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HomeMy WebLinkAboutT15N R1W SEC 8 LT 116AT15N R1W SEC 8 Lot 116A #051-151-32 MUNICIPALITY OF: ANCHORAGE DE '"ITMENT OF HEALTH AND HUMAN SEW ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION FIEPORT Name Address LEGAL DESCRIPTION TANKS "~l' SEPTIC /_F.¥,~ 1-,,:, ~] HOLDING DISTANCES ~ ~ SEPTIC ABSO,PTION ~ TANK FIELD WELL ~/ELL ! 3~- / /z¥o / .OT LINE 4 / / /o / ,~ 6 ~ :OUNDATION ..',.',.',.',.',.9~ ~ / ~o / ~0 TYPE OF SYSTFM [] TRENCH ~ B["D [] W, DRAIN [] O'rHER Installer Dale In$1alled WELLS ~ PRIVATE [] OTHER (Identifv) ~ ,'-, w,-~"~'. J.~ o FT ~ FT REMARKS: Scale: Inspcc,~ rio led b 694-5195 . J-~ ~ ~' ~¢-'Y'/-~ '"-"~ cer§ly Ihd this inspection was porlormod according to all ~uoJcJpeJ and $lalo §uJl~oJJnos J, o§scl Od Jhis dolo;- /~/~G/,¢' ( Health De ailment A royal ~ t / P PP y~ ' . .., -- . 72-013 (3/85) ENGINEER'S SEAL 't!' L ,:: A ¢'*i~m 825 !. ~FI'I::~EI!!::'I', ANCI]DF~AE;h}:~, AK 99h;0:1 264".q 720 F'F.:RM I '1 DATIE :[ S,%UI~::.D: A F::'F::'I... I C A[".IT :'~ f'~DDRE:SS: L.L iq I AL, I F'HONI:i:: IN, ...... ;..:, Uf ( I',AI)I 10.7 I/,./~36 BONIq]: IE KiNG ~:]l::/:l. BOX 2Zl67 CHIJG:I:AK, AK 99567 6 8 8"';?.2 7 6 ! I L)(,I ....NA cel't Jr f y 'Lllat: :[ am l'am:i..I, iar. k,xi.'Ll'"~ 't..l'l~::¢ reqt. L:i.l'emen'Ls ,~'!::H' (::H-i'~'~sJ. te sewers arid Fc)r"Lh by 'Lhc,.) Mun:i. cipa].i'Ly (:',{ Arlchor'aglc;, (MI)A) arlc] LI'H:~ State of Alaska. 2,, :1: t~:i],], :ills'La]] '?,,l'le~ !~i;y~it~)~]l J.l'i a(:;:(:(::)r'dall[:6,~ with a]J. MOA (:::o(::h:'H~ alid and :i.n c:c)mp1:i, ancc~) w:i.t:.ll 't:.hc.) design c: r :i t (-.H" :i a (::,{ 'Lh:i.s p,:-:)rmii:,, 3,, ]' w:i;I.:l adl"mn'~:.~ 'l:.o a:l.] PIOf.~ arid SLa'L~? (::H Alaska I'cH::luir~.xil(,:)n'Ls {c:H" t.l'i~)' s~.:xL bacl:: dJ.s't, ance~B fr[:Hfl any 6~x:i. sk:i.n(~ t,%,)].:l.~, was'Lr.:¢v,h':tt(:~r' d:i. spc~sa], sysi:em c)r. pub:!.JE IF:' A LIl:::"f STAT]:t])N IS II'.IS'f'AL.L,~i:D ]:iq ('tI"-I ARI£A C(3\,'EFd:i:D BY MOA F~LIII..L) IhlG 'I'HI~:N (:1.) ~t1',1 I~:I-IECTRICAI. I:;:'IERMI"I' ~ND INSI:::'IECI ION MtJS] DE OBTA N!LL. NO] BE (./F:'I:::'F~OVED W]:]IiOUT AN [-:]..ECTI:U:CAI. INSF'E~:CI']:ON I::;',IEF'OR'I"~i AND (;~;) 'IHE I:L.I:}:C'II~iCAI.. WORK MUSF BE DONE' BY A L. ICI~]qSIED ~c:=~ ~:.¢e.,~.'~.% :.] .]Z ............................................................................ APF.'I.. El: CAN'T'. BONN IIE K:[NG ..~ UI..) BY F:'. 0 · BQX .f::~PEO:LFJ. O('~TTOk,!S FQR OIxF--(3IIE ('.ffLPIQO ,SYS[Eid LEG{M : I ©1 ll(Sf~ llSN R].N Soo. 8 (~. GENEROL. l:.esB~ ace ..~dvitsor-y Lo Ishe d~)s:i, dn and are I:o be the fi(T[d by the O01~i;Fa31;O~ 1;0 meet HO~, ]> [.C r-ooommalldi:~d that a surveyor ]ooal;e bhe nea. re~st lot DI:~{-'IZ NF[ E[.D rile draJ. nli(::Qd Js to l~ollow ti-to n~,l:,ur'a] ]and oontou,~' lo ma:int.~J.n UI'IlfOF[I1 f;Ot:a], depl;h of thc bed bobton~. [he boB&om oF th~ b~d shall be ~eve], p]uo or m~.l/U~ !.5" Tl~e bed gr'avo] J,$; Lo be oovcred ~,a:iish I:ypar' or labr":ic rnL!l;~}l'[ ~1.. [~oJl o1'" oornb;i, nz~l:~on of soil ond O>(tSl'kld(]d boal"d Jl/5';u].zttLJ()lq lc) a dopl;i~ l'hc~ ar(:~ ov(~r I:ho tt~onc)h J,% to bi: -[.i.l'lJ[~;h gradod Bo I:)F~¢VDFIJ pol/dillg Lo any oornmumd, ty REOQIdI'~ENDED I_E~tCI-IFJ. EI,~D DIHENSIOt\IS Iq3I'AL DEPrt-I::: 3' GRAVEl_ DEPYH::: 6" BlED IJEhIGrl, t-'. 