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Home My WebLink AboutHAMANN LT 4AHc monn Lot 4A #050-611-19 ,~./ 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 MAILING AD DR ESS.? ~--)' LEGAL DESCRI~T>~N LOCATION NO. OF ] Well . ~ Absorption area / DISTANCE TO: c~ " , ] I /a ~ Z I Manufacturer L~ - No. ~.~mpartments ~ ~cap IF HOMEMADE: Inside length -~. Width ~- Liquid~th Well Dwelling PERMIT NO, DISTANCE TO: Manufacturer ~ _~ ~ ..... Mater~l~ ~ L~Nuj~a~it~ gallons No, of lines ~ Length ~ eap~ ~ hre h~of lines Trench//width~/~ .~ Distance between lines Top of tile to finish grade C~ Material beneath tile ~, ~ [~s Total effective r ea Length Width Depth PERMIT NO, Well foundatio~~¢ ~ Nearest Io~-Iin~ DISTANCE TO: D~pth Driller ~ Distance to lot line ~ PERMIT NO. ¢~ .~ Building foundation Sewer line I Septic tank I Absorption area(s) DISTANCE TO: / OTHER PIPE MATERIALS ,/"D SOIL TEST RATING INSTALLER REMARKS APPROVED /,~ : 72-0'13 (R'~/v, 3/78) //I DATE LEGAL by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE688-2759 OWNER OF LAND ADDRESS ""/:" LEGAL DESCRIPTION DATE - Started -// Ended ,, i PERMIT NUMBER DEPTH OF WELL '~ ~f f, L; STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR KIND OF CASING KIND OF FORMATION: From ~' Ft. to ~ o _Ft. From__ Ft. to Ft. From i ,.~.~ Ft. to ·; / Ft. From__ Ft. to Ft. From ' / Ft. to /'3'::~ Ft. From r~[ '~ Ft. to ~ '/ /,Ft. From___Ft. to Ft. From // ,' Ft. to, )1 ~ Ft. From · · ' Ft. to !,, ~' Ft. From__Ft. to Ft. From 'i.~ Ft. to ,"-: ~ Ft. From '~ ;: , Ft. to ' :--~ Ft. From__Ft. to__Ft. From ; ' · ~'': Ft. to ' From '~ '-~' -- .Ft. to ,,~": ;~ Ft. From Ft. to_ Ft. From ,--; ,:~' '~' Ft. to ,?:" :~ Ft. '('"? "-"~9 ?" ~'~:~ ,;~//' ,' From-- f ~"-',.;z.!F~' From_ < :,~,'/,1 v f-A:" '/~,a~,:,,L .:::~ From__ /'[:: ~.~ tg::':C<,~ From , ~?x~Z<:~.:' ', ~ '-. From ~ From From From From Ft. to Ft. Ft. to Ft Ft. to Ft Ft. to Ft. Ft. to Ft. Ft. to Ft Ft. to Ft Ft. to Ft Ft. to Ft. Ft. to _Ft Ft. to Ft Ft. to Ft. Ft. to Ft. Ft. to Ft Ft. to Ft. Ft. to Ft. Ft. to Ft. MISCL. INFORMATION: DRILLER'S NAME .~ ", E:,EF'FIR'T'MENT 6._~/HERLTH aND EN',/I F.: .' NMENTRL ~..?J/, r= _:T I ON , 8.'...~z5 '"L"' STREET., RNCHORR. GE.. RK. '_:.~:~.501 , 264-4720 _ET D,:_ 2:.:~ S;._RRE FEET LEGAL L4~ FIRMMRH ~ T'¢F'E nF ';I"'IZL IflESORF'TION S'¢STEM IS ~~-b[:, ....... ~ . . MR::':: I MUM NUMBER OF BE}ROOMS = ~ ~ ~--x SOIL RRTING ;bb. FI,--'BF::,= THE REQ_IRED SIZE OF THE SOIL FIEfE;ORF~~~(I Ib:~.~ THE LENGTH [',IMENCTFIN I'; THE LEN3TH (IN FEET::, OF THE T[ENCH G~.OI..I[.~[: AN::THE BOTTOfl CF THE E,:.:,::fl,,fl'rZ]N ::!,.4 FEET::. ~ -KHE T~:E~-~C:H ~.,~ Z E:,Tt4 ~ ~ .~Z Zt. FEET. THE GRR',,,'EL DEF'TH ~S THE M~4, ZMUM DEPTH OF GRFI'¢EL BETHEEN THE OLITFRLL P~F'E RN[:, TF'E BOTTOM OF THE E,:.:,CR,,,RTION ,::IN FEET::,. L N_, flN'¢ HEt. LS . - INSTRLLRTIF~N IN=,FE_.II OF RE:,.TRF:ENT TO THIS PROF'ERT'¢ FINE:, THE NUMBER OF RESIDENCES THRT THE HELL HILL SERVE. BRE:KFILLING OF RN¥ SYSTEM HITHOUT FINRL INSPECTION RND RPPROVRL BY THIS DEPRRTMENT HILL BE E;UBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R HELL RND RN¥ ON-SITE SEHAGE DISPOSRL Sh.'STEM IS :1_80 FEET FOR R PRIVRTE HELL OR t50 TO 200 FEET FROM R F'UBLIC HELL [.',EPEN[:,ING UPON THE T'¢PE OF PUBLIC WELL MINIMLIM [.',ISTFINCE FROM FI F'RIVRTE 14ELL TO R PRI',,,'RTE SEHER LINE iS 25 FEET FIN::, TO R COftMUNIT¥ SEHER LINE IS 75 FEET. HELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT HITHIN 3:8 DFI'¢S OF THE HELL COMF'LETION. OTHER RELqUIREMENTS MR¥ RPPL.'