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HomeMy WebLinkAboutSCHROEDER EAST BLK 7 LT 64 -� �� -Ui l- 08 \ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION j ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT �� e NAME /�( PHONE �AIEW UPGRADE MAILING ADe/SS G< ` O 7 _/.j LEGAL DESCRIPTION � LOCATION NO. OF BEDROOMS Well Absorption area, Dwelling PERMIT - DISTANCE TO: j" 2y NO. F - o. Q Manufacturer /^ �,, _/� Material No. of compartments �Liqcapacity in gallons I F HOMEMADE: Inside length Width Liquid depth _ C) yWell U -a DISTANCE TO: ti) Dwelling PERMIT NO. - � ©z `Z x - h Manufacturer- - - - Material - Liquid capacity in gallons ® w: WL L Well Foundation Nearest loi ne i DISTANCE TO: / U "l` /� t No. of lines r Length of at line Total len f Ies Trench PERMIT NO. R widyh o (•!� Distance between lines �tJ /-� Q - r[ .. - - -! -- - _ -_ inches Twoof tVe to finish grafle Material beneath file L, L -2k) inches _ Total effective abs{prpti area w Length Width - Depth PERMIT NO. ' Q� M LU Type of crib _ Crib diameter Crib depth Total effective absorption area rn DISTANCE TO: Well Quilding foundation Nearest lot line Class /D&Vth Diller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS - P- -SO — Q SOIL TEST RATING t I �,•p g -s INSTALLER J R MARKS rl LL, Fa, -01I AmEg ���1 to /�.� % OIr A1,4%% 1 '4 � f 1 Y3 - ".. - APPROVEDDATE " 1 ; 4,.'q a EGAL /%�3, ,col wn.. rOJ I ' 04/3O/85 �L p TAT 1 171 1: 1 0- 117 TO FUQ 1- 9 173 UQ Q 10 17. DEPARTMENT OF HEALTH AND ENVI ' 1:C 99577 ECy! ION 825 L STREET, ANCHORAGE, ns PC 99501 / `U 264~4720 SCHROEDER EAST TDWNSHIP: : W�*:GE� THT I -1- 17: oil K 0,11 SAM for U,I� 11:�, :1-- 1 14 PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: MAX BEDROOMS: 850138 04/3O/85 JACK ROBERTS / | 5 S&S ENGINEERING E8GLE RIVER, 1:C 99577 694�2979 U/ SUBDIVISION: SECTION: 1 SCHROEDER EAST TDWNSHIP: : W�*:GE� 6 14 Listed below are the system" Choose the options availablc t option that best �it6 ~--~---~-~- DEPTH TO PIPE 8OTTOM (FT.) 3.0 ** GRAVEL DEPTH (FT.� 4.0 TOTAL DEPTH (FT,) 7 0 GRAVEL WIDTH (FT.) GRAVEL 1.ENGT� (FT.) 57.0 GRAVEL VOLUME (CU.YDS, > 23,8 TANK SIZE {GALS) SOIL RATING <SQ.FT"/BR) 150 BLOCK: 7 r septic ** DEPTH TD PIPE BOTTOM < 3.5 FT. FIQUIRFS INSULATION ** 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 [amiliar with t|�e requirements [or on�site sewers air! wells as seL �orth by the Municipality o[ Anchorage (MOA) all r! the State o[ Alaska 2. I will install the system in accordance with all MOA codes and regul^tions and in compliance with the design criteria o[ this 3' I will adhere to all MOA and State OF Alaska requirements {or the set back distances {rom any, existing well, wastewater disposalsystem or public sewerage system on this Or any adjacent or nearby lot" 4. I understand that this permit is valid [or a maximum o� 3 bedrooms and any e:largement will ruquire an additional Permit. [F A LIFT STATION IS INSTALLED IN ANAREA COVERED BY MOA BUILDING CODES 'HEN (1) AN ELECTRICAL PERMIT AND INSPECTION O8TA MUST BE INE�; (2) AS-B�IiTS jILL NOT BE APPROVED WITHDUT AN ELECTRICAL INSPECyr ION REPORT� AND (3! T�E' �LECTRICAL WORK MUST BE DONE 8Y A LICENSED ELECTRICIAN, ' '' �IGNED ^f� . A,PLICANT: JACK �� �� � SSUED BY 1 SOILS LOG > _ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 204-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: j1q `- -C �U �%` /_S DATE PERFORMED: LEGAL DESCRIPTION: Z— l"7 ' &-, �t-u ('- 41 C.