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HomeMy WebLinkAboutNORTH SLOPE - EKLUND LT 1North Slope - Eklund Lot 1 #050-581-30 ou I Lot 2 N 36*04'40"W 16.83 N 00'07'10"W 31.04' N 31'01'25"E 19.07' F_ Lot 2 S 89'36'38 357.5 2.2' CANT—\ APPROXIMATE AVALANCHE BOUNDARY Lot 1 89,791 s.f. 25' STREAM MAINTENANCE PROTECTION EASEMENTS I ' APPROXIMATE THREAD OF STREAM 10' UTILITY EASEMENTS N 89*11 6'55"Wi 143.08' Lot 15 III %-WELL CANT —/ � 6.6' x 14.2' \� WOOD SHED—' SEPTIC PIPES 6 Lot 17 10'x16' SHED gI ,a* fc :z � A n VI) 'd — P, - vh w 04 z vp C) to Ln p Ln 0 0 'I 01 I I CD v): zz J. L Q < a) . 0 csZ 0 0 a. C r E a < (51 0 x 0 E c; 0 Om>. a0 Rc to 0 Ln :3 CD 0 Q 0 E C)0 > < 5to- 'No ami _c 0.2 < V) ol C4 00 N N c" ra1.1 cm tn to c . 0 o N r,0- 3 COL, 0 to 0 C) c C 0 ttD r -t 0 0 Q"o 0 v°cc I "m 00 CL (v 0 0 L x C-4 ex r,- c 0 to 0 Q E— 0Le 2 e-0 0 -0 (D or 60 0 0 — C -0 at z 0 0,0 0L (D w s- Cl a 01 6 < V) (D V) (D (D m a 4) CD 3: 0 0 -,sm r L_ vo-,o coz 00— 0 0 Z 0 (x X1 0 0-, q) 0 0 0 0 -0 c x 0 CL 4) 0 V) W >. ..: m 0 c 0 O:E L! 0 > 0 CL m (D Lai ul 4) 0 0. 0 a 0 O a_ 0 —00 C 10 c-2>� V, r o - 3: 0c/) 8d i_ 10 :e U) >.(X 0 i c cl) 2= 4) 0 0020-0 c IX L. r_ zcx a. E c 0 4- 0 z (D 0 (D . > 0 asc 0 F CL v c 'c 0 a 0 r_ E •-22 E = — E 0 CL CL O:E (D > t -i c 00L_-00 0 a 0 < - 0 r 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 PHONE EW ❑ UPGRADE MAILINGADDRE LEGAL DESCRIPTION LOCATION NO. OF BED)300MS VY Well DISTANCE TO: tlo Absorption area �� Dwelling r t-.50 PERMIT Ng,,I, i Z Manufacturer n Matevfal No. of compartments rn Li a:4 in gallons © IF HOMEMADE: Inside length Width Liquid ..depth O Y DISTANCE T Well Dwelling PERMIT NO. ozZ SZH Manu rer gal acity in gallons wU DISTANCE TO: Well l r Foundation t Nearest lot lit �® PERMIT NOF/ Z P w No. of lin?s,� ^ ' V /lXJ Length of each line Total length of lines Trench width =-r- irrultEs Distance be e lines 104 f- Top off t e to finish grade fCt B ()OcK (0 Material beneath tile ; inches Total effective absorption area w C7 Length Width Depth PERMIT NO. i F wd Type of ib d ameter Crib de tal a fective absorpti area rnto DISTANC Wellddingfoun Nearest l J Depth Driller Distant Olot line PERMIT NO.9' Q �w 7 DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER s+ PIPE MATE LS 3a3 SOI L TEST RATING INST q REMARKS Iwo APPROVED DATE LEGAL �/ Z_ty gs karriq sC4)joC_7 72-013(RLrv. 3/78) V 1-111 F•..,F :1 17 1 4 9— 1. -T4T, 13 10 E. fol PA D FN�. FA CA E7 IN � I DEPARTMENT ir_ HEALTH AND ENVIF:i_NMENTAL. PROTECTION 25 'L.: 'STREET, ANCHORAGE, AK. 99501 264-4720 F -°.A F-= F-._ t_ F=F r -A l? E_E 04 I "F- E 0 E07 F --J E' 1`0 T- PERMIT NO. C 510941 :; lD �Li ✓�r5. 1 AP'P'LICANT CLIFFORD F. JOANSON ST. RT. BOX 9126 LOCATION KUPARUK AVE. /�Id2u 5 f 1 !S LEGAL. 1.14 ` lq, p0RTf SL0PM SeD LOT SIZE X5832 AQUI ,E SET I a TYPE OF SOIL. ABSORPTION SYSTEM IS: DRAINFIELD ��hh��a MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (50 FT/6R)== 1.75 THE REQUIRED _IEE OF THE SOIL ABSORPTION ,IwTEhIS: E° E1 F=` IF 1-.i __ to, L_ E� P-4 CA IF F -A —= ED TO CA FT [ e If F= L_ F_3 E= F-° IF VA == "-3" it � LTI THE LENGTH DIMENSION IS THE LENGTH KIN FEET) OF THE TRENCH OR DRAINFIELD.e!?4i:SD THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF TIE c� GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). `i.n F- 01 F= IF F7? I= F �A E_ - VA NJ I E-. "F'- F -f I _. I", - s � ED F= E� F= -F THE GRAVEL DEPTH I=• THE MINIMUM DEPTH OF GRAVEL BETWEEN OUTFALL F'I.'E AND THE BOTTOM OF THE EXCAVATION KIN FEET). FT E=7 Cow E_W I F° EE E? "n E_ F" -T-I :_ T t0hl l 1 : =; I ,- U_ — _1.2i to ED CA FA 1_ F._ Cl 54 PERMIT AP'P'LICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION IN=PEC:TIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. — ------ F.tF E_E FI FR E- FRE0CA A_E I F=: E= E> BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM 'LS 100 FEET FOR: A PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC: WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER: LINE IS 25 FEET AND TO A COMMUNITY :EWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT L.