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HomeMy WebLinkAboutCOLONIAL PARK BLK 3 LT 4 N2Onsite File Colonial Park Block 3 Lot 4 N2 #050-301-27 Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 ® Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report 5 LA)C1190Q 6'S 0-S-0 •- 3©1— a7 Permit Number: PID Number: Name: i `/l� 1 y W0 /6 Gt Wastewater System: El New 1� Upgrade Address: Po$n,t; 6 7G���� �d►oic���tik qq56 ABSORPTION FIELD Phone: (7 /' _ I CO (1 n No. of Bedrooms: ❑Deep Trench Z Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: ®®� Total Depth from original _i GPD/Sq. Ft. Block: Subdivisi Lot:�-� � / �(�erF Depth to pipe bottom from original rade: 1 Gravel depth beneath pip c 6 l-�Ioil(A 1on: Ft. I -� Ft. Township: Range: Section: Fill added above original grad •p Gravel length: 1% a B Ft. 1 Ft. WELL: ❑ New ❑ Upgrade Gravel width: y Number of lines:istaance between lines: _ Ft. 15 Ft. Classification Private, A,B,C): Total Depth: Cas t i Total absorption area: Pipe material: S C(.¢ 40 P•v C_ M aP� VGi dl �rlc t. Ft. SO. Ft. 5 /"! Installer:, Date installed: yv ye -4 v 4jl G AN K B Dn qr: aeDrilled: Static Water Level: r Ft. Yield: :::::�GPM Pump Set at: L4 k Casing Height Above Ground: /1 n0j Ur1 Ft. Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding XS.T.E.P. To Septic Absorption Lin Holding Public/PrivateM nufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines P1 cho,��e Q `1 81l^I� Well' 00'� QO �� �---- �i� ,�( Material: ��e Number of Compartments: surfac Water IQD` i- IC)0'+ 100 � LIFT STATION Lot Line \ Gj` Size in gallons: Manufacturer: ��1�fi�i Foundation Z Qo 3=� \ "Pump on" level at 0" •i "Pump off" level at: p3��a High water alarm at: 6% Curtain Drain AA II /V9n �/ I� i�l Pump Make &Model Electrical Incn-ntin s De. ormgd by: 05-T 0S Hof 91/�t.C7 �t�At1 e;9a v, BENCH MARK Remarks: X/ S ; t Nc- s- ,J it c- T 14.V /� V t�1 �)L d1 C i2 ✓ j �� !) N v AN 1)u.J %i (i Location and Description: J ) /� O -IF- la , (/lJ�1is t .(�_•®® + Assumed Elevation: Ft ENQaj EE6opi, 'i.1ch . ...... ......... r.... �n- S & S ENGINEERING �' G'' Inspections performed b -e.Ul�.ive� _ _ Loop ., _ _r �.,_ n�I�ates: l st m,...::✓!� Eagle river, Alaska 99577 2nd 5—�—, y�i\ ROBERT C. COWAN d et a 4 CE -8801 ��°e�` Department of Health and Human Services�approval��� G_ Reviewed and approved by: �-� r Date:~ V"I'i 72-013 (Rev. 9/91) MOA 25 PERMITNO. SW990065 DEPARTMENT 0�= H�A� CN�IRONMENTA� PAGE L OF TH AND HUMAN SERVICES SCR�ICES DIVISION R0. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephonei 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT z. LEGAL LOT 4, BLOCK 3, COLONIAL PARK S/D P.I.D. NO. 050-301-27 SECOND STRE T �<< LOT 5 LOT 3 q GARAG A EXISTING TB N 3 BEDR❑❑M 1250 GAL, HOUSE S.T,E,P. TANK FCO ST1 ST2 APPROX, LOCATION SHED GROUND WATER TRENCH 1❑F MT1C — MT LOCATED ON NEIGHB❑RING LOT TRAP2 w 4 r t.4- a ci3e3 = 0—swc. ---------------------------- C-M T 2 c—s-1.. i n .v 10' UTILITY EASEMENT 10' UTILITY EASEMENT — — — — — — — — 20' UTILITY EASEMENT SCALE: 1" = 40' 1*7 eN.io• e•.rCah ua to. omw•�.�o��yr ROBERT C. COWAN $4- �PJj.� CE - 8801 r ,PERMIT' N0. SW990065 PAGE 3 OF 3 Municipalit of Anchora e DEPARTMENT OF HEALTH AND H'K'A'N SERVICES ENVIRONMENTAL SERVICES DIVISION P,0. Box 196650 ® Anchorage, Alaska 99519-6650 ® Tete hone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WEE INSPECTION REPORT t4 � iw' LEGAL LOT 4, BLOCK 3, COLONIAL PARK S/D P.I.D. NO. 050-301-27 STT 1 S 2 H /-102.4'H 98.8 1250 GAL S.T.E.P. TANK MT1 = 103.6' TRENCH 1 101.8' ---r SR MT1 = 104.5--,," TRENCH 2 J� 102.4' SR FINAL GRADE - 2" INSULATION _ 98.6' A B FCO 40.0' 21.5' ST1 41.0' 35.5' ST2 41.0' 39.5' MT1 72.5' 60.5' MT2 1 74.0' 1 77.5' FINAL GRADE 2" INSULATION NO WATER FOUND 90.8' B.O.H. N MT1 = 99.8' FINAL GRADE 2" INSULATION MT2 = 100.4' N. t S. I'1 HT -1d-77 INU 1G:^ir t -M WQIKer c-onT raoT. Ir19 Vkvr 074 T7Z. "tn Y.W 0511111999 M52 19076886777 RISING SON ELECTRIC PAGE 02 Kising f'l P.O. Box 670687 hu iak AK, 99567 (907.) 688-6777 Apr IL To Whom It May Concern, This is to certify that Rising Sen Electric installed the electripal to the lift station at i 9546 Second Street Eagle River Alaska, The underground wiring was installed by the excavator. Thank Yo Kevin S, Flornbuckle 1 fit MAY 2 4 1999 munictpalsty jai -ic;noToga At. �4eatfh & HUMan ervicas MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW990065 Legal Description: COLONIAL PARK BILK 3 LT 4 N2 Date Issued: Apr 21, 1999 Expiration Date: Apr 20, 2000 CA ;3 C CL M Parcel ID: 050-301-27 Z4�' Design Engineer: 0003 S & S Engineering Site Address: 019846 2ND ST Owner Name: Gail & Andy Zywot Lot Size: 16200 SQ. FT. Owner Address: PO BOX 670264 Total Bedrooms: 3 Permit