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Home My WebLink AboutREED LT 11d Lot 11 #051-102-16 ArtnA..r 1%., rumr cx wvt.LL INC. Jim Sullivan, CPI qua 5111( PO Box 770197 "k t Lana Eagle River.AK 99577 (907)688-2510 (907)243-2282 Jim ii areticpump.corn Well Decommissioning Log Legal Address: Subdivision: Reed Block: Lot: 11 T: R Section Lot: On-site Water& Wastewater Program certified contractor performing the well decommissioning: Name: Signature: Jim Sullivan Company: Arctic Pump& Well, Inc Well Decommissioning Date 5-5-17 Method of Decommissioning: AMC 15.55.060L1 a.("� b. c.(J Location: Use the space below to provide a drawing of the property showing the following items: • North Arrow • Decommissioned well • Other water wells on the property • Two separate swing tie distances for each well shown on the drawing Note: the swing tie distances shall be measured from either permanent structures or the property corners. Zvi fes I, tvc It v5c Arctic Pump& Well, Inc. Page /off 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 LEGAL DESCRIPTION LOCATION DISTANCE TO: Well t.~ IAbsorptiongrea/ Liq, c city in gallons DISTANCE TO: Manufacturer IF HOMEMADE.: I I nsid~ Well ,/~k//~Dwelli ng DISTANCE T(~: Well / No, of lines Length of each line~/~,, Top of tile to finish grade //' Length ~..~ Type~ Crib diameter DISTANCE TO: Building DISTANCE TO: F o~l'~dation Dwelling J"~ ~. M a t '~;~,a~_.~_~/~. W dth Material J~EW [] UPGRADE Nearest lot line Trenc~ wdts NO. OF BEDROOM~ PERMIT NO. ~, Z No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Total length of lines Distance between lines ~ inches Material beneath tile Total effective absorption area inches Crib depth Total effective ~bsorption area Nearest lot line / Distance to lot line Septic tan k Building foundat4on .... ~'¢ Driller Sewer line OTHER PIPE MATERIALS _p SOIL TEST RATI I NSTif~-L~ ~- REMARKS PERMIT NO, Absorpt on area(s) 75-01//3 (Rev, 3/7-8) / DA~)E LEGAL Permit ~ Type of Soil Absorption System Is: Trench: Drainfield: Maximum Number of Bedrooms: ~ Applicant: Location: Legal Description: ,!UNICIPALITY OF ANCHORAGE Department c' Health and Environmental /rotection 825 L Street, Anchorage, AK. 99501 264-4720 * * *' HANDWRITTEN PERMIT * * * WELL AND/WON-SITE SEWER PERMIT Mailing Address: ~.O, Phone Number: Lot Size: Seepage Bed: .."~ Holding Tank: , Soil Rating(sq.ft/br) ~%~-- DEPTH The Required Size of the Soil Absorption System Is: LENGTH ?---~ GRAVEL DEPTH ¢ // O WIDTH The length dimension is the length(in feet) of the trench or drainfield. 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). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /D¢~ GALLONS * * Permit applicant has the responsibility to inform t~is department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED ~ * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a 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 sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 1 9 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence i~ remodeled to include more that 3 bedrO¢~S.~ A~pl Cant / Date: 7/~ ~ / SWP/024(1/81) August 3~, 1977 :~.76593 Dtar i(oute i]ox 3070 Chu~ftak ~ Alaska 99567 :!,rat ion installation on Lot 11 Rood Subdivision has expired In th~ event you still plan to ins'tall the well and/or on~ g:lte sewer system~ a n~w pe:~'mit is required~ ~'he original If the well has been dri].le, d, a well !ou should be to this depart~tent to docuItlent the installatio~x If you havo any qu(~stions r~gardinq th~ above~ matter~ please do not hesitato to contact this office ilm',~ed.iately at 279~ 251!~ extension 224 oz' 225. }Jincoroly~ ',Les N~ Buchhols~ i~oS~ "~ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 ?