¢. SF'ECIF!E:R'~IONS RND CONSTRUCTION DIRGRRMS RRE Ff',,,'RILRBLE TO INSUF..'E F'R. OPER INSTRLLFITION. I CERTIFY THRT ! '! RM FRMIL. IFtR WITH THE RE~:.!IJIF, EHENF:, FOR ON-SITE =EI. LF..=, RN[:, HELl q RE; SET FORTH B'¢ THE MUNICIPRLtT'¢ OF RNCHORRGE. 2: I HILL INSTRLL THE S'¢STEM IN FICCOR[.',RNCE HITH THE CODES. 3:: I UNDERSTFIND THRT THE ON-SITE SEWER S'¢STEM MR¥ REQUIRE ENLRRGEMENT IF' THE RE':;IDENE:E IS REMO[."ELE[:, TO INCLUDE MORE THRN 4 BEDROOMS. V4. 0 R-s.ell Oyster 694-2774 Performed for: Legal Description: Depth (feet) 0 9__ 13__ 14__ 15__ O & E ENGINEERING & DEVELO"F--MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG Name:. /~//~/~ ~'///L/~/~ L/-~ ~- Soil Characteristics Earl Ellis 688-2280 Tel. No ~z~- :~<~73~ 16__ Ground Water Encountered: Yes Proposed Installation: Seepage Pit__ ~o If yes, what depth Drain Field ertifiei Dd[[t.g by DOC Co, dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALAS KA 99567· TELEPHONE 688-2 ~pt.: Mumc~pal~tYHealth & Human°f Ano~ra~e3e~lces ADDRESS, '- - ~ ') LEGAL DESCRIPTION ~:~'i ..... d!.. /-) //,q,.17 /4/,,JD DATE - Started Ended PERMIT NUMBER / DEl'TH OF WELL <?(3 0 STATIC LEVEL OF WATER F'F (.7,, t ') DRAW DOWN FT. GALS. PER HR {,/ ,5 KIND OF CASING () ~:c;) (.) KIND OF FORMATION: From /) Ft. to-:- Ft. ,_;.ci:,;;,,'t~(~, ,(, T) C.rf ,r) /9 From. From :>~. Ft. to .2.~ Ft. t ~ ..... &~,,v,-. ,1 -- ~- From From ,-~., Ft. to ~}~ Ft. ~ From Ft. to. Ft. to Ft. to Ft. to From~i~+r) Ft. to/'/O Ft. From //]/0 Ft. to/St' .Ft. d';,":D, From_/'('/ Ft. to /("~"0 Ft. From / ('~ Ft. to~ From,J )2)" Ft. to ?/} <' From / Ft. df.. ~/< .'~,:,~. JiO;,~,ts ~/~'<LC'fJ From Ft. L') {:,:)/d,_~c:,.(~ · .. r+ i ~ 'f From ->-~ e )O;' Ft /~;&',:<<3-)Co/d "'9,~" From.~-'-, · Ft. to '"' From Ft. to _Ft.. From--Ft. to Ft. From--Ft. to Ft From--Ft. to Ft. From__Ft. to Ft. From Ft. to Ft. From Ft. to Ft. Et Ft. Ft. Ft. Ft. to--Ft Ft. to Ft. __Ft. to Ft. Ft. to Ft. _Ft. to o*--- Ft. From Ft. to Ft. From__Ft. to__Ft. From Ft. to Ft. From Ft. to Ft. From__Ft. to__Ft. From FLto__Ft. From Ft. to Ft. From Ft. to Ft. MISCL. INFORMATION: ! DRILLER'S NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930450 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:BRAND JEFF I & JANET E OWNER ADDRESS:HC 83 BOX 1626 EAGLE RIVER, ALASKA 99577 DATE ISSUED:10/26/93 EXPIRATION DATE:10/26/94 PARCEL ID:05061119 LEGAL DESCRIPTION: HAMANN LT 4A LOT SIZE: 53227 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1. EXISTING WELL MAY BE CONTINUED IN USE. IF CONTINUED USE IS NOT DESIRED, WELL MUST BE PROPERLY ABANDONED. 2. NEW WELL MUST BE A MINIMUM OF 100' FROM ADJACENT SEWER SYSTEMS. PAGE 2 OF 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 3. SUBMIT WELL LOG WITHIN 30 DAYS OF COMPLETION OF WELL. ISSUED BY: · ~ -'"'~z--~~ DATE: ~ ' . %,-.' . . ..' t "-.. . .': . ;"-~ \ ~_~-. '. -. ,,0'.. "-._. . ~: . :, ~",, ',.. I/-". "1 ' - '"'..