HomeMy WebLinkAboutEKLUTNA HGTS STEWART ADDN LT 4Eklutna
Heights
Stewart Addn
Lot 4
#051-063-21
Municipality of Anchorage
Development Services Department
-
Building Safety Division
On-Sde Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage. AK 99519.6650 Page/ of 3
www.ci.anchorage.ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: -0 J/" D SZ PID Number: D S/— O 6 3 -2 /
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Wastewater stem: New ❑ Upgrade
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Inspections performed by:
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Development Services Department Approval
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Reviewed and approved by:
' Date: °i-; O n f
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DESIGN NOTES:
1. Total Depth of Trench is 9'.
2. Sewer Service Line minimum 2% slope.
3. Trench has 1' Lot Line Waiver& 10' Minimum From Old Trench.
4. Lots Served by Private Water Wells.
r--4 7-1 1 N E W
LEACHFIELD
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ew 1000 G llon Septic Tank
0
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0 7_4IJC' C 2-j
4- A64aa "d 60
MEA Ease.
3-Bdrm House
3
Septic System Construction
Does Not Preclude Adjoining
Lots From Sanitation
Improvements.
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CHECK SEPARATION DISTANCE TO AREA WELLS PR
NOR THRI M
ENGINEERING
172J7 Beor Pow Clicle
Cagle River. Aloako 99577
907.694 7028
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STEWART ADD,
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MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Jul 25, 2005
Expiration Date: Jul 25, 2006
Permit Number: SWO50252 Parcel ID: 051-063-21
Legal Description: EKLUTNA HGTS STEWART ADDN LT 4
Design Engineer: 0838 North Rim Engineering Site Address: 021643 BEAR VIEW PL
Owner Name: CYNTHIA WINETEER Lot Size: 8400 SO. FT.
Owner Address: PO BOX 671735 Total Bedrooms: 3 Permit Bedrooms: 3
CHUGIAK . AK 99567-1735
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Date: 2� 0-r
Date: Zf
Municipality of Anchorage
Development Services Department
Building Safety Division <
\ On-Site Water and Wastewater Program .. a ..
4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage-ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. ati4-64-3'a/ _Permit Number SW
Property owners) ��_ �� e- W'^e��'� —Day phone
CXILn
���`� g address 2/63 �Q/r1,��r'� � `Vl + I' �c�e Zip Code
'3tC�'addfess Pb-$p( (AI-g3`5 0��L_ 6LA1 . aa9.o-4 Zip Code
Legal description (Lot, Block & Sub'd.) --
Legal description (Section, Township & Range)
Lot Size 9f0� Acre q.Ft. Number of Bedrooms -�
THIS APPLICATION IS FOR:
Sewer Only /V_
Well Only El
and Well Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS: ❑
Hot Tub FIJacuzzi
Swimming Pool F1Water Softening Unit ❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner &/authorized agent)
Permit/Rush Fees: '�'� Waiver Fees:
Date of Payment:
Date of Payment: �21�07 y
Receipt Number: 71 2 t 4Receipt Number: W,12
(Rev. 09104)
Municipality of Anchorage
e,
� J
11.0. Ib[ l.Mt(M • Anchorul;c, t\In.ku .Ybl 1 fifM Telephone 0)7)138dii(11 • Pae (!M17)M14M1-I�'•(M)
47M lltnlatw Strccl • ALtchorngc, Alaska 91,\997
""v.nutnl.nrg
Mayor Mark Begich
Building Snfcty Division
July 25, 2005
Northrim Engineering
Steve Eng
17237 Bear Paw Circle
Eagle River, AIS 99577
Subject: Waiver Request for Eldutna Ileights Stewart Add Lot 4
Waiver Request WR#: 050051
Parcel ID # 051-063-21
PERMIT: SW050252
Dear Northrim Engineering:
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to the property line has been approved. The approved separation
distance is 1.0 foot.
This waiver approval applies to the existing absorption field to property line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
Iiv
ooda11il Engineer
On -Site Water & Wastewater Program
Conununity, Security, Prosperity
Municipality of Anchorage
Development Services Department
„r Building Saf[:ty Division
On -Site Watcr and Wastewater Program
4700 Bragaw Strcet
-� P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchomge.ak.us
(907)343-7904
Waiver Review Worksheet
WR#: 050051 PID#: 051-063-21 HAIPermit# PERMIT: SW050252
Date Received: July 25, 2005
Legal Description: Eklutna heights Stewart Add Lot 4
Engineer.
Northrim Engineering
Steve Eng
17237 Bear Paw Circle
Eagle River, AK 99577
Applicant: 1 foot absorbtion field to north lot line waiver
Waiver Requested:1 foot absorbtion field to north lot line waiver
Criteria: Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Waiver Is Granted: X
List Conditions or Reasons for above:
Total:
Waiver is not Granted:
Points:
Date: 7125105 By: Joe Goodall
Name of Reviewer
Rec#: 71254 Amount: $175 Date Paid: 7/25/2005
1-
CRUT EERIr� N�
Norihitim Engineering
17237 Bear Paw Circle
Eagle River, AK 99577
907.694.7028
July 20, 2005
MOA On -Site Water & Wastewater Program
4700 Bragaw St
Anchorage, AK 99519
RE: Septic System Design, Eklutna Hts R H Stewart Addition Lot 4
Lot Line Waiver
The septic system has failed on the subject property. The owners wish to replace
immediately. The soil test was excavated to 15 feet and dry. A lot line waiver to 1 foot is
requested at the back lot line.
Most of the neighboring lots are developed. This site should not negatively impact any of
the other area lots. The slope is relatively flat.
Please review the wastewater system design for the single family home. I have included
design plans & specs, design guidelines, & soil tests. If there is need for additional
information or clarification please give me a call.
Sincerely,
Steve Eng, PE, PI
Design Enclosures
Y�
FAN ,INEERIN�NGG—_ Eklutna tits R H Stewart Add. Lot 4
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: This is an existing single family home @ 3 bedrooms. The system is
in a failure mode and is about 27 years old. The septic system is being replaced. This requires a
new 1000 gallon septic tank. The lot is only 8,400 square feet, as are neighboring lots. A V lot
line waiver is being requested to the back lot line. The neighborhood lots have been developed.
The 100 foot separation will be maintained on the new septic system. No adverse impacts are
expected from developing this lot. The existing water well is located on the drawing as are the
neighboring wastewater systems & water wells. The lot is relatively flat. No conflicts to any
neighbor lots is anticipated. One soil test was conducted. A silty gravel soil with adequate
percolation rate. An application rate of 0.8 GPD/Ff= with 0.5 reduction factor for utilizing a 5'
wide trench was utilized. The old system will be properly abandoned.
Specification Requirements: All components and work must comply with the Municipality of
Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater
Regulations.
• Two compartment, 1000 gallon septic tank.
• Watertight couplings on inlet & outlet.
• 5 foot minimum between the tank and bed. 10 foot to property lines.
• 3 feet of cover or insulation is required for trench; an equivalent of 1" insulation for each foot soil
cover.
• Tank & solid pipe must be set on well compacted, stable soil.
• 4 inch diameter cleanouts with airtight caps are required 1 to 4 feet from foundation wall, prior to any
90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between
the tank and the absorption field, not more than 10 feet from the tank positioned to provide cleanout
access towards the tank and towards the absorption field.
• All cleanouts must extend to at least ground level.
• In solid pipe runs, ASTM D-3034 may be used in hcu of cast iron.
• Trench to be placed level, minimum of 4 feet to groundwater, 6 feet to bedrock from drain -rock.
• Drain rock to be % inch to 2 '/2 inch screened. Drain rock to be distributed uniformly throughout the
trench.
• Perforated pipe to be installed level with perforations down.
• Silt barrier (filter fabric) to be installed above the drain rock.
• Smeared trench sides must be raked or scarified before drain rock placement.
• Backfill over drain rock must not be less than 36".
• The finish grade must be mounded to promote drainage over the trench.
• Insulation must be placed over any pipe installed under driveways or parking areas.
• Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM
D2661,
• Sewer Service Line is minimum 2% slope.
• Septic Tank to be pumped every two years or when required.
• Insulation board to be extruded direct burial polystyrene (Dow Styrofoam III or equal)
• The existing septic system will be abandoned; the septic tank will be pumped, crushed, and filled with
sand/gravcl or removed and properly disposed of.
DESIGN NOTES:
1. Total Depth of Trench is 7.5'.
2. Sewer Service Line minimum 2% slope.
3. Trench has 1' Lot Line Waiver& 10' Minimum From Old Trench.
4. Lots Served by Private Water Wells. N E W
Lafi
LEACHFIELD
ea
0
C7
0
3-Bdrm House
w 1000
Abandon
C5
3
n,
MEA Ease. ! R10
CHECK SEPARATION DISTANCE TO AREA WELLS
NORTHRIM
ENGINEERING
17237 Boor Pow ClrG*
Eoylo River. A/osko 99577
907.694.7028
Septic Tank
00 Gallon Septic T
Septic System Construction
Does Not Preclude Adjoining
Lots From Sanitation
Improvements.
EKLUTNA HTS—
STEWART ADD.