€ITHIN _0 [NAYS OF THE WELL COMPLETION. OTHER: REQUIREMENTS MAY APPLY. SPE:_IFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F= TxF=" I FQ E0 = E_ EE CD EE PI E3 EE F T WWI, IL <4 ED Afl- I CERTIFY THAT 1: I AM FAMILIAR f.•.IITH THE RE"!UIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET' FORTH BY THE MUNICIPALITY OF ANCHORAGE. L: I WILL INSTALL. THE SYSTEM IN ACCORDANCE WITH THE CODES. _: I UNDERSTAND THAT THE ON-SITE _,EWER: SYSTEM MAY RE;!UIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED ---------------------------------------- APPLICANT CLIFFORD F. JOHNSON ISSUED BY +4, 0 1 � r O & E ENG'"NEERING & DEVELORAENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Performed for: Legal Description Depth (feet) 0 2 3 4 5 � 6 VN 7 8 9 10 11 12 13 14 15 16 SOIL LOG Earl Ellis 688-2280 Soil Characteristics 2 44 i/G= ;v�j ;•TMJ /�lI GKti' .E/ Ground Water Encountered: Yes No If yes, what depth Proposed Installation: Seepage Pit Drain Field G� PLOT PLAN ��PERC. TEST it 1 V C;.tzy Performed by:=cc _g:P�s 4.52aZ Date: A, /C- /lo" . •. . (�er�ified �riUin��f,�ng OWNER OF LAND ADDRESS S_ LEGAL DESCRIPT DATE - Started PERMIT NUMBER by DOC Co. 'ba - SULLIVAN WATER WELL'S P.O. BOX 272, CHUGIAK, ALLASKA 99567 • TELEPHONE 688-2759 �- � n ptEPiH-OF WELL /­:; 9 / .—� t /pGLGf STATIC LEVEL OF WATER FT. I / I ION DRAW DOWN Fir' Y,G Ended GALS. PER IdR: tCA�NIG' 9-a u 3 r .. KIND OF FORMATION: ! .y From D Ft. to j s Ft. d&,ffd/.4.✓8duc ems ,From Ft'to Ft. { I FCOm_,Ft. to '%`-/ Ft.0 [f!Y �fR,ir-� �/ �, From Ft. to_.Ft. From Ft. to Ft. 04 ucBtR S �I From MUNICIPALITY OF AN( HORAGE Ft. to From 7cV Ft. tori Ft. S,4.d4 6cy' E't From ENVIROONMENT ECTION Ft. to From / --"rFt. to _Ft 047 64V.4�e.4 From Ft. to FIS P 18 '��� From .�7 Ft. to ..r"s .ter._ ,... i r %ie Ftr S 9^'Q d4;VFrom ,.{... _ , Ft. to a t/ C -EDh ri IV From Ft. to �Ft. F -m G1,V ItI L Ft. to Ft. �I From Ft. to Ft. Flom Ft. to Ft. From Ft. to Ft. "' -- From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft.to Ft. From Ft. to Ft. From - Ft. to Fi. From - Ft. to R Ft. •. ' From Ft. to Ft. ) From Ft. to Ft. From Ft. From Ft. From Ft. MISCL. INFORMATION: From Ft. -From—ft. to_ LFt. From Ft. to Ft. From Ft. DRILLER'S NAME ® Municipality of Anchorage On -Site Water and Wastewater Program n (907)343-7904 6nser* Certificate of On -Site Systems Approval JJ / Parcel I.D. 050-581-30 Expiration Date: 1. GENERAL INFORMATION Complete legal description North Slope - Eklund, Lot 1 Location (site address) 30534 Kuparuk Ave. Current Property owner(s) Kristan Harrison Mailing address Real Estate Agent 30534 Kuparuk Ave 2. TYPE OF DWELLING: Fx_1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone le River, AK 99577 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well F-71 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request Received b Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ �J �J �D�J Waiver Fee $ Date of Payment CJI t l (CP Date of Payment Receipt Number 331 Receipt Number COSA# ()5C[(RL0�"t 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 !slate) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features The operationaflife-cif'all wells and septic systems dependonthe localsoil- -- condition, ground water levels that may Fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Alk. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for _kL bedrooms System #2 Approved for bedrooms Disapproved Phone (907)272-8218 Date 219/2016 Conditional approval for bedrooms, with the following stipulations: By: \ \ wy Original Certificate Date:4_1fA The Municipality of Anchorage Development 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 MunicipAty, 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—[ ., • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval tttc t Fyt,,. Parcel LD, 050-581-30 Expiration Dat ZlZl •L _, U0111111'11 1 1. GENERAL INFORMATION 8 L Complete legal description North Slope - Eklund, Lot 1 APR 2 9 2014 Location (site address) 30534 Kuparuk Ave. Current Property owner(s) Donald & Anita Kuestner Day phone Mailing address 30534 Kuparuk Ave. Real Estate Agent 2. TYPE OF DWELLING: r 0 Single Family (w/wo ADU) ❑ Duplex I ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well El Individual F1 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for:, � r Received by: y (• i r, ' Date: ) ,� fztj 11 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ fi,24V / /j-4(pd%Jaiver Fee $ '/ 4 Date of Payment Y Rq'' a Date of Payment Receipt Number_ 014W 5? 16QReceipt Number COSA# 11c5C-N1/6/) 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 S(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE !/ System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Date 4/17/2014 Conditional approval for bedrooms, with the following stipulations: ,,Ulilli,- By: �!arft Original Certificate Date: Y17-11111( The Municipality of Anchp age Development 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 - ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r ., c If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: North Slope - Eklund, Lot 1 MT1411017 Well type Private If A, B, or C provide PWSID # Date completed 9/8/1981 Sanitary seal (YIN) Y Total depth 129 ft. Cased to 129 ft. FROM WELL LOG Date of test 9/8/1981 Static water level 112 Well production 7 ft. Parcel ID: 050-581-30 Well Log (YIN) Y Wires properly protected (YIN) Y Casing height (above ground) 18+ in. AT INSPECTION 4/16/2014 114 5.7 ft. g.p.m. WATER SAMPLE RESULTS: Coliform ��colonies/100 mL Nitrate O 8897 mg/L Arsenic 6Z f.> ug/L Date of sample: q1t Ie /,)�o t Collected by: P�S B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,250 gal. Number of Compartments 2 Date installed 10/1/1981 Cleanouts(Y/N) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping `1/ o ly Pumper Sts Rct .-.- r C. ABSORPTION FIELD DATA Date installed 10/1/19811 Length 82 ft. Soil rating (g.p.d./ft2 or ftZ/bdrm) Width 5 175 SF/BR ft. Total depth 7.4 ft. Eff. absorption area 707 ft2 Monitoring tube 4/16/2014 Pass System type Deep Trench Gravel below pipe 3 ft. y Depression over field N Date of adequacy test Results (Pass/Fail) For 4 bedrooms Fluid depth in absorption field before test 23 in. Water added 625 gal. New depth 36 in. Elapsed Time: 240 min. Final fluid depth 23 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES WELL ON LOT TO: Size in gallons_ "Pump off' level at Cycles tested _ Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) in. High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 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. Engineer's Printed Name Steven R. Pannone Date 4/17/2014 COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ z 0 l � r O N B it o C K r O I z I m w m ^ m� w O• p mI W 135.9' r*i p z N I w � 30N3�I53a � � N on r N� �o N o m — J In O mD O T 0 D D O m O O c r z O o m z m), o z oomm z zzzC)ac 9> m m z a w m z w� o c m IZTiZ<-ii- 'om ZD�� D (zi) om 0C)Mo-0 M, K: x � DmZ m V i➢m-I Ir' p 0 z r� O o w IT)ZZ * <n o o m J '� '< N D o 0 r*1 K:MN D ANopa v < N ADO m '0 AmOO� c Z ao< L<m-M,w Z m m Doo 0 Dcyo�O Oa7 7>U oFri Fl m zcZ-). M rm9o>rno m D m N 0 5` o z a D A m O On oma-o Z D m m M� D '= VI c tQ Z .0 m fn DAO -ii O"tO'z� U <.+ a D N M o m n o c o z - D D x m 3 0 o m A v Z v >> c = m< m m r v' -K I 7' Z 0 m (A C' a� z N m ,£b'Lbl 3„91,80.00 S/ U)� O G w m m Qy IA �r O 0 J O O C- _ o D rD .... (...... cn N Y O zso m x .......N O 0 > D w c rm.. z 0 a rq 0 _ \ 0 •G \ v nmO X\ I O m 60 Z9 — —� 3„OO,LZ.00 S O c r m w m 7 m m z o rt U)� y G w m m Qy w �r O 60 Z9 — —� 3„OO,LZ.00 S O c r m w m 7 m m z e s � cy su , i)Z. _ o rt U)� y G w m m Qy w O D - D rD mam zso m x O 0 > D w c rm.. z 0 a e s � cy su , i)Z. _ MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES p Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel l.D.# 050-581-18 HAA#iGec��a 1. GENERAL INFORMATION Complete legal description NORTH SLOPE #2• LOT 14 BLOCK 5 Location (site address or directions) 30534 K PARUK AVENUE EAGLE RIVER, AK 99577 Property owner STEWART RIDING Day phone (907) 694-4131 Mailing address 30534 KUPARUK AVENUE EAGLE RIVER AK 99577 Lending agency Day phone Mailing address Agent CAROLYN GREINER w/REMAX Day phone (907) 694-4200 Address 16600 CENTERFIFLD DR. EAGLE RIVER AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 4 XXX 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 XXX Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC ing to the legality and status of system. 72-025 (Rev. 1/91) Front MCA #21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1185.00 at, or prior to, closing for the engineering services provided. 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 ir>spection, the on-site water supply and/or wastewater disposal system is in compliance with all Municl4W and State codes, ordinances, and regulations in effect on the date of this inspection. IL L Name of Firm FIX I:M Engineer's Signature Phone (907) 337-6179 15 In conducting this evaluation, AWWC, Inc.,t toinpted'to-p/ovide a thorough, conscientious engineering analysis of the system in accordance with ADE C and.. A MHS Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of oQ the evaluator of the system. Satisfactory test results do not guarantee future performance o `� O.F. h of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the p�Uj : r 4 system will continue to meet the operational requirements of the ADEC or MOA DHHS. * r The content of this report is for the sole benefit of the owner listed above. Any Q t� ✓ ........ reliance upon or use of this report by any other person or party is not authorized, ' '. �..... . nor will it confer any legal right whatsoever. s. Q ,J1ef�i; 'IA. Gad ess 6. DHHS SIGNATURE � Approved for bedrooms Disapproved Conditional approval for Additional 0 7953 e� .......•..,.