~ ' ' :'.. ~:,. "N~ t. '":'. :-~ . AS-BUILT [ hereby cert [3 t~at I hav~ surveyed thc fo lowing described ~ ?~y~ ~.,:. > ~'~ ~. ~z__~ .............. ~/~3, ,~ ~ ~ · merits si~te~ tbeteo~ ~e wit~ tb~ Etope~ ~nea and ~o ~o~ ove:~ap o: e~oac~ o~ the p~Pc~tY 1)'i~ aaJ~t there- roadw~s, ~ansm~smn lines or other visible easemen~ on said prope~y except as ~ndicated Eera:~n. . ~ntod at Ea'!e ~iver.' Alaska ",, . ' ~-~.;'/ Box asa, ~aa~c p.i¥~r, Alaska 1 ~ Phone (907) Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 'L' Street Room 502 RO. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ~"~ -&//- / ~/ 1. GENERAL INFORMATION Complete legal description t, ot 4k, 24251 Hamann Road Location (site address or directions) Current Property owner(s) Chris Grasse Expiration Date: Eamann Subdivision Dayphone 694-6~36 Mailing address Lending agency Mailing address Day phone Real Estate Agent Renax/kal:hi Olastead Day phone 694 -4200 Mailing Address 16630 Centerfteld Dr., Ste 201, Eagle River, AK 995.77 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: ~ ' .l ~- )~ Ioo NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well ....... Individual Water Storage .... Community Class ..... ~ Public Water System Well 3 TYPE OF WASTEWATER DISPOSAL: m D [] [] Individual On-site Individual Holding Tank Community On-site . Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given_in paragraph 5 by an independent profes~i(~nal civil engineer registered in the State of Al~,ska. Cert!ficates. of, Health Authority Approval are required.for, the transfer of title (except between spouses) on properties served by a single family on-site wastewat~i; disl~osal and/or water supply system. DHHS also issues HAAs upon request to home owners. 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 sampe resu ts ess than 30 days old. 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. 72-025 (Rev. 01.'00)' · ~ STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date s~c~wn below. I verify tl';at my investigation based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S & S ENGINEERING Name of Firm 17034-E~31e-R~ver--I-~o~ Ro--~_~. Address Eaqle Rivert Alaska 99577 Engineer's Printed Name Robe:t C. Cowan DHHS SIGNATURE Approved for__ Disapproved. Conditional approval for Phone Date I '&./I//Oo bedrooms. ~) -~,, .... ,-, ~ bedrooms, with tho [ollowin~ stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other · Expiration Original Certificate Date: Reissue Date: 72-025 (Rev. 01/00)' Municipality of Anchorage Department of Health and Human Senreer,, C E I ¥ E D Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 DEC 1 I Z000 . w~v.ci.anchorage.ak.us (907) 343-4744 MUNICIPAUTY OF ANCHORAGE HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~ '~/ ~ ~ ~/~ Parcel I.D.: A. WELL DATA Well typaP/Z / (/.