/ SLOPE DATE PERFORMED:_ ~7--' ~' '-~'~ WAS GROUND WATER /~/0 s ENCOUNTERED? L E IF YES, ATWHAT DEPTH? SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE '/~ (minutes/inch) TEST RUN BETWEEN FT AND FT CE RTl F I~~'~ / 14 15 16 17~ 18 19 20 COMMENTS PERFORMED BY: 72-008 (6/79) 08-E Russell Oyster 694-2774 Soils 8- Foundations Performed for: GEC. _CHNICAL 8 DEVEL_2MENT Box 90, Davis St,, Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL L? Name: ~x~{ ~,r.,,,,,:~,,,.~:.;,~:~ _~_'0~,~.. ', "z~ CO. Ear/Ellis 688-2280 Land Development Telo No.~ 10 11 12~_ 13 }-5 16 Ground Water Encountered: Yes No If yes, wh~t depth Proposed Installation: Seepage Pit Drain Field~_~'/ I)EP/'x~'I'MEfq-I' OF IIEAL'Ill Al,I[) ENVIRONMEI4TAL PRO'I iCC]ION August 14, 1985 Robert A. Shafer S & S Engineering SR B 196--× Eagle River, Alaska 99577 Subject: Lot 11 Reed Subdivision Dear Mr. Shafer: A waiver of separation of eighty-five(85) feet from the septic tank to the well is hereby granted. This waiver is granted for a three(3) bedroom single family dwelling only. If there are any further questions, please call this office at 264-4720° Sincerely~ Susan E. Oswalt Acting Program Manager On-site Services SEO/Ijw M-W DRILLING, Inc. P.O. Box4-1224 · ]3]0ClnternationalAirport Hoad (907) 274-461 ! ANCHORAGE, At_ASF-,A 99509 DRILLING LOG Use of Well~Om~i~ :%'"/" ':q¢ ' i ' "?-" ..~: Location (address of: Township, Range, Section, if known; or distance main road '"" b tI ?.i' Size of casing. ~" Depth of Hole Static water level ~"[~'~ ft. (abox;e) (below) land surface. Finish of well. (check one) :'- Describe screen or perforation {Well pumping test atx!0 gallons per (hour) (minute) for. feet Cased to ][~L, l feet · - . . . ..' ," ''¥''~, ~:.. open end ( ;":~. i'"' ) ;' WELL LOG ¢,'.,0f drawdo~wz from static level. Date of completion ---~,~ground sudace ~.:~.;.- z.,,..,.~,~,_~-.: Ozve details of formatmns penetrated, size of material, color and hardness Ch'A, ;L P, q St:[ Municipality-of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewa!er Program 4700 South Bragsw 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. _(~ ~ I - I O~-- I ~, '1. GENERAL INFORMATION Completff legal description Location (site address or directions) Expiration Date: Current Property owner(s) Mailing address Day phone Lending agency Day phone Mailing address Real Estate Agent ~;,c1~ ~',~c~- I. ~t~,~*..~- Dayphone Mailing Address '5 it~ t~c_f~ ~; ~ Un/ess othemfise requested, HAA 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 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Ce~ficates of Health Authority Approval (HAA) based only upon the representations given in paragral:h 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval ere 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. (CerUficatas may be reissued for a pedod 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 val{dation date shown below, I veHf7 that my investigation, based on procedures outlined in the Health Authority ~pproval 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 vedfy that based on the informaticn obtained from the Municipality of Anchorage files and from my irwestJgation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance wi~ ail applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm '-~/o~.. Address ~-~ "5 ~. Engineer's Printed Name 5. DSD SIGNATURE ~ Approved for Disapproved. Conditional approval for Phone ~-- , bedrooms. Date ~ - I (} -0 -c.. '"'2.'; ~','" ' bedrcoms, with the following stipulations: Additional Comments Attachments: · HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date: lC/- 0.2_ (Re,,. 0~;/02) M. icipality of Anchorage Development Services Department :~!~ ![~.