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HomeMy WebLinkAboutSAMPSON ESTATES BLK 4 LT 25Sampson Estates. Block 4 Lot 25 #051-822-15 Municipality of Anchorage Page I of a 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 Permit Number: S W9SON-7 PID Number: Name: Wastewater System: ElNew Upgrade KELL.y HEPLE2 Address: 01jue,1AK, AK _ 70713..-,ox 6_709�7 9a5c,-7 ABSORPTION FIELD Phone: No. of Bedrooms: 2 7 wtbE ❑ Deep Trench Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: 0 Total Depth original grade: GPD/Sq. . Ft, Lot:Block: Subdivision: 9 Depth to pipe bottom from original grade: Gravel depth beneath pipe ' a � SAwtt so" C,;5-r. A' FL 3.5 Ft. Township: Range: Section: Fill added above original grade: Gravel length: 5 t -- '— 0-0.5-1 Ft. Ft. WELL: New ❑ Upgrade Gravel width: r Number if lines: Distance 6e b=lween lin extsrtr�y❑ Ft Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: AS,t'v­\ _�>fLI /ATS Ft. Ft. I 5-03 SO. Ft. FSlo/'>3v3-1 Driller: Date Drilled: atic Water Level: Installer: Date installed: Ft. Wf4j TT45f?-<, Yield: mp Set at: Casing Height Above Ground: f TANK GPM Ft. Ft. SEPARATION DISTANCES 5Septic EX+STIWG0 Holding . .E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: acity in gallons: From Tank Field Station Tank Sewer Lines Well- f r Material: Number of Compartments: 10,5- i 5G — as 4- SurfaceLIFT loo — — STATION Water iw'+ �- Lot�? , 39) _ _ Size in gallons: Manufacturer: Line 1 "Pump on" level at: "Pump o vel at: High water alarm at: Foundation 1-0 r 'N Curtain C7 N lL hl c.JN Pump Make el Electrical Inspections performed by: Drain BENCH MARK Remarks: Location and Description: Tv'P or- �e0. Assumed Elevation: I 0c).00 Ft EN 4ffib AL •'� OF q f S & S ENGINEERING'S Inspections performed 034 Eagle RlVer Loop Road. N0.20�ates: 1st g- P; Eagle River, Alaska 99577 2nd o 'l3 -957 ry �p,� ROBERT C. Cf! FrQ 1C�a CE-8801:, ���'• 3 T ' Department of Healt Hu ervices appr al -� Reviewed and approved by: �- Date: 72-013 (Rev. 9/91) MOA 25 Permit No. SW950197 Page 2 of Municipality of Anchorage 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 Legal Description LOT 25, BLOCK 4, SAMPSON ESTATES PID No.: STI ST2 98.0' FINAL GRADE MT1 CO3 93.2' F NAL GRADE INSULAT ON EXISTING 94.5' 1250 GAL 4.3' S 90.8' SEPTIC TANK 87. ♦ 61.0' NO WATER F UND 7-24-95 A B FCO 5' 19' ST1 8' 20' ST2 14' 23' C01 15' 24' FD 17' 25' NEW TRENCH fl CO2 20' 27' MTI C05 CO3 43' 55' i / Tu C04 51' 63' N C05 77' 67' — 004 - 1 CO3 CO2 EXISTING S STEM EXISTING 1000 GAL ST7 BE USED IN THE TUREL z �••,,........S`rgt`7 SEPTI INTEGRITY VERT TANK IED 8-12-95 Eco B Q-) 1.� 0 ` .M• N• N .44Ai..Uy( - • .... .. .. x n. a ^eaxr..i R ERT C. COWAN �C < `/ E - 8801 SCALE 1" = 01 "13� LOT 2 �1\T 72-013 A (Rev. 9/91) MO5 \ PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950197 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:HEPLER KELLY R & CAROL R OWNER ADDRESS:23731 GOLIATH DR CHUGIAK, ALASKA 99567 PARCEL ID:05182215 LEGAL DESCRIPTION: SAMPSON ESTATES BLK 4 LT 25 LOT SIZE: 41784 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: t Pm DATE ISSUED: 8/08/95 EXPIRATION DATE: 8/08/96 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PF RECEIVED P ISSUED BY: DATE: DATE: 7,1 S& HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN July 24, 1995 MUNICIPALITY OF ANCHORAGE Depattment o4 HeaP.th and Human Services P.O. Box 196650 Anchoa.age, AK 99519 REFERENCE: Lot 25; Bloch 4; Sampson E6tatu ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Request you i66ue a permit to upgrade the 6epti.e 6y6tem 6eAving the three bedroom hou6e on the reimeneed property. A teat hole was excavated and a pencolati.on test pen4onmed in the area o4 the pnopoaed upgrade. The approximate location o4 the test hole is located on the attached site plan. At the time o4 excavation no waters was encountered and a4ten. seven day ground water monitoring, the monitoring tube was 4ound to be dry. Attached .is the proposed upgrade design. We do not anticipate any adverse e46ects on neighboring we Z6, septic 6ystems or drainage patterns by the instattatl.on o4 the proposed septic system. There