HomeMy WebLinkAboutYERTON LT 126AYerton Lot 126A #051-144-53 MUNICIPALITY OF ANCHORAGE /{TMENT OF HEALTH AN[) HUMAN SER ,ES DE Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT '~'ANKS DISTANCES 8EPTIO ADSORPTION TANK FIELD LOT LINE FOUNDATION ~ ~. / ,¢~,~ t AS-BUILT DIAGRAM tSI~i~ I drlV,,Way. Waist J)OdlOS, otc) WELl. SEPTIC [] HOLDING TYPE OF SYSTEM TRENCH J~BED [] W. DRAIN [] OTHER '"~al~/ FT ~ O ~:~;::,c~ SOFT /~p I FT WELLS ~PRIVATE ~3 OTHER ddentifv) REMARKS: FT Inspections Ped )rmed by: codily ~al Ihis inspection was pedormed according lo all / 72-013 [3/85) ENGINEER'S SEAL 8~Z',:5 L SLr'e~l.., Anchor'~J~?~ ~].a~k~ 99501 (] N .... ~:1 I T E ,~ E W E R E R M I T Per'.m:i.i'.. Number: 88()0,54 Upgr'ade [;HUG:I:AI<, Al< 99567 I ) ~) s :i. ~j I]e d Day F:'hor'le: 688 ...-',~ :1. 86 Parc:el Id: 051.--~.44-.U3 LcH'.. Legal." SLlbd:i. vil~icH"l~ YER'T'[}N SIJBI)IVI[~ION Lot.?, 126A Blocl<: .... Sec:t i c)rl ~ 9 Townsh J.p: :[SN Range: 1W t..c~t Size 41954 (SC:l,,t't. mr acres) Max Bmc:lpooms: This [:'ermJ. i'.: 3 T'cff. al Capa(:lty, :3 5/~L[ ~MIk/ !!iEF"II[3 I'AI\IKiI MJr'iimum Cot. al !~ept.:ic tank c:apac::L'l:.ylJ i,()()0 ga'~].lal"~s, Each s~::~ptic: Depth tc~ top of ~;ep'L:i.c 'l:.ank (s) '::: 4,,() AF:Tlli:R Uf'l".ll.,l:::. I..I(]URI~i C, AL.I ....... 4.., 46H.I. AND I...Ei:AVE I:~ MESSAGE I:.,()lqolFdJ(.,T I:!:'ER Edxl£. INI'..I: [~,.:, A'I'TAC~HED APPROVED I CER'I'II:::¥ I'I{AI: 1. I am {am:iii. Jar' wJ.'kl'l 'Lhc, pi:~,qt.l:i, pc.)mt~rYt.~i~ t'c~p cH"l-si't.e sc~Wel'S al"HJ w(.~i].s as ~e~.. [cHr'LH I;ly 'Lhe I'%u'l:i.c:i.l:~ali'l:.y of Anchc:H~age (M(]A) and 'khe State oF Alaska,, ;:;'.,,I t~I:i, lJ. J. iH[F[.<'Jt],] ti'i(03 5i~y!iF['.l..Hll :iii acc:cH".danct:e w:i.'U~ a].l 1~10;~ cc:~cles ar'id r'e(.tulat:i.c)ns~= i:uqd in c:c)mp].:i, arlc:e wl.'t.l'l {lie des:i.{:]l"l cp~'~.[?pJ.a [3[ '[.h:[[~ pePm:i.t. ::?:. ~ ~):[.11 ~:~c:il'l(~r~:.) .l:.o i:tl:l. I',KJA ~:~i'~::l S'Lat.~ <~[ Alaska requ~ri~ment~ ¢~:)1" 't.h~ s{i.rt. I:)ac::k d:i. st:.artcco~i~ [r'om arly e].~:i, st:i. rlg wr-):l.].~, ~/~,a~i~te~a't'.(:~)r' dJ.F;,pc:)sa], sys'Lem cH'~ Zl.,, i t.tl'ld~gp~wk.o.r]d 'k. hak this perm:i.t J.s valid fo¥' a maximum of ::5 bedr, c)(:,ns,, :1: a:lscJ ur~del"~[;t..c:tnd that the capac::L'Ly cJf T.he total system :i.s :]; bedl'ooms and any ert].apgesmer'lt will peqLt:i, pearl ac:h::l:i, tic~rJal pePl~:i'L,. (Owiie r i;ltl.u!:i ,'.,k ¢:fl:: 5W5~? I{l:'l:'(}ii{i} t ]1Vi:i DI~i :' I ti (X!Vi!:I;: DI::I:'III I (} I (~1 i)1 it" I I'l L.i: H(:'i i II !i~(~.'. t: I., SCALE PERFORMED FOR~ i~ LEGAL DESCR,PT,ON:/ '4 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15- 16- 17- 18- 19- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST k. t)pJ. IF YES, AT WHAT DEPTH? ~eoP~ihtolrOin~/;ter Aft r,~ ' Dale: Reading Date Gross Net Depth to Net Time Time Water Drop Z . ¢~'~,--, ~ ~, '~../~" /~y~,, 20- - ~ ~ ~ ENGINEERING ~ ~0~4 Eagle River L~p Road .o. ORMED BY ~ ,-, ' ~ ~ _~ ~/C -., ~ERTIFY' THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL S~ATE AND MUNICIPAL GUIDELIN~CT ON THIS DATE. DATE: 72-008 (Rev. 4/85) WAS GROUND WATER ENCOUNTERED? ,~/~') '~ Township, Range, Section: //~"- S~ly ' /~'/L// /' ~ SLOPE ~ PLAN ~ MUNICIPALITY OF ANCHORAGE DI RTMENT OF HEALTH AND HUMAN SER ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPFCTION REPORT Address Phone(s) es-oo ,7__J LEGAL DESCRIPTION TANKS ,/~ SEPTIC E] HOLDING TYPE OF SYSTI-'M TRENCH ~-RED [] W. DRAIN [] OTHER [] PRIVATE [] OTHER fldentifv) REMARKS: DISTANCFS  SEPTIC ABSORPTION TANK FIELD WELL WELL \,,,-.IE-;L-~_ '~/~ FOUNDATION ~ ~ ~ I ~__ AS-BUILT DIAGRAM IShow location el W~ll, septic system, p ope~ty hnes, foundahon, , water bodies, etc) Scale: Inspections Perlormoo by: I .... '~L~z~E ?,IV'~ ...... ]~ ~ - ced~ Ihal ] nspection was pedormed according Io all Monicipal grid 8 8 e guj le~Q~:.~ e~c _qn h s a e: ~/ ~ 72-01S W A I. ZI 'Iii{ I::~'. fi F:' C) I'3C)X I..C) T ,::~ .I. Z Iii: J..C)T I. )(J'~l I.,.JJ\h, I"'1~ X E.3t[DIRCICH"I!] c, ~!!il..J B)5 1 V :1: .% 3: CH~I :: SEC:[' :[ (3N ~ ~? 'I"C)NIxI!BH ]: I:::' zt' :l.G~!~/l· (El(I,, I:::1'. CII::/ I)IEF"TM 'l"C) J:::':[F:'I!!: :(3[3'I"I"(DM (F:'T,,) (!H::~F'IVli:I... I)E!:F:"Tll (I:'T'. , 'T'CITFll- DIEF:"TH (1:::'1'.,) CH::~{.Wli!:I.. L, EN(i~TH (F:I",.) C)I:~IVli::I.. VCJl...I.JMI:: (C;lJ,, Y:C)!i!i,. ) !13133:[.. I:?~¥'I" ]: NC) (EH:;!~ F'T,, F~LI' ,, O D ,, <) ZW:) ,, <) ~ 1 ,, O :1 :, OOO ,, <) .~..;I. ! ,.~ <)<)<),, O ':.'~' TI' ll:i:l',.I (1) N:I:I.I,. NCiT l:'ll:: ('IF:'I:::'I::;:DVE!)::) NI'T'I'IC]I.:I' (~1~I !i!!:LJi:C'I-I::R:[C:(.~I,. :l:tq!i3t:::'li:CT:l:C]lxI I:tI::I:::'(:)FCI": f~N)5 (:3) 'I'I'IE[ I:i:l..,IE C:'I'F/:t: C (.~!. PERFORMED FOR:._~. LEGAL DESCRIPTION:, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF IqEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SLOPE [] SOILS LOG PERCOLATION TEST DATE PERFORMED: ~--~.