Bedrooms: 3 CHUGIAK , AK 99567-0264 This permit is for the construction of: 0 Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. The level of groundwater is to be measured at the time of construction. Received By: Issued By: Date: Date: S&S� pneeRtnG ROBERT C. COWAN, P.E. Al CIVIL ENGINEERS kWA (907) 694-2979 FAX (907) 694-1211 March 31, 1999 HEALTH AUTHORITY APPROVALS MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 SEWER&WATER Anchorage, AK. 99519 MAIN EXTENSIONS REFERENCE: N 1/2 of Lot 4, Block 3, Colonial Park S/D SEWER & WATER INSPECTION Request you issue a permit to install a septic system to serve the three bedroom dwelling on the referenced property, ENDREERINGSTUDIES A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation 2/17/99 water was not found. After seven days of ground WELOWTESCTION &FLOW TEST water monitoringthe monitoring tube was g dry. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The SITE PLANS construction of this system will not prevent any future development on any of the adjacent properties. ROAD DESIGN If you require additional information, please contact us. Sincerely, SOIL TEST obert C. Cowan, P.E. PERCOLATION RCC/rdp TEST Enclosure STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1 " = 40' DESIGN DETAIL V O SCALE y a7 �I CJi N Wy CO M W o �' xz �sM v N km=3. a o [xvzi .- C) 0TI M Z m r, -0 ms�m V• Z � SIlIQv2I TIM ,OOT a CSN ri W .. N < R7 JW o� o I b D one O -4o b �. z O W M tv I � T7 �p y 0 cn w d D 0 Z a o � � I a� �� cn� w n o � �) a �~ a dry d 0 a-- �I v I Myo C� Ul �n .0 0 j N cl d o n LTJ ��z to, e b7 i n h x h a > -0 5-8� O 3y M y � O m W I I S• ( 39 > �d I I 00 C O I trJ C CO r C m 5-8i 10' MIN. a VCI O I 1� M > M r2'� 1. J� 1j^v�1j 1V y r M OF . �S{N., �a O V J 1�--I � O 0 H C7 �Zy t::)-���--yy Z�>0 0J ✓� �/yy i��y O 41 �.{ e/Y O `O� l' N a a�4't `��l d ••. zv�-> I,/° onm �i C7 a- Zr—o -IA c,F rn Yip S�Qz z v, Nmz r I j�N xp� �j' co n • ~/i �lJ$ «? O O x tr 1ti p N p Z ���(� Ob # •� =�17or x,.�',V m ��� o ��� FFR Municipality of Anchorage . DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 ^ SOILS LOG — PERCOLATION TEST PERFORMED FOR:'1 L �I ©"r DATE PERFORM i LEGAL DESCRIPTION: �O 13,A � Township, Range, Section: rBEP�H / SLOPE SITE PLAN (ENGi ER'SL) "Y ROBERT C. COWAN i i J- - XX() I Y' 1 " 2 v . 3 ,J wJ 4- 5 6- 7 7 8- 9- 10- 910 2' 11 ? 12 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS 314151617181920 COMMENTS 15, 0 . lk-. S WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT �� L DEPTH? F'J k p Depth to Water A r' j Monitoring? Date: a Reading Date Gross Time Net Time Depth to Water Net Drop r - f% - 3o MI^) 3 Ys1( N 3.� PERCOLATION RATE ` D (minutes/inch) PERC HOLE DIAMETER - TEST RUN BETWEEN FT AND 3/ FT PERFORMED BY:S & S ENGINEERING I )'`W G CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle liver Loo Road No. 204 � 3 ACCORDANCE T A STAT A D PAL GUIDELINES IN EFFECT ON THIS DATE. DATE: % agleiver,fas a q9 72-008 (Rev. 4/85) 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 (A c%yea PHONE /�� E�I-N_W ]UPGRADE MAILING ADDRESS ``13) LEGAL DESCRIPTION LOCATION NO. OF BE" R',OOMS / J UY DISTANCE TO: Well I Absorption area Dwelling PERMIT NO. ~a Q w I.. Manufacturer 1 Material No. of compartments Cn Liq. capacity in 3llons IF HOMEMADE: Inside length Width Liquid depth Y JAZ DISTANCE TO: Well Dwelling PERMIT NO. = z < Manufacturer Material Liquid capacity in gallons 0 w= DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. J LL Z FZW � No. of lines Length of each line Total length of lines Trench width inches Distance between lines cc F. o Top of tile to finish grade Material beneath tile inches v a Total effectibsorption area 3 C) W a Length Width Depth PERMIT NO. H CL wa Type of crib Crib diameter Crib depth Total effective absorption area W DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. ulBuilding DISTANCE TO: foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS cY , �- a�J Q✓t�.Jf � APPROVED DATE LEGAL�_Q 71-013 (Rev. 3/78) Li_ l 0_0 [° 1 o=: 2 F=° 1 1 Z `0 r. =n Gam"- FA PQ CC G -J r : : 6=2 rte, [rte" DEPARTMENT OF. HEALTH AND ENVIRONMENTAL PROTECTION 825 "L' STREET, ANCHORAGE, AK. 99501 264-4720 CU G'-a!1—'E-- sL IF L � . n E= 61I4 = li U =° Lr- IF PERMIT NO. ( 790364 APPLICANT WAYNE COU I NEA I LOCATION EAGLE RIVER LEGAL_ �\�i� L 4 E: <: COLONIAL F't=IF'K TYPE OF SOIL I-IC:SORBT I ONd SYSTEM NI=I'r' I telUH NUMBER OF BEDROOMS = BOX 763 EAGLE RIVER I DRAINdFIELD /Ous i• LCAT SIZE 14896 E,QI_IARE FEET SOIL RATING < = O FT:'BR) = 140 THE REQUIRED SIZE nF THE SOIL r 1E,' :nF:F'T I OP'zS-T� 1 I IL o F7 T=" -Q' fr -F - = icy THE LENGTH DIMENSION I S THE LENGTH (IN FEET OF THE TRENCH OR DRA I NF I ELD. THE DEPTH OF A TRENCH OR F' I T IS THE DISTANCE BETWEEN•d THE SURFACE OF THE GROUND D IIP• D THE BOTTOM OF THE EXCAVATION (IN FEET). F_ 19 Fw -li- Ty? G~ 04 C2 &1 6-9 Z L-- IF F"" -F 17 ^ - e_o e=a 10 C 7 - THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL iLL F'IF'E AND THE BOTTOM OF THE EXCAVATION (I Nd FEET). F e C n-9 0_0 11 7° C E> in C=' _ ' Z n.