ane no points o4 contamination within the existing well radius which can be seen on the attached site plan. 14 you require additi.onat in4ormation, please contact us. Sincerely, Robert C. Cowan, P.E. RCC19k Enclosure 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 m C rrl rrl r. m ® o � D n n N S rCD f Q M O .Z 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 • z +t l o00 o�� LLs a Ug � N.Vf� DFS>—�—� pa Q Qt• a �UD ` �� y w U D 00 w ` W= z Ld U —0 of 0Y 1 �` OmFyO U Oa=i \\ \ T V) Z \\ \ O ZO OZ \ \ LLIz O N rb�Q Q O \ � = QU) 4z C) p \\ \ O O(n UWF W \ UQ ZLLJ W>-=n0 � QC)D� cl,< 0LLJ z 2 <M Za)L, Z J 0Lii QOO w J Q W>- and �1. N FN-- o a Fr- � O (.Dow \ 11J �ILL, —W�mZ� U1¢m w¢ww IJ F- W (n i�N \ o i-� Ln \ r (n z� °- X 3 O w N N \ w O QUO OWo \ O eco \ Q W S� ��Z LL] < k%'t gra- 3 of Q \ W V) (n J4�ofW O QmoX J \ IJ WZ- �~ O �Z�1 O e � U = m WLR W U Z © a�(n > a W v - ®U ® �� \0 0LLJ �NILSIX3 n CY LLJ� o 1 Y U'' U LL: U Q 0 1 p LII CD U 00 o OZ W UpNpp p a%k m 0Q m � d M H J �/ 0 OF-0 \ U Lo U a UZ \ Ln00 LO N I l 0 l l Z � L'i J Ileo® X p = �" � o C) W J o m=oo �'7 co 0 (D < V)-t� M\ l/� N EO� J D .� \� j U) wC�Z sC LL� (� O�W V) CU; .� W W Z coI�u LL, OO F J G , (x W w �LnMtncD Oa 1 W� ado 3ld'JS 3avaoc 1 NV-ld 31lS ,QS = „L Municipality of Anchorage T DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 KELLY LOG — PERCOLATION TEST PERFORMED FOR: KELLY 1'IFPL,&z DATE PERK LEGAL DESCRIPTION: JPrMQSons X57 L_,��,,gyroWnship, Range, Section: SLOPE SITE PLAN tic. 1 I 6RCz�/viL C�(2GP1v--tc '�1c7. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS 9V( - Sr TY S041-10w7�1G11.-7 Z-0.14, WAS GROUND WATER J� 1� ENCOUNTERED? Y " S IF YES, AT WHAT L O DEPTH? P E Depth to Water Atter 7-a Monitoring? DAY Date: Reading Date Gross Time Net Time Depth to Water Net Drop :q UMN 3516 IYs :Q lvt, �/V6 n 'd1 (U s'lu`r 361 �04— * rr vMw 3 1V, 1,116" G/�J GN PERCOLATION RATE !� rS (minutes/inch) PERC HOLE DIAMETER v TEST RUN BETWEEN q FT AND FT PERFORMED BY: _ "s'- I`' -Wag I QQP R4 CERTIFY THAT IS TEST WAS PERFORMED IN ACCORDANCE WITH AEL1S�At-'EtA48%ihICIIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7 / Z5 G 72-008 (Rev. 4/85) HEALTHAUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER& WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELLINSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN s&S� lineeninG ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CIVIL ENGINEERS 79 CONSTRUCTION PRACTICES FAX(994-29AX07)694- 1211 and MATERIAL SPECIFICATIONS REFERENCE: Lot 25, Block 4, Sampson Estates July 24, 1995 GENERAL: 1. The scope of this project includes the installation of a five foot wide drainfield to serve the existing three bedroom residence on the referenced property. The existing septic tank is to be excavated to verify integrity. If of poor integrity, the tank is to be pumped, crushed and abandoned and a new 1000 gallon septic tank installed. The existing leachfield is to be abandoned such that it may be used in the future. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 25, Block 4, Sampson Estates July 24, 1995 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (roughed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 25, Block 4, July 24, 1995 Sampson Estates 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Tvpe of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 25, Block 4, Sampson Estates July 24, 1995 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 25, Block 4, Sampson Estates July 24, 1995 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER 70 M G ID- Q/4Q1 / / i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION oo* 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE XNEW 5*fie_ J 69b-08311 ❑ UPGRADE MAILINGADDRESS P. 0, a�,x 670�.