~'f~- Date completed ~- Totaldepth ~,~O ft If A, B, or C provide PWSID # Sanitary seal/~'5' Casedto ft Date of test Static water level Well production ~ WATER SAMPLE RESULTS: Coliform O colonias/100 mi Date of sample: / ~/:~/~ FROM WELL LOG B. SEPTIC/HOLDING TANK DATA g.p.m Nitrate O, ~- mg/I Collected by: Ce Well Log Wires properly protected Casing height (above ground) AT INSPECTION / / ~'o ~' g.p.m Other bacteria O colonies/100 mi Tank Typa/Material Date installed ~/,s~ ! Tank size / ~ gal Cleanouts ~ Foundation cleanout tT/~ Depression Date of pumping /~-/C./~/-) Pumper ~"7~ ENGINEERING 170~4 Eegle River Leap Read NO. 204 River, Alas~ca 925~ Number of Compartments ~ over tank ,&CO High water alarm ABSORPTION FIELD DATA Dat, installed ~/~/ Soil rating (g.p.d./lt2 or ~). ~" 5" ¢System type/ Le&~'~" ft / ' Width/~)-// ft Gravel below pipe ~ o,~ Total deptlY/~,:~", Effective absorption area :~'¢¢ft' Monitoring tube_~ Depression over field Date of adequacy test /,~/-7/~ Results(Pass/Fail) ~3S For ~,~ bedrooms Fluid depth in absorption field before test. / ~- ' in Water added ~ ~jal. New depth / ~ __ in. Elapsed Time: '~ ~ rain Final fluid depth / '~' = in Absorption rate > '~5"/~g.p.d. Any rejuvenation treatment (past 12 mo.) (WN & type)/[/~,-v~--,~_~v'o-,,o,,,/ .If yes. give date __ 72-(~6 (Rev. 01/00)' D. LIFT STATION "Pump on" level at f'~Y in "Pump level at .~,~/ Cycles tested Datum SEPARATION DISTANCES in Manhole/Access High water alarm level at in Meets alarm & cimuit requirements SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /Z:~:) ~'- Absorption field on lot On adjacent lots On adjacent lots Public sewer main /,,//^ Public sewer manhole/cleanout Sewer/septic service line Z ~' './- Holding tank /~/,~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~>~ "f- Water main ~//,~- Drainage /~ / A / Property line ~' /~- Water service line ./~ /Y' Wells on adjacent lots //~'~ ~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water Service line Curtain drain /-,/~/v~- Absorption field Surface water Building foundation ~ ./':'~ Water main /v'//~- Surface water / ~ /'*- Ddveway, parking/vehicle/storage Wells on adjacent lots ~'0-~ 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 HAA guidelines in effect on this date. Engineer's Printed Name Date HAA Fee $ ~IDO. oC:> Date of Payment ,/,:,~.-//- 04:~ Receipt Number ~ Waiver Fee $ Date of Payment Receipt Number 72.0~6 (R~v. 01/00)' DEC-13-29~ iiFJ:39 Sg,S ENGIN~:~ING SOV 694 1211 P,02/93 Client CT&R Ref.~ 1007547001 l, rin~ed Dat'erl'tmt 12/12/2000 14:42 Client l~ame S & S £ngiae~r~g Colle~-d Date~l'Ime 12/05/2000 1 pmje~ Nzme.~ L4A~ l~amann S/D Re~-~iv ed Ds. tu/'l'lme 12/06/2000 11:25 Cllen! SamPle ID ~4A Ha.zm~ ~/~ Technical D~rlor Stephen C. ~ Water Sample l~,emarks; 0500 U 0.~00 mg~L EPA '~00.0 lOn'mx SCL To~l Coliform Parcel I.D. # 1. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 050-611-19 HAA# GENERAL INFORMATION Complete legal description Hamann Lot 4A Location (site address or directions) NHN Hamann Road Property owner Jeff & Janet Br~d Mailing address M~ R'~ F~× 1676._ P~91~ Riv~r, Ag: No.est Mortgage/Don Presser Lending agency Mailing address Agent Address Day phone 99577 Day phone 16635 Centerfield Drive, Eaqle River, AK 99577 ReMax of Eagle River/Audrey Mason Day phone 16600 Centerfield Drive, Eagle River, AK 99577 694-3422 694-1144 694-4200 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 '~ TYPE OF WATER SUPPLY: Individual well X Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system, 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 #21 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/orwastewaterdisposalsystem is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverifythatbased on the information obtained from the tvlunicipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Eagle River Enqineerinq Services Address P_O. P¢~× 77t2q~-- P, Rc~I¢_ River, AK Engineer's signature 99577 Phone 694-5195 Date bedrooms. DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA ~1 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type Log present (Y/N) ~7'/'/--/~/ Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed 0 ~./?z./ Driller Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 ~L~O J Cased to FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: -~ Septic/hclding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: r/z./,p" Nitrate B. SEPTIC/HOLDING TANK DATA Date installed ¢ ~]/~'/ ,Z-/L~ / %0" Casing height Wires properly protected (Y/N) g.p.m. AT INSPECTION g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank / ? ,~/,. Other bacteria Collected by: ~'~.--,-~-,,,-~-- ~./~,, Tank size JO(PO Compartments Cleanouts (Y/N) )/~ ..5 Foundation cleanout (Y/N) )/g 5 Depression (Y/N) High water alarm (Y/N) ,/V//,g Alarm tested (Y/N) /"//'~ Date of pumping g)(~/g)?/'~ ~/ Pumper ~ J~- SEPARATION DISTANCES FROM SEPTICiHOLI~Eq'G TANK TO: Well(s) on lot ~-- / z./D ~ On adjacent lots To property line 7'- .~ 5) Absorption field Sudace water/drainage /'//~ -/'//2 D ~ Foundation z~ ~ Water m~drrlservice line 72-026 (3/93)' Front ' CONTINUED ON BACK PAGE C, LIFT STATION /,//Y~ Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at .Cycles tested Meets MOA electrical codes (Y/N). - SEPARATION DISTA~OE~FRoM LIFT STATION TO: Well on. lot ' On adjacent lots D. ABSORPTION FIELD DATA ¢¢ Date installed 0 Length ¢¢ '/5~j ~-/P~/'Width / Total absorption area -2 ? Date of adequacy test 0~/ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) ~/¢' ~/"~,,~. - /¢ / Gravelthickness ..~, 5 Cleanout present (Y/N) Results (pass/fail) Sudace water System type ' Total depth ~', ~¢ 5 Depression over field (Y/N) ,P.4 %5 for ..~ After test If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water /'-/,/.,~ Curtain drain / On adjacent lots :/-/~ ' Property line / '~ ~ ' To existing or abandoned system on lot ~//~) Cutbank /'//~ Water r~aicVservice line -~/~ ' Driveway, parking/vehicle storage area '¢/~ E, ENGINEER'S CERTIFICATION the date I cer~fy that l have checked, verified, or conformed to all M~A an_.d~ HAA guidelines in effect on .~. of this inspection. ¢¢ $~o,,wP 0>1- ~o¢ rcEL. L.. 0~7'5/D~ /bo y/~,~-fEd-F/~ ?-~.P...LL~S../. Signature Engineer's Name Date HAA Fee $ Date of Payment Rece,pt Number Waiver Fee $ Date of Payment Receipt Number CT&I~.Rel~O Cficat ~{~xpl¢ ID Malrix Ordered By · lh'ojcut Nurrto pW$1D Commercial Testing & Engineering Co. Environmomal Laboratory Senrices ~'ae'~a~e'~~e~r~'~r~'~r~~~'~r4~'~ LABORATORY ANALYSIS REPORT 94.1656-1 IIA~.