=" IF 0=0111.11 i = 7 :::�' = = - e.=r e --n 01 r= C =n LL_ 0 Cn G" -°E PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM M TH I' DEPARTMENT DURING THE INSTALLATION INSPECTIt1oN OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. — — — IF 9-4 n_0 < '`' _-a 7 PA 03 F--° Eo C- IT 7 n=n li%g �_ �•=0 FT C F Q E- n-9 0_0 T G- Z CE LBACKFILLING OF ANY SYSTEM WITHOUT FIN• AL INSPECTION t=1i'• D APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTHP•.1CE BETWEEN A (.'.TELL AND A{'•d'r ON-SITE SEWAGE DISPOSAL SY :TEM I 100 FEET FOR A PRIVATE WELL: OF! :150 TO 200 FEET FROM H PUBLIC: WELL DEPENDING UPON THE TYPE OF PUBLIC: WELL. OTHER REQUIREMENT' MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO i I N•a=.URE PROPER INSTALLATION. F=" [C 1F=" F-° 0 : -7 E_ E> C n=- En G'1 E3 i~ FQ .-- ". _ AL. <0 7- �=j I CERTIFY THAT 1: I AN FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. : I WILL INSTALL STALL THE SYSTEM IN ACCORDANCE WITH THE CODES. . I UNDERSTAND DER ,TAN D THAT THE ONd••-SITE 'SEWER SYSTEM hil=i'z REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO i INd+_LUDE MORE THAN i BEDROOMS. S I GNdED :§40 __ (/(/�c7���° __� �t �----------------.--_- FIF'F'L I C:AN�TU Ld 'r'PdE COf_I'S I !'dEt=11 i ISSUED By_ _Xc -------------- GSA E-5_-�-----._ Q P1 f-4 I IZ-- I F=- F= n u -i nK3 F= - ,DEPARTMENT OF lLTH AND ENVIRONMENTAL PR _7CTION 825 ^L~ S/REET, ANCHORAGE.- RK 99501 264-4720 ID "_` I �W F= F-*- F="F= FR M I -r PERMIT NO. ( 790364 )' PPLICHNT WHYNE COUSINEHU BOX 763 EAGLE RIVER 6942140 OC8TION EAGLE RIVER EGHL L 4 B 3 COLONIAL PARK LOT SIZE 14896 SQUARE FEET YPE OF SOIL HBSORBTIOM SYSTEM IS: DRHINFIELD ' RXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING <SQ FT/BR)= 140 HE REQUIRED SIZF THE SOIL A85CIRPTION -Y F=* -IF C-3 FR_ F=I'%-o FE L- ������-r��== �L THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). IF"F= LJ l L ----r" I :E:'C310�� F=-F=F=-I- THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ��F= L> '_E; E= F=> -FI f-- lFF=1 r-4 l< ID C-1 10 C33 Cl r -4:S ERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE ` qSTHLLHTION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE JMBER OF RESIDENCES THAT THE WELL WILL SERVE. <:R> f=iF-ZF= ___ 9CKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS E-P8RTMENT WILL BE SUBJECT TO PROSECUTION. INIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE 5E14HGE DISPOSAL SYSTEM IS 30 FEET FOR H PRIVATE WELL; OR 50 TO 200 FEET FROM 8 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL 7HER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE /RILHBLE TO INSURE PROPER INSTALLATION. �F=- F:;_--"rwj 3: -IF���XFZE=_"=:; E>f_=C--E=PlE-cE=lR_ =---I _. ::L <-=A _7 <-:;I CERTIFY THAT � I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET }RTH BY THE MUNICIPALITY OF ANCHORAGE. � I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES' � I UNDERSTAND THAT THE 8N -SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE _-SIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. -,� [GNED: ` :jSUED �_�L���--_____________DATE __.__'___,,____ -4j 9"b� 4 VI2 ��j������r p_��� STREET, HNCHORHGE, HK� 9��` 1 �� ��������� DEPHRTMENT HEALTH HND ENVIRONMENTHL��OTECTION r 825 '\ 'STREET, - HNCHORHGE, HK� 9� 1 TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MHXIMUM NUMBER OF BEDROOMS = 4 SOIL RHTING (SQ FT/BR)= 150 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS: ������= � ������= �� �����_ �����= �5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE GROUND AND THE BOTTOM'OF THE EXCHYHTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. ' ' THE GRHVEDEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFHLL PIPE HND THE BOTTOM OF THE-EXCHYHTION (IN FEET). �� ����� ���-= ����� ���_���� �������� ����� H PHCKHGE PLHNT MAY BE INSTALLED AT THE PERMITTEE'S OPTION SUBJECT TO THE FOLLOWING CONDITIONS� 1. EITHER H CLHSS I OR II NSF HPPROYED PLHNT MHY BE INSTHLLED. 