`/o Gtiu ,ak /�lC 99sG7 LEGAL DESCRIPTION Sam sbtb 3/0c'p- /,v {- 26 T lSN fZ / V/ . LOCATION NO. OF BEDROOMS Well /00 Absorption area 1 Dwelling /D PERMIT NO. 940700 DISTANCE TO: /Q Uy Q Material / No. of compartments Z Manufacturer wed' LU rn ~ Liq. capacity in gallons I IF HOMEMADE: � Inside length m Width Liquid depth ,s /000 Well Dwelling — PERMIT NO. or 1' DSCE TO: ITAN Material Liquid capacity in gallons O z Q uacturer Manf 2 p Well i Foundation `L© Nearest lot line s Zo PERMIT NO. 64C -7 = DISTANCE TO: / zU w Lu u v JZw No. of lines Length of each line Total length of lines F+errch width Distance between lines it I rfG� �— yl' itae#es ~ ¢ F Top of the to finish grade �� Material beneath tile inches in Total effective absor tion area X382 o Length Width - - Depth .! PERMIT NO. w i F Type of crib Crib diameter r Crib depth „-_ Total effective absorption P area wa LU Well -- Building foundation Nearest lot line N DISTANCE TO: Class vat Depth Driller Distance to lot line PERMIT NO. J �t-� Lu Building foundation Sewer lineSeptic N//3 tank , /bD Absorption area(s) ?10 DISTANCE TO: OTHER PIPE MATERIALS C ASTM 3c3 SOIL TEST RATING INSTALLER �SKcz��s C_or�sfrucfi'nn REMARKS p"- 0 i Ub✓i O tt�(�1 dZ _ H u e r f i , C k ITA e� fa 6�P el ' T� -- APPROV D DATE LEGALdK / �2m PSon .Suc� ��JG% 7 c.o'� ZS r1, O ZO S 70 M G ID- Q/4Q1 / / CF) 00 00 Q 0: iz'� 44 4J 44 EG C' (Ii 4-J:• : 0F. 0 0 0 0 0 0 0 0 0:;F.E. OR O 0: I-.., ci as N:w w w w w L6 U. w w w w V. tit 0 0 0 0 0 0 0 0 O 0 z IX w -1 a) 44 i u rq (9 ai Li rq Q! (4 rc! rd rd rd Cl as cci 0 0 0 f)4 E. . . . . . Iri kv d of CQ z a in w O 0 0 0 0 0 0 0 0 0 0 0 rA w I I I o r4 x C4 x n cG x C4 C4 LQ ww4. Z r� (D D4 E N .r -f 4J ro ro 0 0 >4 ro ro 4-) 0 z o < < ®gyp aX UJ > MM LIJ X 0 mg0 AM wco �: W IL 0 0 CF) 00 00 Q 0: iz'� 44 4J 44 EG C' (Ii 4-J:• : 0F. 0 0 0 0 0 0 0 0 0:;F.E. OR O 0: I-.., ci as N:w w w w w L6 U. w w w w V. tit 0 0 0 0 0 0 0 0 O 0 z IX w -1 a) 44 i u rq (9 ai Li rq Q! (4 rc! rd rd rd Cl as cci 0 0 0 f)4 E. . . . . . Iri kv d of CQ z a in w O 0 0 0 0 0 0 0 0 0 0 0 rA w I I I o r4 x C4 x n cG x C4 C4 LQ ww4. Z r� (D D4 E N .r -f 4J ro ro 0 0 >4 ro ro 4-) 0 z ` . . ����1�1�nfl ��� �� �� �����IEz- r � DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET., ANCHORAGE, AK 99501 264-4720 �t4 FE F;' F` I=-- F-7� M :1 -r- PERMIT NQ: 840708 ^ DATE ISSUED: 08/20/84 APPLICANT: SKAGGS CONSTRUCTION ADDRESS: PC). BOX 670690 ~ CHUGIAK, AK 99567 �] CONTACT PHONE: 688~2831 LEGAL DESCRIP: SUBDIVISION: SAMPSON,^ LOT: 25 BLOCK: 4 SECTION: 3 TOWNSHIP- 15N RANGE: 1W LOT SIZE: 41784 (SQ"FT. OR ACRES) MAX BEDROOMS: Listed below arethe options available ' .on that b a n designing your sept�c system` Choose the option eszits ite. s� DEPTH TO PIPE BOTTOM (FT.)����" GRAVEL DEPTH (FT.) TOTAL DEPTH (FT.)-~ - e � GRAVEL WIDTH (FT.` ---- GRAVEL LENGTH (FT ~ _»--*�� �~ '^ �- �_�~,~v TANK SIZE (GALS/ SOIL RATING (SQ.FT. /BR) �c2/ v tv � ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1. I am familiar with the requirements lot- on-s,,ite sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State o{ a Al sk 2. I will install. the system, in accordance with ales an 'l MOA d ` a^ and in co�pliance with the design criteria of* 'this permit" regulations, 3. I will adhere to all MOA and State of Alaskarequirements ' �o. the set ba k distancesl from any existing well, wastewater disposas temor public bac le. system on this or any adjacent or, nearby lot.'~ 4" I understand that this permit is valid for.a maximum ~f 3 bedroons and ` .any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CQDES THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; ( 2) AG CODES, WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3)�/nuuE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED ISSUED BY U n C� SOILS LOG — MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG—A,PERCOLATION TEST PERFORMED FOR: �[ LY+ L %S)Vd&a5 &1 fiRCa&DATE PERFORMED:vv _7�I// LEGAL DESCRIPTION: Zot 26'✓"kxg�ArSw 5a&6t stave SLOPE SITE PLAN OL 1 111.. Of< 2 ° p sir 3 0 t G o D 4 5 6 7 a 9 10 11 12 13 14 F C^ �a Wf t _a cco®a m¢�¢e1. 1 4 - Ply c JA fri 17� a 1 3» i P°oa Ci: 5283 20 COMMENTS a yawl WAS GROUND WATERS No ENCOUNTERED? L O P E IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depih to Water Net Drop fi l �© 0.42- .42--f#z'0 -f #z'0 3:i5 !