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Home My WebLink AboutPETTIS LT 13 December 14, 1989 ROBERTSHAFER, P,E, ROGERSHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 ATTN: Robbie Robinson REFERENCE: Lot 13; Pettis Subdivision; Dear Robbie, In reference to your inquiries in the classification of the residence on the referenced property, we have been within the building and can confirm that it is in fact a 6 bedroom single family dwelling as we have indicated on the Health Authority Approval foJ~. There is no division of units and there exists only one kitchen. Sincerely, iOBE~ TTSHAF~R,~p. E.~ RJS/gm MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION a' tg89 RECEIVED 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 60~ gl.d--de~ eoueJe,te~ eeJv HeeJo l!qqel~ O~Z~ 'id9 OLIVE - X OCEANVIEW ELEMENTARY SCHOOL E. 120 AVE. DAILEY AVE. 12201 GR. 2731 225 ~) COPYR[GHT 1987 JMR 210 224 -.~(~- 226 237 Rabbit Creek Area Reference Map--P13 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 l.D. # ~\Lo--¢~ ~ ~-.'~'~- ~L~:D HAA# ~"~c,~(~,,~,'~o~_.~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 13; Pettis Subdivision Location(addressordirections) 131 Pcttis Road (b) Property owner Mailing Address (c) Lending Institution Mailing Address H.U.D. #111-020026-203 605 West 4th Avenue, Telephone:(home) Anchorage, Ak. 99501 Telephone Business (d) Real Estate Company and Agent ROGERS REALTY ATTN.' Lyman Mcach¢, Address 8301 Arctic Blvd. Anchorage. Alaska 99518 Telephone 34,¢-8492 (e) Mail the HAA to the following address: (or check heretiC, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle RNer Loop Road No. 204 EaCe River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family E~x. Number of bedrooms 6 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.r',.: Public ~ Community [] Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status, 72-025{Re¥ 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 thevalidation date shown below, l verify that my investigation of this Health Authority Approval shows that the on-site water supp!y and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date 5 ~ 5 ENGiNEERiNG 17034 E~gl~. River Loop Road No, 204 Eagle River, Alaska 99577 Telephone 6. DHHS APPROVAL Approved for ,(2 bedrooms by ._~o~4~ ~IA,T~ Date Approved '~ Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHSdonot conduct inspections or analyze data before a certificate is issued. The MunicipalityofAnchorageisnot responsible for errors or omissions in the professional engineer's work. A. WEL' DA%%'"' Well Classification _..~---.~g ~ ;o !'~ Well Log Present (Y/N) /,J Date Completed Total Depth L)I~. Cased to'~"Ao Static Water Level ! ~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot /'J//'~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line '-?~-- t To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ~ _.T-. fi.lA). MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: If A, B, C, D.E.C. Approved (Y/N) "" I~ ~ O Yield Depth of Grouting -- Pump Set At O1~'_ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots 'On Adjoining Lots ' To Nearest Public Sewer Cleanout/Manhole ~_~ ~ ~'~ ~-M~i~.~,~h~M~ ; Date ~ -- ~ B, SEPTIC/HOLDING TANK DATA Date Installed Size~ No. of Compartments Standpipes (Y/N) Air-%Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped Pumping/Maintenance Contact on File (Y/N)~ ,., ; for Ho,d,ng Tank ,,gh-Water A arm/Y/N/ ',%f' mporary H,ding Tank Permit Y/N/ SEPARATION DISTANCES FROM SEPTIC/HOLDIN ANK: n To Water-Supply Well N%ing Foundatio To Property Line To DiSl~ Field To Water Mainr/Service Line To Stream, Pond, Lake or Major Drainage Course Comments fO,. O .