-- Building Safety Division -~fin~ ~lt'~l- On-Site VCa~er & Wastawater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www. ci,anchorage.ak, us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~- ~oT ~ t ~ '~.~. t.~ ~ 'S't-O A. ~DATA A ~A Well ~pe ,, ~ ifA, ~, or C p~e ~ID · Parcel Well Lo~ (Y/N) '7" Yvlres property protecf/ed (Y/N) ~ Casing heigl~t (al:~ove ground) ~. c/ in. FROM WELL LOG AT INSPECTION Da , test o / / Static water level Well production WATER SAMPLE RESULTS: Coliform colonies/100 mi. Nitrate mg./L Other bacteria __ colonies/100 mi. Arsenic: mg./l. Date of sample: Collected by: SEPTIC/HOLDING TANK DATA Tank s~e 10 ~ gal. Nu~r ~ ~m~n~. ~ Cleano~ ~IN) Foundation dea~m ~IN) ~ Deg~s~n ~er rank ~) ~ ' High ~r a~ ~) AB~OR~ON FIE~ DATA Da~ ins~ll~ ~/g~ Soil m~ng (g.p.d.~ or ~) ~ ~m ~~ Len~ ~ E ~d~ I O E G~el ~1~ pi~ Fluid de~ iff ab~flon field ~m ~st ~ in./ ~r add~ ~1. N~ depffi ~ in. E~p~me: ~n. Fi~lfluiddep~ ~in. ~o~onm~ >= ~O g.p.d. ~y rejuvenation ~a~ent (~st 12 ~.) ~ & W~); ~ If yes, gNe dam D, UFT STATION Date installed 'Pump on' level at Datum Size in~onsf ~/' Cycles.rested E. SEPARATION DISTANCES in. Manhole/Access (Y/N) High water alarm level at Meets alaml & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: On adjacent lots Public sewer manhole/cteanout Holding tank Building foundation . ~ '~' Water main il 0 Wells on adjacent lots Property line j~ ~ ~somtion field Water senace line I 0 4- Surface water Curtain drain Surface water ~ Wells on adjacent lots Driveway, parldngAalhide storage SEPARATION DISTANCE FROM. ABSORPTION FIELD ON LOTTO: Property line .l~d'..-~ Building foundation I 0 ~ Water main Water Sen4ce line ~ 0 ~' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of MunicJpal records that the above systems are in conformance with MOA HAA guidelines in effect on this data. Engineer's Pdnted Name ! '~ J*~,, 4F Date q h o / o z_ HAAFee $ ~)75 Date o P .ent Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number Mu,ficipaliiy of Anchorage Development Services Dej artment Building Sat'ely Division On*Site Water and Wastewa~er Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ct.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0 ~'! -I0 3- I(,, HAA # Expiration Date: 1. GENERAL INFORMATION (jomplete legal des(~ripti(~nLo t JJ, R e e d S ubd '~ v ~. s i on L0$ali0n (site address Or directions) 230~-q Rosebud Ro~ Avenue :C. urre. nt Property owner(s) llurray WtlltnRhara ~Mailing address Lending% , Mailing address Real Estate Agent Mailing Address Unt,ess olherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 P.O. Box 672027, Chugiak, Dayphone None AK 99567 Day phone Greg Lancaster ' Dayphone 562-5592 Century 21/Crawford Real Estate 2739 "C" St.,Anch. 995O3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water. Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding lank [] Communlly On-site Public sewer [] The Municipality of, Anchorage Development Se~,Ices Department (DSD) Issues Certificates o1 Health Aulhority Approval (HAA) based only upon Ihe representations given In paragraph 5 by an Independent professional civil engineer registered In the Stale of Alaska. Certificates of, He?th Authority Approval are required for the transfer o! lille {except between spouses) for propedies served by a single family on-site wastewaler disposal ahd/or water supply system. DSD also Issues HAAs upon requesl to homeowners. Certificates of Health Authority Approval are valid for 90 days from Ihe date of issue for propedies served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of Up to one year wilh valid water samples.) Cedific~tes are valid ~'oi' one year for propedies served by Class A or B wells or a public water system. The Municipality o1 Anchorage Is no~ responsible for errors or omissions In Ihe