~ ~ ~ ~ · SITE PLAN 10- 11 12 13 14 15 16 17 18 19 2O COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Oate Dross Net - Depth to Net Time Time Water Drop / PERCOLATION RATE TEST RUN BETWEEN CERTIFIED __~(minutes/inch) ~*~ Fl' AND FT //./ ..../_ code: (ger ifie Drilling by DOC Co. dba SULLIVAN WATER WELLS P.O, BOX 670272, CHUGIAK, ALASKA 99567 * TELEPHONE 688.2759 OWNER OF LAND (,9£'~J/!;. ,. ,~ '/~) ADDRESS ,~ /,,',~, (',/O ', LEGAL DESCRI~ION /, /~?~; 1~{ ,~ 'Z ~)?~ I~I~') DATE - Started Ended PERMIT NUMBER I)EpTH OF WELL ': ~ 0 (.'~ SI',Vrlc LEVEL OF WATER Fr. c ! "~ DRAW DOWN FT. GALS. Per HR ") KINDOFCASING (, ~;;- ()/,) KIND OF FORMATION: From :~ Ft. to From c) Ft. to / From / / Ft. to From~ © Ft. tod~. Ft. From(',,)' _Ft. to/ From/'~)' ~i _Ft. to /C b Ft. From Ft. to Ft. From/~5,3' Ft. to./~-~ Itt. From Ft. to Ft, From Ft. to Ft From Ft. to Ft From Ft. to Ft From_ Ft. to Ft From .Ft. to Ft. From Ft. to Ft. From .... Ft to Ft. From Ft. to__Ft. From From From_ From From From From From Fl. ti) Fl. to Ft. t() Ft. to__ Ft. to__ Ft. Ft. to.__ Ft. Ft. to__ Ft Ft. _Ft. lo Fl Ft. m Ft. __Ft. ____Ft. Ft Ft. _Ft. toMUNICIP~tl~I'fY OF AN(:HOI~.(~ Ft. to ENV]RO~ENTAL Ft. to Ft. to MISCL. INFORMATION: DRILLER'S NAME /,r;', ; ~I ~ - ' fill::l'::'t ]:[:: ~G"/f?TFE:It. F:I C,C]F'Y E)I::: TI'lEi: I;,JI'EI J., L..[)[:f) I"ILJ~VI' E;Ii:{ [ .... LIIdl.t.~, ' "III ....... ~ I I~' 'I'IIE[ HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTtOH ENGINEERING STUDIES AND REPORTS WELL INSPECTtOH & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS August 29, 1990 ROBERTSHAEER, P.E. ROGERSHAFER CIVIL ENGINEERS (907) 694.2979 FAX 694-1211 MUNICIPALITY OF ANCHORAO-,-,-,-~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Mr. Gene Yerton P.O. Box 670855 Chugiak, Alaska 99567 REFERENCE: Lot 126"A"; Yerton Subdivision 20109 Upper Bowery SEP 1 3.1990 RECEIVED Dear Mr. Yerton, At your request a well flow t~st was performed on the w~ll serving the referenced propety on August 28, 1990. The static water level was measured at 13' 4~" below the top of the well casing. The water was turned on f~ll and the water level was drawn down to the pump at 72' in approximately 15 minutes. At that time the pump was shut off and the water lev~ allowed to recover for thirty minutes. The pump was then turned on and the water level was drawn down to the pump again while the quantity of water pumped was metered. This t~t was performed three times with consistent r~sults. From this t~st it was determined the referenced well wx~ produce approximately 15 gallons per ho~ (GPH). This flow is not guaranteed, subsequent variations can occur. If you have any questions, f/gm or if we may be of further service, please ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 'r'" - WATER WELL RECORD J-'~- STATE DE ALASKA .... '~,'~C., DEPARTMENT OF NATURAL RESOURES;:.&~'? Division of Geologicol ~ Geophysicol Surveys LOCATION OF WiLL (Please complete either la~ lb or lc.) BorOugh Subdi i$ion LOt Block ~ I/4~ NO. DISTANCE~ND DIRECTION FROM ROAD INTER~ECTIONS ~, OWNER OF WEL~: -/7 -~ ~,Subm. ~ del g Cenlrifical ~ Other RECEIVED ' .... Authorized Representalive Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www,ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-144-55 1, GENERAL INFORMATION Expiration Date: Complete legaldescription YERTON SUBDIVISION; LOT 126A, Location (site address or directions) 20109 UPPER I~OWERY LANE * CHUGIAK, AK 00567 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JAMES MEYER Dayphone 688-5641 20109 UPPER BOWERY LANE * CHUGIAK, AK 99567 Day phone LaVONNE VOGT w/ COLDWELL BANKER Day phone 2525 'C" STREET * ANCHORAGE, AK 99503 265-9112 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: .3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 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 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER at, or pdor As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER &: WASTE'WATER CONSULTANTS. INC. Phone Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 337-6179 Engineer's Comments: In conducting this evaluation, AKWWC. Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there ara no hidden defects or encroachments. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authortzed, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ~ Approved for -'~ bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the fllowing stipulations: ~ ,'\' o' '. "O ~.