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Home My WebLink AboutVALLEY VIEW ESTATES #1 BLK 2 LT 9 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 NAME LOCATION PHONE ~NEW ~' ~ Absorpt[onarea//~ Dwelling ~ ~ PERMITNO.~/O/~. Ma~ lu~a~t~e~ETO: ]Well " M~~ I No. of~partments ~ Liq. c IF HOMEMADE: Inside length~ I Width .. ' . Liqui~depth DISTANCE TO: Dwelling PERMIT NO. Liquid capacity in gallons Well , Foundation , Nearest ,ot_~e,/ ~) ! PERMIT NO.(~//O DISTANCE TO: / Z ~ ~ / ~ NO. of lines) ~ ~ Length of each ~ Total length of li~ Trench w~ inches en lines Top of tile to finish grade ~.~ ~ . Length Width Typeofcri I Depth DISTANCE TO: Building foun( Material beneath tile Depth PERMIT NO. Crib depth / foundation rption area Driller Distance to I t line. PERMIT NO' O~2/O//~ ~ Septictank/ 0 ~ OTHER PIPE MATERIALS SO,LTEST INSTALLER REMARKS PPROVED 72 013 {/R'~v. 3/78) ~/ DATE LEGAL F'EF:M I T NO. HPFLI _.ANT LOCRT I ON LEGAL C. F'. DEVELOPMENT SF'RLCE LANE E. R. L.~ B2 VALLEY VIEN E_-.,TRTE_, PO BO,.,, ~2Z.; E. R LOT 694-25:50 4.2~560 ..:,QI_t~F.E FEET TYPE OF --.,.IL HB.=,uRFTION .=Y=TEM I'-]: TF..EN..H MR::4IMLIN NIJMBER OF BEDROOMS = 3: =,OIL RRTIN3 <S-Q FT/BR)= ' '~*~ THE REQUIRED _,I~E OF THE =,OIL RBSORPTION =,-r.=,IEM I--,. E>EF'TH= ~. LE[qt.~TH= 4-i G F-: R ",,,," E L B'EF'T~4=-'= 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF g TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET NIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETNEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE E~<CRVATION (IN FEET). PERMIT APPLICANT HR'..-] THE RE_,PON=-,IBILITT TO INFORM THIS DEF'RRTMENT [',LRING THE IN.=,THLL~tTIuN IN_,FEb] IuN_, OF AN'¢ WELL-.-'], A[:,JRCENT TO THIS FF..OFERT.r AND THE MLIMEER OF RESIDENCES THAT THE NELL NILL SERVE. *-P,* I ,-",- , . '= ' -' ' ~ . . F'4 B'¢ BH_.kFI_LING OF AN%' =,,.=,TEM NITHOUT FINAL IN_,FEuT!uN AND RFPRJ,RL THI_, [:,EPRRTMENT NILL BE SUBJECT TO F'ROSECLTION. MINIMUM DISTANCE BETWEEN R NELL RND RN'¢ ON-SITE SENRGE DISPOSAL S'¢STEM IS L'LI~I~-iI FEET FOR R PRIVATE NELL OR 15Et TO 2E1E1 FEET FROM g PUBLIC WELL DEPENDING UPON THE T'¢PE OF PUBLIC WELL. MINIMUM [.',ISTRNCE FROM R PRIVATE HELL TO R PRIVATE SENER LINE IS 25 FEET AND TO R COMMI..INIT'-/ SENER LINE IS 75 FEET. OTHER REQUIREMENTS MR"/ RPPL'¢. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEF--:F-1 :[ T E.- .F ! [4:ES [)E(f:EF"IE:ER :-1.. ;t .... I CERTIFY THRT I: IRM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SENERS RND HELLS RS SET FORTH BM THE MUNICIPRLITM OF ANCHORAGE. 2: I NILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SMSTEM MAD' REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. RPPLICRNT C.P. DEVELOPMENT 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE Ni. SULLIVAN, MA YOR DEP,a,F]T~4ENT 06 HEALTH AND ENVIRONMENTAL PROTECTION December 31, 1980 C.P. Development Post Office Box 323 Eagle River: Alaska 99577 Permit # 800647 Subject: Lot 9 Block 2 Valley View Estates Subdivision A permit issued by this department for well and/or sewer system has expired as of this date. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, --/ Senior Environmental ~cialist LNB/ljw enc: Copy of Permit SWP/057 , . AND ENV I RONMENTRL ?'*-'OTECT I ON DEPARTMENT ~'~'* HEALTH , " ':"-' ........... .... ., 'STREET, RNL. HURH~E., ' F~ELL R~4C. 0~4--S I TE SE[4EF: PEF~fq I T PERMIT NO. ( 888647 ', APPLICANT C.P. DEVELOPMENT P.O. LOCATION SPRUCE LANE E.R. LEGAL .LOT D BLK 2 VALLEY VIEW EST. BOX LOT SIZE 6D4-2350 4~560 SQURRE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MA>,*IMUM NUMBER OF BEDROOMS = ..