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HomeMy WebLinkAboutSAMS LT BSams Lot B #051-153-45 Municipality of Anchorage 1� Development Services Department °c ^ _Building Safety Division -` On -Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page of www. ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SW080123 PID Number: 051-153-46 Namw CHARLES SHAWBACK Wastewater System: ❑ New © Upgrade Haan. PO BOX 670810 ABSORPTION FIELD Ph"688-0262 Number Dl Seaaant 3 B DaeD Twcn ❑ Slulbw TraKll D Bea O MaW W O Omar. LEGAL DESCRIPTION Sod Ramp TDIN Depfn frda«p^al Areae BbR la. BueawnCrl'. ().6 GPDTr' 15 FI. B SAMS Novi to p"Oonom aan OV" Oraae Gray« (10011D "Mit pp 7awnMp Rape9.7 season Fie ildow a coreorpeWpraaa FL 5.2 FI Gravel lergln: 1.1 Fl. 76 FI. Well: New ❑Upgrade CxarolwMn. Nunperawa D.IaK.bit~ b,e, 5 + FI. 2 10 MIN. rauan(l+mab.A B. C)' Tabl Dsfxn. aaea to FI TdB1aDi0fa�"a1i PAs MeferYll.Ft. F, 790.40 Fe ASTM 03034IF810 EPRIVATE la D,b SWC Wax LevelTING TWEED EXCAVATING Ff 7/16108 PWnp sm a. C'" Napra ADove &j GPM F,.Ft TANK SEPARATION DISTANCES a Septic ❑ Holding ❑ S.T.E.P. ❑Other. To Septic Absorption Lift From Tank Field Station Holding uoiiUPnvate Sewer Line Tank00 aaW«. PREMIER PLASTICS 10000 Gal Me 113' 134'7$'+ Met.w 14.1 a of Compalmerae HDPE 2 sWrao. wa« too•+ 100•+ LIFT STATION Lot LM 5'+ 10'+ F«agelCn 5•+ 10'+ 'PWnD On'brNa 'Pump DK Not veal«ebrm N. cWu^da^ NONE KNOWNX M PWrI°eve"° Eb°I imeDa. p,,,I mea or Rwn.rxa BENCH MARK LOralgrl aw DewpCn. TOP OF CONCRETE BY SHOP DOOR k.algrl. 100.0 FL S&S Engineering Inspections performed by: ISMI S. Birchwood . Rd Dates: 1" 7/16/06 Engineers Stamp ChuglOK, Alaska V9W f��yvyL 2 7/76/08 Development Services Department Approval�•T°' Conditional Approval Date: ° ......eea.r i IL ft Wx Reviewed and approvedrbLI'Date: fa^ eon, INa. I'49ftf r ++. t� V/ V/ W U PERMIT N0. SW0801 23 PACE 2 OF 4 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone (907) 343-7904 • www-ci.anchorage.ok.us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL SAMS LT 8 P.I.D. no. 051-153-45 PERMIT N0. SWO801 23 PAGE 3 OF 4 DEVELOPMENT SERVICEScDEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM 4700 BRAGAW STREET P.O. Box 196650 •Anchorage, Alosko 99519-6650 • Tetephone (907) 343-7904 • www.6onchoroge.ok.us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL SAMS LT B P.I.D. No. 051-153-45 PERMIT No. SWO8O123 PAGE 4 OF 4 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTP.O. Box 196650 *Anchorage, Alaska 99519-6650 • Telephone (907) 343-7904 • wwwd.anchorege.ak.us ION REPORT LEGAL SAMS LT 8 ORIGINAL GRADE FINAL GRADE N1T 1= 91.6' NIT2 = 91.6' FINAL GRADE TOP OF TANK 98.5 — 1 C01=105.5' CO2=106.5' C01=96.8' CO2=96.8' NITS = 91.8' NIT4 =91.8' NO {PATER FOUND 82.5' B.O.H. 2 �— 102.5 2" INSULATION 97.7 NEW 1000 X97.5 GALLON HDPE SEPTIC TANK PA.0. NO. 051-153-45 CO3=106.7' C04 =107.7' CO3=96.8' C04=96.8' MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SWO80123 Legal Description: SAMS LT B Design Engineer: 0003 S & S ENGINEERING Owner Name: CHARLES SHAWBACK Owner Address: PO BOX 670810 CHUGIAK , AK 99567 - Date Issued: Jul 11, 2008 Expiration Date: Jul 11, 2009 Parcel ID: 051-15345 Site Address: 019611 BIRCHWOOD LOOP RD Lot Size: 40082 SO. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of. 0 Disposal Field Z✓ Septic Tank E] Holding Tank F] Privy ❑ Private Well E] 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907)343-7904(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. _. 7 DAY WATER MONITORING IS MISSING. CONSTRUCTION MAY PROCEED AT YOUR'OWN RISK. PROVIDE NEW SOILS LOG WITH 7 DAY WATER MONITORING WITH THE INSPECTION REPORT. Received By: Date: �� 09 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www muni or /onsite U� (� f (907) 343-7904 R n SON -SITE SEWER/WELL PERMIT APPLICATION • FOR A SINGLE FAMILY DWELLING Parcel I.D. 651- Property owner(s)_ i JfR2! ES (>4Q)BRC,e / Day phone K&g address l96/l / iec/Itt Y�Jlj P Zip Code Attu« �c '�C7� �oSitrtaddre o C��3 14 688 -C2tC12 9g66�7 C gYfE Legal description (Sub'd., Block & Lot) 3ffin 5 3b, Lefr' 5 Legal description (Township, Range & Section) Lot Size 'I 08A Sq. Ft. THIS APPLICATION IS FOR (Z all that apply): Absorption Field Septic Tank rj Holding Tank El Privy M Private Well Water Storage Number of Bedrooms 3 THIS APPLICATION IS AN: Initial Upgrade Renewal El I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling app isin accordance with applicable Municipal Codes. (Signature of property owner or Permit/Rush Fees: L160 — 17!3 — Waiver Fees: Date of Payment: Date of Payment: Receipt Number: D 3598) Receipt Number. (Rev. 11105) S& ROBERT C. COV/Atj, p. L:. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAx(907)694.1211 July 9, 2008 TIEAUIII TMONTY ArF FOVALS MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 VANIATENSIOW, Anchorage, AK 99519 REFERENCE: Lot 20113; Section 8; T15N; RIW; S.M. WNER6WATER 1.SPECT:04 It is requested that you issue a permit to install a new septic system to serve the existing three bedroom dwelling on the referenced property. MOREPOITTS "'D"' A test holes was excavated and percolation test performed. The approximate locations of the test holes are located on the attached site plan. At the time of excavation (6/28/08) water was not found. After seven days of monitoring, no ground water was found. WCWNSPECT:av A FLOW TF -T 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. A diverter valve vdll be installed to allow the existing system to be used at a later date. The SITES construction of this system will not prevent any future development on any of the adjacent properties. TaonpDESIcn If you requi tional information, please contact us. Since y, Son TEST obe Shafer, P.E. PERCOLATION TEST Enclosure STRUCTURAL 6 MECMAMCAL 1..".VECTIONS ONS:TE WI„TEwATER DISPOSAL SY TEM DES'CN 15861 S. Birchwood 1.001) Road — Cimgiak, Alaska 99567 4 0 -- r4 --N ��aon "`ui�o Sia UOC3 FI�i1CSV �iU i O W 5...- � r co Q K C) 4 W �� n co F 7 ^�^ �J t1 —0/. O O E"1 oUOSu �Yza N � � Q W a w v � =m z WNLLQ >Q n1 �✓ LL H p W oar pa E— 0 Cl O thaO'n 1i c� v to n J � II O II QNO mJ0 C� M V)V W T Cx. W J 4 O W 5...