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0 & E GEOT -4-,HNI CAL & DE.VELC (VIENi CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Earl Ellis
688-2280
Russell Oyster SOIL. LOG
694-2774 Land Development
Soils Et Foundations
Tel . No
Performed for: Name: �-
Mailing Address:
Legal Description:
UBS��
Death feet)Soil Cha ac eristic
1-Z
1 ®e
3
5
"\cl�-vL- i�Ov -P' CRS r
6_ —
— �
7_
� �y �L � � ,�s �
W
to _
15
16
Ground Water Encountered: YesR y_ No.,,.,—
If yes, what depth_.—
Proposed Installation: Seepage Pit _ Drain Field_
Comments:
Performed by:
Date:— 7
47
leg
J
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date MaAch 27 7999
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
197
(b) Property Owner A
N E. Q. Telephone: Home 5�1-1900
Mailing Address 520 34�h Av�rhonaav_.h
(c) Lending Institution
Telephone
Business
Mailing Address
Roma470U7�h�
(d) Real Estate Company and Agent Re/Max Q4 Ea p2e R�veat A2
Address 16600 C .n end 11h #221 Eaa2e R���on APgf39577
Telephone
(e) Mail the HAA to the following address: or: Check here IN, if hold for pick up.
List contact person and day phone number below.
2. TYPE OF RESIDENCE
Single -Family 91
Number of Bedrooms Thu -0-
3. WATER SUPPLY
Individual Well ❑ Community ❑ Public C
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 CY 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.
72-025 (Rev 8/86) Froni
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 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 S & S ENGINEERING
TyU3a o Telephone rip %�� ?19e2-5;_
Address Eagle River Alaska 99577
Date
.� OF A
.. O
��9 •rU A1•r.r (pl l`.r MlPl or
m4 A. M10"ar a`
3 3sAR� SS JON
6. DHHS APPROVAL
Approved for _. ._ bedrooms by �Eov Ste• Date
Approved Disapproved
Conditional
Terms of Conditional Approval
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
certificates based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in
order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data
before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
Page 2 of 2
72-025 (Rev 8/861 Back
`c
dpQO�\SvpCv
OF P�\L�5
A. WELL ®ATA
), e_o d �' -7 C �f
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4744
Legal Descrip on:
Well Classification — AS — If A, B, C, D.E.C. Approved N) —
Well Log Present (Y/N) ---
Date Completed Yield
Total Depth __ Cased to � Depth of Grouting —
Static Water Level Pump Set At
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well: i
Id Tank on Lot
200
Sanitary Seal on Casing (Y/N) .—
Depression Around Wellhead (Y/N)
On Adjoining Lots
To Septic/Ho
IA;
To Nearest Edge of Absorption Field on Lot '7—�'�\ On Adjoining Lots
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
B. SEPTIC/RDV&M 0 TANK DATA
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
Date Installed
e5 �Size
– 437i � �� No. of Compartments X21
"
Standpipes (7N) .. �Air-tight CapsVN) �� -- Foundation CleanoutV/N) —
Depression over Tank (Y/ ---
�— Date Last Pumped
d�
;for— �—
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/HeJEJ+RgTank:
To Water -Supply Well 12__Od ( To Building Foundation
To Property Line --- o I To Disposal Field —
To Water Main/Service Line —
Course pp
Comments ��S
Page 1 of 2
72-026 (Rev 9 86) F,onl
�I
77
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata �2—� �
— —�—�� Type of System Design /e� I") IG L c:�
Date Installed 1
Length of Field
Width of Field f Depth of Field
t
Gravel Bed Thickness _�D . O
Square Feet of Absorption Area
— Standpipes Present®N)
Depression over Field (Y(gP
Date of Last Adequacy Test
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well I
To Property Line __ \C:�)
To Building Foundation
Lot
To Water Main/Service Line ti C�,
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION I�
Da talled
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
To Existing or Abandoned System on
On Adjoining Lots t fv
To Cutbank (if present)
�/
\ t�C> I -I-
' 'I
— 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 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed G Date — T 2- /C—
Compari)7030Eagle River Loop Re-Ld ?,;,.MOA No. er% -—e?
Eagle River, Alaska 995_7
Receipt No.
Date of Payment 3
Amount: $
Page 2 of 2
72-026 (Rev 8186) Back
E E=n i er' ea
i
mul,11cIpr1_IT,Y o1 nI1c11OIi A(.l
�F ji±:.111 i do t 11vlr.or1,11 iai iF�oi!�crl� ;
825
Irl _
i_inc :.