52' BlED UfDTII:: ICi' 2 Sand ~ilter Re, iL. ired Beneath Septio Gravel Soil Ra_t_j~ngE~i FJedroom OaF~Olty : 5 Sopt:Lo bank size:r: 1000 .~' EAGLE RIVL.. ENGINEERING SERVICES INC. P, O, Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5:[95 CALCDL^TE~ aY ~ CHECKED BY. SCALE / //'-- ,-~O / DATE PERFORMED FOR= SOILS LOG MUNICIPALITY OF ANCHORAGE [] PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L, Street, Anchorage, Alaska 99501 264-4720 · ' SOILS I.OG.- PERCOLATION TEST 12 14 SLOPE SITE PLAN Lou~s A, Eulera CS-6736 Gross Net Depth to Net Reading Date Time Time Water Drop 17- · ,' ,{19.- COM,M'ENTS~'t' ~ 2: PERFORMED BY: 72-005 (6/79) F&R ~u~as-T-t C)N RATE TEST RUN BETWEEN Eagle/~,~r Englneerrn~ Services r.u, u0x773294 '" Eagle Itlver, AK 99577 ~5195 ~ FTAND -- ,, FT CERTIFIED BY: SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PFRCOLATION TEST PERFORME,D FOR: ~ '~q ) ~ '~"/~. DATE PERFORMED:__ LEGAL DESCRIPTION: ~-- ~ ~'- ///6-~ 7-/-~'~/v* ~ / ~/ '~, Oc~ SLOPE SITE PLAN 2 6 7 8 9 10- 11 13- GROUND WATER IF YES, AT WHAT 14 15 16 17 18 19. 2O COMMENTS Gross Net Depth to Net {eading Date Time Time Water Drop PERFORMED BY: 72-008 (6/79) PERCOLATION RATE '~' ~- (minutes/inch) TEST RUN BETWEEN -- FTAND -- FT Eagle River Englneerln0 Se~'ic~,~ P: 0~i~x-770294 Eagle River, ^K 99577' G~4-5195 of Geological and Geophysical Survey/%' (OOOS) A.O.L. PO. 7. CASING; ' ; ~ Thr~ded ~lded ~eel~ land I~rfl~e /' ' 'u*f'[lJ" 12. GROUTING: Fell Grouted: ~Yes " ZCFIVED I~. gATER VELL CONTRACTOR'5 CERTIFICATION: NORTHERN TESTING LABORATORIES, INC. 600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASKA 99709 907479-3115 25~5 FAIRBANKS STREET 4, ANCHORAGE, ALASKA 99503 907-277-8378 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIENT ~,U=WA= =,=T,,,,.D., I I I I I PRIVATE WATER SYSTEM SAMPLE DATE: ~AMPLE TYPE: .. CI Routine r-I Special Purpose C1 Check Sample (for original contaminated sample with lab reference no. - ~ 7:'~'4 ~/. 2 ~.Jld ~.~c,.~' Zip Code ' Purchase Order No, i--I Treated Water 1-1 Untreated Water TO BE COMPLETED BY LABORATORY Received at: ..[~nch. D Fbks. Date Received ~//~' ~//~ ? Time Received Next Sample Due '-'- · COMMENTS: .~_:_ SATISFACTORY · '*::.._.~: '- ' UNSATISFACTORY U ' : ' RESAMPLE R OTHER BACTERIA ~ - OB TOO NUMEROUS TNTC TO COUNT 4 9 10 Signature of Representative MUNICIPALITY (DF ANCHORA~ ..... DI:P'i'..Or H]:ALrH.& ENVIRONMENTAL PROTECTION FEB 1 1989 RECEIVED Reported by ,, / Time . · PERMIT NO. I-'ILJN I C: I':"~'FtL. ]: -r".-2 ~ZIf~-- ~-=II"-JCzlI- .RI"=IGE DEPARTMENT ,._ HEALTH Ri,ID ENVIRONMENTFIL PROTECTION 82.5 "L'" STREET, ANCHORAGE, AK. 995(4t 264-4?20 I....I E=L L F'I[F'~ r'l )E T ( 82E1889 ) APPLICRNT LOCATION LEGAl_ BONNIE J KIHG I'~SNR%W S8 L~GR SRI BOX 2467 99567 LOT SIZE 688-2276 999999 SQUARE FEET MINIMUM DISTANCE BETHEEN R WELL RND RNY ON-.SITE SEIARGE DISPOSAL S"r'STEM IS i00 FEET FOR A PRIVRTE HELL OR :L50 TO 200 FEET FROM R PtJBLI, C WELL DEPENDING UPON THE T'¢PE OF PUBLIC WEL. L. MINIMUM DISTRHCE FROM R PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET RND TO R COMMUNIT'T' SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEF'RRTMENT HITHIH ~0 DR"r'S OF THE WELL COMPLETION. OTHER REQUIREMENTS MA'¢ RPPI_'~'. SPECIFICRTIOHS AND CONSTRUC'rlOH DIAGRAMS ARE RVRILRBLE TO INSURE PROPER INS';TALLRTION. F'EF~:I"I I 11- E::--:P IF RES I~-,ECEi'"IBER I CERTIFY THR'f' ~.: I BM FRMILIAR WITH THE REQUIREMENTS FOR OM-SITE SEWER_, RND WELLS FORTH B'¢ THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTflLL THE SYSTEM IN RCCORDRNCE HITH THE CO[:,E~, I GNED : __ ~&~2~ ............... flPPLICRNT E~HH~2.T KIHG ' / B,,," ' ,-~ ~ )RTE ,[ ~_,I..IED SET ',/4. 0 GR: ~'ER ANCHORAGF AREA BC Department of Environmental Quality 3330 C Street Anchorage, Alaska !)9503 UGH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCAT,ON SEPTIC TANK: DISTANCE FROM WELl INSIDE LENGTH MANUFACTURER ~+l/~I~ I u'r'~ 14 MATERIAL INSIDE WIDTH__ LIQUID DEPTH__ NUMBER OF COMPARTMENTS _LIQUID CAPACITY 100~ GALLONS. SEEPAGE PIT: NUMBER OF PITS ~ DIAMETER ~'~' OR WIDTH I~I, LENGTH~-_, DEPTH LINING MATERIAL /./~v~C~ -- CRIB SIZE: DIAMETER DEPTH _ DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING POUNDATION_~ NEAREST LOT LINE ~01 ABSORPTION AREA (WALL AREA) .SQ. FT. ADDITIONAL ABSORPTION TYPE CONSTRUCTION _ BUILDING NEAREST NFAREST FOUNDATION LOT LINE SEWER LINE CESSPOOl OTHER SOURCES APPROVED_ DISAPPROVED REMARKS DEPTH DISTANCE FRDM: SEPT lC SEF-PAGE TANK SYSTEM DISTANCES: INSTALLED BY: PIPE MATERIAL: LOT SLOPE: ~ ~ L/'~ REMARKS: APPROV ~ GREATER ANCHORAGE AREA BOROUGH SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PHONE FINANCED THROUGH COMPLETION DATE ANTICIPATED SEEPAGE PIT OTHER TO BE INSTALLED BY NOTE~ THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL SE: SUBJECT TO PROSEC:UTION. / SEPTIC TANK 'D __, SEEPAGE PIT (.~'~= DRAIN FIELD TO NEAREST LOT LINE. WATER MAIN TO SEPTIC TANK SEEPAGE PIT /~,~) ALSO CONSIDER Area WELLS. SEEPAGE PIT, SEPTIC TANK,. SEEPAGE PIT DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND iNTO CRIB CROSSING GAP Of EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC 'rANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. SEEPAGE AREA SIZE GRAVEL BACI(FILL CONFORM TO J~OROUG REGULATIONS REGA lNG JNSTAI.LATION. [ CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA E~OROUGH ORDINANCE NO. 28-6B AND THAT THE ABOVE DESCRIBED System IS IN ACCORDANCE WITH SA~D CODE. ' DEPARTMENT OF ENVIRONMFN.TAL QU2L[TY Case ' 3330 "C" Street ANCHORAGE, ALASKA 99503 /erfo~m.ed For '~L~.,,. (~-, [~r-L~< Dated Performed / Legal Descrip~ LoC: j/~ Block - ~vision~/~/~ This Form Reports Soils Log/~ Percolati. on - Soil Test I.!ust ~)ep t.h Feet Soil Was Ground Water If Yes, At What Depth? Reading Date Percolation Rate .~_~. Test Be Logged.. 4' Below Proposed Seepage System Character . I 1 ~ncountered?. y~_~ /~_ Gross Time Iq i ' nuue Proposed Instal-lation: Depth of Inlet COHME~ITS: Net Time Depth to H20 Net Dro.