~ SOIL RATING THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C,E F'-F Hi= L-] L E I'--t G T H = 4:[ (:ii R R %.' E L [:,EF'TH= 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRBINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND RND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH I~ THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). RED- '--=; E P T I PERMIT APPLICANT HRS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES TNAT THE WELL WILL SERVE. Tk~O (2) I ~4SPEE:TI Elf4S ARE ~EI~LIlRE[:, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS :1.88 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN S0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS RRE AVAILABLE TO INSURE PROPER INSTALLATION. F"EF-:t'4 I T E,~-,:P I I:~:ES IDEL-:EI',IE:EF-.' _~:[., I CERTIFY THAT ±: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALIT'¢ OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]:: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN -~: BEDROOMS. ............. 2:. F'. DE'¢ELQPMENT ISSUED EY ~: .......... [ RTE ......... O & E ENG,,~IEERING & DEVELO~'~dENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Performed for: Legal Description: Z. 07- (~ / SOIL LOG Name: Mailing Address: /~ Earl Ellis 688-2280 Depth (feet) Soil Characteristics 12__ ~'7 14__ 15__ 16__ PLOT PLAN PERC. TEST Ground Water Encountered: Yes I,.--' No___ If yes, what depth. /-~ Proposed Installation: Seepage Pit Drain Field__ Comments: Performed by'. '"~-'~ ~~ Date: d by DOC Co, dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688.2759 OWNER OF LAND c~t~.~,,~_~_ W/E/T~' DEl'TH OF WELL ~ ADDRESS ~ ~oX ~n~?~ ~E~ ~0 STATIC. LEVEL OF WATER FT. ~0 LEGAL DESCRI~IO~ ~T4~O ~ Y ~LtJ ~4~ DRAW DOWN FT. DATE- Started ~/P 7 Ended GALS. PER HR ~ 0 . ~ ~DO~ c~sl~ ~ ~ From~ Ft. to Ft. ~J ~ ~ T~ .~ e From · _~F~. From~Ft. to~O~ Ft. ~/~ ~ ~t< From Ft. to_~ .... F~ - MUN~CIPALI~ OF ANCHO~GE From~Ft. to--Ft. ~c~ ~ ~_ From ...... ~t. !~bLTH ~ - ' ENVI~ONb~NTAL P~OTECTION From Ft. ~o__Ft. From ~4~/_Ft. to From__ Ft. to~ Ft. From~Ft. to_~Ft,_ From ~_Ft. to_ Ft. From _. 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 Ft. to Ft .... ,o::/\U$ ~', Ft. C!Fi 1987 Ft. to _Ft._ .Ft. to Ft._ Ft. to Ft ...... nFL to. ,, Ft.~ Ft. to__ .Fi Ft. to .... Ft. .Ft. to ..... Ft._ .Ft. to Ft.__ Ft. to Ft MISCL. INFORMATION: DRILLER'S NAME Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Waslewaler Program 4700 South Brag,3w St. P.O. Box 196650 Anchorage. Al-[ 99519-6650 www.ci.anchorage.ak.us (g07) 3.43-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAIvllLY DWELLING Parcel I.D. 050-521-43 Expiralion Date: GENERAL INFORMATION Completelegaldescription LOl; 9: Location (site address or directions) Current Properly owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Sames& Brenda Smith Dayphone Sue ! partnors Reml F,n~n~ Day phone Unless otherwise requesled, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: ;~ Day phone,694-4994 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 [] Comrnu~ity On-site ~ Public Sewer I II The Municipality of Anchorage Development Services Deparlmenl (DSD) Issues Certificates ot' Health Authority Approval (HAA) based only upon lhe representations given In paragraph 5 by an Independent professional civil engineer regislered In Ihe Slate of Alaska. Certificates of Heallh Authority Approval are required for the transfer o! lille (except between spouses) [or propedies served by a single family on-site waslewater disposal ahdlor water supply system. DSD also Issues HAAs upon request Io homeowners. Cedificales of Health Aulhority Approval are valid for 90 days from the date o1' Issue for properties served by a privale or Class C well and may be reissued