Ij ].: 'I• ince 10:30 a._m,___
t -e'- Da L.c
Date 11-23-77 Wednesday'
--- - -- - -
ins
Irl 5p Pratt ----- J.-)
— ----------
1� oi: APPI;OVAI, 01' IN I'�I:i:;�iJAI, S13taT3T� 7 `7D T�'�1'CEB FACT III'
1. T,e:nc'.i.ng IrYst:i Lut _on request: United BAnk Alaska
645 G Street 99501
276-1911
t•1c).:i_1i_n{; Ad�]z_-c-ass: 1�Pioi,c: _______-____.______ _.
Phone: 694 283'1.___
2. Pr.ope,-ty Oe:nc":: __Z&_W General. Contractors--..-..--..-..----
P1a.i.]_i.i1cJ Address: Post_Offic,e_,_Box
3 . I,cx1 , l Lic:.cr_ :i.lrt:i.on : Lo_tl9 _Schroeder_Subd:i.vi.s_ion------
4: f;:i.ng_lc >',.unl].y { c s .dc,nc:c�: xl
Number of Reurooms: Thre
{Number
of Re�1room°�
iu].c,ple ��cim_ly lzc�sitle,icc � -- ------ ---
c
i�f• - onimun i-I-y/{)ul_)1 Lc ;ysi_em
5. WeJ.L Systems Tnd:i_viclu<zl. l.l (x) - - c'.
Pcrill i.t ;I
Depth of Gie]._i. 71' dela :C,ocJ on 1'.i_Le �)
Cons{ --ruction
6. Sc:wage D . sposa 1. System: CJn- s i Le f>Yst�zn (x)
u Inslall.c d 1977Septic
P:i r'I, C
a n x _-.. --- —
Sc:)i_]_S Ra Le Matey _a].
/Absorption Aria - — - -
-------------------
C )Opt-i.c ':Canbt------- to Absorption A)--(za ----
I . Distances : ^1elJ_ t.o .__--
Al)sorlAion Area
to sewer Linc, Nc�� rc:�{_ i�oL ].r_n� ------ -----
to Nearest .1_,ot I,:i nc'_ .._---------
Pa9o'�w» U zLmcut of Hca)th au� �uv�zoomcutal pcoLe�tioo
npa d W tec yuciI�ti
Rmquost fnc 8Byroa
vl or. Io8iviaual Sewc� zu n � cc
�
�ogaI Dexoxiptzon� L l � ____'-_�_____---.__�-__-
--`~`---~- ----
J
2
3.
4
5
6
MUNICIPALITY OF ANCHORAG
llcpar- tm�:I t (:f. heal th and L;nvironniental PLoi=ec Lion
1325 L str.-est., Anchorage, Alaska 99501
264i-4720
h
Jzc,cluest for Approval of Individual- scorer '131, C7li.e;r l aci_li_t _cs
MEjil ncl Address: Q. �O Phone:
Name of Buyer :------
--- ------ --
Mai ling Addre Phone:
s s .
pending InsL_i-tution:
Ma linq Address: _----------- ---
Real Lor/ Agc:i'c: --- A)c/%
Phone.: Z%6 -/9//
Addr- - Phone
J_
la -ng ess: - --- -----
1,ega1. Descr_.�_pzron: _--__-----
;;tree:: Location:
.>:L n�IlC 1''d illllj' ti E' -S 1C1en Ce.: utll❑ber Of BeCI )"OOIi1S: -
1,1uJt-ple family Residence: ( ) numbs-„- of Becirnoms:
7. l�ater suphl-I: * Individual Well (�) �Publ_-c/comnn.rlity system ( )
f Ind_ -victual ngoI-1, we' L depth - -T
if Community system, name of system
c s' stem: �Un-Sa_1,e ;jVStClil ( ) Public
8, �cwacte Disposal �1
7_f On--siL' system, date of installat- o;1:..�----------_---------
*NOTE: A �%reJ J lcg i_s requ ircd on AL1 weJ l:; driJ-led. since 6/7>.
"ft on-site sewer system is over Cwo(2) years old, an adequacy
csL is-r-equired by t is dc,parLment.
Les of $25.00 must ,accomt cIny c�� sh request before procc ssiny
can be in iti.ated.
3/'77