TO EXCAVATION
LOT
LAYOUT
LOT 4 1# = 20'r/20/05 Ii`Eof 4
U
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120.00 :::>4:D:;:z: WELL 120.20 N
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NOR THRIM
ENGINEERING
17237 Bear Pow Clrcle
EOVO Rl e . Alaoc 99577
907.694.7028
of ,ac 44 EKLUTNA HTS-
49� JR H STEWART ADD. L 4 SUBDIVISION
LAYOUT
' FF-" SEPTIC SYSTEM
REPLACEMENT I' = 40' 7/20/05 2 of 4
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SOILS
NEERING
.OG - PERCOLATION TE
Date Performed) 5/24/05
Performed Fors Cynthia Wineteer
Legal Description Eklutna Hts R H Stewart Add. Lot 4
DEPTH
(FEET)
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
18
19
T.H. Location: See Drawing
rganic
-IM
Silty Gravel
Groundwater? No
Depth
--
Water
Depth
After
Monitorin
.None Date+
6/10/05
#
Date Gross
Time Net Time
De th
Net Di
1
6/1 0
--
4.75'
--
2
6/1 2
2 min
5'
.25'
3
6/1 3--
4
6/1 5
2 min
4.75'
25'
5
6/1 6
--
4'
--
6
6/1 8
2 min
4.25'
.25'
20 = U
21 H
Percolation Rate 8 min./inch Perc ole Diameter
Test Run Between 4' and 5'
Comments - CERTIFY THAT THIS TEST WAS
Performed By NorthRim Eng. I
Performed in Accordance 5 ith All State/Municipal Guidelines in Effect
ON THIS DATE. DATE 6/15
NORTHRIM TES THOLE
LOG T. H. 1
ENGINEERING
17237 Boar Pow Clrclo a�-.:�
E,yI.Ra,69a7028EO
99577 �....- _ GTECHNICAL
6/15/051 of
�\ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
�it/c-
PHONE
/�-
ANEW
_' UPGRADE
MAILING ADDRESS n
/? G. �o x 2/ S� E/ [ E 1v/ 'e_' 41<. 993_77
LEGAL DESCRIPTION
L oT �r , �%�L/Ti✓�¢% S. Sl�I�U- ; 5: 6ccJA C�-i
�j vow/.
LOCATION
NO. OF BEDROOMS
LA�fIGi- L�N�
3
UY
Well
DISTANCE TO: 7 7
Absorption area
Dwelling
%
PERMIT NO.
-790537
i Q
W 1.-
Manufacturer
�QEE,2
Material
�TE�C
No. of compartments
2
w
Li.q. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
/OOO
Y
DISTANCE TO:
Well
Dwelling
PERMIT NO.
J � Z
OZ Q
Manufacturer
Material
Liquid capacity in gallons
O
w=
DISTANCE TO:
Well 7 i
Foundation
S�
Nearest lot lines
PERMIT NO.
Q,�-5
j WZ
No. of lines
Length of each line
Total length of lines
Trench width
Distance between lines
Z w
�—¢
sJ--
S- -
O inches
N
¢ F
Top of tile to finish grade
Material beneath tile
Total effective absorption area
O
3YZ" %O 4/z &'
inches
l g :j0. ,=77
Length
Width
Depth
PERMIT NO.
W
Q H
Type of crib
Crib diameter
Crib depth
Total effective absorption area
UJI
w
W
(n
Well
Building foundation
Nearest lot line
DISTANCE TO:
J
Class
Depth
Driller
Distance to lot line
NO.
J
W
DISTANCE TO:
Building foundation
Sewer line
Sept.c tank
JPERMIT
Absorption area(sl
OTHER
PIPE MATERIALS n
4" Pd 4)kq/,✓ '00/p
SOI L TEST RATING
t
e�L
INSTALLER
il��rL« 11�, /,,,C.to
tl
REMARKS
10
CSO M1/T/ �/c 6.t/T O/t"/ /1'/(f ,C//J L i 7-
P%Rv,/f{-C OF '77' SEPT C-
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CITIJ �x'.a •
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f A+S Earl P. Ellis
•��'
�t
j
J,•.• NO. 1745-E
• sAV
EFpP ••.....-NPS,
APPROVED \`�O DATE LEGAL
Zee E'KG/i%vf}
/�/ S•. STE[lJAer �Do�✓
/y/7g
12-013 13/78)
Mu" I c s 'F71 L_ I rtiI OF= r-ir4 Ica ,Fz: ;rte
fie; -,'
DEPARTMENT OF HEALTH AND ENVIRONMENTAL r'ROTECTION
O 'L' STREET, RNCHORAGE, AK. 99501 l
264-4720
WELL FiNL> ON—!F- I TE SEWER' F3EFRM I T
PERMIT NO. ( 780339 )
APPLICANT KURKA ALASKAN BUILD INC P.O.BOX 2214 E. R. 99577 694-3493
LOCATION
LEGAL L 4 EKLUTNA HTS STEWART ADD LOT SIZE 0400 SQUARE FEET
OF SOIL RBSORBTION SYi TEM I1: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FTr'BR)= 240
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
CEF'TH� 12 LEf-•IGTH= lG1 GFZ"m-,'EL CEF `TH= C;
l!:E LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DR.AINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE 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 MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
F�zEc4u I F2EO SEF=l*T I C TAMC = I IZE= 10ia0 G"LL-ONS
PE,MIT RPPLICnNT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTI ALL ;TMON INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERT4 AND THE
"WAGER OF RESIDENCES TlinT THE WELL WILL SERVE.
-- - TWO C ;� I C��P EST I KDN� FIRE REa7 I I SEC -- -
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL O4' THIS
DEPRRTI MENT WILL BE SUBJECT TO PROSECUTION.
MIi:IML1M DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR H PRPAi l L WLLL.- UK
150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
0w11rr. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRRMS ARE
�� � � gut ��.��eva�
AVAILABLE TO INSURE PROPER INSTALLATION.
^E�cM I T EBF'' I i=:'_ES CC GEML-�EFt 31s 13'�
I CE^TIF',' THAT
A.s I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH DY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THR THE ON-SITE SEWER S' TEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS R D.TO,INCL, 7MORF_�HAN 3 BEDROOMS.
SIGN D: --T- _-- -r� —�--
APPL I INT, *URKA N BUILD INC -
V3.2
ISSUED 01,1-Q"'1-_ G�`-'' DATE---------------
W A L / Ic{CIl2 fC I4
0 Ef E GEC -ECHNI CAL Ef DEVE, )PMENT CO.
Box 90, Davis St , Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster Earl Ellis
694-2774 SOIL LOG 6ae-22eo
Soils Er Foundations �1Land Development
Performed for: Name: /�� 11S,46q ��% ���-s �iyr Tel. No. rc 95/- 3 9
Mailing Address: Y C ��x �/�, �qc« ,���'z �i�7I /%
Legal Description: /CT 5�� Fi« L'r`�/A /14/4,-NTr
Death (feet)
1 /tJL S;�T
2
3
a
5
6
Soil Characteristics
���D. /✓tents r T //�:Q . / o ,�— -�
7
8-7
P,�7-iCC.// F T
�y�
�/EAJ cher
7: Nc
/z
to
�a� Si¢N09' �i1�cc�- /�'i��c
g e,
G - Si�T, �'�a'«5 �1 ,
7%
11
z
Al r�
rjOL'LVL- e1 % / 7�
' z
7 she
1'
D��.r :s <<ss S�%�
7C
13
Ve
Sc
�st
lU
15
L,f`TTc,tfi 6 F / iT
16,
_�� _ 7
Ground Water Encountered: Yes No If yes, what depth
Proposed
Installation: Seepage Pit Drain Field
Comments:
Performed by: ' Date: 7
M- W DRILLING, INC.
DRILLING LOG
Well Owner 14alt Kurka _Use of Well
r
Location (address of: Township, Range, Section, if known; or distance main road
Lot 4 Eklutrm lloirghts Ste:,,ar1 Al idition
� feet Cased to 11--5.3 feet
Size of casing ') Depth of Hole 35
1 0
Static water level ft. (;4kgS_t) (below) land surface. Finish of well (check one) open end
Screen( ) ; Perforated
Describe screen or perforatio
Well pumping test at • 7' gallons per%{hour) (minute) for ? hours with___L_ ft:c
of drawdown from static level.
Date of completion 5/25/73
WELL LOG
My.
C:
y:
PM
Depth in feet from
ground surface
Give details of formations penetrated, size of material, color and hardness
0TO 2
uasiuv 3tiC :u*:
2 TO 7
Silt•, ,--rave!
-
�.
•% 7 TO 10
Loose -,ravel
:-
' 10 TO 40
Silty cobbles
--
40 TO 55
Loose Gravel
55 TO
Silty coh ,1 s;
80 TO 110
Loose rr rn! III +r
110 115
S
TO
115TO 142
Silty -ravc1l
142TO 260
hedrocl , w ter SCUDS ill SI)o;:aLlic1a LL1YC:, = 11`OU"SIC 1C.
TO
TO
TO
�
TO
+
TO
3 — CONTRACTOR
W DRILLINv, INC.
DRILLING LOG
Well Owner
14alt Kurka Use of Well ilOt't.
Location (address of: Township, Range, Section, if known; or distance main road
Lot 4 Eklutna 11 ights Steward A;idi_tion
Size of casing Depth of Hole 4 5 . `
� 3 r �7 feet Cased to 1 3 feet
-Static water level 1`'0 ft. (,4hpvg) (below) land surface. Finish of well (check one) open end
;;;;'• Screen ( ) ; Perforated
Describe screen or perforationIl/:3
Well pumping test at • 5 gallons per.`-hbilr) (minute) for 1 hours with 1�''+;' ft•c
of drawdown from static level.
Date of completion 5/ 2 5/ 7 3
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
_-L
—TO
2___T
0
7
---L
y
—To
10
10
TG
40
40TO
55
55
TO
b0
80
TO
110
110
115
TO
115
142
TO
. 142
260
TO
TO
TO
TO
TO
_TO
Casing- sticku )
Silty gravel
Loose ravel
Silty cobbles
Loose Gravel
Silty coi,hl cs
Loose r't el • Orr rn1-•+lll n -
Sand
Silty E_ravel
Bedrock, water se:>,ps in suoradic F_ractur.ee, +=droll-hogt
/
3 — CONTRACTOR
M U M U PAL F l/ OF H C H 0 tl VA �: J L;=
Z
Development Services Department - - Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-063-21-000
Expiration Date: 9/16/2023
Legal description EKLUTNA HGTS STEWART ADDN LT 4
Site address 21643 BEAR VIEW PL Chugiak AK 99567
Current property owner(s) OTTE DANIEL J & AMY E
The On-site system(s) is/are approved for bedrooms
X Conditional approval for 3 bedrooms, with the following stipulations:
Comments or advisories: 20 yards of cover (topsoil and hydroseed) to be placed over
field by July 20, 2023. Prepaid receipt/invoice from JR's Septic & Excavation
Original Certificate Date: 6/16/2023
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist x Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval_June 2022
MUNICIPALITY OF ANCHORAGE *R L6 W
A.
