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Home My WebLink AboutHAWDITT LT 2 " ' ~' ~'"'~,,,O-r~/ / MUNICIPALITY OF ANCHORAGE ~/ " DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION /--,~"'~'~'-~'~,' ~..~, r · ENVIRONMENTAL ENGINEERING DIVISION ~,,~ ~"~Z=-';~-,~ .~. ~ 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720-- '- ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME A ,~ IPHONE [] NEW LEGAL DESCRIPTION ~ ) LOCA ~ / ) NO. ~ DROOMS ' Well A 'on area i Dwelling j PERMIT NO. ~ ~ Manufacturer ~ - ' ~ ~aterial · No. of compartments ~ JLiq. capacity in gallons IF HOME.DE: Inside length ~ Width Liquid depth ~ ~ ~ DISTANCE TO [ Well Dwelling / I PERMIT NO. ~ ~ Manufacturer I Material Liquid capacity in gallons O I I Well .~ . / I Foundation / Nearest ot ne IPERMITNO, ~ · ~ No, of lines Length of each line . Total len~ of I~nes I Trench ~idth / Distance between lines ~ ~ ~ ~ Top of tile to finish grade ~f / ~ ~ Material beneath tile . ~ I Total effective absorption area ~~ ~ ~ inches ~O Length Width Depth PERMIT NO, ~ ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ ~ ~ Wel~ Building foundatio~ Nearest lot lin~ I DISTANCE TO: Depth Driller Distance to lot line ~ PERMIT NO. ~ I DISTANCE TO: Building foundation Sewer line Septic tank ~ Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING REIV~,R KS LEGAL PERHIT NO. RPF'LICAN'F THOHAS H. HEBSTER PO BO,'/., 14~l ER LOCATION DHRBY"S RD HI .7,. 5 OLD GLEN LEOFIL L~ S. :~0 'fiSNR~W LO'F TYPE OF SOIl.. RE',SORBTION SYSTEM IS: TRENCH MR%IMUf,'I NUNBER OF BEDROOMS = .~. SOiL RATING <SC! FT/AR>= O SqJARE FEET THE REE!I..IIRED SIZE OF' THE SOIL RB::.;ORP"FION .~EI'I ISb ,/ /. THE LENGTH DIMENSION IS TIdE LENGTH <IN FEET) OF THE TRENCH OR DRfllNFIELD. Tt4E DEPTH OF A TRENCH OR PIT I~ THE DISTF-~NCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE DIINIMUM DEPTH OF GRR',/EL BETWEEN THE OUTFRLL PIPE FIN[:, THE BOTTOM OF THE EXCRVRTION (IN FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF RN'¢ WELLS ADJACENT TO THIS PROPERT'¢ RN[:, THE NUPIBER' OF RE~ZDENCES THAT THE WELL WILL ~ERVE. BRCKFILLIN~ OF RNN' ~N%TEM NITHOUT FINAL INSPECTION AND APPROVAL B~¢ THIS [:,EPRRTMENT RILL BE SUBJECT TO PROSECUTION. MINIf'IUM DISTANCE BETWEEN A WELL AND RN'~r' ON-SITE SEWAGE OI;::,t O_flL SYSTEN I=. .i. 00 FEET FOR R PRIVATE WELL~ OR ,, ~ :150 TO ~.~10 FEET FRO['I R PUBLIC WELL. DEPENDING UPON THE T'¢PE OF PI,..IBLIC WELL. JFHER RE~qUIREMEHTS MR'¢ APPLY. ..PE~IFICRTILN~ FiND CLIN::,IR..CFICN [~,IH.~RHf'I~ 8RE 8,¢MIL,HBLE TO INSURE PROPER INSTRLLHTION. t CERTIFY THRT i: I RM FAMILIAR WITH THE REk.qUIRENENTS FOR ON-SITE SEWERS AND, WELLS AS SET FORTH B't' THE blUNICIPRLIT'¢ OF ANCHORAGE, 2: I WILL INSTALL THE SN'STEM IN ACCORDANCE WITH THE CODES. 2:: I UNDERSTAND THAT THE ON-SITE SEWER [S'¢STEM HAY REIDUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN :l BEDROOMS. ~IGN -R~L~CRNT ' THOMAS H. ~4EBSTER c-L July 30, 1978 R&M NO. 851136 Thomas H. Webster P.O. Box 1431 Eagle River, Ak 99577 Subject: Soil Investigation for Sanitary Sewer System, BLM Lot 33 Section 30, T15N, R1W, S.M., Alaska Dear Mr. Webster, Per your request, we visited the subject lot this date to verify the soils and ground water conditions during reconstruction of the septic system. Reconstruction is required to place the drainf±eld wholly within Lot 33 and consists of relocating the drainfield a short distance to the south. The original soils report for the property was prepared by R&M (No. 656223) on May 3, 1976. Site conditions which appear altered at this time are as follows: Approximately 18 inches of fill has been placed over the site. No groundwater was noted in the original test hole, however, this date the groundwater level was measured at 13.0 feet after a stabilization period of about 3 hours. Because of the nearness of the proposed new location of the drain- field, no significant variation in conditions is expected. We appreciate this opportunity to be of service to you, Please contact us if you have any questions concerning this letter or if we can be of additional service. Very truly yours, CONSULTANTS/ INC./ ANCHORAGE FAIRBANKS JUNEAU VALDEZ WASILLA May 3, 1976 b~-. Tom H. Webster 3908 Apollo Dr.. Anchorage, Alaska 99504 MUNICIPALITY OF ANC} O~AO~ ~ ~ m , R & H No. 656223 ENV .