prolessional englneer's work. 4. STATEMENT OF INSPECTION By ENGINEER As certified by my seal al'fixed hereto and as ot~ the validation date shown below, I verify Ihat my Invesligalion, based on procedures outlined In Ihe Health Aulhorlly Approval Guidelines for Ibis applicalion, shows that Ihe on-sile water supply and/'or wastewater disposal syslem Is(are} safe, functional and adequate for the number bedrooms and lype or' structure Indicated herein. I luHber veri~y that based on the Inl'ormalion obtained from the Municipality of Anchorage files and from my Investigation and tnspeclion, the on-site water supply and/or wastewaler disposal system is(are} In compliance With all applicable Municipal and State codes, ordinances, and regulations In effect at the lime of installation. DSD SIGNATURE V'/' Approved for ~'~ Disapproved. Conditional approval for Nameo[Firm S&SEngineerinR Phone 694-2979 Address17034 EaRle River Loop Rd., Ste 204, EaKle River,AK Engineer's PrintedName Robert C. Cowan, P.E. Date 5-1~'-02 ,-~'" -'"...~27L ......... bedrooms, with Ihe following stipulations: Additional Comments Attachments: HAA Checklist Septic Sys{em Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report O{her Original Certificate Date: .~-- / '7 ' O..~-.. (Rev. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bregaw St. P.O. Box 196650 Anchorage, AK 99519-6650 vnvw.cl.ancflorage.ak.us (907) 343-7g04 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: .~ A. WELLDATA ,/~,,/I/~/U V~ ,~--T'~.,.--I,~-- Well type If ~ B, or C Date ~le~ f s~l ~) To~ dep~ fl. ~ fl. k~L~ Date of test Static water level Well production WATER RESULTS: Coliform Nitrate Collected by: B.SEPTIC/HOLDING TANK DATA Tank Type/Material g.p.m. mg./l. weu Log (Y/N) __ Wires propedy protected/~) g.p.m. //~er bacteria colonies/100 mL .;'~anksize//~0~) gal. '. Number of Conlparlments ·. F0undation. . cteanou& (y/N) / Depression over tank (Y/N) i~' Date of pumping ~ Pumper ~'--,~- C. 'ABSORPTION FIELD OATA Lengt'h ~ fl. Width /(~ . Gmval below pipe ~)..-% ft. Totaldepth,~[.~ff. Eff. absorptionerea::~ Moniteringtube ~ Depression over flald ~/ Date Of adequacy test ~ Results (Pass/Fa,) ~t'~S For ~ bedrooms Fluid depth in absoqofion field before test .d~ in. Water added..'~-_~lal. New depth :~ in. Any rejuvenation treatment (past 12 mo.) (YIN & type) Absorption rate >= '~[~"'~ g.p.d. If yes, give date. ~ Elapsed Time: ~O min. Date installed ~__ Cleanouts (Y/N) ~ High water alarm (Y/N) /ky/ Final fluid depth (~) in. D. LIFT STATION Date installed ~//~ Size in gallons 'Pump on" level at .__~. 'Pump off' level et Datum ,// Cycles tested E. SEPARATION'DISTANCES pc.I ,*p c. ! (~ in. Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic sen, ice line SEPARATION DISTANCES FROM WELL ON LOT TO: On adjacent lots ,/~)i~ '4- / On adjacent lots ldo Public sewer manhole/clea~)0/ut '~/"f Holding tank SEPARATION DISTANCES FROM SEPTIC/H~-'I~G TANK ON LOT TO: Building foundation ~ P- Property line Water main /~ I./.. Water service line Wells on adjacent lots //~0 '¥- Absorption field / Sur ce,,.tar SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ;~",J ,"~ Building foundation t/~) ~- Water main {00 WaterSemiceltne /0IJ- Surface water //'0~ ~"-Ddve~ay, pa~kingNehictostorage Curtain drain ~]e/V'~" /~-~/TZ/.X/Wells on adJacent ints /~)..~-/PO~;a~.