with new waler sample resulls less than 30 days old. (Cedificates may be reissued [or a period ot' up !o one year with valid water samples.) Cerlil'ic~[es are valid ~'oi' one year I'or properties served by Class A or B wells or a public water system· The Municipalily or' Anchorage Is no{ responsible [or errors or omissions In Ihe prol'essional engineer's work. D. LIFT STATION Date ins~iled 'Pump on level y in. Datum / E. SEPARATION DISTANCES Size in gallons "Pump off' level at _ in. Cycles tested Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift, tarn on lot Absorption field on lot Public sewer main S..,~wLr~'septic service line On adjacent lots /~(~ t~ On adjacent lots ~ f' '1'- Public sewer manhole/cleanout Holding tank /V/,~ / SEPARATION DISTANCES FROM SEPTIC/I~E~NG TANK ON LOT TO: Building foundation ~- t ~ Property line Absorption field Water main /~//~ Water service line -I- Surface water, Wells on adjacent lotsf~ (j~t ~) ! .~. ]~:D~ Iq_ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line i~ (~) I~._ Building foundation ~ O ~ Water main Water Service line I ~) I~_ Surface water ~) I.j_ Driveway, parking/vehicle storage, ~ I~. Curtain drain ~U.01~; J/~Jlrt4/kJ Wells on adjacent lots I~ I'1 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 date. Engineer's Printed Name ~b~,,~7'-' C . C0~,~., Date /,//! o / r.) 3 HAA Fee $ Date of Payment Receipt Number (Rev. 12/01) ¥ /,o/o 3 Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewatcr Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 xvww.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Health Authority Approval # 030129 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 2, Lot 9 of Valley View Estates #1 subdivision, the well's productivity was determined to be 0.62 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3-bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all panics 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 must be attached to all copies of the subject Health Authority Approval. 4-10-03; 10: 14AM; ;go7 ~15~01 ~ A-- 3 scs Ref.# i 031787002 Client Name S & S Engineering Project Name/# N/A Client $:tmple ID Yal]¢y 'v'icw Est ~ ~ Lg. ~2 Matrix ~ Water PWSID 0 Sample Remarks: All Dates/Times are Alaska Stnndard Time Prlnt~ Date/rime 04/09/2003 17:0~ Collected Date/Time 04/03/2003 15:40 Received Date/Time 04/04/2003 8:00 Technical Director / Stephen_n?~C. Ej~e ALlowable Prep Analysis Parameter Results PQL Units Meth~ Ll~t~ Date Dat~ Init Waters Department Nitrate-N 0.200 U 0.200 mg/L EPA 300.0 (<=10') 04/04/03 t~crobiology I~boratory Total Colifo.n 0 coVl00mL SM18 9222B (<=1) 04/03/03 JS / / I HEEEB¥ C~'R'rlFY .THAT I HAVE SURVEYED t'HE SCALE,. INDIcA~b. iT IS THE EES~NSlBILITY OF THE VlSlOfl P~T.' UND~ NO ClRCU~STAfiCES S~ '~B, ~:-.. ts-6918 , .' OF FENCE LIN~, OR mR EST~LISHING ~ND- DRAWN~ ~~t~:'~ ARY LINES. .... ASBUILT'NO CORNERS SET THIS bATE. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAETH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 050-521-43 ~ HAA # ~ ~--~C~<~),~ Lot 9, Block 2, Valley View Estates Location (site address or directions) 25927 White Spruce, Eagle River, AK 99577. Propedyowne~ ',,Mike & Deidra Moore Ma lng addrbss ........ t. ~_endi~gi~ge'n'CY~-. Greatland Mortgage/Cindy Lindblom Mailing address Day phone 269-6185 Day phone 563-3889 Agent. Address Virginia Kohfield/Remax Eagle River 694-4200 Day phone 16600 Centerfield Dr., Suite 201, Eagle River, AK 99577 Unless Otherwise requested, HAA will'be held for pickup. 