® 0,63 talo nxu 3-35 its 0 4,6 0.1 i) PERCOLATION RATE IV7r 7 (minutes/inch) TCCT RI INI RFTIAIFFN .FT AND `'` FT PERFORMED BY: I - djCERTIFIED BY 72-008 (6/79) DATE: / --( 7 ""Q T 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 051-822-15 HAA # 050/3$ Expiration Date: -7 0 S I. GENERAL INFORMATION Complete legal description Lor 75; Mork 4 • 4amn Location (site address or directions) 23731 Goliath Dr. Chugiak Current Propertyowner(s) Merlin Rasmussen Dayphone688-4708 Mailing address PO Box 220031 Anchorage AK 99522 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise 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 3 TYPE OF WASTEWATER DISPOSAL: 7❑X Individual On-site ®C ❑ Individual Holding tank .❑ ❑ Community On-site ❑ ❑ Public Sewer E3 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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. (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. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Engineering Address 17034 N. Eag1 iver Loop e. Engineer's Printed Name 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. _ Phone 694-2979 Eagle River, AK 99577 Date Y—ILLL-0– )•A. sC.!w ti . j, ; Conditional approval for bedrooms, with the following stipulations: <<<ttt((Y OFe::��% ON-SITE c Additional Comments :WASTEWATER Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other n), By: Al. /�— Original Certificate Date: (Rw 0102) Municipality of Anchorage ' Development Services Department <` Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:LoT 22S/ t)(cck Y ' S_n41MtLoA3 &Z- parcel Ib:_ OSI -e ZZ -1S A. WELL DATA Well type -� t VnTf- Date completed i Z%q Total depth 9: ,ft. Date of test Static water level Well production If A. B. or C provide PWSID # tip Sanitary sealQyN)�&5 Cased to 200 t ft. FROM WELL LOG z0 A IS ELT WATER SAMPLE RESULTS: Coliform colonies/100 ml. Arsenic: "Pt mg./1. B. SEPTIC/HOLDING TANK DATA ft. g.p.m. Nitrate 2.0 mg./I. Date of sample: *0 O5 Well Log(IN Wires properly protected mI) Casing height (above ground) (Z'rt in. AT INSPECTION ft. �_S g.p.m. Other bacteria 40 colonies/100 mi. Collected by: _Sf-S "-&* tll9lTtiYt21K Tank Type/Material SF jI L / 3 Date installed S 0 / $ L/ Tank size 1060 gal. Number of Compartments a Cleanoutsaw) `/Eg Foundation cleanout&N) `LAS Depression over tank MIDIL` _ High water alarm (YIN) tipi Date ofum in P P 9 Pumper —37—'s f U++nPr�lr C. ABSORPTION FIELD DATA Date installed 1 f 3 Soil rating g.p.d./ft r ft=/bdrm) �: g System type '&444(CcxJ J rCFx , Length 63 ft. Width r ft. Gravel below pipe ft. Total depth L .10 ft. Eff. absorption area C,�F5 ft2 Monitoring tube � Depression over field tib Date of adequacy test Z n5 Result Pa ail)i� _s For _3L bedrooms Fluid depth in absorption field before test bqn. Water added SOZgal. New depth AIr in. Elapsed Time: LJJ min. Final fluid depth -Vin. Absorption rate >= SO+ g.p.d. Any rejuvenation treatment (past 12 mo.) ()tn type) 1'20 If yes, give date AJAI- D. LIFT STATION Date installed PN `Pump on" level at NA in. Datum NA- E. SEPARATION DISTANCES Size in gallons AI R Manhole/Access (YIN) 0 "Pump off level atfUp in. High water alarm level at &94in. Cycles tested Meets alarm & circuit requirements? N 1 SEPARATION DISTANCES FROM WE1 LL ON LOT TO: Septic tank/lift station on lot I 60 4- r+ Absorption field on lot I b� Public sewer main k4 - Sewer /septic service line 1 On adjacent lots 1 Oep - On adjacent lots I bO 14 I Public sewer manhole/cleanout /O0 ' - Holding tank tJl't SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: I Absorption field 10 t r Building foundation Water main I Wells on adjacent lots —M�-- Property line II Water service line CC 4 Surface water /60+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON 'OT TO: t '$� /O t Property line 3g Building foundation Water main 'O r/ Water Service line O t Surface water /02 f Driveway, parking/vehicle storage r Curtain drain hada kxywju Wells on adjacent lots /00 f F. COMMENTS G. ENGINEER'S CERTIFICATION i' 1 1 certify that 1 have determined through field inspections and , review of Municipal records that Vm above systems are in conformance with MOA HAA g idel iryeNec tthitsata- Engineer's J/'tura Priinntted Na w.N�.,,.