~tNN CA WA'It~K WORK Ci~cder 79011 EA~.E ~RENGffiE~-~G p~ht~ 9ate 06/071~ UA collect~l~ 06101194 Rcu~V~te ~/021~ ~ 12:30 h~. HA TcdmicM Dh~et m' S Itt, P1J/EN C. E[ g Sampl~ Remm:k,s: L~'t. Anal [late Ditto lult t0 06/03194 CMR i, So~, ~)eciat lnstn~tion.q Above HA = Not Anal, yze,'J- ** S~e .qmnpleRcmarks Abovc Ll'=L~la Trna ~ U=Un&tected~Rt~portedvatt~:i~tltcpra~lir"d°3mnt fit,,atluttlkalt- faT=Oeate, rqhm~ ~ D=Secandaq, diMim~. 5633 n Street, Anchorage, AK 99518-1600 --Tel: (907} 502-2343 Fa~: {nO7) 561-§301 ENVIRONMENIAL FACILITIES IN AFLAS KJ~, COLORADO, FLORIDA. ILLINOi!I, MARYLAND, NEW JERSFY. OHIO, U'IAH, WEST ViRGINIA GENERAL INFORMATION (a) (b) (c) ~ MUNICIPALITY OF ANCHORAGE .,-~,' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF iNSPECTION FOR .HEALTH AUTHORITY APPROVAL OF ON-SIT.E SEWER AND WATER FACILITY Application Date Leg.al Description (include lot, block; subdivision, section, township, range) _. Location (address or directions) Cpplicant is (check ode): Lending institution ~; Owner/builder ~; Buyer ~; Other D (explain); Business 2Gq-lqS'7 .~,~. (d) L~dinglnstitution CL-,prC~I~R J~L'J-IA/~IA-g/~Ic Telephone (e) Real Estate Company and Agent . ',"{'Address ' . . { Telephone (f) Mail the HAA to the following address: ...,. " is-c 5 ' ,.:. ':.,'. :$. ~3 ;CWATER SUPPLY' ', .... ::. ,,~..;; .< x.: ndividual Wel.l~ Community~ Public~ ~oto: I[ community woll systom, must havo writton con~ rmation from tho Stato ~opartmont of [nvironmontal Consorvation attesting to the 4"' SEWAGE DISPOSAL ' :';' ' .... - · ' .' :~- .... · . '- :; :,'-.5,. ' . · : ~: ' ''-?.'~?~-. · "qnsit~ p.~,c B Community B' Holdinfl Tank ~ ._,-"~ ~ :.% ":: ~' -'. ~;.;.}~:~?'/.~::~('~. . .~ Noto: If community woll systom, must havo writton confirmatio~ from tho Stato Dopartment o~ fi~vironmontal Consolation :' ,:'. - ' . ',~t~;'. '4'. 2. :'.:'? -'~' - ;:;3."{::';;':; :'';k: - . ,,. ' -. ~ Page 1 of 2 2.- TYPE OF RESIDENCE ,. ' r' Single-Family,l~' Multi-Family [] :i: Other 5. ENGINEERING FIRM PROVIDe, INSPECTIONS, TESTS, FILE SEARCH, As certified by my seal affixed hereto, and as of the validation date shown below, I venfy that my ~nveshgabonof this Health Abtho~'ity Approval shows that the on-site water su:pply and/or wastewater disposal systemi.s safe, function~_l and.adequate · for the'nu rnber of bed~:0dmSand type of Structur~ indicated h~fein'..i f~l~,' v~rify that based on the inf0rm~i~ion~obtained: ' fro~ the Municipality of Anchorage files and from'my.investigation and~inspectionl the romsite Watef;~'u pply'and/or wastewater disposal system is in compliance with ~tll Municipal and State codes, ordinances; and regulations in effect on the date of this inspection ...... ',_. ~-,'.- ~- -'"" Name of' Ficm - S &5 Engineering' Address '" ,, Date Eagl~ qiver,"AIasEa <29~77 -~: (:,-:-:,: :'. . ~...',..--. z_.-'7_- ~¢' ~o ,'- - DHEP APPROVAL Approved for '¢'*~'~-'~) bedroomg by ~ '~' ~'~ Date Approved ~'~' ' Disapproved . Conditional Terms of Conditional Approval " '-._ CAUTION ~'* The Mbncipality 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. Em ployees 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 ~n the professional engineer's work.' Page 2 of 2 . . . 