HomeMy WebLinkAboutSCHROEDER EAST BLK 6 LT 3ASchroeder
East
Block 6
Lot 3A
#050-071-31
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "U" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
HG�� Sir t.i S c,-4 L oai✓ DISTANCES
Address TO ',SEPFI€E!.!�l�4 ABS$ PTION
FROM TANK FIE WELL
0 0 7`•s l /sem „� Sr: /✓,>; �s �9� ��
Pno�(s) Permit No. WELL ✓,7 (J 7
No. of Betlrooms .p ���
LEGAL DESCRIPTION LOT LINE
Lot Block Subdivision /✓o. j
3 Ec Arlo f Itc EAr7 41.6" FOUNDATION &
"township, Range, Section
T-1 /-/ /1% P ,:z 4—;e_ AS-BUILT DIAGRAM (Show location of wen, septic system, property lines, foundation,
' driveway, water bodies, etc.) TJ
TANK
S
❑ SEPTIC HOLDING — \
Manufaclurer Capacity in gallons
P aat;,2
Material No. of Compartments
TYPE OF SYSTEM
❑ TR1,1CH ❑ BED ❑ W. DRAIN OTHER
Depth topipe ltom from Total depth from original grade
original grade
FT FT
Fill added above origi I grade Gravel depth beneath ppe i, fn' p
FT FT
Gravel length Gravel width _ � e„ Y
r Arn m
FT FT P. Mp 44-
Total absorption area Distance between lines
FT FT
Number of lines Soil rating Pipe material
SO FT
Installer Dal Installed
WELLS
1,2L PRIVATE ❑ OTHER (Identity)
Classification (A, B,C) Total Depth Cased to
FT FT
Installer Dale Installed:
REMARKS:
Scale: eENL"�ten`�$et,p{�
Inspections Performed by: -�
F�gln kivnr fnQinaarin��Serviraa /� � -".ro ���'
Date: P. 0, Box 773294 `
Eagle River, AK 99577 0
/0/1`+ISk 694-5195 ar ` rt1a
certify that this inspection was perlormed according to all s � —
ri.. rl` .r r..
Municipal and Slate guidelinesLou ,�,n
in ellect an this dale: l�' r
,i
Health Dep
S f'. % °.
J
i
Approval: aliment A Date: r " ,r f ` ,� psi \
72-013(3/85)
PERMIT NUMBER
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MISCL. INFORMATION: to i/ r
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DRILLERSNAME �� �J
i
T`o 1-79
MUNICIPALITY OF ANCHORAGE
Department
Of Health & Human Services
825 L Street, Anchorage, Alaska 99501 343-4720
OLDIN8 TANK PERMIT
Permit Number: 880059 Upgrade
Date Issued: 05/26/88
Owner Name: HOME SAVINGS & LOAN
Owner Address: 1001 E. BENSON BLVD, Day Phone:
ANCHORAGE� AK qq508 276-1451
Parc071~28
Lot Legal: Bubdivision: S[IAUOEDER �AST Lot: 3 Block: ��
Section: 1 Township: 14N Range: 2W
Lot gize 28651 (sq"�t. or acres)
Max Bedrooms: This Permit: 3 Total Capacity: 3
HOLDING TANK: Minimum Tank Size: 2,000 gall�ns A high water l
installed on the tank and conn�ct�d to 1he res^deDce D�pth ta a'm must be
zank ( 4"0 �eet requires insulation �ver tank'^ " o zop of holding
ABANDON EXISTIN8 SEPTIC TANK
I CERTIFY THAT:
�amiliar with the requirements �or on�site sewers and ll
2 �orth by the Municipality o[ Anchorage (MOA> and th� 8tate we As as set
. 1 will install the syst�m in Accordance with all MDA codes o�d
th1aska"
3 and in compliance with e design �riteria o� this per0it an regulations,
" Iiwi�llcadhere to all MOA and Statg of Alaska require0ents"�oP the set back
u �m// �F.� /rom any existing own llo waS,tewatter disposal system or publi
4 sewer�ge system on this or, any adjacent or nearby lot c
. 1 undepstand that this permit is valid f�r a m�ximum "� 3 b d
also understand that the �apacity of the total systemois 3 ee'ooms" I
any enlargement wil1 repuire an additional permit. o orooms and
Signed:
.�5_�����=��-���.�-+����
(Owner) HOME SAVINGS & LOAN
Issued 8y:
_ �' DATE:
�..... .... . ....~�
SPECIFICATIONS FOR ON-SITE HOLDING TANK SYSTEM
LEGAL: LOT 3 , BLOCK 6 , Schroeder East Addn.