- � S Q K y`�G� 4ctl� 4 W �� 3� co F 7 W t1 —0/. O O o0 oUOSu �Yza a� Quz 5_ z~ua /J F W a 4 =m z WNLLQ >Q n1 J 4 OU d I QOO)IMHOU I„ 11 N9IS30 NVId-311S W H E ^^O r::) O W 5...- � S Q K 3 J ITi,I USO z U F 7 W ti Nf�,10 o0 4 OU d I QOO)IMHOU I„ 11 N9IS30 NVId-311S W H E ^^O r::) Municipality of Anchorage Development Services Department Building Safely Dh islan On Site Water and Wastewater Program 47DO South Braga, SI. P.O. Box 196650 Anchorage, AK 995196650 www.munl.orgronslle (907)343.7904 yn1�Solis Log - Percolation Test L Performed For: / irkS mOB Dale Performed: Legal Description: I-oT b' 'Evn) g A Township, Range, Section: Depth WASGROUNDWATER ENCOLINTERED7 2- 3. 4- IF YES, AT VO4AT DEPTH? 5- D,pth to Watl•Anar 6- Monitoring? 7• .'.- .-S" SILT/ 6eliVEi r / 8. 9- -12-13- 10- it- 12- 13- 14- 14- 16 - 16-17• 17. 18- WA WASGROUNDWATER ENCOLINTERED7 8 IF YES, AT VO4AT DEPTH? L D,pth to Watl•Anar C P Monitoring? _ �v E r L1 A�7 Reading I Dale I Gross Time u 1. 3" a1 !9 PERCOLAATIONRATE '� �L9 C� .TEST1RldJ COMMENTS �/ 1ILL GP ANDD BETVuEEN PERFORMED BY: peiy„ PERFORMED IN ACCONCE WI t ALL STATE O MUNICII (m`wr•wM�l FT AND Nel Time I Depllr to Wale' I Net Drop In rr PERC HOLE DIAMETER FT --� ERTIFY THAT THIS TEST WAS EFFECT ON TIIIS DATE. DATE: T8 4 2 Municipality of Anchorage Development Services Department Building Safely Division • +.{ On -Site Water and Wastewater Program 4700 South Braga, St. P.O. Box 190850 Anchorage. AK 995190050 www.munl.org/onslle (907)343.7904 �I �1��./Soils Log �-1�Percolation Test Performed For: 041At r re, �iErrW Dale Legal Desai lion: B r 1 S Township. Range. Section - Depth - o26AIV ICS o- 12- 13- 7 -10-12-13 16- 17- 18- 20 - 9 16- 17-18-20- ,2 t % ,2tr Sof-? COMMENTS WAS GROUND WATER 1^ ENCOUNTERED? MID s IF VES. At wT IAt DEptltl L Depth to W.Iwr Ane. 0 Monitoring? P E Dole Reading Dale Gross Yhne Not Time Depth to Wale( NPI Drop 5EE Fc pre C_ 17 r -- TE ST RUN BETWEEN FT AN9 VtnU tIME UTAME TER FT PERFORMED BrS CERTIFY THAT THIS TEST WAS I PERFORMED IN ACCORDANCE WIT LL STATE AND MUNICIPAUI LI N EFFECT ON THIS DATE. DATE: '1 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 CRNEIN `S /� ,�y.n� ` A /1 I. I l.� a S I Ci %Z / p / q fez D ^�t�:>�! ❑ UPGRADE MAILING ADDRESS P�6)< Soot 0�7 EA�-GLt= Ot�lp_/z, ,�• S 77 LEGAL DESCRIPTION •C �-7— ( 1 2 o I B ; �i E= (_ : 9, ! 1 S � ... O'&T- LOCATION �pp j1 r� NO. OF BEDROOMS Well i 40 AbsorptionareaDwelling I / PERMIT N0. DISTANCE TO: / J fit Uy F- Z W< Manufacturer C FES Material _5TE�L. No, of compartments N in gallons Liq.rapa ity IF HOMEMADE: Inside length Width Liquid depth c f 0Z DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons=_ FQ- O DISTANCE TO: Well / StK Foundation / Nearest lot line PERMIT w= 11,51 w LL Z No. of lines Length of each line ` Total lengthDf lir}es �(� Trench width Distance b t nnlines X F Z w i - Ul j Q inches ¢ F Top of tile to finish grade / Material beneath tile -72— Total effecti a absorption area G inches Length Width Depth PERMIT NO. LU Q I- Type of crib Crib diameter Crib depth Total effective absorption area wa w y Well Building foundation Nearest lot line - DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J w � Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS ?47 C PLLt-kT I SOI L TEST RATI }}N''qqG 2-00 l-.4' F 1^f— s /E; r 12—, , INSTALLER F3 ti -L PLA l Fzit-__V_ + T 7o f REMARKS No VVELi, OW Tf+IS L T. �v ib WELL: 0" LOT :?