~ Seepage Pit .Depth Co Drain Field Bottom of-Pit or Trenc'F Test Performed 8Y Certified BY: Date: NORTHEFIN TES'I'ING LABORAlrORIES, INC. 600 UNIVERSITY PLA?J~ WEST, SUITE A FAIRBANKS, ALASKA 99709 907-479-3115 3505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907-277-8378 I]rinking Water Analysis Report for Total Coliform Bacteria TO SE COMPLETED BY CLIENT '~ PmVATE WATE. SYSTEM '~('.~t>~(,'_,('~.~'' ~:.: '~ ~.~ ~ '~ - Mailing Ad re6s Cl~ ' ~ " StetS" Zip Code SAMPLE DATE: SAMPLE 'rYPE: ~ __.~. ~_ Phone: t~ ~z,.~, ., ,., ,, Mo. D~y Yea~ Purchase Order No. [] Routine [] Special Purpose [] Check Sample (for original contaminated sample with lab reference no. [] Treated Water [] Untreated Water Sample Time · ' No, Location Collected 4/1 ~A 'T-t Collected by Laboratory Rof. No. 3 4 5 6 MUNICIPALITY OF ANCHORAGE I~NVIRONMENTAL PROTECTION 7 FEB 1 1989 RECEIVED 8 9 10 Signature of Representative ,!"i FOR LABORATORY USE ONLY TO BE COMPLETED BY LABORATORY Received at:..'[~nch' ~] Fbks. Date Received ~-'/,,~' ' ~ ',' ~ Time Received (- '~',~ ~ Next Sample Due. COMMENTS: SAT)SFACTORY S UNSATISFACTORY U RESAMPLE R OTFIER BACTERIA OB TOO NUMEROUS TNTC TO COUNT DlreGt VerBIcatlon Count LSB BGB Final *No. of Total~Coliform Colonies per 100 mis. Reported by ~ ~ Time / MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL. OF ON-SITE SEWER AND WATI=R FACILITY 264-4720 {tdG -(( ~ ~ Application Date 10/2 1/8 6 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L~ 1~6A~ TI%N~ R~_W, Sec, 8 Location (address or directions) _ ,la, yh~J~_]~V~, _Chugiak (b) Applicant Name ]iO]]J]~..¢_ King (c) Telephone: Home n/a Business 688-/-1448 Applicant Address S.E~~~~_A~_aska 99567 Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution n./2 Telephone Address (e) Real Estate Company and Agent n/~ Address Telephone (f) Mail the HAA to the following address: pic ku~-hy engin~e~ TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms _ '~ Other WATER SUPPLY Individual Well ~ Community [] Public FI Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [] Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and slatus. Page 1 of 2 72-025 (~1/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the varidation 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 thst based on the information obtained from the Mueicipality 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 [~,~,=i:DR~VSR_Fj,~FFRING SERVICES Telephone Address EAGLE RIVER, AK 99577 Date Seal DHEP APPROVAl:./ Approved for ..z,. ( ....... bedrooms by,, ___~ Approved _ ~ii" Disapproved Conditional.~ Terms of Conditional Approval Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL, PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: .-'~ WELL DATA Well Classification Well Log Present (Y/N) /I/ _ Date Corn ~leted 7/~P'''~- Yield Total Depth /.~o / __ Cased to /20" Depth of Grouting Static Water Level o¢:D/ /~/~'~,-' ~,~ -~¢ ~'~.~, ~-.r Pump Set A~ //~ / ¢/.2-" Casing Height Above Ground Electrical Wiring in Conduit (Y/N) /v Separatioe Distances from Well: If A, B, C, D.E,C. Approved (Y/N) _/t~ /.~<- Sanitary Seal on Casing (Y/N) Y Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ; On Adjoining Lots /Z/O" : On Adjoining Lots x2'o~: _ To Nearest Public Sewer 1'o Nearest Sewer Serwce Line on Lot B. SEPTIC/HOLDiNG TANK DATA Date Installed Standpipes (Y/N) /b' Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tack To Water-Supply Well / ~b- / To Property Line /-// / To Water Main/Service Line ~',;"/~ / Course Size ./,-~,o _~¢'"/No, of Compartments _ / Foundation Cleanout ',Y/N)..,~..