2. NUMBER OF BEDROOMS: 3 '¥ 3. TYPE OF WATER sUpPLY: Individual well Community well Public water NOTE: TYPE OF WASTEWATER DISPOSAL: ' individual on-site ...... Holding tank Community on-site Public sewer xxx If community well system provide written confirmation from lng to the legality and status of ~ystem. XXX State ADEC attest-~ NOTE: If community wastewater system, provide written confirmation from State AD,EC attesting to the legality and status of system .... 724)25 (Rev. 1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER DHHS SIGNATURE / Approved for Disapproved. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigatio.n of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the d~ate~is inspection. Name of Firm .... '~ / Phone /~'~'//- ~-~-~ $ & $ ENGINEERING / .... Address 17034 Eagle"~!v~E~Loop Road N,O~0~ , Engineer s signature~ Date 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 D HHS does this as a ecu rtesy 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 '.i:E IVE0 Municipality of Anchorage DEPARTMENT OF HEALTH, & HUMAN SERVICE~G 2 1998 Environmental Services Division MUNiClP^UZ¥ O 825 L Street, Room 502 · Anchorage, Alaska 99501 Health Authority Approval Checklist Legal Description: [,'"~T'~l, ~:)L,~C ~Z~ ~,P;'~&~-o ~lo~-cc~ ~'~( Parcel I.D.: A. WELL DATA Well type ¢~-~q~q"~-- If A, B, or C, attach ADEC letter. ADEC water system number Log present Y~N) ~ Date completed Total depth ~'1 ' Cased to /~ z/ ~ Sanitary seal (~N) ",/ FROM WELL LOG Date of test Static water level Well production Casing height (above ground) Wires properly protected(~N) ~ AT INSPECTION ?,77 ' WATER SAMPLE RESULTS: Coliform ~ Date of sample: "7" ~7 ~ Nitrate ~/Ja ~ Other bacteria Collected by: B; SEPTIC/HOLDING TANK DATA Date installed ~ ~ I? -'~; Tank size Foundation cleanout ~/N) C. ABSORPTION FI~LD':BA~ Date installed (o ~0 Number of Compartments 'Z~ Cleanouts~/N) Depression (Y~[~ ~ High water alarm (Y/N) Pumper Soil rating (g.p.d./fF or fF/bdrm) /3,5-/~.,~.'.System type Length /7/'-~'~' ' "~; ': '~/ ',-¢-/ ' " '~'~ .Wii~th. . Gravel thickness below pipe Total depth Effectiveabsorpti0n area ~o ~' Monitoring Tube present¢/N) ~ Depression overfield Date of adequacy test~ 7~:~ Result~il) ff~ For 3 bedrooms Fluid depth in absorption field before test (in.); ~g ~ immediately after ~o gal. water added (in.): Fluid depth ~ (ins) Minutes later: ~O Absorption rate = ~O~ _g.p.d. Peroxide treatment (past 12 months) ~ ~ 2~ ¢L~ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* ~Eump-eff'-'4evel-a¢-- ......... High water alarm level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption fidd on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots [oc> \'~ Public sewer manhole/cleanout Lift station '~O '''A'' ~0¢'~' W',;,'~'""~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation t,o t Property line Ic~ ~ ~ Absorption field ¢ I Water main/service line ~,c~ ~' ~: Surface water/drainage \oo t4' Wells on adjacent lots ~o~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Curtain drain Building foundation ~,o ~ R Water main/service line Driveway. parking/vehicle storage area [ ~ Wells on adjacent lots t, o-o \ ~- F. ENGINEER'S CERTIFICATION ~ leer#fy that lhave deter~,n'~ed thru~eld inspectiorTs and review of Municipal record~~~ are in conformance with~OA HAA ~idelines in effect on this date. Signatur Engineers ~ ........ Date ~ ~ /~ ~ / ~ ~ ' ~ ~__~ HAA Fee $ Receipt Number OC/O~Z (~7[~/~ '~ ~ Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE MEMORANDUM WATER WELL ADVISORY AUTHORITY APPROVAL NO H~ ~ During a recent Health Authority Approval on-site inspection and test of tile potable water supply well on Lot ~ Block __~ of V~LL&X ~!