-' ON-SITE ~, W&T~AND ~ ~ WASTE~A~E-R .... · Manitenance Agreements Supplemental Engineers Reo~ ~))))]) ))) ) )) ~'' Other Odgina Certifica__te Date: Legal Description: A. WELL DATA Municipality of Anchorage ,o Development Services Department On-S~e water & wastewater Program 4700 South Bragaw St. v P.O. Box 196650 Anctmmge, AK 99519-6650 www.cLanc~omge ,,k.ua (Sm') 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST YERTON SUBDMSION; LOT 126A. *CASED TO BEDROCK Well type ProrATE If A, B, or C provide PVVSID~ N,/A Date completed 6/87 & 9/9o Sanltap/seal (Y/N) YES Total depth 77/200it. Cased to .19/17fl. FROM WELL LOG 6/87 & g/g0 10/23 It. 4/5 g.p.h. Date of test Static water level Well production WATER SAMPLE RESULTS: Parcel ID: 051-144-53 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ Coliform .. 0//0 colonies/100 mi. Arsenic: N/A mgJL. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Tank$ize 1250 gal. Numbar of Compartments ..2. Foundation deanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping 10/22/2002 Pumper C. ABSORPTION FIELD DATA Date installed t~/M Soil rating (~or ff~clrm) 225 Length 36 It, Width 30 It. AT INSPECTION lO/23/20o2 8/22 '*0.16/0.07 *'1,550 GALLON STORAGE TANK IN GARAGE ¢.67/ Nitrate ~moJL. Other bacteria . Date of sampla:lO/28/2002 Collected by: g.p.m. 0/0 colonies/lO0 mi. AKWWC. INC. Date installed 1~/85 Cleanouts (Y/N) YES High water alarm (Y/N) YES CHUGACH PUMPING Totaldepth .4.o.-~.25fl. Eff. absorptlonareal080 ft~ Monitoring tuba _YES Date of adequacy test 10/23/2002 Results (Pass/Fall) P_ASS **8/ Fluid dep~ in al3Sorption field before test 1.5 in. Water added 470 gal. °'9._5/ Elapsed Time: 175 rain, Final fluid depth 3.5 in. ,, Absorption rate >= 450+ Any rejuvermflon treatment (past 12 mo,) (Y/N & b/pe) NONE KNOWN If yes. give date **H20 LEVEL IN kITS WAS ROUGHLY 2 INCHES BELOW THE INV~=.RI IN THE BED C/O PRIOR TO THE ~rART OF THE TEST. System type BED Gravel below pipe 0.5 fl. _ . Depression over field NO For 3 bedrooms *'10/ New depth 4 in. g.p.d. D. LIFT STATION Date installed 7/88 Size in gallons 500 "Pump on' level at 28 in. "Pump off" level at 28 in. Datum BOTI'OM OF TANK Cycles tested 3 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lilt station on lot100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer/septic sewice line 25'+ Holding tank Manhole/A_ _,~ess (Y/N) YES High water alarm level at 34. in. Meets alarm & circuit requirements?. YES On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cieanout N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line I 0'+ Wells on adjacent lots 100°+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 10'+ Surface water 100'+ Wells on adjacent lots 100'+ Property line 10'+ Water service line 10°+ Curtain drain NONE KNOWN COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and mt4ew of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed. Nan~e Date N/A Absoq3tlon field 5'+ Sun'ace water 100'+ JEFFREY ~ C-ARNESS Water main N/A Driveway, parking/vehicle storage Waiver Fee $ Date of Payment Receipt Number 10'+ 19-31-6Z 11:15 FROI~CT&E ENVIROflI~KTAL $~/ % ~TK CT&E Environmental Se~lces Inc. 9075615~01 T-550 P.0Z/03 Fo900 CT&E Ref~ Client Name Client Samgle ID Matrix 1027274001 AIC Water & Wastewater Consultants Inc. Yeaon R/D; Lot 126A Yerton S/D; Lot 126A DI~,inR Water I~WS1D 0 All Dates/Times are Alaska Standard Time Printed Date/Time 10/30/2002 8:47 Collecte~ Dare,Time 10/24,'2002 16:51 Received Date/Time 10/25/2002 10:30 Init Te~hn~at Dtreet~-,,._ Stephef'~de Relea~ By Sample Remarks: ~:P 300.0 - LCS was outside of acceptance cfite~a for ~Titrate; MR and Duplicate were recovered within the cTJtefia for the analyte. Sample results are not affected. Allowable Prep Analysis Psm-at.~r ~.lu PQL Units Med~d I.im~u Date Date Nitme.N 4.67 0.200 mg/L EPA 300.0 (<=101 10/25/02 JS M~.crob:l. ol ogy Laborat:ory Total Coliform 0 col/100mL SMI8 9222B (<=11 10/25/02 SKW ~1~., CT&E Envlr~mental ~l~s Inc. CT&E Ref.# Client Name ProJett Name/# CHeat Snmple ID 1027273001 A~ Water & Wastcwater Consultants Ycrton S/D; Lot 126A Hose Bib Inside Dfinldng Water PWSID 0 All Datea/Tlmec are Alnsk2 Standard Time Printed Date/Time 10/30/2002 8:47 Collected Date/Time 10/24/2002 16:53 Received Date/Time 10/25/2002 10:45 Technical Dlr¢ct~.~.~ StepheJ~Ede Released By ~~ Sample Rema'k~: EP 300.0 - LCS was ou~ide ofacceptsnce criteria for Nitrate; MS and Duplicate were zecovered wlth~n the criteria for the an31ytc. Sample rc~ul~s a~e not affected. Allowable p~ep Anal~s;e plrumc~a- Rcsul~ PQL Units Mc'thod L/m/~ · Date Date Init ~ate~s Department. Nitrate-N 4.62 0.200 mg/L EPA 300.0 (<=lO) llicz'obtolo!~' Laborat. oz'y Total Coli fowa 1~5~2 0 col/100mL SMI8 9222B (<'1) I 0/2~/02 JS SKW ALASKA WATER & WASTEWATER SEPTIC ADEOUACY TEST DATA STREET ADDRESS: "~o~ oc~ ~0~P<r ~o,/'~-(T ~,.,,a. O'~,D~.,.~-/ CLIENT: '~-~.