//' Date Last Pumpee ; for '""~"./~ Temporary Holding Tank Permit (Y/N) '"'"?"~ To Building Foundatior To Disposal Fielc ,/_,~-' / To Stream. Pond. Lake, or Major Drainage Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed / ? ¢?'g g¢~ ~-~ Width of Field /.¢¢'/ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /4/¢ ~' To Building Foundation _~¢., z Lot / 2. / '~"/~'"'"~//¢'~" Type of System Design Length of Field Depth of Field 3 / Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line /¢ / To Existing or Abandoned System on ; On Adjoining Lots '~_7o" To Cutbank (if present) To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~/¢-~ ~¢;zC'~,cf LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signed y.~.-~2~- Date Company .~:"~'~/~" ~/~' -'¢' MOA No. Receipt No. ,:,~,¢,~D? ,,'~.-.~ Date of Paym¢~nt Amount: $ ~/"S . ~--~/~ ,r's Seal Page 2 of 2 72-026 ( 11 ~84) EAGLE RIV ENGINEERING SERVICES INC. P. O. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 SHEET NO . CALCULATED BY CHECKED BY SGALE OF DATE DATE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 App,cation Date __ q -' I - GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 116 A~ T15N R1W Sec, 8 Location (address or directions) __J_a~vhawk Drive , Ch.u~g~ak , (b) Applicar~t Name ':-~-~"~ N,,e.. '~, '~ ~.,~1 Telephone: Home 33?-6015 Business Applicant Address -,~,~ \ ~[.)'1: J-Z~-[ k~ '7 (~,k~,w~.~\ t~.~,,. ~",kl. _('~6,1'~"~ (c) Applicant is (check one): Lending Institution [~; Owner/b~.lilder []; Buyer ~:; Other [] (explain); (d) Lending Institution _.N/A Address Telephone (e) Real Estate Company and Anenl Bon:p. ie King{ - Todays Real'by · Address ~ (Se~ ~{.Ib,?~C_hu~giak, AK 99~7 Telephone 688~4276 (f) Mail the HAA to the following address: TYPI= OF RESIDENCE Single-Family ~] Multi-Family [] Number of Bedrooms ~3 Other WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ~ Public F'] Community [] Holding Tank [] Note: If community well system, must have written confirmation lrom the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIr)ING INSPECTIONS, TESTS, FILE SI-'ARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify t~at my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal syste~h is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that ~ased on the information obtained from the Municipality of Anchorage files and from my investigation and inspe~ the on-site water supply and/or Wastewater dJsposaJ system is in compliance with all Municipal and State codes, ordinances, a~d regulations h~ effect on the date of this inspection.