2. H CONTINUOUS MHINTENHNCE HGREEMENT IS REQUIRED. IF H MHINTENHNCE HGREEMENT IS NOT KEPT CURRENT YOU MHY BE REQUIRED TO ENLHRGE THE SOIL HBSORPTION SYSTEM HND/OR YOU MHY BE SUBJECT TO PROSECUTION. ����� ��> ����������� Fe IF-':-:-- �������-� BHCKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTION HND HPPROYHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTHNCE BETWEEN H WELL HND ANY ON-SITE SEWAGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIYHTE WELL OR 200 FEET FOR H PUBLIC WELL WELL LOGS ARE REQUIRED HND MUST BE RETURNE[ TO THE DEPHRTMENT WITHIN ]0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MHY APPLY. SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS ARE HYHILHBLE TO INSURE PROPER INSTHLLHTION. I CERTIFY THHT 1: I HM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS HND WELLS AS, SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE. 2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES_ ]� I UNDERSTHND THF THE ON-SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESIDENCE I.S. REMODELED THAN 4 BEDROOMS. SIGNED��� _ -------�-- HP�LICHNT S - ,� �SSUED BY-������'__��_������_____DHTE______��_______ Y]� 0 825 '\. STREET, HNCHORHGE, HK� 9��` 1 ^_ 279-2511 ��� ���C� ��_���� �V���� �������� PERMIT NO. ( 77510 ) RPPLICHNT P O BOX ]51 E. R. ]44-]586 LOCHTION EHGLE RIYER LHNE LEGHL N1/2 L4 B] COLONIHL PAR[:-'. SUBD LOT SIZE 2]650 SQUHRE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MHXIMUM NUMBER OF BEDROOMS = 4 SOIL RHTING (SQ FT/BR)= 150 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS: ������= � ������= �� �����_ �����= �5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE GROUND AND THE BOTTOM'OF THE EXCHYHTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. ' ' THE GRHVEDEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFHLL PIPE HND THE BOTTOM OF THE-EXCHYHTION (IN FEET). �� ����� ���-= ����� ���_���� �������� ����� H PHCKHGE PLHNT MAY BE INSTALLED AT THE PERMITTEE'S OPTION SUBJECT TO THE FOLLOWING CONDITIONS� 1. EITHER H CLHSS I OR II NSF HPPROYED PLHNT MHY BE INSTHLLED. 2. H CONTINUOUS MHINTENHNCE HGREEMENT IS REQUIRED. IF H MHINTENHNCE HGREEMENT IS NOT KEPT CURRENT YOU MHY BE REQUIRED TO ENLHRGE THE SOIL HBSORPTION SYSTEM HND/OR YOU MHY BE SUBJECT TO PROSECUTION. ����� ��> ����������� Fe IF-':-:-- �������-� BHCKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTION HND HPPROYHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTHNCE BETWEEN H WELL HND ANY ON-SITE SEWAGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIYHTE WELL OR 200 FEET FOR H PUBLIC WELL WELL LOGS ARE REQUIRED HND MUST BE RETURNE[ TO THE DEPHRTMENT WITHIN ]0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MHY APPLY. SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS ARE HYHILHBLE TO INSURE PROPER INSTHLLHTION. I CERTIFY THHT 1: I HM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS HND WELLS AS, SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE. 2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES_ ]� I UNDERSTHND THF THE ON-SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESIDENCE I.S. REMODELED THAN 4 BEDROOMS. SIGNED��� _ -------�-- HP�LICHNT S - ,� �SSUED BY-������'__��_������_____DHTE______��_______ Y]� 0 ® & E ENGAEERING & ®EVELG'o RENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOCA, 688-2280 Performed for: Name: Tel. No. �9`-ZILIy Mailing Address: �' `�'` L- �� ✓t=� 44 e7957`( - Legal Description: Z•"'s5—' ���« /iLc�.� ��i •� iQ L��1 6L/' Depth (feet) 0 Soil Characteristics 2 4 5 $ i X20 % rte= 10— 0 2 2 13 14 15 16 1 PLOT PLAN PERC. TEST Ground Water Encountered: Yes �No If yes, what depth Proposed Installation: Seepage Pit_ Drain Field- Comments: ield Comments: Performed by:✓Date: i-tLzd -7!7 R&M CONSULTANTS, INC. 5024 CORDOVA O BOX 6087 ® ANCHORAGE, ALASKA 99502 ® PH. 907-279-0483 B TLX. 090-25360 ENGINEERS GEOLOGISTS PLANNERS SURVEYORS July 7, 1977 Mr. Paul Sellens SRA Box 468-B Anchorage, Alaska 99507 R&M No. 751184 Subject: Soil Investigation for Sanitary Sewer System, Lot 4, Block 3, Colonial Park Subdivision, Eagle River, Alaska; Lots 2, 3 & 4, Block 9, Preuss Subdivision, Eagle River, Alaska Dear Mr. Sellens: At your request of June 30, 1977, we conducted a subsurface soils investigation at the proposed location of the sanitary sewer system on the subject lots. The investigation complied with those procedures required by the Municipality of Anchorage, Department of Health and Environmental Protection. This investigation which was accomplished on July 5, 1977, consisted of four test holes drilled to a depth of 20 feet below the existing ground surface. The test holes were sited according to your instructions and their locations are shown on attached Drawings A-01 and A-03. Drilling was accomplished with a rotary drill rig using continuous flight solid - stem auger with an outside diameter of 6 inches. Samples were taken at the depths shown on the soils logs in Drawings A-01, A-02, and A-03. The samples will be held in storage at our lab for approximately six months. In addition, all material brought to the surface by the augers was continuously monitored by an experienced engineering geologist. The topography of Lots 2, 3 and 4, Preuss Subdivision