� cJ '- FDEPTH SLOPE 1 (�, (- 2 2 L-4- 3 er 4 5 6 CJ 7 8 ds 0 9 4� 10 c 11 4 12 13 14 15 16 Ply t 17 $ -A so �ef 18 19 e COMMENTS _/WAS ROUND WATER / �• EN OUNTE RFD? C �1 IF YES, AT WHAT — DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN s �� FT AND (minutes/inch) FT PERFORMED�W: 72-008 (6/79) (�rrltfirb 13rittiug dog DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 272, CHUG IAK, ALASKA 99567 a TELEPHONE 6882759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION------- DATE ESCRIPTION—_DATE . Started Ended PERMIT NUMBER KIND OF FORMATION: DEPTH OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR KIND OF CASING From Ft. to Ft. — — From Ft. to-- Ft. From_ Ft. to Ft. From___ Ft. to_ _Ft. From Ft. to Ft. From_ Ft. to ° —Ft.--- Ft._FromFt. _ From—Ft. to Ft. __. From Ft. to Ft. From— Ft. to Ft. — From---- o Ft. to--Ft.— Ft.FromFt. From—Ft. to Ft._ From____ _Ft. to ------- -Ft. rte= From Ft. to Ft. From Ft. to FtC� -2, U From Ft. to From Ft. toFit, v_ _Ft. From Ft. to Ft. From Ft. to F = i From Ft. to Ft. _ From Ft. to_ P <z� 0 z From— Ft. to —Ft. From Ft. to —Ft. {y From—Ft. to Ft. From o_ Ft. to---Ft.--- _Ft. u: —From— From--Ft, Ft. to Ft. From Ft. to--Ft.— o —Ft.Froin—Ft. From --Ft. to Ft. From— Ft. to_ _—Ft. From Ft. to Ft. From Ft. to Ft. From_ Ft. to Ft. From Ft. to _Ft. From— Ft. to Ft. From_ Ft. to_ _Ft. .._ QS,4iiU� MISCL. INFORMATION: I DRILLER'S NAME MUNICIPALITY OF ANCHORAGE QPRI DEPARTMENT OF HEALTH & HUMAN SERVICESDivision of Environmental Services 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. # HAA # C -A 1. GENERAL INFORMATION Complete legal description Lot 6; 132ock 7; Schnoeden. East Subdivision; Location (site address or directions) 12539 Spking bkook D i.ve Property owner H_11_D. #111-04.37(9 Day phone Mailing address 605 We -6t 4th Avenue Anehon.age A2astza 99501 Lending agency — Day phone Mailing address Agent Fnan SheU ASSOCIATED BROKERS Day phone 563-3333 Address 640 wat 36th Avenue 91 Anchon.an, Ata6fza 99503 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 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 XX Holding tank _ 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. 1/91) From MOA 921 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 _ S & S ENGINEERING Phone 17034 Eagle River Loop Road No. 204 Address Fanla Rivr+r Alac4i 9q5� Engineer's signature Date 2 �� �� -2- 04 OF Al %41 R0GkV1 d.>HAFER ��9�°P.�.l.S5 •N� 6. DHHS SIGNATURE �►Qe�«��,.ge�� Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments M Date 2 `? 2 - The The Municipality of Anchorage Department of Health and Human Services (DHHS) issues HealthAuthority 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 7121 o Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. A. WELL DATA Well type If A, B, or C, attach ADEC letter. DIAD C water system number Log presentQ��%N) y Date completed t B5 Driller ���1�\ ✓/� e) Total depth Cased to Casing height_ Z Sanitary seal fit) Wires properly protected 1) Sewer service line v✓ '4 Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample E. SEPTIC/MOLDING TANK DATA Nitrate Other bacteria 9 Z,+Collected by: :�_ - h Date installed 6/ "2' E'E Tank size 1 Ckz>O Compartments Cleanoutso�N) High water alarm (Y/N) Date of pumping Foundation cleanouCPN) Depression (YQ6Lp rJ Alarm tested (Y/N) Pumper �J t l�j,z f SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: 1 Well(s) on lot On adjacent lots 1(2Q -� Foundation To property line of "� Absorption field I Surface water/drainage � A- (� Water main/service line_ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE FROM WELL LOG AT INSPECTION rr, s Date of test o Static water level 2 �! C _ z r Well flowtn g.p.m. 1 �i _ gn.12�. a Pump level y`L M �, r„ SEPARATION DISTANCES FROM WELL TO: C Septic/hefd Rgtank on lot 1 On adjacent lots Absorption field on lot On adjacent lots ( Public sewer main Public sewer manhole/cleanout Ll Sewer service line v✓ '4 Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample E. SEPTIC/MOLDING TANK DATA Nitrate Other bacteria 9 Z,+Collected by: :�_ - h Date installed 6/ "2' E'E Tank size 1 Ckz>O Compartments Cleanoutso�N) High water alarm (Y/N) Date of pumping Foundation cleanouCPN) Depression (YQ6Lp rJ Alarm tested (Y/N) Pumper �J t l�j,z f SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: 1 Well(s) on lot On adjacent lots 1(2Q -� Foundation To property line of "� Absorption field I Surface water/drainage � A- (� Water main/service line_ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 0 STREET ANCHORAGE, ALASKA 99516 TELEPHONE (907) 562.2343 FAX: (907) 5131.5301 A)iALYSii' GESUI.TS for PONCE 59710 Cherolah Eof.1 9,: rt?69 Sample t 1 Matrix: WATER Client Semple TD : DRINbrNG WATER L6 67 SCR,000 EASI FNSID UA Colleoted JAN 29 92 P ,4:J0 hrs. Received JAN 30 92 2 14:40 hr e. Freseryed with AS REQUIRED Analysis Completed JAN 31 92 Laboratory Supervisor :.STEPNEN C EDE Released By(e/7^ / ` Citenl Name •S & S ENGINEERING CB ent Acct SNSENGP BPOI Regt : n[dered By R.J.S Send Reports to c115iNEERING 2i POB :NONE RECEIVED .................................... ..........................--................... ................I ............... ..... Paralceter 1110F'ite 'Jnjta Method Allowable Lilnits ------------------ ---- NITRA IF -F Nitta ;D) wil 11`A 353.: 10 Samplo RUUTIIi; 3AMP1E. ":•LLS rED Bi R ? 5 Remarks. ............................... ............ ,.................. ....,,........................ ................... ,T .......... ............ I rest$ Ppriormod 30e Specl al Instruc zz or,a Above UA-Unt'vAllehle ND- None Oetocted " 3ee Sample R•'mtks Above NA- Not Aralyzed LJ -Lose Than GT -Greater Than OWN blemuer of the SOS Group (SociOO G6n9rale de Surveillance) _;Qcl G[ 0 ll llili,�;l 111.1 [i 1,1 "14)1;1.110 [7 (l it 0(.1[j Illlll it (II1[[III 11 (lil rillfif'iffilil F I, T ri1-7 Ci _- CCT MUNICIPALITY OF ANCHORAGE IRWR)l Department of Health & Human ServicesDIVISION OF ENVIRONMENTAL SERVICE 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel LD. # C)�n"< 1\ -Q% HAA If �AC)9(`1 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 6; Bloch. 7; Schnoeden East Location (address or directions) 12539 Sranina Bnook Dnive (b) Property owner A.H.F.C.#107096 Mailing Address (c) Lending Institution Mailing Address Telephone : (home) Business Telephone (d) Real Estate Company and Agent Re/Max o6 Eagle Riven ATTN: Eva Loken _ Address 16600 Centek6ieed Vxive Suite 201 Eagle Rivefe, Ak.99577 Telephone 694-4200 (e) Mail the HAA to the following address: (or check here NXif hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17n3�IF River 1 nnop Road No. 2Q4 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family LNx 3. WATER SUPPLY Number of bedrooms — Individual WellXX 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 1Xx 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. 