~ ~ I'~, V< f PHONENUMBER: NUMBEK OF BEDROOM: ~ GALLONS PF_~ DAY NEEDED: SEPTIC: *SEE H.A.A. SITE VISIT CHECKLIST* DATE OF TEST: FIELD MEASUREMENTS: '7'7 ' I TOP OF MT/SUMP TO BOTTOM ....... (MTI) / GG' p (MT2) TOP OF MT/SUMP TO DISTRIBUTION LINE--~ (MTI) / (MT2) STICK-UP OF MT/SUMP ................... I'l'~ (MTI)/ ~." (MT2) TOP OF MT/SUMP TO LIQUID LEVEL-- .... /,~'t ~ (MTI) / 6"~-5" (MT2) METER NUMBER OF BEPTIC TANK MT/SUMP RISE(+)/ TL%IE READING GALLONS LIQUID LEVEL LIQUID LEVEL FA~I,(-I ~t:~ It, Ht,~' ~'H t,¢.s"tffg" ~,~..~ 1/,~. c'~ IO:l-I 1~,5-~'~ ~/I.~-t.- 6~,' /Cz.9" ,-,"/+-I'~ It: I'~ le.'~ ~s'~/~o,., ------ t,"t.s-"/t.'z" .~.~"/~t.~" IZ:e5~ It,"~¢ I I'to / ~'o ~ f,.l'/6, l" RESULTS: .."~ : PASSED ABSORBED GALLONS IN " : FAILED - SEE AWl'ACHED LETTER & °.5" J' GPD) Signature: Date: 6901 Deban' Road. ~;uitc 2-B * Anchorage, Alas~u~ 99~04 · Ph: (907) 3374179 · Fax: (90'/) 3~8-3246 · awws~ala~kaaet ~1~ eBsd !Hdgg:g go-z-nON !9t~gg gCC Z06 !uoo ae~,sn~e~,S~M I~ue .Je~,sM e~s~v :,~8 ~,ues '02 11/08 T"P.I 18:17 FAX 907 2784507 FORTUNE PROP. 1~002 ~~:~'~"' '~'.~ ,'~-"~* ~' ~. ;~. ~ ' ' ' ' "* ~' ':~ ~ '" ~: ~':': ~'' ~ ..... . ., ,~ ...~..~. ,..~, ~}~'~'~,'*.:'~".~ ~. ~. .. .~ ~ ~ / .. . . . . ,' %',:.~'t"'. . ''?~'~. ~:~: .. ,. .... , ..... Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825'L' Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAUILY DWELLING 051-144-53 Parcel I.D. 1. GENERAL INFORMATION Complete legal d~scription HAA# H,,~ Expiration Date: Lot 126A, Yerton Subdivision Location (site address or directions) 20109 Upper Bowery Current Property owner(s) Sidney Hixson Mailing address PO Box 670945~ Chugiak, Lending agency Day phone AK 99567 Day phone 688-5516 Mailing address Real Estate Agent Prudential Vista/Barbara CrittendDayphone 689-6464 MailingAddressl1635 Centerfield Dr., Ea~le River, AK 99577 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: -~~/ NUMBER OF BEDROOMS: 3 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 Department of Health and Human Services (DHHS) 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. 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 are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 01,~0)' o STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. $ & S ENGIN£E~ING 17034 Eagle River Loop Road No. 204 Name of Firm E:lqle River, Alaska 99577 Phone 6 ~ ,y -,,% c~ "74~ Address Engineer's Printed Name Roberl' C. Cowan, ?.E. , ...... Date 3/~'"~.-~'~u-'"-:~.-.:~.... ...... :...~ ~C.o.n.djtio_q~al. approv, al. for .... ,. bedrogms, w.!tl~ !h.e following stipulat'ons ' AdditionalComments - · .. - - Note: The well foz~ this property meets existing'State and Municipal Codes. There are nitrates p re99~t t.:-l, tTJ...sTs ug~st, ed-t Imt-peHodie-t esting-be-performed-t o4ns ure-t h c w~ls-eont inued-suitabitity~- Current nitrate concentration is 9.86 mo~/1. EPA maximum concentration is 10.0 mg/i. More information o~/'hitrate~'is available from the On-Site Services Program, at 343-7904. "'Attachrfi'b~i~:' '"' ; ........... -: ..... .... HAA Checklist ........... D/ · _ Septic System Advisory .......... Well Flow Advisory L,/ Ivlaintenance Agreements ................ Supplemental Engineer's Report .. Expira'tibh Date~ ' f..~' '- ..~ ~)~ 0 I Reissue Date: ............ 75.025 (Rev. 01,'00)' ~... ..... :-,- ?:.: ................................;.:. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Westewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 w~wv.ci.anchorage.ak.us (9O7) Legal Desc~ptlon: A. WELL DATA HEALTH AUTHORITY APPROVAL CHECKLIST Well type _~=IV','O,R'-~'~ If A, B, or C provide PWSID # Total depth ~/ Cased te . Wires properly prote~e~N) Casing height (above ground) FROM WELL LOG/ AT INSPECTION Ste,c.ter, ,. 'f lqo ,.., = 7T _ Well production g.p.m. WATER SAMPLE RESULTS: / ~,o1~--~-,.~ ~ ~'~'~. ~",/0-. 17034 Eagle R;ver Loop Road No. 204 Dateofsample: ~/ le'/ ~ I , Collectedby: _=_,.~,,D~--,. ~..~=~S77 B. SEPTIC/HOLDING TANK DATA Tank Type/Material --~i~:~ ("- '~-~'"'"'";'t'"" artments Date installed ~'-'""~/~/ Tank size 1'~'~ gal. Number of Comp .' .~Do ~ ' Fou?datlon cteanout {~fN) _~ Deprassion over tank (~) Date of pumping ~ / J Z / 0 I Pumper C. ABSORPTION FIELD DATA Date installed ~ Soil rating (g.p.d./fl2 or ~) ~ System type ~'~O/--/~'J ~/~'''~ Lenoth ~(,, ,. width ~,.prave~balowpipe (~- ~ ,. Total depth '~ ,. E.. ~b.or,,o. ~ra= I¢~o~ Mon~oring tub,'/'~"r~, Depr.$io. over ~ald Fluid depth in absorption field before test ~ in. Water added'~'~ gal. New depth '~ in. Elapsed Time: ~2~ min. Final fluid depth 4 in. Absorption rate >: 4~"-0 g.p.d. Any rejuvenation treatment (pest12 mo.) (Y/N & type) /[/O/V'/~' ~-/V'/74J,/~ Ifyes. givedate ~ O. LIFT STATION Date installed ~ / ~ 'Pump on' level at ~ in. Datum ~ E. SEPARATION DISTANCES Size in gallons. ~ 'Pump ofT' level at ~ in. Cycles tested ~ / ManholeJA_,~e__ss (~) ' y'~'~ High water alarm level at ..