~ONM~NiAL PRO'EcNoN MAY 7 cEiVED Test Hole and Soil Iz3g Report for Sanitary System B.L.M. Lot 33 Sec. 30 T15N, }~W, S.H. Dear Mr. We~bster: We are submitting herewith the test boring results ~d our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of April 24, 1976 and those procedures outlined in a letter dated July 15, 1975, by Mr. Rolf Strickland of the Hunicipality of /~cho~age, Department of Environmental Quality. A single test Hole was put down within the Lot 33 area for the pur- pose of defining general s~surface soil conditions for the proposed sanitary system. Excavation was accomplished with a bachoe and the test hole was extended 'to a total depth of 13.5 feet below gro%md surface. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in Fine test hole. We appreciete being given this opportunity to be o~ service to you. Should you have any questions with regard to t~:e above, please do not hesitate to contact us. Very truly yours, it & M CONSUL'PANTS, ,lames W. Rooney Vice President xc: ..'.lunicipality of Anchorage T.H.I 5-3-76 SAND ,ff/oO.%a GFC'IVEL (SP) n_n Layers of Silty Sand 13.5' No Water TaJDle Log !.represents location of Test t.lo!e B-L.H. fat 5{.3 Section 30 T!SN, ~W, S.H. Tom H. }/ebs'ter Log of Test Hole ~Ln chorage, Alaska Well Owner_ M-W' DRILLING, Inc. P.O. Box4-1224 · 1310C International Airport Road (907) 274-4611 ANCHORAGE, ALASKA 99509 DRILLING LOG MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTIOI~ MAY 2 0 RECEIVED .Use of Well Location (address of: Township, Range, Section, if known; or distance mmn road Size of casing (7 Static water level Screen ( Describe screen or perforation Well pumping test at 2 gallons per (H6Qf.)' of drawdown from static level. __Depth of Hole &.',o feet Cased to !'/,, 9 feet 12.!5 ft. (~15i~%~) (below) land surface. Finish of well (check one) open end ( ); Perforated ( ). (minute) for 9 hours with Date of completion 29 2 r):::[ ~. ! gT(~ WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness _TO TO 'ft. .TO TO. _TO .TO. _TO. .TO _TO .TO TO. .TO. .TO .TO. 4 ~/'" ' 2 -- STATE Parcel I.D. # 1. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division 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 GENERAL INFORMATION Complete legal description Hawditt Subdivision Lot 2 T15N, R1W. Sec. 30 Location (site address or directions) 15240 Darby Road Property owner Mailing address Lending agency Mailing address Vietor schmidt 15240 Darby Road, Chugiak, AK P.O. Box 100720, Anchorage, AK Day phone 248-5030 99567 Day phone 265-3406 99510 ,,.~ Agent Address N/A Day phone '~nless.oth~Wise requested, HAA will be held for pickup. 2 'NI~MBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well x NOTE: Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State AD£C attesting to the legality and status of system. 72~)25 (Rev. 1/91) Front MOA#21 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 verifythat 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 Ragl¢, R'ivo'¢ P~ngSno~-clng .q¢~mri(~o~ Phone 694-5]95 Address P.O. Box 773294, Eagle River, AK 99577 Engineer's signature Date -~<-/~Z/~' / DHHS SIGNATURE ~ Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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. Em ployees 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) 8ack MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAl. CHECKI.IST Parcel I.D. ADEC water system number ~'~/~--~ ~z~ ?