• �I Date %•etz4r^ HAA Fee $ Date of Payment Receipt Number 6, ✓&L (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number 3-26-06: 7:31PMt :007 6616301 a 2i SCS ReLN Client Name Project Name/N Client Sample M Matrix Sample Remarks: 1051498001 S & S Engineering Lot 25. Block 4 Sampson Est Lot 25 Block 4 Sampson Est Drinking Water All Dstesmmes an Alaska Standard Time Printed DateMme 03/28/2005 12:11 Collected DatdPime 03212005 14:30 Received Date/time 03/21/2005 15:57 Technical Director Stephen C. Ede Panrncn:r ResultsAllowable Prep Aaalysir PQL Unita Method Container lD Limits Due Date Init Natere Departuent Nitrate -N 200 0.100 mgt EPA 300.0 H (o-lp) 0722815 )Cht Microbiciogv Laboratory Total Coliform 0 0011100mL, SM209222B A (<. 1) 0321/05 TLF ASBUILT 1 HERE13Y CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY. S�/f/.O1 C/)� Fs1Ti9�•-j/LOT ZS B�f/ AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY , COVENANTS OR WHICH DOTNOT APPEAR Old THE RECORDEDIONS SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA BE USED OFFENCE L NES,JOR FOR ESTABLISH NG B IONND- ARY LINES. Go% . SEWARD 6 ASSOCIATES LAND SURVEYING 65 EDAM + PSE OF At GRID] , . ,qTH ` 1 Dv.n. Mark S.w.rd DRAWN�_o8 15-691641 ; fi \ �0�':skxi� � �• tan��rs 4 ter. F MUNICIPALITYCIEANCHORAGE • DEPARTMENT OFHENC Division of Envin On P:Q Box,196650 ''Anctio 343 I�HUMAN SERVICESx,' ental Services. s;Sect(on CERTIFICATE OF HEAL -,L- -- ing to the', TYPE OF WASTEWI Indivi( 670867 iskd' : 99519-6650 .�, tatus ofsysfem V� AQ�C elk " Z 'r , 1 WTHORITY. IILY'DWELLING ` 1 HAA fEa 11 r11 ifs 1et., '; ISAL �s^ttmp Sii Kd,;E6.ta.�P/a ri FiA Day phone 688-TT51ry I 'AK f. 99567 : y - .. P'I. 'm, provide written confirmation from���td atti4s' .�, tatus ofsysfem V� AQ�C elk " Z 'r , 1 �.0 1 ISAL ri aA i 0 {� , 1 e...,, rn 1 , •:.1 t .,,yid: vastewater� system,'prow e`wconfirmation from State At ��legality and status ofsystem; u fir. �� ''il-i i � J1-x„•`r-4� }i L°. �?” i � - � i i_.; . 5. STATEMENT'PF INSPECTION BY r. ENGINEER As certified b;y'm'y y 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 furtherverify 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 regulationsIn effect on the date of this inspection. Name of Firm S1,5ENGINEERING Phone Address Emle River, Alaska 991,77 minim Date The Municipality of Anchorage Department -of Health and Hu man Services (DHHS) issues Health�Authonty Approval Certificates based on1y_'Upo­h_-rajhe representations given in paragraph. &above by. an independent"' Professional engineer registered in theStitebtAlaski. , TheDHHSdoesthis asaCOurtesytopur6hasersofho'mes-."I and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS d6hbt conduct inspections or analyze -'data -before a certificate is issued. The_M unicipality of. Anchorage is not responsible for errors or omissions in the'P:rotessional engineers work. - 72 -025 (R". 181).Back MOA #21 CE 8801 6 DHHS SIGNATURE -7 A j for % _pprovei bedroos.- rn Disapproved.'.. minim Date The Municipality of Anchorage Department -of Health and Hu man Services (DHHS) issues Health�Authonty Approval Certificates based on1y_'Upo­h_-rajhe representations given in paragraph. &above by. an independent"' Professional engineer registered in theStitebtAlaski. , TheDHHSdoesthis asaCOurtesytopur6hasersofho'mes-."I and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS d6hbt conduct inspections or analyze -'data -before a certificate is issued. The_M unicipality of. Anchorage is not responsible for errors or omissions in the'P:rotessional engineers work. - 72 -025 (R". 181).Back MOA #21 Well type p2wR-Ve= If A, B, or C, attach ADEC letter. ADEC water system number �`i Log present `l �S Date completed Tao - a 7 Total depth 200 Cased to Sanitary seal O�) Yz: S 9,04) f FROM WELL LOG Date of test %-X -S1 Static water level 30 Well production so (Es -r.) g.p.m. WATER SAMPLE RESULTS: Coliform Casing height (above ground) I -/- Wires properly protected &M ycs AT INSPECTION 7-S-gS -7y, g.p.m. Nitrate -"LL Other bacteria -11:5— Date of sample: _ ����g� Collected by: �/Q /r n 6-01@A�1,vt ' S S 15k 9 os�z B. SEPTIC/HOLDING TANK DATA Date installed 8 - 30 —40,41 Tank size 1000 G41 Number of Compartments a Cleanouts 0" VES Foundation cleanout - N) VE-> Depression (Y)@ 1Jo High water alarm (YON P'/o DateofPumping Pumper 1.Q.5 fP'jMP1NG C. ABSORPTION FIELD DATA Date installed d- t 5--q6-- Soil rating (g.p.d./ft or ft2/bdrm)0-S CPP A.' System type sHA[,t ow rrzsrxN Length . 