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HomeMy WebLinkAboutSCHWIGER LT 11 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 625 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES E LI7 TO SEPTIC ABSORPTION WELL Address FROM TANK FIELD oRrNoof Phones) Permit No. Bedrooms WELL 1 U t'1" ` O O 21 - 2 "1�1Z- �lOt>2=41 LOT LINE ��1�- 0 1 t ems' LEGAL DESCRIPTION Lot Block Subdivision 1 GWu1j�kF FOUNDATION Township, Range, Section 11 ,, —T-1 - `W SFt^_ CJ AS -BUILT DIAGRAM (Show location of well, septic system, property Imes, foundation, dnveway, water bodies, etc. TANKS SEPTIC ❑ HOLDING 1 Manulacturer Capacity in gallons 1 1� Material No. of Compartments _ TYPE OF SYSTEM " ❑ TRENCH 14 BED ❑ W. DRAIN ❑ OTHER t q, Depth to pipe bottom from Total depth from original grade Z original grade 5 FT 6 FT Fill added above origmal grade Gravel depth beneath pipe If D FT DFT S e- .15 rw Gravel Iongth Gravel width FT ala` FT Total absorption area Distance between lines SQ FT Number of lines Soil rating Pipe material I T to Zl3 SQ Fr i�JC. AS c'M Dom' z�34 AI Installer pate Installed AMA WELLS a t50o - -- oz eo 1 M PRIVATE E) OTHER Odentifv) rn a cl Total Death Cased to Dale I I REMARKS: Scale: �-��, ENGINEER'S SEAL Inspections Performed by: �u; •:�-P; `3yk11. ir �d Date 1 p _3 —CA b _4V F� log' 93 821 435 Icit -_ certlly that this inspection was pertorined according to all ° „r °° °., s 5ENGINEe : y o +r!X.„ . uq Municipal an�I� �Ditlit�gg yTg�19Gi�j0 s� ^. cohort ,0.. Sha,tn z Eagle River,.Alaskra 9� .. n” °° `" •' a Health Department Approval: SY,•.,o Date: ''a is �h'.-y.�µj 411;5 �UN!ClPALIlY DF ANCHOR��� Uepartme:t o< H�alth & H:man Services �25 L Street, A:chorage, Alaska 99501 343-4720 Parcel [d: 05i-153-5� Lut Lega1: �ubdivision: (J. J.; Lot: 1 8lock: 00VV0 Section: 6 Township: 15N Range: 1N Lot Size 44576 (sq.fL^ or acres) Max 8edrooms: [hzs Permit: 5 Total Capac�ty: 5 SEPl|C TANK: Minimum tntal septzc tank capacity: 1,50� gallons. Each septic Lank must have aL least 2 comparLments, Dep�h to top o� septic �ect requ�res insulation over tank(s). THi� BED MUST 8E iNSTALLED AS SHOWN ON THE ENGINEER'S D[SIGN DA[EU 7/13/90. NOTlFY DHHS PRIOR TO ALL INSPECTIONS, THE EXlST~ lNG |RENCH MUSl 8E PROPERLY ABANDUNED. THE �XISTING W�LL SITE MUST BE SHOWN ON THE AS~ 8UILT DRAWING. THIS PERMIT IS FOR A 5 BEDHOOM S[NGLE FAM[LY RESIDENCE ONLY, AND EXPIRES ON 12/31/90, 1 CERlIFY [HA|: 1 i am �amiliar �ith the requzremand wells as se� �o/th by lhe Municipality c/ Anchorage (MOA) and the State o� A1aska. 2. I w��l insta1] the system in accordance wzth al1 MGA ccdes and regu1atzcns, and jn comp1iance with the deszgn criteria o� this permit. 3. [ w�j1 adhere to al| MOA and S�ate of Alaska requiremenLs |or Lhe set ba�k d�sLa�ces (/`om any ex�sting we11, wastewater dispos�1 system o� public spweraqe system on this oi any ad�acent o/ nearby 1o�. u. ] undersiand t�at this permit is va1id �or a maximum o� 5 bedrooms. � a�so unde/stand thai �he capaczty o� tke t�tal system is 5 bedrooms an� any en|argpment wil� requzre an addit�onal permit. ~... . :]wner> HU 1�su:d By: / r� :1 °a `.'pax, . "� • y �ri \\ U DN 4 t 10% :%* &0 727Y ce 44 Y G r a c A rc rtrt W l�E V 31VJS. SQ 44,� t 10% :%* &0 727Y ce 44 Y G r a c A rc rtrt W l�E V 31VJS. Roy) t Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 r ?n,n n SOILS LOG - PERCOLATION TEST �� 'G���� ''Vi=a' •, �` ;; L PERFORMED FOR: �� DATE PERFORMED:_ LEGAL DESCRIPTION: L-0/ 14-(T944� eyok 1 - 2 3 4 5 (J 6 �"/$rte, 7 8 �;. 9 Township, Range, Section: SLOPE 10 4- WAS GROUND WATER ENCOUNTERED? 11 �f� IF YES, AT WHAT s / P ��V�.� - �� DEPTH? /„ p 12 l E 8�� Depth to Water Alter 7 13 Monitoring? -,lam Date: 14 15 16 17 18 19 20 COMMENTS S & S ENGINEERINU PERFORMED BY:kWV*k"-0ggpg5(�ryq��OaQ' R ACCORDANCE V�4AI%A:'Mrp#RM9F PAL 72-008 (Rev. 4/85) SITE PLAN � ® . D . .. ��V�.� .r re 3' PERCOLATION RATE Z2 (minutes/inch) PERC HOLE DIAMETER �!✓ TEST RUN BETWEEN --7— FT AND --1-5 FT V` CERTIFY THAT THI TEST WAS PERFORMED IN ECT ON THIS DATE. DATE: �� MUH���PHL�TY OF A��HORHSE 8epartment o! �eaith & Human Services 82� L Str'�eL, A:ch�rage, Alaska 99501 343-4720 UN-Sl7E |'ermz� Number: 9OO�48 Vate lssued: 08/15/90 ��w/�er Name: HUD Uwner Address: 605 W 4TH A�CH, AK �9501 WELL PEHMlT Parce� Id: O51 -153-5o Lot Lega}: Subjiv�sion: S�IV) }GEN LW: 1 U!ock: �0oo00 Sectzon: 8 [ownship: i5N Range: iW Lot ��ze 4457� �sq.�t. or acres/ Max 8e�ro�ms� |his Permit: 0 Total CapacityL b �ay Phone; 271-�792 WE� o::j mus+bp submitted to Mu:zcipality o{ Anchorage Deyartment oi Hea1th and Human 3e1 ,i1 'es wiLhi: 30 dlys o| well c:mpluta fon . famiiiar with the requirements 1 11 sewers and wo1ls as set �orth hy the Mu:ici via iity o[ Anchorage (MOH> and the Staiska. 