~ Driller Casing height Wires properly protected (Y/N) E 4ENTAL SERVICd;.; .L,h'~iON Legal Description: ~ ~ /-//~,¢..~ ,'fW A, WELL DATA Well type .,/,*-/~-~,/-~ If A, B, or C, attach ADEC letter. Log present (Y/N) ~ /1/ Date completed Total depth /--/'.5'-,~ Cased to / ?' '~ / Sanitary seal (Y/N) .)/ RECEIVED Date of test Static water I~vel Well flow Pump level FROM WELL LOG AT INSPECTION / ..~.~- / g.p.m. 4:9. ~ g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer service line /,~.- ' ; On adjacent lots ,//~"/ ; On adjacent lots Public sewer manhole/cleanout WATER SAMPLE RESULTS: Coliform ~7~ Nitrate /-/¢' ,~.~/~ Other bacteria / Date of sample: ..,4"/.~,/~/ Collected by: ~r-',~ B. SEPTIC/HOLDING TANK DATA Date installed ,/~'2 g Tank size /~>'~ ~--~ Cleanouts (Y/N) r~' Foundation cleanout (Y/N) /V High water alarm (Y/N) /~",/'~ Date of pumping _'~//~/ Compartments .2_ Depression (Y/N) Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /¢~ On adjacent lots To property line ~' / Absorption field Surface water/drainage Foundation Water main/service line 72-0~6 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Oy~les tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed //~' ;:;;'~ %`` Length -~ ¢' / Width Total absorption area ¢~"Z¢,¢ Depression over field (Y/N) Results (pass/fail) f'¢ '¢' J' ~? Peroxide treatment (past 12 months) (Y/N) Soil rating //~4--,¢ System type Gravel thickness .¢- / Total depth Cleanouts present (Y/N) Date of adequacy test for ~ bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot J,.'*.-<-' To building foundation On adjacent lots Surface water Curtain drain /""~ On adjacentlots ~¢~' '*;;~ Property line Cutbank To existing or abandoned system on lot Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name ~ ,,~r ,,~¢~.¢¢¢-~, Date ..5~/'/~'/"~','' HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number :A Eagle River Engineering Services 11940 Business Blvd, Suite #205 P.O. Box 775294 Eagle River, Ak. 99577 694-5195 Fax 694-3297 IType of test: [] Well Flow Test [] Septic Test Only ~ Well & Septic Test [] Other: Meter Monitor Well Tank GPM PSi Remarks Time Reading Level Level Level , ) A Eagle River Engineering Services 11940 Business Blvd, Suite //205 P.O. Box 775294 Eagle River, Ak. 99577 694-5195 Fax 694-3297 Date: IType of test: [] Well Flow Test El Septic Test Only [~ Well & Septic Test El Other: Meter Monitor Well Tank GPM PSI Remarks Time Reading Level Level Level X; ~ u ~q NORTHERN TESTING LABORATORIES, INC. 3330 iNDUSTRiAL WAY FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA g9503 (907) 277-8378 · FAX 274-9645 Eagle River Engineering PO. Box 773294 Eagle River AK 99577 Attn: Louis Butera Our Lab #: Al10035 Location/Project: Hawditt Your Sample ID: Lot 2 Sample Matrix= Water Comments: Report Datez 05/07/91 Date Arrivedz 05/05/91 Date Sampled: 05/03/91 Time Sampled: - Collected By: LM Flag Definitions U = Below Detection Limit DL Stated in Result B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Date Method Parameter Units Result Flag Analyzed EPA 300.0 Nitrate-N mg/1 1.4 05/03/91 Reported By.' William~han Anchorage Operations Manager MUNICIPALITY OF ANCHORAGE 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. # ~)~-'-/ .~)/_..