~ z~. . in. Meets alarm & circuit requirements? _.~--"~ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot / 0 Public sewer main /k//A ,,Se~-/eepflc service line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~ I'~ Property ine. ~' ~'- Water main ~, Water se~ice line / Wells on adjacent lots //~) O SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: / Property line t/ 0 /'J- Building foundation /~) .d'- Water main Water Service line ~ 0 I,./_ Surface water On adjacent lots On adjacent lots Public sewer manholeJ*cleanout Holding tank ,/v'/,,~- //0 0 /-~-- Absorption field ~'- ~ Surface water /07.~ I +" Driveway, parking~mhlcle storage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this data. Engineer's Printed Name ~:)0~'2'~' C. C'~ k/,-~,- Data HAA Fee $ Date of Payment Receipt Number (Rev. 12/00) ~00- Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE MEMORANDUM WATER WELL ADVISORY During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot Block -- of y~.~-P0A~ Subdivision, the well's productivity was determined to be D, ~7 gallons per minute. The minimum well productivity required by this Department (~IC 15.55) for a ~ bedroom residence is Oo · per minute. Although the subject well currently minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory muzt be attached to all copies bf the subject Health Authority Approval. 01-20-QI 1T:I? FROM-CTE ENVIT~Ofl~HTAI. · ~tK CT&E Environmental ..ices Inc. 5615101 T-lO0 P.01/05 F-467 CT&E Ret'.# 1011340002 Client Name S & S Engineering Pro]eft Eame~ ~A ~lent Sample ID Well ~1 L 126A, Yemen ~ Matrix D~g Wat~ Ordered By PWSID 0 Sample Remarks: Client pC)~ Printed Date/Time 03/20/2001 11:36 Collected Daterl'Ime 03/16/2001 16:10 Received Date/Time 03/16/2001 18:00 Technical Director Stephen C. Ede Maters Department Nieat~-N 9.71 PQL Unh~ Me~ho~ Allowable Prep Annlysis [.imiL~ Date Date Init 0.500 mg/L EPA 300.0 10 max 03/16/01 SCL Micreblolo!ty Laboratory Total Coli£otm 0 col/100mL SMI8 9222B 03/16/01 KAP 03-20-01 U:I; FROM-CTE EHVI~OflI, ENTAL 5615101 T-700 P.02/05 F-467 ,~T~_ CT&E £nvl~nmental Se~icee Inc. L-'r&£ Ret.# 1011340001 Client Name S & S Engineering ProJec! Name~# N/A Client Sample ID Well #2 L 126Ao Yer~on S/D Matrix Drinking Water Ordered By PWSID 0 SampIe Re'marks: Clleo! PO# Printed DatedTime 03/20/2001 11:36 Collected Dare,Time 03/16/2001 16:00 RerHved Date/Time 03/16/2001 18:00 Technltal Dl~ctor ~tephen C. Ede Released By ~~ Pilame~' R~'~uIts PQL Nitrare-N Units Meth~xl Allowable P~ep Annlysis Limits D~te Date 9.86 0.500 mg/L EPA 300.0 10 max 03/16/01 Init M~.crobt olog¥ Labozat ox-~' TotalColifonn 0 col/100mL SMI8 9222B 03/16/01 KAP MUNICIPALITY OF ANCHORAGE .~. DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Serwces Section P.O, Box 196650 Anci~orage, Alaska 99519-6650 343-4744 Parcel I.D, # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot~126A; ~erton' Sbbdivisioh Location (site address or directions) 20109 Upper Bowery Chugiak, AK ,.~ ~'" . .......... ',"; ?.Charles Chmzelowlec . Day phone ¢ P, roperty owne,r,~-~ ---- ,~Ji','"': :~'""address"-~P,'.O Box 671490 Chuglak~-AK 99567 ( L.ending,agengy ..... ~ '% . ,Mailing address~;',., '- " Ka . mstea Remax of Ea e River .6 ent Add~ess '- - Usless otDerwise requested, HAA wilJ be held for pickup. NUMBER OF BEDROOMS: TYPE O1" WATER SUPPLY: ~//¢~-¢~A'- 5"~¢f¢¢/Individual well / Community well Public water Day phone Day phone 345-2581 694-4200 XXX NOTE: If community well system, provide written c~nfirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: XXX Individual on-site .: .... Holding tank - ' "'- ' Community on-site Public sewer - NOTE: If community wastewater system, provide written confirmation h'om State ADEC attesting to the legality and status of system. 72-025 (Rev, l/91) Fronl ~OA #21 STATEMENT OF INSPECTION BY ENGINEER AS certified by my seal affixed hereto and asof the vaJidation d~te 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 hereinl I further Verirfy ~hat based On the information obtained from the MuniciPa ty of AnchOrage flies'and from my investigation and inspection, the on'site water suPPly'and/°r wastewater diSpOSal system is in c0mpliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING : 17034 Eagle River Loop Road No. 204 Address Eaqle River, AJaska.g95~Z Engineer's signature ~j~. Phone 6. DHHS SIGNATURE · ~/ Approved for ,-~ bedrooms. Disapproved· Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and'Municipal Codes. There ara ni~ratcc present. It ic cuggested that ~per~d~ ~o ~ performed to insure the wells continued suitabfliaty. Nitrate concentration "is 5.9 m~/l. EFA ,ui~imu~,~ ~o~=~t~tio~ £~ 10.0 ~g/1. ' ..... ~-= ...... ~ nitrates ms available from the On-site Services Program, DHHA, 343-4744. Additional Comments Date 7~ 2. ~ ? 