is generally horizontal and that of Lot 4, Colonial Park Subdivision is rolling. At the time of this investigation all sites had original vegetation consist- ing of spruce & birch trees with moderate underbrush. The tops of the test holes were located at original ground surface with the exception of Test Hole No. 1 which was approximately 1 foot below original ground surface. The soils encountered in the test holes are shown in the test hole logs in Drawings A-01, A-02 and A-03. The symbols used in these Drawings are explained in Drawings B-01 and B-02. The logs display specific conditions encountered at the test location. However, subsurface conditions may vary in other parts of the lot without any apparent surficial evidence of the change. Groundwater was encountered in Test Hole No. 4 (Lot 4, Colonial Park Subdivision) at an approximate depth of 12 feet. Bedrock was not encountered. At the time the test holes were drilled, seasonal frost was not present and permafrost was not encountered. ANCHORAGE FAIRBANKS JUNEAU VALDEZ WASILLA i July 7, 1977 Mr. Paul Sellens Page -2- A percolation test was performed within each test hole at the depth shown in the attached Tables 1 through 4. All depths were measured from the top of the hole. The data in Tables 1 through 4 show average infil- tration from the depths indicated to the bottom of the hole. The measured percolation rates were as follows: Lot Block Subdivision Test Hole No. Percolation Rate 2 9 Preuss 3 1.51 Minutes Per Inch 3 9 Preuss 2 1.91 Minutes Per Inch 4 9 Preuss 1 1.47 Minutes Per Inch 4 3 Colonial Park 4 5.33 Minutes Per Inch We appreciate this opportunity to be of service to you. Please contact us if you have any questions concerning this letter or if we can be of additional service. Very truly yours, R & M CONSULTANTS, INC. Michael Mitchell, Jr. Senior Geologist MMJr/JMB/gld i Jim cCaslin Brown, Ph.D. Head, Earth Sciences Dept. W U a P4 Q a 0 Q LOCATION SKETCH 21' TH-3 1 ' 20' TH-2 0' 25' 25' TH-1 LOTS 2,3 AND 4, BLOCK 9, PREUSS SUBD. EAGLE RIVER, AK Distances shown are approximate and have not been measured by surveying methods. NOT TO SCALE TEST HOLE NO. 1 Scale: 1"=3' rex GRAVELLY SILT w/ SOME SAND (M) moist, brown RD) ------4.0' LOT 2 S ILTY GRAVEL w/ SOP'IE;o SAND (GM) A scattered cobbles 17-y"1411 20' T. D. Groundwater was not encountered. This log depicts subsurface soils observed within the test hole at the location shown. See Drawings B-01 and B-02 for explanation of symbols. DW N: o Jam- LOCATION SKETCH AND F•B• CKD: R&M CONSULTANTS, INC. I F TEST HOLE LOG 110. 1 1 GRID DATE - I PAUL SELLENS PROJ.NO. 751184 SCALE: see abov DWG. NO.- -----A-01--- 8.01 A ?` 2 LOT 3 SILTY SAND w/ TRACE GRAVEL (SM) —11.01 oJq GRAVELLY SILT w/ SM1E SAND (ML) 0?9� scattered cobbles aq �b 9;9 9 l� .Qq C LOT 4 a° — — — — — — — 14.0' �o°� SILTY GRAVEL w/ SOME op owe SAND (GM) 17-y"1411 20' T. D. Groundwater was not encountered. This log depicts subsurface soils observed within the test hole at the location shown. See Drawings B-01 and B-02 for explanation of symbols. DW N: o Jam- LOCATION SKETCH AND F•B• CKD: R&M CONSULTANTS, INC. I F TEST HOLE LOG 110. 1 1 GRID DATE - I PAUL SELLENS PROJ.NO. 751184 SCALE: see abov DWG. NO.- -----A-01--- TEST HOLE LOG NO. 2 TEST HOLE NO. 3 Scale: 1"=3' Scale: 1"=31 SILTY GRAVEL W/ SOME of 42- 13.5' of O ORGANICS GRAVEL (ML) 14.5' ORGANICS 0.51 SILTY GRAVEL W/ SOME SAND oN 0 .0(GIA) 0. 51 SANDY SILT (SM) A SANDY SILT wl TRACE , 9, . I v, - a ., scattered cobbles 2.01 GRAVEL (ML) SANDY SILT w/ SOME 2.51 SANDY SILT wl SOME GRAVEL (ML) GRAVEL (SM) A scattered cobbles 5.01 5.0' 51-6' boulder SILTY GRAVEL w/ SOMEo_o GRAVELLY SAND TRACE TO SAND (GM) SOME SILT (SP -SM) scattered cobbles A of 2 8. 5' SILTY SAND W/ TRACE GRAVEL (SM) A A 20' T.D. Groundwater was not encountered 17.0' SANDY SILT w/ SOME GRAVEL (ML) A 3 —20'T.D. Groundwater was not encountered. -1 DW N: F.B. TEST HOLE LOGS CKD! RM CONSULTANTS, INC. GRID: & -- .... ... ... ... —... PAUL SELLE14S DATE: PROJ.NO, 751184 SCALE:see above DWG,NO- A-02 ------12.0' SILTY GRAVEL W/ SOME SAND (GM) 42- 13.5' O SANDY SILT W/ TRACE GRAVEL (ML) 14.5' SILTY GRAVEL W/ SOME SAND oN 0 .0(GIA) A 2 , 9, . I v, - a ., scattered cobbles A 20' T.D. Groundwater was not encountered 17.0' SANDY SILT w/ SOME GRAVEL (ML) A 3 —20'T.D. Groundwater was not encountered. -1 DW N: F.B. TEST HOLE LOGS CKD! RM CONSULTANTS, INC. GRID: & -- .... ... ... ... —... PAUL SELLE14S DATE: PROJ.NO, 751184 SCALE:see above DWG,NO- A-02 LOCATION SKETCH Colonial Park Subd. Eagle River, AK Distances shown are approximate and have not been measured by surveying methods. NOT TO SCALE TEST HOLE NO. 4 Scale: 1"=3' Of ORGANICS I\— — — — — — — 0.51 1 SANDY SILT w/ SOME GRAVEL