6S Width Gravel thickness below pipe S. S Total depth la Effective absorption area. 6793 Monitoring Tube present V55 Depression over field (YA@ NO Date of adequacy test 1,11A - "If 5YSrO-Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in.), Immediately after= gal. water added (in.): Fluid depth Minutes later: (in.) Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date Municipality of Anchorage � DEPARTMENT OF HEALTH & HUMAN SERVICES o z Environmental Services DivisionCZ 825"L" Street, Room 502 • Anchorage, Alaska 99501 • 343-P74 n m (907) pyo c> rte, D O M T Health Authority Approval Checklist rJ n o O Legal Description: LOT, 3S IBC-oCKH , '�!/+MPSON QST. parcel LD.: ti ij O z A. WELL DATA Well type p2wR-Ve= If A, B, or C, attach ADEC letter. ADEC water system number �`i Log present `l �S Date completed Tao - a 7 Total depth 200 Cased to Sanitary seal O�) Yz: S 9,04) f FROM WELL LOG Date of test %-X -S1 Static water level 30 Well production so (Es -r.) g.p.m. WATER SAMPLE RESULTS: Coliform Casing height (above ground) I -/- Wires properly protected &M ycs AT INSPECTION 7-S-gS -7y, g.p.m. Nitrate -"LL Other bacteria -11:5— Date of sample: _ ����g� Collected by: �/Q /r n 6-01@A�1,vt ' S S 15k 9 os�z B. SEPTIC/HOLDING TANK DATA Date installed 8 - 30 —40,41 Tank size 1000 G41 Number of Compartments a Cleanouts 0" VES Foundation cleanout - N) VE-> Depression (Y)@ 1Jo High water alarm (YON P'/o DateofPumping Pumper 1.Q.5 fP'jMP1NG C. ABSORPTION FIELD DATA Date installed d- t 5--q6-- Soil rating (g.p.d./ft or ft2/bdrm)0-S CPP A.' System type sHA[,t ow rrzsrxN Length . 6S Width Gravel thickness below pipe S. S Total depth la Effective absorption area. 6793 Monitoring Tube present V55 Depression over field (YA@ NO Date of adequacy test 1,11A - "If 5YSrO-Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in.), Immediately after= gal. water added (in.): Fluid depth Minutes later: (in.) Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date D. LIFT' STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump on" level at* .'Pump off' level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /057 ; On adjacent lots /°O Absorption field on lot 1570 ; On adjacent lots 100 ,4 Public sewer main 75 Public sewer manhole/cleanout /yo 't Sewer /septic service line a5 �� Lift station N14 SEPARATION DISTANCES FROM SEPTIC/IlatJ3M TANK ON LOT TO: Foundation io Property line (0-7 Absorption field 3� i Water main/service line /° '` Surface water/drainage /oo f Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: i Building foundation 50 Water main/service line 1� f Surface water /yo 14- Driveway, parking/vehicle storage area 90 Curtain drain 140NE- Wells on adjacent lots /00'./'- F. 00'tF. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal recor ptoFa o in conformance with MOA HAA gu, lines in effect on this date. �'d Signature Engineer's Name &04D %f it 7— �- Co w&} 11) X . � ... r I ROBERT C. COWAN l t Date / t ( 01 4 �c� • CE - 8801 `�4" HAA Fee $ Date of Pay Receipt Nut Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number are 08/21/95 15:39 COMMERCIAL TESTING � 9076941211 NO. 222 D02 CT -&E Environmental Services Inc. 4�4'tQL Laboratory Division �aaa►, C &g Reg.# 9$-3471-1 Laboratory Analysis Report M"a rix NATER Client Sample ID L25 BLK4 SAMPSON EBTAT$8 8/D Client Name S & S ENGINEERING RUSH Order 17213 Ordered by R, COWAN Printed Date 08/31/95 Q 14:58 hrp. project Name Collected Date 08/16/95 0 15:10 hrp. 'project# Received Date 0$116/95 Q 17:00 hrp. PWaID IIA Technical Director STEPHEN C. EDE Reloased Sample Remarke: SAMPLE COLLECTED BY1 JOHN. QC Allowable Ext. Anal Parameter Reaulte Qual Unite Method Limits Date Date Init Nitrate -N 1.64 mg/L EPA 353.2 10. 08/7.8/95 CMR 's ¢vvaa.wwvvsvmw--rvvvvvvYrvvvvvva.ravvvsavw.../ cazsar...y asacan I ...... ass,.......avw.wvvavvvv......vmvow........ " See Special Inatructione Above UA - Unavailable u sea aampia Remarke :Wove NA - Not Analyzed n Undetected, Reported value le the practical quantification limit. DT a heap Than )9;e secondary dilution. GT Q Greater Than c. 200 W. Potter Chive, Anchorage, AK 99518-1605 — Tel: (907) 562-2343 Fax: (907) 561-6301 FNVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND. MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA y MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL) OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date September 8, 1987 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 25: Block 4; Samy)3on Estates 2. Location (address or directions) Gotiath Dt.ive (b) Property Owner Mailing Address Howard Re2ocati.on Telephone: Home Business (c) Lending Institution F.iut Nati.ona2 Bank Telephone Mailing Address Eagle Raven, Alaska (d) Real Estate Company and Agent CENTURY 21, SELECTIVE/Kathy C2ar12e Address 3305 Arctic Boulevard, Suite 103, Anchorage, Alaska 99503 Telephone 562-2221 (e) Mail the HAA to the following address: or: Check here C�, if hold for pick up. List contact person and day phone number below. S 9 S ENGINEERING1694-2979 17034 Eag River LooP Road, Suite 204 Eagla R.iveh, A&Lka 99577 ordered by Myrna John3ton TYPE OF RESIDENCE Single -Family A Number of Bedrooms _ 3 3. WATER SUPPLY Individual Wella 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 OnsiteXX Public ❑ Community ❑ 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 2 72-025 (Rev 8/861 Front 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 --S &S ENGINEERING Telephone Address 17034 Eagle River Loop Road No. 204 Date .n 6. DHHS APPROVAL Approved for bedrooms by p�� 'Q' %Z�" Date Approved �� Disapproved PP Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (Rev 8186) Back MUNICIPALITY OF ANC..,jRAGE ENVIRONMENTAL SERVICES oivI MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) ('-P 2 j 11987 CHECKLIST -FEBRUARY 1984 264-4720 Not D Legal Description: 1-0-r A. WELL DATA Well Classification Sf, If A, B, C, D.E.C. Approved (Y/N) �JQ Well Log Present (9N) - Date Completed %std- % Yield Total Depth 2-'�O Cased to 2oa r Depth of Grouting Static Water Level I loP�� Pump Set At Casing Height Above Ground Z<i! Sanitary Seal on Casing6t5N) Electrical Wiring in Conduit45%N) Separation Distances from Well: Depression Around Wellhead (Y66 To Septic/Melding Tank on Lot L rpa 1 ; On Adjoining Lots t I-,- ToNearest Edge of Absorption FieldI3 Lot �7io ; On Adjoining Lots ` �� I A - To Nearest Public Sewer Line N I To Nearest Public Sewer t Cleanout/Manhole To Nearest Sewer Service Line on Lot 2`� -i' Water Sample Collected by e7S E t�1 t r.ia ;Date � " 8 J 81 Water Sample Test Results B. SEPTIC/b= TANK DATA Date Installed g 'lib 0 Size I 06) _ No. of Compartments 2• Standpipes/N) Air -tight Caps &N) Foundation Cleanout(N) Depression over Tank (y6p Date Last Pumped el - / o' 87 Pumping/Maintenance Contract on File (Y/N) a ; for r— Holding Tank High -Water Alarm (Y/N) � P Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: i To Water -Supply Well _� LPO To Building Foundation To Property Line 1 o i� To Disposal Field /n To Water Main/Service Line % To Stream, Pond, Lake, or Major Drainage Course Comments ?1,-P POM P�­* e7 —,o -7_-L_ Page 1 of 2 72-026(1 1/84) C. ABSORPTION FIELD DATA Soils Rating in Absorptio Strata ,� f��� Type of System Design Q341 Length of Field Date Installed � I Width of Field yl Depth of Field Square Feet of Absorption Area Depression over Field (YO Results of Last Adequacy Test Gravel Bed Thickness CD BBZ Standpipes Present/N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 2twr2 t To Property Line To Existing or Abandoned System on On Adjoining Lots �)'~ To Cutbank (if present) To Building Foundation Lot To Water Main/Service Line l b 4 - To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) ,,Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and H A guidelines in effect on the date of this inspection. SignedS & S ENGINEERING �a ZZ 2.- 17034 Eagle River Loop oa o. 2Q4 to , _ 8,7 —0d MOA No. �9/ � qe• Ar� y04690 goal Receipt No.