7/88) Pagel 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 Telephone 6?5� `Z Address S & S ENGINEER!,,* 17034 g°Qt'-R Date Eagle River, Alaska 99577 6. DHHS APPROVAL Approved for J Approved l/ bedrooms by Disapproved Conditional A 1/)/��— 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 MUNICIPALITY OF ANCHORAGE (MOA) zF` ` 4 • '� Health Authority Approval (MAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: I_--o-r L T>L­oc.ic--% A. WELL DATA Well Classification IV1Diw1If A, B, C, D.E.C. Approved (Y/N) _ Well Log Present ON) __ _. Date Completed Yield .. -Z,01 —_LCL" CPM %cV Total DepthV+0 Cased toV-i9 Depth of Grouting Static Water Level 5" Pump Set At s 1. Casing Height Above Ground f Z `' Sanitary Seal on Casing )N) _ Electrical Wiring in Conduit ON) X Depression Around Wellhead,&D Al SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 1g b ; On Adjoining Lots OL�t To Nearest Edge of Absorption �� Field on Lot � o co ; On Adjoining Lots To Nearest Public Sewer Line t4" y To Nearest Public Sewer Cleanout/Manhole , To Nearest Sewer Service Line on Lot-� Water Sample Collected by V-) (; Date Water Sample Test Results _�-nst= Tat u Cx N� rr�,n s Comments B. SEPTICBI#G TANK DATA Date Installed Size L Hca No. of Compartments Standpipes ON) _--Y-Air-tight CapsO N) -- Foundation Cleanout dqN) _ Depression over Tank (Y/Q Date Last Pumped Sj Z- -cl ,--N Pumping/Maintenance Contact on File (Y/N) fl-� for Holding Tank High -Water Alarm (Y/N) t-4 1rTemporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well \o r>\'1- To Building Foundation To Property Line �.C> To Disposal Field 'To Water Main/Service Line \ a \ } 'To Stream, Pond, Lake or Major Drainage Course \ C� Z) _ Comments Y��r-nPtz tr) �✓� �S� �_SP L 72-026 (Rev. 7/88) Fronl Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �SoI�� _Type of System Design _)r4-�r�1G Date Installed �- -8'5` Length of Field _ a3 Width of Field D th up of Feld Gravel Bed Thickness 3 Square Feet of Absortion Area e% Statndpipes Present ON) V Depression over Field (Y,(�( �/ Date of Last Adequacy Test . G - 11-G 0 Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 1d In t To Property Line I U)I 4 - To Building Foundation 7.0% To Existing or Abandoned System on Lot NIA - ; On Adjoining Lots _ ��) `i` To Water Main/Service Line 1 i ('"- To Cutback (if present) rJ To Stream, Pond, Lake, or Major Drainage Course I Do I`~ To Driveway, Parking Area, or Vehicle Storage Area sl Comments �/5'TG� �� .5 ^Aµ a� 'l�� s� ' i o 4 n-,,Tj a4, D. LIFT STATION Date Installed Size -ire Ilons "Pump On" Level at z High Water Alarm Level at - Tested for Meets MOA Electrical Codes Comments Dimensions Manhole/Access (Y/N) "Pump Off" Vent(Y/N) Pumping Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in inspection. Signed S & S ENGINEERING Company 17036 Eagle River Loop Road No. �B4 P y C , Date MOA No. C� ��� c�0 Receipt No. 0 s -'21z�,l 67— Date —Date of Payment � _z / e 10 Amount: $ //%p. �J Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 rteqt OP—;the d•8t0`�of;this g s S�af CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET • ANCHORAGE, ALASKA 99518 • TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order # 27211 Date Report Printed: SEP 18 90 @ 17:35 Client Sample ID:L6 B7 SCHROEDER EAST PWSID :UA Collected SEP 11 90 @ 18:00 hrs. Received SEP 12 90 @ 15:30 hrs. Preserved with :AS REQUIRED Client Name S 9 S ENGINEERING Client Acct SNSENGP P.O.