~, ~C., ~A)~¢' ,~ ~.. 72-026 (Rev. 7/88) Fronl Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Abs~ption Strata Type of System Design Date Installed Length of Field Width of Field '~, Depth of Field Area~ Gravel Bed Thickness Square Feet of Absortion ~. Statndpipes Present (Y/N) Depression over Field(Y/N) ~ .'~ If"~~ Date of Last Adequacy Test Results of Last Adequacy Test ,~~ SEPARATION DISTANCE FROM ABSORPtiON FIELD: To Water-Supply Well ~ To Property Line To Building Foundation ~% To Existing or Abandoned System on Lot ; On A~oining Lots To Water Main/Service Line "~Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments )V~ Q ~. ~ ~-.t,~J ~ ¢' .~ & JC~ ,,~A7-- D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request*~ Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company 17034 Eagle River Loop Road No, 204 Eagle River, Aia~k~577/ Date MOA No. Receipt No. O ~- ~O ~ ~ ~ ~ ~ Receipt No. Date of Payment ~-/~ - ~O Waiver Fee: $ Amount: $ Date of Payment Page 2 of 2 72-026 (Rev. 7/88) Back CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order ~ 2S237 Date Report Printed: .IUL 10 90 @ !0:45 Client Sample ID:Li3 PETTIS S/D PWSID :UA Collected JUL 2 90 ~ 13:00 hrs. Received JUL 3 90 @ 15:15 hrs. Preserved with :AS REQUIRED Client Name : $ & S ENGINEERING Client Acc+ : SNSENGP P.O.~ NONE RECEIVED Ordered By : R. St[hPER Analysis Completed :JUL 4 90 Send Reports to: Laboratory Supervisor :STEPHEN C. EDE i)S & S ENGINEERING Special Instruct: Chemlab Ref ~: 902231 Lab Smpl ID: 1 Matrix: ~qATER Allowable Parameter Tested ~esult Units Method Limits NITRATE-N ND(O 10) mE/1 EPA 353.2 I0 Sample ROUTINE SM4PLE. Remarks: SAMPLE COLLECTED BY RDJ. 1 Tests Performed See Special Instructions Above UA=Unovarlab!e ND- None Detected "See Sample ~emarks Above NA= Not hl~alyzed LT=Less Than, GT=Greater Than 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. # (-'~ \ (r~ - ;::J~ ~ "-~' ~F"! '~ HAA# ~--'~ ~ °~C~ ~ (~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lo~t 13..' p¢.~t,tis Subd'ivx'.S~/nn Location (address or directions) 131 Pett~s Road (b) Property owner Mailing Address (c) Lending Institution Mailing Address H.U.D.~111-020026-203 '~0'5 W~st 4th Avenue ,Telephone:(home) Anch0rage, AR. 99501 Telephone Business (d) Real Estate Company and Agent 8301 Arctic Blvd. Address ROGER"S RE~ITV A TTN: Anchorage, Ak. 99518 Ed ToEEey Telephone (e) Mail the HAA to the following address: (or check here,~, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eaqle Ri~er Loop Road Ne_. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family E[X Number of bedrooms 3. WATER SUPPLY Individual Well E~X Community [] Public [] ,Note: If community well system, must have written confirmation from the State DePartment of Environmental Conservatic~n 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 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, Iverifythatmyinvestigationofthis Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date Telephone S & S ENGINEERING 17034 ~'a~ ,-,,~. . Eagle River, Alaska 99577 ~PP;~;;i f°r --~----- bed r°°ms bY~~~ PP .,~' Disapproved Conditional Terms of Conditional Approval If and when this residence i~ utilized as a multi-family residence, this ~Iealth Authority Approval is invalid and the on-site well must be reclassified from Single Family Residence to Class "C" Communti¥ well with the Alaska Department of Environmental Conservation. ~/~ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev, 7/88) Back Page 2 of 2 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) ~ He_alth Authority Approval (HAA) :~ '~" i ;i'i,',:;iI.~HECKEIST ' FEBRUARY 1984 ,, .'~"~ '" ..... 