7 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates;based only upon the representations ivan i · professional engih~e~r reg ~tered in the State of Alaska The Duguo-,~ ~..a~ragraph 5 abo. ve by .an ,ndependent · , ,, ,o uuu~.,m as a courtesy ~o purcnasers 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, Municipality of Anchorage //~,~, DEPARTMENT OF HEALTH & HUMAN SI=RVtCES Environmental Services Division MUNICIPALITY OF ANCHO~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (,9~l~[~r-"~'~;~ERvICEs 0 Legal Description: A. WELL DATA Well tyPe ~r Log present(~N) Total depth _ .~.~.l Sanitary seal ((~) Li~, ,, ,JUN 24 1997 o s ,gE,C -i V,E D . Health Authority Approval Checklist L..oT' I Z(o FA. ~,~. r.h./ S'/O Parcel I.D,: If A, B, or C, attach ADEC letter. ADEC water/system number Date completed ~"' I~~ ~ Wires properly protected ~N) FROM WELL LOG ~ Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform AT INSPECTION ~' (~PH g.p.m. Nitrate ~.~', ~ /,3't,.,~ / ~. Other bacteria -'~-- Date of samp~: ~ ~ I I - ~ ~ Collected by: ~' B. SEPTIC/HOI. DINGTANK DATA ~ ~0 ~J~l ~ ~ Date installed ~)-'~%- ~ ~Tank size t Z~O Number of Compartments ~, Cleanouts Foundation cleA~ou~(M~). LID(, Depression (Y~O High water alarm (Y~ Date of p~pifig · "~J0 Pumper ~'~' ¢- [~, C Wl--~,~ /~J C. ABsORPTIoN, FIELD DATA. ' 7,,. Date installed_ ~ ~ Soft rating (g.p,d,/ff* or ft~/bd(m) 'Z2¢~ ~System type Lench '~,, Width ~, '&O Gravel thickness below pipe 0, D Total depth ~ / Date of adequacy test ~J'0 (~'~ Resuits~ai'). ~ For ~ bedrooms Fluid depth in absorption field before test (in.); _ ~['~ Immediately af~L gal. water added (in.): _ Fluiddepth I" '~b¢~ins) Minutes laterL ,:75'~ Absorption rate :: /~-~P '/ g,p.d. Perpxide treatment (past 12 months) (Y~ L~ J~ if yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (~N) High water alarm level at*: Cycles tested ~o Size in gallons ~O() "Pump on" level at' .~ 2- ,'1 "Pump off" level at* _ ,~'¢' q *Datum ,8 ~ ~-~ ,,4 E. SEPARATION DISTANCES SEPARATION DISTANCES PROM WELL ON LOT TO: Septic/holding tank on lot On adjacent lots. Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation iO~ ~' Property line IO' + Absorption field Water main/service line_. I0'''f Sun'ace water/drainage I OO~+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line I f.}l ~. Surface water I OO Curtain drain t,~I~ F. ENGINEER'S CERTIFICATION iO' + Wells on adjacent lots Building foundation I('.)I + Watbr main/service line Driveway, parking/vehicle storage area Wells on adjacent lots , I certify that I have determined thru field inspections and review of Municipal record in conformance with Ill, DA HAA guidelines in effect on this date, Signatur~ /~-J/ ~'""~-7~ Engineer s Name /~,,/3 E..,¢-; ~", ('~ ~ ,¢,,~, HAA Fee $ t,.~C~z¢, ~ Reoe,pt Number ;¢ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number WILL INSPECIION & FLOW TEST 8OIL TEst ROBERT C. COWAN, E E. ROBERTA, 8HAFER, RE. WELL FLOW TEST DATA LEGALDESCRIPTION; i--c?.?- /C~ (~,~ A V~.~ l-'b~J ~ ~:- d.' ' LER' DATE DRILLING COMPLETED: ~ 7 /?~) - DRIL . / ~lSC. DXTA: CASING HEIGHT: /~ I~ '~ SANITARY SEAL: WIRI:8 IN CONDUIT; y~ GRADING O.K.. BAOTERIAANDNTRATEBAMPLESCOLLECTED date: CIVIL ENGINEERS (907) 694-2979 FAX(g07) 694-1211 DATE: 'EST DATA: CLOCK TIME METER. PUMPING READING RATE (GAl-) (GPM) DEPTH 'ro WATER (FT) swl REMARKS 7.-?-/ ,n~/~,zff S ?w/-i ( -'- b,, ,, W,TRA D.AWDOW" RESULTS: WELL CIJRRENTLY PRODUCES TESTED ~Y: FLOW RATE NOT GUARANTEED--SUBSEQUENT VARIATIONS CAN OCCUR. 7034 NORTH EArl E RIVER LOOP ' SUITE ?~)4 · EAGI E RIVER, Al ASI(A 99577 ,~ CI'&E ~nvironmental Services Inc. CT&E Ref.# Client Name Project Name/// Client Smnple iD Matrlx Ordered By PWSID 973039001 S & $ Bngine~ring L126 A Ye~ton $/D L126 A Yvrton Drinlcing Water S~nple Rem~rlc~: Client PO// Printed Date/Time Collected Date/Time 06/11/9'/ Reeeived Date/Time 06/12/99 Technical Director: Stephen C. Released By ,/,~ ~ ~ / , P~L 5.9 O.lOfl mg/L EPA ]00,0 0 cot/lOOmL Sa18 9222B £0/20'd l~O£fiTgfi&06 3UU~8OHDNt~ ISB 3'g.LD ;2:£; &b~ LEGAL DESCRIPTION: # OF BEDROOMS: ,.~ ADEQUACY TEST FORM · ~OBERTC. COWAN, RE. ROBERI'A. SHAFER, RE. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 TYPE OF ABSORPTION SYSTEM: ~)~.:.~ SEPTIC TANK SIZE: SEWEn&w^rER ABSORPTION FIELD DATA: Depression over field (Y~. MAJNEX~'EN$1ONS SEPARATION DISTANCE FROM ABSORPTION FIELD 'ro: Driveway, parking/vehicle storage area: ! D ~ Curtain drain: r Foundation: _~'_' ,~ ,~-~ Foundation eleanouh~_,,~): '._~ Depression .LJFT STATION: "PUMP ON" level at: ] ~,,(I ENGINEERI~GSYUDIES "PUMP OFF" level at: ~eAE~OmS High water alarm level: ,¥1' I~ SEPTIC TANK/FIELD SEPERATION TO WELL: TESTEDBY: o',~/~.