� bedrooms, with the following stipulations: Date 6-2--00 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1191) Back MOA #21 Computer Version RECEIVED Municipality of Anchorage JUN p&vr DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUNICIPALITYGE 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744'v[PONMENTALI Health Authority Approval Checklist Legal Description: NORTHSLOPE #2; LOT 14, BLOCK 5 Parcel I.D.: 050-581-18 A. WELL DATA Well Type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A Log present (YIN) YES Date completed 9/8/81 Total depth 130' Cased to 130' Casing height (above ground) 14" Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES FROM WELL LOG Date of test 9/8/81 Static water level Well production 7 — 9 -p.m - WATER SAMPLE RESULTS: AT INSPECTION 5/23/00 121' 3.8 g.p.m. Coliform 0 Nitrate 1.2 mq/L Other bacteria 0 Date of sample: 5/24/2000 Collected by: A.W.W.C., INC. B. SEPTICIHOLDING TANK DATA Date installed 10/81 Tank size 1250 Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression (Y/N) NO High water alarm (Y/N) N/A Date of Pumping 5/22/2000 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date installed 10/81 Soil rating(g.p.d./ft2orft21bdrm) 175 System type TRENCH Length 82' Width 5' Gravel thickness below pipe 3' Total depth 7' Effective absorption area 707 SQ. FT. Monitoring Tube present (YIN) YES Depression overfield (YM) NO Date of adequacy test 5/23/2000 Results (Pass/Fail) PASS For 4 Bedrooms Fluid depth in absorption field before test (in.); 15" Immediately after 600 gal. water added (in.): 29.5" Fluid depth 15" (ins) Minutes later: 972 Absorption rate = 600+ Peroxide treatment (past 12 months) (Y/N) NONE KNOWN If yes, give date ----- 72-028 (Rev. 3196r Computer Version D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level *_ _Qmle stad E. SEPARATION DISTANCES level at* "Pump off" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septictholding tank on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main Public sewer manhole/cleanout N/A Sewer/septic service line 25'+ Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field 5'+ Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main/service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage area 10'+ Curtain drain F. ENGINEER'S I certify that I 1 of Munlapal with MOA HA Engineer's field inspections and review systems are in conformance )n this date. A. GARNESS HAA Feel 3 6—CE ` 177' Date of Payment b / / f" 1 Receipt Number iV% 3V (3 y ssi 72-026 (Rev. 3mr Computer Version Wells on a Waiver Fee Date of Payment Receipt Number AXr-24-b0 09:45A Carolyn Greiner nom; Siewert Riding Fax. .1(807)C,96-2991 TO, F., 6944161 I /e•LT/l- 95M'r- E45r I(oS.LY) 5CA1.7 1j W 907 694-4151 P_101 P.g. I 0f6 Saturday. Apit 22, 200o 0901 R/9,yG F - .1t cele 3 Are ",rAlc w A «' AS -BUILT EASEMF'NTS OF RECORD, OTHER THAN THOS= SHOWN ON THE RECORDED AT PL1(.E NOT SHOWN HEREON. re'99 - I rs 1 )•.,S ESE , L `S Ll-.GC.n1f) ° hET' IJr. REAR. . Fear.o- °NCS ..RCMR u o k u I w AJ c ft.4•A� G.6 S S � N G� TN / S SCC,e ✓ E. �. NO CORNERS SET THIS DATE I hereby eelify that I lave PrIormed a Mortgagee's mspevioa of the following oescribed property:L d r 1 1/4Rr1i ,*LOPE <:ry,•-u+/v_I_g �nq/� . 1, 6/j A),. Anchorage Recording Precinct, Alaska. and that the imptovemenls ailvated thereon are wilftm rhe properly lines acrd do not overlap or entmech on the property ly ng adjacent thereto, that no improvemmils on propery Iymo Adjacent thereto encroach on the premises in quemion and Mar there are no roadways, t•ansmission Ines or other vimble easements or said Property except as Indicated hereon Dated at Anchorage, Alaska this 2-11+ _ .,_.. day cd Ar;,L 19 9S FRED WALATKA & ASSOC'ATES (9071 249-0666 Engi^eers and Surveyors v t � 1jl � vl u�o ` 4617 Pig AF'f#PXI MAYS Y" arF / Pf 32� ,DZA1A1116 EXs�'MEA/y I•'�S �P l / II f} I - J4 - III I ' /e•LT/l- 95M'r- E45r I(oS.LY) 5CA1.7 1j W 907 694-4151 P_101 P.g. I 0f6 Saturday. Apit 22, 200o 0901 R/9,yG F - .1t cele 3 Are ",rAlc w A «' AS -BUILT EASEMF'NTS OF RECORD, OTHER THAN THOS= SHOWN ON THE RECORDED AT PL1(.E NOT SHOWN HEREON. re'99 - I rs 1 )•.,S ESE , L `S Ll-.GC.n1f) ° hET' IJr. REAR. . Fear.o- °NCS ..RCMR u o k u I w AJ c ft.4•A� G.6 S S � N G� TN / S SCC,e ✓ E. �. NO CORNERS SET THIS DATE I hereby eelify that I lave PrIormed a Mortgagee's mspevioa of the following oescribed property:L d r 1 1/4Rr1i ,*LOPE <:ry,•-u+/v_I_g �nq/� . 