-2343 5633 B Street
~nchorage, APaska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETE-'D BY WATER SUPPLIER
Mo. [)ay Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no,
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE!
No. LOCATION
Time Collected
Collecled By
TO 13E COMPLETED BY LABORATORY
{,
Analysis shows this Water SAMPLE to be;
,,,~atisfactory
E1 Unsatisfactory
[] Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received ~'/4~/
T me .,,oelved / O O
Analytk:al Method: Membrane Filter
* No. of colonies/100 mi.
13ACTERIOLOGICAL WATER ANALYSTS RECOF:~D
READ INSTRUCTIONS
BEFORF
COLLECTING SAMPLE
Membrane Filter: Direct Counl
Verification: LSB
Fecal Coliform Confirmation
BGB
Final Membrane Filter Results
ReportedB¥ ~-~~ _~.,~Date
Coliform/100 mi
TNTC = Too Numerous To Count
OB = Other Bacteria
PART ONE OF TWO
REMAINDER TO FOLLOW
__ Coliform/lO0 mi
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
Department of Heallh & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE- FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prier to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
SEC. r15N; S.M. Z 'r-
Location (address or directions)
NHN CRABTREE LANE
(b) Property owner ALASKA USA FED. CR. UNION
11411
Mailing Address _~.~o× 19~z~25,
Telephone: (home)
Business 786-2750
(c) Lending Institution
Telephone
Mailing Address
(d) Real Estate Company and Agent RE/MAX._OF EAP~LE i~IVEI~ ATTN: EuC._LQ~.¢~
Address 16600 Center~i~d D~iue, ¢201 Eagle Rive% AK. 99577
Telephone_ 694.-4_2~0
(e) Mail the HAA to the following address: (or check here EX if hold for pick up.)
List contact person and day phone number below:
~ & S ENGINEERING
17034_~_ R
Eagle River, Alaska
2, TYPE OF RESIDENCE
Single-Family ~g( Number of bedrooms 5,
3, WATER SUPPLY
Individual Well)¢~ 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 IX-3X 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(Rev. 7/88) Page 1 of 2
5. ENGINFERING FIRM PROVIDING INSPECTIONS, TEST'S, 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 regulations in effect on the date of this inspection.
Name of Firm
Address
Date
S & S ENGINEERING
17034 Es!lie River Loop Road No. 204
Eagle River~ Alaska ~19~i77
Telephone
6. DHHS APPROVAL.
Approved for
Approved ~
Disapproved Conditional
Terms of Conditional Approval
Tile Municipality of Anchorage Department of I-lealth 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 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.
72-025 (Rev. 7/88) Bsck Page 2 of 2
A. WEt. L DATA
MUNICIPAt. ITY OF ANCHORAGE (MOA)
Health.Authority Approval (HAA)
'QI'tE~K~b $!f- FEBRUARY 1984
~:~' ~ 343-4744
. :~.~ Legal Description:
Well Classification ] ~"'~J"~'~ ~
Well Log Present (Y/([~ I'""~ [)ate Completed -
~"c;~"~' Depth of Grouting
Total Depth~0~¢'-- Cased to
Static Water Level ~ ¢~' I
Casing Height Above Ground ---- ~
Electrical Wiring in Conduit ¢~N)
SEPARATION DISTANCES FROM WFLL:
t
To Sept c/Hol.ding Tank on Lot
If A, 13, C, D.E.C. Approved (Y/N)
Pump Set At
Sanitary Seal on Casing~'4)
Depression Around Wellhead (Y/~CJD__
; On Adjoining Lots
To Nearest Edge of Absorption Fiell~o~,Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot __~" '"'~
Water Sample Collected by ~--'~'~
Water Sample Test Results ~'~Z~--'1~¢--~"~-"~