~/ ~9~/ Subdivision, the well's productivity was determined to beo,7~2, gallons per minute. The minimum well productivity required by this Department (~MC 15.55) for a ~ bedroom residence is~, ~ [ gallons per minute. Although the subject well currently exceeds this 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 nnd gardens may be required. This advisory must be at%ached ho all copies ~f the subject Health Authority Approval. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section -. P.O. Box lg6650 Anchorage. Alaska 99519-6650 343-4744 Parce, l~ hO. # C).>"-O - .;-~ / - 1. GENERAL INFORMATION ,Compl'ete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Lot 9~ Block 2~ Va~l~ View E~_~.s L~(;~at, ion.~(~site address or directions) NHN Spruce '" ...' Property owner · P.A. ~ Pau/-~ -.Mail~ng~tddre~-,,.;P.O. Box 5557 ~_ 'Lendtng agency ' Maili~ng addres~~' 'Agent. ~' F~i~a Kohf~d/ R~a~ Eaglo. Eagle Rive~, Day phone AK 99577 Day phone 694-0415 Day phone 694-4200 Address ' 16600 C~n~crfi~ld D~ve Eaql~ RZv~.t,-AK 99577 · ': "unless Othe~vise'~equested; H~ will be held for ptckup.~;}~:~7~;~-~:' ,. 2. _ NUMBER OF BEDRO,~MS ............... ., .... .; ................... Indw~dusI well Public water NOTE: ~ If communi~ well s~smm, provide wd~en confirmatioq.~(om.S~a~.~ .... .. .._,~ing to t~e ~egali~ and status of system. 4. · ~PE OF WASTEWATER DISPOSAL. '..~.;' .~ ~-:~ ?~ . .~:~, %~:r:~;~;~lndividual on-site .~.- . ..... ~k - HO d ng ta .... .. · ", ..... , ~- - '- CommunlW on-site NOTE:' Ifcommu~i~wastewatersystem, providewriffenconfirma~i°nfr°~'Sta~?OE aResting to the legali~ and status of system. 72-025{Rev. 1/91) Front MOA~21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my inves_ti_gation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Mur~icipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & $ ENGINEERING 1.7034 Eagle River Loep Road No. 204 Ea~le Ri~er~ Ale~/[a ~577 ~ Engineer's signature Phone Date 1// 9/~ DHHS SIGNATURE /~v Approved for' '-~ bedrooms. Conditional approv~Ji;'f~)~'<' .~' :.~.,c~ .,:.:. · 13edrooms, with the following stipulations: .... ,' Additional Comments B~:.v~ ~5"~.,..~<', Date //-- 2 .' .,.: ,, ~,- . ~' ~ . ..:.,~ . :. : : ':..,. ; 'The ~umc!pallN q~g~horage Depa~ment of Health and Human Sewmes (DHHS) ~ssues Health Authon~ ':, Approval ~e~ifica~'bas~ only upon the representations given in paragraph 5 above by an independent profe~onal eng~(,regmter~ ~n the State of Alaska, The DHHS does th~s as a cou~esy to purchasem of homes and th~ibtendi'n~ inst'itutions in order to ~tis~ ceflain f~eral and state requirements. Employes of DHHS do not conduct inspections or anal~e data before a ce~ificate is issued, The Municipali~ of Anchorage is not responsible for errom or omi~ions in the professional engin~es work. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825%" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Descriptiou: A. WELL DATA Well (ype Log preseu! 6QN) Total depth Health Authority Approval Checklist IfA, B, or C, attach ADEC letter. ADEC water system number Date completed ~- ¢ 7 Cased to I ob I Casing height (above ground) Sanitary seal ~)N) x,[ FROM WELL LOG Wires properly protected (~N) AT INSPECTION Date oftest Static water level Well production /, fi~- g.p.m. 2, t] WATER SAMPLE RESULTS: Coliform ~) Nitrate Date of sample: 10~16~ B. SEPTIC/HOLDING TANK DATA Date installed ~l'l,~c3t Tank size Foundation'cleanout~N) Date of Pumping /O~q..C' Pumper Collected by: Other bacteria S & S ENGINEERING I/U,~ ~.agie ~iver i.gap ~a~ Eagle River, Alaska 99577 \ ~e,o Number of Compartments ~Z~ Cleanouts~N) . Depression (Y(~ tJ High water alarm (Y~I~ ~ C. ABSORPTION FIELD DATA Datoinstalled t-]- / 7;-8 / Length ~3, ~ Width ~, t Gravel thickness below pipe ,y-t Total depth 9" Efrecti,¢ absorption area ~/~ ~ Monitoriug Tube presont~ ,/ repression over field Date of adequacy test ~O,~tb~ ~'o"'-- Result~Fail) /~,,+ff~ For '3 bedrooms Fluid depth in absorption field before test (in.); t./~, ,t Immediately alter e, 70 gal. water added (in.): Fhfid depth ~/~ (ins.) Minutes later: ~o Absorption rote = -q/,5-d + .g.p.d. Peroxide treatment (past 12 months) (Y~. z.