- C. COMMENTS , Jl4J, S G. ENGINEER'S CERTIFICATION I certify that I have determined through field inapectJor= and review of Municipal mcoMs that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Date ,,,~'/I HAA Fee $ Date of Payment Receipt Number (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number L L n~--I]U I L'I' I t,ereb), certify thai LOT // Anchorage Recording IHstrtct, /~taslca, Gas been surveyed by ,~e and II, at no encroachments .axlst e~cer, t as shorn hereo,. It Is the responsibility or the owner to determine the e~lstence of any easeme~tl, s, covenants, or restrlcllons ~hlch 'do ,or appear on recorded subdivision plat. LIsted distances'prevail and scaling should not be attempled IG determine unshoun dimensions. This survey lq nol adequate toy, nor should It. be used for establishing bo.ndary or fence lines. PlcCLiiYTOCif I.^rll) SUI:VE¥ £ol~li,Arjy 1'.o, Box 67 IoIlg l'honc (!)07) 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 Parcel I.D. 1.' ',GEN'~I~[. INFORMATION C~mpiete legal description ' Lo t' 11, Loe~tion (s~te address or directions) CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY D'v E[LiN( Expiration Date:. ~ -,.T,3. ~-O .~ ,. Reed Subdivision 23069 Rosebud Row Avenue Current Property owner(s) Gene & Jackie Augustine Dayphone. . Mailing address Lending agency PO Box 670247~ Chugiak, AK 99567 Day phone 688-6422 Mailing address Real Estate Agent MailingAddmss 16635 Centerfield Dr., Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 Crittenden Prudential Vista/Barbara Dayphone 689-6464 EaRle River~ AK 99577 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of HeaIth Authority Approval (HAA) based only upon the representations given in paragraph 5 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 less than 30 days old. (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. STATEMENT OF INSPECTION BY ENGINEER· "' ' ' ' · As' certified by my seal affiX(ed hereto and ~s'0! the Validation date shown below. I verity that my !nvestiga~ion. based on procedures out~ ned in the Health Abt~5[it;/Appro,~al Guidelines for this application, shows that the · on-s te Water supply and/or wastewater d sp0sal {~,ste~ is(a~e) safe, functional and adequate for the humber of bedrooms and type of structure indicated here n. I fdrlher verity that b~s~d on t~e informat on obtained from the · ' Municipality of Anchorage fi es and from my'inve{tig~atior~' and inspection, the on-site water supply end/or wastewater disposal system is(are) in comp ~nce'~th a 'ap-plicable Mdnicip~l and State codes, ordinances. and regulations in effect at t? time c~f install~t!on. . .: ......... ' , ~. -. ~ .., . ' · . . Name of Firm ~;o~ ~ou;- ~;,~' '.---r ."---" :;-~""-." .... , ·. , Address Eagle River, Alaska 99577 Engineer's Printed Name Robe=t: C. Co,/an, ?.E: ...... '*. ,Date · , · , ' · "-; ~ "' * '. - ' ' '_.,.w,.~..'~_"~'t%, . . - .... .,~.'"','.."' '. ,"' ..~..'t'-'~ . .. . ...... - ......,..:.. .... K'. ' '?"' _'~_'_'_"_'.'_" _ ............ 5. DS~SIGNATURE · · ..... -." . -' -. '-' "~,"~,'v CE-SS01 ',.~-~. I/ Annmwd f~r ~ bedrooms. ., . : . t~ ,<,~_. ........... .~ ~ Dmapproved. '~'x'Xx'~..''~: . Conditional approval for -. bedrooms, w~th the follow~ng stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other . Odginal Certificate Date: ' ~z~-~ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastawater Program 47OO Soulh Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ct.anchemge.ak.us (DOT} 343-7OO4 HEALTH AUTHORITY APPROVAL CHECKLIST completed Date Total depfl~ ~ft. ff A, B, er C provide PWSID # Well Log (Y/N) Wires pmper~ pmtectecl (Y/N) ~ Casing height (above ground) I 'Z.''f' In. FROM WELL LOG AT INSPECTION Static water level I ~ fl. . ', N fl. / Well production l 0 g.p.m. / g.p.m. z' WATER SAMPLE RESULTS: Coliform colonies/lDo mi. Nit,ate rog.fl. Other bacteria colonies/100 mi. Date of sample: Collected by: Tank Type/Material ~.._.~h/~-~-L.~ '. ~ ' Data installed ~.~=~~ Tank siZe I~ · gal. Number of Compartments Foundation aleanout (Y/N) ~ Depression over tank (y/N)~t~ High water alarm (Y/N) ~J ¢. ABSORI~rlON FI£1.D'DATA Length ~ '. lt. Width "i- I ~ lt. Gravel below pipe Total depth _~'.