72-025 (11/84) , - . WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MO~7/'~ ' HEALTH AUTHORITY APPROVAL (HAA) .... ~.~cipALITY OF ANc~:C~LIST - FEBRUARY 1984 mu'~"~:F. PT OF HEALTH & .... 264-4720 Legal Description: Well Log Present ~_~ Total Depth Z. ~,c.~ ¢ Cased to ~'J~;) / 1/.. Static Water Level Ii A, B, C, D.E,C, Approved (Y/N) Casing Height Above Ground Electrical Wiring in Conduit (:~N')~ Separation Distances from Well: Date Completed ~'~ ~/' Yield Depth of Grouting ~/~' Pump Set At ~ ~ I ¢" Sanitary Seal on Casing~)/.N'~' Depression Around Wellhead (.Y-~ To Septic/Holding Tank on Lot ~ L-3(-~ ~ ~'' ; On Adjoining Lots To Nearest Edge of Absorption Field t~n¢~,~ ~Oc:~ ~' ~ ; On Adjoining Lots To Nearest Public Sewer Line l,.(,i To Nearest Public Sewer Cleanout/Manhole ~ To Nearest Sewer Service Line on Lot Water Sample Collected by ~ ~' ~ r~ ~['-J,i~'~'L~ ~ 6 ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA To Water-Supply Well To Property Line To Water'MeffT~Service Line Course Date Installed ti_ I I-~..~1 Standpipes~'.N')' Air-tight Caps ,~/-N~ Depression over Tank ~i Pumping/Maintenance Contract on File (Y/N) / Holding Tank High-Water Alarm (Y/N) ~ Separation Distances from Septic/Holding Tank: Size '[(-~ ~ No. of Compartments Foundation Cleanout Date Last Pumped ;for Temporary Hotding Tank Permit To Building Foundation [O ~' To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed c~ i\~:~ Width of Field ......~// Square Feet of Absorption Area Depression over Field (N~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well [L_~ ( ~ To Building Foundation ~ ~ Lot ~'~ ~ / ~-;~ ¢...-- Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present~ Date of Last Adequacy Test To Water.M~kn/Service Line -'-~' ~' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line '~--~O\ '~' To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons ~ "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Company Receipt No. Date of Payment Amount: $ Signed ~ ~, 5 i~gh~o;;~-l,.U Date Sl:~¢i~ 'i9d4,, MOA No. Page 2 of 2 72-026 (11/84) Tir~e L:I Time ~ Date Date Date / Inspector Inspector 0~'~0~02\~ ~ .I , Inspecto:: Comments ,:~ Conditional Approval Date Sewer Installed Permit No, Septic Tank Size ,~/, Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY . Property Owner ~ ~.: ' '~; ~ ~ ~' / ~ ~ Phone Mailing Address ~, (~- ~:~'X ?~ ~/ ~_:-c~:,~ ~'~,~..t:~.~? ~,~t..(~ <~:~7 Buyer ~,, ~-/~, //~ ~':~ (~/~ ~ Address Lending Institution ~ ~ /~ F-'¢-{- ~ 7",%T-/--- j~ F2 ,,~--~ Phone Address Realty Co, & Agent j-c/:_~-7-_,e.Y ~J2Tp/~'l T/4~IQ~&-7 Z-'M~.~ //-,~/..~,~'Z..~7o,~ Phone Address /~--~/ ~')' ~""~J"-~) ~--~L-"-~-~Z ~'~-~ LegalDescription ,/-~o7- ~-/~)/ /-/,~ j~-~J AJ .'C~' Single Family [] Multiple Family ~o. of Bedrooms '~ [] Other Wat~Supply ~ Individual ATTACH WELL LOG. A well Icg is required for all wells drilled since June [] Community 1975, For wells drilled prior to that date, give well depth (attach Icg if [] Public Utility available.) Sewa..ge Disposal ~- Individual Year Individual Installed: [] Public Utility When Connected to Public Utility:_ [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.