# NONE RECEIVED Req # Ordered By : R. SHAEER Analysis Completed :SEP 14 90 Send Reports to: Laboratory Superviso :STE HEN C. ED_E 1)S & S ENGINEERING (GP,'G��, Released By G - 2) ...................................................................,.,........................................... Special Instruct: Chemlab Ref #: 903603 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result Unite Method Limits -------------------------------------------------------------------------------------------------------------- NITRATE-N 0.10 N/1 EPA 353.2 10 Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY RAY. ............................................................_............................................... 1 Tests Performed See Special Instructions Above UA-Unavailablo ND- None Detected See Sample Remarks Above NA= Not Analyzed LT -Less Than, GT -Greater Than ,j e P f d P f f 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 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 6 Block 7 Schroder East Subdivision Location (address or directions) 12539 SArinbrook (b) Property Owner Home Savings Telephone. Home Mailing Address % Rich Britton (c) EE H88-0009 #050-071-08 Lending Institution Centrust Mortgage Telephone Mailing Address Real Estate Company and Agent Jeff Amistaso % Ridgeview Prop Address 12212 Old Glen Highway, Eagle River, Alaska Telephone 694-6001 (e) Mail the HAA to the following address: or: Check here Rg�if hold for pick up. List contact person and day phone number below. S & S Engineering 17034 Eagle River Loop Road, Suite 204 Eaqle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Familggx Number of Bedrooms two (2 ) Business ties 99577 3. WATER SUPPLY Individual Welly 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)ax Public ❑ Community E7 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 n-ozs (Rev 8/86) From 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 Telephone _ Address 17034 Eaqle River Loop Road, Suite 204 99577 Date This department has received written confirmationiltterLsl$@alengineer regarding the Conditional Approval of January 11, 1988. The corrections have been accomplished and an inspection has been completed by the engineer. The subject property meets with Muncipal standards is now approved. 6. DHHS APPROVAL Approved for two ( 2) bedrooms by ' Date Approved XXXXXXXXXX Disapproved Conditional Terms of Conditional Approval CAUTION May 26, 1988 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 81861 Back ngr4 16 IN ROBERT A. SHAFER q CIVIL ENGINEER May 25, 1M(TICIpALITY Of ANCHORAGE 694-2979 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION HEALTH AUTHORITY MAY 2 61988 APPROVALS Mun.icipaP%-ty o6 Anchorage RECEIVED DepajL.iment o6 Heath and Human Senv.ices 825 L St)Leet SEWER &WATER Anchorage, A.2aska 99501 MAIN EXTENSIONS REFERENCE: Lot 6; Wock 7; Sch)toede.n East Subdi.vi.sion Request you .issue a 4inat Hea2.th Authon.ity Appkova2 (HAA) ob ,the on -bite. SEWER &WATER sewn and waters baci.tities 2oca.ted on the negenenced