1 accordance with ail MOA codes and regu�.at;ons, �nsta1.1 ystem and �n compiiance wiLh the design criter this paw rmzt. MOA State o( Alaska reiuirement� 'or �.he seL back 00li adhere Lo a1I and |roo� any existing weil, wastewater disposal system or p:blzc ��slances s�wera�z sysLem on this or any adjacent or n,earby ioL. 4` ] undersLan'] Lhat Lhis permii is valid for a maximum o� 0 bedrooms. � ��so unde�stand Lhat 4 ye capacziy of the Lotal sys�em v 5 bedronms pnd ony en|argement � il1 re11uire ai ddiLional permzL. , DEPARTMENT OF HOUSING t URBAN DEVELOPMENT AREA MANAGEMENT BROKER ASSOOIATED BROKERS, INC., 640 W. 36th Suite One Anchorage, AK 99603, (907) 663-3333, FAX (907) 662-3808 08 Aug 90 REF:I40\HUD\LOU S&S Engineering 907 694-2979 17034 Eagle River Lp. Rd. FAX 694-1211 Eagle River, AK 99677 Re: HUD property: �bDRESS S Birchwood Lp, 19967 032464 Schwinger S/D Lot 1 Dear Sir: The home on this lot will be sold by HUD as a single family residence. The well on the property will supply water only to the single family residence located thereon. sincerely, . Z2� z is D. Campbell for Associated Brokers, Inc. HUD Area Management Broker Copy to: HUD, attn Dan Lee � 4� �­ _' ,.. P� C� F�F��� DEPHRTMENT\ '���EHLT� H VIRONMENTHL!'�ROTECTIO;N STREE�, �NC�ORHGE, P,[:::.995@1 - x ' ~ 6 APPL ICHNT RUHHLD SCHWIGER LOCHT1OM, LEGHL _� L167 SE1_-:8 T15N R1W SM BOX 194 MERCY DR TYPE OF SOIL HBSORPTION SYSTEM IS: TRENCH LOT SIZ 103900 SQURIRE MHXIMUM NUMBER OF SOIL RHTING (SQ FT/BR)­ 240 THE REQUIRED SIZE OF ABSORPTION SYSTEM IS: � �����F��� � ��������= ��� �Q���� �E�V�� THE LENGTH DIMEHSIDN IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD( THE MOTH OF H T.F:ENCH OR PIT IS THE DIST8NCE BETWEEN THE SURFACE OF THE GROUHD HND THE GOTTOM OF THE EXCRVHTION (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES. THE GRHVEL DEPTH IS THE NEDEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE GOTTCM OF THE EXCHVHTION (IN FEET) � � ����1 iC_ -IF �=l P-1 T = 2�-= ::1L!f5 1ORD, C3 F! I!—���� PE�MIT APPLICHNT HAS THE TO INFORM Tfw.IS DEPHRTMENT DURING THE MSTHLLHTIOH INSPECTIONS 0F HN� WELLS HDJHCEHT TO THIS PROPERTY HND THE NU!1BER OF RESI�ENCES THAT THE WELL WILL SERYE. 7F Y 14:1 v� NO 7, Z04 "Y F=1 E=_ 117 T 1 319 11"A Km 1=1 IT: K To: K ill U _1, K�E� ~�~ BHCKFILLING OF HNY SYSTEM 9ITHOUT FIHRL IYEN PEE CTION HND HPPROVRL BY THIS DEP9RTMENT N�LL BE SUBJECT TO PROSECUTION MINIMUM DISTHNC�: BETH�EEEN HELL RND HNY TE SB�HGE DISPOSf -!L SYSTEM IS 100 FEET FOR H �RIYHTE WELL OR 150 TO 200 FEET FFOI'-1 H PUBLIC WELL DEPENDING UPON T��c T�p� CF P/'pLIC H�LL mINIM�niDIvNCE FM H WELL TO H SEWER LINE IS 25 FEET H�D 70 H COMMUMIrY SEHER LINE IS 75 FEET. �ELL L�GS :FE REQUIRED HHD MUST BE RETUR�ED TO THE DEPHRTMENT WITHIN D8 DHYS �F T�E WEL! COMPLETION �T�ER REOU�REMEHTS SPECIFICATIONS VAND CONSTRUCTIOH DIHGRHMS HRE RVHILA.BLE TO INSURE PAMPER INSTALLATION. F? rdl Y -F �����E� �E������� ��.� �_E:1 iL_��! L2 TCERTISI �Y T��r I RM FHMIL��� �IT� THE REOUIREMENTS FOR GH�TE SE!�ER5 HM� WELLS HS SET FORTH BY THE OF HNCHORHGE. 2 I NILL INUTA`L THE SYSTEN IM HCCORDHNCE HITH THE CODES ]' I UNDERSTHND-THHT THE ON~SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS �EM;DELE� TO INCLUCE MO�E TH9N 5 BE�ROOMS SISHED: � HPPLIWANT R � � � Municipal' of Anchorage ME R NDUM DATE: September 1, 1982 TO: Laura Crow FROM: Environmental Health Division SUBJECT: Request for Refund - Apcount #2460 Please make arrangements for'the following refund. The well that is to be installed will not be a single family well but a Class "C" well, this permit is issured by the State of. Alaska Department of Environmental Conservation. Thank you. Ronald Schwiger Permit #820341 T15N R1W Section 8 Lot 167 Ronald Schwiger. Box 194 Mercy Drive Eagle River, Alaska 99577 Laura J. Ward Senior Office Assistant LJW Ql.mn iFnR) Receipt # 187593 Refund Well Only: $15.00 -AC/ fu�L Time APPLI� NT FILLS OLU7TUP�LE HAr,,-,�ONLY Time Time Owner S Pho hoTPrapey zi Zip Code 7 Ma4lng Address 'ir Buyer -(--I AS'LkA Date Address Zip Code Date Lending InstItutloV � Phone Address r':q'�7Aet Zip Code Inspector Realty Co. & Agent Inspecto Phone Address Zip Code Field Notes: Legal Description Z zL:- C X)o "1) -7-- Street Location — LL� X, Type of Residence '0 Single Family. El Multiple Family No. of Bedrooms 0 Other Water Supply Individual O�ir1Q LLLJJ /n/. � PLI)Iluq ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Community y El Public Utility APPROVED BEDROOMS For wells drilled prior to that date, give well depth (attach log if available). Sewer Disposal Year Individual Installed: CONDITIONAL APPROVAL' DATE P< Individual 