1, 6/j A),. Anchorage Recording Precinct, Alaska. and that the imptovemenls ailvated thereon are wilftm rhe properly lines acrd do not overlap or entmech on the property ly ng adjacent thereto, that no improvemmils on propery Iymo Adjacent thereto encroach on the premises in quemion and Mar there are no roadways, t•ansmission Ines or other vimble easements or said Property except as Indicated hereon Dated at Anchorage, Alaska this 2-11+ _ .,_.. day cd Ar;,L 19 9S FRED WALATKA & ASSOC'ATES (9071 249-0666 Engi^eers and Surveyors MUNICIPALITYHEA ANCHORAGE • DEPARTMENT OFFHEALTHTH& 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. # 024� - �A� - HAA # 01 1. GENERAL INFORMATION Complete legal description �(J�if7n/ISv97.1 ' �Z' ® o9-ft4 S L,5F Location (site address or directions) Ek- -L CIVEL I? -2 TO L. TD btp" L . To KU PAf_cA lG , —F0 Property owner GI—l%F :MLWS�IJ Day phone Mailing address Lending agency Mailing address Day phone A t D h as .- Holding tank - Community on-site Public sewer, NOTE: If community wastewater system, provide written confirmation from State attesting to the legality and status of system. 72-025(Rw.1/91) Fe MOA#21 en ay one Y; Address v .J' Unless otherwrseerequested, HAA will be held for pickup 2. NUMBER OF BEDROOMS: 3. 'TYPE OF WATER .SUPPLY: Individual well, , Community well ^; _.A' Public water NOTE: ,rlf community well -system, provide written confirmation from State r. ging to the legality and status of system t 4. TYPE OF WASTEWATER DISPOSAL: , 4 Individual on-site Holding tank - Community on-site Public sewer, NOTE: If community wastewater system, provide written confirmation from State attesting to the legality and status of system. 72-025(Rw.1/91) Fe MOA#21 e'. Wdlt)onaf Comments Fg I ni ,,pality of Anchorage Department df Health and Human Services (DHHS) issues Health Authority al Certificates based only upon the representations given in paragraph 5 above by an independent onal enpeer registered in the State of Alaska. The DHHS doesthis as a courtesyto purchasers of homes r'lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not t inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not ible for errors or omissions in the professional engineer's work. 1191) Beek MOAMyt e 'y Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 34R Er H 1 V E D Health Authority Approval Checklist JUN 6 1996 Legal Description: P� F-) Parcel I.D.: Municipality of Anchors e • uman wm as A. WELL DATA Well type W I VA -r - If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) �IC`.� Date completed —' Total depth 2`) Cased to Zq I Csing height (above ground) Sanitary seal (Y/N) ��S Wires properly protected (Y/N) ye-"�; Date of test Static water level Well production FROM WELL LOG 11-2-, WATER SAMPLE RESULTS: AT INSPECTION Coliform CCC, I • Nitrate C` Other bacteria C C c t . Date of sample: �J Ji Collected B. SEPTIC/HOLDING TANK DATA Date installed Tank size Number of Compartments Z Cleanouts (Y/N) C=- Foundation cleanout (Y/N) Depression (Y/N) 110 High water alarm (YIN) !