pnopen.,ty. INSPECTION A eonditionat appnova2 was .issued on January 11, 1988. The conditions ob that appnova2 have, been met and inspected by our o66 ice. F,iU has been placed po've7 the absanpti,on area with sug4.ic,i.ent coven to aUev,iate ENGINEERING STUDIES the possibility o4 the teaeh6ietd 6tteezing on sewage 6LL44acing. AND REPORTS 16 we ma p7v,ide additi.onat in6o)tmation, please contact Rogers/694-2979. Si e lLe t y, l WELL INSPECTION & FLOW TEST � T A. SHAFER, P.E. SITE PLANS R Iss ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE a j C DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL'-(��O�� OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 6; Block 7; Schnoeden East Location (address or directions) 12539 Spntingbnook (b) Property Owner _Home SavdngA Telephone: Home Mailing Address_ ATT ENI ON:_- Rich -841 an,Ayacha& gQ, Z" (c) Lending Institution _C_e t4_U6t_MQ11,tgage Telephone Mailing Address Decemben 7, 1987 Business (d) Real Estate Company and Agent _RIDGEVI W PRi?PEgITES P �AtTiG_3ta5a _ Address __ I. LLf2d_D-fefLlic. hwa y,-Ea.gte--Rive . AL¢&ka____g25Z7 Telephone --694-- (e) Mail the HAA to the following address: or: Check here NJ, if hold for pick up. List contact person and day phone number below. S 9 S ENGINEERING1694-2979 17034 Eagle Riven Loop Road, Suite 204, EagCe Riven, ALa6ka 99577 Ondened by Je64 Ami6to6o 2. TYPE OF RESIDENCE Single-Familyg Number of Bedrooms 3. WATER SUPPLY Individual Well In 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 j7 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 7z-025 rRov- 8'861 From 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by myseal affixed hereto and as of the validation date shown below, I verity 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. Narne of Firm Address __ S & S ENGINEERING Date Telephone 69Cf�z 9% e To P -L L_� i d -r 6. DHHS APPROVAL Approved for Approved '-� bedrooms by Date �sck7sruZ-1��Llcz ^ -- Disapproved —__ gonditional —___ Terms of Conditional Approval CAUTION T e"1 cc e...'�,� G r< r 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 72.0P5 (Rev meet Back 4 � '-� bedrooms by Date �sck7sruZ-1��Llcz ^ -- Disapproved —__ gonditional —___ Terms of Conditional Approval CAUTION T e"1 cc e...'�,� G r< r 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 72.0P5 (Rev meet Back MV�� 1% �- UNJGN �MBALITY OF ANCHORAGE (MOA) Er HgAOYi AUTHORITY APPROVAL (HAA) CHEC"IST - FEBRUARY 1984 264-4744 .. Legal Description: �Gl� jLot;7 _e —fi_ r _ A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present (9N) - Date Completed , i —Yield (•S C ft--� . Total Depth �� _ Cased to 2-12 Depth of Grouting Static Water Level Pump Set At ()� Ll Casing Height Above Ground %f' Sanitary Seal on CasingO?N) Electrical Wiring in Conduit (?N) Depression Around Wellhead (YLNY) Separation Distances from Well: To Septic/HGId rrg Tank on Lot t t ; On Adjoining Lots \ To Nearest Edge of Absorption Field on Lot —\ �� On Adjoining Lots To Nearest Public Sewer Line _ /%�` To Nearest Public Sewer Cleanout/Man hole/N P� To Nearest Sewer Service Line on Lot / Water Sample Collected by Z z� � is} �� �Cq Date (Z- - Water Sample Test Results r1 `� � T� - _lam � �, (/�- �1 tom -Pmt -rte CommentsL' T T`J i l�> ��T c!::zo o_ • E'�-8 S„� B. SEPTIC/HGMWG TANK DATA Date Installed -”%-`� Size ._� oc�>c-_) No. of Compartments