0 Public Utility When Connected to Public Utility: 0 Holding Tank BY: 6/ NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Soils Rating -AC/ fu�L Time Time Time Time -(--I AS'LkA Date Date Date Date Inspector Inspector Inspector Inspecto MUNICIPALITY OF ANCHORAGE Field Notes: ENVIR .O:E'-Tl- .4 1982 RECEIVED APPROVED BEDROOMS /'7CONDITIONS OF rROVAL DISAPPROVED CONDITIONAL APPROVAL' DATE Illy BY: 6/ Soils Rating Date Sewer InstalledWell To Absorption Area Well Log Received Septic Tank Size to Tank Well to T 72023(3/82) I i JJ CONSTRUCTION AN C PERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION . PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of OT 10SEC 9' i /6 I✓ 1/o ST7 CSf3 I FA �Q a t&S'Cy r public water system located in ! 1^fc t P)6 CC Alaska, submitted in accordance with 18 AAC 80.100 by_Z N ca I L c 17 P 1^ have been reviewed and are g approved. conditionally approved (see attached conditions). z g&jw,� zzz� q: 4y_FyrA1 By DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contract order no. or descriptive reference) Approved by Date The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE II The construction of the 4 7 I�'7 ��5 IBJ S �� public water system was completed on /C 7 �I CI — X Z .(date). The system is hereby granted interim approval to operate for 90 days following the cpmpletion date. DATE As -built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The systern is hereby granted final approval t operat . 6Y TITLE DATE rwuNICIPALI ry OF ANCHORAGE n DADTOa C NT nc !AUAI ILJ Q. inn/ i D n Ni r,n 1 F" I- A l oU)l1-5'IJ r•'S'I r",nr r. t ;i NVIROM NI AL FNcINi 4 Nc II 1)1VISIcm1 \Njo S'%] 1. Street Anchoiage, Alaska 99501 I! iriphonp. 264-4720 ON -SITZ: SUUA iF DISPOSAL SYSTEM AND/)I; W I.l- !NSPIE T iON REPORI'I n 1 I / W%7 /p /9,311 DUPGRADF - MAILING ADDRESS p LEGAL DESCRIPTION - -- - - .. _ - -- -- -- - -- I, l 11,o7 S� LOCATION pJ J�U� Uri' I _ �' OF RcAr�ll .�_— a.__..� lNell / DISTANCE TO: 6 �Y --- - / - -- 4bsorption area / Dwelling / PERMIT NO. // r / �7 z /U _ _ 0 3�/ 1- 7 Manufacturer a Ww 2 '2 Material No. of compartments z U)A IIF 1_iq. capacity in gallons IF H O ME MA D E� f v _ Inside length Width Liquid depth p Z _ DISTANCE TO: Well Dwelling e PERMIT NO. u ___ _ Manufacturer _ ___ _ A4aterial _ Liquid capacity in gallons Well / A DISTANCE TO: �S Foundation / Nearest lot line r /.3:7 /�2 PERMIT NO.r W LUT w i z = to No. of lines Leng hof each line 4�9' S /' Total length of lines Trench �.vidth nches Distance between lines -- cc-- F- - - J - -- Top of the to finish grade - �� — Material beneath file r (v Total etfective absorpti n area - ".2 iPmii /�00'W ------- Length Width – Depth PERPAIT NO. Q f- Crib depth Total effective absorption area Type of crib Crib diameter r� Well Buildin foundation N g earest lot line DISTANCE TO: .sly CI s �� I/�+ 4�.--_ Depth -_ W�E�✓�t'-wnC�Yww'i'l Building foundation Driller }� T^ Sewer line Distance to lot line �ir.C�L✓1�+ Septic tank PFRPA IT NOuj' LJ �U ice/ Absorption DISTANCE TO _ /S / T^� areas) OTHCF; N --+ _ -- — PIPE MATERIALS ---------._..__--__— � ,o3C/ -mo--- - - - SOIL TEST RATING --- � f � - - INSTALLER � ------.._-------- I REMARKS ( i I 44 r 6w I I C" PL APPROVED DATE �LEGAI.� 61121 /s� a N Py"Th"PA NAIII PY" 1747 Muo"FUM": r V: a 74 1 J T TV �A A 101 A F TOR, V ASQ—, : ny liw; 7 N f 0 jQWM 1 Y� 1 i 11 1 - f 9 001"WANN' 1 01 Q 1 W? j ! 1 W:: YJS 1 YKAT A Ch 7 P, VIM T A QW: OF ANY 00.1 1 1 - ? A 74 1: W! S� GO V 01: 1 A CH 0, i An 111 t? H 40 911 CA 1 A A 17 1& P FAA ON A&I 1 TV YjK FQ 140 T NUM V., I I U 1 v Ki Q: 1 k j WE, CAN !?14-- 5 1 T. TYWASY i� 4 unna vys r al 1 S: jj:�l 11 101, 1 C Koski. DEPT 41, 1 W'-, FIT Q I NUM 1 QW: 1401 Y, W f "T 'f:f Ad L. 11) A Fill v W 1 K vdam InW I � 31: YEH 'Apd" f ; 'I : � � 1 ; � i. f ! , " E to A PA E t *1 ;"J QYT 1, WAR RG"A"11150 f0m 11YA GG: MY MART M FAFT "APANY AMA 11 Hy NMI CS poly QGWL,'� ," WNP . T OMS Wv mrav num f ! [41 I, rom"Pla !91Pu� 9100 , ! 0 WARP Pounna Y to v 1 mi, m A an T-1 Y 1 K 7 A v? V ON Q TH WT QVI Mny a 1 A A. A. f 40 j 1 KOH Ar"TY S In 13 Q P S 1 T MAPA WN HAL v ;::r 4- my, 1 Y 11, PKTAIAORMW IG! !owl [m nm1 Cjjjp"� jjv�f 1il PAI a1v� A A A Fop 1190140140: 1 E F a in n? 1 RQP T VAX PROMPT, W LOU YOR WDRUI TWAN UP 540fus.v, PY JS A Q 1 Q ® & E ENG MEERING & DEVELOrMEN I GO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 rMa9etl Oyster F:qd till. 694-2774 SOIL LOG 688-221;0 Performed for: Name:�'yf_L� PD �G—��-`�'�r �---/.�— —Tel. No._&w/---� Mailing Address: �� ��' l7- 2 JfC, Legal Description: W7, � � ' �d� /�-------- ----- Depth (feet) 0– Soil Characteristics k�' 9 ____3 _- 5 _. 