� G G Date of Pumping <-I Pumper '1 -2- C. ABSORPTION FIELD DATA Date installed Soil rating -(es or ft2/bdrm) I i `� System type T'C"C I C t I Length 7� Width J Gravel thickness below pipe Total depth T Effective absorption area S "� • Monitoring Tube present (Y/N)� Depression over field (Y/N) Date of adequacy test Results (Pass/Fail) FA s�5 For T bedrooms 1 r i Fluid depth in absorption field before test (in.); • J Immediately afters! -C(% gal. water added (in.): I tl" " Fluid depth �L (ins) Mirrotes later: s Absorption rate = 6GC' + g.p.d. Peroxide treatment (past 12 months) (Y/N) rJ L If yes, give date ,` /A/A 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Lr- Size in gallons Manhole/Access (Y/N) t-1 I 1A "Pump on" level at* N `� "Pump off' level at* T High water alarm level at* Li *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 1 3w, On adjacent lots Absorption field on lot /'J On adjacent lots �G)fi 4 Public sewer main N�l� Public sewer manhole/cleanout iv/ la r I Sewer /septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation C Property line Absorption field CC Water main/service line ^' '� Surface water/drainage �� Wells on adjacent lots ' ' -i- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line '1 i5 Building foundation ^, &C, Water main/service line 14G Surface water Lf/A Driveway, parking/vehicle storage area Curtain drain IJ % Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I a�etermfn d thru f" d . pections and review of Municipal in conforman w'th MO + li sin effect on this date. Signature ) G Engineer's Name Date — 2- 9 -1� HAA Fee 'v • �q Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number .�.. .Mu*.r ..... BRENT�R.�ViON :; � _.CE- t2ii : 04 .......Fro are I 0 • 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 14 Block 5 North Slope Subdivision Location (address or directions) (b) Applicant Name Cliff Johnson Telephone: Home 694-2625 Business App:icantAddress Box 2414 Eagle River Road, Eagle River, Alaska 99577 (c) Applicant is (check one): Lending Institution ❑ , Owner/builder Lam, Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family U Multi -Family ❑ Other Number of Bedrooms four(4) 3. WATER SUPPLY Individual Well ®x Community ❑ Public ❑ Telephone Note: If communitywell system, must have written confirmation from the State Departmentof Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite F&x Public ❑ Community ❑ Holding Tank ❑ Note: If communitywell system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 73025 (11,84) 5. ENGINEERING FIRM PROVIDINASPECTIONS, TESTS, FILE SEARCH, DAPAND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S Fngingering Telephone Address Date Engineer's Seal This department has received written confirmation from the engineer regarding the Conditional Approval of January 14, 1986. The corrections have been accomplished and an inspection has been completed by the engineer. The subject property meets with Municipal_ standards and is now approved. 6. DHEP APPROVAL %) Approved for four (4) bedrooms Date June 17, 1986 Approved XXXXXX Disapproved Conditional Terms of Conditional Approval Q CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for en ors or omissions in the professional engineer's work. Page 2 of 2 72-825 (11/84) A. WELL DATA 111 MUNICIPALITY OF ANCHORAGE (MOo HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 264-4720 X. 1 A 1 9986 Legal Des-�(iption:L-��I+ F� t�LS VED Well Classification '�'• F If A. B, C, D.E.C. Approved (Y/N) a A Well Log PresentdgN) Date Completed '51 - 0— 61 Yield • 5 Ca?V- ( -t II N Total Depth 1?A 1t' Cased to 1SCi I Depth of Grouting — Static Water Level t l L Pump Set