A. GENERAL
1. The drawing and or site plan shall be a part of this specification.
2. All materials and workmanship shall meet the Anchorage Department of
Health and State Department Of Environmental Conservation requirement
3. It is the responsibility of the owner to obtain all necessary permits
or easements and to locate any adjacent multi -family wells.
4. The excavation is to be exactly in the area shown on the site plan,
any deviation requires engineer approval.
5. It is always recommended that a surveyor locate the nearest lot line
position and the location of any easements.
B. HOLDING TANK
1. Holding tank is to be accessible to pumping vehicles.
2. The tank is to be a tank that is approved by the Municipality of
Anchorage with corrosion prevention standard, for septic tank as per,
Uniform Plumbing code.
3. A holding tank must have a four (4) inch diameter standpipe with an
airtight cap to provide pumping access. The standpipe must extend at
least twelve (12) inches above the surface of the ground.
4. A holding tank must. have a watertight manhole to provide access to the
interior of the tank. The manhole must, be at lease twenty (20) inches
in diameter.
5. A holding tank must be equipped I,ith a high water alarm which
regia -tern both visualland audibly inside the dwelling. The alarm
must be positioned to allow at least. three hundred (300) gallons per
bedroom of additional storage after the alarm has been activated.
G. 2000 gallon holding tank is to replace existing 1000 gallon septic
t.anl
7. Alarm and wiring to be to Municipality of Anchorage code by licensed
electrician.
]"(,drooni Capacity _
Holdiiw Tank Size =2000 gal.
EAGLE RAVER ENGINEERING SERVICE
AkLou Butern, P.E.
P.O. Box 7737,94
Engle River, Alaska 99577
Teleplione (907) 694-5795
May 24, 1988
Mr. Dan Bowles
Civil Engineer, On-site Services
Municipality of Anchorage
Department of Health & Human Svcs,
825 "L" Street
Anchorage, AI{ 99,502
REF: Lot 3, Block 6 Schroeder East Addn,
Dear Mr. Bowles:
Ori behalf of my client, Home Savings and Loan, I am submitting a
.request for approval, of a holding tank per for the 3 bedroom
residence located on the above referenced lot.
The home -Located on this lot was designated and permitted to be
served by an on site sewer system. 'Phis was found to be impassible as
the septic system could not be located ort the lot due to the location
of a Class "C" well on the adjacent property and the existence of
impermeable soil. and high ground water table on the remainder of the
lot (see site plan).
It was suggested in a letter dated 8/14/88 from Dan Bowles, that
a Rid -Waste or similar treatment plant be installed so the treated
waste could enter the ground at a point of 100' from the existing
Class "C" well, In a conversation with Susan Oswalt and from my own
knowledge of the situation, I would not recommend an alternative waste
treatment plant at this time, I do not want to subject my client to
the expense of a treatment package that is not proven, and it is my
understanding that a similar Rid -Waste system has not met M.O.A.
testing requirements for was treatment. I also doubt the State
D.F.C. would grant a discharge permit at this time. As my client has a
3 bedroom home existing on this lot, it :is our intention to provide an
adequate and safe means of waste disposal, A holding tank is a safe
and adequate solution that. is ,justified by Ordinance 15,65.090 Section
A.2 as a remedial measure. One positive aspect of this installation is
that the lot wi.11 not be far from a publ-ic sewer lateral, and we
expect that sealer expansion may be accomplished as the economic
climate improves.