343-4744 Well Classification Well Log Present (Y~ f',J Date Completed L.,')~.~, Total Depth ~ Case0 to ;:~ Depth ol Grouting Static Water Level ~, ~ Casing Height Above Ground ~ "~ Electrical Wiring in Conduik~/N) ~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ¢/f~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ~ ~ Legal Description: L-~'c::~m;-- If A, B, C, D.E.C. Approved (Y/N) Yield ~, ~t"~ ¢ Pump Set At Sanitary Seal on Casing~C4~'N) Depression Around Wellhead (Y/~ ; On Adjoining Lots ; On Adjoining Lots ~/~ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ~-~¢~ '~1"~-t~---~-~-'4~"~' ;Date Water Sample Test Results ~/'~'""'~'~"~~ "- '~:;~--"~'~=~% Comments ¢~ t ,/~ L,~, ~ ~.~p-% ~ '"~"~ ¢"~.~ ~ B. SEPTIC/HOLDING TANK DATA Date Installed Size No. of Compartments Standp~ .Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tan~"~......~---- Date Last Pumped ..... Pumping/Maintenance Contact on Fi~__ ____; for Holding Tank High-Water Alarm (Y/N) ~ry Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: ~ To Water-Supply Well _ To Building Foundafll~.,.,~__ To Property Line____ To Disposal Field To Water Main/'Service Line To Stream, Pond, Lake or Major Drainage Course Comments ~"~C~ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soila~,ating in Absorption Strata Type of System Design Date In~d _ Length of Field Width of FielcT'-.. Depth of Field Gravel Bed Thickness Square Feet of Absortion Area ~ Statndpipes Present (Y/N) Depression over Field (Y/N) ~ Date of Last Adequacy Test Results of Last Adequacy TestD ~'~,~ SEPARATION DISTANCE FROM ABSORPTION FIEL To Water-Supply Well To Property Line To Building Foundation To Existing or Aba~d System on Lot ; On Adjoining Lots To Water Main/Service Line To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~'"~O/~ ~_.-)~,r.r~ ,~_~,,../ ~ D. LIFT STATION D%nstalled ~ Si~ze in~ "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) umping 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 inspection. Signed ...... Company ~ ~rn~4._ Ea~le Ri'~er Loop_,_. Road N~. 2U4 MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev 7/88) 8ack Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 in ~4~.~U¥:l¥~,d. ate of this CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. Client Sample ID:LT 13 PETTIS PWSID :UA Collected NOV 9 89 @ 16:30 hrs. Received NOV 10 89 @ 16:00 hrs. Preserved with :AS REQUIRED Analysis Completed :NOV 13 89 Laboratory SupervAso~ :STEPHEN C. EDE Released Ey :~ ~f._~ ANALYSIS REPORT BY SAMPLE £or Work Order ~ 18203 Date Raport Printed: NOV 13 89 @ 21:21 Client Name : S & S ENGR Client Acer : SNSENGP P.O.# NONE RECEIVED Req # Ordered By : R,J,S. Send Reports to: 1)8 ~ S ENGR 2) Special Instruct: Chemlab Ref ~: 8486 Lab Smpl ID: I Matrix: WATER Allowable Parameter Tested Result Unite Method Limits NITRATE-N 0.16 ms/1 EPA 353.2 10 Sample ROUTINE SAMPLE, SAMPLE COLLECTED BY Remarke: 1 Teets Performed ' See Special Instructions Above UA~Unavailable ND= None Detected "See Sample Remarks Above NA= Not Analyzed 5T=Less Than, GT-Greater Than 17034 Eagle River Loop Road ROBERT A. SHAFER Eagle River, Alaska 99577 CIVIL ENGINEER 694-2979 LOCATION OF WELL (Legal Description): WELL DEPTH: ~.,) ~, FT. CASING: DATE DRILLING COMPLETED: ~/'""~ STATIC WATER LEVEL (Top of Casing): ~lr'c> ~ 'Jr' FT. DRILLER: FT. DATE: DATE OF TEST: SCREEN: - ' ELAPSED TIME SINCE DEPTH TO DRAWDOWNI PUMPING CLOCK PUMPING STARTED/ WATER, FT. RECOVERY RATE, GPM REMARKS TIME STOPPED, MIN. 1 '. ~"C:;, 0 -~'.~ 5 ''~: ~ 60(1 hour) 150 180 (3 hours) ~{ k ~ ~ ~ >~;3 '~ ~',~O 240{4 hours) ~q' ~ I' W, ~ / ' RECOVERY t 0 0 5 10 15 20 25 30 35 Comments: Flow is not Guaranteod Subsequent Variations Can Occur.