6 _. YJ 2 L16 t•r�sle PLOT PLAN PERD. TES i 13 14 �_ a vasa I� /�Or; .M„rl;Nc 1 a � Ground Water Encountered: Yes No k If yes, what depth Proposed Installation: Seepage Pit_ , Drain Fiel � nn p p Comments: ��r�I� �`�i� i`l t) Z9n� PL-ar- I Performed by: / v ,fly r F, �� :cs'.--L.-cj���el—:•_t�.i fir--- Date: 17 ALASKA ENVIRONr'NTAL CONTROL SERVIC, ,, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561.5040 .,n'. din..-.. "--r 4., .,r, JOB--- ---- SHEET NO CALCULATED BY C Al CHECKED BY SCA�LE� / U •/ OF nAT� DATE MUNICIPALITY OF ANCHUA(y;' DEPT. OF HEALTH & ENVIRONMENTAL PROTECIIy'� ri 2 RECEIVED municipality of Anchorage MEMORANDUM DATE: September 1, 1982 TO: Laura Crow FROM: Environmental Health Division SUBJECT: Request for Refund - Account ##2460 Please make arrangements for the following refund. rhe well that is to be installed will not be a single family well but a Class "C" well, this permit is issured by the State of Alaska Department of Environmental Conservation. Thank you. Ronald Schwiger Permit ;#820341 T15N R1W Section 8 Lot 167 Ronald Schwiger Box 194 Mercy Drive Earle River, Alaska 99577 Laura J. hard Senior Office Assistant LJW Receipt It 187593 Refund Well Only: $15.00 [VI-W DRILLING, Inc. ~'~. Box 4d224 * ]3~0C International Akl.~ r ~oad ,_.: (907) 274-461 ] '-. ANCHORAGE, ALASKA 99509 Well Owner Rod Scl~d iger DRILLING LOG .Use of Well Dom. Location (address of: Township, Range, Section, if known; or distance main road Section Lot 167 Section 8, T15_~__P,_I)_~_~_.~_~_~_ __ Size of easing Static water level Screen ( ); Perforated ( ). Describe screen or perforation--Sc~t~/t'' Slnrred l inet- f~-~,.~ 1 57'--ra--22fl' Well pumping test at--7 gallons per t~,.W.~T.,j (minute) for 1 hours with .].OD.~' of drawdown from static level. Date of c~mpletion__5 / 27 [ $ 2 Depth of llole.220____--feet Cased lo--17-1 .... feet ~R ft. (~lfO{.') (below) land surface. Finish of well (check ¢,no) open end (}:ZY,.X); WELL LOG Ihqq!] It~ f~*~'! froln 2 35 ........ TO ._ _3. _5 TO. 39 __.3~ ._ .TO ~ __.?_%___'z-u~.55 155 .TO 169 ._l 6~9__.TO 17 2 172 .TO 173 173 .TO 183 _]8_3__3-0 ~98 .. j 9_8__TO___220_ . _2_20__TO .... ....... TO ..... TO .......... MUNICIP^LII¥ OF ANOfORAGE Give details of formations penetrated, size of material, color>~fill t~a~e~ -. ~MVb .: I ',. ' .U t., 1 Ca~i~g~r~U.p_._ S E P 1 5 1O~2 __~.~k_gravel with occasional cobbels Loose Sand & Gravel ............................................. GraM~Cl__qX Gravglly Clay Sandstone Coal f~ -- CUSTOMF. R . . . .. - - . - - - - - - -I - - - - - O. Bul,, •1-1224 - 1310C I nte, A rF. Road (90 7) 274-4611 ANCHORAGE, ALASKA 9950() DRILLING LOG D \Vcil ;�Qj Do LTSe ocl Dom (address of: Township. Ran -e, Sec!ion, if 1,11 d; 1s11ce inaill Se� t i0r, Lot 1.67 Section 8 TI 5 N . li"� Dwh cd liul( _220 ----_-fee; ca'L,i• 1" 71 1('C'L (helow) land Flll:.!' of well ill ;)U:-, D-��ci i�,, sc:een or perfor.-ilion- ('s Pllon-, fl'llill'utc) f0i­___l 35 with_-- occs4(?nal c,,'�,T, C, 1 s RECEIVED from static level. e- S LooFanC Grave_ 7/82 Sit Cravel WELL LOG MUM -PA"' E Gi\ c dl:twl- of f"'] f1w!!j(-1:. J) "11C f 'C 0' 1:, 1_1-1. Co;, : _i; 151 Cb'1e59 _-Z _c,aL'_n- St. ic)'- u I) IQ92 35 Si C r a -Jel %-," 'I, occs4(?nal c,,'�,T, C, 1 s RECEIVED e- S LooFanC Grave_ Sit Cravel 15 DI G,Liv_ Clay 7Z) 5 1 Clay .TO .-Gravelly 16° --TO 172 Sandstone 7Q 4 - - 172- -rl,o__ ___q_7 3 - coal - 173 TO 183 Bro-wn Shale 1 33 _P() I . C) k c' Cray - 0 1'c)__ 2- Sands tons _-amine rained t C' �ICHORAG� 220 -TO Dor-tom of hc).ljci-- MUNIcIPAUTY -DEpT—OF F 1EALTM & EwIRONMENTAL -TO —CUSTOMER MUNICIPALITY OF ANCHORAGE • T Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. #�' Sn - � �) LSCS HAA # ! 1- (-r. -_'A 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1; Schwiger Subdivision (Old Lot 167; Section 8; T15N; R1W; S.M.) Location (address or directions) 19967 Birchwood Loop Road, Chugiak, Alaska (b) Property owner Mailing Address (c) Lending Institution Mailing Address HUD #032464 Telephone : (home) Business Telephone (d) Real Estate Company and Agent ASSOCIATED BROKERS/Sandy Address 640 West 36th Avenue, Anchorage, Alaska 99503 Telephone 563-3333 (e) Mail the HAA to the following address: (or check here [k, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 17034 Eaale River Loop Road, Suite 204 le River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family ❑ Number of bedrooms 5 3. WATER SUPPLY Individual Well Cf Community ❑ Public ❑ Note: If community well systern, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site IN Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7188) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is sai, 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 � y s Telephone— y Address 703^ E3*. a R(ver Loop .Toad No. 204 =.aale Kiyerr �A7 Date — ivt �! L.