If there are any questions or if any additional, information is
required, please Peel free to contact me at 694-5195,
Sincerely,
Loui.s Butera, p,E,
PRI
II AI - - • • -. I
SPRINGBRIJUK DR.
WELL AND SEPTIC SITE PLAN
LEGAL; L❑T 3, BLK 6, SCHR❑EDER EAST ADDNI
OWNER+ HOME SAVINGS AND LOAN
CONTRACTOR; MIKE UHER
EAGLE RIVER ENGINEERING SERVICES
P❑ BX 773294
EAGLE RIVER, AK. 99577
694-5195
F75'
EASEMENT -------
EXISTING LEACH FIELD+
HOLDING "PANIC
CLEANOUT --
SCALE, V = 50'
ANG^ORA(3E. 4':_,A5KA
DEPARTMENT OF HEALTH & HUMAN SERVICES
January 10, 1986
TO: Permit Applicant
Subject: Permit # 850713
Lot 3 Block 6 Schroeder East Subdivision
A permit issued by this Department for an individual well and/or on-site
sewer system has expired as of December 31, 1985.
Permits are issued on a calendar year basis by authority of Municipal
Ordinance. A new permit must be obtained from this Department for any
well and/or on-site sewer system not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to this
Department- for documentation of the installation and to close the permit.
If a private engineer inspected the installation of the on-site sewer system
the original as -built inspection report(three part form) must be sent to
this office for review and approval,and for documentation.
If there are any further questions, please call this office at 264-4720.
Sincerely,
Susan E. Oswalt
Program Manager
On-site Services
SEO/ljw
enc: Copy of Permit
PERMIT NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT PHONE:
H -I I J p " 0 X 1:1 3: H", act 0 .. X - V . "V Up 1=7 All ]I 11, 111[ �Al ll� JEHY,�
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, Al". 99501
264 '4720
850713
11/07/85
BOB DEAN
P.O" BOX 671473
CHUGIAK, A 99567
688~5177
LEGAL DESCRIP: SUBDIVISION, gCHROEDER EAST ADD LOT: 3
SECTION: 1 TOWNSHIP: 14N RANGE:'2W
LOT SIZE: 45000 (SQ"FT" OR (-CR�S)
MAX BEDROOMS: 3
Listed
below are
the nptions available to
system.
Choose
the option that best �its
.... �... ��~�����
DEPTH
TO PIPE BOTTOM
(F -1 3.5 **
GRAVEL
DEPTH (F t.
0"5
TOTAL
DEPTH (FT.
4"0
GRAVEL
WIDTH (FT")
19.O
GRAVEL
LENGTH (Fl.)
36.0
GRAVEL
VOLUME (CU"
YDS.) 25"4
TANK SIZE
(GALS)
1,00O"0 **
SOIL RATING
(SQ"FT^/BR)
15O
BLOCK� 6
you in designing your septic
your site"
** DEPTH TO PIPE BOTTOM < 4"0 FT" MAY REQUIRE A LIFT STATION
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS '
I certi�y that:
1" I am familiar with the requirements for on~site sewers and wells as set
[orth by the Municipality u Anchorage (MOA) and the Gtate of' Alaska"
2. I will install the system in ac: cnrdance with all MOA codes and regulations,
and in compliance with the design criteria othis permit"
3. I will adhere to all MOA and State Of Alaska requirements 4'0r the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot"
4" I understand that this permit is valid for a maximum of ON bedrooms and
any will require an addiLio1101 permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BJILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINEDTS
WlLL NOT PW111MUT M ELECTRICAL AND (3) THE
EiEC e-,, LICENSED ELECTRICIAN,
SIGNED DATE:
......... �....... ...