- Z/~'~ HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 2 Hawditt Subdivision Sec. 30 T15N R1W (b) (c) Location (address or directions) Darby Road Eagle River. AK Property owner Lomas & Nettleton Co. Mailing Address P.O. Box 226407 Dallas, Lending Institution n/a Mailing Address Telephone: (home) TX 75222 Telephone n/a Business214/263-7911 (d) RealEstate Company and Agent H~on Rea]fy ./ Address 2804 W. Northe~'~ Lts. A~choraqe, A~ Telephone 248-2804 Jean Hohnste~n./Barbara Lyon 99503 (e) Mail the HAA to the following address: (or check here r-I, if hold for pick up.) List contact person and day phone number below: Pick up_ by engineer - 694-5195 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms 1 3. WATER SUPPLY Individual Well [] 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 [] 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 flies 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 Eaqle River Enqineerinq Svcs. Telephone 694-5195 Address P.O. Box 773294 Eaqle River, AK 99577 Date 6. DHHS APPROVAL Approved for ~/'~. bedrooms by Approved .//~ Disapproved Terms of Conditional Approval Conditional 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 federai and state requirements. Employees of DHHSdonotconduct inspections or analyze data before a certificate is issued. TheMunicipalityofAnchorageisnot 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) o~ ^NCHI~Ii~ ,A. uthority Approval (HAA) .,,/~,~L s~~VtCr:SONi~LIsT ' FEBRUARY 1984 ~ - 343-4744 Legal Description: ~,c~-N. ~;Z. ~O~u\c~',~% ~.~,c%;~&(~¢) A. WELL DATA Well Classification /O~';'u"~ ~ Well Log Present (Y/N) ~' Date Completed //'//-~ Total Depth /-¢5-~" Cased to ~ ~-4 Depth of Grouting · Static Water Level ~ z//~ //,~,~'~,., ~. ~..,i~; Pump Set At Casing Height Above Ground 3 # ~ Electrical Wiring in Conduit (Y/N) Y SEPARATION DISTANCES FROM WELL: -f / To Septic/Holding Tank on Lot /~o ; On Adjoining Lots -~/~o · To Nearest Edge of Absorption Field on Lot ~15' / i On Adjoining Lots To Nearest Public Sewer Line ~/~ To Nearest Public Sewer Cleanout/Manhole If A, B, C, D.E.C. Approved (Y/N) Yield ~'~' ~,,l/~,v,/:~,, ,~'~, Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments .~. - .~'~-~ _/~.,?. '_~v B. SEPTIC/HOLDING TANK DATA Date Installed /?~' Size Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) /~o ~. Air-tight Caps (Y/N) No. of Compartments ~' Foundation Cleanout (Y/N) Date Last Pumped ~r, /'/~'~' (~"~') ;for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ' -f-/,~o / To Property Line '~5' To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course To Building Foundation To Disposal Field Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /¢ 78 Width of Field ~ / Square Feet of Absortion Area Depression over Field (Y/N) Type of System Design Length of Field -"'""¢¢ / Depth of Field ¢' / Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ,//.¢~ / To Building Foundation /~ / L o t To Water Main/Service Line '~/~ / To Stream, Pond, Lake, or Major Drainage Course ,v To Property Line -~'¢ / To Existing or Abandoned System On ; On Adjoining Lots ¢' ~'¢ / To Cutback (if present) To Driveway, Parking Area, or Vehicle Storage Area D. LIFT STATION /v,x/~ 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 Test. **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 Eagle River Engine0ring Services Company /¢ ,/z,, ?~-,¢/~/~Eagre River, AK 99577 Date 09-!-5195' MOA No, Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 Engineer's Seal .~--%.I~IUNICIPALITY OF ANCHORAGE /- 'h DEPARTMEN'I OF HEALTH AND ENVIRONMENTAL PRO,-'CTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2~ Hawditt T15N R_IW Sec. 30 Location (address or directions) Darby Road~ Eagle River (b) Applicant Name Nathan Brewer Telephone:Home 688-3782 Business N/A Applicant Address SR 'Box '414 ~ Eagle River Alaska 99577 (c) Applicant is (check one): Lending Institution []; Owner/builder [~; Buyer []; Other [] (explain); (d) Lending Institution Home Bq'ui~;y/Sheryl Butte Telephone 415-572-5 Address 2600 .campus Drive, San Mateo, CalifOrnia 94403 (e) Real Estate Company and Agent' ~Connie Bates/Jack White Realt.v Address P.O. Bbx 771699, EaRle River Alaska 99577 Telephone_ 694-'_550'0 (f) Mail the HAA to the following address: pickup TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms 3 Other WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environ mental 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. 