^'}1 Date of Payment Amount: $ - A. VIC% Page 2 of 2 72-026 (11/84) UP 00 O�1% 71 LABORATORIES CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 en 1, A�ccwllj'r Vio 0 r 'J f. -O.') 11.:t -'e w lc�V OW11-1 f U. 'Is ir" .3 1;? rY en 1, A�ccwllj'r e)" Y!j r lc�V OW11-1 f a Gif Yl83 bpj f s } ;;1'CIPALITY OF ANCHORAGE 91VISION OF ENVIRONMENTAL HEALTH Oy HEALTH AND ENVIRONi4ENTAL PROTECTION � T?t1.'i !?AD HL;ALTH AUTHORITY APPROVAL CERTIFICATE Application Date ..tSvaWX `d4wt'G PNS«^""'^ - U ,arlpeion (include lot, block, subdivision, section, township, range) a zc Location (address or directions) Applicants Name SSC r Tele hone - Home M-zS9 Business Applicants Address Po Cicr_ t9l01o9ca �(w4'�� �K �`�S(97 (c) Applicant is (check one) Lending Institution Owner/builder ; Buyer Other (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: p� < CCU, rnl 4 ti Uryl e J _ 7 G' 2. Type of Residence Single -Family �z Multi -Family Number of Bedrooms 3 3. Water Supply Individual Well Community Other (describe) 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 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 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 regula- tions in effect on the date of this inspection. Name of Firm (n�c-wCn a- Ssoc pi`s Telephone Sal -[pis) Address I `S H Date 6. DHEP Approval Approved for e� bedrooms Approved Terms of Conditional R .y /SEAL By ) L?%ts GCJAate ` �c Disapproved I Conditional Approval CAUTION THE 14UNICIPALITY 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 21 7-19-84 /-o t zr MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) APR 17 050 CHECKLIST - FEBRUARY 1984 RECEIVED A. [ELL DATA Well Classification PK/� If A, B, Cr. C, D.E.C. Approved(Y/N) Well Log Present (YIN) _ Date Completed �' 26 "_�� Yield % h Total Depth 200 ��. Cased to 2�0� Depth of Grouting Static water Level 30 -F+._ PSP Set At L'/i' Sanitary Seal on Casing (Y/N)Y Casing Height Above Ground Electrical Wiring in Conduit -(YM) Depression Around Wellhead Separation Distances from Well: To Septic/holding Tank on Lot Iby` On Adjoining Lots > 1 00' To Nearest Edge of Absorption Field on Lot Izo' ; On Adjoining Lots >loo® To Nearest Public Sewer Line ni�bt To Nearest Public Sewer Cleanout/Manhole _ SIA To Nearest Sewer Service Line on Lot f+ Water Sample Collected By L,Qa- ; Date /0"30"S`� Water Sample Test Results Corments B. SEPTIC/HOLDING TANK DATA Date Installed ; zo-84 Size 1000 Gam . No. of Compartments Z Standpipes (Y/bi) Air -tight Caps (Y/N) Y Foundation Cleanout Depression over Tank (Y/N) d Date Last Pumped Pu=ing/Maintenance Contract on File (Ym) —' for — — Holding Tank High-water Alarm (Y/N) ` 'Temporary Holding Tank Permit (YM) Separation Distances from Septic/Holding Tank: To Water -Supply Wall 10x7' To Building Foundation 191 To Property Line -,IO' To Disposal Field 10` To Water Main/Service Lire NJ�_ To Stream, Pond, Lake, or Major Drainage Course -�IDo' Cormrents 331("aa -7/- i`7-2 t [Page 1 of 21 2-15-84 a C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Z)drType of System Design W Date Installed 6Rzo -8` F Length of Field 4121 width of Field Z/' Depth of Field Y ' Gravel Bed Thickness J2" Square Feet of Absorption Area 88Z- Standpipes Present (YM) Y Depression over Field (YM) N Date of Last Adequacy Test Results of Last Adequacy Zest ,r/a Separation Distance from Absorption Field: To Water -Supply Wb11 / Zd' To Property Line > ((` To Building Foundation >(O' To Existing or Abandoned System Cn Lot n ovie. ; On Adjoining Lots To Water Main/Service Line A11A To Cutbank(if present) Ilan To Stream/Pond/Lake/cr Major, Drainage Course >(ooi To Driveway, Parking Area, cr Vehicle Storage Area leo` Comments D. LIFT STATION Date Installed Size in Gallons None. "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(YM) Comments Dimensions Manhole/Access (YM) "Pump Off" Level at Vent (YM) Pumping Cycles during Adequacy Tbst. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I mortify at I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the dat of this inspection. Signed Comoanv L C4' E,bJ, //J� � MOA No. KB1/d5/s [Page 2 of 21 2-15-84