~ ~,~-' I __; On Adjoining Lots
~ To Nearest Public Sewer Cleanout/Manhole
Comments -
B. SFPTIC/HOLDING TANK DATA
Date Installed ~7''"~ ~- Size ~ ~ No. of Compartments
Standpipesc~N) ---y- _Air-tight CapsdC~/N)
Depression over Tank (Y/cf~ -- ]'""~
Pumping/Mainter~ance Contact on File (Y/N)
Hold ng Tank High-Water Alarm (Y/N) _
Foundation Cleanout 4¢~'N)
/.ate Last Pumped ~ --
;fol'
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING 'TANK:
, ~
To Water-Supply Well _
_~ o I..~ To Disposal Field
To'Property Line ~ --
To Water Main/Service Line _
'1-o Building Foundation
To Stream, Pond, Lake or Major Drainage Course
Comments ·~:::' ~
72-026 (Rev. 7/88) F¢ont Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata __L~".,~cz...~
Type of System Design
Date Instarled '~_'~c~ ~ "7 I~ Length of Field
Width of Field
Depth of Field ~:~ 1
Gravel Bed Thickness
Square Feet of Absortion Area __~_~ c;>''¢~ Statndpipes Presentd~TN) ~
Depression over Field (Y/~) I~5
Date of Last Adequacy Test ~--
Results of Last Adequacy Test ~~¢'~ ~ ~ ~
SEPARATION DISTANCE FROM ABSORI~TION FIELD:
To Water-Supply Well _ I t
To Property Line ~.~:::~
To Building Foundatior/ ~:~l.~j.., To Existing or Abandoned System on
Lot t'4/'~' -- ; On Adjoining Lots % 4 ~
To Water Main/Service Line { c::=, I,~ To Cutback (if present) m'~/~ --
To Stream, Pond, Lake, or Major Drainage Course _ ~ ~S:)~ ~
To Driveway, Parking Area, or Vehicle Storage Area --_
Comments
D. LIFT STATION
Date Insta~ed Dimensions
Size in Gallo~
~-- -- Manhole/Access (Y/N) __
"Pump On" Level at ~ "Pump Off" Level at _
High Water Alarm Level at -"'"'""'"""~_ ~: Vent (Y/N)
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
.Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and NAA guidelines in ef.f,ec, C~t~ I~ of this'~
inspection.
S & S ENGINEERING
Signed __ ]7~er
MOA No.
Receipt No.
Date of Payment
Amount: $
72 026 (Rev. 7/88) 8ack
-- Receipt No.
Waiver Fee; $
Date of Payment _
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE[ (907) 562-2343 5633 B Street
Anchorage, Alaska 99518
r)rinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
/~]~..?RIVATE WATER SYSTEM
Name Phone No.
S & $ ENGINEERING
17n!4
Mailing Addrl~-~]le River, Alaska ~'9577
City statp
Mo. Day Year
Zip Code
SAMPLE TYPE:
~ Routine
Check Sample (for routine
with lab ref. no.
U.~ Special Purpose
sample
Treated Water
Untreated Water
SAMPLE[
NO, LOCATION
1 [~.~r- ~]A
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
is shows this Water SAMPLE to be:
isfactory
[] Unsatisfactory
~] Sarnpletoo long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received
Time Fleceived ,'/~' ~'~
Analytical Method: Membrane Filter
* No. of colonies/100 mi.
Lab Ref. No. Result* Analyst
75,54
'L I
I
[ I F-FI
READ INSTRUCTIONS
BEFORE
COLLE:.CTING SAMPLF
BACTERIOLOGICAL WATER ANALYSIS RECORD
Membrane Filter: Direct Count_ (~ Colllorm/100ml
Verification: LTB BGB
Final Membrane Filter Results __ ~
Reported By~.~E;=~-~--I..~..,...=,.~_ Date__
Time: _
']'NTC = Too Numberous To Count
OB = Other Bacteria
~NAL¥SI$ RgPORT NY SAM?LB ~o~ Work Order ~I 16762 ~
~~ FEDERAL TAX 'D~ 92-0040440 ~'~
Da~e Report Printed: S~P 19 89 ~ 10:38
Client Sample ID:LOT 39A SEC 8 TISN RIW SM
PWSID ;UA
Collected SEP ].~ 89 ~ 15:00 ht~.
Received SEP J,5 89 ~ 16:30 hrs.