--p 1 A I is ry �11 � E G P- F-!4-TF-f�- 115 L '� 5F -PTI C- �•a oe qn°1 t T '_410 ( i4L 0 soc oa�Paa�a>ogooc ' ocaa °a'a �� Earl P.Ellis cc;4 NO. 1745-E �a,`-�pR a°ea eaeQNP�� l"1^ 9 ,�,l APPROVED �,�t DATE LEGAL 72-013 tRRev.3/78) OWNER OF LAND Tirxtftrd ��t�lin� ung by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 272, CHUG IAK, ALASKA 99567 • TELEPHONE 688-2759 DEPTH OF WELL. ADDRESS " `' 6 r'; X% - STATIC LEVEL OF WATER FT.� LEGAL DESCRIPTION ! t ' "` ° DRAW VOWN_FT.._ - DATE - Started / I rt cr `- Ended GALS. PER HR f PERMIT NUMBER AJ r j 'i"' `T '= KIND OF CASING KIND OF FORMATION: From Ft. to Ft. From, Ft. tof Ft. 72 From Ft. to Ft. Ft. to From Ft. to `; Ft. Ft. From Ft. to `` ' t. Ft.-- From From From Ft. to Ft. Ft. From Ft. to Y ;.• Ft. From Ft. to Ft ,�4 i,. ,9 +" From -: ''r Ft. to I Ft tom? From__;"-)' Ft. to 7 _ZFl. < G- y £• FromFt. to I -1Ft. f Ft. to— From / `IJFt. From Ft. to Ft. From Ft. to Ft. From - Ft. to Ft. From - Ft. to Ft. From Ft. to Ft. From Ft. to_MUftPALITY OF ANMORAOE DEPT. OF HEALTH & From - Ft. to FNWONMENTAI P�N From Ft. to Ft. MAR 2 0 1985 From Ft. to Ft. From Ft. to FtR E C E 11/ E D From Ft. to Ft. From Ft. to Ft From Ft. to : 4a Ft. ' F' �` From Ft. to Ft. From Y` Ft. to Ft -'• � f � � `�'= �' S � c � r ` `` d4 From Ft. to Ft. From Ft. to - Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft MISCL. INFORMATION: From - Ft. to Ft DRILLER'S NAME � M ����I�������� �0 � �� ~' ���� /l ���ly0� -- � DEPARTMENT � HEALTH AND ENVIRONMENTAL - //� r'TION ' ���. r ' 825 /L' STREET HNCHORHGE HK 9950� 0 ) / / � ��/�YY��V_�/� r~ 264-4720 PERMIT NO. ( 800542 ) ` APPLICANT SAM NESTOR PO BOX 837 EAGLE RIVER 688^~2659 LOCATION BIRCHWO8D LOOP LEGAL LOT 201 B SEC 8 T15NR1W LOT SIZE 41258 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS I SOIL RATING (SQ FT/BR)� 200 THE REQUIRED SIZE OF THE SOIL ABSORPTION�-��TEM IS: �� � C -A EE 1-1 L_ F= r-4 r -A -F��= ������ �������� �-� _ � THE LENGTH DIMENSION IS THE LENGTH (IW 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 8F 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). �E 09 U I F -u E: C -s "-=. VE F:" -IF I C:. _r F=l " K �I ZE F=- -1 ���1-D- �3 " I 1 0 " 1_=5 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE �L.-I ID <:2 > I r-4 "_=� F=- F= I-- -r l C-9 r-4 SEE- �Fw:lm FE �EEG! �1 F;;' F= C -A BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN `` H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE 15 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F:�* a F2 M I -F ���I F_ E=!SF. ��P::- a M E� I -E Fill =-* -1 ���C-1 I CERTIFY THAT 1: I HM 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 THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED: -------.