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 051-063-21
Complete legal description Eklutna Heights Stewart Addition Lot 4
Location (site address) 21643 Bear View Place, Chugiak, AK 99567
Current property owner(s) Daniel & Amy Otte Day phone (907) 570-1402
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ■❑ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑■ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 17yrs _ See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed X Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested:❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ G 80 Waiver Fee $
Date of Payment Date of Payment
COSA # 015 G Z 3 119 7 Waiver #
COSA Application—June 2022
Eklutna Heights Stewart Addition Lot 4 051-063-21
2.9
357
145.3
4.39
18+
5/31/23 Forge Engineering
109 5/30/23
9/19/22
JR's Septic Pumping & Excavation
8/4/05
8.6
N/A N/A
N/A
5/31/23
Benjamin Schiller, P.E.
1*
(907) 522-7773
June 16, 2023
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
6/16/23
Subject: Eklutna Heights Steward Addn L4 – 21643 Bear View Pl
Conditional COSA request
Dear On-Site Services Engineer:
The owners of this property are selling their home. They had a closing date and agreement set up
before they found out that their trench lacked the required cover. It is unclear if significant
settlement has occurred since the installation, or if there was some re-grading done years in the
past.
They have been unable to schedule landscapers or installers to address this issue before the closing
date. However, they have received a detailed quote and paid the invoice for an installer to correct
this deficiency after the closing date. We have attached this paid invoice, and request a conditional
COSA to be issued, with the final COSA to be provided after the fill and hydroseeding has occurred
by July 20, 2023. At that time we will inspect the trench and confirm adequate cover.
Sincerely,
Benjamin Schiller, PE
Invoice
Date
6/14/2023
Invoice #
2022-220
Bill To
Daniel Otte
21643 Bear View Pl.
Chugiak, AK 99567
JR's Septic Pumping and Excavation
PO Box 773415
Eagle River, AK 99577-3415
Project
Cover Leach Field
Terms
Net 30
I look forward to working with you!
Phone #
9076946454
E-mail
jrsseptic@gmail.com
Web Site
www.jrspumping.com
Total
Balance Due
Payments/Credits
Cash, Check, and Credit Card are all accepted
payment methods.
DescriptionQuantity Rate Amount
Crew/equipment to place topsoil in backyard. 1.5' over leach field, and some extra to
level it out. 2 loads of topsoil and 1/2 day. Planning to have completed on the 20th July
2023.
5 275.00 1,375.00
2 loads of topsoil, 20 yards.20 20.00 400.00
Truck time to deliver topsoil.3 125.00 375.00
Hydroseed for topsoil.1,000 0.18 180.00
$2,330.00
$0.00
-$2,330.00
•
• pTF aO ,
Municipality of Anchorage =°:
Y...t. 'iY 74F1:
On-Site Water and Wastewater Program <,,. ;'
(907) 343-7904 s A <<T.
Certificate of On-Site Systems Approval
Parcel I.D. 051-063-21 Expiration Date: S-- I a-10
1
0
1. GENERAL INFORMATION
Complete,,,legal description Lot 4, Eklutna Heights, Stewart Addition
,a1;,*
01.*hidili address) 21 643 Bear View Place, Chugiak, AK 99567
Qurre+Rit onperty o iiher(s) David Robbins Day phone (707) 580-7090
yMai4ir�gdd `"�" 21643 Bear View Place, Chugiak, AK 99567
Real-Estate Qget7t ; ; .; Michelle Webb/RE/MAX Dyn Day phone (907) 242-5252
2. TYPE OFDWELLING:
[21 Single Family (w/wo ADU)
❑ Duplex
•
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received b : ��/ ' `"
Date: /
Y 5
COSA to be released to t/engineer.unless otherwise requested by the engineer.
G
COSA Fee $ 5Z 6 Waiver Fee $
Date of Payment 2/1 $ Date of Payment
Receipt Number Z2-(0°IC" Receipt Number
COSA# OC.-/S7/6(1 / • Waiver#
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,
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 files 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 Pinard Engineering Phone (907) 232-1347
Address PO Box 871347 Wasilla, Alaska 99687
Engineer's Printed Name Paul E. Pinard Date 2/7/18 ,
aelf°410E,444M
'MUM. ...VA
*••491H .,,ory,
6. 'DSD SIGNATURE A•••, •••••� ••;••,��
System#1 ApprovedNThittf•
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Lot 4, Eklutna Heights, Stewart Addn Parcel ID: 051-063-21
A. WELL DATA
Well type Pvt If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 5/25/78 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 357 ft. Cased to 145 ft. Casing height(above ground) 18 in.
FROM WELL LOG AT INSPECTION
Date of test. 5/25/78 1 /29/18
Static water level 180 ft. 109.7 ft.
Well production 0. 5 g.p.m. 2. 6 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate 4.76 mg/L
Arsenic ND ug/L Date of sample: 1 /28/18 Collected by: Pinard Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 8/5/05
Tank size 1000 gal. Number of Compartments 2 Cleanouts(Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N
Date of pumping 6/16/17 Pumper Sanitary Pumpers
C. ABSORPTION FIELD DATA
Date installed 8/5/05 Soil rating (g.p.d./ft2XXEtarlq 0.8 System type Trench
Length 1 �'.r► Width 3 ft. Gravel below pipe 6 ft.
0.040.
Tot • 4' !i
� . bsorption area 565 ft2 Monitoring tube Y Depression over field 14
DAt4.giadei ftl�t�14.
/18 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field bore test 6 in. Water added 630 gal. New depth 24 in.
K�r I*iMAi IVO i*ti •tx `
Elapse1;1 Yi44jriti 6) r * Final fluid depth 6 in. Absorption rate >= 450+ g p d
da t4ve,-30 � ti
Any rejuveT ipiilf��ast 12 mo.) (Y/N &type) None Known If yes, give date
'HOf223xr'`q JI
D. LIFT STATION NA
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100 + On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 751+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank 75' +
Animal containment areas 501+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 51+
Water main 10'+ Water service line 10'+ Surface water 100g+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 11 * Building foundation 101+ Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10 +
Curtain drain None Known Wells on adjacent lots 100'+
F. COMMENTS
* Waiver issued by MOA letter of 7/25/05 for this separation.
G. ENGINEER'S CERTIFICATION +1�tt�ti`
I certify that / have determined through field inspections and
..10-74 OF� . sits
review of Municipal records that the above systems are in AC .�. .��� •S. 1r
conformance with MOA COSA guidelines in effect on this date. �* • r
Engineer's Printed Name Paul E. Pinard •_ N
Date 2/7/18 r�1� . Paul E. Plr>tord 93 2 foi
11,` `'�4
COSA yellow sheet_2-6-15.doc
Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-063-21
1. GENERAL INFORMATION
Expiration Date: �;I _ % 3 /q
Complete legal description Eklutna Hts Stewart Add, Lot 4
Location (site address) 21643 Bear View, Peters Creek, AK
Current Property owner(s) Nasse Day phone 273-7725
Mailing address
Real Estate Agent Diana Webb, Jack White Real Estate Day phone 273-7725
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class C Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Received by: r �� _ Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 14L O
Date of Payment 9 0 � �'l 4
Receipt Number c6dfs
COSA # CSC' I b 0 SD
Date of Payment
Receipt Number.
Waiver #
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,
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 files 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 NorthRim Engineering Phone 694-7028
Address PO Box 770724 Eagle River
Engineer's Printed Name Steve Eng
6. DSD SIGNATURE
-Z System #1 Approved for bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
By. I —� Original Certificate Date: ) I -13-)3
The Municipality of Anchorage Devlopment Services Division (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 9-1-12 dec
If more than I septic system is on the lot:
COSA Checklist # _of _
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description:/!� (,�7�. / f7`s Sfies �A� c�d% a f c� Parcel ID: U S / — 063-2 /
A. WELL DATA
Well type If A, B, or C provide PWSID # Well Log (Y/N) Z
Date completed 5./_Z5_/ 8 Sanitary seal (Y/N)Wires properly protected (Y/N) �!
Total depth '�4zft. Cased to/ --S ft. C Casing height (above ground) / BTin.
FROM WELL LOG AT INSPECTION
Date of test S�� S� 78 / S / 3
Static water level / ft
Well production 0, S g,p,m, 6 g.p.m.
WATER SAMPLE RESULTS:
Coliform _0—colonies/100 mL Nitrate Z• 03 mg/L
Arsenic 0-241k ug/L Date of sample: /a/? /3 Collected by:
e. SEPTIC/HOLDING TANK DATA
Tank Type/Material .. e OL 5 Te.EG Date installed �l5�os
,
Tank size /060 . gal. Number of Compartments Z Cleanouts (Y/N)
Foundation cleanout (Y/N) `1 Depression over tank (Y/N) _,�L High water alarm (Y/N)
I i
Date of pumping 03 /3 Pumper J l] S
—� —
C. ABSORPTION FIELD DATA
Date installed S 0 S Soil rating (g.p.d./ft2 or ft2/bdrm) 8 System type `T P n 0.4
Length � e ft. Width _3 ft. Gravel below pipe C ft.
Total depth 9 It. Eff. absorption area ,�65 fe Monitoring tube 4— Depression over field /l%
Date of adequacy test 1/ S /3 Results (Pass/Fail) /%rj' For 3 bedrooms
Fluid depth in absorption field before test d in. Water added S 7 gal. New depth in.
Elapsed Time: 30 min. Final fluid depth 6 in. Absorption rate >= _�If.SO g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION A1 A
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off level at in. High water alarm level at in.