^_��_
APPLD�ANT:/��O8 DEAN
� p
ISSUED BY y), DATE:
August !A, 1986
Mr, Bob Dean
SR Boy 9352
Eagle River, Alaska. 99577
.1
Subject: Lot 3 Block 6 Schroeder Past Subdivision
Deal. Mr, Dean:
This letter is to confirm our understanding following the conversation
between you, Mr, Robinson and myself on Monday, August 11, 1986
At present the septic system installed on Lot 3 Block 6 Schroeder East
Subdivision is in vioiation of State separation requirements co a Class
C well and various portions of Anchorage Municipal Code 15,65, As
explained by Ir. Robinson, the only solution available at this time
is the installation of an on-site disposal system With effluent of
suitable quality to be discharged into the ground water, With your
permission, two companies handling these systems, have been notified
and should be in contact with you shortly.
As was also e plai_ned, it will be up to you to obtain the se vices of
registered civil engineer to design the disposal system and to ensure
r
separation requirementsL_1=rOID neighboring wells. Once your engineer has
completed his assessment, please call Mr, Robinson at 264-4744. Our
office wishes to work with you to ensure the timely complet _on of this
project. Thank you for your cooperation.
Sincerely,
Dan Bolles
Engineering Tech TIT
DB/ijw
®� pt1 •i..�. :' 1
00 9e$3o ooeo aaa caxu�Da cc�oo so 0
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650 john John R.CC 6922
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: /–o�S 'D�/y �9�"• 911_7 DATE PERFORMED:
Sc�jror% Sulz! / LSi�A</�y/.
LEGAL DESCRIPTION: Z% Township, Range, Section: Sz=e %/ �'2{j/ 6W
�-.—� SLOPE SITE PLAN
(FEET) ,81cpevAl .�J e F,—vv Ile -
1144. 5/G
2 / �rOL(fw`ANO/f
3 GL/a/5f �/ea/lGCsa 5�/7<f
a
5
5*vo
�� 5P
6 G/fz/ / /N-epidffy/
G/Piyl/SG
7
8
0
10 WAS GROUND WATER Nar l�v�ivE
/ ENCOUNTERED?
�a/1.4 y �i1oa,� �Bx) �rcrlllst7lvi� s
a �� $x Moisf 9.�/y_IFY H, ?AT WHATAk4hrWA� DEP
P
12sGu//P- iy/Eg�v eEo /0//9/�� ¢/a/r.! E
�TTpM of .�if�+fWN Oepth to Water Atter
13 71-o/✓ 6 /Z s' Monitoring? // -�— oalo;
14 - 2
15
16
17
18
19
20
/2/->
Inc
00 -Cm- Mg. MORRIS MEN
m mm
m■■■or.■mz.
=wj� Ir"Itsalaymm.r Ili
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND f�FT
COMMENTS y/¢�/%Ul7 O/� 5%� /5 !$O �0 74' 4Le&.�AAI iy��ilvrlGf� C(l�Pq r
PERFORMED BY: � E= s��y�� ' ` C� )t �5 CERTIFY THAT THIS TEST WAS PERFORMED IN
G/7-75 /4�z�1�5
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: _
72-008 (Rev. 4/85)
Jr.'s Cesspool Pumping
16718 Mercy Drive
Eagle River, Alaska 99577
October 21, 1988
To Whom it may concern,
Jr.'s Pumping is interested and willing to contract
with the bank or owner of LOT 3/BLOCK 6 Schroder East
Subdivision to service the 2,000 gallon holding tank on
an as needed basis.
Sincerely,
Barba a J.