72-025 {11/84) Page 1 of 2 ,~ . ~"~ 5. ' ENGINEERI'NG FIRM PROVIDING ~ PECTIONS, TESTS, FILE SEARCH, DATA JD INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of thi~Healtt~· 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 EAGLE RIVER ENGINEERING SERVICES Telephone EAGLE RIVER, AK 99577 Address ~. 0. BOX 773294 Date //~/oc¢'~' 6.q4o5195 Approved for _/* ~,~.~,_~,bedrooms by !o~7~ '/L~''t '~--~¢~/~C~Date- Approved ~,~.~ Disapprove~f' 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 WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) APPROVAL .,___ p~IST- FEBRUARY 1984 E~ViRON~EHt~ 264-4720 ~ ~9~ Legal Description: /~ ~ ~ lOOp / u ~ T /i Well Classification Well Log Present (Y/N) Total Depth Z¢~-¢ / Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by /~ Water Sample Test Results If A, B, C, D.E.C. Approved (Y/N) Date Completed ~7~,/'~ ? ./ ?~ Yield Cased to ? 7, ¢ *"~',-*4~epth of Grouting ~/~ '~" ~ ~, Pump SetAt ~ ~ ' ~ ~;'~ Sanitary Seal on Casing (Y/N) ~ Depression Around Wellhead (Y/N) ; On Adjoining Lots /~o/~'~ ; On Adjoining Lots /~'"~ Comments To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~'-~ ~5 o-~-¢~-~- ~,.'--T ;Date B. SEPTIC/HOLDING TANK DATA Date Installed /g ?g' Size /~¢ ° ~ '~/ No. of Compartments // Foundation Cleanout (Y/N) Standpipes (Y/N) /V Air-tight Caps (Y/N) Depression over Tank (Y/N) '~ ~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) //~./,-;¢' ; for Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /~/*'¢~ ~" / To Property Line Y-lO ~ To Water Main/Service Line '~-/~ / Course Temporary Holding Tank Permit (Y/N) To Building Foundation ,~z/ / To Disposal Field ~' / To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /,~ '2~ Width of Field Square Feet of Absorption Area Depression over Field (Y/N) "~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well *-/~;o / To Building Foundation /4 _7 Lot TO Water Main/Service Line '" '''¢ / To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comrnents Type of System Design Length of Field ,~<-,~" Depth of Field ¢1 / Gravel Bed Thickness ~-- / Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line '~--/o / To Existing or Abandoned System on ; On Adjoining Lots z'- ~o To Cutbank (if present) LIFT STATION /p//,~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed .J,z~~ Date ~ //?/,Cd'- Company /~'t,'~/~,~' ¢ MOANo. '3~2----¢'~¢ '~'- Receipt No. Date of Payment Amount: $ 72-026 (11/84) ~¢IUNICIPALITY OF ANCHORAGE DEPARTt~IENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONIV1ENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name .*~ra¢--~c.¢- TCephone: Home d'~'g~- .7~-~_ Business Applicant Address ._t',~ ,d~o,,~- z¢/,~/ / _/.~_~j-Z¢ ~, ~ ~f 5' ~ .f~' 2';2 (c) Applicant is (check one): Lending Institution []; Owner/builder [~i Buyer []; Other [] (explain); (d) Lending Institution ~'////~ Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family'~ Multi-Family [] Number of Bedrooms '~ Other WATER SUPPLY Individual Well"~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite'~' Public [] 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. 12~r~ t ~ O 72-025 (11/84) 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 IV]unicipalJty 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 Address F. AGLE RIVER ENGIN~'ER'fN6 SERVICES Date EA6LE I~tVEI~, Al( 694o5195 App roved fo r ~Z~ ~(~_~_~ed roD r~.