Datum
E. SEPARATION DISTANCES
WELL ON LOTTO:
Cycles tested Meets alarm & circuit requirements?
Septic tank/lift station on lot /0 0 '-f- On adjacent lots / 0,0 r�
Absorption field on lot 4 go `f On adjacent lots (a 6
Public sewer main NA Public sewer manhole/cleanout J11,4
Sewer /septic service line Z 5 ' Holding tank NlII
Animal containment areas 50'+ Manurelanimal excrete storage areas l0 0
SEPTIC/HOLDING TANK ON LOT TO:
i
Building foundation Z S F Property line ✓� ,r Absorption field S
Water main AIA Water service line So ' Surface water 460
Wells on adjacent lots AIM 14"
ABSORPTION FIELD ON LOT TO:
Property line Building foundation Q f Water main NA
Water Service line 5 O ,� Surface water 00 `� Driveway, parking/vehicle storage 5 D Y
Curtain drain 194 Wells on adjacent lots 00 `f
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name z°'rF/F
Date _4112V13
COSA brown sheet_10-10-12.doc
M
Try Lq
J �l
Municipality of Anchorage O
.•;4
-.� Development Services Department :'.- :�'�•
Building Safety Division =fi"•. �'��•
On -Site Water and 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
FOR A SINGLE FAMILY DWELLING
Parcel I.D.QS/-063—Z/ COSA# 080/70
Expiration Date: — S — Q
1. GENERAL INFORMATION
Complete legal description�N/ /TNA Ms — STA4/1 r 4iil & LOT q
Location (site address) 16y-3 jfSE Z V/Eit2
Current Property owners) r/�s'N ua - Rv ohm$_ Day phone
Mailing address
Lending agency
Mailing address
Day phone
Real Estate Agent 6US/0�2.Li k06f4. IF,rT G Day phone
Mailing Address Olay C'o
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
3
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 Onsite 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 sample results. (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 engineers work.
�i
uo,,
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
"_g
Individual Holding tank
❑
Community On-site
❑
❑
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 Onsite 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 sample results. (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 engineers work.
�i
uo,,
4. 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,
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 files 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
Address PD li0x %70 i
Engineer's Printed Name _,S � �/E lel r
5. DSD SIGNATURE
__z Approved for
Disapproved.
_-3 bedrooms.
Phone�•� 70Ld'
Date .S •30/4
�.... ^ ................
P. .... ............,
;• Steven W. Lig
6256
Y
C �; 4Jf�JJ�•1� a-ry
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By:! �>�� Original Certificate Date:
J
�.
(Rev. 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: 5I/LJ' -AIA 1-1—IS-STFWAZrA4 L� Parcel ID:OSI-063-2/
A. WELL DATA
Well type P If A, B, or C provide PWSID # _
Date completed 42S/74Sanitary seal (YIN) Y
Total depth =ft. Cased to ly5 ft.i�
FROM WELL LOG
Date of test _5.aS1W
Static water level /0040 ft.
Well production 6-5 g.p.m.
WATER SAMPLE RESULTS:
Coliform __Q_colonies/100 mL Nitrate Q S!6mgIL
5%/
Arsenic: Q.(� 4 Date of sample: 70_
B. SEPTIC/HOLDING TANK DATA
Well Log (Y/N)
Wires properly protected (YIN)
Casing height (above ground) /do In.
AT INSPECTION
5bqjoe
2 S ft.
g.p.m.
Other bacteria 0 colonies/100 mL
Collected by: A10C7i i ,� En 9_
Tank Type/Material AA(JPd0LC6' T;4#111. ZST�L Date installed ��•SfG 5
Tank size ZWA gal. Number of Compartments Z Cleanouts (Y/N) y
Foundation cleanout (YIN) Depression over tank (YIN) IJ High water alarm (Y/N) /Y
Date of pumping/3 O 7 Pumper sem/✓/T�/�f �c vrr9PfS
C. ABSORPTION FIELD DATA
Date Installed —0-5
Length ft.
Soil rating (g.p.d./ft2 or ft2/bdrm) 41• d'
Width
3 ft.
system type7'iE'Ego
Gravel below pipe 4:�" ft.
Total depth __2_ ft. Eff. absorption area �Mfe Monitoring tube _Y_ Depression over field N
Date of adequacy test Results (Pass/Fail) JP19-y's For bedrooms
Fluid depth in absorption field before test 6 in. Water added5_00gai. New depths in.
Elapsed Time: min. Final fluid depth -' in. Absorption rate >= SO g.p.d.t
Any rejuvenation treatment (past 12 mo.) (Y/N & type) Un/ lC If yes, give date
D. LIFT STATION /,114'
Date installed Size in gallons J. Manhole/Access (YM)
'Pump on' level in. 'Pump off level at in. High water alarm level at in.
Datum Cycles tested Meets alarm & circuit re irementsl
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 160 i f
Absorption field on lot / O J
Public sewer main
Sewer /septic service line J S "+
Animal containment areas /4 O rf
/
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout /VSA
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
i
Building foundation ,' Property line _�/ Absorption field �5_
Water main Af •`} Water service line S � / f Surface water /00
�r
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line , Building foundation yQ 4- Water main
C f iy �
Water Service line �0 Surface water /60 Driveway, parking/vehlcle storage S-0-YLCurtain drain 41d Wells on adjacent lots f
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are In
conformance with MOA COSA guidelines in effect on this date.
Engineers Printed Name ���✓E ��
Date 6 f 0 k
COSA Fee $ T 3 a
Date of Payment
Receipt Number 0 R % fj
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
of
TH
Steven W. Eng fy��
if' •. PE 6455
aO SFS ..........
ri
NALYTICA
GROUP
Northrim Eng
Attn: Steve Eng
17237 Bear Paw Circle
Eagle River, AK 99577
907-694-7028
Fax: 907-694-7026
Client Sample ID:
Sampling Location: 21643 Bear View
Client Project: Northrim Eng
Sample Matrix: Aqueous
COC N:
PWSk:
Residual Chlorine:
Comments:
LabO: A0805108-OIA
Analytica Imcmational, Inc.
4307 Arctic Blvd.
Anchorage, AK 99503
Phone: 907-258-2155
Fax: 907-258-6634
Report Date:
5/302008
Receipt Date:
5/192008
Sample Date:
5/192008
Sample Time:
I I:OO:OOAM
Collected By:
SE
Flap, Definitions:
MRL = Method Reporting Limit
MCL = Maximum Contaminant Limit
B = Present also in Method Blank
I I = Exceeds Regulatory Limit
M = Matrix Interference
J = Estimated Value
D = Lost to Dilution
•• = RL higher than MCL; target not detected
TNC = Too Numerous to Count - result rejected
CF = Confluent Growth - result rejected
TCNG = Turbid Culture No Growth - rejected
Analysis Method Prep Prep Analysis
Parameter Result Units Flags I%IRL MCL Method Date Date Analyst
92228 (Aqueous) - Membrane Filtration MF Test was conducted by: Analytica- Anchorage
Bacteria, Other <MRL CFU/IOOmL 1.0 5/192008 5/192008 PL
Total Coliform <MRL CFU/IOOmL 1.0 1 5/192008 5/192008 PL
Labs: A0805108 -01B
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
4500-NO3E (Aqueous) - Nitrate Test was conducted by: Analytica - Anchorage
Nitrate as N 0.586 mg/L 0.10 10 5202008 5202008 JQ
Lab0: A0805108 -01C
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
200.8200.8 (Aqueous) - Family Well Water 1
Arsenic
Reported by: Marty Waters,
Laboratory Project Manager
0.673 ug/L
Test was conducted by: Analytica - Thornton
0.15 10 200.8 5272008 5272008 GY
Page I of
X
7
A
%
%
A
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AS-11UMT
.'he4bi certify that -1 111ave gurvel iwiiwing
�e,
7
;scrlbe4,p� BM;
Fdu
Tis- Pt i 46,� -1.
Ahebotage Itecording Precizict,'Ali" 'in'd that: the
re.withlo the property
r, J&4.,.ItJ
linea -sud do not overlayL the properV
,or.,encroach cc
1&1ngAutJscent, thereto, that no Improvements on -prop-L
he
city lying adjacent thereto e4croveh. on;t premises in
ti and that -there are no Toadwayt. transiniaston
quet an
lines'ar Visible exPep
2
other *MeMents'004aid property,
as indicated hereon..
at Zagle 111ver;.Alaski
lday :,
4iW
.
4ROMERf C_ JOHNSON W44%0 , -
Registered ImW-Survey4ir No. 886-18
Box 4156.1 gag)e RivI Alaska- -
Ft" 694-2543
`J; %P
y�z� es
Municipality of Anchorage
Development Services Department ='
Building Safety Division
On -Site Water and Wastewater Program < <
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. HAA # QQW,�%
Expiration Date: 2 — O - O
1. GENERAL INFORMATION
Complete legal description,t47-j S72e4lst2r APA- 4a7- y
Location (site address or directions) Z U q3 $Pn,rw/Ps„t P(c.c t r ?e7erj Crot
Current Property owner(5l..r. d m 4j=1. P C Day phone 727— 7//7
Mailing address 912Lre,(3 Vroc.r RIA ce
Lending agency
Mailing address
Day phone
Real Estate Agent Jot LaShc4de_' Day phone 3/ 7-44*f o
Mailing Address r, r c c ✓
Unless otherwise requested, HAA will be held by DSD for pic up.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
S
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
�❑
0
Individual Holding tank
❑
❑ Community On-site'
❑
❑ Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 sample results. (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
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority 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 files 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
Address
Engineer's Printed NamI E-
5. DSD SIGNATURE
Approved for 3
Disapproved.
Conditional approval for
bedrooms.