• 1 , 1 47 � , ti obi .4. : h erw t: No �� ,��: nary. •ar .-r~ Pi .nCZ.J�� .Vt 6. DHHS APPROVAL . Approved for bedrooms by JCi iN I Ii f+ Date L Approved-- Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 A MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (MAA) CHECKLIST - FEBRUARY 1964 pFP 343-4744 Legal Description: L c. -rI Sc.� \AI im E P_ '>I I> � WELL DATA `�`�� Well CIass 1ficat icq� Q_ ihlSa \l >0 R�_A._d If A, B, C, D.E.C. Approved (Y/N) ~1 - Well Log Present �Y N) - — Date Completed 5 _2_1 - 9Z- Yield 14 A 61?M Total DepthZ7-0 t Cased to M1' Depth of Grouting L4 -1 b -01 O Static Water Level Casing Height Above Ground 12-n� Electrical Wiring in Conduit �7y. N) _— SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot to '_-)%k Pump Set At Sanitary Seal on Casing &N) Depression Around Wellhead (Y63 tJ To Nearest Edge of Absorption Field on Lot �1I ; On Adjoining Lots lCDO '+ — On Adjoining Lots kbo\+- To Nearest Public Sewer Line f r To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Z� (� Water Sample Collected by5����5' '���ti� Date C) '�-CA D Water Sample Test Results �t�-�AcC�tb�� t�AT � �T�pfcrc S Comments B. SEPTIC/MOLDING TANK DATA Date Installed X87, Size _ASC>C) No. of Compartments -2- Standpipes Standpipes ON) _-*Air-tight Caps &N) y Foundation CleanoutON) N) Depression over Tank (Y& fJ Pumping/Maintenance Contact on File (Y/N) Holding Tank High -Water Alarm (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well �EDC>'A" To Building Foundation To Property Line 1 D �' _ To Disposal Field To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Oy �h Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 2-1151,' /69 - Type of System Design - Date Installed t o-'>���C) Length of Field 45 — Width of Field tQ� Depth of Field - L Gravel Bed Thickness Square Feet of Absortion Area , L oZ0`t' Statndpipes Presentl&N) Depression over Field (Y®) Date of Last Adequacy Test �E- Results of Last Adequacy Test N k SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well -p� To Property Line — u� To Building Foundation �� To - �Existing or Abandoned System on �s�� �i- Lot \ C> ; On Adjoining Lots — a To Water Main/Service Line _ �u, To Cutback (if present) I� To Stream, Pond, Lake, or Major Drainage Course bb0- - To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size lions "Pump On" Level at —'--- High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y Comments **Check Permitted Be I certify that I ha ch inspection. Signed Company ^ iei�1C� Date _ ' Eani MOA No. C C Dimensions Manhole/Access (Y/N) . "Pump Off' Level at Pumping Cycles during Adequacy Test. dating Against HAA Request** , verified, or confogMed to all MOA and HAA guideli 99577 /0 / 9111-21 � Receipt No. Date of Payment �G Amount: $ '47o 72-026 (Rev. 7/88) Back Receipt No. — Waiver Fee: $ — Date of Payment Page 2 of 2 UQ%qJ&Ce 6f1his lois �h ,ra.. Sfr,e{py , �, cF SFJ — 4Oc a s - �gA9 RATORFES CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET • ANCHORAGE, ALASKA 99518 • TELEPHONE (907) 562-2343 Client Sample ID:L1 SCHWINGER S/D PWSID :UA Collected OCT 3 90 @ 13:30 his. Received OCT 4 90 @ 13:45 his. Preserved with :AS REQUIRED FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SA16PLE for Work Order 4 27816 Date Report Printed: OCT 8 90 @ 16:44 Client Name S & S ENGINEERING Client Acct SNSENGP P.0.11 NONE RECEIVED Req 4 Ordered By : R. SHAFER Analysis Completed :OCT 5 90 Send Reports to: Laboratory Super i EN C. EDE 1)S & S ENGINEERING Released 8y ��x C' 0/ 2) Special Instruct: Chemlab Ref #: 904064 Lab Smpl ID: 1 Matrix: WATER Parameter Tested Allowable Result Units Method Limits --------------------------------------------------------------------------------------------------------------- NITRATE-N ND(0.10) mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE. Remarks: COLLECTED BY RAY. 1 Tests Performed See Special Instructions Above UA=Unavailable ND= None Detected See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than Oy.�NDFC�HOF Hr L L C° CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562.2343 ` 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM I.D.