~ conditional depending on GWT monitor. Name of Firm Telephone Address EAGLE RIVER ~NGINEERING SERVICES ~GEI~V~7 Date ~2 5/~6 ~0~0~294 694-5195 Approved //k~ DisapproV'¢d Terms of Conditional Approval Conditional CAUTION The Muncipality of Anchorage Department ol Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a cerlificate is issued, The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL [HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~ ~ y- /~UNI(;IPALI'I'Y OF ANCHOP, AQE DEPT. OF HEALTH & ENVII~ONMENTAL PROTECTION r PR Jjl 1~ Well Classification /¢;:2J'LD / &'"/J 2-/~ If A. Bi C, D,ElO. Approved (Y/N) Well Log Present (Y/N) . ~ Date Corn 2leted ~¢~ Yield Total Depth ~/~¢ / Cased to /¢~¢ ' Depth of Grouting /~ Static Water Level ~ / ~/~ %~:~ c'~'~5 Pump Set Al /~ Casing Height Above Groun~ ~ ' Sanitary Seal on Casing (Y/N) Electrical Wiring ~n Conduit (Y/N) ~P Depresmon Around Wellhead [Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ~.~ ¢ : On Aaloining Lots To Nearest Edge of Absorpeon Field on Lot ~Js'-; : On Aaioining Lots ~/~ To Nearest PUDHC Sewer Line /~/~ To Nearest Public Sewer Cieanout/Manhole ~ To Nearest Sewer Service Line on LOt Water Sample Collected by _~ ~' ~ /Z~/~e r,~ . Date _,.~/;~ Water Sample Test Results ~ ~"~ ~¢ ¢~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed -?~ Standpipes (Y/N) _ ,.Y Air-t ght Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank r~igh-Water Alarm [Y/N) Separation Distances from Seotic/Holding Tank: To Water-Su oply Wel "/~' c~ / To Property Line To Water Mair,/Service Line ¢-/o" Course /'~/7/,,~ _ Size /~°~5~'J~ NO. of Comoartmems / / Foundation Cleanout Y/NJ Date Last Pumped _S~/~ : for Temporary Holding Tank Permil (Y/N) "/¢'/'/~ _ To Building Foundation To Disposal Field To Stream Pond. LaKe, or Ma,or Drainage Comments Page I of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /~' Width of Field /z/ / Square Feet of Absorption Area Depression over Fieltl (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ./b-~,-~"~ To Water Main/Service Line ~'/o / To Stream/Pond/Lake/or Major Drainage Course Type of System Design Length of Field /~Z z Depth of Field Gravel Bed Thickness ~ / Standpipes Present (Y/N) Date of Last Adequacy Test To Properly Line -;~/d, / To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) ,¢7~'¢.-.~ ~j'~-~, ~ To Driveway, Parking Area, or Vehicle Storage Area ~-/~ / Comments -¢:~ ./~ ..,¢~-.. ~,¢-.~-4,-..z,.~ ~__?.~,;,- LIFT STATIC. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked verified, or conformed to all MOA and HAA g uidelines in effect on the date of this inspection Signed -~~;~;~:::~ Date MOA No, Company ~,/~-,~/_~ Receipt No. '~,-~-?~C~ Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal dllgql-- Telephone (907) 694-5195 3/2q/86 Mr. Steve Morris Municipality of Anchorage Department of Health and Htmlan Services 825 "L" Street Anchorage, Alaska 995020650 Ref:Lot ll6 A, T15N R1W Sec. 8 Dear Mr. Morris; On behalf of my client, Mrs. Sherry Fisher, I am applying :For an approval of well and septic systems for the above refer- enced lot. The septic system was installed and inspected by the Munici- pality in 1974 as shown on the enclosed inspectiou report. There were two inspection reporvs for lot 116 with the same date aud a check of measurements in the field confirmed the asbuilt For lot 116 A. A soil log and ground waver monitor tube was installed 20' west of the seepage pit by myself in Septembe~ 1985. At that time 'the soil was