Phone i!!�W— 702d°
Date Z& �CS
OF R (�4.T, 11
•p •••N•u q•
i
i
� :�C,TN 3 • /
C:• Sloven W • t,; •1
�+ •. PE 6256 ••i��
bedrooms, with the following stipulations:
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: Original Certificate Date: — Z 0 " 0 S
(Rec O1102)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: �%L t/ %�ti� /� rS – S?F_r ,44'r "d G l( Parcel ID:
A. WELL DATA
Well type If A. B. or C provide PWSID # _ Well Log (YIN)
Date completed T f 7 Sanitary seal (YIN) Wires properly protected (YIN)
Total depth 3S 7 ft. Cased to N -s ft. T Casing height (above ground) in .+
FROM WELL LOG AT INSPECTION
Date of tests/��7t
Static water level
Well production 6. S g.p.m. tQ g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate 3,3 mg./I. Other bacteria G colonies/100 ml.
Arsenic: mg./l. Date of sample:, r�a� Collected by: /Vu rl h Ri.,*, 6v—
B.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material AWo A4,ye iE na tc s Tra
Tank size /d ° ° gal. Number of Compartments Z
Foundation cleanout (YIN) �C_ Depression over tank (YIN) A!
Date of pumping /YFK%T Pumper
C. ABSORPTION FIELD DATA
Date installed �.iT Soil rating (g.p.d./ftz or ftZ/bdrm) QdP
Lengthft. Width 3 ft.
Date installed
Cleanouts (YIN) y
High water alarm (YIN) ty
System type 7 seENo N
Gravel below pipe C ft.
Total depth ft. Eff. absorption are��1`0 Monitoring tube Depression over field
Date of adequacy test lye'uJ Results (Pass/Fail) For _? bedrooms
Fluid depth in absorption field efore test _ in. Water addecj� gal. New depth_ in.
Elapsed Time: _ min Final fluid depth _ in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) .VO If yes, give date
D. LIFT STATION
Date installed Size in gallonsManhole/Access (Y/N)
'Pump on' level at in. 'Pump off" level at in. High water alarm leve t in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot /0 0 f" On adjacent lots /,a o
Absorption field on lot / O G 'r
Public sewer main Niel'
Sewer /septic service line ZS't
On adjacent lots /a 0 't -
Public
f
Public sewer manholelcleanout W14
Holding tank Ar,14
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
r � /
Building foundation q a f Property line Absorption field s
Water main ,t%IA Water service line SO 10- Surface water
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
/ r
Property line Building foundation" / t Water main N111f
r
Water Service line 50rf Surface water /ad, r'f- Driveway, parking/vehicle storage SO F
Curtain drain A/�f Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION �Ar A� ' �► •, �V lf,
I certify that I have determined through field inspections and v * :497—?i • t
review of Municipal records that the above systems are in I
w' • •//rrte�,,....--._--.
conformance with MOA HAA guidelines in effect on this date. •�+n'' j
� ` �� C: • Slerrn VL Cn�,4� �
Engineer's Printed Name / ✓� 6 •di'jl*-. PC 6256
Date
HAA Fee $ !A 3 O
Date of Paymentcl16' os -
Receipt
Receipt Number
(Rev. 12101)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department � s-•• ->.:,:;
/ Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Water Well Advisory
Health Authority Approval # 050469
During a recent Health Authority Approval on-site inspection and test of the
potable water supply well on Block , Lot 4 of Eklutna Heights Stewart
Addition subdivision, the well's productivity was determined to be 0.8
gallons per
minute.
The
minimum well
productivity
required by
this
Department
(AMC
15.55)
for a 3 -bedroom
residence is
0.31 gallons
per
minute. Although the subject well currently exceeds this minimum
requirement, all parties concerned are advised that the production capacity of
the well may fluctuate. Restriction of non-critical water uses such as
washing cars and watering lawns and gardens may be required.
This advisory must be attached to all copies of the subject Health Authority
Approval.
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AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a MQo geeinspection
of the following described property: 1
E/« -CIT q NE/G14T5 SUBD.,
J` J •
R, 14. AT
, .5rEWR195Z ADD/T/DIV
rJQ''��_ t `�E Anchorage Recording Precinct, Alaska, and that the
"'^ ""'•'° "° �` f Improvements situated thereon are within the property lines and
».�. •-•-, f do not overlap or encroach on the property lying adjacent
1, 4 Prod T:a'cr17- �-!fi V thereto, that no improvements on property lying adjacent thereto
n'a•=71S" =t` encroach on the premises In question and that there are no
roadways, transmission lines or other visible easements on said
`p n - •'r property except as indicated hereon.
Dated atAnchorage. Alaska
EASEMENTS OF RECORD, OTHER THAN thus 9 ff day of 5EPrCM6r-R 20 Or
THOSE SHOWN ON THF RFl)ORnFri FFOS--5 D fir, `r FRED WALATKA & ASSOCIATES
EL
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/V B9`571/0"E:
_ -3-
AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a MQo geeinspection
of the following described property: 1
E/« -CIT q NE/G14T5 SUBD.,
J` J •
R, 14. AT
, .5rEWR195Z ADD/T/DIV
rJQ''��_ t `�E Anchorage Recording Precinct, Alaska, and that the
"'^ ""'•'° "° �` f Improvements situated thereon are within the property lines and
».�. •-•-, f do not overlap or encroach on the property lying adjacent
1, 4 Prod T:a'cr17- �-!fi V thereto, that no improvements on property lying adjacent thereto
n'a•=71S" =t` encroach on the premises In question and that there are no
roadways, transmission lines or other visible easements on said
`p n - •'r property except as indicated hereon.
Dated atAnchorage. Alaska
EASEMENTS OF RECORD, OTHER THAN thus 9 ff day of 5EPrCM6r-R 20 Or
THOSE SHOWN ON THF RFl)ORnFri FFOS--5 D fir, `r FRED WALATKA & ASSOCIATES
Mat -Su Test Lab of Alaska
BIO
Mile 3.2 Palmer-Wasilta Hwy.
Midtown Community Business Park
P.O. Box 2749
Palmer, Alaska 99645
Phone: 745-3005 Fax: 746-3070
Drinking Water Analysis Report
Total Coliform Bacteria
Client: /1!U
Address: 3 e� jje PWSID#(if applicable):
fc, rv� L (5-77
Phone #: 69 — 70Fax #: - 70 z Paid:
This Section to be completed by Sampler
Legal Description of Property: aL)
07—
Sample
T
Sample Site Location: Qv T—Q6t_ 1--C�ojc-J- Delivered to Lab By: lido* i rn., G.,,
(I.E.: kitchen sink, bathroom sink, outside hose bib)
Time Sampled: Z33 O Date Sampled: P'lls °s Sampled by: 0.1� -
Sample Type: Routine . Treated:[:] Untreated:❑ Repeat Sample #:
This Section to Be Completed by Lab
Analysis Results:
QSatisfactory
❑Unsatisfactory
❑Sample too long in transit (greater than 30 hrs.)
'Request resample.
Copy Sent to State: Yes : No
Chromogenic/Fluorogenic Method Results:
f Total Coliform Present (P)/Absent (A) Lab I.D. #: c .Ani $
E. Coli Prese
nt (P)/Absent (A)
Date Received: a lei's Time Received: AI! O cb Receives
Date Test Begun: 014 0lI-- Time Test Begun: 1J;r3a Analyst:
Date Completed:(rn or Time Completed: Nj a3 Analyst:
Refer to Back Side for Instructions
Mat -Su Test Lab of Alaska,
Q1EM1 Water Quality Testing.,
Mile 3.2 Palmer-Wasilla Hwy. P.O. Box 2749
Midtown Community Business Park Palmer, Ak. 99645
Phone: (907) 745.3005 Email: mat-sutestlab[7roaemhsa.com Fax: (907) 745-3010
Client: North Rim Engineering Date Arrived: 8/15/05
17237 Bear Paw Circle Report Date: 8/18/05
Eagle River, Ak. 99577 Sample Dale: 8/15/05
Attn.: Sample Time: 1300
Client ID: Lot 4 Eklutna His. Stewart Add. Collected By: SE
PWSID #:
Source:
M.S.T.L.#: 51643
Sample Matrix:
Comments:
Method Parameter Units Results MDL Date Prepared Dale Analyzed MCL
SM 4500-NO3-E Nitrate -N mg/L 3.30 0.50 8/18/05 8/18/05 10.0
SM 4500-NO3-E Nitrite -N mg/L 0.29 0.05 8/18/05 8/18/05 1.0
Total Nitrate/Nitrite mg/L 3.30 0.50 8/18/05 8/18/05 10.0
Legend: MRL - Method Report Level
MCL - Max. Contaminate Level
B - Present In Method Blank
E - Estimated Value
H -Above MCL
D - Lost to Dilution
Reported By Jon Paul Campbell
Lab Manager
MUNICIPALITY OF ANCHORAGE Aik
• 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
Parcel I.D. # C) 6 � — nlo.l)-Q 1
1. GENERAL INFORMATION
Complete legal description
HAA# OQ211-LIDS
ct T,v/F
Location (site address or directions) 2/�S/-3�✓%��� ,"c�tcb
Property owner
Mailing address
Lending agency
WIL( _tAm %4 �5ro.vri'CDay phone
Day phone
Mailing address //JJ
Agent ���� �1GK'7UC- cl//AN✓ Day phone G9y o3s�
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
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
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) Front 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.
David R. Dayton P.E.
Name of Firm 20210 Donalar St. Phone
Chugiak .Alaska 99567
f
Address ) i ,
Engineer's signature
6. DHHS SIGNATURE
LApproved for �� bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Date
\�
.s 0 A, T4s t`
i p •
�4. David R. Dayton
'L: -�, •, h0. 2205-E
bedrooms, with the following stipulations:
By: �J, �4..� Date 7 /2 -"73
111T1r
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragrapn o 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.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 6or Parcel I.D.