a 5.0' SILTY SA14D W/ SOM GRAVEL I X, (SM) scattered cobbles A 12'WD 20' TD Groundwater was not encountered. This log depicts subsurface soils observed within the test hole at the location shown. See Drawings B-01 and B-02 for explanation of symbols. DW N: VZZ F. B. LOCATION SKETCH AND CKD: R&M CONSULTANTS, INC. TEST HOLE LOG NO. 4 GRID: DATE: ENOINE.RS GEOL-100O PLANNERS SUR -I... PAUL SELLENS PROJ-NO 751184 SCALE: see above DWG.NO. A-03 TABLE 1 PERCOLATION TEST PAUL SELLENS TEST HOLE NO. 1 R&M No. 751184 Time Elapsed Time Inches Drop in Inches 12:15 0 8.75 12:16 1 9.75 1.0 12:17 2 10.75 1.0 12:18 3 12.25 1.5 12:19 4 13.25 1.0 12:20 5 14.0 .75 12:21 6 15.0 1.0 12:22 7 16.0 1.0 12:23 8 16.75 .75 12:24 9 17.75 1.0 12:25 10 18.50 .75 12:30 15 23.25 4.75 12:35 20 26.25 3.0 12:40 25 30.0 3.75 12:45 30 33.25 3.25 12:55 40 39.75 6.50 1:05 50 45.25 5.50 1:15 60 49.50 4.25 40.75 Inches Total Drop 1.47 Min/Inch TABLE 2 PERCOLATION TEST PAUL SELLENS TEST HOLE NO. 2 R&M No. 751184 Time Elapsed Time Inches Drop In Inches 12:00 0 9.5 12:01 1 11.0 1.5 12:02 2 11.5 0.5 12:03 3 14.0 2.5 12:04 4 15.25 1.25 12:05 5 16.25 1.0 12:06 6 17.5 1.25 12:07 7 18.5 1.0 12:08 8 19.5 1.0 12:09 9 20.5 1.0 12:10 10 21.5 1.0 12:15 15 26.5 5.0 12:20 20 30.0 3.5 12:25 25 33.0 3.0 12:30 30 36.0 3.0 12:40 40 41.0 5.0 12:50 50 45.5 4.5 1:00 60 49.25 3.75 39.75 Inches Total Drop 1.51 Min/Inch TABLE 3 PERCOLATION TEST PAUL SELLENS TEST HOLE NO. 3 Time Elapsed Time Inches Drop In Inches 1:15 0 7.75 1:16 1 9.75 2.0 1:17 2 11.25 1.5 1:18 3 12.5 1.25 1:19 4 14.0 1.5 1:20 5 15.0 1.0 1:21 6 16.25 1.25 1:22 7 17.5 1.25 1:23 8 18.5 1.0 1:24 9 19.25 0.75 1:25 10 20.0 0.75 1:30 15 23.0 3.0 1:35 20 25.25 2.25 1:40 25 27.5 2.25 1:45 30 29.75 2.25 1:55 40 33.5 3.75 2:05 50 37.0 3.50 2:15 60 39.25 2.25 31.50 Inches Total Drop 1.91 Min/Inch TABLE 4 PERCOLATION TEST PAUL SELLENS TEST HOLE NO. 4 Time Elapsed Time Inches Drop In Inches 10:36 0 6.75 10:37 1 7.25 0.5 10:38 2 8.0 0.75 10:39 3 8.5 0.5 10:40 4 9.0 0.5 10:41 5 9.25 0.25 10:42 6 9.75 0.5 10:43 7 10.0 0.25 10:44 8 10.5 0.5 10:45 9 10.75 0.25 10:46 10 11.0 0.25 10:51 15 12.5 1.5 10:56 20 13.5 1.0 11:01 25 14.25 0.75 11:06 30 15.0 0.75 11:16 40 16.25 1.25 11:26 50 17.25 1.0 11:36 60 18.25 1.0 11.5 Inches Total Drop 5.33 Min/Inch OE ANC'rIOP.AGE by ENNIRONIVEiNTAL r"iaiECTION DOC Co. dba � �� � � af�f �t�]�li"N WATER TIBILLS P.O. BOX 272, CHUGIAK, ALASKA 99567 © TELEPHONE 688-2759 RECEIVED OWNER OF LAND, !, ^�//YIDEPTH OF WELL secl ADDRESS n • I_ �`� � `�C! �S SETA C LEVEL OF WATER FT LEGAL DESCRIPTI DATE, - Started — PERMIT NUMBER KIND OF FORMATION: From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft.. From Ft. to Ft. Ft. to From Ft. to Ft. From Ft. to Ft. Ft. From Ft. to Ft. From From Ft. to Ft. Ft. to From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. MISCL. INFORMATION: Ended ___DRAW DOWN FT. GALS. PER HR KIND OF CASING From Ft. to Ft. Froin—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 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 Ft. From Ft. to Ft DRILLER'S NAME Gu_u L' �:i r o 'L C=° ) G_ a -TV n_o G=- c=5 Vc: L--] 3:3 F° s=ue fl:�; C. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 , L " STREET, ANCHORAGE, AK*. 99 501 264-4720 PERMIT NO. 790-7:25 ) APPLICANT N'. A NE Coil i S I PIEE=ii_in B X 197 EAGLE RIVER 6942140LOCATION i1 � i � La�� i --t (_ bAc l2L LEGAL Ct.�L�=�P� I HL F'K LOT SIZE 2'0000 E,QI_IARE F=EET MINIMUM DISTANC:E BETWEEN A WELL AN[.,- ANY 01%,I -SITE SEWAGE DISPOSAL ''7STENT IS 100 FEET FOR A PRIVATE WELL, OR 150 TO tC' 0 FEET FROM A PUBLIC: WELL DEPENDING UPON'! THE T'A'PE OF PUBLIC: WELL. 14ELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DA`T`A: � �F THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS ANBD CONSTRUCTION DIAGRAMS ARE AVAILABLE TCS INSURE SURE PROPER INSTALLATION. G=° C ER! G -O Z !1 o C=` GZ= � —d G c G= C: C u -u = G= 7! _- _-iL _ --R _=a �= D 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 I q'_= ► ALL THE SYSTEM IN ACCORDANCE WITH THE CODES. SIGNE9 APPLICANT —WAYNE C OUS I N•dEAU—�___—_______ ISSUED '� _— — — D A T E V — S�7,� J�CuDsh()b&�&� u�'� MUNICIPALITY OF ANCHORAGE }'L c �, u ? Y t " m DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services le e2 On -Site Services Section f P.O. Box 196650 Anchorage,'Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING q Parcel I.D. # S0 " 3o I —,)--7',; HAA # 1. GENERAL INFORMATION Complete legal description N% o6 Lot 4; Btock 3; Co.f?on.i,at Patk Subdivision Location (site address or directions) 19846 Second StAeet Eagte Rive. AK Property,owner Ga.i,E? and Andu Z wot Day phone 696-1900 Mailing address P.O. Box 670264 Chugiak, AK 99567 Lending agency Day phone Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone 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 attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 S. STATEMENT OF INSPECTION BY ENGINEER F As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal' system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone 9 7'7 17034 Eagle River Loop Road No. 204 Address Eaale River A6,1— caor-y-,_ Engineer's signature _ 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments 0 4110, 4 Date _ S-1,1-2_& ROBERT C. COWAN i k� `�O�'• CE - 8801 J A bedrooms, with the following stipulations: Date _�_' 12 L1 - 2 9 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 courtesyto purchasers of homes and their lending institutions in orderto 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 #21 .-tea r OF: W W yaw.. nr.� 7 � ROBERT C. COWAN i k� `�O�'• CE - 8801 J A bedrooms, with the following stipulations: Date _�_' 12 L1 - 2 9 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 courtesyto purchasers of homes and their lending institutions in orderto 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 #21 FEND Municipality of Anchorage MAY 2 4 19 DEPARTMENT OF HEALTH & HUMAN SERVICES i Environmental Services Division MUNICIPALITY OF AN 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907)E343-4744ALSI:RvI Health Authority Approval Checklist Legal Description: Parcel I.D.: 6,5 -bate/ a 7 A. WELL DATA Well type ?17 k V l'-j::fiv If A, B, or C, attach ADEC letter. ADEC water system number Log present Date completed f 1 ?=i 7 Total depth Sanitary seal (lr?/N) Date of test Static water level Well production Cased to 0 o FROM WELL LOG WATER SAMPLE RESULTS: !O Coliform 5 Nitrate U 1 Casing height (above ground) t "- Wires properly protected ON) AT INSPECTION D" 95 Date of sample: S- 5 1 Collected by: B. SEPTIC/HOLDING TANK DATA Other bacteria 0 �]• Date installed Tank size i "L�"Z Number of Compartments •7- Cleanouts (ON)� 1 Foundation cleanout O/N) J Depression (Y& n� High water alarm (Y/N) Dof Pumping '��e Pumper f`�Late C. ABSORPTION FIELD DATA Date installed �'7' IGI Soil rating (g.p.d./ft2 or ft2/bdrm) U. System type ��Ll/d /_ Lengthdo)40 Width �� Gravel thickness below pipe Total depth Effective absorption area 6-7d Monitoring Tube present Depression over field (Y,N) lv' Date of adequacy test 'A'/,t "j " Results (Pass/Fail) — For -I— bedrooms Fluid depth in absorption field before test (in.);Immediately after gal. water added (in.): — Fluid depth -(ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* If yes, give date D. LIFT STATION Date installed 5-,, Manhole/Access ON) High water alarm level at* Cycles tested E. SEPARATION DISTANCES 1A y' V, Size in gallons I��-b u "Pump on" level at* q Z " "Pump off" level at* 3 *Datum 15,>-, --b &-t SEPARATION DISTANCES FROM WELL ON LOT TO: � F Septic/holding tank on lot to r�> Absorption field on lot On adjacent lots On adjacent lots Public sewer main n► Public sewer manhole/cleanout Sewer /septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation a C� t Property line ag Absorption Water main/service line to N t- Surface water/drainage 1 b`'Wells on adjacent lots j bo l� SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line I k \ Building foundation Its \k-- Water main/service line Surface water 0 0 \ Driveway, parking/vehicle storage area Curtain drain '/'r Wells on adjacent lots Q e -- F. F. ENGINEER'S CERTIFICATION /certify that/ have determined thru field inspections and review of Municipal records thataffp adovT- -fi are , � .......... in conformance with MOA HAA guideline in effect on this date. Cq�� Signature iv 'f''� • i� ' g 1 Engineer's Name i� �3 i` ,z.� f�. �d L✓oar✓ �....k:.... �f'.. • `---�� �� ROBERT C. COWAN r•t� Date ` 1 c7 �� ��, : CE - 8801 ;u HAA Fee $ Date of Payment j /� 24 ! Receipt NumberSi`7 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number h8UNKCIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OFINSPECTION FOR HEALTH AUTHORITY APPROVAL OFON-SITE SEWER AND WATER FACILITY 2644720 Application Date 1. GENERALK0FQR110ATION (a) Legal Description (include lot, block, subdivision, section, township, range) m ^ ' Location (address or directions) 2nd steet, Eagle Rive- ^` ' . (b) Appiioant@amo —Telephone: Home Business _=~��/A= Applicant Address (o) Applicant is (check one): Lending Institution 0 ; Owner/builder El ; Buyerf-] ; Other 0 (explain); P0^ Box -71568 Eajp�le River Alaska 995 7 (U) Lending |nstituhunTa�phonoAddress 2550 Denali Street, Anchora_�7e. 9950� (e) Real Estate Company and Agent Telephone (f) KAai| the HAA to the following address: Piokno 2. TYPEOFIRBSIDENCE Single-Fami|yO K8u|h'Fami|y[] Other Number ofBedroom, o 3. WATER SUPPLY Individual Well MX Community E1 Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. zi SEWAGE DISPOSAL Onsite El Public El Cornmunity 11 Holding Tank Note: If community well system, must havewritten confirmation frorn the State Department of Environmental Conservation attesting 10the legality and status. Page 1 of 2 /ev25nva* ( . � 5` ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS FILE SEARCH, DATA A111DKNFOR&0ANON As certified by rny 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 ofbedrooms 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 inopaoUon, 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 cf this inspection. f4ema«fFirm EAGLE RIVER ENGINEERING Telephone EAGLE RIVER, AK 99577 Address Date694-5195 6, Approved lor B�rooms by --- Approved Disapproved Terms ofConditional Approval -Engineer's Seal LOUIS 11 ditionsU The MunciPa|ity of Anchorage Department of Hoath and Environmental Protection (DHEP) ianuaa Health Authority Approva! certificates based solely upon the re presentations given in paragraph 5above byanindependent professional engineer registered in the State ofAlaska. The DHEPdoes this uaacourtesy 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 anaiyze data I-efore a certificate is issued, The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed -7 Width of Field /� �✓ /4,-, T e of S stem Desi Yp Y g - Length of Field Depth of Field a i Gravel Bed Thickness Square Feet of Absorption Area G �a Standpipes Present (Y/N) y Depression over Field (Y/N) Date of Last Adequacy Test�- Results of Last Adequacy Test SSfis {�J`ar y ��/S��S' 3 Separation Distance from Absorption Field: To Water -Supply Well ,/��� To Property Line To Building Foundation Ajd "ll e /U To Existing or Abandoned System on Lot ; On Adjoining Lots -> To Water Main/Service Line /0 To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed ,f�✓ Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments To Cutbank (if present) /U T — Dimensions Manhole/Access (Y/N) — "Pump Off' Level at G✓cra-L� — Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have ecked, verified, or conformed to all MOAand HAA guidelines in effect on the date of this inspection. Signed �"�- Date Yll6&S- Company MOA No. -S) —Jd 5— Receipt No. b5l-kl�\V\ Date of Payment Amount: $ A Page 2 of 2 72-026 (11/84) ��,�,,a�Q000e000aoo©e �� •�j9 e Engineer's Seal o o °o o a a° oosfoaooa�.`,T ° Ca 1o°oao dG Louis A. Bu -era J'J O° CE -6736 0 �� pR APPLI' IT FILLS OUT UPPER ONLY Property OwnerhA ` � Phone Mailing Address — Zip Code Buyer Date Address Zip Code Lending Institution /"� L G ��rC� — /1744 J Phone Address��� Zip Code Realty Co. &,Agent.' C,Q Phone Address S f p I f -S 7— Zip Code —(j6�f'� Legal Description `( ( ) CONDITIONAL APPROVAL' Street Location Type of Residence i DATE Single Family BY: ❑ Multiple Family No-. of Bedrooms Soils Rating Date Sewer Installed ❑ Other ' Well Log Received Water Supply Well to Tank /6,-) Septic Tank Size ©DC7 �K Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer 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. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: ( APPROVED BEDROOMS 3 *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area t cx Well Log Received 6�� ( Well to Tank /6,-) Septic Tank Size ©DC7 72-023 (3182) 5. LEGAL DESCRIPTION DATE RECEIVED INSPECTION APPOINTMENTS t ' TIME Z.',316 Jii TIME TIME m LULO- 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS DATE DATE DATE INSPE TOR INSPECTOR INSPEC ICIPALl7y � ATTACH WELL LOG. A well log is required for all wells drilled EDEPr OF )F ANc/1 MUNICIPALITY OF ANCHORAGE V1VjkNTAL P``OrEQ'IoN, DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION D�L 825 L Street - Anchorage, Alaska 9950119791 \ L� INDIVIDUAL/ON-SITE** Z% ENVIRONMENTAL SANITATION DIVISION�� Telephone 264-4720 ❑ PUBLIC UTILITY 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. PROPERTY OWNER PHONE MAILING ADDR S -- r1, A' - PROPERTY RESIDENT (If different from above) PHONE 2. BUYER -� �✓M PHONE SCJ � [ 1 E/��lJ � —7 MAILING ADDRESS 3. LENDING INSTITUTION Gam; -JX� i psi PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION Z_ I3 STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS EP'SINGLE FAMILY ❑ One ❑ Four ❑ Other E_ -]MULTIPLE FAMILY ❑ ,,..,/Two ❑ Five L5 Three ❑ Six 7. WATER SUPPLY * I�'INDIVIDUAL* ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM L� INDIVIDUAL/ON-SITE** Z% 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 R 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 LLQ ❑Septic Tank or ❑ Holding Tank Size: 1000 If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL✓� 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS U,, -APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE l � BY 72-010 (Rev. 6/79)