Gibbs
Manager/Jr.'s
Pumping
MUNICIPALITY OF ANCHORAGE
DEPT. OF H' LFy &
ENVIROTibA--NIAL PROIECTION
i-88
[
'EC HSIE®
Municipality of Anchorage
C Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650 /
Anchorage, AK 99519-6650 L�
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
/Lc�,
FOR A SINGLE FAMILY DWELLING
Parcell.D. 050-07 S/ COSA# NO8
1. GENERAL INFORMATION Expiration Date: /Q—/ -7—Q,9
Complete legal description SCHROEDER EAST, LOT 3A. BLOCK 6
Location (site address) 12436 SPRING BROOK DRIVE • EAGLE RNER. AK 99577
Current Property owner(s) JOHN AUGUSTINE Day phone
Mailing address
Lending agency
Mailing address
351-1705
12436 SPRING BROOK DRIVE • EAGLE RIVER, AK 99577
Day phone
Real Estate Agent SANDRA NUNES w/PRUDNETIAL JACK WHITE Day phone 242-0863
Mailing address 3801 CENTERPOINT DRIVE 41200 • ANCHORAGE. AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
❑
Individual Water Storage
❑
Individual Holding tank
e
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
5.
As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LfD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the fest, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the wafer usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory lost
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confor any legal right whatsoever.
Conditional approval for
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
L/
Phone 337-6179
Date i 3 log
bedrooms, with the flowing stipulations:
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
WASTEWATER
By:Ao� Original Certificate Date: % ' J 7" 0-6
(R" 11105)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: SCHROEDER EAST, LOT 3A, BLOCK 6 Parcel ID: CrEO — O % 1 – 3 1
A. WELL DATA
Well type PRNATE If A, B, or C provide PWSID# N/A
Well Log (Y/N) YES
Date completed 1/1986 Sanitary seal (Y/N) YES
Wires properly protected (Y/N) YES
Total depth 184 ft. Cased to 24 ft.
Casing height (above ground) 18 in.
(BEDROCK)
FROM WELL LOG
AT INSPECTION
Date of test 1/1986
6/13/2008
Static water level 100 ft,
26 ft,
Well production 2 g,p,m,
1.5 —g -P.M.
WATER SAMPLE RESULTS:
Coliform _0 colonies/100 ml. Nitrate _ NO mg./L.
Other bacteria_0 colonies/100 ml.
Arsenic: �Nr) ug./L. Date of sample: 6/6/2008 Collected by: GEG Ltd.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material HOLDING/STEEL
Date installed 10/19/88
Tank size 2000 gal Number of Compartments 1
Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
High water alarm (Y/N) YES
Date of pumping 5/29/2008 Pumper
JR'S PUMPING
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft'or ft=/bdrm)_
System type
Length ft. Width ft
el below pipe ft.
Total depth ft. Eff. absorption area_ ft' M ng tube_ Depression over field
Date of adequacy test u is (Pass/Fail)
For bedrooms
Fluid 'depth in absorption fief re test_ in. Water added _gal New depth _in.
Elapsed Tim _ min. Final fluid depth_ In.
rejuvenation treatment (past 12 mo.) (Y/N & type)
Absorption rate >= g.p.d.
If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump ofP I High water alarm level at
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A On adjacent lots 100'+
Absorption field on lot N/A
Public sewer main N/A
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line
10'+ Surface water ;&1-� f OU f !f d
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Water service line
F. COMMENTS
Building foundation
Wells on adjacent lots
Driveway, parking/vehicle storage
G. ENGINEER'S CERTIFICATION ,.":•-
I certify that I have determined through field inspections and p` e 4❑ Y�
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this ....
date.*Gorne s,:
Engineer's Printed Name JEFFREY A. GARNESS p044 f •. / CE-
Date y 0 �Professlon oo
COSA Fee c Ow,
Date of Payment 14'0 g
Receipt Number
(Rev. f 1105)
Waiver Fee
Date of Payment
Receipt Number
SG9
SGS Reta
1082501001
Client Name
Gamcss Engineering Group, Ltd.