rated GW with a water table at 7'. A well and septic system adequacy test was performed on the lot with both tests being satisfactory. The existing monitor tuhe was checked and there was no indication of' water table to 9'. We are asking that an approval be given to this septic system as the system was installed and inspected by the M~nicipality and now requires approval for home loan financing. ~The owner understands that a new septic system may be needed based on water monitoring this spring. At this point it is known that the system can be replaced and that the water table is ~4' below the operat- level of the seepage p'it. The operating level is defined as meaning the elevation at which 'the leachate exit~ the seepage pit. This level is now at 5' depth which is 4' above any GWT. Please review the enclosed mater±al and contact me ifi there are any questions. olncerely ~ Lou Butera, P.E. EAGLE RI'VER ENGINEERING SERVICEk5 Lou Bulera P.E. ILO, Box 773294 Eagle River, Alaska 99~77 Telephone (907) 694-5195 WELL AND SEPTIC ADEQUACY TEST REPORT LEGAL: Lot 116 B, T15N, R1W, Sec. 8 LOCATION: Chugiak, Alaska RESIDENCE: Single Family, 3 Bedroom WATER SYSTEM: Private Well PUMP YIELD: 5 GPM WELL YIELD: +2.5 GPM SEPTIC SYSTEM: From Municipal Records Tank: 1000 gallons Absorbtion System: Seepage Pit INSTALLED ABSORBTION AREA: 336 sq. ft ORIGINAL SOIL RATING: 85 estimated INSTALLATION DATE: 1974 DATE OF TEST: 3/24/86 TEST PROCEDURE: The drainfield was charged at a steady flow rate of 5 GPM. The septic tank and leachfield sump water levels were monitored referencing a measurement below the top of the standpipes. During the test water was added to the drainfield in increments and the drainfield water level was monitored until it had recovered to within 1" of the original level verifying the required 450 GPD absorbtion rate. The monitoring indicates the system will accept the required 150 gallons per day of efflu- ent per bedroom which is the required standard for a Municipal approval. qUEST RESULTS: The septic system absorbtion rate meets the re- quirements of the Municipality of Anchorage for a 4 bedroom resi- dence use as of the day the system was tested. The seepage pit however does not meet separation distance requirements of vertical distance to water table during certain times of the season as was demonstrated by a groundwater monitor in 1985. This septic system should be replaced with a bed type leachfield at an elevation of 3' total depth which would require replacement of the septic tank. The operational life and the matter of compliance with State and Municipal codes for all water and septic Page 2. Lot 116 A ~ ~'~, systems depends on the local soil conditions groundwater levels that may not be observed from the surface, water usage of the homes being served by the system, and the detail of required testing procedure. There is no guarantee that the system tested will continue to meet these requirements. EAGLE RIV ENGINEERING SER~,CES INC. P. O. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 JOB SHEET NO CALCULATEDBY ~--~ CHECKED BY SCA~E OF DATE _ septic s.~stem elevat~ions !16 R, T15N Rlld Sec,8 tube