Standpipes W/N) Air -tight Caps (SYN) _ Foundation Cleanout�PN) Depression over Tank (Y, a Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) rt =Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/HGk i+}g Tank: I To Water -Supply Well N To Building Foundation To Property Line o I4 To Disposal Field __ To Water Main/Service Line \ � To Stream, Pond, Lake, or Major Drainage Course \ OCA I-� o "% i Comments Page 1 of 2 72-0261Rov 8eM Front CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. \ 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID N 92.0040440 ANALYSIS REPORT BY SAMPLE Client PO# : VERBAL Req #: Client Smpl ID: LT 6 BLK 7 SCHOEDER ESTATES 12-•8-87 Sample Recd : DEC 9 87 Ordered liy : R. SCHAEFER Send Reports To: S & S ENGINEERING R SCHAEFER 17034 EAGLE RIVER LOOP RD., #204 EAGLE RIVER, AK. 99577 Special Instruct: Chemlab Ref #: 8559 Lab Smpl ID: I Matrix: Water Parameter Tested Result/Units ------------------------..----------••------------------------------- NITRATE-N ND(0.10) mg/I Work Order No. : 4271 Client Account : SNSENGP Date Report Printed: DEC 11 87 9 14:41 Released By : 2jff f� Reports Address #2 Sample ROUTINE SAMPLE Remarks: ANALYSIS COMPLETED: 12-9-87 LABORATORY SUPERVISOR: STEPHEN C. EDE C-- 1 Tests Performed See Special Instructions Above ND= None Detected *X See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than Allowable Method Limits ---------------- 10 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAL 111 ANu Cl"......... q . a DIVISION OF ENVIRONMENTAL HEALTH (;E;;t1'elt lf;$+T:' OF INSPECTION FOR HEALTH AUTHORITY APPROVAL s' t)N-SITE SEWER AND WATER FACILITY I 264-4720 MRFa1A'tlOPd tA, ription (include lot, block, subs I_nation (address or directions) �J i Application Date section township, ran e) (b) AlspLrtfnt Narne-.�,' f�y:.,�z� (/— Telephone: Home �� D I Business Applicant Address��, _x/v % Cy c (r) Applicant is (check one): Lending Institution El ; Owner/builder El ; uyery; Other E1 (explain); (d) Lending Institution s -F -` Telephone Address — --- ---- -- --- i C> -f- aZf _ ,�--�------------ (a) Real Estate Company and Agent Address Telephone (f�IiL fhe HAA to the following address: C 2. TYPE OF RESIDE=NCE Single -Family Mplti-Family E1 Other Number of Bedrooms _— -j _- 3. WATER SUPPLY Individual Well 0� Community E_J Public (.1 0 14 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 Onsiteg Public El Community 13 Holding Tank 171 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (1 5. ENOINEEnINC FIRM PROVIDING _4SPECTIONS, TESTS, FILE SEARCH, DA1. NA INFORMATION , As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this 1-1ealth Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or ,.wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date , I 6. DHEP APPROVAL 3 Approved forD lledro Approved .__ �' Disa Terms of Conditional Approval Telephone U tic), t/n Jail: oma Date pproved _ _ , Conditional _------------ - -- 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 (11184) AJC T U tic), t/n Jail: oma Date pproved _ _ , Conditional _------------ - -- 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 (11184) Comments NVl rJ' +3�C6J2<es�K qtr —LI C_ <-- N d A—teed � �- �ri2�� C�, PUC ZV -s 4 L LIz2 �/ZoZo�c T6D .i ) A SEPTIC/l4GL-DtttG TAfeDATA �� �N� S "0 ��� z�c GJ Date Installed Size No. of Compartments Z Standpipes®/N) — Air -tight Caps (M) Foundation Cleanout((Y'N) Depression over Tank (Y/Q Date Last Pumped h� f Pumping/Maintenance Contract on File (Y/N) ;for — Holding Tank High -Water Alarm (Y/N) � A Temporary Holding Tank Permit (Y/N) A Separation Distances from Septic/]14otdkgig Tank: To Water -Supply Well _ l t» k To Building Foundation + To Property Line 1 r� t To Disposal Field _ To Water Main/Service Line Cb To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) IvwNIciPAur`r OF ANCHORAIGr DEPS. 0, HEN -TJI & MUNICIPALITY OF ANCHORAGE (MOP,/ r"%%RON"IENTi.L PROrrcrlON HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 � �; Legal Description: �— �a u� ,` w V _ A. WELL DATA S'�� f F ^ Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present�RN) Date Completed 4" 9'9'"- Yield u F �a M p�Depth Total Depth Cased t"d of Grouting _ Static Water Level 2- Pump Set At V %__ice Casing Height Above Ground — ti 2 Sanitary Seal on Casing(�01\1) _ Electrical Wiring in Conduit CON) Depression Around Wellhead (Y/S Separation Distances from Well: To Septic/UoWlq Tank on Lot t o� a — ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot l 0{6 On Adjoining Lots To Nearest Public Sewer Line 14'A To Nearest Public Sewer t Cleanout/Manhole —o > :4Nearest Sewer Service Line on Lots t�m �eyfill Water Sample Collected byiJ1 f1319G�� Date ✓p auk Water Sample Test Results Comments NVl rJ' +3�C6J2<es�K qtr —LI C_ <-- N d A—teed � �- �ri2�� C�, PUC ZV -s 4 L LIz2 �/ZoZo�c T6D .i ) A SEPTIC/l4GL-DtttG TAfeDATA �� �N� S "0 ��� z�c GJ Date Installed Size No. of Compartments Z Standpipes®/N) — Air -tight Caps (M) Foundation Cleanout((Y'N) Depression over Tank (Y/Q Date Last Pumped h� f Pumping/Maintenance Contract on File (Y/N) ;for — Holding Tank High -Water Alarm (Y/N) � A Temporary Holding Tank Permit (Y/N) A Separation Distances from Septic/]14otdkgig Tank: To Water -Supply Well _ l t» k To Building Foundation + To Property Line 1 r� t To Disposal Field _ To Water Main/Service Line Cb To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) C. A13SORPTION FIELD DATA Soils Rating in Absorption Strata e5o �� _Type of System Design - Z - Q>S Length of Field Date Installed -- Width of Field Depth of Field -- Gravel Bed Thickness - Square Feet of Absorption Area �f57 Standpipes PresentOf N) Depression over Field (Y/IJ� �•� >� Date of Last Adequacy Test Results of Last Adequacy Test Y1DJ� � OC �J?_1 Separation Distance from Absorption Field: Well To Property Line To Water -Supply � To Building Foundation P Lot To Water Main/Service Line I+ To Stream/Pond/Lake/or Major Drainage Course _ On Adjoining Lots To Existing or Abandoned System on To Cutbank (if present) To Driveway, Parking Area, or Vehicle Storage Area —� e � Comments �r-)w GJ✓%' t' `tel/l�T �G��- �G %X1�/1� ,� 1 C'T�i /Y�:�-��� 1�•l� — D. LIFT STATION Dimensions Size in Gallons ,,Pump On" Level at — High Water Alarm Level at "rested for — Electrical Codes (Y/N) - Comments Manhole/Access (Y/N) _ "Pump Off' Level at Vent(Y/N) Cycles during Adequacy Test. Meets MOA rn� ** Check Permitted Bedroom Rating Against HAA Request ** I certify tl�ajl �t$Vdi goarified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ) 09 IEva Ila River Loop Road No. / 6 Signed agfe River99577 , Alaska t `r Compan MOA No. Receipt No. — Date of Payment Amount: $ Page 2 of 2 72-026 (Rev 8'86) RaCk d 0� n mer eal i s