Project Name/M
Schroeder East B6 L3A
Client Sample ID
Schroeder East B6 L3A
Matrix
Drinking Water
PM{'SID
0
Sample Remarks
All Datesfrimes arc Alaska Standard Time
Printed Date/Time
06/19/2008 14:45
Collected Daterrime
06/062008 9:30
Received Date/Time
06/062008 10:30
Technical Director
Stephen C. Ede
Parameter
Results
PQL Units Method ContaincrlD
Allowable
Limits
Prep Analysis
Date Date
[nit
Metals by ICP/M3
Arsenic
ND
5.00 ug/L EP200.8
C
(q0)
06/12/08 06/19/08
NRB
Water$ Department
Total Nitratc/Nitrite-N
ND
0.100 mg/L SM204500NO3-r
B
(<10)
06/17/08
1DZ
Microbiology Laboratory
Colony Count
0
coU100ml. SM20922211
A
(<200)
06/06/08
DLC
Total Coliform
0
col/100mL SM209222B
A
(<I)
06/06/08
DLC
rccal Coliform
0
colIl O0mL SM209222D
A
(<I)
06/06/08
DLC
JLII-13-2003 14:19
NJFil M. M _1 1
ASDUILT-NO CORNERS SET THIS DATE. . SEWARD S
I (HEREBY CERTIFY THAT 1 HAVE SURVEYED THE
SCALE,
FOLLOWING DESCRIBED PROPERTY:Lot 3A,
1" • 40'
Block 6, Schroeder $ubd., Ens[ Addn.
DATE,
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
9/15/92
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF 'ANY
GRID-
EASEMENTS COVENANTS OR RESTRICTIONS
WHICH DO NbT APPEAR OR THE RECORDED SUBDI—
hV352 6.353 '
VISION PLAT. UNDER NO CIRCUMSTANCES SRX)LD
FBr
ANY DATA HEREON BE USED FOR CONSTRUCTION
31-75
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
DRAWNs
ARY LINES.
Df19
907 562 5435 P.02 d
l�
Wojv (Ac t0CCJCA by
ckKpick s, 4 J. PAA
7/t/09. Stp t�ni In v(i5 /nn cC
Vcr;fcol OA -7/2/00- by t<y4 M'u`'
Of
Iti
All !!r !^Otis SR.nI::•.•
o � Z,yl-o3
r.
FEB
o ur At '4%
r ..... A
........ ll ... �
.: t.fR1V� �
Wofto Al/rk E.w.r1�• / .
•.6 LS %691 B ; . �
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES a
Division of Environmental Services �} j
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel 1. D. # CSF , , G1 � - -_�
1. GENERAL INFORMATION
Complete legal description
HAA#_J,J�"IQI�Ja[-
Lot 3A; B2ock 6; Sehtoedet East Subdivision
Location (site address or directions) 12436 Sptingbtook Dkive
Property owner Doug Mut5chte4 Day phone 696-4674
Mailing address
Lending agency
Mailing address
18850 Eagte RiveRiveA R...
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3 ''
3. TYPE OF WATER SUPPLY:
Individual well XX
Community well
Public water
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank XX
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/911 Fran( MOA H21
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 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 5 Phone
S•
Address 17334 Eagle River Loop Road Na. 204
uag':a River. Alaska 99577
Engineer's signature Date
�." All: ® ,
6. DHHS SIGNATURE
cApproved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA 421
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST I"L5
Legal Description:o-f 3k LP �G1�Ze�uEu- Parcel I.D. �.l L %Z" ,Y/
r:,-AaT 6
A. WELL DATA
Well type If A, B, or C, attach ADEC letter. ADEC water system number %
Log present ON) — Date completed Driller
Total depth L Sit Cased to c� Casing height
Sanitary seal &N)
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
6
SEPARATION DISTANCES FROM WELL TO:
Wires properly protected CON)
AT INSPECTION
r
n
(S
zr
N
D -G
g.p.m. 1. ,
g.
_.