PreserYed with :AS REQUIRED
Analysis Completed :SgP 18 89
Laboratory Supe[v?)z ;STRPNgN C. BDg
Client Name : S & S gNGR
Client Acer : SNSRNGP
P.O,~ NONE RBCBIVRD
Req #
Ordered By :
Send Reports to:
d)S & S gNGR
2)
Speei]l
Chemlab Ref il: 7554 Lab Smpl ID: 3 Hatrix: WATER
Paramete~ ~estod Result/Units Hethod
NITRATR N ND(O.IO) rag/}. EPA 353.2
Sample ROUTINE SANPLg. SANPLE COLLECTED BY RDJ
Remarks:
Tests Performed [ See Special Instructions ~boYe UA~Unavallable
None Detected ' See Sample Remarks Above
Not Analyzed LT':Less Than, GT:Greatez Than
NiUNIC, IPALITY OF ANCHORAGE
~.~. DEPARTMENT OF HEALTH & ENVIRONMSNTAL PROTECTION ' ' '
~/x'..~"~ 825 L Street Anchorage Alaska 99501 ......
~ Telephone 264-z 720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEVVER FACILITIES
DI REDTIONS: Complete all parts on page 1. IncomElete requests will not be ErOCeSSed. Please allow
1. PROPERTY OWNER PHONE
' S. Gra contae~ Metropolitan ~274--1631)
MAILING Al)DRESS
:Lt~n Realty 523 W. 8th. AVe. Anchora~_e, ~. 99510
ROPERTY RESIDENT {If different h'om above) PHONE
BUYER
Clarence W. ~ Lavada L. Weigher
MAI LING A DDR ESS
3. LENDING INSTITUTION PHONE
3201 C Street Suite 250~ ~chor~e~ AK. 99503
4. REALTOR/AGENT PHONE
MertDpolit~ ~alty ~ 274-1631
~AILING ADDRESS
, 523 W. 8~. Ave,.~c~o~aqet ~, 99519
~. L~[~E~C~ q~ Sec. 8 Township t5 Nor~:, R~ge 1 West, Seward Mari~an~nnchorage
w~n.~u d~r~e~. ~ird Judicial District, State of Alaska.
8TR EEl LOGATI(~
Cr~tree L~e, ......... ~-, qa~ ,
6. TYPE OP RESIDENCE NUMBER OF BEDROOMS
~ One ~ Foul ~ Other
~] SINGLE FAMILY ~ Two ~ Five --
~] MULTIPLE FAMILY ~ Three ~ Six
7. WATER SUPPLY
~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for aH wells drilled
~ COMMUNITY sin0e June 1975. For weJls drilled prior to that date, give well
~] PUBLIC UT{LITY de[)th (attach Io~ if available.) 2~0
8, SEWAGE DISPOSAL GYSTEM
~] iNDiViDUAL/ON,SITE~* **If individual/on-site, give installgtion date j~ome
If system is owr two {2) years old an adequacy tsst ~s requir0d
~ PUBLIC UTi LITY uy this Deoartment
RECEIPT FOR CERTIFIED ~AIL--30r (plus postaEe) EFORE PROCESSING CAN BE INITIATED.
OR I)ATE
$TR[ET AND NO. ~UNICIPAL[[Y
P.O STATE AND ZIP CODE ~NVIRONMENI,~
Apr. 1971 3800 NOT FOR INTERNAT{OHAL MAIL o0~,0:~0~ 0-460-7t3
THIS SIDE FOR OFFICIAL USE ONL.~'
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
I NSPECTO R INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER sUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
~]PUBLIC UTILITY
Connection Verified
INSTALLER
[]Septic Tank or []Holding Tank
Size: . If Tank iS homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCES Septic/Ho]ding Tank Absorption Area Sewer Line [ Nearest Lot Line
WELLTo:
Absorption Area to nearest Lot Line
5. COMMENTS
E~/' APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate}
[] DISAPPROVED ~
DATE BY (Title)
LEGAL DESCRIPTION
72-010 {Rev, 3/78)
July 17, 1978
Randy ~,~.