~__--_---_-_~_---_~~--_-_~------__ HPPLICH SAM NESTOR ISSUE[) BY.- ���»�-_ _�[)HTE���+����.�`�.����/ V4.0 - �r���^~�~~~���~~��� � ��- �y' r� {}} <�'�:a 9 {Y_t F ;;){� }4$r¢�J�j���y.'�y'fz sty iE: - HEFO—TH A , GYiZ ��;�t�$'j'S,;fMzg— f d IOTFECTX6N PERM t T Vif3. C X300, 4:2 ? T= f T3T� nesp PO 80X 837 ERiL9 sRVOE r i-sem`€ 9 10.r 299 3 I3EC 8 f t" Rim LOT S I . -no =stat rtw. i=esr 'T'r'a8- 13851-W. TfoN s-4.5 T Is- TRFMH `.PR41MP-PJJJl '�aR. 13F 81,E€3RCU3143 _ OIL RKING 040 Tim f i a;KF- OF €` 'SeML f 5i3RR T i CI SYS r"-,[ 5 _ .r ;.F€�3 S :ii�`'��"+"3rou 3 - �CiE {,. '4Sr <rm trcci �` t - i dl� if tJ}s. �f i <.,. T< CCPrH 13F fT TR 4r-H OR Psr 15 TWE DL3TS? sta-TwEENi Thr Sljwl�Pup Time TIME i RVP-t-. OF�TH V `� THE MItN €"M 0� O 13 ffRnwo �M'&F N THE t3E€T #-�.i_ >p tl E : *34l :3 I lig'_ =5 4 r €a ' ` fi' f"t -2,r r M I T FPM t Mf -MRS Pf �� �r f3P I � tfa i i 4' TO it-iFosm Tib t s -Pi=fR T,%w-m i m uxx THE i` T f i tt Lii` . €'1`:f {;sF i `r' i 1_L At ,4:93E`�T TO MIS fiRCOI�.r�'r? AND €tom M-M --R OF r i € THAT Tt 140,1 WILL SSER - O'ER TMEN T WELL 919-jec T TY) pposE u i $ ire{; O --S E r;E DIS}` 0 a 1 t4 Is 100 FECr Ft)P% R PRIVOM WELL OR V119 TO ZOO F0:-:T FR011 R PUBLIC PlF.U. CEMIDUri t. f3 T r� t3F jzi3ieL Ce, + jet 4 . mr-iIi'um of;rFvt>�: F-Rom A PRiVOTE WELL. ft) R VVRT$� SWR T tW to; as FEET SW r'i s3 Y -so-ER t Eric i s 7n F F-r. t THF- i�.'a-mrV ENT-5 tl` DIRFI'-}=!t`; ffE AvR fLael -c TO MS111W FIR13PER IDERrIFY Tmr I' _ I 11H >FRI EL M wi m TWRFs: t l tt T FOR -zuvrc�AN& WLLS AS XT ` C-tRT SY T 2 € 14I1,-1._ U4u3TSL Ti'3:c IN PCC-)R0M-A Mi'i4' TW- f fl '3. T=EAT T8E ON—RITE SS4F-JZ Ve.5TEH MIT? RF�UIPE IF THE I4 t R`-cMCIDE .Cr, TO Un- FIBRE` TTM 3 : 'OMS. " i s JI $ we j. ay A 9 rI� ��y $.fie `'fi� F gra �ii � s•. ��`{a �����—�jEiey -y.��� ��. $ I I I r O & E EN&NEERING & DEVELOP HENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 A SOIL LOG 688-2280 Performed for: Name: �,4� %�� 7rC� /� Tel. No.� Mailing Address: ' e2 600- � 3 7 2 A/,t/f-4E � �jr�' 19 77 Legal Description: ZG-7' 'Z61,6, 1 7-16/,/ /0/ K/ Depth (feet) Soil Characteristics 0 2 3 4 5 . V^ 6 7 � 9 10 11 12 13 14 15 16 Ground Water Encountered: Yes No !�' If yes, what depth Proposed Installation: Seepage Pit- Drain Field Comments: � r F'J Q ti b OmP.'�.' b mOS9 eLG^%�A3B�j•oy 100 PLOT PLAN PERC.TEST /7 7 "Zee? s Or AC4�j � �.• .CbemaOemoa ap maaa4��, 6:'tr��ar k� 0e ti OmP.'�.' b mOS9 eLG^%�A3B�j•oy 100 Performed by: Russell Oyster 694-2774 Performed for: O & E ENGINEERING & DEVELOr-MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG !:s.—' Z�Pde Earl Ellis 688-2280 Tel. No. &!ty ;K? Mailing Address: cox 19`3 ,A�[ i-'' �a�r,7-� -/-J ":Sz 5 'T /-:'-77 Legal Description: �� fin ` -S 4 s L=am �S� �t ( LI(i � M -- I Depth (feet) 0 Soil Characteristics 2 ©&,..4 N tc_�S, 3 4 <12� 6 8 9 10 PLOT PLAN 111 orn�n'J �� 12 PERC.TEST 13 14 1516 /4 L], lel �1 �':. . �l\•'J _ f:921. Ground Water Encountered: Yes No - If yes, what depth Proposed Installation: Seepage Pit— Drain Field /�/1 Comments: 6)P'i&,,-JAL_ ` ©le— Z-6& 'o--4641 ,� aci,, /97 GeJ 1� �,C'GtpC /!J Performed by: Date: J"04 0f MUNICIPALITY OF ANCHORAGE �fi • R Department of Health & Human Services M� j DIVISION OF ENVIRONMENTAL SERVICES 1 9 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D.