A. Well Data
Well type If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) y Date completed -5-/Z)/—Fi13 Driller
Cased to � Casing height Z-�, /
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump levell
FROM WELL LOG
Y_/zi1J_3
/ Yu
U
.5,
AT INSPECTION
7
Wires properly protected (Y/N) r
7'G
AT INSPECTION
O n
z /
0
v
O n �
`
g.p.m. [ ..:' g.p.m.
G
u
U4 c
L �
Q
�m
SEPARATION DISTANCES FROM WELL TO:
w.J,vFY-�
Septic/holding tank on lot
Absorption field on lot
Public sewer main
f L,
On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Sewer service line Z -y 71(-- Petroleum tank
WATER SAMPLE RESULTS:
A1oAIT_
Coliform Nitrate :L 5 Z Other bacteria
Date of sample: %��,' Collected by: J>
B. SEPTIC/HOLDING TANK DATA
Date installed t� /7 �7� Y Tank size t CC) c� Compartments `-
A<,eN0
Cleanouts (Y/N)
? Foundation cleanout (Y/N) ; A • crm..- Depression (Y/N)
ti/
High water alarm (Y/N) ^ �'/+ Alarm tested (Y/N)
Date of pumping 4016%-3 Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot Z;� On adjacent lots Foundation %
To property line 2.5- Absorption field Water main/service line 1"
Surface water/drainage /6)0`t`
CONTINUED ON BACK PAGE
72-026 (3/93)' Front
C. LIFT STATION
Date installed N�� Manufacturer
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
Surface water
Date installed f �1 /�/ Soil rating (GPD/Ft2) oZ 57�fjQ System type
Length S'7 Width ¢o" Gravel thickness 8 Total depth //�Z r A% lL�i
Total absorption area q / L Cleanout present (Y/N) , 3 ' Depression over field (Y/N)
Date of adequacy test & G 3 Results (pass/fail) ��S for .� Bedrooms
Water level in absorption field before test f,7 After test L; 7'04ft?b n /-Xrt-)
Peroxide treatment (past 12 months) (Y/N) /V If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
G�.4VG-�7Ls ✓ v r«i
Well on lot 91 On adjacent lots 01 Property line
To building foundation
4 /
To existing or abandoned system on lot .. k,'Jwtit
On adjacent lots Z Y Cutbank /V61— 1-5� Water main/service line S� r
Surface water /om 4- Driveway, parking/vehicle storage area �t
Curtain drain /(`outs
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
of this inspection.
David R. Dayton P.E. ^.k.! OF Q "ZIt
21210 Donalar St. ,, + ` •.; 4
_,ovy'sak, Alaska 99567 9
r
Signature > PSA;,?'� * A/
Engineer's Name "°" ••••�^ ••••...
Date
HAA Fee $ /;70,(-')0
Date of Payment 7._
Receipt Number 44 721 ( X�-a �)
72-026 (3/93)' Back
Waiver Fee $
Date of Payment
Receipt Number
D. R. DAYTON, P.E., R.L.S.
HC 78 Box 1026 Chugiak, Alaska 99567 (907) 688-2417
WELL FLOW TEST
Legal Description: Lot 4, Eklutna Heights, Stewart Addition
Date of Test: June 26& 27, 1993
Well Depth: 357'
Casing Depth: 145.3'
Static Water Level: 111'
Requirements: 3 Bedroom - 450 gallons per day
Test:
The well was pumped down to the low water shut off level and
allowed to recover for 1 hour. The process was repeated several
times to determine the recovery rate of the well.
Results:
Based on recovery measurements, the well is currently producing
0.53 gallons per minute which is adequate for a 3 bedroom home.
OF A2;7( o�
�E•,,........go p&
... f
f David R. Dayton
NO. 2205-E
3 fl °•• '° C.JV �
�4oaa�e Tss����o
D. R. DAYTON, P.E., R.L.S.
x NgN3 t Chugiak, Alaska 99567 (907)YRM�
20210 Donalar 696-2417
Adequacy Test
Legal Description: Lot 4, Eklutna Heights, Stewart Addition
Date of Test: June 26, 1993
Septic Tank: 1000 gallon, 2 compartment, steel tank (DHHS Records)
Absorption System: 57' long x 40" wide x 8' effective depth trench (DHHS Records)
Soils Rating: 240 sq. ft. per bedroom
Requirements: 3 br - 450 gallons per day
Test:
Water was pumped into the absorption trench while measuring
volume, time and liquid level rise. After the pumping was stopped,
the liquid level drop was measured at timed intervals. The results
plotted on a graph of time and gallons absorbed.
Results:
The septic system absorption trench is currently functioning
adequately for a 3 bedroom home.
(DHHS Records)
�'_ ._moi .�. aas.•a �4-y!.
5 vi• -c. eec. ae °n sb •e si....e� ..
David R. Dayton �r,
6 o� tt
NO. 2205-E
•.
4c'9 PAOFESSIONa4'
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COMMERCIAL TESTING & ENGINEERING CO.
ENVIRONMENTAL LABORATORY SERVICES
5633 B STREET
ANCHORAGE. AK 99518
TEL: 19071 562-2343
FAX 19071561-5301
rr15G5 Member of the SGS Group (Societe Generale de Surveillance)
ENVIRONMENTAL SERVICES IN ALASKA. COLORADO. UTAH. ILLINOIS. OHIO. MARYLAND, WEST VIRGINIA. NEW JERSEY, SOUTH CAROLINA
C UJIMERCIAL TESTING & ENGLN-L�Er�l. c' r✓ v. tl�
Fig CHEMICAL & GEOLOGICAL LABORATORY
TELEPHONE (907) 562-2343 5633 B Street
j Anchorage. Alaska 99518
/ t Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY
❑ PUBLIC WATER SYSTEM I.D. #
^ PRIVATE WATER SYSTEM Analysis shows this Water SAMPLE to be:
/L.Satisfactory
Name Phone No.
❑ Unsatisfactory
Va... rg
SAMPLE DATE: 3
Mo. Day Year
SAMPLE TYPE
2; i
Zip Code
Routine
❑ Check Sample (for routine sample
with lab ref. no. ) ❑ Treated Water
❑ Special Purpose EyUntreated Water
SAMPLE Time Collected
No. LOCATION Collected By
2
3
4
5
❑ Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
.
Date Received �5
Time Received l 0 (S
Analytical Method: Membrane Fitter
No. of colonies/100 ml.
Lab Ref. No. Resuft• Analyst
�
FT -1
ILS m
I� m
m
A r . //�7 -� BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS Membrane Filter: Direct Count Coliform/10o ml
BEFORE Verification: LSB BCB
Fecal Coliform Confirmation
COLLECTING SAMPLE Final Membrane Filter Results / gCollform/10o mi
Reported By Date —
TNTC = Too Numerous To Count Time: (S, a.m.
OB = Other Bacteria
PART ONE OF TWO
*00 REMAINDER Member of the SGS Group (So REMAINDER TO FOLLOW
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date November 25, 1986
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
Off of Dolly on Lapage — Jack White sign in front
(b) Applicant Name Pat Murray Telephone: Home 688-2262 Business
Applicant Address
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder C; Buyer ❑ ; Other ❑ (explain);
0
(e)
Lending Institution Alaska Mutual Bank Telephone
Address Anchorage, Alaska/ATTENTION: Linda Malore
Real Estate Company and Agent Jack White Realty/Linda Banner
Address Eagle River, Alaska
TP1Pnhnna 694-5500
(f) Mie HAA to the following address:
S & S ENGINEERING
SRB 196X Eagle River Road
Eaqle River, Alaska 99577
ordered by Linda Banner
2. TYPE OF RESIDENCE
Single -Family 6 Multi -Family ❑ Other
Number of Bedrooms 3
3. WATER SUPPLY
Individual Well 129 Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite ® Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025(11 s:)
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 insoect�.171, RING
Name of Firm TelephoneSK B 196X
Address
Date
A
4
6. DHEP APPROVAL
Approved for tkll"' O bedrooms by Date
Approved Disapproved Conditional
Terms of Conditional Approval
CAUTION
/ 2-2-30 —26,
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 (n aa)
A.
D�PGE MUNICIPALITY OF ANCHORAGE (MOA)
Fr �Oa HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
��QP�Q,��•a`�,�ey
Legal Description: L 0 7 V G/GL07-hlA 14i -s S/z7
WELL DATA
• If A, B, C, D.E.C.
Well Classification Approved (Y/N
)
Well Log Presently Date Completed Z g'5 R Yield
Total Depth 3 a/ Cased to / Y!5 . A Depth of Grouting
Static Water Level /_L>>, Pump Set At U A --
Casing Height Above Ground
Electrical Wiring in Conduit�&N)
Sanitary Seal on Casing N)
Ya
Depression Around Wellhead (YQ
Separation Distances from Well:
i
To Septic/Holding Tank on Lot On Adjoining Lots
i
To Nearest Edge of Absorption Field on Lot o} —;On Adjoining Lots —
To Nearest Public Sewer Line lqL A To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot
c
14
Water Sample Collected by d r /`(-, "A* ' I cr ; Date .41 ' 30
Water Sample Test Results SP/3C � r
Comments �"1 �=C.L. `(i •1Z.r� �''S� �.-�2r-o71i'•n-t.c`I� :,►-s //-3 CD
B. SEPTIC/HOLDING TANK DATA
Date Installed / 0 Size / no a No. of Compartments
Standpipes (Y/N) Air -tight Caps &N) Foundation Cleanout (Y6
Depression over Tank (Y(D-Dj
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High -Water Alarm (Y/N)
1`f
Date Last Pumped��0-8to
for
Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
�
To Water -Supply Well e To Building Foundation
i
To Property Line 1014 To Disposal Field
To Water Main/Service Line / To Stream, Pond, Lake, or Major Drainage
Course
Comments
Page 1 of 2
72-026111,84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Zyo ` b3x_ Type of System Design C.N
Date Installed /CP -17 - 78 Length of Field s �,
i
Width of Field y� Depth of Field Z
i
Gravel Bed Thickness
Square Feet of Absorption Area 512-0 Standpipes Present P/N)
Depression over Field (Y& Date of Last Adequacy Test
Results of Last Adequacy Test Y Py -m 3 5�>_
Separation Distance from Absorption Field:
To Water -Supply Well X73 To Property Line
r
To Building Foundation 3 3 To Existing or Abandoned System on
Lot ?IJ On Adjoining Lots Z S r
To Water Main/Service Line 16(4To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course �1A
To Driveway, Parking Area, or Vehicle Storage Area Loo
D. LIFT STATION
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at "Pump Off' Level at
High Water Alarm Level at Vent (Y/N)
Tested for
Electrical Codes (Y/N)
Comments
Check Permitted Bedroom Rating Against HAA Request '•
Pumping Cycles during Adequacy Test. Meets MOA
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed S & S ENGINEERING Date
ARB 196X,;,,:>L.r.:+h
Compa MOA No. 00-3
EAGLE RIVER, AK 9957 ��
Receipt No. /o C) i ov �a
Date of Payment
1�.