N o
D
"'
"
�
o
<0
H 0
O M
Septic/holding tank on lot X20 ; On adjacent lots tL.)E' 1
Absorption field on lot /'� ; On adjacent lots
Public sewer main
Sewer service line 170'
Public sewer manhole/cleanout
Petroleum tank 257
k
WATER SAMPLE RESULTS:
Coliform 0 CIOu/1o0n Q • Nitrate Other bacteria
Date of sample: C1 \` ,9,zti Collected by:
B. S/HOLDING TANK DATA
Date installed \�1�`B �� Tank size
260 C�
Compartments
kA O
Cleanouts Q'N) Foundation cleanout &N) V Depression (Y& rJ
High water alarm ON) J Alarm tested (LYON) �
Date of pumping 11 - 1 L -Ci -L—
Pumper Tom. LGS�Paot-
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Wel I(s)onlot IZo On adjacent lots \00 ` Foundation—
To property line o Absorption field 1 Water main/service IinE
Surface water/drainage l' --b
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N) _
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y
— Manufacturer
Manhole/Access (Y/N)
off' level at
Cycles tested —
SEPARATION-D18TAINCE FROM LIFT STATION TO:
on lot On adjacent lots
D. ABSORPTION FIELD DATA
Date installed
Length
Total absorption area
Width
Depression over field (Y/N)
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
Soil rating
Gravel thickness
Surface water
System type
—Total depth
Cleanouts present (Y/N)
Date of adeauae
for
SEPARATION DISTANCE FROM ABS05PTION FIELD TO:
Well on lot
To building foundatio
On adjacent I
Surf water
Curtain drain
E. ENGINEER'S CERTIFICATION
On adjacent lots
Cutbank
If yes, give date
Property line
To existing or abandoned system on lot
Water main/service line_
Driveway, parking/vehicle storage area
bedrooms
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
5 & 5 ENGINEERING
AY'
' Lo�"9A•oo g�'f ej�J Pj
Signature 17334 Eagle Riven Loop Road No, 204v� ��" �" a 4
ragk, River, Alaska e
�� s p�s �,"� r� Kr r �7
n L
Engineer's Name � � 9i�®r--. _ea�Fca Vrna nna,o o• o
0Z Z
Fq/� _ p� l .rn0;
Date ` V6d ''a Rc;ts_
G" is'r o,9 No. 3215 d
V
�p� e
f
HAA Fee $ Waiver Fee: $
Date of Payment C2 % a Date of Payment _
Receipt Number Receipt Number
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
-6H33 t1 STRrET ANGHt)RA( E, ALASKA 09510 TELEEHONC (907) 582-2343 FAX; (907) $01-5301
ANAImi5 RESULTS for INVOICE 1 5806
ChonlcU Ref .1 92.t98R Snwply 1 l9 Katrtx NATER
Client 3anple ID LIA 56 SCHRUM 8A41 3/1)
MID UA
Collected : BEP 14 92 t 16;30 hrv.
Rveelved SEP 15 92 1 19:30 hrv,
Prever Ted with AS REQUIRED
Analyela Completed : SEP 16 82
Lebotatory 3upo i�TRPHEN C. EDt
Rvleaaed By �c,
Client Nana :3 & 5 ENGINRRRING
Client Acct. :SNSENGY
W4
ROO
Ordered By :R. SHAYRR
Send Rvporte ta:
l)S R S EHGIHRRRIHG
2)
P01 :NONE RECEIVED
vw..wowx.en __ .a.sa+n•.+. nwuann-..-..0 wrw wrtnv...............................wu.w nu a -ann.a a a1, n w w w.. w art......... w..... w..•
v •w.rtn.ve...+N•
Parenotet Reaulta Unita Method Wowahle 6imita
..---
NITRATE -N ND` 0.1) oa3/l EPA 353.2 10
Sanple ROUTINE MPLE COLLECTED BI. RAT.
Wmrke: ....
ey+x...u.rt.......n..-....w..............aa.n.a...a.nw..wn..a.-...... .....-......a.......a...nrt.._..e.a...a...........ws.wn......a..