At J •i(-• Casing Height Above Ground 400 Sanitary Seal on Casing'( N) Electrical Wiring in ConduiteN) Depression Around Wellhead (YLO Separation Distances from Well: To Septic/H_o1dimg Tank on Lot ( C 4_ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot 11".2n -1- ; On Adjoining Lots (152o -t To Nearest Public Sewer Line a�A To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ZS ! k Water Sample Collected by S �� Date Water Sample Test Results Comments SEPTICCI#OI_OIAG TANK DATA Date Installed 1 T7- t e) Size 1 Z -S O No. of Compartments Z - Standpipes 6)'N) Air -tight CapsON) Foundation Cleanout IWO Depression over Tank (Y6pDate Last Pumped Pumping/Maintenance Contract on File (Y/N) L v ; for Holding Tank High -Water Alarm (Y/N) A Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/k+afdfFig Tank: To Water -Supply Well t E>CD To Property Line — To Water Main/Service Course rJ To Building Foundation To Disposal Field all A To Stream, Pond, Lake, or Major Drainage Comments TWee_ BV&t— Sri y �^ "_ w P Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA 0 A Soils Rating in Absorption Strata 1 �L�1 Type of System Design r�LS t nl�jr� Date Installed \ o — 1 — 61 Length of Field Width of Field Depth of Field S I M �• Gravel Bed Thickness Square Feet of Absorption Area -1 D i + Standpipes Present (Y,Q Depression over Field (Y/O Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation Lot )i� M] Date of Last Adequacy Test k� To Property Line On Adjoining Lots To Water Main/Service Line l o t �— Tout To Stream/Pond/Lake/or Major Drainage Course 7A To Existing or Abandoned System on �b k (if present) To Driveway, Parking Area, or Vehicle Storage Area 1 C7>o Comments ;�_ NA12&6yAA�1Y V110rt C5 3' V>r— 5 !As3 'Z-, � oJ�xl, � � � 15 A. nIAf c:3- o er- -rtA -- LIFT STATION 176 ''r 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 Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA uidelines in effect on the date of this inspection. Signed LLS66 eNse(p 'aaA1® alfie3 Date X96L UNS Company MOA No. 5R3 196x Receipt No. r -..,_., .k 99477 .r.L +. Date of Payment 1 — Ute- 8"40 011•r. L � a, Amount: $ 5 eal ' *•' 'saboo A Stf'�, u ? RR Page 2 of 2 72-028 (17/84) r A fOWE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME ,OFS SINGLE FAMILY ❑ One ❑ Four ❑ Other ,ex y ❑ MULTIPLE FAMILY �' Three ❑ Six 7. WATER SUPPLY DATE WELL LOG. A well log is required for all wells drilled DATE DAp 1 t7,�,Ct ❑ PUBLIC UTILITY depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM I�GL4 INSPECTOR YEAR ON-SITE SYSTEM WAS INSTALLED. INSPECTOR INSPECTO NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HFAErr I DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTICMARONMENTAL ?I<GT-CTION 825 L Street - Anchorage, Alaska 99501 • NOV 1 1981 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 MAI LI NG ADDRESS '- I Lk/, PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE /� C MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE RESIDENCE NUMBER OF BEDROOMS ,OFS SINGLE FAMILY ❑ One ❑ Four ❑ Other ,ex ❑ Two ❑ Five ❑ MULTIPLE FAMILY �' Three ❑ Six 7. WATER SUPPLY %- 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.) S. SEWAGE DISPOSAL SYSTEM 120 INDIVIDUAL/ON-SITE** 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) THIS SIDE FOR OFFICIAL USE ONLY y i 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 INSTALLER ❑SepticTankor ❑Holding Tank Size: '14If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS LL]' -'APPROVED FOR _- BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE �f/ n—V` BY 72-010 (Rev. 6/79) e- ,