�S�dG7• *�., r� 9�aP r,
Amount: $
Il Ste , 1J,
f Hm liiTS •�0
Page 2 of 2
72-026 (ivea)
Municipality
o�
Anchorage
December 23, 1986
i
F, C. a0x 196650
ANCHORAGE, ALASKA 99519-6650
(907)264-4111
DEPARTMENT OF HEALTH & HUMAN SERVICES
Robert A. Shafer. P.E.
S&S Engineering
SRB 196-X
Eagle River. Alaska 99577
Subject: Lot 4 Eklutna Heigh+ -s Subdivision
Waiver Request WR86-173
Dear Mr. Shafer:
Your request for waivers of the separation distances required
between the septic system on the subject lot and the wells
serving the subject lot and the adjacent Lot 5 have been
granted. The well on the subject lot is located 77 feet from
the septic tank and 97 feet to the leach trench on that same
lot. The well on Lot 5 is located approximately 96 feet from
the leach trench on the subject lot. This department has
received a notarized letter of non -objection from the owners of
Lot 5. The 100 foot separation requirements have been waived
to the existing separations referred to above.
These waivers are based on your assessment that there is little
risk of contamination of these wells from household sewage.
Any upgrades or enlargement of the septic system on the subject
lot will void these waivers.
Sincerely,
Stephen S. Morris
Civil Engineer
On -Site Services
J
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MMCIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HLTMfA_N SERVICES
WAIVER REVIEW WORKSHEET
DATE RECEIVED: LEGAL: L `7" F -L 4.17 n T
ENGINEER: c n c
SR B 196X
EAGLE RIVER, AK 99577
APPLICANT: /AZe.,P
WAIVER REQUESTED: G(lC' 7�
CRITERIA:
1) Geology:
A. Water Table
B. Soil Sorption
C. Permeabilitv
D. Water Table Gradient
E. Horizontal Separation
P -
/ r
Se/J7-1C AH ,, a 77
Gc sem! d '�
Points:
71
Z. o
. 3
Z. o
// / TOTALi 16 .3
Z) Special Conditions: A/
air S��l/ 70
//1lCcrly e,� 7�7Psp leis ui�iC /,y� 6�l Gil r% Gs/4lcJE2f
3) Other:
WAIVER IS: granted, with conditions listed below:
not granted for -easons listed below:
DATE: BY:
:A.".E
SUBJECT
COMPUTATION SHEET
DATE:
SHEET
BY
S CKD
OF
`nli4•r�� j f}PLLs - r tir—o. ��;r-� w�« �Jv a Sc�'rrL I nr s�c:ctro�-/ G2c'Po2(
o-�TaM ol= Sys�2�-t
, I l/r
\
/=i=c'i2c-UCL: --0 ,nIT(9?cc,47, 7L•
OIL S�orSrCAJ - Srr-AAG &eVZ-r.- ris IT2AVL=
�/L?Y �R.AvcrL �l I.VT���oc�ki� �i Z•o���
Lot, wct Lv(r
5I r.7-7 iZfa, vL3 L t u74z't-Pv4-Ar71
�OtJS�`Q�Z'!i tlJ� �'TSSu nnl'Tior`I d � L� �? Z• s/�
�— r/ oar �or� r �?L J�k h-R•,4i�D v — � S r —� ��Y�
i_,ec2i:tbar 19, i9�b
nun -_cipa i i t y of Anchorage'
Depar ti fent of Healt i and c uilan Services
nn_ r
Anchoruce, Alaska 99503
AT"cd]TION: Stave Norris
RSr'ERSD10E': Lots 4 and 5; E':lutna Subdivision
Vlet rte undersi"aned, have Ito oblectlons to the on-site wastewate disposal
system located on Lot 4 being lest than 100 feet from our well as prescribed
by flunicipal Ordinance. Further, we have no ob=ections to the waiver
being requested for the well '.oc te' oil Lot 4.
Sin araly, ��
N rnun and Fr3nJohnson
Lot 5: vlutna Subdivision
Swwww and subscribed belnre the this`22:�G
'day aJ�, 19 9 G
Witness my band and official seal.
'Votary Public
L yCom,6:siur,FapimSepL 13,1J89
ROBERT A.SHAFER
CIVIL ENGINEER
694-2979
$ A
E9C�E RIVER. P�PS�P
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER& WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
December 91 1986
Municipality of Anchorage
Department of Health and Human Services
825 L Street
Anchorage, Alaska 99501
ATTENTION: Steve Morris
REFERENCE: Lot 4; Eklutna Heights
Request you issue the attached Health Authority Approval and grant a
waiver to the horizontal separation distances between the well and the
septic tank located on the referenced property. The on-site wastewater
5isposal system was installed in October, 1978. At the time it was
installed the Municipality of Anchorage accepted a waiver to the septic
tank of 77 feet, to the trench of 97 feet, and to the property line
4 feet.
411 the lots in this subdivision are extremely small (8400 square feet)
and in most cases horizontal separation distances between private wells
and on-site disposal systems were waived at the time of installation.
In addition to the usual documents required for an HAA we are submitting
a plot plan and a copy of our waiver review work sheet. It is our opinion
based upon this risk analysis that the private well is almost sure to
De free from any form of contamination from household sewage. Therefore,
:he requirements of 18AAC72.021 are not required in this case.
If we may be of further service, please contact us.
SRB 196X EAGLE RIVER, ALASKA 99577
j f
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC
g TELEPHONE (907) 562-2343 5633 B Street, x
�f = Anchorage. Alaska 99518 r c
Drinking Water Analysis Feport for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIERI TO BE COMPLETED BY LABORATORY
PUBLIC WATER SYSTEM I.D.#
A Ihows this Water SAMPLE to be:
PRIVATE WATER SYSTEM
-S r✓ �la S -/ - 7
Name Phcne No.
Valllcg Address
j
5 5
Cdy State Zip Code
SAMPLE DATE:
Mo. Day Year
SALE TYPE:
_Routine
Check Sample (for routine sample
with lab ref. no. ) �:j Treated Water
Special Purpose Untreated Water
SAMPLE
NO. LOCATION
2
3
4
5
Time Collected
Collected By
na ysis s
Satisfactory
Unsatisfactory
Sample too long in transit: sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received
Time Received
Analytical Method: Membrane Filter
` No. of colonies/100 ml.
Lab Ref. No.
y4;zo-1S,
Result'
M
ELI
ELI
m
F7
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS Membrane Filter: Direct Count
BEFORE
COLLECTING SAMPLE
Verification: LTB
BGB
Analyst
-D(- C
Coilforml100ml
Final Membrane Fill r sults Cooilforml100ml
Reported By Date ;1 16 ;L /�`oil
Time: I s� 0 a.m.
p.m.
TNTC = Too Numberous To Count
OB = Other Bacteria
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1979
Date C011ecteo Source
a.m.
Data Received Time Received _ p.m. Lab. No.
Dresummiva 10ml 10ml 1 Oml 1 oml 20ml l.Oml O.lml
24 Hours
4e Hours
Confirmatory
4e Hous I I I I I
EMB Broth 24 hours: Broth 43 hours:
Multiple Tuba Report: 10MI Tubes Positive/Total 10m1 Portions
Membrane Filter: Direct Count Coliform/100ml
Verification: LTB BG0
Final Membrane Fllter Assuits / Coliform/100mi
Reporisd By / Date =�
f
Time �c= � �' a.m.
p -m.
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
J _ i
_
P.O. BOX 4.1276 TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL CENTER
Anchorage, Alaska 99509 274-3364 5633 B Street
ueowarowms 9
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
PUBLIC WATER SYSTEM:
Ll�} NO.
/ /
C16&'GfLI, `�%�x �" `
Satisfactory
❑ Unsatisfactory
Public Water System Name
El sample too long in transit: sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
Mailing Address
new sample.
-7 f ,:
City State ZIP Coda
O S 7
Date Received
SAMPLE DATE:
Mo. Day Year
Time Received
SAMPLE TYPE:
Analytical Method:
C,-R-outine
❑ Fermentation Tube
❑ Check Sample (for routine sample 1-1 Treated Water
with lab ref. no. t
7 Membrane Filter
❑ Special Purpose ❑Untreated Water
SAMPLE Time Collected
Lab Ref. No. Result' Analyst
NO. LOCATION Collected By
�-
2
i
3
II
I
m
4 I
F TI
5 I
•�J cf �Oli ^,s�,�-' _ .vim �!P�s:r-�_••.C�
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1979
Date C011ecteo Source
a.m.
Data Received Time Received _ p.m. Lab. No.