-., v .. THIS SYSTEM IS NOT GUARANTEED AGAINST SUBSEQUENT FAILURE 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, AL/~KA 99577 RESULTS: PASS/FAIL: ,~.4 ~, J' EXPLANATION: R'~,~c//.~z, ;" ~-'/ / ~' -¢-~ r,-4 ~.. METER GALLONS LIQUID LEVEL TIME READING .ADDED D~I"rH~N ~ ~ COMMENTS W~LL INSPECTIO~ (TOTAL) &FLOWTEST ~ s.'r. M.T. M.T. JUN-27-97 FRI 16:48 RE/MAX OF EAGLE RIVER FAX NO, 9076960214 P, O1/03 Quadel Industries, Inc. BOX 1047 · 200 TKOY STREET ·COO$ [gAY, OREGON 97420 (503) 269-735I · 1.800-ZS9"7659 * FA,'{; (S03) 269-7300 POLYETHYLENE TANKS MOLDING MATERIALS Union Carbide Resin GPEP;803 Natural 7, or equivalent is a medium-density polyethy- lene resin produced· by the Iow pressure UNIPOL process. This product has been. designed to provide excellent environmental stress.crock resistance, combined with a high degree of rigidity. It also offers out- standing moldability and Iow temperat-ure Impact strength. An ultra, violet stabilizer has been incorporated in the product for improved weatherability.' This resin complies with FDA Food Addl- tive Regulation 21 C.F.R. §177,1520 for Olc,'i? ~.':',":,'m~r~: T.~: ~c'. ?.~. The additlv.~...z present are sanctioned by appropriate food additive regulation,~. TANKS ARE F.D~A. I E.P.A. LISTED JUN-27-97 FRI 16:48 RE/[J~X OF EAGLE RIVER FA× NO, 90769602N P, 02/03 .~,. ,,: ....... ~,, .,,..~x.....~,., .- :,:"m,~'?~ ~?-~,,~'.¢"'-'" ,,' ..... ' .... · ....''.. ', ......... .... · ...... .'.:,. ,.:...' ~":~-~ ~Q {~/HN" .~:?'""' '":"~"* ........... ., . . .: -,.=. ......... .-, . , .... .;.. . . .'. ..... ,'.,....... .:~ g~,.~ "} .: ..... ,,~.......~.,.. ........... · ............ .......... . : ..... · ...,.;.. ,....: .: ~'-:.::" :'.'::" .'"'"'" ' ~ ' .. ' ..... .:":-.':'C" '. '. '.'; · · ~ ", ' ." ". : .'."'... · : ....:.~,. ~' · ~ ...: , '...": ....., . :.~. , ... · . .-' ' ~c~cne,~::"'"'." .,,' .":' '"'.." ' , '. ., · :' 'L~ '.'.'" ':~ ' '"'" : / .'" "" ...,...:...,......:. :, ::' ' ::'::': '" '"" ' ": :':' . ' , .'..~:..,:C, ':.":'..~::~ ...],..:f ". . .'.'. .'.' r .' · k..:,.,,~,,.,' , ,,.-..,~......,.'... .. , .: '. '... :.. ...: . . . · . .' .' ' . ~.' ': .,,:...?~::i .. JUN-27-97 FRI ]6:49 JANMB-96 ~ON RE/HA× OF EAGLE RIVER FRX NO, 9076960214 P, 03/03 ~UROELL INDUgTRIES F'A× NO, 5032897300 P, 03 8506 U '8D Medium De.nsi~ Rotational Moulding Res~ D~a~ty 0.940 g/cue Mdt Ind,sx iL0 dB/tala ]{ ~;hi~ a b? huc~ of ~fiHn~ and pr~obilt~, but ~o~d not ~ ~ed ~ ~ntact Mth Applica~ for ~CL~R ~06 UVBD are p~duc~ ~c~ ~ ~utpment ~. I~/~G~TOEY P~'I..AIR 8506 I~SO hag nd~bje~nn ~ta~ wi~h the Health F~t~un B~ek ~B) of AS]Wi TEST IV~'/'Ht3D D D 1691~ D 790 D 638** D 6"J8*~ D2340 D 740 D dS/m~ ¥^i,Ub5 2O 6~ (100,000) MPa 'C (°F) (7,600) (3,1oo) 118' TDT(,~ JUN.-30' 97(~1ON) 08:39 PARTUSGH/NORTHERN %b:907 344 5755 PARTUSCH Plbg & Htg 8301 Schoon Street Anohorage, Alaska 99518 345-0152 P. 002 RE: 127A YER~NO~I~ItY / 20109 UPPER BOWERY JUNE 30, 1997 TO W~OM IT MAY CONCERN, THE HOLDING TANK, AND PUMP THAT APE INS%ALLED AT 127A UPPgR BOWERY WERE PUT IN TO CODE. THEY WHERE CHECKED BY PAJlTUSCH PLUMBING, AI~D LOOKED TO BE IN wORKING ORDER. THAINK YOU, 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 051-144-53 HAA# HA910231 1. GENERAL INFORMATION Complete legal description Lot 126A Yerton Subdivision Location (site address or directions) 20109 Upper Bowery Property owner Mailing address Gene Yerton Oay phone 688-2186 PO Box 670855, Chugiak, Alaska 99567 Lending agency Mailing address Day phone Agent Darlene Nicholysan % Re/Max of Eaqle 8&~9~one 694-4200 Address ].6600 Centerfield Drive ~201, Eagle River Alaska 99577 Unless otherwise requested, HAA will be held for pickup, NUMBER OF BEDROOMS: three (3) TYPE OF WATER SUPPLY: Individual well xxxxxxx 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 WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXXXXXXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system, 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 Js 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. NameofFirm S & S Engineering Phone 694-2979 17034 Eagle River Loop Road, Suite 204, Eagle River, Alaska Address 99577 Engineer's signature Date Original Certificate has been lost this is a replacement of the original. Engineer's stamp and signature is on file. If there are any questions, please call our office at 343-4744. 6. DHHS SIGNATURE xxxx Approved for three (3) bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: .,~ ,.. . ~ Date July 11, 1992 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. 72~)25 (Rev. 1/91) Back MOA #21 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 Parcell.D.