__~"'. lt. Eft. absorption ares ~)ft2 Monitoring tube _':~ Date of adequacy test ~ Results (Pess/~"-..~ Fluid depth in absorption field before test 0 in. Water edded_~_.~al. · .. Elapsed Time: .~_ min. Final fluid depth O in. Any rejuvenation treatment (pest 12 mo.) (Y/N & type) Depression over field For '~ bedrooms New depth ~' ~'in. Absorption rate >= ~) g.p.d. If yes, give date D. UFT STATION ~ Date installed /~(/~' Size in gaflons. 'Pump on" level at _.~in. "Pump off' level at Datum / Cycles tested E. SEPARATION DISTANCES Manhole/Ac<'e_ _ _~s (Y/N) In. High water alarm levet at iA. Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanidllR, etattorron lot Absorption field on lot Public sewer main /V ~/~-/ Sewer/septic service line ~- ~' '~ On adjacent lots On adjacent lots /0o Public sewer manhole/cieanout Holding tank · ~-f'/~-* SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~' ~ Property line ~ I Absorption field ~'- /'~'- Water main · *' Water senate line / Wells on adjacent lots / SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO' Property line Su ding . tion Water Service line / Curtain drain/~/L/~ ~/'/4//V' Walls on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I te~fy that I have determined through field inspections and rev/ew of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name f['~)~ ~.~,'4 7- ate 7/o/ HAA Fee $ Date of Payment .___~ ~ t~/°/ Rc~.~ipt Number (Rev. 1~) Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCI4ORAGE DEPARTi~'~ENT OF HEALTH AND ENVIRONMENTAl,. PROYECri'tON DIVISION OF ENVIRONMENYAL 14EALYH CER1 IFICA i'E OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWEF/AND WATER FACILITY 264-4720 Application Date ___. :/Z '_./_/?. GENERAL INFORMA'I"!ON (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Apphcant Name _////q/~¢/" ./2~-~zC/v~,'/~?'/" Telephone: 14ome -¢~ BusiRess Applicant Address .3.~. J .... ~x~X) -Y20 Owner/budder~-_; Buyer ~; Ott~er ~ (explain); (c) Applicant is (cbeck one): Lending Institution ~ · Address Telephone (e) Real Estate Company and Agent Address -l"elepi~or]e (f) ,-~¢;-~d the I,AA to the following address: ~i'YPE OF RESIDENCE Single-Family~v]/ Multi-Family r'J Other Number of Bedrooms ......... )~ ........... WATER SUPPLY Individual Well Community I~ Public El Note: If dom munity well systom, must have written confirmation from the State Department of Environmental Conservation attesting to the legalibt and status. SEWAGE DISPOSAL Onsil Public [] Community [] Holding 1-ank [] Note: If community well system, must have written confirmation from tho State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 ENGINEERING FIRIVl PROVIDING INSPECTIONS, TESI'S, Fit. E SEARCH, DA'FA AND INFORMATIOH As cel lifted by my seal affixed hereto and as of the validation date sbowr~ below f vor,f'/that my mn Ces~,gat~on of th~s Hea~th Authority Approval shows that tl~e on-site water supply and/or waslewater dmpossi system ;s safe. ~upct,cnal and adequate for tho number of bedrooms and type of structure indicated herein, i iurther verify that based on the reformation obtamed from the Municipality of Anchorage files and from my investigation and ~r~spoctiorl, the on-s {e water supply and, or wastewater d~sposal systel~ ms mn compliance with all Municipal and State codes, ordmances, and regulat,ons in effect on the date of this inspection. Name of Firm .__ ,.~ .~ ~' ~;'~'~n'~;~;:~.~b,~ ............ Telephone Address '"' ..... Date , ~ ...... -z. z DHEP APPROVAL Approved for -~ _-/_ bedrooms by Approved __ _~. ....... Disapproved Conditional Terms of Conditional Approval CAU'i'ION The Muncipality of Anchorage Department el Health and Environmental Protection (DHEP) ~ssues Health Authority Approval certificates based solel~/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 coudesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of [)HEP do no~ conduct inspections or analyze data before a certificate is issued The Municipality of Anchorage is not responsible for errom or omissions in the professional engineer's work. Page 2 of 2 72-025 (I 1~84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: // WELL DATA Well Classification "---~[\/~ if A, B, C, D.E.C. Approved (Y/N) Well Log Present ,~)/:N')' __ Date Completed '¢ -/," ~ t':~ Yield Total Depth ~.~"'2-" Cased to _J~:~ I.~,~ Depth of Grouting Static Water Level ) ~'O l Pump Set At Casing Height Above Ground Electrical Wiring in Conduit Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole I,'~. I,'~ ~ :~ ~&/Sanitary Seal on Casing ~/1 Depression Around Wellhea~ ; On Adjoining Lots /~ O ~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ~ ;Date B. SEPTIC/HOLDING TANK DATA Date Installed ~ ~'~(¢'~,~' Size ~/~::~' No. of Compartments Stand pi pea ,~AN')" Air-tight C a p s ~/,N')' Foundation Cleanout ~:~N'} Date Last Pu~~,,~ Depression over Tank,(A~) A// '"~'-- ~ ~'~' 'r~ i Pumping/Maintenance Contract on File (Y/N) /.,4--' ;fo/~Oo ' [?¢.,_ ~ / Holding Tank High-Water Alarm (Y/N) ~//'/~- Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding. Tank: To Water-Supply Well ~ ! ~ To Property Line To Water Main/Service Line Course Comments To Building Foundation /,~" ~ To Disposal Field /,'¢ z ¢ To Stream, Pond, Lake, or Major Drainage Page 1 of 2 ABSORPTION FIELD DATA Soils Rating in Absorpti(~n Strata Date Installed ¢') lc')' ~1 ~ Width of Field /O ~ Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /O To Building Foundation ...~O Lot /'///~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field _c~, Depth of Field .z/// .. Gravel Bed Thickness ~'// Standpipes Present U/N) t Date of Last Adequacy Test To Property Line , To Existing or Abandoned System on ; On Adjoining Lots ,.~O t .*' To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) Pump Off" Level at //'~/Z Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signed Receipt No. Pj~]* 604¢97a %&~)~c~ Date of Payment k-k-~k- %d Amount: $ [~ .¢O Page 2 of 2 72-026 (11/84) HEALTH AUTHORITY APPROVALS SEWER &WATER MAIN EXTENSIONS SEWER &WATER INSPECTION SYSTEM DESIGN WELE INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER OISPOSAL SYSTEM OESIGN MUNICIPALITY OF ANCHORAGE DEPT, OF i4EALTPI & L 29 July 27, 1985 ROBERT A. SHAFER CIVIL ENGINEER 694-2979 Municipality of Anchorage Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 REFERENCE: Lot 11; Reed Subdivision Request you issue the attached Health Authority Approval and approve a waiver for the existing septic tank located 89 feet from the private well on the referenced property. The existing on-site waste water disposal system was installed in July 1983 under MOA permit Eagle River, unnumbered. The system was inspected by us and a waiver of 89 feet was approved by the MOA at that time. It is our opinion that the horizontal separation distances prescribed by 18AAC72.021 are not required in this case. The existing well is 180 feet in depth and has a static water level of approximately 150 feet from the surface. The topography in the area is such that surface flows and the tilt of bedrock, if any, would not be in the direction of the well. Included for your review in addition to the Health Authority Application are the following documents: A. Copy of the well log B. Copy of inspection report and permit D. A recent coliform bacteria analysis showing satisfactory results If you require additional information, please contact us. / ?~gBERT A. SHA~ER, P.E. - AS/ss SRB 196X EAGLE RIVER, ALASKA 99577