# Y - I� i-�1� HAA# l���°(L)� 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) (OLD) LOT 20]B Sec 8• T15N• R1Ul• SM� NE(u• Loi 8; Sam'Q Subd�.v.il�.on Location (address or directions) (b) Property owner A&t Mong#.au. Telephone: (home) Business Mailing Address P U Box 770917 Eag.2e Rive&, A "ka 99577 (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the following address: (or check here.X if hold for pick up.) List contact person and day phone number below: 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family Number of bedrooms 3 3. WATER SUPPLY Individual Well INK Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site KX Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone S & S E14GIN6ER Address 034 Eagle River Loop Road No. 204 Eagle River, A as a 7704 f. e, A0 IR Date 6. DHHS APPROVAL Approved for -3 bedrooms by — Date 4 .Approved _ X�..— Disapproved Conditional Terms of Conditional Approval �AlJTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible forerrors oromissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) •=rPF,�r) r �Isalth`Aut}orii Approval (HAA) `�EBRUARY1984 343-4744 Legal Description: ,Loo LA.)I Scn 1 A. WELL DATA Well Classification rola le- I—Aymllw If A, B, C Well Log Present (Y/N) Date Completed /,;"? I i Total Depth_1 !91 Cased to / S_& Depth of Grouting Static Water Level 73 Pump Set At U K Casing Height Above Ground 7k Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) A% D.E.C. Approved (Y/N) Yield cf $gyp t SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot .1001 f, ; On Adjoining Lots loo 4 To Nearest Edge of Absorption Field on Lot loc /t ; On Adjoining Lots X00'- f To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole ii To Nearest Sewer Service Line on Lot 0?:s t Water Sample Collected by 54 SnfGrficatN)j ; Date }P g Water Sample Test Results _5 Atr Gf 11C.I ar — AACfer(YN Comments B. SEPTIC/HOLDIN TANK DATA Date Installed Size 00 No. of Compartments � Standpipes (Y/N) Air -tight Caps (Y/N) - V Foundation Cleanout (Y/N) Depression over Tank (Y/N) Il) Date Last Pumped Pumping/Maintenance Contact on File (Y/N) iJ �A ; for Holding Tank High -Water Alarm (Y/N) tti "Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROMSEPTIC/HOLDING TANK: 7 � To Water -Supply Well 1/00 To Building Foundation fig To Property Line f CO t To Disposal Field I 0 r To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course ly©tom Comments (G10604N dArq Jaw► eP 72-026 (Rev. 7/88) Froni Page.1 of 2- C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata OO Type of System Design i R etc Date Installed 0� Length of Field Width of Field Depth of Field Gravel Bed Thickness a" Square Feet of Absortion Area QQ Statndpipes Present (Y/N) Depression