Dresummiva 10ml 10ml 1 Oml 1 oml 20ml l.Oml O.lml
24 Hours
4e Hours
Confirmatory
4e Hous I I I I I
EMB Broth 24 hours: Broth 43 hours:
Multiple Tuba Report: 10MI Tubes Positive/Total 10m1 Portions
Membrane Filter: Direct Count Coliform/100ml
Verification: LTB BG0
Final Membrane Fllter Assuits / Coliform/100mi
Reporisd By / Date =�
f
Time �c= � �' a.m.
p -m.
rr .j -��I (`� r� �- ' /r� / e.. �.,�_ -- 5 �r1 f i /•� ! 9I5 1 ILLEPHO NE
NE"
l -j �_�ice'_ �� •sf .E� rli.� (-... -..�1 �• r..,� n'r
( J/) 2/. - 014
P.O. 60X 4-1276'013,4-GE,5 S _Er'9 17USINESS U` iK LVD.
A[JG:Al
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”
111kb tFd��er Ar--EyS`.S i:e 0i�` tc'li TOS?_� CG3..;0[Cil �'.'_C[Cri3
TO DE CO"-LLi ED EY t': TEa u;- ,Ll ER
f Ut ,!_IC V.'A ER SYSTi:P,:
I.D. NO.
°ld fZf
City State 711, Code
DATE:
Mo. Day Year
L�'IYPE:
i� "c_tine
Ch k'�rnple (`or routine s=mple
with lab ref. no. - ) - Treated 'Alater
F] J Special Purpose C Untreated Water
SA'dPLE Time Collected
NO. LOCkTION Collected By
1 1LL/ e�.j �,� Ij� 3°S— _(2jO
2
3 [
4
1
5 1
—II TO EI_ CO; '?LUTcJ 1-1 U.` 0, 'CORY --
LF.''.Oi f,-1ORY:
DiEi4 & GEO IABS OF A.K.I;W.
I:=LAE
4649 BUSTi,ESS PP:RK_BLVD.
ADDRESS
ANCHORAGE, ALASKA
o�_te F.sceiv:_d _-z-n � -4 -00
Time Received
A' nelytical Met~od:
G Fermentation Tube
h"embrane Filter
Lab Ref. No.
Result' F.n--lyst
Rev. 1978
L J
LLQ
READ INSTRUCT IONSa.m.
Da:e Recel.ed 10-4-78 —Time Received. 9 :45_Lah.
,3837-7
No. _8837-7
No of Co:cr L• S I I C� ml. or Ko. of Pc_'fir5 s _:Vons.
06-12201b1 BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1978
Date Collected_ 1_.03-78_ _
Source _ —___—
READ INSTRUCT IONSa.m.
Da:e Recel.ed 10-4-78 —Time Received. 9 :45_Lah.
,3837-7
No. _8837-7
Presumptive 2Oml loml
24 Hours
IOml Ionni 1.Oml 0.1 m1
B48
BEFORE
Hours -
Confirmatory
24 Hours
48 Hours
EMB _— _.__ __ _ __ Broth 24 hours:
Eroth 48 hourS:__- _
COLLECTING SAMPLE
Multlple Tube Report, -
10m1 Tubes Posltive/Total 10m1 Portions
Membrane Filter: Direct Count— —
--_ Coliform/100m1
Form No. 18-310 (3-78)
Verification: LTB
Final Membrane Filte//r,,���RResu �
Reported By_ _,�
_BGB _
_ _ n Collfoo M/100m1
Date
Time:—-G`'T,� _
P.m.
? 'N N
May 28, 1980
Rhodi Karelia
Totem Realty
724 ?ast 15th Avenue
Anchorage, Alaska 99501
i
825 "L" STREET
ANCHORAGE, ALASKA 99501
1907' 2CA 4111
"y
Su;jject: Lot 4 Eklutna Heights Subdivision
(Sandra A. Walsh Property)
?approval for your individual sewer and water facilities
can not be granted until t::e following items have been
completed:
(1) The water analysis report be delivered to this
office from Chem Lab, 5633 B Street, for our
review.
(2) The septic tank pumped with a receipt submitted
to this office.
If there are any further questions, please call this
office at 264-4720.
Sincerely,
Les N. Buchholz, R.S.
Senior Environmental Specialist
LNB/ljw
cc: National Bank of Alaska
Mortgage Loan Department
Pouch 7-025 99510
RECEIVED OF
ADDRESS
A4
69M-
RECEIVED
9 fN 1
HOWP�PID BALANCE DUE -w
J
D�
5. LEGAL DESCRIPTION
DAtc RECEIVED
INSPECTION APPOINTM NTS
4S '�� (j
TWE
TIME ,,�
ME
NUMBER OF,BEDROOMS
❑ One E] Four ❑ Other
DATE
DATE
DPE
�' Three ❑ Six
J
( L t
1'
INSPECTOR
INSPECTOR
INSPECT R
MUNICIPALITY OF A
MUNICIPALITY OF ANCHORAGE DEPT. OF . - .LT u
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECj MRONME . i •' - _ - • -CTION
825 L Street - Anchorage, Alaska 99501
•
MAY 2 2 1980
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTYOWNER
PHONE
MAILING ADDRESS
PROPERTY RESIDENT (lf different from above)
PHONE
2. BU R�\\
PHONE
\ bck e_
MAILI ADDRESS
.0 `>lt)
3. LENDING INSTITUTION
PHONE
k R
MAILING ADDRESS
4. ALTOR/AGENT
CA. N-'�Ax a
PHONE
a�Z-o5
MAILING ADDRESS
1 Z�-A
�;15'� e
5. LEGAL DESCRIPTION
Uri- `i "a kA
4S '�� (j
STREET LOCATION
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
❑ One E] Four ❑ Other
LSINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
�' Three ❑ Six
7. WATERS PPLY
INDIVIDUAL*
# ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
(E t �� YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) /J y�
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑ INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
�U q
INSTALLER
eptic Tank or ❑ Holding Tank
Size: 4)-V�) If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL TO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
B Zz:226Y
72-010 (Rev. 6/79)
-A /in /U/7C�7
(77# - T
Rio/ >'D/Z
71t,240 3co-
�0QW)H
pC>47
MUNICIPALITY OF ANCHORAGE
MJNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC��p� LD�EPT. OF HEALTH &
825 L Street - Anchorage, Alaska 99501 et`f&NMENTAL PROTECTION
Subdivision
0`
ENVIRONMENTAL ENGINEERING DIVISION
SEP 2 71978
Telephone 264-4720
h�
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE%&9r C1L%T1TMPVD
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTYOWNER
❑ MULTIPLE FAMILY
PHONE
Walter J. Kurka
694-3493
MAILING ADDRESS
❑ COMMUNITY
Post Office Box 214 99577
❑ PUBLIC UTILITY
PROPERTY RESIDENT (If different from above)
8. SEWAGE DISPOSAL SYSTEM
PHONE
2. BUYER
"If individual/on-site, give installation date 1978
PHONE
Sandy Walsh
❑ PUBLIC UTILITY
by this Department.
MAILING ADDRESS
3. LENDING INSTITUTION
PHONE
Alaska Bank of Commerce
276-7200
MAILING ADDRESS
3230 C Street 99503
4. REALTOR/AGENT
PHONE
Virginia Kohfield, Area Realtors
694-9555
MAILING ADDRESS
Post Office Box 249 99577
5. LEGAL DESCRIPTION
Lot 4 Eklutna Heights
Subdivision
STREET LOCATION
6. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
❑ One ❑ Four ❑ Other
[9X SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
XXX Three ❑ Six
7. WATER SUPPLY
XXX1 INDIVIDUAL'
' ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
(Zk INDIVIDUAL/ON-SITE"
"If individual/on-site, give installation date 1978
If system is over two (2) years old an adequacy test is required
❑ PUBLIC UTILITY
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
7201013/78)
THIS SIDE FOR OFFICIAL USE DN LY
INSPECTION APPMTMENTS
-DATE RECEIVED
THA E
71M E
TIME
DATE
DATE
DATE
IAIVECTOR
INSPECTOR
INSPECTOR
DIRECTIONS:
1. TYPE OFIRESID 4CE
❑ SINGLEFAMiLY
❑ MULTIPLE FAMILY
NSR OF#aROOMB
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
Y. WATE#t SUPPLY
❑ INDIVIDUAL
D COMMUNITY
D PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE -DISPOSAL SYSTEM
❑INDIVIDUAL/ON-SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL TO:
Septic Holding Tank
Absorption Area
r Line
Line
Nearest Lot
Absorption Area to nearest Lot Lure
5. COMMENTS
&--"APPROVED FOR .2 BEDROOMS
❑ CONDIT]ONALAPPROVAL (tetter must accompany cartifleeW
❑ DISAPPROVED
leoon
DATE
'I'l
S1' ttie
rE--QAL DESCRIPTION
72-010 IRev. 3/78)
REALTORS`
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
1.
Type of
Inspection: CMRO VA
FHA CONV X_
2.
Property
Owner:
Walter J. Kurka
Mailing
Address:
p O Box 214 Eagle River
Day Phone 694-3493
3.
Name of
Buyer:
Sandy Walsh
Mailing
Address:
Day Phone
4.
Name of
Lending
Institution: Alaska Bank of Commerce
Mailing
Address:
3230 C Street
Anchorage AK 99503
Phone 276-7200
5.
Name of
Realtor
or Agent: Virginia Kohfield
AREA Inc Realtors
Mailing
Address:
P. O. Box 249
Rag1e Rivar, AT. 995 7
Phone 694-9555
6. Legal Description: Eklutna Hsts Stewart Add Lot,4 _
Location: Peters Creek
7. Type of Facility to be inspected: Residential No. Bdrms. 3
8. Water Supply
Type of Supply: Public Utility Individual x
If Individual, number of dwellings presently served 1
If Individual, depth of well 357'
9. Sewage Disposal System
Type of System: Public Utility Individual (on-site) x
If Individual, date of installation: _A"rnX. ,inly 19]R
113
AREA, INC. REALTORS J Anchorage
"C" St. Office
REALTOR3300 C Street
(907) 278-2525
,� East Anchorage Eagle River
Eastgate Office J Parkgate Office
5437 E. Northern Lights P.O. Box 249
(907) 278-2525 (907) 6949555