--'~ Approved ~__ Disapprove~// J 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. A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Well Classification p,~-~ ~',e Well Log Present (Y/N) y Date Completed TotalDepth g/~'Q / Casedto /'~"g~'~epthofGrouting Static Water Level /~- ~' / Casing Height Above Ground --~ // Electrical Wiring in Conduit (Y/N) /V Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by /~'~'~ Yield //.//. · a~,~' ~'=,~ Pump Set At ~g:',~ i';~,~.~ ~""~-~ ~'~'"^~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) If A, B, C, D.E.C. Approved (Y/N) Water Sample Test Results Comments ; On Adjoining Lots /d~- /'--)~ ~' "'" ;'On Adjoining Lots / To Nearest Public Sewer ,,"~'a,~, c To Nearest Sewer Service Line on Lot ~&- ~- B. SEPTIC/HOLDING TANK DATA Date Installed /~ ,24 ' Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line /o f- To Water Main/Service Line I O Size /g~,o ~/, No. of Compartments 0~' Air-tight Caps (Y/N) ,'~ Foundation Cleanout (Y/N) ~ Date Last Pumped .~,.,x ~' ~,~,,'~'$-'~' /t)//~4 ;for Temporary Holding Tank Permit (Y/N) To Building Foundation ~'// To Disposal Field ~ / To Stream, Pond, Lake, or Major Drainage Course Comments Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed lq ,'~? ~./~.~ r~.¢4.~ "-'- Width of Field &"eo ¢- /' Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: 'Fo Water-Supply Well /~ 'Fo Building Foundation ?o ? /,," Lot /L)o ~' ~-/~/.¢~.¢~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field 6*-¢/¢' Depth of Field ~' / Gravel Bed Thickness '~ / ' ' Standpipes Present (Y/N) Date of Last Adequacy Test To Prol~erty Line /o To Existing or Abandoned System on ; On Adjoining Lots ¢ '*~¢ / To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~~z,~--':~-~ Date Company /.~/.~ ~r.j-- MOA No. Receipt No. Date of Payment 4~ Amount: $ Ak~~ ,C~ Engineer's Seal Page 2 of 2 72-026 (11/84) .agle River Enginearing Services P. O. Box 773294 Eagle River, AK 99577 694-5195 DATE MUNICIPALITY OF ANCHORAGE DFPT ~F HEALTH & ENVIRONMENTAL PROT£CI'IOJ~ BAY 3 0 ~g85 RE, CEI._VED SIGNED ~ ocmv ocr~tlCC. TJ:n - I~,F RFVFRSE SIDE EAGLE RIVER-' EN GINEERIN G:. sERV'ICESi:~i:iii' :: -i':> :i':! State o¢'"A1 aska: Department of.E~v'f~onmental Con~-ervati6:fl .. 437 E','.-'St.-,: 2nd.-_-.F)'oor - . Anchorage¢5:Ala'ska 99501 .. ;,: - . '2.~,~.~_~_.~ ...... '' Ref: Lot 2 Hawditt'Subdivi~ion:- "'.'vfi~sary for you to make.'a d6cision on_app~6~'~'~'%-f .~ request"?:~ 'iv:er~ '-~aSing height. :-~ This":wai~6~"-is for' a..p~'~'~ate well s6¢v:ih~ ,a:,::~:h'gle" fami.l~ ~::~n.. the above.~r, efereffced~:-,l'ot..: . -..?:~:..:tfi'b: gWound slop~s-:a'way from the W~I~ : :-fr'8'~'5~'fi';-::aqu i fe~'::(hb~':.i s 450 feet dee'p f:' and has a:. stat . wel l'"'~ro~'~'~'ontami nat i on'. Th'~ZLiO~'.:~asingsur~d'~din'~'~the';-brig' will.Prot'6~t:.the well f¢om su~f'a~'~::.~:o'ntamination-:-Whi~:6"..ail0~il ~' i ::~'ealed wi~h' '~]],:~fgu~ and the 10" casing'would be'capp6~ with::~'~:l:~]t'er. ......... .Lou Butera P.E, ' :.. - · - '"" --: P:O~ Box 773294 ........ ?~" Eagle River, Alaska 99577 Telephone (907) 694-5195 ".. ':.-...::;:'~::i' '" .- .-/~ .-':'.?:'.. ::'. DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/~'~ESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR 274-2533 May 20, 1985 J Mr. Lou Butera, P.E. Eagle River Engineering Services P.O. Box 773294 Eagle River, Alaska 99577 SUBJECT: Waiver Well Casing Height, Lot 2, Hawditt Subdivision Eagle River, Alaska (8521-WA-165) Dear Mr. Butera: The Department has reviewed the subject waiver request and hereby waives the well casing height to 3 inches on the subject property for a single family residence only. Sincerely, SWE/msm