# I �� Analy s shows this Water SAMPLE to be: PRIVATE WATER SYSTEM LoG4- 2.O11� Satisfactory E)Unsatisfactory NamePhone No. S & S ENGINEERING ❑ Sample too long in transit; sample should fa� NWIL3blRbs o Mailing Ad des not be over 30 hours old at examination agsle River, Alaska 99977 to indicate reliable results. Please send _ new sample via special delivery mail. '/ p Date Received City Stale Zip Code SAMPLE DATE: E � 3 6 _—IOIT1/O _ Mo. Day Year Time Received 1345" SAMPLE TYPE: Analytical Method: Membrane Filter q5� Routine ❑ Check Sample (for routine sample with lab ret. no. _—_) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water No. of colonies/100 ml. SAMPLE Time Collected NO. LOCATION Collected By Lab Ref. No. Result` Analyst 2 L i -- - J 1 - 3 I _ I�-- —J LTJ��- 4 5 BACTERIOLOGICAL WATER ANALYSIS RECORD jr)\J J,) READ INSTRUCTIONS Membrane Filter. Direct Count Coliformfloo ml BEFORE Verification: LTB BGB_ COLLECTING SAMPLE Final Membrane Filter Results Coliformlioo ml Reported By Date _ /C) Time: ��1� a.m. p.m. TNTC = Too Numberous To Count PART ONE OF TWO To OB = Other Bacteria REMAINDER TI FOLLOW l Cyt'. 1 t. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH #t; A CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 R 11 / Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 40 731-oeX 11A .a eAJ;4e s/b /mu/ 5e5?__ff Location (address or directions) (b) Applicant Name Telephone. Home Business �..... .. , . - / � /� moi, Applicant Address S�'� �3ak Z'f�7 L'/%y1�//�' A9, FI3'�6 % (c) (d) Applicant is (check one)': Lending. Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); Lending Instifution ; Address 1 (e) Real Estate Compar Address _ Telephone (f) I . . 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual WellX 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 RM M 72-025 (11/84) �/_ I 5&1 01(76A: 5. ENGINEERING FIRM PROVIDi. A INSPECTIONS, TESTS, FILE SEARCH, D... A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone i Address %�r� l�' Sty/7� l3 /�m<<'ir� ,�.% 5' 'S Date -0:%NN %� OF A44 w lk dAIeAT.. Y • . i No. .......... t, ""66. 6. DHEP APPROVAL C,J Approved for -� bedrooms by e Approved IXI - Disapproved _ Conditional Terms of Conditional Approval 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 engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHORAGEiDEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 Q. 284-4720 J A N 2 Legal Description: z47-/ 01-z7/� A. WELL DATA Well Classificati4\_ 7'91VI� — If A, B, C, D.E,C Approved (Y/N) N Well Log Present ��N) _ Date Completed ��rw — Yieldr1 3. Total Depth Z O " Cased to _ Depth of Grouting _A4 44, Static Water Level n2 _eo3, iz _ Pump Set At — Casing Height Above Ground — I. 9 ;sanitary Seal on Casing(Y N) Electrical Wiring in Condui (Y N) —_. Depression Around Wellhead (Y(N Separation Distances from Well: To Septic/Holding Tank on Lot /'?�' ; On Adjoining Lots lU� To Nearest Edge of Absorption Field on/Lot —t—; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by A_e 5 Date Y6 Water Sample Test Results Ccmments 3'i la'__ `l�-b'y — B. SEPTIC/MOLDING TANK DATA Date Installed Size No. of Compartments _ StandpipesORN) Air -tight Caps(Y)N) Foundation Cleanout (Y N) Depression over Tank (YCN) — Date Last Pumped Pumping/Maintenance Contract on File (Y/N) x 1l ; for _ Holding Tank High -Water Alarm (Y/N) At/if Temporary Holding Tank Permit (Y/N) N 1� Separation Distances from Septic/Holding Tank: m / To Water -Supply Well -- / � To Building Foundation 00 To Property Line — /0 To Disposal Field To Water Main/Service Line Course Comments —_ Page 1 of 2 tl llr-lo_n99IA i Ian% To Stream, Pond, Lake, or Major Drainage / 5c//rv,v&/c C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata J'1 bR'yType of System Design 1r)ek��A/ Date Installed Length of Field /0- f Width of Field -3 Depth of Field z Gravel Bed Thickness G' Square Feet of Absorption Area�Lu-6 Standpipes Present (Y N) Depression over Field (Y6 Date of Last Adequacy Test Results of Last Adequacy Test_%fr%V4111'%'— jt:"Z' %}Ve%/�!_=3dr! f5 Separation Distance from Absorption Field: To Water -Supply Well _ % �Sc To Property Line i To Building Foundation To Existing or Abandoned System on i Lot On Adjoining Lots Y` To Water Main/Service Line //� To Cutbank (if present) 4)��� To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Ins 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) Cycles during Adequacy Test, Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hch cked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed 1 �- Date Company �MOA No.� Receipt No. 17 Date of Payment Amount: $ LE=A Page 2 of 2 72-026 (11/84) Seal CHEMICAL & G,JLOGICAL LABORATORIES r' ALASKA, INC. -" TELEPHONE (907) 5622343 5633 B Street - Anchorage, Alaska 99518 w°^�^°• Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM I.D.ft Analysis shows this Water SAMPLE to be: PRIVATE WATER SYSTEM / – Name /J Phone No. Mailing Address _ /& //h / -.1 City State Zip Code SAMPLE DATE: G i Z" -) G' Mo. Day Year SAMPLE TYPE: `K Routine ❑ Check Sample (for routine sample with lab ref. no. _ ) ❑ Treated Water ❑ Special Purpose 7H, Untreated Water SAMPLE Time Collected NO. LOCATION iy%/ k -1,J ct Collected B 1 2 _.