# _t"-)~\- IL\~-\~?~ HAA# 1. GENERAl- INFORMATION Complete legal description Lot 126 "A"; Ygrton Subdivision; Location (site address or directions) 20109 Upper Bowery Property owner _ Mailing address Lending agency Mailing address_ 670855 Day phone_ 99567 Day phone 688-2186 694-4200 Agent ~zzC¢~z~.~'oh(J£J,J~z~ ~¢.JMa×. of ¢~gZ¢- Riv¢.~___ Day phone Address ~O0 cCerfi~d D¢~u& #201 Eaq£e- River, A~z. 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 % TYPE OF WATER SUPPLY: XX 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 WASTEWATER DISPOSAL: Individual on-site XX 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. 79-025(Rev. 1/91) F¢onl MOA #21 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 flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is [n compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Phone ~ ~ ¢'Z~'~' Name of Firm _ s & s ~:Nm, ........ 17034 t~:~t¢,~ River Loop Road No, 204 Address ' .' - 99~'77 Eng neet signature DHHS SIGNATURE ~ Approved for Disapproved. bedrooms. 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 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 eng'neer s work. 72~25 (Rev, 1/91) BaCX MOA #21  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~c,'¢~'L.L¢ A \] ¢,dZ-~Cb ,--[ S/~ Parcel I.D. · N,V~EN ~AL ,~- ~,i ~ ,biON JuN 18 1991 A. WEI. L DATA Well type '~.~V~'r"~ If A, B, or C, attach ADEC letter, ADEC water system number Log present~__~N) y Date completed (¢-/7-,~7/'~-~/0 Driller_ bPI< Totaldepth 77 ~-OO Casedto /'~ //~ Z¢ Casing height /Z ,4 -/- Wires properly protected ~'~N) ¢ Sanitary seal ~,N) ye// FROM WELL LOG Date of test ~- ~? /~-?o Static water level /E) ' / ,2,~' Well flow '~ ~,'"/'? /,.~'~'?/'/ 4j,,,i~.m. Pump level /...~/. / U/4' SEPARATION DISTANCES FROM WELL TO: AT INSPI"CTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ,,,,- Septic/holding tank on lot _ /~)0 Absorption field on lot / Public sewer main Public sewer service line RECEIVE[) WATER SAMPLE RESULTS: Coliform ~ ¢ '~ ~ ~/~P w4-~, Date of sample: (',~ ~- ~ / Nitrate ~,~ ,5--3/~ c/,/ Collected by: .~ '¢,' ~' ~--¢J 4-',/~/~.---------------~'/'/-/¢~''/~ · B. SEPTIC/HOLDING TANK DATA Date installed I'E) - Cleanouts ~'N) y High water alarm (Y(~.~ Date of pumping Tank size [ 7--'~ ~ Compartments Foundation cleanout (~N) \/ Depression (Y~[]) /'-/ Alarm tested (Y/N) W SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot. ICc To property line Surface water/drainage On adjacent lots I '~ Absorption field lO Foundation Water main/service line 72 026 (Rev. 3/91) Fronl MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed ~' ~ ~' Size in gallons Vent ~/N) High water alarm level Meets MOA electrical codes ,(-~N) "Pump on" level at Manufacturer Man hole/Access~J.5~N) ',¢ "Pump off" level at Cycles tested SEP.~RATION DISTANCE FROM LIFT STATION TO: Well on lot /C~C~ ~ '~ On adjacent lots /~ f*" Surface water /PO fo' D. ABSORPTION FIELD DATA Date installed (~, ~ Length '~ (-~' Width Total absorptioq ~rea Depression over field (Y~[~ / Results(~Tfail) Peroxide treatment (past 12 months} (Y,~ Soil rating ~-?-.-"~ ~/E,¢--/ Gravel thickness C) ,~' .Cleanouts present,/N) Date of adequacy test If ye~, give date System type ~' E.A~ Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot [Oc, ['~ On adjacent lots ~Dc> ['~ Property line To building foundation I ~ To existing or abandoned system on lot On adjacent lots ~O "~" ~ / Cutbank ~ Water main/service line Surface water \c:, c:, ~ Driveway, parking/vehicle storage area Curtain drain I-~ I~,~ 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 inspection. , ,;'034 Eagle Eivor Loop Road No. 204 Signature ........ ,.~ ,~,~,,-,-, Engineer's Name Date ~/t~/¢ ~ HAA Fee $ ~--Z~-O Date of Payment (.O L~::~ c[ 1 Receipt Number 72-02§ (Rev. 3/91} B~ck MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633 B STREET ANCHORAGE, ALASKA99518 TELEPHONE (907)562-2343 ANALYSIS REPORT BY SA}4PLE fo~ WORKordor! 34715 Date Report P~lnted: dON 3 91 ~ 0%07 FAX: (907) 561-5301 Client Sample ID:L126 A YERTON S/D WELL #1 PWSID :UA Collaatad ~I~Y 31 91 ~ 09:30 hrs. Received ~I;~Y 31 91 ~ 12:26 h~s, Preserved with :AS REQUIRED Client Name :S ~ S ENGINEERING Client Aaet :8NSgNGP BPO # PO # NONE RECEIVED Raq # Ordered By Analysis Completed ;I~Y 31 91 Send Ropo~ts to: Laboratory Suporvl.spr jSTEPWEN C. EDE lis ~ S ENGINEERING Chemlab Roi ~: 912365 Lab 8mpl ID: 1 Natrix: WATER Allowable Parameter Tested Result Units ~othod Limits NITRATE-N 3.2 ~/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: RAT. Remarks: I Tests Performed See Special Instructions Above UA=Unavailable ND= None Detected "See Sample Rormrke Above NA= Not Analyzed LT-Less Than, GT-Gzeatar Than