~O/-.- /(~./,~.JnJIf yes, give date Soil rating (g.p.d./ft2 or ft2/bdrm) [ ,3-~//~Kr System type ~ -<> ~o z D. Lllrr STATION Date installed Size in gallons Manhole/Access (Y/N) ~Pump ofF' level tit* High water alarm level at* ~ *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field Oll lot Public sewer maill Sewer/septic sm~'ice line On adjacent lots : On adjacent lots Public sewer manhole/cleanout Lffi station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation \ ~> ~ Property line ! C> I ¥ Absorption field Water mai~ffservice line Vo k 'P Surfi~ce water/drainage ~,Ucv k 4.- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation [ e, ~ Water mail#service line Surfi~ce water \~c>O kY Curtain drain ~.X/b- Driveway, parking/vehicle storage area [5- Wells on adjacent lots .~ ~ ,,-k- Property line F. ENGINEER'S CERTIFICATION ...... · in co,~/brmance uilh )e,[OA HAdl ~uidelines pl effect on this date. ~'~ ~ . .. < ~ 1/17/ / / / ~ o X .on~.r c, cowan /~ ............................................................................................................ ,~i!~F~st~{.~ ........ HAAFee * &~ ' ~ Waiver Fees DateofPaynlent ][~ ~ f~ DateofPayment Rev. 8/95 OSS: haa,wk,doc MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES ~ ~- 0 DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION {MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 9; Block 2; Valley View Estates Addition #I ' August 17, 1987 Location (address or directions) Properly Owner (~¢.2r.~ H¢..x~z Telephone: Home Business Mailing Address (b) (c) (d) Lending Institution KGy PacifZc Mortgage Mailing Address Telephone TARGET REALTY/Myrna Johnston Real Estate Company and Agent P.O. Box 774627, Eagle River, Alaska 99577 Address Telephone 694-2388 (e) Mail the HAA to the followina address: or: Check here [~, if hold for pick up. List contact person and day phone number below. S ~ S ENGINEERING 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 ordered by Myrna Johnston TYPE OF RESIDENCE Single-Family Number: of Bedrooms 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 the legality and status. 4. SEWAGE DISPOSAL Onsite ~ Public [] Community [] . Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 Of 2 ~ 72-025 fRev 8/86~ Front x~h 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION AS certified by my seal affixe~l hereto and as of the validatJou 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 -. & :~ t=NiGiNEEF,;;,;G 17034 Eagle R[¥e~ Loop Road No. 204 Eagle River, Alaska 9957'7 Telephone DHHS APPROVAL Approved for ~-~'¢~2~bedrooms by Approved DisapproYad ' Conditional Date Terms of Conditional Approval CAUTION The Municipality of Anchorage Depadment 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. Page 2 of 2 72-025 fRev 8/86) Back ~ "O?.AGe' · ~ ~C~ ..,s~UNICIPALITY OF ANCHORAGE (MOA) ~C~.~ ~L Sggfl~Cg HEALTH AUTHORITY APPROVAL (HAA) ~' "~t'~ CHECKLIST- FEBRUARY 1984 _ 26 -4 20 WELL DATA Well Classification Well Log Present~l~l) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit~N) Separation Distances from Well: ~-~ ,~:~ Ii A, B, C; D.E.C. Approved (Y/N) ' :¢!_ Date Completedt Yield \ ,~ ~'1'~ Cased to ~ c:2,~, Depth of Grouting '~¢------~" Pump Set At '~-~.. Sanitary Seal on Casing {~N) Depression Around Wellhead (Y~) To Septic/Ho!al!rig Tank on Lot / c~.~ ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~ ~.~" ~ ; On Adjoining Lots To Nearest Public Sewer Line . ~ ~ To Nearest Public Sewer ' CleanouVManhole ~/~ To Nearest Sewer Service Line on Water Sample Collected by ~ ~,~tP~ ;Date Water Sample Test Results ~¢~~ ~~ Comments ~ ~ ~~ ~~ ~ B. SEPTIC/I~i~I~i TANK DATA Date Installed ~(' ! ~ )<~ Standpipes ~N) Air-tight Capsi~)'N) Depression over Tank {Y,~ Pumping/Maintenance Contract on File (Y/N) ¢~ Holding Tank High-Water Alarm (Y/N)/f~ Separation Distances from Septic/Hte~Tank: Size ~ ~ No. of Compartments Foundation Cleanout (~N) r._.~ ~ate Last Pumped.~. for Temporary Holding Tank Permit (Y/N) To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation ~'~:~ To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026{11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata \"'~ '~ ¢~/'¢'4/j'''~ Type of System Design '~7/'~-'~:~-~--~ Date Installed Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Depression over Field (Y/~ Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: TO Water-Supply Well To Building Foundation Lot To Water Main/Service Line Standpipes Present. N) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line (- ~' t'Jr- To Existing or Abandoned System on ; On Adjoining Lots ~ j'J~ TO Cutbank (if present) ~'~ ~ Comments D, LIFT STATION Date Installed Size in Gallons "Pump On" Level at ~//~ High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MCCA and HAA guidelines in effect on the date of this inspection. Signed S & S ENGINEERING Date '¢¢~/2'~f//¢~ /~ 17034 Eagle Rl:ver Loop Road No. 204 /~----~..~' ~-o ~ CompaB~g~[~ ~9577 MOA No. .~c~ipt~o. ~-~ ~/-oO// of yme.t P ¢ 3/-E q Amou.t: $ / OO ¢ Page 2 of 2 72 026 (11/84) '~ APPLIC>~'~ FILLS OUT UPPER HAL" ,ONLY Address Zip Code · Address Zip Code Type of Resi~nce ~ Community ] For wells drilled prior to that date. give well depth (attach Icg if available), Public Utility Sewer Disposal . ~_~?~ . ~ndividual Year individual Installed: ~Pubgc ~ility When Connected to Public.Utility: ~ Holding Tank .' NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~ST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Field Notes: J U L 1 8 1983 ,p~]ity of Anchoragg" ( ~PROVED BEDROOMS ~ 'COND TIONS OF A~tat Protection" ( ) DISAPPROVED ( ) CONDITIONAL APPROVAl* /~- 72-023 (3182) DATE RECEIVED INSPECTION APPOINTMENTS n ,NSPECTOR ,NSPED ,NSPEDTOR MUNICFPALI~ OF ANCHORAGE ~UNICIPALITY OF ANCHORAGE DEPT. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~TI~iRONMEN~AL P~OTECTION 825 U Street - Anchorage, Alaska ENVIRONMENTAL SANITATION DIVISION MAY 2 0 198i Telephone 264-4720 RECEIVgD REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FAClLITI DI RECTION~: Complete all parts on page 1. Incomplete reques~ will not b, ~rocessed. Please allow ten (10) days for processing. 1, PROPERT~ OWNER PHONE MAI LIN~ ADDRESS ~ PROPERTYRESIDEN~{Ifdlfferent from above) ~ ~ ' PHONE 2. BUYER PHON~ MAILING ADDRESS 3, LENDINGIN~TITUTION ~ PHONE I MAILING ADDRESS ~4 REALTOR/AGENT I PHONE t MAI LIN G ADDR ESS STR E ET LO G'ATI ON J [] One [] Four [] SINGLE FAMILY [] Two [] Five ~ MULTIPLE FAMILY .~ Three [] Six [] Other 7. WATER SUPPLY ~ INDIVI DUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** //..~'¢¢'J YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) ~ ) THIS SIDE FOR OFFICIAL USE ONLY 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 ~1~-- ~ ( Connection Verified. INSTALLER []Sept~c/.T.a,.n,k..,.. or []Holding Tank Size: ~g/t_,~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ~'/APPROVED FOR ~ BEDROOMS [~] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev. 6/79)