1 Tvata Pvrfot+aod Sao 3ptclel Instruction Aboyo Uh-UnaTeilehle
HD. None Datectod " See Svnplo Raaerke Abe►e
NA. Not Armlyzed LT -Lena Than, GT•Greatvr Then
� 1 Member of the SOS Ciroup (800M QAnBrnle de Sxvolllance)
MUNICIPALITY OF ANCHORAGE
• Department of Health & Human Services M
DIVISION OF ENVIRONMENTAL SERVICES ~}j
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # C)LO - r7l - t HAA #
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 3A, Block 6 Schroeder C d T14LV�2kI c�
Location (address or directions)
(b) Property owner Hnme Savings & Loan Telephone: (home) Business 246-1451
Mailing Address 1001 East Bpnson Anr-hoa-age, Ak 99508
(c) Lending Institution
Mailing Address
Telephone
(d) Real Estate Company and Agent Heritage Rea It v / Verna Danielson
Address r T (- Rivor Rrl Faq]p Ryver Al- ()()3 77
Telephone 694-4
(e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single -Family 9
3. WATER SUPPLY
Individual Well 12
Number of bedrooms -3
Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site ❑ Public ❑ Community ❑ Holding Tank IZ
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. 7/88) 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 ale Riw-r a)q 'sia Services Telephone 694-5195
Address P.O. BCK 7723294 Eanla Ri.W_r, Ak 99577
Date
E a r'
' c. 6736
(J F�O,p �a o. voueaYd"� m
�` 3 ��aFRGFESStCN}��
6. DHHS APPROVAL
Approved for i)edrooms by `�-y — �`� Date
Approved — Disapproved Conditional
Terms of Conditional Approval
//-9- C/ 01
CfAUTION -- i
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 orderto satisfycertain 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 (Bev. 7/88) Back Page 2 of 2
i� y"��7�
,c
A.
WE TA
Well Classification _
MUNICIPALITY OF ANCHORAGE (MOA)
v Health Authority Approval (HAA) M�
` CHECKLIST - FEBRUARY 1984
343-4744
A-7
Well Log Present (Y/N) Y Date Completed_ �/L15
Total Depth /Yy Cased to Depth of Grouting r'
Legal Description: '/e r 3 /-,& /.,Or- 6 -�-_ ti -.E
/Fa d /' 71'1 2 ?. w SG c • /
Static Water Level ! 3
Casing Height Above Ground
Electrical Wiring in Conduit (YIN) Y
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot 1-2O
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer line 7'� 7s"
If A, B, C, D.E.C. Approved (Y/N) N14
YieldO 8 6.-x-0 890
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
L
On Adjoining Lots 7 �
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole f "
To Nearest Sewer Service Line on Lot 411
Water Sample Collected by_1�"'s�" `�� ; Date ���5
Water Sample Test Results 4 � f "�'X,'�
Comments
B. SEPTIC/HOLDING TANK;DATA
ro-7%-
Date Installed /9 �;� Size No. of Compartments
Standpipes (Y/N) Air -tight Caps (Y/N) k Foundation Cleanout (Y/N) r
Depression over Tank (Y/N) ^' Date Last Pumped
Pumping/Maintenance Contact on File (Y/N) IV14 9' '' • for ��" �Gr -�5�• ���
Holding Tank High -Water Alarm (Y/N) %V Temporary Holding Tank Permit (Y/N) /V
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
T W t -S I Well 42'0 / To Building Foundation
V a er uW
pp y
To Property Line 7' -Id �
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments
To Disposal Field
72-026 (Rev. 7788) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absortion Area
1/.
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Depression over Field (Y/N)
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
_ Statndpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
On Adjoining Lots
To Cutback (if present)
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent(Y/N)
Pumping Cycles during Adequacy "fest.
"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
.aye fi vor u 4 r; zrvi3c;
Company F, u rse</-
Eagle Riva, AK 991,-77
Date 60A -51Q;
MOA No. Sv--;? Y
Receipt No.
Date of Payment ( _y
Amount: $
Waiver Fee: $
Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2