% M¢~'tropolttan
;~chora.~l~, Alaska 99501
Sublloc, t; TISN R1W ~,~ction 8 Lot 39
iact.l~t;zo~ ~a~ not b~
.~,X_onc~ 'khe well caain9 tW~alva(12) ' .' above,~
(2) Fill ~n th~ pl~ around tho w~li <~asinq. I~p~rvious
typ~ soil should bo · ' '
to 9ro~d 1 .;v~,.1 and .lift; p~lt ....
foot away f:ror~. Lh0~ well and will ae~3d~
orte-hundr~t(100) feet a~lay frolu l:hc~
kno%.~ the lo,,,t~c.n of the ~m~Da(~o aroa
1 ~.opor distanc~ frola th~
toun~z is to tho Lank
and the ~oel:,ag.~.~ area is fo'und and it ~,S the prol:~r distance
279-0,I~3 Or J.li.L, En,[llnoert,ng, 276-4113,,
(4)
July
t~st ~ill ne~d %o b~3 obta;[n,~d.
departmon t.
· '- qu,:-sL~on:~, pleeise contac:t this office
at 264,-4720.
Sincerelye
Robert
RCP/1 J h
s)~)kano Mortfr~ ~-,~% COml2any
· ~" ~ __~ MUNICIPALITY OF ANCHORAGE
· DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL HEALTH CASE REVIEW WORK SHEET
I--I PLATTING BOARD i'--I PLANNING & ZONING
CASE NUMUEH NAME
S-5346 T15N R1W Section 8 Lot 39 NE~' plat of Lots 39A
April 2, 1980 and Lot 39B
COMMENT '~O PLANNING BY
April 23, 1980
FOR MEETING OF CASE OF
[] PUBLIC WATER N~_OT_._AVAILABLE TO PETITION AREA
[] PUBLIC SEWER NOT AVAILABLE TO PETITION AREA
HEVIEWEH'S COMMENTS:
71.014 {Rev. 2/781
ALASKA
I rlUIROI mfl TAL COI1TROL
~miin¢~rin~J ~ [~n~ironrn~nf~l
August 29, 198o S R i'.
Mr. Jerry Gottbehuet i %0/
P. O. Box 3628
Anchorage, Alaska 99510
Dear Mr. Gottbehuet: ~.~_..~_~b'-~
On August 29, 1980 our firm drilled three test holes on Lot lA, Broad~.~--~-/,
division. The first two holes were drilled on the upper portion of the lot
in the appropriate locations shown on the attached map. In both holes bedrock
was encountered at a depth of 3.5 feet~
The mobile drill rig was then moved down slope to the location of hole No. 3.
At this point, bedrock was encountered at a depth of 3.5 feet. The rig was
removed and a hole was hand dug within three feet for a percolation test. The
percolation test was run between -15" to '27". The water fall rate was three
minutes per inch for a soils rating of 100 sq. ft./Br. The soil logs are at-
tached.
There must be six feet between a sot1 absorption system and bedrock. Based on
this requirement, a conventional on-site system would not be allowed. It is
'technically feasible,to build up a soil absorption system to obtain th~ proper
~pacing. ~ne potential problem is the surfacina of effluent from such a sys-
tem when the water encounters bedrock~ A visuai check of the area down slope
~from the lot alon~ y~ur driveway was made for water surfacing. Based on the
high level of rainfall this year, if surfacing were a problem it should be
evident along the toe of the cut. No evidence of seepage was found.
As requested, an alternate system for this lot was designed. This design uses
earthwork for embankments. The system will Just fit on the lot with ten foot
margins to the property lines. The size of the area needed could be reduced
if retaining walls were used to terrace the toe. The depth of cover could
also be reduced if the top of the bed were insulated. The rough range of cost
for this system is between $7,000.00 and $9,000.00.
If Imaybeofmore service, please let me know.
Sincerely, '~-
ALASKA ENVIRDN~MENTAL CONTROL SERVICES, INC. _
·
Leroy C. R~etd, Ph.D., P.'E< . /~'~"L
LCR:ur
1220 UJcst 25~1~ A,~nut · Ancbm~. Abb ~3 · [~7) ~76-1361 /