- 3 G1 5 EAD INSTRUCTIONS BEFORE COLLECTING SAMPLE Satisfactory Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to Indicate reliable results. Please send new sample via special delivery mail. Date Received 1 0 d Time Received _I/ Analytical Method: Membrane Filter " No. of colonies/100 ml. Lab Ref. No. /3 Result" nim ni �N BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter. Direct Count Verification: L' BGB Collform1100ml Final Membrane Filter Results!. A ` Collform1100ml Reported By —/-52"j Date �) Time: _ Ov a.m. MUNICIPALITY OF ANCHORAGc p.m. DEPT. OF HEALTH & TNTC = Too Numberous To Count ENVIRONMENTAL PROTECTION OB = Other Bacteria 'ASI 2 21986 RECEIVE© ALASKA C-BOWnTAL COnTROL ser ,CCS, Inc. Engineerinq & Enuironmenlal Sludies OCT 30 1.9 84 RON SCHWIGER SR BOX 195 EAGLE RIVER AK 99577 SELLER — RON SCHWIGER BUYER — SUBDIVISION — SECTION 8 T15N R1W SM BLOCK — LOT — 167 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 1200 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 500 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. A FLOW TEST WAS PREFORMED ON THE WELL. 500 GALLONS OF WATER WAS PUMPED AT A RATE OF 3.8 GPM OVER A DURATION OF 4 HOURS. THE DRAWDOWN WAS 74.86' WITH A RECOVERY TIME OF 60 MINUTES AND THE STATIC WATER LEVEL WAS 63.12 FEET. THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1500 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. ;o Ar�C. Retd, Jr. �•#. No. 2251•!: � ua wj E8S10�Yt-e MUNICIPALITY OF ANC OPAG2 DEPT. OF HEALTH h ENVIRONMENTAL PROTECHON RECEIVED 1200 West 33rd Auenue, Suite B 9 Anchorage. Alaska 99503 • (907) 561-5040 _kI01 CCl ') lrLA It Time APPLICA,NT FILLS OUT UPPER HX - ONLY Time Property Owner 'S A Phone Mainng AddressAl Ar Z)(/l, Zip Code Buyer Address Zip Code Date Lending Institutiodj Phone Address e-1 6< r Zip Code Realty Co. & Agent Phone Address Zip Code Inspector Legal Description Al IZ-�— 1� A-1 Street Location Inspecto Type of Residence 'EJ Single Family Field Notes: D Multiple Family No. of Bedrooms - Cl Other Water Supply ENVY: 11 1 A. -0 l (q Individual 11 Community 0�) h1I11,1AATTACH WELL LOG. A well log is required for all wells drilled since June 1976. El Public Utility For wells drilled prior to that date, give well depth (attach log if available). Sewer Disposal (6 APPROVED BEDROOMS f Ii CONDITIONS P4 Individual Year Individual Installed: DISAPPROVED El Public Utility When Connected to Public Utility: CONDITIONAL APPROVAL' [I Holding Tank DATE NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. BY: _kI01 CCl ') lrLA It Time Time Time Time C—Ij- Date Date Date Date n Inspector Inspector Inspector Inspecto Field Notes: MUNICIPALITY OF ANCHORAGE ENVY: 11 1 A. -0 l RV REC E IV ED (6 APPROVED BEDROOMS f Ii CONDITIONS OF.APPROVAL DISAPPROVED CONDITIONAL APPROVAL' DATE BY: Soils Rating Dale Sewer Installed Well To Absorption Area Well Log Received 70 Aqq -1-1 e Well to Tank Septic Tank Size X11— 01 4VA CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of—AQ L 0 C U W T i L�✓ R IN i23 �_1 F4 C199 01-/1SS'�public water system located in l N-Lj C 1 _ Alaska, submitted in accordance with 18 AAC 80.100 byke� i F' Y have been reviewed and are 4K approved. conditionally approved (see attached conditions). LE DA E If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contract order no. Approved by Date or descriptive reference) The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE / The construction of the 4'r I�'J Ac_ W T public water system was completed on U �� y�_ __(date). The system is hereby granted interim approval to operate for 90 days following the cpmpletion date. or TITLE DATE As -built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval t operat . BY TITLE DATE DIVmON E IRO mL mTN 1..Ceneral Information Application Date (a) Legal Description (include lot, block, subdivision, section, to.ship, ra~e) Location (address or directions) (b) Applicants Name~°~n ~'Az~J¢¢qFg~. Telephone - Home Applicants Address_~'~ (c) Applicant is (check one) Lending Institution Buyer ~ , Other ~ (explain); · (d) Lending eustness ~--~; 0wner/builder..~.; Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single-Family..~T~. Number of Bedrooms 3. ~ater Supply Individual ~ell..