over Field (Y/N) A) Date of Last Adequacy Test Results of Last Adequacy Test tlsfAC-t6dedroopm SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 0(9 �t To Property Line To Building Foundation 34 To Existing or Abandoned System on Lot A-)aNN ; On Adjoining Lots 3o � -f To Water Main/Service Line b t To Cutback (if present) /yONe- To Stream, Pond, Lake, or Major Drainage Course oo t To Driveway, Parking Area, or Vehicle Storage Area _SU r t Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) '*Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Company Date a % MOA No. Receipt No. Date of Payment J " Amount: $ Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/8B) Back Page 2 of 2 .i' _. O�.HOF DfNOfHJ. _ m'0 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 9� E 5633 8 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 A FEDERAL TAX ID # 92-0040440 J° LABORATORIES �kD'. �.�.Jh?? A ANALYSIS REPORT. BY SAMPLE fox Work Order 9 16386 Date Report Printed: SEP 6 89 @ 10:08 Client 3&zple ID:L201 "B" SAMS S/D SEC 8 T15N PAW Client Nana S & S ENGR PWSID :UA Client Acct MENU Collected SEP 4 39 @ hrs. P.O.# NONE RECEIVED Received SEP 5 39 @ 09:00 hrs. Recd E Preserved with :AS REQUIRED Ordered By Analysis Completed :SEP 5 89 Send Reports to: Lahoratozy Super.vieoi :STEPHE14 C. EDE I)S & S ENGR t� Released By c'- 2' vu.:wvaaxana¢..vxat.u�awzccuvvv.asavaocvaao..awvvvva[.'rt,asuvcaawwnnavvamnusiiia.¢.....vnv:nmv.puvvvvmianavmaa's anew. Wwvcaanx Special Inatrurt: Chonlob Ref 6: 7329 Lab Srnpl ID: 1 Matrix: WATER Allowable Parametor Tested Result/units Method Limits - - -- - - - - - - - -- - - - ------------------------------ NITRATE -11 11D(0. 0) m4 /l EPA 353.2 10 Sauplo ROUTINE SAMPLE Renf�rks: SAWLE COLLECTED BY RDJ. =.-- mI T-estcPerformedSee Special ww'wwwwaw waa =' 'caInstructions Above UA -Unavailable NDm None Detected See Sample Ramrks Above NA- Not Analyzed LT -Less Than, GT -Greater Than $°' MUNICIPALITY OF ANCHORAGE r DIVISION OF ENVIRON:SENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION IFICATE APPLICATION FOR HEALTH AUTHORITY APPROVAL CERT 14 Og�4ital Information (a) Legal Description (include lot, block, 7-o / j6 S k ZZA-) Location (address or directions) (b) Applicants Name IW -r Applicants Address Application Date vision, section, township, ra e) ,6 r r /A / &6 t�-3226 rifts Telephone — Home (c) Applicant s (check one) Lending Institution ; Otamer/builder ; Buyer; Other / (explain); (d) Lending Institution //J/�S�l/G��f e Telephone Address �- (e) Real Estate Co. & Agent Address Te Vone (f) {the HAA to the following address: Z. Type of Residence Single—Family Multi—Family Other (describe) Number of Bedrooms 3> Water Supyly Individual Well Community Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public Community F_�:j Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 21 r-. 