~.. de Multi-Famlly~ 3 Other (describe) CommunityF-~ Public~-~ 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, mus: have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] .6. En~ineerin~ Fir~ Providin~ Inspections~ Tests~ File Search~ Data and Inforaatio, ~. As certified by my seal affixed hereto and as of the validation date sho~u belov, I~ verify that my investigation of this Health Authority Approval aho~s that the rater supply and/or ~ste~ater disposal system is safe, f~ctioud a~ Meq~te for the number of bedrooms and type of structure idicatd herein. I further verify t~t, ~'~ based on the iulomatiou obtain~ from the ~nicipality of ~chorage files aM from ~ investigation ~d inspection, the orsite ~ter supply aM/or ~stevater dis~aal system Is in compliance ~th ~1 ~nicipal a~ State c~es, ordinances, aM reg~a- tious in effect on the date of this inspection. Address · DEEP A rovaI . .. Te~s o[ ~Mltlon~ Approval · I CAUTION THE MUNICIPALITY OF ANCHORAGE I~PAETMENT OF HEALTH AND ENViR0~{ENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIO~L ENGXh~ER REGISTERED IN THE STATE OF ALASKA, THE DHEP DOES THL$ A~ A COURTESY TO PURCHASERS OF EOHES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE RE(~UIRE- HENTS, ~.tPLOTEES OF IYJEP DO NOT CO~DUCT INSPECTION~ OR ANALYZE DATA BEFORE A CERTIFICATE I$ ISSUED, THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OK OMISSION~ IN THE PROFESSIONAL ENGINEER'S WORK, (DHEP SEAL) RR//eJ/D18 [Page 2 of 2] 7-19-84 ALASKA [IUIROI ITI I TAL cOrlTROL S Ru C S, J~nqinttrin~I ~ J~n~ironm~nlol Slu~Jie$ InC. OCT $0 1984 RON ~h~IGER 5R BOX 195 EAGLE RIVER AK 99577 SELLER - RON 5CI'IWIGER BUYER - SUBDIVISION - SECTION 8 TISN RIE 5M BLOCK - LOT - 167 ADEQUACY TEST FOR 5EFER SYSTEM THE TYPE OF Iq850RPTION SYSTEM I5 iq TRENCH WITH AN AREA OF 1200 5~FT. THE SYSTEM IS CAPIqBLE OF ACCEPTING 450 GIqLLONS OF FATER PER DiqY. THE SURGE CAPACITY OF THE SYSTEM I5 500 GALLONS. BASED UPON THE TEST DATIq THE SYSTEM I5 ACCEPTIqSLE FOR A 3 BEDROOM HOHE. iq FLOW TEST FAS PREFORMZD ON THE IkELL. 500 GALLON5 OF EATER WA5 PUI~PED iqT iq RATE OF 3.8 GPM OVER A DURATION OF 4 HOtlRS. TIlE DRAWDOifN WA5 74.8¢' WITH iq RECOVERY TIldE OF 60 MINUTE5 AI~ TIlE 5TIqTIC WATER LEVEL IfA5 63.12 FEET. TIlE ~,ELL I5 ADEfUIqTE FOR THIS 3 BEDROOM HOVE. SEPTIC Tiql~K ADEGJACY THE EXISTING SEPTIC TIqNK VOLUIvE OF 1500 I5 ADE~JUATE FOR THIS 3 BEDROOM HOUSE. 1200 Wts! 33rOI [~ucnut. Suilt Be ~ncJ~oro9¢. /~lasEe 99503.[907) 561-5040 A® MUNICIPALITY OF ~gCHORAGE (MOA) HFALTH AUIT~ORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 ' ] E . ,. C.' H~.~LTH & RECEIVED Legal Description Well Classification.~'~-~_ If A, B, cr C, D.E.C. Approved(Y/N) Well Log lhzesent ~N) Date O:mpleted S[2~/~.) Yield Total Depth __~D3)-~ Cased to, 171' . Depth of Grcuting/w,,?~Z/ Static Water [s~l _/~ ~" Pump Set At ,~0'~ ~'~. ~ c[[ ['~.7' ' Casing Height Above Ground ~,9" Sanitary Sea[ on Casing' ~N) Separation Distances ~J~cm Nell.' To Septic/Holdir~3 Tank on Lot /A~_./ ~'~ '~ '" ; On Adjoining Lots ~ om/ To Nearest~ Edge of Absorption Field off Lot ~') ; On Adjoining Lots~/ ;') To Nearest Public Se~ Line ~/~ To Nearest Public Sewer Cleanout/Manhole' m//~_ To Nearest Sewer Servioe .Lihe on LOt Water Sample'Collected By' / ~1 ; Date /0/~'~/~-V wate S le sults _CJ, H. SEPTIC/HOLDING TANK E~TA Date Installed ~/~/~z. Size /~-~) No. of Compartments ?-- Standpipes ~/N) Ai=-tight Caps p/N) Fcundation Cleanout ~/N) Depression o,~r Tank (Y~ Date Last Pumped i-~.O-?~ PumpiP~3/Maintemmnce Co~tract on File (Y/N)~)~- ; fez A;f~ Holding Tank High-Wate~ Alarm (Y/N) A)[f% Temporary Holding Tank Permit (Y/N}4~/;~ Separation Distances from Septic/~olding TaP~k: To Water-Supply W~ll /~,~ To Property Line .~&.~'~ To Water Mair/Se~vine ~ine Course t4/A . .:. To Building Foundation ~7' '') To Disposal Field /~.~' / TO Stz-eam, Pond, Lake, cr Major Drainage Receipt # Date Paid: Amount: [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD E~TA Soils Ratirg in Absorption Strata Date Irmtalled ~/2/$ ~ Width of Field "..~- '/ Square Feet of Absorption Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present ~'~/N) Depression over Field (Y/~ Date of Last Adequacy Test Results of Last Adequacy Test - - Field.- Separation Distance from Absor~ ' To Water-Supply Well -. ;~+ I.) To Prcperty Line To Building Fcundation 92' ~') To Existing or Abandoned System on Lot ~;~ ; On Adjoining Lot~ To Water Main/Servioe Lir~ A;~ To CutbarR(if present) To Stream/Pond/Lake/or Major DrainaGe Course >iDG~ To Driveway, Parking Area, or Vehicle StoraGe A~ea ~ ~ ~°) · D. LIFt STATION Date Irstalled Size in Gallc~ "P~,~ On" Level at High Water Alarm Level at ~/~ Tested for ~/~ Electrical Codes(Y/N) C~.ts Dime ns ic~,s Mar~ole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. M~ets ~DA ** Check Permitted Bedroom Rating ~gairmt F.~A Bequest I certify that I have checked, verified, or ccnfc~.,,~d to all MOA HAA Guidelines in effect on the date cf this ir~pection. KB1/d5./s [PaGe 2 of 21 2-15-$4