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Informatio„ As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation of this Health Authority Approval shows that the on - sit. -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 Say investigation and inspection, the on --site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Address ray Date'>-'Z�c7 —� 6. DHEP Approval Approved for bedrooms By Approved Disapproved Terms of Conditional Approval CAUTION Condit Telephone toG' THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. EMPLOYEES 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 IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 muryicarALITY OF ANCHO" DEPT. OF HEALTH & - ENVIRONMENTAL PROTECTION . MAR 2 01985 RECEIVED Legal Description: �CSti 2< mac./ Well Classification / If A, B, cr Cr D.E.C. Approved(Y/N) eet�� t Well Log Presen (Y)jl) Date Completed Yield�t S Total Depth /` Cased to /S� Depth of Grouting Static Water Level 6 Pump Set At K L-145 Casing Height Above Ground 30 " Sanitary Seal on Casing () Electrical Wiring in Conduit (Y ) Depression Around Wellhead (Y Separation Distances from Well: To Septic%HeidIN Tank on Lot /VO On Adjoining Lots To Nearest Edge of Absorption Field onjLot vQ ; On Adjoining Lots /GLD To Nearest Public Sewer Line � ! � To Nearest Public Sewer hCleanout/Manhole / - ! To Nearest Sewer Service Line on Lot �� f Water Sample Collected By ���/U1 `!�; late -5- ,oO77� Water Sample Test Results Conerents Z=�R pk B. SEPTIC/HOLDING TANK DATA Date Installed &6D Size /z96 Standpipes (Y Air -tight Caps Depression over Tank (YIN)) Date Last Pumping/Maintenance Contract on File (Y/4$ Holding Tank High -Water Alarm aL) Jr -e- No. of Compartments _ Foundation Cleanout) umped 1104— ; for Temporary Holding Tank Permit (YM)P' Separation Distances from SSeptic/Vk! � Tank: To Water -Supply Well AV To Building Foundation To Property Lire l0 _4 To Disposal Field `@ To Water Mair/Service Line `0 To Stream, Pond, Lake, er Major Drainage Course^_. r 0 1�'f _ a I- —z - Comments .e a il0 u Receipt # Date Paid: Amount: 146 1-eI-e-, (Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design %C Date Installed / Length of Field Width of Field LD Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes Presen (Y Q) Depression over Field (Y ) to of Last Adequacy Test Results of Last Adequacy Test 7 Separation Distance from Absorption Field: To Water -Supply Well /Dy To Property Line �y To Building Foundation To Existing or Abandoned System on Lot `✓ ® tiif ; On Adjoining Lots 30 A- To Water Main/Service Line /0 f To Cutbank(if present) -,D ^Jc To Stream/Pond/Lake/cr Major Drainage Course 11-ro r lPT To Driveway, Parking Area, or Vehicle` Storage Area Comwnts�ll `�: S /G �s�>�7�� �l�J` �✓2(/ r _ D. LIFT STATION Date Installed Size in Gallons Dimensions Manhole/Access (YM) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Tested for Pumping c Electrical Codes(Y/N) Comments Test. Meets MOA ** Check Permitted Bedroom Rating Again -at HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed 0 nege gulwa Date 3-ZA -9J CompanyDIVER. ALASKA 04O5Fx MOA No. COO 3 a 1Jq7r.4I# QF KB1/d5/s 4�c 13 l4 (Page 2 of 21 �..�......,"v arsF,�„ :t. si�.r�i Y� Wo. 1057.[ �Jr she a9� MMUM-011!